The spine journal : official journal of the North American Spine Society
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Effective postoperative pain management in patients undergoing elective spinal fusion surgery has been associated with shorter hospital stays, reduced rates of hospital readmissions due to pain, and decreased cost of care. Furthermore, preoperative multimodal analgesia regimens have been shown to decrease postoperative subjective pain measurements and narcotic consumption in patients undergoing spinal fusion and total arthroplasty surgeries. ⋯ This study demonstrates that administering a selective COX-2 inhibitor and GABA-analogue preoperatively can significantly decrease 24-hour postoperative opioid consumption, VAS pain scores, and elapsed time to postoperative mobility in patients undergoing elective spine fusion surgery of ≤5 levels. Optimal standardized dosing and drug combination for preoperative multimodal analgesia remains to be elucidated.
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Multicenter Study
Development of machine learning algorithms for prediction of prolonged opioid prescription after surgery for lumbar disc herniation.
Spine surgery has been identified as a risk factor for prolonged postoperative opioid use. Preoperative prediction of opioid use could improve risk stratification, shared decision-making, and patient counseling before surgery. ⋯ Overall, 5,413 patients were identified, with sustained postoperative opioid prescription of 416 (7.7%) at 90 to 180 days after surgery. The elastic-net penalized logistic regression model had the best discrimination (c-statistic 0.81) and good calibration and overall performance; the three most important predictors were: instrumentation, duration of preoperative opioid prescription, and comorbidity of depression. The final models were incorporated into an open access web application able to provide predictions as well as patient-specific explanations of the results generated by the algorithms. The application can be found here: https://sorg-apps.shinyapps.io/lumbardiscopioid/ CONCLUSION: Preoperative prediction of prolonged postoperative opioid prescription can help identify candidates for increased surveillance after surgery. Patient-centered explanations of predictions can enhance both shared decision-making and quality of care.
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Society increasingly asks Medicine to create "value" for patients. As health-care costs rise, this question will become more important. Debate exists regarding the relative "value" of many surgical procedures, including spinal surgery. Comparison of the relative value that patients experience after different orthopedic procedures is theoretical, but informs the ongoing debate. ⋯ Based upon PROMIS assessments at short-term follow-up, DSC patients receive a larger benefit from surgery than ACLR despite the overall less desirable postoperative PROMIS scores in the DSC cohort. This result, while theoretical, informs the debate regarding the comparative value of DSC to patients.
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Polymethylmethacrylate (PMMA) is the most commonly used filling material when performing percutaneous kyphoplasty (PKP) for the treatment of osteoporotic vertebral compression fractures. However, there are some inherent and unavoidable drawbacks with the clinical use of PMMA. PMMA bone cement tends to leak during injection, which can lead to injury of the spinal nerves and spinal cord. Moreover, the mechanical strength of PMMA-augmented vertebral bodies is extraordinary and this high level of mechanical strength might predispose to adjacent vertebral fractures. A novel biodegradable calcium phosphate-based nanocomposite (CPN) for PKP augmentation has recently been developed to potentially avoid these issues. ⋯ Biodegradable CPN is a potential alternative to PMMA cement in PKP surgery, in which CPN is likely to reduce the cement leakage during the surgery and avoid the post-surgery complications caused by excessive strengths and nondegradability of PMMA cement.
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The potential for osseointegration to provide biological fixation for implants may be related to anatomical site and loading conditions. ⋯ Anatomical site, surgical preparation, biomechanical loading, and graft material play an important role in in vivo response. Bone ingrowth in long bone cortical and cancellous sites does not translate directly to interbody fusions.