Ahmed Albayar, Gabrielle Santangelo, Michael Spadola, Dominick Macaluso, Zarina S Ali, Comron Saifi, Jonathan Heintz, Xiaoyan Han, Warren Bilker, Neil Malhotra, William C Welch, Connor Wathen, Mert Marcel Dagli, Yohannes Ghenbot, Jang Yoon, Vincent Arlet, Ali K Ozturk
Background: Patients often undergo circumferential (anterior and posterior) spinal fusions to maximize adult spinal deformity (ASD) correction and achieve adequate fusion. Currently, such procedures are performed in staged (ST) or same-day (SD) procedures with limited evidence to support either strategy. This study aims to compare perioperative outcomes and costs of ST vs SD circumferential ASD corrective surgeries.
Methods: This is a retrospective review of patients undergoing circumferential ASD surgeries between 2013 and 2018 in a single institution. Patient characteristics, preoperative comorbidities, surgical details, perioperative complications, readmissions, total hospital admission costs, and 90-day postoperative care costs were identified. All variables were tested for differences between ST and SD groups unadjusted and after applying inverse probability weighting (IPW), and the results before and after IPW were compared.
Results: The entire cohort included a total of 211 (ST = 50, SD = 161) patients, 100 of whom (ST = 44, SD = 56) underwent more than 4 levels fused posteriorly and anterior lumbar interbody fusion (ALIF). Although patient characteristics and comorbidities were not dissimilar between the ST and SD groups, both the number of levels fused in ALIF and posterior spinal fusion (PSF) were significantly different. Thus, using IPW, we were able to minimize the cohort incongruities in the number of levels fused in ALIF and PSF while maintaining comparable patient characteristics. In both the whole cohort and the long segment fusions, postoperative pulmonary embolism was more common in ST procedures. After adjustment utilizing IPW, both groups were not significantly different in disposition, 30-day readmissions, and reoperations. However, within the whole cohort and the long segment fusion cohort, the ST group continued to show significantly increased rates of pulmonary embolism, longer length of stay, and higher hospital admission costs compared with the SD group.
Conclusions: Adjusted comparisons between ST and SD groups showed staging associated with significantly increased length of stay, risk of pulmonary embolism, and admission costs.
{"title":"Comparison of Staged vs Same-Day Circumferential Spinal Fusions for Adult Spinal Deformity.","authors":"Ahmed Albayar, Gabrielle Santangelo, Michael Spadola, Dominick Macaluso, Zarina S Ali, Comron Saifi, Jonathan Heintz, Xiaoyan Han, Warren Bilker, Neil Malhotra, William C Welch, Connor Wathen, Mert Marcel Dagli, Yohannes Ghenbot, Jang Yoon, Vincent Arlet, Ali K Ozturk","doi":"10.14444/8548","DOIUrl":"10.14444/8548","url":null,"abstract":"<p><strong>Background: </strong>Patients often undergo circumferential (anterior and posterior) spinal fusions to maximize adult spinal deformity (ASD) correction and achieve adequate fusion. Currently, such procedures are performed in staged (ST) or same-day (SD) procedures with limited evidence to support either strategy. This study aims to compare perioperative outcomes and costs of ST vs SD circumferential ASD corrective surgeries.</p><p><strong>Methods: </strong>This is a retrospective review of patients undergoing circumferential ASD surgeries between 2013 and 2018 in a single institution. Patient characteristics, preoperative comorbidities, surgical details, perioperative complications, readmissions, total hospital admission costs, and 90-day postoperative care costs were identified. All variables were tested for differences between ST and SD groups unadjusted and after applying inverse probability weighting (IPW), and the results before and after IPW were compared.</p><p><strong>Results: </strong>The entire cohort included a total of 211 (ST = 50, SD = 161) patients, 100 of whom (ST = 44, SD = 56) underwent more than 4 levels fused posteriorly and anterior lumbar interbody fusion (ALIF). Although patient characteristics and comorbidities were not dissimilar between the ST and SD groups, both the number of levels fused in ALIF and posterior spinal fusion (PSF) were significantly different. Thus, using IPW, we were able to minimize the cohort incongruities in the number of levels fused in ALIF and PSF while maintaining comparable patient characteristics. In both the whole cohort and the long segment fusions, postoperative pulmonary embolism was more common in ST procedures. After adjustment utilizing IPW, both groups were not significantly different in disposition, 30-day readmissions, and reoperations. However, within the whole cohort and the long segment fusion cohort, the ST group continued to show significantly increased rates of pulmonary embolism, longer length of stay, and higher hospital admission costs compared with the SD group.</p><p><strong>Conclusions: </strong>Adjusted comparisons between ST and SD groups showed staging associated with significantly increased length of stay, risk of pulmonary embolism, and admission costs.</p><p><strong>Level of evidence: 2: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10753336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41215250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abdullah Ghali, Gautham Prabhakar, David Momtaz, Farhan Ahmad, Adam Abbas, Muhammad Shamim, Mahmoud Issa, Varun Bora, Christopher Chaput
Background: Anterior cervical discectomy and fusion (ACDF) is a common procedure for neck arthritis, typically alleviating pain and improving function. Preoperative dehydration has been correlated with postoperative infection, acute renal failure, deep vein thrombosis, and increased hospital length of stay. However, some studies have suggested that preoperative dehydration has a minimal relationship with postoperative outcomes, specifically in arthroplasty and lumbar surgery candidates.
Methods: Patients who underwent ACDF from 2015 to 2020 as part of the American College of Surgeons National Surgical Quality Improvement Program database were identified. We excluded patients who presented with acute trauma. Dehydration was determined using the accepted definition of preoperative blood urea nitrogen to creatinine ratio greater than 20. Lengths of stay and 30-day postoperative adverse events were compared between dehydrated and nondehydrated cohorts, adjusting for baseline features using standard multivariate regression.
Results: We identified 14,932 patients, and 4206 (28.1%) of whom were preoperatively dehydrated. Dehydrated patients had significantly higher odds of wound, hematological, and pulmonary complications; Clavien-Dindo grade IV, delayed length of stay (>5 days); and a lower likelihood of being discharged home (P < 0.005), even after controlling for demographic features (eg, sex, age, body mass index, race, and ethnicity). Furthermore, linear regression suggested an overall half-day increased length of hospital stay for dehydrated patients (95% CI [0.36, 0.60], P < 0.001).
Conclusion: Preoperative dehydration is common among ACDF surgery patients and appears to correlate with an increased risk of postoperative complications and prolonged length of hospital stay. Evaluation of a patient's hydration status from standard preoperative laboratory metrics can be employed for risk stratification, patient counseling, and timing of ACDF surgeries.
{"title":"Preoperative Dehydration Predicts Adverse Events Following Anterior Cervical Discectomy and Fusion.","authors":"Abdullah Ghali, Gautham Prabhakar, David Momtaz, Farhan Ahmad, Adam Abbas, Muhammad Shamim, Mahmoud Issa, Varun Bora, Christopher Chaput","doi":"10.14444/8544","DOIUrl":"10.14444/8544","url":null,"abstract":"<p><strong>Background: </strong>Anterior cervical discectomy and fusion (ACDF) is a common procedure for neck arthritis, typically alleviating pain and improving function. Preoperative dehydration has been correlated with postoperative infection, acute renal failure, deep vein thrombosis, and increased hospital length of stay. However, some studies have suggested that preoperative dehydration has a minimal relationship with postoperative outcomes, specifically in arthroplasty and lumbar surgery candidates.</p><p><strong>Methods: </strong>Patients who underwent ACDF from 2015 to 2020 as part of the American College of Surgeons National Surgical Quality Improvement Program database were identified. We excluded patients who presented with acute trauma. Dehydration was determined using the accepted definition of preoperative blood urea nitrogen to creatinine ratio greater than 20. Lengths of stay and 30-day postoperative adverse events were compared between dehydrated and nondehydrated cohorts, adjusting for baseline features using standard multivariate regression.</p><p><strong>Results: </strong>We identified 14,932 patients, and 4206 (28.1%) of whom were preoperatively dehydrated. Dehydrated patients had significantly higher odds of wound, hematological, and pulmonary complications; Clavien-Dindo grade IV, delayed length of stay (>5 days); and a lower likelihood of being discharged home (<i>P</i> < 0.005), even after controlling for demographic features (eg, sex, age, body mass index, race, and ethnicity). Furthermore, linear regression suggested an overall half-day increased length of hospital stay for dehydrated patients (95% CI [0.36, 0.60], <i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>Preoperative dehydration is common among ACDF surgery patients and appears to correlate with an increased risk of postoperative complications and prolonged length of hospital stay. Evaluation of a patient's hydration status from standard preoperative laboratory metrics can be employed for risk stratification, patient counseling, and timing of ACDF surgeries.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10753349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41153236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Peter G Whang, Vikas Patel, Bradley Duhon, Bengt Sturesson, Daniel Cher, W Carlton Reckling, Robyn Capobianco, David Polly
Background: Sacroiliac (SI) joint fusion is increasingly used to treat chronic SI joint pain. Multiple surgical approaches are now available.
Methods: Data abstraction and random effects meta-analysis of safety and efficacy outcomes from published patient cohorts. Patient-reported outcomes (PROs) and safety measures were stratified by surgical technique: transiliac, including lateral transiliac (LTI) and posterolateral transiliac (PLTI), and posterior interpositional (PI) procedures.
Results: Fifty-seven cohorts of 2851 patients were identified, including 43 cohorts (2126 patients) for LTI, 6 cohorts (228 patients) for PLTI, and 8 cohorts (497 patients) for PI procedures. Randomized trials were only available for LTI. PROs were available for pain (numeric rating scale) in 57 cohorts (2851 patients) and disability (Oswestry Disability Index [ODI]) in 37 cohorts (1978 patients).All studies with PROs showed improvement from baseline after surgery. Meta-analytic improvements in pain scores were highest for LTI (4.8 points [0-10 scale]), slightly lower for PLTI (4.2 points), and lowest for PI procedures (3.8 points, P = 0.1533). Mean improvements in ODI scores were highest for LTI (25.9 points), lowest for PLTI procedures (6.8 points), and intermediate for PI (16.3 points, P = 0.0095).For safety outcomes, acute symptomatic implant malposition was 0.43% for LTI, 0% for PLTI, and 0.2% for PI procedures. Wound infection was reported in 0.15% of LTI, 0% of PLTI, and 0% of PI procedures. Bleeding requiring surgical intervention was reported in 0.04% of LTI procedures and not reported for PLTI or PI. Breakage and migration were not reported for any device. Radiographic imaging evaluation reporting implant placement accuracy and fusion was only available for LTI.
Discussion: Literature support for SI joint fusion is growing. The LTI procedure contains the largest body of available evidence and shows the largest improvements in pain and ODI. Only LTI procedures have independent radiographic evidence of fusion and implant placement. The adverse event rate for all procedures was low.
{"title":"Minimally Invasive SI Joint Fusion Procedures for Chronic SI Joint Pain: Systematic Review and Meta-Analysis of Safety and Efficacy.","authors":"Peter G Whang, Vikas Patel, Bradley Duhon, Bengt Sturesson, Daniel Cher, W Carlton Reckling, Robyn Capobianco, David Polly","doi":"10.14444/8543","DOIUrl":"10.14444/8543","url":null,"abstract":"<p><strong>Background: </strong>Sacroiliac (SI) joint fusion is increasingly used to treat chronic SI joint pain. Multiple surgical approaches are now available.</p><p><strong>Methods: </strong>Data abstraction and random effects meta-analysis of safety and efficacy outcomes from published patient cohorts. Patient-reported outcomes (PROs) and safety measures were stratified by surgical technique: transiliac, including lateral transiliac (LTI) and posterolateral transiliac (PLTI), and posterior interpositional (PI) procedures.</p><p><strong>Results: </strong>Fifty-seven cohorts of 2851 patients were identified, including 43 cohorts (2126 patients) for LTI, 6 cohorts (228 patients) for PLTI, and 8 cohorts (497 patients) for PI procedures. Randomized trials were only available for LTI. PROs were available for pain (numeric rating scale) in 57 cohorts (2851 patients) and disability (Oswestry Disability Index [ODI]) in 37 cohorts (1978 patients).All studies with PROs showed improvement from baseline after surgery. Meta-analytic improvements in pain scores were highest for LTI (4.8 points [0-10 scale]), slightly lower for PLTI (4.2 points), and lowest for PI procedures (3.8 points, <i>P</i> = 0.1533). Mean improvements in ODI scores were highest for LTI (25.9 points), lowest for PLTI procedures (6.8 points), and intermediate for PI (16.3 points, <i>P</i> = 0.0095).For safety outcomes, acute symptomatic implant malposition was 0.43% for LTI, 0% for PLTI, and 0.2% for PI procedures. Wound infection was reported in 0.15% of LTI, 0% of PLTI, and 0% of PI procedures. Bleeding requiring surgical intervention was reported in 0.04% of LTI procedures and not reported for PLTI or PI. Breakage and migration were not reported for any device. Radiographic imaging evaluation reporting implant placement accuracy and fusion was only available for LTI.</p><p><strong>Discussion: </strong>Literature support for SI joint fusion is growing. The LTI procedure contains the largest body of available evidence and shows the largest improvements in pain and ODI. Only LTI procedures have independent radiographic evidence of fusion and implant placement. The adverse event rate for all procedures was low.</p><p><strong>Level of evidence: 1: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10753354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41169560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jacob Greenberg, Matt Magro, R Shane Tubbs, Alexander Spiessberger
{"title":"Anterior Cervical Osteotomy and Corpectomy for Rigid Kyphosis: A Surgical Video.","authors":"Jacob Greenberg, Matt Magro, R Shane Tubbs, Alexander Spiessberger","doi":"10.14444/8555","DOIUrl":"10.14444/8555","url":null,"abstract":"","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10753331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138831987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Troy Q Tabarestani, Timothy Y Wang, David A W Sykes, Vikram A Mehta, Lexie Z Yang, Shein-Chung Chow, Christopher I Shaffrey, Walter F Wiggins, John H Chi, Muhammad M Abd-El-Barr
Background: There has been heightened interest in performing percutaneous lumbar interbody fusions (percLIFs) through Kambin's triangle, an anatomic corridor allowing entrance into the disc space. However, due to its novelty, there are limited data regarding the long-term benefits of this procedure. Our objective was to determine the long-term efficacy and durability of the percutaneous insertion of an expandable titanium cage through Kambin's triangle without facetectomy.
Methods: A retrospective review of patients undergoing percLIF via Kambin's triangle using an expandable titanium cage was performed. Demographics, visual analog scale (VAS) scores, Oswestry Disability Index (ODI), radiographic measurements, perioperative variables, and complications were recorded. VAS, ODI, and radiographic measurements were compared with baseline using the generalized estimating equations assuming normally distributed data. Fusion was assessed with computed tomography (CT) at 1 and 2 years after the procedure.
Results: A total of 49 patients were included. Spondylolisthesis, lumbar lordosis (LL), sacral slope, pelvic tilt, and anterior/posterior disc space height were all significantly improved postoperatively at each time point of 3, 6, 12, and 24 months (P < 0.001). Pelvic incidence-LL mismatch decreased significantly at each follow-up (P < 0.001) with a mean reduction of 4° by 24 months. VAS back scores reduced by >2 points at the 6, 12, and 24 month follow-ups. ODI scores reduced by >15 points at the 12- and 24-month follow-ups. Of the patients who had 1- and 2-year CT images, fusion rates at those time points were 94.4% (17/18) and 87.5% (7/8), respectively. The mean annual rate of surgically significant adjacent segment disease was 2.74% through an average follow-up of 2.74 years.
Conclusion: These results highlight that percLIF, a procedure done without an endoscope or facetectomy, can be performed using an expandable titanium cage through Kambin's triangle with excellent radiographic and clinical results.
Clinical relevance: percLIF via Kambin's triangle is a safe and succesful procedure with long-term improvements in both clinical and radiographic outcomes.
{"title":"Two-Year Clinical and Radiographic Outcomes for Percutaneous Lumbar Interbody Fusion With an Expandable Titanium Cage Through Kambin's Triangle Without Facetectomy.","authors":"Troy Q Tabarestani, Timothy Y Wang, David A W Sykes, Vikram A Mehta, Lexie Z Yang, Shein-Chung Chow, Christopher I Shaffrey, Walter F Wiggins, John H Chi, Muhammad M Abd-El-Barr","doi":"10.14444/8540","DOIUrl":"10.14444/8540","url":null,"abstract":"<p><strong>Background: </strong>There has been heightened interest in performing percutaneous lumbar interbody fusions (percLIFs) through Kambin's triangle, an anatomic corridor allowing entrance into the disc space. However, due to its novelty, there are limited data regarding the long-term benefits of this procedure. Our objective was to determine the long-term efficacy and durability of the percutaneous insertion of an expandable titanium cage through Kambin's triangle without facetectomy.</p><p><strong>Methods: </strong>A retrospective review of patients undergoing percLIF via Kambin's triangle using an expandable titanium cage was performed. Demographics, visual analog scale (VAS) scores, Oswestry Disability Index (ODI), radiographic measurements, perioperative variables, and complications were recorded. VAS, ODI, and radiographic measurements were compared with baseline using the generalized estimating equations assuming normally distributed data. Fusion was assessed with computed tomography (CT) at 1 and 2 years after the procedure.</p><p><strong>Results: </strong>A total of 49 patients were included. Spondylolisthesis, lumbar lordosis (LL), sacral slope, pelvic tilt, and anterior/posterior disc space height were all significantly improved postoperatively at each time point of 3, 6, 12, and 24 months (<i>P <</i> 0.001). Pelvic incidence-LL mismatch decreased significantly at each follow-up (<i>P <</i> 0.001) with a mean reduction of 4° by 24 months. VAS back scores reduced by >2 points at the 6, 12, and 24 month follow-ups. ODI scores reduced by >15 points at the 12- and 24-month follow-ups. Of the patients who had 1- and 2-year CT images, fusion rates at those time points were 94.4% (17/18) and 87.5% (7/8), respectively. The mean annual rate of surgically significant adjacent segment disease was 2.74% through an average follow-up of 2.74 years.</p><p><strong>Conclusion: </strong>These results highlight that percLIF, a procedure done without an endoscope or facetectomy, can be performed using an expandable titanium cage through Kambin's triangle with excellent radiographic and clinical results.</p><p><strong>Clinical relevance: </strong>percLIF via Kambin's triangle is a safe and succesful procedure with long-term improvements in both clinical and radiographic outcomes.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10753344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9951048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
O Kenechi Nwawka, Noah Cha, Lydia M Ko, Vincent R LaSala
Objective: To aid emergent diagnosis of postoperative retropharyngeal hematoma in anterior cervical spine surgery patients, this study investigates ultrasonography's potential role by evaluating the visibility of retropharyngeal and prevertebral soft tissues in the neck using ultrasound and potential correlations with body habitus.
Methods: The visibility of the anterior vertebral bodies and the prevertebral soft tissues in both sides of the neck was recorded and analyzed with 95% CI using the Wilson method. Body mass index, neck circumference, and neck length were measured. A point-biserial correlation was performed to compare body habitus with visibility of vertebrae and prevertebral tissues.
Results: Longus colli muscle and C3 to C6 were successfully visualized in all 10 (100%) cases on both sides. C2 was only visible in 6 (60%) on both sides. C7 was visible in 9 (90%) on the right and 7 (70%) on the left. The esophagus was visible in 7 (70%) on the right and 10 (100%) on the left. There was a significant negative correlation with neck circumference and C2 visibility on the right side, r(8) = -0.76, P = 0.011.
Conclusions: Ultrasonography was successful in visualizing prevertebral tissues, with a trend of obstructed visibility with wider and longer necks.
Clinical relevance: Ultrasonography has potential to aid early detection of postoperative retropharyngeal hematoma after cervical spine surgery.
{"title":"Visibility of Prevertebral Soft Tissues in the Neck Using Ultrasonography: A Feasibility Study.","authors":"O Kenechi Nwawka, Noah Cha, Lydia M Ko, Vincent R LaSala","doi":"10.14444/8546","DOIUrl":"10.14444/8546","url":null,"abstract":"<p><strong>Objective: </strong>To aid emergent diagnosis of postoperative retropharyngeal hematoma in anterior cervical spine surgery patients, this study investigates ultrasonography's potential role by evaluating the visibility of retropharyngeal and prevertebral soft tissues in the neck using ultrasound and potential correlations with body habitus.</p><p><strong>Methods: </strong>The visibility of the anterior vertebral bodies and the prevertebral soft tissues in both sides of the neck was recorded and analyzed with 95% CI using the Wilson method. Body mass index, neck circumference, and neck length were measured. A point-biserial correlation was performed to compare body habitus with visibility of vertebrae and prevertebral tissues.</p><p><strong>Results: </strong>Longus colli muscle and C3 to C6 were successfully visualized in all 10 (100%) cases on both sides. C2 was only visible in 6 (60%) on both sides. C7 was visible in 9 (90%) on the right and 7 (70%) on the left. The esophagus was visible in 7 (70%) on the right and 10 (100%) on the left. There was a significant negative correlation with neck circumference and C2 visibility on the right side, <i>r</i>(8) = -0.76, <i>P</i> = 0.011.</p><p><strong>Conclusions: </strong>Ultrasonography was successful in visualizing prevertebral tissues, with a trend of obstructed visibility with wider and longer necks.</p><p><strong>Clinical relevance: </strong>Ultrasonography has potential to aid early detection of postoperative retropharyngeal hematoma after cervical spine surgery.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10753337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41239579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Don Young Park, Thomas E Olson, Alexander Upfill-Brown, Babapelumi Adejuyigbe, Akash A Shah, William L Sheppard, Cheol Wung Park, Dong Hwa Heo
Background: Biportal spinal endoscopy is increasingly utilized for lumbar disc herniations and lumbar stenosis. The objective was to investigate the safety and effectiveness of the technique in the outpatient vs inpatient setting.
Methods: This is a comparative study of consecutive patients who underwent biportal spinal endoscopy by a single surgeon at a single institution. Demographics, surgical complications, and patient-reported outcomes were prospectively collected and retrospectively analyzed. Statistics were calculated among treatment groups using unpaired t test and χ2 analysis where appropriate. Statistical significance was determined as P < 0.05.
Results: Eighty-four patients were included, 58 (69.0%) as outpatient, 26 (31.0%) as inpatient. Mean follow-up was 7.5 months. Statistically significant differences in age, American Society of Anesthesiologists classification, and Charleston Comorbidity Index scores were reported between cohorts, with younger and healthier patients undergoing outpatient surgery (P < 0.0001). Outpatients were more likely to have discectomies while inpatients were more likely to have decompressions for stenosis. No significant differences in postoperative complications were found between groups.Both cohorts demonstrated significant improvement in visual analog scale (VAS) back and leg pain scores and Oswestry Disability Index scores (P < 0.001). Outpatients had significantly lower postoperative VAS back pain (P = 0.001) and Oswestry Disability Index scores (P = 0.004) at 5-8 weeks compared with inpatients, but there was no significant difference for VAS leg pain scores at all time points between the cohorts.
Conclusions: Early results demonstrate that biportal spinal endoscopy can safely and effectively be performed in both inpatient and outpatient settings.
Clinical relevance: Outpatient biportal spinal endoscopy can be performed successfully in well selected patients, which may reduce the financial burden of spine surgery to the U.S. healthcare system.
{"title":"Biportal Endoscopic Approach for Lumbar Degenerative Disease in the Ambulatory Outpatient vs Inpatient Setting: A Comparative Study.","authors":"Don Young Park, Thomas E Olson, Alexander Upfill-Brown, Babapelumi Adejuyigbe, Akash A Shah, William L Sheppard, Cheol Wung Park, Dong Hwa Heo","doi":"10.14444/8545","DOIUrl":"10.14444/8545","url":null,"abstract":"<p><strong>Background: </strong>Biportal spinal endoscopy is increasingly utilized for lumbar disc herniations and lumbar stenosis. The objective was to investigate the safety and effectiveness of the technique in the outpatient vs inpatient setting.</p><p><strong>Methods: </strong>This is a comparative study of consecutive patients who underwent biportal spinal endoscopy by a single surgeon at a single institution. Demographics, surgical complications, and patient-reported outcomes were prospectively collected and retrospectively analyzed. Statistics were calculated among treatment groups using unpaired <i>t</i> test and <i>χ</i> <sup>2</sup> analysis where appropriate. Statistical significance was determined as <i>P</i> < 0.05.</p><p><strong>Results: </strong>Eighty-four patients were included, 58 (69.0%) as outpatient, 26 (31.0%) as inpatient. Mean follow-up was 7.5 months. Statistically significant differences in age, American Society of Anesthesiologists classification, and Charleston Comorbidity Index scores were reported between cohorts, with younger and healthier patients undergoing outpatient surgery (<i>P</i> < 0.0001). Outpatients were more likely to have discectomies while inpatients were more likely to have decompressions for stenosis. No significant differences in postoperative complications were found between groups.Both cohorts demonstrated significant improvement in visual analog scale (VAS) back and leg pain scores and Oswestry Disability Index scores (<i>P</i> < 0.001). Outpatients had significantly lower postoperative VAS back pain (<i>P</i> = 0.001) and Oswestry Disability Index scores (<i>P</i> = 0.004) at 5-8 weeks compared with inpatients, but there was no significant difference for VAS leg pain scores at all time points between the cohorts.</p><p><strong>Conclusions: </strong>Early results demonstrate that biportal spinal endoscopy can safely and effectively be performed in both inpatient and outpatient settings.</p><p><strong>Clinical relevance: </strong>Outpatient biportal spinal endoscopy can be performed successfully in well selected patients, which may reduce the financial burden of spine surgery to the U.S. healthcare system.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10753325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41151622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marc A Weinstein, Andrew Beaumont, Peter Campbell, Hamid Hassanzadeh, Vikas Patel, Amir Vokshoor, Joshua Wind, Kristen Radcliff, Ilyas Aleem, Domagoj Coric
Background: Lumbar spinal fusion surgeries are increasing steadily due to an aging and ever-growing population. Patients undergoing lumbar spinal fusion surgery may present with risk factors that contribute to complications, pseudarthrosis, prolonged pain, and reduced quality of life. Pulsed electromagnetic field (PEMF) stimulation represents an adjunct noninvasive treatment intervention that has been shown to improve successful fusion and patient outcomes following spinal surgery.
Methods: A prospective, multicenter study investigated PEMF as an adjunct therapy to lumbar spinal fusion procedures in patients at risk for pseudarthrosis. Patients with at least 1 of the following risk factors were enrolled: prior failed fusion, multilevel fusion, nicotine use, osteoporosis, or diabetes. Fusion status was determined by radiographic imaging, and patient-reported outcomes were also evaluated.
Results: A total of 142 patients were included in the analysis. Fusion status was assessed at 12 months follow-up where 88.0% (n = 125/142) of patients demonstrated successful fusion. Fusion success for patients with 1, 2+, or 3+ risk factors was 88.5%, 87.5%, and 82.3%, respectively. Significant improvements in patient-reported outcomes using the Short Form 36, EuroQol 5 Dimension (EQ-5D) survey, Oswestry Disability Index, and visual analog scale for back and leg pain were also observed compared with baseline scores (P < 0.001). A favorable safety profile was observed. PEMF treatment showed a positive benefit-risk profile throughout the 6-month required use period.
Conclusions: The addition of PEMF as an adjunct treatment in patients undergoing lumbar spinal surgery provided a high rate of successful fusion with significant improvements in pain, function, and quality of life, despite having risk factors for pseudarthrosis.
Clinical relevance: PEMF represents a useful tool for adjunct treatment in patients who have undergone lumbar spinal surgery. Treatment with PEMF may result in improved fusion and patient-reported outcomes, regardless of risk factors.
Trial registration: NCT03176303.
背景:由于人口老龄化和不断增长,腰椎融合术正在稳步增加。接受腰椎融合术的患者可能存在导致并发症、假关节、疼痛延长和生活质量降低的风险因素。脉冲电磁场(PEMF)刺激是一种辅助的非侵入性治疗干预措施,已被证明可以改善脊柱手术后的成功融合和患者预后。方法:一项前瞻性、多中心研究研究了PEMF作为腰椎融合术的辅助治疗假关节风险患者。至少有以下1种风险因素的患者被纳入研究:既往融合失败、多水平融合、尼古丁使用、骨质疏松或糖尿病。融合状态通过放射学成像确定,并对患者报告的结果进行评估。结果:共有142名患者被纳入分析。在12个月的随访中评估融合状态,88.0%(n=125/142)的患者证明融合成功。有1、2+或3+危险因素的患者融合成功率分别为88.5%、87.5%和82.3%。与基线评分相比,使用Short Form 36、EuroQol 5 Dimension(EQ-5D)调查、Oswestry残疾指数和背部和腿部疼痛视觉模拟量表的患者报告结果也有显著改善(P<0.001)。观察到良好的安全性。PEMF治疗在所需的6个月使用期内显示出积极的获益风险状况。结论:PEMF作为腰椎手术患者的辅助治疗,尽管有假关节的危险因素,但融合成功率高,疼痛、功能和生活质量显著改善。临床相关性:PEMF是对接受腰椎手术的患者进行辅助治疗的有用工具。PEMF治疗可以改善融合和患者报告的结果,而不考虑风险因素。试验注册号:NCT03176303。
{"title":"Pulsed Electromagnetic Field Stimulation in Lumbar Spine Fusion for Patients With Risk Factors for Pseudarthrosis.","authors":"Marc A Weinstein, Andrew Beaumont, Peter Campbell, Hamid Hassanzadeh, Vikas Patel, Amir Vokshoor, Joshua Wind, Kristen Radcliff, Ilyas Aleem, Domagoj Coric","doi":"10.14444/8549","DOIUrl":"10.14444/8549","url":null,"abstract":"<p><strong>Background: </strong>Lumbar spinal fusion surgeries are increasing steadily due to an aging and ever-growing population. Patients undergoing lumbar spinal fusion surgery may present with risk factors that contribute to complications, pseudarthrosis, prolonged pain, and reduced quality of life. Pulsed electromagnetic field (PEMF) stimulation represents an adjunct noninvasive treatment intervention that has been shown to improve successful fusion and patient outcomes following spinal surgery.</p><p><strong>Methods: </strong>A prospective, multicenter study investigated PEMF as an adjunct therapy to lumbar spinal fusion procedures in patients at risk for pseudarthrosis. Patients with at least 1 of the following risk factors were enrolled: prior failed fusion, multilevel fusion, nicotine use, osteoporosis, or diabetes. Fusion status was determined by radiographic imaging, and patient-reported outcomes were also evaluated.</p><p><strong>Results: </strong>A total of 142 patients were included in the analysis. Fusion status was assessed at 12 months follow-up where 88.0% (<i>n</i> = 125/142) of patients demonstrated successful fusion. Fusion success for patients with 1, 2+, or 3+ risk factors was 88.5%, 87.5%, and 82.3%, respectively. Significant improvements in patient-reported outcomes using the Short Form 36, EuroQol 5 Dimension (EQ-5D) survey, Oswestry Disability Index, and visual analog scale for back and leg pain were also observed compared with baseline scores (<i>P</i> < 0.001). A favorable safety profile was observed. PEMF treatment showed a positive benefit-risk profile throughout the 6-month required use period.</p><p><strong>Conclusions: </strong>The addition of PEMF as an adjunct treatment in patients undergoing lumbar spinal surgery provided a high rate of successful fusion with significant improvements in pain, function, and quality of life, despite having risk factors for pseudarthrosis.</p><p><strong>Clinical relevance: </strong>PEMF represents a useful tool for adjunct treatment in patients who have undergone lumbar spinal surgery. Treatment with PEMF may result in improved fusion and patient-reported outcomes, regardless of risk factors.</p><p><strong>Trial registration: </strong>NCT03176303.</p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10753353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54231486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael Markowitz, Barrett Woods, Gregory Schroeder, Christopher Kepler, David Kaye, Mark Kurd, Joshua Armstrong, Alexander Vaccaro, Kris Radcliff
Background: There has been increased interest in exploring methods to reduce postoperative pain without opioid medications. In 2015, a multimodal analgesia protocol was used involving the perioperative use of celecoxib, gabapentin, intravenous acetaminophen, lidocaine, and liposomal bupivacaine. Overall, the goal was to reduce the utilization of scheduled opioids in favor of nonopioid pain management.
Methods: The results of a consecutive series of 1- to 2-level open primary lumbar fusions were compared to a cohort of patients after the implementation the perioperative multimodal pain management protocol. Primary endpoints included patient-reported pain scores and secondary endpoints included length of stay.
Results: There were 87 patients in the preprotocol cohort and 184 in the protocol cohort. Comparing protocol and preprotocol patients, there were no significant differences in patient demographics. There was significantly average lower pain in the protocol group on postoperative day (POD) 1 (4.50 vs 5.00, P < 0.02) and POD2 (4.42 vs 5.50, P < 0.03). There was a lower pain score on POD0 (4.80 vs 5.00), but it was only clinically significant. There was a correlation between pain and duration of surgery in the preprotocol patients (POD0 R = 0.23, POD1 R = 0.02, POD2 R = 0.38), but not in the protocol patients (POD0 R = -0.05, POD1 R = -0.08, POD2 R = -0.04). There was a shorter length of stay in the protocol cohort (2.0 vs 3.0, P < 0.01). Finally, there was an approximately 35% reduction in morphine milligram equivalents of opioids in the protocol vs preprotocol cohorts (36.2 vs 57.0, P < 0.05).
Conclusion: Our novel multimodal pain management protocol significantly reduced postoperative pain, length of stay, and opioid consumption in this patient cohort. Opioid usage correlated to pain in the protocol patients, while the preprotocol patients had no correlation between opioid use and pain medication.
Clinical relevance: In this study, we demonstrated that preoperative and intraoperative analgesia can reduce postoperative pain medication requirements. Furthermore, we introduced a novel concept of a correlation of pain with opioid consumption as a marker of effective pain management of breakthrough pain.
Level of evidence: 4:
背景:人们对探索在不使用阿片类药物的情况下减轻术后疼痛的方法越来越感兴趣。2015 年,采用了一种多模式镇痛方案,包括围手术期使用塞来昔布、加巴喷丁、静脉注射对乙酰氨基酚、利多卡因和脂质体布比卡因。总之,我们的目标是减少阿片类药物的使用,转而采用非阿片类药物止痛:方法:在实施围手术期多模式疼痛管理方案后,将一系列连续的1至2级开放式腰椎初次融合术的结果与一组患者进行比较。主要终点包括患者报告的疼痛评分,次要终点包括住院时间:结果:方案实施前队列中有 87 名患者,方案实施后队列中有 184 名患者。比较协议患者和协议前患者,在患者人口统计学方面没有明显差异。在术后第 1 天(POD)(4.50 vs 5.00,P < 0.02)和第 2 天(POD2)(4.42 vs 5.50,P < 0.03),协议组患者的平均疼痛程度明显降低。POD0的疼痛评分较低(4.80 vs 5.00),但仅具有临床意义。协议前患者的疼痛与手术时间之间存在相关性(POD0 R = 0.23,POD1 R = 0.02,POD2 R = 0.38),但协议患者的疼痛与手术时间之间不存在相关性(POD0 R = -0.05,POD1 R = -0.08,POD2 R = -0.04)。方案组患者的住院时间更短(2.0 vs 3.0,P < 0.01)。最后,方案队列与方案前队列相比,阿片类药物的吗啡毫克当量减少了约35%(36.2 vs 57.0,P < 0.05):我们的新型多模式疼痛管理方案大大减少了该组患者的术后疼痛、住院时间和阿片类药物用量。协议患者的阿片类药物使用量与疼痛相关,而协议前患者的阿片类药物使用量与止痛药物之间没有相关性:本研究表明,术前和术中镇痛可减少术后镇痛药物的需求量。此外,我们还提出了一个新概念,即疼痛与阿片类药物用量的相关性是有效控制突破性疼痛的标志:4:
{"title":"A Novel Multimodal Postoperative Pain Protocol for 1- to 2-Level Open Lumbar Fusions: A Retrospective Cohort Study.","authors":"Michael Markowitz, Barrett Woods, Gregory Schroeder, Christopher Kepler, David Kaye, Mark Kurd, Joshua Armstrong, Alexander Vaccaro, Kris Radcliff","doi":"10.14444/8484","DOIUrl":"10.14444/8484","url":null,"abstract":"<p><strong>Background: </strong>There has been increased interest in exploring methods to reduce postoperative pain without opioid medications. In 2015, a multimodal analgesia protocol was used involving the perioperative use of celecoxib, gabapentin, intravenous acetaminophen, lidocaine, and liposomal bupivacaine. Overall, the goal was to reduce the utilization of scheduled opioids in favor of nonopioid pain management.</p><p><strong>Methods: </strong>The results of a consecutive series of 1- to 2-level open primary lumbar fusions were compared to a cohort of patients after the implementation the perioperative multimodal pain management protocol. Primary endpoints included patient-reported pain scores and secondary endpoints included length of stay.</p><p><strong>Results: </strong>There were 87 patients in the preprotocol cohort and 184 in the protocol cohort. Comparing protocol and preprotocol patients, there were no significant differences in patient demographics. There was significantly average lower pain in the protocol group on postoperative day (POD) 1 (4.50 vs 5.00, <i>P</i> < 0.02) and POD2 (4.42 vs 5.50, <i>P</i> < 0.03). There was a lower pain score on POD0 (4.80 vs 5.00), but it was only clinically significant. There was a correlation between pain and duration of surgery in the preprotocol patients (POD0 <i>R</i> = 0.23, POD1 <i>R</i> = 0.02, POD2 <i>R</i> = 0.38), but not in the protocol patients (POD0 <i>R</i> = -0.05, POD1 <i>R</i> = -0.08, POD2 <i>R</i> = -0.04). There was a shorter length of stay in the protocol cohort (2.0 vs 3.0, <i>P</i> < 0.01). Finally, there was an approximately 35% reduction in morphine milligram equivalents of opioids in the protocol vs preprotocol cohorts (36.2 vs 57.0, <i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>Our novel multimodal pain management protocol significantly reduced postoperative pain, length of stay, and opioid consumption in this patient cohort. Opioid usage correlated to pain in the protocol patients, while the preprotocol patients had no correlation between opioid use and pain medication.</p><p><strong>Clinical relevance: </strong>In this study, we demonstrated that preoperative and intraoperative analgesia can reduce postoperative pain medication requirements. Furthermore, we introduced a novel concept of a correlation of pain with opioid consumption as a marker of effective pain management of breakthrough pain.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10753327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10170773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mark M Gleeson, Matthew J Solomito, Regina O Kostyun, Sean Esmende, Heeren Makanji
Background: Previous research has shown that underweight patients may be at a greater risk of experiencing postsurgical complications. The purpose of this study was to investigate the association between body mass index (BMI) and postoperative complications following single-level anterior lumbar fusion (ALF).
Methods: All single-level elective ALF procedures performed between 2010 and 2020 were identified in the PearlDiver Mariner Database. Patients were separated into 6 groups based on the World Health Organization BMI classifications. Differences in postsurgical complications (ie, deep vein thrombosis, pulmonary embolism, surgical site infection, hardware malfunction, wound dehiscence, and blood transfusion) among BMI categories were assessed using a χ2 contingency test.
Results: Results indicated that underweight patients (BMI <20) were at a significantly greater risk of developing deep vein thromboses, experiencing hardware malfunction, and requiring blood transfusion compared with any other BMI classification (P < 0.001). Results also demonstrated that underweight individuals had similar risks of developing surgical site infection and wound dehiscence compared with patients classified as having obesity class III.
Conclusion: Underweight patients may be at a greater risk than currently believed of experiencing postoperative complications following single-level ALF procedures.
Clinical relevance: Patients with a BMI of 20 or less should be carefully evaluated prior to surgical intervention to ensure they are optimized for surgery.
Level of evidence: 3:
背景:先前的研究表明,体重过轻的患者可能有更大的风险经历术后并发症。本研究的目的是探讨体重指数(BMI)与单节段腰椎前路融合术(ALF)术后并发症之间的关系。方法:2010年至2020年间进行的所有单节段选择性ALF手术在PearlDiver Mariner数据库中进行了识别。根据世界卫生组织BMI分类将患者分为6组。术后并发症(即深静脉血栓形成、肺栓塞、手术部位感染、硬件故障、伤口裂开和输血)在BMI分类中的差异采用χ2意外检验。结果:结果显示体重过轻患者(BMI P < 0.001)。结果还表明,体重过轻的个体与III级肥胖患者相比,发生手术部位感染和伤口裂开的风险相似。结论:体重过轻的患者可能比目前认为的经历单节段ALF手术的术后并发症的风险更大。临床相关性:BMI为20或更低的患者应在手术干预前仔细评估,以确保他们最适合手术。证据等级:3;
{"title":"Low Body Mass Index Patients Undergoing an Anterior Lumbar Fusion May Have an Increased Risk of Perioperative Complications.","authors":"Mark M Gleeson, Matthew J Solomito, Regina O Kostyun, Sean Esmende, Heeren Makanji","doi":"10.14444/8539","DOIUrl":"10.14444/8539","url":null,"abstract":"<p><strong>Background: </strong>Previous research has shown that underweight patients may be at a greater risk of experiencing postsurgical complications. The purpose of this study was to investigate the association between body mass index (BMI) and postoperative complications following single-level anterior lumbar fusion (ALF).</p><p><strong>Methods: </strong>All single-level elective ALF procedures performed between 2010 and 2020 were identified in the PearlDiver Mariner Database. Patients were separated into 6 groups based on the World Health Organization BMI classifications. Differences in postsurgical complications (ie, deep vein thrombosis, pulmonary embolism, surgical site infection, hardware malfunction, wound dehiscence, and blood transfusion) among BMI categories were assessed using a χ<sup>2</sup> contingency test.</p><p><strong>Results: </strong>Results indicated that underweight patients (BMI <20) were at a significantly greater risk of developing deep vein thromboses, experiencing hardware malfunction, and requiring blood transfusion compared with any other BMI classification (<i>P</i> < 0.001). Results also demonstrated that underweight individuals had similar risks of developing surgical site infection and wound dehiscence compared with patients classified as having obesity class III.</p><p><strong>Conclusion: </strong>Underweight patients may be at a greater risk than currently believed of experiencing postoperative complications following single-level ALF procedures.</p><p><strong>Clinical relevance: </strong>Patients with a BMI of 20 or less should be carefully evaluated prior to surgical intervention to ensure they are optimized for surgery.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10753346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138483092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}