Journal of Neurosurgery: Spine
Volume 38: Issue 2 (Feb 2023)
Illustration from Alvernia et al. (pp 233–241). © Jorge Alvernia, published with permission.

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Restricted access
Dong-Ho Lee
,
Suk-Kyu Lee
,
Jae Hwan Cho
,
Chang Ju Hwang
,
Choon Sung Lee
,
Jae Jun Yang
,
Kook Jong Kim
,
Jae Hong Park
, and
Sehan Park

In Brief

Researchers evaluated the efficacy and safety of oblique posterior endplate resection for wider decompression. This trumpet-shaped decompression (TSD) widened the workspace during anterior cervical discectomy and fusion (ACDF), and 26% of the region posterior to the vertebral body could be accessed using this technique. The construct stability was not adversely affected by TSD as demonstrated by the similar fusion and subsidence rates among patients who underwent TSD and those who did not. TSD can be safely applied during ACDF when compressive lesions extend behind the vertebral body and are not limited to the disc space, enabling adequate decompression without disrupting construct stability.

Free access
Sun-Joon Yoo
,
Jeong-Yoon Park
,
Dong-Kyu Chin
,
Keun-Su Kim
,
Yong-Eun Cho
, and
Kyung-Hyun Kim

In Brief

Researchers investigated the risk factors of mechanical complications after multilevel posterior cervical instrumented fusion surgery based on cervical alignment parameters and patient factors. Low body mineral density, a large number of fused vertebrae, a large preoperative C2-7 sagittal vertical axis, and low C2-7 lordosis were significant risk factors for mechanical complications after posterior cervical fusion surgery.

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Hyung Rae Lee
,
Dong-Ho Lee
,
Sang Yun Seok
,
Woon Sang Lee
,
Minsoo Kim
,
Jae Hwan Cho
,
Chang Ju Hwang
, and
Choon Sung Lee

In Brief

Contrary to the results of previous studies, researchers revealed that hypolordosis was not a risk factor for kyphotic changes in cervical alignment after posterior cervical foraminotomy (PCF). Kyphotic changes in cervical curvature after PCF were related to older age and Pfirrmann grade of the operative levels. Without these risk factors, the natural return of cervical curvature would be expected with the disappearance of radicular pain.

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Nitin Agarwal
,
Alexander A. Aabedi
,
Andrew K. Chan
,
Vijay Letchuman
,
Saman Shabani
,
Erica F. Bisson
,
Mohamad Bydon
,
Steven D. Glassman
,
Kevin T. Foley
,
Christopher I. Shaffrey
,
Eric A. Potts
,
Mark E. Shaffrey
,
Domagoj Coric
,
John J. Knightly
,
Paul Park
,
Michael Y. Wang
,
Kai-Ming Fu
,
Jonathan R. Slotkin
,
Anthony L. Asher
,
Michael S. Virk
,
Regis W. Haid Jr.
,
Dean Chou
, and
Praveen V. Mummaneni
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Satoru Demura
,
Tetsuya Ohara
,
Ryoji Tauchi
,
Kosuke Takimura
,
Kota Watanabe
,
Satoshi Suzuki
,
Koki Uno
,
Teppei Suzuki
,
Haruhisa Yanagida
,
Toru Yamaguchi
,
Toshiaki Kotani
,
Keita Nakayama
,
Kei Watanabe
,
Noriaki Yokogawa
,
Norihiro Oku
,
Hiroyuki Tsuchiya
,
Takuya Yamamoto
,
Ichiro Kawamura
,
Yuki Taniguchi
,
Katsushi Takeshita
,
Ryo Sugawara
,
Ichiro Kikkawa
,
Tatsuya Sato
,
Kenta Fujiwara
,
Tsutomu Akazawa
,
Hideki Murakami
,
Noriaki Kawakami
, and
the Japan Spinal Deformity Institute

In Brief

The incidence and causes of instrument-related complications after primary definitive fusion for pediatric spine deformity were evaluated. Pedicle screw malposition was the primary cause of overall complications and need for subsequent reoperation. In addition to more precise screw insertion techniques, meticulous confirmation, especially regarding medial breach by pedicle screws, may reduce the overall rates of instrument-related complications and revision surgical procedures.

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Shengru Wang
,
Yiwei Zhao
,
Yang Yang
,
Guanfeng Lin
,
Jianxiong Shen
,
Yu Zhao
,
Nan Wu
,
Qianyu Zhuang
,
You Du
, and
Jianguo Zhang

In Brief

Researchers compared the intermediate outcomes of severe congenital early-onset scoliosis (CEOS) patients treated with posterior vertebrectomy/hemivertebrectomy with short fusion and dual growing rods (hybrid technique [HT]) with those of patients who underwent implantation with traditional dual growing rods (TDGRs). The results proved that HT can provide better correction and apex control than TDGRs, with a lower incidence of mechanical complications. HT is a new treatment method for CEOS patients with severe and rigid deformity at the apex level.

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Nathan J. Lee
,
Gerard Marciano
,
Varun Puvanesarajah
,
Paul J. Park
,
William E. Clifton
,
Kevin Kwan
,
Cole R. Morrissette
,
Jaques L. Williams
,
Michael Fields
,
Fthimnir M. Hassan
,
Peter D. Angevine
,
Christopher E. Mandigo
,
Joseph M. Lombardi
,
Zeeshan M. Sardar
,
Ronald A. Lehman Jr.
, and
Lawrence G. Lenke
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Juan Pablo Sardi
,
Bruno Lazaro
,
Justin S. Smith
,
Michael P. Kelly
,
Brian Dial
,
Jeffrey Hills
,
Elizabeth L. Yanik
,
Munish Gupta
,
Christine R. Baldus
,
Chun Po Yen
,
Virginie Lafage
,
Christopher P. Ames
,
Shay Bess
,
Frank Schwab
,
Christopher I. Shaffrey
, and
Keith H. Bridwell

In Brief

This study provides, to the authors' knowledge, the highest-quality data to date on rod fracture (RF) rates following adult symptomatic lumbar scoliosis surgery. At a median 5.1-year follow-up, 38.8% of patients had at least one RF. The estimated RF rates at 2, 4, and 8 years were 11%, 24%, and 49%, respectively. Greater blood loss and postoperative pelvic tilt were significant risk factors for RF. These findings emphasize the importance of long-term follow-up to accurately estimate the true incidence of RF.

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Dean Chou
and
Kazim Narsinh
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Jorge E. Alvernia
,
Emile Simon
,
Krishnakant Khandelwal
,
Cara D. Ramos
,
Eddie Perkins
,
Patrick Kim
,
Patrick Mertens
,
Raffaella Messina
,
Gustavo Luzardo
, and
Orlando Diaz

In Brief

In this anatomical study of the artery of Adamkiewicz (AKA) and the supporting thoracolumbar radiculomedullary arteries (RMAs), the authors showed that a significant percentage (32%) of their cadaveric specimens had additional RMAs other than the AKA and, in some cases, an extra radiculomedullary vessel of the same caliber as the AKA. New evidence, including these findings, demonstrates the robust capabilities of the spinal cord collateral circulation to withstand the sacrifice of several levels of radicular arteries, including the AKA. A paradigm shift from a single RMA (i.e., the AKA) belief toward a collateral network concept has emerged.

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Seokchun Lim
,
Hsueh-han Yeh
,
Mohamed Macki
,
Sameah Haider
,
Travis Hamilton
,
Tarek R. Mansour
,
Edvin Telemi
,
Lonni Schultz
,
David R. Nerenz
,
Jason M. Schwalb
,
Muwaffak Abdulhak
,
Paul Park
,
Ilyas Aleem
,
Richard Easton
,
Jad G. Khalil
,
Miguelangelo Perez-Cruet
, and
Victor Chang

In Brief

Opiate-prescribing practices for elective spinal surgery have come under increasing scrutiny because of the current public health crisis. The authors sought to examine the relationship between outcome and judicious opioid prescribing. When adjusting for a host of confounders, opiate prescribing of less than 225 morphine milligram equivalents over a 7-day period was associated with better outcome for both lumbar and cervical surgery. The authors hope that this provides a framework to curtail opiate prescriptions for spine surgeons.

Open access
Naresh P. Patel
,
Chengyuan Wu
,
Shivanand P. Lad
,
Jessica Jameson
,
Peter Kosek
,
Dawood Sayed
,
Erik I. Waldorff
,
Laura C. Shum
,
Rose Province-Azalde
, and
Leonardo Kapural

In Brief

The authors analyzed the cost-effectiveness of conventional medical management (CMM) versus 10-kHz spinal cord stimulation (SCS) in the treatment of nonsurgical refractory back pain. Treatment with 10-kHz SCS was found to be cost-effective compared with CMM in the 2.1-year time frame. This is the first analysis of cost-effectiveness of SCS in this nonsurgical refractory back pain population, with the added value of prospectively collected healthcare utilization data from a randomized controlled trial.

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Benjamin R. Johnston
,
Stanley Bazarek
,
Margaret Sten
,
Brian S. McIntyre
,
Noam Fine
,
Elise J. B. De
,
Francis McGovern
,
Nucelio Lemos
,
Michael R. Ruggieri Sr.
,
Mary F. Barbe
, and
Justin M. Brown
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Enrique Vargas
,
Praveen V. Mummaneni
,
Joshua Rivera
,
Jeremy Huang
,
Sigurd H. Berven
,
Steve E. Braunstein
, and
Dean Chou

In Brief

The authors compared wound complication rates in metastatic spine tumor patients with a history of preoperative radiation, postoperative radiation within 6 months of surgery, and no radiation. Analysis showed that patients with preoperative radiation had an increased risk of wound complications 7-9 weeks following surgery compared to that in the other groups, despite similar overall wound complication rates. This study provides insight into the timing of wound complications in patients receiving radiation compared to radiation-naive patients.

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Fabian Sommer
,
Pravesh Shankar Gadjradj
, and
Torsten Pippig

In Brief

The primary objective of the study was to evaluate the occurrence of spine injuries and risk factors for spine injuries in ejection seat evacuation. The second objective was the assessment of risk factors for rejection for military flight recertification after ejection seat evacuations. Lumbar fractures are associated with higher odds of rejection for flight recertification than other injuries. This study underlines the importance of diagnosing and treating spine injuries after ejection seat evacuation.

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Luis M. Tumialán
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Luke G. McVeigh
,
Mohamed A. Zaazoue
,
Brandon C. Lane
,
Jason M Voorhies
, and
Jamie Bradbury

In Brief

In this case series, researchers have reported the clinical courses, imaging findings, management techniques, and outcomes at 1 year postoperative for 6 patients who received mesenchymal stem cell bone grafts infected with Mycobacterium tuberculosis. Severe soft-tissue infections occurred, although no extensive skeletal and pulmonary involvement was observed. The severity of these infections arising from stem cell products that undergo alternative sterilization processes raises concerns for increased risk of infection, which should be weighed against the benefits of these grafts.

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Atul Goel
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Hirohito Hirata
,
Tadatsugu Morimoto
,
Masatsugu Tsukamoto
,
Tomohito Yoshihara
,
Takaomi Kobayashi
,
Satoshi Takashima
, and
Masaaki Mawatari
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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.

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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.

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TO THE EDITOR: We read the article by Vargas et al. 1 with great interest (Vargas E, Mummaneni PV, Rivera J, et al. Wound complications in metastatic spine tumor patients with and without preoperative radiation. J Neurosurg Spine. 2023;38[2]:265-270). We appreciate the authors’ efforts to compare wound complication rates in metastatic spine tumor patients with a history of preoperative radiation treatment, postoperative radiation treatment within 6 months of surgery, and no radiation, and their conclusion that the wound complication rate was not significantly different among the three groups, unlike in previous reports. However, as surgeons

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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.

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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.

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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.

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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.

Open access

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.

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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.

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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.

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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%.

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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.

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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.

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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.

Free access

In Brief

Knowledge of the manufacturer of implanted pedicle screw systems may facilitate faster and safer revision surgery. The authors propose an automated computer vision approach to classify posterior thoracolumbar instrumentation systems. This model demonstrates greater accuracy and efficiency over the current practice, with future studies aimed at prospective use.

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In Brief

Researchers investigated the correlation between spinopelvic type and morphological characteristics of lumbar facet joints in patients with degenerative lumbar spondylolisthesis (DLS). Lumbar facet joint morphology was found to be correlated with spinopelvic types in both the DLS and non-lumbar spondylolisthesis (control) groups. This study provides novel evidence for the relationship between the lumbar facet joint morphology and DLS. Additionally, morphological remodeling of the facet joints in DLS plays an important role in spinal balance.

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In Brief

Efforts have been directed at decreasing length of stay (LOS) to reduce healthcare cost. Researchers identified patient, clinical, surgical, and institutional factors predictive of prolonged LOS after three common elective degenerative thoracolumbar spine surgeries. In all groups, worse baseline Oswestry Disability Index scores, experiencing adverse events, and being treated at an institution without protocols to reduce LOS were predictive of prolonged LOS. This study suggests that institutional protocols such as an Enhanced Recovery After Surgery pathway, outpatient surgery, and routine minimally invasive surgery may be effective at decreasing LOS, but further investigation is needed to determine which measures are beneficial.

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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.

Open access

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.

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OBJECTIVE

Posterior cervical fusion is a common surgical treatment for patients with myeloradiculopathy or regional deformity. Several studies have found increased stresses at the cervicothoracic junction (CTJ) and significantly higher revision surgery rates in multilevel cervical constructs that terminate at C7. The purpose of this study was to investigate the biomechanical effects of selecting C7 versus T1 versus T2 as the lowest instrumented vertebra (LIV) in multisegmental posterior cervicothoracic fusion procedures.

METHODS

Seven fresh-frozen cadaveric cervicothoracic spines (C2–L1) with ribs intact were tested. After analysis of the intact specimens, posterior rods and lateral mass screws were sequentially added to create the following constructs: C3–7 fixation, C3–T1 fixation, and C3–T2 fixation. In vitro flexibility tests were performed to determine the range of motion (ROM) of each group in flexion-extension (FE), lateral bending (LB), and axial rotation (AR), and to measure intradiscal pressure of the distal adjacent level (DAL).

RESULTS

In FE, selecting C7 as the LIV instead of crossing the CTJ resulted in the greatest increase in ROM (2.54°) and pressure (29.57 pound-force per square inch [psi]) at the DAL in the construct relative to the intact specimen. In LB, selecting T1 as the LIV resulted in the greatest increase in motion (0.78°) and the lowest increase in pressure (3.51 psi) at the DAL relative to intact spines. In AR, selecting T2 as the LIV resulted in the greatest increase in motion (0.20°) at the DAL, while selecting T1 as the LIV resulted in the greatest increase in pressure (8.28 psi) in constructs relative to intact specimens. Although these trends did not reach statistical significance, the observed differences were most apparent in FE, where crossing the CTJ resulted in less motion and lower intradiscal pressures at the DAL.

CONCLUSIONS

The present biomechanical cadaveric study demonstrated that a cervical posterior fixation construct with its LIV crossing the CTJ produces less stress in its distal adjacent discs compared with constructs with C7 as the LIV. Future clinical testing is necessary to determine the impact of this finding on patient outcomes.

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OBJECTIVE

Spinal deformity surgery is associated with significant blood loss, often requiring the transfusion of blood and/or blood products. For patients declining blood or blood products, even in the face of life-threatening blood loss, spinal deformity surgery has been associated with high rates of morbidity and mortality. For these reasons, patients for whom blood transfusion is not an option have historically been denied spinal deformity surgery.

METHODS

The authors retrospectively reviewed a prospectively collected data set. All patients declining blood transfusion who underwent spinal deformity surgery at a single institution between January 2002 and September 2021 were identified. Demographics collected included age, sex, diagnosis, details of any prior surgery, and medical comorbidities. Perioperative variables included levels decompressed and instrumented, estimated blood loss, blood conservation techniques used, length of surgery, length of hospital stay, and complications from surgery. Radiographic measurements included, where appropriate, sagittal vertical axis correction, Cobb angle correction, and regional angular correction.

RESULTS

Spinal deformity surgery was performed in 31 patients (18 male, 13 female) over 37 admissions. The median age at surgery was 41.2 years (range 10.9–70.1 years), and 64.5% had significant medical comorbidities. A median of 9 levels (range 5–16 levels) were instrumented per surgery, and the median estimated blood loss was 800 mL (range 200–3000 mL). Posterior column osteotomies were performed in all surgeries, and pedicle subtraction osteotomies in 6 cases. Multiple blood conservation techniques were used in all patients. Preoperative erythropoietin was administered prior to 23 surgeries, intraoperative cell salvage was used in all, acute normovolemic hemodilution was performed in 20, and perioperative administration of antifibrinolytic agents was performed in 28 surgeries. No allogenic blood transfusions were administered. Surgery was staged intentionally in 5 cases, and there was 1 unintended staging due to intraoperative blood loss from a vascular injury. There was 1 readmission for a pulmonary embolus. There were 2 minor postoperative complications. The median length of stay was 6 days (range 3–28 days). Deformity correction and the goals of surgery were achieved in all patients. Two patients underwent revision surgery during the follow-up period: one for pseudarthrosis and the other for proximal junctional kyphosis.

CONCLUSIONS

With proper preoperative planning and judicious use of blood conservation techniques, spinal deformity surgery may be performed safely in patients for whom blood transfusion is not an option. The same techniques can be applied widely to the general population in order to minimize blood loss and the need for allogeneic blood transfusion.

Open access

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.

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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.

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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.

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TO THE EDITOR: We read with interest the recent article by Schenck and colleagues 1 regarding interspinous process devices (IPDs) (Schenck CD, Terpstra SES, Moojen WA, et al. Interspinous process device versus conventional decompression for lumbar spinal stenosis: 5-year results of a randomized controlled trial. J Neurosurg Spine. 2022;36[6]:909-917). IPDs were developed as a less destructive alternative to other bony decompression techniques, such as complete laminectomy and discectomy. The IPD simultaneously increases the interspinous distance and helps decompress the canal and foramen through flexion, leading to less aggressive decompression foraminotomies and laminotomies.

Schenck and colleagues

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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.

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Traumatic spinal cord injury (tSCI) is a devastating condition affecting approximately 23–100 per 100,000 patients worldwide. The initial mechanical impact causes direct cellular damage (primary injury) and disruption of the blood–spinal cord barrier, followed by secondary injury defined by ischemic damage and inflammatory response, worsening spinal cord edema and creating an inhibitory environment for neuronal regeneration and remyelination. 1 In addition, the secondary injury can substantially surpass the primary injury, thus worsening symptoms and outcome. Consequently, many therapeutic interventions focus on mitigating secondary injury. Any effective therapy in the acute phase to reduce the injury severity will

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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.

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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.

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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.

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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.

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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.

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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.

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TO THE EDITOR: We read with great interest the article by Elsamadicy et al. 1 (Elsamadicy AA, Koo AB, Reeves BC, et al. Hospital Frailty Risk Score and healthcare resource utilization after surgery for metastatic spinal column tumors. J Neurosurg Spine. 2022;37[2]:241-251). In the study, the Hospital Frailty Risk Score (HFRS) score was applied to hospital discharge records associated with metastatic spinal column tumor (MST) surgery and used to stratify cases into low (61.7%), intermediate (36.2%), and high (2.0%) frailty. 1 HFRS was associated with discharge outcomes and proposed as a novel clinical risk

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This study proposes a novel method utilizing CT scans for measuring true T1 slope and compares it with previously reported substitutes. This novel “overlaying method” was found to be the most reliable substitute for measuring true T1 slope. When CT is available in patients with an invisible radiographic T1 slope, the overlaying method should be used to substitute for T1 slope.

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The authors conducted a survey of thoracolumbar trauma cases to gauge management practices among spine trauma experts. The participants endorsed a range of treatment strategies. Based on the survey results, literature review, and expert consensus, the authors developed an updated management algorithm for incorporating minimally invasive surgery (MIS) techniques into the surgical management of thoracolumbar injuries. The updated algorithm provides a foundation for surgeons interested in safe approaches for using MIS techniques to treat thoracolumbar trauma.

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The objectives of this study were to 1) evaluate the incidence and risk factors of iatrogenic coronal malalignment (CM) and the outcomes of patients with CM, and 2) to assess the outcomes of patients with all three types of postoperative CM. Postoperative iatrogenic CM occurred in 9% of ASD patients with preoperative normal coronal alignment (coronal vertical axis < 3 cm). Clinicians can use these findings to predict which patients are likely to see continued improvements in alignment, as evidenced by radiologic correction, and to help manage patient's expectations of postoperative recovery.

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Researchers present the surgical results for Lenke type 1AR curve and compare anterior and posterior approaches to consider the advantages of anterior surgery. Anterior surgery for the curves could minimize the distal extent of the instrumented fusion without alignment complication. Moreover, anterior surgery for Lenke type 1AR curves would leave more mobile disc space below the fusion.

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Researchers investigated risk factors for the progression of sacroiliac joint (SIJ) degeneration after S2 alar-iliac screw insertion. Preoperative SIJ degeneration and young age at surgery had a significant association with the progression of SIJ degeneration. There is a possibility that S2 alar-iliac screws may affect pre-existing degeneration and the progression of SIJ degeneration in younger patients. Further long-term observation may reveal other effects of S2 alar-iliac screw insertion on SIJ degeneration.