Total joint replacement of the lumbar spine: report of the first two cases with 16 years of follow-up.

Background: Total joint replacement (TJR) of the lumbar spine is a revolutionary procedure that couples the clinical benefits of neural decompression with preservation of natural motion and sagittal balance at the operative level. The TJR procedure involves reconstruction of the entire motion segment using a posterior bilateral transforaminal approach to access the disc space. The TJR implant (MOTUS, 3Spine, Chattanooga, TN, USA) replaces the function of the intervertebral disc and facet joints, performing biomechanically as a new articulation for the resected, degenerated disc and facets.

Are We Finally Ready for Total Joint Replacement of the Spine? An Extension of Charnley's Vision.

Professor Sir John Charnley has been rightfully hailed as a visionary innovator for conceiving, designing, and validating the -the total hip arthroplasty. His groundbreaking achievement forever changed the orthopedic management of chronically painful and dysfunctional arthritic joints. However, the well-accepted surgical approach of completely removing the diseased joint and replacing it with a durable and anatomically based implant never translated to the treatment of the degenerated spine.

Intrathecal Fentanyl With a Myofascial Plane Block in Open Lumbar Surgeries: A Case Series.

Background: Acute postoperative pain control after lumbar surgery is imperative to minimizing long-term narcotic use and associated adverse sequela. The safety of intrathecal morphine for postoperative pain management in spine surgery has been investigated; however, to date, no studies have investigated the safety of intrathecal fentanyl with a myofascial plane (MP) block in lumbar procedures.

Objective: To assess the safety profile of intrathecal fentanyl with a MP block administered during lumbar surgery and the subsequent utilization of postoperative intravenous opioids.

State of the art review of new technologies in spine deformity surgery-robotics and navigation.

Study Design/methods: Review article.

Objectives: The goal of this article is to review the available evidence for computerized navigation and robotics as an accuracy improvement tool for spinal deformity surgery, as well as to consider potential complications, impact on clinical outcomes, radiation exposure, and costs. Pedicle screw and rod construct are widely utilized for posterior spinal fixation in spinal deformity correction.

Surgeons lack of agreement on determining preoperative radiographic and clinical shoulder balance in adolescent and adult idiopathic scoliosis patients.

Purpose: Preoperative shoulder balance is an important factor in determining the upper instrumented vertebrae (UIV). In adolescent and adult idiopathic scoliosis (AIS/AdIS) patients, we studied the intraobserver and interobserver reliability of spinal surgeons' assessment of preoperative shoulder balance using X-rays (XR) and anterior/posterior photographs.

Methods: An observational review of a prospective multicenter database (AIS Lenke Type 1/5/6) and prospective single-institution database (AdIS) was conducted.

Loading of the lumbar spine during transition from standing to sitting: effect of fusion versus motion preservation at L4-L5 and L5-S1.

Background Context: Transition from standing to sitting significantly decreases lumbar lordosis with the greatest lordosis-loss occurring at L4-S1. Fusing L4-S1 eliminates motion and thus the proximal mobile segments maybe recruited during transition from standing to sitting to compensate for the loss of L4-S1 mobility. This may subject proximal segments to supra-physiologic flexion loading.

Seated Lateral X-ray Is a Better Stress Radiograph of the Lumbar Spine Compared to Standing Flexion.

Study Design: Prospective lumbar radiograph analysis.

Objective: To compare changes in lumbar lordosis in standing flexion versus seated lateral radiographs.

Methods: Standing lateral, standing flexion, and seated lateral X-rays of the lumbar spine were obtained in patients presenting with low back pain.

Improvements in Neck Pain and Disability Following C1-C2 Posterior Cervical Instrumentation and Fusion for Atlanto-Axial Osteoarthritis.

Objective: Symptomatic Atlanto-axial (C1-2) osteoarthritis (AAOA) is a common phenomenon in elderly patients; however, there is a paucity of data on the effectiveness of posterior atlanto-axial fusion (PAAF) for this condition. To this end, here we assess changes in patient-reported outcomes and neck-related disability in adult patients undergoing PAAF for symptomatic C1-2 AAOA.

Methods: In this retrospective study, the clinical records of consecutive patients with symptomatic AAOA who underwent PAAF between 2004 and 2017 were reviewed.

A novel MRI-based classification of spinal cord shape and CSF presence at the curve apex to assess risk of intraoperative neuromonitoring data loss with thoracic spinal deformity correction.

Study Design: Retrospective cohort. We present a simple classification system that is able to identify patients with increased odds of losing intraoperative neuromonitoring data during thoracic deformity correction. Type 3 spinal cords, with the cord deformed against the concave pedicle in the axial plane, have ×28 greater odds of losing monitoring data during surgery.

Preoperative halo-gravity traction for treatment of severe adult kyphosis and scoliosis.

Study Design: Retrospective case series.

Objective: To assess the efficacy of preoperative halo-gravity traction (HGT) in the treatment for severe adult kyphosis and scoliosis. Preoperative HGT improves severe curve magnitude and clinical condition in pediatric spinal deformity.

The "kickstand rod" technique for correction of coronal imbalance in patients with adult spinal deformity: initial case series.

Objective: The objective of this study was to describe and evaluate a new surgical procedure for the correction of coronal imbalance (CI) in adult spinal deformity patients, called the "kickstand rod" technique.

Methods: The authors analyzed the records of 24 consecutive patients with pediatric and adult spinal deformity and CI treated between July 2015 and October 2017 with a long-segment fusion and a kickstand rod. For the kickstand rod technique, an iliac screw was placed on the ipsilateral side of the trunk shift and connected proximally through a side-by-side domino link to the thoracolumbar junction; this rod was distracted to promote coronal plane balancing.

Reciprocal change of sagittal profile in unfused spinal segments and lower extremities after complex adult spinal deformity surgery including spinopelvic fixation: a full-body X-ray analysis.

Background Context: Few studies have described reciprocal changes of pathologic compensatory mechanisms in the setting of spinopelvic fixation using full-body radiograph.

Purpose: To elucidate how sagittal alignment of unfused spinal segments and lower extremities change reciprocally following complex thoracolumbar realignment surgery including fusion to the sacrum in adult spinal deformity.

Study Design: Retrospective cohort.

Neurologic Deficit During Halo-Gravity Traction in the Treatment of Severe Thoracic Kyphoscoliotic Spinal Deformity.

Correction of severe spinal deformity is a significant challenge for spinal surgeons. Although halo-gravity traction (HGT) has been shown to be well-tolerated and safe, we report here a case of neurologic decline during treatment. A 24-year-old male presents with severe thoracic kyphoscoliosis with > 180° of 3-dimensional deformity.

Reciprocal Change in Sagittal Profiles After Adolescent Idiopathic Scoliosis Surgery With Segmental Pedicle Screw Construct: A Full-body X-ray Analysis.

Study Design: Retrospective cohort.

Objective: This radiographic analysis using a full-body x-ray evaluated the ways in which the sagittal profiles of the unfused spinal segments, pelvic, and lower extremities spontaneously change after adolescent idiopathic scoliosis (AIS) surgery with segmental pedicle screw constructs.

Summary Of Background Data: Reciprocal lordotic changes in unfused spinal segments after corrective surgery for AIS have been reported.

The Amount of Relative Curve Correction Is More Important Than Upper Instrumented Vertebra Selection for Ensuring Postoperative Shoulder Balance in Lenke Type 1 and Type 2 Adolescent Idiopathic Scoliosis.

Study Design: Retrospective review of a prospectively collected multicenter database.

Objective: To assess how "overcorrection" of the main thoracic curve without control of the proximal curve increases the risk for shoulder imbalance in Lenke type 1 Adolescent Idiopathic Scoliosis (AIS).

Summary Of Background Data: Postop shoulder imbalance is a common complication following AIS surgery.

Drivers of Variability in 90-day Cost for Primary Single-level Microdiscectomy.

Background: The healthcare reimbursement models are rapidly transitioning to pay-per-performance episode of care payment models. These models, if designed well, must account for the variability in the cost of index surgeries during the global period.

Objective: To analyze the variability in 90-d cost and determine the drivers of the variability in total 90-d cost associated with single-level microdiscectomy.

Drivers of Variability in 90-Day Cost for Elective Anterior Cervical Discectomy and Fusion for Cervical Degenerative Disease.

Background: Value-based episode of care reimbursement models is being investigated to curb unsustainable health care costs. Any variation in the cost of index spine surgery can affect the payment bundling during the 90-d global period.

Objective: To determine the drivers of variability in cost for patients undergoing elective anterior cervical discectomy and fusion (ACDF) for degenerative cervical spine disease.

Autologous chondrocyte grafting promotes bone formation in the posterolateral spine.

Background Context: Pseudarthrosis following spinal fusion remains problematic despite modern surgical and grafting techniques. In surgical spinal fusion, new bone forms via intramembranous and endochondral ossification, with endochondral ossification occurring in the hypoxic zones of the fusion bed. During bone development and fracture healing, the key cellular mediator of endochondral ossification is the hypertrophic chondrocyte given its ability to function in hypoxia and induce neovascularization and ossification.

Intersurgeon Cost Variability in Anterior Cervical Discectomy and Fusion.

Study Design: Retrospective review of prospective patient outcomes and cost data.

Objective: To analyze the contribution of surgeon-specific variability in cost and patient-reported outcomes (PROs) to overall variability in anterior cervical discectomy and fusion (ACDF), whereas adjusting for patient comorbidities.

Summary Of Background Data: Cost reduction in surgical care has received increased attention.

Surgeon-Level Variability in Outcomes, Cost, and Comorbidity Adjusted-Cost for Elective Lumbar Decompression and Fusion.

Background: The costs and outcomes following degenerative spine surgery may vary from surgeon to surgeon. Patient factors such as comorbidities may increase the health care cost. These variations are not well studied.

Impact of old age on patient-report outcomes and cost utility for anterior cervical discectomy and fusion surgery for degenerative spine disease.

Purpose: With growing older population and increasing rates of cervical spinal surgery, it is vital to understand the value of cervical surgery in this population. We set forth to determine the cost utility following anterior cervical decompression and fusion (ACDF) for degenerative disease in older patients.

Methods: Patients undergoing ACDF for degenerative diseases were enrolled into prospective longitudinal registry.

In-Toeing Is Often a Primary Care Orthopedic Condition.

Objective: To evaluate in-toeing consults to a pediatric orthopedic clinic to determine the proportion that could be managed by a primary care physician.

Study Design: A prospective registry was created for 143 consecutive children referred to a pediatric orthopedic clinic for "in-toeing." Each patient underwent a careful history and physical examination, which included a rotational profile.

Effect of obesity on cost per quality-adjusted life years gained following anterior cervical discectomy and fusion in elective degenerative pathology.

Background: Obese patients have greater comorbidities along with higher risk of complications and greater costs after spine surgery, which may result in increased cost and lower quality of life compared with their non-obese counterparts.

Purpose: The aim of the present study was to determine cost-utility following anterior cervical discectomy and fusion (ACDF) in obese patients.

Study Design: This study analyzed prospectively collected data.

Does Obesity Correlate With Worse Patient-Reported Outcomes Following Elective Anterior Cervical Discectomy and Fusion?

Background: Studies have investigated the impact of obesity in thoracolumbar surgery; however, the effect of obesity on patient-reported outcomes (PROs) following anterior cervical discectomy and fusion (ACDF) is unknown.

Objective: To examine the relationship between obesity and PROs following elective ACDF.

Methods: Consecutive patients undergoing ACDF for degenerative conditions were evaluated.