Severe Hemorrhagic Cholecystitis in the Absence of Common Predisposing Factors.

Hemorrhagic cholecystitis is a rare and potentially life-threatening complication of acute cholecystitis. It lacks specific diagnostic and management guidelines due to its rarity. We present the case of a 70-year-old male with no typical risk factors who developed hemorrhagic cholecystitis.

Spine surgeon triage of new patient referrals: quantification of surgical conversion rate by clinic referral source.

Background Context: In an effort to efficiently deliver high-value spine surgical care, spine surgery clinics may triage new patient referrals. A triage system with attending surgeon review of referred patient images may improve the surgical conversion rate (SCR) of a spine surgical clinic, and shift the distribution of new patients in clinic toward those most likely to derive benefit from surgery.

Purpose: To quantify SCR and number of triage steps by referral source in a tertiary referral spine clinic where all referrals are triaged by attending surgeons.

Inflammatory Myofibroblastic Tumor Presenting as a Partial Bowel Obstruction: A Case Report.

Intussusception, or telescoping of the bowel, is a rare condition in the adult population that can lead to serious complications, such as obstruction or ischemia. Most cases of intussusception are idiopathic and present with a pathognomonic "target sign" on imaging. Rarely, in adults, intussusceptions can be found with lead points, some of which may be neoplastic.

Preliminary experience with a novel facet-based lateral mass drill guide for the placement of lateral mass screws compared to freehand technique: a cadaveric study.

Background Context: Lateral mass screw fixation is the standard for posterior subaxial cervical fixation. Several freehand surgical techniques for placing lateral mass screws have been described which rely on anatomical landmarks and surgeon mastery of the technique to safely place screws. The accuracy of these freehand techniques is inherently variable and can be influenced by a surgeon's level of clinical experience.

Surgeon Learning Curve and Clinical Outcomes of Minimally Invasive Anterior Lumbar Interbody Fusion With Posterior Percutaneous Instrumentation.

Objectives: This study reports the learning phase of the minimally invasive anterior lumbar interbody fusion (mini-ALIF) approach with a vascular and orthopaedic spine surgeon team.

Methods: Adult patients who underwent primary mini-ALIF at the lowest two segments of the lumbar spine (i.e.

Utilizing previous patient opioid experiences for pain plan implementation: Role of opioid use categorization on inpatient and outpatient opioid use, length of stay, pain scores, and clinic resource utilization following elective spine surgery.

Background: A Pain Plan was formulated for all patients undergoing elective spine surgery at our institution. It was based on prior opioid experiences and developed collaboratively between the patient and the surgeon at a preoperative clinic visit. Category 1 patients had no previous opioid experience, Category 2 patients had remote previous opioid experience with acceptable pain control and no side effects, Category 3 patients had remote previous opioid experience with unacceptable pain control and/or side effects, and Category 4 patients had opioid use leading up to surgery.

Pain Plan Implementation Effect: Analysis of Postoperative Opioid Use, Hospital Length of Stay, and Clinic Resource Utilization for Patients Undergoing Elective Spine Surgery.

Introduction: The Pain Plan was developed collaboratively and implemented a unique systematic approach to reduce opioid usage in elective spine surgery.

Methods: This was a retrospective cohort study comparing patients who underwent elective spine surgery before and after Pain Plan implementation. The Pain Plan was implemented on May 1, 2019.

Effect of Bone Health Optimization on Osteoporosis Screening and Treatment Before Thoracolumbar Fusion.

Objective: Osteoporosis is not rare in thoracolumbar spine fusion patients and may portend poorer surgical outcomes. Implementation of a bone health optimization (BHO) clinic improves osteoporosis screening and treatment in the total joint arthroplasty population. We hypothesize that preoperative osteoporosis is common, under-recognized, and undertreated in thoracolumbar fusion patients and that a BHO clinic will increase preoperative osteoporosis screening rates and pharmacologic osteoporosis treatment in this population.

A Multicenter Evaluation of the Feasibility, Patient/Provider Satisfaction, and Value of Virtual Spine Consultation During the COVID-19 Pandemic.

Objective: To assess the feasibility, patient/provider satisfaction, and perceived value of telehealth spine consultation after rapid conversion from traditional in-office visits during the COVID-19 pandemic.

Methods: Data were obtained for patients undergoing telehealth visits with spine surgeons in the first 3 weeks after government restriction of elective surgical care at 4 sites (March 23, 2020, to April 17, 2020). Demographic factors, technique-specific elements of the telehealth experience, provider confidence in diagnostic and therapeutic assessment, patient/surgeon satisfaction, and perceived value were collected.

Clinical and Radiographic Outcomes of Lateral Interbody Fusion for Adjacent Segment Degeneration.

Study Design: Retrospective cohort study.

Objective: Assessment of outcomes in patients undergoing lateral interbody fusion as part of the surgical treatment of adjacent segment deterioration after previous lumbar spine fusion.

Methods: Adult patients with previous lumbar posterior spinal fusion who presented with adjacent segment degeneration and stenosis refractory to nonoperative treatment and who underwent lateral lumbar interbody fusion were retrospectively analyzed.

Factors Considered in Ranking Spine Surgery Fellowship Applicants: A Survey of Program Directors.

Study Design: Cross-sectional study.

Objective: To determine which factors spine surgery fellowship program directors (PDs) consider most important when ranking applicants.

Summary Of Background Data: Spine surgery is a popular orthopedic subspecialty.

Platelet-Rich Plasma, Bone Morphogenetic Protein, and Stem Cell Therapies.

The frequency of use of "biologics," including platelet-rich plasma (PRP), bone morphogenetic protein (BMP), and stem cell therapies in the treatment of orthopaedic conditions has significantly increased over the past few decades. The use of PRP and stem cells has been proposed for a wide variety of conditions including knee and hip osteoarthritis (OA), tendon strains and tendinopathies, muscle strains, and acute and chronic soft-tissue injuries. It has also been proposed for use in the enhancement of healing during surgical treatments.

Lateral Lumbar Interbody Fusion.

Lateral lumbar interbody fusion (LLIF) is a minimally invasive technique that allows access to the lumbar spine from L1/2 to L4/5 for placement of wide interbody devices. This technique is used in the treatment of degenerative conditions, deformity, and infectious, neoplastic, and traumatic thoracolumbar pathology. LLIF allows placement of interbody devices across the apophysis, which leads to powerful coronal deformity correction and indirect decompression from restoration of disk height.

Fight or flight? Crime as a driving force in business failure and business mobility.

A growing body of research has documented the consequences of neighborhood crime for a myriad of individual, household, and community outcomes. Given that neighborhood businesses figure into the link between neighborhood structure and crime as sources of employment or sites for neighbor interaction, the present study examines the extent to which neighborhood crime is associated with the survival, mobility, and destination locations of businesses in the subsequent year. Using business data from Reference USA (Infogroup, 2015) and crime data from the Southern California Crime Study (SCCS) we assess this question for neighborhoods across cities in the Southern California region.

Intelligent ICU for Autonomous Patient Monitoring Using Pervasive Sensing and Deep Learning.

Currently, many critical care indices are not captured automatically at a granular level, rather are repetitively assessed by overburdened nurses. In this pilot study, we examined the feasibility of using pervasive sensing technology and artificial intelligence for autonomous and granular monitoring in the Intensive Care Unit (ICU). As an exemplary prevalent condition, we characterized delirious patients and their environment.

How great and how good?: Third places, neighbor interaction, and cohesion in the neighborhood context.

Though Ray Oldenburg's (1989) notion of "third places", or places conducive to sociality outside of the realms of home and work, has received both scholarly and popular attention over the past several decades, many of the author's central claims remain empirically untested. The present study considers the association between neighborhood third places, cohesion and neighbor interaction. Drawing on various literatures regarding interaction in public space and neighborhood use-value, we consider how the role of third places might vary according to neighborhood socioeconomic context.

Spine Surgeon Treatment Variability: The Impact on Costs.

Study Design: Cross-sectional analysis.

Objectives: Given the lack of strong evidence/guidelines on appropriate treatment for lumbar spine disease, substantial variability exists among surgical treatments utilized, which is associated with differences in costs to treat a given pathology. Our goal was to investigate the variability in costs among spine surgeons nationally for the same pathology in similar patients.

Percutaneous and open iliac screw safety and accuracy using a tactile technique with adjunctive anteroposterior fluoroscopy.

Background Context: All currently described percutaneous iliac screw placement methods are entirely dependent on fluoroscopy.

Purpose: The purpose of this study was to determine the safety and the accuracy of percutaneous and open iliac screw placement using a primarily tactile technique with adjunctive anteroposterior (AP) fluoroscopy.

Study Design/context: All patients who underwent open and percutaneous iliac screw placement over a 5-year period were identified.

Variability in Surgical Treatment of Spondylolisthesis Among Spine Surgeons.

Background: There are a multitude of treatments for low-grade lumbar spondylolisthesis. There are no clear guidelines for the optimal approach.

Objective: To identify the surgical treatment patterns for spondylolisthesis among United States spine surgeons.

Minimally invasive direct pars repair with cannulated screws and recombinant human bone morphogenetic protein: case series and review of the literature.

OBJECTIVE The objective of this study was to describe the use of a minimally invasive surgical treatment of lumbar spondylolysis in athletes by a fluoroscopically guided direct pars screw placement with recombinant human bone morphogenetic protein-2 (rhBMP-2) and to report on clinical and radiographic outcomes. METHODS A retrospective review was conducted of all patients treated surgically for lumbar spondylolysis via a minimally invasive direct pars repair with cannulated screws. Demographic information, clinical features of presentation, perioperative and intraoperative radiographic imaging, and postoperative data were collected.

Percutaneous Lumbopelvic Fixation for Reduction and Stabilization of Sacral Fractures With Spinopelvic Dissociation Patterns.

Sacral fractures that result in spinopelvic dissociation are unstable injuries that are often treated surgically, with iliosacral screw fixation and/or lumbopelvic fixation from L4 to the pelvis. Open lumbopelvic fixation allows for direct fracture reduction and immediate postoperative weight bearing, but is associated with a relatively high wound complication rate. Open surgery often takes several hours and can be associated with significant blood loss, and therefore may not be well tolerated physiologically in these patients who often have multiple injuries.

Differences in the Surgical Treatment of Lower Back Pain Among Spine Surgeons in the United States.

Study Design: Electronic survey.

Objective: To identify the surgical treatment patterns for low back pain (LBP), among U.S.

The use of intraoperative triggered electromyography to detect misplaced pedicle screws: a systematic review and meta-analysis.

Object: Insertion of instruments or implants into the spine carries a risk for injury to neural tissue. Triggered electromyography (tEMG) is an intraoperative neuromonitoring technique that involves electrical stimulation of a tool or screw and subsequent measurement of muscle action potentials from myotomes innervated by nerve roots near the stimulated instrument. The authors of this study sought to determine the ability of tEMG to detect misplaced pedicle screws (PSs).

Minimally Invasive Versus Open Lumbar Fusion: A Comparison of Blood Loss, Surgical Complications, and Hospital Course.

Background: Perioperative blood loss is a frequent concern in spine surgery and often necessitates the use of allogeneic transfusion. Minimally invasive technique (MIS) is an option that minimizes surgical trauma and therefore intra-operative bleeding. The purpose of this study is to evaluate the blood loss, surgical complications, and duration of inpatient hospitalization in patients undergoing open posterolateral lumbar fusion (PLF), open posterior lumbar interbody fusion (PLIF) with PLF, or MIS transforaminal lumbar interbody fusion (MIS TLIF).

Direct lateral retroperitoneal approach for the surgical treatment of lumbar discitis and osteomyelitis.

Object: The medical management of discitis and osteomyelitis with long-term antibiotic therapy and bracing usually results in eradicated infection. Surgical management is appropriate when medical management fails and in some cases with pyogenic deformity or neurological deficit. The success of surgery depends on adequate debridement of the necrotic infected disc and vertebral body, along with anterior column reconstruction and vertebral stabilization.