Large Rises in Thoracolumbar Fusions by 2040: A Cause for Concern with an Increasingly Elderly Surgical Population

Neifert, Sean N; Martini, Michael L; Hanss, Katie; Rothrock, Robert J.; Gilligan, Jeffrey; Zimering, Jeffrey H.; Caridi, John M.; Oermann, Eric K.

doi:10.1016/j.wneu.2020.06.241

Cited by 16 publications

(13 citation statements)

References 39 publications

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“…This, in turn, has been associated with an increasing volume of both arthroplasty and lumbar spinal surgery with projections for continued rapid growth in years to come. 15,16 These factors have caused a growing interest in the relationship between pathology of the lumbar spine and the lower extremity, as well as the effects of concomitant pathology and subsequent treatment on patient outcomes. A majority of the literature to date has focused on the impacts of spinal surgery on outcomes in lower extremity arthroplasty, as well as on the intertwined effects of lower extremity arthroplasty and spinal fusion on sagittal alignment and hip stability.…”

Section: Discussionmentioning

confidence: 99%

Impact of Lower Extremity Arthroplasty on Improvement of Quality-of-Life Outcomes Following Lumbar Fusion

et al. 2022

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Background: Both hip-spine and knee-spine syndromes can significantly impact a patient's quality of life; however, few studies have investigated their effect on postoperative outcomes following lumbar fusion.Objective: Our study aimed to evaluate the impact of a prior lower extremity arthroplasty on the improvement of patientreported outcome measures (PROMs) following lumbar fusion surgery.Methods: Patients undergoing primary, single, or multilevel lumbar interbody fusion were retrospectively reviewed. Patients missing preoperative PROMs were excluded. PROMs were collected preoperatively and postoperatively and included the Oswestry Disability Index (ODI), 12-Item Short Form Physical Component Summary, Patient-Reported Outcomes Measurement Information System Physical Function, and visual analog scale (VAS). A minimum clinically important difference (MCID) was calculated. Patients were categorized based on a history of hip/knee arthroplasty and propensity score matched. Intragroup improvement of PROM scores and intergroup differences in mean scores were evaluated using a paired t test and linear regression. MCID achievement differences were evaluated using logistic regression.Results: A total of 335 patients were included, with 25 having a history of hip/knee arthroplasty. Arthroplasty patients were significantly older (P = 0.001) and typically had a higher Charlson Comorbidity Index (P ≤ 0.003, both). Patients differed in spinal pathology of degenerative spondylolisthesis (P = 0.049). Nonarthroplasty patients demonstrated significant improvements in all PROMs by 2 years (P < 0.001, all). The arthroplasty group demonstrated significant improvements in all PROMs by 1 year (P < 0.031, all). Preoperative VAS back was significantly worse for nonarthroplasty patients (P = 0.035). MCID achievement did not significantly differ between groups except at 6 months for ODI (P = 0.035).Conclusion: Following lumbar fusion, patients with a past surgical history did not demonstrate differences in outcome measures or MCID from those without. These results suggest that comorbid orthopedic conditions requiring surgery do not negatively impact the ability of patients to improve following lumbar fusion.Clinical Relevance: Prior surgical history of lower extremity arthroplasty should not discourage the use of lumbar fusion when properly indicated, as patients reported clinical improvement regardless of history of hip or knee arthroplasty.

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Section: Discussionmentioning

confidence: 99%

Impact of Lower Extremity Arthroplasty on Improvement of Quality-of-Life Outcomes Following Lumbar Fusion

et al. 2022

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“…4 This finding is of particular importance given that current projections expect continued increases in the volume of lumbar/thoracolumbar procedures over the next several decades because of the increasing population of elderly Americans. 11,12 When evaluating subject matter, spinal trauma, disk disease/disk herniation, postoperative complications, scoliosis/sagittal balance, and anatomy were among the most common question topics. These results mirrored the content found on the examinations in 2002 to 2007, indicating the overall topics tested have not markedly changed over the past 2 decades.…”

Section: Discussionmentioning

confidence: 99%

Recent Trends in Spine Topics on the Orthopaedic In-Training Examination

Lambrechts

D'Antonio

Heard

et al. 2022

J Am Acad Orthop Surg

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Introduction:The Orthopaedic In-Training Examination (OITE) is an important metric for orthopaedic residents and residency programs to gauge a resident's orthopaedic knowledge. Because the OITE is correlated with the likelihood of passing part I of the American Board of Orthopaedic Surgery, greater emphasis is being placed on the examination. However, a detailed look at the questions most likely to appear on the spine subsection of the OITE has not been done in the past decade. Methods: Digital copies of the OITEs during the years 2017 through 2021 were obtained online through the "ResStudy" program within the American Academy of Orthopaedic Surgeons Online Learning Platform. All spine-related questions were categorized into five different categories including type of spine question (knowledgebased, diagnosis, or evaluation/management), anatomical region, imaging modality provided, subject matter, and referenced journal or textbook. The total number and likelihood of each question type to appear on the OITE were defined as mean and percentage of the total number of spine questions, respectively. Results: A total of 139 spine questions were identified on the OITE during the years 2017 to 2021. The most common type of spine questions were evaluation/management (N = 65) and knowledge-based questions. We identified lumbar (N = 45), cervical (N = 42), thoracolumbar (N = 13), and thoracic (N = 12) as the most commonly tested anatomical regions. Spinal trauma (N = 26), disk disease/disk herniation (N = 16), postoperative complications (N = 15), and scoliosis/sagittal balance (N = 15) were the most commonly tested material. Spine (N = 54) was almost two times more likely to be referenced as the source for the tested material compared with other journals or textbooks. Conclusions: Understanding the spine topics most likely to appear on the OITE may allow orthopaedic residents and residency programs to supplement educational objectives toward the highest yield spine topics and journals.

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“…Given an aging population as well as advances in surgical technique and implant selection, the number of surgeries performed each year is increasing. 1 , 2 Concurrently, non-operative treatment options for spine pathology are also increasing in number, timing, and complexity. 3 With the increase in the number of operative and non-operative treatment options comes an increasing responsibility for the surgeon to understand the risks and benefits of each particular treatment.…”

Section: Introductionmentioning

confidence: 99%

Clinical Trial Quality Assessment in Adult Spinal Surgery: What Do Publication Status, Funding Source, and Result Reporting Tell Us?

Danford

Boddapati

Simhon

et al. 2022

Global Spine Journal

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Study Design Narrative Review Objectives The objective of this study was to compare publication status of clinical trials in adult spine surgery registered on ClinicalTrials.gov by funding source as well as to identify other trends in clinical trials in adult spine surgery. Methods All prospective, comparative, therapeutic (intervention-based) trials of adult spinal disease that were registered on ClinicalTrials.gov with a start date of January 1, 2000 and completion date before December 17, 2018 were included. Primary outcome was publication status of published or unpublished. A bivariate analysis was used to compare publication status to funding source of industry vs non-industry. Results Our search identified 107 clinical trials. The most common source of funding was industry (62 trials, 57.9% of total), followed by University funding (26 trials, 24.3%). The results of 76 trials (71.0%) were published, with industry-funded trials less likely to be published compared to non–industry-funded trials (62.9% compared to 82.2%, P = .03). Of the 31 unpublished studies, 13 did not report any results on ClinicalTrials.gov , and of those with reported results, none was a positive trial. Conclusions Clinician researchers in adult spine surgery should be aware that industry-funded trials are less likely to go on to publication compared to non–industry-funded trials, and that negative trials are frequently not published. Future opportunities include improvement in result reporting and in publishing negative studies.

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Large Rises in Thoracolumbar Fusions by 2040: A Cause for Concern with an Increasingly Elderly Surgical Population

Cited by 16 publications

References 39 publications

Impact of Lower Extremity Arthroplasty on Improvement of Quality-of-Life Outcomes Following Lumbar Fusion

Impact of Lower Extremity Arthroplasty on Improvement of Quality-of-Life Outcomes Following Lumbar Fusion

Recent Trends in Spine Topics on the Orthopaedic In-Training Examination

Clinical Trial Quality Assessment in Adult Spinal Surgery: What Do Publication Status, Funding Source, and Result Reporting Tell Us?

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