Notes

Fatality along with years of living missing regarding heart diseases throughout Tiongkok, 2005-2020: Test proof via national death surveillance system.
Postoperative pain management of multilevel lumbar fusion remains challenging. There are few reports of opioid-sparing regional analgesia for spine surgery. We present a novel method for surgeon-placed erector spinae plane (ESP) catheters for multilevel lumbar spine fusion and compare pain- and opioid-related outcomes in a matched cohort who received anesthesiologist-placed ESP blocks.

A retrospective matched pilot study of 18 patients 6 received intraoperative, bilateral ESP catheters. Tunneled catheters were placed under the intact ESP at the proximal end of the incision. Continuous infusions of ropivacaine (0.2%) were started in the postanesthesia care unit (PACU) after emergence from anesthesia and maintained for 48 hours. Catheter patients were matched 12 with 12 patients who received preincision single-shot ESP blocks administered by an anesthesiologist, according to age, gender, American Society of Anesthesiologists class, body mass index, and number of spinal levels fused. All patients were providanalgesia, particularly in centers lacking regional anesthesiology services. Risks, benefits, and efficacy compared to other techniques require prospective study.
Surgeon-placed ESP catheters represent a simple technique to provide regional analgesia, particularly in centers lacking regional anesthesiology services. Risks, benefits, and efficacy compared to other techniques require prospective study.
Individual items within the Patient Health Questionnaire-9 (PHQ-9) have not been assessed as predictors of postoperative outcomes. Our objective is to study the relationship between responses to individual PHQ-9 items and achievement of a minimum clinically important difference (MCID) following anterior cervical discectomy and fusion (ACDF).

A prospective surgical database was reviewed for primary, single-level ACDF procedures performed for degenerative spinal pathology. Patient demographics, preoperative spinal pathology, and perioperative characteristics were recorded. Patient-reported outcome measures (PROMs) including PHQ-9, visual analog scale (VAS) neck and arm, Neck Disability Index, 12-item Short Form physical component score (SF-12 PCS), and Patient-Reported Outcomes Measurement Information System Physical Function were administered at preoperative and 6-week, 12-week, 6-month, 1-year, and 2-year postoperative timepoints. CC-115 molecular weight MCID achievement was determined by comparing postoperative PROM improvementthough overall PHQ-9 scores did not. Providers should inform patients experiencing significant sleep-related difficulties that they may be especially likely to benefit from ACDF surgery.

Evaluation of sleep from the PHQ-9 predicts clinically relevant improvement in neck pain, arm pain, and physical function in patients undergoing ACDF.
Evaluation of sleep from the PHQ-9 predicts clinically relevant improvement in neck pain, arm pain, and physical function in patients undergoing ACDF.
While national databases provide large datasets that can be used to understand trends over time, their correlation with prospectively collected data from local registries has not been established. The purpose of the study was to compare differences in patient demographics and adverse events for patients undergoing elective posterior spinal fusion (PSF) between a national database and institutional registry.

A retrospective chart review was performed. A total of 14,618 patients (13,678 patients from the National Surgical Quality Improvement Program [NSQIP] database and 940 patients from the institutional registry) who underwent elective 1- to 2-level PSF were included in the study. Preoperative patient demographics and comorbidities of each cohort were compared. In addition, postoperative 30-day complications and readmission were collected. A multivariate analysis was performed to examine for differences in risk factors for 30-day adverse events between the 2 cohorts.

A total of 13,678 patients from the actors for patient outcomes are often derived from national databases. This study highlights the differences between study results when outcomes are derived from an institutional registry compared to a national database.
Quality metrics and risk factors for patient outcomes are often derived from national databases. This study highlights the differences between study results when outcomes are derived from an institutional registry compared to a national database.
Posterior lumbar fusions are a common and successful procedure, yet surgical site infection (SSI) is still prevalent and causes significant morbidity. Obesity is a well-established risk factor for SSI. Still, the accuracy of the body mass index (BMI) caused some to suggest other metrics that are more representative of the thickness of the soft-tissue envelope in the surgical site.

A retrospective review of all cases that developed SSI following posterior lumbar fusion over the past 5 years was done. An age and gender-matched control group was formed from the lumbar fusion cases that did not develop SSI. Demographic and clinical data were collected, and morphometric measurements of the soft-tissue envelope were performed at the level of L4 for all cases on standing x-ray imaging and magnetic resonance imaging (MRI).

A total of 366 patients underwent posterior lumbar fusion, 26 of whom developed SSI. BMI and skin to spinous process measurements on x-ray imaging-not MRI-were found to be significantly associated with SSI. Regression analysis further confirmed the strength of the association.

While BMI and MRI measurements are useful, wound depth measurements on x-ray imaging can be predictive of SSI in lumbar fusion cases.

Wound depth measurements are predictive of lumbar wound infection. The information within this study can help surgeons better predict and manage infections of posterior lumbar wounds.
Wound depth measurements are predictive of lumbar wound infection. The information within this study can help surgeons better predict and manage infections of posterior lumbar wounds.
Minimally invasive transforaminal interbody fusion (MIS-TLIF) is an effective procedure for lumbar spine diseases. The procedure can be done using a surgical microscope (SM) or surgical loupes (SL) magnification. However, there are no studies that compared outcomes between using these 2 magnifying devices in the MIS-TLIF procedure. The purpose of this study was to compare clinical outcomes, perioperative complications, and radiographic parameters of MIS-TLIF using SM compared with SL magnification.

We included all patients undergoing 1-level MIS-TLIF between January 2017 and December 2019. Type of magnification (SM vs SL), operative time, blood loss, perioperative complications, cross-sectional area of the spinal canal, and fusion rates were analyzed. Clinical outcomes measurement using the visual analog scale (VAS) and Oswestry Disability Index (ODI) were compared between groups.

A total of 100 patients had underwent MIS-TLIF (SM group 62; SL group 38). Operative time (SM 182.7 ± 41.5 vs SL 165.6 ± 32.ovides similar outcomes except prolonged operative time in the SM group.
Minimally invasive surgery (MIS) has benefits over open surgery for lumbar decompression and/or fusion. Published literature on its cost-effectiveness vs open techniques is mixed.

Systematically review the cost-effectiveness of minimally invasive vs open lumbar spinal surgical decompression, fusion, or discectomy using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

A systematic electronic search of databases (MEDLINE, Embase, and Cochrane Library) and a manual search from the cost-effectiveness analysis (CEA) database and National Health Service economic evaluation database was conducted. Studies that included adult populations undergoing surgery for degenerative changes in the lumbar spine (stenosis, radiculopathy, and spondylolisthesis) and reported outcomes of costing analysis, CEA, or incremental cost-effectiveness ratio were included.

A total of 17 studies were included. Three studies assessed outcomes of MIS vs open discectomy. All 3 reported statistically signifited a reduced cost associated with MIS vs open surgery and suggested better cost-effectiveness, particularly in MIS vs open single- and 2-level TLIF procedure. Most studies had a high risk of bias. Therefore, this review was unable to conclusively recommend MIS over open surgery from a cost-effectiveness perspective.

The incidence of spinal decompressive and fusion surgey and financial constraints on healthcare services continue to increase. This study aims to identify the cost and clinical effectiveness of common approaches to spinal surgery.

3a.
3a.
Spine surgery has evolved at an accelerated pace, allowing the development of more efficient surgical techniques while providing a decreasing rate of morbimortality. One example of these approaches is the anterior lumbar interbody fusion (ALIF). The aim of this study was to evaluate the surgical complication rate when performing ALIF without the help of a vascular "access" surgeon.

A retrospective descriptive study was conducted at the Hospital Universitario San Ignacio between 2014 and 2018 and included all patients who underwent ALIF during this time. A nonsystematic review was performed assessing approach-related complications in ALIF and the impact of "access" surgeons in surgical outcomes.

A total of 337 patients were included and 508 levels were fused. ALIF was performed as ALIF-360° (27%), ALIF-lateral lumbar interbody fusion (LLIF) (8.9%), and stand-alone ALIF (62%). Most procedures were single-level fusions (51.9%), 45.4% involved 2 levels, and 2.6% were 3-level fusions. The mortality rate was rature.
Minimally invasive lateral lumbar interbody fusion is a technique that has become increasingly popular for the treatment of degenerative lumbar spine disease; however, the pertinent surgical vascular anatomy has not been examined in detail. The goal of this study is to examine the anatomy of the lower lumbar and median sacral arteries, which are important determinants of these surgical outcomes.

This is an observational, experimental study based on cadaveric models, including 20 embalmed adult human cadavers. The following measurements were made length of the lumbar and median sacral arteries, vertical distance between the third and fourth lumbar arteries and the superior end plate of the corresponding vertebrae, anterior vertebral body height, and intervertebral disc height.

Our sample showcased considerable variability regarding vascular anatomy around the lower lumbar spine. In 10% of specimens, the abdominal aorta bifurcated at the level of the L3-L4 intervertebral disc, and 20% showed variations inl in spine surgery planning and operative management. These anatomic variations should be identified beforehand to prevent difficulties during surgery and possible complications.
Surgeons have scrutinized spinal alignment and its impact on improving clinical outcomes following anterior cervical discectomy and fusion (ACDF). The primary analysis of this study examines the relationship between change in perioperative cervical lordosis (CL) and health-related quality-of-life (HRQOL) outcomes after ACDF. Secondary analysis evaluates the effects of fusion construct length on outcomes in patients grouped by preoperative cervical alignment.

A retrospective cohort study was performed on an institutional database including patients who underwent 1- to 3-level ACDF. C2-C7 CL was measured preoperatively and at final follow-up. For primary analysis, patients were classified based on their perioperative cervical lordotic correction (1) kyphotic, (2) maintained, and (3) restored. For secondary analysis, patients were categorized based on their preoperative C2-C7 CL (1) kyphotic, (2) neutral, and (3) lordotic. Demographics and perioperative change in patient-reported outcome measures were compared between groups.
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