Direct medical costs after surgical or nonsurgical treatment for degenerative lumbar spinal disease: A nationwide matched cohort study with a 10-year follow-up

Objective The demand for treating degenerative lumbar spinal disease has been increasing, leading to increased utilization of medical resources. Thus, we need to understand how the budget of insurance is currently used. The objective of the present study is to overview the utilization of the National Health Insurance Service (NHIS) by providing the direct insured cost between patients receiving surgery and patients receiving nonsurgical treatment for degenerative lumbar disease. Methods The NHIS-National Sample Cohort was utilized to select patients with lumbar disc herniation, spinal stenosis, spondylolisthesis or spondylolysis. A matched cohort study design was used to show direct medical costs of surgery (n = 2,698) and nonsurgical (n = 2,698) cohorts. Non-surgical treatment included medication, physiotherapy, injection, and chiropractic. The monthly costs of the surgery cohort and nonsurgical cohort were presented at initial treatment, posttreatment 1, 3, 6, 9, and 12 months and yearly thereafter for 10 years. Results The characteristics and matching factors were well-balanced between the matched cohorts. Overall, surgery cohort spent $50.84/patient/month, while the nonsurgical cohort spent $29.34/patient/month (p<0.01). Initially, surgery treatment led to more charge to NHIS ($2,762) than nonsurgical treatment ($180.4) (p<0.01). Compared with the non-surgical cohort, the surgery cohort charged $33/month more for the first 3 months, charged less at 12 months, and charged approximately the same over the course of 10 years. Conclusion Surgical treatment initially led to more government reimbursement than nonsurgical treatment, but the charges during follow-up period were not different. The results of the present study should be interpreted in light of the costs of medical services, indirect costs, societal cost, quality of life and societal willingness to pay in each country. The monetary figures are implied to be actual economic costs but those in the reimbursement system instead reflect reimbursement charges from the government.

SORG Algorithm to Predict 3- and 12-month Survival in Metastatic Spinal Disease: A Cross-Sectional Population-Based Retrospective Study.

In this study, we recruited 40 patients with spinal metastatic disease who were operated at Geneva University Hospitals by the Neurosurgery or Orthopedic teams between the years of 2015 and 2020. We did an ROC analysis in order to determine the accuracy of the SORG ML algorithm and nomogram versus the Tokuhashi Original and Revised Scores. The analysis of data of our independent cohort shows a clear advantage in terms of predictive ability of the SORG ML algorithm and nomogram in comparison with the Tokuhashi scores. The SORG ML had an AUC of 0.87 for 90-days and 0.85 for 1-year. The SORG Nomogram showed a predictive ability at 90-days and 1-year with AUC’s of 0.87 and 0.76 respectively. These results showed excellent discriminative ability as compared with the Tokuhashi Original Score which achieved AUC’s of 0.70 and 0.69 and the Tokuhashi Revised Score which had AUC’s of 0.65 and 0.71 for 3-month and 1-year respectively. The predictive ability of the SORG ML algorithm and nomogram were superior to currently used preoperative survival estimation scores for spinal metastatic disease.

Spinal Disease Predicts CNS Involvement in Patients with Plasma Cell Leukemia

Background: Plasma cell leukemia (PCL) is a rare and aggressive hematologic malignancy with an incidence of approximately 1,200 patients per year in the United States with a median disease-specific survival of 6 months. PCL can either originate de novo (primary PCL) or as a secondary leukemic transformation of multiple myeloma (secondary PCL). A feared complication is infiltration of plasma cells into the central nervous system (CNS), meninges, or cerebrospinal fluid (CSF) which is challenging to treat and most often results in early mortality. We have observed a higher incidence of CNS disease among patients with PCL compared to multiple myeloma and were motivated to conduct a retrospective analysis to identify risk factors for the occurrence of CNS involvement among patients with primary or secondary PCL. Aim: Identify risk factors that should prompt clinicians to obtain a lumbar puncture and neuroimaging to screen for CNS involvement in patients with PCL. Methods: We conducted a retrospective analysis utilizing clinical data from patients who were found to have greater than 5% abnormal plasma cells in their peripheral blood detected by flow cytometry at the Seattle Cancer Care Alliance from 1990 to the present. IRB approval was obtained before data abstraction. Features extracted included laboratory values, radiographic data, pathologic data, treatment regimens, and response outcomes to chemotherapy regimens. The Fisher test was used identify risk factors associated with CNS disease. A P value &lt;0.05 indicated a significantly asymmetrical distribution. The Kaplan-Meier product-limit method was used to estimate survival functions for groups in each risk factor. To determine the independent prognostic ability of each risk factor, multivariate survival analysis was performed using a Cox proportional hazards model. Results: To date, we have studied 21 patients which include 12 males and 9 females. Among this group, 18 patients were Caucasian, 2 patients were African American, and 1 patient's ethnicity was unknown. Four patients were diagnosed with primary PCL and 17 patients had secondary PCL. PCL was detected in the CSF by lumbar puncture in 5 patients (24%). The median overall survival of patients with CNS involvement from the time of PCL diagnosis was 192 days compared to 722 days in patients without CNS involvement. We reasoned that leukemic cells may translocate to the CSF more commonly in patients with spinal disease and evaluated the prevalence of spinal abnormalities. We found that all patients with CNS involvement and only 72% without CNS involvement had one or more spinal abnormalities which included degenerative disc disease, compression fractures of the spine, or lytic lesions of the spine (P &lt; 0.05). We also found a significant correlation between CNS involvement by PCL and Caucasian race, a diagnosis of secondary PCL, and initial treatment with cyclophosphamide and dexamethasone (P &lt; 0.05) Conclusions: In our study population, we observed a high incidence of CNS involvement (24%) among patients with PCL and identified multiple risk factors for the disease including evidence of malignant and non-malignant disease of the spine. These results suggest all patients with PCL should have spinal imaging performed at diagnosis and lumbar puncture should be considered for all patients, especially those with known spinal disease. Disclosures No relevant conflicts of interest to declare.

Impact of the Tranexamic Acid on Bleeding Amount of Surgical Patient With Degenerative Spinal Disease: A Randomized Blinded Study

Objective: This study aims to explore the effectiveness and safety of tranexamic acid (TXA) in reducing the bleeding amount of surgical patients with degenerative spinal disease in the perioperative period.Methods: A total of 80 cases of patients, who underwent elective posterior lumbar interbody fusion surgeries under general anesthesia, were enrolled in this study. The age of these patients ranged within 41–69 years old, and the surgical vertebral body segments were ≥2. The ASA classification was Level I or Level II. These patients were divided into two groups using the random number table (n = 40): TXA group and control group (S group). In the TXA group, the skin was incised after the anesthesia induction, and 20 mg/kg of TXA was immediately injected into the vein. The injection continued at a rate of 10 mg·kg−1·h−1 during the surgery, until the surgery was finished. In the S group, IV and pump injection with an equal amount of normal saline (NS) were performed. Then, the RBC, Hb, HCT, AST, ALT, BUN, Cr, PT, TT, APTT, FIB, and D-dimer were measured before the surgery and at 1 day after the surgery, and the SSFQ, intraoperative bleeding amount, homologous transfusion volume, urine volume, infusion quantity, surgical duration, drainage volume at 24 h after the surgery, total bleeding amount and adverse event occurrence at 1 week after the surgery were recorded.Results: The RBC, Hb and HCT at 1 day after the surgery were higher in TXA group than in the S group (average P &lt; 0.05). Intraoperative bleeding, drainage volume at 24 h after surgery, and total blood loss were lower in the TXA group than in the S group (average P &lt; 0.05). The SSFQ score and length of stay were lesser in the TXA group than in the S group (average P &lt; 0.05). The differences in AST, ALT, BUN, Cr, PT, TT, APTT, FIB, and D-dimer at 1 day after the surgery for these two groups of patients had no statistical significance (average P &gt; 0.05).Conclusion: TXA can reduce the bleeding amount of surgical patients with degenerative spinal disease in the perioperative period and decrease the length of stay, but does not increase the occurrence rate of adverse events, thereby promoting postoperative rehabilitation.Clinical Trial Registration:www.chictr.org.cn/index.aspx, identifier: ChiCTR2000033597.

Impact of Preoperative Total Knee Arthroplasty on Radiological and Clinical Outcomes of Spinal Fusion for Concurrent Knee Osteoarthritis and Degenerative Lumbar Spinal Diseases

Concurrent knee osteoarthritis (KOA) and degenerative lumbar spinal disease (LSD) has increased, but the total knee arthroplasty (TKA) effect on degenerative LSD remains unclear. The aim of this study was to retrospectively analyze to compare radiological and clinical outcomes between spinal fusion only and preoperative TKA with spinal fusion for the patients with concurrent KOA and degenerative LSD. A total of 72 patients with concurrent KOA and degenerative LSDs who underwent spinal fusion at less than three levels were divided in two groups: non-TKA group (n = 50) and preoperative TKA group (n = 22). Preoperative lumbar lordosis (LL) was significantly lower in the preoperative TKA group than the non-TKA group (p < 0.05). Significantly higher preoperative pelvic incidence (PI), PI/LL mismatch, and pelvic tilt (PT) occurred in preoperative TKA group than non-TKA group (all p < 0.05). There was significant improvement of postoperative Oswestry Disability Index and leg Visual Analog Scale in the preoperative TKA group (all p < 0.01). Preoperative TKA could be a benefit for in proper correction of sagittal spinopelvic alignment by spinal fusion. Therefore, preoperative TKA could be considered a preceding surgical option for patients with severe sagittal spinopelvic parameters in concurrent KOA and degenerative LSD.

Isolated High-Grade Malignancy of the Spinal Cord Presenting as Longitudinally Extensive Transverse Myelitis

This article characterizes 2 cases of longitudinally extensive transverse myelitis (LETM) that did not respond to immunotherapy and were diagnosed by biopsy as primary central nervous system (CNS) malignancies. Diffuse H3 K27M-mutant glioma is a recently described entity with very few cases of isolated spinal disease described in adults. Primitive neuroectodermal tumor is similarly uncommon in the spinal cord. Malignancies should be considered in patients who fail to improve with immunomodulatory therapy. We believe the experiences of our center will raise awareness about that point, broaden the existing understanding of the diagnostic approach to LETM, and highlight the need for additional studies.

Veterinary Chiropractic Treatment as a Measure to Prevent the Occurrence of Spondylosis in Boxers

Spondylosis deformans is a spinal disease common to several dog breeds, and several treatments including veterinary chiropractic may be used to treat affected dogs. Little is known, however, about the efficacy of chiropractic treatment as precautionary measure, aiming to reduce the probability of spondylosis development. We performed a randomized study where one half of the Boxer puppies from 17 litters were given veterinary chiropractic treatment at monthly intervals from eight weeks of age until they were one year old, while the other half were given no treatment (treated: n = 44, controls: n = 43). At an age of one year, spondylosis occurrence was recorded based on a scoring of X-ray images of the spine. The frequency of occurrence was significantly lower (p = 0.0478) in the treated dogs (25.0%) than in the controls (46.5%). We also tested if spondylosis occurrence in the treated dogs correlated with the average number of spinal joints with decreased mobility found per chiropractic treatment. No such effect was found, however. In summary, our results suggest that veterinary chiropractic treatment may be successfully used to reduce the probability of early development of spondylosis in young Boxers.