How Do Pelvic Parameters Correlate With Postoperative Outcomes When the Parameters Are Not Measured Preoperatively in Patients Undergoing Instrumented Lumbar Fusion?

Study Design: Retrospective cohort study. Objectives: Racial disparities in postoperative outcomes are unfortunately common. We present data assessing race as an independent risk factor for postoperative complications after spine surgery for Native American (NA) and African American (AA) patients compared with Caucasians (CA). Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for spine procedures performed in 2015. Data was subdivided by surgery, demography, comorbidity, and 30-day postoperative outcomes, which were then compared by race. Regression was performed holding race as an independent risk factor. Results: A total of 4803 patients (4106 CA, 522 AA, 175 NA) were included in this analysis. AA patients experienced longer length of stay (LOS) and operative times ( P < .001) excluding lumbar fusion, which was significantly shorter ( P = .035). AA patients demonstrated higher comorbidity burden, specifically for diabetes and hypertension ( P < .005), while NA individuals were higher tobacco consumers ( P < .001). AA race was an independent risk factor associated with longer LOS across all cervical surgeries (β = 1.54, P <.001), lumbar fusion (β = 0.77, P = .009), and decompression laminectomy (β = 1.23, P < .001), longer operative time in cervical fusion (β = 12.21, P = .032), lumbar fusion (β = -24.00, P = .016), and decompression laminectomy (OR = 20.95, P < .001), greater risk for deep vein thrombosis in lumbar fusion (OR = 3.72, P = .017), and increased superficial surgical site infections (OR = 5.22, P = .001) and pulmonary embolism (OR = 5.76, P = .048) in decompression laminectomy. NA race was an independent risk factor for superficial surgical site infections following cervical fusion (OR = 14.58, P = .044) and decompression laminectomy (OR = 4.80, P = .021). Conclusion: AA and NA spine surgery patients exhibit disproportionate comorbidity burden and greater 30-day complications compared with CA patients. AA and NA race were found to independently affect rates of complications, LOS, and operation time.

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Diabetes and Early Postoperative Outcomes Following Lumbar Fusion

Spine ◽

10.1097/brs.0b013e31814b1bc0 ◽

2007 ◽

Vol 32 (20) ◽

pp. 2214-2219 ◽

Cited By ~ 105

Author(s):

James A. Browne ◽

Chad Cook ◽

Ricardo Pietrobon ◽

M Angelyn Bethel ◽

William J. Richardson

Keyword(s):

Lumbar Fusion ◽

Postoperative Outcomes

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Postoperative Outcomes Following Posterior Lumbar Fusion in Patients With Multiple Sclerosis

Clinical Spine Surgery ◽

10.1097/bsd.0000000000001212 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Pramod N. Kamalapathy ◽

Joshua Bell ◽

Varun Puvanesarajah ◽

Hamid Hassanzadeh

Keyword(s):

Multiple Sclerosis ◽

Lumbar Fusion ◽

Postoperative Outcomes ◽

Posterior Lumbar Fusion

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The association of inflammatory bowel disease and immediate postoperative outcomes following lumbar fusion

The Spine Journal ◽

10.1016/j.spinee.2017.11.007 ◽

2018 ◽

Vol 18 (7) ◽

pp. 1157-1165 ◽

Cited By ~ 4

Author(s):

Joseph E. Tanenbaum ◽

Stephanie T. Kha ◽

Edward C. Benzel ◽

Michael P. Steinmetz ◽

Thomas E. Mroz

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Lumbar Fusion ◽

Postoperative Outcomes ◽

Inflammatory Bowel

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Case Example: Adjacent Segment Disease: What Is It, and How Is It Rated?

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2011.marapr02 ◽

2011 ◽

Vol 16 (2) ◽

pp. 8-9

Author(s):

Marjorie Eskay-Auerbach

Keyword(s):

Clinical Symptoms ◽

Lumbar Fusion ◽

Adjacent Segment Degeneration ◽

Adjacent Segment Disease ◽

Adjacent Segment ◽

Disc Space Narrowing ◽

Disc Disease ◽

Disc Space ◽

Radiographic Findings ◽

Asymptomatic Patients

Abstract The incidence of cervical and lumbar fusion surgery has increased in the past twenty years, and during follow-up some of these patients develop changes at the adjacent segment. Recognizing that adjacent segment degeneration and disease may occur in the future does not alter the rating for a cervical or lumbar fusion at the time the patient's condition is determined to be at maximum medical improvement (MMI). The term adjacent segment degeneration refers to the presence of radiographic findings of degenerative disc disease, including disc space narrowing, instability, and so on at the motion segment above or below a cervical or lumbar fusion. Adjacent segment disease refers to the development of new clinical symptoms that correspond to these changes on imaging. The biomechanics of adjacent segment degeneration have been studied, and, although the exact mechanism is uncertain, genetics may play a role. Findings associated with adjacent segment degeneration include degeneration of the facet joints with hypertrophy and thickening of the ligamentum flavum, disc space collapse, and translation—but the clinical significance of these radiographic degenerative changes remains unclear, particularly in light of the known presence of abnormal findings in asymptomatic patients. Evaluators should not rate an individual in anticipation of the development of changes at the level above a fusion, although such a development is a recognized possibility.

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