The gap between surgeon goal and achieved sagittal alignment in adult cervical spine deformity surgery.

Objective: Malalignment following cervical spine deformity (CSD) surgery can negatively impact outcomes and increase complications. Despite the growing ability to plan alignment, it remains unclear whether preoperative goals are achieved with surgery. The objective of this study was to assess how good surgeons are at achieving their preoperative goal alignment following CSD surgery.

Increasing hub disruption parallels dementia severity in autosomal dominant Alzheimer's disease.

Hub regions in the brain, recognized for their roles in ensuring efficient information transfer, are vulnerable to pathological alterations in neurodegenerative conditions, including Alzheimer's disease (AD). Computational simulations and animal experiments have hinted at the theory of activity-dependent degeneration as the cause of this hub vulnerability. However, two critical issues remain unresolved.

Redefining Clinically Significant Blood Loss in Complex Adult Spine Deformity Surgery.

Study Design: Retrospective analysis of prospectively-collected data.

Objective: This study aims to define clinically relevant blood loss in adult spinal deformity (ASD) surgery.

Background: Current definitions of excessive blood loss following spine surgery are highly variable and may be suboptimal in predicting adverse events (AE).

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.

Degenerative Cervical Myelopathy: History, Physical Examination, and Diagnosis.

: Degenerative cervical myelopathy is a progressive neurological disorder that is commonly encountered in clinical practice and its incidence is expected to increase alongside the aging population. Given the importance of early and accurate diagnosis in this patient population, this narrative review aims to provide a repository of up-to-date information regarding pertinent patient history, physical exam findings, and potential alternate diagnoses. : The PubMed database was queried for publications from 1 January 2019 to 19 March 2024.

The impact of symptom duration on postoperative outcomes in patients undergoing anterior cervical discectomy and fusion: a systematic review and meta-analysis.

Background And Context: The optimal timing at which patients should undergo Anterior Cervical Discectomy and Fusion (ACDF) surgery to achieve the best outcomes has not been determined. Given that patients may experience delays in care and that insurance companies often require a minimum of 6 weeks of conservative treatment before surgery, it is essential to determine the impact of symptom duration on outcomes following ACDF.

Purpose: To evaluate the impact of symptom duration on outcomes following ACDF surgery.

Metastasis of WHO Grade II Meningioma With Subsequent Pathological T12 Fracture: A Case Report.

Case: A 64-year-old woman with a history of World Health Organization Grade II (Ki-67 20%) atypical meningioma presented with T12 vertebral body burst fracture as a complication of metastatic meningioma (SSTR2+). Following disease progression, decompression surgery and stabilization through T10-L2 posterior thoracolumbar instrumented fusion was performed.

Conclusion: This is one of few documented cases of spinal metastatic meningioma causing pathological fracture and the first to detail surgical management and longitudinal follow-up.

Postoperative delirium following total joint arthroplasty: epidemiology, risk factors, and associated complications.

Introduction: Postoperative delirium (POD) is a feared complication following major surgery in elderly patients. Further investigation of the risk factors and consequences of POD following total joint arthroplasty is warranted.

Methods: Patients who underwent total knee arthroplasty (TKA) or total hip arthroplasty (THA) were identified using PearlDiver.

The predictive power of the Roussouly classification on mechanical complications after surgery for adult spinal deformity: systematic review and meta-analysis.

Background: With the increasing prevalence of adult spinal deformity (ASD) in the aging population, the need for corrective surgery has surged, highlighting the importance of preventing mechanical complications (MC) such as junctional kyphosis/failure and rod breakage. The Roussouly classification, which categorizes natural variations in spinal posture, may hold predictive value in assessing the risk of these complications, as it guides the restoration of sagittal alignment based on a patient's preoperative spinal shape.

Methods: PubMed, Cochrane, and Google Scholar (pages 1-20) were searched through August 2024 to find articles comparing the incidence of mechanical complications between patients who were matched and mismatched to their ideal Roussouly shape after surgery for ASD.

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.

Cervical disc arthroplasty is safe across various obesity levels.

Background Context: As surgical indications for cervical disc arthroplasty (CDA) continue to expand, a growing patient population is now becoming indicated for this procedure. Little is known about whether CDA is safe in the overweight and obese populations, and how this procedure compares to anterior cervical discectomy and fusion (ACDF) in this particular demographic.

Purpose: To evaluate the outcomes of CDA across varying levels of body mass indices and to compare these to ACDF.

Have We Made Advancements in Optimizing Surgical Outcomes and Enhancing Recovery for Patients With High-Risk Adult Spinal Deformity Over Time?

Background And Objectives: The spectrum of patients requiring adult spinal deformity (ASD) surgery is highly variable in baseline (BL) risk such as age, frailty, and deformity severity. Although improvements have been realized in ASD surgery over the past decade, it is unknown whether these carry over to high-risk patients. We aim to determine temporal differences in outcomes at 2 years after ASD surgery in patients stratified by BL risk.

Setdb1-loss induces type-I interferons and immune clearance of melanoma.

Despite recent advances in the treatment of melanoma, many patients with metastatic disease still succumb to their disease. To identify tumor-intrinsic modulators of immunity to melanoma, we performed a whole-genome CRISPR screen in melanoma and identified Setdb1 as well as all components of the HUSH complex. We found that loss of Setdb1 leads to increased immunogenicity and complete tumor clearance in a CD8+ T-cell dependent manner.

The effects of pre-operative anti-osteoporotic use on total joint arthroplasty complications: A national database study.

Background: The current study aims to analyze the effect of pre-operative non-bisphosphonate anti-osteoporotic drugs on complication and revision rates following total joint arthroplasty (TJA).

Methods: A retrospective cohort analysis of the PearlDiver (PearlDiver Technologies, Colorado Springs, CO) database was performed. The database was queried to identify all patients who underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA) with history of hip or knee osteoarthritis and either osteopenia or osteoporosis.

When is staging complex adult spinal deformity advantageous? Identifying subsets of patients who benefit from staged interventions.

Objective: The objective of this study was to identify baseline patient and surgical factors predictive of optimal outcomes in staged versus same-day combined-approach surgery.

Methods: Adult spinal deformity (ASD) patients with baseline and perioperative (by 6 weeks) data were stratified based on single-stage (same-day) or multistage (staged) surgery, excluding planned multiple hospitalizations. Means comparison analyses were used to assess baseline demographic, radiographic, and surgical differences between cohorts.

Frail patients require Longer Fusions for Success following Adult Cervical Deformity Surgery.

Background: Adult cervical deformity (ACD) surgery is more frequently being performed in frail patients. Although surgical outcomes are largely successful, there remains significant risk of poor outcomes. The ideal length of fusion constructs in these patients remains debatable.

The $12 Billion Board Certification Process: Examination Characteristics, Revenues, and Expenditures.

Background: Over 90% of U.S. physicians are currently board certified.

Anticoagulation in patients with atrial fibrillation undergoing inpatient total knee arthroplasty: A matched analysis.

Background: Patients with atrial fibrillation (AF) often require lifetime anticoagulation using drugs such as Warfarin and Direct-acting Oral Anticoagulants (DOAC). It is important to assess the impact that prior anticoagulant use has on the post-operative complications in patients with AF undergoing TKA.

Methods: This is a retrospective analysis of the PearlDiver database querying all patients who underwent an inpatient TKA.

Physical Therapy for Patients with Thoracolumbar Vertebral Fractures.

Vertebral fractures are a common cause of back pain and pain-related functional impairments in elderly patients. Despite their widespread occurrence, vertebral fractures frequently remain underdiagnosed, often leading to suboptimal management and poor clinical outcomes. This review specifically examines the role of physical therapy (PT) in managing vertebral fractures, describing current literature and evidence-based guidelines from the American Physical Therapy Association and the American Academy of Orthopaedic Surgeons.