Psychological distress does not predict decisional regret in patients undergoing spinal reconstruction for adult spinal deformity.

Purpose: The study aimed to assess the link between preoperative psychological distress and postoperative decisional regret in adult spinal deformity (ASD) surgery patients. We hypothesized that greater pre-surgery distress would correlate with higher post-surgery regret. This evaluation was based on a retrospective case series from an institution with standardized surgical guidelines for ASD.

Age-adjusted Baseline Neck Disability Index Values: An Analysis of Neck Pain Disability in the General American Population.

Study Design: Survey-based, prospective study.

Objective: Identify age-adjusted baseline neck disability index (NDI) values in the American population.

Background: The NDI is the most widely used tool for assessing self-rated disability in patients with neck pain.

Does Pedicle Morphology Affect the Safety and Accuracy of Pedicle Screw Placement Using 3D-Printed Guides? A 5-Year, Single-Center Experience With 2210 Screws Placed for Adult Spinal Deformity Reconstruction.

Background: Adult spinal deformity (ASD) surgery often involves the placement of pedicle screws using various methods, including freehand technique, fluoroscopic guidance, and computer-assisted intraoperative navigation, each with distinct limitations. Particularly challenging is the instrumentation of pedicles with small or absent cancellous channels (Watanabe types C and D pedicles), commonly found at the apex of large curves where precise screw placement is crucial for effective deformity correction. 3D-printed pedicle screw drill guides (3DPSG) may assist in accurately placing pedicle screws while minimally disrupting the standard ASD surgery workflow.

Describing functional low back pain disability in the American population: a crowd-sourced evaluation of the Oswestry disability index.

Background Context: The Oswestry disability index (ODI) is widely utilized as a patient reported outcome (PRO) tool to assess patients presenting with low back pain (LBP) and following thoracolumbar spine surgery. No primary study has calculated the baseline range of ODI values in the diverse American population. Establishing age-adjusted normative values for ODI in the American population is crucial for assessing the utility of treatment strategies.

Transdural retrieval of retropulsed transforaminal lumbar interbody fusion cages.

Transforaminal lumbar interbody fusions (TLIFs) are performed for various lumbar spine pathologies. Posterior migration of an interbody cage is a complication that may result in neurologic injury and require reoperation. Sparse information exists regarding the safety and efficacy of a transdural approach for cage retrieval.

Are Variable Screw Angle Change and Screw-to-Vertebral Body Ratio Associated With Radiographic Subsidence Following Anterior Cervical Discectomy and Fusion?

Study Design: Retrospective Cohort.

Objective: This study aims to assess the easily measurable radiographic landmarks of screw-to-vertebral body ratio and changes in screw angle to identify if they are associated with early subsidence following an Anterior cervical discectomy and fusion (ACDF).

Methods: A retrospective cohort study was conducted on patients undergoing 1-3 level ACDF with allograft or PEEK cages.

Opiate-reduction protocol for common outpatient spinal procedures: a long-term feasibility study and single-center experience.

Objective: The opioid epidemic continues to be at the forefront of public health. As a response to this crisis, many statewide and national medical groups have sought to develop opioid-prescribing guidelines for both acute and chronic pain states. Given the lack of evidence in the neurosurgical landscape, the authors' institution implemented opioid-prescribing guidelines for common outpatient spinal procedures in 2017, subsequently demonstrating a significant reduction in the narcotics prescribed.

Correction of cervical kyphoscoliosis, bisected spinal cord, and vertebral artery to epidural vein fistula in neurofibromatosis type 1.

Neurofibromatosis-1 (NF1) presents complex challenges due to its multisystemic effects, including kyphoscoliosis, dural ectasia, and arteriovenous fistulas (AVF). We present a case of a 31-year-old male with NF1 exhibiting severe cervical kyphoscoliosis, dural ectasia, a bisected cervical cord, and an arteriovenous fistula, highlighting the intricacies of managing such intricate cases. Rapid weakening in the patient's right arm and leg prompted imaging revealing severe cervical kyphotic deformity and a dural fold dividing the spinal cord.

Is spinopelvic mismatch associated with increased disability at 2 years following short-segment lumbar fusions?

Objective: This study aimed to investigate the impact of pelvic incidence (PI) and lumbar lordosis (LL) matching on health-related quality of life (HRQOL) outcomes in patients undergoing one- or two-level lumbar fusions for degenerative pathology. The study also examined changes in alignment and HRQOL over a 24-month follow-up period.

Methods: A retrospective cohort study used data from a multicenter, prospectively collected database.

Monthly multidisciplinary complex spine conference: a cost-analysis utilizing time-driven activity-based costing.

Purpose: To understand costs and provide an initial framework associated with conference implementation as it pertains to complication prevention.

Methods: Team members' time spent on conference preparation, presentation, and follow-up tasks was recorded and averaged to determine the time required to prepare and present one patient. Using 2022 hourly wage rates based on our urban hospital setting, wage values were calculated for each personnel type and applied to their time spent.

Successful Implantation of a Ventricular Shunt With Termination in the Iliac Bone in the Adult Patient With Obstructive Hydrocephalus.

Background And Importance: With the exception of the 3 classic shunt placement options (ventriculoperitoneal, ventriculopleural, and ventriculoatrial), surgically feasible alternative sites for distal catheter placement remain limited and often require the assistance of an access surgeon. Tubbs et al suggested the possibility of intraosseous cerebrospinal fluid diversion in the ilium, noting that ilium infusion in cadaveric specimens was possible without the development of body edema or fluid overflow. Since this publication, limited case reports have been published on the success of ventriculo-ilium (VI) shunt placement.

Early Compensatory Segmental Angle Changes at L3-L4 and L4-L5 After a L5-S1 Interbody Fusion for a Grade 1 Spondylolisthesis.

Study Design: The retrospective study included patients who underwent an L5-S1 anterior (ALIF) or transforaminal (TLIF) lumbar interbody fusion with posterior pedicle screw instrumentation for grade 1 spondylolisthesis from 2018 to 2022.

Objective: To compare early reciprocal changes at the L3-L4 and L4-L5 adjacent levels 6 months after ALIF or TLIF at L5-S1.

Background: Degenerative and chronic isthmic spondylolistheses often result in decreased segmental lordosis (SL) at L5-S1.

Effects of a comprehensive brain computed tomography deep learning model on radiologist detection accuracy.

Objectives: Non-contrast computed tomography of the brain (NCCTB) is commonly used to detect intracranial pathology but is subject to interpretation errors. Machine learning can augment clinical decision-making and improve NCCTB scan interpretation. This retrospective detection accuracy study assessed the performance of radiologists assisted by a deep learning model and compared the standalone performance of the model with that of unassisted radiologists.

Clinical Guidelines for the Evaluation and Treatment of Lumbar Disc Herniations: How Accurate is the Internet?

Objective: To compare information online regarding lumbar disc herniation (LDH) on commonly searched websites and compare those findings with the evidence-based recommendations listed in the North American Spine Society (NASS) clinical practice guidelines.

Methods: NASS Clinical Practice Guidelines, Internet searches were performed utilizing three common search engines (Google, Bing, Yahoo) and keywords associated with LDH. The top 20 websites from each search were selected.

Personalized Medicine in Orthopaedic Surgery: The Case of Spine Surgery.

Personalized medicine has made a tremendous impact on patient care. Although initially, it revolutionized pharmaceutical development and targeted therapies in oncology, it has also made an important impact in orthopaedic surgery. The field of spine surgery highlights the effect of personalized medicine because the improved understanding of spinal pathologies and technological innovations has made personalized medicine a key component of patient care.

What is the fate of the adjacent segmental angles 6 months after single-level L3-4 or L4-5 lateral lumbar interbody fusion?

Background Context: Lateral lumbar interbody fusion (LLIF) is an effective technique for fusion and sagittal alignment correction/maintenance. Studies have investigated the impact on the segmental angle and lumbar lordosis (and pelvic incidence-lumbar lordosis mismatch), however not much is documented regarding the immediate compensation of the adjacent angles.

Purpose: To evaluate acute adjacent and segmental angle as well as lumbar lordosis changes in patients undergoing a L3-4 or L4-5 LLIF for degenerative pathology.

Incidence, etiology and time course of delays to adult spinal deformity surgery: a single-center experience.

Purpose: We sought to determine the incidence, origin, and timeframe of delays to adult spinal deformity surgery so that institutions using preoperative multidisciplinary patient assessment teams might better anticipate and address these potential delays.

Methods: Complex spine procedures for treatment of adult spinal deformity from 1/1/18 to 8/31/21 were identified. Procedures for infection, tumor, and urgent/emergent cases were excluded.

Anterior Cervical Corpectomy and Fusion for Degenerative Cervical Spondylotic Myelopathy: Case Presentation With Surgical Technique Demonstration and Review of Literature.

Anterior cervical corpectomy and fusion (ACCF) provides an extensive decompression and provides a large surface area for fusion in patients presenting with cervical spondylotic myelopathy. Unfortunately, this procedure is a more difficult spinal surgery to perform (compared with a traditional anterior cervical discectomy and fusion) and has a higher incidence of overall complications. In literature, ACCF has functional outcomes that seem clinically equivalent to those for multilevel anterior cervical discectomy and fusion, especially when contained to 1 vertebral body level, and in cases, for which both posterior and anterior procedures would be appropriate surgical options, may provide greater long-term clinical benefit than posterior fusion or laminoplasty.

Use of Cannulated Reamers to Facilitate Thoracic Diskectomy Using a Minimally Invasive Retropleural Thoracotomy Approach-Surgical Technique.

Background: The surgical treatment of symptomatic thoracic disk herniations is technically challenging. In the past decade, a minimally invasive retropleural thoracotomy approach has become more popular to treat this pathology. However, efficient bone removal to safely perform the diskectomy and spinal cord decompression is difficult with this technique because of the small incision size and long working distance in the thoracic cavity and the proximity of the compressed thoracic cord.

The Impact of Surgical Approach on Sagittal Plane Alignment in Patients Undergoing One- or Two- Level Fusions for Degenerative Pathology: A Multicenter Radiographic Evaluation 6 Months Following Surgery.

Objective: Interbody fusion procedures, including transforaminal (TLIF), posterior (PLIF), anterior (ALIF), and lateral (LLIF), effectively treat lumbar degenerative pathology and provide spinopelvic balance. The objective of this study is to compare changes in spinopelvic parameters 6 months following 1-2 level TLIF, PLIF, ALIF, and LLIF.

Methods: This retrospective study included 18 centers across the United States.

Establishing a Reference Procedure Length for Anterior Cervical Fusions: The Role for Standards in Surgical Process Improvement.

Surgical process improvement strategies are increasingly being applied to specific procedures to improve value. A critical step in any process improvement strategy is the identification of performance benchmarks. Procedure length is a performance benchmark for anterior cervical discectomy and fusion (ACDF) procedures; therefore, we sought to establish reference procedure lengths for 1-level, 2-level, and 3-level ACDFs at both teaching and non-teaching institutions and to describe methods for using this information to advance surgical process improvement initiatives.

The impact of interbody approach and lumbar level on segmental, adjacent, and sagittal alignment in degenerative lumbar pathology: a radiographic analysis six months following surgery.

Background Context: Interbody fusion, including: transforaminal (TLIF), posterior (PLIF), anterior (ALIF), and lateral (LLIF); effectively treat lumbar degenerative pathology and provide spinopelvic balance. Although the decision on surgical approach and technique are multifactorial and patient specific, the impact of the interbody approach on segmental and adjacent level lordosis could be an important factor to consider during pre-operative planning to achieve pre-specified alignment goals.

Purpose: The purpose of this study is to compare the 6-month postoperative radiographic outcomes in the lumbar spine following 1 to 2 level transforaminal (TLIF), posterior (PLIF), anterior (ALIF), and lateral (LLIF) interbody fusions at the L3-4, L4-5, and L5-S1 levels.