Joseph C. Cauthen

A multicenter, prospective, randomized trial evaluating the X STOP interspinous process decompression system for the treatment of neurogenic intermittent claudication : Two-year follow-up results

Study Design. A randomized, controlled, prospective multicenter trial comparing the outcomes of neurogenic intermittent claudication (NIC) patients treated with the interspinous process decompression system (X STOP) with patients treated nonoperatively. Objective. To determine the safety and efficacy of the X STOP interspinous implant. Summary of Background Data. Patients suffering from NIC secondary to lumbar spinal stenosis have been limited to a choice between nonoperative therapies and decompressive surgical procedures, with or without fusion. The X STOP was developed to provide an alternative therapeutic treatment. Methods. 191 patients were treated, 100 in the X STOP group and 91 in the control group. The primary outcomes measure was the Zurich Claudication Questionnaire, a patient-completed, validated instrument for NIC. Results. At every follow-up visit, X STOP patients had significantly better outcomes in each domain of the Zurich Claudication Questionnaire. At 2 years, the X STOP patients improved by 45.4% over the mean baseline Symptom Severity score compared with 7.4% in the control group; the mean improvement in the Physical Function domain was 44.3% in the X STOP group and −0.4% in the control group. In the X STOP group, 73.1% patients were satisfied with their treatment compared with 35.9% of control patients. Conclusions. The X STOP provides a conservative yet effective treatment for patients suffering from lumbar spinal stenosis. In the continuum of treatment options, the X STOP offers an attractive alternative to both conservative care and decompressive surgery.

Economic impact of improving outcomes of lumbar discectomy

BACKGROUND Lumbar discectomy is usually a successful operation with a relatively low cost. Potential adjunctive procedures, such as repairing the anulus fibrosus or nucleus replacements, necessitate a cost-benefit analysis. PURPOSE This economic analysis was performed to understand the potential value of advanced implantable technologies designed to improve outcomes after discectomy. STUDY DESIGN/SETTING Using an insurance claims-based database, the economics of less-than-favorable outcomes after lumbar discectomy were studied. Estimates of improved clinical outcomes because of adjunctive surgical procedural items were modeled. PATIENT SAMPLE Using Current Procedural Terminology (CPT-4) codes and International Classification of Diseases, Clinical Modification procedure codes (ICD-9 CM), all lumbar discectomy patients were identified in a 6-month period from a large, 2002, commercially available claims-based data set representing 3.1 million insured lives. OUTCOME MEASURES Not applicable. METHODS Longitudinal data analysis from 3 years (2002-2004) of the database was performed for evidence of claims after the insureds discectomy (up to 18 months post) as a utilization estimate of surgical and medical treatment resultant of less-than-favorable outcomes. Incidence and cost of secondary operations, medical management, and complications were determined. Using these inputs, an economic model was generated to estimate the effect of improvement in discectomy outcomes. RESULTS Of the 494 patients who had a discectomy within a 6-month period, 137 (28%) had subsequent claims that suggested the outcome was less than favorable within 18 months. Patients whose insurance claims included codes for a second operation (n=52 patients with 56 operations; 11%) and patients being medically/nonsurgically managed (n=85, 17%) were studied. Average reimbursed charges incurred (2006 dollars) of repeated discectomy (80% of cases) was

Spinal Cord Compression Secondary to Extramedullary Hematopoiesis in Two Brothers

6,907 and for arthrodesis (20% of cases) was

Method and apparatus for the treatment of the intervertebral disc annulus

24,375. Average additional medical treatment cost to diagnose or manage poor outcome requiring another surgery was

Methods and devices for spinal disc annulus reconstruction and repair

3,365. Procedure-related complications within 40 days of surgery were evident in 15% of the group; with additional average cost to manage of

Spinal disc annulus reconstruction method and deformable spinal disc annulus stent

3,939. CONCLUSIONS Substantial cost associated with poor discectomy outcomes is often overlooked or underappreciated. Surgical technologies that can improve outcomes of discectomy by 50% to 70% thus improving patient quality of life can be overall cost-neutral between

Quality of life of lumbar stenosis-treated patients in whom the X STOP interspinous device was implanted

971 and

Apparatus and methods for the treatment of the intervertebral disc

1,655 additionally per patient.

Method and apparatus for the treatment of tissue

Case 1. A 40-year-old Negro man, previously reported by Sorsdahl, et al., 7 was initially admitted because of jaundice and anemia. He gave a history of having worked as a laborer until age 35 when he developed generalized weakness and palpitation. The symptoms could be relieved by frequent blood transfusions, but the patient found his exercise tolerance too low to continue work. Examination. Physical findings included hepato-splenomegaly, poor anal sphincter tone, urinary retention, and generalized weakness. The hematocrit was 30%, and the white blood cell count 9,500 with three normoblasts per 100 white cells. The reticulocyte count was 2%, and hemoglobin electrophoresis showed 2% A2 and 23% hemoglobin F. Liver function studies were consistent with obstructive jaundice. X-rays revealed bony changes of generalized reticular appearance with scattered areas of coarse rarefaction in the skull and vertebral bodies. An intrathoracic soft tissue mass, approximately 2 X 2 cm, was found in the region of T-9 and T-10. There was no evidence of bone erosion. The patient was discharged with a diagnosis of intrathoracic extramedullary he-