Keys to diagnosis and management of spinal epidural abscesses: 9 years of institutional experience.

Objective: Spinal epidural abscesses (SEA's) are a challenge to diagnose, particularly if there are non-contiguous (skip) lesions. There is also limited data to predict which patients can be treated with antibiotics alone and which require surgery. We sought to assess which demographics, clinical and laboratory findings can guide both diagnosis and management of SEA's.

Patient-Reported Allergies, a Marker of Preoperative Pain and Disability in Elective Spine Surgery.

Study Design: Retrospective review.

Objective: Previous literature demonstrates mixed results regarding the relationship between patient-reported allergies and pain, function, and satisfaction scores. The objective of this study was to investigate the correlation between patient-reported allergies and preoperative Oswestry Disability Index (ODI), Neck Disability Index (NDI), and Patient-Reported Outcomes Measurement System (PROMIS) scores.

Reducing Radiation and Lowering Costs With a Standardized Care Pathway for Nonoperative Thoracolumbar Fractures.

Study Design: Retrospective observational study.

Objective: There is marked variation in the management of nonoperative thoracolumbar (TL) compression and burst fractures. This was a quality improvement study designed to establish a standardized care pathway for TL fractures treated with bracing, and to then evaluate differences in radiographs, length of stay (LOS), and cost before and after the pathway.

A 5-Year Review of Hospital Costs and Reimbursement in the Surgical Management of Degenerative Spondylolisthesis.

Background: To evaluate charges, expenses, reimbursement, and hospital margins with noninstrumented posterolateral fusion in situ (PLF), posterolateral fusion with pedicle screws (PPS), and PPS with interbody device (PLIF) in degenerative spondylolisthesis with spinal stenosis.

Methods: A retrospective chart review was performed from 2010 to 2014 based on ICD-9 diagnoses of degenerative spondylolisthesis with spinal stenosis in patients undergoing single-level fusions. All charges, expenses, reimbursement, and margins were obtained through financial auditing.

Long-Term Results of Surgery Compared With Nonoperative Treatment for Lumbar Degenerative Spondylolisthesis in the Spine Patient Outcomes Research Trial (SPORT).

Study Design: Randomized trial with a concurrent observational cohort study.

Objective: To compare 8-year outcomes between surgery and nonoperative care and among different fusion techniques for symptomatic lumbar degenerative spondylolisthesis (DS).

Summary Of Background Data: Surgical treatment of DS has been shown to be more effective than nonoperative treatment out to 4 years.

Reoperation for Recurrent Intervertebral Disc Herniation in the Spine Patient Outcomes Research Trial: Analysis of Rate, Risk Factors, and Outcome.

Study Design: This study was a post-hoc subgroup analysis of prospectively collected data in the Spine Patient Outcomes Research Trial (SPORT).

Objective: The aim of this study was to determine the risk factors for and to compare the outcomes of patients undergoing revision disc excision surgery in SPORT.

Summary Of Background Data: Risk factors for reherniation and outcomes after revision surgery have not been well-studied.

Long-term outcomes of lumbar spinal stenosis: eight-year results of the Spine Patient Outcomes Research Trial (SPORT).

Study Design: Randomized trial with a concurrent observational cohort study.

Objective: To compare 8-year outcomes of surgery with nonoperative care for symptomatic lumbar spinal stenosis.

Summary Of Background Data: Surgery for spinal stenosis has been shown to be more effective than nonoperative treatment during 4 years, but longer-term data are less clear.

The SPORT value compass: do the extra costs of undergoing spine surgery produce better health benefits?

Background: The Spine Patient Outcomes Research Trial aimed to determine the comparative effectiveness of surgical care versus nonoperative care by measuring longitudinal values: outcomes, satisfaction, and costs.

Methods: This paper aims to summarize available evidence from the Spine Patient Outcomes Research Trial by addressing 2 important questions about outcomes and costs for 3 types of spine problem: (1) how do outcomes and costs of spine patients differ depending on whether they are treated surgically compared with nonoperative care? (2) What is the incremental cost per quality adjusted life year for surgical care over nonoperative care?

Results: After 4 years of follow-up, patients with 3 spine conditions that may be treated surgically or nonoperatively have systematic differences in value endpoints. The average surgical patient enjoys better health outcomes and higher treatment satisfaction but incurs higher costs.

Surgical versus nonoperative treatment for lumbar disc herniation: eight-year results for the spine patient outcomes research trial.

Study Design: Concurrent prospective randomized and observational cohort studies.

Objective: To assess the 8-year outcomes of surgery versus nonoperative care.

Summary Of Background Data: Although randomized trials have demonstrated small short-term differences in favor of surgery, long-term outcomes comparing surgical with nonoperative treatment remain controversial.

Who should undergo surgery for degenerative spondylolisthesis? Treatment effect predictors in SPORT.

Study Design: Combined prospective randomized controlled trial and observational cohort study of degenerative spondylolisthesis (DS) with an as-treated analysis.

Objective: To determine modifiers of the treatment effect (TE) of surgery (the difference between surgical and nonoperative outcomes) for DS using subgroup analysis.

Summary Of Background Data: Spine Patient Outcomes Research Trial demonstrated a positive surgical TE for DS at the group level.

Psychometric evaluation of a decision quality instrument for treatment of lumbar herniated disc.

Study Design: Retrospective and prospective patient surveys and a physician survey using a sample from American Medical Association master file.

Objective: To evaluate the performance of a new instrument designed to measure the quality of decisions about treatment of herniated disc.

Summary Of Background Data: There is growing consensus on the importance of engaging and informing patients to improve the quality of significant medical decisions, yet there are no instruments currently available to measure decision quality.

Lumbar disc herniation in the Spine Patient Outcomes Research Trial: does educational attainment impact outcome?

Study Design: Randomized trial with concurrent observational cohort. A total of 1171 patients were divided into subgroups by educational attainment: high school or less, some college, and college degree or above.

Objective: To assess the influence of education level on outcomes for treatment of lumbar disc herniation.

Intraoperative ketamine reduces perioperative opiate consumption in opiate-dependent patients with chronic back pain undergoing back surgery.

Background: Ketamine is an N-methyl-d-aspartate receptor antagonist that has been shown to be useful in the reduction of acute postoperative pain and analgesic consumption in a variety of surgical interventions with variable routes of administration. Little is known regarding its efficacy in opiate-dependent patients with a history of chronic pain. We hypothesized that ketamine would reduce postoperative opiate consumption in this patient population.

Degenerative spondylolisthesis versus spinal stenosis: does a slip matter? Comparison of baseline characteristics and outcomes (SPORT).

Study Design: As-treated analysis of the Spine Patient Outcomes Research Trial.

Objective: To compare baseline characteristics and surgical and nonoperative outcomes between degenerative spondylolisthesis (DS) and spinal stenosis (SPS) patients.

Summary Of Background Data: DS and SPS patients are often combined in clinical studies despite differences in underlying pathology and treatment.

Degenerative spondylolisthesis: does fusion method influence outcome? Four-year results of the spine patient outcomes research trial.

Study Design: Clinical trial subgroup analysis.

Objective: To compare outcomes of different fusion techniques treating degenerative spondylolisthesis (DS). Summary of Background Data.

Surgical versus nonoperative treatment for lumbar disc herniation: four-year results for the Spine Patient Outcomes Research Trial (SPORT).

Study Design: Concurrent, prospective, randomized, and observational cohort study.

Objective: To assess the 4-year outcomes of surgery versus nonoperative care.

Summary Of Background Data: Although randomized trials have demonstrated small short-term differences in favor of surgery, long-term outcomes comparing surgical to nonoperative treatment remain controversial.

Transparency in health care: leading the way.

A one-day conference sponsored by Dartmouth-Hitchcock Medical Center focused on external transparency (sharing data outside an organization) also featured discussion of internal transparency (sharing data inside an organization).

SPORT lumbar intervertebral disk herniation and back pain: does treatment, location, or morphology matter?

Study Design: Diskectomy candidates with at least 6 weeks of sciatica and confirmatory imaging were enrolled in a randomized or observational cohort.

Objective: This study sought to determine: (1) whether diskectomy resulted in greater improvement in back pain than nonoperative treatment, and (2) whether herniation location and morphology affected back pain outcomes.

Summary Of Background Data: Previous studies have reported that lumbar diskectomy is less successful for relief of back pain than leg pain and patients with central disc herniations or protrusions have worse outcomes.

What is different about workers' compensation patients? Socioeconomic predictors of baseline disability status among patients with lumbar radiculopathy.

Study Design: Combined analysis of 2 prospective clinical studies.

Objective: To identify socioeconomic characteristics associated with workers' compensation in patients with an intervertebral disc herniation (IDH) or spinal stenosis (SpS).

Summary Of Background Data: Few studies have compared socioeconomic differences between those receiving or not receiving workers' compensation with the same underlying clinical conditions.

Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis.

Background: Management of degenerative spondylolisthesis with spinal stenosis is controversial. Surgery is widely used, but its effectiveness in comparison with that of nonsurgical treatment has not been demonstrated in controlled trials.

Methods: Surgical candidates from 13 centers in 11 U.

Radiculopathy and the herniated lumbar disk: controversies regarding pathophysiology and management.

Lumbar disk herniation is one of the most common problems encountered in orthopaedic practice. Despite the frequency of its occurrence, however, much about lumbar disk herniation is poorly understood. It is important to review the basic and clinical science underlying the pathophysiology and treatment, surgical and nonsurgical, of this disorder.

Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT): a randomized trial.

Context: Lumbar diskectomy is the most common surgical procedure performed for back and leg symptoms in US patients, but the efficacy of the procedure relative to nonoperative care remains controversial.

Objective: To assess the efficacy of surgery for lumbar intervertebral disk herniation.

Design, Setting, And Patients: The Spine Patient Outcomes Research Trial, a randomized clinical trial enrolling patients between March 2000 and November 2004 from 13 multidisciplinary spine clinics in 11 US states.

The impact of comorbidities on the change in short-form 36 and oswestry scores following lumbar spine surgery.

Study Design: This is an observational study of 3482 patients undergoing lumbar spine surgery from the National Spine Network.

Objectives: To explore the influence of medical and psychosocial comorbidities on the change in Short-form 36 (SF-36) general health survey and condition-specific Oswestry Disability Index (ODI) scores in patients undergoing lumbar spine surgery.

Summary Of Background Data: It remains unclear as to which type of health instrument is more appropriate for monitoring improvement in patients who undergo lumbar spine surgery.

Can condition-specific health surveys be specific to spine disease? An analysis of the effect of comorbidities on baseline condition-specific and general health survey scores.

Study Design: This is an observational cross-sectional study of 26,290 patients seen and evaluated in the 25 centers of the National Spine Network.

Objective: To explore the correlation between medical and psychosocial comorbidities, and baseline Short-Form 36 Health Status questionnaire (SF-36) and Oswestry Disability Index (ODI) (Musculoskeletal Outcomes Data Evaluation and Management Systems version with scales reversed so that a score of 100 represents no disability, and a score of 0 represents severe disability) scores in spine patients.

Summary Of Background Data: It remains unclear whether general health questionnaires or condition-specific surveys are superior for evaluating spine patients (Spine 2000;25:3100-3).