Driving abstinence is necessary after lumbar spinal fusion: a prospective cohort study.

PURPOSE: Studies on driving safety after lumbar spinal procedures are rare. Previous studies solely reported on a) driving reaction time (DRT) after lumbar nerve root blocks, b) DRT after discectomy and c) preliminary DRT findings after lumbar fusion. METHODS: DRT was assessed with a driving simulator as described before. Measurements were done one day before surgery (preop DRT), one week after surgery (postop1 DRT), three months (postop2 DRT) and one year postoperatively (postop3 DRT). Back pain was determined with visual analogue scales (VAS) on all four occasions. Additionally, we monitored each patient's pre-operative driving frequency and intake of analgesics. For statistical analysis we used an ANOVA for repeated measurements. RESULTS: Thirt eight of 51 patients completed all measurements (17 monosegmental fusion, 14 polysegmental fusion, seven other lumbar fusion procedures). The longitudinal changes in DRT showed overall significance (p = 0.013). Post-hoc tests determined p = 0.035 for the DRT-increase from pre- to postoperative. We did not determine a significant statistical effect for the type of surgery (p = 0.581) or patient age (p = 0.134). A tendency towards statistical significance was ascertained for the influence of patients' driving frequency on DRT (p = 0.051). CONCLUSIONS: We found increased DRT at the time of discharge after lumbar spinal fusion and therefore recommend driving abstinence for the time thereafter. Based on our findings it appears safe to return to driving at 3 months postoperative.

Damage control surgery with abdominal vacuum and delayed bowel reconstruction in patients with perforated diverticulitis Hinchey III/IV.

OBJECTIVE: With the use of abdominal vacuum therapy, we have developed a damage control concept for patients with perforated diverticulitis and generalized peritonitis. The primary aim of this concept was to enhance recovery and allow bowel reconstruction in a second-look operation. METHODS: A total of 51 patients (28 female, 55%) with a median (range) age of 69 (28-87) years, with perforated diverticulitis Hinchey III (n = 40, 78%) or Hinchey IV (n = 11, 22%) and a median (range) Mannheim peritonitis index of 26 (12-39), admitted between October 2006 and September 2011, were prospectively enrolled in the study. At initial operation, limited resection of the diseased segment, lavage, and application of abdominal vacuum-assisted closure dressing was performed. After patient resuscitation, a second look was performed in an elective setting. RESULTS: Hospital mortality rate was 9.8%; 35 (76%) of patients were discharged with reconstructed colon, and 93% of patients live without a stoma at follow-up. Risk factors for mortality were American Society of Anesthesiologist score (p = 0.01), organ failure at initial presentation (p = 0.03), cardiac comorbidity (p = 0.05), and a Hartmann procedure at second look (p = 0.00). CONCLUSION: With this abdominal vacuum-based damage control concept, an acceptable hospital mortality rate and a high rate of bowel reconstruction at second look were achieved in patients with perforated diverticulitis and generalized peritonitis.

Driving reaction time before and after primary fusion of the lumbar spine.

STUDY DESIGN: Controlled prospective study. OBJECTIVE: To determine whether driving reaction time (DRT) is influenced by primary lumbar fusion. SUMMARY OF BACKGROUND DATA: The effects of radiculopathy and nerve root blocks on DRT have been reported recently. To our knowledge, the relationship between lumbar fusion and DRT has not been previously studied although it is important for driving safety. The aim of the present study was to test the hypotheses that DRT after lumbar fusion is (1) altered after the operation, (2) influenced by pain, (3) influenced by the patient's driving skill, and (4) differs from the DRT of healthy controls. METHODS: Twenty-one consecutive patients (mean age, 53.5 years; SD 10.8) receiving primary lumbar fusion were tested for their DRT 1 day before surgery (preoperative), the day before discharge (postoperative) and 3 months after surgery (follow-up; FU). DRT was assessed using a custom-made driving simulator. The severity of back pain was determined on visual analogue scales separately for usual pain (VAS-U) and pain during testing (VAS-T). We also determined the patients' subjective driving frequency. Normative DRT data from 31 age-matched healthy controls were used for comparison. RESULTS: The preoperative DRT was 685 milliseconds (Md; IQR 246) and the postoperative DRT 728 milliseconds (Md; IQR 264), which was further reduced to 671 milliseconds (Md; IQR 202) after the FU period. Statistical significance was registered between postoperative and FU DRT (P = 0.007). Moderate to high correlations (0.537 < r < 0.680) were found between the VAS rating of back pain and DRT. Control subjects had a DRT of 487 milliseconds (Md; IQR 116), which differed significantly from the DRT of patients at all 3 time points of testing (P < 0.001). CONCLUSION: It appears safe to continue driving after discharge from the hospital following lumbar fusion. DRT improved significantly during FU, indicating a positive effect of the intervention on driving skills. DRT correlates with the severity of back pain.