Risk Factors for Postoperative Urinary Retention Following Lumbar Spine Surgery: A Review of Current Literature and Meta-Analysis.

STUDY DESIGN: Systematic Review and Meta-analysis. OBJECTIVE: Postoperative urinary retention (POUR) is a common complication following lumbar spine surgery (LSS) and timely recognition is imperative to avoid long-term consequences. The aim of the current meta-analysis was to systematically review the literature in order to identify risk factors associated with POUR after LSS. METHODS: In accordance with PRISMA guidelines, a systematic review of the literature was performed using Pubmed, EMBASE, and MEDLINE database for articles on POUR following LSS. A meta-analysis was performed comparing patients with and without POUR; and the factors associated with this adverse event were analyzed. The pooled data were reported as mean differences with 95% confidence intervals (CI; P < .05). Heterogeneity among the studies was evaluated using the I2 statistic. RESULTS: The meta-analysis included 10 studies compromised of 30,300 patients. Based on our analysis, patients who were male, were older in age, underwent instrumented fusion, had diabetes mellitus, coronary artery disease, or benign prostatic hypertrophy had significantly higher risk of developing POUR. Additionally, patients in who developed POUR had significantly longer surgical times and higher volumes of intra-operative fluid administration, as compared with non-POUR patients. The POUR patients also had a significantly higher association with urinary tract infection. Prior surgery, BMI, length of stay, and smoking status did not reveal any statistical association with POUR. CONCLUSIONS: Risk factors associated with POUR following LSS include male gender, older age, longer surgical times, fusion procedures, larger volumes of intraoperative infusions, and associated comorbidities like DM, CAD, and BPH.

The Role of Riluzole in Acute Traumatic Cervical Spinal Cord Injury with Incomplete Neurological Deficit: A Prospective, Randomised Controlled Study.

Introduction: Riluzole, a benzothiazole sodium channel blocker is acknowledged as a neuroprotective agent in spinal cord injury (SCI). Most of this evidence is based on pre-clinical studies and its effectiveness in clinical setting is undetermined, heretofore. Methods: A prospective, randomised-controlled study was conducted between April 2019 and March 2020 at a tertiary-level centre. Patients aged 18-65 years with sub-axial cervical spine injury, who presented within 72 h of injury with incomplete neuro-deficit, were included. They were randomised into groups A (riluzole was administered) and B (no adjuvants). All patients were followed up at 6 weeks/3/6/12 months, and clinical [ASIA motor/sensory scores/grade, SCIM3, and NRS (neuropathic pain)] and radiological evaluation was performed. Results: Twenty-three and 20 patients were included in groups A and B. Two in group A were females, while others were males (p = 0.49). Mean age in groups A and B was 47.7 ± 14.8 and 51.2 ± 14.1 years (p = 0.44). Five patients died prior to 6th-week follow-up. Among the others, there was significant improvement in all neurological parameters in both groups (post-injury vs 1-year; motor score: p < 0.001, sensory score: p < 0.001, SCIM3: p < 0.001, NRS: p < 0.001). In both groups, initial significant improvement was noticed even at the 6th-week follow-up, which further continued until the end of 1 year. There was no statistically significant difference between groups A and B with respect to these neurological parameters (motor: p = 0.15, sensory: p = 0.39, SCIM3: p = 0.68, NRS: p = 0.06). Conclusion: Administration of riluzole did not significantly improve neurological outcome/neuropathic pain in our cohort. Nevertheless, both our groups demonstrated an overall improvement in neurological outcome at 1 year, as compared with immediate post-injury status.

Risk Factors for Postoperative Ileus After Thoracolumbar and Lumbar Spinal Fusion Surgery: Systematic Review and Meta-Analysis.

OBJECTIVE: Postoperative ileus (POI) is a known complication after spine surgery. This study comprehensively reviews the existing literature and evaluates the risk factors associated with POI after thoracolumbar and lumbar fusion surgeries. METHODS: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a comprehensive search was conducted for articles on ileus after the surgical treatment of spinal pathologies. Variables including gender, age, body mass index, comorbidities, approach, type of surgery performed, levels fused, anesthesia time, and length of stay were considered as the main outcomes of measurement. Meta-analyses were conducted using random models according to the between-study heterogeneity, estimated with I2. Sensitivity analysis was performed with heterogeneity greater than 50%. RESULTS: Ten articles compromising a total of 297,809 patients met the inclusion criteria. POI after lumbar surgery had a statistically significant association with increased age, surgical time, anesthesia time, estimated blood loss, and length of stay. The pooled mean differences were 1.70 years (95% confidence interval [CI]: 1.52-1.87, P < 0.0001), 83.02 minutes (CI: 41.20-124.84, P = 0.0001), 64.97 minutes (CI: 31.43-98.50, P = 0.0001), 439.04 cc (CI: 250.60-627.49, P < 0.001), and 2.97 days (CI: 2.54-3.40, P < 0.001), respectively. Furthermore, individuals who underwent spinal fusion had higher odds of POI if they were male (odds ratio [OR]: 1.33; CI: 1.06-1.67; P = 0.01), if an anterior approach was performed (OR: 1.97; CI: 1.29-3.01; P = 0.002), or if >3 vertebral levels were fused (OR: 3.99; CI: 1.28-12.44; P = 0.02). Body mass index did not show any association with POI. CONCLUSIONS: Risk factors associated with POI after spinal fusion surgery include male gender, older age, longer surgical times, higher estimated blood loss, longer lengths of stay, greater numbers of levels of fusion, and anterior surgical approach.

Halo Gravity Traction for the Correction of Spinal Deformities in the Pediatric Population: A Systematic Review and Meta-Analysis.

OBJECTIVE: Halo gravity traction (HGT) is an effective way of managing pediatric spinal deformities in the preoperative period. This study comprehensively reviews the existing literature and evaluates the effect of HGT on various radiographic parameters regarding spinal correction and, secondarily, evaluates the improvement in pulmonary function as well as nutritional status. METHODS: In accordance with PRISMA guidelines, a comprehensive search was conducted for articles on HGT in the treatment of spinal deformity. Spinal deformity after traction and surgery, change of pulmonary function, nutritional status, and prevalence of complications were the main outcome measurements. All meta-analyses were conducted using random models according to the between-study heterogeneity, estimated with I2. RESULTS: A total of 694 patients from 24 studies were included in this review. Compared with pretraction values, the average coronal Cobb angle reduction after traction was 27.66° (95% confidence interval [CI], 23.41-31.90; P < 0.001) and 47.43° (95% CI, 39.32-55.54; P < 0.001) after surgery. The sagittal Cobb angle reduction after HGT and surgery was 27.23° (95% CI, 22.83-31.62; P <0.001) and 36.77° (95% CI, 16.90-56.65; P < 0.001), respectively. There was a statistically significant improvement in the overall pulmonary function, as evident by an increase in a forced vital capacity of 8.44% (95% CI, -5.68 to -11.20; P < 0.001), and an increase in nutritional status, with a percentage correction of body mass index by 1.58 kg/m2 (95% CI, -2.14 to -1.02; P < 0.001) after HGT application. CONCLUSIONS: HGT has been shown to significantly improve coronal deformities, sagittal deformities, nutritional status, and pulmonary function in the preoperative period.