The Rise and Fall of Bone Morphogenetic Protein 2 Throughout the United States.

Study Design: Retrospective Database Study.

Objective: Investigate utilization of bone morphogenetic protein (BMP-2) between 2004 and 2014.

Summary Of Background Data: The utilization, particularly off-label utilization, of BMP-2 has been controversial and debated in the literature.

Three-dimensional Printing of Biomimetic Titanium Mimicking Trabecular Bone Induces Human Mesenchymal Stem Cell Proliferation: An In-vitro Analysis.

Study Design: In vitro analysis.

Objective: The aim of this study was to assess the effect of three-dimensional (3D) printing of porous titanium on human mesenchymal stem cell (hMSC) adhesion, proliferation, and osteogenic differentiation.

Summary Of Background Data: A proprietary implant using three-dimensional porous titanium (3D-pTi) that mimics trabecu-lar bone structure, roughness, porosity, and modulus of elasticity was created (Ti-LIFE technology™, Spineart SA Switzerland).

3D-printed titanium cages without bone graft outperform PEEK cages with autograft in an animal model.

Background Context: Modernization of 3D printing has allowed for the production of porous titanium interbody cages (3D-pTi) which purportedly optimize implant characteristics and increase osseointegration; however, this remains largely unstudied in vivo.

Purpose: To compare osseointegration of three-dimensional (3D) titanium cages without bone graft and Polyether-ether-ketone (PEEK) interbody cages with autologous iliac crest bone graft (AICBG).

Study Design: Animal study utilizing an ovine in vivo model of lumbar fusion.

Dual pitch screw design provides equivalent fixation to upsized screw diameter in revision pedicle screw instrumentation: a cadaveric biomechanical study.

Background Context: There are situations that require the replacement of pedicle screws. They are often exchanged when loose or broken or to accommodate a different sized rod or pedicle screw system. Traditionally, pedicle screws are replaced by up-sizing the core diameter until an interference fit is obtained.

Multi-modal pain control regimen for anterior lumbar fusion drastically reduces in-hospital opioid consumption.

Background: The opioid epidemic is at epic proportions currently in the United States. Exposure to opioids for surgery and subsequent postoperative pain management is a known risk factor for opioid dependence. In addition, opioids can have a negative impact on multiple aspects including clinical outcomes, length of hospital stay, and overall cost of care.

Cannabinoids and orthopedic surgery: a systematic review of therapeutic studies.

Background: Recent work has shed light on the potential benefits of cannabinoids for multimodal pain control following orthopedic procedures. The objective of this review was to summarize the available evidence of analgesic and opioid-sparing effects cannabinoids have in orthopedic surgery and identify adverse events associated with their use.

Methods: A systematic review of the literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines including PubMed, EMBASE, MEDLINE, PsycINFO, and Google Scholar was performed to include all primary, therapeutic studies published on the use of cannabis, and cannabis-derived products in orthopedic surgery.

Is There Additional Value to Flexion-Extension Radiographs for Degenerative Spondylolisthesis?

Study Design: Multicenter retrospective study.

Objective: Flexion-extension radiographs are frequently used to assess motion in patients with degenerative spondylolisthesis. However, they expose patients to additional radiation and increase cost.

Drivers for nonhome discharge in a consecutive series of 1502 patients undergoing 1- or 2-level lumbar fusion.

Objective: Unexpected nonhome discharge causes additional costs in the current reimbursement models, especially to the payor. Nonhome discharge is also related to longer length of hospital stay and therefore higher healthcare costs to society. With increasing demand for spine surgery, it is important to minimize costs by streamlining discharges and reducing length of hospital stay.

Pelvic parameters directly influence ideal S2 alar-iliac (S2AI) screw trajectory.

Background: The utilization of the S2 Alar-Iliac (S2AI) screw provides an optimal method of spinopelvic fixation. The free-hand placement of these screws obviates the use of intra-operative fluoroscopy and relies heavily on sacropelvic anatomy; variations of this anatomy could alter the ideal screw trajectory. The S2AI corridor is near several neurovascular structures, thus an accurate trajectory is critical.

Minimally invasive lateral approaches for the treatment of spinal tumors: single-position surgery without the "flip".

Although primary tumors of the spine and neural elements are rare, metastatic disease to the spine is quite common. Traditionally, surgical treatment for spinal tumor patients involves open decompression with or without stabilization. The single-position minimally invasive (MIS) lateral approach, which has been recently described over the recent decade, allows simultaneous access to the anterior and posterior columns with the patient positioned in the lateral decubitus position.

Tissue-Sparing Posterior Cervical Fusion With Interfacet Cages: A Systematic Review of the Literature.

Study Design: Literature review.

Objectives: Posterior cervical interfacet cages are an alternative to lateral mass fixation in patients undergoing cervical spine surgery. Recently, a percutaneous, tissue-sparing system for interfacet cage placement has been developed, however, there is limited clinical evidence supporting its widespread use.

The Berg balance scale for assessing dynamic stability and balance in the adult spinal deformity (ASD) population.

Background: Adult spinal deformity (ASD) is a prevalent condition in individuals over the age of 65; leading to impaired standing balance and abnormal gait patterns. This functional impairment may be due to the fixed sagittal or coronal malalignment; associated spinal stenosis or deconditioning. The Berg balance scale (BBS) was developed to measure balance by assessing the performance of functional tasks.

Accuracy of cortical bone trajectory screw placement in midline lumbar fusion (MIDLF) with intraoperative cone beam navigation.

Background: Cortical bone trajectory (CBT) screws have been recently described as a method of lumbosacral fixation. These screws are typically inserted under fluoroscopic guidance with a medial-to-lateral trajectory in the axial plane and a caudal-to-cephalad trajectory in the sagittal plane. In an effort to reduce surgeon radiation exposure and improve accuracy, CBT screws may be inserted under navigation with intraoperative cone beam computed tomography (CT).

Job Selection After Orthopedic Surgery Training: Why Are Our Trainees Failing to Select the Right Job?

A survey was administered to a random sampling of the American Academy of Orthopaedic Surgeons (AAOS) members to determine the rate at which recently trained orthopedic surgeons switch their first job and to identify factors affecting the job selection process. There were 351 (21%) respondents. Respondents considered practice location (41%), practice type (28%), and family proximity (23%) as most important while research opportunity (54%) and signing bonus (33%) were considered least important in their first job.

Instrumentation complication rates following spine surgery: a report from the Scoliosis Research Society (SRS) morbidity and mortality database.

Background: Objective of this study is to evaluate demographics, risk factors, and incidence of instrumentation related complications (IRC) in spinal surgeries from 2009-2012. The Scoliosis Research Society (SRS) morbidity and mortality (M&M) database has tremendous value in orthopaedic surgery. SRS gathers surgeon-reported complications, including instrumentation failure, visual complications, neurological deficits, infections, and death.

Defining the Critical Elements of the Most Common Arthroscopic Procedures: A Consensus of Orthopaedic Sports Medicine Surgeons.

Objective To define the critical elements of common procedures in arthroscopic surgery. Methods A survey was administered to surgeons associated with the American Orthopaedic Society for Sports Medicine (AOSSM) to determine the critical elements for four common arthroscopic procedures: anterior cruciate ligament (ACL) reconstruction, knee arthroscopy with meniscal debridement or repair, rotator cuff repair (RCR), and capsulorrhaphy for anterior glenohumeral instability (Bankart repair). Respondents were asked which steps necessitated their direct supervision.

Image-Guided Navigation and Robotics in Spine Surgery.

Image guidance (IG) and robotics systems are becoming more widespread in their utilization and can be invaluable intraoperative adjuncts during spine surgery. Both are highly reliant upon stereotaxy and either pre- or intraoperative radiographic imaging. While user-operated IG systems have been commercially available longer and subsequently are more widely utilized across centers, robotics systems provide unique theoretical advantages over freehand and IG techniques for placing instrumentation within the spine.

Robotic versus freehand S2 alar iliac fixation: in-depth technical considerations.

Achieving fixation and fusion across the lumbosacral junction has been a challenge for spinal deformity surgeons ever since the development of instrumentation. The S2 alar-iliac (S2AI) trajectory has been introduced as a method of pelvic fixation to decrease strain on S1 screws. The S2AI screws differ in several ways from traditional iliac screws.

Postoperative Surgical Site Infection After Spine Surgery: An Update From the Scoliosis Research Society (SRS) Morbidity and Mortality Database.

Study Design: Retrospective review of prospectively collected data.

Objective: Analyze the Scoliosis Research Society (SRS) Morbidity & Mortality (M&M) database to assess the incidence and characteristics related to postoperative surgical site infection (SSI) after spinal deformity surgery.

Summary Of Background Data: Infections involving spinal instrumentation are associated with greater rates of disability.

Optimal Management of Tethered Surgical Drains: A Cadaver Study.

Background: Tethered drains are a complication of drain usage and may result in unintentional retained broken drains, as well as anxiety and uncertainty for the surgeon and the patient. To date, no study has examined the optimal approach for management and removal of tethered drains.

Methods: The study design sought to identify suture size, mechanism of drain fixation (through versus around), points of constriction (one versus multiple) and the efficacy of weighted traction as potential sources of tethered drains by means of four study arms.

Permanent implantation of antibiotic cement over exposed instrumentation eradicates deep spinal infection.

In this case series, we describe an infection treatment protocol involving permanent implantation of antibiotic cement that is effective in eradicating deep infection. Surgical site infection (SSI) is a devastating complication of spine surgery. Unlike the gold-standard two-stage revision in North American hip and knee arthroplasty, there exists no standardized, accepted protocol for the management of deep SSI with instrumentation.

Utilization of intraoperative neuromonitoring throughout the United States over a recent decade: an analysis of the nationwide inpatient sample.

Background: To identify temporal changes to the demographics and utilization of intraoperative neuromonitoring (IONM) throughout the United States (U.S.).

The posterior superior iliac spine and sacral laminar slope: key anatomical landmarks for freehand S2-alar-iliac screw placement.

Objective: The S2-alar-iliac (S2AI) screw is an increasingly popular method for spinopelvic fixation. The technique of freehand S2AI screw placement has been recently described. The purpose of this study was to demonstrate, through a CT imaging study of patients with spinal deformity, that screw trajectories based on the posterior superior iliac spine (PSIS) and sacral laminar slope result in reliable freehand S2AI trajectories that traverse safely above the sciatic notch.