Pulsed Electromagnetic Fields for Cervical Spine Fusion in Patients with Risk Factors for Pseudarthrosis.

Background: Certain demographics and/or risk factors contribute to complications following cervical spinal surgery including pseudarthrosis, prolonged pain, and reduced quality of life (QoL). Pulsed electromagnetic field (PEMF) stimulation is a non-invasive therapy that may enhance fusion success in at-risk patients.

Objective: To evaluate the safety and efficacy of post-operative adjunctive PEMF therapy following cervical spinal surgery in subjects at risk for pseudarthrosis.

Adjunctive Use of Bone Growth Stimulation Increases Cervical Spine Fusion Rates in Patients at Risk for Pseudarthrosis.

Study Design: A prospective multicenter clinical trial (NCT03177473) was conducted with a retrospective cohort used as a control arm.

Objective: The purpose of this study was to evaluate cervical spine fusion rates in subjects with risk factors for pseudarthrosis who received pulsed electromagnetic field (PEMF) treatment.

Summary Of Background Data: Certain risk factors predispose patients to pseudarthrosis, which is associated with prolonged pain, reduced function, and decreased quality of life.

Pulsed Electromagnetic Field Stimulation in Lumbar Spine Fusion for Patients With Risk Factors for Pseudarthrosis.

Background: Lumbar spinal fusion surgeries are increasing steadily due to an aging and ever-growing population. Patients undergoing lumbar spinal fusion surgery may present with risk factors that contribute to complications, pseudarthrosis, prolonged pain, and reduced quality of life. Pulsed electromagnetic field (PEMF) stimulation represents an adjunct noninvasive treatment intervention that has been shown to improve successful fusion and patient outcomes following spinal surgery.

How Do Patients With Predominant Neck Pain Improve After Anterior Cervical Discectomy and Fusion for Cervical Radiculopathy?

Background: The presence of predominant pain in the arm vs the neck as a predictor of postoperative outcomes after anterior cervical discectomy and fusion (ACDF) has been seldom reported; therefore, the purpose of this study was to determine whether patients with predominant neck pain improve after surgery compared to patients with predominant arm pain or those with mixed symptoms in patients undergoing ACDF for radiculopathy.

Methods: A retrospective cohort study was conducted on patients who underwent ACDF at a single center from 2016 to 2018. Patients were split into groups based on preoperative neck and arm pain scores: neck (N) pain dominant group (visual analog scale [VAS] neck ≥ VAS arm by 1.

Does Cervical Spondylolisthesis Influence Patient-Reported Outcomes After Anterior Cervical Discectomy and Fusion Surgery?

Background: No prior work has explored whether the presence of degenerative spondylolisthesis impacts patient-reported outcome measurements (PROMs) after an anterior cervical discectomy and fusion (ACDF); therefore, the goal of the current study was to determine whether the presence of a spondylolisthesis affects PROMs after an ACDF.

Methods: A retrospective cohort study was conducted on patients over the age of 18 who underwent a 1- or 2-level ACDF. All patients received preoperative standing lateral x-rays and were placed into 1 of 2 groups based on the presence of cervical spondylolisthesis from C2-T1: (1) no spondylolisthesis (NS) group or (2) spondylolisthesis (S) group.

Cervical Total Disc Replacement: Long-Term Outcomes.

Degenerative disc disease and associated cervical spondylosis or stenosis are common conditions encountered in clinical practice. These conditions may cause progressive cervical radicular or myelopathic symptoms leading to significant impairment. Although anterior cervical discectomy and fusion (ACDF) has been a reliable surgical treatment of cervical myelopathy and radiculopathy, but limitations include loss of cervical range of motion, the concern for adjacent segment degeneration and disease, pseudoarthrosis, complications related to the choice of intervertebral graft, dysphagia, as well as standard anterior cervical approach risk.

Do Patients with Back Pain-Dominant Symptoms Improve After Lumbar Surgery for Radiculopathy or Claudication?

Background: Currently, few studies have examined whether patients with back or leg pain-predominant symptoms fare better clinically after lumbar spine surgery; therefore, the purpose of this study was to determine whether patients with back pain-dominant symptoms improved to a similar degree as patients with mixed or leg pain-dominant symptoms after lumbar surgery.

Methods: A retrospective cohort study was conducted at a single academic center, in which patients were stratified into three groups: (1) back pain-dominant group (B) (visual analog score [VAS] back - VAS leg ≥ 1.0 point), (2) neutral group (N) (VAS back - VAS leg < 1.

Patient Outcomes Following Short-segment Lumbar Fusion Are Not Affected by PI-LL Mismatch.

Study Design: This is a retrospective cohort study.

Objective: The objective of this study was to further elucidate the relationship between pelvic incidence-lumbar lordosis (PI-LL) mismatch and surgical outcomes in patients undergoing short segment lumbar fusions for degenerative lumbar disease.

Summary Of Background Data: There are few studies examining the relationship between spinopelvic parameters and patient reported outcome measurements (PROMs) in short segment lumbar degenerative disease.

Are Patient Outcomes Affected by the Presence of a Fellow or Resident in Lumbar Decompression Surgery?

Study Design: Retrospective cohort study.

Objective: The aim of this study was to determine whether the presence of a fellow or resident (F/R) compared to a physician assistant (PA) affected surgical variables or short-term patient outcomes.

Summary Of Background Data: Although orthopedic spine fellows and residents must participate in minimum number of decompression surgeries to gain competency, the impact of trainee presence on patient outcomes has not been assessed.

How do C2 tilt and C2 slope correlate with patient reported outcomes in patients after anterior cervical discectomy and fusion?

Background/context: C2 tilt and C2 slope are quick and easy measurements to obtain on lateral radiographs and may be used to determine overall cervical sagittal alignment; however, the influence of these measurements on patient outcomes has not been well established in literature.

Purpose: To determine if C2 tilt and/or C2 slope predict patient outcomes better compared with conventional radiographic measures after an anterior cervical discectomy and fusion (ACDF).

Study Design/setting: Retrospective cohort study.

Guidelines for cortical screw versus pedicle screw selection from a fatigued decompressive lumbar laminectomy model show similar stability and less bone mineral density dependency.

Background: Traditional pedicle screws are the gold standard for lumbar spine fixation; however, cortical screws along the midline cortical bone trajectory may be advantageous when lumbar decompression is required. While biomechanic investigation of both techniques exists, cortical screw performance in a multi-level lumbar laminectomy and fusion model is unknown. Furthermore, longer-term viability of cortical screws following cyclic fatigue has not been investigated.

Development of a Telemedicine Neurological Examination for Spine Surgery: A Pilot Trial.

Study Design: This was a prospective cohort study.

Objective: The objective of this study was to design and test a novel spine neurological examination adapted for telemedicine.

Summary Of Background Data: Telemedicine is a rapidly evolving technology associated with numerous potential benefits for health care, especially in the modern era of value-based care.

Does the Size or Location of Lumbar Disc Herniation Predict the Need for Operative Treatment?

Study Design: Retrospective cohort study.

Objective: The goal of this study was to determine whether the absolute size (mm), relative size (% canal compromise), or location of a single-level, lumbar disc herniation (LDH) on axial and sagittal cuts of magnetic resonance imaging (MRI) were predictive of eventual surgical intervention.

Methods: MRIs of 89 patients were reviewed, and patients were split into groups based on type of management received (34 nonoperative vs 55 microdiscectomy).

Worker's Compensation Terminology.

Injuries to the spine comprise a high percentage of workplace injuries. Spine surgeons' evaluation of injured workers requires attention to facts specific to worker's compensation claims including whether the injury occurred in the scope of employment, whether a work incident was causally related to the injury, and whether the injury contributed to a significant degree to the patient's overall medical condition. An injured worker's compensation is subject to state-specific guidelines and is largely dependent on the degree of disability and whether the disability is temporary or permanent.

Is the Neck Disability Index an Appropriate Measure for Changes in Physical Function After Surgery for Cervical Spondylotic Myelopathy?

Background: The Neck Disability Index (NDI) is a 10-item questionnaire about symptoms relevant to cervical spine pathology, originally validated in the physical therapy literature. It is unclear if all of the items apply to spine surgery. The purpose of this study was to determine if improvements in the composite NDI score or specific NDI domains are appropriate measures for tracking changes in physical function after surgical intervention for cervical spondylotic myelopathy (CSM).

Comparing Patient-reported Outcomes to Patient Satisfaction After a Microdiscectomy for Patient's With a Lumbar Disk Herniation.

Study Design: A retrospective cohort study.

Objective: The objective of this study was to determine if patient satisfaction is predicted by improvement in health-related quality of life (HRQOL) metrics.

Summary Of Background Data: Patient satisfaction is becoming an increasingly common proxy for treatment quality; however, the correlation between patient satisfaction and HRQOL outcome metrics following a lumbar disk herniation is unclear.

Avoiding and Managing Complications in Routine Lumbar Spine Surgery.

Elective lumbar surgery for common degenerative lumbar spine pathology has been consistently demonstrated to have excellent outcomes by multiple validated measures and improves patient quality of life. The rate of complication is low but not unavoidable; there is an increasing recognition of risk factors that can be mitigated to decrease complication rates. When complications occur, prompt recognition and management may minimize deleterious effects on patient outcome.

Proton Pump Inhibitor Use Affects Pseudarthrosis Rates and Influences Patient-Reported Outcomes.

Study Design: Retrospective cohort review.

Objectives: Cervical pseudarthrosis is a frequent cause of need for revision anterior cervical discectomy and fusion (ACDF) and may lead to worse patient-reported outcomes. The effect of proton pump inhibitors on cervical fusion rates are unknown.

Fusion technique does not affect short-term patient-reported outcomes for lumbar degenerative disease.

Background/context: Degenerative lumbar disease can be addressed via an anterior or posterior approach, and with or without the use of an interbody cage. Although several studies have compared the type of approach and technique, there is a lack of literature assessing patient-reported outcome measures (PROMs) and radiographic parameters between different fusion techniques.

Purpose: To determine whether the surgical approach and fusion technique for lumbar degenerative disease had an effect on short-term PROMs and radiographic parameters.

Non-mobile Adjacent Level Cervical Spondylolisthesis Does Not Always Require Fusion in Patients Undergoing ACDF.

Study Design: Retrospective review of a prospectively maintained database.

Objective: Compare outcomes following anterior cervical decompression and fusion (ACDF) between patients with no adjacent level spondylolisthesis (NAS) and adjacent level spondylolisthesis (AS).

Summary Of Background Data: There are no prior studies evaluating the effect of preoperative adjacent-level cervical spondylolisthesis on outcomes following anterior cervical discectomy and fusion (ACDF).

Enhancing Evaluation of Cervical Spine: Thresholds for Normal CT Relationships in the Subaxial Cervical Spine.

Background: Very little normative computed tomography (CT) scan data exist defining expected relationships of vertebral structures in the intact cervical spine. Better understanding of normal relationships should improve sensitivity of injury detection, particularly for facet subluxation. The purpose of this paper was to describe the normal anatomical relationships and most sensitive measurements to detect abnormal alignment in the subaxial cervical spine.

Feasibility of Endoscopic Inspection of Pedicle Wall Integrity in a Live Surgery Model.

Background: Perforations of the pedicle wall during cannulation can occur with experienced surgeons. Direct endoscopic visualization has not been used to inspect pedicles previously due to bone bleeding obscuring the camera visualization. The hypothesis of this study was that endoscopic visualization of pedicle wall integrity was technically feasible and would enable identification of clinically significant pedicle breaches.

Strategies for the Prevention and Treatment of Surgical Site Infection in the Lumbar Spine.

Surgical site infection (SSI) following spine surgery can be devastating for both the patient and the surgeon. It leads to significant morbidity and associated health care costs, from readmissions, reoperations, and subsequent poor clinical outcomes. Complications associated with SSI following spine surgery include pseudarthrosis, neurological deterioration, sepsis, and death.

Reliability and Clinical Utility of the CARDS Classification for Degenerative Spondylolisthesis.

Study Design: Retrospective cohort study.

Objective: The objective of this study is to determine the reliability and clinical utility of the of the proposed CARDS classification for degenerative spondylolisthesis.

Background: The Clinical and Radiographic Degenerative Spondylolisthesis (CARDS) classification system was recently proposed as an alternative to the Meyerding system for classifying degenerative spondylolisthesis (DS).