The spine journal : official journal of the North American Spine Society
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Multicenter Study
The discrepancy between functional outcome and self-reported health status after surgery for degenerative cervical myelopathy.
Surgery for degenerative cervical myelopathy has shown not only to halt neurologic deterioration, but also to improve functional impairments. Despite these improvements, some patients may be dissatisfied with their outcomes. This study aims to (1) investigate discrepancies between postoperative clinical measures and self-reported health status, and (2) identify important predictors of such discrepancies. ⋯ There was a discrepancy between changes in mJOA and self-reports of health status in patients undergoing surgery for degenerative cervical myelopathy. Increased bodily pain at 1-year, smaller improvements in postoperative upper extremity score and increased age were associated with worsened or unchanged general health status, despite clinically significant improvements in overall postoperative function.
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Society increasingly asks Medicine to create "value" for patients. As health-care costs rise, this question will become more important. Debate exists regarding the relative "value" of many surgical procedures, including spinal surgery. Comparison of the relative value that patients experience after different orthopedic procedures is theoretical, but informs the ongoing debate. ⋯ Based upon PROMIS assessments at short-term follow-up, DSC patients receive a larger benefit from surgery than ACLR despite the overall less desirable postoperative PROMIS scores in the DSC cohort. This result, while theoretical, informs the debate regarding the comparative value of DSC to patients.
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Randomized Controlled Trial Multicenter Study
A prospective, international, randomized, noninferiority study comparing an implantable titanium vertebral augmentation device versus balloon kyphoplasty in the reduction of vertebral compression fractures (SAKOS study).
Balloon kyphoplasty (BKP) is a commonly performed vertebral augmentation procedure for painful osteoporotic vertebral compression fractures (OVCFs). ⋯ Study results demonstrated non-inferiority of the TIVAD to the predicate BKP with an excellent risk/benefit profile for results up to 12 months.
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Multicenter Study
Development of machine learning algorithms for prediction of prolonged opioid prescription after surgery for lumbar disc herniation.
Spine surgery has been identified as a risk factor for prolonged postoperative opioid use. Preoperative prediction of opioid use could improve risk stratification, shared decision-making, and patient counseling before surgery. ⋯ Overall, 5,413 patients were identified, with sustained postoperative opioid prescription of 416 (7.7%) at 90 to 180 days after surgery. The elastic-net penalized logistic regression model had the best discrimination (c-statistic 0.81) and good calibration and overall performance; the three most important predictors were: instrumentation, duration of preoperative opioid prescription, and comorbidity of depression. The final models were incorporated into an open access web application able to provide predictions as well as patient-specific explanations of the results generated by the algorithms. The application can be found here: https://sorg-apps.shinyapps.io/lumbardiscopioid/ CONCLUSION: Preoperative prediction of prolonged postoperative opioid prescription can help identify candidates for increased surveillance after surgery. Patient-centered explanations of predictions can enhance both shared decision-making and quality of care.
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Effective postoperative pain management in patients undergoing elective spinal fusion surgery has been associated with shorter hospital stays, reduced rates of hospital readmissions due to pain, and decreased cost of care. Furthermore, preoperative multimodal analgesia regimens have been shown to decrease postoperative subjective pain measurements and narcotic consumption in patients undergoing spinal fusion and total arthroplasty surgeries. ⋯ This study demonstrates that administering a selective COX-2 inhibitor and GABA-analogue preoperatively can significantly decrease 24-hour postoperative opioid consumption, VAS pain scores, and elapsed time to postoperative mobility in patients undergoing elective spine fusion surgery of ≤5 levels. Optimal standardized dosing and drug combination for preoperative multimodal analgesia remains to be elucidated.