Journal of Neurosurgery: Spine
Volume 34: Issue 2 (Feb 2021): Pages 161-350

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Authors: John Paul G. Kolcun, Won Hyung A. Ryu, and Vincent C. Traynelis
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Authors: Michael Lumintang Loe, Tito Vivas-Buitrago, Ricardo A. Domingo, Johan Heemskerk, Shashwat Tripathi, Bernard R. Bendok, Mohamad Bydon, Alfredo Quinones-Hinojosa, and Kingsley Abode-Iyamah

In Brief

The authors assessed the prognostic significance of various clinical and radiographic characteristics, including C1–C2 facet malalignment, in surgical outcomes after foramen magnum decompression in patients with adult Chiari malformation type I (CMI). An important finding was a significant negative correlation between C1–C2 facet malalignment and clinical outcomes evaluated according to the Chicago Chiari Outcome Scale scores at 1–3 and 9–12 months postoperatively. This finding brings into discussion the potential role of atlantoaxial fixation as part of the treatment for CMI cases with atlantoaxial instability.

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Authors: Rushikesh S. Joshi, Darryl Lau, Alexander F. Haddad, Vedat Deviren, and Christopher P. Ames

In Brief

The authors elucidate risk factors contributing to prolonged hospital and intensive care unit (ICU) length of stay following posterior-based osteotomies for cervical deformity correction. Female patients, 12 or more fused segments, and perioperative complication are risk factors for prolonged hospital and ICU stay. Importantly, this study highlights perioperative adverse events that occur following cervical deformity correction. The researchers also discuss management strategies to help guide postoperative monitoring for this unique patient population.

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Authors: Ping-Guo Duan, Praveen V. Mummaneni, Jeremy M. V. Guinn, Joshua Rivera, Sigurd H. Berven, and Dean Chou

In Brief

The aim of this study was to investigate whether fat infiltration of the lumbar multifidus (LM) muscle affects revision surgery rates for ASD after L4–5 transforaminal lumbar interbody fusion (TLIF) for degenerative spondylolisthesis. Fatty infiltration of the LM muscle may be associated with adjacent-segment degeneration after L4–5 TLIF for spondylolisthesis. To the authors' knowledge, this is the first report of this condition.

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Authors: Taewook Kang, Si Young Park, Soon Hyuck Lee, Jong Hoon Park, and Seung Woo Suh

In Brief

The objective of this study was to evaluate the effect on intracranial pressure of biportal endoscopic lumbar discectomy by monitoring cervical epidural pressure changes. The cervical epidural pressure abruptly increased when the epidural space was first connected with the working space, after which there were no significant increases in cervical epidural pressure with constant outflow. Irrigation fluid must be maintained continuously at the lowest irrigation pressure.

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Authors: Koji Tamai, Kunikazu Kaneda, Masayoshi Iwamae, Hidetomi Terai, Hiroshi Katsuda, Nagakazu Shimada, and Hiroaki Nakamura

In Brief

The authors' aim was to demonstrate short-term outcomes of minimally invasive endoscopic surgery in patients with degenerative lumbar disease with either ossification or calcification of the ligamentum flavum. The short-term improvement in Japanese Orthopaedic Association score was significantly lower in patients with degenerative lumbar disease with ossification than in the matched control group. In contrast, there were no significant differences in these scores and perioperative outcomes between patients with calcification and their matched control group. The surgical indications of minimally invasive posterior decompression for patients with calcification can be the same as for patients without calcification; however, indications for patients with ossification should be investigated in future studies, including other surgical methods.

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Authors: John K. Houten, Gila R. Weinstein, Michael J. Collins, and Daniel Komlos

In Brief

The authors investigated the prophylactic use of paraspinal muscle flap closure, a well-established salvage maneuver for wound complication management, to prevent wound infection and dehiscence in patients undergoing thoracolumbar fusion surgery and harboring risk factors for wound complications. The authors also created a protocol for patient risk factors indicating when the muscle flap closure should be considered. The prophylactic use of the paraspinal muscle flap closure method significantly reduced the incidence of wound complications and was associated with very low complication rates, even in subsets of patients with multiple risk factors.

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Authors: Yoji Ogura, Jeffrey L. Gum, Alex Soroceanu, Alan H. Daniels, Breton Line, Themistocles Protopsaltis, Richard A. Hostin, Peter G. Passias, Douglas C. Burton, Justin S. Smith, Christopher I. Shaffrey, Virginie Lafage, Renaud Lafage, Eric O. Klineberg, Han Jo Kim, Andrew Harris, Khaled Kebaish, Frank Schwab, Shay Bess, Christopher P. Ames, Leah Y. Carreon, and the International Spine Study Group (ISSG)

In Brief

The authors made a list of answers to FAQs for adult spinal deformity surgery. It is important because this paper can provide useful information; adult spinal deformity surgery has high complication and revision rates and informed consent is critical.

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Authors: Berendina E. Veerbeek, Robert P. Lamberts, A. Graham Fieggen, Ncedile Mankahla, Richard V. P. de Villiers, Elsabe Botha, and Nelleke G. Langerak

In Brief

The authors investigated whether spinal curvatures (scoliosis, thoracic kyphosis, and lumbar lordosis), spinal abnormalities (spondylolysis and spondylolisthesis), level of pain, and disability changed over a 9-year period in adults with cerebral palsy who underwent selective dorsal rhizotomy more than 25 years ago. None of the outcome measures progressed over a 9-year period in adulthood. Despite the positive outcomes, it is imperative to monitor adults with cerebral palsy for possible progression during the aging process.

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Authors: Remco J. P. Doodkorte, Ricardo Belda, Alex K. Roth, Bert van Rietbergen, Jacobus J. Arts, L. M. Arno Lataster, Lodewijk W. van Rhijn, and Paul C. Willems

In Brief

Researchers used a novel experimental setup to compare the fixation characteristics of pedicle screws, sublaminar wires/tapes, and sublaminar tape–reinforced pedicle screws for adult spinal deformity surgery. A higher failure strength of sublaminar tape–reinforced pedicle screws and a lower fixation stiffness of stand-alone sublaminar fixations compared to pedicle screw fixations provide a clear rationale for the use of sublaminar tapes in adult spinal deformity correction.

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Authors: Nathan J. Lee, Michael W. Fields, Venkat Boddapati, Meghan Cerpa, Jalen Dansby, James D. Lin, Zeeshan M. Sardar, Ronald Lehman Jr., and Lawrence Lenke

In Brief

The objective of this study was to determine the risk profile and clinical impact of unplanned readmissions after adolescent idiopathic scoliosis (AIS) surgery using the Nationwide Readmissions Database. The overall 90-day readmission rate was 4.3%, while the 90-day reoperation rate for patients undergoing fusion surgery for AIS was less than 1%. Quality improvement efforts should focus on patients with risk factors associated with readmissions after AIS surgery. These results can help guide the development of future strategies aimed at improving the quality of care and perhaps assist providers in efficiently allocating healthcare resources.

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Authors: Theresa L. Williamson, Andrew Cutler, Mary I. Cobb, Shervin Rahimpour, Eric R. Butler, Stephen C. Harward, Thomas J. Cummings, and Allan H. Friedman
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Authors: Masaaki Machino, Kei Ando, Kazuyoshi Kobayashi, Hiroaki Nakashima, Shunsuke Kanbara, Sadayuki Ito, Taro Inoue, Hidetoshi Yamaguchi, Hiroyuki Koshimizu, Keigo Ito, Fumihiko Kato, Naoki Ishiguro, and Shiro Imagama

In Brief

The authors aimed to elucidate whether postoperative classification and alterations in increased signal intensity (ISI) on spinal cord MRI reflected the postoperative symptom severity and surgical outcomes in spinal cord injury (SCI) patients without major bone injury. The postoperative ISI was classified as grade 0 (no ISI), 1 (obscure ISI), or 2 (bright ISI). Alterations in ISI were observed postoperatively in 48 patients (48%) and were associated with surgical outcomes. The ISI grade was found to be associated with changes of symptoms during the postoperative course of SCI patients without major bone injury.

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Authors: Roman O. Kowalchuk, Michael R. Waters, K. Martin Richardson, Kelly Spencer, James M. Larner, William H. McAllister, Jason P. Sheehan, and Charles R. Kersh

In Brief

Researchers considered patients treated with stereotactic body radiation therapy for spinal metastases and investigated differing outcomes between the spinal regions. The 36-month local control rates for cervical, thoracolumbar, and sacral treatments were 86%, 73%, and 44%, respectively, and the 36-month local progression-free survival rates were 85%, 67%, and 35%, respectively. These results demonstrate a novel risk stratification by spinal region and suggest that patients with metastases to the sacral spine have decreased local control due to increased planning target volume (PTV), especially with a PTV > 50 cm³.

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Authors: Minh H. Nguyen, Krishna Patel, Julie West, Thomas Scharschmidt, Matthew Chetta, Steven Schulz, Ehud Mendel, and Ian L. Valerio

In Brief

The authors examined the outcomes of oncological spine surgery using a multidisciplinary protocol with collaboration from neurosurgery, plastic surgery, and orthopedic surgery, among others. Their low wound complication rate suggested that a thoughtful multidisciplinary approach can be beneficial to the overall surgical outcomes of oncological spine surgery patients.

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Authors: Michiel E. R. Bongers, Paul T. Ogink, Katrina F. Chu, Anuj Patel, Brett Rosenthal, John H. Shin, Sang-Gil Lee, Francis J. Hornicek, and Joseph H. Schwab

In Brief

In this article, the surgical technique and outcomes of using the free vascularized fibula graft for the reconstruction of spinal defects following total en bloc spondylectomy are described. This reconstruction technique was deemed to be effective, particularly in the cervicothoracic spine. There were high failure rates in the lumbar spine; thus, methods to increase the weight-bearing capacity of the graft should be considered in the lumbar spine.

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Authors: Christine Park, Elizabeth P. Howell, Vikram A. Mehta, Luis Ramirez, Meghan J. Price, Scott R. Floyd, John P. Kirkpatrick, Jordan Torok, Muhammad M. Abd-El-Barr, Isaac O. Karikari, and C. Rory Goodwin

In Brief

This retrospective study aimed to provide evidence of the relationship between stereotactic body radiation therapy (SBRT) fractionation and pain relief and improvement in functional outcomes in patients with spinal metastases. Patients receiving three-fraction SBRT more frequently experienced pain improvement with similar local tumor control compared with patients receiving single-dose SBRT. This study provides evidence that fractionated SBRT may provide better pain improvement with similar local control in metastatic spine patients.

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Authors: Jianning Shao, Jaes Jones, Patrick Ellsworth, Ghaith Habboub, Gino Cioffi, Nirav Patil, Quinn T. Ostrom, Carol Kruchko, Jill S. Barnholtz-Sloan, Varun R. Kshettry, and Pablo F. Recinos

In Brief

The authors studied the epidemiology of spinal cord astrocytoma (SCA) between 1995 and 2016, utilizing the Central Brain Tumor Registry of the United States database to provide a comprehensive epidemiological description of SCAs. The most important finding/contribution of this work to the literature is the description of age-adjusted incidence trends between 1995 and 2016, along with SCA incidence stratified by histology and patient demographics. Due to the rarity of SCA, it has since evaded complete epidemiological description. This study represents the most comprehensive epidemiological descriptions of SCAs to date.

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Authors: Ramez N. Abdalla, Tahaamin Shokuhfar, Michael C. Hurley, Sameer A. Ansari, Babak S. Jahromi, Matthew B. Potts, H. Hunt Batjer, and Ali Shaibani
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Authors: Camilo A. Molina, Frank M. Phillips, Matthew W. Colman, Wilson Z. Ray, Majid Khan, Emanuele Orru’, Kornelis Poelstra, and Larry Khoo

In Brief

The authors performed the first reported cadaveric augmented reality percutaneous pedicle screw insertion with accuracy and precision. The study demonstrated high clinical accuracy in line with modern robotic and manual computer navigation systems. It also yielded high technical precision with early data, suggesting that this method has higher precision than that reported for conventional navigation systems. Technical precision metrics are not widely studied in the field of spine neuronavigation, and further studies are needed to better compare the technical precision of different spine neuronavigation platforms. This study further validates the technical feasibility, accuracy, and safety of this novel spine neuronavigation platform.

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Authors: Zach Pennington, Ethan Cottrill, Daniel Lubelski, Jeff Ehresman, Nicholas Theodore, and Daniel M. Sciubba

In Brief

Enhanced Recovery After Surgery (ERAS) protocols—multimodal care pathways designed to accelerate postoperative patient recovery—have been widely adopted in general surgery and are increasingly being employed in spine surgery. The present systematic review found that spine ERAS protocols decrease hospitalization times without altering complication or readmission rates. However, this review also highlights the absence of a current consensus on what constitutes a spine ERAS protocol and identifies the need for further high-quality evidence.

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The objective of this work was to simplify the complex field of predictive models for the practicing neurosurgeon. The authors graded each model based on characteristics of the original study, in addition to its performance in subsequent validation studies. They found this to stratify existing models in a useful manner. The hope is that in addition to simplifying these models, the utility of prediction model score can push future model development to incorporate the most generalizable and statistically robust methodologies.

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In this study the authors determined the concurrent validity, discriminant ability, and responsiveness of the Patient-Reported Outcomes Measurement Information System (PROMIS) in adult spinal deformity, and they calculated minimal clinically important differences for PROMIS scores. With this information, clinicians will be better equipped to interpret changes in PROMIS scores after surgery for adult spinal deformity.

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In Brief

Pseudarthrosis including rod fracture is a common complication in adult spinal deformity surgery. In this study, researchers analyzed the methods for reducing rod fracture in deformity correction of adult spinal deformity. Greater preoperative sagittal spinopelvic malalignment including preoperative pelvic incidence minus lumbar lordosis mismatch was the crucial risk factor in patients 65 years or older. Application of the cobalt chrome rod, accessory rod technique, or lateral lumbar interbody fusion was found to be effective for reducing the risk of rod fracture.

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In Brief

Patients with cervical deformity (CD) have severe disability and poor health status. Little is known about how patients with fixed CD compare with those with flexible CD. In this study, the authors set out to determine whether patients with rigid CD have worse baseline alignment and require more aggressive surgical corrections than flexible CD patients and found that their outcomes are similar.

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In Brief

Patients with cervical deformity (CD) have severe disability and poor health status. Little is known about how patients with fixed CD compare with those with flexible CD. In this study, the authors set out to determine whether patients with rigid CD have worse baseline alignment and require more aggressive surgical corrections than flexible CD patients and found that their outcomes are similar.

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In Brief

In this study, the authors investigated the impact of different types of accessory rod connectors on stability and instrumentation strain in a long-segment deformity construct using human cadavers. The risk of instrumentation failure and fracture is high in long-segment deformity, and while we know that accessory rods are beneficial, we do not understand the ideal nature of the connector, nor the ideal orientation; an improved understanding would yield decreased failure and fracture rates.

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In Brief

In this study the authors compared the clinical outcome and rate of reintervention between arachnolysis and shunting for syringomyelia secondary to spinal arachnoiditis. The authors showed that arachnolysis led to better outcome and fewer reinterventions than shunting, but that this result was largely driven by the extension of the arachnoiditis. Therefore, arachnolysis should be proposed as a treatment to patients with focal (< 3 spinal segments) arachnoiditis, while surgery should be avoided whenever possible for extensive cases.

Open access

In Brief

The authors compared an adapted simultaneous translation on two rods (ST2R) technique to the standard rod rotation technique for spinal corrections in patients with hypokyphotic adolescent idiopathic scoliosis (AIS). This study revealed that ST2R was more effective in Cobb angle support and corrections of thoracic kyphosis and apex location, with patient decreases in pain and increased treatment satisfaction. This work reveals an improved method using ST2R for AIS corrections and provides a clear and detailed technical description of the technique to enhance adaptation by other surgeons.

Open access

In Brief

Researchers investigated the safety and neurological recovery results in patients with complete (i.e., no function below the level of injury) thoracic spinal cord injury who were implanted with a novel bioresorbable scaffold (Neuro-Spinal Scaffold) during open spine surgery. The results from this first-in-human study are important because they demonstrate that the potential benefits of the Neuro-Spinal Scaffold outweigh the risks in this patient population and support further clinical investigation in a randomized controlled trial.

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In Brief

The primary objective of this randomized controlled trial was to establish whether the X-Stop interspinous distractor device is more or less cost-effective than laminectomy for the treatment of lumbar spinal stenosis. The authors found that laminectomy was more cost-effective, patients had higher quality-of-life scores, and the procedure was cheaper than insertion of the interspinous device. The complication rate and operative time were higher for laminectomy. However, the X-Stop may have a role in patients who are unable to have a laminectomy.

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The authors tested the hypothesis that preoperative cerebrospinal fluid (CSF) biomarkers are altered in patients with cervical spondylotic myelopathy and correlate with neurological status and outcome. Biomarkers of glial and axonal damage in CSF biomarkers were increased, while amyloid breakdown products were decreased. Correlations between preoperative neurological picture and outcome were noted. CSF biomarkers can reflect the ongoing pathophysiology of spinal cord compression and damage and may provide prognostic information on surgical outcome.

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In Brief

Analyzing approximately 3000 degenerative lumbar spine surgeries at Cleveland Clinic, the investigators found that 7% are seen in the ED and 12% are readmitted at 30 days; 3% undergo reoperation within 3 months. Fifty-six percent of patients achieve clinically significant improvement in EuroQOL-5D quality-of-life scores. Prediction nomograms and a web-based calculator were developed to preoperatively identify the likelihood of those outcomes. Concordance indices for the models ranged from 0.63 to 0.84 and can be accessed here: https://riskcalc.org/PatientsEligibleForLumbarSpineSurgery/.

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It is not definitively known whether fusion following decompression and instrumentation for spinal metastatic disease is necessary for a good outcome or even feasible. In this large and comprehensive study, rates of both fusion and hardware failure were found to be low due to a high competing risk of death. These data give further impetus to the study of nonfusion methods in this population, which can reduce both procedural morbidity and healthcare costs.

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The authors assessed the safety of fibrous union in type II odontoid fractures, which occurred commonly with nonoperative management. The use of braced upright cervical radiographs to aid decision-making in type II odontoid fracture management was validated. Operative and nonoperative management outcomes were compared. A management algorithm for these common fractures is provided with supporting safety and efficacy profiles from the authors' high-volume center.

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In Brief

The authors compared standing and supine radiographs for 73 patients and found that those with bilateral sacroiliac (SI) joint vacuum signs, as identified on CT, had a change in pelvic incidence between the supine and standing positions. This suggests there may be increasing motion across the SI joint with significant joint degeneration.

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In Brief

This study aimed to evaluate the clinical and radiological effects of indirect decompression after anterior lumbar interbody fusion for central spinal canal stenosis. The authors believe that their study makes a significant contribution to the literature because it reports on the effects of indirect decompression of central canal stenosis performed using anterior lumbar interbody fusion, which has been less studied, and this is also the first quantitative analysis of indirect decompression after anterior lumbar interbody fusion for central spinal canal stenosis.

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The objective of this study was to elucidate the efficacy of the cyst-dyeing method in microendoscopic spinal decompression surgery for lumbar spinal stenosis caused by facet cysts. The adjunctive cyst-dyeing method effectively delineated cyst and dural boundaries, facilitating safer and more effective cyst separation and neural decompression, even with microendoscopic surgery. Microendoscopic surgery combined with the authors' novel facet cyst-dyeing method is a safe and effective minimally invasive technique for facet-joint cysts.

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In Brief

The authors aimed to determine which radiological parameters related to the aging spine are associated with curve progression in early degenerative lumbar scoliosis (DLS), in particular which factors predict curve progression. In early DLS patients observed for a mean of 13.7 years, asymmetrical disc degeneration in the lower disc space of the apical vertebra, leading to lower apical vertebral disc wedging angles, was the most important factor in predicting curve progression. Therefore, patients with this finding need to be closely monitored.

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The authors used a propensity score–matched analysis for the adjustment of patient baseline and surgical data, including nutritional status, to clarify whether intrawound vancomycin powder decreases surgical site infection (SSI) rates after posterior spinal surgery. Intrawound vancomycin powder reduced the risk of SSI after posterior spinal surgery by half without systemic adverse events, an important finding indicating that the use of intrawound vancomycin powder is a safe and effective procedure for SSI prevention.

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Multilineage-differentiating stress-enduring (Muse) cells are pluripotent stem cells that can migrate after transplantation to an injured site and exert repair effects, showing promise for the treatment of spinal cord injury (SCI). The authors applied Muse cells in a rat model of SCI using a human-derived preclinical product, CL2020. Intravenous administration of CL2020 successfully led to significant functional recovery from SCI, an important finding indicating that intravenous Muse cell administration via CL2020 could be a feasible SCI treatment option in future clinical studies in human patients.

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In Brief

Researchers evaluated radiographic and clinical outcomes after shorter fusion for subtypes of adult spinal deformity and examined factors associated with successful short fusion. If the pelvic incidence is < 47°, the use of short fusion can produce adequate lumbar lordosis for the pelvic incidence, improving both postoperative global spinal alignment and quality of life. The researchers proposed an algorithm to decide when to consider the shorter constructs.

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In Brief

The authors have designed and implemented an Enhanced Recovery After Spine Surgery (ERASS) protocol for patients undergoing elective procedures at a tertiary care facility and evaluated the ERASS protocol's efficacy (e.g., opiate use on postoperative day 1 and length of stay) by comparing patients enrolled in the ERASS group (n = 97) to a historic cohort (n = 146). Implementation of ERASS reduced postoperative opiate consumption and hospitalization, supporting its efficacy in reducing care costs and improving patient outcomes in spine surgery.

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In Brief

This study aimed to compare various surgical methods for Scheuermann kyphosis. In the past, the anterior-posterior approach was the gold standard. Recently, the posterior-only approach with osteotomies accomplished comparable correction of the deformity and few complications. With the technical advancement of deformity correction, the posterior-only surgery needs to be reevaluated as a gold standard for Scheuermann kyphosis.

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In Brief

In the present study the authors looked at the Clinician and Group Consumer Assessment of Healthcare Providers and Systems survey, which allows patients to rate their experience in the outpatient setting, and determined if there is an association between high patient satisfaction and some of the other measures spine surgeons use to determine surgical quality. Due to the public reporting of Clinician and Group Consumer Assessment of Healthcare Providers and Systems scores, it is important to determine their ability to predict surgical quality.

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In Brief

The authors investigated whether appropriately corrected sagittal alignment continues to offer benefits over time in terms of clinical outcomes and mechanical failure. Appropriately corrected sagittal alignment gave the clinical benefits in long-term follow-up, but mechanical failure occurrence was not affected by the appropriateness of sagittal alignment. This study is the first to demonstrate the long-term benefit of achieving the appropriate sagittal alignment in adult spinal deformity surgery.

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In Brief

The authors evaluated health-related quality of life (QOL) in patients with failed back surgery syndrome (FBSS) who underwent high-dose spinal cord stimulation (HD-SCS) for FBSS. This evaluation showed that this procedure resulted in long-term increases in QOL as well as an increase in quality-adjusted life-years. This important finding demonstrates that HD-SCS not only reduces pain, but also may have a major impact in allowing patients with FBSS to return to work.

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In Brief

Most spinal metastasis studies focus on expected survival versus postoperative quality of life (QOL). In this review of QOL studies, low-quality evidence supports the use of the Spine Oncology Study Group Outcome Questionnaire as a disease-specific measure and the EQ-5D as a general measure of QOL outcomes. Preoperative functional status best predicts postoperative QOL across several small retrospective series, but prospective studies, such as the ongoing Metastatic Tumor Research and Outcomes Network (MTRON) trial, are required to produce a useful predictive calculator of postoperative QOL.

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In Brief

A retrospective analysis of 120 spinal laser interstitial thermal therapy (sLITT) procedures was performed. Local control at 12 months was 81.7%. Tumor location in the paraspinal region and salvage treatment were independent predictors of treatment failure. sLITT performed in the lumbar and cervical spine had higher neurological complications than the thoracic region. The authors discuss the outcomes and technical nuances of the procedure to facilitate the learning curve and to allow other surgeons to improve upon their results.

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In Brief

Thoracic ossification of the posterior longitudinal ligament (OPLL) remains one of the most challenging disorders for spine surgeons. No ideal surgical procedures have been developed for patients with thoracic myelopathy caused by OPLL. In this study, the authors' technique of modified decompression through a posterior approach clearly resulted in better surgical results, with the recovery rate of the Japanese Orthopaedic Association score > 70%. Patients who are nonambulatory due to thoracic OPLL could become able to walk again after this procedure.

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In Brief

In this study, the authors evaluated a fluorescence marker for improved visualization of tumor tissue in spinal ependymal tumors. The authors demonstrated the presence of residual fluorescing foci that represented tumor tissue that was not visible under normal white light. Therefore, in the future, this technique might improve the resection of such tumors.

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In Brief

Researchers investigated whether bone mineral density measured in Hounsfield units (HUs) was correlated with proximal junctional failure (PJF). The HU value at the L1 vertebra in the PJF group was lower than that in the control group. L1 trabecular attenuation ≤ 89.25 HUs could predict the incidence of PJF. Under this condition, an upper instrumented vertebra at L2 significantly increases the incidence of PJF. HUs could provide important information for surgeons to make a treatment plan to prevent PJF.

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In Brief

Researchers compared the radiographic features and surgical outcomes of degenerative lumbar spondylolisthesis with and without local coronal imbalance at the spondylolisthesis level. Degenerative lumbar spondylolisthesis with local coronal imbalance constitutes a distinct subgroup characterized by coronal malalignment and loss of whole lumbar lordosis, which may result in worse patient-reported outcomes. The transforaminal lumbar interbody fusion procedure allows reconstruction of the coronal and sagittal lumbar profile, and achievement of satisfactory patient-reported outcomes.