International Journal of Spine Surgery最新文献

Background: Patient education is a key element of spinal surgery informed consent. Patients frequently access health information online, yet this information is unregulated and of variable quality. We aimed to assess the quality of information available on degenerative cervical myelopathy (DCM) websites with a focus on identifying high-quality information websites.

Methods: We performed a Google search using keywords pertaining to DCM. The top 50 websites returned were classified based on their publication source, intended audience, and country of origin. The quality of these websites was assessed using both the DISCERN instrument and Journal of the American Medical Association (JAMA) benchmark criteria. We also utilized a novel Myelopathy Information Scoring Tool (MIST) to assess the comprehensiveness, accuracy, and detail of online DCM information.

Results: The mean DISCERN score was 39.9 out of 80. Only one-quarter of these websites were rated "good" or "excellent" using DISCERN, and the remaining were rated "very poor," "poor," and "fair." The mean JAMA benchmark score was 1.6 out of 4, with 23 out of 50 websites scoring 0. Evaluation using MIST found a mean score of 25.6 out of 50. Using 30 points as a satisfactory MIST cutoff, 72% of DCM websites were deemed critically deficient and unsatisfactory for comprehensive patient education. Both DISCERN and MIST indicated poorest information pertaining to surgical risks and complications as well as treatment outcomes. Websites such as Orthoinfo.aaos.org and Myelopathy.org provided reliable, trustworthy, and comprehensive patient education.

Conclusions: Information available on almost three-quarters of DCM websites was of poor quality, with information regarding complications and treatment outcomes most deficient. Clinicians should be aware of quality sites where patients may be directed to augment patient education and surgical counseling.

Background: Microdiscectomy for patients with chronic lumbar radiculopathy refractory to conservative therapy has significantly better outcomes than continued nonoperative management. The North American Spine Society (NASS) outlined specific criteria to establish medical necessity for elective lumbar microdiscectomy. We hypothesized that insurance providers have substantial variability among one another and from the NASS guidelines.

Methods: A cross-sectional analysis of US national and local insurance companies was conducted to assess policies on coverage recommendations for lumbar microdiscectomy. Insurers were selected based on their enrollment data and market share of direct written premiums. The top 4 national insurance providers and the top 3 state-specific providers in New Jersey, New York, and Pennsylvania were selected. Insurance coverage guidelines were accessed through a web-based search, provider account, or telephone call to the specific provider. If no policy was provided, it was documented as such. Preapproval criteria were entered as categorical variables and consolidated into 4 main categories: symptom criteria, examination criteria, imaging criteria, and conservative treatment.

Results: The 13 selected insurers composed roughly 31% of the market share in the United States and approximately 82%, 62%, and 76% of the market share for New Jersey, New York, and Pennsylvania, respectively. Insurance descriptions of symptom criteria, imaging criteria, and the definition of conservative treatment had substantial differences as compared with those defined by NASS.

Conclusion: Although a guideline to establish medical necessity was developed by NASS, many insurance companies have created their own guidelines, which have resulted in inconsistent management based on geographic location and selected provider.

Clinical relevance: Providers must be cognizant of the differing preapproval criteria needed for each in-network insurance company in order to provide effective and efficient care for patients with lumbar radiculopathy.

Level of evidence: 5:

Background: Our objective is to describe a minimally invasive endoscopic surgical technique for performing lateral lumbar interbody fusion (LLIF). LLIF is a common approach to lumbar fusion in cases of degenerative lumbar disease; however, complications associated with psoas and lumbar plexus injury sometimes arise. The endoscopic modification presented here diminishes the requirement for sustained muscle retraction, minimizing complication risk while allowing for adequate decompression in select cases.

Methods: Endoscopic LLIF (ELLIF) was performed in 3 patients from 2019 to 2021. Surgeries were performed in the lateral position under general anesthesia with neurophysiological monitoring. Discectomy, endplate preparation, and harvesting of iliac crest bone were performed through a working channel endoscope. The introduction of an interbody cage (Joimax EndoLIF) was performed over a nitinol blunt-tip wire (Joimax). No expandable blade retractors were required.

Results: At 2-year follow-up of these 3 patients, the mean visual analog scale (VAS) score for leg pain improved from 9.3 to 1.7, and the mean Oswestry Disability Index (ODI) score improved from 40 to 8.3. There were no complications, readmissions, or recurrence of symptoms during the 2-year follow-up period. Patients spent an average of 36 hours in the hospital postoperatively and returned to normal daily activities after an average of 48 days.

Conclusions: A minimally invasive modification to the LLIF procedure is presented that offers several potential advantages due to the application of endoscopic techniques: reduced muscle retraction, smaller incision, and the opportunity to perform both indirect decompression and endoscopically visualized discectomy in the same fusion procedure.

Clinical relevance: The proposed endoscopic lateral lumbar interbody fusion and decompression is a minimally invasive technique that may provide patients with minimal complications, quick recovery, and good functional recovery.

Level of evidence: 4:

Background: Ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH) are distinct pathological entities that similarly increase the risk of vertebral fractures. Such fractures can be clinically devastating and frequently portend significant neurological injury, thus making their prevention a critical focus. Of particular significance, spinal fractures in patients with AS or DISH carry a considerable risk of mortality, with reports on 1-year injury-related deaths ranging from 24% to 33%. As such, the purpose of this study was to conduct machine learning (ML) analysis to predict postoperative mortality in patients with AS or DISH using the Nationwide Inpatient Sample Healthcare Cost and Utilization Project (HCUP-NIS) database.

Methods: HCUP-NIS was queried to identify adult patients carrying a diagnosis of AS or DISH who were admitted for spinal fractures and underwent subsequent fusion or corpectomy between 2016 and 2018. Predictions of in-hospital mortality in this cohort were then generated by three independent ML algorithms.

Results: An in-hospital mortality rate of 5.40% was observed in our selected population, including a rate of 6.35% in patients with AS, 2.81% in patients with DISH, and 8.33% in patients with both diagnoses. Increasing age, hypertension with end-organ complications, spinal cord injury, and cervical spinal fractures each carried considerable predictive importance across the algorithms utilized in our analysis. Predictions were generated with an average area under the curve of 0.758.

Conclusions: This study's application of ML algorithms to predict in-hospital mortality among patients with AS or DISH identified a number of clinical risk factors relevant to this outcome.

Clinical relevance: These findings may serve to provide physicians with an awareness of risk factors for in-hospital mortality and, subsequently, guide management and shared decision-making among patients with AS or DISH.

Level of evidence: 4: