Surgical Management of Adult Spinal Deformity Patients with Osteoporosis.

Adult spinal deformity (ASD) commonly affects older adults, with up to 68% prevalence in those over 60, and is often complicated by osteoporosis, which reduces bone mineral density (BMD) and increases surgical risks. Osteoporotic patients undergoing ASD surgery face higher risks of complications like hardware failure, pseudoarthrosis, and proximal junctional kyphosis (PJK). Medical management with antiresorptive medications (e.

Degenerative Cervical Myelopathy: History, Physical Examination, and Diagnosis.

: Degenerative cervical myelopathy is a progressive neurological disorder that is commonly encountered in clinical practice and its incidence is expected to increase alongside the aging population. Given the importance of early and accurate diagnosis in this patient population, this narrative review aims to provide a repository of up-to-date information regarding pertinent patient history, physical exam findings, and potential alternate diagnoses. : The PubMed database was queried for publications from 1 January 2019 to 19 March 2024.

The Impact of Symptom Duration on Postoperative Outcomes in Patients Undergoing Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-Analysis.

Background And Context: The optimal timing at which patients should undergo Anterior Cervical Discectomy and Fusion (ACDF) surgery to achieve the best outcomes has not been determined. Given that patients may experience delays in care and that insurance companies often require a minimum of six weeks of conservative treatment before surgery, it is essential to determine the impact of symptom duration on outcomes following ACDF.

Purpose: To evaluate the impact of symptom duration on outcomes following ACDF surgery.

Metastasis of WHO Grade II Meningioma With Subsequent Pathological T12 Fracture: A Case Report.

Case: A 64-year-old woman with a history of World Health Organization Grade II (Ki-67 20%) atypical meningioma presented with T12 vertebral body burst fracture as a complication of metastatic meningioma (SSTR2+). Following disease progression, decompression surgery and stabilization through T10-L2 posterior thoracolumbar instrumented fusion was performed.

Conclusion: This is one of few documented cases of spinal metastatic meningioma causing pathological fracture and the first to detail surgical management and longitudinal follow-up.

Postoperative delirium following total joint arthroplasty: epidemiology, risk factors, and associated complications.

Introduction: Postoperative delirium (POD) is a feared complication following major surgery in elderly patients. Further investigation of the risk factors and consequences of POD following total joint arthroplasty is warranted.

Methods: Patients who underwent total knee arthroplasty (TKA) or total hip arthroplasty (THA) were identified using PearlDiver.

Segmental Lordosis Restoration During Lumbar Degenerative Spinal Fusion: Surgical Techniques and Outcomes.

The science of spinal alignment has progressed rapidly since Jean Doubousset described the cone of economy in the 1970s. It is now clearly established that global and regional spinal alignment are associated with improved patient-reported outcome and rates of success of lumbar spinal fusion. Evidence has now emerged that segmental level-by-level alignment is also associated with positive patient outcomes.

Have We Made Advancements in Optimizing Surgical Outcomes and Enhancing Recovery for Patients With High-Risk Adult Spinal Deformity Over Time?

Background And Objectives: The spectrum of patients requiring adult spinal deformity (ASD) surgery is highly variable in baseline (BL) risk such as age, frailty, and deformity severity. Although improvements have been realized in ASD surgery over the past decade, it is unknown whether these carry over to high-risk patients. We aim to determine temporal differences in outcomes at 2 years after ASD surgery in patients stratified by BL risk.

When is staging complex adult spinal deformity advantageous? Identifying subsets of patients who benefit from staged interventions.

Objective: The objective of this study was to identify baseline patient and surgical factors predictive of optimal outcomes in staged versus same-day combined-approach surgery.

Methods: Adult spinal deformity (ASD) patients with baseline and perioperative (by 6 weeks) data were stratified based on single-stage (same-day) or multistage (staged) surgery, excluding planned multiple hospitalizations. Means comparison analyses were used to assess baseline demographic, radiographic, and surgical differences between cohorts.

The $12 Billion Board Certification Process: Examination Characteristics, Revenues, and Expenditures.

Background: Over 90% of U.S. physicians are currently board certified.

Physical Therapy for Patients with Thoracolumbar Vertebral Fractures.

Vertebral fractures are a common cause of back pain and pain-related functional impairments in elderly patients. Despite their widespread occurrence, vertebral fractures frequently remain underdiagnosed, often leading to suboptimal management and poor clinical outcomes. This review specifically examines the role of physical therapy (PT) in managing vertebral fractures, describing current literature and evidence-based guidelines from the American Physical Therapy Association and the American Academy of Orthopaedic Surgeons.

Which components of the global alignment proportionality score have the greatest impact on outcomes in adult spinal deformity corrective surgery?

Purpose: To investigate the impact of the Global Alignment and Proportion (GAP) score components on patient outcomes in Adult Spine Deformity (ASD) surgery.

Methods: Patients included underwent assessment via the GAP score and its individual components: pelvic version (GAP PV), lumbar lordosis (GAP LL), lumbar distribution index (GAP LDI) and spinopelvic component (GAP SP). Multivariable analyses assessed the association between alignment in these components and clinical outcomes in ASD patients.

Liposomal bupivacaine reduces postoperative pain and opioids consumption in spine surgery: a meta-analysis of 1,269 patients.

Background Context: Postoperative pain management in spine surgery remains a challenge. Liposomal bupivacaine (LB) has emerged as an alternative or adjunct to opioid-based analgesia. However, existing studies evaluating LB efficacy in spine surgery yield conflicting results and a meta-analysis compiling the literature is lacking.

Defining modern iatrogenic flatback syndrome: examination of segmental lordosis in short lumbar fusion patients undergoing thoracolumbar deformity correction.

Purpose: Understanding the mechanism and extent of preoperative deformity in revision procedures may provide data to prevent future failures in lumbar spinal fusion patients.

Methods: ASD patients without prior spine surgery (PRIMARY) and with prior short (SHORT) and long (LONG) fusions were included. SHORT patients were stratified into modes of failure: implant, junctional, malalignment, and neurologic.

Determining the utility of three-column osteotomies in revision surgery compared with primary surgeries in the thoracolumbar spine: a retrospective cohort study in the United States.

Study Design: Retrospective cohort study.

Purpose: To determine the incidence and success of three-column osteotomies (3COs) performed in primary and revision adult spine deformity (ASD) corrective surgeries.

Overview Of Literature: 3COs are often required to correct severe, rigid ASD presentations.

The Conceptualization and Derivation of the Cervical Lordosis Distribution Index.

Summary Of Background Data: Yilgor et al developed the lumbar Lordosis Distribution Index to individualize the pelvic mismatch to each patient's pelvic incidence. The cervical lordosis distribution in relation to its apex has not been characterized.

Objective: Tailor correction of cervical deformity by incorporating the cervical apex into a distribution index(CLDI) to maximize clinical outcomes while lowering rates of junctional failure.