Becker's Spine Review

13 SPINE LEADERSHIP Neurosurgeons vs. Orthopedic Spine Surgeons: Is There a Difference in Spinal Fusion Outcomes? 5 Key Notes By Laura Dyrda A new article published in Spine examines the factors impacting 30-day perioper- ative outcomes for spinal fusion by specialty using the NSQIP database. ere were 9,719 patients who received spinal fusions by either or- thopedic surgeons or neurosurgeons in the American College of Surgeons' National Surgical Quality Improve- ment Program database between 2005 and 2011. Neurosurgeons treated 54 percent of the patients. e research- ers found: 1. Orthopedic surgeons performed more lumbar cases — 76 percent — versus neurosurgeons — 65 percent. 2. ere weren't statistically sig- nificant differences in the number of levels fused between orthopedic surgeons and neurosurgeons. e techniques both specialists chose were also similar. 3. Perioperative outcomes were simi- lar, for the most part, between ortho- pedic surgeons and neurosurgeons. e death rate, return to the oper- ating room and other complications associated with significant morbidity were similar. 4. Neurosurgeons had fewer oper- ations requiring blood transfusions — 8.3 percent — than orthopedic surgeons — 14.6 percent. e same was true when controlling for preop- erative hematocrit history of bleeding disorder, anatomic operation loca- tion, levels fused, operative technique, demographics and comorbidities. 5. e researchers concluded that both specialists had similar metrics for mortality, 30-day readmission and surgical site infection. "Observed differences in blood transfusion rates by specialty were noted, but the cause of this difference is unclear and war- rants further investigation to assess the impact of this difference, if any, on patient outcomes and cost," they concluded. n A new study published in Spine examines adjacent segment disease risk factors for patients 10 years or more after posterior lumbar interbody fusion. The study authors examined patients with disc degeneration and spinal stenosis on an MRI to identify risk factors for developing early-onset radiographical adjacent segment disease using the multivariate logistic regression analysis. The researchers found: 1. Ten years after surgery, the patients showed at the caudal-adjacent level: • Changes in disc height: 12 cases • Vertebral slip: 36 cases • Intervertebral angle on radiographs: 17 cases 2. At the cranial-adjacent level, increased disc degeneration was noticed in 62 cases and spinal stenosis worsened in 68 cases. 3. At the caudal-adjacent level, there was in- creased disc degeneration for 25 patients and worsening spinal stenosis in 12 cases 10 years after surgery. 4. There were 10 patients — 9.9 percent — who required reoperations. Eighty percent of the revision surgeries were performed more than five years after the initial surgery. 5. The researchers found high pelvic incidence was a risk factor for developing the early onset radiographical adjacent segment disease. "Obtaining appropriate lumbar lordosis in PLIF is important for preventing ASD," concluded the study authors. n Spinal Fusion After 10 Years: 5 Key Notes on Adjacent Segment Disease By Laura Dyrda

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