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STUDY DESIGN A retrospective study. OBJECTIVE To determine the impact of sickle cell anemia on perioperative outcomes and resource utilization in elective spinal fusion surgery. SUMMARY OF BACKGROUND DATA Sickle cell anemia has been identified as an important surgical risk factor in otolaryngology, cardiothoracic surgery, general surgery, and total joint arthroplasty. However, the impact of sickle cell anemia on elective spine surgery is unknown. METHODS Hospitalizations for elective spinal fusion surgery between the years of 2001-2014 from the US National Inpatient Sample were identified using ICD-9-CM codes and patients were grouped into those with and without sickle cell anemia. The main outcome measures were in-hospital neurological, respiratory, cardiac, gastrointestinal, renal and urinary, pulmonary embolism, and wound-related complications and mortality. Length of stay and inpatient costs were also collected. Multivariable logistic regressions were conducted to compare the in-hospital outcomes of patients undergoing elective spinal fusion with or without sickle cell anemia. RESULTS From a total of 4,542,719 patients undergoing elective spinal fusions from 2001 to 2014, 456 sickle cell disease patients were identified. Sickle cell anemia is a significant independent predictor for pulmonary embolism [odds ratio (OR)=7.37; confidence interval (CI), 4.27-12.71; P

Introduction Return-to-work (RTW) outcomes following spine surgery are critical information for patients aspiring to return to employment following surgical correction. Among patients receiving workers' compensation (WC), spinal surgery has been repeatedly linked to poor RTW rates. However, among patients not receiving WC, the percentage of patients who return to employment is unclear. Methods We conducted a retrospective cohort study of 326 non-WC patients who underwent spinal surgery at two institutions. We determined RTW status and analyzed potential predictors of RTW status. Results Preoperative work status was the only markedly positive predictor of RTW status; patients who were working prior to their surgery were more likely to return to work after surgery. Patients with at least one comorbidity were less likely to return to employment. All other sociodemographic, surgery-related, and complication variables did not reach statistical significance. However, smoking status, short fusion, and cervical fusion were clinically relevant predictors of a negative RTW status. Discussion Among non-WC patients, employment before surgery was a positive predictor for RTW status. For patients with a positive comorbidity status, a lower likelihood of returning to employment is predicted. Randomized trials are needed to fully explore the effect of predictor variables on RTW status among non-WC patients. Conclusions Patients not receiving WC who underwent spinal surgery had a high chance of returning to employment within 1 year if they had been working at least 3 months before the date of surgery.

Surgical treatment for degenerative conditions of the hip, knee, and spine has an impact on overall healthcare spending. Surgical rates have increased dramatically and considerable regional variation has been observed. The reasons behind these increasing rates and variation across regions have not been well elucidated. We therefore identified demographic (D), social structure (SS), health belief (HB), personal (PR) and community resources (CR), and medical need (MN) factors that drive rates of hip, knee, and spine surgery. We conducted a systematic review to include all observational, population-based studies that compared surgical rates with potential drivers (D, SS, HB, PR, CR, MN). We searched PubMed combining key words focusing on (1) disease and procedure; (2) study methodology; and (3) explanatory models. Independent investigators selected potentially eligible studies from abstract review and abstracted methodological and outcome data. From an initial search of 256 articles, we found 37 to be potentially eligible (kappa 0.86) but only 28 met all our inclusion criteria. Age, nonminority, insurance coverage, and surgeon enthusiasm all increased surgical rates. Rates of arthroplasty were higher for females with higher education, income, obesity, rurality, willingness to consider surgery, and prevalence of disease, whereas spinal rates increased with male gender, lower income, and the availability of advanced imaging. Regional variation in these procedures exists because they are examples of preference-sensitive care. With strategies that may affect change in factors that are potentially modifiable by behavior or resources, extreme variation in rates may be reduced.

Dual-photon absorptiometry characterized bone loss in males aged less than 40 years after complete traumatic paraplegic and quadriplegic spinal cord injury. Total bone mass of various regions and bone mineral density (BMD) of the knee were measured in 55 subjects. Three different populations were partitioned into four groups: 10 controls (healthy, age matched); 25 acutely injured (114 days after injury), with 12 reexamined 16 months after injury; and 20 chronic (greater than 5 years after injury). Significant differences (p less than 0.0001) in bone mass mineral between groups at the arms, pelvis, legs, distal femur, and proximal tibia were found, with no differences for the head or trunk. Post hoc analyses indicated no differences between the acutely injured at 16 months and the chronically injured. Paraplegic and quadriplegic subjects were significantly different only at the arms and trunk, but were highly similar at the pelvis and below. In the acutely injured, a slight but statistically insignificant rebound was noted above the pelvis. Regression techniques demonstrated early, rapid, linear (p less than 0.0001) decline of bone below the pelvis. Bone mineral loss occurs throughout the entire skeleton, except the skull. Most bone loss occurs rapidly and below the pelvis. Homeostasis is reached by 16 months at two thirds of original bone mass, near fracture threshold.

The Charité III (DePuy Spine, Inc, Raynham, Massachusetts) and ProDisc II (Synthes Spine, West Chester, Pennsylvania) artificial disk replacements were approved for use by the United States Food and Drug Administration in October 2004 and January 2006, respectively. The purpose of this study was to retrospectively review 29 patients receiving either disk replacement who presented with complications to the University of California Irvine Spine Center. Specifically, patient outcome data from the Oswestry Disability Index (ODI) and the SF-36 were analyzed. The probable sources of pain were determined based on diagnostic facet and nerve root injections, single photon emission computed tomography bone scans, computed tomography scans, magnetic resonance imaging scans, flexion extension radiographs, patient history, and physical examination and direct surgical observation when possible. Results suggested that the main source of pain is facet degeneration and fractures in this area due to flawed biomechanics of disk replacement design. Oswestry Disability Index and SF-36 scores exhibited marked disability with a large improvement in all scores after revision surgery. This difference was statistically significant for the ODI and the SF-36 MCS (mental), but not for the SF-36 PCS (physical). A successful outcome in the revised patients was achieved completely in the majority, and only partially in some, by a solid fusion after meticulous and complete facet excision and correction of the segmental deformity.

Since its initial description about a century ago, spinal fusion has become a common surgical intervention in the treatment of various debilitating spinal disorders. However, given the complexities and demands of the procedure, patient selection remains a key component in the success of the operation. In this article, we will review the various indications for spinal fusion, the current advances in fusion techniques, as well as the potential complications associated with the procedure.

Forty patients were studied retrospectively to evaluate the effect of epidural steroid injections on low back pain and sciatica characteristic of spinal stenosis or a herniated lumbar disc. All but one of these patients had radicular symptoms. The average age was 55 years, and the average follow-up time was eight months. All patients were injected by the same anesthesiologist with 2 cc of Depomedrol-40. Thirty-six patients received either one, two, or three injections. Four patients received either four or five injections. The overall results were poor, with about 60% of patients reporting varying degrees of relief from leg and back pain immediately after injection. However, at follow-up examination, only 24% were asymptomatic; 40% reported no change in preinjection numbness, weakness, or pain; and approximately 35% had varying degrees of relief with no consistent pattern. Of those who had complete relief, there was no correlation between relief of pain, age, or number of injections. From this study, it appears that approximately 50% of patients with radicular symptoms may receive temporary relief with steroid injection. However, long-term relief occurs in less than 25% of patients.