Anterioposterior Views Coupled With Lateral Views Are the Best for the Intraoperative Radiographic Detection of Retained Surgical Sponges.

Introduction: A retained sponge after spine surgery can cause serious medical complications and medicolegal problems. Intraoperative radiographs are commonly used to detect it. This study evaluated intraoperative radiographs under routine clinical conditions that most spine surgeons experience to detect retained sponges.

Removal of Spinal Instrumentation Is Not Required to Successfully Treat Postoperative Wound Infections in Most Cases.

Introduction: Controversy exists regarding whether spinal implants need to be removed to treat postoperative deep wound infections (DWIs). This retrospective study aimed to determine whether the removal or retention of implants impacts the successful treatment of a DWI after spine surgery.

Methods: Postoperative spine surgery patients presenting with signs of infection who underwent irrigation and debridement (I&D) at Twin Cities Spine Surgeons at Abbott Northwestern Hospital, Minnesota, USA, were studied.

Adding Vertebral Bone Quality to the Fusion Risk Score: Does It Improve Predictions of Postoperative Complications?

Study Design: Retrospective review of prospectively collected data.

Objective: The current study evaluates whether the addition of the Vertebral Bone Quality (VBQ) score to the Fusion Risk Score (FRS) improves its ability to predict perioperative outcomes.

Summary Of Background Data: The FRS was developed to assess preoperative risk in patients undergoing thoracic and lumbar fusions.

Moderate scoliosis continues to progress at 30-year follow-up: a call for concern?

Purpose: This natural history study reports long-term radiographic and clinical outcomes of patients with diagnosis of AIS with curves between 30° and 50°. Our purpose was to determine if any intervention in the natural history is warranted.

Methods: This was a longitudinal descriptive study at a single institution.

Provocative Discography: Diagnostic Efficacy and Safety in Symptomatic Degenerative Disk Disease.

Study Design: This was a retrospective cohort analysis.

Objective: The objective of this study was to report the efficacy and safety profile of provocative discography.

Summary Of Background Data: It is reported that the provocative discogram as a diagnostic test for symptomatic degenerative disk disease induces disk degeneration.

Choose Wisely: Surgical Selection of Candidates for Outpatient Anterior Cervical Surgery Based on Early Complications Among Inpatients.

Background: Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are attractive targets for transition to the outpatient setting. We assessed the prevalence of rapid responses and major complications in the inpatient setting following 1 or 2-level ACDFs and CDAs. We evaluated factors that may place patients at greater risk for a rapid response or a postoperative complication.

Does pelvic incidence tell us the risk of proximal junctional kyphosis in adult spinal deformity surgery?

Purpose: To investigate the relationship between pelvic incidence (PI) and proximal junctional kyphosis (PJK) in patients treated surgically for adult spinal deformity (ASD) with fusion from thoracolumbar junction to sacrum.

Methods: A consecutive series of ASD patients who underwent fusion from the thoracolumbar junction to the sacrum with a minimum of 2-year follow-up was studied. Patients were divided into low PI (≤ 50°) and high PI (> 50°) groups.

Vacuum-Assisted Wound Closure Management for Posterior Lumbar Spine Infections.

A postoperative infection involving the tissues deep to the fascia is defined as a deep wound infection (DWI). Management of such infections after lumbar spinal surgery remains a challenge. One strategy is the use of vacuum-assisted wound closure (VAC) which applies negative pressure to the wound to improve microcirculation and to promote the formation of granulation tissue.

Do Preoperative Nasal Antiseptic Swabs Reduce the Rate of Surgical Site Infections After Adult Thoracolumbar Spine Surgery?

Introduction: Surgical site infection (SSI) remains a major complication after adult spinal surgery. We investigated whether adding preoperative nasal decontamination by antiseptic swab (skin and nasal antiseptic povidone-iodine, SNA-PI) to our antimicrobial protocol reduces the SSI rate among our patients undergoing thoracolumbar spinal surgery.

Methods: We retrospectively reviewed all adult thoracolumbar spinal surgeries performed between June 2015 and May 2017 at a single hospital.

Symptomatic pseudarthrosis requiring revision surgery after 1- or 2-level ACDF with plating: peek versus allograft.

Background: Polyetheretherketone (PEEK) and machined allograft interbody spacers are among devices used as fusion adjuncts in anterior cervical discectomy and fusion (ACDF). Most results are good to excellent but some patients develop pseudarthrosis. We compared the reoperation rates for pseudarthrosis following 1- or 2-level ACDF with PEEK or allograft cages.

Treatment of degenerative spondylolisthesis by instrumented posterolateral versus instrumented posterolateral with transforaminal lumbar interbody single-level fusion.

Background: The purpose of this study was to compare outcomes of patients with degenerative spondylolisthesis treated by posterolateral lumbar fusion (PLF) versus PLF with transforaminal lumbar interbody fusion (PLF + TLIF). Studies of PLF versus PLF + TLIF have shown either equivalence or support for PLF + TLIF in lumbar spine surgery. Many are heterogeneous in the conditions treated, with few considering only spondylolisthesis of degenerative origin.

Validation of the Fusion Risk Score for Thoracic and Lumbar Spine Fusion Procedures.

Study Design: This is a retrospective cohort study.

Objective: This study aimed to determine whether the Fusion Risk Score (FRS) is valid for perioperative complications.

Summary Of Background Data: The FRS was previously formulated from a retrospective review of 364 fusion surgeries in patients over age 65.

Recurrent Surgical Site Infections in the Spine After Treatment With the Vacuum-assisted Closure (VAC) System.

Study Design: This study retrospectively reviewed recurrences of surgical site infections (SSI) in spinal patients treated with vacuum-assisted closure (VAC) technology.

Objective: Identify patient and treatment factors associated with recurrence of SSI after VAC treatment.

Summary Of Background Data: Patients treated with VAC can achieve healing of deep spine wound infections; however, some patients develop a recurrent infection.

Prediction of health status based on postoperative radiographic variables in adult scoliosis.

Objective: To evaluate the effect of surgical treatment on health related quality of life (HRQOL) and radiographic variables in patients with adult scoliosis.

Methods: Sixty-eight patients with adult spinal deformities underwent radiographic analysis. The enrollment criteria were as follows: age older than 18 years, adult degenerative or progressive idiopathic scoliosis (Cobb angle >10°), and surgical treatment within one year before this study was undertaken.

Fusion risk score: evaluating baseline risk in thoracic and lumbar fusion surgery.

Study Design: Retrospective cohort study.

Objective: The fusion risk score (FRS) is introduced to assess baseline risk of spine fusion surgery preoperatively. An objective method of stratifying risk allows the surgeon to control risk through tailoring intervention and explain differences in complication profile in high-complexity practice.

MRI measurement of neuroforaminal dimension at the index and supradjacent levels after anterior lumbar interbody fusion: a prospective study.

Background: Anterior interbody fusion has previously been demonstrated to increase neuroforaminal height in a cadaveric model using cages. No prior study has prospectively assessed the relative change in magnetic resonance imaging (MRI) demonstrated neuroforaminal dimensions at the index and supradjacent levels, after anterior interbody fusion with a corticocancellous allograft in a series of patients without posterior decompression. The objective of this study was to determine how much foraminal dimension can be increased with indirect foraminal decompression alone via anterior interbody fusion, and to determine the effect of anterior lumbar interbody fusion on the dimensions of the supradjacent neuroforamina.

Mechanical Load Study of Lumbar Center of Rotation and Lordosis and Its Potential Relationship to Formation of Rotatory Olisthesis.

Introduction: Rotatory olisthesis is a common finding of adult degenerative scoliosis. An in vitro model of rotatory olisthesis of the lumbar spine and its correlation with the center of rotation (COR) and lumbosacral lordosis (L3-S1) are presented.

Methods: Different centers of rotation and various angles of lumbosacral lordosis were tested for the production of rotatory olisthesis.

Surgeon's view of pedicle screw implantation for the monitoring neurophysiologist.

Pedicle screws have become the gold standard of spinal instrumentation over the past decade owing to their biomechanical superiority. Despite their advantages, pedicle screw instrumentation is potentially dangerous, and surgeons wish to improve accuracy of screw placement to avoid complications associated with screw misplacement. The anatomy of the pedicles is variable throughout the spine, and several landmarks and trajectories have been suggested to aid safe placement of pedicle screws in the spine.

Spinal cord injury from electrocautery: observations in a porcine model using electromyography and motor evoked potentials.

We have previously investigated electromyographic (EMG) and transcranial motor evoked potential (MEP) abnormalities after mechanical spinal cord injury. We now report thermally generated porcine spinal cord injury, characterized by spinal cord generated hindlimb EMG injury activity and spinal cord motor conduction block (MEP loss). Electrocautery (EC) was delivered to thoracic level dural root sleeves within 6-8 mm of the spinal cord (n = 6).

The effect on the pullout strength by the timing of pedicle screw insertion after calcium phosphate cement injection.

Study Design: Biomechanical Cadaveric Study.

Objective: To characterize the pullout strength of calcium phosphate cement augmented screws between 0 and 6 minutes after cement injection.

Summary Of Background Data: Earlier studies with calcium phosphate cement on pedicle screws inserted into a metal mold or sawbone have shown that the augmentation strength can be affected by the time between cement injection and screw insertion.

Repeatability test of C7 plumb line and gravity line on asymptomatic volunteers using an optical measurement technique.

Study Design: Prospective cohort evaluation of C7 plumb line (C7PL) and gravity line (GL) in different standing positions in asymptomatic volunteers.

Objective: To evaluate the repeatability of C7PL and GL in different standing positions using an optical method.

Summary Of Background Data: Both C7PL and GL have been used to assess spinal balance.

Effect of number of fusion levels on S1 screws in long fusion construct in a calf spine model.

Study Design: In vitro biomechanical study evaluating the effect of fusion levels on simulated S1 screws on calf spines.

Objective: To measure the stresses of simulated S1 screws as a function of increasing fusion levels in long-fusion construct.

Summary Of Background Data: Extension of long fusion to sacrum remains a difficult clinical challenge despite the recent knowledge and technology.

Radiculopathy in degenerative lumbar scoliosis: correlation of stenosis with relief from selective nerve root steroid injections.

Objective: The purpose is to define the origin of radiculopathy of patients with degenerative lumbar scoliosis-stenosis and to assess the correlation between percentage of initial radicular leg pain relief with selective nerve root injections and lateral canal dimensions.

Design: Retrospective clinical study.

Setting And Patients: Thirty-six consecutive patients (average age 72) from Twin Cities Spine Center with degenerative lumbar scoliosis (average major curve 25°) and radicular symptoms were studied.

Is it safe to back out pedicle screws after augmentation with polymethyl methacrylate or calcium phosphate cement? A biomechanical study.

Study Design: Biomechanical cadaveric study.

Objective: To determine the torque required to remove pedicle screws augmented with polymethyl methacrylate (PMMA) or calcium phosphate cement (CPC); thus, proving the safety of back out of augmented screws in the osteopotoric model, which would be a more dangerous setting than the nonosteoporotic model.

Summary Of Background Data: To our knowledge, no earlier study has characterized the safety of backing out pedicle screw augmented with PMMA or CPC.