Morselized corticocancellous bone as primary graft for posterior lumbar fusion: a systematic review and meta-analysis.

Purpose: Synthetic cages are commonly used in posterior and transforaminal lumbar interbody fusion procedures. Using morselized corticocancellous bone from spinous processes and laminae has been suggested as an alternative, especially in low-resource settings where access to synthetic cages is limited. The aim of this study was to compare radiographic and functional outcomes of synthetic cages with those of morselized local autograft.

Cervical orthosis does not improve postoperative pain following posterior cervical fusion: a randomized controlled trial.

Purpose: To determine whether postoperative neck pain in the first 4 weeks following multi-level posterior cervical fusion (PCF) with orthosis is equivalent to multi-level PCF without orthosis.

Methods: Patients were randomly assigned in a 1:1 ratio to postoperative orthosis (CO) for 6 weeks or no orthosis (NO). Randomization was stratified by indication (traumatic vs.

Topping-Off a Long Thoracic Stabilization With Semi-Rigid Constructs May Have Favorable Biomechanical Effects to Prevent Proximal Junctional Kyphosis: A Biomechanical Comparison.

Study Design: In-vitro cadaveric biomechanical study.

Objectives: Long posterior spinal fusion is a standard treatment for adult spinal deformity. However, these rigid constructs are known to alter motion and stress to the adjacent non-instrumented vertebrae, increasing the risk of proximal junctional kyphosis (PJK).

Differences in the surgical management of degenerative lumbar spondylolisthesis based on self-reported sex: analysis of the CSORN prospective DLS study.

Objective: Surgical treatment of degenerative lumbar spondylolisthesis (DLS) reliably improves patient-reported quality of life; however, patient population heterogeneity, in addition to other factors, ensures ongoing equipoise in choosing the ideal surgical treatment. Surgeon preference for fusion or decompression alone influences surgical treatment decision-making. Meanwhile, at presentation, patient-reported outcome measures (PROMs) differ considerably between females and males.

Characterizing mJOA-defined post-surgical recovery patterns in patients with degenerative cervical myelopathy.

Background: Degenerative cervical myelopathy is a spinal disorder resulting in progressive cord compression and neurological deficits that are assessed using the modified Japanese Orthopedic Association (mJOA) questionnaire. It is difficult to predict which patients will recover neurological function after surgery, making it challenging for clinicians to set postoperative patient expectations. In this study, we used mJOA subscores to identify patterns of recovery and recovery timelines in patients with moderate and severe myelopathy.

Sagittal alignment in operative degenerative lumbar spondylolisthesis: a scoping review.

Background: The benefit of surgical intervention over conservative treatment for degenerative lumbar spondylolisthesis (DLS) patients with neurologic symptoms is well-established. However, it is currently unclear what breadth of available evidence exists on regional and global sagittal alignment in DLS surgery. As such, the purpose of the current study is to conduct a scoping review to map and synthesize the DLS literature regarding the current radiographic assessment of sagittal spinal alignment in DLS surgery.

Biomechanics of plate fixation following traditional olecranon osteotomy versus novel proximal ulna osteotomy for visualizing a distal humerus injury.

After a distal humeral injury, olecranon osteotomy (OO) is a traditional way to visualize the distal humerus for performing fracture fixation. In contrast, the current authors previously showed that novel proximal ulna osteotomy (PUO) allows better access to the distal humerus without ligamentous compromise. Therefore, this study biomechanically compared plating repair following OO versus PUO.

L3-L4 Hyperlordosis and Decreased Lower Lumbar Lordosis Following Short-Segment L4-L5 Lumbar Fusion Surgery is Associated With L3-L4 Revision Surgery for Adjacent Segment Stenosis.

Study Design: Retrospective review of prospective cohort.

Objectives: Reoperation at L3-L4 for adjacent segment disease (ASD) is common after L4-L5 spine fusion. L4-S1 lower lumbar lordosis (LLL) accounts for the majority of global lumbar lordosis (GLL) and is modifiable during surgery.

Functional outcomes correlate with sagittal spinal balance in degenerative lumbar spondylolisthesis surgery.

Background Context: Degenerative lumbar spondylolisthesis (DLS) is a debilitating condition associated with poor preoperative functional status. Surgical intervention has been shown to improve functional outcomes in this population though the optimal surgical procedure remains controversial. The importance of maintaining and/or improving sagittal and pelvic spinal balance parameters has received increasing interest in the recent DLS literature.

Clinical Outcomes of Bariatric Surgery Before Spinal Fusion: A Systematic Review.

Introduction: Morbidly obese patients are at increased risk for intraoperative and postoperative complications following spinal fusion. Preoperative weight loss can improve clinical outcomes. The present systematic literature review is aimed to evaluate the hypothesis that bariatric surgery before spinal fusion surgery is associated with higher rates of complications and revisions.

Biomechanical Comparison of Subsidence Between Patient-Specific and Non-Patient-Specific Lumbar Interbody Fusion Cages.

Study Design: Biomechanical study.

Objectives: Several strategies to improve the surface of contact between an interbody device and the endplate have been employed to attenuate the risk of cage subsidence. 3D-printed patient-specific cages have been presented as a promising alternative to help mitigate that risk, but there is a lack of biomechanical evidence supporting their use.

A 20-Year Review of Biomechanical Experimental Studies on Spine Implants Used for Percutaneous Surgical Repair of Vertebral Compression Fractures.

A vertebral compression fracture (VCF) is an injury to a vertebra of the spine affecting the cortical walls and/or middle cancellous section. The most common risk factor for a VCF is osteoporosis, thus predisposing the elderly and postmenopausal women to this injury. Clinical consequences include loss of vertebral height, kyphotic deformity, altered stance, back pain, reduced mobility, reduced abdominal space, and reduced thoracic space, as well as early mortality.

Rates, Predictive Factors, and Adverse Outcomes of Fusion Surgery for Lumbar Degenerative Disorders in Ontario, Canada, Between 2006 and 2015: A Retrospective Cohort Study.

Background: The addition of fusion surgery to the decompression for lumbar degenerative disorders remains controversial. The purpose of this study is to compare the rate and outcome of decompression and fusion versus decompression alone.

Methods: This population-based retrospective cohort study used several linked administrative databases to identify patients who underwent spinal decompression surgery in Ontario, Canada, from 2006 to 2015.

Preoperative Disc Angle is an Important Predictor of Segmental Lordosis After Degenerative Spondylolisthesis Fusion.

Study Design: Retrospective Cohort Study.

Objectives: To determine the effect of interbody cages inserted via posterior approach on segmental lordosis in the setting of preoperative lordotic vs kyphotic discs in patients with lumbar degenerative spondylolisthesis (LDS).

Methods: Retrospective analysis of prospectively collected data on assessment and management of LDS patients from 2 contributing centres.

Evaluation of the contact surface between vertebral endplate and 3D printed patient-specific cage vs commercial cage.

Biomechanical study. To evaluate the performance of the contact surface for 3D printed patient-specific cages using CT-scan 3D endplate reconstructions in comparison to the contact surface of commercial cages. Previous strategies to improve the surface of contact between the device and the endplate have been employed to attenuate the risk of cage subsidence.

Accuracy of Patient-Specific Drill Guide Template for Bilateral C1-C2 Laminar Screw Placement: A Cadaveric Study.

Objective: We sought to evaluate the accuracy of using patient-specific drill guides to place bilateral laminar screws in C1 and C2.

Methods: Nine cervical specimens (8 males; mean age: 66.6 [56-73]) with the occiput attached (C0-C3) were used in this study.

Proximal Ulna Osteotomy for Complex Fractures of the Distal Humerus: A 3-Dimensional Laser Analysis and Comparison With Olecranon Osteotomy.

Purpose: The current methods of distal humerus (DH) articular surface visualization only allow a limited view of the joint. This study describes an osteotomy procedure that increases the visualization of and access to the DH articular surface for fixation without compromising ligaments.

Methods: Eighteen fresh-frozen human elbows (9 matched pairs) underwent proximal ulna osteotomy (PUO) or transverse olecranon osteotomy (OO) contralaterally.

Early Versus Delayed Microdiscectomy for Chronic Sciatica Lasting 4-12 Months Secondary to Lumbar Disc Herniation: A Secondary Analysis of a Randomized Controlled Trial.

Objectives: To compare the effect of delaying surgery on clinical outcome in patients with chronic sciatica secondary to lumbar disc herniation.

Methods: Patients with sciatica lasting 4-12 months and lumbar disc herniation at the L4-L5 or L5-S1 level were randomized to undergo microdiscectomy (early surgery) or to receive 6 months of nonoperative treatment followed by surgery if needed (delayed surgery). Outcomes were leg pain, Oswestry Disability Index score (ODI), back pain, SF-36 physical component (PCS) and mental component (MCS) summary scores, employment, and satisfaction measured preoperatively and at 6 weeks, 3 months, 6 months, and 1 year after surgery.

Differentiation of pain-related functional limitations in surgical patients with lumbar spinal stenosis (LSS) using the Oswestry Disability Index: a Canadian Spine Outcomes and Research Network (CSORN) study.

Background Context: The Oswestry Disability Index (ODI) is the most commonly used outcome measure of functional outcome in spine surgery. The ability of the ODI to differentiate pain related functional limitation specifically related to degenerative lumbar spinal stenosis (LSS) is unclear.

Purpose: The purpose of this study was to determine the ability of the functional subsections of the ODI to differentiate the specific patient limitation(s) from symptomatic LSS and the functional impact of surgery.

Discectomy Compared with Standardized Nonoperative Care for Chronic Sciatica Due to a Lumbar Disc Herniation: A Secondary Analysis of a Randomized Controlled Trial with 2-Year Follow-up.

Background: Randomized controlled trials evaluating acute sciatica have not demonstrated prolonged improvements in terms of patient-reported pain and function. For chronic sciatica, however, microdiscectomy has been found to be superior at 1 year. Whether this effect persists during the second year is not known.

Microdiscectomy Is More Cost-effective Than a 6-Month Nonsurgical Care Regimen for Chronic Radiculopathy.

Background: A recent randomized controlled trial (RCT), performed by the authors, comparing early surgical microdiscectomy with 6 months of nonoperative care for chronic lumbar radiculopathy showed that early surgery resulted in improved outcomes. However, estimates of the incremental cost-utility ratio (ICUR), which is often expressed as the cost of gaining one quality-adjusted life year (QALY), of microdiscectomy versus nonsurgical management have varied. Radiculopathy lasting more than 4 months is less likely to improve without surgical intervention and may have a more favorable ICUR than previously reported for acute radiculopathy.

Biomechanical comparison of a C1 posterior arch clamp with C1 lateral mass screws in constructs for C1-C2 fusion.

The aim of this experimental study was to assess the biomechanical performance of a novel C1 posterior arch (C1PA) clamp compared with C1 lateral mass (C1LM) screws in constructs used to treat atlantoaxial instability. These constructs had either C2 pedicle (C2P) screws or C2 translaminar (C2TL) screws. Eight fresh-frozen human cadaveric ligamentous spine specimens (C0-C3) were tested under six conditions: the intact state, the destabilized state after a simulated odontoid fracture, and when instrumented with four constructs (C1LM-C2P, C1LM-C2TL, C1PA-C2P, C1PA-C2TL).

The Impact of Surgical Site Infection on Patient Outcomes After Open Posterior Instrumented Thoracolumbar Surgery for Degenerative Disorders.

Background: Few reports in the literature have described the long-term outcome of postoperative infection from the patient perspective. The aim of the present study was to determine if complicated surgical site infection (SSI) affects functional recovery and surgical outcomes up to 2 years after posterior instrumented thoracolumbar surgery for the treatment of degenerative disorders.

Methods: This retrospective cohort study involved patients who had been enrolled in a previous randomized controlled trial that examined antibiotic use for open posterior multilevel thoracolumbar or lumbar instrumented fusion procedures.