Full-endoscopic Uniportal Odontoidectomy and Decompression of the Anterior Cervicomedullary Junction Using the Retropharyngeal Approach
Conclusion. In the operated patients, the full-endoscopic uniportal surgical technique with anterior retropharyngeal approach was found to be a sufficient and minimally invasive method with the known advantages of an endoscopic procedure under continuous irrigation. It should not be viewed only as competition for other surgical techniques – due to its individual technical parameters, it can also be considered to be an alternative or complementary procedure. Level of Evidence: 4 (Source: Spine)
Source: Spine - July 10, 2018 Category: Orthopaedics Tags: Surgery Source Type: research

Do Preoperative Corticosteroid Injections Increase the Risk for Infections or Wound Healing Problems After Spine Surgery?: A Swiss Prospective Multicenter Cohort Study
Conclusion. Within the here investigated cohort, the risk of SSIs or WHPs following lumbar spinal decompression surgery seems not highly associated with preoperative corticosteroid injections. However, the safe time interval between corticosteroid infiltrations and surgery remains unknown, should not be decreased incautiously, and is the subject of further research. Level of Evidence: 2 (Source: Spine)
Source: Spine - July 10, 2018 Category: Orthopaedics Tags: Surgery Source Type: research

Postoperative Opioid Use, Complications, and Costs in Surgical Management of Lumbar Spondylolisthesis
Study Design. Retrospective analysis on a national longitudinal database (2007–2014). Objective. To determine the association between arthrodesis and complication rates, costs, surgical revision, and postoperative opioid prescription. Summary of Background Data. Arthrodesis in patients receiving laminectomy for lumbar spondylolisthesis remains controversial. However, population-level evidence to support the use of arthrodesis remains limited. Methods. We identified 73,176 patient records and used coarsened exact matching to create comparable populations of patients who received laminectomy or laminectomy w...
Source: Spine - July 10, 2018 Category: Orthopaedics Tags: Health Services Research Source Type: research

Trends in Physician Reimbursement for Spinal Procedures Since 2010
Conclusion. Since 2010, inflation-adjusted reimbursement for spinal procedures increased in our practice. There was a decline from 2010 to 2013. Increases occurred from 2014 to 2016 across all insurers. Medicaid payments more than doubled since 2010. Level of Evidence: 3 (Source: Spine)
Source: Spine - July 10, 2018 Category: Orthopaedics Tags: Health Services Research Source Type: research

Can Early Patient-reported Outcomes Be Used to Identify Patients at Risk for Poor 1-Year Health Outcomes After Lumbar Laminectomy With Arthrodesis?
Conclusion. Although postoperative recovery is variable, early PROs can identify patients at risk for poor 1-year outcomes and may help tailor care during the first year after lumbar laminectomy with arthrodesis. Level of Evidence: 2 (Source: Spine)
Source: Spine - July 10, 2018 Category: Orthopaedics Tags: Health Services Research Source Type: research

Pedicle Subtraction Osteotomy Versus Multiple Posterior Column Osteotomies in Severe and Rigid Neuromuscular Scoliosis
Conclusion. PSO may be an option in correction of severe and rigid neuromuscular scoliosis. It provides better correction of pelvic obliquity without increasing operative time, need for transfusion, or duration of hospitalization as compared to multiple apical PCO technique. Traction radiograph under general anesthesia is a valuable tool in surgical decision making. Level of Evidence: 4 (Source: Spine)
Source: Spine - July 10, 2018 Category: Orthopaedics Tags: Deformity Source Type: research

Predictive Modeling for Blood Transfusion After Adult Spinal Deformity Surgery: A Tree-Based Machine Learning Approach
Conclusion. This investigation produced tree-based machine-learning models of blood transfusion risk after ASD surgery. The random forest model offered very good predictive capability as measured by AUC. Our single classification tree model offered superior ease of implementation, but a lower AUC as compared to the random forest approach, although this difference was not statistically significant at the size of our validation cohort. Clinicians may choose to implement either of these models to predict blood transfusion among their patients. Furthermore, policy makers may use these models on a population-based level to as...
Source: Spine - July 10, 2018 Category: Orthopaedics Tags: Deformity Source Type: research

Commentary Regarding “Caregiver Perceptions and Health-Related Quality-of-Life Changes in Cerebral Palsy Patients After Spinal Arthrodesis”
No abstract available (Source: Spine)
Source: Spine - July 10, 2018 Category: Orthopaedics Tags: Deformity Source Type: research

Caregiver Perceptions and Health-Related Quality-of-Life Changes in Cerebral Palsy Patients After Spinal Arthrodesis
Conclusion. In qualitative and quantitative HRQL assessments, caregivers reported overall improvement in patients’ lives after spinal arthrodesis. Caregivers ranked spine surgery as the most beneficial intervention in the patients’ lives, secondary only to gastrostomy tube insertion. Level of Evidence: 2 (Source: Spine)
Source: Spine - July 10, 2018 Category: Orthopaedics Tags: Deformity Source Type: research

Functional Limitations Due to Stiffness After Long-Level Spinal Instrumented Fusion Surgery to Correct Lumbar Degenerative Flat Back
Conclusion. This study will hopefully allow surgeons to provide patients with ALDFB with a more informed explanation of expected surgery effects on specific ADLs. Level of Evidence: 3 (Source: Spine)
Source: Spine - July 10, 2018 Category: Orthopaedics Tags: Deformity Source Type: research

Psychosocial Factors and Surgical Outcomes in Adult Spinal Deformity: Do Dementia Patients Have More Complications?
Study Design. Retrospective analysis of a prospectively collected, national inpatient hospital database. Objective. We aimed to investigate comorbid psychiatric disorders in the adult spinal deformity (ASD) population. We hypothesized that a high incidence of comorbid psychiatric disorders in ASD would negatively impact perioperative outcomes. Summary of Background Data. Patients with adult spinal fusion (ASF) suffer from severe back pain and often depression. Psychiatric comorbidities in the ASD population are not well understood, despite the apparent psychological effects of spinal deformity–related self-im...
Source: Spine - July 10, 2018 Category: Orthopaedics Tags: Deformity Source Type: research

A Follow-up Study of Postoperative DCM Patients Using Diffusion MRI with DTI and NODDI
Conclusion. The results of t test and correlation with mJOA suggest that DTI and NODDI are valuable for evaluating spinal cord function. Results of NODDI indicate that the reason for FA reduction in DCM may be decreased neurite density, not increased orientation dispersion. Level of Evidence: 3 (Source: Spine)
Source: Spine - July 10, 2018 Category: Orthopaedics Tags: Cervical Spine Source Type: research

Postoperative Emergency Department Utilization and Hospital Readmission After Cervical Spine Arthrodesis: Rates, Trends, Causes, and Risk Factors
Conclusion. Patient comorbidities, traumatic pathologies, and surgical approach are associated with increased postoperative complications. Anterior procedures carry the lowest risk, followed by posterior and then circumferential. Awareness of these findings should help to encourage development of strategies to minimize the rate of postoperative ED utilization and hospital readmission. Level of Evidence: 3 (Source: Spine)
Source: Spine - July 10, 2018 Category: Orthopaedics Tags: Cervical Spine Source Type: research

Sex Differences for Anterior Cervical Fusion: Complications and Length of Stay
Study Design. Retrospective cohort. Objective. To assess differences in baseline characteristics between sexes of patients undergoing anterior cervical discectomy and fusion (ACDF) and risk factors for adverse outcomes according to sex. Summary of Background Data. ACDF is a common treatment for cervical spine disease. To reduce the rate of complications, risk factors associated with adverse events have been identified. However, few studies have examined the risk for inferior outcomes or complications after ACDF by sex. Methods. The American College of Surgeons National Surgical Quality Improvement Program (ACS-N...
Source: Spine - July 10, 2018 Category: Orthopaedics Tags: Cervical Spine Source Type: research

Biomechanical Comparison of Four Different Atlantoaxial Posterior Fixation Constructs in Adults: A Finite Element Study
Conclusion. In this study, C1LM-C2PS fixation was the most stable technique. If surgeons have to use other fixation methods besides the C2 pedicle screw, they need to be aware that additional fixation or postoperative immobilization may be required to achieve ROM restriction. Careful observation at the maximum stress site on the screw including screw loosening, screw-bone interface disruption or screw fracture will be necessary during follow-up imaging examinations (x-ray and computed tomography scan) after atlantoaxial fixation. Level of Evidence: N/A (Source: Spine)
Source: Spine - July 10, 2018 Category: Orthopaedics Tags: Biomechanics Source Type: research

Early Systemic Alterations in Severe Spinal Cord Injury: An Experimental Study on the Impact of Injury Level on Renal Function
Study Design. An experimental model of spinal cord injury (SCI) intended to characterize changes in renal function. Objective. The aim of this study was to evaluate the possible influence of SCI level on renal function during spinal shock. Summary of Background Data. SCI triggers multiple systemic and metabolic alterations. Among them, renal dysfunction stands out. Although several variables have been related to its extent, the impact of the cord injury level on renal function has not been clearly stated, particularly during the spinal shock. Methods. Anesthetized adult Sprague-Dawley rats were subjected to seve...
Source: Spine - July 10, 2018 Category: Orthopaedics Tags: Basic Science Source Type: research

Expansion Thoracoplasty in Rabbit Model: Effect of Timing on Preserving Pulmonary Growth and Correcting Spine Deformity
Conclusion. ET interrupted the natural progression of deformity and pulmonary hypoplasia associated with spine curvature in disease rabbits. However, growth benefits are only seen in cases of the most severe initial deformity and must be balanced against the further impairment to chest wall function associated with repetitive surgery. Level of Evidence: N/A (Source: Spine)
Source: Spine - July 10, 2018 Category: Orthopaedics Tags: Basic Science Source Type: research

Condoliase for the Treatment of Lumbar Disc Herniation: A Randomized Controlled Trial
Conclusion. Condoliase significantly improved symptoms in patients with LDH and was well tolerated. Condoliase is a novel and potent chemonucleolytic drug for the treatment of LDH. Level of Evidence: 1 (Source: Spine)
Source: Spine - July 10, 2018 Category: Orthopaedics Tags: Randomized Trial Source Type: research

A Prospective, Randomized, Multicenter Study Comparing Silicated Calcium Phosphate versus BMP-2 Synthetic Bone Graft in Posterolateral Instrumented Lumbar Fusion for Degenerative Spinal Disorders
Conclusion. SiCaP was safe and well tolerated in patients with degenerative spinal disorders requiring PLF and provided fusion rates similar to BMP-2. Level of Evidence: 2 (Source: Spine)
Source: Spine - July 10, 2018 Category: Orthopaedics Tags: Randomized Trial Source Type: research

“Sunset”
No abstract available (Source: Spine)
Source: Spine - July 10, 2018 Category: Orthopaedics Tags: Imagery Source Type: research

“Giant Panda” A clumsy and lovely giant panda enjoying the delicious bamboo at the Chengdu Research Base of Giant Panda Breeding
No abstract available (Source: Spine)
Source: Spine - June 29, 2018 Category: Orthopaedics Tags: Imagery Source Type: research

To the editor:
No abstract available (Source: Spine)
Source: Spine - June 29, 2018 Category: Orthopaedics Tags: Letters to the Editor Source Type: research

Letter
No abstract available (Source: Spine)
Source: Spine - June 29, 2018 Category: Orthopaedics Tags: Letter to the Editor Source Type: research

Parallel Proximal Fixation in Rib-Based Growing Rod System: A Novel Approach to Deal With Proximal Anchor Migration
Conclusion. Failure of proximal fixation is the most common complication in management of EOS with rib-based distraction. This study identifies that when the number of proximal fixation points are matched, parallel constructs result in lower rates of implant failure and need for unplanned reoperation than in-line constructs. Although this study was limited to patients in whom the VEPTR device was employed, these principles are likely applicable to other rib-based distraction devices used to treat EOS. Level of Evidence: 3 (Source: Spine)
Source: Spine - June 29, 2018 Category: Orthopaedics Tags: Surgery Source Type: research

Feasibility and Accuracy of Thoracolumbar Minimally Invasive Pedicle Screw Placement With Augmented Reality Navigation Technology
Conclusion. MIS screw placement directed by AR with intraoperative 3D imaging in a hybrid OR is accurate and efficient, without any fluoroscopy or x-ray imaging during the procedure. Level of Evidence: N/A (Source: Spine)
Source: Spine - June 29, 2018 Category: Orthopaedics Tags: Surgery Source Type: research

Bibliometric Analysis of Gender Authorship Trends and Collaboration Dynamics Over 30 Years of Spine 1985 to 2015
Study Design. A bibliometric analysis. Objective. The aim of this article was to study bibliometric changes over the last 30 years of Spine. These trends are important regarding academic publication productivity. Summary of Background Data. Inflation in authorship number and other bibliometric variables has been described in the scientific literature. The issue of author gender is taking on increasing importance, as efforts are being made to close the gender gap. Methods. From 1985 to 2015, 10-year incremental data for several bibliometric variables were collected, including author gender. Standard bivariate sta...
Source: Spine - June 29, 2018 Category: Orthopaedics Tags: Literature Review Source Type: research

Outcomes and Complications Following Laminectomy Alone for Thoracic Myelopathy due to Ossified Ligamentum Flavum: A Systematic Review and Meta-Analysis
Conclusion. Thoracic myelopathy secondary to OLF can be treated with laminectomy. However, despite some improvement in JOA score, functional status remains poor postoperatively. Perioperative complications are common, with dural tears and CSF leaks occurring most frequently. OLF is an uncommon condition and more research is needed to better understand how we can improve the outcomes of laminectomy alone for the treatment of thoracic myelopathy due to OLF. Level of Evidence: 3 (Source: Spine)
Source: Spine - June 29, 2018 Category: Orthopaedics Tags: Literature Review Source Type: research

Outpatient Spine Clinic Utilization is Associated With Reduced Emergency Department Visits Following Spine Surgery
Conclusion. Within 90 days following spine surgery, 29% of patients sought care in the ED. However, only one-third of these patients had a complication recorded, and even fewer were readmitted. This suggests a high rate of unnecessary ED utilization. Outpatient utilization of spine clinics was the only factor independently associated with a reduced likelihood of ED utilization. Level of Evidence: 3 (Source: Spine)
Source: Spine - June 29, 2018 Category: Orthopaedics Tags: Health Services Research Source Type: research

Associations of Race and Ethnicity With Patient-Reported Outcomes and Health Care Utilization Among Older Adults Initiating a New Episode of Care for Back Pain
This study included 5117 participants ≥65 years from three US health care systems. The primary BP-related PROs were BP intensity and back-related functional limitations over 24 months. Health care utilization measures included common diagnostic tests and treatments related to BP (spine imaging, spine-related relative value units [RVUs], and total RVUs) over 24 months. Analyses were adjusted for multiple potential confounders including sociodemographics, clinical characteristics, and study site. Results. Baseline BP ratings were significantly higher for blacks vs. whites (5.8 vs. 5.0; P  (Source: Spine)
Source: Spine - June 29, 2018 Category: Orthopaedics Tags: Health Services Research Source Type: research

Quality of Life and Health Utility Scores Among Canadians Living With Traumatic Spinal Cord Injury - A National Cross-Sectional Study
Conclusion. QOL or HU measured by generic HRQOL outcome tools should not be used as outcomes to assess the effectiveness of interventions targeting neurological function in traumatic SCI. A disease-specific instrument that captures the nuances specific to spinal cord injury patients is required. Level of Evidence: 1 (Source: Spine)
Source: Spine - June 29, 2018 Category: Orthopaedics Tags: Health Services Research Source Type: research

Causes and Timing of Unplanned 90-day Readmissions Following Spine Surgery
Conclusion. Nearly half of all unplanned 90-day readmissions were because of pain and medical complications and occurred with a median time of 6 and 12 days, respectively. The remaining 52% of readmissions were directly related to surgery and occurred at various times depending on the specific reason. This timeline for pain and medical readmissions represents an opportunity for targeted postdischarge interventions to prevent unplanned readmissions following spine surgery. Level of Evidence: 3 (Source: Spine)
Source: Spine - June 29, 2018 Category: Orthopaedics Tags: Health Services Research Source Type: research

Descriptive Analysis of State and Federal Spine Surgery Malpractice Litigation in the United States
This study aimed to determine the factors associated with malpractice litigation in cases involving spine surgery in the United States. Summary of Background Data. Medical malpractice is of substantial interest to the medical community due to concerns of increased health care costs and medical decision-making for the sole purpose of reducing legal liability. Methods. The Westlaw online legal database (Thomson Reuters, New York, NY) was searched for verdict and settlement reports pertaining to spine surgery from 2010 to 2015. Data were collected regarding type of procedure, patient age and gender, defendant specialty,...
Source: Spine - June 29, 2018 Category: Orthopaedics Tags: Health Services Research Source Type: research

Risk of Pneumonia After Vertebral Compression Fracture in Women With Low Bone Density: A Population-Based Study
Conclusion. Isolated VCF, especially those involving thoracic region, was associated with increased risk of pneumonia. Level of Evidence: 4 (Source: Spine)
Source: Spine - June 29, 2018 Category: Orthopaedics Tags: Epidemiology Source Type: research

Is Health-related Quality of Life Decreased in Adolescents With Back Pain?
Conclusion. The presence and intensity of cervical pain and the number of painful regions were associated with lower HRQoL in adolescents, which is worrying due to the important relationship between back pain in the adolescence and in the adulthood. Level of Evidence: 3 (Source: Spine)
Source: Spine - June 29, 2018 Category: Orthopaedics Tags: Epidemiology Source Type: research

Minimally Invasive Lateral Lumbar Interbody Fusion for Adult Spinal Deformity: Clinical and Radiological Efficacy With Minimum Two Years Follow-up
Conclusion. LLIF has advantages of indirect decompression and greater improvements of sagittal correction compared to only posterior surgery. LLIF should be conducted considering the above-mentioned benefits and complications including PJK or PJF in ASD. Level of Evidence: 4 (Source: Spine)
Source: Spine - June 29, 2018 Category: Orthopaedics Tags: Deformity Source Type: research

Postoperative Disability After Long Corrective Fusion to the Pelvis in Elderly Patients With Spinal Deformity
Study Design. A prospective case series analysis. Objective. The purpose of this study was to investigate the degree of difficulty in daily activities of adult spinal deformity (ASD) patients after corrective long fusion to the pelvis, with an emphasis on bend forward activities. Summary of Background Data. No prospective studies have been reported regarding the postoperative impairments and their time course after long fusion in ASD patients. Methods. One-hundred three patients [26 men, 77 women; mean age 68 (50–82) years] who underwent corrective long fusion from the thoracic spine to the pelvis were inc...
Source: Spine - June 29, 2018 Category: Orthopaedics Tags: Deformity Source Type: research

Percutaneous Kyphoplasty: Is Bilateral Approach Necessary?
Conclusion. Unilateral percutaneous kyphoplasty is as effective as bilateral percutaneous kyphoplasty both radiologically and clinically. Operative time and the amount of cement used for the surgery are significantly lower in unilateral kyphoplasty, which may play a role in decreasing complication rates. Level of Evidence: 3 (Source: Spine)
Source: Spine - June 29, 2018 Category: Orthopaedics Tags: Deformity Source Type: research

Predictability of Supine Radiographs for Determining In-Brace Correction for Adolescent Idiopathic Scoliosis
Conclusion. Supine radiograph predictably determines the flexibility of the scoliotic curve to brace treatment. It can be used as a guideline to determine the amount of correction achievable with brace-wear. The effectiveness of the brace is dependent on the inherent flexibility of the curve rather than its size or type. Level of Evidence: 3 (Source: Spine)
Source: Spine - June 29, 2018 Category: Orthopaedics Tags: Deformity Source Type: research

Investigation of the Effect of Cervical Radiculopathy on Peripheral Nerves of the Upper Extremity With High-Resolution Ultrasonography
Conclusion. The results of the present study indicate that the changes in the CNR caused by CR do not have any effect on the peripheral nerves. We did not find any affection in peripheral nerve CSA that might have been suggestive of double-crush syndrome in CR. Level of Evidence: 2 (Source: Spine)
Source: Spine - June 29, 2018 Category: Orthopaedics Tags: Diagnostics Source Type: research

Effect of Body Mass on Oxygenation and Intra-Abdominal Pressure When Using a Jackson Surgical Table in the Prone Position During Lumbar Surgery
Conclusion. Turning patients from the supine to the prone position during anesthesia results in an increase in the oxygenation index and a decrease in IAP. Both of these factors are dependent upon the type of surgical frame used and the patient's BMI. The reduction in IAP was particularly significant when a Jackson surgical table was used for overweight patients. Level of Evidence: 4 (Source: Spine)
Source: Spine - June 29, 2018 Category: Orthopaedics Tags: Clinical Case Series Source Type: research

Comparing Lumbar Disc Space Preparation With Fluoroscopy Versus Cone Beam-Computed Tomography and Navigation: A Cadaveric Study
Conclusion. The results of this cadaveric investigation reveal that CBCT+N guidance may be used to assess instrument placement for interbody disc space preparation in a similar length of time, with no difference in instrument passes or endplate violations, in comparison with fluoroscopy. Level of Evidence: 5 (Source: Spine)
Source: Spine - June 29, 2018 Category: Orthopaedics Tags: Basic Science Source Type: research

Facet Sagittal Orientation: Possible Role in the Pathology of Degenerative Lumbar Spinal Stenosis
Conclusion. Sagittalization of lumbar facet joints was considered to be a risk factor for DLSS and may play a role in the pathology of DLSS. Level of Evidence: 3 (Source: Spine)
Source: Spine - June 29, 2018 Category: Orthopaedics Tags: Anatomy Source Type: research

“Giant Panda”
No abstract available (Source: Spine)
Source: Spine - June 29, 2018 Category: Orthopaedics Tags: Imagery Source Type: research

To the editor
No abstract available (Source: Spine)
Source: Spine - June 13, 2018 Category: Orthopaedics Tags: Letters to the Editor Source Type: research

Letters
No abstract available (Source: Spine)
Source: Spine - June 13, 2018 Category: Orthopaedics Tags: Letters to the Editor Source Type: research

Transfusion of Red Blood Cells Stored More Than 28 Days is Associated With Increased Morbidity Following Spine Surgery
Conclusion. Blood stored for>28 days is independently associated with higher odds of developing perioperative complications in patients transfused during spinal surgery. Our results suggest that blood storage duration may be an appropriate parameter to consider when developing institutional transfusion guidelines that seek to optimize patient outcomes. Level of Evidence: 3 (Source: Spine)
Source: Spine - June 13, 2018 Category: Orthopaedics Tags: Surgery Source Type: research

Minimum Detectable Measurement Difference for Health-Related Quality of Life Measures Varies With Age and Disability in Adult Spinal Deformity: Implications for Calculating Minimal Clinically Important Difference
Study Design. Retrospective cohort. Objective. To investigate the minimum detectable measurement difference (MDMD) in the Scoliosis Research Society-22r (SRS-22r) outcomes instrument in adult spinal deformity (ASD) and to evaluate the effect of baseline data on measurable difference. Summary of Background Data. The minimum clinically important difference (MCID) is the smallest, clinically relevant change observed and has been proposed for the SRS-22r instrument in ASD as 0.4. The MCID must be greater than the MDMD to be useful. The MDMD for the SRS-22r has not been calculated, nor have the effect of patient baselin...
Source: Spine - June 13, 2018 Category: Orthopaedics Tags: Health Services Research Source Type: research

Comments on Legal Implications Incidental Surgical Durotomy
No abstract available (Source: Spine)
Source: Spine - June 13, 2018 Category: Orthopaedics Tags: Health Services Research Source Type: research

Medical Malpractice Claims Following Incidental Durotomy Due to Spinal Surgery
Conclusion. This analysis of durotomy-associated closed malpractice claims after spine surgery is the largest yet conducted. Durotomy cannot always be considered an entirely benign event, and these findings have several direct implications for clinicians: late-presenting or dehiscent durotomy may be associated with adverse outcomes and subsequent risk of litigation, timely reoperation in the event of durotomy-related complications may not increase surgeon liability, and spine surgeons should be prepared to defend their choice of durotomy repair technique, should dehiscence occur. Level of Evidence: 3 (Source: Spine)
Source: Spine - June 13, 2018 Category: Orthopaedics Tags: Health Services Research Source Type: research

Increased Risk of Acute Cholecystitis in Patients With Spinal Cord Injury: A Nationwide Population-Based Cohort Study
Conclusion. This population-based cohort study showed that there was an increased risk of AC in patients with SCI. Level of Evidence: 3 (Source: Spine)
Source: Spine - June 13, 2018 Category: Orthopaedics Tags: Epidemiology Source Type: research