OBJECT Lumbar discectomy is one of the most common surgical spine procedures. In order to understand the value of this surgical care, it is important to understand the costs to the health care system and patient for good results. The objective of this study was to evaluate for the first time the cost-effectiveness of spine surgery in Latin America for lumbar discectomy in terms of cost per quality-adjusted life year (QALY) gained for patients in Brazil. METHODS The authors performed a prospective cohort study involving 143 consecutive patients who underwent open discectomy for lumbar disc herniation (LDH). Patient-reported outcomes were assessed utilizing the SF-6D, which is derived from a 12-month variation of the SF-36. Direct medical costs included medical reimbursement, costs of hospital care, and overall resource consumption. Disability losses were considered indirect costs. A 4-year horizon with 3% discounting was applied to health-utilities estimates. Sensitivity analysis was performed by varying utility gain by 20%. The costs were expressed in Reais (R$) and US dollars ($), applying an exchange rate of 2.4:1 (the rate at the time of manuscript preparation). RESULTS The direct and indirect costs of open lumbar discectomy were estimated at an average of R$3426.72 ($1427.80) and R$2027.67 ($844.86), respectively. The mean total cost of treatment was estimated at R$5454.40 ($2272.66) (SD R$2709.17 [$1128.82]). The SF-6D utility gain was 0.044 (95% CI 0.03197–0.05923, p = 0.017) at 12 months. The 4-year discounted QALY gain was 0.176928. The estimated cost-utility ratio was R$30,828.35 ($12,845.14) per QALY gained. The sensitivity analysis showed a range of R$25,690.29 ($10,714.28) to R$38,535.44 ($16,056.43) per QALY gained. CONCLUSIONS The use of open lumbar discectomy to treat LDH is associated with a significant improvement in patient outcomes as measured by the SF-6D. Open lumbar discectomy performed in the Brazilian supplementary health care system provides a cost-utility ratio of R$30,828.35 ($12,845.14) per QALY. The value of acceptable cost-effectiveness will vary by country and region.

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Objective:To assess the prophylactic effects of local vancomycin on an infection of the surgical site in patients undergoing lumbar instrumented fusion.Methods:Retrospective study from January 2011 to June 2014 in patients with symptomatic and refractory lumbar spine stenosis and listhesis who underwent instrumented pedicle screw spinal fusion. Two groups of patient were analyzed, one using vancomycin on the surgical site, vancomycin group (VG) and the control group (CG) without topical vancomycin. The routine prophylactic procedures were performed in both groups: aseptic scrub technique, skin preparation, preoperative intravenous antibiotic therapy. The VG received a dose of 1g of vancomycin mixed with the bone graft every three spinal levels fused and the group consisted of 232 patients.Results:513 patients were analyzed, 232 in the VG and 281 in the CG. There was no statistical difference between the groups when the sex, mean surgery length, and mean bleeding volume were considered. The rate of infection for VG was reduced from 4.98% to 1.29% when compared with CG.Conclusion:The use of vancomycin added to the bone graft in posterior spinal fusion is associated with significantly lower rates of infection.

BACKGROUND: In the context of anterior approach to the cervical spine, dysphagia is a common complication and still without a clear distinction of risk factors. OBJECTIVE: To analyze the risk factors of dysphagia after cervical spine surgery. METHODS: Multicenter prospective study evaluated patients who underwent anterior cervical spine surgery for degenerative pathologies, studying surgical, anesthesia, base disease, and radiological variables (preoperatively, 24 hours, 1 and 3 weeks, and 6 months after surgery), with control group matched. Postoperative dysphagia was assessed by Swallowing Satisfaction Index and Swallowing Questionnaire; besides, based on multiple logistic regression model, a risk factor analysis correlation was applied. RESULTS: In total, 233 cervical patients were evaluated; most common level approached was C5-C6 (71.8%). All showed same decreasing trade for dysphagia incidence-with more cases on cervical group (P < .05); severe cases were rare. At postoperative day 1, identified risk factors were approach to C3-C4 (4.11, P < .01), loss of preoperative cervical lordosis (2.26, P < .01), intubation attempts ≥2 (3.10, P < .01), and left side approach (1.85, P = .02); at day 7, body mass index ≥30 (2.29, P = .02), C3-C4 (3.42, P < .01), and length of surgery ≥90 minutes (2.97, P = .005); and at day 21, C3-C4 were kept as a risk factor (3.62, P < .01). CONCLUSION: A high incidence level of dysphagia was identified, having a clear decreasing trending (number of cases and severity) through postoperative time points; considering possible risk factors, strongest correlation was the approach at the C3-C4 level-statistically significant at the 24 hours, 7 days, and 21 days assessment.

Introduction Lumbar discectomy is one of the most common surgical procedures, with success rates greater than 80%. To better understand the meaning of a good outcome in lumbar disc herniation treatment, it is important to know how much the health care system or the patient need to pay to achieve a good result. The cost–utility studies are useful to evaluate the value of health care interventions. The objective of this study was to evaluate for the first time the cost-effectiveness of spine surgery in Latin America for lumbar discectomy in terms of cost per quality-adjusted life years (QALY) gained in Brazil. Patients and Methods Costs of medical treatment were recorded in 143 consecutive patients who underwent open discectomy for lumbar disc herniation. Direct medical costs comprised medical reimbursement and costs of hospitalization. Indirect costs were considered the disability losses. Utilities were estimated using SF-6D–derived utilities from a 12-month variation in SF-36. A 4-year horizon with 3% discounting was applied to health utilities estimates. Sensitivity analysis was performed by varying utility gain by 20%. The costs were expressed in Reais (R$) and American Dollars ($), at an exchange rate of 2.4:1. Results Direct and indirect costs of open discectomy were estimated at an average of R$ 3.426,72 ($ 1,427.80) and R$ 2.027,67 ($ 844.86), respectively. The mean total cost of treatment was estimated at R$ 5.454,40 ($ 2,272.66) (± R$ 2.709,17/$ 1,128.82) The SF-6D utility gain was 0.0456 (95% CI: 0.03197–0.05923, p = 0.017) at 12 months. The 4-year discounted QALY gain was 0.176928. The estimated cost-utility ratio was R$ 30.828,35 ($ 12,845.14) per QALY gained. The sensitivity analysis showed a range of R$ 25.690,29 ($ 10,714.28)–R$ 38.535,44 ($ 16,056.43) per QALY gained. Conclusion Open discectomy is associated with a significant improvement in health utilities as measured by SF-6D. Open discectomy performed in the Brazilian Supplementary Health System provides a cost–utility ratio of R$ 30.828,35 ($ 12,845.14) per 1 quality-adjusted life year.

Introduction The anchored cervical intersomatic cages made in PEEK is a new promising alternative to anterior cervical locking plates with autologous iliac bone graft for anterior cervical discectomy and fusion. The advantage of such devices is the lack of profile and can provide the stability needed to achieve the arthrodesis. Objectives This study aims to evaluate the outcomes and fusion rates of the anchored intersomatic cage for achieving a stable arthrodesis and compare this result with established fixation methods. The hypothesis is that this device would be associated with low short-term complications and dysphagia, and could achieve a solid fusion and maintains the pain relief. Patients and Methods This was a comparative study in a single center, 50 patients were enrolled; 25 patients who underwent anterior cervical discectomy and fusion with autologous bone graft and locking plate and 25 patients with cervical intersomatic cage with heterologous bone graft. The clinical features Neck and Pain Disability Index; radicular pain, neck pain, and patient satisfaction were evaluated with VAS; and dysphagia scores were recorded preoperative and postoperative. Radiographs evaluated the height of intervertebral disc, implant position, and cervical Cobb angle. All patients had a minimum follow-up of 12 months. Results In all the patients, we found that a stable arthrodesis was achieved; the neck pain and radicular pain significantly reduces after surgery, without change after 1 year of follow-up. We do not have any chronic dysphagia and only one patient complained of minor dysphagia that improved in 2 weeks. Conclusions The cervical-anchored intersomatic cages are new surgical alternative with good functional outcomes, low-complication rates, and better postoperative patient comfort. We think that this is a preliminary assessment and prospective randomized trials are necessary to confirm this observation.

Introducción: Los ensayos de hipotermia sistémica en murinos son costosos, debido a la complejidad de los sistemas. El objetivo de este estudio fue evaluar si el modelo de hipotermia sistémica exógena utilizado en nuestro laboratorio para la hipotermia ocular es útil para reducir significativamente la temperatura de la médula espinal en ratas adultas. Materiales y Métodos: Se utilizaron 36 ratas Sprague-Dawley albinas macho de 60 días, distribuidas en dos grupos: grupo normotermia a 24 °C (n = 18) y grupo hipotermia (n = 18) en cámara fría a 8 °C durante 180 minutos. Resultados: La temperatura rectal promedio fue de 37,71 ± 0,572 °C en el grupo normotermia y 34,03 ± 0,250 °C en el grupo hipotermia (p <0,0001). La temperatura medular promedio fue de 38,8 ± 0,468 °C en el grupo normotermia y de 36,4 ± 0,290 °C en el grupo hipotermia (p <0,0001). Conclusiones: El uso de hipotermia sistémica en ratas de laboratorio parece ser un método prometedor para evaluar los mecanismos fisiológicos y patológicos que se desencadenan en la médula espinal. La exposición al frío en cámara genera hipotermia medular significativa en ratas adultas. Los resultados sugieren que podría ser un modelo adecuado de hipotermia medular de bajo costo.

Multiple alternate fractures are those that present injuries at several levels of the spine separated by at least one healthy vertebral body. A posttraumatic prevalence of up to 23% is reported. 3-5 There are no reports in Argentina. The purpose of this study is to report the prevalence of multiple alternate spine fractures in five hospitals of the City of Buenos Aires, Argentina, and evaluate its connection to other relevant characteristics. Inclusion criteria involve acute fractures of the spine. Classifications used were the following: cervical subaxial 8 and thoracolumbar 9 AO, Anderson for odontoids, 15, 16 Effendi Laurin 17 and Geweiler, 18, 19 ASIA, 20, 21 and Frankel. 22 Statistical analysis consists of two groups: "Alternate" and "Contiguous." Sample distribution, Shapiro-Wilk or Kolmogorov Smirnov test, was used. In comparison of continuous variables, "Student's t-test or the Mann-Whitney U test" was used. To compare the categorical variables, Chi2 test or Fisher's exact test was used. In data analysis, IBM SPSS Macintosh software, version 24.0 (IBM Corp., Armonk, NY, USA), was used. From the five hospitals of Buenos Aires, 514 medical records were reviewed, and 120 patients included, from April 2007 to April 2017. Of the total of spine fractures, 56 (46.7%) were simple, 35 (29.2%) were multiple contiguous, and 29 (24.1%) were multiple alternate. Fifty-four (45%) patients were women, average age of the sample: 40 years old. Within the group of multiple alternate fractures, the cervical area was the most affected in 16 (55.1%) patients. Fractures of nine (31%) patients of the Alternate group were related to a labor accident (9.9% contiguous, significant p = 0.02). Fourteen (48.3%) patients of the Alternate group presented an associated injury (23 patients [25.3%] of the contiguous fractures, with significance p = 0.02). As regards the International Publications, the prevalence of multiple alternate fractures was 24.1% (17 or 19%) 4, 5, 23, 24 with similar production mechanism, male predominance, and an average of 40 years old. 3, 5, 23 The location was similar: cervico-thoracic 24.1%. One in four patients admitted in our centers, with a spine fracture, had at least other vertebrae fractured at a distance. These were associated with neurological alterations, extraspinal injuries, and labor accidents.