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.

Considering Spine Surgery: A Web-Based Calculator for Communicating Estimates of Personalized Treatment Outcomes.

Study Design: Prospective evaluation of an informational web-based calculator for communicating estimates of personalized treatment outcomes.

Objective: To evaluate the usability, effectiveness in communicating benefits and risks, and impact on decision quality of a calculator tool for patients with intervertebral disc herniations, spinal stenosis, and degenerative spondylolisthesis who are deciding between surgical and nonsurgical treatments.

Summary Of Background Data: The decision to have back surgery is preference-sensitive and warrants shared decision making.

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.

A Cohort Study of the Natural History of Odontoid Pseudoarthrosis Managed Nonoperatively in Elderly Patients.

Objective: Although the primary goal of treatment of type II odontoid fracture is bony union, some advocate continued nonsurgical management of minimally symptomatic older patients who have fibrous union or minimal fracture motion. The risk of this strategy is unknown. We reviewed our long-term outcomes after dens nonunion to define the natural history of Type II odontoid fractures in elderly patients managed nonoperatively.

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.

Who should have surgery for spinal stenosis? Treatment effect predictors in SPORT.

Study Design: Combined prospective randomized controlled trial and observational cohort study of spinal stenosis (SpS) with an as-treated analysis.

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

Summary Of Background Data: The Spine Patient Outcomes Research Trial demonstrated a positive surgical TE for SpS 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.

Comparative effectiveness evidence from the spine patient outcomes research trial: surgical versus nonoperative care for spinal stenosis, degenerative spondylolisthesis, and intervertebral disc herniation.

Study Design: Cost-effectiveness analysis of a randomized plus observational cohort trial.

Objective: Analyze cost-effectiveness of Spine Patient Outcomes Research Trial data over 4 years comparing surgery with nonoperative care for three common diagnoses: spinal stenosis (SPS), degenerative spondylolisthesis (DS), and intervertebral disc herniation (IDH).

Summary Of Background Data: Spine surgery rates continue to rise in the United States, but the safety and economic value of these procedures remain uncertain.

Who should have surgery for an intervertebral disc herniation? Comparative effectiveness evidence from the spine patient outcomes research trial.

Study Design: Combined prospective randomized controlled trial and observational cohort study of intervertebral disc herniation (IDH), an as-treated analysis.

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

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

Relationship between preoperative expectations, satisfaction, and functional outcomes in patients undergoing lumbar and cervical spine surgery: a multicenter study.

Study Design: Analysis of prospectively collected multicenter data.

Objective: To explore the relationship between preoperative expectations and postoperative outcomes and satisfaction in lumbar and cervical spine surgery.

Summary Of Background Data: Back pain is one of the most common health problems, leading to the utilization of health care resources, work loss, and sick benefits.

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.

Predominant leg pain is associated with better surgical outcomes in degenerative spondylolisthesis and spinal stenosis: results from the Spine Patient Outcomes Research Trial (SPORT).

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

Objective: To compare baseline characteristics and surgical and nonoperative outcomes in degenerative spondylolisthesis (DS) and spinal stenosis (SpS) patients stratified by predominant pain location (i.e.

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.

Deciphering the crystal ball in spine care: can preoperative patient variables predict postoperative functional outcomes and risks?

Meredith DS, Huang RC, Nguyen J, Lyman S. Obesity increases the risk of recurrent herniated nucleus pulposus after lumbar microdiscectomy. Spine J 2010;10:575-580 (in this issue).

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.