The implementation and efficacy of the Northwestern High Risk Spine Protocol.

Objective: The aims of this study were to determine the efficacy and feasibility of implementation of the intraoperative component of a high risk spine (HRS) protocol for improving perioperative patient safety in complex spine fusion surgery.

Methods: In this paired availability study, the total number of red blood cell units transfused was used as a surrogate marker for our management protocol efficacy, and the number of protocol violations was used as a surrogate marker for protocol compliance.

Results: The 548 patients (284 traditional vs.

The impact of body mass index on hospital stay and complications after spinal fusion.

Background: Obesity is a dominant public health concern and risk factor for disability, with few studies examining its impact in spinal surgery. Patients with a higher body mass index (BMI) have lower functional status, increased pain, and worse physical condition than those with ideal weight.

Objective: To determine associations between BMI categories on adverse patient outcomes after long-segment spinal fusions.

Comprehensive assessment of prophylactic preoperative inferior vena cava filters for major spinal reconstruction in adults.

Study Design: A retrospective data analysis.

Objective: To report a comprehensive assessment of preoperative prophylactic inferior vena cava (IVC) filter placement in spine surgery.

Summary Of Background Data: Venous thromboembolism (VTE) is a serious complication after major spinal reconstructive surgery in adults.

Morbidity and mortality after spinal deformity surgery in patients 75 years and older: complications and predictive factors.

Object: As the population continues to age, relatively older geriatric patients will present more frequently with complex spinal deformities that may require surgical intervention. To the authors' knowledge, no study has analyzed factors predictive of complications after major spinal deformity surgery in the very elderly (75 years and older). The authors' objective was to determine the rate of minor and major complications and predictive factors in patients 75 years of age and older who underwent major spinal deformity surgery requiring a minimum 5-level arthrodesis procedure.

Techniques for operative correction of proximal junctional kyphosis of the upper thoracic spine.

Study Design: Retrospective study of a consecutive series of patients treated for proximal junctional kyphosis (PJK) of the upper thoracic and cervicothoracic spine.

Objective: To discuss corrective techniques for the management of symptomatic kyphosis at the junction of fused and mobile segments of the upper thoracic and cervicothoracic spine in patients who complain of pain, neurological deficit, ambulatory difficulty, and/or social isolation.

Summary Of Background Data: PJK is an unfortunately common, but important, complication seen in long instrumented fusions to the upper thoracic and cervicothoracic spine.

Predicting ideal spinopelvic balance in adult spinal deformity.

Objective: Spinopelvic balance is based on the theory that adjacent segments of the spine are related and influenced by one another. By understanding the correlation between the thoracolumbar spine and the pelvis, a concept of spinopelvic balance can be applied to adult deformity. The purpose of this study was to develop a mathematical relationship between the pelvis and spine and apply it to a population of adults who had undergone spinal deformity surgery to determine whether patients in spinopelvic balance have improved health measures.

Standardizing care for high-risk patients in spine surgery: the Northwestern high-risk spine protocol.

Study Design: Review article of current literature on the preoperative evaluation and postoperative management of patients undergoing high-risk spine operations and a presentation of a multidisciplinary protocol for patients undergoing high-risk spine operation.

Objective: To provide evidence-based outline of modifiable risk factors and give an example of a multidisciplinary protocol with the goal of improving outcomes.

Summary Of Background Data: Protocol-based care has been shown to improve outcomes in many areas of medicine.

Risk-benefit assessment of surgery for adult scoliosis: an analysis based on patient age.

Study Design: Retrospective review of a prospective, multicenter database.

Objective: The purpose of this study was to assess whether elderly patients undergoing scoliosis surgery had an incidence of complications and improvement in outcome measures comparable with younger patients.

Summary Of Background Data: Complications increase with age for adults undergoing scoliosis surgery, but whether this impacts the outcomes of older patients is largely unknown.

Diagnosis and management of metastatic spine disease. A review.

With continued growth of the elderly population and improvements in cancer therapies, the number of patients with symptomatic spinal metastases is likely to increase, and this is a condition that commonly leads to debilitating neurological dysfunction and pain. Advancements in surgical techniques of resection and spinal reconstruction, improvements in clinical outcomes following various treatment modalities, generally increased overall survival in patients with metastatic spine disease, and a recent randomized trial by Patchell and colleagues demonstrating the superiority of a combined surgical/radiotherapeutic approach over a radiotherapy-only strategy have led many to suggest increasingly aggressive interventions for patients with such lesions. Optimal management of spinal metastases encompasses numerous medical specialties, including neurosurgery, orthopedic surgery, medical and radiation oncology, radiology, and rehabilitation medicine.

Posterior vertebral column subtraction osteotomy for the treatment of tethered cord syndrome: review of the literature and clinical outcomes of all cases reported to date.

Tethered cord syndrome (TCS) is a debilitating condition of progressive neurological decline caused by pathological, longitudinal traction on the spinal cord. Surgical detethering of the involved neural structures is the classic method of treatment for lumbosacral TCS, although symptomatic retethering has been reported in 5%-50% of patients following initial release. Subsequent operations in patients with complex lumbosacral dysraphic lesions are fraught with difficulty, and improvements in neurological function are modest while the risk of complications is high.

The costs and benefits of nonoperative management for adult scoliosis.

Study Design: A prospective cohort of adult scoliosis patients treated nonoperatively had a minimum of 2-year follow-up during which time data were collected on the type and quantity of nonoperative treatment used.

Objective: To quantify the use, cost, and effectiveness of nonoperative treatment for adult scoliosis.

Summary Of Background Data: A 2007 systematic review of nonsurgical treatment in adult scoliosis revealed minimal data, and concluded that evidence for nonoperative care was lacking.

Thoracic pedicle subtraction osteotomy for fixed sagittal spinal deformity.

STUDY DESIGN.: A retrospective clinical study. OBJECTIVE.

Posterior vertebral column subtraction osteotomy: a novel surgical approach for the treatment of multiple recurrences of tethered cord syndrome.

Recurrent tethered cord syndrome (TCS) has been reported to develop in 5-50% of patients following initial spinal cord detethering operations. Surgery for multiple recurrences of TCS can be difficult and is associated with significant complications. Using a cadaveric tethered spinal cord model, Grande and colleagues demonstrated that shortening of the vertebral column by performing a 15-25-mm thoracolumbar osteotomy significantly reduced spinal cord, lumbosacral nerve root, and terminal filum tension.

Abdominal complications following kyphosis correction in ankylosing spondylitis.

Spinal deformity surgery is associated with high rates of morbidity and a wide range of complications. The most significant abdominal complications following kyphosis correction, while uncommon, can certainly pose significant infectious and hemodynamic risks to the patient. Abdominal compartment syndrome is the most severe of the sequelae.

An assessment of the reliability of the Enneking and Weinstein-Boriani-Biagini classifications for staging of primary spinal tumors by the Spine Oncology Study Group.

Study Design: Reliability analysis based on expert panel case series review and grading per the Enneking and Weinstein-Boriani-Biagini classification systems.

Objective: To assess the reliability of the Enneking and Weinstein-Boriani-Biagini classification systems.

Summary Of Background Data: The Enneking and Weinstein-Boriani-Biagini (WBB) classifications were developed to stage and facilitate treatment planning in patients with primary spine tumors.

Endovascular embolization of a recurrent cervical giant cell neoplasm using N-butyl 2-cyanoacrylate.

Pre-operative endovascular embolization of spinal giant cell tumors (GCTs) has been an effective strategy to reduce blood loss during surgical resection. Traditionally, spinal GCTs have been embolized with polyvinyl acetate (PVA) particles. We present the pre-operative embolization of a recurrent cervical GCT with N-butyl 2-cyanoacrylate (NBCA) rather than PVA.

Spinal deformity: a new classification derived from neutral upright spinal alignment measurements in asymptomatic juvenile, adolescent, adult, and geriatric individuals.

Objective: In this literature review, the authors analyze data from previously published studies that evaluated neutral upright spinal alignment (NUSA) from the occiput to the pelvis in asymptomatic individuals. Based on the data for NUSA in asymptomatic volunteers, a new classification is proposed for spinal deformity.

Methods: A review of the English literature was conducted to identify studies evaluating NUSA from the occiput to the pelvis in asymptomatic juvenile, adolescent, adult, and geriatric volunteers.

Pedicle subtraction osteotomy.

Objective: Pedicle subtraction osteotomy (PSO) is an effective tool for the correction of fixed sagittal plane deformity. However, there is potentially significant perioperative morbidity associated with this technique. We report our perioperative morbidity rate in recently performed PSO cases treated with our present surgical, anesthetic, and monitoring techniques and discuss complication-avoidance strategies.

Maximizing the potential of minimally invasive spine surgery in complex spinal disorders.

Minimally invasive surgery (MIS) in the spine was primarily developed to reduce approach-related morbidity and to improve clinical outcomes compared with those following conventional open spine surgery. Over the past several years, minimally invasive spinal procedures have gained recognition and their utilization has increased. In particular, MIS is now routinely used in the treatment of degenerative spine disorders and has been shown to be as effective as conventional open spine surgeries.

Surgical treatment of fixed cervical kyphosis with myelopathy.

Study Design: A retrospective clinical study.

Objective: To investigate clinical and radiographic outcomes following the surgical treatment of fixed cervical kyphosis with myelopathy.

Summary Of Background Data: To our knowledge, a study specifically addressing the surgical treatment of fixed cervical sagittal deformity has never before been published.

Spontaneous spinal epidural hematoma of unknown etiology: case report and literature review.

Introduction: Our objective is to emphasize the importance of recognizing and rapidly treating spontaneous spinal epidural hematoma (SSEH). SSEH is a pathologic entity traditionally thought to be exceptionally rare but which, in the era of MR imaging, is becoming increasingly prevalent, and which if treated with sufficient rapidity can be completely curable.

Clinical Presentation: Our particular case presented with clumsiness, neck pain with radiation to both arms, and bilateral arm weakness.

Surgical treatment of vertebral osteomyelitis with recombinant human bone morphogenetic protein-2.

Study Design: A retrospective clinical study.

Objective: To evaluate the use of recombinant human bone morphogenetic protein-2 (rhBMP-2) as the primary graft material for the surgical treatment of vertebral osteomyelitis.

Summary Of Background Data: The clinical and radiographic results using allograft, autograft, and vascularized bone flaps for the surgical treatment of osteomyelitis have been previously reported.

Reversal of neurologic deterioration after vertebral column resection by spinal cord untethering and duraplasty.

Study Design: Case report.

Objective: To describe a novel surgical approach for the treatment of a patient who developed neurologic deterioration after vertebral column resection (VCR).

Summary Of Background Data: VCR is a valuable osteotomy technique for the treatment of fixed spinal deformity.

Pedicled omental flaps as an adjunct in the closure of complex spinal wounds.

Study Design: A retrospective clinical study.

Objective: To evaluate the safety and efficacy of using an omental flap in complex spine reconstruction in patients at high-risk for wound dehiscence.

Summary Of Background Data: Postoperative wound dehiscence represents a major cause of morbidity in patients undergoing instrumented spinal reconstruction.