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.

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.

The Importance of Alignment in the Management of Thoracolumbar Trauma.

Spinal injuries occur in 3% of all patients with trauma, most commonly in males, and often as a result of high-velocity impact followed by abrupt deceleration. The most affected region after spinal trauma is the thoracolumbar junction because of the anterior center of gravity at the T12-L1 vertebral level and the relatively stiff thoracic spine uniting with the mobile lumbar spine. Many classifications exist to guide the choice of operative versus nonoperative management of traumatic injuries at this site.

Electrolyte Disturbances and Repletion in Orthopaedic and Spine Surgery Patients.

Electrolyte derangement, defined as disorders of clinically impactful physiologic ions such as potassium, sodium, calcium, magnesium, and phosphate, has a variety of clinical manifestations. These electrolytes have narrow windows of normal in vivo concentration before neurologic, cardiac, renal, or gastrointestinal consequences occur. Perioperative disturbances in electrolyte concentration can lead to increased morbidity and mortality, longer length of stay, and higher rates of short and medium-term readmission in orthopaedic and spine surgery postoperatively.

Crossing the Cervicothoracic Junction: A Biomechanical Investigation of C7 vs T1 Caudal Selection's Effect on Adjacent Segment Motion in Posterior Cervical Fusion.

Study Design: Biomechanical Study.

Objective: This study aims to evaluate the biomechanical adjacent segment effects of multi-level posterior cervical fusion constructs that terminate at C7 compared to those that terminate at T1 in cadaveric specimens.

Background: The cervicothoracic junction poses unique challenges for spine surgeons.

Lumbar Spondylolisthesis Grading: Current Standards and Important Factors to Consider for Management.

Spondylolisthesis is a common condition with a prevalence of 4-6% in childhood and 5-10% in adulthood. The Meyerding Classification, developed in 1932, assigns grades (I to V) based on the degree of slippage observed on standing, neutral lateral lumbar radiographs. Despite its historical significance and reliability, more factors should be evaluated to predict spondylolisthesis progression, especially in low-grade cases.

Does the Application of Topical Vancomycin Reduce Surgical Site Infections in Spine Surgery? A Meta-analysis of Randomized Controlled Trials.

Background: Surgical site infections (SSIs) represent a major challenge in spine surgery, leading to severe morbidity, mortality, and increased costs. The local application of antibiotics, particularly vancomycin, has emerged as a potential strategy. Individual randomized controlled trials (RCTs) have disagreed about the efficacy of topical vancomycin in preventing SSIs after spine surgery, and so a meta-analysis that pools data from those RCTs might be helpful to inform clinicians' decisions on the topic.

Adolescent idiopathic scoliosis in adulthood.

Adolescent idiopathic scoliosis (AIS) is an abnormal coronal curvature of the spine that most commonly presents in adolescence. While it may be asymptomatic, AIS can cause pain, cosmetic deformity, and physical and psychological disability with curve progression. As adolescents with AIS enter adulthood, condition outcomes vary with some experiencing curve stabilization and others noting further curve progression, chronic pain, osteoporosis/fractures, declines in pulmonary and functional capacity, among others.

Laminoplasty Versus Laminectomy and Posterior Fusion for Cervical Myelopathy : A Meta-Analysis of Radiographic and Clinical Outcomes.

Study Design: Meta-analysis.

Objective: This meta-analysis investigates the outcomes of laminoplasty (LP) and laminectomy with fusion (LF) to guide effective patient selection for these 2 procedures.

Background: Although LF traditionally offers the ability for excellent posterior decompression, it may alter cervical spine biomechanics and increase the risk of adjacent segment degeneration.

Segmental Sagittal Alignment in Lumbar Spinal Fusion: A Review of Evidence-Based Evaluation of Preoperative Measurement, Surgical Planning, Intraoperative Execution, and Postoperative Evaluation.

Background And Objectives: Maintaining and restoring global and regional sagittal alignment is a well-established priority that improves patient outcomes in patients with adult spinal deformity. However, the benefit of restoring segmental (level-by-level) alignment in lumbar fusion for degenerative conditions is not widely agreed on. The purpose of this review was to summarize intraoperative techniques to achieve segmental fixation and the impact of segmental lordosis on patient-reported and surgical outcomes.

Management of traumatic spinal cord injury: A current concepts review of contemporary and future treatment.

Spinal Cord Injury (SCI) is a condition leading to inflammation, edema, and dysfunction of the spinal cord, most commonly due to trauma, tumor, infection, or vascular disturbance. Symptoms include sensory and motor loss starting at the level of injury; the extent of damage depends on injury severity as detailed in the ASIA score. In the acute setting, maintaining mean arterial pressure (MAP) higher than 85 mmHg for up to 7 days following injury is preferred; although caution must be exercised when using vasopressors such as phenylephrine due to serious side effects such as pulmonary edema and death.

Variability in expenses related to spine oncology care: comparison of payer-negotiated rates at National Cancer Institute-Designated Cancer Centers.

Background: As of 2021, the Centers for Medicare and Medicaid Services (CMS) requires all hospitals to publish their commercially negotiated prices. To our knowledge, price variation of spine oncology diagnosis and treatments has not been previously investigated.

Purpose: The aim of this study is to characterize the availability and variation of prices for spinal oncology services among National Cancer Institute-Designated Cancer Centers (NCI-DCC).

Management of Thoracolumbar Vertebral Fractures and Dislocations in Patients with Ankylosing Conditions of the Spine.

Ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH) are bone-forming spinal conditions which inherently increase spine rigidity and place patients at a higher risk for thoracolumbar fractures. Due to the long lever-arm associated with their pathology, these fractures are frequently unstable and may significantly displace leading to catastrophic neurologic consequences. Operative and non-operative management are considerations in these fractures.

Anterior cervical discectomy and fusion versus cervical disc arthroplasty: an epidemiological review of 433,660 surgical patients from 2011 to 2021.

Background Context: Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are commonly performed operations to address cervical radiculopathy and myelopathy. Trends in utilization and revision surgery rates warrant investigation.

Purpose: To explore the epidemiology, postoperative complications, and reoperation rates of ACDF and CDA.

Sacroplasty for Sacral Insufficiency Fractures: Narrative Literature Review on Patient Selection, Technical Approaches, and Outcomes.

Sacral insufficiency fractures commonly affect elderly women with osteoporosis and can cause debilitating lower back pain. First line management is often with conservative measures such as early mobilization, multimodal pain management, and osteoporosis management. If non-operative management fails, sacroplasty is a minimally invasive intervention that may be pursued.

Sagittal Alignment in the Degenerative Lumbar Spine: Surgical Planning.

➤ Sagittal alignment of the spine has gained attention in the field of spinal deformity surgery for decades. However, emerging data support the importance of restoring segmental lumbar lordosis and lumbar spinal shape according to the pelvic morphology when surgically addressing degenerative lumbar pathologies such as degenerative disc disease and spondylolisthesis.➤ The distribution of caudal lordosis (L4-S1) and cranial lordosis (L1-L4) as a percentage of global lordosis varies by pelvic incidence (PI), with cephalad lordosis increasing its contribution to total lordosis as PI increases.

Utilization of Antibiotic Bone Cement in Spine Surgery: Pearls, Techniques, and Case Review.

Vertebral osteomyelitis (VO) encompasses a spectrum of spinal infections ranging from isolated mild vertebral osteomyelitis to severe diffuse infection with associated epidural abscess and fracture. Although patients can often be treated with an initial course of intravenous antibiotics, surgery is sometimes required in patients with sepsis, spinal instability, neurological compromise, or failed medical treatment. Antibiotic bone cement (ABC) has been widely used in orthopedic extremity surgery for more than 150 years, both for prophylaxis and treatment of bacterial infection.

Delayed cerebrospinal fluid (CSF) leak following anterior cervical discectomy and fusion surgery.

Background: An uncommon complication of anterior cervical discectomy and fusion (ACDF) is dura tear, which may be further complicated by cerebral spinal fluid (CSF) leak. Dural tears with CSF leak can lead to catastrophic neurologic outcomes and should be recognized early.

Case Description: This case report describes a 43-year-old female patient with history of Ehlers-Danlos syndrome who presented 1-year post-ACDF with positional headaches and lightheadedness.

Longitudinal Assessment of Modern Spine Surgery Training: 10-Year Follow-up of a Nationwide Survey of Residency and Spine Fellowship Program Directors.

Unlabelled: Spine surgeons complete training through residency in orthopaedic surgery (ORTH) or neurosurgery (NSGY). A survey was conducted in 2013 to evaluate spine surgery training. Over the past decade, advances in surgical techniques and the changing dynamics in fellowship training may have affected training and program director (PD) perceptions may have shifted.

Spinal Cord Stimulators and Intrathecal Pain Pump Removal Versus Retention During Posterior Lumbar Fusion: A Matched Cohort Analysis.

Study Design: Retrospective cohort study.

Objective: To determine risks associated with posterior lumbar arthrodesis after spinal cord stimulator (SCS) and intrathecal pain pump (IPP) insertion.

Summary Of Background Data: SCS and IPPs aid in the management of chronic back and radicular pain.

Adult Spinal Deformity Correction in Patients with Parkinson Disease: Assessment of Surgical Complications, Reoperation, and Cost.

Background: Parkinson disease (PD) is a neurodegenerative disorder that manifests with postural instability and gait imbalance. Correction of spinal deformity in patients with PD presents unique challenges.

Methods: The PearlDiver database was queried between 2010 and 2020 to identify adult patients with spinal deformity before undergoing deformity correction with posterior spinal fusion.