Patient acceptance of reoperation risk for lumbar decompression versus fusion.

Background Context: Lumbar decompression and lumbar fusion are effective methods of treating spinal compressive pathologies refractory to conservative management. These surgeries are typically used to treat different spinal problems, but there is a growing body of literature investigating the outcomes of either approach for patients with lumbar degenerative spondylolisthesis and stenosis. Different operations are associated with different risks and different potential needs for reoperation.

Patient-level patterns in daily prescribed opioid dosage in single level lumbar fusion are associated with postoperative opioid dosage and adverse events: a retrospective analysis of claims data.

Background: Patients undergoing lumbar spine surgery have high rates of preoperative opioid use, which is associated with inferior outcomes and higher risks for opioid dependency postoperatively.

Purpose: Determine whether there are identifiable subgroups of patients that follow distinct patterns in pre- and postoperative opioid dosing. Examine how preoperative patterns in opioid dosing relate to postoperative opioid patterns, opioid cessation, and the risk for adverse events.

Reliability of semi-automated spinal measurement software.

Purpose: In the treatment of patients with adult spinal deformity, analysis of spinopelvic balance is essential in clinical assessment and surgical planning. There is currently no gold standard for measurement, whether done by hand or with digital software. New semi-automated software exists that purports to increase efficiency, but its reliability is unknown in the literature.

Polymethyl methacrylate augmentation and proximal junctional kyphosis in adult spinal deformity patients.

Background: Proximal junctional kyphosis (PJK) is a complication following surgery for adult spinal deformity (ASD) possibly ameliorated by polymethyl methacrylate (PMMA) vertebroplasty of the upper instrumented vertebrae (UIV). This study quantifies PJK following surgical correction bridging the thoracolumbar junction ± PMMA vertebroplasty.

Methods: ASD patients from 2013 to 2020 were retrospectively reviewed and included with immediate postoperative radiographs and at least one follow-up radiograph.

Degenerative lumbar spondylolisthesis: review of current classifications and proposal of a novel classification system.

Purpose: To review existing classification systems for degenerative spondylolisthesis (DS), propose a novel classification designed to better address clinically relevant radiographic and clinical features of disease, and determine the inter- and intraobserver reliability of this new system for classifying DS.

Methods: The proposed classification system includes four components: 1) segmental dynamic instability, 2) location of spinal stenosis, 3) sagittal alignment, and 4) primary clinical presentation. To establish the reliability of this system, 12 observers graded 10 premarked test cases twice each.

Patient-level payment patterns prior to single level lumbar decompression are associated with resource utilization, postoperative payments, and adverse events.

Background: Understanding patient-specific trends in costs and healthcare resource utilization (HCRU) surrounding lumbar spine surgery is critically needed to better inform surgical decision making and the development of targeted interventions.

Purpose: 1) Identify subgroups of patients following distinct patterns in direct healthcare payments pre- and postoperatively, 2) determine whether these patterns are associated with patient and surgical factors, and 3) examine whether preoperative payment patterns are related to postoperative payments, healthcare resource utilization (HCRU), and adverse events.

Study Design/setting: Retrospective analysis of an administrative claims database (IBM Marketscan Research Databases 2007-2015).

Need of vascular surgeon and comparison of value for anterior lumbar interbody fusion (ALIF) in lateral decubitus: Delphi consensus.

Background And Purpose: Anterior lumbar approaches are recommended for clinical conditions that require interbody stability, spinal deformity corrections or a large fusion area. Anterior lumbar interbody fusion in lateral decubitus position (LatALIF) has gained progressive interest in the last years. The study aims to describe the current habit, the perception of safety and the perceptions of need of vascular surgeons according to experienced spine surgeons by comparing LatALIF to the standard L5-S1 supine ALIF (SupALIF).

Healthcare resource utilization and costs 2 years pre- and post-lumbar spine surgery for stenosis: a national claims cohort study of 22,182 cases.

Background Context: Improved understanding of the pre- and postoperative trends in costs and healthcare resource utilization (HCRU) is needed to better inform patient expectations and aid in the development of strategies to minimize the significant healthcare burden associated with lumbar spine surgery.

Purpose: Examine the time course of costs and HCRU in the 2 years preceding and following elective lumbar spine surgery for stenosis in a large national claims cohort.

Study Design/setting: Retrospective analysis of an administrative claims database (IBM® Marketscan® Research Databases 2007-2015).

Advanced Age Does Not Impact Outcomes After 1-level or 2-level Lateral Lumbar Interbody Fusion.

Study Design: This was a retrospective comparative study.

Objective: The objective of this study was to assess the effect of increased age on perioperative and postoperative complication rates, reoperation rates, and patient-reported pain and disability scores after lateral lumbar interbody fusion (LLIF).

Summary Of Background Data: LLIF was developed to minimize soft tissue trauma and reduce the risk of vascular injury; however, there is little evidence regarding the effect of advanced age on outcomes of LLIF.

Rod-Screw Constructs Composed of Dissimilar Metals Do Not Affect Complication Rates in Posterior Fusion Surgery Performed for Adult Spinal Deformity.

Study Design: This was a retrospective cohort study.

Objective: The objective of this study was to compare implant-related complications between mixed-metal and same-metal rod-screw constructs in patients who underwent posterior fusion for adult spinal deformity.

Summary Of Background Data: Contact between dissimilar metals is discouraged due to potential for galvanic corrosion, increasing the risk for metal toxicity, infection, and implant failure.

Preoperative epidural steroid injections are not associated with increased rates of infection and dural tear in lumbar spine surgery.

Purpose: The study objectives were to use a large national claims data resource to examine rates of preoperative epidural steroid injections (ESI) in lumbar spine surgery and determine whether preoperative ESI or the timing of preoperative ESI is associated with rates of postoperative complications and reoperations.

Methods: A retrospective longitudinal analysis of patients undergoing lumbar spine surgery for disc herniation and/or spinal stenosis was undertaken using the MarketScan® databases from 2007-2015. Propensity-score matched cohorts were constructed to compare rates of complications and reoperations in patients with and without preoperative ESI.

Subacute Minimally Invasive Decompression of L5 and S1 Nerve Roots for Neurologic Deficit After Fixation of Unstable Pelvic Fracture: A Case Report and Review of the Literature.

Case: A 73-year-old man experienced immediate neurological decline after percutaneous transsacral screw fixation for a pelvic ring injury sustained after a 25-foot fall. Workup revealed well-positioned screws and compression of the right L5 and S1 nerve roots at the fracture site. Symptoms improved after direct decompression without screw revision.

Remote Virtual Spinal Evaluation in the Era of COVID-19.

Background: With the COVID-19 pandemic disrupting many facets of our society, physicians and patients have begun using telemedicine as a platform for the delivery of health care. One of the challenges in implementing telemedicine for the spine care provider is completing a comprehensive spinal examination. Currently, there is no standardized methodology to complete a full spinal examination through telemedicine.

Timing of Lumbar Spinal Fusion Affects Total Hip Arthroplasty Outcomes.

Unlabelled: Many patients are affected by concurrent disease of the hip and spine, undergoing both total hip arthroplasty (THA) and lumbar spinal fusion (LSF). Recent literature demonstrates increased prosthetic dislocation rates in patients with THA done after LSF. Evidence is lacking on which surgery to do first to minimize complications.

Short-Term Outcomes of Staged Versus Same-Day Surgery for Adult Spinal Deformity Correction.

Study Design: Retrospective cohort study.

Objectives: Assess differences between staged (≤3 days) and same-day surgery in perioperative factors, radiographic measures, and complications.

Summary Of Background Data: Surgical adult spinal deformity correction may require combined anterior and posterior approaches.

Correction to: Intervertebral disc penetration by antibiotics used prophylactically in spinal surgery: implications for the current standards and treatment of disc infections.

Unfortunately, the complete conflict of interest statement was missed out in the original publication. The same is given below.

The Relationship Between Lumbar Lateral Listhesis and Radiculopathy in Adult Scoliosis.

Study Design: Retrospective review and prospective validation study.

Objective: To develop a classification system of lumbar lateral listhesis that suggests different likelihoods of having radiculopathy in adult scoliosis.

Summary Of Background Data: The association of lumbar lateral listhesis with radiculopathy remains uncertain.

The effect of standing variants of the seated position on lumbar intersegmental angulation and spacing: a radiographic study of 20 asymptomatic subjects.

Background: Pain while sitting is the primary complaint of many patients with lumbar spinal ailments, including those with discogenic low back pain and lumbar disc herniations. There has been little basic research on the different mechanical stresses that different sitting positions place on the spine. To demonstrate the effect of different sitting positions on lumbar intersegmental relationships.

Intervertebral disc penetration by antibiotics used prophylactically in spinal surgery: implications for the current standards and treatment of disc infections.

Purpose: The presence of Propionibacterium acnes in a substantial component of resected disc specimens obtained from patients undergoing discectomy or microdiscectomy has led to the suggestion that this prominent human skin and oral commensal may exacerbate the pathology of degenerative disc disease. This hypothesis, therefore, raises the exciting possibility that antibiotics could play an important role in treating this debilitating condition. To date, however, little information about antibiotic penetration into the intervertebral disc is available.

Improved biomechanics of two alternative kyphoplasty cementation methods limit vertebral recollapse.

The clinical efficacy of vertebral cement augmentation for compression fractures (VCFs) remains undetermined. Recent studies have shown that refracture and progression of deformity may occur after augmentation with significant clinical consequences. Vertebral body height loss following kyphoplasty has also been observed with cyclic loading.

Lumbar epidural steroid injections for herniation and stenosis: incidence and risk factors of subsequent surgery.

Background Context: Lumbosacral epidural steroid injections (ESIs) have increased dramatically despite a narrowing of the clinical indications for use. One potential indication is to avoid or delay surgery, yet little information exists regarding surgery rates after ESI.

Purpose: The purpose of this research was to determine the proportion of patients having surgery after lumbar ESI for disc herniation or stenosis and to identify the timing and factors associated with this progression.

Selective Anterior Lumbar Interbody Fusion for Low Back Pain Associated With Degenerative Disc Disease Versus Nonsurgical Management.

Study Design: This is a retrospective cohort study.

Objective: To evaluate the long-term outcomes of selective one- to two-level anterior lumbar interbody fusions (ALIFs) in the lower lumbar spine versus continued nonsurgical management.

Summary Of Background Data: Low back pain associated with lumbar intervertebral disc degeneration is common with substantial economic impact, yet treatment remains controversial.

Does timing of transplantation of neural stem cells following spinal cord injury affect outcomes in an animal model?

Background: We previously reported that functional recovery of rats with spinal cord contusions can occur after acute transplantation of neural stem cells distal to the site of injury. To investigate the effects of timing of administration of human neural stem cell (hNSC) distal to the site of spinal cord injury on functional outcomes in an animal model.

Methods: Thirty-six adult female Long-Evans hooded rats were randomized into three experimental and three control groups with six animals in each group.