Opioid prescribing guidelines for spine surgery patients: a multisite analysis of guideline implementation and monitoring with an automated text messaging platform.

Objective: The aim of this study was to describe the effect of opioid prescribing guideline implementation for elective spine surgery cases on prescribing and consumption behaviors in a multisite academic hospital system. The effectiveness of an automated text messaging system as a tool to monitor postoperative opioid use and pain outcomes and inform guideline development and deployment is also evaluated.

Methods: The authors conducted a prospective study of postoperative opioid use behaviors and patient-reported outcomes for 2101 elective spine surgery cases between December 2018 and March 2022, prior to and following the implementation of opioid-prescribing guidelines in February 2021 at three urban hospital sites within a large academic health system.

Upper instrumented vertebra pedicle screw loosening following adult spinal deformity surgery: incidence and outcome analysis.

Objective: Surgical correction of adult spinal deformity (ASD) is associated with a high rate of hardware complication that can be challenging to predict. Hardware integrity and alignment after surgery are typically followed with standing radiography, where pedicle screw loosening may be incidentally identified but the clinical significance of which is often unclear. This study aimed to identify the incidence and implications of pedicle screw loosening at the upper instrumented vertebra (UIV) after surgical correction of ASD.

Machine Learning Models Leveraging Smartphone-Based Patient Mobility Data Can Accurately Predict Functional Outcomes After Spine Surgery.

The development of adjacent segment disease or the progression of spondylosis following the surgical treatment of spinal stenosis and spondylolisthesis is well documented and can lead to subsequent functional decline after a successful index surgery. The early detection of negative inflection points during patients' functional recovery can improve timely intervention. In this study, we developed machine learning (ML) models to predict the occurrence of post-operative decline in patient mobility.

Preoperative anemia is associated with increased length of stay in adult spinal deformity surgery: evaluation of a large single-center patient cohort and future suggestions for patient optimization.

Purpose: This study aimed to investigate the relationship of preoperative hemoglobin levels as an independent prognostic factor for hospital and intensive care unit (ICU) length of stay (LOS) in patients undergoing surgery for adult spinal deformity (ASD), with the intent of determining whether there exists a correlation and enhancing patient preoperative optimization protocols.

Methods: The authors reviewed consecutive patients who underwent elective thoracolumbosacral posterior spinal fusion (PSF) involving six or more vertebrae for ASD from January 1, 2013, to December 13, 2021, with a minimum follow-up period of two years. This study primarily investigated the association of preoperative hemoglobin levels with hospital and ICU LOS.

Diabetes and heart disease do not affect short-term lumbar fusion outcomes accounting for other risk factors in a matched cohort analysis.

Objectives: Comprehensive preoperative management involves the identification and optimization of medical comorbidities while avoiding excessive healthcare utilization. While diabetes and heart disease are major causes of morbidity that can worsen surgical outcomes, further study is needed to evaluate how well current perioperative strategies mitigate their risks. This study employs an exact matching protocol to isolate the effects of both diabetes and cardiovascular disease on spine surgery outcomes.

Blood loss during three column osteotomies: influence on outcomes and mitigation strategies.

Background: Three column osteotomies (3CO) are a powerful tool for the correction of rigid sagittal spinal deformities. However, 3CO surgeries are technically demanding procedures that are associated with prolonged operative times, large amounts of intraoperative blood loss, and high rates of post-operative neurological and medical complications. The purpose of this retrospective cross-sectional study is to delineate the effects of blood loss, blood transfusion, and tranexamic acid use on perioperative outcomes following 3CO.

Multi-institutional review of characteristics and management of gunshot wounds to the spine.

Background Context: Gunshot wounds (GSWs) to the vertebral column represent an important cause of morbidity and mortality in the United States, constituting approximately 20% of all spinal injuries. The management of these injuries is an understudied and controversial topic, given its heterogeneity and lack of follow-up data.

Purpose: To characterize the management and follow-up of GSWs to the spine.

Lumbar Facet Arthroplasty Versus Fusion for Grade-I Degenerative Spondylolisthesis with Stenosis: A Prospective Randomized Controlled Trial.

Background: The comparative effectiveness of decompression plus lumbar facet arthroplasty versus decompression plus instrumented lumbar spinal fusion in patients with lumbar spinal stenosis and grade-I degenerative spondylolisthesis is unknown.

Methods: In this randomized, controlled, Food and Drug Administration Investigational Device Exemption trial, we assigned patients who had single-level lumbar spinal stenosis and grade-I degenerative spondylolisthesis to undergo decompression plus lumbar facet arthroplasty (arthroplasty group) or decompression plus fusion (fusion group). The primary outcome was a predetermined composite clinical success score.

The FDA Reclassification of Cervical Pedicle and Lateral Mass Screws: A Case Study in Regulatory History.

The classification of medical devices by the Food and Drug Administration (FDA) involves rigorous scrutiny from specialized panels that designate devices as Class I, II, or III depending on their levels of relative risk to patient health. Posterior rigid pedicle screw systems were first classified by the FDA in 1984 and have since revolutionized the treatment of many spine pathologies. Despite this early classification by the FDA, posterior cervical pedicle and lateral mass screws were not reclassified from unclassified to Class III and then to Class II until 2019, nearly 35 years after their initial classification.

Global and Gender Equity in Oligodendroglioma Research: A Comprehensive Bibliometric Analysis Following the COVID-19 Pandemic.

Oligodendrogliomas are rare brain tumors arising from oligodendrocytes; there is a limited understanding of their pathogenesis, which leads to challenges in diagnosis, prognosis, and treatment. This study aimed to conduct a comprehensive bibliometric analysis of the oligodendroglioma literature to assess the current state of research, identify research trends, and elucidate implications for future research. The Lens database was used to retrieve journal articles related to "oligodendroglioma" without geographic or temporal restrictions.

Primary intradural extraosseous Ewing's sarcoma of the L3 nerve root: illustrative case.

Background: Ewing's sarcoma is an uncommon, aggressive malignancy that typically presents as an osseous lesion, most commonly in children and adolescents. Very rarely Ewing's sarcoma can present as an intradural extramedullary mass mimicking more common tumors.

Observations: A 32-year-old female had a left L3 nerve root-associated lesion identified in the setting of recent-onset radiculopathy.

Relationship Between Comorbidity Burden and Short-Term Outcomes Across 4680 Consecutive Spinal Fusions.

Objective: Preoperative management requires the identification and optimization of modifiable medical comorbidities, though few studies isolate comorbid status from related patient-level variables. This study evaluates Charlson Comorbidity Index (CCI)-an easily derived measure of aggregate medical comorbidity-to predict outcomes from spinal fusion surgery. Coarsened exact matching is employed to control for key patient characteristics and isolate CCI.

The Digital Impact of Neurosurgery Awareness Month: Retrospective Infodemiology Study.

Background: Neurosurgery Awareness Month (August) was initiated by the American Association of Neurological Surgeons with the aim of bringing neurological conditions to the forefront and educating the public about these conditions. Digital media is an important tool for disseminating information and connecting with influencers, general public, and other stakeholders. Hence, it is crucial to understand the impact of awareness campaigns such as Neurosurgery Awareness Month to optimize resource allocation, quantify the efficiency and reach of these initiatives, and identify areas for improvement.

A Prospective Cohort Study of Radiation Exposure to a Spine Surgeon's Exposed Body Parts During Utilization of Intraoperative Radiation-based Imaging.

Study Design: Prospective cohort study.

Summary Of Background Data: C-arm fluoroscopy and O-arm navigation are vital tools in modern spine surgeries, but their repeated usage can endanger spine surgeons. Although a surgeon's chest and abdomen are protected by lead aprons, the eyes and extremities generally receive less protection.

Preoperative Predictors of Survival in Patients With Spinal Metastatic Disease.

Background: There remains a number of factors thought to be associated with survival in spinal metastatic disease, but evidence of these associations is lacking. In this study, we examined factors associated with survival among patients undergoing surgery for spinal metastatic disease.

Methods: We retrospectively examined 104 patients who underwent surgery for spinal metastatic disease at an academic medical center.

The Differences Between Same-Day and Staged (Circumferential) Fusion Surgery in Adult Spinal Deformity: Protocol for a Systematic Review.

Background: Adult spinal deformity (ASD) is a deformity in the curvature of the adult spine. ASD includes a range of pathology that leads to decreased quality of life for patients as well as debilitating morbidities. Treatment can range from nonoperative management to long-segment surgical corrections and depends greatly on the deformity and patient profiles.

Incidental Durotomy Repair in Lumbar Spine Surgery: Institutional Experience and Review of Literature.

Study Design: : Retrospective Chart Review.

Objectives: Incidental durotomies (IDs) are common spine surgery complications. In this study, we present a review on the most commonly utilized management strategies, report our institutional experience with case examples, and describe a stepwise management algorithm.

A Prospective Study of Lumbar Facet Arthroplasty in the Treatment of Degenerative Spondylolisthesis and Stenosis: Results from the Total Posterior Spine System (TOPS) IDE Study.

Study Design: Prospective randomized Food and Drug Administration investigational device exemption clinical trial.

Objective: The purpose of the present study is to report the 1-year clinical and radiographic outcomes and safety profile of patients who underwent lumbar facet arthroplasty through implantation of the Total Posterior Spine System (TOPS) device.

Summary Of Background Data: Lumbar facet arthroplasty is one proposed method of dynamic stabilization to treat grade-1 spondylolisthesis with stenosis; however, there are currently no Food and Drug Administration-approved devices for facet arthroplasty.

Prospective, randomized controlled multicenter study of posterior lumbar facet arthroplasty for the treatment of spondylolisthesis.

Objective: The purpose of this study was to evaluate the safety and efficacy of a posterior facet replacement device, the Total Posterior Spine (TOPS) System, for the treatment of one-level symptomatic lumbar stenosis with grade I degenerative spondylolisthesis. Posterior lumbar arthroplasty with facet replacement is a motion-preserving alternative to lumbar decompression and fusion. The authors report the preliminary results from the TOPS FDA investigational device exemption (IDE) trial.