Publications by authors named "Jeffrey L Gum"

Article Synopsis
  • The study investigates how different reasons for revision surgery in adult spinal deformity (ASD) patients affect their postoperative outcomes, revealing a high incidence of reoperations.
  • A sample of 891 ASD patients was analyzed retrospectively, categorizing their revisions by cause, and assessing complications, radiographic results, and disability metrics.
  • Findings suggest that different etiologies (mechanical, infection, wound, and SI pain) lead to varying outcomes, with mechanical issues showing less improvement over time compared to others.
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Objective: The objective of this study was to identify baseline patient and surgical factors predictive of optimal outcomes in staged versus same-day combined-approach surgery.

Methods: Adult spinal deformity (ASD) patients with baseline and perioperative (by 6 weeks) data were stratified based on single-stage (same-day) or multistage (staged) surgery, excluding planned multiple hospitalizations. Means comparison analyses were used to assess baseline demographic, radiographic, and surgical differences between cohorts.

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Purpose: Understanding the mechanism and extent of preoperative deformity in revision procedures may provide data to prevent future failures in lumbar spinal fusion patients.

Methods: ASD patients without prior spine surgery (PRIMARY) and with prior short (SHORT) and long (LONG) fusions were included. SHORT patients were stratified into modes of failure: implant, junctional, malalignment, and neurologic.

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Objective: Smoking has been shown to negatively impact spinal health, as well as the outcomes of spinal fusion. Published reports show conflicting data regarding whether smoking negatively impacts patient outcomes following lumbar decompression. The objective of this study was to investigate whether smoking affects the outcomes of patients undergoing lumbar decompression for spinal stenosis or herniated disc.

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Article Synopsis
  • Tranexamic acid (TXA) is used in adult spinal deformity surgery to reduce blood loss, but there's no agreed-upon dosing method.
  • A study analyzed data from 265 complex ASD patients, categorizing them into low, medium, and high TXA dose groups and measuring blood loss, complications, and RBC transfusions.
  • Findings revealed that lower TXA doses resulted in significantly higher blood loss and increased RBC transfusions compared to high doses, suggesting that higher TXA dosing may be more effective in minimizing blood loss during surgery.
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Background: Our understanding of the relationship between sagittal alignment and mechanical complications is evolving. In normal spines, the L1-pelvic angle (L1PA) accounts for the magnitude and distribution of lordosis and is strongly associated with pelvic incidence (PI), and the T4-pelvic angle (T4PA) is within 4° of the L1PA. We aimed to examine the clinical implications of realignment to a normal L1PA and T4-L1PA mismatch.

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Purpose: To evaluate the variability in intraoperative fluid management during adult spinal deformity (ASD) surgery, and analyze the association with complications, intensive care unit (ICU) requirement, and length of hospital stay (LOS).

Methods: Multicenter comparative cohort study. Patients ≥ 18 years old and with ASD were included.

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Study Design: This study was a retrospective propensity-matched study of patients receiving opioid sparing anesthesia (OSA) and those who did not receive an opioid sparing anesthesia regimen.

Objectives: To determine whether patients undergoing spine fusion for deformity fared better with an OSA regimen than those not having an OSA regimen.

Summary Of Background Data: There has been a tremendous focus on opioid overuse.

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Study Design: Retrospective analysis of prospectively collected data.

Objective: Evaluate the impact of prior cervical constructs on upper instrumented vertebrae (UIV) selection and postoperative outcomes among patients undergoing thoracolumbar deformity correction.

Background: Surgical planning for adult spinal deformity (ASD) patients involves consideration of spinal alignment and existing fusion constructs.

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Purpose: Adult spinal deformity (ASD) patients with sagittal plane deformity (N) or structural lumbar/thoraco-lumbar (TL) curves can be treated with fusions stopping at the TL junction or extending to the upper thoracic (UT) spine. This study evaluates the impact on cost/cumulative quality-adjusted life year (QALY) in patients treated with TL vs UT fusion.

Methods: ASD patients with > 4-level fusion and 2-year follow-up were included.

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Purpose: To assess impact of baseline disability on HRQL outcomes.

Methods: CD patients with baseline (BL) and 2 year (2Y) data included, and ranked into quartiles by baseline NDI, from lowest/best score (Q1) to highest/worst score (Q4). Means comparison tests analyzed differences between quartiles.

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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.

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Study Design: Diagnostic accuracy study.

Objective: To establish a simple method of phantomless bone mineral density (BMD) measurement by using preoperative lumbar Computed Tomography (CT) scans, and compare the accuracy of reference tissue combinations to diagnose low BMD against uncalibrated Hounsfield units (HUs).

Summary Of Background Data: HUs are used as a measure of BMD; however, associations between HU and T-scores vary widely.

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Article Synopsis
  • The study investigates the effectiveness of three-column osteotomies (3CO) in correcting complex sagittal spinal deformities and their associated complications during surgery for adult spinal deformity (ASD).
  • It included a cohort of 648 patients, comparing outcomes between those who underwent 3CO and those who did not, finding that 3CO procedures had a significantly higher incidence of complications but offered similar health-related quality of life (HRQL) benefits.
  • Results indicated that patients undergoing 3CO were older and frailer, faced more severe deformities, and experienced higher risks for blood loss and longer hospital stays, but they achieved greater segmental correction outcomes.
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Background: Severe sagittal plane deformity with loss of L4-S1 lordosis is disabling and can be improved through various surgical techniques. However, data are limited on the differing ability of anterior lumbar interbody fusion (ALIF), pedicle subtraction osteotomy (PSO), and transforaminal lumbar interbody fusion (TLIF) to achieve alignment goals in severely malaligned patients.

Methods: Severe adult spinal deformity patients with preoperative PI-LL >20°, L4-S1 lordosis <30°, and full body radiographs and PROMs at baseline and 6-week postoperative visit were included.

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Study Design: Prospective multicenter database post-hoc analysis.

Objectives: Opioids are frequently prescribed for painful spinal conditions to provide pain relief and to allow for functional improvement, both before and after spine surgery. Amidst a current opioid epidemic, it is important for providers to understand the impact of opioid use and its relationship with patient-reported outcomes.

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Article Synopsis
  • This study is a case-control research aimed at creating a classification system for different types of degenerative changes and failures at the proximal junction after spinal surgery.
  • The system outlines four degeneration types: Type 1 (multilevel symmetrical collapse), Type 2 (single adjacent level collapse), Type 3 (fracture), and Type 4 (spondylolisthesis), based on data from patients who had spinal fusion.
  • Findings reveal that degeneration affects nearly half of the patients, with Type 3 having the shortest time before needing revision surgery, while Type 1 shows the lowest revision rate, indicating varying risks associated with each type.
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Article Synopsis
  • The study retrospectively reviews patient data to assess whether changes in the position of the upper instrumented vertebral (UIV) screw during surgery predict the development of proximal junctional kyphosis or failure (PJK/PJF).
  • It involves a cohort of 143 cases analyzed over an average follow-up of 3.5 years, revealing that significant changes in the screw's angle are correlated with higher rates of PJK/PJF and the need for surgical revision.
  • The findings suggest that a change of the screw position greater than 5° notably increases the risk of both developing PJK/PJF and requiring revision surgery, highlighting the importance of careful surgical technique.
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Study Design: Retrospective observational cohort.

Objectives: This study explores the impact of Intraoperative hypotension (IOH) on postoperative complications for major thoracolumbar spine fusion procedures.

Summary Of Background Data: IOH with mean arterial pressure (MAP) <65 mm Hg is associated with postoperative acute kidney injury (AKI) in general surgery.

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Article Synopsis
  • The study compares two workflows for placing cortical bone trajectory (CBT) screws during robotic-assisted spinal surgery: a traditional "Tap" three-step method and a new "No-Tap" two-step method.
  • It analyzed metrics like screw-related complications, surgical time, and blood loss in 91 No-Tap and 88 Tap cases, finding that No-Tap significantly reduced robotic time without increasing the risk of complications.
  • The results suggest that the No-Tap technique is a safer, more efficient alternative to the traditional tapping method in this type of surgery.
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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.

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Objective: Sagittal alignment measured on standing radiography remains a fundamental component of surgical planning for adult spinal deformity (ASD). However, the relationship between classic sagittal alignment parameters and objective metrics, such as walking time (WT) and grip strength (GS), remains unknown. The objective of this work was to determine if ASD patients with worse baseline sagittal malalignment have worse objective physical metrics and if those metrics have a stronger relationship to patient-reported outcome metrics (PROMs) than standing alignment.

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