A retrospective analysis of 513 patients undergoing pedicle subtraction osteotomy for adult spinal deformity by a single surgical team: are elderly patients at an elevated risk for complications?

Objective: This study aimed to assess whether elderly patients (aged ≥ 70 years) face an elevated risk of complications following pedicle subtraction osteotomy (PSO) for adult spinal deformity (ASD) compared with younger patients (< 70 years) and to evaluate if clinical and radiological outcomes differ between these age groups.

Methods: A retrospective analysis of 513 patients undergoing PSO for ASD by a single surgical team between January 2006 and January 2023 was conducted. Patients were categorized by age (≥ 70 years and < 70 years).

Effects of pelvic fixation strategies and multi-rod constructs on biomechanics of the proximal junction in long thoracolumbar posterior instrumented fusions: a finite-element analysis.

Purpose: To assess the effect of various pelvic fixation techniques and number of rods on biomechanics of the proximal junction of long thoracolumbar posterior instrumented fusions.

Methods: A validated spinopelvic finite-element (FE) model was instrumented with L5-S1 ALIF and one of the following 9 posterior instrumentation configurations: (A) one traditional iliac screw bilaterally ("2 Iliac/2 Rods"); (B) T10 to S1 ("Sacral Only"); (C) unilateral traditional iliac screw ("1 Iliac/2 Rods"); (D) one traditional iliac screw bilaterally with one midline accessory rod ("2 Iliac/3 rods"); (E) S2AI screws connected directly to the midline rods ("2 S2AI/2 Rods"); and two traditional iliac screws bilaterally with two lateral accessory rods connected to the main rods at varying locations (F1: T10-11, F2: T11-12, F3: T12-L1, F4: L1-2) ("4 Iliac/4 Rods"). Range of motions (ROM) at T10-S1 and T9-T10 were recorded and compared between models.

Hip Osteoarthritis in Patients Undergoing Surgery for Severe Adult Spinal Deformity: Prevalence and Impact on Spine Surgery Outcomes.

Background: Hip osteoarthritis (OA) is common in patients with adult spinal deformity (ASD). Limited data exist on the prevalence of hip OA in patients with ASD, or on its impact on baseline and postoperative alignment and patient-reported outcome measures (PROMs). Therefore, this paper will assess the prevalence and impact of hip OA on alignment and PROMs.

Impact of Self-Reported Loss of Balance and Gait Disturbance on Outcomes following Adult Spinal Deformity Surgery.

The objective of this study was to evaluate if imbalance influences complication rates, radiological outcomes, and patient-reported outcomes (PROMs) following adult spinal deformity (ASD) surgery. ASD patients with baseline and 2-year radiographic and PROMs were included. Patients were grouped according to whether they answered yes or no to a recent history of pre-operative loss of balance.

Odontoid fractures above C2 to pelvis posterior instrumented fusions: a single center's 11-year experience.

Purpose: To define the prevalence, characteristics, and treatment approach for proximal junction failure secondary to odontoid fractures in patients with prior C2-pelvis posterior instrumented fusions (PSF).

Methods: A single institution's database was queried for multi-level fusions (6+ levels), including a cervical component. Posterior instrumentation from C2-pelvis and minimum 6-month follow-up was inclusion criteria.

Height Gain Following Correction of Adult Spinal Deformity.

Background: Height gain following a surgical procedure for patients with adult spinal deformity (ASD) is incompletely understood, and it is unknown if height gain correlates with patient-reported outcome measures (PROMs).

Methods: This was a retrospective cohort study of patients undergoing ASD surgery. Patients with baseline, 6-week, and subanalysis of 1-year postoperative full-body radiographic and PROM data were examined.

Duration of neurological deficit and outcomes in the surgical treatment of spinal coccidioidomycosis.

Objective: Vertebral osteomyelitis is a rare complication of coccidioidomycosis infection. Surgical intervention is indicated when there is failure of medical management or presence of neurological deficit, epidural abscess, or spinal instability. The relationship between timing of surgical intervention and recovery of neurological function has not been previously described.

Reliability of a Novel Classification System for Thoracic Disc Herniations.

Study Design: This is a cross-sectional survey.

Objective: The aim was to assess the reliability of a proposed novel classification system for thoracic disc herniations (TDHs).

Summary Of Background Data: TDHs are complex entities varying substantially in many factors, including size, location, and calcification.

Association Between the Bone Density of Posterior Fusion Mass and Mechanical Complications After Thoracolumbar Three-Column Osteotomy for Adult Spinal Deformity.

Study Design: Retrospective comparative study.

Objective: To assess the relationship of fusion mass bone density on computed tomography (CT) and the development of rod fractures (RFs) and proximal junctional kyphosis (PJK).

Summary Of Background Data: Few studies have evaluated the relationship of fusion mass bone density to mechanical complications.

Patient Frailty Influences Outcome After Open, But Not Minimally Invasive, Transforaminal Interbody Fusion: A Case Series of 115 Patients With Lumbar Degenerative Disease.

Background: For transforaminal lumbar interbody fusion (TLIF), there are equally good open and minimally invasive surgery (MIS) options.

Objective: To determine if frailty has a differential effect on outcome for open vs MIS TLIF.

Methods: We performed a retrospective review of 115 TLIF surgeries (1-3 levels) for lumbar degenerative disease performed at a single center; 44 MIS transforaminal interbody fusions and 71 open TLIFs were included.

Influence of Preoperative T1-Slope and Cervical Sagittal Vertical Axis on Postoperative Cervical Sagittal Alignment Following Posterior Cervical Laminoplasty.

Background: Assess correlation between preoperative cervical sagittal alignment (T1 slope [T1S] and C2-C7 cervical sagittal vertical axis [cSVA]) and postoperative cervical sagittal balance after posterior cervical laminoplasty.

Methods: Consecutive patients who underwent laminoplasty at a single institution with >6 weeks postoperative follow-up were divided into 4 groups based on preoperative cSVA and T1S (Group 1: cSVA <4 cm/T1S <20°; Group 2: cSVA ≥4 cm/T1S ≥20°; Group 3: cSVA <4 cm/T1S ≥20°; Group 4: cSVA <4 cm/T1S <20°). Radiographic analyses were conducted at 3 timepoints, and changes in cSVA, C2-C7 cervical lordosis (CL), and T1S -CL were compared.

Combined retropleural thoracotomy and posterior spinal approach for thoracic dumbbell Schwannoma: Case series and review of the literature.

Background: Dumbbell schwannomas of the thoracic spine are challenging to cure surgically. Surgeons are familiar with posterolateral approaches to the spine, however, these may provide inadequate exposure for large tumors extending to ventral extraspinal compartments. Ventrolateral transpleural approaches offer direct access to the ventral thoracic spine and intrathoracic cavity, though are associated with increased morbidity and pulmonary complications, and may necessitate a staged procedure in order to address concomitant dorsal pathology.

Development and internal validation of predictive models to assess risk of post-acute care facility discharge in adults undergoing multi-level instrumented fusions for lumbar degenerative pathology and spinal deformity.

Purpose: To develop a model for factors predictive of Post-Acute Care Facility (PACF) discharge in adult patients undergoing elective multi-level (≥ 3 segments) lumbar/thoracolumbar spinal instrumented fusions.

Methods: The State Inpatient Databases acquired from the Healthcare Cost and Utilization Project from 2005 to 2013 were queried for adult patients who underwent elective multi-level thoracolumbar fusions for spinal deformity. Outcome variables were classified as discharge to home or PACF.

Modified Kickstand Rod Technique for the Correction of Adult Idiopathic Scoliosis.

Adult idiopathic scoliosis (ADIS) is the delayed form of adolescent idiopathic scoliosis (AIS) which is defined as a three-dimensional deformity with a lateral curvature of more than 10° in adults with prior history of AIS. Surgery is necessary for patients with symptoms of chronic pain, neuromotor deficits and cardiopulmonary problems with a Cobb angle exceeding 45°. In untreated patients, AIS may lead to ADIS which can cause serious problems like osteoarthritis, progressive deformity and spinal stenosis.

Sacral Pedicle Subtraction Osteotomy for Treatment of High-Grade Spondylolisthesis: A Technical Note and Review of the Literature.

Background: Lumbosacral deformities are caused by high-grade spondylolisthesis, fractures, iatrogenic flat back, and other etiologies. The S1 pedicle subtraction osteotomy (PSO) can facilitate reduction of spondylolisthesis and lower the pelvic incidence. There are limited reports on the indications and outcomes of this technique.

Proximal Junctional Spondylodiscitis Following Adult Spinal Deformity Surgery: Case Series and Review of the Literature.

Background: Proximal junctional failure (PJF) following multilevel thoracolumbar instrumented to the pelvis for adult spinal deformity (ASD) is relatively uncommon but considerably disabling. While the leading etiology is mechanical, other rarer etiologies can play a role in its development. The purpose of this study was to present a case series of ASD patients who experienced PJF secondary to proximal junctional spondylodiscitis (PJS) after long-segment thoracolumbar posterior instrumented fusions.

Cardiac Complications After 3-Column Osteotomy for Adult Spinal Deformity Patients With Formal Cardiac Clearance: Identifying Key Risk Factors and Threshold Cutoffs Via Recursive Partitioning Analysis.

Background: Despite formal cardiac clearance, a subset of 3-column osteotomy (3CO) patients still experience cardiac complications (CCs).

Objective: To define the incidence and risk factors for CC in 3CO patients who had formal cardiac clearance and assess the utility of the Revised Cardiac Risk Index (RCRI) and preoperative metabolic equivalent (MET) functional ability in predicting perioperative CC.

Methods: Patients with adult spinal deformity (ASD) who underwent 3CO deformity correction from 2006 to 2019 were retrospectively reviewed.

Economic Impact of Revision Operations for Adjacent Segment Disease of the Subaxial Cervical Spine.

Introduction: Adjacent segment disease (ASD) of the cervical spine is a common disabling phenomenon that often requires surgical intervention. The goal of this study was to evaluate the economic impact of revision operations for cervical ASD.

Methods: Consecutive adults who underwent revision cervical spine surgery for ASD at a single institution between 2014 and 2017 were retrospectively reviewed.

Kickstand Rod With Asymmetric Pedicle Subtraction Osteotomy for Treatment of Adult Kyphoscoliosis With Severe Coronal Imbalance.

Background: The kickstand rod has been described for the treatment of severe coronal imbalance. We present a modified description that combines an asymmetric pedicle subtraction osteotomy (PSO) for correction of severe kyphoscoliosis.

Objective: To describe the use of a temporary kickstand rod.

Incidence and Risk Factors of Mechanical Complications After Posterior-Based Osteotomies for Correction of Moderate to Severe Adult Cervical Deformity: 1-Year and 2-Year Follow-up.

Background: Rigid cervical deformity (CD) requires multilevel and/or high-grade osteotomies and long-construct fusions to achieve adequate correction. The incidence of mechanical complications (MCs) remains incompletely studied.

Objective: To define the incidence and risk factors for MC.

RAPT score and preoperative factors to predict discharge location following adult spinal deformity surgery.

Purpose: To assess factors, including RAPT score, predictive of non-home discharges following adult spinal deformity (ASD) operations.

Methods: Adults who underwent thoracolumbar instrumented fusions to the pelvis for ASD (1/2019-1/2020) were reviewed. Patient demographics, RAPT metrics, hospital length of stay (LOS), operative details, and complications were compared between patients discharged home and non-home.

Operative Treatment of Severe Scoliosis in Symptomatic Adults: Multicenter Assessment of Outcomes and Complications With Minimum 2-Year Follow-up.

Background: Few reports focus on adults with severe scoliosis.

Objective: To report surgical outcomes and complications for adults with severe scoliosis.

Methods: A multicenter, retrospective review was performed on operatively treated adults with severe scoliosis (minimum coronal Cobb: thoracic [TH] ≥ 75°, thoracolumbar [TL] ≥ 50°, lumbar [L] ≥ 50°).

Utility of intraoperative neuromonitoring and outcomes of neurological complication in lower cervical and upper thoracic posterior-based three-column osteotomies for cervical deformity.

Objective: For severe and rigid adult cervical deformity, posterior-based three-column osteotomies (3COs) are warranted, but neurological complications are relatively high with such procedures. The performance measures of intraoperative neuromonitoring (IONM) during cervicothoracic 3CO have yet to be studied, and there remains a paucity of literature regarding the topic. Therefore, the authors of this study examined the performance of IONM in predicting new neurological weakness following lower cervical and upper thoracic 3CO.

Incidence of Chronic Periscapular Pain After Adult Thoracolumbar Deformity Correction and Impact on Outcomes.

Objective: Extension of the posterior upper-most instrumented vertebra (UIV) into the upper thoracic (UT) spine allows for greater deformity correction and reduced incidence of proximal junction kyphosis (PJK) in adult spinal deformity (ASD) patients. However, it may be associated with chronic postoperative scapular pain (POSP). The goal of this study was to assess the relationship between UT UIV and persistent POSP, describe the pain, and assess its impact on patient disability.

Correlation of Paraspinal Muscle Mass With Decompensation of Sagittal Adult Spinal Deformity After Setting of Fatigue Post 10-Minute Walk.

Objective: The purpose of this study was to investigate the changes in spinopelvic parameters before and after the setting of muscle fatigue along with its correlation with pre-existing paraspinal and psoas muscle mass.

Methods: Single-center retrospective review of prospectively collected data was conducted on 145-adults with symptomatic loss of lumbar lordosis (LL). Radiographs were taken before and after walking for 10 minutes.