New: What's New in Spine Surgery?

In the following article "What's new in spine surgery, a perspective on latest approaches to treat cervical spinal deformity is discussed by Bridwell, KH et al, this is a very latest compilation of spine related works. At the bottom of this paper, the authors list some interesting recent works under the topic evidence based treatment in Orthopedic surgeries? in addition to their lengthy and useful reference list that will be of great interest to many.

The Journal of Bone and Joint Surgery (American). 2009;91:1822-1834.
doi:10.2106/JBJS.I.00488
© 2009 The Journal of Bone and Joint Surgery, Inc.

What's New in Spine Surgery

Keith H. Bridwell, MD¹, Paul A. Anderson, MD², Scott D. Boden, MD³, Alexander R. Vaccaro, MD⁴ and Jeffrey C. Wang, MD^{5 1} Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, Suite 11300 West Pavilion, Campus Box 8233, St. Louis, MO 63110. E-mail address: bridwellk@wudosis.wustl.edu

Many controversies still exist with regard to the surgical treatment of cervical spine pathology. The role of allograft, autograft, plate fixation, and bone morphogenetic protein is not entirely clear. There is still debate about the surgical treatment of myelopathy anteriorly as opposed to posteriorly. Clearly, there is substantial anatomic variation in the location of the vertebral artery. Disc arthroplasty for the cervical spine continues to appear to be a viable option for patients with single-level pathology.

Lumbar Fusion & Analgesic related Death?

In one of the latest issue of "Spine" (Spine: 1 April 2009 - Volume 34 - Issue 7 - pp 740-747doi: 10.1097/BRS.0b013e31819b2176Surgery), a study related to lumbar fusion and analgesic death been analyzed and reported. The authors claim that the risk of death was higher in those patients who received instrumentation and especially inter vertebral cage placement when compared to bone only fusion??. Though I have not heard any perioperative death or even serious consequences in huge number of spine cases we did in the recent past, this report is a caution to look into the analgesic effect spine fusion, streamlining the usage of analgesics that are less toxic is extremely important.

Mortality After Lumbar Fusion Surgery
Juratli, Sham Maghout MD, MPH; Mirza, Sohail K. MD, MPH; Fulton-Kehoe, Deborah PhD, MPH; Wickizer, Thomas M. PhD; Franklin, Gary M. MD, MPH

Abstract

Study Design. Retrospective population-based cohort study.

Objective. To describe mortality after lumbar fusion surgery in Washington State workers' compensation claimants in the perioperative period and beyond.

Summary of Background Data. Although lumbar fusion surgery can be associated with serious complications, perioperative mortality is generally considered rare. Population-based mortality estimates have been limited to surgery in older adults.

Methods. We identified all Washington State workers' compensation claimants who underwent fusion between January 1994 and December 2001 (n = 2378) and assessed the frequency, timing, and causes of death. Mortality follow-up was concluded in 2004. Death was ascertained from Washington State vital statistics records and from the workers' compensation claims database. Poisson regression was used to obtain age- and gender-adjusted mortality rates. Years of potential life lost, percent of potential life lost, and mean potential life lost were calculated for the leading 5 causes of death and we calculated the risk of death associated with selected predictors.

Results.

Among the 2378 lumbar fusion subjects in the study cohort, 103 were deceased by 2004. The 3-year cumulative mortality rate was 1.93% (95% confidence interval, 1.41%-2.57%). The 90-day perioperative mortality rate was 0.29% (95% confidence interval, 0.11%-0.60%). The risk of perioperative mortality was positively associated with repeat fusions. The age- and gender-adjusted all-cause mortality rate was 3.1 deaths per 1000 worker-years (95% confidence interval, 0.9-9.8).

Analgesic-related deaths were responsible for 21% of all deaths and 31.4% of all potential life lost.

The risk of analgesic-related death was higher among workers who received instrumentation or intervertebral cage devices compared with recipients of bone-only fusions (1.1% vs. 0.0%; P = 0.03) and among workers with degenerative disc disease (age- and gender-adjusted mortality rate ratio, 2.71) (95% confidence interval, 1.17-6.28).

The burden was especially high among subjects between 45 and 54 years old with degenerative disc disease (rate ratio, 7.45).

Conclusion. Analgesic-related deaths are responsible for more deaths and more potential life lost among workers who underwent lumbar fusion than any other cause. Risk of analgesic-related death was especially high among young and middle-aged workers with degenerative disc disease.

© 2009 Lippincott Williams & Wilkins, Inc.

BMP in Back surgery?:- What and Who?

Bone Morphogenic protein (BMP) is used in certain surgical procedures that involves lower lumbar surgery, but not in other procedures why?. Is BMP good compared to patients own bone transplantation or bone marrow substitute?. Right now it seems lime the FDA has approved BMP to be used only in lower lumbar cases such as L5-S1 procedures?. But, if BMP has anything to do with neurophysiological signals, not sure if there are any reports?.

Brain writes in this column about BMP, it's present usages and more...!. The full article can be read from his original site spine universe, click the topic for the link. 

BMP: The What and the Who

Brian R. Subach, MD, FACS
Neurosurgeon/Spine Surgeon
Virginia Spine Institute
Reston, VA

The title of this article asks two completely different but equally important questions. First, the "what." RhBMP-2 (recombinant bone morphogenetic protein, BMP) is a genetically engineered protein which both recruits bone forming cells to the surgical area and "turns on" local cells to the bone-making process. BMP is used for conditions requiring spinal fusion and stimulation of bone growth.