Multivariate Analysis on Risk Factors for Post-Operative Ileus After Lateral Lumbar Interbody Fusion.

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Multivariate Analysis on Risk Factors for Post-Operative Ileus After Lateral Lumbar Interbody Fusion.

Spine (Phila Pa 1976). 2014 Jan 29;

Authors: Al Maaieh MA, Du JY, Aichmair A, Huang RC, Hughes AP, Cammisa FP, Girardi FP, Sama AA

Abstract
STRUCTURED ABSTRACT: Study Design. Retrospective Cohort StudyObjective. To assess for independent risk factors of postoperative ileus (POI) after lateral lumbar interbody fusion (LLIF).Summary of Background Data. POI is frequently observed in anterior lumbar interbody fusion (ALIF) due to significant bowel manipulation during the approach. LLIF is a minimally invasive approach to the anterior column with reduced bowel manipulation and surgical time. However, there is a paucity of literature on POI after LLIF.Methods. A retrospective review was performed of records of patients who underwent LLIF from January 2006 to December 2011 at a single institution. Patients with prolonged and recurrent POI were identified by review of hospital stay documentation by a fellowship-trained spine surgeon and a research fellow. POI patients were matched 1:1 to a control cohort without POI. Uni- and multi-variate analyses were performed on demographic, co-morbidity, surgical indication, medication, and peri-operative details to identify independent risk factors for POI.Results. Incidence of prolonged or recurrent POI after LLIF was 7.0% (42/596). Post-operative length of stay was significantly higher for POI patients (9.9±4.3 days) compared to control patients (5.6±4.1 days) (p<0.001). The incidence of ileus in the first 100 LLIF cases (11%) was not significantly higher than in the last 100 LLIF cases (6%) (p = 0.21). Independent risk factors were history of GERD (p<0.01, adjusted odds ratio (aOR): 24.31), posterior instrumentation (p = 0.002, aOR: 19.48), and LLIF at L1-2 (p = 0.04, aOR: 7.82). A history of prior abdominal surgery approached significance as an independent protective factor (p = 0.07, aOR: 0.29).Conclusions. There was a relatively high incidence of POI after LLIF. Independent risk factors for POI were a history of GERD, posterior instrumentation, and LLIF at L1-2. A history of prior abdominal surgery approached significance as an independent protective factor.

PMID: 24480952 [PubMed – as supplied by publisher]

Factors Affecting the Post Operative Progression of Thoracic Kyphosis in Surgically Treated Adult Patient With Lumbar Degenerative Scoliosis.

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Factors Affecting the Post Operative Progression of Thoracic Kyphosis in Surgically Treated Adult Patient With Lumbar Degenerative Scoliosis.

Spine (Phila Pa 1976). 2014 Jan 29;

Authors: Yagi M, Hosogane N, Okada E, Watanabe K, Machida M, Tezuka M, Matsumoto M, Asazuma T

Abstract
Study Design. A retrospective case series of patients treated surgically for degenerative lumbar scoliosis (DLS).Objective. To determine incidence and risk factors of progressive global thoracic kyphosis (pGTK) after surgery for DLS.Summary of Background Data. Sagittal balance affects the surgical treatment of spinal deformity in adults. Little is known about the loss of sagittal balance due to pGTK, or about the risk factors for pGTK, after surgery for DLS.Methods. We reviewed records from a multi-center database of adults with DLS, treated with posterior spinal fusion. Inclusion required an age of 50 years or more at the time of surgery, an upper instrumented vertebrae (UIV) at T9 and below, more than 5 fused segments, and at least 2 years of follow-up. We included 73 patients with a mean age of 68.3 years (range 51-77 years) and a mean follow-up period of 3.6 years (range 2-11 years). Independent risk factors for pGTK were identified by logistic regression analysis.Results. Significant pGTK, defined as an increase in thoracic kyphosis of more than 10° from before surgery to the time of final follow-up, was observed in 41% of the patients. Loss of the sagittal vertical axis (SVA) was larger in patients with pGTK than without (4.7 vs. 1.5 cm; p = 0.02). Risk analysis showed larger lumbar lordosis correction in patients with pGTK. Multivariate logistic regression analysis identified an age greater than 75 (odds ratio [OR], 5.53; p = 0.02, 95% confidence interval [CI] [1.4-22.4]) and sacro-pelvic fusion (OR = 2.66, p = 0.02, 95% CI [1.5-11.1]) as independent risk factors for pGTK.Conclusion. The pGTK incidence after surgery for DLS was 41%. Age, sacro-pelvic fusion, and a larger sagittal correction were identified as pGTK risk factors. Long-term follow-up will provide more data on the clinical impact of pGTK in elderly patients.

PMID: 24480961 [PubMed – as supplied by publisher]

An association can be found between hounsfield units and success of lumbar spine fusion.

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An association can be found between hounsfield units and success of lumbar spine fusion.

HSS J. 2014 Feb;10(1):25-9

Authors: Schreiber JJ, Hughes AP, Taher F, Girardi FP

Abstract
BACKGROUND: Measuring Hounsfield units (HUs) from computed tomography (CT) scans has recently been proposed as a tool for assessing vertebral bone quality, as it has been associated with bone mineral density, compressive strength, and fracture risk. Vertebral bone quality is believed to be an important determinant of outcome and complication rates following spine surgery and potentially influences success of interbody spinal fusion.
QUESTIONS/PURPOSES: The purpose of this study was to investigate the association between HU on CT scans and fusion success in patients with lateral transpsoas surgery for lumbar interbody fusion (LIF).
METHODS: The CT scans of 28 patients with a combined 52 levels of stand-alone LIF were evaluated at a minimum of 12 weeks postoperatively. Coronal and sagittal images were evaluated for evidence of fusion, and HU values were collected from axial images. HU measurements were also taken from vertebral bodies proximal to the construct to evaluate global bone quality.
RESULTS: Of the 52 LIF levels, 73% were assessed as fused and 27% were nonunited at the time of evaluation. The successful fusion levels had significantly higher HU measurements than the nonunion levels (203.3 vs. 139.8, p < 0.001). Patients with successful fusion constructs also had higher global bone density when vertebral bodies proximal to the construct were compared (133.7 vs. 107.3, p < 0.05).
CONCLUSION: With the aging population and increasing prevalence of osteoporosis, preoperative assessment of bone quality prior to spinal fusion deserves special consideration. We found that a successful lumbar fusion was associated with patients with higher bone density, as assessed with HU, both globally and within the fusion construct, as compared to patients with CT evidence of nonunion.

PMID: 24482618 [PubMed]

Early results of sacro-iliac joint fixation following long fusion to the sacrum in adult spine deformity.

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Early results of sacro-iliac joint fixation following long fusion to the sacrum in adult spine deformity.

HSS J. 2014 Feb;10(1):30-5

Authors: Schroeder JE, Cunningham ME, Ross T, Boachie-Adjei O

Abstract
BACKGROUND: The sacro-iliac joint (SIJ) is the largest joint in the human body. When the lumbar spine is fused to the sacrum, motion across the SIJ is increased, leading to increased degeneration of the SIJ. Degeneration can become symptomatic in up to 75% of the cases when a long lumbar fusion ends with a sacral fixation. If medical treatments fail, patients can undergo surgical fixation of the SIJ.
QUESTIONS/PURPOSES: This study reports the results of short-term complications, length of stay, and clinical as well as radiographic outcomes of patients undergoing percutaneous SIJ fixation for SIJ pain following long fusions to the sacrum for adult scoliosis.
METHODS: A retrospective review of all the patients who underwent a percutaneous fixation of the SIJ after corrective scoliosis surgery was performed in a single specialized scoliosis center between the years 2011-2013. Ten SIJ fusions were performed in six patients who failed conservative care for SIJ arthritis. Average age was 50 (range 25-60 years). The patients were 15.3 years in average after the original surgical procedure (range 4-25 years). Average post-operative follow-up was 10.25 months (range 15-4 months). The medical charts of the patients were reviewed for hospital stay, complications, pre- and post-operative pain, quality of life, and satisfaction with surgery using the visual analogues score (VAS), Scoliosis Research Society (SRS)22 and Oswestry Disability Index (ODI) questionnaires. Images were reviewed for fixation of the SIJ, fusion, and deviation of the implants from the SIJ.
RESULTS: There were no complications in surgery or post-operatively. Discharge was on post-operative day 2 (range 1-4 days). Leg VAS score improved from 6.5 to 2.0 (P < 0.005; minimal clinically important difference (MCID) 1.6). Back VAS score decreased from 7.83 to 2.67 mm (P < 0.005; MCID 1.2). ODI scores dropped from 22.2 to 10.5 (P = 0.0005; MCID 12.4). SRS22 scores increased from 2.93 to 3.65 (P = 0.035; MCID 0.2) with the largest increases in the pain, function, and satisfaction domains of the questionnaires.
CONCLUSION: Fixation of the SIJ in patients that fail conservative care for SIJ arthritis after long fusions ending in the sacrum provides a reduction in back pain and improved quality of life in the short and medium range follow-up period.

PMID: 24482619 [PubMed]

Shared decision-making in back pain consultations: an illusion or reality?

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Shared decision-making in back pain consultations: an illusion or reality?

Eur Spine J. 2014 Jan 30;

Authors: Jones LE, Roberts LC, Little PS, Mullee MA, Cleland JA, Cooper C

Abstract
PURPOSE: Amid a political agenda for patient-centred healthcare, shared decision-making is reported to substantially improve patient experience, adherence to treatment and health outcomes. However, observational studies have shown that shared decision-making is rarely implemented in practice. The purpose of this study was to measure the prevalence of shared decision-making in clinical encounters involving physiotherapists and patients with back pain.
METHOD: Eighty outpatient encounters (comprising 40 h of data) were observed audio-recorded, transcribed verbatim and analysed using the 12-item OPTION scale. The higher the score, the greater is the shared decision-making competency of the clinicians.
RESULTS: The mean OPTION score was 24.0 % (range 10.4-43.8 %).
CONCLUSION: Shared decision-making was under-developed in the observed back pain consultations. Clinicians’ strong desire to treat acted as a barrier to shared decision-making and further work should focus on when and how it can be implemented.

PMID: 24477377 [PubMed – as supplied by publisher]