Chemoprophylactic Anticoagulation After Spine Surgery Does Not Increase Epidural Hematoma Risk: A Propensity-matched Analysis.

Study Design: A retrospective cohort study.

Objective: To calculate the magnitude of any increased risk of epidural hematoma (EDH) associated with chemoprophylactic anticoagulation (chemoprophylaxis), if any.

Summary Of Background Data: Chemoprophylaxis for the prevention of venous thromboembolic events may be associated with an increased risk of EDH after spine surgery.

Using machine learning and big data for the prediction of venous thromboembolic events after spine surgery: A single-center retrospective analysis of multiple models on a cohort of 6869 patients.

Objective: Venous thromboembolic event (VTE) after spine surgery is a rare but potentially devastating complication. With the advent of machine learning, an opportunity exists for more accurate prediction of such events to aid in prevention and treatment.

Methods: Seven models were screened using 108 database variables and 62 preoperative variables.

A Hierarchical Approach to Realignment Strategies in Adult Cervical Deformity Surgery.

Study Design: Retrospective cohort study.

Objective: Construct an individualized cervical realignment strategy based on patient parameters at the presentation that results in superior 2-year health-related quality of life metrics and decreased rates of junctional failure and reoperation following adult cervical deformity surgery.

Summary Of Background Data: Research has previously focused on adult cervical deformity realignment thresholds for maximizing clinical outcomes while minimizing complications.

A Single Proximal Interlocking Bolt May Be Sufficient for Retrograde Nailing of Extra-articular Femur Fractures.

Objective: To evaluate whether a single proximal interlocking bolt was sufficient during the treatment of extra-articular femur fractures with retrograde medullary nailing.

Design: Retrospective comparative study.

Setting: Academic Level 1 trauma center.

Anterior approach lumbar fusions cause a marked increase in thromboembolic events: Causal inferences from a propensity-matched analysis of 1147 patients.

Objective: Anterior lumbar fusions are thought to be associated with elevated venous thromboembolic event (VTE) rates, but the magnitude of this increase in VTE is not well described. The objective of this study was to quantify any increase in VTE caused by anterior approach lumbar fusion.

Methods: 1147 consecutive lumbar fusions performed at our institution over a six-year period were identified, and clinical and demographic data were collected.

Post-operative follow-up care after acute spinal trauma: What is the reality?

•Only 23.7% of acute spinal trauma patients who underwent instrumentation met or surpassed one-year of clinical follow-up care.•Factors associated with lower rates of completed follow-up are ISS, presence of non-ambulatory spinal cord injury, history of IVDA, and insurance.

Should Global Realignment Be Tailored to Frailty Status for Patients Undergoing Surgical Intervention for Adult Spinal Deformity?

Study Design: Retrospective cohort study.

Objective: Assess whether modifying spinal alignment goals to accommodate frailty considerations will decrease mechanical complications and maximize clinical outcomes.

Summary Of Background Data: The Global Alignment and Proportion (GAP) score was developed to assist in reducing mechanical complications, but has had less success predicting such events in external validation.

Chemoprophylactic Anticoagulation Following Lumbar Surgery Significantly Reduces Thromboembolic Events After Instrumented Fusions, Not Decompressions.

Study Design: Retrospective cohort.

Objective: To quantify any reduction in venous thromboembolic events (VTEs) caused by chemoprophylaxis among lumbar surgery patients.

Summary Of Background Data: Chemoprophylactic anticoagulation (chemoprophylaxis) is used to prevent VTE after lumbar surgery.

Crossing the Bridge From Degeneration to Deformity: When Does Sagittal Correction Impact Outcomes in Adult Spinal Deformity Surgery?

Background: Patients with less severe adult spinal deformity (ASD) undergo surgical correction and often achieve good clinical outcomes. However, it is not well understood how much clinical improvement is due to sagittal correction rather than treatment of the spondylotic process.

Purpose: Determine baseline thresholds in radiographic parameters that, when exceeded, may result in substantive clinical improvement from surgical correction.

The Clinical Impact of Failing to Achieve Ideal Proportional Realignment in Adult Spinal Deformity Patients.

Summary Of Background Data: The impact of not achieving ideal realignment in the global alignment and proportion (GAP) score in adult spinal deformity (ASD) correction on clinical outcomes is understudied at present.

Objective: To identify the clinical impact of failing to achieve GAP proportionality in ASD surgery.

Study Design: Retrospective cohort.

Classifying vertebral artery anatomy abnormality in children with skeletal dysplasia.

Purpose: Skeletal dysplasia (SKD) have predictably abnormal occipitocervical skeletal anatomy, but a similar understanding of their vertebral artery anatomy is not known. Knowledge and classification of vertebral artery anatomy in SKD patients is important for safe surgical planning. We aimed to determine if predictably abnormal vertebral artery anatomy exists in pediatric SKD.

Relationship between crossover sign and anterior center-edge angle.

Purpose: The aim of this study was to evaluate the relationship between the anterior center-edge angle (ACEA) and lateral center-edge angle (LCEA) and crossover ratio.

Methods: Consecutive patients presenting for evaluation of hip pain were reviewed. The following measurements were recorded and analyzed: Crossover ratio, LCEA, ACEA, and alpha-angle.

Factors associated with venous thromboembolic events following ICU admission in patients undergoing spinal surgery: an analysis of 1269 consecutive patients.

In BriefIn a retrospective study the authors examined 1269 patients who underwent spinal surgery and were admitted to the intensive care unit (ICU) and identified factors that are associated with venous thromboembolic events (VTEs) in this "high risk" group. Amongst these high-risk factors were: surgeries longer than 4 hours, comorbid disease, patients needing an osteotomy, and patients undergoing spinal stabilization for fractures. Identification of factors that can be optimized prior to surgery will decrease the rates of VTE.

Venous thromboembolism events following spinal fractures: A single center experience.

Objective: Venous thromboembolic events (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), are a major cause of readmission, morbidity, and mortality after spine surgery. Patients with spinal fractures are particularly at an increased risk for VTE. The objective of this study is to understand VTE risk factors in this patient population and to examine current institutional practices.

Epidemiology and national trends in prevalence and surgical management of metastatic spinal disease.

Surgical treatment for spinal metastasis has benefited from improvements in surgical techniques. However, the trends in treatment and outcomes for spinal metastasis surgery have not been well-established in a pediatric population. Patients <20 years old with metastatic spinal tumors undergoing spinal surgery were identified in the KID database.

Predictors of Readmissions and Reoperations Related to Venous Thromboembolic Events After Spine Surgery: A Single-Institution Experience with 6869 Patients.

Background: Readmission and reoperation are used as hospital and surgeon quality metrics. Venous thromboembolic (VTE) events, including deep vein thrombosis and pulmonary embolism (PE), are a major cause of readmission, morbidity, and mortality after spine surgery. Specific procedural, perioperative, and patient characteristics may be associated with these outcomes.

The timing of venous thromboembolic events after spine surgery: a single-center experience with 6869 consecutive patients.

OBJECTIVE Venous thromboembolic events (VTEs), including both deep venous thrombosis (DVT) and pulmonary embolism, are a major cause of morbidity and mortality after spine surgery. Prophylactic anticoagulation, or chemoprophylaxis, can prevent VTE. However, the timing of VTEs after spine surgery and the effect of chemoprophylaxis on VTE timing remain underinvestigated.

Timing and risks of chemoprophylaxis after spinal surgery: a single-center experience with 6869 consecutive patients.

OBJECTIVE Venous thromboembolism (VTE) after spinal surgery is a major cause of morbidity, but chemoprophylactic anticoagulation can prevent it. However, there is variability in the timing and use of chemoprophylactic anticoagulation after spine surgery, particularly given surgeons' concerns for spinal epidural hematomas. The goal of this study was to provide insight into the safety, efficacy, and timing of anticoagulation therapy after spinal surgery.

Muscarinic cholinergic receptor antagonists in the VTA and RMTg have opposite effects on morphine-induced locomotion in mice.

The ventral tegmental area (VTA) and the rostromedial tegmental nucleus (RMTg) each contribute to opiate reward and each receive inputs from the laterodorsal tegmental and pedunculopontine tegmental nuclei, the two principle brainstem cholinergic cell groups. We compared the contributions of VTA or RMTg muscarinic cholinergic receptors to locomotion induced by morphine infusions into the same sites. VTA co-infusion of atropine completely blocked VTA morphine-induced locomotion providing additional support for the important role of VTA muscarinic cholinergic receptors in the stimulant effects of opiates.