Journal of neurosurgery. Spine
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Administrative databases are increasingly being used to establish benchmarks for quality of care and to compare performance across peer hospitals. As proposals for accountable care organizations are being developed, readmission rates will be increasingly scrutinized. The purpose of the present study was to assess whether the all-cause readmissions rate appropriately reflects the University of California, San Francisco (UCSF) Medical Center hospital's clinically relevant readmission rate for spine surgery patients and to identify predictors of readmission. ⋯ The authors' findings identify the potential pitfalls in the calculation of readmission rates from administrative data sets. Benchmarking algorithms for defining hospitals' readmission rates must take into account planned staged surgery and eliminate unrelated reasons for readmission. When this is implemented in the calculation method, the readmission rate will be more accurate. Current tools overestimate the clinically relevant readmission rate and cost.
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Minimally invasive lateral transpsoas interbody fusion (LTIF) has emerged as a popular surgical technique in a remarkably short period of time. The authors' experience with this procedure and anecdotal evidence in the literature suggest that the iliac crest may occasionally prevent access to the L4-5 interspace during minimally invasive LTIF. The authors propose that removal of a minimal amount of ilium would allow for successful exposure of the L4-5 interspace in those cases with a "high-riding" iliac crest. Therefore, the objective of this study was to evaluate the feasibility of iliac osteotomy to enhance exposure of the L4-5 interspace for minimally invasive LTIF. ⋯ A significant portion of patients may have a high-riding iliac crest and that may have had an impact on minimally invasive LTIF in this series; L4-5 cases are rare in relation to midlumbar spine cases in most minimally invasive LTIF patient series. Significant caudal displacement of the tubular system was achieved with minimal iliac osteotomy, ensuring access to the L4-5 interspace in all specimens while maintaining the minimally invasive philosophy behind minimally invasive LTIF.
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Previous studies have reported on the minimum clinically important difference (MCID), a threshold of improvement that is clinically relevant for lumbar degenerative disorders. Recent studies have shown that pre- and postoperative health-related quality of life (HRQOL) measures vary among patients with different diagnostic etiologies. There is also concern that a patient's previous care experience may affect his or her perception of clinical improvement. This study determined if MCID values for the Oswestry Disability Index (ODI), 36-Item Short-Form Health Survey (SF-36), and back and leg pain are different between patients undergoing primary or revision lumbar fusion. ⋯ The MCID values were similar for the revision and primary lumbar fusion groups, even when subgroup analysis was done for different diagnostic etiologies, simplifying interpretation of clinical improvement. The results of this study further validate the use of patient-reported HRQOLs to measure clinical effectiveness, as a patient's previous experience with care does not seem to substantially alter an individual's perception of clinical improvement.
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Randomized Controlled Trial
Prospective randomized study of cervical arthroplasty and anterior cervical discectomy and fusion with long-term follow-up: results in 74 patients from a single site.
The purpose of this study was to evaluate the long-term results of cervical total disc replacement (TDR) and anterior cervical discectomy and fusion (ACDF) in the treatment of single-level cervical radiculopathy. ⋯ Both cervical TDR and ACDF groups showed excellent clinical outcomes that were maintained over long-term follow-up. Both groups showed low index-level and adjacent-level reoperation rates. Both cervical TDR and ACDF appear to be viable options for the treatment of single-level cervical radiculopathy.