The spine journal : official journal of the North American Spine Society
-
The retrotransverse foramen (RTF), arcuate foramen (AF), unclosed transverse foramen (UTF) and posterior atlas arch defects (PAAD) are anatomic variations of the atlas vertebra that surgeons must be aware of before spine surgery is performed. ⋯ The present study has revealed no sex differences in the prevalence of AF, UTF, RTF or PAAD in both Caucasian and sub-Saharan African subjects. This research has also indicated no differences in the prevalence of the UTF, AF and RTF between Zulu, Xhosa and Sotho subjects. In addition, this study has revealed no differences in the Type A, UTF, AF, and RTF prevalence between the sub-Saharan African (all subjects) and the Caucasian subjects. These variations may be known by surgeons before spine surgery for better planning.
-
About 85% of the patients with low back pain seeking medical care have nonspecific low back pain (NsLBP), implying that no definitive cause can be identified. Nonspecific low back pain is defined as low back pain and disability which cannot be linked to an underlying pathology, such as cancer, spinal osteomyelitis, fracture, spinal stenosis, cauda equine, ankylosing spondylitis, and visceral-referred pain. Many pain conditions are linked with elevated serum levels of pro-inflammatory biomarkers. Outcomes of interest are NsLBP and the level of pro-inflammatory biomarkers. ⋯ This study found moderate evidence for (i) a positive association between the pro-inflammatory biomarkers CRP and IL-6 and the severity of NsLBP, and (ii) a positive association between TNF-α and the presence of NsLBP. Conflicting and limited evidence was found for the association between TNF-α and Regulated on Activation, Normal T Cell Expressed and Secreted and severity of NsLBP, respectively.
-
The prevalence of dialysis-dependent patients in the United States is growing. Prior studies evaluating the risk of perioperative adverse events for dialysis-dependent patients are either institutional cohort studies limited by patient numbers or administrative database studies limited to inpatient data. ⋯ Dialysis patients undergoing elective spine surgery are at significantly higher risk of aggregated adverse outcomes, return to the operating room, readmission, and death than non-dialysis patients, even after controlling for patient demographics and overall health (as indicated by ASA class). These differences need to be considered when determining treatment options. Additionally, with bundled payments expected in spine surgery, physicians and hospitals need to account for increased costs and liabilities when working with dialysis patients.
-
Observational Study
The influence of hand grip strength on surgical outcomes after surgery for degenerative lumbar spinal stenosis: a preliminary result.
Although a number of prognostic factors have been demonstrated to be associated with surgical outcome of degenerative lumbar spinal stenosis (DLSS), no study has investigated the relation between hand grip strength (HGS) and treatment outcome of DLSS. ⋯ Patients with preoperative high HGS display better surgical outcome in terms of disability and health status 6 months after spine surgery. Preoperative HGS can act as a predictor of surgical outcome in patients with DLSS.
-
As health-care transitions to value-based models, there has been an increased focus on patient factors that can influence peri- and postoperative adverse events, resource use, and costs. Many studies have reported risk factors for systemic complications after cervical fusion, but none have studied chronic opioid therapy (COT) as a risk factor. ⋯ Preoperative opioid use among patients who underwent cervical fusion increases complication rates, postoperative opioid usage, health-care resource use, and costs. These risks may be reduced by restricting the duration of preoperative opioid use or weaning off before surgery. Better understanding and management of pain in the preoperative period with judicious use of opioids is critical to enhance outcomes after cervical fusion surgery.