Evidence-based spine-care journal最新文献

{"title":"Commentary on: \"Sterile Seroma Resulting from Multilevel XLIF Procedure as Possible Adverse Effect of Prophylactic Vancomycin Powder: A Case Report\".","authors":"Scott L Parker, Clinton J Devin","doi":"10.1055/s-0034-1386759","DOIUrl":"https://doi.org/10.1055/s-0034-1386759","url":null,"abstract":"Postoperative surgical site infection (SSI) is the second most common health care – associated infection in the United States, second only to urinary tract infections, and resulting in an estimated 8,205 deaths in 2002 alone. 1 Furthermore, SSIs have been shown to result in a prolongation of hospital stay by 9.7 days and increase treatment cost by $20,842 per admission. 2 Assuch, signi fi cant attention has been focused on means of reducing SSIs and their associated morbidity and excess health care costs. Gram-positive microorganisms are the most common cause of SSI following spine surgery. 3 The use of prophylactic intrawound vancomycin powder has recently become a more common practice due to its ease of application, low cost, and ability to achieve high local con-centrations with low systemic levels. 4,5 A recent meta-analy-sis found that vancomycin powder was associated with a signi fi cant reduction in SSI (odds ratio: 0.19, 95% con fi dence interval: 0.09 – 0.38). 6 Furthermore, cost analyses on patients undergoing lumbar fusion procedures have demonstrated that the use of vancomycin powder was associated with a cost savings of $438,165 per 100 spinal fusions performed. 7 As with any new technology, medication, or technique, adverse events and/or sequelae will inevitably surface following generalized practice implementation. Well-described adverse drug reactions to systemic intravenous vancomycin use include red","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"5 2","pages":"134-5"},"PeriodicalIF":0.0,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0034-1386759","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32716963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on: \"L4 and L5 Spondylectomy for En Bloc Resection of Giant Cell Tumor and Review of the Literature\".","authors":"Aron Lazary","doi":"10.1055/s-0034-1387801","DOIUrl":"https://doi.org/10.1055/s-0034-1387801","url":null,"abstract":"Giant cell tumor (GCT; also known as osteoclastoma) is a locally aggressive, intermediate primary bone tumor characterized by osteoclast-like, multinucleated giant cells and the overexpression of receptor activator of nuclear factor kB ligand (RANKL) produced by stromal tumor cells. The tumorigenesis seemed to be associated with mutations of a histone (H3F3A) gene. Prevalence of GCT can be different in different regions/ethnical groups; e.g., GCT is rare in the United States—approximately 4 to 5% of primary bone tumors—but more often occurs in China where it is 10 to 20%.1 Local recurrence is common in surgically treated cases. Globally, malignant transformation has been described in 10% of cases, and lung metastases have been described in 1 to 4% of cases. Metastasizing can occur in benign, primary lesions as well and more frequently in recurrent GCTs and in spinal lesions.2 3 According to the Enneking surgical staging system, GCT is rarely S1 (latent); in 90% of cases, it is S2 (active with extensive cortical thinning and bulging) or S3 (aggressive with soft-tissue component). Management of GCT is often challenging and requires a multidisciplinary approach. In the spine, the osteolytic lesion can result in pathological fracture and consequential instability. Furthermore, the locally aggressive expansion of the tumor can cause neurological symptoms even in its early stage. The Enneking appropriate, en bloc resection of an S3 spinal lesion is a technically challenging surgery with high risk for perioperative complications and functional loss. \u0000 \u0000The case report of Santiago-Dieppa et al demonstrates the complexity of such a surgery. Regarding the differential diagnosis, on one hand, the imaging studies present the typical diagnostic findings in the case of spinal GCT: lytic, aggressive tumor in L4–L5 with local extension across the L4–L5 disc and to the spinal canal. On the other hand, the patient was 58 years old. That age is not typical for the appearance of a GCT, which is usually diagnosed in the second to fourth decade. The patient had local and irradiating pain but no neurological symptom. Considering the unpredictable nature of the tumor and the high risk for local recurrence, the authors performed an en bloc L4–L5 spondylectomy followed by lumbopelvic reconstruction. The description of the technical details of the two-stage surgery clearly shows the difficulty of the management of such a patient; however, more data on the total time of the surgery, blood loss, and hospital stay would have been more informative. In the reported case, the sagittal alignment is properly reconstructed, but I would have been also interested about the bone-grafting procedure, which is the key element of the long-term stability of the lumbopelvic reconstruction. Despite the proper surgical technique and the careful perioperative care, complications occur in almost all of these patients. The reported deep wound infection and CSF leak are the most common complicati","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"5 2","pages":"158-9"},"PeriodicalIF":0.0,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0034-1387801","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32716966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vertebral artery anomalies at the craniovertebral junction: a case report and review of the literature.","authors":"Amir M Abtahi,&nbsp;Darrel S Brodke,&nbsp;Brandon D Lawrence","doi":"10.1055/s-0034-1386751","DOIUrl":"https://doi.org/10.1055/s-0034-1386751","url":null,"abstract":"<p><p>Study Design Case report. Objective The objective of this study was to report a case of an unstable C1 burst fracture in the setting of a vertebral artery anomaly at the craniovertebral junction. Methods A 55-year-old man was admitted to the hospital with severe neck pain after falling approximately 15 feet and landing on his head. Computed tomography scan of the cervical spine revealed an unstable fracture of the C1 ring with magnetic resonance imaging evidence of a transverse ligament rupture as well as a congenital synchondrosis of the posterior arch of C1. He was neurologically intact. CT angiography (CTA) of the neck revealed an anomalous course of the right vertebral artery at the C1-C2 level. Results Surgical intervention consisted of occiput-C3 fusion, thus avoiding the placement of C1 lateral mass screws and risking vertebral artery injury. Conclusion We present a case of an unstable C1 burst fracture with an anomalous course of the right vertebral artery demonstrated by CTA. The presence of vertebral artery anomalies at the craniovertebral junction may prevent safe placement of C1 lateral mass screws and therefore influence the treatment options for upper cervical spine pathologies. To minimize the risk of vertebral artery injury, we elected to perform an occiput to C3 fusion. Thorough assessment of the vascular anatomy is recommended before operative intervention in the upper cervical spine to minimize the risk of complications. </p>","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"5 2","pages":"121-5"},"PeriodicalIF":0.0,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0034-1386751","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32786515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive factors for acute proximal junctional failure after adult deformity surgery with upper instrumented vertebrae in the thoracolumbar spine.","authors":"Prokopis Annis,&nbsp;Brandon D Lawrence,&nbsp;William R Spiker,&nbsp;Yue Zhang,&nbsp;Wei Chen,&nbsp;Michael D Daubs,&nbsp;Darrel S Brodke","doi":"10.1055/s-0034-1386755","DOIUrl":"https://doi.org/10.1055/s-0034-1386755","url":null,"abstract":"<p><p>Study Type Retrospective cohort study. Introduction Acute proximal junctional failure (APJF) was recently defined by the International Spine Study Group as: postoperative fracture of the upper instrumented vertebrae (UIV) or UIV + 1; UIV implant failure; proximal junctional kyphosis (PJK) increase > 15 degrees; or need for proximal extension of the fusion within 6 months of surgery.1 The incidence and revision rates of APJF have been reported to be higher when the UIV is located in the lower thoracolumbar (TL) spine mostly because of high incidence of UIV or UIV + 1 fractures.2 Sagittal deformity overcorrection has been considered as a potential risk factor.34 Objective The purpose of this study is to assess independent predictive factors and timing for revisions of APJF in adult deformity patients with UIV in the TL (T9-L2) spine. Methods Retrospective review of 135 consecutive patients with minimum 2-year follow-up, treated at a single institution for adult spinal deformity, all with UIV in the TL spine (T9-L2). Fusions were divided into three cohorts based on the UIV location (T9-T10 vs. T11-T12 vs. L1-L2). Demographic data were reviewed and radiographic parameters were measured preoperatively, immediately postoperatively, at 6 months and at the final follow-up. Incidence and failure modes of APJF, as well as timing for APJF revision are reported. Risk factors for APJF were assessed with univariate and multivariate regression analysis models. Results A total of 135 consecutive patients were reviewed, with mean follow-up 42 months (24-126). Mean age was 66 years (24-86). There were no differences in the preoperative radiographic parameters between patients in any of the three cohorts with APJF. The incidence of APJF was 38.5%, with a trend toward higher APJF in the T9-T10 group (p = 0.07) (Table 1). When UIV was at T10, the incidence of APJF was 57.1%, significantly higher than the adjacent vertebrae, T9 and T11 (p = 0.03 and p = 0.01, respectively). The overall revision rate for APJF was 17%, most often for UIV fracture, while PJK > 15 degrees alone had the highest 2 and 5 years survival (100%) (Fig. 1). Univariate analysis revealed preoperative sagittal vertical axis > 5 cm, postoperative PJA > 5 degrees and thoracic kyphosis > 30 degrees, and instrumentation to the pelvis as risk factors for APJF (Table 2). Multivariate regression analysis confirmed postoperative PJA > 5 degrees, and greater correction of lumbar lordosis (LL) as independent risk factors for APJF (Table 3). Conclusion The incidence of APJF in adult deformity patients is high if the UIV is in the lower thoracic or lumbar spine, with a trend toward higher rates when the UIV is at T10. Fracture at the UIV lead to the highest revision rate, while PJK > 15 degrees without fracture or hardware failure had the longest revision-free survival. Postoperative PJA > 5 degrees and greater correction of LL are independent risk factors for APJF. </p>","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"5 2","pages":"160-2"},"PeriodicalIF":0.0,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0034-1386755","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32716967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrical stimulation to enhance spinal fusion: a systematic review.","authors":"Paul Park, Darryl Lau, Erika D Brodt, Joseph R Dettori","doi":"10.1055/s-0034-1386752","DOIUrl":"10.1055/s-0034-1386752","url":null,"abstract":"<p><p>Study Design Systematic review. Clinical Questions Compared with no stimulation, does electrical stimulation promote bone fusion after lumbar spinal fusion procedures? Does the effect differ based on the type of electrical stimulation used? Methods Electronic databases and reference lists of key articles were searched up to October 15, 2013, to identify randomized controlled trials (RCTs) comparing the effect of electrical stimulation to no electrical stimulation on fusion rates after lumbar spinal fusion for the treatment of degenerative disease. Two independent reviewers assessed the strength of evidence using the Grades of Recommendation Assessment, Development and Evaluation (GRADE) criteria. Results Six RCTs met the inclusion criteria. The following types of electrical stimulation were investigated: direct current (three studies), pulsed electromagnetic field (three studies), and capacitive coupling (one study). The control groups consisted of no stimulation (two studies) or placebo (four studies). Marked heterogeneity in study populations, characteristics, and design prevented a meta-analysis. Regardless of the type of electrical stimulation used, cumulative incidences of fusion varied widely across the RCTs, ranging from 35.4 to 90.6% in the intervention groups and from 33.3 to 81.9% in the control groups across 9 to 24 months of follow-up. Similarly, when stratified by the type of electrical stimulation used, fusion outcomes from individual studies varied, leading to inconsistent and conflicting results. Conclusion Given the inconsistency in study results, possibly due to heterogeneity in study populations/characteristics and quality, we are unable to conclude that electrical stimulation results in better fusion outcomes compared with no stimulation. The overall strength of evidence for the conclusions is low. </p>","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"5 2","pages":"87-94"},"PeriodicalIF":0.0,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4174185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32716462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on: \"Vertebral Artery Anomalies at the Craniovertebral Junction: A Case Report and Review of the Literature\".","authors":"Robert W Molinari","doi":"10.1055/s-0034-1386757","DOIUrl":"https://doi.org/10.1055/s-0034-1386757","url":null,"abstract":"The authors report a case of an unstable C1 fracture with magnetic resonance imaging demonstrating rupture of the transverse ligament. Posterior vertebral artery anomaly in the form of a right persistent first intersegmental artery was identified preoperatively in the region of the right posterior C1–C2 lateral mass interval. The surgical plan was altered to avoid the anomalous vertebral artery and the patient was successfully managed with an uncomplicated occiput to C3 instrumentation and fusion procedure. The literature review includes a discussion of the work by Uchino et al who have reported a persistent first intersegmental artery in up to 3.2% of normal subjects and an overall prevalence of craniovertebral junction vertebral artery anomalies of 5%.1 \u0000 \u0000This article is an important addition to the existing literature as it highlights the relatively high prevalence of vertebral artery anomalies at the craniovertebral junction. The case described involves an aberrant vertebral artery with an anomalous course located posteriorly between the C1 and C2 lateral masses. This particular vertebral artery anomaly poses great risk to the conventional placement of C1 lateral mass screws through previously described techniques involving the exposure of the C1 lateral mass or placement of the screw through the C1 posterior ring. The anomaly was identified preoperatively by computed tomography angiography in this case, and intraoperative vertebral artery injury was avoided. The utility of the use of routine of preoperative imaging studies to demonstrate the course of the bilateral vertebral arteries before any planned exposure of the craniocervical junction is clearly implied in this case report. \u0000 \u0000The significance of this case report and review of the literature lies in the identification of the increased risk of complication involving vertebral artery injury through a routine posterior cervical spine surgical exposure. Much of the existing literature involving vertebral artery injury in cervical spinal surgery has focused on injuries incurred with anterior cervical spinal surgical procedures. Tortuous anterior course of the vertebral artery in the subaxial cervical spine has been well described by Curylo et al in approximately 5.5% of subjects.2 Multiple reports of injury to the vertebral artery during anterior cervical decompression surgery exist in the literature.3 Five studies reported rates of 0.10 to 1.96%, depending on the type of anterior cervical spine procedure.3 There remains, however, a paucity of literature with respect to vertebral artery injury incurred with a posterior cervical surgical exposure. Molinari et al recently reported vertebral artery injury in two cases involving a persistent first intersegmental artery in the region of C1–C2. Both injuries were incurred with routine posterior exposure of the C1–C2 anatomy. A review of the existing literature demonstrates few publications on this topic.3 \u0000 \u0000The authors should be applauded for ","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"5 2","pages":"126"},"PeriodicalIF":0.0,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0034-1386757","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32716962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to prove the value proposition of spine surgery.","authors":"Jens Chapman","doi":"10.1055/s-0034-1390026","DOIUrl":"https://doi.org/10.1055/s-0034-1390026","url":null,"abstract":"Spine care has come under increased scrutiny due to its substantial contribution to our unfavorable healthcare cost development. This has brought a growing awareness to the question of the relationship of the costs relative to benefits derived from spine interventions. Undoubtedly, this is probably the most pressing “hot button” topic in spine surgery around the world. While there is a general consensus that the current healthcare cost trajectories are unsustainable for just about any of the global economies, the specific methods for the calculation of value of spine care is less than straightforward as valid measurements for outcomes are just beginning to become more well defined, and calculations of cost in health remain surprisingly difficult to establish—especially when the impact of observation time frames is becoming increasingly apparent.1 \u0000 \u0000In this issue of Evidence-Based Spine-Care Journal (EBSJ), our readership will find several articles that address the issue of value in spine care directly or indirectly. For instance, the impact of potentially unnecessary studies and surgical techniques (magnetic resonance imaging in adolescents and electrical stimulation to enhance spinal fusions) and a critical reflection on the safety of performing spine surgery in an outpatient setting are examples of opportunities to achieve meaningful cost savings by being more selective in our application of resources. Specifically, outpatient spine surgery performed in specialized ambulatory surgery centers has become an increasingly appealing choice in many countries for certain spine procedures in an effort to minimize the major cost factor in spine-care delivery hospitals.2 \u0000 \u0000As we are looking for ways to measure outcomes, the frequently vague window of follow-up is becoming an increasingly relevant concern. In the study by Aichmair et al,3 attempts were made to reconnect with discectomy patients up to 10 years later. Despite some methodological limitations of achieving sizeable follow-up numbers in one of the most diverse metropolitan areas in the world—New York—with its notorious horizontal migration patterns, one of the cardinal insights of this study underscores the importance of defining follow-up parameters relative to outcomes assessments. Finally, a critical “Science in Spine” article points out the limitations and potential of “big data” mined from increasingly readily available administrative databases. These types of databases have recently gained popularity for value-related studies on spine surgery. It is important to realize what information can be gleaned from these types of investigations and where their shortcomings lie. \u0000 \u0000Staying with the theme of “value in spine care,” the EBSJ readership might find interest in a prospectively randomized study that looked at 400 patients treated with epidural injections with and without steroids for lumbar spinal stenosis. In what is destined to become a hotly debated future landmark study, the widespr","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"5 2","pages":"73"},"PeriodicalIF":0.0,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0034-1390026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32716458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidental findings on magnetic resonance imaging of the spine in the asymptomatic pediatric population: a systematic review.","authors":"Uma Ramadorai,&nbsp;Justin Hire,&nbsp;John G DeVine,&nbsp;Erika D Brodt,&nbsp;Joseph R Dettori","doi":"10.1055/s-0034-1386753","DOIUrl":"https://doi.org/10.1055/s-0034-1386753","url":null,"abstract":"<p><p>Study Design Systematic review. Clinical Question What is the prevalence of incidental magnetic resonance imaging (MRI) findings of the spine in asymptomatic pediatric patients? Methods Electronic databases and reference lists of key articles were searched up to December 15, 2013, to identify studies reporting the incidence or prevalence of incidental findings on MRI in asymptomatic pediatric patients. Athletes or children with a known history of trauma, infection, or congenital abnormalities were excluded. Results Seven publications, one prospective cohort, and six cross-sectional studies met the inclusion criteria. The most commonly reported findings on MRI were disc-related and included degenerative disc disease (seven studies, prevalence 19.6%), disc herniation/protrusion (four studies, 2.9%), disc height/narrowed disc space (two studies, 33.7%), and endplate changes (two studies, 5.3%). Other disc-related findings, reported by one study each, included bulging disc, abnormal nucleus shape, annular tear, high intensity zone, and nerve root compression, with prevalences ranging from 4.5 to 51.6%. Spondylolisthesis and spondylolysis were reported by one study each with a prevalence of 2.3 and 0%, respectively. Other findings reported included tumors and infections (one study, 0% for both) and Scheuermann-type changes (one study, 7.7%). Conclusions The prevalence of positive MRI findings in the asymptomatic pediatric population is higher than previously assumed, particularly in regard to disc morphology, highlighting the importance of correlating the history and physical examination to the MRI findings to avoid misdiagnosis or over-treatment in the pediatric population. </p>","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"5 2","pages":"95-100"},"PeriodicalIF":0.0,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0034-1386753","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32716463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on: \"To the Occiput or Not? C1-C2 Ligamentous Laxity in Children with Down Syndrome\".","authors":"W Bradley Jacobs","doi":"10.1055/s-0034-1386758","DOIUrl":"https://doi.org/10.1055/s-0034-1386758","url":null,"abstract":"Siemionow and Chou review the surgical management of atlantoaxial instability in the context of Down syndrome, using two interesting illustrative cases with different craniocervical abnormalities (atlantoaxial rotatory subluxation and os odontoideum). Both patients present with significant craniocervical spinal cord compression, and in this context, they highlight the specific case nuances that prompt occiptocervical fusion in one case and isolated atlantoaxial fixation in the other. However, it is important to note that while the authors refer to the presence of basilar invagination (and cranial settling) in these cases, a review of the accompanying radiographic images suggests that while significant craniocervical deformity and atlantoaxial instability is present, neither case truly has a diagnosis of basilar invagination nor cranial settling.","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"5 2","pages":"119-20"},"PeriodicalIF":0.0,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0034-1386758","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32716465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outpatient surgery in the cervical spine: is it safe?","authors":"Michael J Lee, Iain Kalfas, Haley Holmer, Andrea Skelly","doi":"10.1055/s-0034-1389088","DOIUrl":"10.1055/s-0034-1389088","url":null,"abstract":"<p><p>Study Design Systematic review. Study Rationale As the length of stay after cervical spine surgery has decreased substantially, the feasibility and safety of outpatient cervical spine surgery come into question. Although minimal length of stay is a targeted metric for quality and costs for medical centers, the safety of outpatient cervical spine surgery has not been clearly defined. Objective The objective of this article is to evaluate the safety of inpatient versus outpatient surgery in the cervical spine for adult patients with symptomatic or asymptomatic degenerative disc disease. Methods A systematic review of the literature was undertaken for articles published through February 19, 2014. Electronic databases and the bibliographies of key articles were searched to identify comparative studies evaluating the safety of inpatient versus outpatient surgery in the cervical spine. Spinal cord stimulation, spinal injections, and diagnostic procedures were excluded. Two independent reviewers assessed the strength of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system, and disagreements were resolved by consensus. Results Five studies that met the inclusion criteria were identified. One study reported low risk of hematoma (0% of outpatients and 1.6% of inpatients). Two studies reported on mortality and both reported no deaths in either group following surgery. Dysphagia risks ranged from 0 to 10% of outpatients and 1.6 to 5% of inpatients, and infection risks ranged from 0 to 1% of outpatients and 2 to 2.8% of inpatients. One study reported that no (0) outpatients were readmitted to the hospital due to a complication, compared with four inpatients (7%). The overall strength of evidence was insufficient for all safety outcomes examined. Conclusion Though the studies in our systematic review did not suggest an increased risk of complication with outpatient cervical spine surgery, the strength of evidence to make a recommendation was insufficient. Further study is needed to more clearly define the role of outpatient cervical spine surgery. </p>","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"5 2","pages":"101-11"},"PeriodicalIF":0.0,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4174186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32716464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}