Volume 32: Issue 1 (Jan 2020): Pages 1-153
in Journal of Neurosurgery: SpineFigure from Lau et al. (pp 23–30).
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In Brief
The authors studied opioid use after cervical spine surgery for degenerative cervical spine conditions. They evaluated the relationship between preoperative opioid use and 1-year postoperative opioid use, patient outcomes, and satisfaction. Patients with or without preoperative opioid use reported similar improvement in outcomes and satisfaction with surgery, but patients who reported preoperative opioid use were more likely to be using opioids after surgery. Preoperative opioid weaning may be one way to reduce postoperative opioid use.
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In Brief
This review of a single-surgeon 7-year experience with complex circumferential cervical decompressive and fusion surgery revealed a high incidence of minor and major complications with this type of surgery. The information provided by this study is critical for surgeons encountering patients with severe spondylotic myelopathy to properly counsel their patients, weigh the risk-benefit profile of such surgery, and ultimately make the most appropriate treatment plan.
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In Brief
The authors performed a cadaveric laboratory study to measure the stabilizing effects of the terminal dorsal ligamentous complex and the construct length as part of posterior cervical fusion operations. They found that the significant stabilizing forces of the C2–3 and C7–T1 segments should be accounted for when exposing and fusing this region of the spine.
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In Brief
This study demonstrates that in patients without cervical deformity, cervical sagittal parameters such as cervical sagittal vertical axis, lordosis, and T1 slope are not the most important determinants of pain and disability outcomes. This is important because it highlights the importance of preserving normal parameters rather than aiming to augment lordosis or alignment when performing anterior discectomy and fusion.
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In Brief
The authors compared the results of 33 patients undergoing a traditional open transforaminal lumbar interbody fusion with those of 33 patients undergoing midline transforaminal lumbar interbody fusion for the treatment of degenerative lumbar conditions and found a reduction in total direct costs, although the difference was not statistically significant. Demonstrating cost-effectiveness of minimally invasive procedures is important, given the finite financial resources in healthcare.
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In Brief
The authors evaluated the long-term clinical outcome of patients who underwent total posterior arthroplasty using the TOPS System. The results of this 11-year study demonstrate that, in patients with spinal stenosis and degenerative spondylolisthesis, wide decompression and implantation of the study hardware maintain clinical improvement and radiological stability. The TOPS System preserved motion at the instrumented level.
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In Brief
The authors compared rod fracture rates in patients undergoing surgery for correction of adult spinal deformity (ASD) with transforaminal lumbar interbody fusion (TLIF) versus anterior lumbar interbody fusion (ALIF) at the caudal levels of long spinal deformity constructs. The results demonstrate that both ALIF and TLIF procedures at the caudal levels of long spinal deformity constructs achieved similar and satisfactory ASD correction.
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In Brief
The authors investigated whether Hounsfield units (HU) increase following treatment with teriparatide, a medicine that stimulates bone growth. Their finding that improved density of bones resulting from teriparatide can be measured with HU, which can be determined on routine CT scans, is important in that it provides a surrogate measurement tool to assess a patient’s bone density following teriparatide therapy.
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In Brief
The authors performed a systematic review of the literature to better understand the risks and oncological benefits of spinal dural resection in cases of malignant spinal tumors with dural contamination or infiltration.
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In Brief
The current retrospective cohort study examined outcomes of single-fraction stereotactic radiosurgery (SRS; photons) as definitive treatment or as a surgical adjuvant therapy for patients with newly diagnosed chordomas treated at Memorial Sloan Kettering Cancer Center. With an 89% 5-year local control rate, SRS can deliver an ablative dose, and the question becomes how we best integrate this therapy into treatment paradigms to reduce morbidity and improve local tumor control.
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In Brief
Leiomyogenic tumor rarely occurs in the spine, and published information on this disease is limited. To the best of the authors’ knowledge, this is the first reported case series regarding the clinical features and long-term surgical outcomes of leiomyogenic tumor of the spine. The pathology and possible prognostic factors affecting disease-free survival were also investigated in this study.
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In Brief
The authors provide insight on the adverse event profile, length of stay, mortality, and reoperation in the spinal oncology population. This study may provide a basis for a quality improvement initiative.
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In Brief
The authors conducted a systematic review and meta-analysis of the available preclinical and clinical literature to determine the effects of electrical stimulation therapies on spinal fusion. The findings of this work—that electrical stimulation devices may produce clinically significant increases in arthrodesis rates among patients undergoing spinal fusion—substantially add to the literature on the effect of these therapies on spinal fusion. This is the largest and most comprehensive study to date on the effect of electrical stimulation therapies on spinal fusion.
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In Brief
This was the first study to identify the incidence of intraoperative hypotension for patients with acute traumatic spinal cord injuries and to demonstrate that this relative hypotension occurred at a greater proportion than previously reported in the intensive care unit setting. This is important given that systemic hypotension can cause hypoperfusion of the spinal cord, leading to deleterious neurological outcomes associated with secondary spinal cord injury.
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