Trends in isolated lumbar spinal stenosis surgery among working US adults aged 40–64 years, 2010–2014

Raad, Micheal; Donaldson, Callum J.; Dafrawy, Mostafa H. El; Sciubba, Daniel M.; Riley, Lee H.; Neuman, Brian J.; Kebaish, Khaled M.; Skolasky, Richard L.

doi:10.3171/2018.1.spine17964

Cited by 22 publications

(14 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The variability in indications, choice of surgical technique, and outcomes is notorious in elective spine surgery for LSS. 21,22,27 This variability, combined with the psychological influencing factors and beliefs inherent to degenerative pathologies of the lumbar spine, makes accurate clinical predictions exceedingly hard. 4 This lack of predictability for both the clinical outcome and adverse events-such as, for example, iatrogenic spondylolisthesis requiring fusion after decompression alone-means that correctly informing our patients on a case-to-case basis is complicated.…”

Section: Discussionmentioning

confidence: 99%

Machine learning–based preoperative predictive analytics for lumbar spinal stenosis

Siccoli

Wispelaere

Schröder

et al. 2019

Neurosurgical Focus

View full text Add to dashboard Cite

OBJECTIVEPatient-reported outcome measures (PROMs) following decompression surgery for lumbar spinal stenosis (LSS) demonstrate considerable heterogeneity. Individualized prediction tools can provide valuable insights for shared decision-making. The authors aim to evaluate the feasibility of predicting short- and long-term PROMs, reoperations, and perioperative parameters by machine learning (ML) methods.METHODSData were derived from a prospective registry. All patients had undergone single- or multilevel mini-open facet-sparing decompression for LSS. The prediction models were trained using various ML-based algorithms to predict the endpoints of interest. Models were selected by area under the receiver operating characteristic curve (AUC). The endpoints were dichotomized by minimum clinically important difference (MCID) and included 6-week and 12-month numeric rating scales for back pain (NRS-BP) and leg pain (NRS-LP) severity and the Oswestry Disability Index (ODI), as well as prolonged surgery (> 45 minutes), extended length of hospital stay (> 28 hours), and reoperations.RESULTSA total of 635 patients were included. The average age was 62 ± 10 years, and 333 patients (52%) were male. At 6 weeks, MCID was seen in 63%, 76%, and 61% of patients for ODI, NRS-LP, and NRS-BP, respectively. At internal validation, the models predicted MCID in these variables with accuracies of 69%, 76%, and 85%, and with AUCs of 0.75, 0.79, and 0.92. At 12 months, 66%, 63%, and 51% of patients reported MCID; the observed accuracies were 62%, 74%, and 66%, with AUCs of 0.68, 0.72, and 0.79. Reoperations occurred in 60 patients (9.5%), of which 27 (4.3%) occurred at the index level. Overall and index-level reoperations were predicted with 69% and 63% accuracy, respectively, and with AUCs of 0.66 and 0.61. In 15%, a length of surgery greater than 45 minutes was observed and predicted with 78% accuracy and AUC of 0.54. Only 15% of patients were admitted to the hospital for longer than 28 hours. The developed ML-based model enabled prediction of extended hospital stay with an accuracy of 77% and AUC of 0.58.CONCLUSIONSPreoperative prediction of a range of clinically relevant endpoints in decompression surgery for LSS using ML is feasible, and may enable enhanced informed patient consent and personalized shared decision-making. Access to individualized preoperative predictive analytics for outcome and treatment risks may represent a further step in the evolution of surgical care for patients with LSS.

show abstract

Section: Discussionmentioning

confidence: 99%

Machine learning–based preoperative predictive analytics for lumbar spinal stenosis

Siccoli

Wispelaere

Schröder

et al. 2019

Neurosurgical Focus

View full text Add to dashboard Cite

show abstract

“…Surgery for spinal stenosis was the fastest-growing type of lumbar surgery in the United States from 1980-2000 and while from 2002-2007 surgical rates overall declined, complex fusion procedures increased 15 fold, from 1.3 to 19.9 per 100,000 beneficiaries [5-6]. With LSS being the most common reason for patients older than 65 years old to have spinal surgery, the assessment of comorbidities, along with the radiographic evaluation of the anatomic severity and degree of neurogenic claudication symptoms, is essential in the decision making as to which procedure is most appropriate for the patient.…”

Section: Discussionmentioning

confidence: 99%

“…It is well established that the greater the invasiveness of a procedure the greater the risk of intra-operative complications due to more extensive dissection, decortication of bone, longer operative time, anesthesia risks and possible placement of implants and potential neural damage or cerebrospinal fluid leaks [5-8]. Furthermore, studies confirm that fusion is associated with greater complications and postoperative mortality than decompression alone [6-7]. Extensive lumbar surgical procedures can also carry the consequences of increased healthcare use from longer hospital stays, skilled nursing facility use and revision surgery [8].…”

Section: Discussionmentioning

confidence: 99%

The Use of Vertiflex® Interspinous Spacer Device in Patients With Lumbar Spinal Stenosis and Concurrent Medical Comorbidities

Hartman¹,

Granville²,

Jacobson³

2019

Cureus

View full text Add to dashboard Cite

The use of the Vertiflex® interspinous spacer is a recent minimal invasive procedure useful in the treatment of lumbar spinal stenosis (LSS). It is used mostly by interventional pain physicians who can also perform the minimally invasive lumbar decompression (MILD procedure). Previously when a patient had clinical symptomatic neurogenic claudication (NC) and radiologic findings of lumbar stenosis and had failed conservative treatment, the options were decompressive laminectomy, laminectomy with pedicle fixation at one or more levels or laminotomy combined with interlaminar stabilization (Coflex® implant). These procedures were performed by neurosurgeons and orthopedic spine surgeons. However, the majority of patients with LSS are elderly and have multiple comorbidities that can make open spinal surgery, even when limited to one level, an anesthesia risk as well as vulnerable to the risk associated with hospitalization and recovery after spine surgery. The minimally invasive approaches to interspinous stabilization make it possible to treat localized symptomatic stenosis in a broader group of patients that do not want or cannot, have general anesthesia or extensive lumbar surgery, especially in the prone position. This article examines the use of the Vertiflex® implant in an elderly population with significant comorbidities that underwent successful outpatient implantation at one or two levels. In addition, it serves to familiarize spine surgeons about the possibility of using more minimal approaches to treat LSS.

show abstract

“…For modern spinal fusion techniques, bone grafts are typically ground into slurries or fragments before being applied to the decorticated bone surface. The pathway to fusion can be divided broadly into five stages: (1) the initial inflammatory cascade and (2) vascularization of the formed fibrovascular stroma followed by (3) osteoinduction, (4) osteoconduction, and (5) remodeling. 5 Osteoinduction represents the differentiation of stem cells into osteoblasts and chondroblasts that induce new bone growth.…”

Section: Bone Grafts and Fusionmentioning

confidence: 99%

“…In the United States, an increasing number of surgical procedures are performed for degenerative conditions of the cervical and lumbar spine and a greater use of instrumentation. [1][2][3] Conventional radiography remains the first-line modality to assess the postoperative spine for proper placement of surgical hardware, hardware integrity, and the development of osseous fusion. The advanced imaging modalities, including computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, and nuclear medicine examinations, provide additional utility and details not provided by conventional radiography to detect problems that may otherwise be missed or require further detailed interpretation.…”

mentioning

confidence: 99%

Update on Imaging of Spinal Fixation Hardware

Winegar

Kay

Chadaz

et al. 2019

Semin Musculoskelet Radiol

View full text Add to dashboard Cite

This article discusses instrumented spinal surgeries, the radiologic assessment of spinal fixation hardware, and the potential complications of spinal hardware. Radiography is the standard for the postoperative assessment of spinal hardware. Computed tomography and magnetic resonance imaging play a valuable role in the detection of hardware and postsurgical-related complications such as infection, pseudarthrosis, and malpositioned instrumentation. Familiarity with the normal imaging appearance of implanted spinal hardware along with the expected progression of normal postoperative osseous arthrodesis enables recognition of potential complications and helps facilitate appropriate clinical management.

show abstract

Trends in isolated lumbar spinal stenosis surgery among working US adults aged 40–64 years, 2010–2014

Cited by 22 publications

References 23 publications

Machine learning–based preoperative predictive analytics for lumbar spinal stenosis

Machine learning–based preoperative predictive analytics for lumbar spinal stenosis

The Use of Vertiflex® Interspinous Spacer Device in Patients With Lumbar Spinal Stenosis and Concurrent Medical Comorbidities

Update on Imaging of Spinal Fixation Hardware

Contact Info

Product

Resources

About