Publications by authors named "Carreon L"
Purpose: To characterize the type, content, and results of care interventions that support spine surgery patients in their early post-discharge recovery.
Methods: This systematic review was conducted according to PRISMA guidelines. The literature search was conducted in March 2022 (updated in May 2023) in MEDLINE (Ovid), EMBASE (Ovid), CINAHL (Ebsco), PsycINFO (Ovid), and Scopus.
Background: One in three women and one in five men over the age of 50 will experience an osteoporotic fracture. Vertebral fractures can be very painful, affect patients' daily function, and in severe cases require hospitalization. Traditionally, fracture pain is treated conservatively with analgesics, and bracing.
View Article and Find Full Text PDFStudy Design: Register-based cohort study based on linked data from multiple national registries.
Objective: To describe the sociodemographic and health characteristics of individuals in Denmark with osteoporotic vertebral fractures (OVF) and analyze time trends. The study compares labor market participation and comorbidities between OVF patients and a matched control group without these fractures.
Objective: Smoking has been shown to negatively impact spinal health, as well as the outcomes of spinal fusion. Published reports show conflicting data regarding whether smoking negatively impacts patient outcomes following lumbar decompression. The objective of this study was to investigate whether smoking affects the outcomes of patients undergoing lumbar decompression for spinal stenosis or herniated disc.
View Article and Find Full Text PDFResponse to the Letter to the editor concerning "A propensity-matched study of patients with symptomatic lumbar spinal stenosis opting for surgery versus not" by Rikke K. Jensen et al.
Brain Spine
September 2024
Article Synopsis
- - The study is a secondary data analysis of an NIH-sponsored research focusing on cost-effectiveness between surgical and non-surgical treatments for Adult Symptomatic Lumbar Scoliosis (ASLS) eight years post-enrollment.
- - Previous analyses at the five-year mark showed a cost-effectiveness ratio (ICER) of $44,033 (As-Treated) and $27,480 (Intent-to-treat), while the current eight-year data suggests that surgical treatment is more economically favorable, with an ICER of $20,569 per Quality Adjusted Life Year (QALY) gained.
- - The conclusion highlights that operative treatment for ASLS presents a more cost-effective option compared to non-operative treatment, as indicated
Article Synopsis
- The study explores the impact of revision surgery on patient-reported outcomes (PROs) following initial surgeries for grade 1 spondylolisthesis, comparing decompression-only and decompression plus fusion (D+F) treatments.
- Data was collected from over 600 patients, revealing that 13.3% of decompression-only patients and 9.8% of D+F patients required revision surgery within 5 years, with revision patients reporting worse outcomes.
- The findings indicate that while revision surgery affects PROs adversely, patients undergoing D+F see a more significant decline in their reported outcomes compared to those who only had decompression surgery.
Multicentre investigation on the effect of decompressive surgery on Balance and physical ActiviTy Levels amongst patients with lumbar Spinal stenosis (B-ATLAS): protocol for a prospective cohort study.
BMJ Open
September 2024
Introduction: Patients with lumbar spinal stenosis may have poor balance, decreased physical function and problems maintaining physical activity levels due to radiculopathy. Decompressive surgery is often indicated if conservative management fails to achieve a satisfactory clinical outcome. While surgical management has proven effective at treating radiculopathy, and patients report increased physical function postoperatively, objective measures of postural control and physical activity remain sparse.
View Article and Find Full Text PDFStudy Design: This study was a retrospective propensity-matched study of patients receiving opioid sparing anesthesia (OSA) and those who did not receive an opioid sparing anesthesia regimen.
Objectives: To determine whether patients undergoing spine fusion for deformity fared better with an OSA regimen than those not having an OSA regimen.
Summary Of Background Data: There has been a tremendous focus on opioid overuse.
Article Synopsis
- The study compares the outcomes of transforaminal interbody fusion (TLIF) and anterior lumbar interbody fusion (ALIF) combined with posterior fusion (AP) regarding post-operative complications and pain management in patients.
- Results show that TLIF patients experienced shorter operative times and hospital stays compared to AP patients, but there was no significant difference in residual leg or back pain between the two approaches.
- Overall, both surgical methods had similar complication rates, except for constipation, which was more prevalent in the AP group, suggesting that the choice of surgical approach should consider these factors.
Article Synopsis
- The study examines six cases of perioperative spinal cord injury (SCI) that occurred during complex adult deformity surgeries, noting their causes, treatments, and outcomes.
- Out of 272 patients from the Scoli-RISK-1 cohort study, 2.2% experienced SCI, with cases occurring both during and after surgery.
- The findings highlight the importance of close postoperative monitoring and timely intervention to prevent lasting neurological damage.
Article Synopsis
- * Patients showed significant improvements in incision color, hypertrophy, and overall appearance over two years, with no cases of incisional hernia or bulging.
- * The study concluded that anterior lumbar surgeries are safe and result in acceptable cosmetic outcomes, contrasting with prior reports of higher morbidity linked to these procedures.
Article Synopsis
- This study is a retrospective analysis of data collected from patients who underwent surgery for low grade spondylolisthesis, aiming to identify factors that predict delayed improvement post-surgery.
- Among the 436 patients included, most experienced quick clinical enhancements, but about 21.4% showed delayed recovery, reaching the minimal clinically important difference (MCID) at 12 months rather than 3 months.
- Key factors linked to this delayed improvement were poorer pre-surgery walking ability, better initial pain scores, and worse leg pain scores at the 3-month mark.*
Study Design: Diagnostic accuracy study.
Objective: To establish a simple method of phantomless bone mineral density (BMD) measurement by using preoperative lumbar Computed Tomography (CT) scans, and compare the accuracy of reference tissue combinations to diagnose low BMD against uncalibrated Hounsfield units (HUs).
Summary Of Background Data: HUs are used as a measure of BMD; however, associations between HU and T-scores vary widely.
Introduction: The Scoliosis Research Society-30 (SRS-30) is a questionnaire originally developed from the SRS-22r questionnaire and is used to evaluate adolescent idiopathic scoliosis (AIS). It comprised questions on five domains: function, pain, self-image, mental health, and satisfaction, with seven additional questions related to postoperative aspects. In addition to the original English version, translations in multiple languages have been effectively applied.
View Article and Find Full Text PDFArticle Synopsis
- This study is a case-control research aimed at creating a classification system for different types of degenerative changes and failures at the proximal junction after spinal surgery.
- The system outlines four degeneration types: Type 1 (multilevel symmetrical collapse), Type 2 (single adjacent level collapse), Type 3 (fracture), and Type 4 (spondylolisthesis), based on data from patients who had spinal fusion.
- Findings reveal that degeneration affects nearly half of the patients, with Type 3 having the shortest time before needing revision surgery, while Type 1 shows the lowest revision rate, indicating varying risks associated with each type.
Article Synopsis
- The study retrospectively reviews patient data to assess whether changes in the position of the upper instrumented vertebral (UIV) screw during surgery predict the development of proximal junctional kyphosis or failure (PJK/PJF).
- It involves a cohort of 143 cases analyzed over an average follow-up of 3.5 years, revealing that significant changes in the screw's angle are correlated with higher rates of PJK/PJF and the need for surgical revision.
- The findings suggest that a change of the screw position greater than 5° notably increases the risk of both developing PJK/PJF and requiring revision surgery, highlighting the importance of careful surgical technique.
Study Design: Retrospective observational cohort.
Objectives: This study explores the impact of Intraoperative hypotension (IOH) on postoperative complications for major thoracolumbar spine fusion procedures.
Summary Of Background Data: IOH with mean arterial pressure (MAP) <65 mm Hg is associated with postoperative acute kidney injury (AKI) in general surgery.
Article Synopsis
- The study compares two workflows for placing cortical bone trajectory (CBT) screws during robotic-assisted spinal surgery: a traditional "Tap" three-step method and a new "No-Tap" two-step method.
- It analyzed metrics like screw-related complications, surgical time, and blood loss in 91 No-Tap and 88 Tap cases, finding that No-Tap significantly reduced robotic time without increasing the risk of complications.
- The results suggest that the No-Tap technique is a safer, more efficient alternative to the traditional tapping method in this type of surgery.
Article Synopsis
- The study evaluates the Quality of Recovery (QoR-15) score in patients after elective lumbar spine surgery, focusing on their recovery quality during the early post-discharge phase.
- Conducted in Denmark, the research tracked patients' QoR-15 scores pre-surgery and at specific post-discharge intervals using a mobile health app, revealing significant improvement over time.
- Key findings show that while the overall QoR-15 score improved from discharge to day 14, only eight of the fifteen specific recovery items were influential in determining the quality of recovery, highlighting areas for further research.
Study Design: Retrospective quality improvement study.
Objective: To investigate if the rate of unsuspected malignancy in biopsies in patients with VCF who underwent percutaneous vertebroplasty (PVP) at the same orthopedic department has changed after the implementation of a new MRI scanning protocol.
Summary Of Background Data: Discrimination between benign and malign vertebral compression fracture (VCF) can be difficult.
Article Synopsis
- - The study examined the frequency and risk factors associated with medial breaches of the pedicle wall during robotic-assisted cortical bone trajectory (RA-CBT) screw placements in 145 adult patients from January 2019 to July 2022.
- - Out of 784 screws analyzed, 30 (3.8%) exhibited a medial breach, with a notable correlation to lower bone quality (measured by Hounsfield units), the placement of screws on the right side, and screws in the upper instrumented vertebra.
- - Despite these breaches, no patients required additional surgery for screw repositioning, and there were no significant differences in clinical outcomes between patients with or without a medial breach.
Article Synopsis
- Decompression surgery for lumbar spinal stenosis (LSS) is the most common spine surgery in Denmark, with around 75% of patients experiencing pain relief after one year, but 25% seeing little improvement.
- A predictive decision support tool called PROPOSE was developed to aid discussions between doctors and LSS patients by presenting the pros and cons of surgery.
- Evaluation of PROPOSE showed good performance in predicting outcomes for walking distance and leg pain, confirming its effectiveness in real-world clinical settings.