Reoperations Following Cervical Disc Replacement

Branko Skovrlj,이동호,John Michael Caridi,Samuel Kang-Wook Cho 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.3

Cervical disc replacement (CDR) has emerged as an alternative surgical option to cervical arthrodesis. With increasing numbers of patients and longer follow-ups, complications related to the device and/or aging spine are growing, leaving us with a new challenge in the management and surgical revision of CDR. The purpose of this study is to review the current literature regarding reoperations following CDR and to discuss about the approaches and solutions for the current and future potential complications associated with CDR. The published rates of reoperation (mean, 1.0%; range, 0%–3.1%), revision (mean, 0.2%; range, 0%–0.5%), and removal (mean, 1.2%; range, 0%–1.9%) following CDR are low and comparable to the published rates of reoperation (mean, 1.7%; range; 0%–3.4%), revision (mean, 1.5%; range, 0%–4.7%), and removal (mean, 2.0%; range, 0%–3.4%) following cervical arthrodesis. The surgical interventions following CDR range from the repositioning to explantation followed by fusion or the reimplantation to posterior foraminotomy or fusion. Strict patient selection, careful preoperative radiographic review and surgical planning, as well as surgical technique may reduce adverse events and the need for future intervention. Minimal literature and no guidelines exist for the approaches and techniques in revision and for the removal of implants following CDR. Adherence to strict indications and precise surgical technique may reduce the number of reoperations, revisions, and removals following CDR. Long-term follow-up studies are needed, assessing the implant survivorship and its effect on the revision and removal rates.

Trends in the Charges and Utilization of Computer-Assisted Navigation in Cervical and Thoracolumbar Spinal Surgery

Dominy Calista L.,Tang Justin E.,Arvind Varun,Cho Brian H.,Selverian Stephen,Shah Kush C.,Kim Jun S.,Cho Samuel Kang-Wook 대한척추외과학회 2022 Asian Spine Journal Vol.16 No.5

Study Design: Retrospective national database study.Purpose: This study is conducted to assess the trends in the charges and usage of computer-assisted navigation in cervical and thoracolumbar spinal surgery.Overview of Literature: This study is the first of its kind to use a nationwide dataset to analyze trends of computer-assisted navigation in spinal surgery over a recent time period in terms of use in the field as well as the cost of the technology.Methods: Relevant data from the National Readmission Database in 2015–2018 were analyzed, and the computer-assisted procedures of cervical and thoracolumbar spinal surgery were identified using International Classification of Diseases 9th and 10th revision codes. Patient demographics, surgical data, readmissions, and total charges were examined. Comorbidity burden was calculated using the Charlson and Elixhauser comorbidity index. Complication rates were determined on the basis of diagnosis codes.Results: A total of 48,116 cervical cases and 27,093 thoracolumbar cases were identified using computer-assisted navigation. No major differences in sex, age, or comorbidities over time were found. The utilization of computer-assisted navigation for cervical and thoracolumbar spinal fusion cases increased from 2015 to 2018 and normalized to their respective years’ total cases (Pearson correlation coefficient=0.756, <i>p</i> =0.049; Pearson correlation coefficient=0.9895, <i>p</i> =0.010). Total charges for cervical and thoracolumbar cases increased over time (Pearson correlation coefficient=0.758, <i>p</i> =0.242; Pearson correlation coefficient=0.766, <i>p</i> =0.234).Conclusions: The use of computer-assisted navigation in spinal surgery increased significantly from 2015 to 2018. The average cost grossly increased from 2015 to 2018, and it was higher than the average cost of nonnavigated spinal surgery. With the increased utilization and standardization of computer-assisted navigation in spinal surgeries, the cost of care of more patients might potentially increase. As a result, further studies should be conducted to determine whether the use of computer-assisted navigation is efficient in terms of cost and improvement of care.

Role of Posterior Ligamentous Reinforcement in Proximal Junctional Kyphosis: A Cadaveric Biomechanical Study

Jun Sup Kim,Zoe Beatrice Cheung,Varun Arvind,John Caridi,Samuel Kang-Wook Cho 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.1

Study Design: Cadaveric biomechanical study. Purpose: The purpose of this study was to biomechanically evaluate the effect of preserving or augmenting the interspinous ligament (ISL) and supraspinous ligament (SSL; ISL/SSL) complex between the upper instrumented vertebra (UIV) and UIV+1 using a cadaveric model. Overview of Literature: Adult spinal deformity is becoming an increasingly prevalent disorder, and proximal junctional kyphosis (PJK) is a well-known postoperative complication following long spinal fusion. Methods: Pure moments of 4 and 8 Nm were applied to the native and instrumented spine, respectively (n=8). The test conditions included the following: native spine (T7–L2), fused spine (T10–L2), fused spine with a hand-tied suture loop through the spinous processes at T9–T10, and fused spine with severed T9–T10 ISL/SSL complex. Results: The flexion range of motion (ROM) at T9–T10 of the fused spine loaded at 8 Nm increased by 62% compared to that of the native spine loaded at 4 Nm. The average flexion ROM at T9–T10 for the suture loop and severed ISL/SSL spines were 141% (p =0.13) and 177% (p =0.66) of the native spine at 4 Nm, respectively (p -values vs. fused). Conclusions: Transection of the ISL/SSL complex did not significantly change flexion ROM at the proximal junctional segment following instrumented spinal fusion. Furthermore, augmentation of the posterior ligamentous tension band with a polyester fiber suture loop did not mitigate excessive flexion loads on the proximal junctional segment. We postulate that the role of the posterior ligamentous tension band in mitigating PJK is secondary to the anterior column support provided by the vertebral body and intervertebral disc.

Risk Factors for 30- and 90-Day Readmission due to Intestinal Bowel Obstruction after Posterior Lumbar Fusion

Mikhail Christopher Mina,Warburton Andrew,Girdler Steven Joseph,Platt Samantha,Cong Guang-Ting,Cho Samuel Kang-Wook 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.5

Study Design: A retrospective analysis of data from the Healthcare Cost and Utilization Project Nationwide Readmissions Database (HCUP-NRD). Purpose: To identify the perioperative characteristics associated with 30-day and 90-day readmission due to intestinal bowel obstructions (IBOs) following posterior lumbar fusion (PLF) procedure. Overview of Literature: PLF procedures are used to repair spinal injuries and curvature deformities. IBO is a common surgical complication and its repair often necessitates surgery that increases the readmission rates and healthcare costs. Previous studies have identified the preoperative risk factors for 30-day readmissions in PLF; however, no study has specifically investigated IBO or identified risk factors for 90-day readmissions. Methods: Data on demographic characteristics and medical comorbidities of patients who underwent PLF with subsequent readmission were obtained from the HCUP-NRD. The perioperative characteristics that were significantly different between patients readmitted with and without an active diagnosis of IBO were identified with bivariate analysis for both 30-day and 90-day readmissions. The significant characteristics were then included in a multivariate analysis to identify those that were independently associated with 30-day and 90-day readmissions. Results: Drug abuse (odds ratio [OR], 4.00), uncomplicated diabetes (OR, 2.06), having Medicare insurance (OR, 1.65), age 55–64 years (OR, 2.42), age 65–79 years (OR, 2.77), and age >80 years (OR, 3.87) were significant risk factors for 30-day readmission attributable to IBO after a PLF procedure. Conclusions: Of the several preoperative risk factors identified for readmission with IBO after PLF surgery, drug abuse had the strongest association and was likely to be the most clinically relevant factor. Physicians and care teams should understand the risks of opioid-based pain management regimens, attempt to manage pain with a multimodal approach, and minimize the opioid use.