Every month, JBJS publishes a Specialty Update—a review of the most pertinent and impactful studies published in the orthopaedic literature during the previous year in 13 subspecialties. Click here for a collection of all OrthoBuzz Specialty Update summaries.
This month, OrthoBuzz asked Theodore Choma, MD and Darrel Brodke, MD, co-authors of the June 15, 2016 Specialty Update on spine surgery, to select the five most clinically compelling findings from among the more than 40 studies they cited.
Antifibrinolytics
–A Level-I meta-analysis of 11 RCTs showed that tranexamic acid significantly lowered perioperative blood loss and transfusion requirements during spine surgery, with no associated increased incidence of heart attack or pulmonary embolism.1
Adult Spinal Deformity
–An analysis of prospective registry data from 766 adult patients with spinal deformity found that health-related quality-of-life scores for those patients prior to any intervention were lower than pre-intervention scores for patients with arthritis, chronic lung disease, diabetes, and congestive heart failure. The authors concluded that the global burden of spinal deformity warrants research and health-policy attention comparable to that given to other high-burden conditions.2
Lumbar Spine
–A double-blind RCT of patients presenting to the emergency department with acute nonradicular low back pain found no difference in one-week disability scores among three groups: those given naproxen + cyclobenzaprine; those given naproxen + oxycodone/acetaminophen; and those given naproxen + placebo. The findings led the authors to conclude that adding those drugs to naproxen provides no clinical benefit.3
–A post-hoc analysis of SPORT data focused on patients ≥80 years old with degenerative spondylolisthesis found that operative treatment conferred a significant benefit relative to nonoperative treatment. The researchers found no significant increases in postoperative complication or mortality rates in this patient population compared with younger post-op patients.
Spine Fractures
–A 16- to 22-year follow-up of a previous randomized trial of 47 patients from the 1990s who had been randomized to operative or nonoperative treatment after a stable thoracolumbar burst fractures found that those treated nonoperatively had less pain and better function than those who had been treated operatively.
References
- Cheriyan T,Maier SP 2nd., Bianco K, Slobodyanyuk K, Rattenni RN, Lafage V, Schwab FJ, Lonner BS, Errico TJ. Efficacy of tranexamic acid on surgical bleeding in spine surgery: a meta-analysis. Spine J. 2015Apr 1;15(4):752-61. Epub 2015 Jan 21.
- Pellisé F, Vila-Casademunt A, Ferrer M, Domingo-Sàbat M, Bagó J, Pérez Grueso FJ, Alanay A, MannionAF, Acaroglu E;European Spine Study Group, ESSG. Impact on health related quality of life of adult spinal deformity (ASD) compared with other chronic conditions. Eur Spine J. 2015 Jan;24(1):3-11. Epub 2014 Sep 14.
- Friedman BW, Dym AA, Davitt M, Holden L, Solorzano C, Esses D, Bijur PE, Gallagher EJ. Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for treating acute low back pain: a randomized clinical trial. JAMA. 2015 Oct 20;314(15):1572-80.