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1.
World Neurosurg ; 133: e789-e795, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31605849

RESUMO

BACKGROUND: Obesity has been shown to be associated with higher rates of complications after lumbar spine surgery. However, the evidence regarding the impact of body mass index (BMI) on outcomes following posterior cervical fusions (PCFs) remains limited. METHODS: The 2012-2017 American College of Surgeons National Surgical Quality Improvement Program database was queried using Current Procedural Terminology code 22600 to identify PCFs. Patients undergoing anterior cervical spine surgery and surgery for deformity, malignancy, or infection were excluded. Patients with missing data with regard to weight, height, and 30-day outcomes were excluded. BMI (kg/m2) was categorized into 4 groups: 1) <25.0, 2) 25.0-29.9, 3) 30.0-34.9, and 4) ≥35.0. Multivariate regression analyses were constructed to assess independent impact of BMI on 30-day outcomes while controlling for baseline clinical characteristics. RESULTS: Of 2786 patients with PCFs, 710 (25.5%) had BMI <25.0, 919 (33.0%) had BMI between 25.0 and 29.9, 655 (23.5%) had BMI between 30.0 and 34.9, and 502 (18.0%) had BMI ≥35.0. Following adjustment for baseline demographics and clinical characteristics, increased BMI was not associated with a higher risk of any adverse events, severe adverse events, minor adverse events, bleeding requiring transfusion, or readmissions within 30 days of surgery. BMI ≥35.0 versus BMI <25.0 was associated only with a higher risk of deep surgical site infections (odds ratio 4.61; P = 0.009). CONCLUSIONS: With the exception of a higher rate of deep surgical site infections seen in obese patients, increased BMI does not seem to have a major impact on 30-day outcomes following PCFs.


Assuntos
Índice de Massa Corporal , Vértebras Cervicais/cirurgia , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Estados Unidos , Adulto Jovem
2.
World Neurosurg ; 133: e592-e599, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31568900

RESUMO

BACKGROUND: More than 120,000 anterior cervical discectomy and fusions (ACDFs) are performed annually. Pseudarthrosis is a potential delayed adverse event that affects up to 33% of patients. The degree to which this adverse event affects both patient quality-of-life (QOL) outcomes and health care costs is poorly understood. METHODS: Patients who underwent revision surgery for pseudarthrosis between 2007 and 2012 were identified and matched to controls not experiencing pseudarthrosis in a 1:2 fashion (case/control). Cases and controls were compared regarding total health care costs incurred in the year after the index ACDF and QOL outcomes on the following metrics: EuroQol Five-Dimensions Questionnaire, Patient Health Questionnaire-9, and Pain Disability Questionnaire. RESULTS: Of 738 patients who underwent ACDF, 11 underwent surgery for pseudarthrosis. No differences were noted between cases and controls regarding any of the matched variables. Patients in the pseudarthrosis cohort had poorer postoperative scores on the EuroQol Five-Dimensions Questionnaire mobility, usual activities, pain/discomfort, and quality-adjusted life-year dimensions. In addition, 64% of patients with pseudarthrosis had worsened quality-adjusted life-year scores compared with only 9% of controls (P < 0.01). Patients with pseudarthrosis also had poorer mental health (P < 0.01) and pain disability outcomes (P < 0.01) than did controls. Pseudarthrosis was associated with significant increases in direct costs, direct postoperative costs, and total costs (all P < 0.01). CONCLUSIONS: This is the first study to characterize the effect of surgical revision for pseudarthrosis on both QOL outcomes and care costs after ACDF. Patients requiring revision experienced significantly poorer QOL outcomes and higher care costs relative to controls.


Assuntos
Discotomia/efeitos adversos , Pseudoartrose/cirurgia , Qualidade de Vida , Fusão Vertebral/efeitos adversos , Adulto , Idoso , Feminino , Custos de Cuidados de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Pseudoartrose/economia , Pseudoartrose/etiologia , Reoperação/economia
3.
World Neurosurg ; 133: 90-96, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31568901

RESUMO

BACKGROUND: Although adjacent segment disease (ASD) following anterior cervical fusion has been well described in the literature, there is relative paucity of data on this pathology after posterior cervical fusion. To our knowledge, there have been no reported cases of proximal ASD following posterior fusion to C2. CASE DESCRIPTION: We present 2 cases of proximal ASD presenting as retroodontoid pseudotumors following posterior fusion to C2, both in middle-aged females without history of rheumatologic disease. The first occurred in a patient with Klippel-Feil deformity 13 years after C2-6 posterior cervical fusion, the second in a patient 3 and a half years following revisional circumferential C2-T2 fusion. Both were successfully treated with proximal extension of laminectomy and fusion to the occiput, supplemented in the first patient by transdural decompression of retroodontoid mass. CONCLUSIONS: Proximal ASD can manifest as retroodontoid pseudotumor at variable time intervals following posterior fusion to C2. Clinicians must account for this possibility in their decision making.


Assuntos
Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/efeitos adversos , Cervicalgia/diagnóstico por imagem , Doenças da Coluna Vertebral/etiologia , Fusão Vertebral/efeitos adversos , Vértebras Cervicais/diagnóstico por imagem , Feminino , Humanos , Síndrome de Klippel-Feil/diagnóstico por imagem , Síndrome de Klippel-Feil/cirurgia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Cervicalgia/cirurgia , Processo Odontoide/diagnóstico por imagem , Processo Odontoide/cirurgia , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/cirurgia , Resultado do Tratamento
4.
World Neurosurg ; 133: e690-e694, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31568911

RESUMO

OBJECTIVE: Adjacent segment disease (ASD) is a long-term complication of lumbar spinal fusion. This study aims to evaluate demographic and operative factors that influence development of ASD after fusion for lumbar degenerative pathologies. METHODS: A retrospective cohort study was performed on patients undergoing instrumented lumbar fusion for degenerative disorders (spondylolisthesis, stenosis, or intervertebral disk degeneration) with a minimum follow-up of 6 months. RESULTS: Our inclusion criteria were met by 568 patients; 29.4% of patients had developed surgical ASD. Median follow-up was 2.8 years. Multivariate logistic regression analysis showed that decompression of segments outside the fusion construct had higher ASD (odds ratio = 2.6; P < 0.001), and those undergoing fusion for spondylolisthesis had lower ASD (odds ratio = 0.47; P = 0.003). CONCLUSIONS: Results of our study show that the most important surgical factor contributing to ASD is decompression beyond fused levels. Hence caution should be exercised when decompressing spinal segments outside the fusion construct. Conversely, spondylolisthesis patients had the lowest ASD rates in our cohort.


Assuntos
Descompressão Cirúrgica/efeitos adversos , Complicações Pós-Operatórias/etiologia , Fusão Vertebral/efeitos adversos , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
5.
World Neurosurg ; 133: e619-e626, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31568914

RESUMO

OBJECTIVE: Although postoperative urinary retention (POUR) is common after spine surgery, the association of this adverse event with other morbidities and patient-reported outcomes is not fully understood. We sought to examine the sequelae of POUR after lumbar spine surgery. METHODS: The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a large prospective multicenter registry. MSSIC was queried with multivariate analysis for factors that are associated with POUR, the association of POUR with 90-day adverse events, and the effect of POUR on 2-year patient-reported outcomes and satisfaction. RESULTS: Multivariate analysis identified hardware revision (odds ratio [OR], 0.61), 1 operative level (OR, 0.74), and ambulation on postoperative day zero (OR, 0.65) to be protective for POUR. Factors associated with POUR included age (OR, 1.19), male gender (OR, 1.58), body mass index <25 (OR, 1.22), diabetes (OR, 1.28), coronary artery disease (OR, 1.20), fusion surgery (OR, 1.27), and longer surgery (OR, 1.11). Patients who had POUR were more likely to be readmitted, develop a urinary tract infection, and develop an infection (P < 0.001). POUR was associated with decreased likelihood of achieving Oswestry Disability Index minimal clinically important difference at 90 days (P < 0.001), but not at 1 year after surgery. POUR was associated with dissatisfaction with surgery at 90 days (P < 0.001), 1 year (P = 0.004), and 2 years after surgery (P = 0.011). CONCLUSIONS: POUR is common after lumbar spine surgery, and the demographic, diagnostic, and surgical factors that are associated with POUR are identified. POUR is associated with several adverse events, and patients who have POUR were less likely to be satisfied with surgery up to 2 years after surgery.


Assuntos
Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Fusão Vertebral/efeitos adversos , Retenção Urinária/epidemiologia , Retenção Urinária/etiologia , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Vértebras Lombares , Masculino , Michigan , Pessoa de Meia-Idade , Sistema de Registros , Fatores de Risco
6.
World Neurosurg ; 133: e68-e75, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31465851

RESUMO

BACKGROUND: Horner syndrome is an infrequently seen complication of anterior cervical discectomy and fusion (ACDF). Multicenter studies have reported a very low incidence, less than 0.1%. OBJECTIVE: To identify the incidence in, characteristics of, and postoperative course in patients in whom postoperative Horner syndrome developed after ACDF. METHODS: We performed a retrospective review of all patients who experienced Horner syndrome after ACDF for cervical degenerative disease at a single tertiary care institution between 2017 and 2018. A systematic review was then performed to identify studies investigating prevalence, diagnosis, and treatment of postoperative Horner syndrome after ACDF. RESULTS: Of 1116 patients at our institution who underwent ACDF, the incidence of Horner syndrome was 0.45%. C4/5 and C5/6 were the 2 most common surgical levels. The complication was noted to occur immediately after surgery, and at least partial improvement was identified in all patients an average 3.5 months after surgery (range, 10 days to 6 months). These findings were consistent with our systematic review of 21 studies that showed an incidence of 0.6% (range, 0.02% to 4.0%), the most common surgical level C5/6 (64%), and 82% of patients experiencing at least partial resolution of symptoms within 1 year (60.7% complete, 21.4% partial resolution). CONCLUSION: Horner syndrome occurs in 0.6% of patients undergoing ACDF. Careful postoperative examination should reveal this complication, which may be underdiagnosed or underreported in larger multicenter case series. The majority of patients experience complete resolution of symptoms within 6 months to 1 year and can be treated conservatively and expectantly.


Assuntos
Vértebras Cervicais/cirurgia , Discotomia/efeitos adversos , Síndrome de Horner/etiologia , Degeneração do Disco Intervertebral/cirurgia , Complicações Intraoperatórias/etiologia , Fusão Vertebral/efeitos adversos , Idoso , Feminino , Síndrome de Horner/epidemiologia , Humanos , Incidência , Complicações Intraoperatórias/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sistema Nervoso Simpático/lesões , Centros de Atenção Terciária/estatística & dados numéricos , Resultado do Tratamento
7.
World Neurosurg ; 133: 155-158, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31493605

RESUMO

BACKGROUND: Pseudohypoxic brain swelling (PHBS), also known as postoperative intracranial hypotension-associated venous congestion, is a rare complication after neurosurgery characterized by rapid and often severe postoperative deterioration in consciousness and distinct imaging findings on brain magnetic resonance imaging. Imaging findings associated with PHBS include computed tomography and magnetic resonance imaging findings that resemble hypoxic changes and intracranial hypotensive changes in basal ganglia and thalamus, telencephalic, and infratentorial regions without notable changes in intracranial vasculature. CASE DESCRIPTION: This report describes the case of an L4-5 microdiskectomy with posterior decompression and fusion complicated by clinical and radiographic findings resembling PHBS without a known intraoperative durotomy. CONCLUSIONS: Spine surgeons should be alerted to the possibility that PHBS may occur in patients even after an operation without known durotomy or cerebrospinal fluid leakage and with spontaneous clinical resolution unrelated to suction drainage changes or epidural blood patches.


Assuntos
Edema Encefálico/etiologia , Descompressão Cirúrgica/efeitos adversos , Hipotensão Intracraniana/etiologia , Fusão Vertebral/efeitos adversos , Espondilolistese/cirurgia , Idoso , Edema Encefálico/diagnóstico por imagem , Feminino , Humanos , Hipotensão Intracraniana/diagnóstico por imagem , Imagem por Ressonância Magnética , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
8.
J Bone Miner Metab ; 38(1): 54-62, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31292724

RESUMO

The impact of autologous iliac crest bone graft versus BMP-2 to improve fusion rates for posterolateral fusion (PLF) of the lumbar spine remains unanswered. Single-institution-centered data dominate the literature, providing results that may be contradictory or inconclusive. The aim of this paper is to analyze data pooled from multiple well-controlled studies that examined both ICBG and BMP-2 for use in PLF. This meta-analysis also provides details of success in different subsets of patients with variable risk factors for delayed and non-unions. Six high-quality randomized clinical trials were selected. Efficacy, morbidity, quality of life, and safety were compared between the BMP-2 group and the ICBG group. A total of 908 patients were included in the study. At 24 months, 94% of patients achieved fusion in the BMP-2 group and 83% in the ICBG group. At 6 and 12 months, the fusion was also greater in the BMP-2 group (86% vs. 60% and 88% vs. 80%, respectively). Surgical time, intraoperative blood loss, and hospitalization days also showed significant differences in favor of the experimental group (p < 0.01). There were no differences between two groups in the Oswestry Disability Index, 36-Item Short Form Health Survey and Back Pain Score, whereas a greater number of additional surgical procedures were performed in the ICBG group (p = 0.001). In conclusion, the use of BMP-2 in PLF reduced the surgical morbidity and had more beneficial effects on the fusion rate. The quality of life based on clinical scores was the same in both groups.


Assuntos
Proteína Morfogenética Óssea 2/farmacologia , Transplante Ósseo , Ílio/efeitos dos fármacos , Ílio/transplante , Fusão Vertebral , Perda Sanguínea Cirúrgica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Viés de Publicação , Qualidade de Vida , Fatores de Risco , Fusão Vertebral/efeitos adversos , Resultado do Tratamento
9.
Medicine (Baltimore) ; 98(44): e17678, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689785

RESUMO

RATIONALE: Emergence is not simply the reverse process of induction. Many dynamic situations could occur in this period by distinct neurobiology as recent studies indicated. Herein we report a rare case of failure of emergence from general anesthesia after cervical spine surgery. PATIENT CONCERNS: Despite the perioperative vital signs and laboratory results were unremarkable, the patient could not recover his mental status and spontaneous breathing during emergence. 20 minutes after cessation of anesthetic drug administration, his blood pressure suddenly began to decrease requiring transfusion and vasopressor. DIAGNOSIS: After thorough inspection of intraoperative alterations of hemodynamic and metabolic values, which showed no significant changes except possible signs of delayed volume loss, cerebrovascular bleeding was most suspected as the cause of the event. Computed tomography was performed and infratentorial hemorrhage after cervical spine surgery was checked. INTERVENTIONS: Decompression operation was required for removing the hemorrhage. However, the patient's family refused further management considering his limited life expectancy. OUTCOMES: The patient expired on postoperative day 5. LESSONS: Failure to awaken is a relatively rare event. It could be confused with simple delayed emergence, which is often caused by residual drug effect. However, when it occurs, the result could be devastating. Therefore, appropriate recognition and prompt response are required to decrease the mortality and morbidity of the patient.


Assuntos
Anestesia Geral/efeitos adversos , Hemorragias Intracranianas/induzido quimicamente , Complicações Pós-Operatórias/induzido quimicamente , Descompressão Cirúrgica/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Fusão Vertebral/efeitos adversos
10.
Medicine (Baltimore) ; 98(44): e17740, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689822

RESUMO

To identify independent factors associated with prolonged hospital length of stay (LOS) in elderly patients undergoing first-time elective open posterior lumbar fusion surgery.We retrospectively analyzed the data of 303 elderly patients (age range: 60-86 years) who underwent first-time elective open lumbar posterior fusion surgery at our center from December 2012 to December 2017. Preoperative and perioperative variables were extracted and analyzed for all patients, and multivariate stepwise regression analysis was used to determine the variables affecting the LOS and important predictors of LOS prolongation (P < .001).The mean age of the patients was 67.0 ±â€Š5.5 years, and the mean LOS was 18.5 ±â€Š11.8 days, ranging from 7 to 103 days. Of the total, 166 patients (54.8%) were men and 83 patients (27.4%) had extended LOS. Multiple linear regression analysis determined that age (P < .001), preoperative waiting time ≥7 days (P < .001), pulmonary comorbidities (P = .010), and diabetes (P = .010) were preoperative factors associated with LOS prolongation. Major complications (P = .002), infectious complications (P = .001), multiple surgeries (P < .001), and surgical bleeding (P = .018) were perioperative factors associated with LOS prolongation. Age (P < .001), preoperative waiting time ≥7 days (P < .001), infectious complications (P < .001), and multiple surgeries (P < .001) were important predictors of LOS prolongation.Extended LOS after first-time elective open posterior lumbar fusion surgery in elderly patients is associated with factors including age, preoperative waiting time, infectious complications, and multiple surgeries. Surgeons should recognize and note these relevant factors while taking appropriate precautions to optimize the modifiable factors, thereby reducing the LOS as well as hospitalization costs.


Assuntos
Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Fusão Vertebral/estatística & dados numéricos , Fatores de Tempo , Tempo para o Tratamento/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Complicações Pós-Operatórias/etiologia , Período Pré-Operatório , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Listas de Espera
11.
Medicine (Baltimore) ; 98(46): e17891, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725634

RESUMO

An observational study.To evaluate the safeties of placing three different alternative C2 screws using the freehand technique under high riding vertebral artery (HRVA) and to analyze the C2 morphometry in patients with HRVA.A retrospective analysis of radiologic data was performed on patients that underwent C2 instrumentation from September 2004 to December 2017. Two hundred fifty-one patients were included, and 90 of these patients (35.9%) had a unilateral or bilateral HRVA. We placed three alternative C2 screws including superior pars, inferior pars, and translaminar screws. Computed tomography was used to assess cortical breeches of screw placement and obtain morphometric measurements of C2 pars and lamina, that is, superior pars height/length, inferior pars length, and laminar thickness/length. We used the modification of the all India Institute of Medical Sciences outcome to define cortical breach.In total, 117 alternative C2 screws were inserted in 90 patients; 7 superior pars screws (6%), 69 inferior pars screws (59.0%), and 41 translaminar (35%) screws. Although cortical breaches occurred during 31 screw placements (26.5%), these were unacceptable in only two cases (1.7%). No symptomatic neurovascular complication was observed after screw placement in any case. Mean height of C2 superior pars was 3.8 ±â€Š1.8 mm and mean thickness of C2 lamina was 5.2 ±â€Š1.1 mm. Mean lengths of superior pars, inferior pars, and lamina were 17.8 ±â€Š3.0 mm, 13.6 ±â€Š2.2 mm, and 26.7 ±â€Š3.3 mm, respectively. Superior pars height and lamina thickness < 3.5 mm that was a minimal diameter of cervical screw were 49.6% and 6.8%, alternative C2 screw was not available in these cases.Placements of alternative C2 screws using the freehand technique were achieved accurately and safely in patients with HRVA. However, preoperative morphometric evaluation is essential to determine the best option for C2 instrumentation and C2 screw length to avoid neurovascular complications.


Assuntos
Vértebras Cervicais/cirurgia , Parafusos Pediculares/classificação , Fusão Vertebral/métodos , Artéria Vertebral/anatomia & histologia , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais/anatomia & histologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos
12.
Spine (Phila Pa 1976) ; 44(22): 1558-1563, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31689250

RESUMO

STUDY DESIGN: Retrospective. OBJECTIVE: To examine the relationship between American Society of Anesthesiologists (ASA) score and inpatient pain and narcotics consumption following anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA: Higher ASA scores have been previously linked to increased postoperative complication rates, healthcare costs, length of stay, and hospital readmissions. However, to our knowledge, there have not been previous investigations into the association between ASA scores and postoperative inpatient pain and narcotics utilization following ACDF. METHODS: Patients who underwent a single-level, primary ACDF were retrospectively reviewed and stratified into two cohorts based on ASA score less than or equal to 2 or ASA score more than 2. ASA score was tested for association with demographic variables and perioperative characteristics using student's t test, chi-squared analysis, and Fisher exact test. Inpatient pain scores and narcotics consumption on each postoperative day were then compared between cohorts using bivariate linear regression. RESULTS: Two hundred eleven patients who underwent ACDF were included: 184 had an ASA score less than or equal to 2 and 27 had an ASA score more than 2. Higher ASA score was associated with older age, higher comorbidity burden as measured by the modified Charlson Comorbidity Index (CCI), and lower prevalence of obesity. Higher ASA scores were associated with longer duration of hospital stay, while other perioperative characteristics were similar between ASA score cohorts. There were no differences in inpatient Visual Analog Scale (VAS) pain scores, or hourly, daily, and cumulative inpatient narcotic consumption between cohorts on any postoperative day. CONCLUSION: This retrospective investigation demonstrated that a higher ASA score is associated with increased operative time following ACDF. However, ASA score was determined not to be an independent risk factor that can predict postoperative pain or narcotics consumption among patients who undergo ACDF. Therefore, postoperative pain in the inpatient setting can be managed with similar modalities regardless of ASA score for patients undergoing ACDF. LEVEL OF EVIDENCE: 3.


Assuntos
Vértebras Cervicais/cirurgia , Discotomia/efeitos adversos , Entorpecentes , Dor Pós-Operatória , Fusão Vertebral/efeitos adversos , Humanos , Entorpecentes/administração & dosagem , Entorpecentes/uso terapêutico , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia , Readmissão do Paciente/estatística & dados numéricos , Estudos Retrospectivos
13.
Spine (Phila Pa 1976) ; 44(22): 1564-1570, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31689252

RESUMO

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: Evaluate the trends in management and inpatient outcomes in patients with syndromic scoliosis undergoing spinal deformity correction. SUMMARY OF BACKGROUND DATA: Syndromic scoliosis (SS) refers to scoliosis that is most commonly associated with systemic disease including Ehler Danhlos syndrome (EDS), Marfan syndrome (MF), Down syndrome (DS), Achondroplasia (AP), and Prader-Willi syndrome (PWS). Limited data exist evaluating hospital outcomes in patients with SS undergoing spinal deformity correction. METHODS: The Kids' Inpatient Database (KIDS) was queried from 2001 to 2012 to identify all pediatric patients with scoliosis undergoing spinal fusion. These patients were then sub-divided into two cohorts: (1) patients with idiopathic scoliosis (IS) and (2) patients with syndromic scoliosis. Trends in surgical management, and postoperative morbidity and mortality were assessed. Length of stay and total hospital charges were additionally analyzed. A sub-analysis to characterize outcomes in each syndrome was also performed. RESULTS: An estimated 1071 patients with SS were identified and compared with 24,989 pediatric patients with IS. MF (36.8%), Down syndrome (16.0%), and PWS (14.9%) were the most common diagnoses among patients with SS. Between 2001 and 2012, there was a significant decline in the number of anterior procedures performed in both cohorts. Conversely, the number of posterior based procedures increased. SS was associated with increased major complications (2.7% compared with 1.0% in IS; P < 0.001) and minor complication rates (41.0% compared with 28.5% in IS; P < 0.001). Patients with AP incurred the highest rate of major complications (10.7%), minor complications (60.8%), and intraoperative durotomies (6.1%). Total hospital charges increased significantly over the 12-year span. CONCLUSION: Trends in management of syndromic scoliosis have paralleled that of idiopathic scoliosis. Syndromic scoliosis is associated with increased risks with surgical deformity correction. Further prospective studies are warranted to evaluate the reasons for these differences. LEVEL OF EVIDENCE: 3.


Assuntos
Escoliose , Fusão Vertebral , Hospitalização , Humanos , Estudos Retrospectivos , Escoliose/epidemiologia , Escoliose/cirurgia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/estatística & dados numéricos , Resultado do Tratamento
14.
Spine (Phila Pa 1976) ; 44(21): E1256-E1263, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31634301

RESUMO

STUDY DESIGN: Retrospective review of a multicenter, prospective database. OBJECTIVE: Our aim was to compare complication rates and maintenance of radiographic correction at 2 years after posterior spinal fusion (PSF) with or without cross-links in patients with cerebral palsy (CP)-related scoliosis. SUMMARY OF BACKGROUND DATA: Cross-links are frequently used in PSF to correct scoliosis in patients with CP because they are thought to increase the stiffness and torsional rigidity of the construct. METHODS: We reviewed the records of patients with CP who underwent primary PSF with or without cross-links between August 2008 and April 2015. Inclusion criteria were minimum follow-up of 2 years, availability of complications data (implant failure, surgical site infection, revision), and pre- and postoperative measurements of the major curve (measured using the Cobb method). The 256 patients included in this analysis had a mean age of 14.1 ±â€Š2.7 years. Ninety-four patients had cross-links (57% using one cross-link; 43% using two cross-links) and 162 patients did not have cross-links. P < 0.05 was considered statistically significant. RESULTS: The two groups did not differ significantly with regard to sex, age at surgery, preoperative menarche status, Gross Motor Function Classification System level, major curve magnitude, pelvic obliquity, kyphosis, and lordosis angles. There were no significant differences between groups in the correction achieved or the maintenance of correction at 2 years for the major curve, pelvic obliquity, kyphosis, or lordosis (all P > 0.05). Complication rates were similar between the cross-link group (16%, N = 15) and the non-cross-link group (14%, N = 22). CONCLUSION: At 2 years after PSF to treat CP-related scoliosis, patients had no significant differences in the degree of correction achieved, the maintenance of correction, or the rate of complications between those whose fusion constructs used cross-links and those whose constructs did not. LEVEL OF EVIDENCE: 3.


Assuntos
Paralisia Cerebral/complicações , Escoliose/etiologia , Escoliose/cirurgia , Fusão Vertebral/métodos , Adolescente , Criança , Feminino , Humanos , Cifose/patologia , Lordose/patologia , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Escoliose/patologia , Fusão Vertebral/efeitos adversos , Vértebras Torácicas/cirurgia , Resultado do Tratamento
15.
J Pediatr Orthop ; 39(10): 500-504, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31599858

RESUMO

BACKGROUND: Opioids are commonly used after posterior spinal instrumented fusion (PSIF) for adolescent idiopathic scoliosis (AIS). Prescription opioids use can potentially lead to misuse, abuse, dependence, and overdose death. Prolonged opioid use has not been extensively studied in the postoperative AIS population. The purpose of this study is to identify risk factors associated with prolonged opioid use after PSIF for AIS. METHODS: A large insurance database was queried for AIS patients undergoing PSIF. Patients with prolonged postoperative opioid use were defined as those receiving new prescriptions for an opioid medication >6 weeks following the date of surgery, up to 8 months postoperatively. Preoperative and intraoperative risk factors for prolonged opioid use were then examined, including the number of spinal levels fused, preoperative opioid prescriptions, demographic variables, pertinent comorbidities (anxiety, depression, attention deficit hyperactivity disorder, and autism) and other preoperative prescriptions (anxiolytics, antidepressants, nonopioid analgesics, neuropathic medications, and attention deficit hyperactivity disorder medications). Each variable's independent risk for prolonged postoperative opioid use was examined utilizing a multivariable binomial regression analysis. P<0.05 was considered statistically significant. RESULTS: A total of 511 patients were included in the study. Of this 50 patients (9.78%) were found to have prolonged opioid use following scoliosis surgery. Preoperative opioid use (odds ratio, 2.93; P<0.001) was the most significant predictor of prolonged postoperative opioid use. In addition, female sex, obesity, a preoperative diagnosis of anxiety and a preoperative prescription for a muscle relaxer were also significant positive risk factors for prolonged postoperative opioid use. Several factors were found to be protective against prolonged postoperative opioid use. Fewer total fusion levels, compared with ≥13 levels, had a significantly lower risk of prolonged opioid use. Preoperative anxiolytic and antidepressant use were also both negative predictors of prolonged opioid use. CONCLUSIONS: Efforts at addressing preoperative opioid use, anxiety, obesity, and providing multimodal pain management strategies should be considered to reduce additional postoperative opioid prescriptions after PSIF for AIS. LEVEL OF EVIDENCE: Level III-retrospective comparative study.


Assuntos
Analgésicos Opioides/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Escoliose/epidemiologia , Escoliose/cirurgia , Fusão Vertebral/efeitos adversos , Demandas Administrativas em Assistência à Saúde , Adolescente , Ansiolíticos/uso terapêutico , Antidepressivos/uso terapêutico , Ansiedade/tratamento farmacológico , Ansiedade/epidemiologia , Criança , Comorbidade , Feminino , Humanos , Masculino , Relaxantes Musculares Centrais/uso terapêutico , Obesidade/epidemiologia , Dor Pós-Operatória/etiologia , Período Pós-Operatório , Período Pré-Operatório , Fatores de Proteção , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Fatores de Tempo , Adulto Jovem
16.
Spine (Phila Pa 1976) ; 44(20): 1412-1417, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31589199

RESUMO

STUDY DESIGN: A retrospective clinical study. OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of fluoroscopy-guided atlantoaxial pedicle screw fixation in patients younger than 12 years. SUMMARY OF BACKGROUND DATA: C1-C2 pedicle screw fixation is a widely accepted treatment method for atlantoaxial dislocation (AAD). However, data regarding its use for atlantoaxial fusion (AAF) in children are limited. METHODS: Thirty-six consecutive patients younger than 12 years underwent C1-C2 pedicle screw fixation for AAD between 2007 and 2017. Anatomical parameters of the C1 pedicle were measured on preoperative computed tomography (CT). Accuracy of pedicle screw fixation was assessed on postoperative CT using the following definitions: Type I, screw threads completely within the bone; Type II, less than half the diameter of the screw violating the surrounding cortex; and Type III, clear violation of the transverse foramen or spinal canal. Demographic, surgical, radiation dose, and clinical data were recorded. RESULTS: Patients underwent 144 screw fixations (67 C1 pedicle screws, 68 C2 pedicle screws, 5 C1 lateral mass screws, and 4 C-2 laminar screws) for a variety of pediatric AADs, with 36.5 ±â€Š8.5 months of follow-up. Among the 135 pedicle screws, 96.3% were deemed "safe" (Type I or II) and 80.7% (109/135) of the screws were rated as being ideal (Type I); five screws (3.7%) were identified as unacceptable (Type III). Average estimated blood loss (EBL) was 92 mL, and the average total radiation exposure during the operation was 6.2 mGy (in the final 26 cases). There were no neurovascular injuries. All patients showed radiographic stability and symptom resolution. CONCLUSION: C1-C2 pedicle screw fixation under fluoroscopy is safe and effective for the treatment of AAD in children younger than 12 years. However, it may be technically challenging owing to the special anatomical features of children and should be performed by experienced surgeons. LEVEL OF EVIDENCE: 3.


Assuntos
Articulação Atlantoaxial , Luxações Articulares , Parafusos Pediculares , Fusão Vertebral , Cirurgia Assistida por Computador , Articulação Atlantoaxial/diagnóstico por imagem , Articulação Atlantoaxial/cirurgia , Criança , Fluoroscopia , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Fusão Vertebral/estatística & dados numéricos , Cirurgia Assistida por Computador/efeitos adversos , Cirurgia Assistida por Computador/estatística & dados numéricos
17.
Spine (Phila Pa 1976) ; 44(20): E1181-E1187, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31589201

RESUMO

STUDY DESIGN: Single institution retrospective clinical review. OBJECTIVE: To investigate the relationship between levels fused and clinical outcomes in patients undergoing open and minimally invasive surgical (MIS) lumbar fusion. SUMMARY OF BACKGROUND DATA: Minimally invasive spinal fusion aims to reduce the morbidity associated with conventional open surgery. As multilevel arthrodesis procedures are increasingly performed using MIS techniques, it is necessary to weigh the risks and benefits of multilevel MIS lumbar fusion as a function of fusion length. METHODS: Patients undergoing <4 level lumbar interbody fusion were stratified by surgical technique (MIS or open), and grouped by fusion length: 1-level, 2-levels, 3+ levels. Demographics, Charlson Comorbidity Index (CCI), surgical factors, and perioperative complication rates were compared between technique groups at different fusion lengths using means comparison tests. RESULTS: Included: 361 patients undergoing lumbar interbody fusion (88% transforaminal, 14% lateral; 41% MIS). Breakdown by fusion length: 63% 1-level, 22% 2-level, 15% 3+ level. Op-time did not differ between groups at 1-level (MIS: 233 min vs. Open: 227, P = 0.554), though MIS at 2-levels (332 min vs. 281) and 3+ levels (373 min vs. 323) were longer (P = 0.033 and P = 0.231, respectively). While complication rates were lower for MIS at 1-level (15% vs. 30%, P = 0.006) and 2-levels (13% vs. 27%, P = 0.147), at 3+ levels, complication rates were comparable (38% vs. 35%, P = 0.870). 3+ level MIS fusions had higher rates of ileus (13% vs. 0%, P = 0.008) and a trend of increased adverse pulmonary events (25% vs. 7%, P = 0.110). MIS was associated with less EBL at all lengths (all P < 0.01) and lower rates of anemia at 1-level (5% vs. 18%, P < 0.001) and 2-levels (7% vs. 16%, P = 0.193). At 3+ levels, however, anemia rates were similar between groups (13% vs. 15%, P = 0.877). CONCLUSION: MIS lumbar interbody fusions provided diminishing clinical returns for multilevel procedures. While MIS patients had lower rates of perioperative complications for 1- and 2-level fusions, 3+ level MIS fusions had comparable complication rates to open cases, and higher rates of adverse pulmonary and ileus events. LEVEL OF EVIDENCE: 3.


Assuntos
Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Fusão Vertebral , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Fusão Vertebral/estatística & dados numéricos , Resultado do Tratamento
18.
Medicine (Baltimore) ; 98(39): e17316, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574861

RESUMO

The purpose of this study was to investigate the effect of intraoperative positions in single-level (L4-5) transforaminal lumbar interbody fusion (TLIF) on segmental and overall lumbar lordosis (LL) in patients with lumbar degenerative disease. Thirty-eight consecutive patients who had undergone single-segment (L4-5) TLIF with 0° polyetheretherketone (PEEK) cage and pedicle screw fixation were evaluated. Twenty patients underwent surgery on the four-poster type frame with hip flexion at 30° (Group I) and 18 patients were operated on a Jackson spinal table to adjust their hip flexion to 0° (Group II). Preoperative standing, intraoperative prone, and postoperative standing lateral radiographs were obtained in each patient. The overall and segmental LL were analyzed according to the position in which the patients were placed for their operation and results compared between Groups I and II. Intraoperative intervertebral segmental LL at L4-5 and L5-S1 was increased in Group II than in Group I, whereas postoperative intervertebral segmental LL at L4-5 (fused level) was increased LL. In Group I intraoperative intervertebral segmental LL at L4-5 did not achieve sufficient lordosis, whereas postoperative intervertebral segmental LL at L3-4 was increased. The overall spinal alignment was unaffected by the decreased segmental LL in the fused level owing to the compensation of the upper adjacent segments. The more the hip was extended intraoperatively, the more the segmental lordosis increased in the lower lumbar spine. Thus, selecting the appropriate surgical table and hip position are very important. Underachievement of segmental lordosis leads to the acceleration of upper adjacent segment load.


Assuntos
Cuidados Intraoperatórios/métodos , Lordose , Vértebras Lombares , Mesas Cirúrgicas , Posicionamento do Paciente/métodos , Fusão Vertebral , Idoso , Feminino , Humanos , Lordose/diagnóstico , Lordose/fisiopatologia , Lordose/cirurgia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Radiografia/métodos , Amplitude de Movimento Articular , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Espondilolistese/cirurgia
19.
Medicine (Baltimore) ; 98(42): e17505, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626106

RESUMO

The purpose of the study was to identify risk factors of cage subsidence and evaluate surgical outcome by at least 12 months postoperative follow-up.We retrospectively investigated 113 consecutive patients who underwent anterior surgery to relieve spine cord compression resulted from localized heterotopic ossification, from July, 2011 to February, 2016. We divided the patients into 2 groups: cage subsidence <2 mm group and ≥2 mm group. According to magnetic resonance imaging (MRI), the severity of increased signal intensity (ISI) was classified into grade 0, 1, and 2. Clinical outcome was assessed by the Japanese Orthopedic Association (JOA) scoring system. Logistic regression analysis and receiver-operating characteristic (ROC) curve were utilized for predicting risk factors of cage subsidence, and the recovery rate was evaluated by Kruskal-Wallis test or Mann-Whitney U test.Logistic regression with cage subsidence as the dependent variable showed independent risks associated with a cervical sagittal malalignment (odds ratio [OR] 11.23, 95% confidence interval [CI] 3.595-35.064, P < .001), thoracic 1 (T1) slope angle (OR 1.59, 95% CI 1.259-1.945, P < .001), and excisional thickness (OR 2.38, 95% CI 1.163-4.888.0, P = .018). The cut-off values of T1 slope and excisional thickness were 19.65 angle and 3.7 mm, respectively. Patients with high occupying ratio (P = .001) and high ISI grade (P = .012) are more likely to occur lower recovery rate.Patients with high T1 slope angle or preoperative kyphotic deformity should avoid excessive removal of endplate and vertebral body so as to reduce the occurrence of cage subsidence. Poor outcome was closely related to cervical sagittal malalignment and higher ISI grade.


Assuntos
Discotomia/efeitos adversos , Ossificação Heterotópica/cirurgia , Complicações Pós-Operatórias/etiologia , Compressão da Medula Espinal/cirurgia , Fusão Vertebral/efeitos adversos , Vértebras Cervicais/cirurgia , Discotomia/métodos , Feminino , Seguimentos , Humanos , Cifose/fisiopatologia , Cifose/cirurgia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Ossificação Heterotópica/fisiopatologia , Complicações Pós-Operatórias/epidemiologia , Equilíbrio Postural , Estudos Retrospectivos , Caixa Torácica/cirurgia , Fatores de Risco , Compressão da Medula Espinal/fisiopatologia , Fusão Vertebral/métodos , Resultado do Tratamento
20.
J Clin Neurosci ; 69: 170-174, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31495653

RESUMO

To investigate the impact of obesity on the restoration of sagittal balance after posterior lumbar interbody fusion (PLIF). To examine the correlation between obesity and sagittal balance and their influence on clinical efficacy. A total of 183 patients who underwent PLIF for degenerative lumbar diseases between Jan 2015 and Dec 2015 were enrolled in this study. Based on their BMI, patients were divided into three groups: normal weight group (Group A), overweight group (Group B), and obesity group (Group C). Demographic data, intraoperative data, sagittal balance parameters, and clinical function scores were compared between each group. Correlation analysis was conducted between the BMI scores and each sagittal balance parameter. Multiple linear regression was used to assess the impact of each variable on clinical outcomes. All patients finished an average of 22.3 months follow-up. Group C had significantly higher blood loss and longer operations than Group A. SL and PT improved significantly in Group A while did not change in Group C. Compared with Group C, Group postoperative pelvic tilt (PT) was better restored in Group A. BMI was significantly correlated with change of lumbar lordosis (LL) and PT. Multiple linear regression analysis indicated that BMI and change of PT had a great influence on ODI improvement. Obesity may hinder the correction of sagittal balance and improvement of clinical efficacy in patients who undergo PLIF. Restoration of PT should be paid more attention to during surgery, as it may be associated with satisfactory clinical outcomes especially for obesity.


Assuntos
Dor Lombar/complicações , Obesidade/complicações , Postura , Fusão Vertebral , Resultado do Tratamento , Adulto , Idoso , Feminino , Humanos , Dor Lombar/cirurgia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos
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