Spinal News International Issue 51 – May 2019

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May

Issue

19 51 Francis Lovecchio: Opioid consumption patterns

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Eric Lamoutte: The effects of day of surgery

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Cages in ACDF are associated with a higher non-union rate than allograft Investigators found a higher rate of non-union associated with intervertebral cages than with allograft in a recent retrospective analysis, which led to the conclusion that allograft may be superior to cages in anterior cervical discectomy and fusion (ACDF). This research, by Sean Pirkle (Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago Medical Center, Chicago, USA) and colleagues, was recently published in Spine.

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he investigators note that in recent years, the use of an intervertebral cage in anterior discectomy and arthrodesis has gained popularity. Concurrently, attention has been given to the use of either bone graft or cages during this procedure, as well as the occurrence of non-union, which the authors mention can lead to “poor clinical outcome and the need for revision surgery, whether posterior or anterior, presenting an additional risk to the patient”. Pirkle and colleagues remark that the increased prevalence of cage use, alongside the negative effects of non-union for the patient, make this a necessary and timely study. The authors describe the research as a retrospective database review of 6,130 patients registered in the PearlDiver national database through Humana Insurance from 2007–2016. All ACDF patients with anterior plating who were active in the database for at least one year were included in the study. Pirkle and colleagues excluded patients with a fracture history within one year of intervention, past arthrosis of hand, foot, or ankle, or a planned posterior approach. Patients were stratified by number of levels treated, tobacco use, and diabetic condition. Non-union rates

The non-resorbable nature of the intervertebral cage may represent a literal block for fusion formation. ”

Ronald Bartels:

Profile

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Advanced method of quantifying the cone of economy may allow practitioners to determine appropriate treatment options A new method to quantify the boundaries of Dubousset’s cone of economy, the centre of mass displacements, and the amount of sway within the cone of economy along with the energy expenditure for a specific patient, has been developed and evaluated by Ram Haddas and Isador Lieberman of the Texas Back Institute (Plano, USA).

of structural allograft and intervertebral cage groups after one year were then compared using Chi-squared analyses. The investigators report that 4,063 patients were included in an allograft treatment group, while 2,067 were included in a cage treatment group. Overall, they found that non-union rates were “significantly higher” in the cage group (5.32%) than in the allograft group (1.97%) and when controlling for confounders, they observed increased rates of non-union in the cage group, achieving statistical significance in 25 of the 26 analyses. Pirkle and colleagues comment: “Although the non-

LIEBERMAN RECENTLY PRESENTED the results of this study at the 19th Annual Conference of the International Society for the Advancement of Spine Surgery (ISASS; 3–5 April, Anaheim, USA). Haddas and Lieberman set out to evaluate this method to quantify the dimensions of the cone of economy and the energy expenditure associated with maintaining a balanced posture within the cone of economy in adult degenerative scoliosis (ADS) patients compared to matched non-scoliotic controls. They note that ADS patients exhibit a variety of postural changes within their cone of economy, involving the spine, pelvis and lower extremities, in their effort to compensate for the altered posture. They defined balance as the ability of the human body to maintain its centre of mass within the base of support with minimal postural sway, and note that the cone of economy refers to the stable region of upright standing posture. In general, though, the brain, through the righting reflex, will sacrifice focal Continued Continued on page on page 2 2

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