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Influence of racial disparities on patient-reported satisfaction and short- and long-term perception of health status after elective lumbar spine surgery.

OBJECTIVE In spine surgery, racial disparities have been shown to impact various aspects of surgical care. Previous studies have associated … ical records of adult (age ≥ 18 years) patients who had undergone elective lumbar spine surgery for spondylolisthesis (grade 1), disc herniation, or stenosis at a major academic institution were included in this study. Patient demographics, comorbidities, postoperative complications, and 30-day readmission rates were collected. Patients had prospectively collected …

Comparative analysis of perioperative surgical site infection after minimally invasive versus open posterior/transforaminal lumbar interbody fusion: analysis of hospital billing and discharge data from 5170 patients.

OBJECT: Surgical site infection (SSI) after lumbar fusion results in significant patient morbidity and associated medical resource utilizati … ts undergoing 1- or 2-level MI or open P/TLIF for lumbar spondylotic disease, disc degeneration, or spondylolisthesis. The ICD-9-CM procedure codes were used to identify patients undergoing P/TLIF and those experiencing SSI. Infection-related costs were obtained from the total costs incurred by the hospital for SSI-related care provided during inpatient or hospital …

The Efficacy and Safety of Prophylactic Intravenous Tranexamic Acid on Perioperative Blood Loss in Patients Treated with Posterior Lumbar Interbody Fusion.

OBJECTIVE: To investigate the efficacy and safety of a prophylactic intravenous administration of tranexamic acid (TXA) 30 minutes before skin incision on perioperative blood loss in patients treated with posterior lumbar interbody fusion (PLIF). METHODS: A total of 63 patients who underwent PLIF were recruited and divided into a TXA group (n = 26) and a control group (n = 37). Intraoperative blood loss, postoperative blood loss, duration of tube drainage, hospitalization time, blood transfusion rate, and incidence of complications were compared between the 2 groups. RESULTS: There were no s

[Impact of obesity in the pathophysiology of degenerative disk disease and in the morbidity and outcome of lumbar spine surgery].

Obesity (BMI>30Kg/m2) is a pandemic with severe medical and financial implications. There is growing evidence that relates certain metabolic processes within the adipose tissue, preferentially abdominal fat, with a low-intensity chronic inflammatory state mediated by adipokines and other substances that favor disk disease and chronic low back pain. Obesity greatly conditions both the preoperative evaluation and the spinal surgical technique itself. Some meta-analyses have confirmed an increase of complications following lumbar spine surgery (mainly infections and venous thrombosis) in obese su

Clinical outcomes of two minimally invasive transforaminal lumbar interbody fusion (TLIF) for lumbar degenerative diseases.

BACKGROUND: There are two modified TLIF, including MIS-TLIF and TLIF through Wiltse approach (W-TLIF). Although both of the two minimally invasive surgical procedures can be effective in the treatment for lumbar degenerative diseases, no comparative analysis has been made so far regarding their clinical outcomes. OBJECTIVE: To compare the clinical outcomes of MIS-TLIF and W-TLIF for the treatment for single-segment degenerative lumbar diseases. METHODS: Ninety-seven patients with single-segment degenerative lumbar disorders were included in this study. Forty-seven underwent MIS-TLIF surgery

Early postoperative analgesic effects of a single epidural injection of ropivacaine administered preoperatively in posterior lumbar interbody spinal arthrodesis: a pilot randomized controlled trial.

BACKGROUND: Despite the suitable characteristics of ropivacaine as an epidural analgesic agent, such as better preservation of motor function and less neurotoxicity, we are aware of no data on its clinical application in pain management following lumbar spine surgery. The purpose of the present study was to evaluate the preemptive analgesic effects and safety of a single epidural injection of ropivacaine during lumbar arthrodesis. METHODS: We performed a randomized, double-blinded, intention-to-treat study. Patients with planned one-level posterior lumbar interbody arthrodesis were randomly a

Outcomes of Conservative Versus Surgical Treatment of Dropped Head Syndrome in a Single Institution: A Case Series and Review of the Literature.

Dropped head syndrome (DHS), also known as camptocephalia, is characterized by a mobile chin-on-chest deformity from hypotonia of the cervical extensor muscle or hypertonia of the anterior neck muscles. There remains a paucity of quality published literature on this topic, particularly its management. The objective of this study is to identify radiographic and clinical outcomes of surgery as compared to nonsurgical treatment, to summarize the literature, and to create a decision-making paradigm for managing patients with DHS. As such, we report outcomes of our retrospective chart review series

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… The cervical radiograph showed severe spondylolisthesis with possible subluxation of C3 on C4 and C4 on C5. CT and MRI were performed to better evaluate the cervical anatomy and deformity, unremarkable for any evidence of fracture, tumor, or instability. … The cervical radiograph demonstrated cervical kyphosis centered around a grade 1 spondylolisthesis of C4 on C5 with mild to moderate multilevel degenerative joint disease most outstanding at C5-6. No fractures or lesions were identified on CT. …

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… Logistic regression analyses were performed to identify factors associated with achieving MCID, and subgroup analysis assessed the impact of low-grade degenerative spondylolisthesis (SPL) on outcomes. … Our findings support the efficacy and long-term stability of endoscopic decompression for lumbar spinal stenosis, including degenerative low-grade spondylolisthesis. …

Feasibility and patient-reported outcomes after outpatient single-level instrumented posterior lumbar interbody fusion in a surgery center: preliminary results in 16 patients.

STUDY DESIGN: Retrospective study. OBJECTIVE: To report surgical and patient-reported outcomes after outpatient lumbar fusions in an ambulatory setting. SUMMARY OF BACKGROUND DATA: There is growing interest in the potential benefits of outpatient spine surgery such as reduced costs, consistent operative team, and decreased postoperative complications during in-hospital recovery. However, there are limited studies on outcomes after outpatient lumbar fusions, to guide patient selection, treatment techniques and postoperative expectations. METHODS: Medical records of 16 consecutive patients, w

Electrical stimulation threshold in chronically compressed lumbar nerve roots: Observational study.

OBJECTIVES: Intraoperative neuromonitoring (IONM) is a common practice in spinal surgery, mostly during pedicle screw placement. However, there is not enough information about the factors that can interfere with IONM data. One of these factors may be existing damage of the nerve root whose function must be preserved. The main purpose of the present study is to evaluate the effect of chronic compression in lumbar nerve roots in terms of stimulation thresholds during direct nerve stimulation. PATIENTS AND METHODS: Direct electrical stimulation was performed in 201 lumbar nerve roots during lumb

[Sacral insufficiency, unexpected clinical entity as a cause of low back pain. Report of two cases].

BACKGROUND: sacral insufficiency fractures are a cause of debilitating pain in the elderly. These fractures were first described as a clinical entity in 1982. The bone in these patients is structurally weakened and often associated with diseases such as osteoporosis, cancer and immunological processes. This translates into back and pelvic pain unrelated to trauma. These fractures are usually caused by fatigue in most cases. Bone scans and MRI are the imaging studies with the most sensitivity for detecting sacral insufficiency. CLINICAL CASES: two patients with sacral insufficiency fractures w

Motion-preserving surgery can prevent early breakdown of adjacent segments: Comparison of posterior dynamic stabilization with spinal fusion.

STUDY DESIGN: A retrospective study. OBJECTIVES: This study aims to determine the prevalence and nature of adjacent-segment deterioration after posterior ligamentoplasty, posterolateral lumbar fusion (PLF) versus posterior lumbar interbody fusion (PLIF). SUMMARY OF BACKGROUND: Motion-preserving technologies including disc arthroplasty and ligamentoplasty were gaining interest to reduce the risk of adjacent-segment morbidity. However, few clinical studies have reported the prevalence of adjacent-segment disease in motion-preserving surgeries. METHODS: Two-hundred and eighteen consecutive pat

A case study on osteoporosis in a male athlete: looking beyond the usual suspects.

After presenting with chronic low back pain, a male track athlete was diagnosed with bilateral lysis at L5, slight listhesis at L5 on S1; asymmetrical lysis at L4; and right L5/S1 disc bulge with minimal S1 nerve root contact. Conservative treatment was chosen. After participating in a bone density pilot study using dual-energy X-ray absorptiometry (DEXA) investigating alcohol consumption patterns in intercollegiate athletes, he was diagnosed with osteopenia and osteoporosis in his lumbar spine. Therapeutic drug intervention and rehabilitation were initiated.Athletes with normal physiologic fu

Adjacent segment degeneration after lumbar spinal posterolateral fusion with instrumentation in elderly patients.

This retrospective study investigated adjacent segments radiologically and clinically after posterolateral fusion of the lumbar spine with instrumentation. Thirty-two patients over 60 years old with a postoperative follow-up of at least 4 years were included. These patients all met the criteria of a postoperative symptom-free period of over 2 years, evident fusion mass seen on plain radiographs, and no implant breakage or loosening. There was 81.3% excellent and good clinical results (26/32). For all patients, flexion and extension views of the lumbar spine were done preoperatively and postope

Lumbar spine: quantitative and qualitative assessment of positional (upright flexion and extension) MR imaging and myelography.

PURPOSE: To compare measurements of the sagittal diameter of the lumbar dural sac obtained at positional magnetic resonance (MR) imaging and at functional myelography and to assess the influence of various body positions on the dural sac and the intervertebral foramina. MATERIALS AND METHODS: Thirty consecutive patients referred for lumbar myelography were examined with an open 0.5-T MR imager, Sagittal T2-weighted fast spin-echo images were acquired with patients in the supine, upright flexion, and upright extension positions. The midsagittal diameter of the dural sac was measured at the lev

[3D-MR myelography in diagnosis of lumbar spinal nerve root compression syndromes. Comparative study with conventional myelography].

65 patients with nerve root compression syndrome were examined using a new type of MR-technique, which is comparable to the conventional X-r … comparable to that of conventional X-ray myelography. In cases of severe spinal canal stenosis and spondylolisthesises, and in cases of postoperative scar tissue with nerve root compressions, the sensitivity of the 3D-MRM is higher as compared to that of conventional X-ray myelography.

Evaluation of V-type titanium cable internal fixation for the treatment of young adult fifth lumbar spondylolysis: technical notes and a retrospective clinical study.

BACKGROUND: Various strategies, each with its own set of limitations, are available for managing lumbar spondylolysis. In response, our depa … ach relies on the prerequisite that patients with minimal intervertebral disc injury or mild lumbar spondylolisthesis demonstrate high overall success rates but experience low failure rates associated with internal fixation. Most significantly, this technique involves segmental internal fixation, which safeguards the functional spinal unit (FSU).