Authors:Marko Jug, Nataša Kejžar, Matej Cimerman and Fajko F. Bajrović
In this paper, the authors report on the effect of timing of surgical decompression (SD) within 24 hours of acute traumatic cervical spinal cord injury on significant neurological recovery and estimate the optimal time window for SD using receiver operating characteristic analysis. This is significant because the optimal time window for SD is unknown.
Authors:Saksham Gupta, Blake M. Hauser, Mark M. Zaki, Edward Xu, David J. Cote, Yi Lu, John H. Chi, Michael Groff, Ayaz M. Khawaja, Mitchel B. Harris, Timothy R. Smith and Hasan A. Zaidi
The authors studied the epidemiology and morbidity of traumatic spine injuries related to sports in the pediatric population. This study is important since it can help providers and parents alike better identify risks associated with sports-related spine injuries and understand the prognosis of these injuries.
Authors:Richard J. Zeman, Xialing Wen, Chitti R. Moorthy and Joseph D. Etlinger
The results of this study of contusion injury and subsequent x-irradiation in rats indicate that x-irradiation in a region rostral to the injury epicenter is most critical for recovery of locomotor function. This minimal target is potentially therapeutic since it allows for a greatly reduced target volume so that uninjured tissue is not needlessly irradiated.
To gain insight into the natural history and risk factors for traumatic vertebral artery injury (TVAI) in the geriatric population, the authors compared biometric, clinical, and imaging data for patients with TVAI evaluated at a level 1 trauma center and found that TVAI is associated with a significantly greater risk of mortality in the older adult population (age 65 years or older) than in the younger adult population, despite the 2 groups having similar Injury Severity Scores. Given the rapidly enlarging geriatric age group, increased understanding of how key pathologies affect this patient population differently is critical.
Authors:Shahed Tish, Ghaith Habboub, Min Lang, Quinn T. Ostrom, Carol Kruchko, Jill S. Barnholtz-Sloan, Pablo F. Recinos and Varun R. Kshettry
The authors used the Central Brain Tumor Registry of the United States database, which is provided by the Centers for Disease Control and Prevention, to document the incidence rates of spinal schwannomas in the United States between 2006 and 2014. The authors believe their article provides a comprehensive analysis of the population-based incidence of spinal schwannomas, which is necessary considering the paucity of population-based epidemiological studies reporting on this pathological entity.
Authors:Dhiego Chaves de Almeida Bastos, Richard George Everson, Bruno Fernandes de Oliveira Santos, Ahmed Habib, Rafael A. Vega, Marilou Oro, Ganesh Rao, Jing Li, Amol J. Ghia, Andrew J. Bishop, Debra Nana Yeboa, Behrang Amini, Laurence D. Rhines and Claudio Esteves Tatsui
The authors compared the outcomes of patients treated with spinal laser interstitial thermotherapy (SLITT) and open surgery for thoracic epidural metastatic spinal cord compression without neurological deficits. This is the first study to compare the conventional treatment to SLITT. The authors were able to demonstrate that SLITT is not inferior to open surgery regarding local control, with fewer complications and faster recovery time.
Authors:Ziev B. Moses, Thomas C. Lee, Kevin T. Huang, Jeffrey P. Guenette and John H. Chi
The authors conducted a prospective trial of cryoablation for head, neck, and spine tumors at their institution and performed an analysis of patients treated for metastatic spine disease. They found encouraging radiographic disease control, bone regrowth, and reductions in pain scores. Blood loss, hospital stay, and complications were all favorable. The readership may consider minimally invasive cryoablation as an option for patients burdened with metastatic spine disease.
Authors:Yue-Qi Du, Teng Li, Chao Ma, Guang-Yu Qiao, Yi-Heng Yin and Xin-Guang Yu
The authors investigated, for the first time, the biomechanical properties of C2 bicortical translaminar screw fixation and C2–3 transarticular screw fixation as alternative techniques to the Goel-Harms technique for atlantoaxial fixation. The authors believe that these new fixation techniques may serve as alternative procedures when the Goel-Harms technique is not feasible due to anatomical constraints.
Authors:Christopher D. Witiw, Fabrice Smieliauskas, Sandra A. Ham and Vincent C. Traynelis
Little is currently known about the uptake of cervical disc replacement (CDR) surgery in the general patient population. This study of American commercial insurance claims data suggests a substantial rise in the utilization of CDR for symptomatic single-level cervical spondylotic pathology between 2009 and 2017. The increase appears to have begun in 2013 and continued thereafter. Uptake of this new technology is much stronger in some regions of the United States than in others.
Authors:Zoe E. Teton, Barry Cheaney II, James T. Obayashi and Khoi D. Than
In a retrospective review of all patients in a 5-year period who underwent multiple-level anterior cervical discectomy and fusion (ACDF), the authors examined rates of pseudarthrosis (nonunion) and reoperation in patients who received PEEK implants compared with those who received structural allograft implants. The results for multiple-level ACDF reinforce prior work on single-level ACDF at the same institution by similarly demonstrating significantly higher rates of nonunion and reoperation in patients who received PEEK than in patients who received structural allograft.
The authors investigated the definitive factors associated with surgical outcomes for thoracic ossification of the posterior longitudinal ligament (T-OPLL) because the outcomes of surgical intervention are not always favorable. Recognizing the surgery-related risk factors shown in this study is important in order to avoid poor outcomes following T-OPLL surgery.
In this study, using multiple health-related quality of life parameters, the authors showed that the surgical outcomes of lumbar spinal stenosis (LSS) patients with knee osteoarthritis (KOA) are favorable, although poorer than those of LSS patients without KOA, particularly in terms of returning to routine work or ordinary activities even after lumbar spinal surgery. This study is important because it indicated that the preoperative status of KOA should be considered when planning treatment for LSS patients and estimating the efficacy of lumbar spinal surgery.
Authors:Da Zou, Aikeremujiang Muheremu, Zhuoran Sun, Woquan Zhong, Shuai Jiang and Weishi Li
The authors investigated the relation between Hounsfield unit (HU) values measured on computed tomography and the risk of pedicle screw loosening in patients who underwent lumbar pedicle screw fixation for degenerative lumbar spine disease. The important findings that the HU value is significantly correlated with the incidence of screw loosening and can be used as an independent factor to predict screw loosening after pedicle screw fixation provide a basis for the application of HU values for surgical planning in the increasing number of patients with degenerative lumbar spine disease.
Authors:Zhaoyang Xu, Guoxiong Lin, Han Zhang, Shengchun Xu and Ming Zhang
In the lumbar intervertebral foramina the adipose zone gradually tapers and rotates from the inferoposterolateral aspect to the superoanteromedial aspect, but its configuration in the upper lumbar intervertebral foramina was more complex than in the lower lumbar intervertebral foramina. The planning of an optimal transforaminal approach is different between the upper and lower lumbar intervertebral foramina, and in general it should be through the inferior compartment below the spinal ganglia or the superior endplate of the intervertebral disc.
Authors:Rune T. Paulsen, Jan Sørensen, Leah Y. Carreon and Mikkel Ø. Andersen
The authors evaluated the cost-effectiveness of a referral for postoperative physical rehabilitation in patients recovering from lumbar disc herniation. They found that a routine referral to physical rehabilitation was not cost-effective compared to no referral.
Authors:Mikhail Lew P. Ver, Jeffrey L. Gum, Charles H. Crawford III, Mladen Djurasovic, R. Kirk Owens II, Morgan Brown, Portia Steele and Leah Y. Carreon
The authors performed robot-assisted (RA) midline lumbar interbody fusion (MIDLIF) in a comparison with open traditional transforaminal lumbar interbody fusion (TLIF) and MIDLIF performed with navigation. RA-MIDLIF had the lowest operating room time, estimated blood loss, and length of stay and was comparable to TLIF and MIDLIF in terms of cost. This study shows promising results for using RA-MIDLIF as an alternative procedure for lumbar fusion.
Authors:Waleed Brinjikji, Elisa Colombo and Giuseppe Lanzino
The authors retrospectively reviewed a large case series of spinal vascular malformations in the cervical spine from patients diagnosed and treated at their institution. This study is important because it is the largest single-institution case series on cervical spine arteriovenous malformations in the literature to date.
Authors:Mark N. Pernik, Luke J. Dosselman, Salah G. Aoun, Adrienne D. Walker, Kristen Hall, Valery Peinado Reyes, David L. McDonagh and Carlos A. Bagley
The role of tranexamic acid and its safety as a surgical adjunct for long-segment spinal fusion are still unclear. The authors present one of the largest surgical series of first-time procedures and found that tranexamic acid can decrease intraoperative and postoperative blood loss significantly without increasing the risk.
The authors investigated the role of platelet-rich plasma (PRP) in augmentation of bony union following spinal fusion surgery. In their systematic review, the authors found that patient-reported outcomes were similar between patients undergoing fusion with PRP and bone graft and those undergoing fusion alone. Moreover, they found that those undergoing fusion alone had a more successful fusion. It is important to evaluate potential supportive interventions that will minimize failure.
The authors aimed to evaluate the improvement in cervical lordosis and sagittal alignment after vertebral body sliding osteotomy (VBSO). VBSO markedly improves segmental cervical lordosis through multiple cervical anterior discectomies and fusions above and below the VBSO level, and a preserved vertebral body may provide more structural support.
The authors identified the most relevant risk factors that predispose patients to ≥ 24-hour admission following anterior lumbar interbody fusion (ALIF) spine surgery. The identification of these risk factors is important because it is a first step before considering the transitioning of appropriately selected patients to undergo ALIF spine surgery in the ambulatory surgery center setting.
The authors performed a retrospective review in patients who had undergone biportal endoscopic discectomy by a single surgeon after diagnosis of lumbar disc herniation between January 2016 and June 2018. The key finding in this study was that biportal endoscopic discectomy can be effective for high-grade migrated lumbar disc herniation without prolonged operation time and with satisfactory clinical outcomes.
The authors tested a new treatment (to their knowledge first reported here) with combined methylprednisolone and ozone in a rat model of spinal cord injury. The important results of this study suggest that methylprednisolone and ozone in combination may be more beneficial for the treatment of spinal cord injury than methylprednisolone alone.
This study provided assessment of a large single-center cohort of patients with thoracolumbar kyphosis in ankylosing spondylitis. The authors determined the rate of and the risk factors for surgery-related complications demonstrated on radiography after pedicle subtraction osteotomy. A high incidence of complications related to mechanical failure and surgical technique can develop; therefore, thorough radiographic investigation before surgery is needed to determine whether complete ossification occurs along the anterior and posterior longitudinal ligaments.
The authors describe a novel method in the treatment of severe, active osteomyelitis and discitis of the spine. The use of antibiotic-infused polymethylmethacrylate (aPMMA) strut graft in this setting reduces dead space, administers local antibiotics to the infection bed, and provides structural support. To the authors' knowledge, the use of aPMMA is novel for treating cases of severe, pyogenic osteomyelitis requiring extensive debridement and stabilization, followed at a later date by replacement with permanent hardware.
This study compares the effectiveness and complication profiles of two surgical techniques (Smith-Petersen osteotomy and 3-column osteotomy) to correct severe cervical deformities. This study is important because it will help surgeons decide which technique would be most appropriate for their patients.
The current study compares the outcomes between conventional open decompression and minimally invasive decompression for patients with low-grade spondylolisthesis. The authors found comparable outcomes between the two procedure groups, indicating that both procedures may be associated with optimum outcomes.
The authors clarified the incidence and risk factors for progression of ossification of the posterior longitudinal ligament (OPLL) in asymptomatic subjects. This is the first observational study of OPLL progression in asymptomatic subjects based on long-term CT follow-up data.
The authors collected and reviewed patient, tumor, and treatment characteristics for all patients with histologically confirmed spinal myxopapillary ependymoma (MPE) treated consecutively from 1974 to 2015 at a tertiary institution. The results support aggressive initial surgical resection to provide the longest recurrence-free interval and RT at the time of salvage for patients treated with surgery alone in the upfront setting. Surveillance imaging of the entire neuraxis is crucial as distant failure is not uncommon, and radiotherapy at the time of relapse is critical to preventing MPE recurrence.
The authors introduced a novel "in-out-in" technique for posterior C2 screw fixation, the C2 medial pedicle screw. This technique can provide 3-column rigid fixation with satisfactory stability and can be considered to be an efficient alternative when using a C2 pedicle screw is not possible in patients with anatomical constraints.
This study demonstrated that smoking had no adverse effects on the improvements of clinical outcomes in pedicle screw–based Dynesys dynamic stabilization surgery. For smokers, the rates of screw loosening trended lower (without significance), but the chances of secondary surgery for adjacent segment disease were higher than in the nonsmoking patients. However, the optimal surgical strategy to stabilize the lumbar spine of smoking patients requires future investigation.
While previous studies have looked at risk factors for incidental durotomy in spine surgery, there has been no simple-to-use calculator where these risk factors can be plugged in by the surgeon. The authors created such a clinical calculator and believe that this tool will enable surgeons to become more aware of the true effects of these risk factors.
In this study, the authors identified a link between depression and worse clinical outcomes after surgery in adult Chiari malformation type 1 (CM-1) patients. This novel finding emphasizes the importance of optimizing the management of depression preoperatively and ensuring appropriate follow-up for psychiatric illness in the postoperative period to achieve the best possible surgical outcome in CM-1 patients. It also highlights the importance of crosstalk between neurosurgeons and psychiatrists in the treatment of CM-1 patients with severe clinical depression.
The authors present data on perioperative complications in obese patients who underwent anterior fusion lumbar interbody fusion and identify for the first time a body mass index threshold associated with increased risk. It is their hope that this will help modify current guidelines for this particular patient population.
The authors conducted a multicenter study of patients with spinal epidural arteriovenous fistulas (edAVFs), a rare type of spinal vascular malformation. This study is the largest case series of patients with spinal edAVFs, and it provides specific treatment strategies for edAVFs.
Cervical sagittal balance has some innate properties and others that are dependent on the alignment of the rest of the spine, most importantly, the upper thoracic region. The authors investigated the changes in the cervical sagittal vertical axis and lordosis resulting from a change in T1 tilt, as might be seen in patients in whom progressive thoracic kyphosis might develop with age.
The authors analyzed the outcomes of a cohort of NF1 patients with early-onset scoliosis (EOS) treated with growing rods (GRs), a method with very few reported studies. This technique provided satisfactory spinal deformity control in EOS patients with NF1 while allowing substantial spinal growth. Additional findings were that adequately contoured dual GRs with proximal hooks placed in nondystrophic regions should be used to minimize implant-related complications, and surgeons should not attempt to correct kyphosis at GR implantation because it will occur gradually throughout a lengthening program.
The authors present a pilot study of an innovative minimally invasive surgery technique targeting the pathophysiology of craniocervical junction–related syringomyelia (CCJS) in adult patients. The authors hypothesize that creating a pressure-release mechanism at the foramen magnum through a minimally invasive foramen magnum durectomy and obexostomy will equilibrate the pressure between the spinal canal and subarachnoid space, to cure CCJS.
The use of iliac screws, in addition to lumbosacral fusion using a metal cage, improves the outcomes of long fusion surgery in adult spinal deformity patients, and this would serve as a useful guideline for spine surgeons who plan and perform spinal reconstruction surgery.
The current study analyzed the biomechanical properties of two methods of fixation to the occiput to achieve occipitocervical junction stabilization. One method employs standard midline screw fixation and the second an intracranial anchor with a compressive locking mechanism. Using nondestructive and destructive testing methods, the results indicated no biomechanical differences between the two techniques and provide a biomechanical basis for the use of an occipital anchor as a viable clinical alternative to an occipital plate.
The authors identified characteristics of patients with cervical spondylotic myelopathy that predict favorable improvement after surgery. This is important because it helps patients and their surgeons make decisions about whether or not to proceed with surgery for this condition.
The authors examined how the degree of tumor embolization influenced intraoperative blood loss in spine tumor surgery. They found that blood loss was lower for those having ≥ 90% of their tumor embolized prior to surgery compared with those having less than 90% embolized. A better understanding between extent of embolization and intraoperative blood loss allows for better risk-benefit analysis.
This meta-analysis investigated the efficacy of cell salvage in reducing perioperative blood transfusions. The findings support modest efficacy of intraoperative cell salvage systems in reducing intraoperative units transfused in patients undergoing spine surgery. However, no significant effects were observed with respect to intraoperative, postoperative, and total transfusion rates or postoperative and total units transfused. Further cost analysis studies are necessary to evaluate the cost-effectiveness of cell saver in spine surgery.
The authors performed a single-patient retrospective review of a novel endoscopic technique for resection of a lumbar osteoblastoma. This paper details the feasibility of this technique to achieve a gross-total resection without complication in an appropriately selected patient.
In patients with neurological deficits from metastatic spinal cord compression, the authors quantified improvement in quality of life as mean quality-adjusted life years (QALY) gained and also identified preoperative motor weakness, bowel or bladder disturbance, and ASA class to be associated with outcomes. The finding that the mean QALY gained correlates with the number of years the patient lives after surgical decompression is important because it indicates that surgery can be beneficial to patients with a shorter life expectancy, and thus the guidelines recommending against surgery for short-lived patients need to be debated further.
The risk factors for postoperative medical complications in adult spinal deformity surgery were evaluated. The significant risks were a prognostic nutritional index < 50, male sex, and delayed ambulation. Improvement of preoperative nutritional status and postoperative early ambulation are important to avoid medical complications.
The authors report the effect of obesitH5:H14+H5:H1410y on the oblique lumbar interbody fusion (OLIF) and perioperative morbidity in obese and nonobese patients. To their knowledge, there have been no reports on the effect of obesity on OLIF perioperative factors and morbidity.
The authors performed a prospective study to evaluate the safety and effectiveness of ultrasonography (US)–MR image fusion navigation for percutaneous transforaminal endoscopic discectomy (PTED). They found that US-MR image fusion navigation is accurate for performing PTED in patients with lumbar disc herniation and is associated with a significantly lower total radiation dose and less intraoperative pain than fluoroscopic guidance. It is a promising technology for performing PTED, which requires significantly less radiation than fluoroscopy.
Sacral insufficiency fractures are a rare complication after lumbosacral arthrodesis. In this study, the authors analyzed a single-center institutional cohort of patients who underwent surgical management for this complication. Presenting symptoms and diagnostic imaging findings are discussed. Salvage surgical techniques (e.g., lumbopelvic fixation with iliac screws) and associated outcomes and complications are also described. The literature was reviewed and the authors proposed a management algorithm to help other surgeons faced with this rare but potentially challenging complication.
This is the first paper on the feasibility of a combination technique using sacral-alar-iliac and cortical bone trajectory screws. This technique could be a valid option for lumbosacral fixation due to the ease of rod placement with potential reduction in the operative time and blood loss.
The authors investigated the widely reported benefits of using tranexamic acid (TXA) to decrease blood loss in patients undergoing elective lumbar spine surgery for degenerative pathologies. The results of this study show that through decreased blood loss attributable to TXA, the overall costs of blood transfusions were less when TXA treatment was used.
This study investigates the importance of an early treatment of the mean arterial blood pressure (MABP) in spinal cord–injured patients. No previous study has investigated the correlation between neurological outcome and MABP in the prehospital, operative, and early postoperative phases. The authors found that continuous MABP levels ≥ 80 mm Hg have a significant correlation with and a moderate impact on long-term neurological outcome in the initial critical acute phase after spinal cord injury through to the first few days postoperatively.