Diagram from Safaee et al. (pp 331–339). © Kenneth X. Probst, published with permission.
In Brief
This study was designed to define the impact of injury severity on the therapeutic effect size of neuroprotective interventions following acute spinal cord injury (SCI) in a preclinical rodent model. Neuroprotective effects on locomotor recovery and extent of tissue sparing were assessed in rats. Surgical spinal cord decompression (durotomy or myelotomy) was neuroprotective in the spinal cord contusion injury model. The neuroprotective therapeutic effect size was only evident in animals with moderate SCIs, not in severe SCI, suggesting the existence of a ceiling effect of neuroprotective interventions.
In Brief
Postoperative ileus (PI) is a common complication after thoracolumbar posterior spinal fusion (PSF), but the effect of total intravenous anesthesia (TIVA) as a PI risk factor has not been assessed. TIVA was independently associated with PI on multivariate analysis, and propensity-matched analysis demonstrated higher intraoperative opiate use in patients having TIVA versus those having inhaled anesthesia. These results highlight the importance of preoperative planning and collaboration with anesthesiology to determine the risks and benefits of using TIVA for PSF.
In Brief
Pedicle screw loosening and pullout are common problems in spinal fusion. This study assessed the biomechanical strength of pedicle screw impaction grafting in a cadaveric model.
In Brief
The study objective was to define rates of and risk factors for proximal junctional failure (PJF) based on a longer-term follow-up of operatively treated adult symptomatic lumbar scoliosis (ASLS) patients. The overall PJF rate was 28.8% at a mean 4.3-year follow-up. On multivariate analysis, an increased PJF risk was associated with a greater BMI and preoperative thoracic kyphosis and lower preoperative proximal junctional angle. Collectively, this study provides the highest quality data to date on rates of PJF following primary ASLS surgery.
In Brief
The authors used telomere length to assess associations between biological age and postoperative complications after spinal deformity surgery. Shorter telomere length (older biological age) was associated with increased complications despite a nonsignificant difference in chronological age. These data provide the impetus to further investigate biomarkers of aging and their potential to improve the accuracy of current risk assessment tools. In some cases, biological age may be a modifiable risk factor that can be optimized preoperatively.
In Brief
The objective of this study was to identify if the Global Alignment and Proportion (GAP) score was predictive of the patient-reported outcomes as measured by PROMIS (pain, physical function) and Scoliosis Research Society-22 spinal deformity questionnaire (function, pain, self-image, satisfaction, subtotal) scores. The authors found that postoperative GAP score predicts long-term health-related quality of life outcomes for adult spinal deformity surgery. The authors recommend decreasing the postoperative GAP score and improving proportioning as a goal when planning sagittal plane correction in adult spinal deformity surgery.
In Brief
Approximately 25% of patients experience new-onset neck pain after surgery for cervical spondylotic myelopathy. The authors investigated which patient- or surgery-related factors might be associated with new-onset pain. A higher level of disability at baseline, more affected levels, and symptoms lasting longer than 3 months were associated with the risk of new-onset pain. Most patients with new-onset pain were satisfied with surgery, suggesting that the risk of new-onset neck pain should not hinder indicated operations.
In Brief
Researchers evaluated the biomechanics of a new anterior atlanto-occipital transarticular screw fixation technique on cadaveric specimens. Regarding atlanto-occipital instability, there was no statistically significant difference in the range of motion and neutral zone for anterior atlanto-occipital transarticular screw fixation compared with conventional posterior fixation. Anterior transarticular screw fixation is a biomechanically effective salvage technique for posterior atlanto-occipital fixation and may also serve as supplemental fixation.
Multilevel cervical disc arthroplasty: a review of optimal surgical management and future directions
In Brief
Two or more levels of cervical disc arthroplasty (CDA) have become a popular treatment for cervical disc herniation or spondylosis, especially in Asia and Europe. Multilevel CDA outscores anterior cervical discectomy and fusion, in appropriately selected patients, for preservation of mobility and a decrease in adjacent-segment disease. Levels of kyphotic deformity or ossification of the posterior longitudinal ligament should undergo fusion rather than arthroplasty. Consideration of individual level and use of hybrid CDA–fusion constructs are suggested for multilevel uneven degeneration.
In Brief
The authors reviewed risk factors and preventative measures for dysphagia after cervical spine surgery. There are numerous patient-reported outcomes questionnaires available to define dysphagia in cervical spine patients. Readers will be able to recognize validated dysphagia questionnaires and utilize risk mitigation techniques to improve dysphagia rates after cervical spine surgery.
In Brief
The authors present an evidence-based scoring system called the “Spinal Infection Treatment Evaluation Score” (SITE Score) to assess the emerging population with de novo spinal infections. Nonsurgical or surgical treatment for de novo spinal infections is often decided case by case on the basis of personal preference, affiliation, and experience rather than evidence-based variables. The authors built a foundation for an evidence-based treatment decision process using the SITE scoring system, which is intended to be a helpful tool to guide physicians' therapeutic decisions about de novo spinal infections.
In Brief
The aim of this study was to assess the value of conservative treatment in spinal cord cavernous malformation patients. The authors' results indicate that conservative treatment often implies the experience of recurrent bleeding events, and interestingly, the capacity of neurological rehabilitation decreases with every hemorrhage. These data reinforce the value of surgery and suggest early treatment.
In Brief
Researchers evaluated the comprehensive outcomes of lumbar fusion in elderly patients older than 85 years with mid-term follow-up. Lumbar fusion in patients older than 85 years was performed with satisfactory postoperative outcomes despite the greater incidence of lumbar vertebral fractures and postoperative delirium. This study provides important information for clinicians performing lumbar fusion.
In Brief
The authors conducted a study to compare clinical and patient-reported outcomes between patients who underwent lumbar spine surgery with and without workers' compensation (WC) status. The results showed significantly worse postoperative pain, disability, and quality of life, as well as delayed return to work, in patients receiving WC. The study adds value by generating discussion among peers to analyze reasons for the increased correlation between adverse outcomes and compensation status, as well as generating ideas to equalize outcomes between both groups.
TO THE READERSHIP: An error appeared in the article by Page et al. (
During editing, two headings in
Preoperative patient baseline characteristics
In Brief
Spinopelvic sagittal alignment and compensation in adult cervical kyphotic deformity has not been thoroughly evaluated. This study found that adult cervical deformity is associated with upper cervical hyperlordosis and thoracic hypokyphosis. In severe kyphotic deformity and sagittal malalignment, thoracolumbar junction kyphosis and lumbar hyperlordosis also develop. There is significant correction of these compensatory mechanisms following cervical reconstruction. A better understanding of spinopelvic sagittal compensation will help guide surgical indications and parameters for cervical reconstruction.
In Brief
Strategies such as collecting patient-reported outcome measures, leveraging immersive technology, and utilizing patient review systems can enhance a clinical practice and build a research program. Such activities need the presence of a team to mechanize research output and maximize productivity.
In Brief
To better understand postsurgical outcomes for degenerative cervical myelopathy (DCM), the authors identified and predicted outcome trajectories 2 years postsurgery. DCM patients followed distinct recovery trajectories in the first 2 years postoperatively, with most experiencing substantial improvement and a significant minority experiencing little improvement or worsening. The identification of DCM surgery recovery trajectories and their predictors may help clinicians with perioperative counseling and have a positive impact on treatment decision-making, especially for patients with mild DCM.
In Brief
Researchers investigated the current epidemiologic landscape of spinal osteomyelitis and spondylodiscitis (SD) and analyzed cases requiring operative management. Results demonstrated that 45.5% of cases of Staphylococcus aureus SD in the US are resistant to beta-lactam antibiotics. Cases of MRSA are more likely to be managed surgically and have higher rates of complications and reoperations as compared with MSSA. Early detection and prompt operative management are imperative to reduce risk of complications.
OBJECTIVE
The focus of this modified Delphi study was to investigate and build consensus regarding the medical management of children with moderate and severe acute spinal cord injury (SCI) during their initial inpatient hospitalization. This impetus for the study was based on the AANS/CNS guidelines for pediatric SCI published in 2013, which indicated that there was no consensus provided in the literature describing the medical management of pediatric patients with SCIs.
METHODS
An international, multidisciplinary group of 19 physicians, including pediatric neurosurgeons, orthopedic surgeons, and intensivists, were asked to participate. The authors chose to include both complete and incomplete injuries with traumatic as well as iatrogenic etiologies (e.g., spinal deformity surgery, spinal traction, intradural spinal surgery, etc.) due to the overall low incidence of pediatric SCI, potentially similar pathophysiology, and scarce literature exploring whether different etiologies of SCI should be managed differently. An initial survey of current practices was administered, and based on the responses, a follow-up survey of potential consensus statements was distributed. Consensus was defined as ≥ 80% of participants reaching agreement on a 4-point Likert scale (strongly agree, agree, disagree, strongly disagree). A final meeting was held virtually to generate final consensus statements.
RESULTS
Following the final Delphi round, 35 statements reached consensus after modification and consolidation of previous statements. Statements were categorized into the following eight sections: inpatient care unit, spinal immobilization, pharmacological management, cardiopulmonary management, venous thromboembolism prophylaxis, genitourinary management, gastrointestinal/nutritional management, and pressure ulcer prophylaxis. All participants stated that they would be willing or somewhat willing to change their practices based on consensus guidelines.
CONCLUSIONS
General management strategies were similar for both iatrogenic (e.g., spinal deformity, traction, etc.) and traumatic SCIs. Steroids were recommended only for injury after intradural surgery, not after acute traumatic or iatrogenic extradural surgery. Consensus was reached that mean arterial pressure ranges are preferred for blood pressure targets following SCI, with goals between 80 and 90 mm Hg for children at least 6 years of age. Further multicenter study of steroid use following acute neuromonitoring changes was recommended.
In Brief
Researchers examined degenerative changes at segments superjacent to the lumbosacral transitional vertebra in Bertolotti syndrome patients. Compared with controls, Bertolotti syndrome patients had a significantly greater pelvic incidence (PI) and were more likely to have adjacent-segment disease (ASD) (L4-5). However, after controlling for age and sex, PI and ASD did not have a significant association within the cohort of Bertolotti patients. The altered biomechanics and kinematics in this condition may be a causative factor in this degeneration, although proof of causation is not possible in this study. This association may warrant closer follow-up protocols for patients treated for Bertolotti syndrome.
In Brief
The objective of this paper was to examine outcomes in elderly patients with spinal cord injury with the hope that the findings would guide clinicians in discussing the risks and benefits of aggressive surgical and ICU care. The key finding was that these patients have high complication rates, many of which are related to vasopressor use for mean arterial pressure goals. However, despite this, many patients do show improvement. These findings allow surgeons to have informed discussions about the expected outcomes and complications after spinal cord injury in the elderly.
In Brief
This study reports additional spinal growth and its effect on the spinal alignment after adolescent idiopathic scoliosis (AIS) surgery. The mean spinal height growth was 0.88 cm in this patient population. Age, sex, and Risser stage were significant predictors for growth. The LL tended to increase, the SVA tended to move backward, and the PT tended to decrease in patients with a spinal height increase < 1 cm. The study provides a reference for preoperative consultation and comprehending the pathophysiology of the spine after AIS surgery.
In Brief
The objective of this study was to evaluate the capability of preoperative lymphopenia to predict postoperative outcomes in patients with metastatic spine disease. Lymphopenia was not associated with either 30-day mortality or 30-day major complications, contradicting prior research that had shown this relationship. Further research into reliable prognostic tools in this population is needed.
In Brief
Researchers used finite element analysis to assess the biomechanical effect of semirigid spinal fixation techniques on developing mechanical complications. The analysis has shown that the semirigid fixation techniques increase mobility and therefore provide a more gradual transition in motion between the instrumented and healthy spinal segments. After successful biomechanical testing and clinical trials, the findings of this study could impact research strategies and clinical practice, given the high incidence of proximal junctional kyphosis.
In Brief
This study compared postoperative cervical sagittal alignment and function in symptomatic cervical myelopathy patients with cervicothoracic junction (CTJ)-spanning versus C7-terminating multilevel posterior cervical fusion (PCF) constructs. Crossing the CTJ may provide greater correction but may not translate into improved function and may be associated with worse short-term patient-reported outcomes. This study provides evidence to assist surgeons in their decision-making for the lowest instrumented vertebra for multilevel PCF constructs in patients with cervical myelopathy.
In Brief
Thirty-day readmission has become an increasingly important metric to optimize the value ratio of quality over cost. In this report, the authors examined the readmissions of 174 patients who underwent minimally invasive transforaminal lumbar interbody fusion and found that urinary retention, constipation, and persistent radicular symptoms were the leading causes of readmission. Addition of a bowel regimen, a more proactive urological algorithm, and bilateral decompression when necessary has decreased 30-day readmissions for this procedure at the authors' institution.
TO THE EDITOR: We read with interest the article by Shen et al.
In Brief
The objective of this study was to determine how the international AO Spine community conceptualizes and characterizes frailty in the context of spinal metastatic disease. Respondents from the community indicated that they commonly evaluate frailty based on general impressions rather than using frailty tools. The authors attained consensus regarding the association between numerous preoperative clinical variables and frailty. This study represents an important first step toward defining the multidimensional nature of frailty. The results will inform the development of an objective tool for evaluating frailty in the context of spinal metastatic disease.
In Brief
Researchers compared anterior cervical discectomy and fusion (ACDF) versus posterior decompression in multilevel degenerative cervical myelopathy without ossification of the posterior longitudinal ligament. The two techniques were similar in patient-reported outcomes at 1 year. Higher dysphagia and lower surgical site infection, C5 palsy, operative bleeding, and hospital stay were associated with the ACDF approach. Treatment decision-making should be individualized. Factors such as a narrower C4-5 foramen or higher infection risk factors favor an anterior approach, whereas baseline dysphagia would favor a posterior approach.
In Brief
Researchers created a simulation model to investigate the cause of divergent results between 2 landmark randomized controlled trials from the US and Sweden in 2016 investigating whether laminectomy or fusion is preferred in patients with grade 1 lumbar spondylolisthesis. Simulated results for fusion showed 2-4 times more treatment heterogeneity than for laminectomy alone predominantly explaining these divergent results. This emphasizes the need for future trials investigating which patients benefit most from surgical instrumentation for lumbar spondylolisthesis.
In Brief
Researchers used a novel vertebral bone quality (VBQ) score based on preoperative MR images to assess bone mineral density (BMD) in patients undergoing spine surgery. The VBQ score had a moderate negative correlation with the patient's BMD, and a VBQ score < 3.05 could initially exclude osteoporosis. The novel VBQ score provides an additional means and opportunity for BMD assessment and screening for osteoporosis.
In Brief
This study evaluated whether artificial intelligence-based unsupervised cluster analysis of a prospective multicenter database of 286 patients with complex adult spinal deformity (ASD) could identify patterns of deformity that predisposed them to perioperative outcomes. Four radiographic clusters were identified: hyper-thoracic kyphosis, severe coronal malalignment, severe sagittal malalignment, and moderate sagittal malalignment. Baseline patient-reported outcomes and surgical management differed between groups, but outcomes were equivalent. This work defines radiographic ASD subtypes but reinforces that they do not impact perioperative outcomes.
In Brief
Researchers investigated factors associated with failure to return to work (RTW) in patients with cervical spondylotic myelopathy undergoing spine surgery. Among employed patients with good surgical outcomes, failure to RTW was associated with higher neck pain at baseline and at 3 months postoperatively. Spine surgeons should consider tempering the expectations of RTW in patients with high preoperative neck pain, because these patients are at higher risk for failure to RTW.
OBJECTIVE
Patient-reported outcomes (PROs) have become the standard means to measure surgical outcomes. Insurers and policy makers are also increasingly utilizing PROs to assess the value of care and measure different aspects of a patient’s condition. For cervical myelopathy, it is currently unclear which outcome measure best reflects patient satisfaction. In this investigation, the authors evaluated patients treated for cervical myelopathy to determine which outcome questionnaires best correlate with patient satisfaction.
METHODS
The Quality Outcomes Database (QOD), a prospectively collected multi-institutional database, was used to retrospectively analyze patients undergoing surgery for cervical myelopathy. The North American Spine Society (NASS) satisfaction index, Neck Disability Index (NDI), numeric rating scales for neck pain (NP-NRS) and arm pain (AP-NRS), EQ-5D, and modified Japanese Orthopaedic Association (mJOA) scale were evaluated.
RESULTS
The analysis included 1141 patients diagnosed with myelopathy, of whom 1099 had an NASS satisfaction index recorded at any of the follow-up time points. Concomitant radiculopathy was an indication for surgery in 368 (33.5%) patients, and severe neck pain (NP-NRS ≥ 7) was present in 471 (42.8%) patients. At the 3-month follow-up, NASS patient satisfaction index scores were positively correlated with scores for the NP-NRS (r = 0.30), AP-NRS (r = 0.32), and NDI (r = 0.36) and negatively correlated with EQ-5D (r = −0.38) and mJOA (r = −0.29) scores (all p < 0.001). At the 12-month follow-up, scores for the NASS index were positively correlated with scores for the NP-NRS (r = 0.44), AP-NRS (r = 0.38), and NDI (r = 0.46) and negatively correlated with scores for the EQ-5D (r = −0.40) and mJOA (r = −0.36) (all p < 0.001). At the 24-month follow-up, NASS index scores were positively correlated with NP-NRS (r = 0.49), AP-NRS (r = 0.36), and NDI (r = 0.49) scores and negatively correlated with EQ-5D (r = −0.44) and mJOA (r = −0.38) scores (all p < 0.001).
CONCLUSIONS
Neck pain was highly prevalent in patients with myelopathy. Notably, improvement in neck pain–associated disability rather than improvement in myelopathy was the most prominent PRO factor for patients. This finding may reflect greater patient concern for active pain symptoms than for neurological symptoms caused by myelopathy. As commercial payers begin to examine novel remuneration strategies for surgical interventions, thoughtful analysis of PRO measurements will have increasing relevance.
In Brief
The objectives of this study were to determine the relationships between disc height loss and pseudarthrosis, revision surgery for pseudarthrosis, and patient-reported outcomes after anterior cervical discectomy and fusion (ACDF). Disc height loss was not predictive of pseudarthrosis or revision surgery for pseudarthrosis but was predictive of less clinical improvement. This study is, to the authors' knowledge, the largest study to date to assess the impact of disc height loss on patient-reported outcomes in ACDF.
In Brief
Researchers identified preoperative risk factors for postoperative coronal imbalance in patients undergoing correction for adult spinal deformity (ASD). Baseline evaluation of global alignment is of outmost importance when planning ASD surgery. Type C coronal imbalance (trunk shifted toward the convexity of the main curve) and an increased preoperative sagittal vertical axis put the patient at risk of postoperative coronal imbalance. Maintaining or restoring global alignment is a key goal of ASD surgery. While much attention has been paid to studying the sagittal plane, less has been devoted to coronal balance. This is the first pooled analysis to address this topic.
TO THE EDITOR: We read with great interest the article by Miller et al.
In Brief
Investigators reviewed and classified 201 medical malpractice cases pertaining to laminectomy between 2000 and 2022. Delayed or denied treatment was identified as the primary source of litigation risk to providers, accounting for 52.7% of the reviewed malpractice litigations. Analysis of these cases may provide clinicians with a better understanding of malpractice risk factors and, in turn, practices through which these risk factors may be mitigated.
In Brief
Decompression and instrumented fusion are commonly performed as the surgical treatment in patients with symptomatic isthmic spondylolisthesis. However, evidence is lacking as to whether fusion is indeed superior to decompression alone for these patients. In this study, the authors demonstrated that adding fusion to decompression is a superior treatment in terms of functional outcome and perceived recovery. The findings of this study support the scientific basis for the widespread practice of fusion in isthmic spondylolisthesis.
TO THE EDITOR: We read the article by Vargas et al.
In Brief
Researchers used motion capture technology to conduct gait analysis of cervical spondylotic myelopathy (CSM) patients before and after surgical intervention. It was found that patients displayed significant improvement in several parameters following surgery, although the improvements were not to the levels of those of healthy control comparisons. This study adds value to the field by better quantifying improvements in gait parameters for CSM patients after surgery and providing comparison points to other subjective myelopathy outcome measures.
In Brief
This systematic review and meta-analysis investigated whether prolonged antibiotic prophylaxis, compared with 24 hours of prophylaxis for drains used in posterior spinal surgery, reduces the risk of surgical site infection. The authors found that a prolonged antibiotic regimen does not reduce the odds of surgical site infection. The findings of this investigation will help reduce excessive antibiotic use in spine surgery.
In Brief
By capturing real-time features related to spine health, mobile health (mHealth) assessments have the potential to transform multiple aspects of spine care. Yet mHealth applications may not be familiar to many spine surgeons and other spine clinicians. This narrative review provides an overview of the technology, analytical considerations, and applications of mHealth tools for evaluating spine surgery patients. Both current and emerging uses are discussed, as are potential obstacles that must be overcome.
In Brief
Researchers evaluated the association of Disease Activity Score in rheumatoid arthritis (RA) patients with cervical spine deformity during a 10-year period of optimal treatment of systemic disease. They found that even though 50% of patients were in remission after 10 years, 40% of patients developed at least mild RA-associated cervical spine deformity. This indicates that, even in this era of disease-modifying antirheumatic drugs and biologicals, cervical deformity is prevalent among RA patients and should not be neglected in patients' treatment plans and information.
In Brief
Methylprednisolone (MP) in acute traumatic spinal cord injury (ATSCI) remains controversial. The second National Acute Spinal Cord Injury Study (NASCIS2) and Sygen studies used identical MP dosages, which allowed for construction of a case-level pooled data set. The original 1990 NASCIS2 study had a large percentage of patients without an ATSCI, and the positive results reported were only in a sub-subgroup. No MP drug effect was noted in the combined data set, removing the rationale for the use of MP in ATSCI.
OBJECTIVE
The burden of spinal trauma in low- and middle-income countries (LMICs) is immense, and its management is made complex in such resource-restricted settings. Algorithmic evidence-based management is cost-prohibitive, especially with respect to spinal implants, while perioperative care is work-intensive, making overall care dependent on multiple constraints. The objective of this study was to identify determinants of decision-making for surgical intervention, improvement in function, and in-hospital mortality among patients experiencing acute spinal trauma in resource-constrained settings.
METHODS
This study was a retrospective analysis of prospectively collected data in a cohort of patients with spinal trauma admitted to a tertiary referral hospital center in Dar es Salam, Tanzania. Data on demographic, clinical, and treatment characteristics were collected as part of a quality improvement neurotrauma registry. Outcome measures were surgical intervention, American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade improvement, and in-hospital mortality, based on existing treatment protocols. Univariate analyses of demographic and clinical characteristics were performed for each outcome of interest. Using the variables associated with each outcome, a machine learning algorithm-based regression nonparametric decision tree model utilizing a bootstrapping method was created and the accuracy of the three models was estimated.
RESULTS
Two hundred eighty-four consecutively admitted patients with acute spinal trauma were included over a period of 33 months. The median age was 34 (IQR 26–43) years, 83.8% were male, and 50.7% had experienced injury in a motor vehicle accident. The median time to hospital admission after injury was 2 (IQR 1–6) days; surgery was performed after a further median delay of 22 (IQR 13–39) days. Cervical spine injury comprised 38.4% of the injuries. Admission AIS grades were A in 48.9%, B in 16.2%, C in 8.5%, D in 9.5%, and E in 16.6%. Nearly half (45.1%) of the patients underwent surgery, 12% had at least one functional improvement in AIS grade, and 11.6% died in the hospital. Determinants of surgical intervention were age ≤ 30 years, spinal injury level, admission AIS grade, delay in arrival to the referral hospital, undergoing MRI, and type of insurance; admission AIS grade, delay to arrival to the hospital, and injury level for functional improvement; and delay to arrival, injury level, delay to surgery, and admission AIS grade for in-hospital mortality. The best accuracies for the decision tree models were 0.62, 0.34, and 0.93 for surgery, AIS grade improvement, and in-hospital mortality, respectively.
CONCLUSIONS
Operative intervention and functional improvement after acute spinal trauma in this tertiary referral hospital in an LMIC environment were low and inconsistent, which suggests that nonclinical factors exist within complex resource-driven decision-making frameworks. These nonclinical factors are highlighted by the authors’ results showing clinical outcomes and in-hospital mortality were determined by natural history, as evidenced by the highest accuracy of the model predicting in-hospital mortality.
In Brief
To minimize the risk of complications in spinal fusion surgery, assessment of osteoporosis is essential. The authors performed a systematic review to assess the effectiveness of CT and MRI to measure bone mineral density (BMD). According to their analysis of the 42 studies meeting the selection criteria, specialized MRI, quantitative CT, and opportunistic CT imaging appear to be viable alternatives to DEXA in assessing BMD that may result in time and cost savings.
In Brief
The authors reviewed a series of 79 patients who underwent separation surgery for metastatic spine tumors involving the cervicothoracic junction (CTJ) to assess the durability of CTJ spinal instrumentation. All patients had lateral mass and pedicle screw instrumentation with either fixed-diameter (3.5 mm or 4.0 mm) or dual-diameter (3.5 mm or 4.0/5.5 mm) rods, and 10 underwent vertebral body reconstruction with poly-methyl-methacrylate. The overall complication rate was 18.8%, and the overall 2-year cumulative rate of hardware failure was 11%.
In Brief
The objective of this paper was to clarify the existing definitions of postoperative C5 palsy within the literature. The key finding is that the definitions of postoperative C5 palsy had significant heterogeneity, and the definitions of C5 palsy were often unrelated to clinical significance. This study adds value to the field by proposing standardized criteria for defining severity of postoperative C5 palsy and recovery.
In Brief
A triage algorithm for patients with spinal disorders was implemented in a tertiary clinical center. Significant reduction in advanced imaging was observed that resulted in substantial cost savings. Rates of surgery remained constant and no increase in complications was observed.
In Brief
Metastatic spinal tumors occur in 20%–40% of cancer patients, yet there has been minimal progress in developing targeted therapies against tumors that have spread to the spinal column. Researchers utilized verteporfin-loaded microparticles to treat spinal metastatic cancer. Verteporfin is a potent inhibitor of the YAP pathway, an important driver of cancer tumorigenicity. By targeting unique genetic drivers of metastasis with verteporfin-loaded microparticles in vitro and in vivo, researchers demonstrated that inhibition of the YAP regulatory axis led to diminished metastatic invasion properties and enhanced radiotherapy effectiveness in spinal metastatic cancer cells, laying the groundwork for future novel targeted therapy.