Should We Operate on Octogenarians with Cervical Myelopathy or Radiculopathy?

Study Design: Retrospective Cohort.

Objective: Investigate the disparities between octogenarians and non-octogenarians undergoing cervical spine surgery regarding perioperative, and postoperative outcomes.

Summary Of Background Data: As the population ages, the demand for elective cervical spine surgery among older, more active adults increases.

Attitudes regarding barriers to entry and the learning curve associated with endoscopic decompression-only surgery: an international survey.

Background Context: Endoscopic spine decompression surgery (ESDS) offers numerous benefits, including reduced tissue damage, smaller incisions, shorter recovery times, and a lower risk of complications. However, its adoption among spine surgeons in the United States has been slow. The reluctance to adopt ESDS can be attributed to factors such as the learning curve, cost of equipment and training, and limited access to necessary resources.

Factors Associated With Return to Work Following Laminoplasty for Degenerative Cervical Myelopathy.

Study Design: Retrospective cohort study.

Objective: To identify factors predictive of returning to work within 90 days of laminoplasty for degenerative cervical myelopathy (DCM).

Background: DCM is a debilitating condition resulting from spinal canal stenosis and spinal cord compression.

Open Versus Endoscopic Approach for Thoracic Disk Herniations: Equivalent Short-Term Outcomes With Significantly Different Costs.

Background And Objectives: Open thoracic diskectomy often requires significant bone resection and fusion, whereas an endoscopic thoracic diskectomy offers a less invasive alternative. Therefore, we sought to compare one-level open vs endoscopic thoracic diskectomy regarding (1) perioperative outcomes, (2) neurological recovery, and (3) total cost.

Methods: A single-center, retrospective, cohort study using prospectively collected data of patients undergoing one-level thoracic diskectomy was undertaken from 2018 to 2023.

Revisiting the Posterior Approach for Cervical Radiculopathy Utilizing Endoscopic Techniques: A Favorable Short-Term Outcome and Cost Comparison With Anterior Cervical Discectomy and Fusion.

Background: Cervical radiculopathy is a spine ailment frequently requiring surgical decompression via anterior cervical discectomy and fusion (ACDF) or posterior foraminotomy/discectomy. While endoscopic posterior foraminotomy/discectomy is gaining popularity, its financial impact remains understudied despite equivalent randomized long-term outcomes to ACDF. In a cohort of patients undergoing ACDF vs endoscopic posterior cervical foraminotomy/discectomy, we sought to compare the total cost of the surgical episode while confirming an equivalent safety profile and perioperative outcomes.

Endoscopic Versus Traditional Thoracic Discectomy: A Multicenter Retrospective Case Series and Meta-Analysis.

Background And Objectives: Surgical treatment for symptomatic thoracic disc herniations (TDH) involves invasive open surgical approaches with relatively high complication rates and prolonged hospital stays. Although advantages of full endoscopic spine surgery (FESS) are well-established in lumbar disc herniations, data are limited for the endoscopic treatment of TDH despite potential benefits regarding surgical invasiveness. The aim of this study was to provide a comprehensive evaluation of potential benefits of FESS for the treatment of TDH.

Stopping at C2 Versus C3/4 in Elective Posterior Cervical Decompression and Fusion: A 5-Year Follow-up Study.

Study Design: This is a retrospective cohort study.

Objective: In patients undergoing elective posterior cervical laminectomy and fusion (PCLF) with a minimum of 5-year follow-up, we sought to compare reoperation rates between patients with an upper instrumented vertebra (UIV) of C2 versus C3/4.

Summary Of Background Data: The long-term outcomes of choosing between C2 versus C3/4 as the UIV in PCLF remain unclear.

Safety of early discharge after elective lumbar spine surgery with subfascial drains and association with significant reduction in length of stay.

Objective: After lumbar spine surgery, postoperative drain removal often delays discharge. Whether inpatient drain removal reduces the risk of surgical site infection (SSI) or hematoma remains controversial. Therefore, in patients undergoing elective lumbar spine surgery, the authors sought to determine the impact of inpatient versus outpatient drain removal on the following variables: 1) length of hospital stay (LOS), and 2) postoperative complications.

Racial and Socioeconomic Disparities in Laminoplasty Versus Laminectomy With Fusion in Patients With Cervical Spondylosis.

Study Design: A retrospective cohort study using prospectively collected data.

Objective: The aim of this study was to investigate preoperative differences in racial and socioeconomic factors in patients undergoing laminoplasty (LP) versus laminectomy and fusion (LF) for degenerative cervical myelopathy (DCM).

Summary Of Background Data: DCM is prevalent in the United States, requiring surgical intervention to prevent neurological degeneration.

Impact of occupational characteristics on return to work for employed patients after elective cervical spine surgery.

Objective: In a cohort of employed patients undergoing elective cervical spine surgery with an uncomplicated postoperative course, the authors sought to determine the demographic, functional, and occupational characteristics associated with return to work (RTW) following surgery.

Methods: A retrospective cohort study of prospectively collected data was undertaken of patients undergoing elective cervical spine surgery for degenerative disease in the Quality Outcomes Database. Study inclusion criteria were: 1) employed prior to surgery and planned to RTW, 2) no unplanned readmissions, 3) achieved 30% improvement on the Neck Disability Index (NDI), and 4) were satisfied with the surgical outcome at 3 or 12 months postoperatively.

Impact of Unplanned Readmission on Patient-Reported Outcomes After Cervical Spine Surgery: A National Study of 13 355 Patients.

Background And Objectives: Although risk factors for unplanned readmission after cervical spine surgery have been widely reported, less is known about how readmission itself affects patient-reported outcome measures (PROMs). Using the Quality Outcomes Database registry of patients undergoing elective cervical spine surgery, we sought to (1) determine the impact of unplanned readmission on PROMs and (2) compare the effect of specific readmission reasons on PROMs.

Methods: An observational study was performed using a multi-institution, retrospective registry for patients undergoing cervical spine surgery.

Determining the Effect of Intraoperative TXA on Postoperative Blood Loss in ACDF.

Study Design: Retrospective cohort study using prospectively collected data.

Objective: To determine the effectiveness of intraoperative tranexamic acid (TXA) in anterior cervical discectomy and fusion (ACDF) on postoperative blood loss.

Summary Of Background Data: TXA has been proven to be a safe and effective agent in reducing blood loss after cervical surgery; however, its efficacy when used intraoperatively for ACDF surgeries had yet to be researched.

Which Bone Mineral Density Measure Offers a More Reliable Prediction of Mechanical Complications in Adult Spinal Deformity Surgery: Hounsfield Units or DEXA Scan?

Objective: In patients undergoing adult spinal deformity (ASD) surgery, we sought to: (1) determine the relationship between dual-energy x-ray absorptiometry (DEXA)-measured bone mineral density (BMD), T-scores, and Hounsfield units (HU), and (2) compare the ability of DEXA-measured BMD, T-scores, and HU to predict mechanical complications and reoperations.

Methods: A single-institution retrospective cohort study was undertaken for cases from 2013 to 2017.

Inclusion Criteria: ≥5-level-fusion, sagittal/coronal deformity, and 2-year follow-up.

The importance of Hounsfield units in adult spinal deformity surgery: finding an optimal threshold to minimize the risk of mechanical complications.

Background: Low bone mineral density (BMD) is a well-established risk factor for mechanical complications following adult spinal deformity (ASD) surgery. Hounsfield units (HU) measured on computed tomography (CT) scans are a proxy of BMD. In ASD surgery, we sought to: (I) evaluate the association of HU with mechanical complications and reoperation, and (II) identify optimal HU threshold to predict the occurrence of mechanical complications.

Awake transforaminal endoscopic lumbar discectomy in an ambulatory surgery center: early clinical outcomes and complications of 100 patients.

Purpose: Transforaminal endoscopic discectomy has been found to have equivalent outcomes to traditional discectomy techniques. Controversy exists concerning whether this should be performed under general anesthetic with neuromonitoring or can be safely performed on awake patients without neuromonitoring. This study aimed to evaluate the safety and effectiveness of awake transforaminal endoscopic discectomy in an ambulatory setting.

Comparing Patient-Reported Outcomes, Complications, Readmissions, and Revisions in Posterior Lumbar Fusion With, Versus Without, an Interbody Device.

Study Design: Retrospective analysis on prospectively collected data.

Objectives: To compare posterior lumbar fusions with versus without an interbody in: (1) Patient-reported outcomes (PROs) at 1 year and (2) postoperative complications, readmission, and reoperations.

Summary Of Background Data: Elective lumbar fusion is commonly used to treat various lumbar pathologies.

Durotomy- and Irrigation-Related Serious Adverse Events During Spinal Endoscopy: Illustrative Case Series and International Surgeon Survey.

Background: Durotomy during endoscopic spine surgery can cause a patient's neurological or cardiovascular status to deteriorate unexpectedly intra- or postoperatively. There is currently limited literature regarding appropriate fluid management strategies, irrigation-related risk factors, and clinical consequences of incidental durotomy during spinal endoscopy, and no validated irrigation protocol exists for endoscopic spine surgery. Thus, the present article sought to (1) describe 3 cases of durotomy, (2) investigate standard epidural pressure measurements, and (3) survey endoscopic spine surgeons on the incidence of adverse effects believed to result from durotomy.

Transforaminal Lumbar Interbody Fusion Versus Posterolateral Fusion Alone in the Treatment of Grade 1 Degenerative Spondylolisthesis.

Background: Transforaminal lumbar interbody fusion (TLIF) and posterolateral fusion (PLF) alone are two operations performed to treat degenerative lumbar spondylolisthesis. To date, it is unclear which operation leads to better outcomes.

Objective: To compare TLIF vs PLF alone regarding long-term reoperation rates, complications, and patient-reported outcome measures (PROMs) in patients with degenerative grade 1 spondylolisthesis.

Endoscopic transforaminal treatment of a thoracic perineural cyst: a case report.

Background And Importance: To describe the first case of a thoracic perineural cyst successfully treated using a direct thoracic transforaminal endoscopic approach.

Methods: Case report.

Clinical Presentation: A 66-year-old male presented with right-sided radicular pain in a T4 distribution.