bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can Surgeon Demographic Factors Predict Postoperative Complication Rates After Elective Spinal Fusion?
Authors: Chun Danielle S. , Cook Ralph W. , Weiner Joseph A. , Schallmo Michael S. , Barth Kathryn A. , Singh Sameer K. , Freshman Ryan D. , Patel Alpesh A. , Hsu Wellington K. 
Published: March 2018

Study Design:
Retrospective cohort.

Objective:
Determine whether surgeon demographic factors influence postoperative complication rates after elective spine fusion procedures.

Background:
Surgeon demographic factors have been shown to impact decision making in the management of degenerative disease of the lumbar spine. Complication rates are frequently reported outcome measurements used to evaluate surgical treatments, quality-of-care, and determine health care reimbursements. However, there are few studies investigating the association between surgeon demographic factors and complication outcomes after elective spine fusions.

Methods:
A database of US spine surgeons with corresponding postoperative complications data after elective spine fusions was compiled utilizing public data provided by the Centers for Medicare and Medicaid Services (2011–2013) and ProPublica Surgeon Scorecard (2009–2013). Demographic data for each surgeon was collected and consisted of: surgical specialty (orthopedic vs. neurosurgery), years in practice, practice setting (private vs. academic), type of medical degree (MD vs. DO), medical school location (United States vs. foreign), sex, and geographic region of practice. General linear mixed models using a Beta distribution with a logit link and pairwise comparison with post hoc Tukey-Kramer were used to assess the relationship between surgeon demographics and complication rates.

Results:
2110 US-practicing spine surgeons who performed spine fusions on 125,787 Medicare patients from 2011 to 2013 met inclusion criteria for this study. None of the surgeon demographic factors analyzed were found to significantly affect overall complication rates in lumbar (posterior approach) or cervical spine fusion.

Conclusions:
Publicly available complication rates for individual spine surgeons are being utilized by hospital systems and patients to assess aptitude and gauge expectations. The increasing demand for transparency will likely lead to emphasis of these statistics to improve outcomes. We conclude that none of the surgeon demographic factors analyzed in this study are associated with differences in overall complications rates in patients undergoing elective spine fusion as published by the ProPublica Surgeon Scorecard.

Level of Evidence:
Level 3.
Superior Segment Facet Joint Violation During Instrumented Lumbar Fusion is Associated With Higher Reoperation Rates and Diminished Improvement in Quality of Life
Authors: Levin Jay M. , Alentado Vincent J. , Healy Andrew T. , Steinmetz Michael P. , Benzel Edward C. , Mroz Thomas E. 
Published: March 2018

Study Design:
A retrospective cohort study at a single tertiary care center.

Objective:
To determine the impact of superior segment facet joint violation (FJV) during lumbar fusion on reoperation rates and quality of life (QOL).

Summary of Background Data:
Although lumbar fusion is an efficacious and durable treatment for numerous spinal pathologies, adjacent segment degeneration remains a serious complication. FJV has been suggested to alter load-bearing capability and potentially contribute to adjacent segment degeneration.

Materials and Methods:
Patients who underwent instrumented lumbar fusion surgery between 2009 and 2013 with postoperative computed tomography imaging were included. Patients were placed in the FJV group if either of the superior segment facet joints were compromised by the pedicle screw or rod. Patients with preserved facet joints were placed in the control group. Demographic, perioperative, QOL, and reoperation data were collected. QOL scores including the Pain Disability Questionnaire, Patient Health Questionnaire-9, and EuroQOL 5 Dimensions (EQ-5D) were acquired.

Results:
Of 240 patients included, 112 patients were found to have FJV and the remaining 128 patients were placed in the control group. One year following lumbar fusion, QOL outcomes and reoperation rates were similar between the FJV and control groups. At 2-year follow-up, patients in the FJV group were less likely to make a significant improvement in EQ-5D (P=0.041). Also, the reoperation rate in the FJV group was significantly higher than in the control group at 2 years (15.2% vs. 6.3%, respectively; P=0.024) and 3 years (19.6% vs. 9.4%, P=0.023). Multivariable logistic regression showed FJV to be an independent predictor of both (1) failing to make a significant improvement in EQ-5D (P=0.046) and (2) undergoing reoperation at both 2 and 3 years postoperatively (P=0.024 and 0.020, respectively).

Conclusions:
FJV was independently associated with a higher reoperation rate and diminished improvement in QOL.
Efficacy of Target Drug Delivery and Dead Space Reduction Using Antibiotic-loaded Bone Cement for the Treatment of Complex Spinal Infection
Authors: Masuda Soichiro , Fujibayashi Shunsuke , Otsuki Bungo , Kimura Hiroaki , Matsuda Shuichi 
Published: March 2018

Study Design:
A retrospective study.

Objectives:
We have treated complex cases of surgical site infection (SSI) successfully using antibiotic-loaded bone cement to avoid the need for implant removal. In the present study, we describe a new treatment option for SSI.

Summary of Background Data:
Although there are several treatment options for SSI after spinal surgery involving instrumentation, several types of problems may arise and are difficult to cure.

Materials and Methods:
Eleven patients with SSI after undergoing spinal surgery involving instrumentation were studied. All had been refractory to conventional treatments, including intravenous antibiotic administration and conventional debridement and irrigation. Antibiotic-loaded bone cement was placed on and around the instrumentation to cover them and to occupy the surrounding dead space. Two general types of antibiotics were loaded into the polymethylmethacrylate bone cement. The recipes for the mixture were changed depending on the bacterial cultures. Sensitive antibiotics were administered generally for 2–6 weeks until the C-reactive protein level was normalized.

Results:
All patients were treated successfully using antibiotic-loaded bone cement. Only 1 patient needed a repeat of this procedure to treat an infection. Antibiotic-loaded bone cement was placed in situ in all patients during the follow-up period and there were no significant adverse events.

Conclusions:
Antibiotic-loaded bone cement treatment reduces the dead space and achieves the targeted drug delivery simultaneously. Treatment using antibiotic-loaded bone cement is an effective treatment option for complex spinal SSI.
Risk Factors and Management of Incidental Durotomy in Lumbar Interbody Fusion Surgery
Authors: Enders Frederik , Ackemann Amelie , Müller Simon , Kiening Karl , Orakcioglu Berk 
Published: March 2018

Study Design:
This is a retrospective study analysis.

Objective:
In this retrospective study we evaluated risk factors for incidental durotomy and its impact on the postoperative course.

Summary of Background Data:
Lumbar interbody fusion (LIF) is increasingly applied for the treatment of degenerative instability. A known complication is incidental durotomy.

Materials and Methods:
A cohort of 541 patients who underwent primary LIF surgery between 2005 and 2015 was analyzed. Previous lumbar surgery, age, surgeon’s experience, intraoperative use of a microscope, and the number of operated levels were assessed and the risk for incidental durotomy was estimated using the Log-likelihood test and Wald test, respectively. The association of incidental durotomy and outcome parameters was analyzed using the quantile regression model.

Results:
In 77 (14.2%) patients intraoperative cerebrospinal fluid (CSF) fistula was observed. Previous lumbar surgery (P<0.001), number of operated levels (P=0.03), and surgeon’s experience (P=0.01) were significantly associated with incidental durotomy. Incidental durotomy was significantly associated with a prolonged bed rest (P<0.001), hospital stay (P=0.041), and an increased use of postoperative antibiotics (P<0.001). Eleven of 77 patients with incidental durotomy (14.3%) developed postoperative CSF fistula of whom 10 (91%) needed revision surgery for dural repair.

Conclusions:
We could identify important risk factors for incidental durotomy in LIF surgery. In patients who had undergone previous lumbar surgery and those with multilevel disease particular precaution is required. Furthermore, we were able to verify the morbidity associated with CSF fistula as shown by increased immobilization and follow-up surgeries for postoperative CSF fistula which emphasizes the importance to develop strategies to minimize the risk for incidental durotomy.
The Timing of Surgery Affects Return to Work Rates in Patients With Degenerative Lumbar Stenosis in a Workers’ Compensation Setting
Authors: Tye Erik Y. , Anderson Joshua T. , Haas Arnold R. , Percy Rick , Woods Stephen T. , Ahn Uri M. , Ahn Nicholas U. 
Published: March 2018

Study Design:
Retrospective Cohort Study.

Objective:
The objective of this study is to determine how time to surgery affects outcomes for degenerative lumbar stenosis (DLS) in a workers’ compensation (WC) setting.

Summary of Background Data:
WC subjects are known to be a clinically distinct population with variable outcomes following lumbar surgery. No study has examined the effect of time to surgery in this clinically distinct population.

Materials and Methods:
A total of 227 Ohio WC subjects were identified who underwent primary decompression for DLS between 1993 and 2013. We allocated patients into 2 groups: those that received operative decompression before and after 1 year of symptom onset. Our primary outcome was, if patients were able to make a stable return to work (RTW). The authors classified subjects as RTW if they returned within 2 years after surgery and remained working for >6 months.

Results:
The early cohort had a significantly higher RTW rate [50% (25/50) vs. 30% (53/117); P=0.01]. A logistic regression was performed to identify independent variables that predicted RTW status. Our regression model showed that time to surgery remained a significant negative predictor of RTW status (P=0.04; odds ratio, 0.48; 95% confidence interval, 0.23–0.91). Patients within the early surgery cohort cost on average, $37,332 less in total medical costs than those who opted for surgery after 1 year (P=0.01). Furthermore, total medical costs accrued over 3 years after index surgery was on average, $13,299 less when patients received their operation within 1 year after symptom onset (P=0.01).

Conclusions:
Overall, time to surgery had a significant impact on clinical outcomes in WC subjects receiving lumbar decompression for DLS. Patients who received their operation within 1 year had a higher RTW rate, lower medical costs, and lower costs accrued over 3 years after index surgery. The results presented can perhaps be used to guide surgical decision-making and provide predictive value for the WC population.
Assessing Online Patient Education Readability for Spine Surgery Procedures
Authors: Long William W. , Modi Krishna D. , Haws Brittany E. , Khechen Benjamin , Massel Dustin H. , Mayo Benjamin C. , Singh Kern 
Published: March 2018

Background Context:
Increased patient reliance on Internet-based health information has amplified the need for comprehensible online patient education articles. As suggested by the American Medical Association and National Institute of Health, spine fusion articles should be written for a 4th–6th-grade reading level to increase patient comprehension, which may improve postoperative outcomes.

Purpose:
The purpose of this study is to determine the readability of online health care education information relating to anterior cervical discectomy and fusion (ACDF) and lumbar fusion procedures.

Study Design:
Online health-education resource qualitative analysis.

Methods:
Three search engines were utilized to access patient education articles for common cervical and lumbar spine procedures. Relevant articles were analyzed for readability using Readability Studio Professional Edition software (Oleander Software Ltd). Articles were stratified by organization type as follows: General Medical Websites (GMW), Healthcare Network/Academic Institutions (HNAI), and Private Practices (PP). Thirteen common readability tests were performed with the mean readability of each compared between subgroups using analysis of variance.

Results:
ACDF and lumbar fusion articles were determined to have a mean readability of 10.7±1.5 and 11.3±1.6, respectively. GMW, HNAI, and PP subgroups had a mean readability of 10.9±2.9, 10.7±2.8, and 10.7±2.5 for ACDF and 10.9±3.0, 10.8±2.9, and 11.6±2.7 for lumbar fusion articles. Of 310 total articles, only 6 (3 ACDF and 3 lumbar fusion) were written for comprehension below a 7th-grade reading level.

Conclusions:
Current online literature from medical websites containing information regarding ACDF and lumbar fusion procedures are written at a grade level higher than the suggested guidelines. Therefore, current patient education articles should be revised to accommodate the average reading level in the United States and may result in improved patient comprehension and postoperative outcomes.
Clinical and Radiologic Comparison of Minimally Invasive Surgery With Traditional Open Transforaminal Lumbar Interbody Fusion
Authors: Price Julian P. , Dawson John M. , Schwender James D. , Schellhas Kurt P. 
Published: March 2018

Study Design:
Retrospective analysis of prospective data for parallel, consecutive series of patients (Level III).

Objective:
Compare clinical results and radiographic outcomes of minimally invasive surgery (MIS) versus open techniques for transforaminal lumbar interbody fusion (TLIF).

Summary of Background Data:
Minimally invasive techniques allow transforaminal exposure with decreased soft tissue disruption, but the question remains whether surgical and functional outcomes are equivalent to open techniques.

Materials and Methods:
A consecutive series of 452 1 or 2-level TLIF patients at a single institution between 2002 and 2008 were analyzed. A total of 148 were MIS patients and 304 were open. Operative time, estimated blood loss, infection rate, and hospital length of stay were recorded. Oswestry disability index (ODI) and visual analog (VAS) pain scores were documented preoperatively and postoperatively. Fusion was assessed radiologically at a minimum of 1 year follow-up.

Results:
There were proportionally more 2-level than 1-level procedures in the open group compared with the MIS group; there were more Workers’ Compensation patients among 1-level procedures than 2-level. There were more Spondylolisthesis patients and fewer Degenerative Disk Disease patients among one-level procedures compared with 2-level. Blood loss and operative time were lower in the MIS group. Length of hospital stay in the MIS cohort was shorter compared with the open cohort. There were 3 deep wound infections in the open cohort. ODI and VAS (leg and back) scores improved in both groups at 1 year compared with preoperative scores and did not differ between MIS and open cohorts. Fusion rate was similar for both groups (91% overall). One-level procedures and BMP use were associated with higher fusion rate, regardless of approach.

Conclusions:
MIS TLIF produces comparable clinical and radiologic outcomes to open TLIF with the benefits of decreased intraoperative blood losses, shorter operative times, shorter hospital stays, and fewer deep wound infections.
Use of an Alternative Surgical Corridor in Oblique Lateral Interbody Fusion at the L5–S1 Segment
Authors: Chung Nam-Su , Jeon Chang-Hoon , Lee Han-Dong 
Published: March 2018

Study Design:
Technical report.

Objective:
To demonstrate the use of an alternative surgical corridor in oblique lateral interbody fusion (OLIF) at the L5–S1 segment.

Summary of Background Data:
OLIF L5–S1 is essentially performed through the central disk space between the bifurcations of the iliac vessels, which is sometimes difficult due to the vascular structures that obstruct the surgical field. Another concern is retrograde ejaculation following superior hypogastric plexus injury in male patients.

Materials and Methods:
The alternative surgical corridor involves the lateral disk space external to the left iliac vessels. The patient position and the retroperitoneal approach are similar to those used in the conventional OLIF L5–S1. The left iliac vessels are identified and mobilized medially to the midline of the L5–S1 disk space. The vascular structures are then protected using the conventional OLIF 51 retractor system.

Results:
Six patients underwent OLIF L5–S1 through the alternative lateral surgical corridor. The L5–S1 disk spaces were always exposed sufficiently for disk preparation and cage insertion. The postoperative radiographs showed a satisfactory L5–S1 reconstruction with good cage position. There were no perioperative complications during the surgical access and reconstruction procedures.

Conclusions:
When the central approach to the L5–S1 disk space poses a risk of vascular or superior hypogastric plexus injury, use of a lateral approach external to the left iliac vessels can be an alternative method to perform OLIF L5–S1.
Ethnic Variations in Radiographic Parameters and SRS-22 Scores in Adult Spinal Deformity
Authors: Hosogane Naobumi , Ames Christopher , Matsumoto Morio , Yagi Mitsuru , Matsuyama Yukihiro , Taneichi Hiroshi , Yamato Yu , Takeuchi Daisaku , Schwab Frank , Shaffrey Christopher , Smith Justin S. , Bess Shay , Lafage Virginie 
Published: March 2018

Study Design:
Retrospective review of North American and Japanese adult spinal deformity (ASD) database.

Objective:
To investigate the ethnical differences in radiographic parameters and Scoliosis Research Society (SRS)-22 between North American and Japanese ASD.

Summary of Background Data:
Previous comparison study between North American and Japanese ASD patients has revealed Japanese patients had marked pelvic tilt deformity and had lower Oswestry Disability Index scores corresponding to established thresholds of radiographic deformity. However, the subjects of the previous study included relatively younger ASD patients (above 18 y) of idiopathic origin.

Materials and Methods:
Total 282 ASD patients older than 50 years, 211 patients from North America (United States) and 71 patients from Japan (JP), with minimum 2-year follow-up postoperatively were included in the study. Radiologic parameters were compared at the baseline and at 2-year follow-up. SRS-22 score was used for the comparison of clinical outcome.

Results:
At baseline, Japan showed significantly worse sagittal alignment such as smaller lumbar lordosis (LL), larger pelvic incidence (PI), and larger sagittal vertical axis than United States. However, Japan had significantly fewer levels fused than United States (US, 12.66±4.6; JP, 8.49±2.7). At 2 years after the surgery, Japan still had significantly worse residual sagittal deformity. Comparison of SRS-22 scores revealed Japan had better pain but worse functional domain scores at baseline which improved to comparable levels to the United States at 2 years. Self-image and mental health scores in Japan were significantly worse both at baseline and at 2 years. Analysis of factors affecting SRS-22 satisfaction score at 2 years revealed that previous spinal fusion surgery in the United States and LL, PI-LL, and sagittal vertical axis at 2 years in Japan had significant correlation.

Conclusions:
These similarities and discrepancies may be influenced by the cultural or lifestyle differences between both nations and should be considered when interpreting the results of ASD studies among different ethnicities.
Distribution and Determinants of 90-Day Payments for Multilevel Posterior Lumbar Fusion
Authors: Jain Nikhil , Phillips Frank M. , Khan Safdar N. 
Published: March 2018

Study Design:
A retrospective, economic analysis.

Objective:
The objective of this article is to analyze the distribution of 90-day payments, sources of variation, and reimbursement for complications and readmissions for primary ≥3-level posterior lumbar fusion (PLF) from Medicare data. A secondary objective was to identify risk factors for complications.

Summary of Background Data:
Bundled payments represent a single payment system to cover all costs associated with a single episode of care, typically over 90 days. The dollar amount spent on different health service providers and the variation in payments for ≥3-level PLF have not been analyzed from a bundled perspective.

Materials and Methods:
Administrative claims data were used to study 90-day Medicare (2005–2012) reimbursements for primary ≥3-level PLF for deformity and degenerative conditions of the lumbar spine. Distribution of payments, sources of variation, and reimbursements for managing complications were studied using linear regression models. Risk factors for complications were studied by stepwise multiple-variable logistic regression analysis.

Results:
Hospital payments comprised 73.8% share of total 90-day payment. Adjusted analysis identified several factors for variation in index hospital payments. The average 90-day Medicare payment for all multilevel PLFs without complications was $35,878 per patient. The additional average cost of treating complications with/without revision surgery within 90 days period ranged from $17,284 to $68,963. A 90-day bundle for ≥3-level PLF with readmission ranges from $88,648 (3 levels) to $117,215 (8+ levels). Rates and risk factors for complications were also identified.

Conclusions:
The average 90-day payment per patient from Medicare was $35,878 with several factors such as levels of surgery, comorbidities, and development of complications influencing the cost. The study also identifies the risks and costs associated with complications and readmissions and emphasize the significant effect these would have on bundled payments (additional burden of up to 192% the cost of an average uncomplicated procedure over 90 days).

Level of Evidence:
Level 3.