The spine journal : official journal of the North American Spine Society
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Randomized Controlled Trial
The clinical efficacy of short-term steroid treatment in multilevel anterior cervical arthrodesis.
Dysphagia is the most common complication of anterior cervical discectomy and fusion (ACDF), and it is closely related to prevertebral soft-tissue swelling (PSTS). A few studies have found that local or systemic methylprednisolone is effective against laryngopharyngeal edema and airway obstruction. ⋯ The short-term use of systemic methylprednisolone after ACDF appears to be effective in relieving dysphagia and decreasing the PSTS. Furthermore, the short-term use of methylprednisolone was not associated with any adverse effects of short-term IV steroid usage, such as peptic ulcer disease or postoperative infection. The clinical use of methylprednisolone in relieving dysphagia and decreasing PSTS deserves consideration during the early postoperative period.
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Despite an increase in the clinical use of no-profile anchored interbody cages (AIC) for anterior cervical discectomy and fusion (ACDF) procedures, there is little published biomechanical data describing its stabilizing effect relative to the traditional anterior plating technique over two contiguous levels. ⋯ The anchored cage fusion construct conferred similar acute biomechanical stability in lateral bending and axial rotation ROMs relative to rigid anterior plating. We identified a statistically significant reduction (Δ=3.4°, combined over two levels) in sagittal plane ROM conferred by the ALP relative to the AIC construct. Our biomechanical findings may support the clinical use of no-profile integrated interbody devices over two contiguous levels in ACDF.
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Although the high cost of spine surgery is generally recognized, there is little information on the extent to which payments vary across hospitals. ⋯ Medicare payments for episodes of spine surgery vary widely across hospitals. As they respond to the new financial incentives inherent in health care reform, high cost hospitals should focus on the use of spinal fusion and postacute care.
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Review Meta Analysis
Association of rs11190870 near LBX1 with adolescent idiopathic scoliosis in East Asians: a systematic review and meta-analysis.
The rs11190870 single nucleotide polymorphism in the 3'-flanking region of the LBX1 gene has been implicated in the etiology of adolescent idiopathic scoliosis (AIS). A thorough appraisal of the evidence supporting this association has not been previously attempted. ⋯ Based on a comprehensive analysis of the currently available evidence, rs11190870 is likely a susceptibility variant for AIS in East Asians. Further investigation of this association is necessary in other populations.
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The role of preoperative (preop) narcotic use and its influence on outcomes after spinal deformity surgery are unknown. It is important to determine which patient factors and comorbidities can affect the success of spinal deformity surgery, a challenging surgery with high rates of complications at baseline. ⋯ In adults with degenerative scoliosis taking narcotics a significant decrease in pain medication use was noted after surgery. All outcome scores significantly improved postop in both groups. However, the Narc group had significantly greater improvements in SRS pain scores versus the NoNarc group.