The spine journal : official journal of the North American Spine Society
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Patients undergoing minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) frequently present with lower extremity neurologic symptoms with or without associated lower back pain. While symptomatic improvement of leg and back pain has been reported, the resolution of back pain when it is a predominant presenting symptom remains underreported following MI-TLIF. ⋯ Following MI-TLIF, patients with lower extremity neurologic symptoms with and without a significant component of back pain have improvements in back pain, leg pain, and ODI regardless of their primary presenting pain complaint; however, patients who presented with predominantly leg pain were more likely to meet MCID criteria for improvement in their back pain and ODI score.
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Multicenter Study
Machine learning algorithms for prediction of health-related quality-of-life after surgery for mild degenerative cervical myelopathy.
Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction worldwide. Current guidelines recommend management based on the severity of myelopathy, measured by the modified Japanese Orthopedic Association (mJOA) score. Patients with moderate to severe myelopathy, defined by an mJOA below 15, are recommended to undergo surgery. However, the management for mild myelopathy (mJOA between 15 and 17) is controversial since the response to surgery is more heterogeneous. ⋯ Machine learning models showed good predictive power and provided information about the phenotypes of mild DCM patients most likely to benefit from surgical intervention. Overall, machine learning may be a useful tool for management of mild DCM, though external validation and prospective analysis should be performed to better solidify its role.
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The complication profile and higher cost of care associated with preoperative opioid use and spinal fusion is well described. However, the burden of opioid use and its impact in patients undergoing lumbar discectomy is not known. Knowledge of this, especially for a relatively benign and predictable procedure will be important in bundled and value-based payment models. ⋯ Chronic preoperative opioid use was present in 12% of a national cohort of lumbar discectomy patients. Such opioid use was associated with significantly higher post-operative healthcare utilization, risk of revision surgery, and costs at 90-days and 1-year postoperatively. Two-third of chronic preoperative opioid users had continued long-term postoperative opioid use. However, a 3-month prescription free period before surgery in chronic opioid users reduces the risk of long-term postoperative use. This data will be useful for patient education, pre-operative opioid use optimization, and risk-adjustment in value-based payment models.