Operative Techniques in Orthopaedics最新文献

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.

Achieving adequate hemostasis in spine surgery is critical for both the patient and surgeon. Currently, there are 2 major topical hemostatic matrix agents used in spine surgery—Floseal (Baxter Healthcare, Deerfield, Illinois, USA) and Surgiflo (Ethicon Inc., Raritan, New Jersey, USA). While both products have been shown to be effective at achieving hemostasis, there is no consensus supporting the use of one agent over another in spine surgery. There are studies comparing outcomes and cost between Floseal and Surgiflo, but a significant portion of the studies have industry affiliations. Generally, existing literature reports low to moderate cost savings in favor of one agent or the other, with no clinically significant differences in patient-based outcomes such as postoperative hematomas. Animal model studies also suggest unique complications, including epidural fibrosis and associated nerve root compression with use of a flowable topical hemostatic agent. Further nonindustry-affiliated studies are warranted to compare efficacy, patient outcomes, cost analyses, and possible unique complications associated with the two hemostatic agents.

Cervical disc arthroplasty (CDA) is a motion-preserving treatment option for managing cervical radiculopathy and myelopathy. While CDA may be an excellent surgical technique for select patients, there are many technical challenges that make this procedure less forgiving than anterior cervical discectomy and fusion. The purpose of this article is to provide a brief overview of cervical disc arthroplasty, indications, surgical technique, surgical considerations, implant selection, and complications.

In recent years, augmented reality (AR) has emerged as a promising technology in spine surgery. Its benefits are numerous, including enhanced surgical accuracy, improved anatomic approximation, and uninterrupted visualization. It has proven particularly valuable in spinal fusion, allowing for meticulous planning of screw trajectories and precise alignment of screws, plates, and implants, resulting in low complication rates. Additionally, AR reduces radiation exposure by minimizing the need for intraoperative fluoroscopy. The technology has also been utilized for surgical education and training, enabling real-time feedback through telementoring. However, challenges exist. Discomfort and wearability issues are reported with current AR models, and the need for 3D image rendering prolongs procedure time. Accuracy is compromised in patients with larger body habitus, necessitating improvements in calibration to individual anatomies. Cost is another significant challenge as it requires advanced imaging capabilities in operating rooms, along with expenses for AR hardware, software, training, and personnel. Ongoing research is necessary to evaluate the sustained benefits and potential complications of AR in spine surgery. While AR demonstrates advantages in terms of patient outcomes and surgical accuracy, continued optimization is essential to enhance accessibility and success in spine surgery and orthopaedic surgery as a whole.