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Paul J.C.,New York University | Lonner B.S.,Mount Sinai Medical Center Beth Israel Hospital | Goz V.,New York University | Weinreb J.,New York University | And 3 more authors.
Spine Journal | Year: 2015

Background context Revision adult spinal deformity surgery (RASDS) is a particularly high-risk intervention. Purpose The aim was to assess complication rates in RASDS by surgeon and hospital operative volume. Study design/setting This was a retrospective analysis of prospectively collected data. Patient sample Based on a Nationwide Inpatient Sample (NIS) database (2001-2010), patients aged older than 21 years (International Classification of Diseases, Ninth Revision, Clinical Modification) with spine arthrodesis for scoliosis were included. For longitudinal analysis, the 2008-2011 New York State Inpatient Database (NY SID) was queried. Outcome measures The outcome measures included complication rate after RASDS. Methods Cases were identified as primary or revision surgery with or without osteotomy performed. Annual surgeon and hospital volumes were stratified into quartiles via identifier codes. Case complexity was determined using a novel operative complexity index, based on available NIS operative parameters: levels fused, approach, osteotomy, and revision status. The primary end point was morbidity during the hospital stay. New York State Inpatient Database analysis allowed for identification of rate of reoperation for infection or pseudarthrosis/implant failure. One-way analysis of variance was used to assess continuous measures, chi-square for categorical measures. Results Of 139,150 adult spinal deformity surgery (ASDS) cases, 4,888 revision with hospital identifiers and 1,978 with surgeon identifiers were identified. Higher-volume surgeons performed more revision cases and cases requiring osteotomy. With increasing hospital volume, complication rate for RASDS decreased (9.7% vs. 12.9% at highest- vs. lowest-volume centers, p<.001). The highest-volume surgeons showed significant decreases in the rate of major complications for RASDS (8.8% vs. 10.7% for lowest-volume surgeons, p<.001). A similar trend was observed for ASDS cases requiring osteotomy. Multiple logistic regression analysis showed that the highest-volume hospitals and surgeons showed a reduced odds ratio for all complications compared with lowest-volume hospitals. For the NY SID, 528 RASDS cases indicated reoperation rates for infection and pseudarthrosis/implant failure after RASDS were increased for the lowest-volume hospitals and surgeons. Conclusions Perioperative complication rate associated with RASDS is lower when patients are treated by high-volume surgeons at high-volume centers. As complex cases requiring osteotomy and combined approaches are more frequent at high-volume centers, an operative complexity index helps predict the likelihood of volume-dependent complication rates. Future interhospital and intersurgeon comparisons should account for these case characteristics so that similar case complexity is compared in these analyses. © 2015 Elsevier Inc. Source

Auerbach J.D.,Yeshiva University | Kean K.,Temple University | Milby A.H.,University of Pennsylvania | Paonessa K.J.,Norwich Orthopaedic Group | And 4 more authors.
Spine | Year: 2016

Study Design. A cross-sectional survey of surgeon members of the Scoliosis Research Society (SRS). Objective. This study sought to characterize the incidence, clinical presentation, diagnostic workup, treatment, and neurologic prognosis following delayed postoperative neurologic deficit (DPND) in patients undergoing spinal deformity surgery. Summary of Background Data. DPND is a potentially devastating condition following spinal surgery, characterized by the development of a neurological deficit within hours or days of the surgical procedure. To date, only case reports and small case series have been published on the topic. Methods. We developed a survey to characterize DPND following spinal deformity surgery. This survey was distributed to surgeon members of the SRS through email and standard mail. The overall response rate was 38% (352/929). Results. Our results suggest an estimated DPND incidence of 1 of 9910 cases (0.01%). Eighty-one surgeons (23%) experienced at least 1 DPND in the past 10 years (92 total cases). Most common diagnoses were scoliosis (69%), kyphosis (23%), and spondylolisthesis (14%); 20% were revision surgeries. The number of hours to deficit onset was as follows: 1 to 12 (36%), 13 to 24 (27%), 25 to 48 (27%), more than 48 (10%). The most commonly cited sources of injury included ischemic injury (38%) and cord compression (15%). Forty-one percent experienced complete neurologic recovery, 26% partial, and 33% no recovery. Twenty-one percent of patients achieved final neurologic status within 1 week, 38% by 1 month, and 73% by 6 months. Patients with compression-related DPND had a significantly greater likelihood of experiencing some neurologic recovery (≥1 ASIA Grade) than ischemia-related DPND (86% versus 51%, P=0.049). Conclusions. DPND occurs at an estimated incidence of 0.01%. Sixty-three percent of DPND cases occurred within the first 24hours and 90% within 48hours. Complete (41%) or partial (26%) neurologic recovery may be expected, especially in compression-related DPND, emphasizing the need for perioperative vigilance, prompt recognition, and early intervention. © 2016 Wolters Kluwer Health, Inc. Source

Barzilay Y.,Hebrew University of Jerusalem | Segal G.,AposTherapy Research Group | Lotan R.,Edith Wolfson Medical Center | Regev G.,Sourasky Medical Center | And 4 more authors.
European Spine Journal | Year: 2015

Purpose: To assess the changes in gait pattern and clinical symptoms of patients with chronic non-specific low back pain (CNSLBP) following a home-based biomechanical treatment (HBBT). Methods: This was a retrospective analysis of 60 CNSLBP patients. All patients underwent a gait evaluation and completed self-assessment questionnaires at pre-treatment and after 3 and 6 months of a HBBT (AposTherapy). Twenty-four healthy, aged-matched individuals served as a reference group. Results: Significant differences were found in all gait parameters and clinical symptoms between patients with CNSLBP and healthy people before treatment. Significant improvements were found in all gait parameters and clinical measures following 6 months of therapy including an increase in gait velocity (10.6 %), step length (5.6 %), cadence (5 %), and quality of life and a decrease in pain (13.3 %). There were no significant differences between groups in the gait parameters following 6 months of treatment. Conclusions: Significant differences exist between patients with CNSLBP and healthy controls in terms of gait pattern and self-assessed health status. The examined HBBT led to significant improvements in gait pattern, reduction in pain, improved function and increased quality of life. However, future studies should validate these results while comparing this treatment to other treatment modalities. © 2015 Springer-Verlag Berlin Heidelberg Source

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