Sarcopenia as a Risk Factor for Complications Following Pedicle Subtraction Osteotomy.

Study Design: Retrospective cohort.

Objective: The objective was to determine if sarcopenia is an independent risk factor for complications in adult spinal deformity (ASD) patients undergoing pedicle subtraction osteotomy (PSO) and define categories of complication risk by sarcopenia severity.

Summary Of Background Data: Sarcopenia is linked to morbidity and mortality in several orthopedic procedures.

The Impact of the COVID-19 Pandemic on the Functionality of International Surgical Volunteer Organizations.

Background: Surgical volunteer organizations have been severely limited during the ongoing coronavirus disease pandemic. Our purpose was to identify obstacles to surgical volunteer organizations secondary to COVID-19 and their responses.

Methods: Forty-one surgical volunteer organizations participated in a web-based survey (156 invited, 26% response rate).

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.

Spinal Epidural Hematoma Producing Neural Compression After Bilateral Rod Fractures in Failed Long-Construct Fusion: A Case Report.

Case: A 75-year-old woman with remote history of T10-S1 spinal fusion with pelvic fixation presented with radicular back pain and numbness in the right lower extremity. Imaging showed bilateral rod fractures at L4-5 and a dorsal spinal epidural hematoma (SEH) with associated severe canal narrowing and cauda equina compression. The patient underwent bilateral L4-5 laminectomies, hematoma evacuation, reinforcement of multilevel nonunion, and implant replacement.

Biomechanical Comparison of Dual and Posterior Locking Plates in an Ex Vivo Comminuted Olecranon Fracture Model.

Purpose: Comminuted olecranon fractures are commonly fixed with posterior locking plates (PLPs). Though biomechanically validated, this method comes with risks of symptomatic implant prominence and wound breakdown. Dual locking plates (DLPs) placed on the medial and lateral surfaces of the olecranon theoretically avoid these risks and allow for fixation of proximal fracture fragments in multiple planes.

International Orthopaedic Volunteer Opportunities in Low and Middle-Income Countries.

Globally, the burden of musculoskeletal conditions continues to rise, disproportionately affecting low and middle-income countries (LMICs). The ability to meet these orthopaedic surgical care demands remains a challenge. To help address these issues, many orthopaedic surgeons seek opportunities to provide humanitarian assistance to the populations in need.

Adult Spinal Deformity Surgery Is Associated with Increased Productivity and Decreased Absenteeism From Work and School.

Study Design: Retrospective cohort study.

Objective: We hypothesized that adult spinal deformity (ASD) surgery would be associated with improved work- and school-related productivity, as well as decreased rates of absenteeism.

Summary Of Background Data: ASD patients experience markedly decreased health-related quality of life along many dimensions.

Partial Delaminated Quadriceps Tendon Rupture: A Case Report.

Case: We present a case of a 41-year-old male bodybuilder with a partial delaminated quadriceps tendon rupture after a traumatic injury. Partial quadriceps tendon tears are rare overall and usually are treated nonoperatively with conservative management depending on the patient's limitations. He was found to have an intact superficial quadriceps tendon with a partial thickness tear of the vastus intermedius and delamination of the undersurface quadriceps tendon precluding active knee extension.

Understanding Health Economics in Spine Surgery.

»: The United States has faced substantial increases in health-care expenditure, with specifically large increases in spine surgery costs.

»: Many different formulas are utilized to determine value in spine surgery, including cost- benefit analyses, cost-effectiveness analyses, and cost-utility analyses, with the overall determination of value being quality/cost.

»: Quality often is calculated indirectly using either process measures or outcome measures and represents the potential benefit of a given intervention, usually over a specific time period to yield quality-adjusted life years.

Global Volunteering in Orthopaedics: Availability and Implementation Considerations.

The World Health Organization describes traumatic injuries as a "neglected epidemic" in developing countries, accounting for more deaths annually than HIV/AIDS, malaria, and tuberculosis combined. Low- and middle-income countries rely on volunteer assistance to address the growing surgical disease burden of traumatic injuries. Efforts to increase the availability of international electives for orthopaedic trainees can help with the short-term need for surgical personnel abroad and facilitate sustainability through capacity building, maximizing long-term benefits for all parties.

Patients Who Undergo Primary Lumbar Spine Fusion After Recent but Not Remote Total Hip Arthroplasty Are at Increased Risk for Complications, Revision Surgery, and Prolonged Opioid Use.

Objective: To evaluate the effect of a recent history of total hip arthroplasty (THA) on primary lumbar spine fusion (LSF) for concurrent hip and spine disease.

Methods: A total of 98,242 patient records from the PearlDiver Database were evaluated and divided into 3 cohorts: 1) patients with a history of LSF alone, 2) patients with a history of LSF for newly diagnosed lumbar disease after having a remote THA> 2 years previously, and 3) patients with a history of LSF after having recent THA <2 years before LSF who initially presented with concurrent hip and lumbar spine disease and underwent THA before LSF. Postoperative outcomes were assessed with multivariable logistic regression to determine the effect of THA on outcomes after LSF with respect to postoperative complications, LSF revision rates, and opioid use.

Recognition and Management of Emergent Spinal Pathology Among First-Line Providers.

Spinal emergencies require prompt identification, management, and surgical referral (if needed) from first-line providers. Diagnostic delays from a failure to recognize emergency conditions can lead to adverse patient outcomes. The objective of this study was to understand the proficiency with which first-line providers can recognize and manage spinal conditions, particularly spinal emergencies.

Proximal junctional failure prevention in adult spinal deformity surgery utilizing interlaminar fixation constructs.

Proximal junctional kyphosis (PJK) is a common complication following fusion for Adult Spinal Deformity. PJK and proximal junctional failure (PJF) may lead to pain, neurological injury, reoperation, and increased healthcare costs. Efforts to prevent PJK and PJF have aimed to preserve or reconstruct the posterior spinal tension band and/or modifying instrumentation to allow for more gradual transitions in stiffness at the cranial end of long spinal constructs.

Osteochondral Allograft Transplantation: Identifying the Biomechanical Impact of Using Shorter Grafts and Pulsatile Lavage on Graft Stability.

This study seeks to identify the ability of shorter osteochondral allografts (OCAs) to resist displacement/failure. Additionally, this study seeks to evaluate the effect of pulsatile lavage (PL) on the biomechanical stability of the OCA. Fifteen-millimeter diameter, human cadaveric, OCAs of 4, 7, and 10 mm in depth were harvested for comparison of resistance to compressive and tensile loads.

Diagnosis and Management of Hip Abductor Insufficiency.

Greater Trochanteric Pain Syndrome (GTPS) is a common cause of lateral hip pain, with an incidence of 1.8 per 1000 patients, most commonly occurring between the fourth and sixth decades of life. When GTPS fails to improve with conservative management, hip abductor insufficiency should be suspected.

Sarcopenia as a Risk Factor for Prosthetic Infection After Total Hip or Knee Arthroplasty.

Background: Sarcopenia, an age-related loss of muscle mass and function, has been previously linked to an increased risk of morbidity, mortality, and infection after a variety of surgical procedures. This study is the first to evaluate the impact of the psoas-lumbar vertebral index (PLVI), a validated marker for central sarcopenia, on determining post-arthroplasty infection status.

Methods: This is a case-control, retrospective review of 30 patients with prosthetic joint infection (PJI) diagnosed by the Musculoskeletal Infection Society criteria compared to 69 control patients who underwent a total hip or knee arthroplasty.

Spinal Emergencies in Primary Care Practice.

Atraumatic spinal emergencies often present a diagnostic and management dilemma for health care practitioners. Spinal epidural abscess, cauda equina syndrome, and spinal epidural hematoma are conditions that can insidiously present to outpatient medical offices, urgent care centers, and emergency departments. Unless a high level of clinical suspicion is maintained, these clinical entities may be initially misdiagnosed and mismanaged.