Early clinical outcomes and medical complications following long segment fusion for adult spinal deformity with and without three column osteotomy.

Background: Surgical treatment of adult spinal deformity (ASD) commonly involves long-segment fusion with or without three column osteotomies (3CO) to provide satisfactory correction of sagittal and coronal balance. While some clinical studies have implicated 3CO as a driver of high surgical complication rates, these prior investigations are limited by small sample size. Herein, we compare early outcomes and adverse events in patients undergoing long segment posterior spinal fusion for ASD with and without 3CO.

Discharge within 1 day following elective single-level transforaminal lumbar interbody fusion: a propensityscore-matched analysis of predictors, complications, and readmission.

Study Design: This was a retrospective case-control study using 8 years of data from a nationwide database of surgical outcomes in the United States.

Purpose: This study aimed to improve our understanding of the risk factors associated with a length of stay (LOS) >1 day and aid in reducing postoperative hospitalization and complications.

Overview Of Literature: Despite the proven safety of transforaminal lumbar interbody fusion (TLIF), some patients face prolonged postoperative hospitalization.

Surgical site infection rates in open versus endoscopic lumbar spinal decompression surgery: A retrospective cohort study.

Background: Lumbar decompression is a commonly performed procedure for the operative management of several degenerative lumbar spinal pathologies. Although open approaches are considered the traditional method, endoscopic techniques represent a relatively novel, less-invasive option to achieve neural element decompression. Here within, we examine if the use of endoscopic techniques decreases the risk of post operative infections.

The Risk of Adverse Events in Smokers Undergoing Spinal Fusion: A Systematic Review and Meta-Analysis.

Study Design: Systematic review and meta-analysis.

Objectives: Determine if tobacco use is associated with increased risk of postoperative adverse events within 90 days in patients undergoing spinal fusion surgery.

Methods: Databases were queried to identify cohort studies that directly compared smokers with non-smokers and provided the absolute number of adverse events and the population at risk.

Chordoma of the Skull Base: A National Cancer Database Analysis of Current Practice Patterns and Outcomes.

Background: Chordomas of the skull base are aggressive locally destructive tumors that arise from the remnants of the fetal notochord. Current guidelines recommend maximal safe surgical resection followed by adjuvant radiation therapy. However, because of the rarity of these tumors, the optimal radiotherapeutic regimen regarding dose and modality is unclear.

Vasoplegia Following Complex Spine Surgery: Incidence and Risk.

Study Design: Retrospective cohort study.

Objectives: Vasoplegia is a life-threatening form of distributive or vasodilatory shock that is characterized by reduced systemic vascular resistance with resultant hypotension and normal to elevated cardiac output affecting morbidity and mortality. Vasoplegia in the context of Spine Surgery has not been described previously.

A Retrospective Comparative Analysis of Perioperative Complications in Navigated versus Conventional Thoracolumbar Fusion in the Setting of Adult Spinal Deformity.

Objective: Stereotactic intraoperative computer-assisted navigation has been shown to improve pedicle screw accuracy in spinal fusion surgery, but evidence of impact of navigation on clinical outcomes is lacking. The aim of this study is to compare rates of perioperative complications between navigated and nonnavigated procedures for deformity correction.

Methods: An administrative database was queried for adult patients undergoing thoracolumbar fusion procedures for deformity.

Use of intraoperative MRI for resection of intracranial tumors: A nationwide analysis of short-term outcomes.

Objective: Recent evidence supports the use of intraoperative MRI (iMRI) during resection of intracranial tumors due to its demonstrated efficacy and clinical benefit. Though many single-center investigations have been conducted, larger nationwide outcomes have yet to be characterized.

Methods: We used the American College of Surgeons National Surgical Quality Improvement Program database to examine baseline characteristics and 30-day postoperative outcomes among patients undergoing craniotomy for tumor resection with and without iMRI.

Thrombocytopenia as an Independent Prognostic Indicator Following Extradural Spinal Tumor Resection.

Objective: Few studies have examined the prognosis for patients with baseline thrombocytopenia undergoing extradural spine tumor resection. Our objective was to evaluate mortality, readmission, and other 30-day outcomes in patients with varying degrees of preoperative thrombocytopenia undergoing osseous extradural tumor excision.

Methods: A multicenter registry was queried for patients treated from 2011-2019.

A novel anatomo-physiologic high-grade spondylolisthesis model to evaluate L5 nerve stretch injury after spondylolisthesis reduction.

L5 nerve palsy is a well-known complication following reduction of high-grade spondylolisthesis. While several mechanisms for its occurrence have been proposed, the hypothesis of L5 nerve root strain or displacement secondary to mechanical reduction remains poorly studied. The aim of this cadaveric study is to determine changes in morphologic parameters of the L5 nerve root during simulated intraoperative reduction of high-grade spondylolisthesis.

The Risk of Nonunion in Smokers Revisited: A Systematic Review and Meta-Analysis.

Study Design: Systemic review and meta-analysis.

Objective: To review and establish the effect of tobacco smoking on risk of nonunion following spinal fusion.

Methods: A systematic search of Medline, Embase, Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews from inception to December 31, 2020, was conducted.

Predictors of Extended Hospitalization and Early Reoperation After Elective Lumbar Disc Arthroplasty.

Background: Lumbar disc arthroplasty (LDA) has emerged as a motion-sparing alternative to lumbar fusion. Although LDA may be amenable to the ambulatory surgical setting, to date no study has identified the factors predisposing patients to extended hospital stay.

Methods: A national surgical quality improvement database was queried from 2011 to 2019 for patients undergoing elective, single-level, primary LDA.

Surgical Management of Charcot Spinal Arthropathy in the Face of Possible Infection.

Background: The design is a retrospective cohort study. Charcot spinal arthropathy (CSA) is a rare and poorly understood progressive destructive spine condition that usually affects patients with preexisting spinal cord injury. The complexity of this condition, especially when additionally burdened by superimposed infection in the CSA zone, can potentially lead to suboptimal management such as protracted antibiotic therapy, predisposition to hardware failure, and pseudarthrosis.

Pathognomonic macular ripples are revealed by polarized infrared retinal imaging.

A pathognomonic macular ripple sign has been reported with scanning laser ophthalmoscopy images in patients with foveal hypoplasia, though the optical basis of this sign is presently unknown. Here we present a case series of seven individuals with foveal hypoplasia (based on spectral domain optical coherence tomography). Each patient underwent infrared scanning laser ophthalmoscopy retinal imaging in both eyes, acquired with and without a polarization filter and assessment for a ripple-like effect in the fovea.

Iliac Screw Fixation Revisited: Improved Clinical and Radiologic Outcomes Using a Modified Iliac Screw Fixation Technique.

Study Design: A retrospective study.

Objective: To describe the modified iliac screw (mILS) technique and compare it to other spinopelvic fixation techniques in terms of wound healing complications, hardware prominence, and failure.

Summary Of Background Data: The traditional entry point of an iliac screw often causes postoperative gluteal pain from the prominent screw head.

Outcomes and Patterns of Care in Adult Skull Base Chondrosarcoma Patients in the United States.

Background: Chondrosarcomas of the skull base are rare intracranial tumors of chondroid origin. The rarity of these lesions has made it difficult to form a consensus on optimal treatment regimens. The aim of this study was to provide a comprehensive analysis of prognostic factors, treatment modalities, and survival outcomes in patients with chondrosarcoma of the skull base.

Assessing the Clinical Safety Profile of Computer-Assisted Navigation for Posterior Cervical Fusion: A Propensity-Matched Analysis of 30-Day Outcomes.

Background: Computer-assisted navigation (CAN) has been shown to improve accuracy of screw placement in procedures involving the posterior cervical spine, but whether the addition of CAN affects complication rates, neurologic or otherwise, is presently unknown. The objective of this study is to determine the effect of spinal CAN on short-term clinical outcomes following posterior cervical fusion.

Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried from 2011 to 2018.

Incidence, Management, and Outcomes of Adult Patients with Spinal Chondrosarcoma in the United States.

Objective: Spinal chondrosarcomas are rare primary malignant neoplasms composed of cartilage-producing cells. They are slow-growing but locally aggressive lesions that have high rates of recurrence and progression after treatment. We provide the largest comprehensive analysis of prognostic factors, treatment modalities, and survival outcomes in patients with spinal chondrosarcoma using a large, prospectively collected national database.

Incidence, Management, and Outcomes of Adult Spinal Chordoma Patients in the United States.

Study Design: Retrospective cohort study.

Objective: Spinal chordomas are rare primary malignant neoplasms of the primitive notochord. They are slow growing but locally aggressive lesions that have high rates of recurrence and metastasis after treatment.

High-Grade Spinal Hemangioma: A National Cancer Database Analysis.

Background: Spinal hemangiomas are common primary tumors of the vertebrae. Although these tumors are most frequently benign and asymptomatic, they can rarely exhibit aggressive growth and invasion into neighboring structures. Treatment for these aggressive variants is controversial, often involving surgery, chemotherapy, and/or radiotherapy.

Incidence, Management, and Outcomes of Spinal Giant Cell Tumor of Bone in Adult Patients: A National Cancer Database Analysis.

Objective: Giant cell tumors (GCTs) constitute 5% of all primary bone tumors with spinal GCTs (SGCTs) accounting for 2%-15% of all GCTs. The standard of care for SGCT has been maximal surgical resection. However, many adjuvant therapies have been used owing to the difficulty in achieving gross total resection combined with the high local recurrence rate.

Emerging Insight in the Use of an Active Post Discharge Surveillance Program in Spine Surgery: A Retrospective Pilot Study.

Background: With smartphones being present in everyday life, we have witnessed an increasing use of applications designed for mobile communication devices that are aimed at facilitating patient engagement in different medical arenas. Such applications are meant to improve communications with patients and ultimately improve patient care. The aim of this study was to report on our early experiences using Active Post Discharge Surveillance (APDS) relative to invasiveness of the spine surgery and patient age and gender.

The new onset of dysphagia four years after anterior cervical discectomy and fusion: Case report and literature review.

Background: Dysphagia is a common complication immediately following anterior cervical spine surgery. However, its onset more than 1-year postoperatively is rare.

Case Description: A 45-year-old male initially underwent a C3-4 and C5-6 anterior cervical discectomy and fusion (ACDF).

Tulip-Screw Head Disjunction from Posterior C2 Fracture Fixation Instrumentation.

This report presents an unusual case of instrumentation failure after posterior fixation of a C2 fracture and reviews currently available treatment alternatives. The patient, a 53-year-old female, initially presented to the emergency department at an outside facility with acute alcohol intoxication and acute neck pain following a fall from a ladder. CT demonstrated bilateral C2 pars fractures and unstable posteroinferior displacement of the posterior elements.