The spine journal : official journal of the North American Spine Society
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Comparative Study
Comparison of long-term clinical and radiographic outcomes between alternative-level and all-level fixation unilateral open-door laminoplasty.
Titanium mini-plate has been used in unilateral open-door laminoplasty to maintain the open angle of laminae. Previously, both all-level fixation (C3-C7) and alternative-level (C3, C5, C7) unilateral open-door laminoplasty have been proven to have satisfactory clinical outcomes. However, whether they could achieve similar long-term clinical and radiographic efficacy is still questionable. ⋯ Despite a difference in the maintenance of open angle, both fixation methods achieved satisfactory clinical outcomes. We believe alternative-level fixation is also a safe, effective, and economical fixation method.
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Postoperative C5 palsy is not an uncommon complication in patients who undergo expansive open-door laminoplasty. However, the etiology is unclear and likely multifactorial. Nerve root lesions and spinal cord lesions have been previously proposed theories. ⋯ This study provides clinicians with a more detailed understanding of the anatomic structure and potential mechanism of C5 palsy. Consideration of the meningovertebral ligaments and the intervertebral foramen may provide new directions for reducing the incidence of this complication.
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Recent trends in medicare utilization and reimbursement for anterior cervical discectomy and fusion.
Anterior cervical discectomy and fusion (ACDF) has been considered the gold standard for treating various cervical spine pathologies stemming from cervical degenerative disorders. While cervical artificial disc replacement has emerged as an alternative in select cases, ACDF still remains a commonly performed procedure. ⋯ While ACDF volume and utilization has continued to increase since 2012, Medicare payments to hospitals and surgeons have struggled to keep up with inflation. Our study confirms that Medicare reimbursement per case continues to decrease at a disproportionate rate for surgeons, compared to hospitals. The increasing trend in procedures performed at ambulatory surgical centers shows promise for a future model of cost-efficient and value-based care.
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Reliable estimation of the likelihood for prolonged postoperative opioid use may aid targeted interventions for high-risk patients. Previous studies have recommended differing methodologies for prediction of sustained postoperative opioid use. ⋯ The SOS score clinically outperformed oral MME as a predictive measure for outcomes following lumbar spine surgery. The SOS score may be valuable for identifying individuals at high-risk for sustained prescription opioid use and associated adverse events following spine surgery.
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Many different pain and functional outcomes are used to determine progress after surgical intervention for lumbar spinal stenosis (LSS); it is unknown how these different outcomes correlate, or whether timing of pain measurement is important. ⋯ Our results suggest that for patients with LSS, the context of the pain measurement matters, and it is important to measure pain after walking (provoked pain). Results also suggest that when examining the relationship between pain and function, objective measures of function are preferable (eg, a walking test). Finally, given the lack of association between measures of pain, it is important to understand that each pain measure is addressing a different pain construct. Therefore, when conducting outcomes studies, it is imperative to compare the exact same pain measures across time points.