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Rani Nasser, Sanjay Yadla, Mitchell G. Maltenfort, James S. Harrop, D. Greg Anderson, Alexander R. Vaccaro, Ashwini D. Sharan and John K. Ratliff

T he incidence of complications in spinal surgery remains unclear. Authors of previous reports have surmised that between 10 and 20% of patients undergoing surgical spinal procedures suffer adverse events or complications. 29 , 51 , 53 Most spinal literature consists of retrospective analyses that are assumed to underestimate the complication incidence. In the present study we assessed the different rates of complications reported in prospective and retrospective analyses of spine surgery complications through a systematic review of the spine surgery

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Alan H. Daniels, Roy Ruttiman, Adam E. M. Eltorai, J. Mason DePasse, Bielinsky A. Brea and Mark A. Palumbo

M edical malpractice litigation increasingly affects the delivery and cost of health care. In 2014, malpractice payments totaled $3.9 billion in the United States. 18 , 20 The risk of malpractice encourages the defensive medicine practices of increased diagnostic testing, unnecessary referrals, and patient avoidance. 4 , 5 Neurosurgeons have the highest annual rate of malpractice claims of any medical specialty, with 19.1% of neurosurgeons facing a claim annually. 11 , 14 Spine surgery represents the majority of malpractice claims for neurosurgeons 9 and

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Kalil G. Abdullah, Edward C. Benzel and Thomas E. Mroz

distinct questions regarding treatment efficacy. In SPORT, the investigators compared surgical versus conservative management for common spinal disorders, and the randomized, controlled trials published in 2009 examined the benefits of vertebroplasty versus a sham procedure in the treatment of osteoporotic fractures. These were notable trials because 1) Class I evidence had been lacking in the field of spine surgery and 2) the authors applied a prospective study design to answer important and common clinical questions. However, none of these studies was an example of CER

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M. Sami Walid and Joe Sam Robinson Jr.

H ealth care costs in the US have been rising linearly in the past decades, surpassing $2.5 trillion in 2009. 7 With increasing frequency of surgical spine procedures in an era of economic restraint, 2 health care providers ever more struggle to keep up with health care costs. Previous research has suggested that comorbidities may increase the hospitalization cost of patients who undergo spine surgery. 8–10 To study the prevalence of major comorbidities among patients undergoing expensive spine procedures and to examine their impact on hospital cost, we

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Adib A. Abla, Joseph C. Maroon, Richard Lochhead, Volker K. H. Sonntag, Adara Maroon and Melvin Field

golf in the last 12 months. 6 Worldwide, this number is at least double and includes 10%–20% of the adult population. 15 Lower-back pain is often the first or second most common reason for patients to see a physician. Lower-back pain and its association with golf has been reported, 3 , 5 , 13 but the return to golf specifically after back or other spine surgery has not been studied. Cervical and lumbar surgeries, including fusion, are common procedures. In the 5-year period between 2002 and 2006, spine fusion procedures alone numbered 328,426 in 20% of community

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Marco V. Corniola, Bertrand Debono, Holger Joswig, Jean-Michel Lemée and Enrico Tessitore

of fast-track lumbar fusion procedures 32 have been published. As in abdominal surgery, the use of minimally invasive spine surgery (MISS) 33 preceded the introduction of ERAS in spine surgery. The essential aspects of ERAS in spine surgery are reviewed in this paper. Special consideration was given to the risks and benefits for patients and caregivers, as well as to the medical and economical aspects. Methods We systematically and comprehensively reviewed the published literature on ERAS using the search function in MEDLINE (US National Library of Medicine), the

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Nicolas Dea, Anne Versteeg, Charles Fisher, Adrienne Kelly, Dennis Hartig, Michael Boyd, Scott Paquette, Brian K. Kwon, Marcel Dvorak and John Street

al. reported on 942 consecutive patients admitted to a quaternary care referral center undergoing spinal surgery and found that 87% had at least one documented AE. 17 The patient population represented all admissions undergoing any type of spine surgery, either emergency or elective. Campbell et al. 3 prospectively studied 128 patients undergoing thoracic and/or lumbar spine surgery at the neurosurgical spine unit of a university hospital and documented AEs occurring within the first 30 days of the operative procedure. They found that 59.4% of the patients

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Peter G. Campbell, Sanjay Yadla, Jennifer Malone, Mitchell G. Maltenfort, James S. Harrop, Ashwini D. Sharan and John K. Ratliff

surgery, the authors demonstrated a consistent underreporting of complications in retrospective studies. 18 Few studies offer an unambiguous examination of perioperative complications through prospective study. The majority of prospective assessments in the spine literature are industry-sponsored device trials that limit their assessment to specific spinal implants in carefully selected surgical patients. 1 , 12 , 21 Prospective studies using an easily replicated complication definition while focusing on the complication incidence after spine surgery are limited

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Bhiken I. Naik, Thomas N. Pajewski, David I. Bogdonoff, Zhiyi Zuo, Pamela Clark, Abdullah S. Terkawi, Marcel E. Durieux, Christopher I. Shaffrey and Edward C. Nemergut

M ajor deformity correction spine surgery can be associated with significant perioperative blood loss. 12 , 16 This blood loss is related to multiple factors, including the number of surgically treated levels and osteotomies performed, primary versus repeat surgery, single versus staged procedures, and whether an anterior and/or posterior approach is performed. The risk of significant bleeding is further exacerbated in older patients because of a thin periosteum and wide vascular channels encountered in osteoporotic bone. 9 Norton et al., in a

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Mazin Elsarrag, Sauson Soldozy, Parantap Patel, Pedro Norat, Jennifer D. Sokolowski, Min S. Park, Petr Tvrdik and M. Yashar S. Kalani

A study of 95 patients undergoing colorectal surgery observed an increased sense of readiness for discharge (41st to 99th percentile), satisfaction with pain control (43rd to 98th percentile), and likelihood of the patient recommending the hospital (32nd to 89th percentile) in the ERAS group compared to the control group. 48 Given the apparent benefits of ERAS programs in other surgical disciplines, it is not surprising that its implementation in spine surgery is becoming increasingly common. Wainwright et al. 52 provided an excellent overview for recovery