State of the union: a review of lumbar fusion indications and techniques for degenerative spine disease

Reid, Patrick; Morr, Simon; Kaiser, Michael G.

doi:10.3171/2019.4.spine18915

Cited by 114 publications

(81 citation statements)

References 158 publications

(88 reference statements)

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“…However, the literature regarding fusions for lumbar discectomy patients remains controversial with significant variation in clinical practice. 10 Several studies have reported the inefficacy of an additional fusion in improving functional outcomes compared with discectomy alone. [11][12][13][14] Our study attempts to identify ingrained practice pattern biases that exist amongst surgeons performing isolated discectomies versus discectomy and fusion for management of lumbar disc herniation with radiculopathy.…”

Section: Discussionmentioning

confidence: 99%

Disparities in Rates of Fusions in Lumbar Disc Pathologies

Kim

Ryoo

Ostrov

et al. 2020

Global Spine Journal

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Study Design: Retrospective cohort study. Objective: To identify disparities in surgical decision making for lumbar disc pathologies based on patient demographics, hospital characteristics, and temporal characteristics of admission. Methods: A retrospective analysis of patients admitted for surgical intervention of disc herniation or degeneration was performed to observe the effect of demographic, hospital, and admission-related factors on the decision to perform an isolated decompression or decompression with single level fusion using the National Inpatient Sample. Results: Of 84 953 patients with lumbar disc pathologies, 69 975 patients were treated electively, and 14 978 patients were treated nonelectively. Hispanic and Asian/Pacific Islander patients were less likely to receive a fusion for elective cases compared with White patients (odds ratio [OR] 0.88, P = .004; OR 0.70, P < .001, respectively). In elective cases, privately insured and self-paying patients were less likely to receive a fusion compared with Medicare patients (OR 0.83, P < .001; OR 0.66, P < .001, respectively), while this effect was limited to self-pay patients in nonelective cases (OR 0.44, P < .001). Urban teaching and nonteaching hospitals were less likely to perform fusions compared with rural hospitals in nonelective cases (OR 0.47, P < .001; OR 0.58, P < .001, respectively). Private for-profit hospitals were associated with higher rates of fusion in both elective and nonelective cases (OR 1.16, P = .003; OR 1.94, P < .001). Conclusion: This study illustrates disparities in the modality of surgical intervention for lumbar disc pathologies in terms of demographics, hospital characteristics, and temporal characteristics of admission. The development of more evidence-based guidelines is warranted to reduce variability seen in treatment regimens for these conditions.

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Section: Discussionmentioning

confidence: 99%

Disparities in Rates of Fusions in Lumbar Disc Pathologies

Kim

Ryoo

Ostrov

et al. 2020

Global Spine Journal

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“…Spatial mapping and recognition of the physical environment is a crucial difference between augmented reality and other navigations systems using conventional display methods. Projecting the required information directly into the line-of sight of the surgeon is considered the natural progression of these well-established methods mitigating the errors associated with attention shift by directly projecting the navigation guidance onto the surgical field [ 22 , 23 ]. Incekara et al evaluated the same AR headset for pre-operative planning of neurosurgical tumor resection in 25 patients.…”

Section: Discussionmentioning

confidence: 99%

Augmented reality in the operating room: a clinical feasibility study

Dennler

Bauer

Scheibler

et al. 2021

BMC Musculoskelet Disord

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Background Augmented Reality (AR) is a rapidly emerging technology finding growing acceptance and application in different fields of surgery. Various studies have been performed evaluating the precision and accuracy of AR guided navigation. This study investigates the feasibility of a commercially available AR head mounted device during orthopedic surgery. Methods Thirteen orthopedic surgeons from a Swiss university clinic performed 25 orthopedic surgical procedures wearing a holographic AR headset (HoloLens, Microsoft, Redmond, WA, USA) providing complementary three-dimensional, patient specific anatomic information. The surgeon’s experience of using the device during surgery was recorded using a standardized 58-item questionnaire grading different aspects on a 100-point scale with anchor statements. Results Surgeons were generally satisfied with image quality (85 ± 17 points) and accuracy of the virtual objects (84 ± 19 point). Wearing the AR device was rated as fairly comfortable (79 ± 13 points). Functionality of voice commands (68 ± 20 points) and gestures (66 ± 20 points) provided less favorable results. The greatest potential in the use of the AR device was found for surgical correction of deformities (87 ± 15 points). Overall, surgeons were satisfied with the application of this novel technology (78 ± 20 points) and future access to it was demanded (75 ± 22 points). Conclusion AR is a rapidly evolving technology with large potential in different surgical settings, offering the opportunity to provide a compact, low cost alternative requiring a minimum of infrastructure compared to conventional navigation systems. While surgeons where generally satisfied with image quality of the here tested head mounted AR device, some technical and ergonomic shortcomings were pointed out. This study serves as a proof of concept for the use of an AR head mounted device in a real-world sterile setting in orthopedic surgery.

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“…This could reflect an aging population, but also an improvement in the diagnostic process, intraoperative technologies (like spinal navigation) and perioperative care of these patients. However, while a clear benefit in terms of pain, disability and return to work has been shown in patients suffering from spinal instability [ 46 – 48 ], recent RCT’s [ 47 , 49 ] have questioned the usefulness of spinal fusion procedures for other conditions like spinal stenosis or degenerative spondylolisthesis. As a matter of fact, in many situations and in many health systems, decision-making regarding indications for spinal fusion is driven by surgeons’ and patients’ preferences, hospital factors and reimbursement policies [ 45 , 50 ].…”

Section: Discussionmentioning

confidence: 99%

A randomized controlled TRIal of cognitive BEhavioral therapy for high Catastrophizing in patients undergoing lumbar fusion surgery: the TRIBECA study

Scarone

Smeets

Kuijk

et al. 2020

BMC Musculoskelet Disord

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Background Around 20% of patients undergoing spinal fusion surgery have persistent back or leg pain despite surgery. Pain catastrophizing is the strongest psychological predictor for chronic postsurgical pain. Psychological variables are modifiable and could be target for intervention. However, randomized controlled trials evaluating the effectiveness of psychological interventions to reduce chronic pain and disability after spinal fusion in a population of patients with high preoperative pain catastrophizing scores are missing. The aim of our study is to examine whether an intervention targeting pain catastrophizing mitigates the risk of chronic postsurgical pain and disability. Our primary hypothesis is that targeted perioperative cognitive behavioral therapy decreases the risk of chronic postsurgical pain and disability after spinal fusion surgery in high catastrophizing patients. Methods We will perform a two-center prospective, single-blind, randomized, controlled study comparing lumbar spinal fusion surgery outcome between 2 cohorts. Adult patients selected for lumbar spinal fusion with decompression surgery and a minimum score of 24 on the pain catastrophizing scale will be randomized with 1:1 allocation for either perioperative cognitive behavioral therapy (intervention group) or a perioperative education plus progressive exercise program (control group). Patients randomized to the intervention group will receive six individual sessions of cognitive behavioral therapy, two sessions before the operation and four after. Primary outcome is the Core Outcome Measures Index at 12 months. Secondary outcomes include pain, disability, depression and quality of life. Discussion This is the first trial that evaluates the effectiveness of cognitive behavioral therapy as a perioperative tool to improve pain and disability after spinal fusion surgery in comparison with an educational/exercise control intervention, in patients with high levels of pain catastrophizing. If perioperative cognitive behavioral therapy proves to be effective, this might have important clinical implications, reducing the incidence of chronic postsurgical pain and improving outcome after spinal fusion surgery. Trial registration Clinicaltrials (NCT03969602). Registered 31 May 2019,

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State of the union: a review of lumbar fusion indications and techniques for degenerative spine disease

Cited by 114 publications

References 158 publications

Disparities in Rates of Fusions in Lumbar Disc Pathologies

Disparities in Rates of Fusions in Lumbar Disc Pathologies

Augmented reality in the operating room: a clinical feasibility study

A randomized controlled TRIal of cognitive BEhavioral therapy for high Catastrophizing in patients undergoing lumbar fusion surgery: the TRIBECA study

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