Friday, 20 December 2013

Spinal Fusion for Adult Scoliosis: What Are Survival Rates?

An article recently published in The Spine Journal found that survival rate for primary spinal fusion in adult scoliosis patients was 89.8 percent at one year postoperatively.

The study examined 59 patients 21 years or older that underwent primary surgery for idiopathic or degenerative curves and were followed for minimum of two years postoperatively. Survival rate at three years was 73.4 percent and 64 percent at five years. At 10 years postoperatively, the survival rate was 60.9 percent.

Over the entire follow-up period, 35.6 percent of patients underwent revision surgery, with the most common reasons for the revision being:

•    Painful/prominent implants
•    Adjacent segment disease
•    Infection

A higher revision rate was found among American Society of Anesthesiologists Type II patients and double surgical approach patients.

Source : Becker's Spine Review , 16th Dec 2013 

Spine and Orthopedic Devices and Implants

Here are seven things for spine surgeons to know...

Budget bill would stall Medicare pay cut, raise physician pay 0.5%.

The House of Representatives passed a bipartisan budget last week that would impact Medicare payment cuts to physicians if passed by the Senate. Under the sustainable growth rate, Medicare announced it would cut physician pay 20.1 percent in 2014. The budget would postpone that pay cut rate until April 1, 2014 and give physicians a 0.5 percent raise during the interim period.

AAOS supports SGR repeal efforts.

The American Academy of Orthopaedic Surgeons supports the recent legislative efforts to repeal the sustainable growth rate. AAOS encouraged Congress to continue to repeal and replace the SGR formula as soon as possible.

Orthopedist compensation decreased by 10% from 2011 to 2012.

Compensation decreased by 10 percent or more than 10 percent for orthopedists from 2011 to 2012. Of the respondents, about 20 percent saw a 10 percent or more decrease and 32 percent saw compensation remain the same.

Spinal fusion survival rates for adult scoliosis as high as 89.8%.

An article recently published in The Spine Journal found the survival rate for primary spinal fusion in adult scoliosis patients was 89.8 percent at one year postoperatively.

Survival rate at three years was 73.4 percent and 64 percent at five years. Over the entire follow-up period, 35.6 percent of patients underwent revision surgery.

FDA committee called for Class 3 device designation on spinal sphere devices.

After meeting recently, a U.S. Food and Drug Administration committee agreed spinal sphere devices should be classified as Class 3 devices, which require premarket approval.

NuVasive announced US launch of ALIF column realignment device.

San Diego-based NuVasive's anterior column realignment device for anterior lumbar interbody fusion launched in the U.S. The ALIF ACR is tasked with correcting the sagittal plane imbalance that advanced degeneration can cause.

Dr. Richard Wohns among first to perform two-level cervical disc replacement using Mobi-C.

Richard Wohns, MD, JD, MBA, performed the first two-level cervical artificial disc replacement surgery in the Northwest and one of the first in the nation, using Mobi-C Cervical Disc Prosthesis.

Source : Becker's Spine Review , 17th Dec 2013

UI researchers: Bracing is effective in adolescents with idiopathic scoliosis

Longer daily wear is best to avoid surgery

A multi-center study led by University of Iowa researchers to determine whether wearing back braces would prevent the need for spinal correction surgery in children with adolescent idiopathic scoliosis (AIS) was cut short when early results were overwhelmingly in favor of bracing.

The study was published in the New England Journal of Medicine today (Sept. 19. 2013).

Stuart Weinstein, MD, Ignacio V. Ponseti Chair and Professor of Orthopaedic Surgery and Professor of Pediatrics at University of Iowa Children’s Hospital, and Lori Dolan, PhD, a research scientist in The Department of Orthopaedics and Rehabilitation at the UI Carver College of Medicine, led a study team that set out to compare the risk of curve progression in patients with AIS who wore a brace with patients who did not. The study team, from the Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST), recruited patients who were at risk for continued worsening of their spinal curves based on age, skeletal immaturity and curve severity.

AIS is a curvature of the spine with no clear underlying cause. In mild cases, monitoring over time by a physician may be all that is needed. However, in more severe cases – especially when the child is still growing – the use of a brace, or even surgery, may be recommended. Left untreated, more serious curves can be painful and deforming.

Weinstein has been working with scoliosis patients for nearly 40 years, and although bracing has been used as a treatment for curvature of the spine since 1948, he says there has always been some question as to whether it was truly an effective way to avoid surgery.

“The efficacy of bracing was never really proven,” he says. “I wasn’t sure if braces really worked or not, and I’ve treated thousands of patients.”

He says the literature about bracing “wasn’t convincing that it worked.” Additionally, he says, some patients still required surgery after wearing a brace.

For the study, investigators enrolled 383 subjects at 25 institutions in the United States and Canada between March 2007 and Feb 2011. Although the study began as a completely randomized clinical trial, the team eventually added a “preference cohort,” where patients and families could choose their own treatment. About 40 percent of study participants were randomly assigned to bracing or to close observation without bracing. The remaining participants made their own choice regarding bracing or observation.

Patients in the observation arm received no specific treatment, while those in the bracing arm were instructed to wear a brace for 18 hours per day. Treatment was considered to be unsuccessful when a curve progressed to 50 degrees or greater – a point at which surgery is typically recommended. Treatment was considered a success when the child reached the age of skeletal maturity without this degree of curve progression.

In January 2013, the trial was stopped early after finding that bracing significantly reduced the risk of curve progression and the need for surgery, and that more hours of brace wear was associated with higher success rates. Among both the randomized and preference cohorts, 72 percent in the bracing group, and 48 percent in the observation group achieved success. In addition, the results suggest that the more a patient wore the brace, the better the results; wearing a brace more than 13 hours per day was associated with success rates of 90 to 93 percent.

“This study definitely shows braces work and are effective in preventing the need for surgery,” Weinstein says. “Children who are at risk should be treated with a brace, and they should wear it at least 13 hours a day for it to be effective.”

According to the researchers, the findings are clinically relevant to patients for whom bracing would typically have been recommended. But until now, that recommendation had not been based on solid data. “This study presents important evidence addressing the fundamental question facing families and clinicians dealing with the diagnosis of AIS – does bracing prevent the need for surgery? The answer is clearly ‘yes’,” Weinstein says.

The investigators also suggest that current bracing indications may be too broad, since 48 percent of patients in the observation group and 41 percent of patients in the bracing group who wore the brace infrequently also achieved success. “Further analysis will help us identify those AIS patients for whom bracing may be the most beneficial,” Weinstein concludes.

Source : Yotta Fire , 17th Dec 2013