The implementation and efficacy of the Northwestern High Risk Spine Protocol.

Objective: The aims of this study were to determine the efficacy and feasibility of implementation of the intraoperative component of a high risk spine (HRS) protocol for improving perioperative patient safety in complex spine fusion surgery.

Methods: In this paired availability study, the total number of red blood cell units transfused was used as a surrogate marker for our management protocol efficacy, and the number of protocol violations was used as a surrogate marker for protocol compliance.

Results: The 548 patients (284 traditional vs.

How does accounting for worker productivity affect the measured cost-effectiveness of lumbar discectomy?

Background: Back pain attributable to lumbar disc herniation is a substantial cause of reduced workplace productivity. Disc herniation surgery is effective in reducing pain and improving function. However, few studies have examined the effects of surgery on worker productivity.

Driving after orthopaedic surgery.

The decision to drive after orthopaedic injury or surgery is fraught with legal and safety issues. Although driving is an important part of most patients' lives, there are no well-established guidelines for determining when it is safe to drive after injury or treatment. Typically, impairment in driving ability is measured by changes in the time needed to perform an emergency stop.

Case report of an abscess developing at the site of a hematoma following a direct lateral interbody fusion.

Background Context: A direct lateral interbody fusion (DLIF) is relatively new, yet commonly performed procedure in spine surgery. This procedure is associated with risk, including damage to nerve or vascular structures. However, to our knowledge, there has not been a case of an abscess developing at the site of a postoperative hematoma after this procedure.

The Professional Athlete Spine Initiative: outcomes after lumbar disc herniation in 342 elite professional athletes.

Background Context: Although clinical outcomes after lumbar disc herniations (LDHs) in the general population have been well studied, those in elite professional athletes have not. Because these athletes have different measures of success, studies on long-term outcomes in this patient population are necessary.

Purpose: This study seeks to define the outcomes after an LDH in a large cohort of professional athletes of American football, baseball, hockey, and basketball.

Standardizing care for high-risk patients in spine surgery: the Northwestern high-risk spine protocol.

Study Design: Review article of current literature on the preoperative evaluation and postoperative management of patients undergoing high-risk spine operations and a presentation of a multidisciplinary protocol for patients undergoing high-risk spine operation.

Objective: To provide evidence-based outline of modifiable risk factors and give an example of a multidisciplinary protocol with the goal of improving outcomes.

Summary Of Background Data: Protocol-based care has been shown to improve outcomes in many areas of medicine.

Delayed epidural hematoma after spinal surgery: a report of 4 cases.

Symptomatic postoperative epidural hematoma is a rare and potentially devastating complication of spinal surgery. The overwhelming majority of reported cases have occurred in the immediate postoperative period. A recent publication defined the clinical entity of delayed postoperative epidural spinal hematoma as neurologic deterioration due to an epidural hematoma occurring at least 3 days after the index procedure.

Ulnar collateral ligament reconstruction in elite throwing athletes.

Purpose: Ulnar collateral ligament (UCL) injuries may result in disabling valgus instability in throwing athletes. We evaluated the docking technique for UCL reconstruction and describe a modification to the technique.

Methods: UCL surgery was indicated in 20 high-level baseball players (13 professional and 7 collegiate) based on medial elbow pain preventing effective throwing, clinically apparent medial elbow laxity, and magnetic resonance arthrogram consistent with UCL injury.

Infraspinatus muscle atrophy in professional baseball players.

Background: Infraspinatus muscle atrophy has been observed in athletes who stress their upper extremities in an overhead fashion. The majority of such case reports have been in volleyball players, with far fewer cases reported in baseball players.

Hypothesis: Infraspinatus muscle atrophy occurs to a notable degree in professional baseball players.

Muscle flap salvage of spine wounds with soft tissue defects or infection.

Study Design: This retrospective study was designed to analyze the results of 22 patients treated for postoperative soft tissue defects of the spine.

Objective: To demonstrate the utility of flaps in the salvage of spine wounds.

Summary Of Background Data: In the literature, the treatment of postoperative spine infections is with serial débridement, antibiotic irrigation catheters, drains, and occasional removal of spinal implants.