Variation in Surgical Decision Making for Degenerative Spinal Disorders. Part I: Lumbar Spine

Irwin, Zareth N.; Hilibrand, Alan S.; Gustavel, Michael; McLain, Robert F.; Shaffer, William O.; Myers, Mark E.; Glaser, John A.; Hart, Robert A.

doi:10.1097/01.brs.0000181057.60012.08

Cited by 141 publications

(91 citation statements)

References 28 publications

(18 reference statements)

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“…6 There remains little or no medical, clinical, or surgical evidence to support such variability. 4,7,8 The underlying causes of the international and regional variations found in rates of spine surgery are unknown. Potential factors include lack of scientific evidence, financial incentives and disincentives to surgical intervention, and differences in clinical training and professional opinion.…”

Section: Introductionmentioning

confidence: 99%

United States’ Trends and Regional Variations in Lumbar Spine Surgery: 1992–2003

Weinstein

Lurie

Olson

et al. 2006

Spine

781

494

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Study Design-Repeated cross-sectional analysis using national Medicare data from the Dartmouth Atlas Project.Objectives-To describe recent trends and geographic variation in population-based rates of lumbar fusion spine surgery.Summary of Background Data-Lumbar fusion rates have increased dramatically during the 80s and even more so in the 90s. The most rapid increase appeared to follow the approval of a new surgical implant device.Methods-Medicare claims and enrollment data were used to calculate age-, sex-and raceadjusted rates of lumbar laminectomy/discectomy and lumbar fusion for fee-for-service Medicare beneficiaries over age 65 in each of the 306 U.S. Hospital Referral Regions between 1992 and 2003. Conclusions-The rate of specific procedures within a region or "surgical signature" is remarkably stable over time. However, there has been a marked increase in rates of fusion and a coincident shift and increase in cost. Rates of back surgery were not correlated with the per-capita supply of orthopaedic and neurosurgeons. Results-Lumbar

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Section: Introductionmentioning

confidence: 99%

United States’ Trends and Regional Variations in Lumbar Spine Surgery: 1992–2003

Weinstein

Lurie

Olson

et al. 2006

Spine

781

494

View full text Add to dashboard Cite

show abstract

“…United States Medicare claims analysis has shown that lumbar spine surgery rates rose during the 1980s and between 1990 and 2003, which revealed tripling spinal fusion rates. Population-based research had clearly demonstrated variations in proportion of spinal surgery across regions and subsequent geographic variations in outcome [8][9][10]. Regional variability is a hallmark of scientific uncertainty about the likely outcomes of spinal surgery.…”

Section: Introductionmentioning

confidence: 99%

A decade’s experience in lumbar spine surgery in Belgium: sickness fund beneficiaries, 2000–2009

2012

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Purpose The purpose is to study rates, trends, geographic variations and outcome of lumbar spine surgery in the Belgian population during the last decade. Methods This is a retrospective cohort study using administrative data of the largest Belgian sickness fund from January 1, 2000 through December 31, 2009. Cases included lumbar laminectomy, combined discectomy and fusion, posterior interarticular fusion, anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF) and standard discectomy. The main outcome measures were age-and sex-adjusted rates of lumbar spine surgery, 1-year mortality, 1-year iterative surgery, no return to work (RTW) rate 1 year after surgery and length of hospital stay. Multivariate logistic regression analysis was used to determine the association between age, sex, geographic region, type of surgery, year of intervention and duration of pre-operative sick leave on outcome. Results Spine surgery rates rose 44 % from 2001 through 2009 and data for 2009 showed twofold variations in spine surgery rates among 10 Belgian provinces. Reported 1-year mortality varied from 0.6 to 2.5 % among surgical procedures performed in 2008. The overall 5-year reoperation rate was 12 %. RTW rates 1 year after standard discectomy, ALIF, PLIF and combined discectomy and fusion for the follow-up sample of 2008 were 14.4, 22.7, 26.1 and 30.6 %, respectively. The median length of hospital stay significantly decreased throughout the decade. Type of surgery and geographic region were significantly related to patient outcomes. Conclusions Regional variations highlight professional uncertainty and controversy. The study results point to the need for peer comparisons and surgeon feedback.

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“…A artrodese produz sempre uma restrição da mobilidade e uma consequente alteração da biomecânica segmentar que, em muitos casos, é considerada inadequada à patologia existente [11][12][13][14] . Nas fases precoces da doença degenerativa da coluna lombar, o recurso à estabilização dinâmica interespinhosa tem vindo a ser referido como uma das possibilidades terapêuticas [15][16][17][18][19] .…”

Section: Introductionunclassified

Instrumentação interespinhosa na doença degenerativa da coluna lombar: medição da altura do disco no segmento instrumentado

Consciência

2009

Coluna/Columna

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INTRODUÇÃO: na última década, a instrumentação interespinhosa vem sendo mais frequentemente utilizada. Apesar dos inúmeros artigos publicados em revistas internacionais de reconhecido mérito científico, são escassas as referências à modificação da altura do disco no segmento tratado, secundária àquela instrumentação. OBJECTIVO: quantificar uma eventual modificação da altura discal decorrente da aplicação de instrumentação interespinhosa (DIAM - Cousin-Biotech - Medtronic Sofamor Danek Inc©). MÉTODOS: o autor avalia um grupo de 20 pacientes com patologia degenerativa da coluna lombar e os seguintes critérios de inclusão: idade >40 e <80; índice de massa corporal <40; dor visual analogue scale (VAS) >6; Oswestry Disability Index (ODI) >30; Zung Depression Rating Scale <39; Modified Somatic Perception Questionnaire (MSPQ) <15; degenerescência vertebral tipo 2 e 3 da classificação de Benzel e discal tipo 3 e 4 da classificação de Pfirrmann. Utilizando uma fórmula matemática, e um programa computorizado de imagem (Adobe Photoshop 9.0 CS2), foram efectuadas medições em radiografias da coluna lombar obtidas na incidência de perfil em posição ortostática. A amplificação utilizada para esses exames foi de 70%, tendo sido comparados os valores obtidos no pré-operatório com os referentes a dois anos após a cirurgia. RESULTADOS: foi constatado um aumento global em média de 1,53 mm com desvio padrão de 1,09 mm e p=0,0002, quando avaliadas as diferenças decorrentes da aplicação da referida fórmula. Contudo, quando foi analisada a variação anterior e posterior separadamente, observou-se diferença média superior (0,45 mm) na variação da distância intervertebral posterior (p=0,0002) quando comparada com a anterior (p=0,001), o que indicia um ligeiro efeito cifosante da instrumentação. CONCLUSÕES: nos casos de doença degenerativa lombar de tipo 2/3 de Benzel e 3/4 de Pfirmann, a aplicação de sistemas interespinhosos poderá proporcionar uma modificação da altura do disco intervertebral, aumentando-o ligeiramente, o que inevitavelmente influenciará as dimensões do canal vertebral.

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Variation in Surgical Decision Making for Degenerative Spinal Disorders. Part I: Lumbar Spine

Cited by 141 publications

References 28 publications

United States’ Trends and Regional Variations in Lumbar Spine Surgery: 1992–2003

United States’ Trends and Regional Variations in Lumbar Spine Surgery: 1992–2003

A decade’s experience in lumbar spine surgery in Belgium: sickness fund beneficiaries, 2000–2009

Instrumentação interespinhosa na doença degenerativa da coluna lombar: medição da altura do disco no segmento instrumentado

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