Spinal Fusion in the United States

Rajaee, Sean S.; Bae, Hyun; Kanim, Linda E.A.; Delamarter, Rick B.

doi:10.1097/brs.0b013e31820cccfb

Cited by 908 publications

(513 citation statements)

References 14 publications

Supporting

Mentioning

477

Contrasting

Unclassified

Order By: Relevance

“…The frequency of spinal surgery has increased during the last decade, especially in patients aged 65 years and older [1,2]. This includes multilevel instrumentation which is often associated with severe pain and consumption of large amounts of opioids thereby hindering postoperative mobilization and rehabilitation [3,4].…”

Section: Introductionmentioning

confidence: 99%

A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery

et al. 2013

View full text Add to dashboard Cite

Purpose Major spine surgery with multilevel instrumentation is followed by large amount of opioid consumption, significant pain and difficult mobilization in a population of predominantly chronic pain patients. This case-control study investigated if a standardized comprehensive pain and postoperative nausea and vomiting (PONV) treatment protocol would improve pain treatment in this population. Methods A new regimen with acetaminophen, NSAIDs, gabapentin, S-ketamine, dexamethasone, ondansetron and epidural local anesthetic infusion or patient controlled analgesia with morphine, was introduced in a post-intervention group of 41 consecutive patients undergoing multilevel (median 10) instrumented spinal fusions and compared with 44 patients in a pre-intervention group. Results Compared to patients in the pre-intervention group, patients treated according to the new protocol consumed less opioid on postoperative day (POD) 1 (P = 0.024) and 2 (P = 0.048), they were mobilized earlier from bed (P = 0.003) and ambulation was earlier both with and without a walking frame (P = 0.027 and P = 0.027, respectively). Finally, patients following the new protocol experienced low intensities of nausea, sedation and dizziness on POD 1-6. Conclusions In this study of patients scheduled for multilevel spine surgery, it was demonstrated that compared to a historic group of patients receiving usual care, a comprehensive and standardized multimodal pain and PONV protocol significantly reduced opioid consumption, improved postoperative mobilization and presented concomitant low levels of nausea, sedation and dizziness.

show abstract

Section: Introductionmentioning

confidence: 99%

A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery

et al. 2013

View full text Add to dashboard Cite

show abstract

“…Much of this variation involves the use of high-intensity, expensive surgical interventions such as instrumented interbody fusions [2,5,15,17,21]. At the same time, several authors have documented that the increase in the use of interbody fusion-based procedures was not only associated with increased risk of complications and cost, but also occurred to some extent in patients not typically indicated for these interventions such as those with lumbar spinal stenosis [2,5,17].…”

Section: Introductionmentioning

confidence: 99%

“…Prior research has demonstrated a great degree of variation both in terms of indications for spine surgical intervention as well as the types of procedures performed for a wide range of similar spinal disorders [2,5,11,15,17,20,21]. Much of this variation involves the use of high-intensity, expensive surgical interventions such as instrumented interbody fusions [2,5,15,17,21].…”

Section: Introductionmentioning

confidence: 99%

Is There Variation in Procedural Utilization for Lumbar Spine Disorders Between a Fee-for-Service and Salaried Healthcare System?

Schoenfeld

Makanji

Jiang

et al. 2017

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Background Whether compensation for professional services drives the use of those services is an important question that has not been answered in a robust manner. Specifically, there is a growing concern that spine care practitioners may preferentially choose more costly or invasive procedures in a fee-for-service system, irrespective of the underlying lumbar disorder being treated. Questions/purposes (1) Were proportions of interbody fusions higher in the fee-for-service setting as opposed to the salaried Department of Defense setting? (2) Were the odds of interbody fusion increased in a fee-for-service setting after controlling for indications for surgery? Methods Patients surgically treated for lumbar disc herniation, spinal stenosis, and spondylolisthesis (2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014) were identified. Patients were divided into two groups based on whether the surgery was performed in the fee-forservice setting (beneficiaries receive care at a civilian facility with expenses covered by TRICARE insurance) or at a Department of Defense facility (direct care). There were 28,344 patients in the entire study, 21,290 treated in fee-for-service and 7054 treated in Department of Defense facilities. Differences in the rates of fusion-based procedures, discectomy, and decompression between both healthcare settings were assessed using multinomial logistic regression to adjust for differences in case-mix and surgical indication. Results TRICARE beneficiaries treated for lumbar spinal disorders in the fee-for-service setting had higher odds of receiving interbody fusions (fee-for-service Conclusions The preferential use of interbody fusion procedures was higher in the fee-for-service setting irrespective of the underlying diagnosis. These results speak to the existence of provider inducement within the field of spine surgery. This reality portends poor performance for surgical practices and hospitals in Accountable CareThis study was supported in part by a grant from the Henry M. Jackson Foundation of the Department of Defense (AHH). All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research. This work was performed at

show abstract

“…Patient outcome, however, has not improved. Effectiveness of spinal fusion is reevaluated now 75,76) . Furthermore, frequency of spinal fusion depends on physician's enthusiasm 77) .…”

Section: Fusionmentioning

confidence: 99%

The Recent Trend in Diagnosis and Treatment of Chronic Low Back Pain

Kikuchi

2017

Spine Surg Relat Res

View full text Add to dashboard Cite

Abstract:Introduction: Development of evidence-based medicine has made a big change in diagnosis and treatment of chronic low back pain. The recent trend is assessed through a review of literature. Methods: The articles published in these 10 years are reviewed, and important points are examined. Results: In diagnosis, challenges for history taking and limit of imaging or clinical guidelines are revealed. In treatment, cognitive behavioral treatment and exercises are proved effective. Sleep disturbance has recently attracted attention as a factor associated with low back pain. Cost-effectiveness of diagnosis and treatment modalities has come to be emphasized. Conclusions: Diagnosis and treatment of chronic low back pain have been significantly changing. Multidisciplinary and multidimensional approach is essential. Chronic low back pain should be treated as a total pain, not a local pain.

show abstract

Spinal Fusion in the United States

Cited by 908 publications

References 14 publications

A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery

A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery

Is There Variation in Procedural Utilization for Lumbar Spine Disorders Between a Fee-for-Service and Salaried Healthcare System?

The Recent Trend in Diagnosis and Treatment of Chronic Low Back Pain

Contact Info

Product

Resources

About