Spine surgery outcome in patients who sought compensation after a motor vehicle accident: a retrospective cohort study.

BACKGROUND: Back and neck pain are common after road traffic injury and are treated by spine surgery in some cases. This study aimed to describe the outcomes of spine surgery in people who made an insurance claim after road traffic accidents without an associated spinal fracture or dislocation. METHODS: This study was a retrospective cohort based on insurers' data of Compulsory Third Party (CTP) claims. File audit and data extraction were undertaken using a study-specific proforma. Primary outcomes were ongoing pain and symptoms, complications, return to work and pre-injury duties, and ongoing treatment 2 years following spine surgery. Secondary outcomes were health care costs based on data provided by the insurers. RESULTS: After screening 766 files, 90 cases were included (female: 48; mean age: 46 years). Among the subjects who were working prior the injury, the rate of return to work was 37% and return to pre-injury duties was 23% 2 years following the surgery. The average number of appointments with health care professionals in the 1 year after surgery was 21, compared to 10 for the 1 year prior to surgery (p = 0.03). At 2 years following the initial surgery, 21% of claimants had undergone revision spine surgery; 68% reported ongoing back pain and 41% had ongoing radicular symptoms. The difference between costs 1 year before and after surgery (excluding surgical costs) was statistically significant (p = 0.04). Fusions surgery was associated with higher total costs than decompression alone. After adjusting for surgery type, lumbar surgery was associated with higher costs in the 1 year after surgery and total surgical costs compared to cervical surgery. CONCLUSIONS: The majority of claimants continued having clinical symptoms, continued using health care and did not return to work despite undertaking spine surgery.

Surgical management of recurrent lumbar disc herniation and the role of fusion.

This systematic review was performed to evaluate the various operative management strategies for recurrent lumbar disc herniation (RLDH), including the efficacy of instrumented spinal fusion (ISF) at repeat discectomy, and whether the operative approach for repeat discectomy, minimally invasive (MID) or conventional open discectomy (CD), affected the outcomes. RLDH is one of the most common complications of lumbar discectomies. Whilst repeat discectomy is the standard procedure performed, the routine addition of ISF has been advocated to improve outcomes and prevent reherniation. A comprehensive search of the MEDLINE, EMBASE, CINAHL and Cochrane databases was performed. The measured outcomes included the rate of satisfactory clinical outcome, improvement in leg and back pain, Japanese Orthopaedic Association (JOA) recovery score, and complication rates. In total, 37 studies met our inclusion criteria, with 1483 patients. The rate of satisfactory outcomes was found to be statistically similar between the patients undergoing a discectomy with or without fusion (77.8% with ISF versus 79.5% without ISF; p=0.665). Back pain and JOA scores showed greater improvements in the patients undergoing discectomy and fusion, compared to discectomy alone. The rate of satisfactory outcomes was marginally higher in the patients undergoing MID compared to CD (MID 81.2% versus CD 77.5%; p=0.248). However, the leg pain improvement was similar. The postoperative back pain improvement was greater in the MID group (52.5% MID versus 36.3% CD), but with lower complication rates, specifically durotomies (MID 5.2% versus CD 15.3%; p<0.001). There is no evidence to recommend the routine addition of ISF in the management of RLDH. The data suggest that MID has lower complication rates than CD in the setting of RLDH, yet unequivocal evidence is lacking.

Peripheral venous and arterial blood gas analysis in adults: are they comparable? A systematic review and meta-analysis.

Peripheral venous blood gas (PVBG) analysis is increasingly being used as a substitute for arterial blood sampling; however, comparability has not been clearly established. To determine if the pH, PCO2 and PO2 obtained from PVBG analysis is comparable with arterial blood gas (ABG) analysis. A search was conducted of electronic databases as well as hand-searching of journals and reference lists through December 2012 to identify studies comparing PVBG with ABG analysis in adult subjects. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. A meta-analysis using a random effects model was used to calculate the average difference (bias) and the limits of agreement for the venous and arterial pH, PCO2 and PO2 . A total of 18 studies comprising 1768 subjects were included in the meta-analysis. There was considerable heterogeneity between studies with I(2) approaching 100%. There was little difference between the pH obtained from the PVBG and the ABG, with the arterial pH typically 0.03 higher than the venous pH (95% confidence interval 0.029-0.038). The venous and arterial PCO2 were not comparable because the 95% prediction interval of the bias for venous PCO2 was unacceptably wide, extending from -10.7 mm Hg to +2.4 mm Hg. The PO2 values compared poorly, the arterial PO2 typically 36.9 mm Hg greater than the venous with significant variability (95% confidence interval from 27.2 to 46.6 mm Hg). PVBG analysis compares well with ABG analysis for pH estimations in adults but not to the PCO2 or PO2 . These differences are sufficiently large to be of clinical significance.