Comparative Analysis of Two Transforaminal Lumbar Interbody Fusion Techniques: Open TLIF Versus Wiltse MIS TLIF
STUDY DESIGN/METHODS:Retrospective cohort study at a single institution. OBJECTIVE:To analyze the perioperative and postoperative outcomes of patients who underwent open transforaminal lumbar interbody fusion (O-TLIF) and bilateral minimally invasive (MIS) Wiltse approach TLIF (Wil-TLIF). SUMMARY OF BACKGROUND DATA/BACKGROUND:Several studies have compared Open TLIF to MIS TLIF, however, comparing the techniques using a large cohort of one-level TLIFs has not been fully explored. METHODS:We reviewed the charts of patients undergoing a single-level primary posterior lumbar interbody fusion between 2012 and 2017. The cases were categorized as Open TLIF (traditional midline exposure including lateral exposure of transverse processes) or bilateral paramedian Wiltse TLIF approach. Differences between groups were assessed by t-tests. RESULTS:227 patients underwent one-level primary TLIF (116 O-TLIF, 111 Wil-TLIF). There was no difference in age, gender, ASA or BMI between groups. Wil-TLIF had the lowest EBL (197â€ŠmL vs. 499â€ŠmL O-TLIF, pâ€Š=â€Šâ€Š<â€Š.001), LOS (2.7 days vs. 3.6 days O-TLIF, pâ€Š=â€Šâ€Š<â€Š.001), overall complication rate (12% vs. 24% O-TLIF, pâ€Š=â€Š.015), minor complication rate (7% vs. 16% O-TLIF, pâ€Š=â€Š.049), and 90-day readmission rate (1% vs. 8% O-TLIF, pâ€Š=â€Š.012). Wil-TLIF was associated with the higher fluoroscopy time (83â€Šsec vs. vs. 24â€Šsec O-TLIF, pâ€Š=â€Šâ€Š<â€Š.001). There was not a significant difference in operative time, intraoperative or neurological complications, extubation time, reoperation rate, or infection rate. CONCLUSIONS:In comparing Wiltse MIS TLIF to Open TLIF, the minimally invasive paramedian Wiltse approach demonstrated the lowest EBL, LOS, readmission rates and complications, but longer fluoroscopy times when compared to the traditional open approach. LEVEL OF EVIDENCE/METHODS:3.
Impact of presenting patient characteristics on surgical complications and morbidity in early onset scoliosis
This study sought to assess comorbidity profiles unique to early-onset-scoliosis (EOS) patients by employing cluster analytics and to determine the influence of isolated comorbidity clusters on perioperative complications, morbidity and mortality using a high powered administrative database. The KID database was queried for ICD-9 codes pertaining to congenital and idiopathic scoliosis from 2003, 2006, 2009, 2012. Patients <10â€¯y/o (EOS group) were included. Demographics, incidence and comorbidity profiles were assessed. Comorbidity profiles were stratified by body systems (neurological, musculoskeletal, pulmonary, cardiovascular, renal). K-means cluster and descriptive analyses elucidated incidence and comorbidity relationships between frequently co-occurring comorbidities. Binary logistic regression models determined predictors of perioperative complication development, mortality, and extended length-of-stay (â‰¥75th percentile). 25,747 patients were included (Age: 4.34, Female: 52.1%, CCI: 0.64). Incidence was 8.9 per 100,000 annual discharges. 55.2% presented with pulmonary comorbidities, 48.7% musculoskeletal, 43.8% neurological, 18.6% cardiovascular, and 11.9% renal; 38% had concurrent neurological and pulmonary. Top inter-bodysystem clusters: Pulmonary disease (17.2%) with epilepsy (17.8%), pulmonary failure (12.2%), restrictive lung disease (10.5%), or microcephaly and quadriplegia (2.1%). Musculoskeletal comorbidities (48.7%) with renal and cardiovascular comorbidities (8.2%, OR: 7.9 [6.6-9.4], pâ€¯<â€¯0.001). Top intra-bodysystem clusters: Epilepsy (11.7%) with quadriplegia (25.8%) or microcephaly (20.5%). Regression analysis determined neurological and pulmonary clusters to have a higher odds of perioperative complication development (OR: 1.28 [1.19-1.37], pâ€¯<â€¯0.001) and mortality (OR: 2.05 [1.65-2.54], pâ€¯<â€¯0.001). Musculoskeletal with cardiovascular and renal anomalies had higher odds of mortality (OR: 1.72 [1.28-2.29], pâ€¯<â€¯0.001) and extLOS (OR: 2.83 [2.48-3.22], pâ€¯<â€¯0.001). EOS patients with musculoskeletal conditions were 7.9x more likely to have concurrent cardiovascular and renal anomalies. Clustered neurologic and pulmonary anomalies increased mortality risk by as much as 105%. These relationships may benefit pre-operative risk assessment for concurrent anomalies and adverse outcomes. Level of Evidence: III - Retrospective Prognostic Study.
Incidence, trends, and associated risks of developmental hip dysplasia in patients with Early Onset and Adolescent Idiopathic Scoliosis
Introduction/UNASSIGNED:Early Onset and Adolescent Idiopathic Scoliosis, relatively common diagnoses (âˆ¼3% general population), have been associated with developmental dysplasia of the hip (DDH); a more rare spectrum of anomalies related to the abnormal development of acetabulum, proximal femur, and hip joint. To the best of our knowledge, no high powered investigations have been performed in an attempt to assess incidence and associated risks of DDH in scoliosis patients. Methods/UNASSIGNED:The KID database was queried for ICD-9 codes from 2003 to 2012 pertaining to EOS (Congenital and Idiopathic <10y/o) and AIS patients. Descriptive analysis assessed patient demographics and yearly trends in hip dysplasia rates. EOS and AIS patients with hip dysplasia were isolated, and incidence of hospital admissions for associated anomalies (osteonecrosis, osteoarthritis, recurrent hip dislocation, hip ankylosis) and hip arthroplasty (totalÂ +Â partial) were investigated. Univariate analysis of hip pathology determined significant predictors of hip arthroplasty. Binary logistic regression analysis was used to determine the relationship between these predictors. Results/UNASSIGNED:111,827 scoliosis patients (EOS: 25,747; AIS: 77,183) were included. AIS patients were older (15.2 vs 4.3), more female (64.2% vs 52.1%), had a higher CCI (0.84 vs 0.64), and less racially diverse (all pâ€¯<â€¯0.001). The incidence of hip dysplasia was 1.4% for AIS patients and 3.9% for EOS patients (pâ€¯<â€¯0.001). Of the AIS (nâ€¯=â€¯1073) and EOS (nâ€¯=â€¯1005) patients with hip dysplasia, 0.3% (pâ€¯>â€¯0.05 between groups) developed hip osteonecrosis, 0% of patients were coded as having a hip labral tear, hip ankylosis, and 0.6% (EOS: 0.2%; AIS: 0.9%, pâ€¯=â€¯0.025) developed hip osteoarthritis. AIS patients were more likely to have recurrent hip dislocations (35.4% vs 17.0%, pâ€¯<â€¯0.001), and both groups had similar primary hip arthroplasty rates (6.7% vs 5.4%, pâ€¯=â€¯0.118) and revision hip arthroplasty rates (0% vs 0.4%, pâ€¯=â€¯0.053). Hip osteoarthritis (OR: 13.43[5.21-34.66], p=<0.001) and older age (OR: 1.039[1.007-1.073], pâ€¯=â€¯0.017) were the only significant predictors of hip arthroplasty (p=<.001). Conclusions/UNASSIGNED:The incidence of hip dysplasia in EOS and AIS populations is higher than that of the general population. The rate of DDH was 3.9% and 1.8% for EOS and AIS, respectively. While the incidence of DDH is higher, associated anomalies of osteoarthritis, osteonecrosis, labral tears, and ankylosis appear to be a minimal risk for AIS and EOS patients with Hip Dysplasia.
Progressive Infantile Scoliosis Managed With Osteopathic Manipulative Treatment
Does aspirin administration increase perioperative morbidity in patients with cardiac stents undergoing spinal surgery?
STUDY DESIGN: Cohort. OBJECTIVE: To compare the perioperative morbidity of patients with cardiac stents after spine surgery who continue to take aspirin before and after the operation with a similar group of patients who preoperatively discontinued aspirin. SUMMARY OF BACKGROUND DATA: The preoperative discontinuation of anticoagulant therapy has been the standard of care for orthopedic surgical procedures. However, recent literature has demonstrated significant cardiac risk associated with aspirin withdrawal in patients with cardiac stents. Although it has recently been demonstrated that performing orthopedic surgery while continuing low-dose aspirin therapy seems to be safe, studies focused on spinal surgery have not yet been performed. Because of the risk of intraspinal bleeding and the serious consequences of subsequent epidural hematoma with associated spinal cord compression, spinal surgeons have been reluctant to operate on patients taking aspirin. METHODS: This institutional review board-approved study included 200 patients. Preoperative parameters and postoperative outcome measures were analyzed for 100 patients who underwent spinal surgery after the discontinuation of anticoagulation therapy and 100 patients who continued to take daily aspirin through the perioperative period. The primary outcome measure was serious bleeding-related postoperative complications such as spinal epidural hematoma. The operative time, intraoperative estimated blood loss, hospital length of stay, transfusion of blood products, and 30-day hospital readmission rates were also recorded and compared. RESULTS: The patients who continued taking aspirin in the perioperative period had a shorter hospital length of stay on average (4.1 +/- 2.7 vs. 6.2 +/- 5.8; P < 0.005), as well as a reduced operative time (210 +/- 136 vs. 266 +/- 143; P < 0.01), whereas there was no significant difference in the estimated blood loss (642 +/- 905 vs. 697 +/- 1187), the amount of blood products transfused, overall intra- and postoperative complication rate (8% vs. 11%), or 30-day hospital readmission rate (5% vs. 5%). No clinically significant spinal epidural hematomas were observed in either of the study groups. CONCLUSION: The current study has observed no appreciable increase in bleeding-related complication rates in patients with cardiac stents undergoing spine surgery while continuing to take aspirin compared with patients who discontinued aspirin prior to surgery. Although very large studies will be needed to determine whether aspirin administration results in a small complication rate increase, the current study provides evidence that perioperative aspirin therapy is relatively safe in patients undergoing spinal surgery. LEVEL OF EVIDENCE: 2.
Feasibility of a Cost-Effective, Video Analysis Software-Based Mobility Protocol for Objective Spine Kinematics and Gait Metrics: A Proof of Concept Study
The purpose of this study was to investigate the potential of a high-throughput, easily implemented, cost-effective, video analysis software-based mobility protocol to quantify spine kinematics. This prospective cohort study of clinical biomechanics implemented 2-dimensional (2D) image processing at a tertiary-care academic institution. Ten healthy, able-bodied volunteers were recruited for 2D videography of gait and functional motion. The reliability of a 2D video analysis software program for gait and range of motion metrics was evaluated over 2 independent experimental sessions, assessing for inter-trial, inter-session, and inter-rater reliability. Healthy volunteers were evaluated for simple forward and side bending, rotation, treadmill stride length, and more complex seated-to-standing tasks. Based on established intraclass correlation coefficients, results indicated that reliability was considered good to excellent for simple forward and side bending, rotation, stride length, and more complex sit-to-standing tasks. In conclusion, a cost-effective, 2D, video analysis software-based mobility protocol represents a feasible and clinically useful approach for objective spine kinematics and gait metrics. As the complication rate of operative management in the setting of spinal deformity is weighed against functional performance and quality of life measures, an objective analysis tool in combination with an appropriate protocol will aid in clinical assessments and lead to an increased evidence base for management options and decision algorithms.
New Delhi : Jaypee Brothers Medical Publishers, 2015
Basic science of degenerative disk disease
New Delhi : Jaypee Brothers, 2015
Overview of spinal deformity surgery
New Delhi : Jaypee Brothers, 2015
Level of play: Return to sports following surgery for adolescent idiopathic scoliosis [Meeting Abstract]
BACKGROUND CONTEXT: Adolescent idiopathic scoliosis (AIS) is largely an asymptomatic condition with little impact on function in a young, active population. Little is known about the level of activity of the postoperative AIS patient other than from non-descriptive patient outcome questionnaires. PURPOSE: The purpose of this study was to assess return to sports participation in operatively treated AIS patients. STUDY DESIGN/SETTING: Retrospective questionnaires were administered to consecutively enrolled operative AIS patients. PATIENT SAMPLE: Operative AIS patients. OUTCOME MEASURES: Intensity and time spent in the sport after surgery for AIS. METHODS: A retrospective study of consecutive operative AIS patients presenting for their 1- or 2-year postoperative visits and who were engaged in a sport or dance regularly before surgery were administered the SRS-22, Activity Questionnaire for Adults and Adolescents (AQuAA) and a customized questionnaire on return to sport. The intensity and time spent in the sport were compared pre- and postsurgery using Wilcoxon signed-rank tests. RESULTS: 38 patients were enrolled (age 14.2 yrs; 84.2% female; 36 PSF, 2 combined approaches; levels fused 9.5; mean FU 1.5 yrs). 36/38 (94.7%) returned to their sports after surgery. Median times to begin training after surgery was 3-6 months and to fully return to sport was 6-12 months. Among these 36 patients, 29 (80.6%) were able to return to their previous or a higher level of competition. Nine (25%) patients had reduced intensity of participating sport (p=0.0005). Most frequently played sports after surgery were: in Contact category Football (5.3%), in Light Contact category: Baseball/Softball (23.7%), Soccer (15.8%) and Volleyball (15.8%); in Noncontact category: Swimming/Diving (26.3%), Dance (23.7%) and Track & Field (13.2%); and in Recreational category: Running/Jogging (44.7%), Swimming (noncompetitive, 28.9%) and Strength training (23.7%) (please note that patients may participate in multiple sports within and!