Posterior Extensive Circumferential Decompressive Reconstructive Technique in Surgical Treatment of Upper Thoracic Spine Compressive Lesions

Omran, Khaled; Abdel-Fattah, Ahmed S

doi:10.1016/j.wneu.2018.11.194

Cited by 5 publications

(7 citation statements)

References 12 publications

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“…This is probably due to the neurological consequences leading to disruption of functional abilities, emphasizing the indication for surgery. Studies that examined surgery techniques recorded a considerable number of patients with compromised preoperative neurological status [2,[7][8][9][10][13][14][15]23,25]. On the other hand, fewer studies evaluated functional outcomes from conservative management among individuals with spinal tuberculosis; however, those who underwent conservative management were less likely to have neurological deficits to begin with [16,17].…”

Section: Discussionmentioning

confidence: 99%

“…Although various surgical techniques feature among our selected articles, all involved spinal debridement, osteotomy, and stabilization, whether by grafting or instrumentation. These techniques decompress the spinal cord to relieve the impingement and fixate the spine to prevent further injury [2,[7][8][9][10][11][12][13][14]23,25,29]. In short, spinal cord compression requires surgical intervention to promote neurological recovery and permits early initiation of rehabilitative training for improvement in functional outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Singh et al [2], Sun et al [7], and Ran et al [8] found that the posterior spinal surgical approach produced a significant improvement in the AIS score among patients with AIS B, AIS C, and AIS D on admission, but lesser improvement was observed in those with AIS A. However, Omran and Abdel-Fattah [9] found that the posterior extensive circumferential decompressive reconstructive technique could also improve the neurological outcome of patients who were initially graded as AIS A. Posterior spinal stabilization surgery with titanium mesh or autogenous iliac bone graft also demonstrated improvement in the Frankel Grading, from grade D to E [10]. Meanwhile, surgery via the anterior approach was shown to improve the level of disability based on Japanese Orthopaedic Association (JOA) scores among patients with cervical spinal tuberculosis, as shown in studies by Xing et al [11] and Liu et al [12].…”

Section: Modes Of Treatmentmentioning

confidence: 98%

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Functional Outcomes in Spinal Tuberculosis: A Review of the Literature

et al. 2021

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Spinal tuberculosis often leads to neurological deficit and subsequent deterioration in functional outcomes. This review assesses the recent evidence on functional outcomes in spinal tuberculosis, highlighting functional recovery, assessment tools for functional measures, and associative factors for functional recovery. Using PubMed, a literature search was done using the terms "spinal tuberculosis," "tuberculous spondylitis," "tuberculous spondylodiscitis," and "functional outcome" for original articles published between January 2010 and December 2019. A total of 191 search results were found. Detailed screening showed that 19 articles met the eligibility criteria: 13 of these focused on surgical methods, four on conservative management, and two on rehabilitation approaches. The outcome measures used for functional assessment were the Oswestry Disability Index (11 articles), Japanese Orthopaedic Association score (n=3), modified Barthel Index (n=2), Functional Independence Measure (n=2), and 36-item Short-Form Health Survey (n=1). Functional outcome was mainly affected by pain, spinal cord compression, and inpatient rehabilitation. No significant difference in functional outcome was found between conservative management and surgery for cases with uncomplicated spinal tuberculosis. Most studies focused on surgery as the mode of treatment and used pain-related functional measures; however, these assessed functional limitations secondary to pain, and not neurological deficits. Further studies may consider examining functional outcomes in spinal tuberculosis by utilizing spinal cord-specific functional outcome measures, to evaluate outcome measures as a prognostic tool, and to measure functional outcomes from specific rehabilitation interventions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Modes Of Treatmentmentioning

confidence: 98%

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Functional Outcomes in Spinal Tuberculosis: A Review of the Literature

et al. 2021

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“…For example, the treatment of spinal chordoma generally requires a complex spine procedure such as en-bloc surgical excision and multilevel instrumented fusion [ 5 , 12 ]. This generally is associated with increased length of stay,need for rehabilitation, complications, the risk for emergency department visits, hospital readmission, need for pain prescription refills, and cost [ 5 , 11 , 13 ]. Both diseases have elevated risk for recurrence (~ 57% for cranial and 27% for spinal disease) which may necessitate further treatment [ 12 , 14 – 16 ].…”

Section: Discussionmentioning

confidence: 99%

Economics of the Management of Craniospinal Chordoma and Chondrosarcoma and the feasibility of the bundled payment model

et al. 2020

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Background: The Centers for Medicare and Medicaid Services (CMS) created a new reimbursement model "Bundled Payment for Care Improvement (BPCI)" which reimburses providers a predetermined payment in advance to cover all possible services rendered within a certain time window. Chordoma and Chondrosarcoma are locally aggressive malignant primary bony tumors. Treatment includes surgical resection and radiotherapy with substantial risk for recurrence which necessitates monitoring and further treatment. We assessed the feasibility of the BPCI model in these neurosurgical diseases. Methods: We selected patients with chordoma/chondrosarcoma from inpatient admission table using the International Classification of Disease, 9th (ICD-9), and 10th (ICD-10) revision codes. We collected the patients' demographics and insurance type at the index hospitalization. We recorded the following outcomes length of stay, total payment, discharge disposition, and complications for the index hospitalization. For post-discharge, we collected the 30 days and 3/6/12 months inpatient admission, outpatient service, and medication refills. Continuous variables were summarized by means with standard deviations, median with interquartile and full ranges (minimum-maximum); Continuous outcomes were compared by nonparametric Wilcoxson rank-sum test. All tests were 2-sided with a significance level of 0.05. Statistical data analysis was performed in SAS 9.4 (SAS Institute, Inc, Cary, NC). Results: The population size was 2041 patients which included 1412 patients with cranial (group1), 343 patients with a mobile spine (group 2), and 286 patients with sacrococcygeal (group 3) chordoma and chondrosarcoma. For index hospitalization, the median length of stay (days) was 4, 6, and 7 for groups 1, 2, and 3 respectively (P<.

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“…[5,12] This generally is associated with increased length of stay, need for rehabilitation, complications, risk for emergency department visits, hospital readmission, need for pain prescription refills, and cost. [5,11,13] Both diseases have high risk for recurrence (~ 57% for cranial and 27% for spinal disease) which may necessitate further treatment. [12,[14][15][16] These factors make these two conditions valuable to explore the cost and patterns of expenditure over time and the feasibility of adopting the BPCI model for reimbursement.…”

Section: Discussionmentioning

confidence: 99%

Economics of the Management of Craniospinal Chordoma and Chondrosarcoma and the Feasibility of the Bundled Payment Model

Aljuboori

Ugiliweneza

Wang

et al. 2020

Preprint

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Background Healthcare expenditures are continuously rising in the United States. The Centers for Medicare and Medicaid Services (CMS) created a new reimbursement model called the “Bundled Payment for Care Improvement (BPCI)”. This model reimburses providers a predetermined payment in advance to cover all possible services delivered to patients within a certain time window. Chordoma and Chondrosarcoma are locally aggressive malignant primary bony tumors. Treatment includes surgical resection and radiotherapy with substantial risk for recurrence which necessitates monitoring and further treatment. We assess the BPCI model in complex neurosurgical diseases. Methods We obtained data from the United States MarketScan database. Patients were identified patients using the International Classification of Diseases 10 codes. Results A total of 2041 patients were included. 1412 patients had cranial, 343 patients had a mobile spine, and 286 patients had sacrococcygeal chordoma and chondrosarcoma. For Index hospitalization, the median length of stay (days) was 4, 6, and 7, mean total payments were ($58,130), ($84,854), and ($82,440), and complication rates were 30%, 35%, and 43% for groups 1, 2, and 3, respectively. The payments during the first 6 months after discharge were comparable to the amounts reimbursed during the index hospitalization for all groups. Conclusion The management of craniospinal chordoma and chondrosarcoma is costly and sustained over time. The success of BPCI requires a joint effort between insurers and hospitals. It should consider patients’ comorbidities, the complexity of the disease. Finally, adoption of quality improvement programs by hospitals can help with cost reduction.

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Posterior Extensive Circumferential Decompressive Reconstructive Technique in Surgical Treatment of Upper Thoracic Spine Compressive Lesions

Cited by 5 publications

References 12 publications

Functional Outcomes in Spinal Tuberculosis: A Review of the Literature

Functional Outcomes in Spinal Tuberculosis: A Review of the Literature

Economics of the Management of Craniospinal Chordoma and Chondrosarcoma and the feasibility of the bundled payment model

Economics of the Management of Craniospinal Chordoma and Chondrosarcoma and the Feasibility of the Bundled Payment Model

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