Cervical Spine Stenosis Causing Diaphragmatic Paralysis: A Case Study and Narrative Review of Clinical Presentations and Outcomes.

Study Design: Case report and narrative review.

Objective: To explore the therapeutic role of surgical and nonsurgical treatment of diaphragmatic paralysis secondary to spinal cord and nerve root compression.

Summary Of Background Data: Phrenic nerve dysfunction due to central or neuroforaminal stenosis is a rare yet unappreciated etiology of diaphragmatic paralysis and chronic dyspnea.

Evaluating Adult Idiopathic Scoliosis as an Independent Risk Factor for Critical Illness in SARS-CoV-2 Infection.

Background: Thoracic spinal deformities may reduce chest wall compliance, leading to respiratory complications. The first SARS-CoV-2 (L-variant) strain caused critical respiratory illness, especially in vulnerable patients. This study investigates the association between scoliosis and SARS-CoV-2 (COVID-19) disease course severity.

Testing and Optimizing Guided Thinking Tasks to Promote Physical Activity: Protocol for a Randomized Factorial Trial.

Background: Insufficient physical activity is associated with various health risks; however, most current physical activity interventions have critical barriers to scalability. Delivering interventions via technology and identifying active and inert components in early-phase development are ways to build more efficient and scalable interventions. We developed a novel intervention to promote physical activity that targets 3 brief guided thinking tasks, separately and in combination, using brief audio recordings: (1) episodic future thinking (EFT), (2) positive affective imagery (PAI), and (3) planning.

Is there a morphometric cause of Chiari malformation type I? Analysis of existing literature.

Although many etiologies have been proposed for Chiari malformation type I (CM-I), there currently is no singular known cause of CM-I pathogenesis. Advances in imaging have greatly progressed the study of CM-I. This study reviews the literature to determine if an anatomical cause for CM-I could be proposed from morphometric studies in adult CM-I patients.

A Comparison of Outcomes for Spinal Trauma Patients at Level I and Level II Centers.

Study Design: Retrospective analysis of a national database.

Objective: To characterize the spine trauma population, describe trauma center (TC) resources, and compare rates of outcomes between the American College of Surgeons (ACS) level I and level II centers.

Summary Of Background Data: Each year, thousands of patients are treated for spinal trauma in the United States.

Surgery for spinal deformity: non-elective admission status is associated with higher cost of care and longer length of stay.

Introduction: Surgery is commonly indicated for adult spinal deformity. Annual rates and costs of spinal deformity surgery have both increased over the past two decades. However, the impact of non-elective status on total cost of hospitalization and patient outcomes has not been quantified.

Assessing the Impact of Neurogenic Claudication on Outcomes Following Decompression With Lumbar Interbody Fusions in Patients With Lumbar Spinal Stenosis.

Study Design: Retrospective cohort study.

Objectives: To conduct the first comprehensive national-level study examining specific risks, outcomes, and costs surrounding surgical treatment of lumar spinal stenosis (LSS) in patients with and without neurogenic claudication (NC).

Methods: Data for patients with or without NC who underwent decompression with a lumbar interbody fusion approached anteriorly (ALIF), posteriorly (PLIF), or laterally (LLIF) for LSS was collected from the 2013-2014 National Inpatient Sample using International Classification of Disease codes.

Afternoon Surgical Start Time Is Associated with Higher Cost and Longer Length of Stay in Posterior Lumbar Fusion.

Background: Existing research about surgical start time is equivocal about associations between outcomes and late start times, and there is only one published report investigating start time in spine surgery. Therefore, the objective of this study was to assess associations between surgical start time, length of stay (LOS), and cost in lumbar spine surgery.

Methods: Patients at a single institution undergoing posterior lumbar fusion (PLF) were grouped based on whether they received their surgery before or after 2 pm, with those receiving their surgery between 12 am and 6 am and receiving surgery for tumors, trauma, or infections being excluded.

Utility of the Hospital Frailty Risk Score for Predicting Adverse Outcomes in Degenerative Spine Surgery Cohorts.

Background: As spine surgery becomes increasingly common in the elderly, frailty has been used to risk stratify these patients. The Hospital Frailty Risk Score (HFRS) is a novel method of assessing frailty using International Classification of Diseases, Tenth Revision (ICD-10) codes. However, HFRS utility has not been evaluated in spinal surgery.

Increased Risk of Transient Cerebral Ischemia After Subarachnoid Hemorrhage in Patients with Premorbid Opioid Use Disorders: A Nationwide Analysis of Outcomes.

Background: Subarachnoid hemorrhage (SAH) is the most morbid sequela of intracranial aneurysms. Although mortality from SAH has been declining, opioid use in the United States has surged, and neurosurgeons are increasingly tasked with operating on patients with opioid use disorders (OUDs). There is a deficit in the literature regarding how OUDs affect SAH outcomes, particularly transient cerebral ischemic (TCI) events.

Later Surgical Start Time Is Associated With Longer Length of Stay and Higher Cost in Cervical Spine Surgery.

Study Design: Retrospective study of a surgical cohort from a single, large academic institution.

Objective: The aim of this study was to investigate associations between surgical start time, length of stay, cost, perioperative outcomes, and readmission.

Summary Of Background Data: One retrospective study with a smaller cohort investigated associations between surgical start time and outcomes in spine surgery and found that early start times were correlated with shorter length of stay.

Adjacent Segment Reoperation and Other Perioperative Outcomes in Patients Who Underwent Anterior Lumbar Interbody Fusions at One and Two Levels.

Objective: This is the first large retrospective analysis of patients undergoing anterior lumbar interbody fusion (ALIF) with concern for clinical determinants leading to reoperation for adjacent segment disease (ASD). The objective of this study is to examine the specific perioperative and clinical determinants that affect need for adjacent segment reoperation in patients who underwent 1-level and 2-level ALIF procedures for degenerative disc disorders.

Methods: All cases at our institution between 2008 and 2016 involving an ALIF performed for degenerative disc disorders at 1 or 2 levels were examined.

von Willebrand factor and factor VIII are independently required to form stable occlusive thrombi in injured veins.

von Willebrand factor (VWF) protects factor VIII (FVIII) from proteolysis and mediates the initial contact of platelets with the injured vessel wall, thus playing an important role in hemostasis and thrombosis. VWF is crucial for the formation of occlusive thrombi at arterial shear rates. However, with only a few conflicting studies published, the role of VWF in venous thrombosis is still unclear.

Systemic antithrombotic effects of ADAMTS13.

The metalloprotease ADAMTS13 (a disintegrin-like and metalloprotease with thrombospondin type I repeats 13) cleaves highly adhesive large von Willebrand factor (VWF) multimers after their release from the endothelium. ADAMTS13 deficiency is linked to a life-threatening disorder, thrombotic thrombocytopenic purpura (TTP), characterized by platelet-rich thrombi in the microvasculature. Here, we show spontaneous thrombus formation in activated microvenules of Adamts13-/- mice by intravital microscopy.

Shigatoxin triggers thrombotic thrombocytopenic purpura in genetically susceptible ADAMTS13-deficient mice.

Thrombotic thrombocytopenic purpura (TTP) is a life-threatening illness caused by deficiency of the vWF-cleaving protease ADAMTS13. Here we show that ADAMTS13-deficient mice are viable and exhibit normal survival, although vWF-mediated platelet-endothelial interactions are significantly prolonged. Introduction of the genetic background CASA/Rk (a mouse strain with elevated plasma vWF) resulted in the appearance of spontaneous thrombocytopenia in a subset of ADAMTS13-deficient mice and significantly decreased survival.