The spine journal : official journal of the North American Spine Society
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The patient experience of care as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is currently used to determine hospital reimbursement. The current literature inconsistently demonstrates an association between patient satisfaction and surgical outcomes. ⋯ Top-box OHR was not associated with pre- to 1-year postoperative improvement in EQ-5D, PDQ, and VAS-BP. Although the associations between high satisfaction and improvement in health status did not reach statistical significance, the best estimates from our multivariable models reflect greater clinical improvement with top-box satisfaction. Future studies should seek to investigate whether HCAHPS are a reliable indicator of quality care in lumbar spine surgery.
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Brace treatment for adolescent idiopathic scoliosis (AIS) is generally prescribed for 18-23 hours per day, but the minimal time of brace wear per day to stop progression of AIS is still unclear. Compliance of patients with AIS with brace treatment is reported to be between 27% and 47% of the prescribed time, brace wear especially at school is often described as embarrassing by adolescent patients. It has been reported that a higher rate of compliance leads to a significantly lower rate of curve progression. Theoretically, prescribing brace treatment 16 hours instead of 23 hours per day (patients are allowed to attend school free of their brace) could lead to a higher rate of compliance, and subsequently reduce progression rate of patients with AIS. ⋯ Twelve to 16 hours of brace wear per day did not lead to a higher progression rate of AIS compared with more than 16 hours in our study group. Our analysis showed that smoking status of parents possibly contributes to the risk of developing AIS; however, we did not find an impact on progression of scoliosis.
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Perioperative neurologic complications after spine surgery may increase morbidity and health-care costs related to the procedure. ⋯ The incidence rate of perioperative neurologic deficits associated with elective spine surgery documented in the NIS has increased over the time period from 1999 to 2011. The number of elective spine procedures performed has also increased over the same time period. Finally, outcomes data indicate that occurrence of perioperative neurologic complications is associated with increased rates of morbidity and mortality, as well as increased health-care use and cost. These trends indicate that the perioperative neurologic complications following spine surgery represent a growing problem in today's health-care system; further study is warranted to prevent and treat these complications to improve patient care and reduce health-care use and cost.
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Patients with degenerative lumbar stenosis (DLS) adopt a forward flexed posture in an attempt to decompress neural elements. The relationship between sagittal alignment and severity of lumbar stenosis has not previously been studied. ⋯ Severity of central lumbar stenosis as graded on MRI correlates with severity of sagittal malalignment. These findings support theories of sagittal malalignment as a compensatory mechanism for central lumbar stenosis.
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Randomized Controlled Trial Multicenter Study
Total disc replacement versus multidisciplinary rehabilitation in patients with chronic low back pain and degenerative discs: 8-year follow-up of a randomized controlled multicenter trial.
Lumbar total disc replacement (TDR) is a treatment option for selected patients with chronic low back pain (LBP) that is non-responsive to conservative treatment. The long-term results of disc replacement compared with multidisciplinary rehabilitation (MDR) have not been reported previously. ⋯ Substantial long-term improvement can be expected after both disc replacement and MDR. The difference between groups is statistically significant in favor of surgery, but smaller than the prespecified clinically important difference of 10 ODI points that the study was designed to detect. Future research should aim to improve selection criteria for disc replacement and MDR.