Factors Associated With Extended Length of Stay and 90-Day Readmission Rates Following ACDF.

Study Design: Retrospective.

Objective: Identify patient risk factors for extended length of stay (LOS) and 90-day hospital readmissions following elective anterior cervical discectomy and fusion (ACDF).

Methods: Included ACDF patients from 2013 to 2017 at a single institution.

Preoperative Hemoglobin Predicts Postoperative Transfusion Despite Antifibrinolytics During Total Knee Arthroplasty.

Current antifibrinolytics have decreased perioperative blood loss; however, some patients still require transfusions postoperatively. The authors sought to determine the risk factors associated with postoperative transfusions and to establish a "cutoff" preoperative hemoglobin threshold value specific to total knee arthroplasty (TKA) that would identify patients who would benefit from blood conservation programs. The institutional database was queried for primary TKA patients.

A Quartet of Elastic Stable Intramedullary Nails for More Challenging Pediatric Femur Fractures.

Introduction: The insertion of 2 elastic stable intramedullary nails (ESINs) is a common treatment for pediatric femur fractures. However, the use of this technique in length-unstable or metadiaphyseal fractures has historically been associated with higher complication rates. To improve stability, the addition of a third ESIN has been assessed biomechanically and clinically, but the addition of a fourth nail has only been evaluated biomechanically.

Pedicle screw placement accuracy using ultra-low radiation imaging with image enhancement versus conventional fluoroscopy in minimally invasive transforaminal lumbar interbody fusion: an internally randomized controlled trial.

OBJECTIVE A previous study found that ultra-low radiation imaging (ULRI) with image enhancement significantly decreases radiation exposure by roughly 75% for both the patient and operating room personnel during minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) (p < 0.001). However, no clinical data exist on whether this imaging modality negatively impacts patient outcomes.

MIS Single-position Lateral and Oblique Lateral Lumbar Interbody Fusion and Bilateral Pedicle Screw Fixation: Feasibility and Perioperative Results.

Study Design: Retrospective review of prospectively collected data of the first 72 consecutive patients treated with single-position one- or two-level lateral (LLIF) or oblique lateral interbody fusion (OLLIF) with bilateral percutaneous pedicle screw and rod fixation by a single spine surgeon.

Objective: To evaluate the clinical feasibility, accuracy, and efficiency of a single-position technique for LLIF and OLLIF with bilateral pedicle screw and rod fixation.

Summary Of Background Data: Minimally-invasive lateral interbody approaches are performed in the lateral decubitus position.

Ankylosing Spondylitis Increases Perioperative and Postoperative Complications After Total Hip Arthroplasty.

Background: Ankylosing spondylitis (AS) is a chronic autoimmune spondyloarthropathy that primarily affects the axial spine and hips. Progressive disease leads to pronounced spinal kyphosis, positive sagittal balance, and altered biomechanics. The purpose of this study is to determine the complication profile of patients with AS undergoing total hip arthroplasty (THA).

The Impact of Lumbar Spine Disease and Deformity on Total Hip Arthroplasty Outcomes.

Concomitant spine and hip disease in patients undergoing total hip arthroplasty (THA) presents a management challenge. Degenerative lumbar spine conditions are known to decrease lumbar lordosis and limit lumbar flexion and extension, leading to altered pelvic mechanics and increased demand for hip motion. In this study, the effect of lumbar spine disease on complications after primary THA was assessed.

Sagittal Balance Correction in Lateral Interbody Fusion for Degenerative Scoliosis.

Background: Sagittal balance restoration has been shown to be an important determinant of outcomes in corrective surgery for degenerative scoliosis. Lateral interbody fusion (LIF) is a less-invasive technique which permits the placement of a high lordosis interbody cage without risks associated with traditional anterior or transforaminal interbody techniques. Studies have shown improvement in lumbar lordosis following LIF, but only one other study has assessed sagittal balance in this population.

Laminoplasty versus laminectomy with fusion for the treatment of spondylotic cervical myelopathy: short-term follow-up.

Background Context: Laminoplasty and laminectomy with fusion are two common procedures for the treatment of cervical spondylotic myelopathy. Controversy remains regarding the superior surgical treatment.

Purpose: To compare short-term follow-up of laminoplasty to laminectomy with fusion for the treatment of cervical spondylotic myelopathy.

Cervical Myelopathy Doubles the Rate of Dislocation and Fracture After Total Hip Arthroplasty.

Background: Cervical spondylotic myelopathy (CSM) is a common and underdiagnosed cause of gait dysfunction, rigidity, and falls in the elderly. Given the frequent concurrency of CSM and hip osteoarthritis, this study is designed to evaluate the relative risk of CSM on perioperative and short-term outcomes after total hip arthroplasty (THA).

Methods: The Medicare Standard Analytical Files were searched from 2005 to 2012 to identify all patients undergoing primary THA and the subset of patients with preexisting CSM.

Renal artery injury during lateral transpsoas interbody fusion: case report.

Lateral interbody fusion (LIF) via the retroperitoneal transpsoas approach is an increasingly popular, minimally invasive technique for interbody fusion in the thoracolumbar spine that avoids many of the complications of traditional anterior and transforaminal approaches. Renal vascular injury has been cited as a potential risk in LIF, but little has been documented in the literature regarding the etiology of this injury. The authors discuss a case of an intraoperative complication of renal artery injury during LIF.

Should We Think Twice About Psychiatric Disease in Total Hip Arthroplasty?

Background: Psychiatric disease (PD) is common, and the effect on complications in total hip arthroplasty (THA) is poorly understood. The purpose of this study was to evaluate the medical and surgical postoperative complication profile in patients with PD, and we hypothesize that they will be significantly increased compared with control group.

Methods: A search of the entire Medicare database from 2005 to 2011 was performed using International Classification of Disease version 9 codes to identify 86,976 patients who underwent primary THA with PD including bipolar (5626), depression (82,557), and schizophrenia (3776).

The Impact of Lumbar Spine Disease and Deformity on Total Hip Arthroplasty Outcomes.

Concurrent spine and hip disease is common. Spinal deformities can restrict lumbar range of motion and lumbar lordosis, leading to pelvic obliquity and increased pelvic tilt. A comprehensive preoperative workup and component templating ensure appropriate compensation for altered pelvic parameters for implantation of components according to functional positioning.

The role of iatrogenic foraminal stenosis from lordotic correction in the development of C5 palsy after posterior laminectomy and fusion.

Background: Post-operative C5 nerve root palsy is a known complication following cervical spine surgery. Although several theories have been proposed, there remains no consensus as to the etiology of the palsies. Multiple pre-operative radiographic measures have been assessed for utility in predicting palsy.

CT accuracy of percutaneous versus open pedicle screw techniques: a series of 1609 screws.

Introduction: Traditional open exposure for posterior instrumentation requires significant soft tissue mobilization and causes significant blood loss and increased recovery time. Mal-placed screws can injure nerve roots, the spinal cord, viscera, vasculature and the cardiopulmonary system. Placement of pedicle screws using a minimally invasive technique can decrease bleeding risk, damage to soft tissues, and post-operative pain.

C5 palsy after cervical laminectomy and fusion: does width of laminectomy matter?

Background Context: A common complication of cervical laminectomy and fusion with instrumentation (CLFI) is development of postoperative C5 nerve palsy. A proposed etiology is excess nerve tension from posterior drift of the spinal cord after decompression. We hypothesize that laminectomy width will be significantly increased in patients with C5 palsy and will correlate with palsy severity.

Extreme lateral interbody fusion with posterior instrumentation for spondylodiscitis.

The purpose of this study was to evaluate our initial experience utilizing extreme lateral interbody fusion (XLIF; NuVasive, San Diego, CA, USA) with percutaneous posterior instrumentation to treat 11 spondylodiscitis patients between January 2011 and February 2014. Although medical management is the first line treatment for spondylodiscitis, many patients fail antibiotic therapy and bracing, or present with instability, neurologic deficits, or sepsis, requiring operative debridement and stabilization. High rates of fusion and infection clearance have been reported with anterior lumbar interbody fusion (ALIF), but this approach requires a morbid exposure, associated with non-trivial rates of vascular and peritoneal complications.

Time Spent in Lateral Sleep Position and Asymmetry in Glaucoma.

Purpose: To explore sleep position in asymmetric primary open-angle glaucoma (POAG) with a focus on low pressure glaucoma (LPG).

Methods: Sleep laboratory videos of 54 POAG patients were examined for lateral sleep. Then, 29 LPG patients (intraocular pressure [IOP] < 22 mm Hg) with an intereye visual field index (VFI) asymmetry of more than 5% continuously recorded their sleep position at home for 2 nights by using a portable device.

The controversy surrounding bone morphogenetic proteins in the spine: a review of current research.

Bone morphogenetic proteins have been in use in spinal surgery since 2002. These proteins are members of the TGF-beta superfamily and guide mesenchymal stem cells to differentiate into osteoblasts to form bone in targeted tissues. Since the first commercial BMP became available in 2002, a host of research has supported BMPs and they have been rapidly incorporated in spinal surgeries in the United States.

Interrater and intrarater agreements of magnetic resonance imaging findings in the lumbar spine: significant variability across degenerative conditions.

Background Context: Magnetic resonance imaging (MRI) is frequently used in the evaluation of degenerative conditions in the lumbar spine. The relative interrater and intrarater agreements of MRI findings across different pathologic conditions are underexplored, as most studies are focused on specific findings.

Purpose: The purpose of this study was to characterize the interrater and intrarater agreements of MRI findings used to assess the degenerative lumbar spine.

Optimal aspiration volume of vertebral bone marrow for use in spinal fusion.

Background Context: Bone marrow aspirate (BMA) has shown promise as a bone graft option in spinal fusion. The vertebral body is a convenient source for marrow aspirate as it is accessed in routine course of pedicle screw instrumentation. Studies have relied on data from the iliac crest to determine optimal aspiration volume from the vertebral body.

3D-FSE Isotropic MRI of the Lumbar Spine: Novel Application of an Existing Technology.

Study Design: Retrospective diagnostic trial.

Objective: To determine the diagnostic performance of 3-dimensional isotropic fast/turbo spin-echo (3D-TSE) in routine lumbar spine magnetic resonance imaging (MRI).

Summary Of Background Data: Conventional 2-dimensional fast spin-echo (2D-FSE) MRI requires independent acquisition of each desired imaging plane.

Lower-extremity weight-bearing compliance is maintained over time after biofeedback training.

Previous studies have shown immediate compliance with weight-bearing instructions to be better after biofeedback training than after verbal or scale training. This study assessed retention of biofeedback training to determine potential clinical applicability. Twelve participants were enrolled in a prospective clinical study at an academic orthopedic center.

Routine imaging for anterior cervical decompression and fusion procedures: a survey study establishing current practice patterns.

The number of anterior cervical decompression and fusion procedures performed annually in the United States rose 8-fold from 1990 to 2004. Imaging for anterior cervical decompression and fusion procedures contributes to health care costs and exposes patients and staff to radiation. Despite this, no standard of care for such imaging has been defined, and imaging practices have remained largely uncharacterized.