What’s New in Spine Surgery 2020

Every month, JBJS publishes 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 OrthoBuzz summaries of these “What’s New” articles. This month, co-author Jacob M. Buchowski, MD, selected the 5 most clinically compelling findings from the >30 studies summarized in the June 17, 2020 “What’s New in Spine Surgery.

Adult Spinal Deformity
A recent randomized controlled trial compared operative vs nonoperative treatment among 63 adult patients with symptomatic lumbar scoliosis. An additional 223 patients were included in an observational arm of the study. At 2 years, 64% of the randomized patients in the nonoperative group had crossed over to the operative group. In an as-treated analysis, surgery was associated with superior improvement, but the high crossover rate precludes making firm comparative conclusions.

Spinal Cord Injuries
—A small study of 3 subjects1 who had sustained a spinal cord injury investigated the delivery of spatially selective stimulation to posterior nerve roots innervating the lumbosacral spinal cord through an implantable pulse generator with real-time triggering capability. This method reestablished adaptive control over previously paralyzed muscles, and subjects were eventually able to walk or bike during spatiotemporal stimulation.

Cervical Myelopathy
—A prospective study of >700 patients with degenerative cervical myelopathy2 examined the impact of surgical management on neck pain outcomes. Using the Neck Disability Index at baseline and at 6, 12, and 24 months postoperatively, researchers found significant improvement in functional and pain scores that met or exceeded the minimum clinically important difference at all follow-up time points.

Lumbar Stenosis
—A retrospective study of >1,800 patients with symptomatic lumbar stenosis3 investigated whether pain improvements could be obtained surgically with decompression alone without fusion. At 1 year after surgery, decompression alone was associated with significant improvement in all patient-reported outcomes, suggesting that a concomitant fusion may not be required in such cases.

Opioid Consumption
—A retrospective study of nearly 29,000 patients4 examined the effects of chronic preoperative opioid therapy on medium- and long-term outcomes after lumbar arthrodesis surgery. Postoperatively, chronic opioid use prior to surgery was associated with an increased risk of 90-day emergency department visits and prolonged 1- and 2-year narcotic use.

References

  1. Wagner FB, Mignardot JB, Le Goff-Mignardot CG, Demesmaeker R, Komi S, Capogrosso M, Rowald A, Se´añez I, Caban M, Pirondini E, Vat M, McCracken LA, Heimgartner R, Fodor I, Watrin A, Seguin P, Paoles E, Van Den Keybus K, Eberle G, Schurch B, Pralong E, Becce F, Prior J, Buse N, Buschman R, Neufeld E, Kuster N, Carda S, von Zitzewitz J, Delattre V, Denison T, Lambert H, Minassian K, Bloch J. Courtine G. Targeted neurotechnology restores walking in humans with spinal cord injury. Nature. 2018 Nov;563(7729):65-71. Epub 2018 Oct 31.
  1. Schneider MM, Tetreault L, Badhiwala JH, Zhu MP, Wilson J, Fehlings MG. 42. The impact of surgical decompression on neck pain outcomes in patients with degenerative cervical myelopathy: results from the multicenter prospective AOSpine studies. Spine J. 2019 Sep;19(9):S21.
  2. Bech-Azeddine R, Fruensgaard S, Andersen M, Carreon LY. 215. Outcomes of decompression without fusion in patients with lumbar spinal stenosis with back pain. Spine J. 2019 Sep;19(9):S106.
  3. Eisenberg JM, Kalakoti P, Hendrickson NR, Saifi C, Pugely AJ. 142. Impact of preoperative chronic opioid therapy on long-term outcomes, reoperations, complications and resource utilization after lumbar arthrodesis. Spine J. 2019 Sep; 19(9):S68-9.

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