Pseudarthrosis rate following anterior cervical discectomy with fusion using an allograft cellular bone matrix: a multi-institutional analysis.

Objective: The use of osteobiologics, engineered materials designed to promote bone healing by enhancing bone growth, is becoming increasingly common for spinal fusion procedures, but the efficacy of some of these products is unclear. The authors performed a retrospective, multi-institutional study to investigate the clinical and radiographic characteristics of patients undergoing single-level anterior cervical discectomy with fusion performed using the osteobiologic agent Osteocel, an allograft mesenchymal stem cell matrix.

Methods: The medical records across 3 medical centers and 12 spine surgeons were retrospectively queried for patients undergoing single-level anterior cervical discectomy and fusion (ACDF) with the use of Osteocel.

Operative time and learning curve between fluoroscopy-based instrument tracking and robot-assisted instrumentation for patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).

Introduction: Instrument-navigation modalities including CT-guided and robot-assisted methods claim both efficacy and accuracy when applied to spine surgery, yet often increase setup and operating times which can translate to increased costs. To see the impact of different technologies on surgical efficiency, we studied the impact of a single surgeon's experience with a multitude of instrument navigational technologies.

Methods: Consecutive patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) were analyzed.

A Smartphone App With a Digital Care Pathway for Patients Undergoing Spine Surgery: Development and Feasibility Study.

Background: There is a great unmet clinical need to provide patients undergoing spinal surgery and their caregivers with ongoing, high-quality care before and after surgery in an efficiency-focused health care environment.

Objective: The objective of this study is to design, develop, and evaluate the acceptability and feasibility of a novel planning-, outcomes-, and analytics-based smartphone app called ManageMySurgery (MMS) in patients undergoing elective spine surgery (MMS-Spine).

Methods: The development process of the MMS app was conducted over 2 sequential stages: (1) an evidence-based intervention design with refinement from surgeon and patient feedback and (2) feasibility testing in a clinical pilot study.

Effect of Instrument Navigation on C-arm Radiation and Time during Spinal Procedures: A Clinical Evaluation.

Introduction: As minimally invasive spine surgery gains popularity, a focused effort must be made to reduce intraoperative radiation exposure to levels as low as reasonably achievable. Here, we demonstrate the clinical efficacy of a novel technology to aid in instrument navigation that aims to reduce intraoperative radiation exposure, number of fluoroscopic images, and time required to perform the most radiation intensive portions of a multitude of spinal procedures.

Methods: An internally randomized controlled study was performed over a 1-month period in order to clinically evaluate the effect of the C-arm assisted instrument tracking system, TrackX, on surgeon workflow, time, and radiation emitted.

Computer-Assisted Instrument Navigation Versus Conventional C-Arm Fluoroscopy for Surgical Instrumentation: Accuracy, Radiation Time, and Radiation Exposure.

Compared with open procedures, minimally invasive surgical procedures are associated with increased radiation exposure and long-term health risks. Ultralow radiation imaging coupled with image enhancement and instrument tracking (ULRI-IE/IT) is a new image modifier that allows a computer to show real-time movement of an instrument as it is adjusted, mimicking live fluoroscopy but without continuous radiation production. The purpose of this study was to determine the accuracy and radiation output of ULRI-IE/IT compared with unassisted conventional fluoroscopy in a variety of surgical procedures.

Influence of racial disparities on patient-reported satisfaction and short- and long-term perception of health status after elective lumbar spine surgery.

OBJECTIVE In spine surgery, racial disparities have been shown to impact various aspects of surgical care. Previous studies have associated racial disparities with inferior surgical outcomes, including increased complication and 30-day readmission rates after spine surgery. Recently, patient-reported outcomes (PROs) and satisfaction measures have been proxies for overall quality of care and hospital reimbursements.

Thrombolysis is an Independent Risk Factor for Poor Outcome After Carotid Revascularization.

Background: Thrombolysis is the standard of care for acute ischemic stroke patients presenting in the appropriate time window. Studies suggest that the risk of recurrent ischemia is lower if carotid revascularization is performed early after the index event. The safety of early carotid revascularization in this patient population is unclear.

Spinal Fusion for Pediatric Spondylolisthesis: National Trends, Complications, and Short-Term Outcomes.

Background: Current surgical management guidelines for pediatric spondylolisthesis (PS) are reliant on data from single-center cohorts.

Objective: To analyze national trends and predictors of short-term outcomes in spinal fusion surgery for PS by performing a retrospective cross-sectional analysis of the Kids' Inpatient Database (KID).

Methods: The KID (sampled every 3 yr) was queried from 2003 to 2012 to identify all cases (age 5-17) of spinal fusion for PS (n = 2646).

Minimally invasive transforaminal lumbar interbody fusion with expandable versus static interbody devices: radiographic assessment of sagittal segmental and pelvic parameters.

OBJECTIVE Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has been adopted as an alternative technique to hasten recovery and minimize postoperative morbidity. Advances in instrumentation technologies and operative techniques have evolved to maximize patient outcomes as well as radiographic results. The development of expandable interbody devices allows a surgeon to perform MIS-TLIF with minimal tissue disruption.

Electrophysiological Sequelae of Hemispherotomy in Ipsilateral Human Cortex.

Hemispheric disconnection has been used as a treatment of medically refractory epilepsy and evolved from anatomic hemispherectomy to functional hemispherectomies to hemispherotomies. The hemispherotomy procedure involves disconnection of an entire hemisphere with limited tissue resection and is reserved for medically-refractory epilepsy due to diffuse hemispheric disease. Although it is thought to be effective by preventing seizures from spreading to the contralateral hemisphere, the electrophysiological effects of a hemispherotomy on the ipsilateral hemisphere remain poorly defined.

Spinal fusion for pediatric neuromuscular scoliosis: national trends, complications, and in-hospital outcomes.

OBJECTIVE The objective of this study was to determine if the recent changes in technology, surgical techniques, and surgical literature have influenced practice trends in spinal fusion surgery for pediatric neuromuscular scoliosis (NMS). In this study the authors analyzed recent trends in the surgical management of NMS and investigated the effect of various patient and surgical factors on in-hospital complications, outcomes, and costs, using the Nationwide Inpatient Sample (NIS) database. METHODS The NIS was queried from 2002 to 2011 using International Classification of Diseases, Ninth Edition, Clinical Modification codes to identify pediatric cases (age < 18 years) of spinal fusion for NMS.

Readmission after spinal cord injury: analysis of an institutional cohort of 795 patients.

Background: Recent studies in other fields have suggested that healthcare on the weekend may have worse outcomes. In particular, patients with stroke and acute cardiovascular events have shown worse outcomes with weekend treatment. It is unclear whether this extends to patients with spinal cord injury.

Interpedicular height as a predictor of radicular pain in adult degenerative scoliosis.

Background Context: Spine surgeons must correlate clinical presentation with radiographic findings in a patient-tailored approach. Despite the prevalence of adult degenerative scoliosis (ADS), there are few radiographic markers to predict the presence of radiculopathy. Emerging data suggest that spondylolisthesis, obliquity, foraminal stenosis, and curve concavity may be associated with radiculopathy in ADS.

Fractional anisotropy to quantify cervical spondylotic myelopathy severity.

Background: A number of clinical tools exist for measuring the severity of cervical spondylotic myelopathy (CSM). Several studies have recently described the use of non-invasive imaging biomarkers to assess severity of disease. These imaging markers may provide an additional tool to measure disease progression and represent a surrogate marker of response to therapy.

Population-based approaches to treatment and readmission after spinal cord injury.

Background: Recent studies in surgical and non-surgical specialties have suggested that patients admitted on the weekend may have worse outcomes. In particular, patients with stroke and acute cardiovascular events have shown worse outcomes with weekend treatment. It is unclear whether this extends to patients with spinal cord injury (SCI).

Chiari malformation Type I surgery in pediatric patients. Part 1: validation of an ICD-9-CM code search algorithm.

OBJECTIVE Administrative billing data may facilitate large-scale assessments of treatment outcomes for pediatric Chiari malformation Type I (CM-I). Validated International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code algorithms for identifying CM-I surgery are critical prerequisites for such studies but are currently only available for adults. The objective of this study was to validate two ICD-9-CM code algorithms using hospital billing data to identify pediatric patients undergoing CM-I decompression surgery.

Chiari malformation Type I surgery in pediatric patients. Part 2: complications and the influence of comorbid disease in California, Florida, and New York.

OBJECTIVE Chiari malformation Type I (CM-I) is a common and often debilitating pediatric neurological disease. However, efforts to guide preoperative counseling and improve outcomes research are impeded by reliance on small, single-center studies. Consequently, the objective of this study was to investigate CM-I surgical outcomes using population-level administrative billing data.

Characterization of complications associated with open and endoscopic craniosynostosis surgery at a single institution.

OBJECT The authors present a retrospective cohort study examining complications in patients undergoing surgery for craniosynostosis using both minimally invasive endoscopic and open approaches. METHODS Over the past 10 years, 295 nonsyndromic patients (140 undergoing endoscopic procedures and 155 undergoing open procedures) and 33 syndromic patients (endoscopic procedures in 10 and open procedures in 23) met the authors' criteria. Variables analyzed included age at surgery, presence of a preexisting CSF shunt, skin incision method, estimated blood loss, transfusions of packed red blood cells, use of intravenous steroids or tranexamic acid, intraoperative durotomies, procedure length, and length of hospital stay.

Clinical Outcome Measures in Chiari I Malformation.

Chiari malformation type 1 (CM-I) is a common and often debilitating neurologic disease. Reliable evaluation of treatments has been hampered by inconsistent use of clinical outcome measures. A variety of outcome measurement tools are available, although few have been validated in CM-I.

Endovascular Thrombectomy for Anterior Circulation Stroke: Systematic Review and Meta-Analysis.

Background And Purpose: Stroke affects ≈700,000 patients annually. Recent randomized controlled trials comparing endovascular thrombectomy (ET) with medical therapy, including intravenous thrombolysis (IVT) with tissue-type plasminogen activator, have shown effectiveness of ET for some stroke patients. The study objective is to evaluate the effect of ET on good outcome in stroke patients.

Congenital Acute Myeloid Leukemia with Unique Translocation t(11;19)(q23;p13.3).

Congenital leukemia is rarely encountered in clinical practice, even in tertiary children's hospitals. Leukemia may cause significant coagulopathy, putting the patient at risk of intracranial hemorrhage. In this case, the authors present a female infant with a unique mixed phenotypic congenital acute myeloid leukemia showing mixed-lineage leukemia (MLL) rearrangement and severe coagulopathy resulting in a large subdural hematoma.

Validation of an International Classification of Diseases, Ninth Revision Code Algorithm for Identifying Chiari Malformation Type 1 Surgery in Adults.

Background: The use of administrative billing data may enable large-scale assessments of treatment outcomes for Chiari Malformation type I (CM-1). However, to utilize such data sets, validated International Classification of Diseases, Ninth Revision (ICD-9-CM) code algorithms for identifying CM-1 surgery are needed.

Objective: To validate 2 ICD-9-CM code algorithms identifying patients undergoing CM-1 decompression surgery.

Complications and Resource Use Associated With Surgery for Chiari Malformation Type 1 in Adults: A Population Perspective.

Background: Outcomes research on Chiari malformation type 1 (CM-1) is impeded by a reliance on small, single-center cohorts.

Objective: To study the complications and resource use associated with adult CM-1 surgery using administrative data.

Methods: We used a recently validated International Classification of Diseases, Ninth Revision, Clinical Modification code algorithm to retrospectively study adult CM-1 surgeries from 2004 to 2010 in California, Florida, and New York using State Inpatient Databases.