Predictors of Subsidence and Its Clinical Impact Following Expandable Cage Insertion in Minimally Invasive Transforaminal Interbody Fusion

Subramanian, Tejas; Merrill, Robert; Shahi, Pratyush; Pathania, Shane; Araghi, Kasra; Maayan, Omri; Zhao, Eric; Shinn, Daniel; Kim, Ashley; Kamil, Robert; Song, Junho; Dalal, Sidhant; Vaishnav, Avani S.; Othman, Yahya A.; Steinhaus, Michael E.; Sheha, Evan; Dowdell, James; Iyer, Sravisht; Qureshi, Sheeraz A.

doi:10.1097/brs.0000000000004619

Cited by 8 publications

(5 citation statements)

References 35 publications

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“…For example, Smith et al reported patient satisfaction following outpatient lumbar fusion surgery to be 92%, 32 with other similar studies demonstrating satisfaction rates upwards of 80% 33 . These results are well in line with existing literature on satisfaction following inpatient lumbar fusion 36–40 . This is maybe unsurprising, but our systematic review reinforces the idea that lumbar fusion surgery can be performed effectively, with high-quality PROMs and satisfaction even in the outpatient setting.…”

Section: Discussionsupporting

confidence: 89%

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Comparison of the Safety of Inpatient versus Outpatient Lumbar Fusion

Subramanian,

Akosman,

Amen

et al. 2023

Spine

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Study Design. Systematic Review and Meta-Analysis Objective. The objective of this study is to synthesize the early data regarding and analyze the safety profile of outpatient lumbar fusion. Summary of Background Data. Preforming lumbar fusion in an outpatient or ambulatory setting is becoming an increasingly employed strategy to provide effective value-based care. As this is an emerging option for surgeons to employ in their practices, the data is still in its infancy. Methods. This study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies that described outcomes of inpatient and outpatient lumbar fusion cohorts were searched from PubMed, Medline, The Cochrane Library, and Embase. Rates of individual medical and surgical complications, readmission, and reoperation were collected when applicable. Patient reported outcomes were additionally collected if reported. Individual pooled comparative meta-analysis was performed for outcomes of medical complications, surgical complications, readmission, and reoperation. Patient reported outcomes were reviewed and qualitatively reported. Results. The search yielded 14 publications that compared outpatient and inpatient cohorts with a total of 75,627 patients. Odds of readmission demonstrated no significant difference between outpatient and inpatient cohorts (OR=0.94 [0.81 - 1.11]). Revision surgery similarly was no different between the cohorts (OR=0.81 [0.57 - 1.15]). Pooled medical and surgical complications demonstrated significantly decreased odds for outpatient cohorts compared to inpatient cohorts (OR=0.58 [0.34 - 0.50], OR=0.41 [0.50 - 0.68] respectively). Patient reported outcome measures were largely the same between the cohorts when reported, with few studies showing better ODI and VAS-Leg outcomes among outpatient cohorts compared to inpatient cohorts. Conclusion. Preliminary data regarding the safety of outpatient lumbar fusion demonstrates a favorable safety profile in appropriately selected patients, with patient reported outcomes remaining comparable in this setting. There is no data in the form of prospective and randomized trials which is necessary to definitively change practice.

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Section: Discussionsupporting

confidence: 89%

“…33 These results are well in line with existing literature on satisfaction following inpatient lumbar fusion. [36][37][38][39][40] This is maybe unsurprising, but our systematic review reinforces the idea that lumbar fusion surgery can be performed effectively, with high-quality PROMs and satisfaction even in the outpatient setting.…”

Section: Literature Reviewsupporting

confidence: 54%

Comparison of the Safety of Inpatient versus Outpatient Lumbar Fusion

Subramanian,

Akosman,

Amen

et al. 2023

Spine

Self Cite

View full text Add to dashboard Cite

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“…Patients were split up into two cohorts based on the intraoperative modality: robotics (ExcelsiusGPS, Globus Medical Inc., Audubon, PA) and navigation (Stryker SpineMask, Stryker Corp., Kalamazoo, MI). The robotics and navigation workflows 12,13,15,16 and the MI-TLIF technique [17][18][19][20][21][22] were utilized, as previously described in the literature by our group.…”

Section: Methods Study Design and Patient Selectionmentioning

confidence: 99%

Comparison of Robotics and Navigation for Clinical Outcomes Following Minimally Invasive Lumbar Fusion

Shahi

Subramanian

Araghi

et al. 2023

Spine

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Study Design. Retrospective cohort. Objective. To compare navigation and robotics in terms of clinical outcomes after minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). Summary of Background Data. Although robotics has been shown to have advantages like reduced radiation exposure, greater screw size, and slightly better accuracy over navigation, none of the studies has compared these two modalities in terms of clinical outcomes. Methods. Patients who underwent single-level MI-TLIF using robotics or navigation and had a minimum of 1-year follow-up were included. The robotics and navigation groups were compared for improvement in patient-reported outcome measures (PROMs), minimal clinically important difference, patient-acceptable symptom state, response on the global rating change scale, and screwrelated complication and reoperation rates. Results. A total of 278 patients (143 robotics, 135 navigation) were included. There was no significant difference between the robotics and navigation groups in the baseline demographics, operative variables, and preoperative PROMs. Both groups showed significant improvement in PROMs at below six and six months or above, with no significant difference in the magnitude of improvement between the two groups. Most patients achieved minimal clinically important difference and patient-acceptable symptom state and reported feeling better on the global rating change scale, with no significant difference in the proportions between the robotics and navigation groups. The screw-related complication and reoperation rates also showed no significant difference between the two groups. Conclusions. Robotics did not seem to lead to significantly better clinical outcomes compared with navigation following MI-TLIF. Although the clinical outcomes may be similar, robotics offers the advantages of reduced radiation exposure, greater screw size, and slightly better accuracy over navigation. These advantages should be considered when determining the utility and cost-effectiveness of robotics in spine surgery. Larger multicenter prospective studies are required in the future to further investigate this subject.

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“…Using TikTok’s search algorithm, we selected a sample of 50 videos for each hashtag utilized, including “#spinalfusion,” “#scoliosissurgery,” and “#spinaldecompression.” These hashtags were chosen as they provided a representative sample of spine surgery [ 9 - 17 ]. The 3 hashtags additionally had the most views of spine surgery hashtags and thus provide a good sample of content available on TikTok.…”

Section: Methodsmentioning

confidence: 99%

“…These hashtags were chosen as they provided a representative sample of spine surgery. [9][10][11][12][13][14][15][16][17] The 3 hashtags additionally had the most views of spine surgery hashtags and thus provide a good sample of content available on TikTok. Videos were excluded if they had less than 1,000 views, were duplicates, non-English language, and if they lacked audio or visual content.…”

Section: Video Selection and Data Collectionmentioning

confidence: 99%

Quality of Spine Surgery Information on Social Media: A DISCERN Analysis of TikTok Videos

Subramanian,

Araghi,

Akosman

et al. 2023

Neurospine

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Objective: The use of social media applications to disseminate information has substantially risen in recent decades. Spine and back pain-related hashtags have garnered several billion views on TikTok. As such, these videos, which share experiences, offer entertainment, and educate users about spinal surgery, have become increasingly influential. Herein, we assess the quality of spine surgery content TikTok from providers and patients.Methods: Fifty hashtags encompassing spine surgery (“#spinalfusion,” “#scoliosissurgery,” and “#spinaldecompression”) were searched using TikTok’s algorithm and included. Two independent reviewers rated the quality of each video via the DISCERN questionnaire. Video metadata (likes, shares, comments, views, length) were all collected; type of content creator (musculoskeletal, layperson) and content category (educational, patient experience, entertainment) were determined.Results: The overall DISCERN score was, on average, 24.4. #Spinalfusion videos demonstrated greater engagement, higher average likes (p = 0.02), and more comments (p < 0.001) compared to #spinaldecompression and #scoliosissurgery. #Spinaldecompression had the highest DISCERN score (p < 0.001), likely explained by the higher percentage of videos that were educational (p < 0.001) and created by musculoskeletal (MSK) professionals (p < 0.001). Compared to laypersons, MSK professionals had significantly higher quality videos (p < 0.001). Similarly, the educational category demonstrated higher quality videos (p < 0.001). Video interaction trended lower with MSK videos and educational videos had the lowest interaction of the content categories (likes: p = 0.023, comments: p = 0.005).Conclusion: The quality of spine surgery videos on TikTok is low. As the influence of the new social media landscape governs how the average person consumes information, MSK providers should participate in disseminating high-quality content.

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Predictors of Subsidence and Its Clinical Impact Following Expandable Cage Insertion in Minimally Invasive Transforaminal Interbody Fusion

Cited by 8 publications

References 35 publications

Comparison of the Safety of Inpatient versus Outpatient Lumbar Fusion

Comparison of the Safety of Inpatient versus Outpatient Lumbar Fusion

Comparison of Robotics and Navigation for Clinical Outcomes Following Minimally Invasive Lumbar Fusion

Quality of Spine Surgery Information on Social Media: A DISCERN Analysis of TikTok Videos

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