News and Research for Spine Professionals

New Guidelines and App for Antiplatelet and Anticoagulant Therapy During Interventional Spine and Pain Procedures

Guidelines and app to clinical decision-making on when to stop antiplatelet and anticoagulant therapies in patients undergoing interventional spine and pain procedures to avoid serious bleeding, and when to restart the agents after the procedures.

At What Surgical Cost Does Transforaminal Lumbar Interbody Fusion Become Less Cost-Effective Than Posterolateral Fusion for Spondylolisthesis?

Study outcomes in JNS Spine suggest the cost of TLIF per QALYs vs PSF in the treatment of spondylolisthesis depends on factors, including the accuracy of cost assumptions.

Adult Native Vertebral Osteomyelitis Clinical Guideline

A summary of the Infectious Diseases Society of America’s (IDSA) recently published clinical practice guideline for treating native vertebral osteomyelitis, with commentary by Jeffrey Gudin, MD.

MRI Findings Not Helpful in Determining Herniated Disc-Related Sciatica Treatment

New research finds that MRI has no value in the decision making between early surgery and prolonged conservative care.

Paradigm Shift in Adult Spinal Deformity

The severity of sagittal plane deformity drives pain, disability, and surgical outcomes. This is according to a new paper from the Scoliosis Research Society recently published in Spine Deformity.

MIS for the Spine Improves Deformity with Fewer Intraoperative Complications and Lower Costs

Minimally invasive spine surgery improved deformity and is associated with fewer intraoperative complications and lower costs.

How Can Spine Surgeons Protect Themselves in the Anti-Opioid Climate?

Mitchell F. Reiter, MD, discussed the current anti-opioid climate and its impact on spine care experts in the opening session to “The Opioid Predicament: Implications for Spine Physicians and Surgeons” during NASS 2017.

Geographic Variations in Outcomes of Decompression Surgery for Degenerative Cervical Myelopathy

New findings show regional differences in demographics, causation, and surgical approaches for patients with degenerative cervical myelopathy, but similar efficacy worldwide.

Nonopioids for Chronic Pain Management

William Sullivan, MD, discussed nonopioid medication choices for the treatment of moderate to severe chronic pain, many options are those used to manage acute pain but with a couple of additions.

Generic Celecoxib Receives FDA Approval

FDA approves first versions of generic celecoxib and names two pharmaceutical companies who have received approval to market the drugs.

Can a Diet High in Processed Fat and Sugar Cause Disc Degeneration?

The role of advanced glycation endproducts (AGEs) and type 2 diabetes in the development of degenerative disc disease is the topic of this study.

Two-Level Cervical Artificial Disc Replacement Update

Building on one-level data supporting the efficacy of total disc replacement for cervical disc degeneration discussed at ISASS19, Domagoj Coric, MD, presented current evidence on two-level cervical disc replacement, which he said is “even more compelling.”

Reasons for Selecting ACDF Over Total Disc Replacement in Cervical Spine Surgery

Study outcomes revealed reasons for choosing anterior cervical discectomy and fusion (ACDF) over cervical total disc replacement in a consecutive series of patients undergoing cervical spine surgery.

Low Reoperation Rate After Cervical Total Disc Replacement With ProDisc-C

Large consecutive series study outcome over a 15-year period at a single institution of patients undergoing C-TDR with the ProDisc-C device showed a relatively low overall reoperation rate.

Cervical Total Disc Replacement and Routine Osteoporosis Screening

While osteoporosis is a contraindication for total disc replacement both in the lumbar and cervical spine, new findings suggest that routine DEXA scans may not be necessary for all cervical total disc replacement candidates.

Multimodal Pain Management Approaches in Neurosurgery

Neuromodulators and preemptive analgesia were presented by Sharad Rajpal, MD, during Spine Summit, the 33rd Annual Meeting of the Section on Disorders of the Spine and Peripheral Nerves.

SI Joint Fusion Shows High Success Rate Regardless of Level of Response to SI Joint Block

Patients who underwent sacroiliac joint fusion using the iFuse Implant System showed a high success rate regardless of their level of response to diagnostic SI joint block.

SI Joint Fusion Linked to Fewer Revision Surgeries Versus SI Joint Fixation

When a spine surgeon switched from SI joint fixation with screws to SI joint fusion using the iFuse Implant System® (SI-BONE, Inc), he found that fewer patients returned with continued SI joint pain and needing surgical revision.

Stepwise, Standardized Staged Protocol for Surgical Correction of Adult Spinal Deformity Improves Functional Outcomes

Results of a new stepwise, standardized approach to circumferential minimally invasive surgery (CMIS) for the correction of adult spinal deformity.

Number of Cervical Spine Surgeries Increased in the Last Decade

“I think the overall trends regarding the number of cervical spine procedures is increasing due to a multitude of factors".

Current Updates in Spinal Surgical Site Infections

While research on diagnosis, prevention, and treatment of spinal surgical site infections (SSIs) is rapidly emerging, there is little evidence to guide surgeons in the management of this complication.

Epidural Steroid Injections May Delay Surgery, But Only Minimally

The review article evaluated the findings from 26 studies to determine whether epidural steroid injections have a surgery-sparing effect on patients with back pain.

Risk Stratification Approach to Spinal Surgical Management

Risk stratification is important in empowering informed choice regarding surgery, and in determining the appropriateness of surgical management in spinal deformity.

Preemptive Multimodal Analgesia Regimens Control Pain Following Spine Surgery

Emerging evidence also supports preemptive multimodal analgesia in controlling pain following spine surgery.

Robotic-Guided S2AI Screw Placement Offers Accurate and Efficient Sacropelvic Fixation

Robotic-guided S2-alar iliac (S2AI) screw placement was found to be accurate and efficient in sacropelvic fixation in a recent retrospective review.

Expandable Technology in Minimally Invasive TLIF

Findings from a prospective longitudinal study involving 25 patients who underwent MIS TLIF with an in situ expandable interbody device.

What Spine Specialists Need to Know About MACRA

MACRA was written to measure quality improvements in patient outcomes. Unfortunately, many of the measures proposed do not apply to specialists.

Use of Trinity Evolution Bone Matrix Shows High Success Rate in Single-Level Anterior Cervical Discectomy and Fusion

Seventy-five percent of the study participants were current or former smokers, diabetic, overweight, obese or extremely obese and considered to be at high risk for bone growth failure.

Artificial Disc Replacement: Lessons Learned From IDE Trial Outcomes

During ISASS19's artificial disc symposium, Dr. Jack Zigler discussed very "robust and reproducible" data for cervical and lumbar artificial disc replacement that included cost studies.

Visualized Endoscopic Transforaminal Technique Shows Efficacy in Foraminal Stenosis

Retrospective review of cases showed good to excellent 5-year outcomes in the majority of patients with foraminal spinal stenosis who underwent endoscopic transforaminal decompression using Yeung's technique.

Spine Surgery Improves Physical Functioning and QOL in Mild Degenerative Cervical Myelopathy

The conundrum of improving physical function and quality of life issues in patients with mild degenerative cervical myelopathy is the focus in this large prospective cohort study.

The Changing Face of Spinal Cord Injury Trials

From studies on neuroprotective approaches to novel biologics, new discoveries are anticipated to translate into breakthroughs in this field.

Measures May Prevent Common Complications of Spinal Cord Injury

Researchers highlighted early measures that may prevent acute complications of spinal cord injury.

Allograft Linked to Higher Fusion Rates Over Intervertebral Cages in ACDF

Review of 6,100 patients who underwent ACDF found the rate of nonunion was higher in cases using synthetic intervertebral cages than in cases using structural allograft raising the question when to choose cages over allograft.

Pseudarthrosis Found in Half of Patients With PEEK Implants for Anterior Cervical Discectomy and Fusion

Use of PEEK cages for ACDF was linked to a 5-fold increased incidence of pseudarthrosis compared with use of allograft materials, and a nearly 2-fold increase in the rate of subsequent revision surgery for pseudarthrosis, according to findings from a retrospective study presented at the 2018 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves Annual Meeting.

Bundled Payments in Spine Surgery: Current Understanding and Future Directions

Efficacy of the bundled payment model has been demonstrated in total joint arthroplasty. However, concerns have been raised on whether bundled payments are appropriate for spine surgery.

Outpatient Transforaminal Endoscopic Decompression for Spinal Stenosis Linked to Cost Savings

Study outcomes provide reassurance to spine surgeons and payers that there is a real value proposition with outpatient endoscopic spine surgery, and the complication rate was lower than that for traditional microdiscectomy.

Predictors of Success With the iFuse Implant System Confirmed in Pooled Analysis

This pooled analysis marks publication of the 50th peer-reviewed study of the iFuse implant system, and confirms that minimally invasive SI joint fusion with iFuse significantly improves outcomes.

Increase in Lumbar Spine Bone Mineral Density in Infants Receiving Vitamin D

Is there an increase seen in lumbar spine bone mineral density in infants who receive a high dose of vitamin D daily ?

Using Age, Bone Mineral Density, and Spine Fracture Status to Predict Fracture Risk

Researchers found that the most predictive risk factors for incident fracture were age, bone mineral density, and spine fracture status.

Screening for Osteoporotic Vertebral Fractures: A Simple, Cost-effective Tool

Research was presented on a screening program for osteoporotic vertebral fractures (VF)—and how that program increases bisphosphonate prescriptions and eventually reduces the number of fractures.

Triple Herb Product Helps Prevent Osteoporosis in Spine and Hip

Researchers investigated the impact of a triple herb product in post-menopausal women with osteopenia.

Great Diversity Found in Outcome Domains Used in Adult Spinal Deformity Studies

New research shows “great diversity” in outcome domains and patient-reported outcome measures used in 144 studies on adult spinal deformity.

Volume-Outcome Benchmarks in Lumbar Spine Surgery

Volume-based benchmarks study for common lumbar spine surgeries received “The Spine Journal” Outstanding Paper: Value in Spine Care awarded at the North American Spine Society 2017 Annual Meeting.

Comparing Surgical Costs for Adult Spinal Deformity: Posterior-Only Versus Combination Anterior-Posterior

Researchers compared a posterior-only approach to a combination surgical anterior-posterior technique to determine which was most cost effective.

What’s a More Cost Effective Treatment for Cervical Radiculopathy: Epidural Injections or Surgery?

Results of a study comparing the cost effectiveness of epidural injections to anterior cervical discectomy and fusion (ACDF) in the treatment of cervical radiculopathy.

Ossification Shape May Predict Outcomes of Laminoplasty in the Treatment of Cervical Myelopathy

Read on to learn about an important predictor of poor surgical outcomes following laminoplasty.

Integrating Spinal Cord Stimulation into Surgical Practice

During the 31st Annual Meeting of the North American Spine Society, Dr. F. Todd Wetzel discussed use of spinal cord stimulation in the context of failed back surgery syndrome.

Adding Value to the Conservative Management of Degenerative Disc

Physicians who incorporate the biopsychosocial model can add value to the management and treatment of patients who have degenerative disc disease.

Infections in Spine Surgery: The Role of Occult Pathogens

Celeste Abjornson, MD, focused on occult, indolent infections that result from contamination or are innate. Environments created by adding hardware to the body may lead to biofilm development, which is another source of occult infection in spinal surgery.
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