Introduction: Ascribed to the accepted and published circumstances that effectuate fusion rates, the growing prevalence of the obesity, poor bone matrix and burgeoning chronic opioid use, currently burden the diminishing health of the complex spine patient. In this paper, the authors discuss current medical illnesses surrounding lumbar fusion failures, behaviors affecting surgical decisions, and the employed measures to effectuate the potential mishaps within this populace.

Methods: Observational, retrospective case review was performed on ten failed lumbar fusion cases. Exacting information on patient history as it related to the post-operative period, medication usage, causative events, as well as deviations from these treatment recommendations are cited. The denominator for this composition was the two hundred and forty lumbar fusion cases (n=240) completed over a two year period. Pseudoarthrosis rates as it normally occurs for this risk-adjusted populace is also presented. Intraoperative and follow-up X-rays are provided for discussed cases.

Results: Complex Spinal Practices either in academic or private practice setting subserve the patient populace of failed back syndromes and previously treated conditions. The 'higher acuity label' of these patients is demonstrated by the ongoing treatment of chronic disease processes or and an increased assigned ASA score. The vast majority of these patients' health habits, (n=10) had a deleteriously effect on the surgical outcome when a mishap befell the recovery.

Conclusions: The prevalence of falls with resultant surgical failure, appears to be on the rise comparing lumbar fusion patients twenty years ago to present. Patterned behavior and co-morbidities inclusive of osteopenia and chronic opioid use are more ubiquitous within this populace, necessitating pre-operative discussions as higher levels of risk clearly relate to less than desired surgical outcomes.

Patient Care: Changing Trends in Pain Management Fall Risk

Learning Objectives: Identifying High Risk Patients Bone Stimulators

References: 1. http://medicalxpress.com/news/2013-09-sharp-opioid-drugs-non-cancer-pain.html