scholarly journals New Insights from Immunohistochemistry for the Characterization of Epidural Scar Tissue

2013 ◽  
Vol 5;17 (5;9) ◽  
pp. 465-474
Author(s):  
Paulo Pereira
Keyword(s):  
Lumbar Spine ◽  
Spine Surgery ◽  
Fibrous Tissue ◽  
Scar Tissue ◽  
Nerve Fibers ◽  
Lumbar Spine Surgery ◽  
Pathophysiological Mechanism ◽  
Epidural Fibrosis ◽  
Lumbar Surgery ◽  
Transmission Electron

Background: The association between epidural fibrosis and recurrent symptoms after lumbar spine surgery remains a matter of debate in scientific literature and the underlying pathophysiological mechanism has not been clearly elucidated. Objective: To investigate the presence of nerve fibers and the expression of osteopontin in epidural fibrous tissue after lumbar surgery in humans. Study Design: Laboratory study of human tissue samples. Methods: Twenty-four patients with persistent or recurrent low back and/or leg pain after lumbar spine surgery, in whom no relevant findings were present on magnetic resonance imaging (MRI) besides epidural scar tissue, were submitted to epiduroscopy. Biopsy samples of epidural scar tissue resting in the posterior epidural and periradicular space were obtained from 15 patients, using an endoscopic grasping forceps, in locations where the stimulation with the tip of a Fogarty consistently reproduced pain. Biopsy samples were processed for examination under optical and transmission electron microscopes and under a fluorescence microscope after incubation in primary antibodies against beta3- tubulin or against osteopontin. Results: Optical and transmission electron microscopy revealed a homogeneous fibrous tissue rich in collagen and lacking nerve fibers. No immunofluorescence was present in any of the samples immunoreacted against beta3-tubulin. In the samples immunoreacted against osteopontin, a punctate signal was detected around the collagen fibers. Limitations: Being a human study, there was no control group, so it is not possible to determine the contribution of osteopontin in the formation of epidural fibrosis and its relation to the patients’ symptoms. Additional animal studies are needed to investigate these issues. Conclusion: Rather than direct stimulation of nociceptors in the epidural scar tissue, other factors should relate epidural fibrosis and recurrent symptoms after lumbar spine surgery. Osteopontin seems to play a role in the formation of epidural fibrosis. Key words: Osteopontin, failed back surgery syndrome, epidural fibrosis, immunofluorescence, beta3-tubulin, epiduroscopy, nerve fibers, lumbar surgery

scholarly journals Long-term impact of obesity on patient-reported outcomes and patient satisfaction after lumbar spine surgery: an observational study

2021 ◽  
Vol 34 (1) ◽  
pp. 73-82 ◽  
Author(s):  
Christine Park ◽  
Alessandra N. Garcia ◽  
Chad Cook ◽  
Christopher I. Shaffrey ◽  
Oren N. Gottfried
Keyword(s):  
Patient Satisfaction ◽  
Lumbar Spine ◽  
Spine Surgery ◽  
Patient Reported Outcomes ◽  
Normal Weight ◽  
Lumbar Spine Surgery ◽  
Morbidly Obese ◽  
Lumbar Surgery ◽  
Patient Reported

OBJECTIVEObese body habitus is a challenging issue to address in lumbar spine surgery. There is a lack of consensus on the long-term influence of BMI on patient-reported outcomes and satisfaction. This study aimed to examine the differences in patient-reported outcomes over the course of 12 and 24 months among BMI classifications of patients who underwent lumbar surgery.METHODSA search was performed using the Quality Outcomes Database (QOD) Spine Registry from 2012 to 2018 to identify patients who underwent lumbar surgery and had either a 12- or 24-month follow-up. Patients were categorized based on their BMI as normal weight (≤ 25 kg/m2), overweight (25–30 kg/m2), obese (30–40 kg/m2), and morbidly obese (> 40 kg/m2). Outcomes included the Oswestry Disability Index (ODI) and the visual analog scale (VAS) for back pain (BP) and leg pain (LP), and patient satisfaction was measured at 12 and 24 months postoperatively.RESULTSA total of 31,765 patients were included. At both the 12- and 24-month follow-ups, those who were obese and morbidly obese had worse ODI, VAS-BP, and VAS-LP scores (all p < 0.01) and more frequently rated their satisfaction as “I am the same or worse than before treatment” (all p < 0.01) compared with those who were normal weight. Receiver operating characteristic curve analysis revealed that the BMI cutoffs for predicting worsening disability and surgery dissatisfaction were 30.1 kg/m2 and 29.9 kg/m2 for the 12- and 24-month follow-ups, respectively.CONCLUSIONSHigher BMI was associated with poorer patient-reported outcomes and satisfaction at both the 12- and 24-month follow-ups. BMI of 30 kg/m2 is the cutoff for predicting worse patient outcomes after lumbar surgery.

Ambulation on Postoperative Day #0 Is Associated With Decreased Morbidity and Adverse Events After Elective Lumbar Spine Surgery: Analysis From the Michigan Spine Surgery Improvement Collaborative (MSSIC)

Neurosurgery ◽  
2019 ◽  
Vol 87 (2) ◽  
pp. 320-328 ◽  
Author(s):  
Hesham Mostafa Zakaria ◽  
Michael Bazydlo ◽  
Lonni Schultz ◽  
Muwaffak Abdulhak ◽  
David R Nerenz ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Adverse Events ◽  
Spine Surgery ◽  
Postoperative Care ◽  
Enhanced Recovery ◽  
Cost Savings ◽  
Lumbar Spine Surgery ◽  
Lumbar Surgery ◽  
Single Level ◽  
Vein Thrombosis

Abstract BACKGROUND While consistently recommended, the significance of early ambulation after surgery has not been definitively studied. OBJECTIVE To identify the relationship between ambulation on the day of surgery (postoperative day (POD)#0) and 90-d adverse events after lumbar surgery. METHODS The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a prospective multicenter registry of spine surgery patients. As part of routine postoperative care, patients either ambulated on POD#0 or did not. The 90-d adverse events of length of stay (LOS), urinary retention (UR), urinary tract infection (UTI), ileus, readmission, surgical site infection (SSI), pulmonary embolism/deep vein thrombosis (PE/DVT), and disposition to a rehab facility were measured. RESULTS A total of 23 295 lumbar surgery patients were analyzed. POD#0 ambulation was associated with decreased LOS (relative LOS 0.83, P &lt; .001), rehab discharge (odds ratio [OR] 0.52, P &lt; .001), 30-d (OR 0.85, P = .044) and 90-d (OR 0.86, P = .014) readmission, UR (OR 0.73, P = 10), UTI (OR 73, P = .001), and ileus (OR 0.52, P &lt; .001) for all patients. Significant improvements in LOS, rehab discharge, readmission, UR, UTI, and ileus were observed in subset analysis of single-level decompressions (4698 pts), multilevel decompressions (4079 pts), single-level fusions (4846 pts), and multilevel fusions (4413 pts). No change in rate of SSI or DVT/PE was observed for patients who ambulated POD#0. CONCLUSION POD#0 ambulation is associated with a significantly decreased risk for several key adverse events after lumbar spine surgery. Decreasing the incidence of these outcomes would be associated with significant cost savings. As ambulation POD#0 is a modifiable factor in any patient's postoperative care following most spine surgery, it should be encouraged and incorporated into spine-related, enhanced-recovery-after-surgery programs.

scholarly journals Risk Factors for Postoperative Venous Thromboembolic Events in Patients Undergoing Lumbar Spine Surgery

2018 ◽  
Vol 9 (4) ◽  
pp. 409-416 ◽  
Author(s):  
Alexander Nazareth ◽  
Anthony D’Oro ◽  
John C. Liu ◽  
Kyle Schoell ◽  
Patrick Heindel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lumbar Spine ◽  
Spine Surgery ◽  
Lumbar Spine Surgery ◽  
Thromboembolic Events ◽  
Lumbar Surgery ◽  
Factors Associated ◽  
Patient Demographics ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic

Study Design: Retrospective, database study. Objectives: The aim of this study was to investigate incidence and risk factors associated with venous thromboembolic events (VTEs) after lumbar spine surgery. Methods: Patients who underwent lumbar surgery between 2007 and 2014 were identified using the Humana within PearlDiver database. ICD-9 (International Classification of Diseases Ninth Revision) diagnosis codes were used to search for the incidence of VTEs among surgery types, patient demographics and comorbidities. Complications including DVT and PE were queried each day from the day of surgery to postoperative day 7 and for periods 0 to 1 week, 0 to 1 month, 0 to 2 months, and 0 to 3 months postoperatively. Results: A total of 64 892 patients within the Humana insurance database received lumbar surgery between 2007 and 2014. Overall VTE rate was 0.9% at 1 week, 1.8% at 1 month, and 2.6% at 3 months postoperatively. Among patients that developed a VTE within 1 week postoperatively, 45.3% had a VTE on the day of surgery. Patients with 1 or more identified risk factors had a VTE incidence of 2.73%, compared with 0.95% for patients without risk factors ( P < .001). Risk factors associated with the highest VTE incidence and odds ratios (ORs) were primary coagulation disorder (10.01%, OR 4.33), extremity paralysis (7.49%, OR 2.96), central venous line (6.70%, OR 2.87), and varicose veins (6.51%, OR 2.58). Conclusions: This study identified several patient comorbidities that were independent predictors of postoperative VTE occurrence after lumbar surgery. Clinical VTE risk assessment may improve with increased focus toward patient comorbidities rather than surgery type or patient demographics.

scholarly journals Lumbar spine surgery across 15 years: trends, complications and reoperations in a longitudinal observational study from Norway

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e028743 ◽  
Author(s):  
Margreth Grotle ◽  
Milada Cvancarova Småstuen ◽  
Olaf Fjeld ◽  
Lars Grøvle ◽  
Jon Helgeland ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Observational Study ◽  
Elderly People ◽  
Spine Surgery ◽  
Incidence Rates ◽  
Public Hospitals ◽  
Western World ◽  
Lumbar Spine Surgery ◽  
Lumbar Surgery ◽  
Longitudinal Observational Study

BackgroundStudies from different Western countries have reported a rapid increase in spinal surgery rates, an increase that exceeds by far the growing incidence rates of spinal disorders in the general population. There are few studies covering all lumbar spine surgery and no previous studies from Norway.ObjectivesThe purpose of this study was to investigate trends in all lumbar spine surgery in Norway over 15 years, including length of hospital stay, and rates of complications and reoperations.DesignA longitudinal observational study over 15 years using hospital patient administrative data and sociodemographic data from the National Registry in Norway.Setting and participantsPatients aged ≥18 years discharged from Norwegian public hospitals between 1999 and 2013.Outcome measuresAnnual rates of simple (microsurgical discectomy, decompression) and complex surgical procedures (fusion, disc prosthesis) in the lumbar spine.ResultsThe rate of lumbar spine surgery increased by 54%, from 78 (95% CI (75 to 80)) to 120 (107 to 113) per 100 000, from 1999 to 2013. More men had simple surgery whereas more women had complex surgery. Among elderly people over 75 years, lumbar surgery increased by a factor of five during the 15-year period. The rates of complications were low, but increased from 0.7% in 1999 to 2.4% in 2013.ConclusionsThere was a substantial increase in lumbar spine surgery in Norway from 1999 to 2013, similar to trends in other Western world countries. The rise in lumbar surgery among elderly people represents a significant workload and challenge for health services, given our aging population.

scholarly journals Ambulation on POD#0 Is Associated With Decreased Adverse Events After Elective Lumbar Spine Surgery: Analysis of the Michigan Spine Surgery Improvement Collaborative (MSSIC)

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Hesham M Zakaria ◽  
Rachel J Hunt ◽  
Theresa A Elder ◽  
Michael Bazydlo ◽  
Lonni Schultz ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Adverse Events ◽  
Spine Surgery ◽  
Enhanced Recovery ◽  
Cost Savings ◽  
Lumbar Spine Surgery ◽  
Lumbar Surgery ◽  
Single Level ◽  
Patient Variables ◽  
Multilevel Fusion

Abstract INTRODUCTION The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a multicenter quality-improvement collaborative. Using MSSIC, we sought to identify the relationship between ambulation on the day of surgery (POD#0) and 90-d adverse events after lumbar surgery, specifically length of stay (LOS), urinary retention (UR), urinary tract infection (UTI), ileus, readmission, surgical site infection (SSI), PE/DVT, and disposition to a rehab facility. METHODS In 23295 lumbar surgery patients, matching was performed to ensure overlap on patient variables. Generalized estimating equations (GEE) models were run on the matched dataset to further account for patient demographics, medical history, and surgical intensity. RESULTS POD#0 ambulation was associated with decreased LOS (OR 0.83, P < .001), UR (OR 0.73, P = .008), UTI (OR 0.52, P = .001), ileus (OR 0.52, P < .001), 30-d (OR 0.84, P = .035) and 90-d (OR 0.86, P = .009) readmission, and rehab discharge (OR 0.52, P < .001) for all patients. POD#0 ambulation after single-level decompression (6244 patients) decreased LOS (OR 0.72, P < .001), UR (OR 0.73, P = .004), UTI (OR 0.43, P = .003), and rehab discharge (OR 0.18, P < .001). Ambulation after multilevel decompression (5526 patients) was associated with decreased LOS (OR 0.73, P < .001), UR (OR 0.75, P = .04), ileus (OR 0.60, P = .027), and rehab discharge (OR 0.44, P < .001). Ambulation after single-level fusion (5790 patients) decreased LOS (OR 0.85, P < .001), 30-d readmission (OR 0.77, P = .032), and rehab discharge (OR 0.65, P = .004). Ambulation after multilevel fusion (5735 patients) decreased LOS (OR 0.88, P < .001), UTI (OR 0.60, P = .003), ileus (OR 0.51, P = .02), 30-d readmission (OR 0.77, P = .032), and rehab discharge (OR 0.59, P < .001). No change in rate of or DVT/PE was observed for patients who ambulated POD#0. CONCLUSION POD#0 ambulation is associated with a significantly decreased risk for several key adverse events after lumbar spine surgery. Decreasing the incidence of these outcomes would be associated with significant cost savings. As ambulation POD#0 is a modifiable factor in any patient's postoperative care following most spine surgery, it should be encouraged and incorporated into spine-related enhanced recovery after surgery (ERAS) programs.

Venous Air Embolism during Anterior Lumbar Surgery

2013 ◽  
Vol 1 (1) ◽  
pp. 30-32
Author(s):  
Stephen O Bader ◽  
Susie J Cho ◽  
James W Heitz
Keyword(s):  
Lumbar Spine ◽  
Cardiac Function ◽  
Transesophageal Echocardiography ◽  
Spine Surgery ◽  
Air Embolism ◽  
Volume Status ◽  
Lumbar Spine Surgery ◽  
Lumbar Surgery ◽  
Venous Air Embolism ◽  
Clinical Changes

ABSTRACT The use of transesophageal echocardiography (TEE) has improved the detection of venous air embolism (VAE), especially in the case of small VAE where clinical changes can be subtle and erroneously attributed to volume status or cardiac function. We present a case of VAE in a 62 years old female that occurred during anterior lumbar spine surgery that was diagnosed with the aid of TEE. As anterior lumbar spines surgery is traditionally not associated with VAE, we believe this is the first reported case of VAE in this type of procedure. How to cite this article Cho SJ, Bader SO, Heitz JW. Venous Air Embolism during Anterior Lumbar Surgery. J Perioper Echocardiogr 2013;1(1):30-32.

The role of mitomycin C in reducing recurrence of epidural fibrosis after repeated operation in a laminectomy model in rats

2006 ◽  
Vol 4 (4) ◽  
pp. 329-333 ◽  
Author(s):  
Jin-Yul Lee ◽  
Werner Stenzel ◽  
Mario Löhr ◽  
Hartmut Stützer ◽  
Ralf-Ingo Ernestus ◽  
...  
Keyword(s):  
Side Effects ◽  
Mitomycin C ◽  
Fibrous Tissue ◽  
Scar Tissue ◽  
Lumbar Spine Surgery ◽  
Control Group ◽  
Epidural Fibrosis ◽  
The Reformation ◽  
Secondary Procedures

Object Extensive peridural fibrosis after lumbar spine surgery may contribute to poor outcome and recurrent symptoms leading to repeated operation. Secondary procedures are considerably hampered by the presence of scar tissue. Moreover, after excision of the peridural scar, the fibrous tissue may recur, leading to unsuccessful surgical outcome. Mitomycin C (MMC), an alkylating antibiotic substance isolated from Streptomyces caespitosus, potentially suppresses fibroblast proliferation after surgical intervention. The authors investigated the effect of MMC on the reformation of epidural fibrosis in a laminectomy model in rats. Methods Twenty-four Wistar rats underwent a repeated lumbar laminectomy 3 months after the first operation. In 12 rats, MMC in a concentration of 1 mg/ml was locally applied to the laminectomy site. No treatment was performed in the control group of the other 12 rats. All rats underwent clinical evaluation. Mobility ratings and any evidence of neurological deficit were recorded. Twelve weeks after the second operation, the animals were killed for histological examination. The extent of epidural fibrosis and dural adherence was evaluated. All MMC-treated animals showed reduced epidural scarring, compared with the control group. In nine MMC-treated rats (75%), dural adhesions were moderate. In contrast, all control sites showed dense epidural fibrosis with marked dural adherence. No side effects of the treatment were observed. Conclusions In this experimental study, MMC in a concentration of 1 mg/ml locally applied significantly reduced recurrence of epidural fibrosis and dural adhesions without any side effects after repeated spinal surgery in a laminectomy model in rats.

scholarly journals Efficacy of the erector spinae plane block in lumbar spinal surgery patients: a systematic review

2019 ◽  
Author(s):  
Yong Qiu ◽  
Teng-jiao Zhang ◽  
Ling-bing Meng ◽  
Zhen Hua
Keyword(s):  
Lumbar Spine ◽  
Postoperative Pain ◽  
Randomized Controlled Trials ◽  
Spine Surgery ◽  
Erector Spinae ◽  
Lumbar Spine Surgery ◽  
Controlled Trials ◽  
Lumbar Surgery ◽  
Randomized Controlled ◽  
Pain Scores

Abstract Background: Erector spinae palne block (ESPB) as a new trunk fascia block technique was proposed in 2016. Because of its clear analgesic effect and simple operation, it has aroused the interest of many nerve block experts. However, there are few clinical studies on ESPB for lumbar surgery, and its benefits are controversial. The goal of this review paper is to summarize the use of ESPB for lumbar spine surgery in order to better understand and promote this technique.Methods: Pubmed, EMBASE, Cochrane library, ClinicalTrial.gov databases were searched up to July 30, 2019. According to the inclusion and exclusion criteria established in advance, “lumbar spine surgery” and “ESPB” related MesH terms, free-text words were used. Data on pain scores, analgesic consumptions and adverse effects were reported. All processes follow PRISMA statement guidelines.Results: A total of 171 participants from 11 publications were identified, including two randomized controlled trials, one retrospective cohort study, four case report, four cases series. Block operation plane from T8 to L4. The main anesthetics used in block are bupivacaine, ropivacaine and lidocaine. There was evidence for reducing postoperative pain scores and analgesic consumptions.Conclusion: ESPB in lumbar spine surgery have the potential to relieve lumbar postoperative pain and reduce the use of analgesic drugs. Randomized controlled trials of high quality and large samples are needed to further clarify the benefits of ESPB in lumbar surgery patients.

scholarly journals Two cases of supratentorial lobar intracranial hemorrhage following lumbar decompression and stabilization

2021 ◽  
Vol 12 ◽  
pp. 221
Author(s):  
Ahmed Kashkoush ◽  
Vikram Chakravarthy ◽  
Mark Bain ◽  
Iain Kalfas ◽  
Michael Steinmetz
Keyword(s):  
Lumbar Spine ◽  
Intracranial Hemorrhage ◽  
Spine Surgery ◽  
Lumbar Spine Surgery ◽  
Dural Tear ◽  
Case Description ◽  
Lumbar Surgery ◽  
Left Temporal Lobe ◽  
Intracranial Hemorrhages ◽  
Instrumented Fusion

Background: Lumbar spine surgery with or without intraoperative dural tear (DT) may contribute to postoperative subdural hematomas and/or cerebellar intracranial hemorrhages (ICHs). Here, we present two patients, one with and one without an intraoperative DT occurring during lumbar surgery, both of whom developed acute postoperative supratentorial ICHs. Case Description: Two patients developed supratentorial lobar ICH following lumbar decompressions and fusion. The first patient, without an intraoperative DT, developed multiple ICHs involving the left cerebellum and left temporal lobe. The second patient, following an L4-5 decompression/instrumented fusion involving a DT, postoperatively developed a large right frontal ICH. Conclusion: Here, two patients undergoing lumbar spine surgery with/without DT subsequently developed significant ICH.

Revision lumbar surgery in elderly patients with symptomatic pseudarthrosis, adjacent-segment disease, or same-level recurrent stenosis. Part 1. Two-year outcomes and clinical efficacy

2013 ◽  
Vol 18 (2) ◽  
pp. 139-146 ◽  
Author(s):  
Owoicho Adogwa ◽  
Ricardo K. Carr ◽  
Katherine Kudyba ◽  
Isaac Karikari ◽  
Carlos A. Bagley ◽  
...  
Keyword(s):  
Back Pain ◽  
Lumbar Spine ◽  
Elderly Patients ◽  
Spine Surgery ◽  
Radicular Pain ◽  
Lumbar Spine Surgery ◽  
Adjacent Segment ◽  
Lumbar Surgery ◽  
Recurrent Stenosis ◽  
Surgery In Elderly

Object Same-level recurrent lumbar stenosis, pseudarthrosis, and adjacent-segment disease (ASD) are potential complications that can occur after index lumbar spine surgery, leading to significant discomfort and radicular pain. While numerous studies have demonstrated excellent results following index lumbar spine surgery in elderly patients (age > 65 years), the effectiveness of revision lumbar surgery in this cohort remains unclear. The aim of this study was to assess the long-term effectiveness of revision lumbar decompression and fusion in the treatment of symptomatic pseudarthrosis, ASD, and same-level recurrent stenosis, using validated patient-reported outcomes. Methods After a review of the institutional database, 69 patients who had undergone revision neural decompression and instrumented fusion for ASD (28 patients), pseudarthrosis (17 patients), or same-level recurrent stenosis (24 patients) were included in this study. Baseline and 2-year scores on the visual analog scale for leg pain (VAS-LP), VAS for back pain (VAS-BP), Oswestry Disability Index (ODI), and Zung Self-Rating Depression Scale (SDS) as well as the time to narcotic independence, time to return to baseline activity level, health state utility (EQ-5D, the EuroQol-5D health survey), and physical and mental component summary scores of the 12-Item Short-Form Health Survey (SF-12 PCS and MCS) were assessed. Results Compared with the preoperative status, VAS-BP was significantly improved 2 years after surgery for ASD (mean ± standard deviation 9 ± 2 vs 4.01 ± 2.56, p = 0.001), pseudarthrosis (7.41 ± 1 vs 5.52 ± 3.08, p = 0.02), and same-level recurrent stenosis (7 ± 2.00 vs 5.00 ± 2.34, p = 0.003). The 2-year ODI was also significantly improved after surgery for ASD (29 ± 9 vs 23.10 ± 10.18, p = 0.001), pseudarthrosis (28.47 ± 5.85 vs 24.41 ± 7.75, p = 0.001), and same-level recurrent stenosis (30.83 ± 5.28 vs 26.29 ± 4.10, p = 0.003). The Zung SDS score and SF-12 MCS did not change appreciably after surgery in any of the cohorts, with an overall mean 2-year change of 1.01 ± 5.32 (p = 0.46) and 2.02 ± 9.25 (p = 0.22), respectively. Conclusions Data in this study suggest that revision lumbar decompression and extension of fusion for symptomatic pseudarthrosis, ASD, and same-level recurrent stenosis provides improvement in low-back pain, disability, and quality of life and should be considered a viable treatment option for elderly patients with persistent or recurrent back and radicular pain. Mental health symptoms may be more refractory to revision surgery.

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