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  • Author or Editor: Joel A. Finkelstein x
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Joel A. Finkelstein and Carolyn E. Schwartz

The purpose of this article is to review the current state of outcome measurement in spine surgery, with an emphasis on patient-reported outcome measures (PROMs). The commonly used generic and disease-specific outcome measures used in spinal surgery and research will be discussed. The authors will introduce the concepts of response shift and appraisal processes, which may affect the face validity of PROMs, as well as their interpretation over time. It is not uncommon for there to be a discrepancy between the observed and expected outcome, which is not wholly explainable by objective measures. Current work on understanding how appraisal affects outcome measurement will be discussed, and future directions will be suggested to facilitate the continued evolution of PROMs.

There has been an evolution in the way clinicians measure outcomes following spinal surgery. In moving from purely physical, objective measures to a growing emphasis on the patient’s perspective, spine surgery outcomes are better able to integrate the impact at multiple levels of relevant change. Appraisal concepts and methods are gaining traction as ways to understand the cognitive processes underlying PROMs over time. Measurement of appraisal is a valuable adjunct to the current spine outcome tools.

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Miriam Kim, Paul Nolan and Joel A. Finkelstein

Object. The 11th rib extrapleural—retroperitoneal approach offers an alternative means for access to the thoracolumbar junction. It provides excellent operative exposure without the need to transgress the diaphragm, resulting in less morbidity and reduced risk of pulmonary complications. This approach, however, has been dismissed by many surgeons offering the unsubstantiated criticism that it affords limited access. Thus far, only technical descriptions of the operative procedure are available in the literature, without documentation of the clinical outcomes of these patients.

In the current study the authors describe the 11th rib extrapleural—retroperitoneal approach to the thoracolumbar junction, and they evaluate the associated early and late morbidity in these patients.

Methods. From September 1996 to August 1999, the authors collected prospective data of consecutive patients who underwent surgery for a variety of pathological conditions of the thoracolumbar junction via this approach. In 26 consecutive patients requiring an anterior spinal procedure, lesions located between T-10 and T-11 were studied and followed for a mean period of 17 months (range 1–36 months). There were 13 men and 13 women whose mean age was 47 years (range 16–80 years), with the following pathological entities: trauma (13 cases), neoplasm (six cases), infection (two cases), and deformity (five cases). There were no cases of neurological deterioration. There were no significant pulmonary complications, and only one patient required insertion of a postoperative chest tube.

Conclusions. The 11th rib extrapleural—retroperitoneal approach was successfully used to treat patients with a variety of lesions in the thoracolumbar junction and was associated with little morbidity. The authors believe that previous criticism suggesting that this approach provides only limited access is unsubstantiated.