Journal of Spinal Disorders & Techniques

Significant changes are occurring in the health care field, and spine surgeons must have an understanding of business strategy if they are going to adapt to the new health care environment. Spine surgeons will be required to demonstrate how their service provides a unique value to their patients or else the patients will obtain care from competitors. Classic methods for demonstrating value such as academic prestige and superior clinical outcomes may no longer be sufficient in the evolving health care field, and surgeons will need to demonstrate a comprehensive and cost-effective treatment algorithm for a diagnosis...

Regression models are commonly used in spine research today, and they can be used to explain or predict an outcome. A regression model can indicate the relative impact of each variable on the expected outcome, so when the model has been developed, it can be used to predict the outcome for a hypothetical patient.

No abstract text is available yet for this article.

PURPOSE: Cervical spondylotic myelopathy (CSM) is a condition resulting from cervical stenosis. Manifestations of CSM include paresthesia in the extremities, loss of fine motor skills, balance problems, and bowel and bladder dysfunction in advanced disease. Laminoplasty is one surgical treatment option. The goal of laminoplasty is to reposition the laminae to expand the spinal canal, allowing the spinal cord to migrate posteriorly. There are various laminoplasty techniques; the main ones being open-door laminoplasty and double-door laminoplasty...

STUDY DESIGN: A prospective clinical study. OBJECTIVE: To assess the clinical and radiographic results of activ L total disk replacement (TDR) on degenerative disk diseases. SUMMARY OF BACKGROUND DATA: There are few reports on Activ L TDR, and this is the first in China. MATERIALS AND METHODS: From March 2009 to March 2012, 32 patients with degenerative disk disease underwent either monosegmental or bisegmental lumbar TDR, which was documented in a prospective observational mode...

STUDY DESIGN: This study compares the accuracy rates of lumbar percutaneous pedicle screw placement (PPSP) using either 2-dimensional (2-D) fluoroscopic guidance or 3-dimensional (3-D) stereotactic navigation in the setting of minimally invasive spine surgery (MISS). This represents the largest single-operator study of its kind and first comprehensive review of 3-D stereotactic navigation in the setting of MISS. OBJECTIVE: To examine differences in accuracy of lumbar pedicle screw placement using 2-D fluoroscopic navigation and 3-D stereotaxis in the setting of MISS...

STUDY DESIGN: Systematic review with meta-analysis. OBJECTIVE: To (1) evaluate long-term patient-centered clinical outcomes after lumbar arthrodesis with or without decompression for lumbar spondylosis (LS); and (2) compare these outcomes with those of alternative treatments, including nonsurgical and surgical which maintain mobility of the lumbar spine. SUMMARY OF BACKGROUND DATA: The effective treatment of LS is a complex clinical and economic concern for patients and health care providers...

STUDY DESIGN: A retrospective clinical analysis. OBJECTIVE: The aim of this study was to compare the effectiveness of the wake-up test with that of combined monitoring of transcranial electrical stimulation motor evoked potentials (TES-MEP) and cortical somatosensory evoked potentials (CSEP) in spinal surgery. SUMMARY OF BACKGROUND DATA: TES-MEP/CSEP combined monitoring is being increasingly recognized as the ideal approach to detect spinal neurophysiological compromise during spinal surgery; however, as a result the merit of the wake-up test is now in doubt...

STUDY DESIGN: A prospective randomized and blinded comparative study of 2 patient groups with >5-year follow-up. OBJECTIVE: To compare the clinical outcomes and postoperative posterior muscle changes in patients with advanced degenerative disk disease undergoing 2-level circumferential spinal fusion using a posterior midline versus a paraspinal approach. SUMMARY OF BACKGROUND DATA: Lumbar spinal fusion is often performed using a circumferential (anterior and posterior) technique...

STUDY DESIGN: This study was a retrospective one. OBJECTIVE: The objective of the study was to analyze the causes, prevalence of, and risk factors for coronal decompensation in long adult lumbar spinal instrumentation and fusion (from thoracic or upper lumbar spine) to L5 or S1. SUMMARY OF BACKGROUND DATA: Coronal and sagittal decompensation after long fusions for spinal deformities can affect outcomes negatively. There is no study reporting the natural history of coronal spinal balance after long spinal fusions...

STUDY DESIGN: Retrospective CT analysis of anterior fusion in thoracolumbar trauma. OBJECTIVE: The aim of this study was to compare fusion rates of different bone grafts and to analyze risk factors for pseudarthrosis. SUMMARY OF BACKGROUND DATA: Interbody fusion is indicated in anterior column defects. Different grafts are used: autologous iliac crest, titanium mesh cages filled with cancellous bone, and autologous ribs. It is not clear which graft offers the most reliable fusion...

STUDY DESIGN: The clinical study was conducted on 145 patients who received either a novel guidance method or a conventional fluoroscopic method for the percutaneous pedicle screw placement in the lumbar spine. OBJECTIVE: The aim of this study was to introduce a novel guidance method for percutaneous pedicle screw placement and to compare it with the conventional fluoroscopic method. SUMMARY OF BACKGROUND DATA: Conventional fluoroscopic method was associated with a long screw placement and a more fluoroscopy time...

STUDY DESIGN: Prospective study. OBJECTIVE: To determine the clinical outcome and change in foraminal dimension after anterior cervical discectomy and fusion (ACDF) and to investigate the correlation between clinical outcome and foraminal dimension. SUMMARY OF BACKGROUND DATA: No previous studies have evaluated the correlation between clinical outcome and foraminal dimension after ACDF in foraminal stenosis. METHODS: A consecutive series of 44 patients (114 foramina) undergoing planned ACDF due to foraminal stenosis were studied...

No abstract text is available yet for this article.

As the US health care system transitions toward a value-based system, providers and health care organizations will have to closely scrutinize their current processes of care. To do this, a value chain analysis can be performed to ensure that only the most efficient steps are followed in patient care. Ultimately this will produce a higher quality or equal quality product for less cost by eliminating wasteful steps along the way.

Venous thromboembolic embolism (VTE) is a potentially serious and life-threatening complication in spine surgery. However, VTE incidence and prophylaxis in spine surgery remains controversial. Current recommendations for VTE prophylaxis address "spine surgery" as a single broad category and mainly consider patient factors when determining risk. We performed a literature review to determine the varying VTE and bleeding risks within spine surgery to develop an individualized prophylactic algorithm. Our review suggests that the current guidelines on VTE prophylaxis for spine surgery from NASS and ACCP are suboptimal...

STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: To evaluate anterior decompression and fusion compared with posterior laminoplasty when treating multilevel cervical compressive myelopathy. SUMMARY OF BACKGROUND DATA: Satisfactory results have been reported with both anterior decompression and fusion and posterior laminoplasty in the treatment of multilevel cervical compressive myelopathy. However, which method is safer and more effective remains controversial...

The minimally invasive posterior cervical foraminotomy procedure has become a common and successful procedure for the treatment of cervical radiculopathy. Specifically, the minimally invasive approach allows for decreased postoperative pain, blood loss, and length of hospitalization by preserving the surrounding soft tissue as compared with the traditional open approach. This article and accompanying video demonstrates the technique for a primary, single-level minimally invasive posterior cervical foraminotomy as performed through a tubular retractor...

Modern computing power has given us the ability to approach statistical questions in a manner which was previously impossible because of the time-consuming nature of the calculations required. Computer power has enabled the use of Bayesian inference techniques, based on 18th century theory, to frame statistical questions in probability.

STUDY DESIGN: This is a retrospective study. OBJECTIVE: To assess the effects of noninvasive positive-pressure ventilation (NIPPV) through evaluations of outcomes and incidences of postoperative pulmonary complications among patients with flaccid neuromuscular scoliosis for pulmonary support in the perioperative periods. BACKGROUND DATA: There is no report on the effects of NIPPV on neuromuscular scoliosis patient during the perioperative periods...