Introduction: There is clinical equipoise regarding the ideal upper instrumented vertebrae (UIV) for elective posterior cervical decompression and fusion (PCDF). Instrumentation may be performed at the axial C2 level, or at the subaxial C3/C4 vertebrae. To our knowledge, a true "value" (outcomes per dollar spent) comparison axial versus subaxial UIV for PCDF has never been performed.
View Article and Find Full Text PDFBackground: The increasing prevalence of obesity has raised concerns about its impact on surgical outcomes and healthcare costs. This study evaluates the influence of Body Mass Index (BMI) on intraoperative costs and operative times during open Transforaminal Lumbar Interbody Fusion (TLIF) procedures using a Time-Driven Activity-Based Costing (TDABC) approach.
Methods: A retrospective analysis was conducted on 279 patients who underwent TLIF between 2019 and 2022.
Background: Many studies have evaluated the effect of preoperative disability status on functional outcomes following spine surgery. However, no research has compared the "value" (outcomes per dollar spent) of surgery for patients with different levels of diagnosis-specific disability.
Methods: We retrospectively reviewed 429 patients who underwent neurosurgical anterior cervical discectomy and fusion.
Background And Objectives: A few studies have compared the value (outcomes per dollar spent) provided by transforaminal endoscopic discectomy (TED) vs microdiscectomy (MD) for lumbar disc herniations. Here, we attempt to address this gap using a novel Operative Value Index (OVI), which combines a procedure-specific patient-reported outcome with intraoperative cost data based on time-driven activity-based costing.
Methods: MD (n = 95) and TED (n = 23) performed by neurosurgeons at our institution from 2017 to 2022 were retrospectively identified.
Background And Objectives: Endoscopic lumbar diskectomy (ED) is a minimally invasive option for addressing lumbar disk herniations. With the introduction of value-based care systems, assessing the true cost of certain procedures is critical when creating reimbursement models and comparing procedures. Here, we compared the costs of performing a microdiskectomy (MD) and ED using time-driven activity-based costing.
View Article and Find Full Text PDFStudy Design: The present study is a single-center, retrospective cohort study of patients undergoing neurosurgical anterior cervical discectomy and fusion (ACDF).
Objective: Our objective was to use time-driven activity-based costing (TDABC) methodology to determine whether surgeons' case volume influenced the true intraoperative costs of ACDFs performed at our institution.
Summary Of Background Data: Successful participation in emerging reimbursement models, such as bundled payments, requires an understanding of true intraoperative costs, as well as the modifiable drivers of those costs.
Background And Objectives: Percutaneous endoscopic lumbar diskectomy (PELD) is an effective, minimally invasive method for removal of lateral lumbar disk herniations. This minimally invasive technique can be applied with high success and lead to faster recovery than traditional methods. Unfortunately, adoption of these techniques in the United States has been slow.
View Article and Find Full Text PDFStudy Design: Retrospective Cohort Study.
Introduction: The 11-item modified Frailty index (mFI-11) by the ACS-NSQIP database was used to predict which patients are high risk for complications and inpatient mortality. ACS-NSQIP now has switched to the 5-item MFI.
Background: There is a lack of data on whether intracranial pressure (ICP)-guided therapy with an intraparenchymal fiberoptic monitor (IPM) or an external ventricular drain (EVD) leads to superior outcomes. Our goal is to determine the relationship between ICP-guided therapy with an EVD or IPM and mortality.
Methods: Retrospective analysis of severe traumatic brain injury cases that required IPM or EVD placement for ICP-guided therapy from January 1, 2010 to December 31, 2020.
Background: Although not a technically difficult operation, cranioplasty is associated with high rates of complications. The optimal timing of cranioplasty to mitigate complications remains the subject of debate.
Objective: To report outcomes between patients undergoing cranioplasty at ultra-early (0-6 weeks), intermediate (6 weeks to 6 months), and late (>6 months) time frames.
Study Design: Retrospective Cohort Study.
Objectives: To determine the ability of early vital sign abnormalities to predict functional independence in patients with SCI that required surgery.
Methods: A retrospective analysis of data extracted from the Pennsylvania Trauma Outcome Study database.
Background: Spinal synovial cysts are lesions that most commonly occur in the lumbar region. The need for an instrumented spinal fusion in addition to lumbar decompression with removal of the synovial cyst is unknown.
Objective: To test the hypothesis that select patients who underwent decompression with instrumented fusion for lumbar synovial cysts would be less likely to have subsequent surgery (SS) in a 2-year period than patients treated with laminectomy alone.
Background: Opioids are commonly prescribed for chronic pain before spinal surgery and research has shown an increased rate of postoperative adverse events in these patients.
Objective: This study compared the incidence of 2-year subsequent surgical procedures and postoperative adverse events in patients undergoing lumbar fusion with or without 90-day preoperative opioid use. We hypothesized that patients using preoperative opioids would have a higher incidence of subsequent surgery and adverse outcomes.
We report the case of a 62-year-old man who presented with a progressive myelopathy secondary to spinal cord compression from an odontoid process fracture and subaxial central canal stenosis. The patient underwent a C1-T2 posterior decompression and instrumented fusion (PCDF) and did well immediately postoperatively. However, on POD1, he developed a right hypoglossal nerve (HN) palsy attributed to direct mechanical compression or injury from the C1 lateral mass screw (LMS), which improved following a revision and screw replacement.
View Article and Find Full Text PDFIntroduction The American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) 2014 lumbar fusion guidelines for stenosis with degenerative spondylolisthesis (DS) support surgical decompression and fusion as an effective treatment option for symptomatic stenosis associated with DS. The association between the number of levels decompressed in patients with single-level fusion and clinical outcomes has never been published. Methods A retrospective analysis of a single-center, prospectively collected database was performed on 77 patients to compare the effect of the number of decompression levels in patients that received single-level fusion surgery.
View Article and Find Full Text PDFBackground: Cervical pseudarthrosis is a postoperative adverse event that occurs when a surgically induced fusion fails to establish bone growth connecting the 2 regions. It has both clinical and financial implications and may result in significant patient morbidity; it continues to be one of the leading causes of pain after surgery.
Methods: A retrospective longitudinal cohort study was performed.
Study Design: Retrospective case-control study.
Objective: To compare health-related quality of life outcomes at one-year follow-up between patients who did and did not develop surgical site infection (SSI) after thoracolumbar spinal fusion.
Summary Of Background Data: SSI is among the most common healthcare-associated complications.
Background: Patients with a history of surgically treated cervical myelopathy and lumbar pathology requiring fusion present complex challenges, and literature describing patient-reported outcomes in this cohort beyond patients with tandem spinal stenosis is sparse. This has led to unclear guidelines in the literature. We present the first dataset comparing patient-reported outcomes for lumbar fusion in patients with isolated lumbar pathology versus patients with a history of surgically treated cervical myelopathy.
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