The spine journal : official journal of the North American Spine Society
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The majority of patients with preoperative upper extremity weakness show improvements in motor function after anterior cervical discectomy and fusion (ACDF). Although numerous studies have examined both the extent and time course to which motor function can be expected to improve, few have shown that these improvements in motor function translate to improved health related quality of life (HRQOL) outcomes. ⋯ Patients with preoperative weakness generally exhibited worse pain and HRQOL measures preoperatively, and showed greater potential for improvement after ACDF. Patients with a shorter duration of preoperative weakness had greater potential for improvement in HRQOL measures after ACDF compared with those with longer duration of symptoms. ACDF is an effective procedure to improve strength and HRQOL measures across all patient groups under appropriate indications.
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Reliable estimation of the likelihood for prolonged postoperative opioid use may aid targeted interventions for high-risk patients. Previous studies have recommended differing methodologies for prediction of sustained postoperative opioid use. ⋯ The SOS score clinically outperformed oral MME as a predictive measure for outcomes following lumbar spine surgery. The SOS score may be valuable for identifying individuals at high-risk for sustained prescription opioid use and associated adverse events following spine surgery.
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Comparative Study
Comparison of long-term clinical and radiographic outcomes between alternative-level and all-level fixation unilateral open-door laminoplasty.
Titanium mini-plate has been used in unilateral open-door laminoplasty to maintain the open angle of laminae. Previously, both all-level fixation (C3-C7) and alternative-level (C3, C5, C7) unilateral open-door laminoplasty have been proven to have satisfactory clinical outcomes. However, whether they could achieve similar long-term clinical and radiographic efficacy is still questionable. ⋯ Despite a difference in the maintenance of open angle, both fixation methods achieved satisfactory clinical outcomes. We believe alternative-level fixation is also a safe, effective, and economical fixation method.
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Postoperative C5 palsy is not an uncommon complication in patients who undergo expansive open-door laminoplasty. However, the etiology is unclear and likely multifactorial. Nerve root lesions and spinal cord lesions have been previously proposed theories. ⋯ This study provides clinicians with a more detailed understanding of the anatomic structure and potential mechanism of C5 palsy. Consideration of the meningovertebral ligaments and the intervertebral foramen may provide new directions for reducing the incidence of this complication.
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Recent trends in medicare utilization and reimbursement for anterior cervical discectomy and fusion.
Anterior cervical discectomy and fusion (ACDF) has been considered the gold standard for treating various cervical spine pathologies stemming from cervical degenerative disorders. While cervical artificial disc replacement has emerged as an alternative in select cases, ACDF still remains a commonly performed procedure. ⋯ While ACDF volume and utilization has continued to increase since 2012, Medicare payments to hospitals and surgeons have struggled to keep up with inflation. Our study confirms that Medicare reimbursement per case continues to decrease at a disproportionate rate for surgeons, compared to hospitals. The increasing trend in procedures performed at ambulatory surgical centers shows promise for a future model of cost-efficient and value-based care.