Authors:Shireen Parsai, Aditya Juloori, Lilyana Angelov, Jacob G. Scott, Ajit A. Krishnaney, Inyang Udo-Inyang, Tingliang Zhuang, Peng Qi, Matthew Kolar, Peter Anderson, Stacey Zahler, Samuel T. Chao, John H. Suh and Erin S. Murphy
This study is the first to specifically describe the application of spine radiosurgery in adolescent and young adult patients. A registry of patients was retrospectively reviewed to report oncological outcomes and toxicity. The authors describe in detail the techniques employed for designing and delivering radiosurgery. This study is timely in an era in which metastatic pediatric sarcomas are treated aggressively with radiosurgery to all sites of disease.
Authors:Jeff Ehresman, Andrew Schilling, Zach Pennington, Chengcheng Gui, Xuguang Chen, Daniel Lubelski, A. Karim Ahmed, Ethan Cottrill, Majid Khan, Kristin J. Redmond and Daniel M. Sciubba
The authors created a scoring system that can be used to detect bone quality from an MR image of the lumbar spine in order to predict whether patients with spine metastases will fracture their spines. This tool will allow healthcare providers to estimate bone quality in these patients without requiring the patients to undergo dual-energy x-ray absorptiometry scanning in order to avoid any delays in care.
Authors:Alessandro Cianfoni, Daniela Distefano, Pietro Scarone, Gianfranco A. Pesce, Vittoria Espeli, Luigi La Barbera, Tomaso Villa, Michael Reinert, Giuseppe Bonaldi and Joshua A. Hirsch
The authors assessed whether a new minimally invasive procedure, stent screw–assisted internal fixation, is feasible, safe, and efficacious in stabilizing severe vertebral fractures caused by extensive neoplastic spinal lesions and whether the results are stable at follow-up. This study is important because it shows that this new technique can be used to stabilize severe spinal lesions, avoiding the invasiveness of a standard surgical approach in medically fragile patients affected by these tumors.
Authors:Praveen V. Mummaneni, Mohamad Bydon, John Knightly, Mohammed Ali Alvi, Anshit Goyal, Andrew K. Chan, Jian Guan, Michael Biase, Andrea Strauss, Steven Glassman, Kevin T. Foley, Jonathan R. Slotkin, Eric Potts, Mark Shaffrey, Christopher I. Shaffrey, Regis W. Haid Jr., Kai-Ming Fu, Michael Y. Wang, Paul Park, Anthony L. Asher and Erica F. Bisson
The authors studied patients undergoing surgery for low-grade spondylolisthesis in a multisite study and looked at factors associated with nonroutine discharge. These results are important in that they may help surgeons optimize patient outcomes and help drive down costs associated with these procedures.
Authors:Dana L. Cruz, Ethan W. Ayres, Matthew A. Spiegel, Louis M. Day, Robert A. Hart, Christopher P. Ames, Douglas C. Burton, Justin S. Smith, Christopher I. Shaffrey, Frank J. Schwab, Thomas J. Errico, Shay Bess, Virginie Lafage and Themistocles S. Protopsaltis
This study validates the recently developed Total Disability Index (TDI), a single instrument to evaluate functional status in patients complaining of both back and neck pain. The TDI could be a valuable method for total spine assessment in a clinical setting and is less time consuming than legacy measures.
Authors:Huan Liu, Junlong Wu, Yu Tang, Haiyin Li, Wenkai Wang, Changqing Li and Yue Zhou
The authors compared lumbar pedicle screw placements using a traditional radiograph-guided method to placements using augmented reality–guided methods in an experimental setting. The study demonstrated that the placement of lumbar pedicle screws using augmented reality technology is safe and more efficient than traditional methods. This technology may be used in clinical situations in the future.
One of the technical problems encountered in performing lumboperitoneal shunt (LPS) surgery involves operative positioning, and few reports have described the abdominal procedure for LPS surgery in great detail. In this paper the authors introduce an LPS via a lateral abdominal laparotomy. They aimed to analyze their method in terms of technical features and outcomes. This modification of the routine LPS method simplifies the procedure and may make it more widely acceptable.
Authors:Minghao Wang, Dean Chou, Chih-Chang Chang, Ankit Hirpara, Yilin Liu, Andrew K. Chan, Brenton Pennicooke and Praveen V. Mummaneni
In this study, the authors compared the pseudarthrosis rates between PEEK and structural allograft anterior cervical discectomy and fusion with a minimum 2-year follow-up, which has not yet been reported in any other study to their knowledge. They hope that the conclusions in this paper will be helpful for surgeons in the selection of implants in clinical practice.
False-positive intraoperative muscle motor evoked potential monitoring results due to systemic effects of anesthetics and physiological changes continue to be a challenging issue especially for cervical spine disorders, and this retrospective study revealed for the first time that adding facial motor evoked potentials as controls significantly reduced false-positive muscle motor evoked potential monitoring results during cervical spine surgery.
Authors:Kishan Patel, Hardy Evans, Samuel Sommaruga, Pia Vayssiere, Tariq Qureshi, Luis Kolb, Michael G. Fehlings, Joseph S. Cheng, Enrico Tessitore, Karl Schaller and Aria Nouri
Klippel-Feil syndrome (KFS) is a rare congenital disorder characterized by fusion of cervical spine vertebrae. This syndrome has not been well studied in the literature. In the present study, the authors used data from a rare disease registry, which represents one of the largest collections of KFS patient data to date, to describe the pain experienced by KFS patients. This report provides novel information about the characteristics and management of KFS-related pain.
The authors’ findings provide important insights and guidance on surgical and clinical management for the prevention of C5 palsy after cervical open-door laminoplasty. Making an excessive lateral bony gutter in patients with a narrow C5 intervertebral foramen might be a cause of C5 palsy.
Authors:Alan H. Daniels, Daniel B. C. Reid, Wesley M. Durand, D. Kojo Hamilton, Peter G. Passias, Han Jo Kim, Themistocles S. Protopsaltis, Virginie Lafage, Justin S. Smith, Christopher I. Shaffrey, Munish Gupta, Eric Klineberg, Frank Schwab, Douglas Burton, Shay Bess, Christopher P. Ames, Robert A. Hart and the International Spine Study Group
Deciding where to end a construct proximally in adult spinal deformity cases is complex, and indications for upper thoracic (UT) versus lower thoracic (LT) endpoints remain unclear. The authors evaluated the demographic, radio-graphic, and surgical characteristics associated with surgeon choice to fuse to the UT spine. Furthermore, they com-pared radiographic, clinical, and health-related quality of life outcomes in patients following UT versus LT fusion. Such information may help inform patient counseling and surgical decision-making in the future.
Authors:Takamasa Watanabe, Masahiro Kanayama, Masahiko Takahata, Itaru Oda, Kota Suda, Yuichiro Abe, Junichiro Okumura, Yoshihiro Hojo and Norimasa Iwasaki
The primary contribution of this paper is that it demonstrates the safety of spine surgery in patients 80 years of age or older. The authors believe that this contribution will be helpful to spine surgeons who treat elderly patients suffering from spinal diseases.
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.
Typically, neurosurgeons perform surgery in the craniovertebral junction (CVJ), but do not focus on the the dura mater. The authors conducted a microsurgical anatomical study of the dura mater of the CVJ using 4 formalin-fixed, continuous, human cadaveric dura maters, extending from the posterior fossa to the C2 level. The dura mater at the CVJ displayed dynamic morphological changes within an extremely short segment, and its characteristic anatomical features were not similar to those in the cranial regions. Knowledge of the dura mater in the CVJ facilitates successful surgery, especially in Chiari malformations.
Spinal cord hypoperfusion is an important potential cause of myelopathy. The authors report the technique and workup for patients presenting with a rare cause of vascular spinal cord myelopathy—diaphragmatic crus syndrome—which results from compression of a lumbar intersegmental artery and subsequently hypoperfusion of the artery of Adamkiewicz.
In patients with spinal tuberculosis, the authors sought a solution to preserving mobility after spine surgery, providing stability equivalent to that of posterior/posterolateral decompression, and decreasing the cost of surgery. They devised a technique of lamina-sparing decompression using a posterior-only approach to allow simultaneous decompression and instrumentation while preserving the healthy posterior bony structure as much as possible. The study results demonstrate that this method allows stabilization of the spine with fewer instrumented vertebrae because of its retention of as many anatomical structures as possible.
The authors performed anterior selective stabilization combined with laminoplasty for massive ossification of the posterior longitudinal ligament (OPLL). The surgery may provide a safe and effective alternative to anterior decompression and fusion for the treatment of patients with massive OPLL.
The authors showed successful 1-year clinical outcome of lateral interbody fusion without posterior decompression in degenerative lumbar spinal disease with severe canal stenosis on preoperative MRI. The cross-sectional area of the thecal sac on MRI expanded postoperatively over time during the minimum 1-year follow-up period. Based on these data, the indication for lumbar interbody fusion will further expand.
The authors assessed the impact of bone growth (heterotopic ossification [HO]) surrounding the Prestige LP Cervical Disc prosthesis over time during long-term patient follow-up at 2 and 10 years after 2-level cervical disc arthroplasty (CDA) to determine whether HO significantly affects the outcome, including range of motion, or the safety of the procedure and device. It is important for clinicians and patients to know that even severe HO may not significantly reduce the effectiveness or safety (occurrence of severe adverse events or need for secondary surgeries) of CDA performed with the Prestige LP Cervical Disc.
The authors investigated 9 novel CT criteria to define union after anterior cervical discectomy and fusion (ACDF), with surgical exploration as the standard of reference. The methods, results, and analyses reported here provide a broad range of tools to assess pseudoarthrosis on CT scans and to make well-informed, evidence-based decisions regarding indications of the need for further surgical treatment after ACDF.
The primary aim of this study was to evaluate the diagnostic accuracy of intraoperative somatosensory evoked potential (SSEP) monitoring in detecting new lower-extremity neurological deficits. The authors found that patients with new postoperative lower-extremity neurological deficits were 5.9 times more likely to have significant changes in lower-extremity SSEPs during posterior thoracic fusion. The results underscore the importance of SSEPs as a neurophysiological surrogate for impending neurological deficits.
The authors evaluated whether mismatch of the endplate and implant can predict the grade of implant subsidence. They found no correlation between endplate-implant area, width, or length mismatch and Marchi subsidence grade for stand-alone lateral lumbar interbody fusion (LLIF), as well as no correlation between either endplate-implant mismatch or Marchi subsidence grade and postoperative radiculopathy. The data did suggest, however, that the use of 18-mm-width implants, compared to a 22-mm-width implant, in stand-alone LLIF may increase the risk of developing higher-grade subsidence necessitating reoperation.
This study assessed local control rates and toxicity outcomes in gastrointestinal (GI) spine cancers treated with stereotactic radiosurgery. This study is important because it highlights the need to establish optimal radiation doses for GI spinal tumors.
As registry research becomes more popular, it is important to investigate factors that may introduce bias in such research. One such factor is loss to follow-up. The authors present the characteristics of patients who were lost to follow-up in their study of patients with spondylolisthesis.
This retrospective chart review analysis suggests that involving plastic surgery in complex closure of posterior spinal defects after resection of neoplastic disease may reduce wound complications in a subset of spinal oncology patients. The authors grouped preoperative risk factors into categories and quantified the presence of those risk factors to stratify and directly compare risk as well as wound outcomes between patient cohorts with wounds closed by plastic surgery versus neurosurgery. This work will be a significant addition to the literature and of interest to spine surgeons seeking strategies for minimizing wound complications in the spinal oncology population.
In the present article, the authors summarized the literature on the application of diffusion tensor imaging (DTI) in cervical spondylotic myelopathy (CSM) to better inform readers of the current state of DTI in CSM research and future avenues of investigation.
The authors analyzed the impact of the L4–5 prosthetic positioning on functional results, which has not been done before. The prosthetic positioning can be chosen during surgery with the aid of fluoroscopic control. If a certain position provides better outcomes, the surgical technique can be improved to always reproduce the same accurate prosthetic positioning.
The authors analyzed two prospective studies of the five-repetition sit-to-stand (5R-STS) test for objective functional impairment (OFI) in patients with degenerative lumbar spinal disease, to evaluate whether the severity stratification for the recently proposed 5R-STS is valid and how the severity of OFI interacts with other patient-reported outcome measures. It is vital to improve understanding of the 5R-STS test as a new outcome measure because objective functional tests allow for quick and solid estimates of OFI in patients with degenerative lumbar pathologies.
The study evaluated how the core spine outcome measures used in clinical research differ in their ability to capture clinically important change. It is important because it identifies redundancies in the measurement of pain and discusses gaps in the current core battery. It suggests other key concepts that should be measured to track recovery from spine surgery.
Multiple factors are involved in characterizing patient satisfaction during a clinic visit. The authors performed a retrospective study of all spine surgeons in their health center to identify the important determinants that affect patient satisfaction. This updated framework will allow practices to target specific areas for improvement.
The authors compared the outcomes and demographics of patients with metastatic spine disease that was treated with radiation only or surgery with or without radiation to develop a pathway to improve patient care. These findings are important, as new treatments continue to emerge for the metastatic spine population, and research is needed to track outcomes in real time.
The authors developed optimal and safe spine MRI protocols for patients with deep brain stimulation devices for whom restrictions are usually in place in terms of MRI use. Thorough safety data acquisition may allow protocols outside vendor guidelines with a maximized number of slices, reducing the need for radiologist supervision.
The authors evaluated the efficacy and toxicity of SSRS for patients with thyroid cancer and found that non–dose-escalated SSRS is capable of providing excellent long-term local control with minimal toxicity.
The authors compared two methods of interbody fusion—transsacral fixation and transforaminal lumbar interbody fusion—at the L5–S1 level in long fusion constructs in patients with adult spinal deformity. This study suggests that transsacral fixation may decrease potential instrument-related complications requiring revision while decreasing operating room time and implant-related costs compared to transforaminal lumbar interbody fusion.
The authors systematically reviewed databases of medical literature to identify studies of cauda equina syndrome and its incidence. This information is important for organizing healthcare services and especially out-of-hours imaging arrangements, as MRI is required for all patients with suspected cauda equina syndrome.
The authors studied the level of patient activation among patients who underwent cervical and lumbar spine surgery and found that patients who are highly active or engaged in their own care had subsequently greater satisfaction with their surgical care at 1 year postoperatively. This study is important because patient activation is an important metric of high-quality healthcare and is potentially modifiable through brief interventions.
Patients with cervical spondylotic myelopathy underwent surgery, and quantitative tests were used to determine the improvement in hand function and dexterity after surgery. This is the first prospective study to quantitatively assess the improvement in upper extremity function after surgery.
The authors describe the first two cases in world literature in which bilateral C2 pedicles were reconstructed in old hangman's fracture in which C2 pedicle was absent due to chronic fracture and reabsorption. One of the two cases (Case 2), is the first reported case of severe C2-3 spondyloptosis with C2 displaced up to the level of C4.
Instead of performing revision surgery for recurrent tethered cord syndrome, the authors shortened the spinal column to release the tension on the spinal cord, avoiding the scarred and previously operated upon area. By avoiding this area, risks of CSF leak, spinal cord injury from cord dissection, and wound healing problems are mitigated, hopefully decreasing complications from addressing recurrent adult tethered cord syndrome.
The authors monitored the radiation exposure of different members of the operating room staff by using a wearable personal dosimetry device that provides real-time feedback. Radiation exposure is not without risk, and traditional methods of radiation monitoring using biannual dosimetry badges do not provide real-time feedback that can effect strategic changes in the operating room. Real-time feedback using a personal dosimetry device may allow operating room staff to change their behaviors to decrease radiation exposure.
The authors analyzed associations between changes in depression/anxiety from before and 12 months after spine surgery, as well as changes in patient-reported outcomes (PROs) at the same time points. PROs were diminished among patients with persistent or new-onset depression or anxiety. These findings indicate a need to address the mental health of spine surgery patients because doing so may improve their postoperative PROs.
The authors tried to find associations of symptoms derived from spinal meningiomas with tumor location and size. Symptomatology of spinal meningiomas has never been studied in detail as much as in this article.
The authors conducted a systematic review of the adult literature to identify gender differences in clinical assessment scores before and after lumbar spine surgery. Identifying and reducing gender bias in medical decision-making and outcome reporting may facilitate equitable healthcare delivery; limited literature is available to guide the surgical management of lumbar spine disease, which differentiates on the basis of demographic factors (such as gender).
This is one of the largest studies regarding extracranial chordoma and chondrosarcoma. The analysis of this cohort gives some critical information on prognostic factors and optimization of treatment results. The degree of resection is of paramount importance for a patient’s outcome. If surgical stabilization is needed for these challenging patients, the authors’ data would suggest the use of carbon-reinforced polyetheretherketone-based implants.