Demoralization, Patient Activation, and the Outcome of Spine Surgery.

It is now well established that psychosocial factors can adversely impact the outcome of spine surgery. This article discusses in detail one such recently-identified "risk" factor: demoralization. Several studies conducted by the author indicate that demoralization, an emotional construct distinct from depression, is associated with poorer pain reduction, less functional improvement and decreased satisfaction among spine surgery patients.

Lumbar spine finite element model for healthy subjects: development and validation.

Finite element (FE) method is a proven powerful and efficient tool to study the biomechanics of the human lumbar spine. However, due to the large inter-subject variability of geometries and material properties in human lumbar spines, concerns existed on the accuracy and predictive power of one single deterministic FE model with one set of spinal geometry and material properties. It was confirmed that the combined predictions (median or mean value) of several distinct FE models can be used as an improved prediction of behavior of human lumbar spine under identical loading and boundary conditions.

Robotic-guided sacro-pelvic fixation using S2 alar-iliac screws: feasibility and accuracy.

Purpose: To review our experience with robotic guided S2-alar iliac (S2AI) screw placement.

Methods: We retrospectively reviewed patients who underwent S2AI fixation with robotic guidance. Screw placement and deviation from the preoperative plan were assessed by fusing preoperative CT (with the planned S2AI screws) to postoperative CT.

An Approach to Lumbar Revision Spine Surgery in Adults.

Along with the increase in lifestyle expectations in the aging population, a dramatic rise in surgical rates has been observed over the past 2 decades. Consequently, the rate of revision spine surgery is expected to increase. A systematic approach to treatment is required for the adult patient presenting with late or chronic complications after spinal surgery.

Cervical coronal alignment matters.

Kim SW, Paik S-H, Oh J-K, Kwak Y-H, Lee H-W, You K-H. The impact of coronal alignment of device on radiographic degeneration in the case of total disc replacement. Spine J 2016:16:470-9 (in this issue).

Prospective, Randomized Comparison of One-level Mobi-C Cervical Total Disc Replacement vs. Anterior Cervical Discectomy and Fusion: Results at 5-year Follow-up.

Introduction: There is increasing interest in the role of cervical total disc replacement (TDR) as an alternative to anterior cervical discectomy and fusion (ACDF). Multiple prospective randomized studies with minimum 2 year follow-up have shown TDR to be at least as safe and effective as ACDF in treating symptomatic degenerative disc disease at a single level. The purpose of this study was to compare outcomes of cervical TDR using the Mobi-C(®) with ACDF at 5-year follow-up.

Effects of volitional spine stabilization on lifting task in recurrent low back pain population.

Purpose: To examine the influence of volitional preemptive abdominal contraction (VPAC) and recurrent low back pain (rLBP) on trunk mechanics and neuromuscular control during a symmetric lifting task.

Methods: A 2 × 2 crossover mixed design was used to examine the effects of VPAC and group. Thirty-seven healthy individuals and 32 rLBP individuals performed symmetric box lifting trials with and without VPAC to a 1-m height table 3D trunk, pelvis, and hip joint angle and electromyographic magnitude variables were obtained.

Evaluating Osseointegration Into a Deeply Porous Titanium Scaffold: A Biomechanical Comparison With PEEK and Allograft.

Study Design: This was a biomechanical push-out testing study using a porcine model.

Objective: The purpose was to evaluate the strength of implant-bone interface of a porous titanium scaffold by comparing it to polyetheretherketone (PEEK) and allograft.

Summary Of Background Data: Osseointegration is important for achieving maximal stability of spinal fusion implants and it is desirable to achieve as quickly as possible.

Cost Variation Within Spinal Fusion Payment Groups.

Study Design: Retrospective, large administrative database.

Objective: To investigate cost variation within current spinal fusion diagnosis-related groups (DRGs).

Summary Of Background Data: Medicare reimbursement to hospitals for spinal fusion surgery is provided as a fixed payment for each admission based on DRG.

Clinical Incidence of PJK/ASD in Adult Deformity Surgery: A Comparison of Rigid Fixation and Semirigid Fixation-Semirigid.

In the debate regarding whether rigid or semirigid fixation is better for proximal junctional kyphosis (PJK)/adult spinal deformity (ASD) correction, this presentation posits that semirigid fixation is the better approach. For ASD correction, might is not right, and a rigid approach does not solve the problems associated with PJK.

Variation in Costs of Spinal Implants in United States Academic Medical Centers.

Study Design: Retrospective study of benchmarking database.

Objective: To evaluate the variability in direct costs of spinal implants across various academic medical centers, determining variability between and within specific manufacturers, and to measure the relationship between purchasing volume and price.

Summary Of Background Data: Spinal implants are a significant component of the cost of surgery.

Comparison of 1-Level Versus 2-Level Anterior Cervical Discectomy and Fusion: Clinical and Radiographic Follow-Up at 60 Months.

Study Design: This study represents a posthoc analysis of data collected from 2 control arms of a prospective, randomized study.

Objective: The purpose of this study was to compare results of patients undergoing 1- versus 2-level anterior cervical discectomy and fusion (ACDF).

Summary Of Background Data: For single-level ACDF, reported outcomes have generally been good; however, results for 2 levels have been less consistent.

Risk of Contamination in Assembled vs Disassembled Instruments in Hip Arthroplasty Surgery.

Background: Periprosthetic joint infection (PJI) is one of the most common causes of revision total hip arthroplasty (THA) and associated with higher costs, prolonged pain, and worse clinical outcomes. Many factors have been linked to increased infection rates, one being the operative equipment and instrumentation used during the surgical procedure. With few arthroplasty instruments designed for complete disassembly and increasingly complex instrument designs, this study seeks to understand the effect that instrument disassembly plays on infection using disassembled and assembled standard femoral broach handles (BHs).

Evaluation of Decompression and Interlaminar Stabilization Compared with Decompression and Fusion for the Treatment of Lumbar Spinal Stenosis: 5-year Follow-up of a Prospective, Randomized, Controlled Trial.

Introduction: If nonoperative treatment for lumbar stenosis fails, surgery may be considered. This traditionally includes decompression often combined with fusion. Desire for less extensive surgery led to developing new techniques and implants, including an interlaminar device designed with the goal of providing segmental stability without fusion, following decompression.

Seven-year cost-effectiveness of ProDisc-C total disc replacement: results from investigational device exemption and post-approval studies.

OBJECTIVE The purpose of this study was to evaluate the 7-year cost-effectiveness of cervical total disc replacement (CTDR) versus anterior cervical discectomy and fusion (ACDF) for the treatment of patients with single-level symptomatic degenerative disc disease. A change in the spending trajectory for spine care is to be achieved, in part, through the selection of interventions that have been proven effective yet cost less than other options. This analysis complements and builds upon findings from other cost-effectiveness evaluations of CTDR through the use of long-term, patient-level data from a randomized study.

Subsequent surgery rates after cervical total disc replacement using a Mobi-C Cervical Disc Prosthesis versus anterior cervical discectomy and fusion: a prospective randomized clinical trial with 5-year follow-up.

OBJECTIVE Cervical total disc replacement (TDR) has been shown in a number of prospective clinical studies to be a viable treatment alternative to anterior cervical discectomy and fusion (ACDF) for the treatment of symptomatic degenerative disc disease. In addition to preserving motion, evidence suggests that cervical TDR may result in a lower incidence of subsequent surgical intervention than treatment with fusion. The goal of this study was to evaluate subsequent surgery rates up to 5 years in patients treated with TDR or ACDF at 1 or 2 contiguous levels between C-3 and C-7.

Restoration of Cervical Alignment is Associated with Improved Clinical Outcome after One and Two Level Anterior Cervical Discectomy and Fusion.

Background: Anterior cervical discectomy and fusion (ACDF) remains the standard of care for patients with cervical radiculopathy who are unresponsive to conservative care. However, the maintenance and restoration of cervical alignment as a predictive factor for outcome has not yet been fully evaluated. The purpose of this study was to evaluate the impact of maintaining or restoring cervical alignment on one and two level ACDF patients' outcome.

Predicting the progression of vertebral fractures in patients with multiple myeloma.

Background Context: Patients with multiple myeloma (MM) incur significant degradation in quality of life because of progressive osteolytic vertebral fractures. No studies have investigated predictors of fracture progression, and limited data are available for predicting the development of future fractures.

Purpose: The purpose of this study was to identify independent predictors of vertebral fracture progression and the development of future vertebral fracture.

Intrawound Vancomycin Decreases the Risk of Surgical Site Infection After Posterior Spine Surgery: A Multicenter Analysis.

Study Design: Secondary analysis of data from a prospective multicenter observational study.

Objective: The aim of this study was to evaluate the occurrence of surgical site infection (SSI) in patients with and without intrawound vancomycin application controlling for confounding factors associated with higher SSI after elective spine surgery.

Summary Of Background Data: SSI is a morbid and expensive complication associated with spine surgery.

The Influence of Insurance Status on the Surgical Treatment of Acute Spinal Fractures.

Study Design: A retrospective, propensity score, multivariate analysis of the National Trauma Data Bank (NTDB) between 2008 and 2011.

Objective: The aim of this study was to determine the relationship between insurance status and rates of surgery for acute spinal fractures with and without spinal cord injury (SCI).

Summary Of Background Data: The decision for surgery in patients with spinal fractures is often based on fracture pattern and stability, associated SCI, and the presence of ligamentous and other associated injuries.

ProDisc-C Total Disc Replacement Versus Anterior Cervical Discectomy and Fusion for Single-Level Symptomatic Cervical Disc Disease: Seven-Year Follow-up of the Prospective Randomized U.S. Food and Drug Administration Investigational Device Exemption Study.

Background: In patients with single-level cervical degenerative disc disease, total disc arthroplasty can relieve radicular pain and preserve functional motion between two vertebrae. We compared the efficacy and safety of cervical total disc arthroplasty with that of anterior cervical discectomy and fusion (ACDF) for the treatment of single-level cervical degenerative disc disease between C3-C4 and C6-C7.

Methods: Two hundred and nine patients at thirteen sites were randomly treated with either total disc arthroplasty with ProDisc-C (n = 103) or with ACDF (n = 106).

Radiographic progression of vertebral fractures in patients with multiple myeloma.

Background Context: Nearly 70% of patients with multiple myeloma (MM) experience vertebral fracture. As a consequence, these patients suffer significantly poorer quality of life. However, no studies have characterized the natural progression of these fractures.

Superion(®) InterSpinous Spacer for treatment of moderate degenerative lumbar spinal stenosis: durable three-year results of a randomized controlled trial.

Purpose: This report provides the 3-year clinical outcomes from the randomized, controlled US Food and Drug Administration Investigational Device Exemption trial of the Superion(®) for the treatment of moderate degenerative lumbar spinal stenosis.

Patients And Methods: The Superion(®) was evaluated in the treatment of subjects aged 45 years or older suffering from symptoms of intermittent neurogenic claudication, secondary to a confirmed diagnosis of moderate degenerative lumbar spinal stenosis at one or two contiguous levels from L1 to L5. Patients were treated between June 2008 and December 2011 at 31 investigational sites.