RESUMO
The most popular approach to treating symptomatic cervical disk disease is anterior cervical discectomy and fusion. Although this procedure has significant long-term clinical success, it is associated with progressive adjacent segment degeneration with an annual incidence of â¼3%. Total disk arthroplasty was designed as an alternative to fusion that could preserve segmental motion at the operative level and potentially delay or prevent adjacent-level breakdown. The etiology of adjacent segment pathology (ASP) is multifactorial, and it is likely that most cases of ASP are unavoidable. When attempting to surgically prevent ASP, it is important to consider nonfusion alternatives, be judicious in one's level selection, and attempt to restore sagittal alignment. When ASP becomes a clinical problem, it is important to have an algorithm for how best to treat it.
Assuntos
Vértebras Cervicais , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Radiculopatia/prevenção & controle , Discotomia/efeitos adversos , Humanos , Complicações Pós-Operatórias/prevenção & controle , Fusão Vertebral/efeitos adversosRESUMO
INTRODUCTION: Postoperative C5 nerve root palsy is a known complication after cervical surgery. The effect of increasing number of levels fused on the prevalence of C5 palsy after anterior cervical diskectomy and fusion (ACDF) is unclear. METHODS: Medical records of ACDF patients that included the C4-5 level at one institution were retrospectively reviewed. C5 palsy was defined as motor decline of the deltoid and/or biceps brachii muscle function by at least 1 level on standard manual muscle testing. RESULTS: A total of 196 patients met the inclusion criteria, with no significant differences noted between groups undergoing single- or multi-level ACDF. The overall C5 palsy rate was 5.1%. Palsy rates were not statistically significant based on the number of levels fused. Six of the 10 patients with C5 palsy had complete recovery of motor strength, whereas 2 patients had at least some level of strength recovery. CONCLUSION: The overall C5 palsy rate was 5.1% for all patients undergoing up to four-level ACDF. The rate of postoperative motor decline was lowest in the patients undergoing two-level ACDF and highest in the single-level group, but this finding did not reach statistical significance. The prognosis for strength recovery by final follow-up is excellent. LEVEL OF EVIDENCE: Level III, Case-control.
Assuntos
Vértebras Cervicais/cirurgia , Discotomia , Paralisia/enzimologia , Complicações Pós-Operatórias/epidemiologia , Fusão Vertebral , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Surgical site infection (SSI) following spine surgery can be devastating for both the patient and the surgeon. It leads to significant morbidity and associated health care costs, from readmissions, reoperations, and subsequent poor clinical outcomes. Complications associated with SSI following spine surgery include pseudarthrosis, neurological deterioration, sepsis, and death. Its management can be very challenging. The diagnosis of SSI involves the interpretation of combined clinical, laboratory, and occasionally radiologic findings. Most infections can be treated with an appropriate course of antibiotics and bracing if required. Surgical intervention is usually reserved for infections resistant to medical management, the need for open biopsy/culture, evolving spinal instability or deformity, and neurologic deficit or deterioration. A thorough knowledge of associated risk factors is required and patients should be stratified for risk preoperatively. The multifaceted approach of risk stratification, early diagnosis and effective treatment, is essential for successful prevention and effective treatment and crucial for a satisfactory outcome.
Assuntos
Vértebras Lombares/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Infecção da Ferida Cirúrgica/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Avaliação da Deficiência , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Infecção da Ferida Cirúrgica/diagnóstico por imagem , CaminhadaRESUMO
STUDY DESIGN: Retrospective cohort. OBJECTIVE: To assess the incidence of and risk factors for delay of elective lumbar fusion surgery, as well as medical and surgical complications associated with surgical delay. SUMMARY OF BACKGROUND DATA: Lumbar fusion is a well-established treatment for patients with degenerative spondylolisthesis with stenosis who have failed conservative management. Rarely, patients admitted for elective lumbar fusion may experience a delay in surgery past the day of admission. The incidence of, and risk factors for, delay of elective lumbar fusion surgery and the complications associated therewith have never been previously evaluated. METHODS: We retrospectively reviewed the ACS-NSQIP registry utilizing Current Procedural Terminology (CPT) codes 22612, 22558, 22630, and 22633 to identify all patients undergoing a single level spinal fusion. The data were then subdivided into cohorts consisting of patients with and without surgical delay. Demographic information, preoperative risk factors for delay, as well as intraoperative and postoperative complications were compared between the groups. RESULTS: We identified 2758 (5.46%) patients as experiencing a delay before lumbar fusion. Multivariate analysis was then performed and identified male sex, American Society of Anesthesiologists classes 3 and 4, and chronic steroid use as risk factors increasing the rate of surgical delay. Multiple complication rates were also significantly higher in the delayed group, including an almost 10-fold increase in mortality rate (0.2% vs. 1.9%, respectively, Pâ<â0.001). CONCLUSION: Delays in elective surgery can affect medical system resource utilization, increasing costs and leading to worse patient outcomes. Patients with chronic steroid use and higher American Society of Anesthesiologists class may be at risk for surgical delay in lumbar fusion beyond the day of admission, and are at increased risk for significant complications postoperatively. Thorough medical evaluation and preoperative optimization may be indicated for these patients. LEVEL OF EVIDENCE: 4.
Assuntos
Procedimentos Cirúrgicos Eletivos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/efeitos adversos , Tempo para o Tratamento , Fatores Etários , Idoso , Procedimentos Cirúrgicos Eletivos/mortalidade , Feminino , Nível de Saúde , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fusão Vertebral/mortalidade , Esteroides/uso terapêutico , Estados Unidos/epidemiologiaRESUMO
To curb the unsustainable rise in health care costs, novel payment models are being explored which focus on value rather than volume. Underlying this reform is an accurate understanding of costs and outcomes. The Patient Protection and Affordable Care Act, the Institute of Medicine, and the Agency for Healthcare Research and Quality have specifically advocated for the use of registries to help define the real-world effectiveness of surgical interventions to help guide health care reform. Registries can help define value by documenting surgical efficacy, and specifically by reporting patient-based outcome measures. Over the past 10 years, several spine registries have been initiated and some others have expanded. These are providing a repository of evidence for surgical value. Herein, we will review the components of a well-designed registry and provide examples of such registries and their impact on health care delivery.
Assuntos
Sistema de Registros , Coluna Vertebral/fisiologia , Bases de Dados como Assunto , Seguimentos , Humanos , Medidas de Resultados Relatados pelo PacienteRESUMO
Traditionally, the success of a researcher has been judged by the number of publications he or she has published in peer-review, indexed, high impact journals. However, to quantify the impact of research in the wider scientific community, a number of traditional metrics have been used, including Impact Factor, SCImago Journal Rank, Eigenfactor Score, and Article Influence Score. This article attempts to provide a broad overview of the main traditional impact metrics that have been used to assess scholarly output and research impact. We determine that there is no perfect all-encompassing metric to measure research impact, and, in the modern era, no single traditional metric is capable of accommodating all facets of research impact. Academics and researchers should be aware of the advantages and limitations of traditional metrics and should be judicious when selecting any metrics for an objective assessment of scholarly output and research impact.
Assuntos
Bibliometria , Pesquisa/normas , Humanos , Fator de Impacto de Revistas , Revisão por ParesRESUMO
The prestige of publication has been based on traditional citation metrics, most commonly journal impact factor. However, the Internet has radically changed the speed, flow, and sharing of medical information. Furthermore, the explosion of social media, along with development of popular professional and scientific websites and blogs, has led to the need for alternative metrics, known as altmetrics, to quantify the wider impact of research. We explore the evolution of current research impact metrics and examine the evolving role of altmetrics in measuring the wider impact of research. We suggest that altmetrics used in research evaluation should be part of an informed peer-review process such as traditional metrics. Moreover, results based on altmetrics must not lead to direct decision making about research, but instead, should be used to assist experts in making decisions. Finally, traditional and alternative metrics should complement, not replace, each other in the peer-review process.
Assuntos
Bibliometria , Pesquisa , Fator de Impacto de RevistasRESUMO
Many of the studies in the spine surgical literature using national databases have been directed at examining adverse events, readmission rates, cost, and risk factors for poorer outcomes. Although such studies allow for assessment of large cohorts taken from multiple institutions, they are limited by data collection methods, short-term follow-up, and minimal assessment of functional outcomes. Furthermore, few studies are directed at producing actionable practice changes to improve patient care. Recent work aimed at producing databases with more relevance to spine surgery represent exciting developments to the rapidly growing field of health outcomes research.
Assuntos
Procedimentos Neurocirúrgicos/efeitos adversos , Readmissão do Paciente , Complicações Pós-Operatórias/etiologia , Doenças da Coluna Vertebral/cirurgia , Bases de Dados Factuais/estatística & dados numéricos , Humanos , Readmissão do Paciente/economia , Fatores de Risco , Doenças da Coluna Vertebral/economiaRESUMO
With the introduction of several publicly available national databases to study surgical outcomes, the use of such databases for spine surgery research has increased dramatically. These databases allow researchers to retrospectively examine data from a large sample of patients. This rise in the use of national databases to study surgical outcomes parallels an increasing reliance by administrators, payers, and third-party graders to evaluate surgical quality with the use of large administrative databases. A good understanding of the most commonly utilized databases for spine surgery is important for critical assessment of this growing body of literature.