Journal of Neurosurgery: Spine
Volume 40: Issue 2 (Feb 2024)

Illustration from Lee et al. (pp 132–142). © Jae-Koo Lee, published with permission.

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In Brief

This study aimed to research differences in blood loss, operative time, and postoperative hospitalization in patients discontinuing or not discontinuing antithrombotic therapy before elective lumbar decompression. This study found no statistical differences in these variables between patients discontinuing and those not discontinuing their antithrombotic therapy prior to decompression for lumbar spinal stenosis. Additionally, no early complications were recorded. These findings suggest that antithrombotic therapy may not be discontinued during elective decompression for lumbar spinal stenosis.

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In Brief

This study aimed to investigate the role of supine pelvic tilt (PT) in predicting mechanical failure following surgical correction for lumbar degenerative kyphosis. When postoperative PT aligns with the supine measurement, the risk of mechanical failure significantly decreases. The study offers the concept of personalized target ranges for PT correction, potentially transforming adult spinal deformity management. Also, this study is the first to shed light on PT overcorrection, offering valuable insights for improved surgical outcomes.

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OBJECTIVE

The purpose of this study was to investigate the influence of sagittal alignment according to age-adjusted pelvic incidence minus lumbar lordosis (PI-LL) and lordosis distribution index (LDI) on the occurrence of adjacent-segment disease (ASD) after lumbar fusion surgery.

METHODS

This study retrospectively reviewed 234 consecutive patients with lumbar degenerative diseases who underwent 1- or 2-level lumbar fusion surgery. Demographic and radiographic (preoperative and 3-month postoperative) data were collected and compared between ASD and non-ASD groups. Binary logistic regression analysis was performed to evaluate adjusted associations between potential variables and ASD development. A subanalysis was further conducted to assess their relationships in the range of different PI values.

RESULTS

With a mean follow-up duration of 70.6 months (range 60–121 months), 118 patients (50.4%) were diagnosed as having cranial radiological ASD. Univariate analyses showed that older age, 2-level fusion, worse preoperative pelvic tilt and LL, lower pre- and postoperative LDI, and more improvement in sagittal vertical axis were significantly correlated with the occurrence of ASD. No significant differences in the PI-LL and age-adjusted PI-LL (offset) were detected between ASD and non-ASD groups. Multivariate analysis identified postoperative LDI (OR 0.971, 95% CI 0.953–0.989, p = 0.002); 2-level fusion (OR 3.477, 95% CI 1.964–6.157, p < 0.001); and improvement of sagittal vertical axis (OR 0.992, 95% CI 0.985–0.998, p = 0.039) as the independent variables for predicting the occurrence of ASD. When stratified by PI, LDI was identified as an independent risk factor in the groups with low and average PI. Lower segmental lordosis (OR 0.841, 95% CI 0.742–0.954, p = 0.007) could significantly increase the incidence of ASD in the patients with high LDI.

CONCLUSIONS

Age-adjusted PI-LL may have limited ability to predict the development of ASD. LDI could exert an important effect on diagnosing the occurrence of ASD in the cases with low and average PI, but segmental lordosis was a more significant risk factor than LDI in individuals with high PI.

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In Brief

Researchers studied the efficacy of minimally invasive short-segment fusion with anterior column realignment for adult spinal deformity (ASD). In a select group of 61 ASD patients with pelvic incidence - lumbar lordosis mismatch > 10°, a mean fusion length of 3.0 levels decreased both the mismatch and Oswestry Disability Index scores by nearly half at a minimum 2-year follow-up. The procedure served best for a preoperative mismatch > 26.4° but clinically worked well also for a mismatch > 26.4°.

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In Brief

The purpose of this study was to provide a standardized protocol for intraoperative neuromonitoring, and to describe clinical outcomes in a cohort of individuals who underwent lateral lumbar interbody fusion surgery. This study provides a protocol algorithm for intraoperative neuromonitoring alert responses in patients undergoing lateral lumbar interbody surgery. Postoperative neurological deficit is most associated with multilevel fusion, and patients with alerts had a low rate of persistent deficit. Future research is needed to validate these findings using a more rigorous comparative study design.

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In Brief

This study aimed to compare the outcomes of one- and two-level minimally invasive lumbar microdiscectomy in treating herniated nucleus pulposus using patient-reported outcome measures. At the 1-year mark, patients who underwent two-level discectomy showed less improvement in leg pain with a lower achievement of minimal clinically important difference compared with those who underwent one-level discectomy. This research provides valuable data for clinicians to set patient expectations and underscores the need for further studies evaluating long-term outcomes for minimally invasive microdiscectomies.

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In Brief

The authors aimed to determine the most efficient treatment strategy for ambulatory patients with metastatic epidural spinal cord compression (MESCC). A trend toward improved local control (LC) with stereotactic body radiotherapy (SBRT) compared to conventional external beam radiotherapy was demonstrated. Surgery followed by adjuvant radiotherapy showed no significant benefit in terms of either LC or ambulatory function compared with radiotherapy alone. SBRT is an extremely promising treatment modality being integrated into treatment algorithms. The role of surgery is still debatable for patients with MESCC in the absence of neurologic deficit.

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In Brief

This retrospective study identified factors associated with favorable long-term neurological outcomes after spinal intramedullary ependymoma resection. The findings suggest that early surgical intervention and the absence of ataxia or gait disturbances are associated with a complete functional recovery. Interestingly, a small subset of patients experience persistent neurological deficits postresection. These insights support early surgical approaches in oligosymptomatic patients and indicate a need for further study of potentially more aggressive tumor subtypes with less favorable outcomes.

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In Brief

This paper intended to compare the clinical characteristics of spinal cord glioblastoma between adolescents and young adults (AYAs) and older adults, aiming to uncover unique clinical characteristics in AYAs. AYAs with spinal cord glioblastoma faced significantly worse survival rates compared with older adults, with distinct clinical characteristics contributing to their poorer prognosis. This study sheds light on the unique challenges that AYAs encounter when dealing with this rare, aggressive tumor, emphasizing the need for tailored treatments and further research in age- specific cancer management.

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In Brief

The aim of this study was to explore the patient characteristics that influence surgical decision-making in the operative management of cervical spondylotic myelopathy (CSM). Posterior surgery was performed in patients with older age, worse systemic disease, increased myelopathy, and greater levels of stenosis. Anterior surgery was more often performed in patients who were employed and with intervertebral disc herniation. The selection of approach for patients with CSM depends on patient demographics and symptomology.

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In Brief

The objective of this work was to perform a systematic literature review and critical appraisal of existing evidence to determine risk factors for C5 palsy (C5P). C5P is clearly associated with foraminal stenosis, especially when posterior procedures are performed. C5P is also related to decreased AP diameter, but the association is less clear. These data are helpful in preoperative discussions and may lead to surgical strategies to limit the risk of postoperative C5P.

Open access

In Brief

Two-year outcomes are presented for 125 patients implanted with 10-kHz high-frequency spinal cord stimulation within a randomized controlled trial evaluating treatment for chronic nonsurgical back pain (NSBP). The study is the first to publish long-term outcomes in a large cohort of NSBP patients where all participants had a spine surgeon consultation for inclusion. Results demonstrated a durable 2-year 82% responder rate (≥ 50% pain relief) and clinically important improvements in quality of life and function.

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In Brief

This research aimed to compare a novel spinal navigation system, using preoperative fan-beam CT, with a traditional counterpart using intraoperative cone-beam CT. The key finding indicates that the novel system achieves comparable accuracy, significantly reduces intraoperative preparation time, reduces radiation exposure, and is expected to be more cost-effective than traditional systems. This study adds value to the broader body of research by confirming that navigated spine surgery, particularly with a preoperative fan-beam CT-based system, not only shortens operative time but also holds promise for improved accessibility in less privileged settings.

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OBJECTIVE

While adhesive incision drapes are widely used for reducing surgical site infection (SSI), evidence remains scarce on whether impregnated adhesive incision draping can further reduce the rate of SSI in spine surgery.

METHODS

All patients treated surgically in the authors’ high-volume university spine center from January 2018 to December 2021 were retrospectively evaluated and divided into cohorts treated before (the control cohort) and after (the study cohort) introduction of an iodophor-impregnated adhesive incision drape (instead of a standard nonimpregnated adhesive incision drape) at their institute. Epidemiological aspects, baseline characteristics, operative records, and rate and characteristics of postoperative SSI were analyzed and compared between cohorts.

RESULTS

Two thousand two hundred seventy-nine consecutively treated patients were included, with an overall SSI rate of 0.5%. Baseline patient findings and surgical characteristics (including indication, localization, procedure, and duration of surgery) did not significantly differ between the 1125 patients in the control cohort and the 1154 patients in the study cohort. Uni- and multivariate analyses showed that use of an iodophor-impregnated adhesive incision drape was the only factor significantly associated with a lower risk of SSI. The SSI rate was significantly lower in the study cohort (0.2% vs 0.8%, p = 0.036). While germs of the skin microbiome such as Staphylococcus epidermidis and S. aureus were predominantly prevalent in both cohorts, fecal germs such as Enterococcus/Enterobacter species were found only in the control cohort and not in the study cohort.

CONCLUSIONS

The use of iodophor-impregnated adhesive incision drapes in spine surgery can help to lower the rate of postoperative SSI and aid in reducing the risk of fecal germ infections.

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In Brief

The purpose of this retrospective study was to determine the risk factors of refracture in the same cemented vertebrae after percutaneous kyphoplasty for Kümmell's disease. A volume fraction < 21.23%, bone mineral density T-score < -3.25, and anti-osteoporosis therapy are the main factors influencing refracture. The risk prediction score based on these factors can be used to forecast the incidence of refracture. At the same time, it can guide the clinical treatment of Kümmell's disease.

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In Brief

By using simulations of deformity corrections based on the alignment obtained during the procedure within the fusion, this study demonstrated that undercorrection is a major factor resulting in distal junctional kyphosis failure.

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OBJECTIVE

Cervical spondylotic myelopathy (CSM) can cause significant difficulty with driving and a subsequent reduction in an individual’s quality of life due to neurological deterioration. The positive impact of surgery on postoperative patient-reported driving capabilities has been seldom explored.

METHODS

The CSM module of the Quality Outcomes Database was utilized. Patient-reported driving ability was assessed via the driving section of the Neck Disability Index (NDI) questionnaire. This is an ordinal scale in which 0 represents the absence of symptoms while driving and 5 represents a complete inability to drive due to symptoms. Patients were considered to have an impairment in their driving ability if they reported an NDI driving score of 3 or higher (signifying impairment in driving duration due to symptoms). Multivariable logistic regression models were fitted to evaluate mediators of baseline impairment and improvement at 24 months after surgery, which was defined as an NDI driving score < 3.

RESULTS

A total of 1128 patients who underwent surgical intervention for CSM were included, of whom 354 (31.4%) had baseline driving impairment due to CSM. Moderate (OR 2.3) and severe (OR 6.3) neck pain, severe arm pain (OR 1.6), mild-moderate (OR 2.1) and severe (OR 2.5) impairment in hand/arm dexterity, severe impairment in leg use/walking (OR 1.9), and severe impairment of urinary function (OR 1.8) were associated with impaired driving ability at baseline. Of the 291 patients with baseline impairment and available 24-month follow-up data, 209 (71.8%) reported postoperative improvement in their driving ability. This improvement seemed to be mediated particularly through the achievement of the minimal clinically important difference (MCID) in neck pain and improvement in leg function/walking. Patients with improved driving at 24 months noted higher postoperative satisfaction (88.5% vs 62.2%, p < 0.01) and were more likely to achieve a clinically significant improvement in their quality of life (50.7% vs 37.8%, p < 0.01).

CONCLUSIONS

Nearly one-third of patients with CSM report impaired driving ability at presentation. Seventy-two percent of these patients reported improvements in their driving ability within 24 months of surgery. Surgical management of CSM can significantly improve patients’ driving abilities at 24 months and hence patients’ quality of life.

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OBJECTIVE

Depression has been implicated with worse immediate postoperative outcomes in adult spinal deformity (ASD) correction, yet the specific impact of depression on those patients undergoing minimally invasive surgery (MIS) requires further clarity. This study aimed to evaluate the role of depression in the recovery of patients with ASD after undergoing MIS.

METHODS

Patients who underwent MIS for ASD with a minimum postoperative follow-up of 1 year were included from a prospectively collected, multicenter registry. Two cohorts of patients were identified that consisted of either those affirming or denying depression on preoperative assessment. The patient-reported outcome measures (PROMs) compared included scores on the Oswestry Disability Index (ODI), numeric rating scale (NRS) for back and leg pain, Scoliosis Research Society Outcomes Questionnaire (SRS-22), SF-36 physical component summary, SF-36 mental component summary (MCS), EQ-5D, and EQ-5D visual analog scale.

RESULTS

Twenty-seven of 147 (18.4%) patients screened positive for preoperative depression. The nondepressed cohort had an average of 4.83 levels fused, and the depressed cohort had 5.56 levels fused per patient (p = 0.267). At 1-year follow-up, 10 patients still reported depression, representing a 63% decrease. Postoperatively, both cohorts demonstrated improvement in their PROMs; however, at 1-year follow-up, those without depression had statistically better outcomes based on the EQ-5D, MCS, and SRS-22 scores (p < 0.05). Patients with depression continued to experience higher NRS leg scores at 1-year follow-up (3.63 vs 2.22, p = 0.018). After controlling for covariates, the authors found that depression significantly impacted only 1-year follow-up MCS scores (β = 8.490, p < 0.05).

CONCLUSIONS

Depressed and nondepressed patients reported similar improvements after MIS surgery, except MCS scores were more likely to improve in nondepressed patients.

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In Brief

Limited research has been conducted on the clinical characteristics and outcomes of isolated spinal aneurysms (ISAs). The authors performed a comprehensive analysis of ISAs at their institutions and found a potential correlation between the morphology of the ISAs and their underlying causes. Furthermore, their findings suggested that saccular ISAs observed in young patients may be remnants of spinal cord arteriovenous shunts. This study offers novel insights into the etiology of ISAs.

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In Brief

This study was performed to identify the risk factors of adjacent-segment disease after short fusion for de novo degenerative lumbar stenosis. The authors found that disc wedging angle greater than 2.5°, presence of facet tropism, and foraminal stenosis greater than grade 2 preoperatively at the adjacent level to the fusion were risk factors for adjacent-segment disease. Therefore, one should consider including the segment with these pathologies within the fusion.

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In Brief

This study aimed to evaluate the safety and efficacy of surgical interventions within 24 hours versus after 24 hours for the management of acute traumatic central cord syndrome (ATCCS). The key findings suggest that early surgery (≤ 24 hours) may offer advantages, particularly in terms of lower complication rates, though improvements in American Spinal Injury Association motor scores were not significantly different compared to surgical procedures performed later (> 24 hours). This study adds value to the ongoing debate regarding the optimal timing for surgical intervention in ATCCS, highlighting the potential benefits of earlier surgery and emphasizing the need for further research to elucidate clinical implications.

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OBJECTIVE

Degenerative spine conditions affect many people each year. These conditions have been shown to negatively impact pain, function, and patient quality of life (QOL), which often require surgical intervention. It is understood that sleep plays an important role in all of these factors. However, the relationship between sleep disruption and lumbar surgery is not well understood. The objective of this study was to use a large database to understand the relationship between sleep quality and lumbar spine surgery outcomes.

METHODS

The surgical database of the authors’ institute was used to identify all patients undergoing lumbar spine surgery for degenerative spine disease from January 1, 2012, through December 31, 2021. Patient-Reported Outcomes Measurement Information System (PROMIS) sleep disturbance scores were collected, and only patients with both pre- and postoperative scores were included. Additional measures related to disability, pain, and depression were also obtained. Chart review was performed to collect patient demographics, health risk factors, and information related to sleep disturbances such as sleep medication usage and prior sleep condition diagnosis.

RESULTS

The study had 674 patients who met the criteria. At 3, 6, and 12 months postoperatively, there was a significant decrease in sleep disruption scores (i.e., sleep improvement), although these decreases were not greater than the minimal clinically important difference (MCID). When stratified based on preoperative sleep quality, patients with poor preoperative scores (PROMIS sleep disruption > 63.04) showed a significant decrease in sleep disruption by 8.17 at 3 months, 7.99 at 6 months, and 7.21 at 12 months. All of these decreases were greater than the sleep disruption MCID of 6.5. Multivariate analysis showed high preoperative sleep disruption and improvement in PROMIS physical health were most associated with decreased postoperative sleep disruption at all postoperative time points.

CONCLUSIONS

In patients with degenerative spine conditions, lumbar spine surgery offers improvement in sleep disruption for all patients. Those with poor preoperative sleep quality are more likely to see clinical improvement in their sleep disruption.

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In Brief

This study aimed to assess the influence of the connection levels and rod configuration of the accessory rod (AR) on rod fracture occurrence in patients with adult spinal deformity who underwent long level constructs and pedicle subtraction osteotomy. The authors' findings revealed that the D-shaped configuration of AR and lower end of AR below S1–2 (i.e., long AR) can be preventive methods for reducing rod fracture. Here, they have provided the first comprehensive outline for the AR technique.

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In Brief

This study retrospectively compared outcomes and complications between patients with upper instrumented vertebrae at L4 and L5 when correcting pediatric L5–S1 spondylolisthesis. The authors found that fusion to L5 is as effective as extension to L4, though there was a higher chance of adjacent-segment instability. This suggests that extending fusion to L4 might not be crucial, offering new insights for future treatment strategies.

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In Brief

The purpose of the present study was to modify and validate the Clavien-Dindo-Sink complication classification system for applications in spine surgery. The proposed classification system demonstrated excellent inter- and intrarater reliability in spine surgery cases. This modified classification system provides a useful framework to better communicate the severity of spine-related complications.

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In Brief

The goal of this study was to identify the effect of surgery within 8 hours in older patients with cervical spinal cord injury (CSCI). Urgent surgery within 8 hours for patients older than 70 years who had CSCI did not increase the perioperative complication rate and improved the American Spinal Injury Association motor scores. Urgent surgery within 8 hours for older patients with CSCI need not be avoided due to the risk of perioperative complications and may be desirable for a favorable neurological prognosis.

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OBJECTIVE

Both the Global Alignment and Proportion (GAP) score and Roussouly classification account for the lordosis distribution index (LDI), but the LDI of the GAP score (G-LDI) is typically set to 50%–80%, while the LDI of the Roussouly classification (R-LDI) varies depending on the degree of pelvic incidence (PI). The objective of this study was to validate the ability of the G-LDI to predict mechanical complications and compare it with the predictive probability of R-LDI in patients with long-level fusion surgery.

METHODS

A total of 171 patients were divided into two groups: 93 in the nonmechanical complication group (non-MC group) and 78 in the mechanical complication group (MC group). The mean age of the participants was 66.79 ± 8.56 years (range 34–83 years), and the mean follow-up period was 45.49 ± 16.20 months (range 24–62 months). The inclusion criteria for the study were patients who underwent > 4 levels of fusion and had > 2 years of follow-up. The predictive models for mechanical complications using the G-LDI and R-LDI were analyzed using binomial logistic regression and receiver operating characteristic analyses.

RESULTS

There was a significant correlation between R-LDI and PI (r = −0.561, p < 0.001), while there was no correlation between G-LDI and PI (r = 0.132, p = 0.495). In reference to G-LDI, most patients in the non-MC group were classified as having alignment (72, 77.4%), while the MC group had an inhomogeneous composition (aligned: 34, 43.6%; hyperlordosis: 37, 47.4%). The agreement between the G-LDI and R-LDI was moderate (κ = 0.536, p < 0.001) to fair (κ = 0.383, p = 0.011) for patients with average or large PI, but poor (κ = −0.255, p = 0.245) for those with small PI. The areas under the curve for the G-LDI and R-LDI were 0.674 (95% CI, 0.592–0.757) and 0.745 (95% CI, 0.671–0.820), respectively.

CONCLUSIONS

The R-LDI, which uses a PI-based proportional parameter, enables individual quantification of LL for all PI sizes and has been shown to have a higher accuracy in classifying cases and a stronger correlation with the risk of mechanical complications compared with G-LDI.

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In Brief

Researchers aimed to quantify pre- and postoperative paraspinal muscular variation following posterior lumbar interbody fusion (PLIF) in patients with degenerative lumbar spinal stenosis (DLSS) and measure the association of this variation with adjacent-segment degeneration (ASD). Compensatory postoperative decrease in fatty infiltration of the psoas major muscle at the adjacent level was a protective factor for ASD in DLSS patients after PLIF.

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In Brief

The purpose of this study was to explore the effect of multiple social factors on postoperative outcomes and satisfaction in patients undergoing surgery for cervical spondylotic myelopathy. The effect of social factors is additive in that patients with a higher number of factors are less likely to improve compared to those with only one social factor. The social context of patients is an important factor to consider when discussing expectations and outcomes for surgery.

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Social media platforms have taken a prominent role in healthcare for both patients and providers in various areas of medicine, including spine surgery. Patients increasingly use social media to learn about their condition, find treatment options, and research the surgeon entrusted with their care. The latter has incentivized surgeons to enhance their online presence in nonprofessional (e.g., Facebook, Instagram, and X [formerly known as Twitter]) as well as professional (e.g., LinkedIn) platforms. Nearly all spine surgeons now have an account in social media. Furthermore, a more ubiquitous presence on social media correlates with a higher rating

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In Brief

The purpose of the study was to determine if the presence of myelography dye affects HU measurements of bone density on CT studies. The results showed that the presence of myelography dye had no clear effect on CT HU measurements of bone density, thus supporting the use of CT myelograms for bone density assessment in the absence of standard CT images.

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In Brief

Spine surgeons are at increased risk of work-related musculoskeletal disorders (MSDs). The authors assessed the rate of MSDs and comfort in the use of surgical instruments in an anonymous survey of a diverse cohort of spine surgeons. The study reports a high rate of MSDs and a persistent gender-based difference in comfort in instrument use. These findings can guide efforts to mitigate MSDs and promote surgeon-centered approaches to instrument development.

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OBJECTIVE

Cadaveric and dry 3D model-based simulation training is a valuable educational tool for neurosurgical residents. Such simulation training is an opportunity for residents to hone technical skills and decision-making and enhance their neuroanatomy knowledge. The authors describe the growth and development of the Oregon Health & Science University Department of Neurological Surgery resident-focused, hands-on, spine-simulation surgery courses and provide details of course evaluations, layout, and setup.

METHODS

A four-part spine surgical simulation series, including two human cadaveric and two dry 3D model-based courses, was created to provide resident spine procedure training. Residents participated in the spine simulation series (2017–2021) and completed annual course curriculum and anonymous post-course evaluations. Evaluations included both Likert scale items and free-text responses. Responses to Likert scale items were analyzed in Python. Free-text responses were quantified using the Valence Aware Dictionary for Sentiment Reasoner. Descriptive statistics were calculated and plotted using Python’s seaborn and matplotlib library modules.

RESULTS

The analysis included 129 spine (occipitocervical, thoracolumbar, and spine model fusion I and II) simulation course evaluations. Likert responses demonstrated high average responses for evaluation questions (4.67 ± 0.90 and above). The average compound sentiment value was 0.58 ± 0.28.

CONCLUSIONS

This is the first time Likert responses and sentiment analysis have been used to demonstrate how neurosurgical residents positively value a hands-on spine simulation training. Simulation is an essential component of neurosurgical resident education training. The authors encourage other neurosurgical education programs to develop and leverage spine simulation as a teaching tool.

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In Brief

This study compares outcomes after kyphoplasty in patients stratified by age and frailty assessed by the Risk Analysis Index (RAI). Frailty was found to serve as a better predictor than age for 30-day and 1-year postoperative complications following kyphoplasty. Age alone should not be used as an exclusion criterion during patient selection, and the RAI is a straightforward assessment tool to be used for patient selection, as a guide in surgical decision-making, and to better facilitate discussions with patients.

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In Brief

This article aimed to examine the relationship between pelvic tilt changes and global compensatory parameters after adult spinal deformity (ASD) corrective surgery. The authors found that patients who had their pelvic tilt normalized postoperatively were more likely to demonstrate resolution of thoracic and lower-extremity compensatory parameters, and they also experienced lower complication rates. This study highlights the need for consideration of global compensatory mechanisms when planning ASD surgery in order to optimize realignment and ameliorate the risk of adverse outcomes.

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In Brief

This article aimed to examine the current information on cervical spine deformity (CSD) surgery with particular emphasis on radiographic alignment, deformity morphology, perioperative optimization, and surgical strategy. Additionally, consideration of the specific patient presentation, overall physiological health state, and disease attributable morbidity is discussed to provide a more individualized approach to treatment. The authors report that the field continues to evolve, and that it is an area primed to benefit significantly from further innovation. This study provides a synopsis of current CSD knowledge and may serve as a reference and springboard for future research endeavors aimed at enhancing CSD patient care.

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In Brief

This study investigated the impact of pelvic incidence (PI) and lumbar lordosis (LL) matching on clinical outcomes in patients undergoing one- or two-level lumbar fusions for degenerative pathology. Proper PI-LL matching in one- and two-level lumbar fusions for degenerative pathology leads to improved outcomes at the 24-month follow-up. Patients with maintained proper alignment after surgery experience continued improvement in disability levels. Surgeons should consider longer follow-up in patients in whom proper alignment was not initially achieved.

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TO THE EDITOR: We read with interest the article by Prasse et al., 1 which concluded postoperative remote patient monitoring and communication after complete endoscopic surgery could be achieved using the SPINEhealthie app (Prasse T, Yap N, Sivakanthan S, et al. Remote patient monitoring following full endoscopic spine surgery: feasibility and patient satisfaction. J Neurosurg Spine. 2023;39[1]:122-131). However, several concerns have arisen regarding this study.

First, while we acknowledge the convenience and enhanced patient satisfaction associated with an in-app chat function for communication with healthcare providers, we are apprehensive about its potential to increase the

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OBJECTIVE

Questions regarding anticipated pain improvement and functional recovery postsurgery are frequently posed in preoperative consultations. However, a lack of data characterizing outcomes for the first postoperative days only allows for anecdotal answers. Hence, the assessment of ultra-early patient-reported outcome measures (PROMs) is essential for patient-provider communication and patient satisfaction. The aim of this study was to elucidate this research gap by assessing and characterizing PROMs for the first days after full endoscopic spine surgery (FESS).

METHODS

This multicenter study included patients undergoing lumbar FESS from March 2021 to July 2023. After informed consent was provided, data were collected prospectively through a smartphone application. Patients underwent either discectomy or decompression. Analyzed parameters included demographics, surgical details, visual analog scale scores for both back and leg pain, and the Oswestry Disability Index (ODI) score. Data were acquired daily for the 1st postoperative week, as well as after 2 weeks, 3 months, and 6 months.

RESULTS

A total of 182 patients were included, of whom 102 underwent FESS discectomy and 80 underwent FESS decompression. Significant differences between the discectomy and decompression groups were found for age (mean 50.45 ± 15.28 years and 63.85 ± 13.25 years, p < 0.001; respectively), sex (p = 0.007), and surgery duration (73.45 ± 45.23 minutes vs 98.05 ± 46.47 minutes, p < 0.001; respectively). Patients in both groups reported a significant amelioration of leg pain on the 1st postoperative day (discectomy group VAS score: 6.2 ± 2.6 vs 2.4 ± 2.9, p < 0.001; decompression group: 5.3 ± 2.8 vs 1.9 ± 2.2, p < 0.001) and of back pain within the 1st postoperative week (discectomy group VAS score: 5.5 ± 2.8 vs 2.8 ± 2.2, p < 0.001; decompression group: 5.2 ± 2.7 vs 3.1 ± 2.4, p < 0.001). ODI score improvement was most pronounced at the 3-month time point (discectomy group: 21.7 ± 9.1 vs 9.3 ± 9.1, p < 0.001; decompression group: 19.3 ± 7.8 vs 9.9 ± 8.3, p < 0.001). For both groups, pain improvement within the 1st week after surgery was highly predictive of later benefits.

CONCLUSIONS

Ultra-early PROMs reveal an immediate pain improvement after FESS. While the benefits in pain reduction plateaued within the 1st postoperative week for both groups, functional improvements developed over a more extended period. These results illustrate a biphasic rehabilitation process wherein initial pain alleviation transitions into functional improvement over time.

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In Brief

The aim of this paper was to identify predictors of the best 24-month improvements in disability, quality of life, and functional status in patients undergoing surgery for cervical spondylotic myelopathy. Shorter preoperative symptom duration, arm-pain only complaints, lower body mass index, and anterior operative approaches were associated with the best outcomes. The finding that shorter preoperative symptom duration was associated with the best disability outcomes suggests that early surgery may be beneficial for patients with cervical spondylotic myelopathy.

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In Brief

Researchers assessed the effects of gender on postoperative outcomes following elective spine surgery. Males are more likely to experience death and medical complications, while females are more likely to face wound-related surgical complications. At the institutional level, females more often experience nonroutine discharge and longer hospital stays. These findings identify that a patient's gender and accompanying comorbidities may be important factors when considering preoperative expectation management and postoperative risk assessment.

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In Brief

The purpose of this study was to assess the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, and systemic immune-inflammation index in predicting postoperative outcomes among patients with surgically treated spinal metastasis. The authors found high preoperative NLR and systemic immune-inflammation index to be independently associated with 30-day mortality, whereas elevated NLR was associated with shorter overall survival. Although further validation is needed, these biomarkers may be used in determination of surgical candidacy or for incorporation into existing prognostication models.

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In Brief

In this paper, the authors aimed to explore sex differences in the accuracy and optimal diagnostic thresholds of vertebral bone quality (VBQ) scores used in assessing bone mineral density (BMD). VBQ scores were more accurate in predicting low BMD in female than in male patients, with similar thresholds for both sexes. This study suggests that clinicians should be prudent when using VBQ scores to assess BMD in male patients, to avoid obtaining spurious results.

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OBJECTIVE

Leiomyosarcoma (LMS) is a rare, aggressive soft-tissue sarcoma that seldom spreads to the bone. The spine can be either the site of LMS osseous metastases or the primary tumor site. The optimal treatment option for spinal LMS is still unclear. The authors present a cohort of patients with spinal LMS treated with either upfront surgery or upfront CyberKnife stereotactic radiosurgery (SRS).

METHODS

The authors retrospectively studied the clinical and radiological outcomes of 17 patients with spinal LMS treated at their institution between 2004 and 2020. Either surgery or SRS was used as the upfront treatment. The clinical and radiological outcomes were assessed. A systematic review of the literature was also conducted.

RESULTS

Of the 17 patients (20 spinal lesions), 12 (70.6%) were female. The median patient age was 61 years (range 41–80 years). Ten patients had upfront surgery for their spinal lesions, and 7 had upfront CyberKnife radiosurgery. The median follow-up was 11 months (range 0.3–130 months). The median overall survival (OS) for the entire cohort was 13 months (range 0.3–97 months). In subgroup analysis, the median OS was lower for the surgical group (13 months, range 0.3–50 months), while the median OS for the SRS group was 15 months (range 5–97 months) (p = 0.5). Forty percent (n = 4) of those treated with surgery presented with local recurrence at a median of 6.7 months (range 0.3–36 months), while only 14% (n = 1) of those treated with CyberKnife radiosurgery had local recurrence after 5 months. Local tumor control (LTC) rates at the 6-, 12-, and 18-month follow-ups were 72%, 58%, and 43%, respectively, for the SRS group and 40%, 30%, and 20%, respectively, for the surgery group (p < 0.05). The literature review included 35 papers with 70 patients harboring spinal LMS; only 2 patients were treated with SRS. The literature review confirms the clinical and radiological outcomes of the surgical group, while data on SRS are anecdotal.

CONCLUSIONS

The authors present the largest series in the literature of spinal LMS and the first on SRS for spinal LMS. This study shows that LTC is statistically significantly better in patients receiving upfront SRS instead of surgery. The OS does not appear different between the two groups.

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In Brief

It has been hypothesized that cervical foraminal stenosis affecting the spinal nerves results in changes in the multifidus and rotatores muscles. The results of this study demonstrated level- and side-specific correlations between fatty infiltration of the multifidus and rotatores muscles and severity of cervical foraminal stenosis. Given the segmental innervation of these muscles, the authors hypothesize that the increased fatty infiltration could be reflective of changes due to muscle denervation from cervical foraminal stenosis.

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In Brief

Researchers used a large administrative database to follow patients longitudinally after single-level cervical disc arthroplasty and anterior cervical discectomy and fusion. In contradiction to the available data from cervical disc replacement randomized control trials, no difference out to 10 years was found in the cervical reoperation rates between the two procedures. This is the largest long-term outcome data study to compare the two procedures as they are actually used in clinical practice.