Managing the Complex Patient with Degenerative Cervical Myelopathy: How to Handle the Aging Spine, the Obese Patient, and Individuals with Medical Comorbidities.

Degenerative cervical myelopathy (DCM) is the most common cause of nontraumatic spinal cord injury worldwide. Even relatively mild impairment in functional scores can significantly impact daily activities. Surgery is an effective treatment for DCM, but outcomes are dependent on more than technique and preoperative neurologic deficits

A Brief History of Quality Improvement in Health Care and Spinal Surgery.

While medical and technological advances continue to shape and advance health care, there has been growing emphasis on translating these advances into improvement in overall health care quality outcomes in the United States. Innovators such as Abraham Flexner and Ernest Codman engaged in rigorous reviews of systems and patient outcomes igniting wider spread interest in quality improvement in health care. Codman\u27s efforts even contributed to the founding of the American College of Surgeons. This society catalyzed a quality improvement initiative across the United States and the formation of the Joint Commission on Accreditation of Hospitals. Since that time, those such as Avedis Donabedian and the Institute of Medicine have worked to structure the process of improving both the quality and delivery of health care. Significant advances include the defining of minimum standards for hospital accreditation, 7 pillars of quality in medicine, and the process by which quality in medicine is evaluated. All of these factors have affected current practice more each day. In a field such as spinal surgery, cost and quality measures are continually emphasized and led to large outcome databases to better evaluate outcomes in complex, heterogeneous populations. Going forward, these databases will be instrumental in developing practice patterns and improving spinal surgery outcomes

Surgical Site Infection: a Review

Infection of the spine may occur spontaneously, by direct hematogenous or contiguous spread from an area of infection, or secondarily to an inciting event such as trauma or spine operation. The overall rate of spine surgery has increased steadily over the last decade. Medicare spending on inpatient spine surgery has doubled over the same period with lumbar fusion representing the greatest percentage of spending.1 Surgical site infection (SSI) after spinal surgery is not uncommon, leading to increased morbidity and mortality. The incidence of surgical site infection after spine surgery varies and depends on several factors including immune status of patient, surgical level, use of instrumentation and use of prophylactic antibiotic treatment. Multivariate logistic regression analysis identifies increased age of patient, long-term systemic use of steroids, insulin dependent diabetes, obesity, positive smoking status, preoperative hematocrit, disseminated cancer, fusion and operative duration as statistically significant predictors of postoperative infection.2–4 The incidence of SSI is less than 3% with simple procedures such as decompressive laminectomy and/or diskectomy but the incidence increases to as high as 12% with the addition of instrumentation.5 The time of presentation of SSI can range from a couple of days post-surgery to several years after surgery

Incidence of fracture in adjacent levels in patients treated with balloon kyphoplasty: a review of the literature.

The available evidence suggests that the treatment of painful vertebral compression fractures (VCFs) secondary to osteoporosis or multiple myeloma, by cement augmentation with balloon kyphoplasty (BK), is both safe and effective. However, there is uncertainty in the literature concerning the potential of the procedure to influence the risk for adjacent segment fracture. The aim of this article is to review the available peer-reviewed literature, regarding adjacent vertebral body fractures after kyphoplasty augmentation

Improving Post-operative Educational Handouts After Spine Surgery

Background Problem Statement: After spine surgery, patients are given take home instructions which are outdated and provide limited answers to frequently asked questions. This leads to increased office calls and overnight calls to on-call physician. Project AIM: Improving educational handouts given to patients after spine surgery Aim is to analyze current handouts given to patients after spine surgery Identify frequently asked questions by patients after surger

Intramedullary Spinal Cord Metastases and Radiation Therapy: A Case Report

Intramedullary spinal cord metastases (ISCM) are a clinically rare, although devastating, complication of disseminated cancer. These lesions have been reported to originate from many types of solid tumors, although primary lung carcinoma, particularly small cell, is the most common etiology. These metastases, which can occur anywhere along the spinal cord, often represent the end-stage of the disease process with limited survival outcomes. Patients with ISCM may develop a variety of neurological deficits with treatment goals aimed at palliation. Different modalities of treatment have been found to preserve or restore ambulation and neurological function. The options for therapeutic intervention include surgical, chemotherapeutic, and radiation therapy. We describe a case of ISCM in a patient with disseminated small cell lung cancer with magnetic resonance imaging that illustrates a complete tumor response to radiation therap