Cervical orthosis does not improve postoperative pain following posterior cervical fusion: a randomized controlled trial.

Purpose: To determine whether postoperative neck pain in the first 4 weeks following multi-level posterior cervical fusion (PCF) with orthosis is equivalent to multi-level PCF without orthosis.

Methods: Patients were randomly assigned in a 1:1 ratio to postoperative orthosis (CO) for 6 weeks or no orthosis (NO). Randomization was stratified by indication (traumatic vs.

Differences in the surgical management of degenerative lumbar spondylolisthesis based on self-reported sex: analysis of the CSORN prospective DLS study.

Objective: Surgical treatment of degenerative lumbar spondylolisthesis (DLS) reliably improves patient-reported quality of life; however, patient population heterogeneity, in addition to other factors, ensures ongoing equipoise in choosing the ideal surgical treatment. Surgeon preference for fusion or decompression alone influences surgical treatment decision-making. Meanwhile, at presentation, patient-reported outcome measures (PROMs) differ considerably between females and males.

Radiologic and Clinical Evaluation of Posterolateral Versus Transforaminal Interbody Fusion in Degenerative Lumbar Spondylolisthesis.

Study Design: Retrospective cohort study.

Objective: The primary objective is to compare foraminal height (FH) and disk height (DH) differences in posterolateral (PLF) and transforaminal interbody fusions (TLIFs) and secondarily correlate these measurements with patient-reported outcomes.

Background: The impact FH has on patient outcomes in degenerative lumbar spinal fusion surgery is unknown.

Sagittal alignment in operative degenerative lumbar spondylolisthesis: a scoping review.

Background: The benefit of surgical intervention over conservative treatment for degenerative lumbar spondylolisthesis (DLS) patients with neurologic symptoms is well-established. However, it is currently unclear what breadth of available evidence exists on regional and global sagittal alignment in DLS surgery. As such, the purpose of the current study is to conduct a scoping review to map and synthesize the DLS literature regarding the current radiographic assessment of sagittal spinal alignment in DLS surgery.

L3-L4 Hyperlordosis and Decreased Lower Lumbar Lordosis Following Short-Segment L4-L5 Lumbar Fusion Surgery is Associated With L3-L4 Revision Surgery for Adjacent Segment Stenosis.

Study Design: Retrospective review of prospective cohort.

Objectives: Reoperation at L3-L4 for adjacent segment disease (ASD) is common after L4-L5 spine fusion. L4-S1 lower lumbar lordosis (LLL) accounts for the majority of global lumbar lordosis (GLL) and is modifiable during surgery.

Functional outcomes correlate with sagittal spinal balance in degenerative lumbar spondylolisthesis surgery.

Background Context: Degenerative lumbar spondylolisthesis (DLS) is a debilitating condition associated with poor preoperative functional status. Surgical intervention has been shown to improve functional outcomes in this population though the optimal surgical procedure remains controversial. The importance of maintaining and/or improving sagittal and pelvic spinal balance parameters has received increasing interest in the recent DLS literature.

Patient's expectations of surgery for lumbar degenerative spondylolisthesis: analysis by type of surgery and patient factors from the Canadian Spine Outcomes and Research Network (CSORN).

Background Context: Preoperative expectations influence postoperative outcomes. Patients with lumbar degenerative spondylolisthesis have especially high expectations of pain relief and overall functional well-being compared to patients with lumbar stenosis.

Purpose: The primary objective was to analyze preoperative expectations of lumbar DS patients with respect to the type of surgery proposed (decompression vs decompression and fusion).

Preoperative Disc Angle is an Important Predictor of Segmental Lordosis After Degenerative Spondylolisthesis Fusion.

Study Design: Retrospective Cohort Study.

Objectives: To determine the effect of interbody cages inserted via posterior approach on segmental lordosis in the setting of preoperative lordotic vs kyphotic discs in patients with lumbar degenerative spondylolisthesis (LDS).

Methods: Retrospective analysis of prospectively collected data on assessment and management of LDS patients from 2 contributing centres.

Preoperative Patient-reported Outcomes are not Associated With Sagittal and Spinopelvic Alignment in Degenerative Lumbar Spondylolisthesis.

Study Design: Prospective cohort study.

Objective: The aim of this study was to evaluate whether sagittal and spinopelvic alignment correlate with preoperative patient-reported outcomes (PROs) in degenerative lumbar spondylolisthesis (DLS) with spinal stenosis.

Summary Of Background Data: Positive global sagittal balance and spinopelvic malalignment are strongly correlated with symptom severity in adult spinal deformity, but this correlation has not been evaluated in DLS.

Early Versus Delayed Microdiscectomy for Chronic Sciatica Lasting 4-12 Months Secondary to Lumbar Disc Herniation: A Secondary Analysis of a Randomized Controlled Trial.

Objectives: To compare the effect of delaying surgery on clinical outcome in patients with chronic sciatica secondary to lumbar disc herniation.

Methods: Patients with sciatica lasting 4-12 months and lumbar disc herniation at the L4-L5 or L5-S1 level were randomized to undergo microdiscectomy (early surgery) or to receive 6 months of nonoperative treatment followed by surgery if needed (delayed surgery). Outcomes were leg pain, Oswestry Disability Index score (ODI), back pain, SF-36 physical component (PCS) and mental component (MCS) summary scores, employment, and satisfaction measured preoperatively and at 6 weeks, 3 months, 6 months, and 1 year after surgery.

Discectomy Compared with Standardized Nonoperative Care for Chronic Sciatica Due to a Lumbar Disc Herniation: A Secondary Analysis of a Randomized Controlled Trial with 2-Year Follow-up.

Background: Randomized controlled trials evaluating acute sciatica have not demonstrated prolonged improvements in terms of patient-reported pain and function. For chronic sciatica, however, microdiscectomy has been found to be superior at 1 year. Whether this effect persists during the second year is not known.

Microdiscectomy Is More Cost-effective Than a 6-Month Nonsurgical Care Regimen for Chronic Radiculopathy.

Background: A recent randomized controlled trial (RCT), performed by the authors, comparing early surgical microdiscectomy with 6 months of nonoperative care for chronic lumbar radiculopathy showed that early surgery resulted in improved outcomes. However, estimates of the incremental cost-utility ratio (ICUR), which is often expressed as the cost of gaining one quality-adjusted life year (QALY), of microdiscectomy versus nonsurgical management have varied. Radiculopathy lasting more than 4 months is less likely to improve without surgical intervention and may have a more favorable ICUR than previously reported for acute radiculopathy.

The Impact of Surgical Site Infection on Patient Outcomes After Open Posterior Instrumented Thoracolumbar Surgery for Degenerative Disorders.

Background: Few reports in the literature have described the long-term outcome of postoperative infection from the patient perspective. The aim of the present study was to determine if complicated surgical site infection (SSI) affects functional recovery and surgical outcomes up to 2 years after posterior instrumented thoracolumbar surgery for the treatment of degenerative disorders.

Methods: This retrospective cohort study involved patients who had been enrolled in a previous randomized controlled trial that examined antibiotic use for open posterior multilevel thoracolumbar or lumbar instrumented fusion procedures.

The Development of Novel 2-in-1 Patient-Specific, 3D-Printed Laminectomy Guides with Integrated Pedicle Screw Drill Guides.

Objective: To determine if 2-in-1 patient-specific laminectomy and drill guides can be safely used to perform laminectomy and pedicle screw insertion.

Methods: This was a cadaveric study designed to test novel 2-in-1 patient-specific laminectomy guides, with modular removable pedicle screw drill guides. Three-dimensional (3D) printing has not been applied to laminectomy.

Back Dominant Pain Has Equal Outcomes to Radicular Dominant Pain Following Posterior Lumbar Fusion in Adult Isthmic Spondylolisthesis: A CSORN Study.

Study Design: Retrospective Cohort Study.

Objectives: This study aimed to determine how the surgeon-determined and patient-rated location of predominant pain influences patient-rated outcomes at 1-year after posterior lumbar fusion in adult isthmic spondylolisthesis.

Methods: We retrospectively reviewed consecutive patients prospectively enrolled in the Canadian Spine Outcomes and Research Network national registry between 2009 and 2017 that underwent posterior lumbar fusion for isthmic spondylolisthesis.

Geometric and volumetric relationship between human lumbar vertebrae and "Black-bone" MRI-based models.

Background: This study will examine the differences between human lumbar vertebrae, three-dimensional (3D) scans of these bones, 3D models based on 'Black-bone' magnetic resonance imaging (MRI) scans, and 3D-printed models.

Materials And Methods: 3D mesh models were created from the "Black-bone" MRI data from two cadaveric human spines, and then 3D printed. Four models were analysed and compared: anatomic bones, 3D-scanned models, MRI models and 3D-printed models.

Lumbar degenerative spondylolisthesis: factors associated with the decision to fuse.

Background Context: The indication to perform a fusion and decompression surgery as opposed to decompression alone for lumbar degenerative spondylolisthesis (LDS) remains controversial. A variety of factors are considered when deciding on whether to fuse, including patient demographics, radiographic parameters, and symptom presentation. Likely surgeon preference has an important influence as well.

A systematic review of metal ion concentrations following instrumented spinal fusion.

Purpose: Metallic spinal implants undergo wear and corrosion which liberates ionic or particulate metal debris. The purpose of this study was to identify and review studies that report the concentration of metal ions following multi-level spinal fusion and to evaluate the impact on clinical outcomes.

Methods: Databases (PubMed, EBSCO MEDLINE) were searched up to August 2019 for studies in English-language assessing metal ion levels [chromium (Cr), titanium (Ti), nickel (Ni)] in whole blood, serum, or plasma after spinal fusion using a specific search string.

Anatomical relationship between the accessory process of the lumbar spine and the pedicle screw entry point.

Introduction: The vertebra accessory process (or tubercle) of the lumbar spine is an understated landmark which lies caudal to the mammillary process at the base of the transverse process. To our knowledge, no studies compare its relation to pedicle entry point for screw placement. We proposed to evaluate whether a valid and reliable relationship exists between the accessory process and the projected pedicle axis.

Geometric and Volumetric Relationship Between Human Lumbar Vertebra and CT-based Models.

Rationale And Objectives: Crucial to the process of three-dimensional (3D) printing is the knowledge of how the actual structure or organ relates dimensionally to its corresponding medical image. This study will examine the differences between human lumbar vertebrae, 3D scans of these bones, 3D models based on computed tomographic (CT) scans, and 3D-printed models.

Materials And Methods: CT scans were obtained for six human lumbar spines.

Surgery versus Conservative Care for Persistent Sciatica Lasting 4 to 12 Months.

Background: The treatment of chronic sciatica caused by herniation of a lumbar disk has not been well studied in comparison with acute disk herniation. Data are needed on whether diskectomy or a conservative approach is better for sciatica that has persisted for several months.

Methods: In a single-center trial, we randomly assigned patients with sciatica that had lasted for 4 to 12 months and lumbar disk herniation at the L4-L5 or L5-S1 level in a 1:1 ratio to undergo microdiskectomy or to receive 6 months of standardized nonoperative care followed by surgery if needed.

The Effect of Prolonged Postoperative Antibiotic Administration on the Rate of Infection in Patients Undergoing Posterior Spinal Surgery Requiring a Closed-Suction Drain: A Randomized Controlled Trial.

Background: Closed-suction drains are frequently used following posterior spinal surgery. The optimal timing of antibiotic discontinuation in this population may influence infection risk, but there is a paucity of evidence. The aim of this study was to determine whether postoperative antibiotic administration for 72 hours (24 hours after drain removal as drains were removed on the second postoperative day) decreases the incidence of surgical site infection compared with postoperative antibiotic administration for 24 hours.