bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of Spinal Tumors in a High Volume Center has Direct Impact on Local Recurrence, Morbidity, and Mortality
Authors: Lador Ran , Bandiera Stefano , Gasbarrini Alessandro , Ghermandi Riccardo , Boriani Stefano 
Published: March 2018

Objective of the Study:
En bloc resections of spine tumors aim at locally controlling the disease for both improving the patient’s quality of life as well as improving mortality. The purpose of this study was to compare the outcome between patients who were initially treated in a high volume specialized center, and patients who initially underwent either invasive diagnostic procedure or an initial surgical attempt to treat the disease in a different center.

Materials and Methods:
A retrospective study of 1681 patients affected by spine tumors—treated from 1990 to 2015 by the same team.

Results:
A total of 220 en bloc resections that were performed on 216 patients during that period. Most of the tumors were primary—165 cases (43 benign and 122 malignant), metastases occurred in 55 cases. One hundred sixty-eight patients (77.8%) were solely treated in the institute and were considered noncontaminated cases (NCCs) and 48 (22.2%) were previously treated elsewhere and were considered contaminated cases (CCs). Median follow-up was 45 months (0–371).
Thirty-three local recurrences (15.28%) were recorded. Fourteen patients (29.17%) from the CC and 19 (11.31%) from the NCC group.
A total of 153 complications were observed in 100 out of 216 patients (46.2%). Sixty-four of these patients (30%) suffered 1 complication, while the rest had 2 or more. Twenty-eight (58%) of the CC group and 72 (42.85%) of the NCC group, had at least 1 complication.
Sixty patients died as a result of the disease during the follow-up period. Twenty-one (43.75%) and 39 (23.21%) patients died in the CC and NCC cohorts, respectively.
CC, surgical margins of the resected tumor—intralesional, marginal, and malignant tumors, were statistically significant independent risk factors for local recurrence of the tumor. Contamination, local recurrence, neoadjuvant radiotherapy, the number of level resected, and metastatic tumors compared with primary malignant tumor, were shown to be independent risk factors for patient’s death.

Conclusions:
It is apparent that there is a substantial added risk in performing either invasive diagnostic procedures or attempting a surgical resection of the tumor in a nonspecialized center. This risk includes both higher recurrences of the tumor as well as increased mortality. It is therefore reasonable to conclude that the whole treatment, from biopsy to resection, should be performed in the same center, and this center should be a high volume, specialized in treating these type of spine pathologies.
The surgeon who treats the patient first has a great responsibility, as it is the first treatment that most affects prognosis. To reduce the chance of local recurrence, morbidity, and mortality, all invasive diagnosis and treatment, should be performed by an experienced team, as the consequences are dramatic.
Incidence and Factors Predictive of Dysphagia and Dysphonia After Anterior Operation With Multilevel Cervical Spondylotic Myelopathy
Authors: Yu Shunzhi , Chen Zhi , Yan Ning , Hou Tiesheng , He Shisheng 
Published: March 2018

Study Design:
Retrospective database analysis.

Objective of the Study:
The objective of the study was to quantify the incidence of dysphagia and dysphonia and assess the associated risk factors after multilevel cervical anterior operation.

Summary of Background Data:
Anterior approach for multilevel cervical spondylotic myelopathy has been developed and obtained favorable outcomes. As number of fused levels increased, the operation difficulty, invasiveness and operative risks are higher. Meanwhile, the 2 most common postoperative complications described in the literature are dysphonia and dysphagia.

Materials and Methods:
Two hundred thirty-six multilevel cervical spondylotic myelopathy patients between October 2004 and June 2012 were included in the study. All patients undergoing anterior operation, and incidences of dysphagia were identified. Risk factors were assessed using logistic regression.

Results:
At a minimum of 1 year after operation, 70.6% (n=156) were 3-level anterior operation and 29.4% (n=65) were 4-level anterior operation. The overall dysphagia rate was 23.1% (51 patients). The overall dysphonia rate was 28.5% (63 patients). Logistic regression analysis demonstrated that risk factors for dysphagia included age, operation time and lack of tracheal traction exercise. Age, operation time were 2 factors significantly related to dysphonia.

Conclusions:
The incidence of postoperative dysphagia and dysphonia is relative higher after multilevel anterior operation. Age and operation time carry a greater risk of postoperative dysphagia and dysphonia. Tracheal traction exercise might help patients reduce postoperative dysphagia. Sufficient preoperative preparation and evaluation combining with proficient and precise operation technique are suggested when multilevel anterior fusion is performed.
Comparing Short-term Complications of Inpatient Versus Outpatient Single-level Anterior Cervical Discectomy and Fusion
Authors: Khanna Ryan , Kim Robert B. , Lam Sandi K. , Cybulski George R. , Smith Zachary A. , Dahdaleh Nader S. 
Published: March 2018

Study Design:
Multicenter propensity score-adjusted retrospective cohort study.

Objective:
To determine baseline 30-day complication rates for anterior cervical discectomy and fusion (ACDF) and compare clinical complications for patients undergoing single-level ACDFs between inpatient and outpatient settings.

Summary of Background Data:
ACDF remains the most common procedure in the treatment of a variety of cervical disc pathologies, making it a focus of quality improvement initiatives. Outpatient single-level ACDFs are becoming more common and offer advantages including reducing nosocomial infections and costs, as well as improved patient satisfaction.

Materials and Methods:
The 2011–2013 NSQIP datasets were queried to identify all patients who underwent single-level ACDF procedures using current procedural terminology codes. Outpatient and inpatient cohorts were matched 1:1 using propensity score analysis to assess short-term outcomes. The outcomes assessed included 30-day medical and surgical complications, reoperation, readmission, and mortality.

Results:
In total, 6940 patients underwent a single-level ACDF with an overall complication rate of 4.2%. A total of 5162 patients (74.4%) had an inpatient hospital stay after surgery, whereas 1778 patients (25.6%) had outpatient surgery. After matching based on preoperative and operative characteristics to account for potential confounders, the overall complication rate was higher in the inpatient arm compared with the outpatient arm (2.5% vs. 1.2%; P=0.003). The 30-day readmission rate was also higher but not significant in the inpatient group than the outpatient group (2.2% vs. 1.8%; P=0.355). Mortality was the same with 0.1% in both groups (P=0.564).

Conclusions:
Patients undergoing outpatient single-level ACDF had a lower 30-day complication rates than those undergoing it in the inpatient setting. Outpatient surgery for single-level ACDF is safe and a favorable option for suitable patients.

Level of Evidence:
Level 3.
A Comparative Study of Anterior Decompression With Fusion and Posterior Decompression With Laminoplasty for the Treatment of Cervical Spondylotic Myelopathy Patients With Large Anterior Compression of the Spinal Cord
Authors: Hirai Takashi , Yoshii Toshitaka , Arai Yoshiyasu , Sakai Kenichiro , Torigoe Ichiro , Maehara Hidetsugu , Tomori Masaki , Taniyama Takashi , Sato Hirokazu , Okawa Atsushi 
Published: March 2018

Study Design:
This is a retrospective observational single-center study.

Objectives:
To compare anterior decompression and fusion (ADF) and laminoplasty (LAMP) for the treatment of cervical spondylotic myelopathy (CSM) patients with large anterior compression in terms of clinical and radiologic outcomes.

Summary of Background Data:
We have reported that insufficient posterior decompression could be often seen after laminoplasty for CSM patients with preoperative anterior clearance of the spinal cord, defined as an interval <4 mm between the preoperative the modified K-line and anterior structure of the spinal canal at most compressive segment on sagittal T1-weighted magnetic resonance imaging. Here we conduct a study comparing ADF and LAMP for the treatment of CSM patients with such a risk factor.

Materials and Methods:
Of the 221 consecutive CSM patients treated with either ADF or LAMP between 2008 and 2012 at our hospital, 79 patients in whom the interval was <4 mm with age ranged from 50 to 79 years were enrolled. Patients with myelopathy caused by single-level disk herniation, tumor or ossification of posterior longitudinal ligament, or patients with a history of cervical spine injury were excluded. The Japanese Orthopedic Association (JOA) scoring system for cervical myelopathy, recovery rate of the JOA score at the time of 2 years after surgery were investigated as clinical outcomes to compare these 2 groups.

Results:
Demographics were almost similar between ADF and LAMP groups. The mean preoperative and postoperative JOA scores were 10.9 and 13.8 points for ADF group and 10.1 and 12.4 points for LAMP group, indicating that the recovery rate of JOA score was significantly greater in ADF group (49.6%) than that in LAMP group (38.2%; P=0.047). In LAMP group, spinal cord deformity was a significant predictive factor for unsatisfactory clinical outcome.

Conclusion:
ADF provided better surgical treatment for the patients with absence of preoperative anterior clearance of the spinal cord.
Semirigid Waved Rod System for the Treatment of the Degenerative Lumbar Diseases
Authors: Wang Lei , Lin Dasheng , Zou Weitao , Liu Hui , Lian Kejian 
Published: March 2018

Background:
The semirigid pedicle screw instrumentation has gained wide popularity in recent decennium in lumbar fusion surgery. However, few data were documented to compare the clinical efficacy between semirigid and traditional rigid pedicle screw systems.

Materials and Methods:
A total of 96 patients with degenerative lumbar diseases were selected to perform operations between 2008 and 2013. The patients were prospectively randomized into 2 groups: 50 patients were managed by semirigid waved rod systems and 46 patients were intervened by traditional rigid straight stiff rod systems. X-rays and computed tomography were utilized to examine the interbody fusion status in the follow-up in detail. Surgical parameters such as operative time, blood loss, and total hospital stay were calculated and compared. Visual Analog Scale and Oswestry Disability Index were used to assess clinical efficacy postoperatively.

Results:
No significant differences were found about demographic data between groups. There were no significant differences regarding the surgical parameters including operative time, blood loss, and total hospital stay. Visual Analog Scale and Oswestry Disability Index postoperatively were also similar between the 2 instrumentations (P>0.05). The fusion rate was higher in the semirigid group (45/50) than in the traditional group (34/46) (P=0.039) at the final follow-up.

Conclusions:
Waved rod may be better in facilitating interbody fusion compared with traditional straight rod, although waved rod and straight stiff rod can both get similar clinical efficacy. Meanwhile, waved rod is likely superior in alleviating adjacent degeneration segments.
Novel Index to Quantify the Risk of Surgery in the Setting of Adult Spinal Deformity
Authors: Diebo Bassel G. , Jalai Cyrus M. , Challier Vincent , Marascalchi Bryan J. , Horn Samantha R. , Poorman Gregory W. , Bono Olivia J. , Cherkalin Denis , Worley Nancy , Oh Jason , Naziri Qais , Spitzer Allison , Radcliff Kris , Patel Ashish , Lafage Virginie , Paulino Carl B. , Passias Peter G. 
Published: March 2018

Study Design:
Retrospective review of the Nationwide Inpatient Sample from 2001 to 2010, a prospectively collected national database.

Objective:
Structure an index to quantify adult spinal deformity (ASD) surgical risk based on risk factors for medical complications, surgical complications, revisions (R), mortality (M) rates, and length of hospital stay.

Summary of Background Data:
Evidence supporting ASD surgery cost-effectiveness and anticipating surgical risk is critical to evaluate the risk/benefit balance of such treatment for patients.

Materials and Methods:
Discharges ages 25+, 4+ levels fused, diagnoses specific for scoliosis, and refusions. Five multivariate models determined independent risk factors that increased the risk of ≥1 for medical complications, surgical complications, R, M, and length of hospital stay. Models controlled for age, sex, race, revision status, surgical approach, levels fused, and osteotomy utilization. Odds ratios (ORs) were weighted using Nationwide Inpatient Sample weight files and based on their predictive category: 2 times for revision predictors and 4 times for mortality predictors. Predictors with OR≥1.5 were considered clinically relevant. Fifty points were distributed among the predictors based on their accumulative OR to establish a risk index.

Results:
A total of 10,912 ASD discharges were identified (mean age: 62 y; 73% females; 14% revision cases). The structured risk index incorporated the following factors based on accumulative ORs: pulmonary circulation disorder (42.05), drug abuse (21.86), congestive heart failure (15.25), neurological disorder (17.31), alcohol abuse (13.24), renal failure (11.64), age>65 (12.28), coagulopathy (11.65), level +9 (6.7), revision (3.35), and osteotomy (3). These risk factors were scored: 14, 7, 5, 5, 4, 4, 4, 4, 2, 1, 1, respectively. Three risk thresholds were proposed: mild (0–10), moderate (10–20), severe >20/50 points.

Conclusions:
This study proposes an index to quantify the possible risk of morbidity before ASD surgery that will help patients, health insurance companies, and socioeconomic studies in assessing surgical risk/benefits.

Level of Evidence:
Level III.
Nerve Root and Lumbar Plexus Proximity to Different Extraforaminal Lumbar Interbody Fusion Trajectories
Authors: Kumar Abhishek , Merrill Robert K. , Qureshi Sheeraz A. 
Published: March 2018

Study Design:
Cadaver study.

Objective:
To investigate the safety of the extraforaminal lumbar interbody fusion approach.

Summary of Background Data:
Over the last decade the number of techniques available for lumbar interbody fusion has increased. Recent interest has developed in an extraforaminal approach to the intervertebral disc to reduce the morbidity associated with facetectomy. The safety of this extraforaminal corridor with regards to the exiting nerve root and lumbar plexus has yet to be assessed.

Methods:
With the cadaver prone, the C-arm was positioned over the disc of interest and aligned perpendicular to the superior endplate of the inferior vertebral body, with the superior articular process bisecting the available disc space. Three needles were passed into the disc and labeled medial, middle, and lateral. After needle placement, each nerve root and the lumbar plexus were dissected. The distance of each needle to these structures was measured and discectomy was performed to assess potential graft length from a transforaminal and extraforaminal approach.

Results:
We performed the method on levels L1–L5 bilaterally on 2 cadavers, totaling 16 attempts for each needle position. The average distance to nerve of the medial approach (3.2±1.1 mm) was statistically greater than both the middle (1.1±1.4 mm) and lateral (−0.2±2.9 mm) approaches (P<0.0001 for both). The distance to plexus of the medial approach (14.3±6.2 mm) was greater than the middle (9.2±6.1 mm) approach and statistically greater than the lateral (5.2±5.6 mm) approach (P=0.001). There was a greater graft length available by the extraforaminal lumbar interbody fusion approach (36.1±2.7 mm) than the transforaminal lumbar interbody fusion approach (29.3±3.5 mm, P<0.0001).

Conclusions:
The safest trajectory was the medial, passing adjacent to the superior articular process. The close proximity, however, means that neuromonitoring and tubular dilators would be necessary to use this technique in a clinical setting.

Level:
Level V.
Risk Factors Associated With Failure to Reach Minimal Clinically Important Difference in Patient-reported Outcomes Following Minimally Invasive Transforaminal Lumbar Interbody Fusion for Spondylolisthesis
Authors: Hijji Fady Y. , Narain Ankur S. , Bohl Daniel D. , Yom Kelly H. , Kudaravalli Krishna T. , Lopez Gregory D. , Singh Kern 
Published: March 2018

Study Design:
Retrospective cohort.

Objective:
To determine risk factors associated with failure to reach the minimal clinically important difference (MCID) in patient-reported outcomes (PROs) for patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) for spondylolisthesis.

Summary of Background Data:
The MCID of PROs are often utilized to determine the benefit of spinal procedures. However, negative predictive factors for reaching MCID in patients surgically treated for lumbar spondylolisthesis have been difficult to elucidate.

Materials and Methods:
A prospectively maintained surgical database of patients who were diagnosed with lumbar spondylolisthesis and surgically treated with a single level MIS TLIF from 2010 to 2016 was reviewed. Patients with incomplete PRO survey data or <6-month follow-up were excluded from the analysis. MCID for visual analogue scale (VAS) back, VAS leg, and Oswestry Disability Index (ODI) was obtained from established values in the literature. All risk factors were then assessed for association with failure to reach MCID using bivariate and multivariate regression adjusting for preoperative characteristics.

Results:
A total of 165, 76, and 73 patients treated with MIS TLIF for spondylolisthesis had complete PRO data for VAS back, VAS leg, and ODI, respectively, and were thus included in the analysis for the respective PRO. Overall, 75.76%, 71.05%, and 61.64% of patients treated with a single level MIS TLIF for spondylolisthesis reached MCID for VAS back, VAS leg, and ODI, respectively. On multivariate analysis, patients were less likely to achieve MCID for VAS back following surgical treatment if they received workers’ compensation (P<0.001). No other measured factors were noted to independently correlate with MCID achievement.

Conclusions:
The results of this study suggest that a majority of patients with spondylolisthesis achieve MCID for commonly measured PROs following MIS TLIF for spondylolisthesis. However, worker’s compensation insurance status may serve as a negative predictive factor for reaching MCID.
Preoperative Opioid Use
Authors: Faour Mhamad , Anderson Joshua T. , Haas Arnold R. , Percy Rick , Woods Stephen T. , Ahn Uri M. , Ahn Nicholas U. 
Published: March 2018

Study Design:
Retrospective comparative case-control study.

Objectives:
The objectives of this study are: (1) How preoperative opioid use impacts RTW status after single-level cervical fusion for radiculopathy? and (2) What are other postsurgical outcomes affected by preoperative opioid use?

Summary of Background Data:
Opioid use has increased significantly in the past decade. The use of opioids has a drastic impact on workers’ compensation population, an at-risk cohort for poorer surgical and functional outcomes than the general population.

Methods and Materials:
Data was retrospectively collected from Ohio Bureau of Workers’ Compensation between 1993 and 2011. The study population included patients who underwent single-level cervical fusion for radiculopathy as identified by current procedural terminology codes and International Classification of Diseases-9 codes. On the basis of opioid use before surgery, two groups were constructed (opioids vs. non-opioids). Using a multivariate logistic regression model, the effect of preoperative opioid use on return to work (RTW) status after fusion was analyzed and compared between the groups.

Results:
In the regression model, preoperative opioid use was a negative predictor of RTW status within 3-year follow-up after surgery. Opioid patients were less likely to have stable RTW status [odds ratio (OR), 0.50; 95% confidence interval (CI), 0.38-0.65; P=0.05] and were less likely to RTW within the first year after surgery (OR, 0.50; 95% CI, 0.37-0.66; P=0.05) compared with controls. Stable RTW was achieved in 43.3% of the opioids group and 66.6% of control group (P=0.05). RTW rate within the first year after fusion was 32.5% of opioids group and 57% of control group (P<0.05).
Reoperation and permanent disability rates after surgery were higher in the opioid group compared with the control group (P<0.05).

Conclusions:
In a workers’ compensation, patients with work-related injury who underwent single-level cervical fusion for radiculopathy and received opioids before surgery had worse RTW status, a higher reoperation rate, and higher rate of awarded permanent disability after surgery.
Is Body Mass Index a Risk Factor for Revision Procedures After Minimally Invasive Transforaminal Lumbar Interbody Fusion?
Authors: Narain Ankur S. , Hijji Fady Y. , Bohl Daniel D. , Yom Kelly H. , Kudaravalli Krishna T. , Singh Kern 
Published: March 2018

Study Design:
Retrospective cohort study.

Objective:
To determine if an association exists between body mass index (BMI) and the rate of revision surgery after single-level minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).

Summary of Background Data:
MIS TLIF is an effective treatment for lumbar degenerative disease. Previous studies in the orthopedic literature have associated increased BMI with increased postoperative complications and need for revision. Few studies have evaluated the association between BMI and the risk for revision after minimally invasive spinal procedures.

Materials and Methods:
A surgical registry of patients who underwent a single-level MIS TLIF for degenerative pathology between 2005 and 2014 was reviewed. Patients were stratified based on BMI category: normal weight (BMI<25), overweight (BMI, 25–29.9), obese I (BMI, 30–34.9), and obese II–III (BMI≥35). BMI category was tested for association with demographic and procedural characteristics using 1-way analysis of variance (ANOVA) for continuous variables, and χ2 analysis or the Fisher exact test for categorical variables. BMI category was tested for association with undergoing a revision fusion procedure within 2 years after MIS TLIF using multivariate Cox proportional hazards survival analysis modeling.

Results:
In total, 274 patients were analyzed; of these, 52 (18.98%) were normal weight, 101 (36.86%) were overweight, 62 (22.63%) were obese I, and 59 (21.53%) were obese II–III. On multivariate Cox proportional hazards survival analysis modeling, BMI category was not associated with undergoing a revision procedure within 2 years after MIS TLIF (P=0.599). On multivariate analysis, younger age (P=0.004) was associated with increased risk of undergoing a revision after MIS TLIF.

Conclusions:
The results of this study suggest that increasing BMI is not a risk factor for undergoing a revision procedure after MIS TLIF. As such, patients with high BMI should be counseled regarding having similar rates of needing a revision procedure after MIS TLIF as those with lower BMI.

Level of Evidence:
Level IV.