Oliver G. S. Ayling, Raphaele Charest-Morin, Matthew E. Eagles, Tamir Ailon, John T. Street, Nicolas Dea, Greg McIntosh, Sean D. Christie, Edward Abraham, W. Bradley Jacobs, Christopher S. Bailey, Michael G. Johnson, Najmedden Attabib, Peter Jarzem, Michael Weber, Jerome Paquet, Joel Finkelstein, Alexandra Stratton, Hamilton Hall, Neil Manson, Y. Raja Rampersaud, Kenneth Thomas, and Charles G. Fisher
The objective of the paper was to compile the adverse event profile after surgery for lumbar degenerative pathologies, on a national level, and to compare rates among centers. The key finding in this study is that the rate of major adverse events was consistent among centers, but the minor adverse event rate was variable and depended on the strategy by which adverse events were captured. This study provides a framework for the detection and reporting of adverse events.
Yuichiro Morishita, Ryota Taniguchi, Osamu Kawano, and Takeshi Maeda
The purpose of this study was to elucidate the pathophysiology of synovial facet joint cysts after lumbar decompression surgery. The patients with lumbar degenerative disease who had a potential biomechanical lumbar instability might have a high risk for formation of a lumbar facet synovial cyst after bilateral posterior decompression surgery. A better understanding of the underlying mechanisms that lead to the formation of postdecompression synovial cysts in facet joints may allow practitioners to avoid this postoperative complication.
Christian Iorio-Morin, Charles G. Fisher, Edward Abraham, Andrew Nataraj, Najmedden Attabib, Jerome Paquet, Thomas Guy Hogan, Christopher S. Bailey, Henry Ahn, Michael Johnson, Eden A. Richardson, Neil Manson, Ken Thomas, Y. Raja Rampersaud, Hamilton Hall, and Nicolas Dea
Thomas J. Buell, Christopher I. Shaffrey, Shay Bess, Han Jo Kim, Eric O. Klineberg, Virginie Lafage, Renaud Lafage, Themistocles S. Protopsaltis, Peter G. Passias, Gregory M. Mundis Jr., Robert K. Eastlack, Vedat Deviren, Michael P. Kelly, Alan H. Daniels, Jeffrey L. Gum, Alex Soroceanu, D. Kojo Hamilton, Munish C. Gupta, Douglas C. Burton, Richard A. Hostin, Khaled M. Kebaish, Robert A. Hart, Frank J. Schwab, Christopher P. Ames, Justin S. Smith, and the International Spine Study Group
Researchers compared fractional curve correction, health-related quality of life (HRQL), and complications associated with L4–S1 transforaminal lumbar interbody fusion (TLIF) versus anterior lumbar interbody fusion (ALIF) for the operative treatment of adult symptomatic thoracolumbar/lumbar scoliosis (ASLS). The results demonstrated comparable fractional correction (66.7% for TLIF patients vs 64.8% for ALIF patients). Also, TLIF was associated with reduced operative duration, inferior HRQL, and more rod fractures compared with ALIF. These results may represent the most comprehensive assessment of TLIF versus ALIF for the operative treatment of ASLS focused on fractional correction.
Justin S. Smith, Christopher I. Shaffrey, Christine R. Baldus, Michael P. Kelly, Elizabeth L. Yanik, Jon D. Lurie, Christopher P. Ames, Shay Bess, Frank J. Schwab, and Keith H. Bridwell
The study objective was to assess disease burden of other orthopedic conditions in patients with adult symptomatic lumbar scoliosis (ASLS) using a prospectively collected cohort. The findings demonstrate that patients with ASLS have high orthopedic disease burden, with almost 25% having a fracture or nonthoracolumbar orthopedic condition requiring surgical treatment during the mean 3.8-year follow-up. These conditions may impact health-related quality of life and outcomes assessments of both nonoperative and operative treatments for patients with ASLS.
Michael M. Safaee, Alexander F. Haddad, Marissa Fury, Patrick R. Maloney, Justin K. Scheer, Darryl Lau, Vedat Deviren, and Christopher P. Ames
The object of this study was to assess the efficacy of ligament augmentation for the prevention of proximal junctional failure (PJF) in adult spinal deformity surgery with a minimum 1-year follow-up. In a propensity-matched comparison, ligament augmentation reduced reoperation for PJF from 22.5% to 2.5%. In a multivariate model, the absence of ligament augmentation was associated with increased odds of reoperation for PJF (OR = 5.434, p = 0.001). These data provide additional support for ligament augmentation as a prevention strategy for PJF.
Thomas J. Buell, Christopher I. Shaffrey, Han Jo Kim, Eric O. Klineberg, Virginie Lafage, Renaud Lafage, Themistocles S. Protopsaltis, Peter G. Passias, Gregory M. Mundis Jr., Robert K. Eastlack, Vedat Deviren, Michael P. Kelly, Alan H. Daniels, Jeffrey L. Gum, Alex Soroceanu, D. Kojo Hamilton, Munish C. Gupta, Douglas C. Burton, Richard A. Hostin, Khaled M. Kebaish, Robert A. Hart, Frank J. Schwab, Shay Bess, Christopher P. Ames, Justin S. Smith, and The International Spine Study Group (ISSG)
Bo Li, Andrew K. Chan, Praveen V. Mummaneni, John F. Burke, Michael M. Safaee, and Dean Chou
The objective of this paper was to describe the technical procedure of placing the S1–alar iliac (S1-AI) screw with text, illustrations, and narrated video. The key finding is that it affords both sacral and pelvic fixation through a single step with one screw. This study may add value in that the S1-A1 technique requires less distal dissection of the sacrum, allows for easier rod connection, and may be an option in degenerative spinal surgeries needing pelvic fixation.
Blake M. Hauser, Saksham Gupta, Samantha E. Hoffman, Mark M. Zaki, Anne A. Roffler, David J. Cote, Yi Lu, John H. Chi, Michael W. Groff, Ayaz M. Khawaja, Timothy R. Smith, and Hasan A. Zaidi
The authors used a national database to evaluate sports-related spine injuries in adults. Cycling constituted the most common mechanism of spine injury overall, whereas water sports were the most common cause of injuries involving the spinal cord. Factors associated with requiring additional rehabilitation services after discharge included obesity and concomitant injuries. These results may highlight opportunities to implement preventative measures, and further study is required to fully understand the clinical implications of these findings.
Mohammed Ali Alvi, Waseem Wahood, Shyam J. Kurian, Jad Zreik, Molly M. Jeffery, James M. Naessens, Robert J. Spinner, and Mohamad Bydon
The authors analyzed data for routine lumbar decompression from a single state–level ambulatory surgery database. Although ambulatory surgery centers (ASCs) have historically been associated with lower costs for outpatient procedures, the results of this current analysis indicate that for routine lumbar decompression, ASCs are associated with significantly higher costs compared with the costs for undergoing the procedure at a hospital outpatient setting.
Alessandro Boaro, Jeffrey Leung, Harrison T. Reeder, Francesca Siddi, Elisabetta Mezzalira, Gang Liu, Rania A. Mekary, Yi Lu, Michael W. Groff, Jukka-Pekka Onnela, and Timothy R. Smith
The objective of this study was to investigate the feasibility of using personal smartphones to accurately characterize patients' mobility after spine surgery. Smartphone-derived GPS features were shown to accurately characterize perioperative mobility trends and significantly correlate to current patient-reported outcome measures. The results of this study unveiled an opportunity for the use of personal devices as objective, accurate, and noninvasive tools for the follow-up of patients undergoing spine surgery.
Amro Al-Habib, Wajda Alhothali, Abdulrahman Albakr, Sherif Elwatidy, Ghaida Alawaji, Hissah Alabdulsalam, Fahad Albadr, Metab Alkubeyyer, Abdullah Abu Jamea, Waleed Awwad, Anhar Ullah, Faisal Fakhouri, and Abdulrazag Ajlan
Researchers evaluated the elasticity of the human spinal cord in vivo using intraoperative sheer wave elastography ultrasound. The spinal cord expressed an increased stiffness (higher elasticity value) with external compression. Following adequate decompression, the previously compressed spinal cord expressed significantly lower elasticity values (softer). Such findings could advance our understanding of the biophysical properties of the spinal cord and may further assist in future research concerning the diagnosis and management of spinal cord compression.
Vincent J. Alentado, Robert P. Berwanger, Anabel M. Konesco, Alex J. Potts, Caroline A. Potts, David W. Stockwell, Lana Dbeibo, John J. DePowell, Eric M. Horn, Saad A. Khairi, Shannon P. McCanna, Jean-Pierre Mobasser, Richard B. Rodgers, and Eric A. Potts
The authors evaluated the efficacy of a sodium oxychlorosene–based infection prevention protocol in patients who underwent posterior instrumented spinal fusion. This is the first report of the use of sodium oxychlorosene in spinal fusion. This novel, intraoperative sodium oxychlorosene–based infection prevention protocol helped to significantly decrease rates of infection after both elective and nonelective spine surgical procedures, without negatively impacting other postoperative procedure-related metrics. Prevention of surgical site infection decreases repeated operations, decreases patient morbidity, and may increase patient satisfaction.
Tong Liu, Kai Li, Yongli Wang, Zilong Zhao, Xin Chen, Fanjian Li, Lu Zhao, Zhijun Peng, Tao Zhu, and Jianning Zhang
The authors aimed to identify factors that influence neurological status after treatment in order to facilitate decision-making for clinicians confronted with spinal cavernous malformation (SCM) and to help them make decisions about when and if to perform surgical intervention. In clinical practice, the treatment strategy for patients with SCM should be based on subarachnoid hemorrhage, lesion size, morphology, extent of hemosiderin involvement, and motor dysfunction and balanced with clinical symptoms.
Oluwaseun O. Akinduro, Diogo P. Garcia, Dominique M. O. Higgins, Tito Vivas-Buitrago, Mark Jentoft, David A. Solomon, David J. Daniels, Zach Pennington, Wendy J. Sherman, Mychael Delgardo, Mohamad Bydon, Maziyar A. Kalani, George Zanazzi, Nadejda Tsankova, Bernard R. Bendok, Paul C. McCormick, Daniel M. Sciubba, Sheng-fu Larry Lo, Jennifer L. Clarke, Kingsley Abode-Iyamah, and Alfredo Quiñones-Hinojosa
In this study, the authors analyzed a group of adult patients with high-grade spinal glioma who were treated at six tertiary care academic centers in the United States. The purpose was to assess the effect of histone H3 K27M mutation on the prognosis of patients with tumor harboring this mutation. The authors revealed that although all high-grade spinal gliomas had an abysmal prognosis, the presence of this mutation led to somewhat more favorable patient outcomes compared with those of patients without the mutation. Further understanding of the genetic drivers of these complex tumors will help to develop novel targeted therapies.
The authors evaluated the impact of an opioid stewardship program on perioperative opioid consumption, prescribing, and clinical outcomes after multilevel lumbar fusion. A significant decrease was found in perioperative opioid prescribing, consumption, and opioid-related side effects after implementation of the opioid stewardship program. These gains were achieved without adverse effects on pain scores or length of stay. The greatest impact of opioid stewardship programs for spine surgery may be on changing prescriber behavior.
This study aimed to compare the association of two frailty metrics and the Charlson Comorbidity Index (CCI) with postoperative morbidity in patients who underwent operations for spinal metastases. The frailty metrics were independently predictive of prolonged length of stay, nonroutine discharge, and complications, whereas CCI was only predictive of complications. These findings suggest that measures of physiological reserve may be superior markers of postoperative outcomes compared with individual demographic characteristics.
Researchers evaluated the feasibility of the over-the-arch (OTA) screw for C1 fixation and assessed possible complications. Screw insertion into the C1 lateral mass with conventional techniques is often challenging in patients with a deformed posterior arch and inferior lateral mass. The OTA technique was safe and useful for C1 screw fixation in patients in whom conventional techniques could not be employed.
The authors investigated the impact of intraoperative position on thoracolumbar spinal fractures with spinal ankylosing disorder (SAD). The lateral decubitus position appears to be a safe approach and can be expected to have the effect of closing or maintaining the fracture void or the preventive effect of intraoperative extension displacement of the fractured site, which is often seen in the prone position during surgery for thoracolumbar fractures involving SAD.
Functional outcome was assessed 10 years after decompressive surgery in patients with spinal cord compression due to degenerative cervical stenosis. More than 70% of patients had an improved or stabilized functional status at 10 years, and an initial positive effect was maintained in three-quarters. These results provide guidance for long-term patient counseling, which is becoming increasingly relevant due to higher longevity.
In this study the authors present the largest case series to date evaluating 90-day complication, revision, and readmission rates for robot-assisted spine surgery in which current-generation robotic guidance systems were used. A literature review is also performed. The results suggest that robotic guidance is associated with low rates of intraoperative and postoperative implant-related complications. Ninety-day complication, revision, and readmission rates are low and comparable to what is currently documented in the literature.
The authors used a discrete choice experiment in patients with sciatica to quantify lumbar discectomy preferences because this is elective surgery for which patient preferences are important in determining procedures. Of all tested attributes, effect on leg pain was the most important in patient decision, followed by out-of-pocket costs, wait time, general anesthesia, hospitalization, and recovery period. These findings suggest that proposed advantages of minimally invasive spine surgery (e.g., small scar size, no need of general anesthesia) are not necessarily perceived as most important by patients; therefore spine surgeons should include patient preferences in shared decision making regarding surgical techniques for sciatica.
The study objective was to understand the natural history of lumbopelvic sagittal changes and compensatory mechanisms after multilevel decompression in patients with developmental lumbar spinal stenosis stratified for each of the Roussouly sagittal profiles. Patients were prospectively followed for 2–10 years. Study results support lumbopelvic sagittal stability that was sustained until the final follow-up. Such data may be crucial in predicting patients' prognosis, lumbar sagittal alignment evolution, and the need for prophylactic or corrective deformity surgery.
This study proposes a novel method utilizing CT scans for measuring true T1 slope and compares it with previously reported substitutes. This novel “overlaying method” was found to be the most reliable substitute for measuring true T1 slope. When CT is available in patients with an invisible radiographic T1 slope, the overlaying method should be used to substitute for T1 slope.
Researchers set out to investigate the course of the L5 nerve root in the pelvis and to clarify a safe zone for inserting the sacral screw. The L5 nerve roots always coursed outward after exiting the intervertebral foramina and were positioned close to the ala of the sacrum. Surgeons can prevent the S1 pedicle screw from injuring the L5 nerve root.
Correct-level localization continues to be a problem in spinal surgery, and so the authors sought to formalize this further in a systematic review of the most common localization techniques. This was a qualitative review, and although one technique could not be shown to be superior, the authors found that one or more of the techniques should be used to minimize wrong-level surgery. The value of this study is that it summarizes current localization techniques and their benefits and shortcomings.
The objective of this study was to prospectively evaluate the radiographic, surgical, and subjective outcomes of patients with adult spinal deformity undergoing minimally invasive correction techniques. The study demonstrated significant improvement in patients' subjective outcome scores after 1 year of follow-up in 75 patients, with a 52% overall complication rate and 21% reoperation rate.
Anterior lumbar interbody fusion is used at the lumbosacral junction to achieve lordosis correction. The authors evaluated the use of hyperlordotic implants to restore lordosis in the absence of osteotomies and found that hyperlordotic implants provide significantly more lordosis correction than lordotic implants, although the increase in segmental lordosis is approximately half of the inherent graft lordosis. Hyperlordotic implants provide significantly more lordosis, but posterior osteotomies should be considered to achieve further lordosis restoration.
Researchers set out to assess the long-term validity and establish potential minimal clinically important difference (MCID) values of the Veterans RAND 12 Item Health Survey Physical Component Score (VR-12 PCS) in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). The VR-12 PCS demonstrated excellent responsiveness, good discriminant validity, excellent convergent validity, and minimal floor and ceiling effects up to 2 years after MIS TLIF. The VR-12 PCS may serve as a valid measure of long-term physical function in patients undergoing MIS TLIF.
The authors evaluate the safety and efficacy of a partial transpedicular approach with ultrasonic aspiration and intraoperative ultrasound guidance to resect thoracic disc herniations of various sizes, locations, and calcification status. This 43-patient case series demonstrates a safety profile similar to published reports and efficacy in resecting all thoracic disc herniation morphologies, including giant, midline, and calcified discs. The authors report a posterior technique with an accompanying operative video that should be included in the spine surgeon's arsenal to safely resect thoracic disc herniations.
This article reexamines cervical corticospinal tract (CST) anatomy and function, which are a cornerstone of many traumatic clinical syndromes. With this article, the authors hope to alert the reader that there is no somatotopic organization of the cervical CST in the human spinal cord and that many of the syndromes with prominent upper-extremity dysfunction that clinicians ascribe to pinpoint injuries of the CST are in fact related to the critically important role that the CST has in arm and hand function.
The authors performed an updated meta-analysis and systematic review of studies comparing the outcomes between endoscopic (uni- and biportal) and microscopic techniques for the treatment of lumbar stenosis. Both techniques are safe and effective, but results showed that patients who undergo endoscopic surgery seem to report less postoperative low-back pain and have a significantly reduced hospital stay. Future large prospective randomized controlled trials are needed to confirm these findings.
Researchers reviewed the impact of severity and level of injury on long-term, secondary health conditions (SHCs) in patients with traumatic spinal cord injury. Motor-complete injury leads to increased occurrence of SHCs during the subacute and chronic stage in comparison to motor-incomplete injury. A difference between tetraplegia and paraplegia was less pronounced. This information can be used for early detection and potential prevention of SHCs in patients with SCI.
Degenerative cervical myelopathy can result in significant morbidity for patients. There is debate regarding both timing of surgery and operative outcomes in patients with long-standing myelopathy. The purpose of this study was to assess postoperative outcomes of delayed surgical treatment. The results show improvement in patients with both short- and long-term symptom duration and suggest that patients with delayed presentation can still undergo successful surgical management.
Tranexamic acid (TXA) is a well-established antifibrinolytic agent that has been shown to reduce blood loss in a variety of surgical applications, including spine surgery. Although TXA administration is not a standard of care within neurosurgery, the authors investigated its utility in reducing patient blood loss during laminectomy and fusion with posterior instrumentation, one of the most common procedures used to treat degenerative conditions of the spine. Statistical analysis suggested that TXA significantly reduced perioperative blood loss in 411 patients, an important finding indicating that TXA may reduce morbidity, mortality, and costs associated with blood transfusions in spine surgery.
In this study, the authors identify the relevant baseline parameters that predict multimodal treatment failure in patients with either intravenous drug use (IVDU)–associated or non-IVDU–associated spinal epidural abscess (SEA). Patients with IVDU SEA represent a unique population with a distinct set of baseline parameters (including albumin levels as well as concomitant endocarditis and endplate destruction) that predict treatment failure. Knowledge of relevant prognosticating factors will allow for the design of tailored treatment and follow-up regimens.
The authors compared the incidence and features of adjacent segment disease (ASD) between two different surgical techniques (open vs minimally invasive surgery [MIS]) after a minimum follow-up of 10 years. According to study findings, the incidence of ASD was not different after single-level (L4–5) fusion via an open or MIS approach. This is the first study to show the long-term results of the incidence of ASD after open versus MIS fusion; however, larger cohorts or randomized controlled studies are necessary to confirm the study results.
Sociodemographic factors such as race and income are increasingly recognized as being associated with outcomes following spine surgery. In the present study of a large cohort of patients treated for spinal metastases at a single comprehensive cancer center, the authors found that although medical comorbidities and baseline functional status most strongly predict the occurrence of postoperative complications, socioeconomic factors including race, income, and insurance status best predict nonhome discharge. Further identifying and understanding socioeconomic disparities can lead to targeted interventions to address these disparities.
Researchers retrospectively compared spinal anesthesia's use in lumbar fusion surgery with its use in simple spine surgery. Spinal anesthesia is safe and effective in complex lumbar surgery with many potential advantages that merit further study.
Researchers used the preoperative T1–L1 pelvic angle in the standing position to predict proximal junctional kyphosis after long fusion surgery in patients with adult spinal deformity. The preoperative T1–L1 pelvic angle in the standing position was associated more closely with the occurrence of proximal junctional kyphosis after surgery compared with other conventional radiographic parameters. This simple parameter is useful for the prediction of proximal junctional kyphosis. These findings may provide important information for surgical planning, postoperative management, and obtaining informed consent for patients.
The authors compared 2- and 3-year outcomes for circumferentially minimally invasive surgery (cMIS) and hybrid approaches for correcting adult spinal deformity (ASD). Hybrid approaches were associated with a greater coronal Cobb angle improvement compared to cMIS techniques. cMIS techniques were associated with superior disability and back pain improvement at 2 years, but this difference was no longer evident at 3 years. This study provides insight into the comparative clinical durability of these less invasive strategies for correcting ASD.
The authors evaluated the relationship between the difference in lumbar lordosis (DiLL) in the preoperative supine and standing positions and spinal sagittal alignment and determined whether this difference affected postoperative clinical outcomes in patients with lumbar spinal stenosis. DiLL was strongly correlated with spinal sagittal alignment, and in the DiLL(+) group, postoperative low-back pain relapsed. DiLL can be useful as a new spinal alignment evaluation method that supports the conventional method for spinal sagittal alignment evaluation.
The objective of this paper was to investigate the perioperative complications of hybrid surgery (HS) compared with those of anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA). The results indicated that HS is noninferior to ACDF and CDA in terms of early postoperative outcomes among patients treated for degenerative disc disease. This study adds to the evidence that equitable outcomes can be achieved after all three procedures if patients are selected appropriately.
The objective in this paper was to investigate the epidemiology of spinal arteriovenous shunts and the differences in characteristics between these lesions occurring at different spinal levels by using multicenter hospital-based surveillance as an inventory survey. The crude incidence rate was 0.234 per 100,000 person-years for all spinal arteriovenous shunts, and there were some differences in the clinical characteristics between the upper and lower spinal levels. The present study is the first reported inventory survey of spinal arteriovenous shunts.
Researchers investigated the impact of lumbar sagittal profiles on pelvic orientation and pelvic motion during postural changes in patients with ankylosing spondylitis to evaluate the potential risk of prosthetic dislocation after total hip arthroplasty. Patients with lumbar kyphosis were at higher risk of anterior prosthetic dislocation, while those with lordotic lumbar sagittal profiles were at higher risk of posterior dislocation. These findings could help predict the risk of prosthetic dislocation in these patients.
The authors conducted a survey of thoracolumbar trauma cases to gauge management practices among spine trauma experts. The participants endorsed a range of treatment strategies. Based on the survey results, literature review, and expert consensus, the authors developed an updated management algorithm for incorporating minimally invasive surgery (MIS) techniques into the surgical management of thoracolumbar injuries. The updated algorithm provides a foundation for surgeons interested in safe approaches for using MIS techniques to treat thoracolumbar trauma.
The objectives of this study were to 1) evaluate the incidence and risk factors of iatrogenic coronal malalignment (CM) and the outcomes of patients with CM, and 2) to assess the outcomes of patients with all three types of postoperative CM. Postoperative iatrogenic CM occurred in 9% of ASD patients with preoperative normal coronal alignment (coronal vertical axis < 3 cm). Clinicians can use these findings to predict which patients are likely to see continued improvements in alignment, as evidenced by radiologic correction, and to help manage patient's expectations of postoperative recovery.
The authors attempted to determine the utility of preoperative electrodiagnostic testing in selecting nerve transfer pairings in tetraplegia. The key finding of this study was that the characterization of donor and recipient nerves based on zones of spinal cord injury can aid in detecting lower motor neuron damage with implications in final motor outcomes. Using multimodal electrodiagnostic data to grade donor and recipient nerves can be invaluable in planning nerve transfers in tetraplegia.
The objective of this study was to investigate the relationship between facet joint opening (FJO) on CT and facet joint effusion (FJE) on MRI in patients who underwent less invasive decompression procedures for lumbar spinal stenosis. The correspondence rate between FJO and FJE was not high. However, levels with both FJO and FJE had a higher risk of requiring further surgery than those with other radiological findings. The findings of this study, namely the impact of FJO and FJE, could be helpful to daily clinics and especially for spine surgeons treating patients with lumbar spinal stenosis.
The authors retrospectively determined the long-term revision rate 5-15 years (mean 8.2 years) after minimally invasive decompression (MID) for lumbar spinal stenosis in 246 consecutive patients with (n = 140) and those without degenerative grade I spondylolisthesis (DS). For stable DS (< 5-mm motion) and leg-dominant symptoms due to central or lateral recess stenosis, the long-term reoperation rates including adjacent segments were 15.7% and 15.1%, respectively, in patients with and without spondylolisthesis. Durable surgical survival is achievable with MID alone in selected DS patients.
The feasibility of lateral transpsoas interbody fusion in the prone position has recently been established. The authors report early clinical and radiographic outcomes after 1 year of using this technique in practice (29 patients; 39 levels). The procedure was well tolerated with significant postoperative improvement in clinical scores. The approach was aborted in 1 patient, and the most common complication was anterior longitudinal ligament rupture. This novel technique has acceptable early clinical and radiographic outcomes.
The authors investigated functional, oncological, and quality-of-life (QOL) outcomes in a large series of patients who underwent surgery for cauda equina ependymoma (CEE) and myxopapillary ependymoma (MPE). Important findings were that larger tumors were associated with recurrences and worse outcomes, surgery should be aimed at achieving en bloc gross-total resection, and some features of MPE are associated with higher recurrence rates. Outcomes are usually favorable, but the mean QOL after treatment is inferior to that of the general population. This study may contribute to optimization of treatment and preoperative counseling of CEE patients.
Matching the surgical with the conceptual center of rotation (COR) is difficult with pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR). The authors aimed to examine sagittal correction geometry and surgical COR in three-column osteotomy. In PSO and VCR, the COR was mainly in the anterior and anterior or middle column, respectively. Surgical and conceptual COR matched in 65% and 31% of cases, respectively. Matching is difficult and failed in about two-thirds of patients. To avoid sagittal translation, the use of temporary rods, tracking rods, or special instruments for correction is recommended.
The aim of this study was to assess the success rates of short-level posterior lumbar interbody fusion (PLIF) for patients with diffuse idiopathic skeletal hyperostosis extending to the lumbar segment (L-DISH). The authors found that L-DISH was associated with a high rate of postoperative symptoms related to early-onset adjacent segment disease and pseudarthrosis, especially at a lower segment and one distance from the segment adjacent to L-DISH. Little evidence is available to recommend short-level PLIF as the standard surgery.
This study aimed to examine the effect of preoperative teriparatide administration on cancellous bone with bone histomorphometry and to clarify the timing of preoperative administration for osteoporotic patients with spinal fusion. Dynamic bone formation became significant after 3 months of administration and reached a peak at 4 months. The authors recommend at least 3 months of preoperative teriparatide administration to provide a more substantial anabolic effect from the early postoperative stage.
This study aimed to understand patient complaints after spine surgery and identify unique characteristics of the patients who submitted them. Patient complaints were most often related to quality of care and communication breakdown. Multiple clinical and demographic factors were found to be associated with patient complaints. This study provides a foundational understanding of patient grievances following spine surgery and can guide approaches to best care for patients at high risk for postoperative complaints.
This prospective study demonstrated the efficacy of using synthetic MRI to assess bone quality of the spine. Quantitative proton density (PD) and T1 intensity sequences generated with synthetic MRI were significantly correlated with T-score of the lumbar spine determined with dual-energy x-ray absorptiometry; in particular, PD was excellent for prediction of osteopenia and osteoporosis. This novel MRI technology has the potential to impact spine care by improving preoperative evaluations of bone density in patients with degenerative lumbar spine disorders.
In this study the authors report the accuracy of the first 205 consecutively placed pedicle screws inserted using augmented reality assistance with a unique head-mounted display navigation system at their institution. The authors describe an accuracy of 98.0% as determined by a Gertzbein-Robbins grade of A or B. Augmented reality depicted through a unique head-mounted display is a novel and clinically accurate technology for the navigated insertion of pedicle screws.