The spine journal : official journal of the North American Spine Society
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Models for predicting recovery in traumatic spinal cord injury (tSCI) patients have been developed to optimize care. Several models predicting tSCI recovery have been previously validated, yet recent findings question their accuracy, particularly in patients whose prognoses are the least predictable. ⋯ Previously tested prediction models demonstrated a lower predictive accuracy for AIS B+C than AIS A+D patients. These models were unable to effectively prognosticate AIS A+D patients separately; a failure that was masked when amalgamating the two patient populations. This suggests that former prediction models achieved strong prognostic accuracy by combining AIS classifications coupled with a disproportionately high proportion of AIS A+D patients.
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Evidence of impaired pain modulation in adolescents with idiopathic scoliosis and chronic back pain.
Although 40% of adolescent idiopathic scoliosis (AIS) patients present with chronic back pain, the pathophysiology and underlying pain mechanisms remain poorly understood. We hypothesized that development of chronic pain syndrome in AIS is associated with alterations in pain modulatory mechanisms. ⋯ Chronic back pain has an impact in the quality of life of adolescents with idiopathic scoliosis. We demonstrated a high prevalence of impaired pain modulation in this group. The association between deformity severity and somatosensory dysfunction may suggest that spinal deformity can be a trigger for abnormal neuroplastic changes in this population contributing to chronic pain syndrome.
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Surgical site infection (SSI) following spine surgery is associated with increased morbidity, reoperation rates, hospital readmissions, and cost. The incidence of SSI following posterior cervical spine surgery is higher than anterior cervical spine surgery, with rates from 4.5% to 18%. It is well documented that higher body mass index (BMI) is associated with increased risk of SSI after spine surgery. There are only a few studies that examine the correlation of BMI and SSI after posterior cervical instrumented fusion (PCIF) using national databases, however, none that compare trauma and nontraumatic patients. ⋯ Our study demonstrates that our rate of SSI after PCIF is within the range of what is cited in the literature. Interestingly, we did not see a statistically significant difference in the rate of infection between our trauma and nontrauma group. Overall, diabetes and elevated BMI are associated with increased risk of SSI in all patients, who underwent PCIF with even a higher risk in patient, who are both diabetic and obese. Obese patients should be counseled on elevated SSI risk after PCIF, and those with diabetes should be medically optimized before and after surgery when possible to minimize SSI.
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Prescription opioid abuse is a public health emergency. Opioid prescriptions for spine patients account for a large proportion of use. Some states have implemented statutory limits on prescribers, however it remains unclear whether such laws are effective. ⋯ The institution of mandatory statewide opioid prescription limits has resulted in a significant reduction in initial and 30-day opioid prescriptions following lumbar spine surgery. Decreased opioid utilization was observed in all patients, regardless of preoperative opioid tolerance or procedure performed. No significant change in postoperative ED visits or unplanned hospital readmissions was seen following implementation of the legislation. This investigation provides preliminary evidence that narcotic limiting legislation may be effective in decreasing opioid prescriptions after lumbar spine surgery for both opioid-naïve and opioid-tolerant patients.
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Surgical treatment of cervical ossification of the posterior longitudinal ligament (OPLL) has a high risk of various complications. Anterior decompression with fusion (ADF) and laminoplasty (LAMP) are the most representative surgical procedures. However, few studies have compared the two procedures in terms of perioperative surgical complications. ⋯ The present study, using a large nationwide database, demonstrated that perioperative complications were more common in the ADF group, but that surgical site infection (SSI) was more frequently observed in the LAMP group.