A novel lumbar total joint replacement may be an improvement over fusion for degenerative lumbar conditions: a comparative analysis of patient-reported outcomes at one year

Sielatycki, John A.; Devin, Clinton J.; Pennings, Jacquelyn S.; Koscielski, Marissa; Metcalf, Tyler; Archer, Kristin R.; Dunn, Robert; Humphreys, S. Craig; Hodges, Scott D.

doi:10.1016/j.spinee.2020.12.001

Cited by 14 publications

(18 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition to mean PRO values, minimum clinically important difference (MCID) defined as an increase of 30% from baseline was calculated. 11 PROs were prospectively collected over the phone or via email before surgery and 3 months postoperatively. Patients with NRS back pain/ leg pain values of 0 preoperative and postoperative were excluded from the MCID analysis.…”

Section: Discussionmentioning

confidence: 99%

How Much Blood Loss Is Too Much for a 1-Level Open Lumbar Fusion?

Chanbour

Chen²,

Roth³

et al. 2023

Int J Spine Surg

View full text Add to dashboard Cite

Background: Despite the known association between increased estimated blood loss (EBL) and suboptimal perioperative outcomes, the exact threshold of EBL that impacts outcomes following elective spine surgery remains unknown. In a cohort of patients undergoing elective 1-level open posterior lumbar fusion, we sought to identify EBL thresholds associated with: (1) prolonged length of stay (LOS), (2) postoperative complications, and (3) patient-reported outcomes (PROs).Methods: A retrospective, single-center study was performed of patients undergoing elective, 1-level open posterior lumbar fusion with and without interbody fusion between October 2010 and April 2021. The primary exposure variable was EBL. Primary outcomes included: (1) LOS, (2) 30-day complications, and (3) 3-month PROs. Minimum clinically important difference was set at 30% improvement from baseline. For purposes of receiver-operating characteristic curves, LOS was dichotomized as 1 vs ≥2 days.Results: Of the 2028 patients undergoing posterior lumbar fusion surgery, 1183 underwent 1-level fusions, 763 (64.5%) with interbody fusion and 420 (35.5%) without. With interbody fusion: Median (interquartile range [IQR]) EBL was 350 mL (200-600), and median (IQR) LOS was 2 days (2-3). A positive linear association was found between EBL and LOS (P < 0.001) but not with PROs. EBL above 275 mL was associated with LOS beyond postoperative day 1 (POD1) (area under the curve [AUC] = 0.73, 95% CI 0.68-0.78, P < 0.001), with no significant association with overall complications or PROs. Without interbody fusion: Median EBL (IQR) was 300 mL (150-500), and median (IQR) LOS was 3 days (2-4). A positive linear association was found between EBL and LOS (P < 0.001) but not with PROs. EBL above 238 mL was associated with LOS beyond POD1 (AUC = 0.78, 95% CI 0.71-0.85, P < 0.001), with no impact on overall complications or PROs.Conclusions: In patients undergoing 1-level posterior lumbar fusion, EBL volumes greater than 275 and 238 mL in patients with and without interbody fusion, respectively, were associated with increased LOS beyond POD1. No effect was found regarding 30-day complications and 3-month PROs. Although EBL did not directly impact complications or PROs, surgeons may expect longer LOS when higher EBL is reported.Clinical Relevance: EBL above 275 mL with an interbody and 238 mL without an interbody were associated with prolonged LOS beyond POD1 in 1-level open lumbar fusion.Level of Evidence: 3.

show abstract

Section: Discussionmentioning

confidence: 99%

How Much Blood Loss Is Too Much for a 1-Level Open Lumbar Fusion?

Chanbour

Chen²,

Roth³

et al. 2023

Int J Spine Surg

View full text Add to dashboard Cite

show abstract

“…Proportion of patients achieving a 30% reduction in preoperative PRO scores were compared as well. 24 A P-value <0.05 was considered statistically significant. The analysis was performed using SPSS version 20 (IBM Inc., Chicago, IL).…”

Section: Discussionmentioning

confidence: 99%

Is it Better to Stop at C2 or C3/4 in Elective Posterior Cervical Decompression and Fusion?

Roth

Khan

Chotai

et al. 2021

Spine

Self Cite

View full text Add to dashboard Cite

Study Design. Retrospective cohort study. Objective. (a) Compare operative variables, complications, and patient-reported outcomes (PROs) in patients with an upper instrumented vertebrae (UIV) of C2 versus C3/4, and (b) assess outcomes based on C2 screw type. Summary of Background Data. When performing elective posterior cervical laminectomy and fusion (PCLF), spine surgeons must choose the upper instrumented vertebrae (UIV) at the subaxial cervical spine (C3/4) versus C2. Differences in longterm complications and PROs remain unknown. Methods. A single-institution, retrospective cohort study from a prospective registry was conducted. All patients undergoing elective, degenerative PCLF from December 2010 to June 2018 were included. Patients were divided into a UIV of C2 versus C3/4. Groups were 2:1 propensity matched for fusion extending to the thoracic spine. Demographics, operative, perioperative, complications, and 1-year PRO data were collected. Results. One hundred seventeen patients underwent elective PCLF and were successfully propensity matched (39 C2 vs. 78 C3/4). Groups were similar in fusion extending to the thoracic spine (P ¼ 0.588). Expectedly, the C2 group had more levels fused (5.63 AE 1.89) compared with the C3/4 group (4.50 AE 0.91) (P ¼ 0.001). The C2 group had significantly longer operative time (P < 0.001), yet no differences were seen in estimated blood loss (EBL) (P ¼ 0.494) or length of stay (LOS) (P ¼ 0.424). Both groups significantly improved all PROs at 1-year (EQ-5D; NRS-NP/AP; NDI). Both groups had the same percentage of surgical adverse events at 6.8% (P ¼ 1.00). Between C2 screw type, no differences were seen in operative time, EBL, LOS, complications, or PROs. Conclusion.In patients undergoing elective PCLF, those instrumented to C2 had only longer operative times compared with those stopping at C3/4. No differences were seen in EBL, LOS, 1-year PROs, and complications. Type of C2 screw had no impact on outcomes. Besides increased operative time, instrumenting to C2 had no detectable difference on surgical outcomes or adverse event rates.

show abstract

“…The posterior approach has seen recent interest in being utilized. Sielatycki has been able to show at 1 year, the LTJR cohort showed signifi cant improvement in ODI and NRS back and leg pain as compared to TLIF [17].…”

Section: Thousands Of Lumbar Tdrs Are Conducted In the Unitedmentioning

confidence: 97%

The Lateral Approach in Lumbar Total Disc Replacement: A Literature Review

Amer¹,

Issa²,

Higginbotham³

et al. 2021

Int J Spine Res

View full text Add to dashboard Cite

Lumbar disc replacement has become an area of interest for many practicing spine surgeons. As newer technology emerges focusing on motion sparing devices, novel techniques are being employed to better serve patients and increase post-operative outcomes. Traditionally, the anterior approach is utilized in total disc arthroplasty of the lumbar spine, although many are beginning to favor the use of a lateral approach. The lateral approach not only allows for the maintenance of the Anterior Longitudinal Ligament (ALL), but also avoids the great vessels during surgery which are encountered in the traditional anterior approach. Research has shown the lateral approach in total disc replacements (TDR) of the lumbar spine to be a not inferior alternative to the anterior approach, with long-term pain relief and a low complication rate.

show abstract

A novel lumbar total joint replacement may be an improvement over fusion for degenerative lumbar conditions: a comparative analysis of patient-reported outcomes at one year

Cited by 14 publications

References 33 publications

How Much Blood Loss Is Too Much for a 1-Level Open Lumbar Fusion?

How Much Blood Loss Is Too Much for a 1-Level Open Lumbar Fusion?

Is it Better to Stop at C2 or C3/4 in Elective Posterior Cervical Decompression and Fusion?

The Lateral Approach in Lumbar Total Disc Replacement: A Literature Review

Contact Info

Product

Resources

About