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Background: Opioid use in North America has increased rapidly in recent years. Preoperative opioid use is associated with several negative outcomes. Our objectives were to assess patterns of opioid use over time in Canadian patients who undergo spine surgery and to determine the effect of spine surgery on 1 -year postoperative opioid use. Methods: A retrospective analysis was performed on prospectively collected data from the Canadian Spine Outcomes and Research Network for patients undergoing elective thoracic and lumbar surgery. Self-reported opioid use at baseline, before surgery and at 1 year after surgery was compared. Baseline opioid use was compared by age, sex, radiologic diagnosis and presenting complaint. All patients meeting eligibility criteria from 2008 to 2017 were included. Results: A total of 3134 patients provided baseline opioid use data. No significant change in the proportion of patients taking daily (range 32.3%-38.2%) or intermittent (range 13.7%-22.5%) opioids was found from pre-2014 to 2017. Among patients who waited more than 6 weeks for surgery, the frequency of opioid use did not differ significantly between the baseline and preoperative time points. Significantly more patients using opioids had a chief complaint of back pain or radiculopathy than neurogenic claudication (p < 0.001), and significantly more were under 65 years of age than aged 65 years or older (p < 0.001). Approximately 41% of patients on daily opioids at baseline remained so at 1 year after surgery. Conclusion: These data suggest that additional opioid reduction strategies are needed in the population of patients undergoing elective thoracic and lumbar spine surgery. Spine surgeons can be involved in identifying patients taking opioids preoperatively, emphasizing the risks of continued opioid use and referring patients to appropriate evidence-based treatment programs. Contexte : En Amerique du Nord, l'utilisation d'opioldes a augmente rapidement dans les dernieres annees. La prise d'opio'ides en periode preoperatoire est associee a plusieurs issues negatives. Cette etude visait a evaluer l'evolution des tendances dans l'utilisation d'opio'ides des patients canadiens ayant subi une chirurgie spinale, et de determiner les effets de la chirurgie sur leur utilisation 1 an apres l'operation. Methodes : Une analyse retrospective a ete realisee a partir de donnees recueillies de maniere prospective par le Canadian Spine Outcomes and Research Network pour les patients ayant subi une chirurgie thoracique ou une chirurgie spinale elective. On a compare l'utilisation autodeclaree d'opio'ides au debut du suivi, avant la chirurgie et 1 an apres la chirurgie. L'utilisation d'opio'ides au depart a ete comparee selon le sexe, l'age, le diagnostic radiologique et le motif de consultation. Entre 2008 et 2017, tous les patients satisfaisant aux criteres d'admissibilites ont ete inclus dans l'etude. Resultats : Au total, 3134 patients ont fourni des donnees sur leur prise d'opioldes au debut du suivi. Il n'y avait pas de changement significatif dans la proportion de patients utilisant quotidiennement (32,3 % a 38,2 %) ou occasionnellement (13,7 % a 22,5 %) des opioldes entre les patients a l'etude avant 2014 et ceux a l'etude de 2014 a 2017. Parmi les patients qui ont attendu plus de 6 semaines avant la chirurgie, la frequence de la prise d'opioldes n'a pas change de maniere significative entre le debut du suivi et la rencontre preoperatoire. Une proportion significativement plus grande de patients qui utilisaient des opioldes consultaient principalement pour des douleurs au dos ou une radiculopathie que pour une claudication neurogene (p < 0,001), et il y avait une proportion significativement plus grande de patients de moins de 65 ans qui utilisaient des opioldes que de patients de 65 ans ou plus (p < 0,001). Environ 41 % des patients qui prenaient quotidiennement des opioldes au depart le faisaient aussi 1 an apres la chirurgie. Conclusion : Ces donnees suggerent que des strategies supplementaires de reduction de l'utilisation d'opioldes sont necessaires pour les patients qui subissent une chirurgie thoracique ou une chirurgie spinale elective. Il est possible de demander aux chirurgiens specialises dans ce domaine de reperer les patients qui prennent des opioldes avant l'operation, puisque l'utilisation prolongee comporte des risques, et de les aiguiller vers un programme de traitement adequat et fonde sur des donnees probantes., Opioid use has increased rapidly in the last 20 years in the United States and Canada. (1-3) While previous studies have suggested opioids are safe and efficacious in patients with [...]

Lumbar stiffness leads to greater hip dependence to achieve sagittal motion and increases instability after total hip arthroplasty (THA). We aimed to determine parameters that influence lumbar stiffness among patients with hip pathology. We hypothesized that modifiable (degenerative changes, spinal canal stenosis, facet orientation) and nonmodifiable factors (muscle condition) would be associated with lumbar spine stiffness. In this retrospective case‐cohort study from a tertiary referral center, consecutive patients presenting at a hip specialist clinic underwent standing and deep‐seated radiographic assessment to measure lumbar lordosis (∆LL) (stiffness: ∆LL < 20°), hip flexion (∆PFA: pelvic femoral angle), and degree of degenerative‐disc‐disease (DDD) (facet osteoarthritis, disc height, endplate proliferative changes). Of these, 65 patients were selected with previous lumbar spine magnetic resonance imaging, allowing to determine lumbar facet orientation, spinal canal stenosis (Schizas classification), and flexor‐ and extensor‐muscle atrophy (Goutallier classification). Mean ∆LL was 45° (range: 11°–72°) and four patients (6%) exhibited spine stiffness. Patients with multilevel DDD (n = 22) had less ∆LL than those with no/single level (n = 43) DDD (34° [range: 11°–53°] vs. 51° [21°–72°]; p < 0.001). Number of DDD levels correlated strongly with ∆LL (ρ = −0.642; p < 0.001). Spinal stiffness was only seen in patients with ≥4 DDD levels. There was no correlation between ∆LL and facet orientation (p > 0.05). ∆LL correlated strongly with extensor atrophy at L3–L4 (ρ = −0.473), L4–L5 (ρ = −0.520), and L5–S1 (ρ = −0.473) and poorly with flexors at L4–L5 (ρ = −0.134) and L5–S1 (ρ = −0.227). Lumbar stiffness is dependent on modifiable (muscle atrophy) and nonmodifiable (extend of DDD) factors. This can guide nonoperative management of hip pathology, emphasizing the relevance of core muscle rehabilitation to improve posture and stiffness. Identification ≥4 DDD levels should alert surgeons of increased THA instability risk. Level of evidence: level IV, cohort series. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective analysis was performed of a multi-center Canadian Spine Outcomes and Research Network (CSORN) surgical database. Objective: To determine the rate and time to return to work (RTW) based on workload intensity after elective degenerative lumbar spine surgery. Methods: Patients working pre-operatively, aged greater than 18, who underwent a primary one- or two-level elective lumbar spine surgery for degenerative conditions between January 2015 and October 2020 were evaluated. The percentage of patients who returned to work at 1 year and the time to RTW post-operatively were analyzed based on workload intensity. Results: Of the 1290 patients included in the analysis, the overall rate of RTW was 82% at 1 year. Based on workload there was no significant difference in time to RTW after a fusion procedure, with median time to RTW being 10 weeks. For non-fusion procedure, the sedentary group had a statistically significantly quicker time to RTW than the light-moderate (P <.005) and heavy-very heavy (<.027) groups. Conclusions: The rate of RTW ranged between 84% for patients with sedentary work to 77% for patient with a heavy-very heavy workload. Median time to resumption of work was about 10 weeks following a fusion regardless of work intensity. There was more variability following non-fusion surgeries such as laminectomy and discectomy reflecting the patient's job demands. [ABSTRACT FROM AUTHOR]

Traumatic spinal cord injuries (TSCI) greatly affect the lives of patients and their families. Prognostication may improve treatment strategies, health care resource allocation, and counseling. Multivariable clinical prediction models (CPMs) for prognosis are tools that can estimate an absolute risk or probability that an outcome will occur. We sought to systematically review the existing literature on CPMs for TSCI and critically examine the predictor selection methods used. We searched MEDLINE, PubMed, Embase, Scopus, and IEEE for English peer-reviewed studies and relevant references that developed multivariable CPMs to prognosticate patient-centered outcomes in adults with TSCI. Using narrative synthesis, we summarized the characteristics of the included studies and their CPMs, focusing on the predictor selection process. We screened 663 titles and abstracts; of these, 21 full-text studies (2009-2020) consisting of 33 distinct CPMs were included. The data analysis domain was most commonly at a high risk of bias when assessed for methodological quality. Model presentation formats were inconsistently included with published CPMs; only two studies followed established guidelines for transparent reporting of multivariable prediction models. Authors frequently cited previous literature for their initial selection of predictors, and stepwise selection was the most frequent predictor selection method during modelling. Prediction modelling studies for TSCI serve clinicians who counsel patients, researchers aiming to risk-stratify participants for clinical trials, and patients coping with their injury. Poor methodological rigor in data analysis, inconsistent transparent reporting, and a lack of model presentation formats are vital areas for improvement in TSCI CPM research. [ABSTRACT FROM AUTHOR]