Opioids and analgesics use after adult spinal deformity surgery correlates with sagittal alignment and preoperative analgesic pattern.

PURPOSE: To assess pain, health-related quality of life (HRQOL) scores and sagittal parameters of adult spinal deformity (ASD)-operated patients in the context of their analgesic consumption especially opioids (narcotics) over the first year postoperative period. METHODS: In total, 372 patients from a multicenter database were stratified into 3 groups at baseline: 241 patients in the minimal group (no analgesic, or NSAIDs/narcotics weekly or less), 64 in the NSAIDs every day group and 67 in the narcotics every day group. HRQOL and back and leg pain scores were evaluated at 6 months and 1 year postoperatively. Also several sagittal alignment parameters were assessed. RESULTS: Significant improvements in pain and HRQOL scores were observed across all 3 groups by 1 year (P < 0.05) postoperatively. While the minimal group had the best pre- and postoperative HRQOL scores, the NSAID group demonstrated the best improvement in HRQOL. Only the minimal group displayed continued improvement from 6 months to 1 year. 90%, 65% and 40% of minimal, NSAID and narcotic groups of patients, respectively, no longer took any analgesics at 1 year postoperatively. Alternatively, 36% of patients in the narcotics group continued to take narcotics at 1 year. Residual malalignment increased NSAIDs consumption in different groups at 1 year. CONCLUSION: This study evaluated the analgesics use after ASD surgery in relation to the clinical and radiological outcomes. Despite important postoperative opioids consumption in the narcotics group, clinical outcome yet improved. Malalignment parameters demonstrated a predictive value in regard to NSAIDs' usage. These slides can be retrieved under Electronic Supplementary Material.

Spine Surgical Procedures during Coronavirus Disease 2019 Pandemic: Is It Still Possible to Take Care of Patients? Results of an Observational Study in the First Month of Confinement

Methods@#Between March 17, 2020 and April 17, 2020, information on spine surgical activity was prospectively collected at our institution. This surgical activity related to the first month of confinement in France was compared to the activity during the same period in 2019 to evaluate the impact of the COVID-19 pandemic on surgical activities. @*Results@#In order to reduce the contamination rate of patients and medical staff during hospitalization, the spine department was completely reorganized. Non-urgent elective spine surgeries were cancelled. When considering the global amount of surgeries procedures during the first month of confinement, a decrease of almost 50% was observed in the number of surgical procedures. During the study period, 62 patients were eligible for spine surgery. The numbers of patients managed for tumor and infectious cases were stable, while a considerable reduction was observed in the number of trauma and degenerative cases. During the follow-up period, two patients were tested as COVID+ during the postoperative course, and no cases of medical or paramedical staff contamination were reported using polymerase chain reaction-testing. @*Conclusions@#During the COVID-19 pandemic, it is possible to maintain spine surgical activity. Each surgical procedure must be discussed and organized with all the caregivers involved. Indications for surgery must be in line with the scientific guidelines and adapted to each healthcare facility.

Use of Cement-Augmented Percutaneous Pedicular Screws in the Management of Multifocal Tumoral Spinal Fractures

STUDY DESIGN: Retrospective case series observational study. PURPOSE: Cancer patients are often aged and are further weakened by their illness and treatments. Our goal was to evaluate the efficiency and safety of using minimally invasive techniques to operate on spinal fractures in these patients. OVERVIEW OF LITERATURE: Vertebroplasty is now considered to be a safe technique that allows a significant reduction of the pain induced by a spinal tumoral fracture. However, few papers describe the kyphosis reduction that can be achieved by combining percutaneous fixation and anterior vertebral reconstruction. METHODS: We studied 35 patients seen between December 2013 and October 2016 who had at least one pathological spinal fracture and multiple vertebral metastases. The population’s mean age was 67 years, and no patients included had preoperative neurological deficits. The patients underwent a minimally invasive surgery consisting of a percutaneous pedicular fixation with cement-enhanced screws and anterior reconstruction comprising kyphoplasty when possible or corpectomy in cases of excessive damage to the vertebral body. Back pain, traumatic local and regional kyphosis, and Beck’s Index were collected pre- and postoperatively, and at 3-, 6-, and 12-month follow-ups. RESULTS: Mean follow-up time was 13.4 months. Significant reductions in back pain (p<0.001) and local (p<0.001) and regional kyphosis (p=0.006) were found at the 6-month follow-up (alpha risk level <0.05). Beck’s Index was also significantly increased, indicating good restoration of the anterior vertebral height. By the final follow-up, no screws had fallen/pulled out. There were no infectious or neurological complications. CONCLUSIONS: Percutaneous cement-enhanced fixation for pathological fractures has proven a safe and efficient technique in our experience, enabling weak patients to rapidly become ambulatory again without complications. Further follow-up of the patients is necessary to assess the long-term effects of this technique and the continued quality of life of our patients.