A Proposed Method to Quantify the Effect of Head and Shoulder Position on Kyphotic Deforming Forces before and after Spine Surgery

OBJECTIVEIn 2017, Michigan passed new legislation designed to reduce opioid abuse. This study evaluated the impact of these new restrictive laws on preoperative narcotic use, short-term outcomes, and readmission rates after spinal surgery.METHODSPatient data from 1 year before and 1 year after initiation of the new opioid laws (beginning July 1, 2018) were queried from the Michigan Spine Surgery Improvement Collaborative database. Before and after implementation of the major elements of the new laws, 12,325 and 11,988 patients, respectively, were treated.RESULTSPatients before and after passage of the opioid laws had generally similar demographic and surgical characteristics. Notably, after passage of the opioid laws, the number of patients taking daily narcotics preoperatively decreased from 3783 (48.7%) to 2698 (39.7%; p < 0.0001). Three months postoperatively, there were no differences in minimum clinically important difference (56.0% vs 58.0%, p = 0.1068), numeric rating scale (NRS) score of back pain (3.5 vs 3.4, p = 0.1156), NRS score of leg pain (2.7 vs 2.7, p = 0.3595), satisfaction (84.4% vs 84.7%, p = 0.6852), or 90-day readmission rate (5.8% vs 6.2%, p = 0.3202) between groups. Although there was no difference in readmission rates, pain as a reason for readmission was marginally more common (0.86% vs 1.22%, p = 0.0323).CONCLUSIONSThere was a meaningful decrease in preoperative narcotic use, but notably there was no apparent negative impact on postoperative recovery, patient satisfaction, or short-term outcomes after spinal surgery despite more restrictive opioid prescribing. Although the readmission rate did not significantly increase, pain as a reason for readmission was marginally more frequently observed.

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Implementation of a patient-specific tapering protocol at discharge decreases total opioid dose prescribed for 6 weeks after elective primary spine surgery

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2020-101324 ◽

2020 ◽

Vol 45 (6) ◽

pp. 474-478

Author(s):

Sarah S Joo ◽

Oluwatobi O Hunter ◽

Mallika Tamboli ◽

Jody C Leng ◽

T Kyle Harrison ◽

...

Keyword(s):

Spine Surgery ◽

Joint Replacement ◽

Oral Morphine ◽

Hospital Length ◽

Opioid Consumption ◽

Hospital Length Of Stay ◽

Patient Specific ◽

Opioid Dose ◽

Before And After ◽

Primary Spine

Background and objectivesAt our institution, we developed an individualized discharge opioid prescribing and tapering protocol for joint replacement patients and implemented the same protocol for neurosurgical spine patients. We then tested the hypothesis that this protocol will decrease the oral morphine milligram equivalent (MME) dose of opioid prescribed postdischarge after elective primary spine surgery.MethodsIn this retrospective cohort study, we identified all consecutive elective primary spine surgery cases 1 year before and after introduction of the protocol. This protocol used the patient’s prior 24-hour inpatient opioid consumption to determine discharge opioid pill count and tapering schedule. The primary outcome was total opioid dose prescribed in oral MME from discharge through 6 weeks. Secondary outcomes included in-hospital opioid consumption in MME, hospital length of stay, MME prescribed at discharge, opioid refills, and rates of minor and major adverse events.ResultsEighty-three cases comprised the final sample (45 preintervention and 38 postintervention). There were no differences in baseline characteristics. The total oral MME (median (IQR)) from discharge through 6 weeks postoperatively was 900 (420–1440) preintervention compared with 300 (112–806) postintervention (p<0.01, Mann-Whitney U test), and opioid refill rates were not different between groups. There were no differences in other outcomes.ConclusionsThis patient-specific prescribing and tapering protocol effectively decreases the total opioid dose prescribed for 6 weeks postdischarge after elective primary spine surgery. Our experience also demonstrates the potential generalizability of this protocol, which was originally designed for joint replacement patients, to other surgical populations.

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The impact of the 2006 Massachusetts health care reform law on spine surgery patient payer-mix status and age

Journal of Neurosurgery Spine ◽

10.3171/2017.4.spine161141 ◽

2017 ◽

Vol 27 (6) ◽

pp. 694-699 ◽

Cited By ~ 2

Author(s):

Nicolas W. Villelli ◽

Hong Yan ◽

Jian Zou ◽

Nicholas M. Barbaro

Keyword(s):

Health Care ◽

New York ◽

Health Care Reform ◽

Health Care System ◽

Spine Surgery ◽

Private Insurance ◽

New York State ◽

Before And After ◽

The Impact ◽

Care System

OBJECTIVESeveral similarities exist between the Massachusetts health care reform law of 2006 and the Affordable Care Act (ACA). The authors’ prior neurosurgical research showed a decrease in uninsured surgeries without a significant change in surgical volume after the Massachusetts reform. An analysis of the payer-mix status and the age of spine surgery patients, before and after the policy, should provide insight into the future impact of the ACA on spine surgery in the US.METHODSUsing the Massachusetts State Inpatient Database and spine ICD-9-CM procedure codes, the authors obtained demographic information on patients undergoing spine surgery between 2001 and 2012. Payer-mix status was assigned as Medicare, Medicaid, private insurance, uninsured, or other, which included government-funded programs and workers’ compensation. A comparison of the payer-mix status and patient age, both before and after the policy, was performed. The New York State data were used as a control.RESULTSThe authors analyzed 81,821 spine surgeries performed in Massachusetts and 248,757 in New York. After 2008, there was a decrease in uninsured and private insurance spine surgeries, with a subsequent increase in the Medicare and “other” categories for Massachusetts. Medicaid case numbers did not change. This correlated to an increase in surgeries performed in the age group of patients 65–84 years old, with a decrease in surgeries for those 18–44 years old. New York showed an increase in all insurance categories and all adult age groups.CONCLUSIONSAfter the Massachusetts reform, spine surgery decreased in private insurance and uninsured categories, with the majority of these surgeries transitioning to Medicare. Moreover, individuals who were younger than 65 years did not show an increase in spine surgeries, despite having greater access to health insurance. In a health care system that requires insurance, the decrease in private insurance is primarily due to an increasing elderly population. The Massachusetts model continues to show that this type of policy is not causing extreme shifts in the payer mix, and suggests that spine surgery will continue to thrive in the current US health care system.

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The Role of the Physical Therapist Before and After Lumbar Spine Surgery

Orthopedic Clinics of North America ◽

10.1016/s0030-5898(20)31341-9 ◽

1983 ◽

Vol 14 (3) ◽

pp. 649-659

Author(s):

M. Wayne Sawyer

Keyword(s):

Lumbar Spine ◽

Spine Surgery ◽

Physical Therapist ◽

Lumbar Spine Surgery ◽

Before And After

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Comparison of the effect of intravenous dexmedetomidine and lignocaine spray instilled into the endotracheal tube on extubation response in patients undergoing spine surgery

Journal of Neuroanaesthesiology and Critical Care ◽

10.4103/2348-0548.190070 ◽

2016 ◽

Vol 03 (03) ◽

pp. 239-244 ◽

Cited By ~ 1

Author(s):

Debojyoti Dutta ◽

Mukesh Godara ◽

Shobha Purohit ◽

Poonam Kalra ◽

Satya Sharma ◽

...

Keyword(s):

Blood Pressure ◽

Endotracheal Tube ◽

Spine Surgery ◽

Spontaneous Respiration ◽

Sedation Level ◽

Before And After ◽

Group D ◽

Rapid Emergence ◽

Better Than

Abstract Background: In spine surgery rapid emergence and extubation with haemodynamic stability is crucial for early neurological examination. Here, we have studied the effect of α2 agonist – dexmedetomidine intravenous (IV) and lignocaine spray instilled into the endotracheal tube at the end of the procedure to attenuate the extubation responses. Methods: A total of 45 patients undergoing spine surgery were randomly allocated in three groups. After the return of spontaneous respiration, Group-D: Dexmedetomidine 0.3 mcg/kg IV, Group-L: 10% lignocaine spray 1.5 mg/kg through endotracheal route and Group-P: Normal saline IV given over 60 s. Haemodynamic responses (systolic blood pressure, diastolic blood pressure, mean arterial pressure [MAP], heart rate [HR] and SpO2) were recorded before and after administration of drugs and also duration of emergence, extubation, quality of extubation and post-operative sedation level were evaluated. Results: The increase in MAP and HR during extubation was significantly less in Group-D than Group-L and Group-P, 2 min after administration of the respective drugs (P < 0.05). There were no significant differences in the grade of a cough after extubation and post-operative sedation level. Conclusion: Dexmedetomidine (0.3 mcg/kg) attenuates haemodynamic response better than lignocaine spray (1.5 mg/kg) during emergence and extubation. It also provides smooth extubation and easy recovery without any post-operative sedative effect.

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Assessment of the effectiveness of physiotherapy after surgical treatment of the cervical or lumbar spine

Medycyna Manualna ◽

10.5604/01.3001.0014.1206 ◽

2020 ◽

Vol XXIII (4) ◽

pp. 19-30

Author(s):

Adrian KUŻDŻAŁ ◽

Justyna LISZKA

Keyword(s):

Surgical Treatment ◽

Lumbar Spine ◽

Spine Surgery ◽

Rehabilitation Program ◽

Lumbar Pain ◽

Lumbar Spine Surgery ◽

Cervical Pain ◽

Cervical Spine Surgery ◽

Before And After ◽

Degree Of Disability

Objective. The aim of the study was to assess the effectiveness of physiotherapy, including assessment of the functional level of patients after surgical treatment of the spine. Material and methods. The study involved 46 people after cervical or lumbar spine surgery. The research was carried out using the author's questionnaire, the Oswestry questionnaire was used to assess the level of disability in people with lumbar pain. The NDI questionnaire was used to assess the degree of disability in people with cervical pain. The study was conducted before and after the ZUS-rehabilitation program, i.e. 3 weeks after it was started. Results. The intensity of lumbar pain before the stay remained strong, while after rehabilitation the pain remained moderate. The intensity of cervical pain before rehabilitation remained strong, while after rehabilitation the pain was mild. Before rehabilitation of patients after lumbar spine surgery the degree of disability was moderate and severe, while after rehabilitation it was mild and to a lesser extent moderate. In patients after cervical spine surgery, the level of disability before the stay was moderate and severe, but after physiotherapy - mild. Conclusions. The implemented physiotherapy program of patients after spine surgery is effective in reducing pain and improving the functioning of patients in daily activities. However, it is still necessary to verify and improve the methods of post operative physiotherapy of the spine so as to increase efficiency and therapy effectiveness in all evaluated domains.

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