scholarly journals Unintended durotomy in lumbar degenerative spinal surgery: a 10-year systematic review of the literature

2015 ◽  
Vol 39 (4) ◽  
pp. E8 ◽  
Author(s):  
George M. Ghobrial ◽  
Thana Theofanis ◽  
Bruce V. Darden ◽  
Paul Arnold ◽  
Michael G. Fehlings ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Spinal Surgery ◽  
Retrospective Studies ◽  
Degenerative Disease ◽  
Open Approach ◽  
Lumbar Surgery ◽  
Lumbar Degenerative Disease ◽  
Medline Search ◽  
Lumbar Spinal Surgery ◽  
Lumbar Spinal

OBJECT Unintended durotomy is a common occurrence during lumbar spinal surgery, particularly in surgery for degenerative spinal conditions, with the reported incidence rate ranging from 0.3% to 35%. The authors performed a systematic literature review on unintended lumbar spine durotomy, specifically aiming to identify the incidence of durotomy during spinal surgery for lumbar degenerative conditions. In addition, the authors analyzed the incidence of durotomy when minimally invasive surgical approaches were used as compared with that following a traditional midline open approach. METHODS A MEDLINE search using the term “lumbar durotomy” (under the 2015 medical subject heading [MeSH] “cerebrospinal fluid leak”) was conducted on May 13, 2015, for English-language medical literature published in the period from January 1, 2005, to May 13, 2015. The resulting papers were categorized into 3 groups: 1) those that evaluated unintended durotomy rates during open-approach lumbar spinal surgery, 2) those that evaluated unintended durotomy rates during minimally invasive spine surgery (MISS), and 3) those that evaluated durotomy rates in comparable cohorts undergoing MISS versus open-approach lumbar procedures for similar lumbar pathology. RESULTS The MEDLINE search yielded 116 results. A review of titles produced 22 potentially relevant studies that described open surgical procedures. After a thorough review of individual papers, 19 studies (comprising 15,965 patients) pertaining to durotomy rates during open-approach lumbar surgery were included for analysis. Using the Oxford Centre for Evidence-Based Medicine (CEBM) ranking criteria, there were 7 Level 3 prospective studies and 12 Level 4 retrospective studies. In addition, the authors also included 6 studies (with a total of 1334 patients) that detailed rates of durotomy during minimally invasive surgery for lumbar degenerative disease. In the MISS analysis, there were 2 prospective and 4 retrospective studies. Finally, the authors included 5 studies (with a total of 1364 patients) that directly compared durotomy rates during open-approach versus minimally invasive procedures. Studies of open-approach surgery for lumbar degenerative disease reported a total of 1031 durotomies across all procedures, for an overall durotomy rate of 8.11% (range 2%–20%). Prospectively designed studies reported a higher rate of durotomy than retrospective studies (9.57% vs 4.32%, p = 0.05). Selected MISS studies reported a total of 93 durotomies for a combined durotomy rate of 6.78%. In studies of matched cohorts comparing open-approach surgery with MISS, the durotomy rates were 7.20% (34 durotomies) and 7.02% (68), respectively, which were not significantly different. CONCLUSIONS Spinal surgery for lumbar degenerative disease carries a significant rate of unintended durotomy, regardless of the surgical approach selected by the surgeon. Interpretation of unintended durotomy rates for lumbar surgery is limited by a lack of prospective and cohort-matched controlled studies.

A Review of Techniques, Time Demand, Radiation Exposure, and Outcomes of Skin-anchored Intraoperative 3D Navigation in Minimally Invasive Lumbar Spinal Surgery

Spine ◽  
2020 ◽  
Vol 45 (8) ◽  
pp. E465-E476 ◽  
Author(s):  
Avani S. Vaishnav ◽  
Robert K. Merrill ◽  
Harvinder Sandhu ◽  
Steven J. McAnany ◽  
Sravisht Iyer ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Radiation Exposure ◽  
Spinal Surgery ◽  
3D Navigation ◽  
Lumbar Spinal Surgery ◽  
Lumbar Spinal

scholarly journals Objective evaluation of postoperative changes in real-life activity levels in the postoperative course of lumbar spinal surgery using wearable trackers

2019 ◽  
Author(s):  
Masahiro Inoue ◽  
Sumihis Orita ◽  
Kazuhide Inage ◽  
Miyako Suzuki ◽  
Kazuki Fujimoto ◽  
...  
Keyword(s):  
Spinal Surgery ◽  
Therapeutic Effects ◽  
Activity Levels ◽  
Lumbar Surgery ◽  
Preoperative Period ◽  
Spinal Disease ◽  
Activity Tracker ◽  
Postoperative Changes ◽  
Lumbar Spinal Surgery ◽  
Lumbar Spinal

Abstract Background: Lumbar spinal disease causes disability in daily activities. Operative treatments are aimed at pain relief and rapid return to routine activity. Patient-based outcome measures are used to evaluate pathology and therapeutic effects associated with lumbar spinal disease. However, it remains unknown how much such treatment improves the activity levels. The purpose of current study was to evaluate the changes in activity levels before and after lumbar spinal surgery using a wearable activity tracker and to compare the relationship between the results and the patient-based outcomes. Methods: Sixty patients who underwent lumbar surgery were studied. The physical activity of participants was objectively evaluated using a wearable Micro-Motion logger system (Actigraph). We measured the amount of activity before and at 1, 3, 6, and 12 months after the surgery to evaluate postoperative changes. Additionally, Japanese Orthopaedic Association Back Pain Evaluation Questionnaire, Oswestry Disability Index, Roland-Morris Disability Questionnaire and Visual analog scale were measured as a patient-based outcomes of pain and ADL-related scores and the corresponding relationships with the actual activity levels were evaluated. Results: The amount of actual activity decreased significantly 1 month after the surgery compared to that during the preoperative period, which then improved after 3 months postoperatively ( p < 0.01). Furthermore, there was a significant improvement 6 months after the surgery compared to that during the preoperative period ( p < 0.05). Moreover, the change in activity amount for each period was strongly correlated, regardless of the period. In contrast, a significant improvement was observed at 1 month after the surgery in almost all items of the patient-based questionnaires ( p < 0.05). Conclusions: The objective activity tracker demonstrated that lumbar surgery results in the amount of activity decreasing 1 month just after the surgery followed by gradual postoperative recovery within 3 months. In contrast, patient-based outcomes showed improvement in 1 month, which was significantly different from the change in actual activity, indicating the gap between the patient-oriented clinical score and their actual activities.

204. A review of time-demand, radiation exposure and outcomes of skin-anchored intraoperative 3D navigation in minimally invasive lumbar spinal surgery

2019 ◽  
Vol 19 (9) ◽  
pp. S98-S99
Author(s):  
Avani S. Vaishnav ◽  
Yahya A. Othman ◽  
Steven J. McAnany ◽  
Sravisht Iyer ◽  
Todd J. Albert ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Radiation Exposure ◽  
Spinal Surgery ◽  
3D Navigation ◽  
Lumbar Spinal Surgery ◽  
Lumbar Spinal

scholarly journals Objective evaluation of postoperative changes in real-life activity levels in the postoperative course of lumbar spinal surgery using wearable trackers

2020 ◽  
Author(s):  
Masahiro Inoue ◽  
Sumihis Orita ◽  
Kazuhide Inage ◽  
Miyako Suzuki ◽  
Kazuki Fujimoto ◽  
...  
Keyword(s):  
Spinal Surgery ◽  
Therapeutic Effects ◽  
Activity Levels ◽  
Lumbar Surgery ◽  
Preoperative Period ◽  
Spinal Disease ◽  
Activity Tracker ◽  
Postoperative Changes ◽  
Lumbar Spinal Surgery ◽  
Lumbar Spinal

Abstract Background: Lumbar spinal disease causes disabilities in performing daily activities. Operative treatments are aimed at pain relief and rapid return to routine activity. Patient-based outcome measures are used to evaluate pathologies and therapeutic effects associated with lumbar spinal disease. Nevertheless, it remains unknown as to how much such treatment improves activity levels.The purpose of the current study was to measure changes in activity levels before and after lumbar spinal surgery using a wearable activity tracker and to analyze the differences between results and patient-based outcomes.Methods: Sixty patients who underwent lumbar surgery were studied. The physical activity of participants was objectively evaluated using a wearable Micro-Motion logger system (Actigraph). We measured the amount of activity before and at 1, 3, 6, and 12 months after the surgery to evaluate postoperative changes. The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire, Oswestry Disability Index, Roland-Morris Disability Questionnaire and visual analog scale were used to assess patient-based outcomes of pain and activities of daily living-related scores; we analyzed the relationships between scores and actual activity levels. Results: The amount of actual activity decreased significantly 1 month after the surgery compared to that during the preoperative period, which then improved after 3 months postoperatively (p <0.01). Furthermore, there was a significant improvement 6 months after the surgery compared to that during the preoperative period (p < 0.05). The changes in activity for each period were strongly correlated, regardless of the period. In contrast, a significant improvement was observed at 1 month after the surgery in almost all items of the patient-based questionnaires (p < 0.05).Conclusions: The objective activity tracker demonstrated that lumbar surgery results in the amount of activity decreasing 1 month just after surgery followed by gradual postoperative recovery within 3 months. By contrast, patient-based outcomes showed improvement in 1 month that was significantly different from the change in actual activity, indicating a gap between patient-oriented clinical scores and their actual activities.

scholarly journals Objective evaluation of postoperative changes in real-life activity levels in the postoperative course of lumbar spinal surgery using wearable trackers

2020 ◽  
Author(s):  
Masahiro Inoue ◽  
Sumihis Orita ◽  
Kazuhide Inage ◽  
Miyako Suzuki ◽  
Kazuki Fujimoto ◽  
...  
Keyword(s):  
Spinal Surgery ◽  
Therapeutic Effects ◽  
Activity Levels ◽  
Lumbar Surgery ◽  
Preoperative Period ◽  
Spinal Disease ◽  
Activity Tracker ◽  
Postoperative Changes ◽  
Lumbar Spinal Surgery ◽  
Lumbar Spinal

Abstract Background: Lumbar spinal disease causes disabilities in performing daily activities. Operative treatments are aimed at pain relief and rapid return to routine activity. Patient-based outcome measures are used to evaluate pathologies and therapeutic effects associated with lumbar spinal disease. Nevertheless, it remains unknown as to how much such treatment improves activity levels. The purpose of the current study was to measure changes in activity levels before and after lumbar spinal surgery using a wearable activity tracker and to analyze the differences between results and patient-based outcomes. Methods: Sixty patients who underwent lumbar surgery were studied. The physical activity of participants was objectively evaluated using a wearable Micro-Motion logger system (Actigraph). We measured the amount of activity before and at 1, 3, 6, and 12 months after the surgery to evaluate postoperative changes. The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire, Oswestry Disability Index, Roland-Morris Disability Questionnaire and visual analog scale were used to assess patient-based outcomes of pain and activities of daily living-related scores; we analyzed the relationships between scores and actual activity levels. Results: The amount of actual activity decreased significantly 1 month after the surgery compared to that during the preoperative period, which then improved after 3 months postoperatively ( p <0.01). Furthermore, there was a significant improvement 6 months after the surgery compared to that during the preoperative period ( p < 0.05). The changes in activity for each period were strongly correlated, regardless of the period. In contrast, a significant improvement was observed at 1 month after the surgery in almost all items of the patient-based questionnaires ( p < 0.05). Conclusions: The objective activity tracker demonstrated that lumbar surgery results in the amount of activity decreasing 1 month just after surgery followed by gradual postoperative recovery within 3 months. By contrast, patient-based outcomes showed improvement in 1 month that was significantly different from the change in actual activity, indicating a gap between patient-oriented clinical scores and their actual activities.

scholarly journals Objective evaluation of postoperative changes in real-life activity levels in the postoperative course of lumbar spinal surgery using wearable trackers

2020 ◽  
Author(s):  
Masahiro Inoue ◽  
Sumihis Orita ◽  
Kazuhide Inage ◽  
Miyako Suzuki ◽  
Kazuki Fujimoto ◽  
...  
Keyword(s):  
Spinal Surgery ◽  
Therapeutic Effects ◽  
Activity Levels ◽  
Lumbar Surgery ◽  
Preoperative Period ◽  
Spinal Disease ◽  
Activity Tracker ◽  
Postoperative Changes ◽  
Lumbar Spinal Surgery ◽  
Lumbar Spinal

Abstract Background: Lumbar spinal disease causes disabilities in performing daily activities. Operative treatments are aimed at pain relief and rapid return to routine activity. Patient-based outcome measures are used to evaluate pathologies and therapeutic effects associated with lumbar spinal disease. However, it remains unknown how much such treatment improves the activity levels. The purpose of current study was to evaluate the changes in activity levels before and after lumbar spinal surgery using a wearable activity tracker and to compare the relationship between the results and the patient-based outcomes. Methods: Sixty patients who underwent lumbar surgery were studied. The physical activity of participants was objectively evaluated using a wearable Micro-Motion logger system (Actigraph). We measured the amount of activity before and at 1, 3, 6, and 12 months after the surgery to evaluate postoperative changes. Additionally, the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire, Oswestry Disability Index, Roland-Morris Disability Questionnaire and Visual analog scale were used to assess patient-based outcomes of pain and ADL-related scores and the corresponding relationships with the actual activity levels were evaluated. Results: The amount of actual activity decreased significantly 1 month after the surgery compared to that during the preoperative period, which then improved after 3 months postoperatively (p < 0.01). Furthermore, there was a significant improvement 6 months after the surgery compared to that during the preoperative period (p < 0.05). Moreover, the change in activity amount for each period was strongly correlated, regardless of the period. In contrast, a significant improvement was observed at 1 month after the surgery in almost all items of the patient-based questionnaires (p < 0.05). Conclusions: The objective activity tracker demonstrated that lumbar surgery results in the amount of activity decreasing 1 month just after surgery followed by gradual postoperative recovery within 3 months. In contrast, patient-based outcomes showed improvement in 1 month, which was significantly different from the change in actual activity, indicating the gap between the patient-oriented clinical score and their actual activities.

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