bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact of Cage Dimensions, Positioning, and Side of Approach in Extreme Lateral Interbody Fusion
Authors: Alimi Marjan , Lang Gernot , Navarro-Ramirez Rodrigo , Perrech Moritz , Berlin Connor , Hofstetter Christoph P. , Moriguchi Yu , Elowitz Eric , Härtl Roger
Published: March 2018

Study Design:

This is a retrospective single-center study.

Objective:

The aim of the study was to evaluate the impact of cage characteristics and position toward clinical and radiographic outcome measures in patients undergoing extreme lateral interbody fusion (ELIF).

Summary of Background Data:

ELIF is utilized for indirect decompression and minimally invasive surgical treatment for various degenerative spinal disorders. However, evidence regarding the influence of cage characteristics in patient outcome is minimal.

Materials and Methods:

Patients undergoing ELIF between 2007 and 2011 were included in a retrospective study. Demographic and perioperative data, as well as cage characteristics and side of approach were extracted. Radiographic parameters including lumbar lordosis, foraminal height, and disc height as well as clinical outcome parameters (Oswestry Disability Index and Visual Analog Scale) were measured preoperatively, postoperatively, and at the latest follow-up examination. Cage dimensions, in situ position, and type were correlated with radiographic and clinical outcome parameters.

Results:

In total, 84 patients with a total of 145 functional spinal units were analyzed. At the last follow-up of 17.7 months, radiographic and clinical outcome measures revealed significant improvement compared with before surgery with both, 18 and 22 mm cage anterior-posterior diameter subgroups (P≤0.05). Among cage characteristics, 22 mm cages presented superior restoration of foraminal and disc heights compared with 18 mm cages (P≤0.05). Neither position of the cage (anterior vs. posterior), nor the type (parallel vs. lordotic) had a significant impact on restoration of foraminal height and lumbar lordosis. Moreover, the side of surgical approach did not influence the amount of foraminal height increase.

Conclusions:

Cage anterior-posterior diameter is the determining factor in restoration of foraminal height in ELIF. Cage height, type, positioning, and side of approach do not have a determining role in radiographic outcome in the present study. Sustainable foraminal height restoration is achieved by implantation of wider cages.

Level of Evidence:

Level 3.
Vancomycin Powder Regimen for Prevention of Surgical Site Infection in Complex Spine Surgeries
Authors: Van Hal Michael , Lee Joon , Laudermilch Dann , Nwasike Chinedu , Kang James
Published: March 2018

Study Design:

In total, 496 patients of a single surgeon cohort examining the surgical-site infection (SSI) rates with the addition of vancomycin powder in both diabetic and revision spine surgery cases. A historical control group of 652 patients were compared from the same surgeon over an earlier time period before the inception of using vancomycin powder prophylaxis.

Objective:

The objective of this study was to describe and compare the rates of infection in high-risk patient populations while using vancomycin powder.

Summary of Background Data:

Vancomycin powder may not decrease an already low rate of infection. Therefore, use of vancomycin powder in high-risk patients with a higher rate of infection would potentially show benefit of vancomycin powder.

Materials and Methods:

In total, 496 patient charts were collected from a database of cases. Patients were included in the cohort if they had revision spinal operation or if they were diabetic. Patients in the time period July 2010 to August 2013 were included in the vancomycin protocol where 1 g of vancomycin powder was added to the wound before wound closure. Cases were considered positive if there was a positive culture or if there was sufficient clinical suspicion to treat. As a control to this cohort, 692 charts were reviewed from a earlier time period of the same surgeon and institution.

Results:

In total, 28 patients of 496 (5.6%) patients in the cohort returned to the operating room for seroma, hematoma, draining wound, or infection. Sixteen of these patients (16/496, 3.2%) had a culture positive infection or were treated as an infection. This rate was significantly lower than the historical rate before the protocol.

Conclusions:

Although vancomycin does seem to be useful in decreasing SSIs, it is not a panacea. SSIs in high-risk patients were not completely eliminated by the vancomycin protocol.
Minimally Invasive Posterior Cervical Foraminotomy
Authors: Peto Ivo , Scheiwe Christian , Kogias Evangelos , Hubbe Ulrich
Published: March 2018

Study Design:

Retrospective cohort study.

Objective:

Assessment of outcome after minimally invasive posterior cervical foraminotomy (MI-PCF).

Summary of Background Data:

Surgical management of cervical radiculopathy represents a controversial area in spinal surgery. Preferred approaches include both anterior cervical discectomy and posterior cervical foraminotomy (PCF). Numerous studies showed comparable results. Employing PCF eliminates risks associated with anterior approach. PCF as originally described by Spurling and Scoville necessitates extensive stripping of cervical muscles to expose the cervical spine, resulting in muscle injury, impaired muscle function, prolonged postoperative neck pain, and increased use of narcotics. There are only few studies investigating outcome after employing MI-PCF.

Materials and Methods:

Retrospective review of 34 patients who underwent MI-PCF for presenting complaints, postoperative and follow-up outcome.

Results:

In the last follow-up the weakness resolved completely in 62.6% of patients, in 4.1% improved and in 16.5% remained unchanged. In the last follow-up 76.7% of patients originally presenting with pain reported complete resolution of pain and 10% reported partial improvement of pain. In total, 23.5% of patients were lost during follow-up as far as pain was concerned. In the last follow-up, 75% of patients achieved relative neck-pain-freedom (Visual Analog Scale≤3) at rest and 62.5% of patients under strain. The mean neck pain on Visual Analog Scale at rest was 2.13 (SD=2.42) and 3.34 (SD=3.01) under strain. In total, 93.8% (n=15) of patients would undergo the same procedure for the same achieved result.

Conclusions:

Minimally invasive cervical foraminotomy is an effective procedure for decompression of cervical nerve roots regardless the type of the stenosis. Even employing minimally invasive technique still causes neck pain in the long term affecting up to 25% of patients. More randomized control studies are required to clarify the benefits of minimally invasive PCF.
Radiographic and Clinical Results of Freehand S2 Alar-Iliac Screw Placement for Spinopelvic Fixation
Authors: Park Young-Seop , Hyun Seung-Jae , Park Jong-Hwa , Kim Ki-Jeong , Jahng Tae-Ahn , Kim Hyun-Jib
Published: March 2018

Study Design:

This was a retrospective clinical case series.

Objective:

The purpose of this study was to evaluate mid-term outcomes of S2 ala-iliac (S2AI) screw fixation in patients who underwent multilevel posterior spinal fusion surgery.

Summary of Background Data:

There have been few reports on radiographic and clinical outcomes in patients who underwent spinopelvic reconstruction surgery using S2AI screw installation.

Materials and Methods:

Twenty-three patients were treated by a single spinal surgeon between September 2013 and June 2014 utilizing segmental instrumentation with pedicle and S2AI screw. Instrumentation including S2AI screw was performed by a freehand technique. Surgical, radiographic, clinical outcomes and complications were evaluated to determine surgical results of S2AI screw fixation.

Results:

The mean follow-up period was 16.9 months (ranged, 13–22 mo). The average number of fusion levels was 7.9 vertebral bodies. There were no cases of neurological deficit and violation of acetabulum or sciatic notch. A peri-screw halo was found in 1 patient and cortical wall violation was observed in 4 patients. The number of lateral and medial breaches was 2 and 3, respectively. All of them were asymptomatic. One patient experienced sacroiliac joint pain after S2AI screw installation. There was no case of screw/rod fracture and revision surgery for S2AI screw.

Conclusions:

Radiographic and clinical outcomes of freehand S2AI screw fixation was acceptable. Sacroiliac joint irritation symptoms after S2AI screw fixation were rare. S2AI screw instrumentation can be a good alternative for spinopelvic fixation.

Level of Evidence:

Level 4.
Spinopelvic Parameters in Asymptomatic Subjects Without Spine Disease and Deformity
Authors: Noshchenko Andriy , Hoffecker Lilian , Cain Christopher M.J. , Patel Vikas V. , Burger Evalina L.
Published: March 2018

Study Design:

A systematic review with meta-analysis.

Objective:

To combine published data, focusing on the development of optimal spinopelvic parameters in adult asymptomatic subjects without spine deformity while taking into consideration the impact of potential confounders.

Summary of Background Data:

A well-grounded approach to define the optimal spinopelvic parameters is necessary for planning surgical correction of spine deformity.

Materials:

Selection criteria: (1) randomized and nonrandomized prospective, cross-sectional, and retrospective studies; (2) participants: asymptomatic subjects without spine deformity aged above 18 years; (3) studied parameters: lumbar lordosis (LL), pelvic incidence, sacral slope, and pelvic tilt; (4) potential confounders: method of measurement, sex, age, ethnicity, weight, height, and body mass index. Search method: Ovid MEDLINE (1946-current) and EMBASE (1980-current), all years through October 2015 were included. Data were collected: number of enrolled subjects, means of the studied characteristics, SD, SE of the means, 95% confidence intervals. A meta-analysis was performed to evaluate the pooled means and range of optimal values (pooled mean±pooled SD) taking into consideration the impact of confounders. The GRADE approach was applied to evaluate the level of evidence.

Results:

Seventeen of 1018 studies were included (2926 subjects from 9 countries). The pooled means and the optimal ranges were: LL (L1–S1), 54.6 (42–67) degrees; LL (L1–L5), 37.0 (22–53) degrees; pelvic incidence, 50.6 (39–62) degrees; sacral slope, 37.7 (28–48) degrees; pelvic tilt, 12.6 (3–22) degrees. The pooled results were statistically significant (P<0.001), but heterogeneous. Impact of the following confounders was revealed: method of measurement, ethnicity, age, and body mass index. A methodology was created to define an individualized optimal value and range of each studied parameter taking into consideration the influence of confounders.

Conclusions:

The pooled results and developed methodology can be used as diagnostic criteria for evaluation of the spinopelvic parameters, planning of surgical interventions and evaluation of the treatment effect.
The Impact of L5 Sacralization on Fusion Rates and Clinical Outcomes After Single-level Posterior Lumbar Interbody Fusion (PLIF) at L4–L5 Level
Authors: Lee Gun Woo , Shin Ji-Hoon , Ryu Seung Min , Ahn Myun-Whan
Published: March 2018

Study Design:

Retrospective review of prospectively collected data.

Objective:

To determine the impact of L5 sacralization on fusion rates and clinical outcomes after single-level posterior lumbar interbody fusion (PLIF) surgery at the L4–L5 level.

Summary of Background Data:

L5 sacralization can produce greater stress concentration at the adjacent segment (L4–L5); therefore, L4–L5 PLIF surgery in patients with L5 sacralization may negatively affect fusion rate and be associated with poor clinical outcomes. However, no study has examined the impact of L5 sacralization on fusion rates and clinical outcomes of patients who undergo L4–L5 PLIF surgery.

Materials and Methods:

Of 153 patients who underwent L4–L5 PLIF, data of 145 who met the study criteria were retrospectively reviewed. Among them, 31 patients had L5 sacralization (group A), whereas the remaining 114 patients did not (group B). The primary study endpoint was fusion rate evaluated using dynamic radiographs and computed tomographic scans. Secondary endpoints included (1) pain intensity in the lower back and radiating to the lower extremities on the visual analog scale; (2) clinical outcomes assessed using the Oswestry Disability Index and 12-item Short Form Health Survey; (3) surgical outcomes; and (4) complications.

Results:

Fusion rate evaluated using dynamic radiographs and computed tomographic scans at 6 months after surgery did not differ significantly between patients with and without sacralization (P=0.70 and 0.81, respectively), whereas fusion rate at 1 year after surgery did (P=0.04 and 0.04, respectively). In particular, patients with type II or III L5 sacralization had significantly lower fusion rates than those with other types of or no L5 sacralization. Pain intensity, clinical and surgical outcomes, and complications did not differ significantly between groups.

Conclusions:

Patients with type II or III L5 sacralization may have worse fusion rates after L4–L5 PLIF surgery than those with type I or no sacralization.
Association Between Allogeneic Blood Transfusion and Postoperative Infection in Major Spine Surgery
Authors: Fisahn Christian , Jeyamohan Shiveindra , Norvell Daniel C. , Tubbs Richard S. , Moisi Marc , Chapman Jens R. , Page Jeni , Oskouian Rod J.
Published: March 2018

Study Design:

Retrospective cohort study.

Objective:

The objective of this study is to compare the incidence of infection in patients who do and do not receive blood transfusions in major deformity surgery (>8 levels).

Summary of Background Data:

Postoperative infections increase morbidity and mortality rates in spine surgery and generate additional costs for the health care system. It has been proposed that blood transfusions increase the risk of wound infection, urinary tract infection, pneumonia, and sepsis.

Methods:

A total of 56 patients met the study criteria, receiving spine surgery involving the fusion of 8 levels or more. Patient-specific characteristics, starting and ending hematocrits, number of units transfused and infections including urinary tract infection, wound infection, pneumonia, and sepsis were documented. Differences in infection risk between those who did and did not undergo a transfusion and their 95% confidence intervals were calculated.

Results:

Groups were similar with respect to baseline and surgical characteristics except for smoking status, operative time, estimated blood loss, and ending hematocrit. The overall infection rate was greater in patients who underwent transfusion than those who did not (36% vs. 10%; P=0.03). Wound infections (n=5) were only observed in those who underwent a transfusion. Smokers were more likely to receive a transfusion and more likely to experience infection. A stratified analysis demonstrated an increased risk of infection associated with transfusion; however, the risk was greater in smokers, suggesting the effect of transfusion on infection could be modified by smoking. Patients undergoing transfusion experienced a significantly longer hospital stay (P=0.01).

Conclusions:

Allogeneic red blood cell transfusion in major spine surgery could be a risk factor for postoperative infection. This increased risk seems to be magnified in those who smoke. Further studies are warranted, and risks of blood loss and transfusion-related complications in smokers also potentially merit exploration.

Level of Evidence:

Level 3.
A Comprehensive Meta-Analysis of the Adjacent Segment Parameters in Cervical Disk Arthroplasty Versus Anterior Cervical Discectomy and Fusion
Authors: Dong Liang , Wang Dongqi , Chen Xiujin , Liu Tuanjing , Xu Zhengwei , Tan Mingsheng , Hao Dingjun
Published: March 2018

Study Design:

This is a meta-analysis of controlled trials.

Objective:

To assess the overall condition of adjacent segment of cervical disk arthroplasty (CDA) compared with anterior cervical discectomy and fusion (ACDF).

Summary of Background Data:

With the increase in CDA and ACDF, surgeons are taking more attention to adjacent segment degeneration (ASDeg) and adjacent segment disease (ASDis). There are more and more meta-analyses comparing the efficacy of CDA with ACDF, however, there are few meta-analyses referring to adjacent segment parameters, and investigators are still unable to arrive at the same conclusion.

Methods:

Several important databases were searched for controlled trials comparing CDA and ACDF before February 2016 according to PRISMA guidelines. The analysis parameters included follow-up time, operative segments, cervical range of motion (ROM), adjacent segment motion, ASDeg, ASDis and adjacent segment reoperation. The risk of bias scale and Newcastle-Ottawa Scale were used to assess the papers. Subgroup analysis and sensitivity analysis were used to analyze the reason for high heterogeneity.

Results:

Forty-one controlled trials fulfilled the inclusion criteria, including 36 English papers and 5 Chinese. The average follow-up time of all included patients was 39 months. Compared with ACDF, the rate of adjacent segment reoperation in the CDA group was significantly lower (P<0.01), and the advantage of CDA group increased with the increasing of follow-up time according to subgroup analysis. The rate of ASDeg in CDA was significantly lower than that of ACDF (P<0.01). There was no statistical difference between upper and lower ASDeg using the same surgical method (P>0.05). CDA provided a greater cervical ROM than did ACDF (P<0.01). There was a lower adjacent segment ROM and the rate of ASDis in CDA compared with ACDF (P<0.05).

Conclusions:

Compared with ACDF, the advantages of CDA were lower ASDeg, ASDis, adjacent segment reoperation and adjacent segment motion; and higher cervical ROM. However, there was no statistical difference between upper and lower adjacent segment ROM/ASDeg using the same surgery.
Iliac Crest Bone Graft
Authors: Lopez Gregory D. , Hijji Fady Y. , Narain Ankur S. , Yom Kelly H. , Singh Kern
Published: March 2018

Typical sources for graft material utilized in minimally invasive transforaminal lumbar interbody fusion include both autograft and allograft. Autograft is frequently utilized due to its theorized benefits in promoting fusion. During minimally invasive transforaminal lumbar interbody fusion, autograft is often obtained locally during the laminectomy and facetectomy. However, this locally obtained bone graft has exhibited questionable osteoconductive properties, often necessitating the addition of biologics to improve fusion rates. Iliac crest bone graft (ICBG) has previously been reported to be a safe and efficacious source for bone graft. Although ICBG has been noted to be an excellent material for facilitating fusion, concern for harvest site morbidity has substantially decreased its popularity. The purpose of this surgical technique is to provide a method of minimally invasive ICBG harvesting to potentially reduce the need for extra incisions, shorten operative times, and prevent postoperative graft site morbidity.
Diagnostic Utility of Intraoperative Neurophysiological Monitoring for Intramedullary Spinal Cord Tumors
Authors: Azad Tej D. , Pendharkar Arjun V. , Nguyen Viet , Pan James , Connolly Ian D. , Veeravagu Anand , Popat Rita , Ratliff John K. , Grant Gerald A.
Published: March 2018

Study Design:

Systematic review and meta-analysis.

Objective:

The aim of this study was to systematically evaluate the diagnostic utility of intraoperative neurophysiological monitoring (IONM) for detecting postoperative injury in resection of intramedullary spinal cord tumors (IMSCT).

Summary of Background Data:

Surgical management of IMSCT can involve key neurological and vascular structures. IONM aims to assess the functional integrity of susceptible elements in real time. The diagnostic value of IONM for ISMCT has not been systematically evaluated.

Methods:

We performed a systematic review of the PubMed and MEDLINE databases for studies investigating the use of IONM for IMSCT and conducted a meta-analysis of diagnostic capability.

Results:

Our search produced 257 citations. After application of exclusion criteria, 21 studies remained, 10 American Academy of Neurology grade III and 11 American Academy of Neurology grade IV. We found that a strong pooled mean sensitivity of 90% [95% confidence interval (CI), 84–94] and a weaker pooled mean specificity of 82% (95% CI, 70–90) for motor-evoked potential (MEP) recording changes. Somatosensory-evoked potential (SSEP) recording changes yielded pooled sensitivity of 85% (95% CI, 75–91) and pooled specificity of 72% (95% CI, 57–83). The pooled diagnostic odds ratio for MEP was 55.7 (95% CI, 26.3–119.1) and 14.3 (95% CI, 5.47–37.3) for SSEP. Bivariate analysis yielded summary receiver operative characteristic curves with area under the curve of 91.8% for MEPs and 86.3% for SSEPs.

Conclusions:

MEPs and SSEPs appear to be more sensitive than specific for detection of postoperative injury. Patients with perioperative neurological deficits are 56 times more likely to have had changes in MEPs during the procedure. We observed considerable variability in alarm criteria and interventions in response to IONM changes, indicating the need for prospective studies capable of defining standardized alarm criteria and responses.
Efficacy of Conical Laminoplasty After Thoracic Laminectomy
Authors: Kobayashi Kazuyoshi , Imagama Shiro , Ando Kei , Nishida Yoshihiro , Ishiguro Naoki
Published: March 2018

Study Design:

Retrospective clinical study.

Objective:

To evaluate the results of a new method of laminoplasty, referred to as conical laminoplasty.

Summary of Background Data:

In surgery for a thoracic intradural tumor, laminectomy is frequently used for tumor resection. However, laminoplasty may be more effective due to prevention of damage to the posterior elements. This method can be performed as recapping T-saw laminoplasty and conical laminoplasty which we refer.

Materials and Methods:

After en bloc laminectomy, conical laminoplasty (group C; 21 cases) or recapping T-saw laminoplasty (group R; 17 cases) was performed for patients with thoracic spinal cord tumors. If neither was possible, laminectomy (group L; 16 cases) was performed.

Result:

The number of laminae removed and Japanese Orthopedic Association recovery rates did not differ significantly among the 3 groups. Sagittal kyphosis significantly worsened at final follow-up in group L, but did not change significantly in groups C and R.

Conclusions:

Conical laminoplasty is particularly useful in a case in which T-saw laminoplasty cannot be performed due to tumor expansion in the canal and ossification of the ligamentum flavum. Conical laminoplasty also preserves the posterior elements, which reduces the risk of worsening of kyphosis postoperatively.
Transoral Closed Reduction of Fixed Atlanto-Axial Rotatory-Subluxation (AARS) in Childhood and Adolescence
Authors: Jeszenszky Dezsoe , Fekete Tamas , Kleinstück Frank , Haschtmann Daniel , Loibl Markus
Published: March 2018

Atlanto-axial rotatory-subluxation (AARS) is the most common pediatric cervical spine injury. Patients usually present with contralateral rotation and inclination of the upper cervical spine after minor trauma, or associated with an infection of the upper respiratory tract. According to the authors, initial management of patients with acute and chronic AARS type I–II should comprise closed reduction and immobilization with a cervical collar or a Halo-Body-Jacket. Surgical options of open reduction or C1/2 fusion should be restricted to irreducible or recurrent subluxations. This paper reviews the detailed technique of transoral closed reduction of AARS, as well as the preoperative and postoperative considerations.
Treatment of Degenerative Lumbar Spondylolisthesis With Fusion or Decompression Alone Results in Similar Rates of Reoperation at 5 Years
Authors: Vorhies John S. , Hernandez-Boussard Tina , Alamin Todd
Published: March 2018

Study Design:

Population-based analysis of administrative discharge records from California, Florida, and New York inpatient, ambulatory, and emergency department settings between 2005 and 2011, utilizing Healthcare Cost and Utilization Project data.

Objective:

We aimed to compare, and characterize rates of reoperation and readmission among patients with degenerative spondylolisthesis treated with surgical decompression alone versus fusion.

Summary of Background Data:

Degenerative lumbar spondylolisthesis with stenosis can be treated by decompression with or without fusion. Fusion has traditionally been preferred. We hypothesized that rates of reoperation after decompression alone would be higher than after fusion.

Materials and Methods:

We undertook a population-based analysis of administrative discharge records from California, Florida, and New York inpatient, ambulatory, and emergency department settings between 2005 and 2011, with Healthcare Cost and Utilization Project data. We identified all patients who had degenerative spondylolisthesis who were treated with decompression alone or with fusion and compared their rates of reoperation at 1, 3, and 5 years from the index operation. We used descriptive statistics and a hierarchical logistic regression model to generate risk-adjusted odds of all-cause readmissions.

Results:

Our study consisted of 75,024 patients with spondylolisthesis; 6712 (8.95%) of them underwent decompression alone and 68,312 (91.05%) of them underwent fusion. Rates of reoperation were higher for decompression versus fusion at 1 year; 6.87% versus 5.53% (P≤0.001), but at 3 years; 13.86% versus 12.91% (P=0.18) and 5 years; 16.9% versus 17.7% (P=0.398) years rates of reoperation were not statistically different. Patients treated with decompression alone that had a second operation tended to have the operation sooner 512.6 versus 567.4 days (P=0.008).

Conclusions:

Our study suggests that treatment of degenerative spondylolisthesis with fusion or decompression alone results in similar rates of reoperation at 5 years. This medium term data indicate that decompression alone may be a viable treatment for some patients with degenerative spondylolisthesis.
The Difference in Clinical Outcomes After Anterior Cervical Fusion, Disk Replacement, and Foraminotomy in Professional Athletes
Authors: Mai Harry T. , Chun Danielle S. , Schneider Andrew D. , Hecht Andrew C. , Maroon Joseph C. , Hsu Wellington K.
Published: March 2018

Study Design:

Retrospective case series.

Object:

To compare postoperative outcomes of professional athletes treated for cervical disk herniation after anterior cervical discectomy and fusion (ACDF) and posterior foraminotomy (PF), or total disk replacement (TDR).

Summary of Background Data:

ACDF, PF, and TDR have all led to excellent outcomes in the general population but the unique demands in the professional athlete necessitate specific study.

Methods:

Athletes of 4 major American professional sports leagues—National Football League, Major League Baseball, National Hockey League and National Basketball Association—diagnosed with cervical disk herniation and managed operatively were identified. Athletes were grouped into cohorts based on operation type. Athlete performance outcome measures were calculated based on sport-specific statistics and assessed as a percentage change after surgery to standardize comparison across sports.

Results:

A total of 101 professional athletes were identified (ACDF=86, PF=13, and TDR=2). The PF cohort had a significantly greater return to play rate and shortest time to return after surgery (P=0.03 and P=0.04, respectively). However, the reoperation rate at the index level was significantly higher in PF athletes compared with ACDF (46.2% vs. 5.8%; P<0.001) over the study follow-up period (average, 13.5 y). There was no significant difference in performance score after surgery for all surgical cohorts (P=0.41) and among cohorts (P=0.41). When analyzed by sport only baseball athletes experienced a significant decrease in performance after surgery (P=0.049).

Conclusions:

ACDF and PF are both viable options with excellent outcomes in professional athletes. PF allows a significantly higher rate and quicker return to play but portends a higher risk for reoperation compared with ACDF. TDR results are limited in our cohort and require further study to determine professional athlete outcomes.

Level of Evidence:

Level IV.
Novel Technique for Sacral Alar-Iliac (S2AI) Fixation
Authors: Andrade Nicholas S. , Okafor Louis , Neuman Brian J.
Published: March 2018

Objective:

To provide reasoning and steps for the placement of sacral alar-iliac (S2AI) screws for pelvic arthrodesis to aid osseous lumbosacral fusion.

Summary of Background Data:

Studies support lower rates of screw breakage and need for revision surgery or hardware removal for S2AI screws compared with traditional iliac bolts, as well as low rates of pseudoarthrosis and arthritis associated with this hardware placement.

Materials and Methods:

A case video of S2AI placement demonstrates our operative technique and is accompanied by procedural description of surgical maneuvers.

Results and Surgical Techniques:

One patient underwent lumbosacral fusion surgery aided by S2AI-mediated pelvic fixation.

Conclusions:

The present technique utilizing S2AI screws provides for successful pelvic fixation to aid in lumbosacral fusion, with no need for subcutaneous tissue dissection and improved outcomes compared with traditional iliac bolts.
Variation in Spine Surgeon Selection Criteria Between Neurosurgery and Orthopedic Surgery Patients
Authors: Hijji Fady Y. , Narain Ankur S. , Haws Brittany E. , Witiw Christopher D. , Kudaravalli Krishna T. , Yom Kelly H. , Deutsch Harel , Singh Kern
Published: March 2018

Study Design:

A cross-sectional survey study.

Objective:

The objective of this study is to determine if there are any differences in spine surgeon selection criteria between neurosurgery patients and orthopedic patients.

Background Information:

The evolution of the health care delivery system has allowed for increased patient autonomy in provider selection. However, the process and criteria by which patients choose particular spine surgeons is not well understood. Furthermore, differences in physician selection criteria used by patients who present either to a neurosurgery or orthopedic spine surgeon has not been previously established.

Materials and Methods:

An anonymous questionnaire consisting of 26 questions was administered to 644 patients seeking treatment from either a single neurosurgery-trained or orthopedics-trained spine surgeon at an urban institution. Four questions pertained to demographic variables. Sixteen questions asked patients to rate specific spine surgeon selection criteria in terms of importance (scale, 1–10). Six questions were multiple choice, asking patients to select their preferences towards aspects of a spine surgeon. Patient responses were compared using χ2 analysis or Fisher exact test for categorical variables.

Results:

The 3 most important factors for selecting a spine surgeon were the same for neurosurgery and orthopedic surgery patients: board certification (neurosurgery, orthopedic surgery) (9.07±2.35, 9.22±1.79), in-network provider status (8.01±3.15, 8.09±3.03), and surgeon bedside manner (7.88±2.52, 8.07±2.29). When listing their preference regarding surgeon specialty training, 82.74% of neurosurgery patients and 48.81% of orthopedic surgery patients preferred a surgeon who was trained in neurosurgery.

Conclusions:

The growth in patient autonomy within the current health care system has emphasized the importance of identifying patient preferences in the physician selection process.

Board certification, in-network insurance status, and bedside manner may be the most influential factors for patients in spine surgeon selection irrespective of surgical subspecialty. Patients may also be more likely to seek spine surgeons with neurosurgery training over orthopedic surgery training. The present study provides spine surgeons a framework to improve both patient recruitment and patient satisfaction.
Heterogeneity of Reporting Outcomes in the Spine Surgery Literature
Authors: Cooper Maxwell E. , Torre-Healy Luke A. , Alentado Vincent J. , Cho Samuel , Steinmetz Michael P. , Benzel Edward C. , Mroz Thomas E.
Published: March 2018

Study Design:

Review of spine surgery literature between 2005 and 2014 to assess the reporting of patient outcomes by determining the variability of use of patient outcomes metrics in the following categories: pain and disability, patient satisfaction, readmission, and depression.

Objective:

Expose the heterogeneity of outcomes reporting and discuss current initiatives to create more homogenous outcomes databases.

Summary of Background Data:

There has been a recent focus on the reporting of quality metrics associated with spine surgery outcomes. However, little consensus exists on the optimal metrics that should be used to measure spine surgery outcomes.

Materials and Methods:

A PubMed search of all spine surgery manuscripts from January 2005 through December 2014 was performed. Linear regression analyses were performed on individual metrics as well as outcomes categories as a fraction of total papers reviewing surgical outcomes.

Results:

Outcomes reporting has increased significantly between January 1, 2005 and December 31, 2014 [175/2871 (6.1%) vs. 764/5603 (13.6%), respectively; P<0.001; R
2=98.1%]. For the category of pain and disability reporting, Visual Analog Score demonstrated a statistically significant decrease in use from 2005 through 2014 [56/76 (73.7%) vs. 300/520 (57.7%), respectively; P<0.001], whereas Oswestry Disability Index increased significantly in use [19/76 (25.0%) vs. 182/520 (35.0%), respectively; P<0.001]. For quality of life, EuroQOL-5 Dimensions increased significantly in use between 2005 and 2014 [4/23 (17.4%) vs. 30/87 (34.5%), respectively; P<0.01]. In contrast, use of 36 Item Short Form Survey significantly decreased [19/23 (82.6%) vs. 57/87 (65.5%), respectively; P<0.01]. For depression, only the Zung Depression Scale underwent a significant increase in usage between 2005 and 2014 [0/0 (0%) vs. 7/13 (53.8%), respectively; P<0.01].

Conclusions:

Although spine surgery outcome reporting has increased significantly over the past 10 years, there remains considerable heterogeneity in regards to individual outcomes metrics utilized. This heterogeneity makes it difficult to compare outcomes across studies and to accurately extrapolate outcomes to clinical practice.
Perioperative Nutritional Optimization in Spine Surgery
Authors: Qureshi Rabia , Rasool Mohammad , Puvanesarajah Varun , Hassanzadeh Hamid
Published: March 2018

Nutritional optimization in patients undergoing spine surgery is important as improved surgical outcomes and decreased rates of complications have been noted in optimized patients. With the increasingly high numbers of elderly patient and patients with metabolic comorbidities undergoing spine procedures, perioperative nutritional status should be enhanced for the best possible surgical outcomes. Methods of optimization include preoperative screening with Nutritional Risk Score or other scoring systems, looking for changes in body mass index, detecting sarcopenia, and screening for metabolic abnormalities. Assessment of blood glucose, electrolytes, cholesterol, vitamin levels, visceral proteins, and lean body mass must be done preoperatively and close monitoring should be continued postoperatively. Albumin helps to determine the health status of patients before surgery and prealbumin as a predictor of surgical outcomes is being investigated. Malnourished patients should be given balanced diets replenishing key nutrient deficits, glucose should be maintained with sliding scale insulin or continuous infusions and immunonutrition may be implemented. Postoperatively, patients should initiate a diet as soon as possible to decrease overall length of stay and complication rates, facilitating return to normal activities.
Mini-open Lateral Retropleural Approach for Symptomatic Thoracic Disk Herniations
Authors: Yen Chun-Po , Uribe Juan S.
Published: March 2018

Background:

Surgeries for symptomatic thoracic disk herniations (TDH) remain challenging.

Objective:

A mini-open lateral retropleural approach is described and the clinical outcomes are reported.

Materials and Methods:

A total of 23 patients underwent mini-open lateral retropleural diskectomy. Patients were placed in a lateral position. A 5-cm lateral incision was made followed by resection of the rib after careful dissection of its undersurface from the endothoracic fascia. The fascia was incised and separated from parietal pleura to widen the retropleural space. The rib head was removed followed by a pedicle resection below the TDH to expose the dura. A posterior partial corpectomy above and below the disk was performed to create a space ventral to the TDH, which was later dissected away from the dura and removed.

Results:

Fourteen males and 9 females comprised the clinical cohort. Five presented with axial back pain, 7 with radicular pain and 11 with myelopathy. All but 2 disks were successfully removed. The mean blood loss was 214cc and the mean hospital stay was 5.3 days. There was no mortality or new neurological deficits. The mean follow-up was 15.4 months.

Conclusions:

Mini-open lateral retropleural approach is safe and effective to remove symptomatic TDH with minimal morbidities and fast patient recovery.
Effectiveness of Surgical Treatment for Tarlov Cysts
Authors: Dowsett Laura E. , Clement Fiona , Coward Stephanie , Lorenzetti Diane L. , Noseworthy Tom , Sevick Laura , Spackman and Eldon
Published: March 2018

Summary of Background Data:

In the general population, it has been estimated that 1.5% of people have ≥1 Tarlov cysts, with about 13% of those being symptomatic. Despite a range of options for treatment, there is debate about when, and how to optimally treat individuals with Tarlov cysts among clinicians, and among policy decision makers.

Objective:

To summarize the current evidence on surgical treatment of Tarlov cysts.

Study Design:

A systematic review was completed.

Methods:

Nine databases were searched. Abstracts and full-texts were assessed by 2 reviewers. To be included, studies had to assess safety, efficacy, or effectiveness of treating Tarlov cysts, had to be written in English or French, and had to be a randomized, quasi-randomized, observational cohort, case control, or case series design including ≥2 participants. Logistic regression analysis was undertaken on the patient-level data collected to assess the association of patient and cyst characteristics on treatment success.

Results:

In total, 31 studies were included in this systematic review; all were case series. Among the 646 participants included in these 31 studies, 210 experienced complete resolution of symptoms (32%), 327 had partial resolution (50%), 106 did not have any improvement or worsening of symptoms (16%), and 3 had their symptoms worsen after surgery (0.4%). A number of adverse events were reported after surgery; however, all were temporary. The analysis of 49 patients with data on cyst size resulted in the odds of complete resolution of symptoms being lower for patients with larger cysts (odds ratio=0.53, P-value=0.107) although this finding is not statistically significant. For those with a cyst >1.5 cm the odds of complete resolution were (odds ratio=0.36, P-value=0.190) compared with those with a cyst <1.5 cm.

Conclusions:

The evidence suggests that surgery for symptomatic Tarlov cysts may be an effective option for partially or completely relieving symptoms. Contrary to previous findings larger cysts were not associated with completely relieving symptoms.
The Effect of Severity of Illness on Spine Surgery Costs Across New York State Hospitals
Authors: Kaye I. David , Adrados Murillo , Karia Raj J. , Protopsaltis Themistocles S. , Bosco Joseph A.
Published: March 2018

Study Design:

Observational database review.

Objective:

To determine the effect of patient severity of illness (SOI) on the cost of spine surgery among New York state hospitals.

Summary of Background Data:

National health care spending has risen at an unsustainable rate with musculoskeletal care, and spine surgery in particular, accounting for a significant portion of this expenditure. In an effort towards cost-containment, health care payers are exploring novel payment models some of which reward cost savings but penalize excessive spending. To mitigate risk to health care institutions, accurate cost forecasting is essential. No studies have evaluated the effect of SOI on costs within spine surgery.

Materials and Methods:

The New York State Hospital Inpatient Cost Transparency Database was reviewed to determine the costs of 69,831 hospital discharges between 2009 and 2011 comprising the 3 most commonly performed spine surgeries in the state. These costs were then analyzed in the context of the specific all patient refined diagnosis-related group (DRG) SOI modifier to determine this index’s effect on overall costs.

Results:

Overall, hospital-reported cost increases with the patient’s SOI class and patients with worse baseline health incur greater hospital costs (P<0.001). Moreover, these costs are increasingly variable for each worsening SOI class (P<0.001). This trend of increasing costs is persistent for all 3 DRGs across all 3 years studied (2009–2011), within each of the 7 New York state regions, and occurs irrespective of the hospital’s teaching status or size.

Conclusions:

Using the 3M all patient refined-DRG SOI index as a measure of patient’s health status, a significant increase in cost for spine surgery for patients with higher SOI index was found. This study confirms the greater cost and variability of spine surgery for sicker patients and illustrates the inherent unpredictability in cost forecasting and budgeting for these same patients.
The Epidemiology of Vertebral Osteomyelitis in the United States From 1998 to 2013
Authors: Issa Kimona , Diebo Bassel G. , Faloon Michael , Naziri Qais , Pourtaheri Sina , Paulino Carl B. , Emami Arash
Published: March 2018

Study Design:

This is a epidemiological database analysis.

Objectives:

The objectives of this article are to assess the following characteristics of vertebral osteomyelitis (VO): (1) incidence and patient demographics, (2) mortality rate, (3) length-of-stay (LOS), and (4) admission costs.

Summary of Background:

VO is a serious disease with potentially devastating clinical consequences. At present, there is limited data on the epidemiology of VO in the United States as previous reports are based on older studies with small sample sizes.

Methods:

We used the Nationwide Inpatient Sample database and estimated that 228,044 patients were admitted for VO in the United States between 1998 and 2013. Data were extracted on patient demographics, comorbidities, inpatient mortality, LOS, and inflation-adjusted hospitalization charges. Multivariable regression analyses were performed.

Results:

The incidence of VO admission was 4.8 per 100,000, increasing from 8021 cases (2.9/ 100,000) in 1998 to 16,917 cases (5.4/100,000) in 2013. Majority of patients were white (74%), male (51%), younger than 59 years of age (49.5%), and carried Medicare insurance (50%). The increase in incidence for male and females was similar. The mortality rate during hospital stay was 2.1%, decreasing from 2% in 1998 to 1.7% in 2006 and increasing to 2.2% in 2013. Risk factors for mortality included increased age, male sex, and higher comorbidity score. History of congestive heart failure [odds ratio (OR)=2.45], cerebrovascular disease (OR=1.92), liver disease (OR=2.33), hepatitis C (OR=2.36), and renal disease (OR=1.88) was associated with higher mortality rate. Mean LOS was 9.2 days, decreasing from 9.1 days in 1998 to 8.8 days in 2013. The mean estimated hospital charges for admission were $54,599, however, this increased from $24,102 in 1998 (total of $188.8 millions) to $80,786 in 2013 (total of $1.3 billions).

Conclusion:

This condition is associated with lengthy and expensive hospital stays resulting in a significant burden to patients and the health care system.
Adjacent Level Degeneration
Authors: Miller Justin , Sasso Rick , Anderson Paul , Riew K. Daniel , McPhilamy Austin , Gianaris Thomas
Published: March 2018

Study Design:

Prospective randomized, 2-center, clinical trial.

Objective:

To prospectively compare adjacent level degeneration between the Bryan Cervical Disc Prosthesis and anterior cervical discectomy and fusion (ACDF), and assess the reliability of our measurements utilizing a method not previously described.

Summary of Background Data:

ACDF is a reliable and proven procedure for the treatment of radiculopathy and/or myelopathy. Despite a successful track record several limitations including adjacent segment degeneration/disease, loss of viscoelastic disc properties, perioperative immobilization, graft site morbidity, pseudarthrosis, and plating complications have been identified. An original driving force and theoretical basis for total disc arthroplasty was prevention of adjacent level degeneration.

Materials and Methods:

Seventy-nine patients were enrolled and followed prospectively at 2 centers in a multicenter, Food and Drug Administration Investigational Device Exemption trial for the Bryan Cervical Disc arthroplasty. Neutral lateral radiographs were obtained preoperatively and postoperatively, and at 1-, 2-, 4-, and out to 7-year follow-up after surgery. The cephalad, adjacent level above the blinded procedure level was analyzed for all patients and time points by measuring the anteroposterior distance and the vertical disc height. A ratio was created using disc height/anteroposterior distance.

Results:

Seventy patients (Bryan Cervical Disc N=34 and ACDF N=36) met inclusion criteria. Both fusion and arthroplasty groups showed a significant (P=0.001) decrease in disc height over time, indicative of adjacent level degeneration. Overall change in disc height between groups was not significantly different. Using our measurement technique, the overall interreviewer reliability was good [intrareviewer correlation coefficients (95% confidence interval)=0.77 (0.55–0.85)] and intrareviewer reliability was excellent [0.93 (0.91–0.94) and 0.85 (0.81–0.87)].

Conclusions:

Adjacent level degeneration occurs in a similar manner in both the ACDF and total disc arthroplasty group. Our measurement technique is reliable and to the best of our knowledge not previously reported in the literature.
Combining Bilateral Magnetically Controlled Implants Inserted Parallel to the Spine With Rib to Pelvis Fixation
Authors: Hell Anna K. , Groenefeld Katharina , Tsaknakis Konstantinos , Braunschweig Lena , Lorenz Heiko M.
Published: March 2018

Spine-based fixation of magnetically controlled lengthening devices has been successfully performed for children with early-onset scoliosis. However, spinal manipulation may lead to ossifications, stiffness, and autofusion as previously described. To avoid these problems, a surgical technique combining bilateral externally controlled magnetic device implantation with a rib cradle and pelvic hook fixation was introduced by us in 2011. By using a bilateral single-rib or double-rib cradle fixation and a pelvic hook, the magnetic device is percutaneously inserted. The spine corrects indirectly without further manipulation. In small rib diameter or severe osteoporosis, double-rib cradles are used. Our introduced technique enables modification of the rib vertebral angle, which may be beneficial in children with spinal muscular atrophy and rib-cage deformity. This nonrandomized prospective study describes 18 children with neuromuscular scoliosis treated first by this method. All patients followed the same protocol, with expansion procedures being performed 5 months after surgery and every 3 months thereafter. Clinical, radiologic, and complication data were analyzed, showing a significant reduction in scoliosis and pelvic obliquity and an increase in spinal length, which could be maintained over a follow-up period of 1.2 years. The overall complication rate was lower than previously described, with 8%, 2 of them requiring surgery.