Publish Before Print
in Journal of Neurosurgery: Spine
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In Brief
Cervical deformity is difficult to define due to the high variability in normal cervical alignment based on postural- and thoracolumbar-driven changes to cervical alignment. This study identified whether patterns of sagittal deformity could be established based on radiographic neutral and dynamic alignment. Three distinct patterns of cervical deformity were identified—flat neck, focal deformity, and cervicothoracic deformity. These findings represent a first step in developing a classification system that can guide surgical treatment for cervical deformity and choice of fusion level.
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In Brief
This is a case series of 119 consecutive Medicare patients who underwent anterior cervical discectomy and fusion (ACDF) in an ambulatory surgery center (ASC). This is important because the Centers for Medicare & Medicaid Services has reconsidered coverage for ASC ACDF in the Medicare population due to concerns about safety and outcomes in this population. This study provides scientific data and analysis as they relate to those concerns that are affecting policy decisions.
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In Brief
This study is unique by being population based with 5 years of follow-up comparing cervical posterior foraminotomy with anterior decompression and fusion surgery. The authors conclude that posterior foraminotomy is equal to anterior decompression and fusion in patient satisfaction but results in more secondary surgeries on the index level. Despite the motion-preserving technique, posterior foraminotomy did not protect against adjacent-segment pathology, which is new and important information that contradicts common knowledge of today.
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In Brief
Wrong-level spine surgery can be disastrous for patients. The authors’ technique of preoperative radiopaque coil localization allows for quick and accurate localization intraoperatively.
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In Brief
The authors performed thorough clinical and statistical analyses of reoperation rates, clinical outcomes, and potential risk factors such as adjacent segment disease and screw loosening in a large series of 322 patients who underwent pedicle screw–based semi-rigid instrumentation of the lumbar spine using a topping-off approach with a polyetheretherketone rod system. Importantly, in the topping-off technique only the segments requiring fusion were included in the instrumentation, thus creating a smooth transition from stabilized to free motion segments, which is in contrast to other reported topping-off techniques.
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In Brief
The authors analyzed data from a series of patients who underwent surgery for thoracic ossification of the posterior longitudinal ligament (OPLL) and found that preoperative CT showed discontinuity between rostral and caudal ossified lesions in all but one of the patients. They compared measures of recovery in relationship to discontinuity or continuity of the OPLL at different postoperative time points and suggest that earlier postoperative development of continuity may be beneficial.
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In Brief
This study aimed to determine if nerve transfer after long-term decentralization restores lower urinary tract function in canines. This study is important for patients who sustain spinal cord or cauda equina injuries that prioritize recovery of bladder function.
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In Brief
Dural resection has been demonstrated to influence outcomes for cranial meningiomas, but the role of dural resection in spinal meningiomas remains a matter of some debate, The authors performed a systematic analysis of the literature to better understand the risks and outcomes associated with dural resection in patients undergoing surgical intervention for spinal meningiomas.
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In Brief
The authors present a series of 11 patients with primary neck pain who underwent cervical spine fusion after a finding of facet osteoarthritis and a positive radionucleotide imaging study. Significant improvements in patient-reported neck pain and neck disability were found at 12-month follow-up. This case series represents the largest available to date and adds support to a growing body of evidence that suggests the usefulness of radionucleotide imaging for identification of a cervical facetogenic pain generator.
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In Brief
There is controversy about the role of scaffolds as an adjunctive therapy to mesenchymal stem cell (MSC) transplantation in spinal cord injury (SCI). The findings of this study showed that scaffolds + MSCs is more effective than scaffolds and MSCs alone in improving motor function following SCI in animal models, when used in the acute phase of injury.
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In Brief
Repair of spina bifida defects in utero does not benefit half of the children completely. This is typically due to incomplete closure of the defect. To improve on patient outcomes, a patch graft may be used. The authors found that patches made from cryopreserved human umbilical cords were superior in their healing properties to acellular dermal matrix patches. In summary, human umbilical cord patch repair of spina bifida defects may improve on patient outcomes.
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In Brief
The aim of this study was to use baseline demographic, clinical, and surgical factors to predict a poor overall outcome following cervical deformity (CD) corrective surgery. Identifying patient-specific factors that predict a poor outcome following CD surgery may help to improve patient outcomes.
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In Brief
In a retrospective cohort study, the authors investigated the clinical and radiological differences between 3-level cer-vical disc arthroplasty (CDA) and 3-level anterior cervical discectomy and fusion (ACDF). The study is important because it demonstrated the effectiveness and efficacy of 3-level CDA, which, unlike ACDF, not only successfully preserved but also slightly increased the mobility at the 3 index levels.
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In Brief
Surgical site infection (SSI) remains a notable cause of postoperative morbidity and mortality with current operative techniques and antiseptic protocols, indicating a clear need for improved understanding and reduction of the risk factors. Over a 4-year period at a major institution, the authors determined the rate of deep SSI in 2252 consecutive patients. They demonstrated that male sex, coronary artery disease, and diabetes were associated with increased SSI, whereas the implementation of presurgical chlorhexidine showers reduced SSI.
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In Brief
Researchers from Johns Hopkins conducted a systematic review of operative and nonoperative management strategies for Scheuermann kyphosis. Correction and maintenance of correction were higher in the surgical intervention group than the bracing group. Of the surgical patients, there has been a recent trend toward the increased use of a posterior-only versus combined anterior-posterior approach. The posterior-only approach provides similar or superior correction compared to the anterior-posterior approach, along with a milder complication profile and identical maintenance of correction.
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In Brief
The authors conducted an analysis of a prospective registry of patients who had undergone surgery for lumbar disc herniation. They determined whether late surgery is associated with worse outcomes and if there is a maximum time to surgery (waiting period) after which outcomes start to decline. It is vital to improve understanding of surgical timing and its influence on patient-reported outcomes. This knowledge is key to treatment planning, informed shared decision-making, and patient counseling.
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In Brief
This study is one of the first retrospective reviews of an uncommonly used surgical procedure, T2 pedicle subtraction osteotomy, to treat cervicothoracic deformity.
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In Brief
This study examines how surgeon experience affects perioperative complications and quality measures following thoracolumbar 3-column osteotomy (3CO) in adult spinal deformity. This study is important because it helps identify complications associated with 3CO early in a surgeon's career and helps understand when surgeons overcome the learning curve.
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In Brief
The authors developed a novel prone positioning system able to cater to complex spine patients with advanced frailty and deformity, beyond the capacity of conventional prone positioning systems. This system allows surgery to be performed with the patient prone, eliminating the need for the sitting position, and moreover has marked benefits in terms of safety and economy.
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In Brief
With new advances in minimally invasive surgery (MIS), the authors revised and updated the previously published MISDEF (minimally invasive spinal deformity surgery) algorithm. This updated algorithm was then validated. This is important because there is little consensus as to when MIS vs open surgery is appropriate. This algorithm provides a practical decision-making guide to practitioners.
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In Brief
The authors examined a 14-year series of patients who experienced C5 palsy following posterior cervical spine surgery. They investigated surgical and clinical predictors of the extent and timing of recovery following the onset of C5 palsy. They found that deltoid weakness at the time of C5 palsy diagnosis was the best predictor of both outcomes. The authors believe their results may be used by providers to help counsel and set expectations for patients suffering this complication.
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In Brief
The authors performed a cadaveric laboratory study to measure the stabilizing effects of the terminal dorsal ligamentous complex and the construct length as part of posterior cervical fusion operations. They found that the significant stabilizing forces of the C2–3 and C7–T1 segments should be accounted for when exposing and fusing this region of the spine.
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In Brief
This study demonstrates that in patients without cervical deformity, cervical sagittal parameters such as cervical sagittal vertical axis, lordosis, and T1 slope are not the most important determinants of pain and disability outcomes. This is important because it highlights the importance of preserving normal parameters rather than aiming to augment lordosis or alignment when performing anterior discectomy and fusion.
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In Brief
This is the first study to investigate early cephalad adjacent segment degeneration following single-level posterior lumbar interbody fusion (PLIF) with cortical bone trajectory screw fixation for degenerative lumbar spondylolisthesis and to compare these results with those after single-level PLIF using traditional trajectory screw fixation for the same pathology.
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In Brief
The current retrospective cohort study examined outcomes of single-fraction stereotactic radiosurgery (SRS; photons) as definitive treatment or as a surgical adjuvant therapy for patients with newly diagnosed chordomas treated at Memorial Sloan Kettering Cancer Center. With an 89% 5-year local control rate, SRS can deliver an ablative dose, and the question becomes how we best integrate this therapy into treatment paradigms to reduce morbidity and improve local tumor control.
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In Brief
The authors performed a systematic review of the literature to better understand the risks and oncological benefits of spinal dural resection in cases of malignant spinal tumors with dural contamination or infiltration.
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In Brief
The authors investigated whether Hounsfield units (HU) increase following treatment with teriparatide, a medicine that stimulates bone growth. Their finding that improved density of bones resulting from teriparatide can be measured with HU, which can be determined on routine CT scans, is important in that it provides a surrogate measurement tool to assess a patient’s bone density following teriparatide therapy.
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In Brief
The authors compared rod fracture rates in patients undergoing surgery for correction of adult spinal deformity (ASD) with transforaminal lumbar interbody fusion (TLIF) versus anterior lumbar interbody fusion (ALIF) at the caudal levels of long spinal deformity constructs. The results demonstrate that both ALIF and TLIF procedures at the caudal levels of long spinal deformity constructs achieved similar and satisfactory ASD correction.
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In Brief
The authors studied opioid use after cervical spine surgery for degenerative cervical spine conditions. They evaluated the relationship between preoperative opioid use and 1-year postoperative opioid use, patient outcomes, and satisfaction. Patients with or without preoperative opioid use reported similar improvement in outcomes and satisfaction with surgery, but patients who reported preoperative opioid use were more likely to be using opioids after surgery. Preoperative opioid weaning may be one way to reduce postoperative opioid use.
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In Brief
The authors conducted a systematic review and meta-analysis of the available preclinical and clinical literature to determine the effects of electrical stimulation therapies on spinal fusion. The findings of this work—that electrical stimulation devices may produce clinically significant increases in arthrodesis rates among patients undergoing spinal fusion—substantially add to the literature on the effect of these therapies on spinal fusion. This is the largest and most comprehensive study to date on the effect of electrical stimulation therapies on spinal fusion.
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In Brief
This was the first study to identify the incidence of intraoperative hypotension for patients with acute traumatic spinal cord injuries and to demonstrate that this relative hypotension occurred at a greater proportion than previously reported in the intensive care unit setting. This is important given that systemic hypotension can cause hypoperfusion of the spinal cord, leading to deleterious neurological outcomes associated with secondary spinal cord injury.
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In Brief
Leiomyogenic tumor rarely occurs in the spine, and published information on this disease is limited. To the best of the authors’ knowledge, this is the first reported case series regarding the clinical features and long-term surgical outcomes of leiomyogenic tumor of the spine. The pathology and possible prognostic factors affecting disease-free survival were also investigated in this study.
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In Brief
The authors evaluated the long-term clinical outcome of patients who underwent total posterior arthroplasty using the TOPS System. The results of this 11-year study demonstrate that, in patients with spinal stenosis and degenerative spondylolisthesis, wide decompression and implantation of the study hardware maintain clinical improvement and radiological stability. The TOPS System preserved motion at the instrumented level.
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In Brief
The authors provide insight on the adverse event profile, length of stay, mortality, and reoperation in the spinal oncology population. This study may provide a basis for a quality improvement initiative.
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In Brief
This review of a single-surgeon 7-year experience with complex circumferential cervical decompressive and fusion surgery revealed a high incidence of minor and major complications with this type of surgery. The information provided by this study is critical for surgeons encountering patients with severe spondylotic myelopathy to properly counsel their patients, weigh the risk-benefit profile of such surgery, and ultimately make the most appropriate treatment plan.
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In Brief
The authors compared the results of 33 patients undergoing a traditional open transforaminal lumbar interbody fusion with those of 33 patients undergoing midline transforaminal lumbar interbody fusion for the treatment of degenerative lumbar conditions and found a reduction in total direct costs, although the difference was not statistically significant. Demonstrating cost-effectiveness of minimally invasive procedures is important, given the finite financial resources in healthcare.
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In Brief
The authors compared clinical outcomes in patients with and without depression or anxiety who underwent surgery for cervical compressive myelopathy. Patients with depression or anxiety showed significant improvements in clinical outcomes after surgery. Patients with cervical compressive myelopathy would be expected to have improved clinical outcomes regardless of any preoperative mental disorders.
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