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2013년 11월 30일 토요일

Does smoking have an impact on fusion rate in single-level anterior cervical discectomy and fusion with allograft and rigid plate fixation?

Brief review

이 논문은 단일분절에 전방경유 경추 절제 및 유합술(ACDF)를 시행한 환자들을 대상으로 흡연여부가 유합률에 영향을 주는가에 대해 연구한 내용 입니다.

단일 분절에 ACDF를 시행한 환자 573(흡연자156+비 흡연자417)의 데이터를 분석하여 수술시점으로부터 2년이 지난 후, 방사선학적 측정을 통해 유합률을 조사하였습니다
.
결과적으로 본 연구의 대상이 된 흡연, 비 흡연 환자들 간의 유합률에는 통계적으로 유의한 차이가 없다고 합니다. (p=0.867)



*Title: Does smoking have an impact on fusion rate in single-level anterior cervical discectomy and fusion with allograft and rigid plate fixation?
흡연이 동종골과 금속판 고정을 동반한 전방경유 경추 절제 및 유합술에서 유합률에 영향을 미치는가?

*Authors: Myles Luszczyk, Justin S. Smith, Jeffrey S. Fischgrund, Steven C. Ludwig, Rick C. Sasso, Christop her I. Shaffrey, Alexander R. Vaccaro




Object
Effect of smoking on fusion rates of the cervical and lumbar spine
: -In multilevel fusions: shown to negatively affect. (in cervical and lumbar)
-In single-level anterior cervical discectomy and fusion(ACDF): has yet to investigated.

Purpose: To address the effect of smoking on fusion rates in patients undergoing a 1-level ACDF with allograft and a locked anterior cervical plate.


Methods
Subject: patients underwent a 1-level ACDF with allograft and a locked cervical plate.

Subject number: 573 patients(156 smokers + 417 nonsmokers)

follow-up period: 24 months

Evaluation method: assessed radiographic evidence (lateral, neutral, and flexion/extension)

-The authors reviewed subject patients data.


Results
Overall fusion rate: 91.4% (all patients)

Solid fusion:
- nonsmokers: 382 patients (91.6%)
- smokers: 142 (91.0%)
-->No difference in the union rates between smokers and nonsmokers.(p=0.867)


Conclusions
Not significantly different in fusion status between smokers and nonsmokers who underwent a single-level ACDF with allograft and a locked anterior cervical plate.

2013년 11월 25일 월요일

Interspinous spacers compared with decompression or fusion for lumbar stenosis: complications and repeat operations in the medicare population

Brief review



*Title: Interspinous spacers compared with decompression or fusion for lumbar stenosis: complications and repeat operations in the medicare population.

*Author: Richard A. Deyo, Brook I. Martin, Alex Ching, Anna N. A. Tosteson, Jeffrey G. Jarvik, William Kreuter, Sohail K. Mirza.




STUDY DESIGN
Retrospective cohort analysis of Medicare claims for 2006-2009.


OBJECTIVE
To examine whether interspinous distraction procedures are 1)used selectively in patients with more advanced age or comorbidity.
2)associated with fewer complications, lower costs, and less revision surgery than laminectomy or fusion surgery.


SUMMARY OF BACKGROUND DATA
There are few population-based data evaluating patterns of interspinous spacer surgery and nonsurgical care.


METHODS
Medicare inpatient claims data divided into 4 groups. (with stenosis undergoing surgery, n = 99,084)
(1) interspinous process spacer alone
(2) laminectomy and a spacer
(3) decompression alone
(4) lumbar fusion (1-2 level)

-To compare age and comorbidity, cost of surgery, rates of revision surgery, major medical complications, wound complications, mortality, and 30-day readmission rates.


RESULTS
Age: received spacers > decompression or fusion
Comorbidity: received spacers > decompression or fusion
Complications (major medical): spacer alone < decompression or fusion surgery
Hospital payments: fusion procedures > spacer surgery > decompression alone
-These associations persisted in multivariate models adjusting for patient age, sex, comorbidity score, and previous hospitalization.


CONCLUSION

Interspinous distraction procedures fewer complications, higher rates of revision surgery to compared with decompression or fusion.

2013년 11월 19일 화요일

Percutaneous interspinous spacer versus open decompression: a 2-year follow-up of clinical outcome and quality of life.

Brief review

이 논문은 척추의 극돌기 사이에 spacer라고 하는 확장기를 삽입하는 수술과 기존의 개복을 통한 감압수술(요추3-4번 혹은 요추 4-5)을 받은 45명의 환자를 대상으로 각각 2년간의 추적조사를 통해 임상적 결과와 삶의 질을 비교하는 내용 입니다
수술 후의 삶의 질, 일상생활 가능 정도, 보행거리 등을 평가하였으며 2년간 대상 환자들을 추적조사한 결과, 극돌기간 확장기 삽입술을 시행한 환자들에 비해 개복 감압술을 시행한 환자들이 모든 평가항목에서 우수한 결과를 보였습니다.



*Title: Percutaneous interspinous spacer versus open decompression: a 2-year follow-up of clinical outcome and quality of life.
극돌기간 경피적 확장기 삽입술 대 개복 감압술: 2년간의 임상적 결과와 삶의 질 추적조사

*Author: Beyer F, Yagdiran A, Neu P, Kaulhausen T, Eysel P, Sobottke R.




PURPOSE
-To compares the effectiveness of Percutaneous interspinous stand-alone spacers and open decompressive surgery.

-To determine the validity of using percutaneous interspinous spacer.



METHODS
Study type: Open prospective non-randomized study

Inclusion criteria: symptomatic lumbar stenosis between L3 and L5
Exclusion criteria: undergone previous surgery at the investigated level

Subject number: 45 patients

Divided 2 groups
-Group 1: underwent percutaneous interspinous stand-alone spacers (n = 12)
-Group 2: underwent bilateral open microsurgical decompression (n = 33)

Evaluation parameter:
1. patient data (using “Spine Tango” register; data collecting system)
2. operative report (contains disease, surgery information, complications)
3. Core Outcome Measures Index (COMI)**
4. SF-36 :Physical Component Summaries(PCS)**, Mental Momponent Summaries(MCS)**
5. Oswestry Disability Index (ODI)
6. Visual Analog Scale (VAS)
7. walking distance

Follow-up time: 6 weeks, 3, 6, 9, 12, 24 months post-surgery



RESULTS (after 2 yrs)
Revision -In group1: 5patients required implant removal and open decompression
                - In group2: none

Blood loss: group1<500ml
          500ml<group2<1000ml

Average speed of walking tolerance: 1.5km/h (improved for both groups)

Clinical outcome(VAS, ODI): group 1<group 2

Quality Of Life(SF-36-PCS/MCS): group 1<group 2



CONCLUSION
-Decompression proved superior to percutaneous stand-alone spacer implantation in our two observational cohorts.

-Recommend Interspinous spacer implantation only within randomized controlled trials for the collection of reliable data and conclusions for the spine surgeon.

2013년 11월 17일 일요일

The efficacy of lumbar discectomy and single-level fusion for spondylolisthesis: results from the NeuroPoint-SD registry

Brief review


*Title: The efficacy of lumbar discectomy and single-level fusion for spondylolisthesis: results from the NeuroPoint-SD registry.

*Author: Zoher Ghogawala, Christopher I. Shaffrey, Anthony L. Asher, Robert F. Heary, Tanya Logvinenko, Neil R. Malhotra, Stephen J. Dante, R. John Hurlbert, Andrea F. Douglas, Subu N. Magge, Praveen V. Mumm aneni, Joseph S. Cheng, Justin S. Smith, Michael G. Kaiser, Khalid M. Abbed, Daniel M. Sciubba, Daniel K. Resnick




Object
Purpose:
-To establish a multicenter cooperative research group.
-To demonstrate the feasibility of developing a registry to assess the efficacy of common lumbar spinal procedures.


Methods
Study type: Observational prospective cohort study (13 US academic, community sites)

Subject: Total 160 patients (lumbar disc herniation 125 + spondylolisthesis 35)
-Unselected patients undergoing lumbar discectomy or single-level fusion for spondylolisthesis.

Follow-up time: 1, 3, 6, 12 months after surgery

Evaluation method: SF-36, Oswestry Disability Index (ODI), and visual analog scale (VAS)
-pre&post


Results
-There were 198 enrolled over 1 year.
Median age: 45 yrs (49% female) for lumbar discectomy (n = 148)/
58 yrs (58% female) for lumbar spondylolisthesis (n = 50)

Complications: 12 patients (6.1%)  -At 30 days
(10 patients (6.8%) with disc herniation and 1 (2%) with spondylolisthesis)

Follow-up rate: 88.3% (over 1 yr)

Clinical outcomes(VAS, ODI, SF-36 scores): Both lumbar discectomy and single-level fusion procedures were significant improvements(p ≤ 0.0002).

Return to work: 80% of patients (for 1 yr).


-Flow diagram of the NeuroPoint-SD study showing enrollment and follow-up compliance rates.


Conclusions

-It is feasible to build a national spine registry for the collection of high-quality prospective data to demonstrate the effectiveness of spinal procedures in actual practice.

2013년 11월 14일 목요일

Risk of infection following posterior instrumented lumbar fusion for degenerative spine disease in 817 consecutive cases.

Brief review


이 논문은 퇴행성 척추질환 때문에 후방경유 요추 유합술을 받은 817명의 환자에게 나타난 감염률과 감염에 영향을 끼치는 요소들을 연구한 논문 입니다.
후향적으로 환자의 데이터를 검토하여 감염률을 조사했고, 단계적 다변량 비례 위험 회귀분석법을 통하여 요추감염과 연관성이 있는 요소들을 알아냈습니다.
연구대상인 817명의 환자에 대해서는 감염률이 4.5% 나타났고,  나이, 당뇨지수, 비만도, 이전에 척추수술을 시행했는지의 여부, 재원기간 등의 요소들이 감염에 영향을 끼치는 것으로 나타났습니다.



*Title: Risk of infection following posterior instrumented lumbar fusion for degenerative spine disease in 817 consecutive cases.
퇴행성 척추질환으로 후방경유 요추 유합술을 시행한 817명의 사례에 대한 감염의 위험성

*Author: Kaisorn L. Chaichana, Mohamad Bydon, David R. Santiago-Dieppa, Lee Hwang, Gregory McLoughlin, Daniel M. Sciubb a, Jean-Paul Wolinsky, Ali Bydon, Ziya L. Gokaslan, Timothy Witham




Object
The rate and factors of infection risk remains unclear for Posterior lumbar spinal fusion (for degenerative spine disease)
Purpose: To ascertain the incidence and factors of postoperative spinal infections.


Methods
Period: 1993 ~ 2010
Subject: 817 patients who underwent posterior lumbar fusion for degenerative disease.
-Retrospectively data reviewed.
-To identify the infection factors, using Stepwise multivariate proportional hazards regression analysis.


Results
1. Infection rate: 4.5%
(37 patients out of 817 patients developed postoperative spine infection at a median of 0.6 months (IQR 0.3-0.9) ).

2. Infection factors
1. age (RR 1.004 [95% CI 1.001-1.009], p = 0.049)
2. diabetes (RR 5.583 [95% CI 1.322-19.737], p = 0.02)
3. obesity (RR 6.216 [95% CI 1.832-9.338], p = 0.005)
4. previous spine surgery (RR 2.994 [95% CI 1.263-9.346], p = 0.009)
5. duration of hospital stay (RR 1.155 [95% CI 1.076-1.230], p = 0.003).


Conclusions

-Several factors were associated with an risk of infection among patients underwent lumbar fusion for degenerative disease. (factors: older age, diabetes, obesity, prior spine surgery, and length of hospital stay) 

2013년 11월 12일 화요일

Clinical and Radiologic Outcomes of TLIF Applications With or Without Pedicle Screw: A Double Center Prospective Pilot Comparative Study

Brief review


*Title: Clinical and Radiologic Outcomes of TLIF Applications With or Without Pedicle Screw: A Double Center Prospective Pilot Comparative Study
척추경나사 사용 유무에 따른 추간공경유 요추 유합술의 임상적, 방사선학적 결과
: 두 기관의 예비 전향적 비교 연구

*Author: Kadir Kotil, Mustafa Ali Akc¸etin, Yildiray Savas



STUDY DESIGN
Prospective cohort data by merging data from comparative studies.


OBJECTIVE
To compare clinical and radiologic outcomes of the transforaminal lumbar interbody fusion (TLIF) procedure with or without pedicle screw support in stable patients with a degenerative disease.


SUMMARY OF BACKGROUND DATA
-TLIF is routinely performed with the support of pedicle screws.
-Problem: TLIF procedure without pedicle screw support has not yet been reported.


METHODS
Period: 2006.02 ~ 2009.05
Subject: patients underwent decompression and fusion (using TLIF)
-Group A: TLIF with pedicle screw (n=30)
-Group B: TLIF without pedicle screw (n=30)
Mean follow-up period: 31mon
Mean age: 45.5 yrs


RESULTS



group A
group B
Sex ratio (female: male)
19:11
18:12
Pseudoarthrosis (patients)
2
3
Mean operating time (min)
110
73
Mean blood loss (mL)
410
220
Cage loosening (patients)
0
1
sciatic pain
4
1

-VAS, ODI (after 1months):  A > B (P<0.005)
                 (after 3 months): Not significantly differ (P<0.89).

-Cost: A(3-fold higher) > B


CONCLUSIONS
-TLIF procedure without pedicle screw would be sufficient in the management of stable patients with lumbar degenerative disease after single-level decompression.

-And this technique is less costs and complications compared with pedicle screwing.

2013년 11월 11일 월요일

Clinical and radiological outcome of anterior-posterior fusion versus transforaminal lumbar interbody fusion for symptomatic disc degeneration: a retrospective comparative study of 133 patients

Brief review

이 논문은 전-후방 유  유합술 대 추간공경유 요추유합술의 임상적, 방사선학적 결과를 비교한 논문으로, 두 수술을 받은 총 133명의 환자에 대해 차트리뷰와 설문등을 통해 수술 후 환자의 상태를 평가했습니다. 

만족도, 삶의 질 평가점수, 일상생활가능정도는 두 그룹이 비슷하고 수술시간, 재원일수, 출혈량, 수술 중 합병증 률은 전-후방경유 유합술을 받은 환자들이 더 높은 결과를 보여줬습니다. 

 결론부분에서 특이한 점은 없었고 위의 수술 후 결과를 요약한 내용과, 요추 유합술 후의 결과에 영향을 미칠 수 있는 요소들이 매우 많다는 일반적인 사실만 나와있습니다.


*Title: Clinical and radiological outcome of anterior-posterior fusion versus transforaminal lumbar interbody fusion for symptomatic disc degeneration: a retrospective comparative study of 133 patients.
전-후방 유  유합술 대 추간공경유 요추유합술의 임상적, 방사선학적 결과: 133명 환자의 후향적 비교연구.

*Author: Antonio A. Faundez, James D. Schwender, Yair Safriel, Thomas J. Gilbert, Amir A. Mehbod, Francis Denis, Ensor E. Transfeldt, Jill M. Wroblewskia




Background
There are many data compare anterior/posterior spine fusion (APF) and transforaminal lumbar interbody fusion (TLIF).
*Problem: Only few studies from one institution compares the two techniques.


Method
Subject number: 133 patients (68 APF + 65 TLIF)
Inclusion criteria:
-Had symptomatic disc degeneration of the lumbar spine.
-Only those with one or two-level surgeries.
Evaluation method:
1. Clinical chart and radiologic reviews
2. fusion solidity assessed
3. functional outcomes:
·SF-36(pre, post op)
·Oswestry Disability Index (ODI)
·Satisfaction questionnaire

-The minimum follow-up period: 24 months.


Results
1. Operating Time, hospital stay: less in the TLIF group.
2. Blood loss: slightly less in the TLIF group
3. Complications: Intra-operative- higher in the APF group (due to vein lacerations)
    Postoperative- higher in the TLIF group
    (due to graft material extruding against the nerve root or wound drainage)
4. The pseudarthrosis** rate: statistically equal
5. functional outcomes:
-SF-36: signifiicant improvements in both groups.
-Mean ODI scores: 33.5 (APF), 39.5 (TLIF group)
-Satisfaction rate: equal for the two groups.

Conclusion
-There are numerous, distinctive factors influencing results of each spinal fusion approach.




** pseudarthrosis: 위관절 혹은 가관절. -골절부의 뼈가 잘 유합되지 않아 마치 관절처럼 움직이는 상태. 골절 후 골 고정이 잘못 되거나, 골절부가 세균에 감염되었을 때 발생한다.

2013년 11월 6일 수요일

The da Vinci Robotic Surgical Assisted Anterior Lumbar Interbody Fusion: Technical Development and Case Report

Brief review


로봇수술기기인 다빈치를 이용해 전방경유 요추 유합술을 시행한 case에 대한 보고와 기술적 방법에 대한 내용 입니다
기존의 개복수술시보다 다빈치 카메라를 이용했을 때, 다각도로 시야확보가 가능해 디스크 내부공간이나 주변의 구조가 더 잘보여 효과적이라는 결론 입니다.


*Title: The da Vinci Robotic Surgical Assisted Anterior Lumbar Interbody Fusion: Technical Development and Case Report
다빈치 로봇수술기기 유도 하 전방경유요추유합술: 기술적 개발과 증례보고

*Author: William J. Beutler, Walter C. Peppelman, Jr, Luciano A. DiMarco




Study Design
Technique development to use the da Vince Robotic Surgical System for anterior lumbar interbody fusion(ALIF) at L5–S1 is detailed.


Objective
To evaluate and develop the da Vinci robotic assisted laparoscopic anterior lumbar stand-alone interbody fusion procedure.


Summary of Background Data
The da Vinci robot provides intra abdominal dissection and visualization advantages compared with the traditional open and laparoscopic approach.


Methods
-Development the surgical techniques using the da Vinci robot continued to progress with placement of fusion cage in a human cadaver, completed first in the laboratory setting and then in the operating room.

-Finally, the first patient with fusion completed using the da Vinci robot–assisted approach is presented.

Results
-Blood loss: minimal.
-Visualization(inside the disc space & surrounding structures):
Using the da Vinci robot > open and laparoscopic techniques.

Conclusion
The da Vinci robot Surgical System technique is now described for the transperitoneal approach to the anterior lumbar spine.

2013년 11월 4일 월요일

An Institutional Six-year Trend Analysis of the Neurological Outcome After Lateral Lumbar Interbody Fusion: A 6-Year Trend Analysis of a Single Institution.

Brief review


*Title: An Institutional Six-year Trend Analysis of the Neurological Outcome After Lateral Lumbar Interbody Fusion: A 6-Year Trend Analysis of a Single Institution.
측부요추체 유합술 후의 신경학적 결과의 6년간 기관 동향 분석: 단일 기관의 6년간의 동향 분석

*Author: Alexander Aichmair, Marios G. Lykissas, Federico P. Girardi, Andrew A. Sama, Darren R. Lebl, Fadi Taher, Frank P. Cammisa, and Alexander P. Hughes




STUDY DESIGN
Retrospective case series.


OBJECTIVE
To evaluate the proportional trend of neurological deficits after lateral lumbar interbody fusion (LLIF) at a single institution.


SUMMARY OF BACKGROUND DATA
Lumbar nerve roots are prone to iatrogenic damage during the transpsoas approach in LLIF, and postoperative neurological sequelae remain a major concern.


METHODS
Subject number: 451 patients (undergone LLIF)

Period: 2006.03~2012.04

-The electronic medical records and office notes were retrospectively reviewed.
(For reports on postoperative neurological deficits)


RESULTS
>>The number of included patients who underwent LLIF
(mean follow up period: 15.4±9.2 months)
-2006~2008: 47 patients (group A)
-2009~2010: 155 patients (group B)
-2011~2012: 91 patients (group C)


>>Indicate a decreasing proportional trend or postoperative sensory deficits (SDs), motor deficits (MDs), and anterior thigh pain (TP).
-SDs- immediate postoperative: statistically significant in decreasing proportion (P=0.018)
         - last follow-up: close to statistically significant in decreasing proportion (P=0.126)

-TP -immediate postoperative: close to statistically significant in decreasing proportion 
         (P = 0.098)
  -last follow-up: close to statistically significant in decreasing proportion (P = 0.136)


CONCLUSION
The present data indicate a decreasing proportional trend for SDs, MDs, anterior TP
(Institutional learning curve during a 6-year time period of performing LLIF)