Skeletal Stem Cells: A Basis for Orthopaedic Pathology and Tissue Repair.

➢ Skeletal stem cells (SSCs) continually replenish mature cell populations to support skeletal homeostasis.➢ SSCs repopulate by self-renewal, have multilineage potential, and are long-lived in vivo.➢ SSCs express specific combinations of cell surface markers that reflect their lineage identity.

Robotic-Assisted Navigation in Single-Level Transforaminal Lumbar Interbody Fusion Reduces Surgeons' Mental Workload Compared With Fluoroscopic and Computed Tomographic Techniques: A Nonrandomized Prospective Controlled Trial.

Background: Pedicle screw placement during spine fusion is physically and mentally demanding for surgeons. Consequently, spine surgeons can become fatigued, which has implications for both patient safety and surgeon well-being.

Purpose: We sought to assess the cognitive workload of surgeons placing pedicle screws using robotic-assisted navigation compared with fluoroscopic and computed tomography (CT)-assisted placement.

Pitch-classifier model for professional pitchers utilizing 3D motion capture and machine learning algorithms.

Introduction: A pitcher's ability to achieve pitch location precision after a complex series of motions is of paramount importance. Kinematics have been used in analyzing performance benefits like ball velocity, as well as injury risk profile; however, prior utilization of such data for pitch location metrics is limited.

Objective: To develop a pitch classifier model utilizing machine learning algorithms to explore the potential relationships between kinematic variables and a pitcher's ability to throw a strike or ball.

Inducing Angiogenesis in the Nucleus Pulposus.

Bone morphogenetic protein (BMP) gene delivery to Lewis rat lumbar intervertebral discs (IVDs) drives bone formation anterior and external to the IVD, suggesting the IVD is inhospitable to osteogenesis. This study was designed to determine if IVD destruction with a proteoglycanase, and/or generating an IVD blood supply by gene delivery of an angiogenic growth factor, could render the IVD permissive to intra-discal BMP-driven osteogenesis and fusion. Surgical intra-discal delivery of naïve or gene-programmed cells (BMP2/BMP7 co-expressing or VEGF expressing) +/- purified chondroitinase-ABC (chABC) in all permutations was performed between lumbar 4/5 and L5/6 vertebrae, and radiographic, histology, and biomechanics endpoints were collected.

A multi-stem cell basis for craniosynostosis and calvarial mineralization.

Craniosynostosis is a group of disorders of premature calvarial suture fusion. The identity of the calvarial stem cells (CSCs) that produce fusion-driving osteoblasts in craniosynostosis remains poorly understood. Here we show that both physiologic calvarial mineralization and pathologic calvarial fusion in craniosynostosis reflect the interaction of two separate stem cell lineages; a previously identified cathepsin K (CTSK) lineage CSC (CTSK CSC) and a separate discoidin domain-containing receptor 2 (DDR2) lineage stem cell (DDR2 CSC) that we identified in this study.

A vertebral skeletal stem cell lineage driving metastasis.

Vertebral bone is subject to a distinct set of disease processes from long bones, including a much higher rate of solid tumour metastases. The basis for this distinct biology of vertebral bone has so far remained unknown. Here we identify a vertebral skeletal stem cell (vSSC) that co-expresses ZIC1 and PAX1 together with additional cell surface markers.

Robot-navigated pedicle screw insertion can reduce intraoperative blood loss and length of hospital stay: analysis of 1,633 patients utilizing propensity score matching.

Background Context: Navigation and robotic technologies have emerged as an alternative option to conventional freehand techniques for pedicle screw insertion. However, the effectiveness of these technologies in reducing the perioperative complications of spinal fusion surgery remains limited due to the small cohort size in the existing literature.

Purpose: To investigate whether utilization of robotically navigated pedicle screw insertion can reduce the perioperative complications of spinal fusion surgery-including reoperations-with a sizeable cohort.

Improving Racial and Ethnic Disparities in Outpatient Anterior Cervical Discectomy and Fusion Driven by Increasing Utilization of Ambulatory Surgical Centers in New York State.

Study Design: Retrospective cohort study.

Objective: The purpose of this study was to assess trends in disparities in utilization of hospital outpatient departments (HOPDs) and ambulatory surgical centers (ASCs) for outpatient ACDF (OP-ACDF) between White, Black, Hispanic, and Asian/Pacific Islander patients from 2015 to 2018 in New York State.

Summary Of Background Data: Racial and ethnic disparities within the field of spine surgery have been thoroughly documented.

Identification of Novel Genetic Markers for the Risk of Spinal Pathologies: A Genome-Wide Association Study of 2 Biobanks.

Background: Identifying genetic risk factors for spinal disorders may lead to knowledge regarding underlying molecular mechanisms and the development of new treatments.

Methods: Cases of lumbar spondylolisthesis, spinal stenosis, degenerative disc disease, and pseudarthrosis after spinal fusion were identified from the UK Biobank. Controls were patients without the diagnosis.

3D surface topographic measurements for idiopathic scoliosis are highly correlative to patient self-image questionnaires.

Purpose: Adolescent idiopathic scoliosis (AIS) is a deformity of the spine that results in external asymmetry of the torso in the shoulder, waist, and rib hump. Several patient reported outcome measures (PROMS) including the Trunk Appearance Perception Scale (TAPS) and SRS-22r self-image domain are used to measure the patient's self-perception. The purpose of this study is to investigate the relationship between objective surface topographic measurements of the torso to subjective patient self-perception.

Telemedicine in Spine Patients: Utilization and Satisfaction Remain High Even After Easing of COVID-19 Lockdown Restrictions.

Study Design: Retrospective cohort study.

Objective: The objectives of the present study were to (1) define telemedicine utilization rates during and after the initial height of the COVID-19 lockdown period and (2) determine patient satisfaction with telemedicine during and after the initial height of the COVID-19 lockdown period for spine patients at an orthopedic specialty hospital.

Summary Of Background Data: Previous studies have shown high patient satisfaction with telemedicine during the initial height of the COVID-19 pandemic.

Discovery of a Vertebral Skeletal Stem Cell Driving Spinal Metastases.

Vertebral bone is subject to a distinct set of disease processes from those of long bones, notably including a much higher rate of solid tumor metastases that cannot be explained by passive blood flow distribution alone. The basis for this distinct biology of vertebral bone has remained elusive. Here we identify a vertebral skeletal stem cell (vSSC), co-expressing the transcription factors ZIC1 and PAX1 together with additional cell surface markers, whose expression profile and function are markedly distinct from those of long bone skeletal stem cells (lbSSCs).

3D Surface Topographic Optical Scans Yield Highly Reliable Global Spine Range of Motion Measurements in Scoliotic and Non-Scoliotic Adolescents.

Background: Adolescent idiopathic scoliosis results in three dimensional changes to a patient’s body, which may change a patient’s range of motion. Surface topography is an emerging technology to evaluate three dimensional parameters in patients with scoliosis. The goal of this paper is to introduce novel and reliable surface topographic measurements for the assessment of global coronal and sagittal range of motion of the spine in adolescents, and to determine if these measurements can distinguish between adolescents with lumbar scoliosis and those without scoliosis.

Abaloparatide Enhances Fusion and Bone Formation in a Rabbit Spinal Arthrodesis Model.

Study Design: Prospective randomized placebo controlled animal trial.

Objective: Determine the effect of daily subcutaneous abaloparatide injection on the intervertebral fusion rate in rabbits undergoing posterolateral fusion.

Study Of Background Data: Despite the wide utilization of spine fusion, pseudarthrosis remains prevalent, and results in increased morbidity.

Kinetic and kinematic comparisons in high school pitchers with low and high pitch location consistency.

Background: Although ball velocity has often been associated with increased kinetics at the upper extremity and risk of injury in youth and adolescent pitchers, it is unclear if the performance metric pitch location consistency has any positive or negative associations with pitching kinetics.

Methods: High school pitchers (n = 59) pitched 8-12 fastballs using 3D motion capture (480 Hz). Pitchers were divided into high-consistency (HiCon) and low-consistency (LoCon) groups based on the absolute center deviation of each pitcher's pitch to the center of the pitcher's mean pitch location.

Current treatment and decision-making factors leading to fusion vs decompression for one-level degenerative spondylolisthesis: survey results from members of the Lumbar Spine Research Society and Society of Minimally Invasive Spine Surgery.

Background: Degenerative spondylolisthesis (DS) is one of the most common pathologies spine surgeons treat. While a number of potential factors have been identified, there is no current consensus on which variables most impact the decision to fuse vs. decompress alone in this population.

Minimally Invasive Lumbar Decompression Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion for Treatment of Low-Grade Lumbar Degenerative Spondylolisthesis.

Study Design: A retrospective cohort comparison study.

Objective: To compare perioperative outcomes, radiographic parameters, and patient-reported outcome measures (PROMs) between minimally invasive unilateral laminotomy with bilateral decompression (MIS-ULBD) versus MIS transforaminal lumbar interbody fusion (MIS-TLIF) for treatment of low-grade lumbar degenerative spondylolisthesis.

Summary Of Background Data: While lumbar degenerative spondylolisthesis is a common condition, optimal surgical treatment remains controversial.

Telemedicine Visits Can Generate Highly Accurate Diagnoses and Surgical Plans for Spine Patients.

Study Design: A Retrospective cohort study.

Objective: To (1) assess whether diagnoses and surgical plans established during a new patient telemedicine visit changed following an in-person evaluation and (2) determine any differences in perioperative outcomes between patients who only had a telemedicine visit before surgery versus those who had a telemedicine visit followed by an in-person evaluation before surgery.

Summary Of Background Data: Data on capability of telemedicine to deliver high-quality preoperative assessment without a traditional in-person interaction and physical examination is lacking.

Factors Associated With Increasing Length of Stay for Rheumatoid Arthritis Patients Undergoing Total Hip Arthroplasty and Total Knee Arthroplasty.

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are cost-effective procedures that decrease pain and improve health-related quality of life for patients with advanced symptomatic arthritis, including rheumatoid arthritis (RA). Patients with RA have a longer length of stay (LOS) after THA or TKA than patients with osteoarthritis, yet the factors contributing to LOS have not been investigated. : We sought to identify the factors contributing to LOS for patients with RA undergoing THA and TKA at a single tertiary care orthopedic specialty hospital.

Reliability of automated topographic measurements for spine deformity.

Purpose: This study introduces a novel surface-topographic scanning system capable of automatically generating a suite of objective measurements to characterize torso shape.

Research Question: what is the reliability of the proposed system for measurement of trunk alignment parameters in patients with adolescent idiopathic scoliosis (AIS) and controls?

Methods: Forty-six adolescents (26 with AIS and 20 controls) were recruited for a prospective reliability study. A series of angular, volumetric, and area measures were computed from topographic scans in each of three clinically relevant poses using a fully automated processing pipeline.

Preoperative opioids before adult spinal deformity surgery associated with increased reoperations and high rates of chronic postoperative opioid use at 3-year follow-up.

Purpose: To determine the association of preoperative opioid prescriptions with reoperations and postoperative opioid prescriptions after adult spina deformity (ASD) surgery. With the current opioid crisis, patients undergoing surgery for ASD are at particular risk for opioid-related complications due to significant preoperative disability and surgical morbidity. No previous studies consider preoperative opioids in this population.

Do preoperative clinical and radiographic characteristics impact patient outcomes following one-level minimally invasive transforaminal lumbar interbody fusion based upon presenting symptoms?

Background Context: Patients undergoing minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) frequently present with lower extremity neurologic symptoms with or without associated lower back pain. While symptomatic improvement of leg and back pain has been reported, the resolution of back pain when it is a predominant presenting symptom remains underreported following MI-TLIF.

Purpose: The purpose of this study was to compare clinical outcomes at 1 year of patients undergoing MI-TLIF with lower extremity neurologic symptoms with and without a significant component of back pain.

Less Invasive Pediatric Spinal Deformity Surgery: The Case for Robotic-Assisted Placement of Pedicle Screws.

Pediatric spinal deformity involves a complex 3-dimensional (3D) deformity that increases the risk of pedicle screw placement due to the close proximity of neurovascular structures. To increase screw accuracy, improve patient safety, and minimize surgical complications, the placement of pedicle screws is evolving from freehand techniques to computer-assisted navigation and to the introduction of robotic-assisted placement. : The aim of this review was to review the current literature on the use of robotic navigation in pediatric spinal deformity surgery to provide both an error analysis of these techniques and to provide recommendations to ensure its safe application.