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Andrew G. LEE

diffuse optic disc swelling (anterior ischemic optic neuropathy). Less commonly, it may occur with an optic disc that appears normal with no evidence of disc swelling (retrobulbar or posterior forms). Both anterior and posterior ischemic optic neuropathy have been reported after general surgical procedures, 1, 5–9 and one study in the ophthalmological literature 6 described four of these cases following lumbar spine surgery. The recognition and treatment of this entity, however, may not be widely appreciated by neurosurgeons. This report emphasizes that the

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Michael F. Shriver, Valerie Zeer, Vincent J. Alentado, Thomas E. Mroz, Edward C. Benzel and Michael P. Steinmetz

complications are transient, some result in permanent deficit and severe disability in patients undergoing lumbar spine surgery. 7 , 11 , 15 , 21 , 23 , 28 , 32 Thus, surgeons must be mindful of intraoperative patient positioning to relieve potentially harmful pressure upon susceptible structures. 4 Complications related to positioning during lumbar spine surgery are typically analyzed from an institutional perspective. 14 , 26 , 29 , 46 A systematic review of complications following the numerous positioning options for lumbar spine surgery has not been previously

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Jay M. Levin, Robert D. Winkelman, Joseph E. Tanenbaum, Edward C. Benzel, Thomas E. Mroz and Michael P. Steinmetz

satisfaction is particularly acute for common and costly procedures, which have the largest potential impact on hospital reimbursement. The incidence and cost of lumbar spine surgery are increasing in the United States. 4 , 8 , 22 , 25 , 28 For example, aggregate hospital charges for surgical treatment of lumbar stenosis has increased by 40% between 2002 and 2007, mostly attributed to the rising rate of complex fusions performed. Additionally, as the United States population continues to age, the prevalence of spinal stenosis, the most common indication for lumbar spine

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Francis Lovecchio, Jeffrey G. Stepan, Ajay Premkumar, Michael E. Steinhaus, Maria Sava, Peter Derman, Han Jo Kim and Todd Albert

common tenets of such interventions. Currently, the lack of knowledge regarding average postoperative opioid consumption following lumbar spine surgery inhibits the ability to form quantitative evidence-based guidelines. Arbitrarily assigning a number of pills to each surgery without high-quality data on opioid consumption patterns could run the risk of widespread uncontrolled pain or an abundance of unused pills. Thus, qualitative guidelines may prove effective in reducing the number of opioids prescribed at discharge. The purpose of the present study was to

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Padraic O'Neill, Christine Knickenberg, Senarath Bogahalanda and Anthony E. Booth

extradural catheter as proposed by others, 16, 18 and thereby diminish the potentially increased risk of postoperative infection caused by an indwelling catheter. We are therefore reporting our experience with the use of intrathecal morphine for postoperative pain relief following lumbar spine surgery in a double-blind trial in 24 patients. Clinical Material and Methods The investigation was approved by the ethics committee of Walsgrave Hospital, and the patient's informed consent was obtained in the preoperative period. All patients undergoing lumbar spine

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Yoshimasa Takahashi, Tetsuro Sato, Hironori Hyodo, Tomomaro Kawamata, Eiji Takahashi, Naohisa Miyatake and Masako Tokunaga

used at the time of durotomy. In 2010, Espiritu and colleagues 5 reported that the risk factors for durotomy were the surgeon's length of experience and the patient's age. The purpose of this study was to clarify the anatomical location of and the specific causative factors for durotomy during primary lumbar spine surgery. Methods We retrospectively reviewed 1014 consecutive cases involving patients who underwent a surgical procedure for the treatment of degenerative lumbar spinal disease at our institution between 2002 and 2008. These operations were

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Jeff Ehresman, Zach Pennington, Andrew Schilling, Ravi Medikonda, Sakibul Huq, Kevin R. Merkel, A. Karim Ahmed, Ethan Cottrill, Daniel Lubelski, Erick M. Westbroek, Salia Farrokh, Steven M. Frank and Daniel M. Sciubba

O f patients who undergo elective lumbar spine surgery annually in the United States, 1 approximately 17% of patients 2 will require allogeneic blood transfusion. Prior research has found allogeneic transfusion to be associated with higher complication rates, 2 , 3 , 33 including increases in the rates of surgical site infections, 4 thromboembolic events, 5 and kidney injuries. 6 Additionally, the use of allogeneic blood products is associated with significant increases in cost, reported to average between $526 per patient for anterior lumbar cases and

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Masahiro Kanayama, Tomoyuki Hashimoto, Keiichi Shigenobu, Fumihiro Oha and Daisuke Togawa

S urgical site infection is a devastating complication in spine surgeries, and appropriate prevention is a key to successful lumbar surgeries. The incidence of postoperative spinal infection increases with the complexity of the procedure and is reported as less than 1% in discectomy 6 , 14 and as high as 10% in instrumentation surgery. 2 , 12 The use of prophylactic antibiotics has been documented to reduce the rate of SSI. For example, the rate of SSI in lumbar spine surgery has been reported as 1 to 4% with prophylactic antibiotics and 6 to 13% without

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Ross C. Puffer, Ryan Planchard, Grant W. Mallory and Michelle J. Clarke

, Mallory. Critically revising the article: Clarke, Puffer, Mallory. Reviewed submitted version of manuscript: Clarke. Approved the final version of the manuscript on behalf of all authors: Clarke. Statistical analysis: Puffer, Mallory. Study supervision: Clarke. References 1 Andreshak TG , An HS , Hall J , Stein B : Lumbar spine surgery in the obese patient . J Spinal Disord 10 : 376 – 379 , 1997 2 Buerba RA , Fu MC , Gruskay JA , Long WD III , Grauer JN : Obese Class III patients at significantly greater risk of multiple

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Gabriel A. Smith, Steven Chirieleison, Jay Levin, Karam Atli, Robert Winkelman, Joseph E. Tanenbaum, Thomas Mroz and Michael Steinmetz

the profitability of healthcare systems and providers. With this payment system, hospitals and providers are incentivized to provide streamlined quality care, aiming for an inpatient LOS at or below the CMS-reported expected LOS. 9 While HCAHPS survey responses directly affect reimbursement and LOS impacts cost, little is known about whether LOS influences HCAHPS survey responses following lumbar spine surgery. Initial work examining whether LOS impacts patient-reported satisfaction with healthcare has revealed mixed results. Early studies of LOS and patient