Acute disc herniation following surgical decompression of lumbar spinal stenosis: a retrospective comparison of mini-open and minimally invasive techniques.

BACKGROUND: Disc herniation following decompression of lumbar spinal stenosis is a less familiar surgical complication. Previous studies suggested that open lumbar decompression techniques, associated with relative segmental instability especially in the presence of degenerated disc in older patients, are more likely to result in disc herniation compared to minimally invasive techniques. The current study compares the incidence of acute disc herniation following mini-open and minimally invasive decompression of lumbar spinal stenosis. METHODS: This was a retrospective study reviewing 563 patients who underwent spinal decompression for symptomatic lumbar stenosis by mini-open bilateral partial laminectomy technique or minimally invasive laminotomy utilizing a tubular system. Demographic and clinical data were collected and compared between the groups. RESULTS: Postoperative disc herniation rate was significantly lower in the minimally invasive group with 2 of 237 cases (0.8%) versus 19 of 326 cases (5.8%) in the mini-open group (p = 0.002). This finding was more noticeable following multi-level procedures with no case of postdecompression disc herniation in the minimally invasive group compared to 8 of 39 cases (20.5%) in the mini-open group (p = 0.003). CONCLUSION: The incidence of postoperative disc herniation following spinal decompression for symptomatic lumbar stenosis was 5.8% following mini-open bilateral partial laminectomy compared to only 0.8% after minimally invasive laminotomy (p = 0.002). These findings highlight the more extensive nature of mini-open surgery associated with relative segmental instability that poses a greater risk for postoperative disc herniation.

Proximal Femur Fractures in the Elderly-A Novel Modality to Predict Mortality: The Neutrophil-to-Lymphocyte Ratio.

Background: The assessment and identification of elderly patients with proximal femur fractures (PFF) who are at high risk of postoperative mortality may influence the treatment decision-making process. The purpose of this study was to determine whether the neutrophil-to-lymphocyte ratio (NLR) could be used to predict postoperative mortality in the elderly population. Methods: A four-year retrospective cohort study of electronic medical records was conducted at a single tertiary care hospital between 2015 and 2018. Data from 1551 patients aged 65 years and older who underwent surgical treatment for PFF were collected and analyzed. The data included complete blood counts at admission, demographic information, underlying illnesses, type of surgery, and postoperative mortality and complications during the first year of follow-up. A survival analysis model was utilized. Results: The mean age was 90.76 ± 1.88 years, 1066 (68.7%) women. Forty-four (2.8%) patients experienced postoperative infection. A higher NLR0 was independently associated with higher all-cause mortality rates in patients who underwent surgical treatment for PFF (p = 0.041). Moreover, the mean NLR0 value was higher when the death occurred earlier after surgery (p < 0.001). Conclusions: When combined with other clinical and laboratory findings, NLR0 levels may serve as a potentially valuable, inexpensive, and reliable prognostic biomarker to improve risk stratification for elderly patients who are candidates for PFF surgery. Furthermore, with additional research, we could potentially develop a treatment algorithm to identify patients at high risk of postoperative mortality.

Red cell distribution width-A mortality predictor in older adults with proximal femoral fracture.

BACKGROUND: Identifying elderly patients with proximal femoral fractures (PFF) who are at risk of postoperative mortality may influence the treatment decision-making process. The purpose of this study was to examine whether red blood cell distribution width (RDW) can serve as a predictor of postoperative mortality in these patients. METHODS: A retrospective cohort study of electronic medical records at a single tertiary care hospital over a 3-year period between 2015 and 2018. We reviewed the records of 1574 patients aged > 65 years who underwent surgical treatment for PFF and who's preoperative RDW levels were available. Data collected consisted of patient demographics, underlying illnesses at the time of admission, type of procedure performed as well as postoperative mortality and complications over the course of a 1-year follow-up period. The cohort was then divided into two groups based on their RDW levels at the time of admission: low (<14.5%) and high (>14.5%). RESULTS: The mean age was 90.77±1.87 years; 68.7% were women. Majority of patients (69.1%) underwent closed reduction internal fixation; 414 (26.4%) underwent hemiarthroplasty, and 71 (4.5%) had total hip arthroplasty. At admission, 576 patients (36.6%) had high RDW levels and 998 (63.4%) had low RDW levels. There were no statistically significant differences between the groups with regard to age, gender, type of surgery, or duration. Patients with high RDW had more co-morbidities (p<0.001) and more abnormal laboratory test results when compared to patients with low RDW. Overall mortality rate within 1-year post-surgery was 17.5% (276 patients). All-cause mortality was greater for patients with high baseline RDW, at 3 months (p = 0.001), 6 months (p<0.0001), and 1-year post-surgery (p<0.0001). Forty-four (2.8%) patients had surgical site infection (SSI) without any significant association to baseline RDW levels. CONCLUSIONS: Preoperative RDW levels, when combined with clinical and laboratory findings, may help to improve the risk stratification of older patients who are candidates for PFF. With further research, a treatment algorithm could be developed to potentially identify patients at high risk of preoperative mortality, allowing for more conservative management.