Determining the utility of three-column osteotomies in revision surgery compared with primary surgeries in the thoracolumbar spine: a retrospective cohort study in the United States.

Study Design: Retrospective cohort study.

Purpose: To determine the incidence and success of three-column osteotomies (3COs) performed in primary and revision adult spine deformity (ASD) corrective surgeries.

Overview Of Literature: 3COs are often required to correct severe, rigid ASD presentations.

Expectations of clinical improvement following corrective surgery for adult cervical deformity based on functional disability at presentation.

Purpose: To assess impact of baseline disability on HRQL outcomes.

Methods: CD patients with baseline (BL) and 2 year (2Y) data included, and ranked into quartiles by baseline NDI, from lowest/best score (Q1) to highest/worst score (Q4). Means comparison tests analyzed differences between quartiles.

The Impact of Peri-operative Enhanced Recovery After Surgery Protocols on Outcomes Following Adult Cervical Deformity Surgery.

Study Design: Retrospective cohort study.

Objectives: To assess the impact of Enhanced recovery after surgery (ERAS) protocols on peri-operative course in adult cervical deformity (ACD) corrective surgery.

Methods: Patients ≥18 yrs with complete pre-(BL) and up to 2-year (2Y) radiographic and clinical outcome data were stratified by enrollment in an ERAS protocol that commenced in 2020.

Highest Achievable Outcomes for Adult Spinal Deformity Corrective Surgery: Does Frailty Severity Exert a Ceiling Effect?

Study Design: Retrospective single-center study.

Objective: To assess the influence of frailty on optimal outcome following ASD corrective surgery.

Summary Of Background Data: Frailty is a determining factor in outcomes after ASD surgery and may exert a ceiling effect on the best possible outcome.

Assessing the effects of prehabilitation protocols on post-operative outcomes in adult cervical deformity surgery: does early optimization lead to optimal clinical outcomes?

Purpose: To investigate the effect of a prehabilitation program on peri- and post-operative outcomes in adult cervical deformity (CD) surgery.

Methods: Operative CD patients ≥ 18 years with complete baseline (BL) and 2-year (2Y) data were stratified by enrollment in a prehabilitation program beginning in 2019. Patients were stratified as having undergone prehabilitation (Prehab+) or not (Prehab-).

Comparison of multilevel low-grade techniques versus three-column osteotomies in adult spinal deformity surgery: does harmonious correction matter?

Objective: Recent debate has arisen between whether to use a three-column osteotomy (3CO) or multilevel low-grade (MLG) techniques to treat severe sagittal malalignment in adult spinal deformity (ASD) surgery. The goal of this study was to compare the outcomes of 3CO and MLG techniques performed in corrective surgeries for ASD.

Methods: ASD patients who had a baseline PI-LL > 30° and 2-year follow-up data were included.

Predictors of reoperation for spinal disorders in Chiari malformation patients with prior surgical decompression.

Background: Chiari malformation (CM) is a cluster of related developmental anomalies of the posterior fossa ranging from asymptomatic to fatal. Cranial and spinal decompression can help alleviate symptoms of increased cerebrospinal fluid pressure and correct spinal deformity. As surgical intervention for CM increases in frequency, understanding predictors of reoperation may help optimize neurosurgical planning.

Risk of spinal surgery among individuals who have been re-vascularized for coronary artery disease.

Hypothesis: Revascularization is a more effective intervention to reduce future postop complications.

Methods: Patients undergoing elective spine fusion surgery were isolated in the PearlDiver database. Patients were stratified by having previous history of vascular stenting (Stent), coronary artery bypass graft (CABG), and no previous heart procedure (No-HP).

Outcomes and survival analysis of adult cervical deformity patients with 10-year follow-up.

Background: Previous studies have demonstrated that adult cervical deformity patients may be at increased risk of death in conjunction with increased frailty or a weakened physiologic state. However, such studies have often been limited by follow-up duration, and longer-term studies are needed to better assess temporal changes in ACD patients and associated mortality risk.

Purpose: To assess if patients with decreased comorbidities and physiologic burden will be at lessened risk of death for a greater length of time after undergoing adult cervical deformity surgery.

The Importance of Incorporating Proportional Alignment in Adult Cervical Deformity Corrections Relative to Regional and Global Alignment: Steps Toward Development of a Cervical-Specific Score.

Study Design/setting: Retrospective single-center study.

Background: The global alignment and proportion score is widely used in adult spinal deformity surgery. However, it is not specific to the parameters used in adult cervical deformity (ACD).

Can Baseline Disability Predict Outcomes in Adult Spinal Deformity Surgery?

Study Design: Retrospective Cohort Study.

Objective: To assess if there is a threshold of baseline disability beyond which the patient-reported outcomes after surgical correction of adult spinal deformity (ASD) are adversely impacted.

Background: Patient-reported outcomes vary after correction of adult spinal deformity, even when patients are optimally realigned.

The Predictive Potential of Nutritional and Metabolic Burden: Development of a Novel Validated Metric Predicting Increased Postoperative Complications in Adult Spinal Deformity Surgery.

Study Design: A retrospective cohort review.

Objective: To develop a scoring system for predicting increased risk of postoperative complications in adult spinal deformity (ASD) surgery based on baseline nutritional and metabolic factors.

Background: Endocrine and metabolic conditions have been shown to adversely influence patient outcomes and may increase the likelihood of postoperative complications.

Surgical costs in adult cervical Deformity: Do higher cost surgeries lead to better Outcomes?

Background: As our focus on delivering cost effective healthcare increases, interventions like cervical deformity surgery, which are associated with high resource utilization, have received greater scrutiny. The purpose of this study was to assess relationship between surgical costs, deformity correction, and patient reported outcomes in ACD surgery.

Methods: ACD Patients ≥ 18 years with baseline (BL) and 2-year (2Y) data were included.

The Impact of Lumbopelvic Realignment Versus Prevention Strategies at the Upper-instrumented Vertebra on the Rates of Junctional Failure Following Adult Spinal Deformity Surgery.

Study Design/setting: Retrospective.

Objective: Evaluate the surgical technique that has the greatest influence on the rate of junctional failure following ASD surgery.

Summary Of Background Data: Differing presentations of adult spinal deformity(ASD) may influence the extent of surgical intervention and the use of prophylaxis at the base or the summit of a fusion construct to influence junctional failure rates.

Concurrent Presence of Thoracolumbar Scoliosis and Chiari Malformation: Is Operative Risk Magnified?

Study Design: Retrospective review of Kids' Inpatient Database (KID).

Purpose: Identify the risks and complications associated with surgery in adolescents diagnosed with Chiari and scoliosis.

Overview Of Literature: Scoliosis is frequently associated with Chiari malformation (CM).

Factors Influencing Maintenance of Alignment and Functional Improvement Following Adult Spinal Deformity Surgery: A 3-Year Outcome Analysis.

Study Design: This was a retrospective review.

Objective: To assess the factors contributing to durability of surgical results following adult spinal deformity (ASD) surgery.

Summary Of Background: Factors contributing to the long-term sustainability of ASD correction are currently undefined.

Impact of Frailty on the Development of Proximal Junctional Failure: Does Frailty Supersede Achieving Optimal Realignment?

Background: Patients undergoing surgery for adult spinal deformity (ASD) are often elderly, frail, and at elevated risk of adverse events perioperatively, with proximal junctional failure (PJF) occurring relatively frequently. Currently, the specific role of frailty in potentiating this outcome is poorly defined.

Purpose: To determine if the benefits of optimal realignment in ASD, with respect to the development of PJF, can be offset by increasing frailty.

Costs of Surgery in Adult Spinal Deformity: Do Higher Cost Surgeries Lead to Better Outcomes?

Study Design: This was a retrospective study.

Objective: To assess the impact of surgical costs on patient-reported outcomes in adult spinal deformity (ASD).

Summary Of Background Data: With increased focus on delivering cost-effective health care, interventions with high-resource utilization, such as ASD surgery, have received greater scrutiny.

Natural history of adult spinal deformity: how do patients with suboptimal surgical outcomes fare relative to nonoperative counterparts?

Objective: Management of adult spinal deformity (ASD) has increasingly favored operative intervention; however, the incidence of complications and reoperations is high, and patients may fail to achieve idealized postsurgical results. This study compared health-related quality of life (HRQOL) metrics between patients with suboptimal surgical outcomes and those who underwent nonoperative management as a proxy for the natural history (NH) of ASD.

Methods: ASD patients with 2-year data were included.

Long-term Morbidity in Patients After Surgical Correction of Adult Spinal Deformity: Results From a Cohort With Minimum 5-year Follow-up.

Study Design: Retrospective.

Objective: The objective of this study is to describe the rate of postoperative morbidity before and after two-year (2Y) follow-up for patients undergoing surgical correction of adult spinal deformity (ASD).

Summary Of Background Data: Advances in modern surgical techniques for deformity surgery have shown promising short-term clinical results.

Patient-Centered Outcomes Following Prone Lateral Single-Position Approach to Same-Day Circumferential Spine Surgery.

Study Design: Retrospective study.

Objective: Evaluate surgical characteristics and postoperative 2-year results of the PL approach to spinal fusion.

Summary Of Background Data: Prone-lateral(PL) single positioning has recently gained popularity in spine surgery due to lower blood loss and operative time but has yet to be examined for other notable outcomes, including realignment and patient-reported measures.

A Hierarchical Approach to Realignment Strategies in Adult Cervical Deformity Surgery.

Study Design: Retrospective cohort study.

Objective: Construct an individualized cervical realignment strategy based on patient parameters at the presentation that results in superior 2-year health-related quality of life metrics and decreased rates of junctional failure and reoperation following adult cervical deformity surgery.

Summary Of Background Data: Research has previously focused on adult cervical deformity realignment thresholds for maximizing clinical outcomes while minimizing complications.

External Validation of the National Surgical Quality Improvement Program Calculator Utilizing a Single Institutional Experience for Adult Spinal Deformity Corrective Surgery.

Background: Identify the external applicability of the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) risk calculator in the setting of adult spinal deformity (ASD) and subsets of patients based on deformity and frailty status.

Methods: ASD patients were isolated in our single-center database and analyzed for the shared predictive variables displayed in the NSQIP calculator. Patients were stratified by frailty (not frail <0.

Failure to Normalize Risk Profile of Spine Fusion Patients With Coronary Artery Disease Previously Treated With Percutaneous Stent Revascularization.

Background: The impact of an initially less invasive cardiac intervention on outcomes of future surgical spine procedures has been understudied; therefore, we sought to investigate the effect of coronary stents on postoperative outcomes in an elective spine fusion cohort.

Methods: Elective spine fusion patients were isolated with International Classification of Diseases-Ninth Edition and current procedural terminology procedure codes in the PearlDiver database. Patients were stratified by number of coronary stents: (1) 1 to 2 stents (ST12); (2) 3 to 4 stents (ST34); (3) no stents.

The Effects of Global Alignment and Proportionality Scores on Postoperative Outcomes After Adult Spinal Deformity Correction.

Background: Recent studies have suggested achieving global alignment and proportionality (GAP) alignment may influence mechanical complications after adult spinal deformity (ASD) surgery.

Objective: To investigate the association between the GAP score and mechanical complications after ASD surgery.

Methods: Patients with ASD with at least 5-level fusion to pelvis and minimum 2-year data were included.