Temporal Changes in PROMs Improvement and Recovery Kinetics Following Transforaminal Endoscopic Lumbar Discectomy.

Study Design: Retrospective cohort study.

Objective: to analyze trends in PROMs improvement and recovery kinetics following transforaminal endoscopic lumbar discectomy and foraminotomy (TELD).

Summary Of Background Data: As TELDs become an increasingly common alternative to fusions for lateral disc herniations, it is important to understand patients' postoperative recovery timelines to manage patient expectations.

The cost-utility of intraoperative tranexamic acid in adult spinal deformity patients undergoing long posterior spinal fusion.

Purpose: This study aims to evaluate the cost-utility of intraoperative tranexamic acid (TXA) in adult spinal deformity (ASD) patients undergoing long posterior (≥ 5 vertebral levels) spinal fusion.

Methods: A decision-analysis model was built for a hypothetical 60-year-old adult patient with spinal deformity undergoing long posterior spinal fusion. A comprehensive review of the literature was performed to obtain event probabilities, costs and health utilities at each node.

Inflation-adjusted medicare physician reimbursement for adult spinal deformity surgery substantially declined from 2002 to 2020.

Purpose: Physician fees for orthopaedic surgeons by the Centers for Medicare and Medicaid Services (CMS) are increasingly scrutinized. The present retrospective review aims to assess whether adult spinal deformity (ASD) surgeries are properly valued for Medicare reimbursement.

Methods: Current Procedural Terminology (CPT) codes related to posterior fusion of spinal deformity of ≤ 6, 7-12, and ≥ 13 vertebral levels, as well as additional arthrodesis and osteotomy levels, were assessed for (1) Compound annual growth rate (CAGR) from 2002 to 2020, calculated using physician fee data from the CMS Physician Fee Schedule Look-Up Tool; and (2) work relative value units (RVUs) per operative minute, using data from the National Surgical Quality Improvement Program.

Abnormal Postoperative PROMIS Scores are Associated With Patient Satisfaction in Adult Spinal Deformity and Degenerative Spine Patients.

Study Design: Retrospective review.

Objectives: To evaluate (1) patient satisfaction after adult spine surgery; (2) associations between the number of abnormal PROMIS domain scores and postoperative satisfaction; and (3) associations between the normalization of a patient's worst preoperative PROMIS domain score and postoperative satisfaction.

Summary Of Background Data: Although "legacy" patient-reported outcome measures correlate with patient satisfaction after adult spine surgery, it is unclear whether PROMIS scores do.

Predicting 30-day mortality after surgery for metastatic disease of the spine: the H-FAILS score.

Purpose: Scoring systems for metastatic spine disease focus on predicting long- to medium-term mortality or a combination of perioperative morbidity and mortality. However, accurate prediction of perioperative mortality alone may be the most important factor when considering surgical intervention. We aimed to develop and evaluate a new tool, the H-FAILS score, to predict 30-day mortality after surgery for metastatic spine disease.

A Modified Endoscopic Access for Lumbar Foraminal Pathologies; Posterolateral "Intertransverse" Endoscopic Approach to Minimize Postoperative Dysesthesia Following Transforaminal Approach.

Objective: To present an innovative, modified endoscopic approach for foraminal/extraforaminal pathologies, to reduce postoperative dysesthesia (POD) following the conventional transforaminal endoscopic approach (the access angle more than 45° from the midline), since POD is one of the major documented disadvantages that may compromise patient satisfaction.

Methods: We introduce a modified posterolateral technique, termed the intertransverse approach, utilizing a steeper access angle less than 25° through the intertransversarii muscle and the intertransverse space with expanding Kambin triangle via lateral facetectomy/foraminoplasty, to reduce dorsal root ganglion/exiting nerve root irritation under direct visualization and lower the incidence of POD. Consecutive patients undergoing endoscopic spine surgery via the intertransverse approach for foraminal and/or extraforaminal disc herniations or bony stenosis were retrospectively reviewed.

Uniportal, Transforaminal Endoscopic Thoracic Discectomy: Review and Technical Note.

Symptomatic thoracic disc herniations are a rare entity and their operative treatment is challenging. Open approaches, despite providing excellent access, are associated with significant access morbidity from thoracotomy, and this has led to an increased interest in minimally invasive techniques such as mini-open approach, thoracoscopic approach and the endoscopic approach. In this article, we describe the technical points for performing a transforaminal endoscopic thoracic discectomy and summarize its literature outcomes in the context of other minimally invasive approaches.

Laminectomy vs Fusion for Intradural Extramedullary Tumors.

Background: Laminectomy (LA) and LA with fusion (LAF) have been demonstrated as surgical techniques that treat intradural extramedullary tumors (IDEMTs). The purpose of the present study was to compare the rate of 30-day complications following LA vs LAF for IDEMTs.

Methods: Patients undergoing LA for IDEMTs from 2012 to 2018 were identified in the National Surgical Quality Improvement Program database.

Delays in Presentation After Traumatic Spinal Cord Injury-A Systematic Review.

Background: Prompt surgical decompression after traumatic spinal cord injury (TSCI) may be associated with improved sensorimotor outcomes. Delays in presentation may prevent timely decompression after TSCI.

Objective: To systematically review existing studies investigating delays in presentation after TSCI in low- and middle-income countries (LMICs) and high-income countries (HICs).

Predictors of Blunt Cerebrovascular Injury, Stroke, and Mortality in Patients with Cervical Spine Trauma.

Background: Blunt cerebrovascular injury (BCVI), defined as blunt traumatic injury to the carotid or vertebral arteries, is associated with significant risk of stroke and mortality. Cervical spine trauma is a recognized risk factor for BCVI.

Objective: The objective of this study was to identify significant predictors of BCVI and its sequelae in patients with known cervical spine injury.

Preoperative patient activation predicts minimum clinically important difference for PROMIS pain and physical function in patients undergoing elective spine surgery.

Background Context: Patient activation is a patient's willingness to take independent actions to manage their own health care.

Purpose: The goal of this study is to determine whether preoperative patient activation measure (PAM) predicts minimum clinically important difference (MCID) for Patient-Reported Outcomes Measurement Information System (PROMIS) pain, physical function, depression, and anxiety for patients undergoing elective spine surgery.

Study Design/setting: Retrospective review.

Increased Severity of Anemia Is Associated with Postoperative Complications following a Adult Spinal Deformity Surgery.

Background: Anemia is a modifiable risk factor for postoperative complications following surgery. This study aimed to determine the impact of preoperative anemia severity on 30-day postoperative complications following adult spinal deformity (ASD) surgery.

Methods: Adults undergoing spinal fusion for ASD from 2012 to 2018 were identified in the National Surgical Quality Improvement Program database.

Prescription Patterns, Associated Factors, and Outcomes of Opioids for Operative Foot and Ankle Fractures: A Systematic Review.

Background: Pain management after foot and ankle surgery must surmount unique challenges that are not present in orthopaedic surgery performed on other parts of the body. However, disparate and inconsistent evidence makes it difficult to draw meaningful conclusions from individual studies.

Questions/purposes: In this systematic review, we asked: what are (1) the patterns of opioid use or prescription (quantity, duration, incidence of persistent use), (2) factors associated with increased or decreased risk of persistent opioid use, and (3) the clinical outcomes (principally pain relief and adverse events) associated with opioid use in patients undergoing foot or ankle fracture surgery?

Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for our review.

30-day postoperative sepsis risk factors following laminectomy for intradural extramedullary tumors.

Background: Posterior laminectomy (LA) for resection of intradural extramedullary tumors (IDEMTs) is associated with postoperative complications, including sepsis. Sepsis is an uncommon but serious complication that can lead to increased morbidity and mortality, prolonged hospital stays, and greater costs. Given the susceptibility of a solid tumor patients to sepsis-related complications, it is important to recognize IDEMT patients as a unique population when assessing the risk factors for sepsis after laminectomy.

AM-PAC mobility scores predict non-home discharge following adult spinal deformity surgery.

Background Context: Adult spinal deformity (ASD) surgery requires an extended recovery period and often non-routine discharge. The Activity Measure for Post-Acute Care (AM-PAC) Basic Mobility Inpatient Short Form (6-Clicks) is a prediction tool, validated for other orthopedic procedures, to assess a patient's ability to mobilize after surgery.

Purpose: To assess the thresholds of AM-PAC scores that determine non-home discharge disposition in patients who have undergone ASD surgery.

Emergency Department Visits After Outpatient Spine Surgery.

Study Design: A retrospective study.

Objective: This study sought to characterize the incidence and timing of postoperative emergency department (ED) visits after common outpatient spinal surgeries performed at ambulatory surgery centers (ASCs) and at hospital outpatient departments (HOPDs).

Summary Of Background Data: Outpatient spine surgery has markedly grown in popularity over the past decade.

Disparities in Elective Spine Surgery for Medicaid Beneficiaries: A Systematic Review.

Study Design: Systematic review.

Objectives: We sought to synthesize the literature investigating the disparities that Medicaid patients sustain with regards to 2 types of elective spine surgery, lumbar fusion (LF) and anterior cervical discectomy and fusion (ACDF).

Methods: Our review was constructed in accordance with Preferred Reporting Items and Meta-analyses (PRISMA) guidelines and protocol.

Bone Mineral Density T-Score is an Independent Predictor of Major Blood Loss in Adult Spinal Deformity Surgery.

Study Design: Retrospective Cohort Study.

Objective: The purpose of this study was to determine the effect of low bone mineral density (BMD), as assessed by preoperative Dual-energy X-ray Absorptiometry (DEXA) scans, on intraoperative blood loss following adult spinal deformity (ASD) surgery.

Methods: Patients who received spinal fusion for ASD (>5 levels fused) at a single academic center from 2010-2018 were included in this study.

Adoption of awake spine surgery - trends from a national registry over 14 years.

Background Context: Awake spine surgery is growing in popularity, and may facilitate earlier postoperative recovery, reduced cost, and fewer complications than spine surgery conducted under general anesthesia (GA). However, trends in the adoption of awake (ie, non-GA) spine surgery have not been previously studied.

Purpose: To investigate temporal trends in non-GA spine surgery utilization and outcomes in the United States.

Laminectomy Versus Laminectomy with Fusion for Intradural Extramedullary Tumors: A Systematic Review and Meta-Analysis.

Objective: The primary objective of our systematic review and meta-analysis was to systematically compare the reported outcomes between laminectomy and laminectomy with fixation/fusion (LF) for the treatment of intradural extramedullary tumors (IDEMTs). Our secondary objective was to compare the outcomes between different laminectomy exposure techniques.

Methods: PubMed and Embase were queried for literature on laminectomy and LF for IDEMTs.

Applying to Fellowship During a Pandemic: Lessons Learned From the 2020-2021 Orthopaedic Spine Fellowship Application Cycle.

Introduction The COVID-19 pandemic resulted in a transition to a virtual format for all medical residency and fellowship application processes. Previous studies have discussed the successful implementation of virtual interviews, but a deep analysis of how the application process has changed for orthopedic surgery fellowship programs during the pandemic is lacking. The purpose of this study was to assess how COVID-19 impacted the orthopedic spine fellowship application and selection process.

Effect of the COVID-19 Pandemic on the Orthopaedic Surgery Residency Application Process: What Can We Learn?

Introduction: The goal of this study was to assess the influence of the coronavirus disease 2019 pandemic on the orthopaedic surgery residency application process in the 2020 to 2021 application cycle.

Methods: A survey was administered to the program directors of 152 Accreditation Council for Graduate Medical Education-accredited orthopaedic surgery residency programs. The following questions were assessed: virtual rotations, open houses/meet and greet events, social media, the selection criteria of applicants, the number of applications received by programs, and the number of interviews offered by programs.