The spine journal : official journal of the North American Spine Society
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Posterior cervical fusion (PCF) has been shown to be an effective treatment for cervical spondylosis, but is associated with a 9% complication rate and high costs. To limit such complications and costs, it is imperative that proper selection of surgical candidates occur for those most likely to do well with the surgery. Affective disorders, such as depression, are associated with worsened outcomes after lumbar surgery; however, this effect has not been evaluated in patients undergoing cervical spine surgery. ⋯ Of patients who undergo PCF, those with a greater degree of preoperative depression have lower improvements in postoperative QOL compared with those with less depression. Additionally, patients with better preoperative health states also attain lower 1-year QOL improvements.
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Surgical site infection (SSI) associated with instruments remains a serious and common complication in patients who undergo total en bloc spondylectomy (TES). It is very important that the risk factors for SSI are known to prevent it. ⋯ This study identified combined anterior and posterior approach and nonuse of iodine-supported spinal instruments to be independent risk factors for SSI after TES. Iodine-supported spinal instrument was extremely effective for prevention of SSI in patients with compromised status, and it had no detection of cytotoxic or adverse effects on the patients.
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The use of a rod reduction device can have deleterious consequences on pedicle screw pullout strength (POS) in the thoracic spine. However, posterior-only osteotomies in the thoracic spine are often performed to improve flexibility of the spine and offset forces of deformity correction maneuvers. ⋯ Despite thoracic Ponte osteotomies and increased flexibility of the spinal segments, the rod reduction device still significantly decreased pedicle screw POS, typically resulting in outright failure of the screw-bone interface. Therefore, rod reduction technique of any kind should be performed with caution as it frequently results in suboptimal pedicle screw fixation.
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Previous research has failed to identify strong consistent risk factors for low back pain (LBP). A plausible solution is to conduct hypothesis-generating studies, such as twin case-control surveys. ⋯ Twins attributed the differences in LBP history to risk factors related to physical workload. Future studies investigating the risk factors for LBP should include valid and comprehensive assessments of these factors.
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Some, smaller studies have investigated the effect of preoperative depression on postoperative improvement in quality of life (QOL). However, they have not used the Patient Health Questionnaire 9 (PHQ-9) in self-reported depression. ⋯ Increased preoperative pain and depression were shown to be associated with significantly reduced improvement in postoperative QOL, as measured by the EQ-5D.