ABSTRACT
Enhanced recovery after surgery (ERAS) has been shown to shorten length of hospital stay and reduce perioperative complications in many types of surgeries. However, there has been a paucity of research examining the application of ERAS to major spinal surgery. The current study was performed to compare complications and hospital stay after laminoplasty between an ERAS group and a traditional care group.The ERAS group included 114 patients who underwent laminoplasty managed with an ERAS protocol between January 2016 and June 2017. The traditional care group included 110 patients, who received traditional perioperative care between November 2014 and December 2015. Postoperative hospital stay (POPH), physiological function, postoperative visual analogue scale (VAS) pain score, and postoperative complications were compared between the 2 groups.The mean POPH was significantly shorter in the ERAS group than traditional care group (5.75â±â2.46 vs. 7.67â±â3.45 d, Pâ<â.001). ERAS protocol significantly promoted postoperative early food-taking (8.45â±â2.94âh vs 21.64â±â2.66âh, Pâ<â.001), reduced the first time of assisted walking (30.79â±â14.45 vs. 65.24â±â25.34âh, Pâ<â.001), postoperative time of indwelling urinary catheters (24.76â±â12.34 vs. 53.61â±â18.16âh, Pâ<â.001), and wound drainage catheters (43.92â±â7.14 vs. 48.85â±â10.10âh, Pâ<â.001), as compared with the traditional care group. Pain control was better in the ERAS group than traditional care group in terms of mean VAS score (2.72â±â0.46 vs. 3.35â±â0.46, Pâ<â.001) and mean maximum VAS score (3.76â±â1.12 vs. 4.35â±â1.15, Pâ<â.001) in 3 days after surgery. The morbidity rate was 21.05% (24 of 114 patients) in the ERAS group and 20.90% (23 of 110 patients) in the control group (Pâ=â.75).The ERAS protocol is both safe and feasible for patients undergoing laminoplasty, and can decrease the length of postoperative hospitalization without increasing the risk of complications.
Subject(s)
Cervical Vertebrae/surgery , Laminoplasty/methods , Perioperative Care/methods , Aged , Catheters/statistics & numerical data , Clinical Protocols , Female , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , Pain Management/methods , Patient Education as Topic , Postoperative Complications/epidemiology , Retrospective StudiesABSTRACT
Patients with cervical ossification of the posterior longitudinal ligament (OPLL) who are K-line (-) are thought to have poor clinical outcomes after laminoplasty. The aim of this study is to compare the clinical results of patients with OPLL who were K-line (-) in the neck neutral position but K-line (+) in the neck extension position (NEP group) with patients with OPLL who were K-line (+) in the neck neutral position (NNP group).Retrospectively, 42 patients who underwent cervical laminoplasty for OPLL by our surgical group during 2012 and 2013 were reviewed and were followed for at least 2 years. The patients were divided into 2 groups according to K-line status. Standing plain radiographs of the cervical spine were obtained pre- and postoperatively. Cervical spine alignment parameters included the C2-7 Cobb angle and range of motion (ROM) measured on lateral radiographs. Clinical evaluation included pre- and postoperative JOA, NDI, and VAS scores.Ten patients were classified in the NEP group, and 32 patients were classified in the NNP group. Preoperatively, the OPLL involved segments were 4.10â±â1.66 in the NEP group and 2.53â±â1.16 in the NNP group (Pâ=â.005). The canal-occupying ratios were 58.40â±â11.11% in the NEP group and 29.08â±â11.38% in the NNP group (Pâ<â.001). The mean Cobb angle of both the groups had not changed significantly at the last follow-up. The mean cervical ROM of both the groups had decreased at the last follow-up. The mean JOA score of the NEP group improved significantly from 9.70â±â2.16 to 12.50â±â2.27 (Pâ=â.014). The mean JOA score of the NNP group improved significantly from 11.91â±â1.69 to 14.93â±â1.58 (Pâ<â.001). The mean JOA recovery rate was 32.71â±â40.45% in the NEP group and 59.00â±â33.80% in the NNP group (Pâ=â.036). The NDI scores of both groups were significantly decreased, and the VAS scores of both groups had not changed significantly at the last follow-up.Laminoplasty is a relatively effective and safe procedure for patients with K-line (-) in the neck neutral position but K-line (+) in the neck extension position. Instead of anterior surgery, we recommend laminoplasty for those patients with OPLL extending to 3 or more segments.