Journal of Neurosurgery: Spine
Volume 34: Pages 1-160

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Authors: Michael M. H. Yang, Jay Riva-Cambrin, Jonathan Cunningham, Nathalie Jetté, Tolulope T. Sajobi, Alex Soroceanu, Peter Lewkonia, W. Bradley Jacobs, and Steven Casha

In Brief

The authors developed a clinical prediction score to identify patients at risk of developing poor postoperative pain control after spine surgery. Seven variables predictive of inadequate pain control were incorporated into this score. This score accurately predicted the probability of heightened pain after elective spine surgery. The ability of clinicians to risk-stratify patients preoperatively creates an opportunity to develop anticipatory therapies and personalized clinical care pathways to improve pain outcomes after spine surgery.

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Authors: Praveen V. Mummaneni, John F. Burke, Andrew K. Chan, Julie Ann Sosa, Errol P. Lobo, Valli P. Mummaneni, Sheila Antrum, Sigurd H. Berven, Michael S. Conte, Sarah B. Doernberg, Andrew N. Goldberg, Christopher P. Hess, Steven W. Hetts, S. Andrew Josephson, Maureen P. Kohi, C. Benjamin Ma, Vaikom S. Mahadevan, Annette M. Molinaro, Andrew H. Murr, Sirisha Narayana, John P. Roberts, Marshall L. Stoller, Philip V. Theodosopoulos, Thomas P. Vail, Sandra Wienholz, Michael A. Gropper, Adrienne Green, and Mitchel S. Berger

In Brief

The authors utilized a Delphi technique to establish consensus and create perioperative protocols for emergent, urgent, and elective procedures during the early days of the COVID-19 pandemic. These protocols were designed with the input of 7 department chairs as well as the chief medical officer, an epidemiologist, an ethicist, and a statistician. The protocols presented may provide guidance to hospital teams if there is another surge in COVID-19 cases creating a strain on healthcare resources.

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Authors: Thiago S. Montenegro, Kevin Hines, Paul P. Partyka, and James Harrop

In Brief

The authors have observed that references cited often do not correlate with the work or are misreferenced. When a reader or future author inquires about a citation and the source of the data cannot be located, this causes concern regarding attribution and may perpetuate erroneous interpretations that can affect patient care. This responsibility for accuracy also falls on the editors, reviewers, and publishers. In a review of four spine journals, the authors discovered variability in the reference accuracy rates. The goal of this paper is to educate about the need for correctly referencing the literature and spending the additional time to be accurate.

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Authors: Luca Ricciardi, Sokol Trungu, Alba Scerrati, Pasquale De Bonis, Oriela Rustemi, Mauro Mazzetto, Giorgio Lofrese, Francesco Cultrera, Cédric Y. Barrey, Alessandro Di Bartolomeo, Amedeo Piazza, Massimo Miscusi, and Antonino Raco

In Brief

The authors retrospectively evaluated the role of different risk factors in influencing the fusion rate after Anderson type II odontoid fractures. In their case series, more than 7 days between injury and surgery was the most relevant risk factor for nonfusion and was associated with a 48 times higher risk. Therefore, the duration from injury to surgery may influence the fusion rate more than patients' interindividual characteristics and radiological measurements.

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Authors: Chris Yin Wei Chan, Chee Kidd Chiu, Yun Hui Ng, Saw Huan Goh, Xin Yi Ler, Sherwin Johan Ng, Xue Han Chian, Pheng Hian Tan, and Mun Keong Kwan

In Brief

This retrospective study analyzed the preoperative and postoperative radiological shoulder and neck parameters following posterior spinal fusion (PSF) in two subtypes of Lenke 1 curves. Lenke 1 (stiff) curves had a significantly higher incidence of left medial (T1 tilt) shoulder and neck imbalance (cervical axis) than Lenke 1 (flexible) curves. Following PSF, +ve T1 tilt was noted in 41% of Lenke 1 (stiff) patients versus 2.0% in Lenke 1 (flexible) patients. Recognizing these two Lenke 1 curve subtypes preoperatively would allow surgeons to tailor their surgical strategy to prevent positive medial shoulder imbalance, particularly in Lenke 1 (stiff) curves.

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Authors: Jesse J. McClure, Bhargav D. Desai, Leah M. Shabo, Thomas J. Buell, Chun-Po Yen, Justin S. Smith, Christopher I. Shaffrey, Mark E. Shaffrey, and Avery L. Buchholz

In Brief

The researchers retrospectively reviewed 3- and 4-level anterior cervical discectomy and fusion cases to determine fusion rates and time to fusion at each level. Fusion rates and time to fusion were not significantly different from C3 to C6; however, C6–7 was less likely to fuse and took longer to do so. The researchers provide possibilities as to why fusion rates vary in the literature, and they provide clinical expectations for physicians and patients regarding fusion success rates and length of time to fusion.

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Authors: Koichi Murata, Shunsuke Fujibayashi, Bungo Otsuki, Takayoshi Shimizu, Kazutaka Masamoto, and Shuichi Matsuda

In Brief

Fluoroscopy is still widely used for percutaneous pedicle screw insertion. The coaxial fluoroscopic view of the pedicle to place the percutaneous pedicle screw is expected to improve the accuracy and decrease the risk of the superior facet joint violation. The authors clarified the accuracy of percutaneous pedicle screw insertion and identified the risk factors for malposition, which to their knowledge have not been shown in previous reports.

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Authors: Mladen Djurasovic, Steven Glassman, Jeffrey L. Gum, Charles H. Crawford III, R. Kirk Owens II, and Leah Y. Carreon
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Authors: Akira Matsumura, Takashi Namikawa, Minori Kato, Yusuke Hori, Noriaki Hidaka, and Hiroaki Nakamura

In Brief

Here, the authors evaluated the prevalence of postoperative coronal imbalance (CIB) and its related factors in patients with adult lumbar scoliosis. The key findings were that postoperative CIB negatively affects health-related quality of life, and an imbalanced correction between thoracolumbar or lumbar and lumbosacral curves may cause postoperative CIB. This study demonstrated the importance of postoperative coronal balance in adult spinal deformity surgery.

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Authors: Christine Park, Alessandra N. Garcia, Chad Cook, Christopher I. Shaffrey, and Oren N. Gottfried

In Brief

The goal of this study was to investigate the long-term clinical outcome differences across BMI classifications in patients who underwent lumbar spine surgery. The authors found that higher BMI was associated with poorer outcomes and satisfaction at both the 12- and 24-month follow-ups. A BMI of 30 kg/m2 was the cutoff for predicting worse patient outcomes after lumbar surgery. BMI is a significant patient factor that can affect outcomes after spine surgery.

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Authors: Ping-Guo Duan, Praveen V. Mummaneni, Minghao Wang, Andrew K. Chan, Bo Li, Rory Mayer, Sigurd H. Berven, and Dean Chou

In Brief

Researchers retrospectively investigated whether obesity affected surgery rates for adjacent-segment disease (ASD) after transforaminal lumbar interbody fusion (TLIF) for spondylolisthesis. Obesity may be associated with an increased risk of surgery for ASD after TLIF for patients with a pelvic incidence minus lumbar lordosis (PI-LL) mismatch. The clinical significance of this study serves as a reminder to the surgeon that the high risk of surgery for ASD should be taken into consideration in obese patients with a PI-LL mismatch.

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Authors: Marcel R. Wiley, Leah Y. Carreon, Mladen Djurasovic, Steven D. Glassman, Yehia H. Khalil, Michelle Kannapel, and Jeffrey L. Gum

In Brief

The authors investigated patient predictors for 90-day emergency room (ER) visit after elective lumbar spine surgery, which were found to include prior ER visit, underserved zip code, and multiple chronic medical conditions. Predictors for readmission were obesity, race, prior ER visits, multiple chronic medical conditions, ER admission, and elevated hemoglobin A1c. Proper patient selection, appropriate postoperative pain management, and optimization of modifiable risk factors prior to surgery can lower the risk for 90-day ER visits and readmissions and reduce healthcare costs.

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Authors: Griffin R. Baum, Alex S. Ha, Meghan Cerpa, Scott L. Zuckerman, James D. Lin, Richard P. Menger, Joseph A. Osorio, Simon Morr, Eric Leung, Ronald A. Lehman Jr., Zeeshan Sardar, and Lawrence G. Lenke

In Brief

The authors sought to validate the Global Alignment and Proportion score in a cohort of patients undergoing adult spinal deformity surgery. No statistically significant difference was found in the rate of mechanical complications between proportioned, mildly disproportioned, and severely disproportioned groups. The current validation study revealed poor generalizability in this patient population. Despite clear benefits of the Global Alignment and Proportion score, the results bring forth the possibility that certain unmeasured elements may contribute to mechanical complications that are not addressed by this score. Future studies are required to improve on the predictive value for postoperative mechanical complications.

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Authors: Mostafa H. El Dafrawy, Owoicho Adogwa, Adam M. Wegner, Nicholas A. Pallotta, Michael P. Kelly, Khaled M. Kebaish, Keith H. Bridwell, and Munish C. Gupta

In Brief

The authors performed a study to determine the intra- and interobserver reliability of a new classification system that allows the description of all possible constructs used across three-column osteotomies (3COs) in terms of rod configuration and density. This new, comprehensive multirod construct classification system with good inter- and intraobserver reliability and a high degree of agreement allows for a standardized description of multirod constructs across 3COs.

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Authors: Remi A. Kessler, Ansh Bhammar, Nikita Lakomkin, Raj K. Shrivastava, Jonathan J. Rasouli, Jeremy Steinberger, Joshua Bederson, Constantinos G. Hadjipanayis, and Deborah L. Benzil

In Brief

The authors investigated spinal cord injury (SCI) incidence in the US Army Special Forces (SF), its mechanisms of acquisition, and potential areas for intervention by addressing key issues pertaining to personal protective equipment and body armor use. SCI had a high self-reported incidence, with the primary cause attributed to airborne operations and most injuries occurring while wearing headgear and no body armor. Combat-related spinal injuries constitute more than 11% of all US casualties from the recent Iraq and Afghanistan wars, yet the current profile of war-related SCI is poorly understood and has not been previously examined in the SF.

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Authors: Matthew P. Guttman, Jeremie Larouche, Frank Lyons, and Avery B. Nathens

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In patients with multiple traumatic injuries, surgeons are unsure as to the optimal timing for surgical repair of spine fractures in patients without spinal cord injury. While awaiting surgery, patients are at risk for complications due to immobility. The authors set out to define the optimal time to perform surgery to repair spinal fractures that occur following trauma. They showed that surgical repair within 24 hours of injury can reduce major complications by 25%–30%.

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Authors: Andrew M. Gardeck, Xuan Pu, Qiuyu Yang, David W. Polly, and Kristen E. Jones

In Brief

The authors developed a novel standardized resident training module for placement of thoracolumbar pedicle screws in a reproducible synthetic spine model utilizing 3D navigation. Neurosurgery and orthopedic surgery residents used a 3D navigation system to place pedicle screws in the synthetic spine training model. Two sessions were completed at least 10 days apart. The residents had significant improvement between the first and second sessions. This model will enhance efficiency and safety of resident education through improving proficiency with pedicle screw placement.

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Authors: Zach Pennington, Jeff Ehresman, Ethan Cottrill, Daniel Lubelski, Kurt Lehner, James Feghali, A. Karim Ahmed, Andrew Schilling, and Daniel M. Sciubba

In Brief

Expected survival is a key determinant of surgical candidacy in patients with spinal metastases. To date, numerous scoring systems have been put forth without achieving consensus on which is the best clinical tool when evaluating surgical candidates. Here, the authors review previously published scoring systems, highlighting their relative strengths and weaknesses and summarizing previous comparative studies aimed at identifying the scoring system with the greatest prognostic accuracy. They found that the more comprehensive web-based Skeletal Oncology Research Group predictive calculators are likely the best available tools; however, further refinement is necessary, including the incorporation of quality-of-life predictors.

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Authors: Nebojsa Lasica, Djula Djilvesi, Bojan Jelaca, and Petar Vulekovic
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Authors: Raghu Samala, Mohit Agrawal, Kanwaljeet Garg, and Manmohan Singh
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Authors: Kanwaljeet Garg and Manmohan Singh
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The authors assessed the safety of fibrous union in type II odontoid fractures, which occurred commonly with nonoperative management. The use of braced upright cervical radiographs to aid decision-making in type II odontoid fracture management was validated. Operative and nonoperative management outcomes were compared. A management algorithm for these common fractures is provided with supporting safety and efficacy profiles from the authors' high-volume center.

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In Brief

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

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In Brief

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

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In Brief

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

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In Brief

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

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

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In Brief

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

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

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In Brief

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

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

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

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In Brief

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

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

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

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

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

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

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

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In Brief

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

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The authors used multicenter data to investigate outcomes and complications associated with adult spinal deformity (ASD) surgery in patients with severe global coronal malalignment (GCM). Despite high rates of associated complications, there was significant improvement in radiographic and health-related quality-of-life outcome measures, and a residual GCM of 3 cm was identified as a potential realignment threshold associated with a worse outcome. The full clinical significance of GCM, especially when more severe, and its surgical correction have yet to be fully elucidated for ASD surgery, but these results likely represent initial progress.

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In this study the authors aimed to investigate a large number of atlantoaxial rotatory fixation (AARF) cases to construct an algorithm to determine the best treatment for patients with AARF. This study makes a significant contribution to the literature and, to the best of the authors' knowledge, is the first study to review more than 100 cases.

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The authors performed the first systematic review of the pathologies associated with cervical angina, a rare noncardiac syndrome of chest pain, as well as the different treatments used to manage this condition. Ultimately, the authors found that cervical herniation accounts for the majority of cases of cervical angina, and that surgical interventions are generally used to provide pain relief, although physical therapy and medical management strategies can be effective. The clinical significance of these findings is that cervical angina should be considered as a differential diagnosis when patients present with angina of noncardiac etiology.

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The authors conducted a review of the available literature reporting studies of radiological predictors of reoperation following lumbar discectomy. Disc height index, sagittal range of motion, and type 1 Modic changes were found to be strongly related to an increased rate of reoperation. These findings add to the evidence in favor of the argument for considering spinal fusion as a primary operation in patients at high risk of recurrence.

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The objective of this study was to estimate the incidence rate of spine-specific skeletal related events (SREs) in patients with non–small cell lung cancer and to quantify the impact of SREs on overall mortality. The presence of SREs was found to be associated with an increased incidence rate of mortality. The observed findings may be used to help patients and providers make treatment decisions based on the presence (or lack thereof) of SREs.

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Researchers presented a large consecutive series of 39 surgically treated cases with progressive dystrophic lumbar scoliosis secondary to neurofibromatosis type 1 to assess the unique characteristics associated with surgical treatment. Surgical strategies for dystrophic lumbar scoliosis secondary to neurofibromatosis type 1 were diverse, being crucially determined by the location and the severity of dystrophic changes. Additional posterior satellite rods or supplementary anterior fusion is necessary in cases with insufficient apical screw density. Despite a high incidence of postoperative coronal imbalance, improvement of coronal balance was frequently confirmed during follow-up.

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As the healthcare field strives for optimized inpatient stays, one of the greatest limiting factors is postoperative discharge planning. In patients with spine tumors, the authors found that factors affecting discharge status were frailty, lower serum albumin level, staged surgeries, and emergency admissions. These factors were combined into a simple-to-use web-based calculator, which multidisciplinary teams can now use to assess patient likelihood of requiring rehabilitation and begin this discharge planning process earlier to avoid unnecessary days spent in the hospital.

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In this study the authors looked at the effect of adding more interbody devices (metal cages) to fusion surgery for patients with scoliosis who have specific pain in the low back and/or down their legs (caused by the so-called fractional curve area of the spine). The authors showed that using more of these metal cages allows more correction of certain aspects of the spine in these patients without drastically changing the complication rate.

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Transforaminal lumbar interbody fusion (TLIF) is an effective treatment for lumbar degenerative conditions. Although an expandable TLIF cage could theoretically affect foraminal height and lumbar lordosis, the outcomes on spinopelvic parameters have not been well addressed. The objective of this study is to compare the radiographic outcomes of patients who underwent a TLIF with expandable versus static cages. The results demonstrated that subsidence and endplate violation may negate any significant gains compared to static cages and provided long-term results of expandable cages, and identified factors that influence the surgical result when expandable cages were used.

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The authors analyzed the anatomical characteristics of dural defects and surgical techniques in treating spontaneous CSF leaks. This case series is important because it is the first to analyze the microsurgical anatomy of ventral dural defects in spontaneous CSF leaks in detail.

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The authors compared the outcomes of microsurgical versus endovascular treatment of spinal dural arteriovenous fistulas (dAVFs). The study results showed that progression-free survival was longer with index neurosurgery than with index endovascular treatment and that neurosurgery via limited laminectomy was superior to endovascular embolization as a primary treatment for complete dAVF obliteration. This study is important because it provides the most recent and largest data set of patients with spinal dAVFs based on a multicenter cohort.

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

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