Disparities in Surgical Intervention and Health-Related Quality of Life Among Racial/Ethnic Groups With Degenerative Lumbar Spondylolisthesis.

Background And Objectives: Racial and socioeconomic disparities in spine surgery for degenerative lumbar spondylolisthesis persist in the United States, potentially contributing to unequal health-related quality of life (HRQoL) outcomes. This is important as lumbar spondylolisthesis is one of the most common causes of surgical low back pain, and low back pain is the largest disabler of individuals worldwide. Our objective was to assess the relationship between race, socioeconomic factors, treatment utilization, and outcomes in patients with lumbar spondylolisthesis.

Assessing the variation and drivers of cost in 1-level lumbar fusion: a time-driven activity-based costing analysis.

Background Context: As value-based health care arrangements gain traction in spine care, understanding the true cost of care becomes critical. Historically, inaccurate cost proxies have been used, including negotiated reimbursement rates or list prices. However, time-driven activity-based costing (TDABC) allows for a more accurate cost assessment, including a better understanding of the primary drivers of cost in 1-level lumbar fusion.

Practice Variation Within a Single Institution in Management of Degenerative Spondylolisthesis.

Study Design: This was a retrospective cohort study.

Objective: The objective of this study was to assess variation in care for degenerative spondylolisthesis (DS) among surgeons at the same institution, to establish diagnostic and therapeutic variables contributing to this variation, and to determine whether variation in care changed over time.

Summary Of Background Data: Like other degenerative spinal disorders, DS is prone to practice variation due to the wide array of treatment options.

Laminoplasty-an underutilized procedure for cervical spondylotic myelopathy.

Background Content: Cervical laminoplasty (LP) and laminectomy and fusion (LF) are commonly used surgical techniques for cervical spondylotic myelopathy (CSM). Several recent studies have demonstrated superior perioperative metrics and decreased overall costs with LP, yet LF is performed far more often in the United States.

Purpose: To determine the percentage of patients with CSM who are radiographically candidates for LP.

Development of prediction models for clinically meaningful improvement in PROMIS scores after lumbar decompression.

Background: The ability to preoperatively predict which patients will achieve a minimal clinically important difference (MCID) after lumbar spine decompression surgery can help determine the appropriateness and timing of surgery. Patient-Reported Outcome Measurement Information System (PROMIS) scores are an increasingly popular outcome instrument.

Purpose: The purpose of this study was to develop algorithms predictive of achieving MCID after primary lumbar decompression surgery.

Surgeon-level variance in achieving clinical improvement after lumbar decompression: the importance of adequate risk adjustment.

Background Context: Patient-Reported Outcome Measurement Information System (PROMIS) scores are increasingly utilized in clinical care. However, it is unclear if PROMIS can discriminate surgeon performance on an individual level.

Purpose: The purpose of this study was to examine surgeon-level variance in rates of achieving minimal clinically important difference (MCID) after lumbar decompression.

Laminoplasty versus laminectomy and fusion for cervical spondylotic myelopathy: a cost analysis.

Background Context: Laminectomy with fusion (LF) and laminoplasty (LP) are commonly used to treat cervical spondylotic myelopathy (CSM). The decision regarding which procedure to perform is largely a matter of surgeon's preference, while financial implications are rarely considered.

Purpose: We aimed to better understand the financial considerations of LF compared to LP in the treatment of CSM.

Development of machine learning and natural language processing algorithms for preoperative prediction and automated identification of intraoperative vascular injury in anterior lumbar spine surgery.

Background: Intraoperative vascular injury (VI) may be an unavoidable complication of anterior lumbar spine surgery; however, vascular injury has implications for quality and safety reporting as this intraoperative complication may result in serious bleeding, thrombosis, and postoperative stricture.

Purpose: The purpose of this study was to (1) develop machine learning algorithms for preoperative prediction of VI and (2) develop natural language processing (NLP) algorithms for automated surveillance of intraoperative VI from free-text operative notes.

Patient Sample: Adult patients, 18 years or age or older, undergoing anterior lumbar spine surgery at two academic and three community medical centers were included in this analysis.

Can natural language processing provide accurate, automated reporting of wound infection requiring reoperation after lumbar discectomy?

Background: Surgical site infections are a major driver of morbidity and increased costs in the postoperative period after spine surgery. Current tools for surveillance of these adverse events rely on prospective clinical tracking, manual retrospective chart review, or administrative procedural and diagnosis codes.

Purpose: The purpose of this study was to develop natural language processing (NLP) algorithms for automated reporting of postoperative wound infection requiring reoperation after lumbar discectomy.

Predicting prolonged opioid prescriptions in opioid-naïve lumbar spine surgery patients.

Importance: Preoperative determination of the potential for postoperative opioid dependence in previously naïve patients undergoing elective spine surgery may facilitate targeted interventions.

Objective: The purpose of this study was to develop supervised machine learning algorithms for preoperative prediction of prolonged opioid prescription use in opioid-naïve patients following lumbar spine surgery.

Design: Retrospective review of clinical registry data.

Natural language processing for automated detection of incidental durotomy.

Background: Incidental durotomy is a common intraoperative complication during spine surgery with potential implications for postoperative recovery, patient-reported outcomes, length of stay, and costs. To our knowledge, there are no processes available for automated surveillance of incidental durotomy.

Purpose: The purpose of this study was to develop natural language processing (NLP) algorithms for automated detection of incidental durotomies in free-text operative notes of patients undergoing lumbar spine surgery.

Discharge Disposition After Anterior Cervical Discectomy and Fusion.

Objective: Age and comorbidity burden of patients going anterior cervical discectomy and fusion (ACDF) have increased significantly over the past 2 decades, resulting in increased expenditures. Non-home discharge after ACDF contributes to increased direct and indirect costs of postoperative care. The purpose of this study was to identify independent prognostic factors for discharge disposition in patients undergoing ACDF.

Normal intervertebral segment rotation of the subaxial cervical spine: An study of dynamic neck motions.

Background: Accurate knowledge of the intervertebral center of rotation (COR) and its corresponding range of motion (ROM) can help understand development of cervical pathology and guide surgical treatment.

Methods: Ten asymptomatic subjects were imaged using MRI and dual fluoroscopic imaging techniques during dynamic extension-flexion-extension (EFE) and axial left-right-left (LRL) rotation. The intervertebral segment CORs and ROMs were measured from C34 to C67, as the correlations between two variables were analyzed as well.

Development of machine learning algorithms for prediction of prolonged opioid prescription after surgery for lumbar disc herniation.

Background Context: Spine surgery has been identified as a risk factor for prolonged postoperative opioid use. Preoperative prediction of opioid use could improve risk stratification, shared decision-making, and patient counseling before surgery.

Purpose: The primary purpose of this study was to develop algorithms for prediction of prolonged opioid prescription after surgery for lumbar disc herniation.

Sagittal spinal parameters after en bloc resection of mobile spine tumors.

Background Context: En bloc resection and reconstruction (EBR) in patients with spinal malignancy aims to achieve local disease control. This is an invasive procedure with significant alterations of the physiological anatomy and subsequently, the spino-pelvic alignment. Sagittal spinal parameters are useful measurements to objectively identify disproportionate alignment on a radiograph.

Development of a machine learning algorithm predicting discharge placement after surgery for spondylolisthesis.

Purpose: We aimed to develop a machine learning algorithm that can accurately predict discharge placement in patients undergoing elective surgery for degenerative spondylolisthesis.

Methods: The National Surgical Quality Improvement Program (NSQIP) database was used to select patients that underwent surgical treatment for degenerative spondylolisthesis between 2009 and 2016. Our primary outcome measure was non-home discharge which was defined as any discharge not to home for which we grouped together all non-home discharge destinations including rehabilitation facility, skilled nursing facility, and unskilled nursing facility.

Machine learning for prediction of sustained opioid prescription after anterior cervical discectomy and fusion.

Background Context: The severity of the opioid epidemic has increased scrutiny of opioid prescribing practices. Spine surgery is a high-risk episode for sustained postoperative opioid prescription.

Purpose: To develop machine learning algorithms for preoperative prediction of sustained opioid prescription after anterior cervical discectomy and fusion (ACDF).

Practice Variation Among Surgeons Treating Lumbar Spinal Stenosis in a Single Institution.

Study Design: A retrospective study.

Objective: The aim of this study was to examine practice variation in the treatment of lumbar spinal stenosis and identify targets for reducing variation.

Summary Of Background Data: Lumbar spinal stenosis is a degenerative condition susceptible to practice variation.

Computer-Assisted Navigation for Real Time Planning of Pedicle Subtraction Osteotomy in Cervico-Thoracic Deformity Correction.

Background: Pedicle subtraction osteotomy (PSO) at the cervicothoracic junction (CTJ) is a powerful technique to correct severe kyphosis and sagittal malalignment. Reported techniques have demonstrated the safety and efficacy of the PSO, however limited visualization of surrounding tissues increases the potential for complications with this advanced technique.

Objective: To describe the application of computed tomographic (CT)-based image guidance to the planning and execution of PSO at the CTJ.

Reoperation of decompression alone or decompression plus fusion surgeries for degenerative lumbar diseases: a systematic review.

Purpose: The objective of this paper was to compare the reoperation rates, timing and causes between decompression alone and decompression plus fusion surgeries for degenerative lumbar diseases through a systematic review of the published data.

Methods: A search of the literature was conducted on PubMed/MEDLINE, EMBASE and the Cochrane Collaboration Library. Reports that included reoperations after decompression alone and/or decompression plus fusion surgeries were selected using designed eligibility criteria.

The impact of mental health on patient-reported outcomes in cervical radiculopathy or myelopathy surgery.

Optimizing functional outcomes and disability status are essential for effective surgical treatment of cervical spine disorders. Mental impairment is common among patients with cervical spine complaints; yet little is known about the impact of baseline mental status with respect to overall patient-reported outcomes. This was a retrospective analysis of patients with cervical spondylosis with myelopathy(CM) or radiculopathy(CR: cervical disc herniation, stenosis, or spondylosis without myelopathy) at 2-year follow-ups.

Variation in costs among surgeons for lumbar spinal stenosis.

Background Context: Lumbar spinal stenosis is a common condition in the elderly for which costs vary substantially by region. Comparing differences between surgeons from a single institution, thereby omitting regional variation, could aid in identifying factors associated with higher costs and individual drivers of costs. The use of decision aids (DAs) has been suggested as one of the possible tools for diminishing costs and cost variation.

Decompressive surgery for lumbar spinal stenosis across the Atlantic: a comparison of preoperative MRI between matched cohorts from the US and Norway.

Background: There are no uniform guidelines regarding when to operate for Lumbar Spinal Stenosis (LSS). As we apply findings from clinical research from one population to the next, elucidating similarities or differences provides important context for the validity of extrapolating clinical outcomes. The aim of this study was to compare the morphological severity of lumbar spinal stenosis on preoperative MRI in patients undergoing decompressive surgery in Boston, USA, and Trondheim, Norway.