Generating the American Shoulder and Elbow Surgeons Score Using Multivariable Predictive Models and Computer Adaptive Testing to Reduce Survey Burden.

Background: The preferred patient-reported outcome measure for the assessment of shoulder conditions continues to evolve. Previous studies correlating the Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive tests (CATs) to the American Shoulder and Elbow Surgeons (ASES) score have focused on a singular domain (pain or physical function) but have not evaluated the combined domains of pain and physical function that compose the ASES score. Additionally, previous studies have not provided a multivariable prediction tool to convert PROMIS scores to more familiar legacy scores.

Knee Disarticulations Versus Transfemoral Amputations: Functional Outcomes.

Objectives: To determine whether there is a patient-reported functional difference between combat-related knee disarticulations (KDs) and transfemoral amputations (TFAs).

Setting: Role 3 Military Trauma Centers.

Patients: We identified and contacted all KDs and TFAs performed at the Walter Reed National Military Medical Center, Walter Reed Army Medical Center, and National Naval Medical Center from January 2003 until July 2012 to participate in a retrospective functional cohort analysis.

Effects of rod reduction on pedicle screw fixation strength in the setting of Ponte osteotomies.

Background Context: The use of a rod reduction device can have deleterious consequences on pedicle screw pullout strength (POS) in the thoracic spine. However, posterior-only osteotomies in the thoracic spine are often performed to improve flexibility of the spine and offset forces of deformity correction maneuvers.

Purpose: To investigate the effect on pedicle screw POS caused by the rod reduction technique in the presence of facet osteotomies in the thoracic spine.

Pedicle screw reinsertion using previous pilot hole and trajectory does not reduce fixation strength.

Study Design: Fresh-frozen human cadaveric biomechanical study.

Objective: To evaluate the biomechanical consequence of pedicle screw reinsertion in the thoracic spine.

Summary Of Background Data: During pedicle screw instrumentation, abnormal appearance on fluoroscopic imaging or low current reading with intraoperatively evoked electromyographic stimulation of a pedicle screw warrants complete removal to reassess for pedicle wall violation or screw malposition.

The effect of cervical posterior foraminotomy on segmental range of motion in the setting of total disc arthroplasty.

Study Design: Human cadaveric biomechanical analysis.

Objective: To investigate the effect on cervical spine segmental stability that results from a posterior foraminotomy after cervical disc arthroplasty (CDA).

Summary Of Background Data: Posterior foraminotomy offers the ability to decompress cervical nerves roots while avoiding the need to extend a previous fusion or revise an arthroplasty to a fusion.

Systematic review and meta-analysis of minimally invasive transforaminal lumbar interbody fusion rates performed without posterolateral fusion.

The need for posterolateral fusion (PLF) in addition to interbody fusion during minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF) has yet to be established. Omitting a PLF significantly reduces overall surface area available for achieving a solid arthrodesis, however it decreases the soft tissue dissection and costs of additional bone graft. The authors sought to perform a meta-analysis to establish the fusion rate of MIS TLIF performed without attempting a PLF.

Pedicle screw "hubbing" in the immature thoracic spine: a biomechanical and micro-computed tomography evaluation.

Background: A previous biomechanical study using adult thoracic vertebrae (both normal and osteoporotic bone density) demonstrated the deleterious effect of the pedicle screw hubbing technique. Pedicle screw "hubbing" involves seating and engaging the ventral aspect of the screw head onto the dorsal lamina cortex. This technique is postulated to provide a load-sharing effect by improving pullout resistance, as well as decreasing cephalocaudad toggling and implant loosening.

A model to predict limb salvage in severe combat-related open calcaneus fractures.

Background: Open calcaneus fractures can be limb threatening and almost universally result in some measure of long-term disability. A major goal of initial management in patients with these injuries is setting appropriate expectations and discussing the likelihood of limb salvage, yet there are few tools that assist in predicting the outcome of this difficult fracture pattern.

Questions/purposes: We developed two decision support tools, an artificial neural network and a logistic regression model, based on presenting data from severe combat-related open calcaneus fractures.

Return to sports after surgery to correct adolescent idiopathic scoliosis: a survey of the Spinal Deformity Study Group.

Background Context: There are no guidelines for when surgeons should allow patients to return to sports and athletic activities after spinal fusion for adolescent idiopathic scoliosis (AIS). Current recommendations are based on anecdotal reports and a survey performed more than a decade ago in the era of first/second-generation posterior implants.

Purpose: To identify current recommendations for return to sports and athletic activities after surgery for AIS.

Incidence and morbidity of concomitant spine fractures in combat-related amputees.

Background Context: High-energy blasts are the most frequent cause of combat-related amputations in Operations Iraqi and Enduring Freedom (OIF/OEF). The nondiscriminating effects of this mechanism often result in both appendicular and axial skeletal injuries. Despite this recognized coincident injury pattern, the incidence and consequence of spine fractures in trauma-related combat amputees are unknown.

Outcomes following cervical disc arthroplasty in an active duty military population.

Symptomatic cervical radiculopathy is a common problem in the active duty military population and can cause significant disability leading to limited duty status and loss of operational readiness and strength. Based on their increasing experience with cervical disc arthroplasty (CDA) in this unique patient population, the authors set out to further evaluate the outcomes and complications of CDA in active duty military patients. A retrospective review of a single military tertiary medical center was performed between August 2008 and August 2012 and the clinical outcomes of patients who underwent cervical disc arthroplasty were evaluated.

Update on the evidence for adjacent segment degeneration and disease.

Background Context: The evidence surrounding the topic of adjacent segment degeneration and disease has increased dramatically with an abundant amount of literature discussing the incidence of and techniques to avoid it. However, this evidence is often confusing to discern because of various definitions of both adjacent segment degeneration and disease.

Purpose: To organize and review the recent evidence for adjacent segment degeneration and disease.

A systematic review of cervical artificial disc replacement wear characteristics and durability.

Study Design:  Systematic review.Clinical questions: (1) What evidence is available from studies of cervical total disc arthroplasty (C-ADR) failure and retrieval regarding durability, wear, and reasons for failure of C-ADR? (2) What evidence is available from experimental models regarding the durability of C-ADR beyond 5 years?

Methods:  We searched electronic databases to identify published reports of explanted cervical artificial discs and biomechanical simulations of disc wear.

Results:  Nine articles were identified describing 17 devices explanted from human patients and four articles describing 23 devices explanted from non-human subjects.

What is the best way to optimize thoracic kyphosis correction? A micro-CT and biomechanical analysis of pedicle morphology and screw failure.

Study Design: A human cadaveric biomechanical analysis.

Objective: The purpose of this study was to evaluate the bone density/trabecular width of the thoracic pedicle and correlate that with its resistance against compressive loading used during correction maneuvers in the thoracic spine (i.e.