Aims. The escalating demand for medical resources to address spinal diseases as society ages is an issue that requires careful evaluation. However, few studies have examined trends in spinal surgery, especially unscheduled hospitalizations or surgeries performed after hours, through large databases. Our study aimed to determine national trends in the number of spine surgeries in Japan. We also aimed to identify trends in after-hours surgeries and unscheduled hospitalizations and their impact on complications and costs. Methods. We retrospectively investigated data extracted from the Diagnosis Procedure Combination database, a representative
Aims. With resumption of elective spine surgery services in the UK following the first wave of the COVID-19 pandemic, we conducted a multicentre British Association of Spine Surgeons (BASS) collaborative study to examine the complications and deaths due to COVID-19 at the recovery phase of the pandemic. The aim was to analyze the safety of elective spinal surgery during the pandemic. Methods. A prospective observational study was conducted from eight spinal centres for the first month of operating following restoration of elective spine surgery in each individual unit. Primary outcome measure was the 30-day postoperative COVID-19 infection rate. Secondary outcomes analyzed were the 30-day mortality rate, surgical adverse events, medical complications, and length of
People with severe, persistent low back pain (LBP) may be offered lumbar spine fusion surgery if they have had insufficient benefit from recommended non-surgical treatments. However, National Institute for Health and Care Excellence (NICE) 2016 guidelines recommended not offering spinal fusion surgery for adults with LBP, except as part of a randomized clinical trial. This survey aims to describe UK clinicians’ views about the suitability of patients for such a future trial, along with their views regarding equipoise for randomizing patients in a future clinical trial comparing lumbar spine fusion surgery to best conservative care (BCC; the FORENSIC-UK trial). An online cross-sectional survey was piloted by the multidisciplinary research team, then shared with clinical professional groups in the UK who are involved in the management of adults with severe, persistent LBP. The survey had seven sections that covered the demographic details of the clinician, five hypothetical case vignettes of patients with varying presentations, a series of questions regarding the preferred management, and whether or not each clinician would be willing to recruit the example patients into future clinical trials.Aims
Methods
Historically, patients undergoing surgery for adolescent idiopathic scoliosis (AIS) have been nursed postoperatively in a critical care (CC) setting because of the challenges posed by prone positioning, extensive exposures, prolonged operating times, significant blood loss, major intraoperative fluid shifts, cardiopulmonary complications, and difficulty in postoperative pain management. The primary aim of this paper was to determine whether a scoring system, which uses Cobb angle, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and number of levels to be fused, is a valid method of predicting the need for postoperative critical care in AIS patients who are to undergo scoliosis correction with posterior spinal fusion (PSF). We retrospectively reviewed all AIS patients who had undergone PSF between January 2018 and January 2020 in a specialist tertiary spinal referral centre. All patients were assessed preoperatively in an anaesthetic clinic. Postoperative care was defined as ward-based (WB) or critical care (CC)Aims
Methods
Psychoeducative prehabilitation to optimize surgical outcomes is relatively novel in spinal fusion surgery and, like most rehabilitation treatments, they are rarely well specified. Spinal fusion patients experience anxieties perioperatively about pain and immobility, which might prolong hospital length of stay (LOS). The aim of this prospective cohort study was to determine if a Preoperative Spinal Education (POSE) programme, specified using the Rehabilitation Treatment Specification System (RTSS) and designed to normalize expectations and reduce anxieties, was safe and reduced LOS. POSE was offered to 150 prospective patients over ten months (December 2018 to November 2019) Some chose to attend (Attend-POSE) and some did not attend (DNA-POSE). A third independent retrospective group of 150 patients (mean age 57.9 years (SD 14.8), 50.6% female) received surgery prior to POSE (pre-POSE). POSE consisted of an in-person 60-minute education with accompanying literature, specified using the RTSS as psychoeducative treatment components designed to optimize cognitive/affective representations of thoughts/feelings, and normalize anxieties about surgery and its aftermath. Across-group age, sex, median LOS, perioperative complications, and readmission rates were assessed using appropriate statistical tests.Aims
Methods
Increasing numbers of posterior lumbar fusions
are being performed. The purpose of this study was to identify trends
in demographics, mortality and major complications in patients undergoing
primary posterior lumbar fusion. We accessed data collected for
the Nationwide
The aim of this study was to identify the risk factors for adverse events following the surgical correction of cervical spinal deformities in adults. We identified adult patients who underwent corrective cervical spinal surgery between 1 January 2007 and 31 December 2015 from the MarketScan database. The baseline comorbidities and characteristics of the operation were recorded. Adverse events were defined as the development of a complication, an unanticipated deleterious postoperative event, or further surgery. Patients aged < 18 years and those with a previous history of tumour or trauma were excluded from the study.Aims
Methods
The National
We have assessed the influence of somatisation on the outcome of treatment in 81 patients with chronic low back pain. All, irrespective of whether treatment was surgical or conservative, had a significantly better (p <
0.001) health-related quality of life at follow-up on all but one scale of the SF-36. Lower health-related quality of life at follow-up correlated significantly with a higher tendency to somatise before treatment and at follow-up. A logistic regression analysis yielded two factors which predicted the outcome; somatisation (p <
0.001) and ‘doctor shopping’ (the number of physicians consulted before the present
HIV predisposes patients to opportunistic infections. However, with the establishment of Highly Active Anti-Retroviral Therapy (HAART), patients’ CD4 counts are maintained, as is a near normal life expectancy. This study aimed to establish the impact of HIV on the bacteriology of spondylodiscitis in a region in which tuberculosis (TB) is endemic, and to identify factors that might distinguish between them. Between January 2014 and December 2015, 63 consecutive cases of spontaneous spondylodiscitis were identified from a single-centre, prospectively maintained database. Demographics, presenting symptoms, blood results, HIV status, bacteriology, imaging, and procedure undertaken were reviewed and comparisons made of TB, non-TB, and HIV groups. There were 63 patients (22 male, 41 female) with a mean age of 42.0 years (11 to 78; Aims
Patients and Methods
There is little information about the optimum number of implants
to be used in the surgical treatment of idiopathic scoliosis. Retrospective
analysis of prospectively collected data from the Swedish spine
register was undertaken to discover whether more implants per operated
vertebra (implant density) leads to a better outcome in the treatment of
idiopathic scoliosis. The hypothesis was that implant density is
not associated with patient-reported outcomes, the correction of
the curve or the rate of reoperation. A total of 328 patients with idiopathic scoliosis, aged between
ten and 20 years at the time of surgery, were identified in the
Swedish spine register (Swespine) and had patient reported outcomes
including the Scoliosis Research Society 22r instrument (SRS-22r)
score, EuroQol 5 dimensions quality of life, 3 level (EQ-5D-3L)
score and a Viual Analogue Score (VAS) for back pain, at a mean
follow-up of 3.1 years and reoperation data at a mean follow-up
of 5.5 years. Implant data and the correction of the curve were
assessed from radiographs, preoperatively and a mean of 1.9 years
postoperatively. The patients were divided into tertiles based on
implant density. Data were analyzed with analysis of variance, logistic
regression or log-rank test. Some analyses were adjusted for gender,
age at the time of surgery, the flexibility of the major curve and
follow-up.Aims
Patients and Methods
The aim of this study was to determine whether the sequential
application of povidone iodine-alcohol (PVI) followed by chlorhexidine
gluconate-alcohol (CHG) would reduce surgical wound contamination
to a greater extent than PVI applied twice in patients undergoing
spinal surgery. A single-centre, interventional, two arm, parallel group randomised
controlled trial was undertaken, involving 407 patients who underwent
elective spinal surgery. For 203 patients, the skin was disinfected before surgery using
PVI (10% [w/w (1% w/w available iodine)] in 95% industrial denatured
alcohol, povidone iodine; Videne Alcoholic Tincture) twice, and
for 204 patients using PVI once followed by CHG (2% [w/v] chlorhexidine
gluconate in 70% [v/v] isopropyl alcohol; Chloraprep with tint).
The primary outcome measure was contamination of the wound determined
by aerobic and anaerobic bacterial growth from samples taken after
disinfection.Aims
Patients and Methods
Using the United States Nationwide Inpatient
Sample, we identified national trends in revision spinal fusion
along with a comprehensive comparison of comorbidities, inpatient
complications and surgical factors of revision spinal fusion compared
to primary spinal fusion. In 2009, there were 410 158 primary spinal fusion discharges
and 22 128 revision spinal fusion discharges. Between 2002 and 2009,
primary fusion increased at a higher rate compared with revision
fusion (56.4% In the multivariable logistic regression model for all spinal
fusions, depression (odds ratio (OR) 1.53, p <
0.001), psychotic
disorders (OR 1.49, p <
0.001), deficiency anaemias (OR 1.35,
p <
0.001) and smoking (OR 1.10, p = 0.006) had a greater chance
of occurrence in revision spinal fusion discharges than in primary
fusion discharges, adjusting for other variables. In terms of complications,
after adjusting for all significant comorbidities, this study found
that dural tears (OR 1.41; p <
0.001) and surgical site infections
(OR 3.40; p <
0.001) had a greater chance of occurrence in revision
spinal fusion discharges than in primary fusion discharges (p <
0.001). A p-value <
0.01 was considered significant in all final
analyses. Cite this article:
The demand for spinal surgery and its costs have
both risen over the past decade. In 2008 the aggregate hospital
bill for surgical care of all spinal procedures was reported to
be $33.9 billion. One key driver of rising costs is spinal implants.
In 2011 our institution implemented a cost containment programme
for spinal implants which was designed to reduce the prices of individual
spinal implants and to reduce the inter-surgeon variation in implant costs.
Between February 2012 and January 2013, our spinal surgeons performed
1493 spinal procedures using implants from eight different vendors.
By applying market analysis and implant cost data from the previous
year, we established references prices for each individual type
of spinal implant, regardless of vendor, who were required to meet
these unit prices. We found that despite the complexity of spinal
surgery and the initial reluctance of vendors to reduce prices,
significant savings were made to the medical centre. Cite this article: 2015; 97-B:1102–5.
This study examined spinal fractures in patients
admitted to a Major Trauma Centre via two independent pathways,
a major trauma (MT) pathway and a standard unscheduled non-major
trauma (NMT) pathway. A total of 134 patients were admitted with
a spinal fracture over a period of two years; 50% of patients were
MT and the remainder NMT. MT patients were predominantly male, had
a mean age of 48.8 years (13 to 95), commonly underwent surgery
(62.7%), characteristically had fractures in the cervico-thoracic
and thoracic regions and 50% had fractures of more than one vertebrae,
which were radiologically unstable in 70%. By contrast, NMT patients
showed an equal gender distribution, were older (mean 58.1 years;
12 to 94), required fewer operations (56.7%), characteristically
had fractures in the lumbar region and had fewer multiple and unstable
fractures. This level of complexity was reflected in the length
of stay in hospital; MT patients receiving surgery were in hospital
for a mean of three to four days longer than NMT patients. These
results show that MT patients differ from their NMT counterparts
and have an increasing complexity of spinal injury. Cite this article:
Whether to combine spinal decompression with
fusion in patients with symptomatic lumbar spinal stenosis remains
controversial. We performed a cohort study to determine the effect
of the addition of fusion in terms of patient satisfaction after
decompressive spinal surgery in patients with and without a degenerative spondylolisthesis. The National Swedish Register for Spine Surgery (Swespine) was
used for the study. Data were obtained for all patients in the register
who underwent surgery for stenosis on one or two adjacent lumbar
levels. A total of 5390 patients fulfilled the inclusion criteria
and completed a two-year follow-up. Using multivariable models the
results of 4259 patients who underwent decompression alone were
compared with those of 1131 who underwent decompression and fusion.
The consequence of having an associated spondylolisthesis in the
operated segments pre-operatively was also considered. At two years there was no significant difference in patient satisfaction
between the two treatment groups for any of the outcome measures,
regardless of the presence of a pre-operative spondylolisthesis.
Moreover, the proportion of patients who required subsequent further
lumbar surgery was also similar in the two groups. In this large cohort the addition of fusion to decompression
was not associated with an improved outcome. Cite this article:
We compared a group of 46 somatised patients with a control group of 41 non-somatised patients who had undergone elective surgery to the lumbar spine in an attempt to identify pre-operative factors which could predict the outcome. In a prospective single-centre study, the Distress and Risk Assessment method consisting of a modified somatic perception questionnaire and modified Zung depression index was used pre-operatively to identify somatised patients. The type and number of consultations were correlated with functional indicators of outcome, such as the Oswestry disability index and a visual analogue score for pain in the leg after follow-up for six and 12 months. Similar improvements in the Oswestry disability index were found in the somatised and non-somatised groups. Somatised patients who had a good outcome on the Oswestry disability index had an increased number of orthopaedic consultations (50 of 83 patients (60%) vs 29 of 73 patients (39.7%); p = 0.16) and waited less time for their surgery (5.5 months) (
We investigated the pre-operative and one-year post-operative health-related quality of life (HRQOL) outcome by using a Euroqol (EQ-5D) questionnaire in 263 patients who had undergone surgery for herniation of a lumbar disc. Data from the National Swedish Register for lumbar spinal surgery between 2001 and 2002 were used and, in addition, a comparison between our cohort and a Swedish EQ-5D population survey was performed. We analysed the pre- and post-operative quality of life data, age, gender, smoking habits, pain and walking capacity. The mean age of the patients was 42 years (20 to 66); 155 (59%) were men and 69 (26%) smoked. Pre-operatively, 72 (17%) could walk at least 1 km compared with 200 (76%) postoperatively. The mean EQ-5D score improved from 0.29 to 0.70, and the HRQOL improved in 195 (74%) of the patients. The pre-operative score did not influence the post-operative score. In most patients, all five EQ-5D dimensions improved, but did not reach the level reported by an age- and gender-matched population sample (mean difference 0.17). Predictors for poor outcome were smoking, a short pre-operative walking distance, and a long history of back pain.