The spine journal : official journal of the North American Spine Society
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Obese patients have greater comorbidities along with higher risk of complications and greater costs after spine surgery, which may result in increased cost and lower quality of life compared with their non-obese counterparts. ⋯ Anterior cervical discectomy and fusion provided a significant gain in health state utility in obese patients, with a mean 2-year cost-utility of $68,070 per QALYs gained, which can be considered moderately cost-effective. Morbidly obese patients had lower cost-effectiveness; however, surgery does provide a significant improvement in outcomes. Obesity, and specifically morbid obesity, should to be taken into consideration as physician and hospital reimbursements move toward a bundled model.
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Coexisting Parkinson's disease (PD) and cervical spondylotic myelopathy (CSM) presents a diagnostic and therapeutic challenge due to symptomatic similarities between the diseases. Whereas CSM patients are routinely treated with surgery, PD patients face poorer outcomes following spine surgery. No studies have investigated the quality of life (QOL) outcomes following decompression in coexisting PD and CSM. ⋯ This is the first study to characterize QOL outcomes following cervical decompression for patients with coexisting PD and CSM. Although myelopathy may have been less severe among PD patients, a significant reduction in pain-related disability was observed following decompression. However, PD predicted diminished improvement in overall QOL measured by the EQ-5D.
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Observational Study
Liposomal bupivacaine incisional injection in single-level lumbar spine surgery.
Postsurgical pain control is important in spine surgery as it can lead to earlier mobilization, decreased length of stay, decreased side effects from narcotic medications, and improved patient satisfaction. Liposomal bupivacaine (LB) is an injectable formulation of bupivacaine, providing prolonged local anesthesia, up to 72 hours postinjection. Although, LB has been used with increasing frequency following other musculoskeletal procedures, specifically total joint replacements, its pre-emptive analgesic effect following lumbar microdiscectomy has hitherto not been reported. If administration of LB as a pre-emptive analgesic agent at the end of microdiscectomy resulted in reduced postoperative pain, then this could minimize adverse events related to narcotic pain medication use and improve acute clinical outcomes. ⋯ We found that patients who received LB field blocks required IV narcotic pain medication for a significantly decreased length of time (average delta=10.3 hours). Although this is a surrogate for earlier discharge, within the numbers studied, this did not translate into a significantdifference in VAS scores or total morphine equivalents. It is uncertain, if the independent effect of LB may have been masked by the multimodal postoperative pain control protocol in use. Further study is required to best understand the potential benefit of pre-emptive analgesia in elective spine surgery. Its impact would likely be more significant in more invasive procedures.