Economic Effects of Anti-Depressant Usage on Elective Lumbar Fusion Surgery.

Background: It has been suggested, although not proven, that presence of concomitant psychiatric disorders may increase the inpatient costs for patients undergoing elective surgery. This study was designed to test the hypothesis that elective lumbar fusion surgery is more costly in patients with under treatment for depression.

Methods: This is a retrospective case-control study of 142 patients who underwent elective lumbar fusion.

Direct Cost and Complications Associated With Total Joint Arthroplasty in Patients With Preoperative Anxiety and Depression.

Introduction: The outcome of total joint arthroplasty (TJA) may be affected by numerous factors including the mental health status of patients and the presence of psychological disorders Therefore, the present study was designed and conducted to determine the impact of concomitant psychiatric disorders on the hospitalization charges and complications in patients with preoperative depression or anxiety undergoing TJA.

Materials And Methods: International Classification of Diseases, Ninth Revision, codes were used to identify perioperative complications in patients with and without concomitant diagnosis of depression or anxiety who underwent TJA at our institution during 2009. Hospitalization charges and complications were compared for patients with and without depression or anxiety undergoing TJA.

Increased mean arterial pressure goals after spinal cord injury and functional outcome.

Introduction: Acute spinal cord injury (SCI) is often treated with induced hypertension to enhance spinal cord perfusion. The optimal mean arterial pressure (MAP) likely varies between patients. Arbitrary goals are often set, frequently requiring vasopressors to achieve, with no clear evidence supporting this practice.

Management of psychosis and agitation in medical-surgical patients who have or are at risk for prolonged QT interval.

We review the literature on management of psychosis and agitation in medical-surgical patients who have or are at risk for prolonged QT interval, a risk factor for torsade de pointes (TdP), and we describe our protocols for treating these patients. We searched PubMed and PsycInfo for relevant studies and found few papers describing options for treating psychosis and agitation in these patients. Prolonged QTc interval has been more often associated with low-potency phenothiazines such as thioridazine; however, it may occur with high potency typical antipsychotics such as fluphenazine and haloperidol as well as with atypical antipsychotics such as quetiapine, risperidone, olanzapine, iloperidone, and particularly ziprasidone.

Traumatic central cord syndrome: neurologic recovery after surgical management.

The purpose of this study was to evaluate neurologic recovery following an acute, traumatic central cord syndrome (TCCS) injury. We retrospectively reviewed 69 patients who were treated surgically following an acute TCCS injury. The American Spinal Injury Association (ASIA) motor scores (AMS) were obtained from the time of presentation, from the time of hospital discharge, and from the most recent follow-up visit.

Antidepressants and the risk of abnormal bleeding during spinal surgery: a case–control study.

Introduction: Antidepressant medications are widely used by patients requiring spinal surgery. In spite of a generally favorable safety profile of newer antidepressants, several prior studies have suggested an association between use of serotonergic antidepressants and excessive bleeding. This study was designed to determine if there was any association between antidepressant use and the risk of excessive intraoperative blood loss during spinal surgery, and whether particular types of antidepressants were specifically associated with this increased blood loss.

Mini-open versus open decompression and fusion for lumbar degenerative spondylolisthesis with stenosis.

The outcome of less invasive surgical techniques in comparison to traditional surgical techniques has been the source of debate. In this retrospective study, 51 patients who had undergone posterior lumbar fusion along with bilateral decompression were enrolled. Twenty-one patients underwent fusion using a standard, midline open technique (open group) and 30 patients underwent fusion using a mini-open technique, with a small, central incision for the decompression and bilateral paramedian incisions for the posterolateral fusion and placement of cannulated pedicle screws (mini-open group).

A radiographic analysis of degenerative spondylolisthesis at the L4-5 level.

Object: Lumbar degenerative spondylolisthesis (LDS) is common and has generally been characterized as a homogeneous disease entity in the literature and in clinical practice. Because disease variability has not been carefully characterized, stratification of treatment recommendations based on scientific evidence is currently lacking. In this study, the authors analyzed radiographic parameters of patients with LDS at the L4-5 level to better characterize this entity.

Anterior interbody arthrodesis with percutaneous posterior pedicle fixation for degenerative conditions of the lumbar spine.

This is a retrospective case series to evaluate clinical variables, complications and outcome of 50 patients who underwent anterior lumbar interbody fusion (ALIF) supplemented with posterior percutaneous pedicle screw fixation for degenerative conditions of the lumbar spine. Twenty-four patients underwent single-level fusion and 26 patients had a two-level fusion for a total of 76 levels fused. The mean lengths of the anterior and posterior (including repositioning) portions of the procedure were 131 and 102 min, respectively.

Role of intraoperative neurophysiologic monitoring in lumbosacral spine fusion and instrumentation: a retrospective study.

Background: This study was carried out to determine the efficacy of IONM in detecting iatrogenic neural injury during pedicle screw insertion, in comparison to the efficacy of computerized tomography (CT) and direct visual inspection of adjacent nerve roots.

Methods: We reviewed the records of 86 patients, who had had 414 titanium pedicle screws inserted for posterior lumbar instrumentation. A standardized multimodality technique under total intravenous anesthesia was used.

Sources and patterns of pain in lumbar disc disease: revisiting Francis Murphey's theory.

Object: Francis Murphey's theory was analyzed to determine whether or not his opinion is evidence-based medicine and whether or not it can be applied clinically.

Methods: The English literature was reviewed using Medline in reference to Dr. Murphey's theory of discogenic chronic LBP, which was first postulated in 1967.