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Historically, back pain has been an inciting complaint for the initiation of opioids. Aggressive marketing of opioids to treat back pain coupled with the initiation of pain being treated as "the fifth vital sign" contributed to the emerging opioid crisis in the USA. West Virginia (WV) has long been considered the epicenter of the crisis. In 2018, the WV legislature passed a bill that placed prescribing limits on opioids. Our group set out to investigate the impacts of opioid prescribing restrictions through a sequential, mixed methods study evaluating prescription trends and stakeholder experiences. These stakeholder experiences generated emergent themes regarding the evolution of the opioid crisis up to and beyond the implementation of the bill, which is of relevance to neurosurgeons and back pain treatment. This study explores those findings for a neurosurgical audience. This study consisted of open-ended, semi-structured interviews with a purposive sample of 50 physicians, pharmacists, and patients in WV. Interviews were recorded and transcribed verbatim. Content analysis was utilized as the methodological orientation. Five theoretical domains relevant to the treatment of back pain emerged, describing the prevalence of opioid use, barriers to access care, the importance of opioids for function in resource-poor rural areas, disconnected and siloed care, and patient views on the impacts of pain care gaps and solutions. Spinal pain care in rural WV is complex due to identified challenges. Care siloing factors in suboptimal spinal pain care. Future work should define, implement, and assess the real-world effectiveness of treatment paradigms for the full spectrum of surgical and non-surgical back pain complaints. Neurosurgeons should be present in this arena.
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West Virginia, the only state entirely in Appalachia, is considered the epicenter of the opioid crisis. Children raised in families affected by opioid use disorder can develop their own substance use disorder later in life. The continuing opioid crisis coupled with social and health disparities suggest families in West Virginia are vulnerable to generational cycles of substance misuse. This qualitative study uses content analysis to present emergent themes discerned from participant interviews on the opioid epidemic and impacts of a restrictive opioid prescribing law in West Virginia. Participants in this study described how using opioids has impacted their lives, their family, and community. They recognized drug use was embedded along familial groups and influenced by significant others such as partners or peers. Parents described how children were a strong motivator for recovery and how they felt remorse for exposing their children to their drug use. This study highlights the importance of community engagement, parental support, and early identification of vulnerable young people to lessen the intergenerational continuance of substance use.
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OBJECTIVES: To explore the continuum of pain and addiction for patients with chronic pain (CP) who used opioids during a time of restrictive opioid prescribing in West Virginia. DESIGN: This qualitative descriptive study used a content analysis of semistructured interviews. Themes were identified through a reflective, iterative coding process. Consolidated criteria for reporting qualitative research guidelines were followed. SETTING: West Virginia. PARTICIPANTS: Twenty people who used opioids to treat a CP condition, 10 pharmacists, 10 primary care providers, and 10 specialists. INTERVENTION: Semistructured interviews. MAIN OUTCOME MEASURE: To better understand the impact of restrictive prescribing measures on people who used opioids for CP. RESULTS: Patients initiated opioids for acute, painful conditions and described how long-term use led to physical dependence and, for some, opioid use disorder. Restrictive opioid prescribing laws led to care interruptions and decreased access and availability of prescribed opioid pain medication, driving some patients to seek illicit drugs. Economic considerations influenced drug use as the price of purchasing prescription opioids on the street went up, making heroin a cheaper alternative. Patients who transitioned to buprenorphine/naloxone as a treatment for pain or opioid use disorder viewed it as a positive change and a "life saver." CONCLUSIONS: Opioid use for CP is complex and multifaceted. The continuum of pain and opioid use disorder can begin with a prescription for acute pain and continue for the treatment of CP. Patients described how continued opioid use was not to "get high" but for pain control to improve their quality of life, continue to work, and be productive. For those who experience physical dependence on opioids, access to treatment is vital to recovery and pain management. KEY MESSAGE: Without individualized managed care, people confronted with a sudden interruption in prescription opioids may turn to illicit drugs to mitigate symptoms of opioid withdrawal and physical dependence.
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Early studies suggest medical cannabis (MC) has the potential to benefit people who suffer from chronic pain by offering a less addictive alternative to opioids; however, most investigators agree more research is indicated. Today, in 2023, cannabis remains a Schedule I drug and is an illegal substance in the United States under the Controlled Substances Act of 1970. Despite this designation, as of February 2022, 37 states, three territories, and the District of Columbia allowed using cannabis products to treat certain painful medical conditions. The contradictory status of federal and state legislation regarding cannabis use has resulted in delays and restrictions on relevant research. As a result, an inadequate foundation of knowledge exists needed to inform policy, program, and practice decisions concerning MC to treat pain. Implementing and controlling access to MC is influenced by overlapping individual, interpersonal, community, and organizational influences that all fall under the umbrella of federal and state policies. Increasingly, the legalization and expanded access to MC necessitates the integration of evidence, policy, and social-ecological reality. To adequately delineate these complex factors to anticipate and plan future interventions at multiple levels, we propose a social-ecological framework (SEF) for using MC to treat pain. This SEF assumes the transactional relationship between the individual and the environment and that no single factor can predict behavior or health outcomes. Our framework illustrates five dynamic levels of analysis that interact between dimensions. Key elements and intersections are discussed at the intrapersonal, interpersonal, institutional, community, and policy levels.
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Objectives: There is a strong association between alcohol consumption and traumatic brain injury (TBI). Students are known to consume alcohol at a high rate. Despite the connection between alcohol and TBI, this is one of few studies to examine the connection between students, alcohol, and TBI. The objective of this study was to explore the relationship between students, alcohol, and TBI. Materials and Methods: A retrospective chart review utilizing the institutional trauma data back was performed for patients 18-26 years of age, admitted to the emergency department with a diagnosis of a TBI and positive blood alcohol. Patient diagnosis, injury mechanism, alcohol level on admission, urine drug screen, mortality, injury severity score, and discharge disposition were recorded. The data were analyzed using Wilcoxon rank-sum tests and Chi-square tests to identify differences between students and non-student groups. Results: Six hundred and thirty-six charts were reviewed for patients aged 18-26 with a positive blood alcohol level and TBI. The sample included 186 students, 209 non-students, and 241 uncertain of status. The student group had significantly higher levels of alcohol than the non-student group (P < 0.0001). P < 0.0001 showed that overall alcohol levels for males are significantly higher than levels of alcohol for females in the student group. Conclusion: Alcohol consumption contributes to significant injuries such as TBI in college students. Male students had a higher prevalence of TBI, and higher alcohol levels than female students. These results can be used to inform and better target harm reduction and alcohol awareness programs.
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BACKGROUND: West Virginia (WV) has been at the forefront of the opioid crisis in the United States, with the highest rate of opioid overdose mortality involving prescription opioids in the country. To curb the crisis, the state government implemented a restrictive opioid prescribing law in March 2018, Senate Bill 273 (SB273), to decrease opioid prescribing. However, sweeping changes in opioid policy can have downstream effects on stakeholders such as pharmacists. This study is part of a sequential mixed methods investigation of the impact of SB273 in WV in which we interviewed various stakeholders-including pharmacists-about the impact of the law. OBJECTIVES: This paper aims to explore how pharmacy practice during the opioid crisis impacted the need for restrictive legislation and how SB273 impacted subsequent pharmacy practice in WV. METHODS: Semi-structured interviews were conducted with 10 pharmacists who were practicing in counties that had been designated as high-prescribing counties based upon county-level prescribing/dispensing data from state records. Analysis of the interviews was informed by the methodological orientation of content analysis to identify emerging themes. RESULTS: Participants described confronting questionable opioid prescriptions, treatment costs, and insurance coverage driving opioids as a first-line choice for pain management, as well as the influence of corporate policies and the immense responsibility of being the "last line of defense" in the opioid crisis. A central impediment to the care of patients was the inability of the pharmacists to effectively communicate their concerns to prescribers, making improved prescriber-dispenser communication an essential next step in minimizing opioid care gaps. CONCLUSION: This is one of few qualitative studies that have explored pharmacists' experiences, perceptions, and role in the opioid crisis leading up to and during the enactment of a restrictive opioid prescribing law. In light of the difficulties they faced, a restrictive opioid prescribing law was viewed positively by pharmacists.
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Analgésicos Opioides , Farmacéuticos , Humanos , Estados Unidos , Analgésicos Opioides/efectos adversos , West Virginia , Epidemia de Opioides , Pautas de la Práctica en MedicinaRESUMEN
CONTEXT: Stigma is known to impact the care of patients with opioid use disorder (OUD). OBJECTIVES: This qualitative study seeks to understand how stigma is expressed in the medical chart by healthcare workers towards patients with cancer pain and OUD treated at an academic medical center. METHODS: This descriptive qualitative study utilized a thematic analysis approach to analyze the medical charts of 25 hospitalized patients with current or previous opioid use disorder and cancer with respect to their pain care in forty pain-related hospital admissions to a tertiary academic center from 2015 to 2020. The codebook utilized a well-characterized stigma framework and emerging themes were identified through an iterative, comparative method. COREQ guidelines were followed. RESULTS: Evidence of stigma marking was present in the medical chart aligning with several intersecting stigmas. Drivers such as blame and stereotypes impeded pain care, while facilitators such as legal or policy influences and non-care advocates could be either positive or negative determinants to pain care. Care by known providers within the healthcare environment was largely a facilitator of improved pain care. CONCLUSIONS: Healthcare provider stigma must be addressed as its effects are both quantitatively and qualitatively affecting patient care; in particular access to pain treatment. Continuity of care by known care providers may improve pain care for patients with cancer and OUD who are acutely hospitalized.
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Neoplasias , Trastornos Relacionados con Opioides , Humanos , Dolor , Atención a la Salud , Investigación Cualitativa , Neoplasias/terapiaRESUMEN
In North America, stigma remains a significant barrier to treating obesity. Many candidates for medical weight management do not seek treatment, possibly related to anticipated and internalized stigma and weight bias. Pharmacologic treatment of obesity remains highly stigmatized, despite advances in drug development and medical weight management programs. People contemplating medical weight management are likely to see information about "diet pills" on social media sites, such as Twitter. However, Twitter has been found to contain false and stigmatizing information. This study examines a sample of 2170 Tweets to better understand the content through the lens of obesity stigma. Tweets were collected over a seven-day period containing general terms such as "diet pills," "weight loss pills," or "fat burner" using the Twitter advanced search option. The analysis revealed that almost 50% of Tweets containing "diet pills" contained stigmatizing language. The most common elements of stigma communication were taking personal blame for obesity and the perils associated with taking medications for weight loss. Further analysis revealed sub-themes such as profiting from social pressures to lose weight, distrust of physicians and the practice of obesity medicine, lack of efficacy of medications, and the use of social media to disseminate stigma. Most Tweets were from personal accounts followed by direct sales of weight loss supplements. The findings have potential implications for medically supervised weight management programs and may drive the need for more evidence-based social media messaging around obesity related healthcare.
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Medios de Comunicación Sociales , Humanos , Estigma Social , Comunicación , Obesidad/tratamiento farmacológico , Pérdida de PesoRESUMEN
BACKGROUND: Medication for opioid use disorder (MOUD) includes administering medications such as buprenorphine or methadone, often with mental health services. MOUD has been shown to significantly improve outcomes and success of recovery from opioid use disorder. In WV, only 18% of providers including physicians, physician assistants, and nurse practitioners are waivered, and 44% of non-waivered providers were not interested in free training even if compensated. This exploratory research seeks to understand intervention-related stigma in community-based primary care providers in rural West Virginia, determine whether financial incentives for training may be linked to levels of stigma, and what level of financial incentives would be required for non-adopters of MOUD services provision to obtain training. METHOD: Survey questions were included in the West Virginia Practice-Based Research Network (WVPBRN) annual Collective Outreach & Research Engagement (CORE) Survey and delivered electronically to each practice site in WV. General demographic, staff attitudes and views on compensation for immersion training for delivering MOUD therapy in primary care offices were returned. Statistical analysis included logistic and multinomial logistic regression and an independent samples t-test. RESULTS: Data were collected from 102 participants. Perceived stigma did significantly predict having a waiver with every 1-unit increase in stigma being associated with a 65% decreased odds of possessing a waiver for buprenorphine/MOUD (OR = 0.35; 95% CI 0.16-0.78, p = 0.01). Further, t-test analyses suggested there was a statistically significant mean difference in perceived stigma (t(100) = 2.78, p = 0.006) with those possessing a waiver (M = 1.56; SD = 0.51) having a significantly lower perceived stigma than those without a waiver (M = 1.92; SD = 0.57). There was no statistically significant association of stigma on whether someone with a waiver actually prescribed MOUD or not (OR = 0.28; 95% CI 0.04-2.27, p = 0.234). CONCLUSION: This survey of rural primary care providers demonstrates that stigmatizing beliefs related to MOUD impact the desired financial incentive to complete a one-day immersion, and that currently unwaivered providers endorse more stigmatizing beliefs about MOUD when compared to currently waivered providers. Furthermore, providers who endorse stigmatizing beliefs with respect to MOUD require higher levels of compensation to consider such training.
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Buprenorfina , Trastornos Relacionados con Opioides , Humanos , Motivación , Trastornos Relacionados con Opioides/tratamiento farmacológico , Buprenorfina/uso terapéutico , Metadona , Atención Primaria de Salud , Tratamiento de Sustitución de Opiáceos , Analgésicos OpioidesRESUMEN
Mixed methods research is an approach that intentionally integrates both quantitative and qualitative research methods to answer a research question. The hallmark of mixed methods research is a focus on designing studies that integrate both quantitative and qualitative data, yielding greater results than either method could yield on its own. There are a number of fundamental concepts that are essential to conducting mixed methods research. These include a methodological approach that employs one of the three core study designs, involvement of a multidisciplinary team that includes both methodological and subject matter experts, and meticulous planning to ensure that the data collected can ultimately be integrated to yield findings that answer the original research question to the investigators' (and funders') satisfaction. In this article, we will discuss mixed methods research designs, data sources typically used in mixed methods research, and common data analysis and integration strategies. We will also provide examples of mixed methods research projects that have been used in vascular surgery. The intent of this article was to provide an overview of the field of mixed methods research, enabling the reader to critically assess mixed methods research studies in the literature and consider how this methodology might benefit their own research endeavors.
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Cirujanos , Humanos , Investigación Cualitativa , Proyectos de InvestigaciónRESUMEN
BACKGROUND: The incidence of pain-generating degenerative spinal problems in patients who are currently using or have previously used drugs has increased as substance use disorder (SUD) becomes a chronic, lifelong condition. Health system-level data in recent years indicate a significant increase in patients with coexisting SUD and degenerative disc disease, representing an emerging population. A retrospective electronic medical record review identified seven patients with SUD who underwent elective spine surgery by orthopedic or neurosurgical staff from 2012 to 2021. The authors present two of these illustrative cases and a framework that can be used in the treatment of similar patients. OBSERVATIONS: Substances used included opioids, benzodiazepines, barbiturates, cocaine, methamphetamines, hallucinogens, lysergic acid diethylamide, phencyclidine, and cannabis. All were abstaining from drug use preoperatively, with four patients in a formal treatment program. Five patients were discharged with an opioid prescription, and two patients deferred opioids. Three experienced a relapse of substance use within 1 year. All patients presented for follow-up, although two required additional contact for follow-up compliance. LESSONS: Perioperative protocols focusing on patient-led care plans, pain control, communication with medication for opioid use disorder providers, family and social support, and specific indicators of possible poor results can contribute to better outcomes for care challenges associated with these diagnoses.
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PURPOSE: Opioid use disorder has caused significant morbidity and mortality resulting in opioid prescribing limiting laws, such as State Bill 273 in West Virginia. The purpose of this study is to explore the impacts of a restrictive opioid prescription law on physicians in medical practice in West Virginia. METHODS: A qualitative study with open-ended semistructured interviews with a purposive sample of physicians in West Virginia. Interviews were recorded and transcribed verbatim. A preliminary code book was developed by 3 coinvestigators. Interview transcriptions were analyzed with a code-based text search query. Content analysis was utilized as the methodological orientation underpinning for the current work. RESULTS: Interviews were conducted with 20 physicians (10 primary care physicians and 10 specialty physicians) in practice in West Virginia. Physicians identified 5 theoretical domains related to SB273: changing opioid prescribing and documentation requirements; rural socioeconomic disparities; a continuum between chronic pain and substance use disorder; difficulty in balancing patient needs and the concern for diversion; lack of available alternatives to opioids for chronic. CONCLUSION: Prescribing opioids in rural West Virginia is complex due to identified challenges. Recommendations for opioids prescribing legislation include clear messaging of guidelines and recommendations, efforts to address socioeconomic disparities of health and pain, and improved accessibility for treatment of both pain and dependence in rural communities are important areas of growth in the rural health care environment.
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Dolor Crónico , Epidemia de Opioides , Humanos , Epidemia de Opioides/prevención & control , Analgésicos Opioides/efectos adversos , Manejo del Dolor , West Virginia/epidemiología , Pautas de la Práctica en Medicina , Dolor Crónico/tratamiento farmacológicoRESUMEN
Introduction: Social support is key to wellness, especially during times of stress and uncertainty. The working climate, including the multidisciplinary medical community provides opportunities for both positive and negative wellness experiences. The purpose of this study is to explore residents' concepts of wellness and the influence of programs, faculty, peers, and nursing and ancillary staff. Methods: An email with a link to the REDCap survey was sent to each resident (n=450) in the school of medicine at West Virginia University asking them to give examples of ways their wellness has been supported (or not) by faculty members, their program, co-residents, and nursing and ancillary staff. The residents returned 51 completed surveys (11% response rate). Seven residents participated in a face to face interview. A content analysis using Hale's adaptation of resident wellness (based upon Maslow's Hierarchy of Needs) as the theoretical framework was conducted on the data. Results: Positive wellness elements frequently focused on time, supportive actions, and social connection. Negative examples impacting wellness included feeling disrespected, not being included in decision making, conflicts, and feeling unappreciated. Suggestions from the residents often described low cost interventions such as being" included" and feeling part of the team. Conclusion: The participants described how all members of the healthcare team can support resident wellness in a variety of domains. Peers, support staff in the hospital environment, faculty supervisors, and the program overall can contribute to the basic physiologic needs, safety, belonging, esteem, and self-actualization of resident learners through social support.
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INTRODUCTION: The use of telemedicine increased during the global Coronavirus disease 2019 (COVID-19) pandemic. Rural populations often struggle with adequate access to care while simultaneously experiencing multiple health disparities. Yet, telemedicine use during the COVID-19 pandemic has been understudied on its effect on visit completion in rural populations. The primary purpose of this study is to understand how telemedicine delivery of family medicine care affects patient access and visit completion rates in a rural primary care setting. METHODS: We performed a retrospective cohort study on primary care patient visits at an academic family medicine clinic that serves a largely rural population. We gathered patient demographic and visit type and completion data on all patients seen in the West Virginia University Department of Family Medicine between January 2019 and November 2020. RESULTS: The final sample included 110,999 patient visits, including 13,013 telemedicine visit types. Our results show that telemedicine can increase completion rates by about 20% among a sample of all ages and a sample of adults only. Working-aged persons are more likely to complete telemedicine visits. Older persons with higher risk scores are more likely to complete their visits if they use telemedicine. CONCLUSIONS: Telemedicine can be a tool to improve patient access to primary care in rural populations. Our findings suggest that telemedicine may facilitate access to care for difficult-to-reach patients, such as those in rural areas, as well as those who have rigid work schedules, live longer distances from the clinic, have complex health problems, and are from areas of higher poverty and/or lower education.
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COVID-19 , Telemedicina , Adulto , Anciano , Anciano de 80 o más Años , COVID-19/epidemiología , Humanos , Pandemias , Atención Primaria de Salud , Estudios Retrospectivos , Población RuralRESUMEN
OBJECTIVES: West Virginia (WV) is the only state entirely located in Appalachia, a large, mostly rural area in the eastern United States. WV has the highest adult obesity rate in the United States, as well as one of the highest physical inactivity rates. Obesity has been found to be significantly higher in rural counties than in urban counties, and many rural communities do not have the resources to address this growing health concern. It is well documented that healthy eating and becoming more physically active can be successful in reducing weight and managing obesity-related illness. Despite this overwhelming evidence, obesity rates in WV continue to climb. The purpose of this study was to understand the factors associated with obesity in WV and identify what influences the behavior of people in regard to weight loss and exercise. METHODS: Four focus groups were conducted across the state of WV, transcribed, and thematically analyzed to examine the facilitators and barriers associated with healthy behaviors. The Consolidated Framework for Implementation Research (CFIR) was used as an approach to classify characteristics and plan implementation strategies integrating five domains. The CFIR has been used to identify potential barriers and facilitators to interventions and can be used before or during an intervention. In addition, the CFIR has been used as a framework to guide analysis and provide a means to organize intervention stakeholders' perceptions of barriers and facilitators to successful interventions. RESULTS: Participants identified barriers and facilitators across all 5 major domains of the CFIR-intervention characteristics, outer setting (eg, cultural norms, infrastructure), inner setting (eg, access to knowledge), characteristics of individuals, and the implementation process-and 16 subdomains. Participants discussed how socioeconomic, cultural, and environmental factors influenced diet and exercise. Cost, family culture, and limited access to resources (eg, healthy foods, community-based fitness programs, health care) were common themes expressed by participants. CONCLUSIONS: The results of this study identify how individuals living in rural Appalachian view lifestyle changes and what influences their ability to pursue physical activity and healthy eating. Future programs to encourage healthy lifestyles in Appalachia need to consider the characteristics of the given community to achieve the goal of a tailored lifestyle intervention program that is feasible and effective. In addition, the findings suggest that the CFIR can be used to implement and refine intervention strategies that can be used in the real world.
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Ejercicio Físico , Pérdida de Peso , Adulto , Región de los Apalaches/epidemiología , Humanos , Obesidad/epidemiología , Obesidad/prevención & control , Conducta SedentariaRESUMEN
BACKGROUND: West Virginia has one of the highest rates of opioid overdose related deaths and is known as the epicenter of the opioid crisis in the United States. In an effort to reduce opioid-related harms, SB 273 was signed in 2018, and aimed to restrict opioid prescribing in West Virginia. SB 273 was enacted during a time when physician arrests and convictions had been increasing for years and were becoming more prevalent and more publicized. This study aims to better understand the impact of the legislation on patients and providers. METHODS: Twenty semi-structured interviews were conducted with opioid-prescribing primary care physicians and specialists practicing throughout West Virginia. RESULTS: Four themes emerged, 1. Fear of disciplinary action, 2. Exacerbation of opioid prescribing fear due to restrictive legislation, 3. Care shifts and treatment gaps, and 4. Conversion to illicit substances. The clinicians recognized the harms of inappropriate prescribing and how this could affect their patients. Decreases in opioid prescribing were already occurring prior to the law implementation. Disciplinary actions against opioid prescribers resulted in prescriber fear, which was then exacerbated by SB 273 and contributed to shifts in care that led to forced tapering and opioid under-prescribing. Providers felt that taking on patients who legitimately required opioids could jeopardize their career. CONCLUSION: A holistic and patient-centered approach should be taken by legislative and disciplinary bodies to ensure patients are not abandoned when disciplinary actions are taken against prescribers or new legislation is passed.
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Analgésicos Opioides , Sobredosis de Opiáceos , Analgésicos Opioides/efectos adversos , Miedo , Humanos , Pautas de la Práctica en Medicina , Estados Unidos , West VirginiaRESUMEN
Objectives: Specialized rehabilitation is important for people with traumatic spinal cord injuries (SCIs) to optimize function, independence and mitigate complications, and access to this service varies by the payor. In West Virginia, admission to acute rehabilitation facilities is a "non-covered entity," impeding access to this care for patients with SCI and Medicaid. Our previous work examined the discharge disposition from an acute care hospital of patients with and without Medicaid and found that Medicaid patients were almost twice as likely to be discharged home or to a nursing home, despite similar injury severity and younger age compared to non-Medicaid patients. West Virginia is a largely rural state with multiple health-care challenges. A lack of availability of rehabilitation facilities for Medicaid beneficiaries likely explains this difference. This present study examines the relationship between insurance coverage, discharge disposition at time of injury, and long-term outcomes for people in West Virginia with traumatic SCI. Materials and Methods: This study utilized a retrospective chart review and telephone survey from a Level 1 Trauma Center in West Virginia. Participants included 200 patients with traumatic SCI from 2009 to 2016 in West Virginia. Thirty-four patients completed the survey through telephone interviews, with another 16 completing the survey but declining to answer economic questions. Survey participants were asked the Craig Handicap Assessment and Reporting Technique (CHART), which indicates the degree of impairment, and disability; they experience years after initial injury and rehabilitation. Proportional odds regression models, a regression model generalization of the Wilcoxon rank sum test, were employed where normal distribution of the response variables was not assumed and was performed, controlling for age and injury severity. Results: Total CHART score correlated with discharge disposition (P = 0.01). Insurance type correlated with mobility sub-score (P = 0.03). Conclusion: Patients discharged to a rehabilitation center have overall higher CHART scores post-injury, indicating better long-term outcomes than those discharged home or a nursing home. People with Medicaid as payors had lower scores for mobility than those with other insurance coverage.
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Charcot spinal arthropathy presents significant surgical challenges, with large bony defects and limitations in fixation and reconstruction which are exacerbated in often numerous revision surgeries. These challenges make the development of additional salvage techniques useful. We report on a technique of thecal transection and canal fusion with structural allograft as a salvage technique for refractory cases of Charcot spinal arthropathy. We illustrate the technique with 4 procedures done in 3 patients, over a period of 10 years.