Surgical Management of Thoracolumbar Adjacent Segment Disease: Techniques and Outcomes in 107 Patients Undergoing Surgical Intervention.

Background: Adjacent segment disease (ASD) is a known sequela of thoracolumbar instrumented fusions. Various surgical options are available to address ASD in patients with intractable symptoms who have failed conservative measures. However, the optimal treatment strategy for symptomatic ASD has not been established.

Characteristics and Outcomes of Patients Treated with Cervical Spine Fusion at High Volume Hospitals.

Background: High volume (HV) has been associated with improved outcomes in various neurosurgical procedures. The objective of this study was to explore the regional distribution of HV spine centers for cervical spine fusion and compare characteristics and outcomes for patients treated at HV centers versus lower volume centers.

Methods: The National Inpatient Sample database 2016-2020 was queried for patients undergoing cervical spine fusion for degenerative pathology.

Does hinge sidedness influence laterality of C5 palsy after expansile open-door cervical laminoplasty?

Objective: Cervical expansile open-door laminoplasties (EOLPs) have an open side and a hinge side, with the open side being bridged by grafts or miniplates. The authors explored the possibility that the open-door side might have a greater incidence of C5 palsy due to a greater stretch of the ipsilateral C5 nerve root.

Methods: This study was a retrospective review of prospectively collected data over a period of 25 years specifically assessing surgical complications.

Single-Position Lateral Approach for Revision Thoracolumbar Corpectomy With Delayed Ipsilateral Kidney Atrophy: Technical Note and Discussion of Complications.

Improvements in navigation technology have enabled surgeons to safely offer single-position fusion surgeries, demonstrating shorter operating times and reduced length of stay (LOS) as compared to traditional lateral and prone dual-position surgeries. However, no studies to date describe revision thoracolumbar corpectomy with simultaneous posterior rod removal and replacement in the lateral position. Furthermore, this is the first reported complication of delayed ipsilateral kidney atrophy following lateral lumbar surgery.

Ancient Schwannoma Presenting at the Cauda Equina: A Report of a Rare Case.

Ancient schwannoma is an uncommon variant of schwannoma. While many reports have presented defining histologic and clinical features of ancient schwannoma, there are only a very few cases in the literature, to our knowledge, of ancient schwannoma presenting at the cauda equina. The current report of ancient schwannoma presenting at the cauda equina adds to the literature and discusses the identification of specific histologic characteristics, the role of conservative medical management, surgical resection, and prognostication in this select subset of patients.

Incremental benefits of circumferential minimally invasive surgery for increasingly frail patients with adult spinal deformity.

Objective: Circumferential minimally invasive surgery (cMIS) may provide incremental benefits compared with open surgery for patients with increasing frailty status by decreasing peri- and postoperative complications.

Methods: Operative patients with adult spinal deformity (ASD) ≥ 18 years old with baseline and 2-year postoperative data were assessed. With propensity score matching, patients who underwent cMIS (cMIS group) were matched with similar patients who underwent open surgery (open group) based on baseline BMI, C7-S1 sagittal vertical axis, pelvic incidence to lumbar lordosis mismatch, and S1 pelvic tilt.

Associations with daily opioid use during hospitalization following lumbar fusion: A contemporary cohort study.

Background: Predicting opioid use after lumbar spine fusion remains a challenge. The aim of this study was to identify clinical and demographic parameters that could be associated with opioid use trends during hospitalization after lumbar spine fusion.

Methods: A cohort study of prospective data for all lumbar fusions performed by single surgeon for an 18-month period from 2019 to 2020 was conducted.

Big Data in the Clinical Neurosciences.

The clinical neurosciences have historically been at the forefront of innovation, often incorporating the newest research methods into practice. This chapter will explore the adoption, implementation, and refinement of big data and predictive modeling using machine learning within neurosurgery. Initial development of national databases arose from surgeons aiming to improve outcome predictions for patients with traumatic brain injury in the 1960s.

Defining the Time Benefit of Awake Versus General Anesthesia for Single-Level Lumbar Spine Surgery.

Background: Awake anesthesia with monitored anesthesia care (MAC) might confer time benefits compared with traditional general anesthesia (GA) in the setting of single-level lumbar spine surgery. Therefore, we sought to define the quantitative time difference spent in the operating room between the MAC and GA approaches for single-level lumbar spine surgery.

Methods: A prospectively maintained database of the senior surgeon was reviewed for single-level lumbar spine surgeries from 2019 to 2020 performed with the patient under either GA or MAC.

Long-Term Clinical Outcomes With the Activ-L Lumbar Arthroplasty System.

Background: Low back pain (LBP) due to degenerative disc disease (DDD) is the most common occupational disorder worldwide. Lumbar total disc replacement (LTDR) has provided an alternative to rigid fusion to relieve pain with less motion restriction. We present clinical results with long-term follow-up from a single-center, single-surgeon series of patients treated with the Activ-L artificial disc.

Awake Endoscopic Transforaminal Lumbar Interbody Fusion: A Technical Note.

Background: Advances in modern spinal fusion techniques have allowed for less peri-operative morbidity and more rapid recovery from surgery. The addition of endoscopy to minimally invasive surgery (MIS) fusion techniques represents the latest progression of efforts to minimize the impact of surgical intervention.

Technique: MIS transforaminal lumbar interbody fusion (TLIF) is performed endoscopically through a sub-centimeter working portal.

The Value of a Synthetic Model-based Training Lab to Increase Proficiency with Endoscopic Approaches to the Spine.

Introduction: The learning curve associated with endoscopic approaches to the spine is well established. In this study, we present our endoscopic training methodology and discuss the concepts and rationale of laboratory training as it relates to improving comfort and skill with endoscopic techniques.

Materials And Methods: A three-part endoscopic training laboratory for neurosurgical trainees and attendings was organized at the University of Miami, which included a lecture, instrumentation demonstration, and both synthetic model and cadaveric practice sessions.

Intermediate-term clinical and radiographic outcomes with less invasive adult spinal deformity surgery: patients with a minimum follow-up of 4 years.

Background: Little information exists regarding longer-term outcomes with minimally invasive spine surgery (MISS), particularly regarding long-segment and deformity procedures. We aimed to evaluate intermediate-term outcomes of MISS for adult spinal deformity (ASD).

Methods: This retrospective review of a prospectively collected multicenter database examined outcomes at 4 or more years following circumferential MIS (cMIS) or hybrid (HYB) surgery for ASD.

A case of primary central nervous system lymphoma presenting as a shunt complication.

The authors describe an 82-year-old female with a right frontal ventriculoperitoneal (VP) shunt for long-standing normal pressure hydrocephalus (NPH) who presented with worsening incontinence and gait instability. She was found to have right lateral ventricle collapse around the shunt catheter and subsequently underwent shunt revision, which failed to improve her symptoms. Magnetic resonance imaging (MRI) was obtained on postoperative day two, which demonstrated a ventricular lesion.

Minimally Invasive Spinal Deformity Surgery: Analysis of Patients Who Fail to Reach Minimal Clinically Important Difference.

Background: It is well known that clinical improvements following surgical intervention are variable. While all surgeons strive to maximize reliability and degree of improvement, certain patients will fail to achieve meaningful gains. We aim to analyze patients who failed to reach minimal clinically important difference (MCID) in an effort to improve outcomes for minimally invasive deformity surgery.

Use of Single-Photon Emission Computed Tomography Imaging for Hypermetabolic Facet Identification in Diagnosis of Cervical and Axial Back Pain.

Background: Few studies have used hybrid single-photon emission computed tomography (SPECT)/computed tomography (CT) scan to identify degenerative facet disease. We aimed to determine the incidence of hypermetabolic facets on SPECT/CT imaging in patients with axial neck or back pain to elucidate the value of SPECT/CT scan in identifying pain generators.

Methods: A retrospective review of adult patients with axial neck or back pain was conducted.

Preoperative SPECT imaging as a tool for surgical planning in patients with axial neck and back pain.

Objective: Hybrid SPECT with CT imaging has been used to help elucidate pain generators in patients with axial neck and back pain, identifying potential sites for treatment. Few studies have examined its role in spine surgery and most literature focuses on its use postoperatively. The authors describe the largest series to date of patients with symptomatic spondylosis who underwent preoperative SPECT imaging for surgical planning.

Endoscopic Lumbar Interbody Fusion.

Spine surgeons have recently developed more advanced and less invasive techniques. One significant example of recent surgical innovation is the advent of endoscopic-assisted spine surgery. Endoscopic lumbar interbody fusions are increasingly used to treat lumbar degenerative disease in a minimally invasive approach that minimizes pain and maximizes outcomes.

Endoscopic transforaminal lumbar interbody fusion without general anesthesia: technical innovations and outcomes.

Innovations in surgical techniques and technologies have enabled spine surgeons to offer patients less morbid alternatives to traditional spine procedures. This review will explore the development of the endoscopic transforaminal lumbar interbody fusion (TLIF) without general endotracheal anesthesia (GETA) and discuss the technical refinements and innovations learned from experiences with this technique. The Awake TLIF employs several key technological innovations: (I) conscious sedation; (II) endoscopic visualization; (III) an expandable interbody device; (IV) recombinant human bone morphogenetic protein; (V) long-acting local analgesia; and (VI) percutaneous instrumentation.

Use of Cervical Disk Arthroplasty to Treat Noncontiguous Cervical Disk Herniations.

Background: Cervical disk arthroplasty is now a widely accepted alternative to anterior cervical interbody fusion, which is known to reduce normal cervical motion and increase the incidence of adjacent segment disease. Although multiple studies report the use of cervical disk arthroplasty to treat multilevel cervical disease, this is the first report in the literature detailing the placement of multiple, noncontiguous artificial disks.

Case Description: We describe a 41-year-old male who presented with myelopathy and left upper extremity radiculopathy resulting from 2 cervical disk herniations separated by a normal intervening level.

Novel Application of a New Lateral System for Adjacent-level Revision Surgery: A Case Report.

In recent years, lateral lumbar interbody fusion (LLIF) has grown in popularity as a minimally invasive spine surgery (MISS) approach that can be offered to patients with prior surgeries from a posterior approach. In this report, we present a patient with a focal disease and a history of multiple posterior lumbar surgeries who underwent LLIF with a novel application of the Duo system (Spineology Inc., MN, USA) adjacent to prior surgical levels and without posterior instrumentation.

Surgical Site Infection as a Risk Factor for Long-Term Instrumentation Failure in Patients with Spinal Deformity: A Retrospective Cohort Study.

Background: Surgical site infection (SSI) remains a complication of spine deformity surgery. Although fusion/instrumentation failure in the setting of SSI has been reported, few studies have investigated the relationship between these entities. We examine the relationship between early SSI and fusion/instrumentation failure after instrumented fusion in patients with thoracolumbar scoliosis.

Less invasive spinal deformity surgery: the impact of the learning curve at tertiary spine care centers.

Objective: The past decade has seen major advances in techniques for treating more complex spinal disorders using minimally invasive surgery (MIS). While appealing from the standpoint of patient perioperative outcomes, a major impediment to adoption has been the significant learning curve in utilizing MIS techniques.

Methods: Data were retrospectively analyzed from a multicenter series of adult spinal deformity surgeries treated at eight tertiary spine care centers in the period from 2008 to 2015.