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Diagnosis and management of metastatic spine disease

A review

Daniel M. Sciubba, Rory J. Petteys, Mark B. Dekutoski, Charles G. Fisher, Michael G. Fehlings, Stephen L. Ondra, Laurence D. Rhines, and Ziya L. Gokaslan

are slightly more prone to the development of spinal metastases, probably reflecting the slightly higher prevalence of lung cancer in men, and of prostate cancer over breast cancer. 107 This disparity may vanish, however, as adjuvant therapies for breast cancer increase the overall survival of patients with this disease, thus increasing the period during which lesions in the spine may arise. Spinal metastases are most likely to originate from breast, lung, or prostate tumors, reflecting the high prevalence of these tumors and their tendency to metastasize to bone

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Responsiveness of standard spine outcome tools: do they measure up?

Carolyn E. Schwartz, Roland B. Stark, Phumeena Balasuberamaniam, Mopina Shrikumar, Abeer Wasim, and Joel A. Finkelstein

S pine outcome research has progressed in important ways over the past 2 decades. On Deyo and colleagues’ recommendations of using a standard spine outcome battery of patient-reported outcomes (PROs), 7 study results across clinics and investigators became more directly comparable. This standardization has enabled a more evidence-driven research base on which to make decisions about treatment choices. 1 , 17 Nonetheless, the passage of time has led to a larger selection of measures and methods for detecting outcomes and change over time in clinical research

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Dysphagia after cervical spine surgery: a review of risk factors and preventative measures

Vincent J. Alentado, Erica F. Bisson, and Eric A. Potts

D ysphagia is a common adverse outcome after cervical spine surgery. Fluoroscopic swallow studies demonstrate that persistent difficulty in swallowing after anterior cervical spine surgery is due to pharyngeal weakness secondary to tissue dissection and retraction during surgery. 1 Its presence in the postoperative period has been shown to negatively impact quality of life for patients. 2 Moreover, postoperative dysphagia after anterior cervical spine surgery has been shown to significantly increase hospital length of stay, in-hospital mortality, direct

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Arachnoid web of the spine: a systematic literature review

Peyton L. Nisson, Ibrahim Hussain, Roger Härtl, Samuel Kim, and Ali A. Baaj

A rachnoid web of the spine (AWS) is a rare, perplexing disease entity that can cause insidious progression of weakness and myelopathy in otherwise healthy patients. There is a growing number of reports on individuals presenting with any combination of upper motor neuron findings, weakness, radiculopathy, or paresthesias and no more than a slight indentation of the spinal cord on imaging. 2 , 5 , 8 , 17 , 20 , 22 Coined the “scalpel sign” by Reardon et al., this radiographic finding has become pathognomonic for an intradural extramedullary AWS, in the absence

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Development and validation of a predictive model for 90-day readmission following elective spine surgery

Scott L. Parker, Ahilan Sivaganesan, Silky Chotai, Matthew J. McGirt, Anthony L. Asher, and Clinton J. Devin

patients whose return trips to the hospital could have been avoided. 3 , 6 As part of the HRRP, the CMS is currently collecting data that may be used to financially penalize institutions based on high readmission rates after total joint arthroplasty. 2 This policy may soon extend to other surgical procedures, including spine surgery. Hospital readmissions following spine surgery can dramatically raise costs and reduce the overall value of surgical spine care; thus, a better understanding of the factors associated with readmission after spine surgery is needed to

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Patient-reported outcomes 3 months after spine surgery: is it an accurate predictor of 12-month outcome in real-world registry platforms?

Scott L. Parker, Anthony L. Asher, Saniya S. Godil, Clinton J. Devin, and Matthew J. McGirt

and ineffective care for patients undergoing lumbar spine surgery, then significant economic savings may be realized as registries begin to power value-based measurement and reform. Accordingly, in the current study we set out to determine whether 3-month patient-reported outcomes (PROs) accurately predict 12-month outcomes in patients undergoing elective lumbar spine surgery; and hence, whether 3-month measurement systems suffice to identify effective versus noneffective spine care. Methods All patients undergoing elective spinal surgery at our institution

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Feasibility of CT-based intraoperative 3D stereotactic image-guided navigation in the upper cervical spine of children 10 years of age or younger: initial experience

Timothy J. Kovanda, Shaheryar F. Ansari, Rabia Qaiser, and Daniel H. Fulkerson

S tereotactic CT-guided intraoperative navigation is becoming commonplace in adult spine surgery. Navigation may improve the accuracy of screw placement, guide resection, and allow confirmation of appropriate screw position before completion of the case. Previous studies have evaluated the efficacy of navigation in the adult cervical spine, 16 , 17 , 28 , 36 but there is very little information regarding its use in children. There are a number of specific concerns and challenges in performing navigation in the cervical spine of young children. The authors

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A comparison of the Wiltse versus midline approaches in degenerative conditions of the lumbar spine

John T. Street, R. Andrew Glennie, Nicolas Dea, Christian DiPaola, Zhi Wang, Michael Boyd, Scott J. Paquette, Brian K. Kwon, Marcel F. Dvorak, and Charles G. Fisher

alternative to minimizing wound complications in this high-risk group of patients. 2 , 3 , 6 , 8 , 11 , 16 The Wiltse approach to the posterior lumbar spine was first described in 1968. It was proposed as an alternate direct approach to the facet joint and transverse process, rather than the conventional midline approach. 34 , 35 As a muscle-splitting approach through the sacrospinalis muscle and between the multifidus and longissimus, the Wiltse approach theoretically leads to less tissue destruction and blood loss and potentially improved postoperative pain. With time

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Perception of frailty in spinal metastatic disease: international survey of the AO Spine community

Mark A. MacLean, Miltiadis Georgiopoulos, Raphaële Charest-Morin, C. Rory Goodwin, Ilya Laufer, Nicolas Dea, John H. Shin, Ziya L. Gokaslan, Laurence D. Rhines, John E. O’Toole, Daniel M. Sciubba, Michael G. Fehlings, Byron F. Stephens, Chetan Bettegowda, Sten Myrehaug, Alexander C. Disch, Cordula Netzer, Naresh Kumar, Arjun Sahgal, Niccole M. Germscheid, Michael H. Weber, and on behalf of the AO Spine Knowledge Forum Tumor

T he prevalence of spinal metastatic disease (SMD) is increasing with the aging population and advances in medical as well as surgical care. 1 – 3 Medical, radiation, and surgical oncologists face the formidable challenge of assessing patients’ physical reserve and ability to tolerate spine surgery for metastatic disease. Prognostication of SMD-related surgical outcomes remains complicated by the need to consider numerous preoperative systemic variables known to influence postoperative outcomes, including demographics, medical comorbidities, biochemical

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Iatrogenic contralateral foraminal stenosis following lumbar spine fusion surgery: illustrative cases

Faisal Konbaz, Sahar Aldakhil, Fahad Alhelal, Majed Abalkhail, Anouar Bourghli, Khawlah Ateeq, and Sami Aleissa

Lumbar spine surgery for degenerative conditions reduces pain and disability and improves function. 1 Many degenerative pathologies require fusion to optimize surgical outcomes. There are several fusion methods, such as posterolateral fusion, transforaminal lumbar interbody fusion (TLIF), anterior lumbar interbody fusion, and lateral lumbar interbody fusion (LLIF). 2 Previous studies have reported many possible complications after spinal fusion, including ipsilateral nerve injury, wound infections, recurrent pain, and cerebrospinal fluid leak. 3 Acute