Adjacent Segment Reoperation and Other Perioperative Outcomes in Patients Who Underwent Anterior Lumbar Interbody Fusions at One and Two Levels.

OBJECTIVE: This is the first large retrospective analysis of patients undergoing anterior lumbar interbody fusion (ALIF) with concern for clinical determinants leading to reoperation for adjacent segment disease (ASD). The objective of this study is to examine the specific perioperative and clinical determinants that affect need for adjacent segment reoperation in patients who underwent 1-level and 2-level ALIF procedures for degenerative disc disorders. METHODS: All cases at our institution between 2008 and 2016 involving an ALIF performed for degenerative disc disorders at 1 or 2 levels were examined. A total of 404 ALIF cases, of which 268 were single-level (66.33%) and 136 were 2-level procedures (33.67%), were included. Adjacent segment reoperation was the primary outcome. Secondary outcomes included increased blood loss, extended surgery duration, greater nonhome discharge, extended hospitalization, and higher total direct costs. Univariate and multivariate logistic regression assessed how number of levels fused related to perioperative outcomes. RESULTS: The patient cohorts shared similar demographic characteristics and showed expected differences in certain intraoperative outcomes. After controlling for preoperative and intraoperative variables, multivariate regression showed that patients who underwent 2-level ALIFs experienced increased odds of adjacent segment reoperation (P = 0.0424) but no other adverse clinical outcomes. CONCLUSIONS: Our findings support a biomechanical hypothesis of ASD onset after fusion, suggesting that the risk of ASD after ALIF lies primarily in the number of levels fused rather than any demographic or intraoperative variables.

Perioperative Outcomes of Spinal Cord Stimulator Placement in Patients with Complex Regional Pain Syndrome Compared with Patients without Complex Regional Pain Syndrome.

BACKGROUND AND OBJECTIVE: Complex regional pain syndrome (CRPS) is a multifaceted disorder resulting in an abnormal pain response to tissue injury. Among key CRPS features are neurogenic inflammation, maladaptive plasticity, and vasomotor dysfunction, which can result in severe pain and disability. Spinal cord stimulation (SCS) is an efficacious treatment for several chronic pain conditions and may improve pain and life quality in CRPS patients with CRPS. However, little information exists regarding perioperative outcomes of patients with CRPS undergoing surgical implantation of an SCS device. METHODS: Patients were included if they underwent an SCS procedure at our institution between 2008 and 2016 for chronic pain. Cases were excluded if the procedure involved stimulator removal or if it was an outpatient procedure. Multivariate regression assessed the effect of CRPS and other clinical variables on perioperative outcomes. RESULTS: Eighty-one inpatient SCS implantation cases for chronic pain were included, with 9 patients (11.1%) having a CRPS diagnosis. The CRPS cohort received higher mean quantities of intraoperative opioids and had a lower proportion of patients reporting meaningful pain reduction (16.7%) in the 24-hour postoperative setting compared with patients without CRPS (35.9%), although this was not statistically significant. Multivariate regression modeling suggested that CRPS was a significant predictor of increased odds of extended time to the postanesthesia care unit discharge (P = 0.0406) and higher direct costs of hospitalization (P = 0.0326). CONCLUSIONS: Our data suggest that CRPS may pose several unique risks in the perioperative period after inpatient SCS implantation. These findings support the need for future prospective investigations examining risks and outcomes for SCS procedures in this population.

Non-cell-adhesive substrates for printing of arrayed biomaterials.

Cellular microarrays have become extremely useful in expediting the investigation of large libraries of (bio)materials for both in vitro and in vivo biomedical applications. An exceedingly simple strategy is developed for the fabrication of non-cell-adhesive substrates supporting the immobilization of diverse (bio)material features, including both monomeric and polymeric adhesion molecules (e.g., RGD and polylysine), hydrogels, and polymers.