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Item Open Access A comparative study on the effect of age on Neck Disability Index improvement at 24 months after surgical intervention for cervical spondylotic myelopathy: a Quality Outcomes Database study.(Journal of neurosurgery. Spine, 2025-05) Porche, Ken; Sherrod, Brandon A; Rosero, Spencer; Chan, Andrew K; Shaffrey, Christopher I; Gottfried, Oren N; Bydon, Mohamad; Asher, Anthony L; Coric, Domagoj; Potts, Eric A; Foley, Kevin T; Wang, Michael Y; Fu, Kai-Ming; Virk, Michael S; Knightly, John J; Meyer, Scott; Upadhyaya, Cheerag D; Shaffrey, Mark E; Uribe, Juan S; Tumialán, Luis M; Turner, Jay D; Chou, Dean; Haid, Regis W; Mummaneni, Praveen V; Park, Paul; Bisson, Erica FObjective
Cervical spondylotic myelopathy (CSM) is often accompanied by neck pain, which, along with more recognized neurological deficits like motor and sensory changes, significantly impacts patients' quality of life. The authors examined whether age influences improvements in neck disability and related quality-of-life measures after surgery for CSM. Using the Neck Disability Index (NDI) as the primary outcome, they compared long-term outcomes at 24 months among patients aged ≥ 65, ≥75, and < 65 years, exploring the effects of surgical intervention on both pain-related disability and functional recovery in older adults.Methods
Using the Quality Outcomes Database, the authors conducted a detailed propensity score-matched analysis on cohorts aged ≥ 65 and ≥ 75 years compared with a < 65-year-old cohort while controlling for baseline NDI scores, other demographic variables, health status, underlying pathology, number of levels, indication for surgery, surgical approach, and type of surgery. Differences in NDI total and subdomain scores at 24 months postoperatively were the primary measures of improvement. Age-related variability in NDI differential was assessed. EQ-5D and calculated SF-6D were secondary measures.Results
Of the 1141 patients in the cohort (January 2016 to December 2018), 687 patients were < 65 years, 325 were 65 to < 75 years, and 129 were ≥ 75 years of age. After propensity score matching, 197 patients each were well matched in the ≥ 65-year (mean 71.4 years) and < 65-year (mean 55.3 years) cohorts; similarly, 57 patients each were matched in the ≥ 75-year (mean 78.3 years) and < 65-year (mean 55.8 years) cohorts. Improvements in NDI scores and subdomain scores, EQ-5D, and calculated SF-6D were consistent at 3, 12, and 24 months postoperatively across all cohorts. At 24 months, patients ≥ 65 years showed NDI score improvements (-14.7 ± 22.3) similar to those < 65 years (-13.0 ± 21.3, p = 0.454), and patients ≥ 75 years demonstrated NDI improvements (-15.0 ± 19.7) comparable to those < 65 years (-17.6 ± 20.4, p = 0.499). A sensitivity analysis for linear relationship found that NDI improvement was statistically greater in older patients (7.5 points every 30 years, p < 0.0001), but this difference was below the minimal clinically important difference. Other clinical outcomes were similar between cohorts.Conclusions
Surgical intervention for CSM yields substantial and similar improvements in NDI scores and other metrics among various age groups, including those aged at least 65 and 75 years. These results highlight the effectiveness of surgery across a broad patient demographic, underscoring its value in treating CSM irrespective of age.Item Open Access Gain of care independence following surgical intervention for cervical spondylotic myelopathy: a Quality Outcomes Database study.(J Neurosurg Spine, 2025-05-30) Agarwal, Nitin; Bisson, Erica F; Bydon, Mohamad; Asher, Anthony L; Chan, Andrew K; Wang, Michael Y; Haid, Regis W; Knightly, John J; Gottfried, Oren N; Shaffrey, Christopher I; Virk, Michael S; Shaffrey, Mark E; Park, Paul; Foley, Kevin T; Coric, Domagoj; Upadhyaya, Cheerag D; Potts, Eric A; Tumialán, Luis M; Fu, Kai-Ming G; Lavadi, Raj Swaroop; Johnson, Sarah E; Chou, Dean; Mummaneni, Praveen VOBJECTIVE: Chronic spinal degenerative diseases have been associated with reduced quality of life and dependency on others for personal needs and care. The change between preoperative and postoperative care dependency has yet to be explored in patients with cervical spondylotic myelopathy (CSM). In this retrospective study of a prospectively collected database, the authors evaluated the return to independence in performing self-care following surgical intervention for CSM. METHODS: The CSM dataset of the Quality Outcomes Database (QOD) Spine CORe study group was queried. Care dependency was assessed using the personal care component of the Neck Disability Index (NDI) questionnaire, having an ordinal scale from 0 to 5, with 5 representing the inability to independently perform activities of daily living. Numeric rating scale (NRS) scores for arm pain and neck pain were recorded at a 24-months postoperative follow-up. Multivariable logistic regression analyses were performed to identify baseline risk factors for an inability to care for oneself and the symptoms leading to care dependency at 24 months postoperatively. Satisfaction with surgery was measured using the 4-point North American Spine Society (NASS) index. RESULTS: Of the 1137 patients with CSM and baseline personal care scores, 167 (14.7%) were care dependent at baseline (NDI personal care score ≥ 3). Patients with care dependency at baseline were predominantly Medicare beneficiaries and had a high school or lower level of education. Long-term follow-up rates for this study were 82.5% for NDI, 84.8% for patient satisfaction with surgery, 82.4% for NRS arm pain, and 81.8% for NRS neck pain. Of the care-dependent patients, more than 80% became independently able to care for themselves by the 24-month follow-up. Patients with resolved care dependency at 24 months had demonstrated lower baseline NDI and NRS neck pain scores (p < 0.01 for both). Neck pain was significantly associated with care dependency at 24 months' follow-up (p < 0.01). Patients who reported improvement in their ability to care for themselves noted higher postoperative satisfaction (NASS score 1-2) at the 3-month (89.4% vs 80.2%, p < 0.01) and 24-month (88.2% vs 67.4%, p < 0.01) follow-ups. CONCLUSIONS: Fifteen percent of patients with CSM depended on others for care preoperatively. After surgery to treat CSM, 81.8% of those who had depended on others for care became independent. Patients with improvements in care dependency noted higher postoperative satisfaction at the 3-month and 24-month follow-ups. Patients with resolved care dependency on long-term follow-up had lower NDI and NRS neck pain scores at baseline. Surgery had a significant impact on patients' attainment of independence.Item Open Access Item Open Access Withaferin A reduces pulmonary eosinophilia and IL-25 production in a mouse model of allergic airways disease.(bioRxiv, 2024-08-26) Agner, Kevin; McQuade, Victoria L; Womble, Jack; Guttenberg, Marissa A; Phatak, Sanat; Ingram, Jennifer LSeveral studies report that ashwagandha, a traditional Ayurvedic supplement, has anti-inflammatory properties. Type 2 (T2) asthma is characterized by eosinophilic airway inflammation. We hypothesized that allergen-induced eosinophilic airway inflammation in mice would be reduced following administration of Withaferin A (WFA), the primary active phytochemical in Ashwagandha. C57BL/6J mice were given 10 total intra-peritoneal injections of 2 mg/kg WFA or vehicle control, concurrent with 6 total intranasal administrations of 50 μg house dust mite extract (HDM) or saline control over 2 weeks. We observed that treatment with WFA reduced allergen-induced peribronchial inflammation and airway eosinophil counts compared to mice treated with controls. In addition, we observed that treatment with WFA reduced lung levels of interleukin-25 (IL-25) but increased lung gene expression levels of its co-receptor, Il17ra, in HDM-challenged mice compared to HDM-challenged mice that received the vehicle control. This study pinpoints a potential mechanism by which WFA modulates allergen-induced airway eosinophilia via the IL-25 signaling pathway. Future studies will investigate the effects of WFA administration on lung eosinophilia and IL-25 signaling in the context of chronic allergen-challenge.Item Open Access ‘Rigid demand’: Economic imagination and practice in China’s urban housing market(Urban Studies, 2018-05) Wang, MengqiChina’s socialist market economy is predominated by strong state-owned sectors. In the real estate market, the government further controls land and regulates social services based on property ownership. But how do ordinary market actors perceive this configuration and strategise their economic practice accordingly? Based on 20 months of ethnographic fieldwork, this article explores buyers’ and estate agents’ imagination of and practice in the housing market with a focus on the folk concept of rigid demand. Rigid demand (gangxu) refers to the belief that people have to buy a home regardless of price. Presenting how people invoke a range of referents and contexts when talking about rigid demand, I show that common Chinese market actors understand and approach the housing market not as an end in itself but as a mechanism devised and maneuvered by big market players such as the government and developers. Furthermore, actors believe that the market has a social purpose and is susceptible to agentive interventions. Ultimately, I argue that the social representation of the socialist housing market constructs and contests the legitimacy of certain economic practices and influences market performance accordingly.Item Open Access Calculating Needs and Prescribing Properties: Chaiqian and the Commensuration of Value at Nanjing’s Urban Edge(Positions, 2022-08-01) Wang, MAbstract This article examines how local governments calculate and allocate compensation to displaced peasants in demolition-relocation projects, known as chaiqian 拆迁 (demolition and relocation projects), at the urban edge of eastern Nanjing. Based on twenty months of ethnographic fieldwork, this article shows that, contrary to popular imaginings, chaiqian in Nanjing do not exclude peasants from urban development but seek to exploit the uneven urban and rural property regimes and bring rural spaces, including people, real estate, and crops, into the urban system. The government-developer growth coalition, motivated by real estate–driven urban expansion, engineers this process with the aid of calculative technologies and protocols of commensuration. Moreover, technocrats such as chaiqian cadres and urban planners can never fully translate rural real estate into monetary value. They have to constantly update and negotiate protocols of calculation with property-owning villagers to solve emerging issues of commensuration. The villagers, on the other hand, engage with these technologies of valuation to raise claims to a larger share of wealth in chaiqian compensation. Demolition and relocation projects thus are not merely the execution of a developmental ideal but assemble urban accumulation as an ongoing process of value translation and transformation. They also show how urban accumulation at the edge of eastern Nanjing is a contested hegemonic process.Item Open Access The craft of urgency: performing prosperity, running capital, and the making of a buying crowd in home presales in Nanjing, China(Journal of Cultural Economy, 2020-07-03) Wang, MThis article examines home presales–the selling of future residential properties–at the urban fringe of Nanjing, China. It argues for an analytical focus on urgency as a temporal quality that creates the local housing market and facilitates urban accumulation. I examine how urgency, grounded in a linear imagination of urban development, motivates home presales for developers, estate agents, and homebuyers. In particular, to speed up the turnaround time of investment, developers conjure up a vision of prosperity by building extravagant sales centers to organize home presales. Estate agents working at the sales center organize promotional events to attract, register, and manage a buying crowd. If properly managed, the buying crowd could reach the size of a festival-like presale, whereby hundreds of apartments are sold within one day. Capital at the urban fringe accumulates through the synchronization of these activities in which the sales center crafts an affective temporality of transaction by cultivating and managing an exuberant buying crowd. The craft of urgency emphasizes the performative agencement that assembles the condition for urgency to come into being.Item Open Access Xiaoqu in Motion: Gated Housing Compounds and the Infrastructure of China’s Urban Biopolitics(Urbanities, 2025-05-31) Wang, MengqiItem Open Access It Takes a Village-Evolving Role for Dedicated Teams for COPD Management.(Respiratory care, 2025-05) MacIntyre, Neil RItem Open Access Fostering the Facilitator: Promoting Clinical Educators' Interprofessional Education Facilitation Skills and Socialization Using Exclusively Online Learning.(Journal of allied health, 2024-01) Key-Solle, Mikelle; Covington, Kyle; McGann, Kathleen A; Phillips, Beth C; Hudak, Nicholas MHealth professions educators can benefit from continuing education to more effectively facilitate interprofessional education (IPE) in clinical settings. Online learning formats enable broader participation and overcome barriers to in-person events, though few studies describe the most effective platforms and methods of online continuing education for this purpose. In the context of the COVID-19 pandemic, we developed a 6-week interactive online program implemented via an integrated online educational platform (OEP) to equip participants with knowledge and skills to better facilitate IPE in clinical settings. Program outcomes evaluation involved mixed-methods data analysis from OEP site usage statistics, pre/post-program surveys, pre/post program validated self-assessment surveys, and post-pro¬gram focus group. Twenty-four participants representing 5 professions from inpatient and outpatient clinical settings completed the program. Quantitative findings include statistically significant improvement in all of 11 measures of IPE knowledge and skills developed for this study, 4 of 9 socialization measures, and 7 of 18 facilitation measures. Qualitative findings include participants placing value on multiple modes of instruction, facilitated small group engagement, brief condensed asynchronous content, clear expectations of program time commitment, and detailed understanding of the OEP.Item Open Access Comments(Neurosurgery, 2017-09-01) Fatemi, P; Grant, GAbstract BACKGROUND: Blunt cerebrovascular injury is uncommon in the pediatric population; penetrating cerebrovascular injuries are even rarer and are thus poorly understood. OBJECTIVE: To describe the diagnosis and management of penetrating cerebrovascular injuries and describe outcomes of available treatment modalities. METHODS: Clinical and radiographic data were collected retrospectively from a multicenter trauma registry for children screened for cerebrovascular injury during 2003 to 2013 at 4 academic pediatric trauma centers. RESULTS: Among 645 pediatric patients evaluated with computed tomography angiography with blunt cerebrovascular injury, 130 also had a penetrating trauma indication. Seven penetrating cerebrovascular injuries were diagnosed in 7 male patients (mean age 12.4 years, range 12-18 years). Focal neurological deficit and concomitant intracranial injury were each seen in 2 patients. There were 2 intracranial carotid artery injuries, 4 extracranial carotid artery injuries, and 1 vertebral artery injury. The majority of injuries were higher than grade I (5/7; 71%): 2 were grade I, 1 grade II, 2 grade III, and 2 grade IV. The 2 patients with grade III injuries required open surgery, and 1 patient with a grade IV injury underwent endovascular treatment. Two patients suffered immediate stroke secondary to the penetrating cerebrovascular injury. There were no delayed neurological deficits from the penetrating injuries, and no patients died as a result of the injuries. CONCLUSION: This is the largest series of penetrating cerebrovascular trauma in the pediatric literature. Although rare, penetrating cerebrovascular injuries can be high-grade injuries that require urgent recognition and may require aggressive endovascular and/or open surgery for treatment.Item Open Access Operative vs Nonoperative Treatment for Adult Symptomatic Lumbar Scoliosis at 8-Year Follow-Up: A Nonrandomized Clinical Trial.(JAMA surgery, 2025-04) Smith, Justin S; Kelly, Michael P; Yanik, Elizabeth L; Baldus, Christine R; Pham, Vy; Ben-Israel, David; Lurie, Jon D; Edwards, Charles; Glassman, Steven D; Lenke, Lawrence G; Buchowski, Jacob M; Carreon, Leah Y; Crawford, Charles H; Lewis, Stephen J; Koski, Tyler; Lafage, Virginie; Gupta, Munish C; Kim, Han Jo; Ames, Christopher P; Bess, Shay; Schwab, Frank J; Shaffrey, Christopher I; Bridwell, Keith HImportance
Long-term follow-up studies of operative and nonoperative treatment of adult symptomatic lumbar scoliosis (ASLS) are needed to assess benefits and durability.Objective
To assess the durability of treatment outcomes for operative vs nonoperative treatment of ASLS.Design, setting, and participants
The Adult Symptomatic Lumbar Scoliosis 1 (ASLS-1) study was a multicenter, prospective study with randomized and observational cohorts designed to assess operative vs nonoperative ASLS treatment. Operative and nonoperative patients were compared using as-treated analysis of combined randomized and observational cohorts. Patients with ASLS aged 40 to 80 years were enrolled at 9 centers in North America. Data were analyzed from November 2023 to July 2024.Interventions
Operative and nonoperative treatment approaches.Main outcomes and measures
Primary outcomes measures were the Oswestry Disability Index (ODI) and Scoliosis Research Society 22 (SRS-22) at 2-, 5-, and 8-year follow-up.Results
The 286 enrolled patients (104 in the nonoperative group: median [IQR] age, 61.9 [54.4-68.8] years; 97 female [93%]; 182 in the operative group: median [IQR] age, 60.2 [53.5-66.6] years; 161 female [88%]) had follow-up rates at 2, 5, and 8 years of 90% (256 of 286), 70% (199 of 286), and 72% (205 of 286), respectively. At 2 years, compared with those in the nonoperative group, patients in the operative group had better ODI (mean difference = -12.98; 95% CI, -16.08 to -9.88; P < .001) and SRS-22 (mean difference = 0.57; 95% CI, 0.45-0.70; P < .001) scores, with mean differences exceeding the minimal detectable measurement difference (MDMD) for ODI (7) and SRS-22 (0.4). Mean differences at 5 years (ODI = -11.25; 95% CI, -15.20 to 7.31; P <.001; SRS-22 = 0.58; 95% CI, 0.44-0.72; P < .001) and 8 years (ODI = -14.29; 95% CI, -17.81 to -10.78; P <.001; SRS-22 = 0.74; 95% CI, 0.57-0.90; P < .001) remained as favorable as at 2 years without evidence of degradation. The treatment-related serious adverse event (SAE) incidence rates for operative patients at 2, 2 to 5, and 5 to 8 years were 22.24, 9.08, and 8.02 per 100 person-years, respectively. At 8 years, operative patients with 1 treatment-related SAE still had significant improvement, with mean treatment differences that exceeded MDMD (ODI = -9.49; 95% CI, -14.23 to -4.74; P < .001; SRS-22 = 0.62; 95% CI, 0.41-0.84; P < .001).Conclusions and relevance
Results of this nonrandomized clinical trial reveal that, on average, operative treatment for ASLS provided significantly greater clinical improvement than nonoperative treatment at 2-, 5- and 8-year follow-up, with no evidence of deterioration. Operative patients with a treatment-related SAE still maintained greater improvement than nonoperative patients. These findings suggest long-term durability of surgical treatment for ASLS and may prove useful for patient management and counseling.Trial registration
ClinicalTrials.gov Identifier: NCT00854828.Item Open Access Access to Physical Therapy in a Medically Underserved, Urban Community(Journal of Health Care for the Poor and Underserved, 2019) Huber, Gail M; Bitzer, Grant; Corazzi, Christopher; Fitzsimmons, Stephanie; Melissa, Horgan; Shelley, Jordan; Hollowell, Alescia; Healey, William EItem Open Access Spontaneous spinal epidural abscess in patients 50 years of age and older: a 15-year institutional perspective and review of the literature: clinical article.(Journal of neurosurgery. Spine, 2014-03) Adogwa, Owoicho; Karikari, Isaac O; Carr, Kevin R; Krucoff, Max; Ajay, Divya; Fatemi, Parastou; Perez, Edgar L; Cheng, Joseph S; Bagley, Carlos A; Isaacs, Robert EObject
A spinal epidural abscess (SEA) is a rare but severe infection requiring prompt recognition and management. The incidence of SEA has doubled in the past decade, owing to an aging population and to increased use of spinal instrumentation and vascular access. The optimal management of SEAs in patients 50 years of age and older remains a matter of considerable debate. In an older patient population with multiple comorbidities, whether intravenous antibiotics alone or in combination with surgery lead to superior outcomes remains unknown. The present study retrospectively analyzes cases of SEAs, in patients 50 years of age and older, treated at Duke University Medical Center over the past 15 years.Methods
Eighty-two patients underwent treatment for a spinal epidural abscess between 1999 and 2013. There were 46 men and 36 women, whose overall mean age (± SD) was 65 ± 8.58 years (range 50-82 years). The mean duration of clinical follow-up was 41.38 ± 86.48 weeks. Thirty patients (37%) underwent surgery for removal of the abscess, whereas 52 (63%) were treated more conservatively, undergoing CT-guided aspiration or receiving antibiotics alone based on the results of blood cultures. The correlation between pretreatment variables and outcomes was evaluated in a multivariate regression analysis.Results
Back pain and severe motor deficits were the most common presenting symptoms. Compared with baseline neurological status, the majority of patients (68%) reported being neurologically "better" or "unchanged." Twelve patients (15%) had a good outcome (7 [23%] treated operatively vs 5 [10%] treated nonoperatively, p = 0.03), while clinical status in 41 patients (50%) remained unchanged (10 [33%] treated operatively vs 31 [60%] treated nonoperatively, p = 0.01). Overall, 20 patients (25%) died (9 [30%] treated operatively vs 11 [21%] treated nonoperatively, p = 0.43). In a multivariate logistic regression model, an increasing baseline level of pain, the presence of paraplegia or quadriplegia on initial presentation, and a dorsally located SEA were independently associated with poor outcomes.Conclusions
The results of the study suggest that in patients 50 years of age and older, early surgical decompression combined with intravenous antimicrobial therapy was not associated with superior clinical outcomes when compared with intravenous antimicrobial therapy alone.Item Open Access Protocol for isolation of endothelial cells from adult mouse brain(STAR Protocols, 2025-06) Miglietta, Audrey G; David-Bercholz, Jennifer; Munji, Roeben N; Pulido, Robert S; Soung, Allison L; Terrando, Niccolò; Daneman, Richard; Yang, TingItem Open Access Porous Embodiment and Poetic Knowledge: An Emergent Dialogue Between a Puppetry Artist and a Neuroscientist(Leonardo, 2025-04-01) Tsaplina, Marina; White, Leonard EAbstract This article illustrates a collaboration-in-formation between a performing artist and a neuroscientist. The authors focus on the early clarification of cross-disciplinary language and their recognition of the frameworks, overlaps, and divergences between how puppetry animation and neuroscience approach body, breath, imagination, disability, embodiment, consciousness, and research itself. The authors briefly discuss the creative process in puppetry performance and ask questions about what normative assumptions exist in neuroscience and how they interface with the authors’ perspectives as researcher-practitioners.Item Open Access Preoperative serum albumin level as a predictor of postoperative complication after spine fusion.(Spine, 2014-08) Adogwa, Owoicho; Martin, Joel R; Huang, Kevin; Verla, Terence; Fatemi, Parastou; Thompson, Paul; Cheng, Joseph; Kuchibhatla, Maragatha; Lad, Shivanand P; Bagley, Carlos A; Gottfried, Oren NStudy design
Retrospective cohort study.Objective
To investigate the association between preoperative baseline serum albumin and postoperative surgical complication.Summary of background data
The prevalence of malnutrition in the hospitalized patient population has only been recently recognized. Preoperative hypoalbuminemia (serum albumin <3.5 g/dL) has been shown to be associated with increased morbidity and mortality rates. The prognostic implications and significance of hypoalbuminemia after spine fusion surgery remain unknown. In this study, we assess the predictive value of preoperative nutritional status (serum albumin level) on postoperative complication rates.Methods
The medical records of 136 consecutive patients undergoing spine fusion at Duke University Medical Center were reviewed. Preoperative serum albumin level was assessed on all patients and used to quantify nutritional status. Albumin less than 3.5 g/dL was recognized as hypoalbuminemia (malnourished). Patient demographics, comorbidities, and postoperative complication rates were collected. Patients were also stratified into 2 groups based on their cause, namely elective degenerative/deformity versus nonelective cases. The association between preoperative serum albumin level and postoperative complication was assessed via logistic regression analysis.Results
Overall, 40 (29.4%) patients experience at least 1 postoperative complication. Patients undergoing elective surgery had more complications based on preoperative albumin levels (malnourished patients: 35.7% vs. nourished patients: 11.7%, P = 0.03), whereas those undergoing nonelective surgery had similar complication rates (malnourished patients: 46.5% vs. nourished patients: 42.1%, P = 0.75). For patients undergoing elective spinal surgery, logistic regression with and without propensity score adjustment for risk factors, demonstrated that preoperative serum albumin level was a significant predictor of postoperative complications (OR: 4.21; 95% CI: 1.09-16.19; P = 0.04) and (OR: 4.54; 95% CI: 1.17-19.32; P = 0.04), respectively.Conclusion
Preoperative hypoalbuminemia is an independent risk factor for postoperative complications after elective spine surgery for degenerative and deformity causes, and should be used more frequently as a prognostic tool to detect malnutrition and risk of adverse surgical outcomes.Level of evidence
2.Item Open Access Psychosocial factors and surgical outcomes: are elderly depressed patients less satisfied with surgery?(Spine, 2014-09) Adogwa, Owoicho; Carr, Kevin; Fatemi, Parastou; Verla, Terence; Gazcon, Gustavo; Gottfried, Oren; Bagley, Carlos; Cheng, JosephStudy design
Longitudinal cohort study.Objective
In this study, we set out to assess the effect of preoperative depression on patient satisfaction after revision lumbar surgery.Summary of background data
Patient satisfaction ratings are increasingly being used in health care as a proxy for quality of care. In the elderly, affective disorders such as depression have been shown to influence patient-reported outcomes and self-interpretation of health status.Methods
A total of 69 patients aged 65 years or older undergoing revision neural decompression and instrumented fusion for same-level recurrent stenosis-associated back and leg pain were included in this study. Preoperative Zung self-rating depression score, comorbidities, and postoperative satisfaction with surgical care and outcome were assessed for all patients. Baseline and 2-year visual analogue scale (VAS)-leg pain, VAS-back pain, Oswestry Disability Index, Short Form-12 physical component score and Short Form-12 mental component score, as well as health-state utility (EuroQol 5D) were assessed. Factors associated with patient satisfaction after surgical procedures were assessed via multivariate logistic regression analysis.Results
Compared with baseline, there was a statistically significant improvement in VAS-back pain 2.76±2.73 (pseudarthrosis [1.94±2.81], adjacent segment disease [4.35±3.16]), same-level recurrent stenosis [2±2.23]), VAS-leg pain 2.66±4.12, (adjacent segment disease [2.24±4.46] and same-level recurrent stenosis [3±3.78]). Two-year Oswestry Disability Index improved after surgery for pseudarthrosis (4.05±7.65), adjacent segment disease (6±13.63) and same-level recurrent stenosis (4.54±5.97). In a multivariate logistical regression model, increasing preoperative Zung self-rating depression scale scores were independently associated with patient dissatisfaction 2 years after revision lumbar surgery, (P<0.001).Conclusion
This study demonstrates that independent of surgical effectiveness, baseline depression influence patient satisfaction with health care, 2 years after revision lumbar surgery. Quality improvement initiatives using patient satisfaction as a proxy for quality of care should account for patients' baseline depression as a potential confounder especially in this age group.Level of evidence
3.Item Open Access Negative pressure wound therapy reduces incidence of postoperative wound infection and dehiscence after long-segment thoracolumbar spinal fusion: a single institutional experience.(The spine journal : official journal of the North American Spine Society, 2014-12) Adogwa, Owoicho; Fatemi, Parastou; Perez, Edgar; Moreno, Jessica; Gazcon, Gustavo Chagoya; Gokaslan, Ziya L; Cheng, Joseph; Gottfried, Oren; Bagley, Carlos ABackground context
Wound dehiscence and surgical site infections (SSIs) can have a profound impact on patients as they often require hospital readmission, additional surgical interventions, lengthy intravenous antibiotic administration, and delayed rehabilitation. Negative pressure wound therapy (NPWT) exposes the wound site to negative pressure, resulting in the improvement of blood supply, removal of excess fluid, and stimulation of cellular proliferation of granulation tissue.Purpose
To assess the incidence of wound infection and dehiscence in patients undergoing long-segment thoracolumbar fusion before and after the routine use of NPWT.Study design
Retrospective study.Patient sample
One hundred sixty patients undergoing long-segment thoracolumbar spine fusions were included in this study.Outcome measures
Postoperative incidence of wound infection and dehiscence.Methods
All adult patients undergoing thoracolumbar fusion for spinal deformity over a 6-year period at Duke University Medical Center by the senior author (CB) were included in this study. In 2012, a categorical change was made by the senior author (CB) that included the postoperative routine use of incisional NPWT devices after primary wound closure in all long-segment spine fusions. Before 2012, NPWT was not used. After primary wound closure, a negative pressure device is contoured to the size of the incision and placed over the incision site for 3 postoperative days. We retrospectively review the first 46 cases in which NPWT was used and compared them with the immediately preceding 114 cases to assess the incidence of wound infection and dehiscence.Results
One hundred sixty (NPWT: 46 cases, non-NPWT: 114 cases) long-segment thoracolumbar spine fusions were performed for deformity correction. Baseline characteristics were similar between both cohorts. Compared with the non-NPWT cohort, a 50% decrease in the incidence of wound dehiscence was observed in the NPWT patient cohort (6.38% vs. 12.28%, p=.02). Similarly, compared with the non-NPWT cohort, the incidence of postoperative SSIs was significantly decreased in the NPWT cohort (10.63% vs. 14.91%, p=.04).Conclusions
Routine use of incisional NPWT was associated with a significant reduction in the incidence of postoperative wound infection and dehiscence.Item Open Access Clinical implication of complications on patient perceived health status following spinal fusion surgery.(Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia, 2015-02) Verla, Terence; Adogwa, Owoicho; Fatemi, Parastou; Martin, Joel R; Gottfried, Oren N; Cheng, Joseph; Isaacs, Robert EApproximately 2% to 16% of patients undergoing spinal surgery suffer adverse events or complications. There is a paucity of studies evaluating the impact of complications on long-term outcomes. The purpose of this study was to assess the long-term effects of surgical complications on patient functional improvement and overall health status, using a multi-institutional, prospective spine outcomes registry. A total of 1498 patients undergoing primary lumbar fusion for low back pain and/or radiculopathy between January 2003 and December 2010 were enrolled. All patients completed the Oswestry Disability Index (ODI), Medical Outcome Study Short Form 36 (SF-36), and back and leg pain numerical rating scores (Visual Analog Scale [VAS]) before surgery and at 1 and 2 years post-operatively. Patients were stratified based on the occurrence of a peri or post-operative complication, and by major versus minor complications. Baseline and 2 year clinical outcome scores were compared between cohorts. Both groups were similar at baseline. Complications occurred in 115 (7.68%) patients. The most common complications were cerebrospinal fluid leak (49.18%), bleeding requiring transfusion (13.11%) and nerve root injury (9.83%). Compared to baseline, there was no significant difference in the extent of functional improvement (ODI, VAS, SF-36) between both patient groups at 1 and 2 years post-operatively. Furthermore, there was no significant difference in outcome scores between patients with minor versus major complications. Within the context of an ongoing debate on the consequences of complications, we observed no lasting effect of complications on the patient's interpretation of overall health status and functional improvement at 1 and 2 years following elective lumbar spine surgery.