OBJECT Previous forceplate studies analyzing the impact of sagittal-plane spinal deformity on pel... more OBJECT Previous forceplate studies analyzing the impact of sagittal-plane spinal deformity on pelvic parameters have demonstrated the compensatory mechanisms of pelvis translation in addition to rotation. However, the mechanisms recruited for this pelvic rotation were not assessed. This study aims to analyze the relationship between spinopelvic and lower-extremity parameters and clarify the role of pelvic translation. METHODS This is a retrospective study of patients with spinal deformity and full-body EOS images. Patients with only stenosis or low-back pain were excluded. Patients were grouped according to T-1 spinopelvic inclination (T1SPi): sagittal forward (forward, > 0.5°), neutral (-6.3° to 0.5°), or backward (< -6.3°). Pelvic translation was quantified by pelvic shift (sagittal offset between the posterosuperior corner of the sacrum and anterior cortex of the distal tibia), hip extension was measured using the sacrofemoral angle (SFA; the angle formed by the middle of t...
METHODS: A total of 168 intact L4-L5 spinal segments (87M/81F, 53.1612.1 yrs) were tested using p... more METHODS: A total of 168 intact L4-L5 spinal segments (87M/81F, 53.1612.1 yrs) were tested using pure moment loading (7.5 Nm) simulating flexion-extension, lateral bending and axial rotation. Axial compression tests (to 300N) were performed on 38 of the specimens. Gender, age and BMI (at time of death) were collected from the donor records provided by local tissue banks and were analyzed with biomechanical parameters using one way-ANOVA, Pearson correlation and multiple regression analyses. RESULTS: Considering the entire population (n5168), there were no statistical differences between all male and all female groups in terms of age or BMD. The mean BMI in the female group was significantly greater than in the male group (p50.005). Further subdivision of groups into BMI!30 (52M/30F) and BMIO30 (30M/42F) did not result in any differences in mean age, BMD or BMI between male and female groups in either BMI category (pO0.1). The segments from the obese (BMIO30) male group were significantly more mobile than those from the non-obese (BMI! 30) male group during axial rotation (p50.018), while there was no difference in the female group (p50.687). There were no differences in mobility between spines from obese and non-obese donors during flexion-extension or lateral bending, for either gender. In the non-obese population, the ROM during axial rotation was significantly greater for the female vs. male group (p50.009). There was no significant difference between gender in the obese population (p50.892). Axial compressive stiffness was significantly greater for the obese population for both the female group and the entire study group (p!0.01); however, the difference was non-significant in the male population (p50.304). Correlation analysis confirmed a significant negative correlation between BMI and resistance to deformation during axial compression in the female group (R5-0.65, p50.004), with no relationship in the male group (R50.03, p50.9). There was a significant negative correlation between ROM during flexion-extension and BMI for the female group (R5-0.38, p50.001), with no relationship in the male group (R50.06, p50.58). CONCLUSIONS: The unknown proportion of symptomatic vs asymptomatic donors in each group is a confounding factor. However, based on flexibility and compression tests, lumbar spinal segments from obese vs non-obese donors seem to behave differently, biomechanically, during axial rotation and compression, with coinciding gender differences. The noted gender differences in the biomechanical behavior at L4-L5 may be related to differences in gait patterns, weight distribution and childbearing.
Preoperative anemia is a well-established risk factor for short-term mortality in patients underg... more Preoperative anemia is a well-established risk factor for short-term mortality in patients undergoing non-cardiac surgery, but appropriate thresholds for transfusion remain uncertain. The objective of this study was to determine long-term outcomes associated with anemia, hemorrhage and red blood cell transfusion in patients undergoing non-cardiac surgery. We performed a long-term follow-up study of consecutive subjects undergoing hip, knee, and spine surgery between November 1, 2008 and December 31, 2009. Clinical data were obtained from administrative and laboratory databases, and retrospective record review. Pre-operative anemia was defined as baseline hemoglobin <13 g/dL for men and <12 g/dL for women. Hemorrhage was defined by ICD-9 coding. Data on long-term survival were queried from the Social Security Death Index (SSDI) database. Logistic regression models were used to identify factors associated with long-term mortality. 3,050 subjects underwent orthopedic surgery. Pre...
The spine journal : official journal of the North American Spine Society, Jan 29, 2015
Numerous studies have demonstrated poorer outcomes in patients with Workers' Compensation (WC... more Numerous studies have demonstrated poorer outcomes in patients with Workers' Compensation (WC) when compared to those without WC following treatment of various of health conditions including spine disorders. It is thus important to consider compensation status when assessing treatment outcomes in spine surgery. However, reported strengths of association have varied significantly (1.31-7.22). The objective of this study was to evaluate the association of unsatisfactory outcomes on compensation status in spine surgery patients. Meta-analysis PATIENT SAMPLE: Not applicable OUTCOME MEASURE: Demographics, type of surgery, country, follow-up time, patient satisfaction, return to work and non-union events. Both prospective and retrospective studies that compared outcomes between compensated and non-compensated patients in spine surgery were included. Two independent investigators extracted outcome data. The meta-analysis was performed using Revman software. Random effects model was use...
Retrospective. . This study assessed the feasibility of combining ODI/NDI into one shorter "... more Retrospective. . This study assessed the feasibility of combining ODI/NDI into one shorter "Total Disability Index" (TDI) from which reconstructed scores could be computed. Oswestry and Neck Disability Index (ODI and NDI) are not pure assessments of disability related to back and neck respectively. Due to similarities/redundancies of questions, ODI scores may be elevated in neck pain patients and the converse is true for NDI in back pain patients. Spine patients completed ODI and NDI, and complaints were recorded as back pain (BP), neck pain (NP) or both (BNP). Questionnaire scores were compared across cohorts via descriptives and Spearman (ρ) correlations. In exploring the feasibility of merging ODI/NDI, TDI was constructed from 9 ODI and 5 NDI items. Extracting questions from TDI, reconstructed 9-item rODI and 10-item rNDI indices were formed and compared with true ODI/NDI. There were 1207 subjects: 741 BP, 134 NP, 268 BNP. Mean ODI: 37 ± 21, and mean NDI: 32 ± 21. Patie...
Retrospective review of a prospectively collected database. This study compares patient demograph... more Retrospective review of a prospectively collected database. This study compares patient demographics, incidence of comorbidities, procedure-related complications, and mortality following primary vs. revision adult spinal deformity surgerySummary of Background Data. While adult spinal deformity (ASD) surgery has been extensively investigated, no previous study has provided nationwide estimates of patient characteristics and procedure-related complications for primary vs. revision spinal deformity surgery comparatively. Nationwide Inpatient Sample data collected between 2001 and 2010 was analyzed. Discharges with procedural codes for anterior and/or posterior thoracic and/or lumbar spinal fusion and refusion were included for patients aged 25+ and 4+ levels fused with any diagnoses specific for scoliosis. Patient demographics, comorbidity and procedure-related complications incidence were determined for primary vs. revision cohorts. Multivariate analysis reported as (OR [95% CI]). Dis...
OBJECT Adult spinal deformity (ASD) surgery is known for its high complication rate. This study e... more OBJECT Adult spinal deformity (ASD) surgery is known for its high complication rate. This study examined the impact of obesity on complication rates, infection, and patient-reported outcomes in patients undergoing surgery for ASD. METHODS This study was a retrospective review of a multicenter prospective database of patients with ASD who were treated surgically. Patients with available 2-year follow-up data were included. Obesity was defined as having a body mass index (BMI) ≥ 30 kg/m(2). Data collected included complications (total, minor, major, implant-related, radiographic, infection, revision surgery, and neurological injury), estimated blood loss (EBL), operating room (OR) time, length of stay (LOS), and patient-reported questionnaires (Oswestry Disability Index [ODI], Short Form-36 [SF-36], and Scoliosis Research Society [SRS]) at baseline and at 6 weeks, 1 year, and 2 years postoperatively. The impact of obesity was studied using multivariate modeling, accounting for confoun...
The Journal of bone and joint surgery. American volume, Jan 17, 2015
Wound drains that are left in place for a prolonged period of time have a higher rate of bacteria... more Wound drains that are left in place for a prolonged period of time have a higher rate of bacterial contamination. Following spinal surgery, a drain is often left in place for a longer period of time if it maintains a high output. Given the major consequences of an infection following spinal surgery and the lack of data with regard to the use of antibiotics and drains, we performed a study of patients with a drain following spinal surgery to compare infection rates between those who were treated with antibiotics for twenty-four hours and those who received antibiotics for the duration for which the drain was in place. We performed a prospective randomized trial of 314 patients who underwent multilevel thoracolumbar spinal surgery followed by use of a postoperative drain. The patients were randomized into two groups, one of which received perioperative antibiotics for twenty-four hours (twenty-four-hour group) and the other of which received antibiotics for the duration that the drain...
Unplanned hospital readmissions result in significant clinical and financial burdens to patients ... more Unplanned hospital readmissions result in significant clinical and financial burdens to patients and the healthcare system. Readmission rates and causes have been investigated using large administrative databases which have certain limitations in data reporting and coding. The objective of this study was to provide a description of 90 day post-discharge readmissions following surgery for common degenerative cervical spine pathologies at a large-volume tertiary hospital. The study also compared the readmission rates of patients who underwent anterior- and posterior-approach procedures. The administrative records from a single-center, high-volume tertiary institution were queried using ICD-9 codes for common cervical pathology over a three year period to determine the rate and causes of readmissions within the 90 days following the index surgery. A total of 768 patients underwent degenerative cervical spine surgery during the three year study period. Within 90 days of discharge, 24 (3.13%) patients were readmitted; 16 (2.06%) readmissions were planned for lumbar surgery; 8 (1.04%) readmissions were unplanned. 640 patients underwent procedures involving an anterior approach and 128 patients underwent procedures involving a posterior approach. There were 14 (2.17%) planned readmissions in the anterior group and 2 (1.5%) in the posterior group. The unplanned readmission rate was 0.63% (4 patients) and 3.13% (4 patients) in the anterior and posterior groups, respectively. (p=0.0343). The 90 day post-discharge unplanned readmission rate that followed elective degenerative cervical spine surgery was 1.04%. The unplanned readmission rate associated with posterior-approach procedures (3.13%) was significantly higher than that of anterior-approach procedures (0.63%). IV.
Myocardial necrosis in the perioperative period of noncardiac surgery is associated with short-te... more Myocardial necrosis in the perioperative period of noncardiac surgery is associated with short-term mortality, but long-term outcomes have not been characterized. We investigated the association between perioperative troponin elevation and long-term mortality in a retrospective study of consecutive subjects who underwent hip, knee, and spine surgery. Perioperative myocardial necrosis and International Classification of Disease, Ninth Revision-coded myocardial infarction (MI) were recorded. Long-term survival was assessed using the Social Security Death Index database. Logistic regression models were used to identify independent predictors of long-term mortality. A total of 3,050 subjects underwent surgery. Mean age was 60.8 years, and 59% were women. Postoperative troponin was measured in 1,055 subjects (34.6%). Myocardial necrosis occurred in 179 cases (5.9%), and MI was coded in 20 (0.7%). Over 9,015 patient-years of follow-up, 111 deaths (3.6%) occurred. Long-term mortality was 16.8% in subjects with myocardial necrosis and 5.8% with a troponin in the normal range. Perioperative troponin elevation (hazard ratio 2.33, 95% confidence interval 1.33 to 4.10) and coded postoperative MI (adjusted hazard ratio 3.51, 95% confidence interval 1.44 to 8.53) were significantly associated with long-term mortality after multivariable adjustment. After excluding patients with coronary artery disease and renal dysfunction, myocardial necrosis remained associated with long-term mortality. In conclusion, postoperative myocardial necrosis is common after orthopedic surgery. Myocardial necrosis is independently associated with long-term mortality at 3 years and may be used to identify patients at higher risk for events who may benefit from aggressive management of cardiovascular risk factors.
We undertook a biomechanical study to compare the pullout strength of 3.5-mm AO screws placed in ... more We undertook a biomechanical study to compare the pullout strength of 3.5-mm AO screws placed in two different orientations within the bovine cervical spine. The first set of screws were oriented obliquely and passed through the lateral mass, as recommended by the AO group. The orientation of the second set was anterior to posterior through the lateral mass, as recommended by Roy-Camille. All screw holes were drilled and tapped by a spinal surgeon experienced with both techniques. Pullout force was measured on an Instron materials testing machine using a self-centering screw-holding chuck and loading rate of 0.833 mm/sec. Although the bone strength in the Roy-Camille orientation was greater (46.7 N/mm versus 36.1 N/mm, p < 0.05), the overall mean pullout force for the AO orientation was greater (607 N versus 471 N, p < 0.025) due to the longer length of bone available for screw purchase (17.0 mm versus 10.3 mm).
The Journal of bone and joint surgery. American volume, Jan 21, 2014
Antifibrinolytics can reduce intraoperative blood loss. The primary aim of this study was to dete... more Antifibrinolytics can reduce intraoperative blood loss. The primary aim of this study was to determine the efficacy of intraoperative tranexamic acid, epsilon-aminocaproic acid, and placebo at reducing perioperative blood loss and the transfusion rate in patients with adolescent idiopathic scoliosis undergoing posterior spinal arthrodesis. This is a prospective, randomized, double-blind comparison of tranexamic acid, epsilon-aminocaproic acid, and placebo used intraoperatively in patients with adolescent idiopathic scoliosis. One hundred and twenty-five patients with adolescent idiopathic scoliosis were randomly assigned to the tranexamic acid, epsilon-aminocaproic acid, or control groups. Parameters recorded included estimated blood loss, hematocrit, blood product usage, drain output, and total blood losses. The primary outcomes were intraoperative blood loss and postoperative drainage. Secondary outcomes were transfusion requirements and hematocrit changes both intraoperatively an...
Open discectomy is the &quot;gold standard&quot; for operative intervention in patients w... more Open discectomy is the &quot;gold standard&quot; for operative intervention in patients with herniated lumbar discs whose conservative treatment has failed. Over 60 years the indications for surgery and the expected success rates have been clearly elucidated. The specific patient selection and determination of surgical procedures continues to evolve. Recurrent herniations occur at a low rate, and serious complications are rare.
Anterior-posterior surgery is indicated for the treatment of lumbar instability in the presence o... more Anterior-posterior surgery is indicated for the treatment of lumbar instability in the presence of simultaneous compromise of both the anterior and the posterior spinal elements or to augment the stability and rigidity of a fusion construct. The addition of an anterior interbody fusion to a posterior instrumented fusion serves to more successfully restore sagittal balance, effect indirect neural decompression, and to decrease pedicle screw strain by reconstituting the load-sharing ability of the anterior column. A variety of posterior fixation and minimally invasive techniques has been demonstrated to increase circumferential construct stiffness and rates of fusion. Semin Spine Surg 17:277-284
Spinal infections can arise in a variety of anatomical locations and structures and encompass ver... more Spinal infections can arise in a variety of anatomical locations and structures and encompass vertebral osteomyelitis, discitis, disc space infection, epidural abscesses, and infection of the adjacent soft tissue structures. Plain radiography, computed tomography, magnetic resonance imaging (MRI), and nuclear imaging all have a role in the diagnosis of spinal infection. MRI continues to be the gold standard for the imaging diagnosis of spinal infections. 67 Gallium citrate and Tc-99m-methylene diphosphonate scintigraphy have become the standard for nuclear imaging of the spine. Fluorine-18-fluorodeoxyglucose positron emission tomography, strepavidin/ 111 In-biotin, and 99m -ciprofloxacin have shown promise for aiding in the diagnosis and evaluation of spinal infection but warrant further study. Semin Spine Surg 19:106-112.
OBJECT Previous forceplate studies analyzing the impact of sagittal-plane spinal deformity on pel... more OBJECT Previous forceplate studies analyzing the impact of sagittal-plane spinal deformity on pelvic parameters have demonstrated the compensatory mechanisms of pelvis translation in addition to rotation. However, the mechanisms recruited for this pelvic rotation were not assessed. This study aims to analyze the relationship between spinopelvic and lower-extremity parameters and clarify the role of pelvic translation. METHODS This is a retrospective study of patients with spinal deformity and full-body EOS images. Patients with only stenosis or low-back pain were excluded. Patients were grouped according to T-1 spinopelvic inclination (T1SPi): sagittal forward (forward, > 0.5°), neutral (-6.3° to 0.5°), or backward (< -6.3°). Pelvic translation was quantified by pelvic shift (sagittal offset between the posterosuperior corner of the sacrum and anterior cortex of the distal tibia), hip extension was measured using the sacrofemoral angle (SFA; the angle formed by the middle of t...
METHODS: A total of 168 intact L4-L5 spinal segments (87M/81F, 53.1612.1 yrs) were tested using p... more METHODS: A total of 168 intact L4-L5 spinal segments (87M/81F, 53.1612.1 yrs) were tested using pure moment loading (7.5 Nm) simulating flexion-extension, lateral bending and axial rotation. Axial compression tests (to 300N) were performed on 38 of the specimens. Gender, age and BMI (at time of death) were collected from the donor records provided by local tissue banks and were analyzed with biomechanical parameters using one way-ANOVA, Pearson correlation and multiple regression analyses. RESULTS: Considering the entire population (n5168), there were no statistical differences between all male and all female groups in terms of age or BMD. The mean BMI in the female group was significantly greater than in the male group (p50.005). Further subdivision of groups into BMI!30 (52M/30F) and BMIO30 (30M/42F) did not result in any differences in mean age, BMD or BMI between male and female groups in either BMI category (pO0.1). The segments from the obese (BMIO30) male group were significantly more mobile than those from the non-obese (BMI! 30) male group during axial rotation (p50.018), while there was no difference in the female group (p50.687). There were no differences in mobility between spines from obese and non-obese donors during flexion-extension or lateral bending, for either gender. In the non-obese population, the ROM during axial rotation was significantly greater for the female vs. male group (p50.009). There was no significant difference between gender in the obese population (p50.892). Axial compressive stiffness was significantly greater for the obese population for both the female group and the entire study group (p!0.01); however, the difference was non-significant in the male population (p50.304). Correlation analysis confirmed a significant negative correlation between BMI and resistance to deformation during axial compression in the female group (R5-0.65, p50.004), with no relationship in the male group (R50.03, p50.9). There was a significant negative correlation between ROM during flexion-extension and BMI for the female group (R5-0.38, p50.001), with no relationship in the male group (R50.06, p50.58). CONCLUSIONS: The unknown proportion of symptomatic vs asymptomatic donors in each group is a confounding factor. However, based on flexibility and compression tests, lumbar spinal segments from obese vs non-obese donors seem to behave differently, biomechanically, during axial rotation and compression, with coinciding gender differences. The noted gender differences in the biomechanical behavior at L4-L5 may be related to differences in gait patterns, weight distribution and childbearing.
Preoperative anemia is a well-established risk factor for short-term mortality in patients underg... more Preoperative anemia is a well-established risk factor for short-term mortality in patients undergoing non-cardiac surgery, but appropriate thresholds for transfusion remain uncertain. The objective of this study was to determine long-term outcomes associated with anemia, hemorrhage and red blood cell transfusion in patients undergoing non-cardiac surgery. We performed a long-term follow-up study of consecutive subjects undergoing hip, knee, and spine surgery between November 1, 2008 and December 31, 2009. Clinical data were obtained from administrative and laboratory databases, and retrospective record review. Pre-operative anemia was defined as baseline hemoglobin <13 g/dL for men and <12 g/dL for women. Hemorrhage was defined by ICD-9 coding. Data on long-term survival were queried from the Social Security Death Index (SSDI) database. Logistic regression models were used to identify factors associated with long-term mortality. 3,050 subjects underwent orthopedic surgery. Pre...
The spine journal : official journal of the North American Spine Society, Jan 29, 2015
Numerous studies have demonstrated poorer outcomes in patients with Workers' Compensation (WC... more Numerous studies have demonstrated poorer outcomes in patients with Workers' Compensation (WC) when compared to those without WC following treatment of various of health conditions including spine disorders. It is thus important to consider compensation status when assessing treatment outcomes in spine surgery. However, reported strengths of association have varied significantly (1.31-7.22). The objective of this study was to evaluate the association of unsatisfactory outcomes on compensation status in spine surgery patients. Meta-analysis PATIENT SAMPLE: Not applicable OUTCOME MEASURE: Demographics, type of surgery, country, follow-up time, patient satisfaction, return to work and non-union events. Both prospective and retrospective studies that compared outcomes between compensated and non-compensated patients in spine surgery were included. Two independent investigators extracted outcome data. The meta-analysis was performed using Revman software. Random effects model was use...
Retrospective. . This study assessed the feasibility of combining ODI/NDI into one shorter "... more Retrospective. . This study assessed the feasibility of combining ODI/NDI into one shorter "Total Disability Index" (TDI) from which reconstructed scores could be computed. Oswestry and Neck Disability Index (ODI and NDI) are not pure assessments of disability related to back and neck respectively. Due to similarities/redundancies of questions, ODI scores may be elevated in neck pain patients and the converse is true for NDI in back pain patients. Spine patients completed ODI and NDI, and complaints were recorded as back pain (BP), neck pain (NP) or both (BNP). Questionnaire scores were compared across cohorts via descriptives and Spearman (ρ) correlations. In exploring the feasibility of merging ODI/NDI, TDI was constructed from 9 ODI and 5 NDI items. Extracting questions from TDI, reconstructed 9-item rODI and 10-item rNDI indices were formed and compared with true ODI/NDI. There were 1207 subjects: 741 BP, 134 NP, 268 BNP. Mean ODI: 37 ± 21, and mean NDI: 32 ± 21. Patie...
Retrospective review of a prospectively collected database. This study compares patient demograph... more Retrospective review of a prospectively collected database. This study compares patient demographics, incidence of comorbidities, procedure-related complications, and mortality following primary vs. revision adult spinal deformity surgerySummary of Background Data. While adult spinal deformity (ASD) surgery has been extensively investigated, no previous study has provided nationwide estimates of patient characteristics and procedure-related complications for primary vs. revision spinal deformity surgery comparatively. Nationwide Inpatient Sample data collected between 2001 and 2010 was analyzed. Discharges with procedural codes for anterior and/or posterior thoracic and/or lumbar spinal fusion and refusion were included for patients aged 25+ and 4+ levels fused with any diagnoses specific for scoliosis. Patient demographics, comorbidity and procedure-related complications incidence were determined for primary vs. revision cohorts. Multivariate analysis reported as (OR [95% CI]). Dis...
OBJECT Adult spinal deformity (ASD) surgery is known for its high complication rate. This study e... more OBJECT Adult spinal deformity (ASD) surgery is known for its high complication rate. This study examined the impact of obesity on complication rates, infection, and patient-reported outcomes in patients undergoing surgery for ASD. METHODS This study was a retrospective review of a multicenter prospective database of patients with ASD who were treated surgically. Patients with available 2-year follow-up data were included. Obesity was defined as having a body mass index (BMI) ≥ 30 kg/m(2). Data collected included complications (total, minor, major, implant-related, radiographic, infection, revision surgery, and neurological injury), estimated blood loss (EBL), operating room (OR) time, length of stay (LOS), and patient-reported questionnaires (Oswestry Disability Index [ODI], Short Form-36 [SF-36], and Scoliosis Research Society [SRS]) at baseline and at 6 weeks, 1 year, and 2 years postoperatively. The impact of obesity was studied using multivariate modeling, accounting for confoun...
The Journal of bone and joint surgery. American volume, Jan 17, 2015
Wound drains that are left in place for a prolonged period of time have a higher rate of bacteria... more Wound drains that are left in place for a prolonged period of time have a higher rate of bacterial contamination. Following spinal surgery, a drain is often left in place for a longer period of time if it maintains a high output. Given the major consequences of an infection following spinal surgery and the lack of data with regard to the use of antibiotics and drains, we performed a study of patients with a drain following spinal surgery to compare infection rates between those who were treated with antibiotics for twenty-four hours and those who received antibiotics for the duration for which the drain was in place. We performed a prospective randomized trial of 314 patients who underwent multilevel thoracolumbar spinal surgery followed by use of a postoperative drain. The patients were randomized into two groups, one of which received perioperative antibiotics for twenty-four hours (twenty-four-hour group) and the other of which received antibiotics for the duration that the drain...
Unplanned hospital readmissions result in significant clinical and financial burdens to patients ... more Unplanned hospital readmissions result in significant clinical and financial burdens to patients and the healthcare system. Readmission rates and causes have been investigated using large administrative databases which have certain limitations in data reporting and coding. The objective of this study was to provide a description of 90 day post-discharge readmissions following surgery for common degenerative cervical spine pathologies at a large-volume tertiary hospital. The study also compared the readmission rates of patients who underwent anterior- and posterior-approach procedures. The administrative records from a single-center, high-volume tertiary institution were queried using ICD-9 codes for common cervical pathology over a three year period to determine the rate and causes of readmissions within the 90 days following the index surgery. A total of 768 patients underwent degenerative cervical spine surgery during the three year study period. Within 90 days of discharge, 24 (3.13%) patients were readmitted; 16 (2.06%) readmissions were planned for lumbar surgery; 8 (1.04%) readmissions were unplanned. 640 patients underwent procedures involving an anterior approach and 128 patients underwent procedures involving a posterior approach. There were 14 (2.17%) planned readmissions in the anterior group and 2 (1.5%) in the posterior group. The unplanned readmission rate was 0.63% (4 patients) and 3.13% (4 patients) in the anterior and posterior groups, respectively. (p=0.0343). The 90 day post-discharge unplanned readmission rate that followed elective degenerative cervical spine surgery was 1.04%. The unplanned readmission rate associated with posterior-approach procedures (3.13%) was significantly higher than that of anterior-approach procedures (0.63%). IV.
Myocardial necrosis in the perioperative period of noncardiac surgery is associated with short-te... more Myocardial necrosis in the perioperative period of noncardiac surgery is associated with short-term mortality, but long-term outcomes have not been characterized. We investigated the association between perioperative troponin elevation and long-term mortality in a retrospective study of consecutive subjects who underwent hip, knee, and spine surgery. Perioperative myocardial necrosis and International Classification of Disease, Ninth Revision-coded myocardial infarction (MI) were recorded. Long-term survival was assessed using the Social Security Death Index database. Logistic regression models were used to identify independent predictors of long-term mortality. A total of 3,050 subjects underwent surgery. Mean age was 60.8 years, and 59% were women. Postoperative troponin was measured in 1,055 subjects (34.6%). Myocardial necrosis occurred in 179 cases (5.9%), and MI was coded in 20 (0.7%). Over 9,015 patient-years of follow-up, 111 deaths (3.6%) occurred. Long-term mortality was 16.8% in subjects with myocardial necrosis and 5.8% with a troponin in the normal range. Perioperative troponin elevation (hazard ratio 2.33, 95% confidence interval 1.33 to 4.10) and coded postoperative MI (adjusted hazard ratio 3.51, 95% confidence interval 1.44 to 8.53) were significantly associated with long-term mortality after multivariable adjustment. After excluding patients with coronary artery disease and renal dysfunction, myocardial necrosis remained associated with long-term mortality. In conclusion, postoperative myocardial necrosis is common after orthopedic surgery. Myocardial necrosis is independently associated with long-term mortality at 3 years and may be used to identify patients at higher risk for events who may benefit from aggressive management of cardiovascular risk factors.
We undertook a biomechanical study to compare the pullout strength of 3.5-mm AO screws placed in ... more We undertook a biomechanical study to compare the pullout strength of 3.5-mm AO screws placed in two different orientations within the bovine cervical spine. The first set of screws were oriented obliquely and passed through the lateral mass, as recommended by the AO group. The orientation of the second set was anterior to posterior through the lateral mass, as recommended by Roy-Camille. All screw holes were drilled and tapped by a spinal surgeon experienced with both techniques. Pullout force was measured on an Instron materials testing machine using a self-centering screw-holding chuck and loading rate of 0.833 mm/sec. Although the bone strength in the Roy-Camille orientation was greater (46.7 N/mm versus 36.1 N/mm, p < 0.05), the overall mean pullout force for the AO orientation was greater (607 N versus 471 N, p < 0.025) due to the longer length of bone available for screw purchase (17.0 mm versus 10.3 mm).
The Journal of bone and joint surgery. American volume, Jan 21, 2014
Antifibrinolytics can reduce intraoperative blood loss. The primary aim of this study was to dete... more Antifibrinolytics can reduce intraoperative blood loss. The primary aim of this study was to determine the efficacy of intraoperative tranexamic acid, epsilon-aminocaproic acid, and placebo at reducing perioperative blood loss and the transfusion rate in patients with adolescent idiopathic scoliosis undergoing posterior spinal arthrodesis. This is a prospective, randomized, double-blind comparison of tranexamic acid, epsilon-aminocaproic acid, and placebo used intraoperatively in patients with adolescent idiopathic scoliosis. One hundred and twenty-five patients with adolescent idiopathic scoliosis were randomly assigned to the tranexamic acid, epsilon-aminocaproic acid, or control groups. Parameters recorded included estimated blood loss, hematocrit, blood product usage, drain output, and total blood losses. The primary outcomes were intraoperative blood loss and postoperative drainage. Secondary outcomes were transfusion requirements and hematocrit changes both intraoperatively an...
Open discectomy is the &quot;gold standard&quot; for operative intervention in patients w... more Open discectomy is the &quot;gold standard&quot; for operative intervention in patients with herniated lumbar discs whose conservative treatment has failed. Over 60 years the indications for surgery and the expected success rates have been clearly elucidated. The specific patient selection and determination of surgical procedures continues to evolve. Recurrent herniations occur at a low rate, and serious complications are rare.
Anterior-posterior surgery is indicated for the treatment of lumbar instability in the presence o... more Anterior-posterior surgery is indicated for the treatment of lumbar instability in the presence of simultaneous compromise of both the anterior and the posterior spinal elements or to augment the stability and rigidity of a fusion construct. The addition of an anterior interbody fusion to a posterior instrumented fusion serves to more successfully restore sagittal balance, effect indirect neural decompression, and to decrease pedicle screw strain by reconstituting the load-sharing ability of the anterior column. A variety of posterior fixation and minimally invasive techniques has been demonstrated to increase circumferential construct stiffness and rates of fusion. Semin Spine Surg 17:277-284
Spinal infections can arise in a variety of anatomical locations and structures and encompass ver... more Spinal infections can arise in a variety of anatomical locations and structures and encompass vertebral osteomyelitis, discitis, disc space infection, epidural abscesses, and infection of the adjacent soft tissue structures. Plain radiography, computed tomography, magnetic resonance imaging (MRI), and nuclear imaging all have a role in the diagnosis of spinal infection. MRI continues to be the gold standard for the imaging diagnosis of spinal infections. 67 Gallium citrate and Tc-99m-methylene diphosphonate scintigraphy have become the standard for nuclear imaging of the spine. Fluorine-18-fluorodeoxyglucose positron emission tomography, strepavidin/ 111 In-biotin, and 99m -ciprofloxacin have shown promise for aiding in the diagnosis and evaluation of spinal infection but warrant further study. Semin Spine Surg 19:106-112.
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Papers by Thomas Errico