Operative Techniques in Orthopaedics最新文献

Interest in motion-preserving procedures, particularly in the cervical spine, remains high and several techniques have found greater acceptance and adoption for the appropriately indicated patient, particularly cervical disc replacement and cervical laminoplasty. Techniques in the lumbar spine have shown less consistent results, although continued interest drives development of continued innovation. Particular attention to the quality of the literature, especially with patient selection, choice of comparison group, and statistical methodology in early studies are crucial for critical evaluation of any novel technique or device.

In recent years, outpatient spine surgery has gained momentum as a promising approach to improve healthcare value by reducing costs and enhancing patient outcomes. This narrative review presents an updated summary of studies exploring the clinical outcomes and cost savings associated with outpatient spine surgery. Our review highlights the growing acceptance of outpatient spine surgery, which is driven by advancements in surgical techniques, anesthesia protocols, and perioperative care pathways. Several procedures, including lumbar discectomy, lumbar laminectomy plus/minus fusion, anterior cervical decompression and fusion , and cervical disc arthroplasty, have shown success in the outpatient setting. A search strategy was employed to identify relevant studies from the MEDLINE database. Seventeen retrospective cohort studies met the inclusion criteria. Outpatient spine surgery demonstrated favorable clinical outcomes, including lower readmission and reoperation rates, shorter hospital stays, and comparable mortality rates. Additionally, analysis of feasibility outcomes revealed significant cost reductions and decreased operative timing with outpatient procedures. Despite its benefits, challenges persist in implementing outpatient spine surgery. Careful patient selection, standardized protocols, and appropriate financial planning are essential to ensure safe and successful integration into healthcare systems. Patient education and engagement are also crucial for promoting optimal outcomes.

Recent decades have seen numerous significant advancements in the field of spinal and lumbar fusion surgeries, including the augmentation of surgical precision with robotic navigation. Use of robotic navigation in single-position lumbar fusion surgery (SPLS), which utilizes a lateral approach and requires no mid-procedure repositioning of the patient, has been shown to improve outcome measures and overall operative efficiency in addition to reducing patient time under anesthesia. Despite indications that robotically-assisted SPLS is superior to more traditional approaches in terms of cost and outcomes, relatively few surgeons currently utilize this innovative combination. This is largely attributed to the well-documented learning curve associated with robotically assisted surgery. In an attempt to mitigate this and reduce the barrier to entry for robotically-assisted spinal surgery, this report will give a detailed description of the workflow for SPLS procedures using robotic navigation. The authors will also give best-practice recommendations applicable for spine surgeons and surgical residents unfamiliar with surgical robotics systems.

Lower health literacy is associated with worse patient outcomes, yet physicians tend to overestimate patients’ health literacy. To assess spine surgeons’ ability to accurately estimate patients’ health literacy, this study administered the Newest Vital Sign (NVS) to spine surgery patients and recorded 2 spine surgeons’ estimations of those patients’ health literacy levels. Spine surgeons’ estimates were in moderate agreement with patients’ NVS scores, and spine surgeons tended to overestimate patients’ health literacy. Surgeons’ estimates were more accurate for patients with the following characteristics: Adequate health literacy, White, age 60 and older, and male. These findings highlight the potential for routine NVS administration to promote health equity, quality, and safety in spine surgery.