Zane Littell, Elizabeth Ablah, Hayrettin Okut, Joey Dean, Camden Whitaker
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引用次数: 0
Abstract
Study design: Retrospective chart review.
Objective: To determine whether there was a difference in postoperative pain among patients undergoing direct lateral interbody fusion (DLIF) who had rib removal compared with those who did not.
Background: DLIF is a minimally invasive, lateral transpsoas surgical approach for spinal fusion that has a lower 2-year pain rating when compared with an open procedure. However, the DLIF surgical approach of the L1/L2 spinal level can be obstructed by the ribs. It is unknown whether patients undergoing a DLIF with rib removal experience more pain than their counterparts without rib removal.
Methods: Patients who underwent a DLIF from an individual spine surgeon at Wesley Medical Center between January 1, 2014 and December 31, 2018 were grouped by rib status: with removal versus without. Postoperative pain, measured by a 0 (no pain) to 10 (worst pain) Visual Analog Scale (VAS), was recorded on the day of discharge.
Results: The analysis included data from 136 patients, 75 with removal and 61 without. Patient demographics did not differ significantly by age, sex, insurance, estimated blood loss, or length of stay. However, number of spinal levels fused was greater when rib removal occurred, 4.5 versus 3.5 (P = 0.008). The mean baseline VAS with rib removal was 6.6 (1.7) and at discharge it was 7.6 (2.1). The mean baseline VAS without removal was 6.7 (2.0) compared with 7.8 (1.8) at discharge. The multivariate model predicting discharge VAS indicated there was no difference in pain by rib removal status (P = 0.180). VAS at discharge was associated with positive morphine milligram equivalents; as the VAS pain score increased so did the morphine dose (P = 0.028).
Conclusion: Patients undergoing a DLIF with rib removal expressed no difference in postoperative pain compared with patients without rib removal.
期刊介绍：
Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure.
Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.
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