Cervical Disc Displacement in Military Pilots.

Introduction: Cervical disc displacement (CDD) may disqualify pilots from flying and have a profound impact on military unit capability. The objective of this retrospective database review is to characterize the incidence and demographic predictors of symptomatic cervical spine disc displacement in pilots of fixed- and rotary-wing aircraft and ground-based controls.

Materials And Methods: The Defense Military Epidemiology Database was queried for first-occurrence ICD-9 code 722.

Risk factors for distal junctional failure in long-construct instrumentation for adult spinal deformity.

Purpose: The aim of this study is to identify risk factors associated with postoperative DJF in long constructs for ASD.

Methods: A retrospective review was performed at a tertiary referral spine centre from 01/01/2007 to 31/12/2016. Demographic, clinical and radiographic parameters were collated for patients with DJF in the postoperative period and compared to those without DJF.

Indicators for Substantial Neurological Recovery Following Elective Anterior Cervical Discectomy and Fusion.

Study Design: Retrospective cohort study.

Objective: The purposes of this study were to determine the rate of improvement of significant preoperative weakness, identify risk factors for failure to improve, and characterize the motor recovery of individual motor groups.

Summary Of Background Data: While neck and arm pain reliably improve following anterior cervical discectomy and fusion (ACDF), the frequency and magnitude of motor recovery following ACDF remain unclear.

A Systematic Review of Risk Factors Associated With Distal Junctional Failure in Adult Spinal Deformity Surgery.

Background: The surgical management of adult spinal deformity (ASD) is a major surgical undertaking associated with considerable perioperative risk and a substantial complication profile. Although the natural history and risk factors associated with proximal junctional kyphosis (PJK) and proximal junctional failure are widely reported, distal junctional failure (DJF) is less well understood.

Study Design: A systematic review was carried out.

Radiographic Measures of Spinal Alignment Are Not Predictive of the Development of C5 Palsy Following Anterior Cervical Discectomy and Fusion Surgery.

Background: Postoperative C5 palsy is a common complication following cervical decompression, occurring more frequently after posterior-based procedures. It has been theorized that this is the result of C5 nerve stretch resulting from spinal cord drift with these procedures. As such, it is thought to be less common after anterior cervical decompression and fusion (ACDF).

Regenerative Medicine Modalities for the Treatment of Degenerative Disk Disease.

Degenerative disk disease is a pathologic state associated with axial skeletal pain, radiculopathy, and myelopathy, and will inevitably increase in prevalence in parallel with an aging population. The objective of regenerative medicine is to convert the inflammatory, catabolic microenvironment of degenerative disease into an anti-inflammatory, anabolic environment. This comprehensive review discusses and outlines both in vitro and in vivo efficacy of regenerative treatment modalities for degenerative disk disease, such as; mesenchymal stem cells, gene therapy, tissue engineering, and biologic treatments.

Spinopelvic Dissociation: Assessment, Reduction Strategies, and Fixation Techniques.

Spinopelvic dissociation is a rare injury associated with 2% to 3% of transverse sacral fractures and 3% of sacral fractures associated with pelvic ring injuries. When spinopelvic dissociation is expediently identified and treated appropriately, patient outcomes can be maximized, highlighting the importance of early diagnosis and treatment. Because of its rarity and complexity, there remains a paucity of high-level evidence-based guidance on treating this complex issue.

The Incidence, Risk Factors, and Complications Associated With Surgical Delay in Multilevel Fusion for Adult Spinal Deformity.

Study Design: Retrospective database review.

Objectives: The incidence and risk factors for surgical delay of multilevel spine fusion for adult spinal deformity (ASD), and the complications corresponding therewith, remain unknown. The objectives of this study are to assess the incidence and risk factors for unexpected delay of elective multilevel spinal fusions on the date of surgery as well as the postoperative complications associated with these delays.

A Comparison of Revision Rates and Patient-Reported Outcomes for a 2-Level Posterolateral Fusion Augmented With Single Versus 2-Level Transforaminal Lumbar Interbody Fusion.

Study Design: Retrospective, single institution, multisurgeon case control series.

Objective: To determine whether there are differences in reoperation rates or outcomes for patients undergoing 2-level posterolateral fusion (PLF) augmented by a transforaminal lumbar interbody fusion (TLIF) at only one of the levels or at both.

Methods: A total of 416 patients were identified who underwent 2-level PLF with a TLIF at either one of those levels (n = 183) or at both (n = 233) with greater than 1-year follow-up.

Surgical Management of Thoracolumbar Burst Fractures: Surgical Decision-making Using the AOSpine Thoracolumbar Injury Classification Score and Thoracolumbar Injury Classification and Severity Score.

The management of thoracolumbar burst fractures is controversial with no universally accepted treatment algorithm. Several classification and scoring systems have been developed to assist in surgical decision-making. The most widely accepted are the Thoracolumbar Injury Classification and Severity Score (TLICS) and AOSpine Thoracolumbar Injury Classification Score (TL AOSIS) with both systems designed to provide a simple objective scoring criteria to guide the surgical or nonsurgical management of complex injury patterns.

Percutaneous Pedicle Screws in the Obese: Should the Skin Incision Be More Lateral?

Objective: To determine if the skin incision for lumbar percutaneous pedicle screws should be more lateral in the obese patient.

Methods: This was a retrospective radiographic analysis of 30 obese and non-obese lumbar spine computed tomography (CT) radiographs comparing the depth of soft tissue along the anatomic axis of the pedicle at L4 and L5.

Results: The average distance from the pedicle trajectory on the skin to the lateral border of the pedicle at L4 was 1.

Severe Lumbar Disability Is Associated With Decreased Psoas Cross-Sectional Area in Degenerative Spondylolisthesis.

Study Design: Retrospective cohort.

Objectives: Alterations in lumbar paraspinal muscle cross-sectional area (CSA) may correlate with lumbar pathology. The purpose of this study was to compare paraspinal CSA in patients with degenerative spondylolisthesis and severe lumbar disability to those with mild or moderate lumbar disability, as determined by the Oswestry Disability Index (ODI).

Risk Factors for Adverse Cardiac Events After Lumbar Spine Fusion.

Background: To determine the incidence and risk factors for adverse cardiac events after lumbar spine fusion.

Methods: A total of 50 495 patients were identified through the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database who underwent lumbar spine fusion between 2005 and 2015. The 30-day postoperative data were analyzed to assess for the incidence of adverse cardiac events including cardiac arrest or myocardial infarction.

C5 Motor Palsy After Single- and Multi-level Anterior Cervical Diskectomy and Fusion: A Retrospective Review.

Introduction: Postoperative C5 nerve root palsy is a known complication after cervical surgery. The effect of increasing number of levels fused on the prevalence of C5 palsy after anterior cervical diskectomy and fusion (ACDF) is unclear.

Methods: Medical records of ACDF patients that included the C4-5 level at one institution were retrospectively reviewed.

Surgical Strategies to Prevent Adjacent Segment Disease in the Cervical Spine.

The most popular approach to treating symptomatic cervical disk disease is anterior cervical discectomy and fusion. Although this procedure has significant long-term clinical success, it is associated with progressive adjacent segment degeneration with an annual incidence of ∼3%. Total disk arthroplasty was designed as an alternative to fusion that could preserve segmental motion at the operative level and potentially delay or prevent adjacent-level breakdown.

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.

Fracture Risk in Ulnohumeral Arthroplasty-A Biomechanical Study.

Purpose: Ulnohumeral arthroplasty, also known as the Outerbridge-Kashiwagi procedure, was popularized after reports of successful results in 1978, and has long been a means of management for ulnohumeral arthritis. However, there are concerns over the loss of integrity of the distal humerus as a result of fenestration. The purpose of this study was to examine the relationship between the size of fenestration and fracture risk.

Surgical Decision Making for Thoracolumbar Spine Injuries in Polytrauma Patients.

The management of thoracolumbar spine injuries in patients with multiple traumatic injuries is a challenge complicated by multiple competing medical and surgical demands. Safe and effective treatment of polytrauma patients with a thoracolumbar spine injury requires a multidisciplinary approach that involves surgical and critical care teams. The Thoracolumbar Injury Classification and Severity Score, which was developed to facilitate consistent surgical decision making in patients with a thoracolumbar spine injury, provides objective criteria for the classification and management of thoracolumbar spine injuries.

Spine Registries: Where Do We Stand?

To curb the unsustainable rise in health care costs, novel payment models are being explored which focus on value rather than volume. Underlying this reform is an accurate understanding of costs and outcomes. The Patient Protection and Affordable Care Act, the Institute of Medicine, and the Agency for Healthcare Research and Quality have specifically advocated for the use of registries to help define the real-world effectiveness of surgical interventions to help guide health care reform.

Intraoperative pedicle screw navigation does not significantly affect complication rates after spine surgery.

Various forms of intraoperative computer-assisted navigation technologies exist, and have consistently been shown to improve pedicle screw accuracy. However, the overall clinical effects of inaccurate pedicle screw placement have been debated. We examined the clinical effects of improved pedicle screw accuracy with computer navigation technology in reducing complication rates in patients undergoing multi-level spinal fusion.

Risk Factors for and Complications After Surgical Delay in Elective Single-Level Lumbar Fusion.

Study Design: Retrospective cohort.

Objective: To assess the incidence of and risk factors for delay of elective lumbar fusion surgery, as well as medical and surgical complications associated with surgical delay.

Summary Of Background Data: Lumbar fusion is a well-established treatment for patients with degenerative spondylolisthesis with stenosis who have failed conservative management.