Does the ACS NSQIP Surgical Risk Calculator Accurately Predict Complications Rates After Anterior Lumbar Interbody Fusion Procedures?

Study Design: Clinical case series.

Objective: The aim of this study was to determine the effectiveness of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) surgical risk calculator in the prediction of complications after anterior lumbar interbody fusion (ALIF).

Summary Of Background Data: Identifying at-risk patients may aid in the prevention of complications after spine procedures.

Multicenter study of lumbar discectomy with Barricaid annular closure device for prevention of lumbar disc reherniation in US patients: A historically controlled post-market study protocol.

Background: Patients with large defects in the annulus fibrosus following lumbar discectomy have high rates of symptomatic reherniation. The Barricaid annular closure device provides durable occlusion of the annular defect and has been shown to significantly lower the risk of symptomatic reherniation in a large European randomized trial. However, the performance of the Barricaid device in a United States (US) population has not been previously reported.

Controlled Laboratory Comparison Study of Motion With Football Equipment in a Destabilized Cervical Spine: Three Spine-Board Transfer Techniques.

Background: Numerous studies have shown that there are better alternatives to log rolling patients with unstable spinal injuries, although this method is still commonly used for placing patients onto a spine board. No previous studies have examined transfer maneuvers involving an injured football player with equipment in place onto a spine board.

Purpose: To test 3 different transfer maneuvers of an injured football player onto a spine board to determine which method most effectively minimizes spinal motion in an injured cervical spine model.

Accuracy of intraoperative computed tomography-based navigation for placement of percutaneous pedicle screws.

MISS techniques have gained recent popularity. The proposed benefits of these techniques include reduced tissue trauma, reduced blood loss, less perioperative pain, and a quicker recovery and return to normal activities. The purpose of this study was to evaluate the accuracy of intraoperative computed tomography (CT)-based navigation for placement of percutaneous pedicle screws in a cadaveric model.

Surgeon-industry conflict of interest: survey of opinions regarding industry-sponsored educational events and surgeon teaching: clinical article.

Object: Conflict of interest (COI) as it applies to medical education and training has become a source of considerable interest, debate, and regulation in the last decade. Companies often pay surgeons as faculty for educational events and often sponsor and give financial support to major professional society meetings. Professional medical societies, industry, and legislators have attempted to regulate potential COI without consideration for public opinion.

Surgeon-industry conflict of interest: survey of North Americans' opinions regarding surgeons consulting with industry.

Background Context: Surgeon-industry conflict of interest (COI) has become a source of considerable interest. Professional medical societies, industry, and policy makers have attempted to regulate potential COI without consideration for public opinion.

Purpose: The objective of this study was to report on the opinions of individuals representing the general public regarding surgeon-industry consulting relationships.

Motion is reduced in the unstable spine with the use of mechanical devices for bed transfers.

Context: Excessive spinal motion generated during multiple bed transfers of patients with unstable spine injuries may contribute to neurological deterioration.

Objective: To evaluate spinal motion in a cadaveric model of global spinal instability during hospital bed transfers using several commonly used techniques.

Design/participants: A motion analysis and evaluation of hospital bed transfer techniques in a cadaveric model of C5-C6 and T12-L2 global spinal instability.

Estimating the effective radiation dose imparted to patients by intraoperative cone-beam computed tomography in thoracolumbar spinal surgery.

Study Design: Observational.

Objective: To estimate the radiation dose imparted to patients during typical thoracolumbar spinal surgical scenarios.

Summary Of Background Data: Minimally invasive techniques continue to become more common in spine surgery.

Physician-industry conflict of interest: public opinion regarding industry-sponsored research.

Object: The nature of physician-industry conflict of interest (COI) has become a source of considerable concern, but is often not discussed in the research setting. With reduced funding available from government and nonprofit sources, industry support has enthusiastically grown, but along with this comes the potential for COI that must be regulated. In this era of shared decision making in health care, society must have input into this regulation.

Postoperative infection treatment score for the spine (PITSS): construction and validation of a predictive model to define need for single versus multiple irrigation and debridement for spinal surgical site infection.

Background Context: There is very little evidence to guide treatment of patients with spinal surgical site infection (SSI) who require irrigation and debridement (I&D) in deciding need for single or multiple I&Ds or more complex wound management such as vacuum-assisted closure dressing or soft-tissue flaps.

Purpose: The purpose of this study was to build a predictive model that stratifies patients with spinal SSI, allowing us to determine which patients will need single versus multiple I&D. The model will be validated and will serve as evidence to support a scoring system to guide treatment.

Morbidity and mortality of major adult spinal surgery. A prospective cohort analysis of 942 consecutive patients.

Background Context: To date, most reports on the incidence of adverse events (AEs) in spine surgery have been retrospective and dependent on data abstraction from hospital-based administrative databases. To our knowledge, there have been no previous rigorously performed prospective analysis of all AEs occurring in the entire population of patients presenting to an academic quaternary referral center.

Purpose: To determine the mortality and true incidence and severity of morbidity (major and minor, medical and surgical) in adults undergoing complex spinal surgery, both trauma and elective, in a quaternary referral center.

Spinal instability neoplastic score: an analysis of reliability and validity from the spine oncology study group.

Purpose: Standardized indications for treatment of tumor-related spinal instability are hampered by the lack of a valid and reliable classification system. The objective of this study was to determine the interobserver reliability, intraobserver reliability, and predictive validity of the Spinal Instability Neoplastic Score (SINS).

Methods: Clinical and radiographic data from 30 patients with spinal tumors were classified as stable, potentially unstable, and unstable by members of the Spine Oncology Study Group.

Removing a patient from the spine board: is the lift and slide safer than the log roll?

Background: After spine board immobilization of the trauma victim and transport to the hospital, the patient is removed from the spine board as soon as practical. Current Advanced Trauma Life Support's recommendations are to log roll the patient 90 degrees, remove the spine board, inspect and palpate the back, and then log roll back to supine position. There are several publications showing unacceptable motion in an unstable spine when log rolling.

Cervical collars are insufficient for immobilizing an unstable cervical spine injury.

Background: Cervical orthoses are commonly used for extrication, transportation, and definitive immobilization for cervical trauma patients. Various designs have been tested frequently in young, healthy individuals. To date, no one has reported the effectiveness of collar immobilization in the presence of an unstable mid-cervical spine.

A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group.

Study Design: Systematic review and modified Delphi technique.

Objective: To use an evidence-based medicine process using the best available literature and expert opinion consensus to develop a comprehensive classification system to diagnose neoplastic spinal instability.

Summary Of Background Data: Spinal instability is poorly defined in the literature and presently there is a lack of guidelines available to aid in defining the degree of spinal instability in the setting of neoplastic spinal disease.

Cervical spine motion generated with manual versus jackson table turning methods in a cadaveric c1-c2 global instability model.

STUDY DESIGN.: Cadaveric biomechanical study. OBJECTIVE.

Comparison of the flat torso versus the elevated torso shoulder pad removal techniques in a cadaveric cervical spine instability model.

Study Design: Controlled laboratory study in a cadaveric model.

Objective: To determine if removing shoulder pads using the elevated torso technique generated less spinal segment motion than using the flat torso method.

Summary Of Background Data: Guidelines for care of the injured football player with a suspected spinal injury recommend initial immobilization with shoulder pads and helmet in place.

Survey of spine surgeons on attitudes regarding osteoporosis and osteomalacia screening and treatment for fractures, fusion surgery, and pseudoarthrosis.

Background Context: Osteoporosis and osteomalacia are significant risk factors for fracture and spine instrumentation failure. Low-energy fractures are becoming increasingly more common because of an increase in life expectancy and age of the population. Decreased bone density is an independent risk factor for instrumentation failure in spinal fusion operations.

Comparing cervical spine motion with different halo devices in a cadaveric cervical instability model.

Study Design: Biomechanical evaluation of conventional and noninvasive halos in cadaveric C1-C2 and C5-C6 instability models.

Objective: To compare the ability of a conventional halo and noninvasive halo (NIH) to immobilize the unstable cervical spine at the C1-C2 and C5-C6 levels.

Summary Of Background Data: Many successful outcomes have been reported in cervical spine injury treatment with the conventional halo (CH); however, complications related to pin sites have been reported.

Comparison of thoracolumbar motion produced by manual and Jackson-table-turning methods. Study of a cadaveric instability model.

Background: Patients who have sustained a spinal cord injury remain at risk for further neurologic deterioration until the spine is adequately stabilized. To our knowledge, no study has previously addressed the effects of different bed-to-operating room table transfer techniques on thoracolumbar spinal motion in an instability model. We hypothesized that the conventional logroll technique used to transfer patients from a supine position to a prone position on the operating room table has the potential to confer significantly more motion to the unstable thoracolumbar spine than the Jackson technique.

Transferring patients with thoracolumbar spinal instability: are there alternatives to the log roll maneuver?

Study Design: Using a cadaveric model, the amount of spinal motion generated during the execution of various prehospital transfer techniques was evaluated using a crossover study design.

Objective: To assess the quantity of segmental motion generated across a globally unstable thoracolumbar spine during the execution of the log roll (LR), lift-and-slide, and 6-plus-person (6+) lift.

Summary Of Background Data: The LR has been reported to be inappropriate for transferring patients with thoracolumbar injuries.

Cervical spine motion in manual versus Jackson table turning methods in a cadaveric global instability model.

Study Design: A study of spine biomechanics in a cadaver model.

Objective: To quantify motion in multiple axes created by transfer methods from stretcher to operating table in the prone position in a cervical global instability model.

Summary Of The Background Data: Patients with an unstable cervical spine remain at high risk for further secondary injury until their spine is adequately surgically stabilized.