Does Minimally Invasive Percutaneous Posterior Instrumentation Reduce Risk of Proximal Junctional Kyphosis in Adult Spinal Deformity Surgery? A Propensity-Matched Cohort Analysis.

Background: Proximal junctional kyphosis (PJK) is a known complication after spinal deformity surgery. One potential cause is disruption of posterior muscular tension band during pedicle screw placement.

Objective: To investigate the effect of minimally invasive surgery (MIS) on PJK.

A controlled anterior sequential interbody dilation technique for correction of cervical kyphosis.

Object: Cervical kyphosis can lead to spinal instability, spinal cord injury, and disability. The correction of cervical kyphosis is technically challenging, especially in severe cases. The authors describe the anterior sequential interbody dilation technique for the treatment of cervical kyphosis and evaluate perioperative outcomes, degree of correction, and long-term follow-up outcomes associated with the technique.

Adverse events in neurosurgery and their relationship to quality improvement.

Adverse events are common in neurosurgery. Their reporting is inconsistent and widely variable due to nonuniform definitions, data collection mechanisms, and retrospective data collection. Historically, neurosurgery has lagged behind general and cardiac surgical fields in the creation of multi-institutional prospective databases allowing for benchmarking and accurate adverse event/outcomes measurement, the bedrock of evidence used to guide quality improvement initiatives.

Incidence of Low Back Pain After Lumbar Discectomy for Herniated Disc and Its Effect on Patient-reported Outcomes.

Background: Long-term postdiscectomy degenerative disc disease and low back pain is a well-recognized disorder; however, its patient-centered characterization and quantification are lacking.

Questions/purposes: We performed a systematic literature review and prospective longitudinal study to determine the frequency of recurrent back pain after discectomy and quantify its effect on patient-reported outcomes (PROs).

Methods: A MEDLINE search was performed to identify studies reporting on the frequency of recurrent back pain, same-level recurrent disc herniation, and reoperation after primary lumbar discectomy.

Comparison of two minimally invasive surgery strategies to treat adult spinal deformity.

Object: Minimally invasive surgery (MIS) techniques are becoming a more common means of treating adult spinal deformity (ASD). The aim of this study was to compare the hybrid (HYB) surgical approach, involving minimally invasive lateral interbody fusion with open posterior instrumented fusion, to the circumferential MIS (cMIS) approach to treat ASD.

Methods: The authors performed a retrospective, multicenter study utilizing data collected in 105 patients with ASD who were treated via MIS techniques.

The role of decision analytic modeling in the health economic assessment of spinal intervention.

Study Design: Narrative review.

Objective: To review the common tenets, strengths, and weaknesses of decision modeling for health economic assessment and to review the use of decision modeling in the spine literature to date.

Summary Of Background Data: For the majority of spinal interventions, well-designed prospective, randomized, pragmatic cost-effectiveness studies that address the specific decision-in-need are lacking.

The effects of smoking on perioperative outcomes and pseudarthrosis following anterior cervical corpectomy: Clinical article.

Object: Smoking is one of the leading causes of preventable morbidity and death in the U.S. and has been associated with perioperative complications.

Cost-effectiveness of lumbar discectomy and single-level fusion for spondylolisthesis: experience with the NeuroPoint-SD registry.

Object: There is significant practice variation and uncertainty as to the value of surgical treatments for lumbar spine disorders. The authors' aim was to establish a multicenter registry to assess the efficacy and costs of common lumbar spinal procedures by using prospectively collected outcomes.

Methods: An observational prospective cohort study was completed at 13 academic and community sites.

Comparison between C1-2 Fixation with and without Supplemental Posterior Wiring.

Study Design Retrospective analysis. Clinical Question Is there a difference between the screw-rod construct (SRC) procedure without wiring and the SRC procedure with wiring with respect to fusion, implant failure, reoperation, donor-site morbidity, and complication rates? Patients and Methods We performed a retrospective analysis of 26 patients who underwent C1-2 fixation between 2004 and 2012 (SRC with wiring and structural bone graft, 13 patients; SRC with autograft but without wiring, 13 patients). Fusion was assessed using dynamic X-rays in all patients and computed tomographic scans in selected cases.

Is there a difference in range of motion, neck pain, and outcomes in patients with ossification of posterior longitudinal ligament versus those with cervical spondylosis, treated with plated laminoplasty?

Object: There are little data on the effects of plated, or plate-only, open-door laminoplasty on cervical range of motion (ROM), neck pain, and clinical outcomes. The purpose of this study was to compare ROM after a plated laminoplasty in patients with ossification of posterior longitudinal ligament (OPLL) versus those with cervical spondylotic myelopathy (CSM) and to correlate ROM with postoperative neck pain and neurological outcomes.

Methods: The authors retrospectively compared patients with a diagnosis of cervical stenosis due to either OPLL or CSM who had been treated with plated laminoplasty in the period from 2007 to 2012 at the University of California, San Francisco.

Intraoperative neuromonitoring with MEPs and prediction of postoperative neurological deficits in patients undergoing surgery for cervical and cervicothoracic myelopathy.

Object: The use of intraoperative neurophysiological monitoring (IONM) in surgical decompression surgery for myelopathy may assist the surgeon in taking corrective measures to reduce or prevent permanent neurological deficits. We evaluated the efficacy of IONM in cervical and cervicothoracic spondylotic myelopathy (CSM) cases.

Methods: The authors retrospectively reviewed 140 cases involving patients who underwent surgery for CSM utilizing IONM during 2011 at the University of California, San Francisco.

The role of minimally invasive techniques in the treatment of adult spinal deformity.

Many surgeons use minimally invasive surgery (MIS) approaches for treatment of patients with adult degenerative spinal deformity. The feasibility and efficacy of these techniques in the treatment of certain subtypes of degenerative deformities have been reported. In this article, several MIS techniques are discussed and an established 6-level treatment algorithm (MiSLAT) is presented, to help guide spinal surgeons in the use of MIS techniques for the treatment of patients with degenerative deformity.

Independent predictors of complication following surgery for spinal metastasis.

Purpose: Surgery for spinal metastasis is often associated with significant morbidity. Despite a number of preoperative scoring systems/scales and identified variables that have been reported to predict complication risk, clinical studies that directly evaluate this issue using multivariate analysis are scarce. The goal of our study was to assess independent predictors of complication after surgery for spinal metastasis.

Simulation-based trial of surgical-crisis checklists.

Background: Operating-room crises (e.g., cardiac arrest and massive hemorrhage) are common events in large hospitals but can be rare for individual clinicians.

Validation of the surgical Apgar score in a neurosurgical patient population.

Object: The surgical Apgar score (SAS) reliably predicts postoperative death and complications and has been validated in a large cohort of general and vascular surgery patients. However, there has been limited study of the utility of the score in the neurosurgical population. The authors tested the hypothesis that the SAS would predict postoperative complications and length of stay after neurosurgical procedures.

Patterns in neurosurgical adverse events: intracranial neoplasm surgery.

Object: Neurosurgery is a high-risk specialty currently undertaking the pursuit of systematic approaches to measuring and improving outcomes. As part of a project to devise evidence-based safety interventions for specialty surgery, the authors sought to review current evidence in cranial tumor resection concerning the frequency of adverse events in practice, their patterns, and current methods of reducing the occurrence of these events. This review represents part of a series of papers written to consolidate information about these events and preventive measures as part of an ongoing effort to ascertain the utility of devising system-wide policies and safety tools to improve neurosurgical practice.

Patterns in neurosurgical adverse events: open cerebrovascular neurosurgery.

Object: As part of a project to devise evidence-based safety interventions for specialty surgery, we sought to review current evidence concerning the frequency of adverse events in open cerebrovascular neurosurgery and the state of knowledge regarding methods for their reduction. This review represents part of a series of papers written to consolidate information about these events and preventive measures as part of an ongoing effort to ascertain the utility of devising system-wide policies and safety tools to improve neurosurgical practice.

Methods: The authors performed a PubMed search using search terms "cerebral aneurysm", "cerebral arteriovenous malformation", "intracerebral hemorrhage", "intracranial hemorrhage", "subarachnoid hemorrhage", and "complications" or "adverse events.

Patterns in neurosurgical adverse events: endovascular neurosurgery.

As part of a project to devise evidence-based safety interventions for specialty surgery, the authors sought to review current evidence in endovascular neurosurgery concerning the frequency of adverse events in practice, their patterns, and current methods of reducing the occurrence of these events. This review represents part of a series of papers written to consolidate information about these events and preventive measures as part of an ongoing effort to ascertain the utility of devising system-wide policies and safety tools to improve neurosurgical practice. Based on a review of the literature, thromboembolic events appeared to be the most common adverse events in endovascular neurosurgery, with a reported incidence ranging from 2% to 61% depending on aneurysm rupture status and mode of detection of the event.

Patterns in neurosurgical adverse events: cerebrospinal fluid shunt surgery.

Object: As part of a project to devise evidence-based safety interventions for specialty surgery, the authors sought to review current evidence in CSF shunt surgery concerning the frequency of adverse events in practice, their patterns, and the state of knowledge regarding methods for their reduction. This review may also inform future and ongoing efforts for the advancement of neurosurgical quality.

Methods: The authors performed a PubMed search using search terms "cerebral shunt," "cerebrospinal fluid shunt," "CSF shunt," "ventriculoperitoneal shunt," "cerebral shunt AND complications," "cerebrospinal fluid shunt AND complications," "CSF shunt AND complications," and "ventriculoperitoneal shunt AND complications.

The design, development, and implementation of a checklist for intraoperative neuromonitoring changes.

Object: The purpose of this study was to provide an evidence-based algorithm for the design, development, and implementation of a new checklist for the response to an intraoperative neuromonitoring alert during spine surgery.

Methods: The aviation and surgical literature was surveyed for evidence of successful checklist design, development, and implementation. The limitations of checklists and the barriers to their implementation were reviewed.

Minimally invasive transforaminal lumbar interbody fusion for spondylolisthesis in patients with significant obesity.

Comparative studies evaluating efficacy and safety of minimally invasive spinal fusion between patients with significant obesity (body mass index [BMI]≥35 kg/m(2)) and those of normal weight are scarce. We examined complication rates and outcomes for minimally invasive transforaminal lumbar interbody fusion (MITLIF) in patients with significant obesity and those of normal weight undergoing treatment for symptomatic spondylolisthesis. Patients with a BMI≥35 kg/m(2) or <25 kg/m(2) undergoing elective MITLIF for symptomatic spondylolisthesis for the period 2006-09 were identified.