North American Spine Society Journal最新文献

{"title":"62. What effect does T1 slope have on sagittal balance and the relationship with caudal end of 3- or more-level posterior cervical fusions?","authors":"","doi":"10.1016/j.xnsj.2024.100400","DOIUrl":"10.1016/j.xnsj.2024.100400","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><p>Previous studies have highlighted the biomechanical effect of high T1 slopes on lordic force and the subsequent acceleration of kyphosis in postoperative cervical laminoplasties. While the data and collective opinion remain varied when determining whether the caudal end of a posterior cervical fusion should routinely be in the cervical or thoracic spine, adjacent level stenosis and nonunion are leading precipitating factors of revision.</p></div><div><h3>PURPOSE</h3><p>The study investigated the effect of T1 slope on postoperative sagittal vertical axis (SVA) and whether extension of posterior cervical fusions into the upper thoracic spine provides improved sagittal balance in comparison to C7 caudal level. Our hypothesis was does extension of posterior cervical fusions across the cervicothoracic junction lead improved sagittal balance in comparison to C7 caudal level.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>Multicenter retrospective study.</p></div><div><h3>PATIENT SAMPLE</h3><p>A total of 224 adult spine patients.</p></div><div><h3>OUTCOME MEASURES</h3><p>Clinical and radiographic outcomes.</p></div><div><h3>METHODS</h3><p>A database of 327 patients who underwent a 3- or more<strong>-</strong>level posterior cervical fusion with 2-year follow<strong>-</strong>up was created. Two cohorts were created based on fusion caudal level, those whose fusion terminated at C7 and those whose fusions extended to T1 or T2. The cohorts were then divided again into two subgroups, high T1 slope (&gt;25°) and low T1 slope (≤25°) and subject to comparative analysis.</p></div><div><h3>RESULTS</h3><p>A total of 224 patients were included in the C7 caudal cohort and 103 were included in the T1/T2 caudal cohort. The mean age of C7 and T1/T2 groups were 61±12 yrs and 63.1±12.6 yrs, respectively. Mean BMI of the C7 cohort was 28.9±6.8, and 29.1±5.8 in the T1/T2 cohort. Mean SVA was significantly higher in patients with high T1 slopes (mean range 34.2-44.1mm) as compared to patients with Low T1 slopes (mean range 21-28.9mm) across all time intervals (pre-op to 24 months post-op). Additionally, the 25^th percentile SVA of High T1 slopes were greater than the median SVA values of Low T1 slopes at all intervals. For both the high and low T1 slope cohorts, patients with a caudal T1/T2 had comparatively higher SVA values than their C7 counterparts at all intervals despite maintenance of cervical lordosis, however these differences were not statistically significant.</p></div><div><h3>CONCLUSIONS</h3><p>Increased sagittal imbalance was comparatively higher in patients with &gt;25° T1 slope ranging across preoperative to 24 months postoperative radiographic measurements. Extension of the posterior cervical fusion to T1 or T2 did not improve sagittal balance in patients with high T1 slopes. In fact, extension of posterior cervical fusions across the junction lead to increased positive sagittal imbalance. The results of this stu","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000933/pdfft?md5=eed4aedb8df49bbb9fcaf5289dd9875b&pid=1-s2.0-S2666548424000933-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141846411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"54. How much change in Oswestry Disability Index is necessary to make your patient satisfied after lumbar surgery?","authors":"","doi":"10.1016/j.xnsj.2024.100392","DOIUrl":"10.1016/j.xnsj.2024.100392","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><p>Evaluating the overall quality of care involves considering patient-reported outcomes. While in theory, postoperative functional improvement, as indicated by the Oswestry disability index (ODI), should result in postoperative patient satisfaction, the exact correlation has not been consistently evidenced in the literature. This study seeks to demonstrate the extent of ODI improvement required for achieving patient satisfaction two years post elective lumbar surgery.</p></div><div><h3>PURPOSE</h3><p>To evaluate the association between ODI improvement and patient reported satisfaction and to define ODI cut-off values indicative for patient satisfaction after elective lumbar surgery.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>Retrospective data collection from a single-center prospective cohort study.</p></div><div><h3>PATIENT SAMPLE</h3><p>A total of 383 prospectively enrolled patients who underwent elective lumbar surgery between 2014 and 2021.</p></div><div><h3>OUTCOME MEASURES</h3><p>The baseline ODI, 2-year postoperative ODI, and 2-year postoperative patient satisfaction were assessed. Patient satisfaction was evaluated using a scale from 1 (no satisfaction) to 5 (very satisfied). Patients with a score ≥ 4 were defined as satisfied.</p></div><div><h3>METHODS</h3><p>We prospectively enrolled patients who underwent elective lumbar surgery for degenerative disc disease. Patient reported outcome scores were assessed 2 years postoperatively. The differences between pre- and postoperative ODI were evaluated. Patients with ODI improvement versus no ODI improvement were investigated. Patients were stratified based on whether they achieved patient satisfaction after surgery. A cut-off for ODI improvement, with the goal of achieving patient satisfaction, was calculated using receiver operating characteristic (ROC) analysis. Differences in scores between groups were examined using the Mann-Whitney-U test. Multivariable logistic regression was applied to examine the association between scores and patient satisfaction, adjusted for age, sex and BMI. Statistical significance was set at p&lt;0.05.</p></div><div><h3>RESULTS</h3><p>A total of 383 patients with age 65 ± 10 years (57% female) were included. Of these, 23% received decompression alone, and 77% underwent fusion and decompression surgery. Baseline ODI significantly improved from 60 ± 21 preoperatively to 18 ± 20 2 years postoperatively in average (p=&lt;0.01). Absolute and percentage ODI changes were 21 ± 12 and 69 ± 35%. An improvement in ODI was achieved in 91% of the patients. In total, 77% of patients showed a satisfaction score of ≥ 4. The baseline (p = 0.02) and postoperative (p &lt; 0.01) assessed ODI, as well as the difference from pre- to postoperative ODI, were significantly associated with patient satisfaction (p &lt; 0.01). Attaining an absolute improvement of ≥ 19 ODI points (AUC 0.75) or ≥ 66% (AUC 0.86) was linked to patient satisfaction. The perce","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000854/pdfft?md5=eb01fd6fd0fcaa336590e8e6daa99b91&pid=1-s2.0-S2666548424000854-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141838714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P13. Efficacy and limitations of continuous local antibiotic perfusion for patients with surgical site infection after instrumented spinal surgery; a retrospective multicenter study","authors":"","doi":"10.1016/j.xnsj.2024.100417","DOIUrl":"10.1016/j.xnsj.2024.100417","url":null,"abstract":"<div><h3>Background Context</h3><p>Surgical site infection (SSI) is one of the most serious postoperative complications following spinal instrumented surgery. We previously reported the potential of continuous local antibiotic perfusion (CLAP) to retain the implants for SSI after spinal instrumented surgery (<em>J Clin Neurosci</em>, 2021). Nonetheless, the effectiveness and limitations of CLAP for patients with SSI after spinal instrumented surgery remain unclear.</p></div><div><h3>Purpose</h3><p>To elucidate the efficacy and limitations of CLAP for patients with SSI after spinal instrumented surgery.</p></div><div><h3>Study Design/Setting</h3><p>A retrospective multicenter case series study.</p></div><div><h3>Patient Sample</h3><p>A total of 40 patients treated with CLAP for SSI after spinal instrumented surgery were included in the present study.</p></div><div><h3>Outcome Measures</h3><p>The ratio of implant retention was calculated. We examined factors including age, sex, presence of diabetes, type of surgery (primary or revision), surgical level (cervical or thoracolumbar), number of fused vertebrae, pathogen causation, duration from diagnosis to CLAP installation, and temporal changes in white blood cell count (WBC; x10³/μL) and C-reactive protein (CRP) based on blood test results.</p></div><div><h3>Methods</h3><p>Patients were categorized into 2 groups: a favorable outcome group of 28 patients where SSI was promptly controlled after CLAP and a poor outcome group of 12 cases where additional surgery was required or resulted in fatal outcomes after CLAP. The correlation between the two groups was assessed and risk factors contributing to poor outcomes after CLAP were analyzed.</p></div><div><h3>Results</h3><p>Among the 40 patients, implants have been removed before CLAP installation in 12 cases. Except for these cases, CLAP achieved successful control of SSI with implant retention in 25 out of 28 patients (89%). Only two patients experienced uncontrolled SSI even after CLAP, resulting in the removal of all implants. Across all cases, a significant improvement in both WBC and CRP levels was observed one week after CLAP (p&lt;.01). In the poor outcome group, the proportion of elderly patients aged over 75 years was significantly higher (p=.01), antibiotic-resistant pathogens were detected more frequently (p=.022), and the WBC value at 1 week after CLAP (poor group: 7.7±2.4, favorable group: 5.8±1.6) was significantly elevated (p=.013) compared to the favorable group. Multivariate analysis showed the above three parameters were the independent risk factors contributing to poor outcomes after CLAP.</p></div><div><h3>Conclusions</h3><p>CLAP proved effective in achieving a high rate of implant retention for controlling SSI after spinal instrumented surgery. However, poor outcomes following CLAP were associated with factors such as advanced age, antibiotic-resistant pathogens, and inadequate improvement in WBC values one week after CLAP.","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424001100/pdfft?md5=670db39f4662896b1fd2b8ad8cb92e04&pid=1-s2.0-S2666548424001100-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141842862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"20. Strategies for addressing failed cervical total disc replacement: a series of 42 patients","authors":"","doi":"10.1016/j.xnsj.2024.100358","DOIUrl":"10.1016/j.xnsj.2024.100358","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><p>As with any spine surgery, there are failures with cervical total disc replacement (TDR). These may generally be classified as surgeon or technical error (including patient selection), biomechanical failure, biological (osteolysis, allergy, etc.) or other reasons. Surgeons performing TDR should be aware of the types of failure leading to the need for subsequent surgery and have a strategy to address these situations.</p></div><div><h3>PURPOSE</h3><p>This study's purpose was to describe modes of failure of cervical TDR and related treatment strategies.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>The study was based on detailed record review.</p></div><div><h3>PATIENT SAMPLE</h3><p>This study included a consecutive series of 42 patients (57 disc levels) undergoing cervical TDR removal or revision surgery.</p></div><div><h3>OUTCOME MEASURES</h3><p>Outcome was based on the TDR removal or revision surgery, reason for removal/revision, duration from implantation to removal/revision, and estimated blood loss during the procedure.</p></div><div><h3>METHODS</h3><p>A surgery log was reviewed to identify patients undergoing cervical TDR removal/revision surgery, including those whose index TDR was implanted at remote facilities. Chart review was conducted to collect general descriptive data, reasons for TDR removal/revision, duration from index implantation to re-operation, and the subsequent procedure performed.</p></div><div><h3>RESULTS</h3><p>Among the 42 patients, 31 underwent TDR removal and ACDF, TDR removal and replacement with another TDR was performed in 10 patients, and in one patient the TDR was revised by repositioning it. The mean blood loss was 37.2 ml (range: 5-150 ml). The mean duration from the index surgery to removal/revision was 37.6 months (range: 0 to 216 months). In all cases, removal/revision surgery was completed without complication. The most common reason for removal was severe osteolysis, often involving C. acnes infection, and was primarily associated with one implant type. TDR removal and fusion were also performed in cases of subsidence, device migration, treatment of symptoms arising from posterior anatomy (facet joints, posterior osteophytes, stenosis, etc.) or approach-related complications and pain. TDR replacement was feasible in cases with hypermobility, metal allergy (after a nonmetallic device became available), and for oversized implant use (provided a smaller implant design was available). In one case of symptoms related to TDR malpositioning, the device was successfully revised into appropriate position.</p></div><div><h3>CONCLUSIONS</h3><p>For cases of cervical TDR failure, replacing a TDR with another such implant is feasible in some patients. Reasons for revision or removal after C TDR surgery include biomechanical failure, implant migration, surgeon or technical error, or biological reasons (osteolysis, metal allergy, etc.). The type of failure can help the surgeon create a s","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000519/pdfft?md5=07883ebff8dc903fd6985783f23cf90a&pid=1-s2.0-S2666548424000519-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141843972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P24. Vertebral body sliding osteotomy as a surgical strategy for the treatment of cervical myelopathy: complications and pitfalls","authors":"","doi":"10.1016/j.xnsj.2024.100428","DOIUrl":"10.1016/j.xnsj.2024.100428","url":null,"abstract":"<div><p>This abstract contains content that is significantly similar to the authors' previously published abstract in <em>Neurospine</em>. For access to the original publication, please visit <span><span>https://pubmed.ncbi.nlm.nih.gov/37401086/</span><svg><path></path></svg></span></p></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424001215/pdfft?md5=b9264ca9ad0615d5e0675c608e343c1d&pid=1-s2.0-S2666548424001215-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141852807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"36. Effects of intraoperative epidural steroids for lumbar spine surgery in lumbar spinal canal stenosis","authors":"","doi":"10.1016/j.xnsj.2024.100374","DOIUrl":"10.1016/j.xnsj.2024.100374","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><p>Pain control methods after spinal surgery are not yet standardized. Postoperative pain relief effects affect patient satisfaction and postoperative rehabilitation and hospital stay. Postoperative pain relief is especially important for elderly patients. Although the effects of steroids after lumbar disc herniation surgery have been reported, their effects on lumbar spinal stenosis are still unclear.</p></div><div><h3>PURPOSE</h3><p>The purpose of this study is to evaluate the efficacy of intraoperative epidural steroids in lumbar canal stenosis surgery.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>A randomized controlled trial.</p></div><div><h3>PATIENT SAMPLE</h3><p>We enrolled 40 adult patients scheduled for elective lumbar decompression surgery of lumbar canal stenosis. Inclusion criteria were 60-85 years old and decompression between 1 to 3 levels. Exclusion criteria were fusion surgery, reoperation surgery, diabetes mellitus, chronic inflammatory diseases, chronic renal dysfunction, drug allergy, postoperative delirium, and dementia.</p></div><div><h3>OUTCOME MEASURES</h3><p>We evaluated visual analog scale (VAS), Time Up and Go Test, C-reactive proteins (CRP) of blood data, The cytokines IL-6 of wound drainage and postoperative complications. The primary outcome is VAS of postoperatively, and the second outcomes are laboratory data, postoperative complication and walking ability.</p></div><div><h3>METHODS</h3><p>This study was a prospective double<strong>-</strong>blind placebo controlled randomized study. Patients were divided into two groups (steroid group, control group) using a random number table before surgery. In the steroid group, we injected 6.6 mg of dexamethasone epidurally after surgical decompression and before wound closure. In the control group we similarly injected the same volume of saline epidurally before wound closure. Opioids were not used postoperatively. A Cox-2 inhibitor was taken orally for 5 days, and Diclofenac Sodium suppositories were used as needed. We investigated the VAS of average daily pain and maximum pain of back pain and leg pain on postoperative days (POD) 0, 1, 2, 3, 5, 7, and 14. The VAS evaluation was performed by a nurse who was unaware of the group classification. CRP and Time Up and Go Test were investigated preoperatively and on POD 1, 3, and 7. IL-6 was investigated in drain fluid on POD 2.</p></div><div><h3>RESULTS</h3><p>The steroid group had 19 patients (<strong>m</strong>ale 11, <strong>f</strong>emale 8), with an average age of 72.9 years and an average number of decompressions of 1.7. The control group had 21 patients (male 14, female 7), with an average age 74.2 years and average number of decompressions of 1.8. There were no significant differences in patient data between the two groups. Back pain (VAS) on POD 0, 1, 2, and 3 were significantly lower in the steroid group compared to the control group. Postoperative VAS (back pain/wound pain) was 41.4 mm","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000672/pdfft?md5=7bf130e51a657ff5761b55afc4071daa&pid=1-s2.0-S2666548424000672-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141848223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"21. Association between paraspinal muscle quality and surgery for adjacent segment disease","authors":"","doi":"10.1016/j.xnsj.2024.100359","DOIUrl":"10.1016/j.xnsj.2024.100359","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><p>Adjacent segment disease (ASD) is one of the most common complications after spinal fusion, occurring a rate of approximately 2% a year. Increased loading and mobility at the adjacent segments are theorized mechanisms of ASD. The paraspinal muscles act as dynamic stabilizers of the lumbar spine and recently the suboptimal quality of the musculature such as increased fat infiltration has been implicated as a potential risk factor for ASD and need for subsequent surgery.</p></div><div><h3>PURPOSE</h3><p>To examine the association between paraspinal muscle degeneration and risk of ASD.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>Retrospective cohort study.</p></div><div><h3>PATIENT SAMPLE</h3><p>Patients undergoing lumbar spinal fusion procedures at a single institution.</p></div><div><h3>OUTCOME MEASURES</h3><p>Paraspinal muscle fat percentage and circumferential surface area (CSA)</p></div><div><h3>METHODS</h3><p>We conducted a retrospective comparison of adult spinal fusion patients at our institution from 2009-2022. Comparison cohorts were those with ASD and non-ASD patients age, gender, and BMI matched to the ASD cohort. Inclusion criteria were presurgical MRI that included full paraspinal musculature visualization and a minimum one-year follow-up. We measured paraspinal fat percentage and CSA at L3 and at the proximal end of their future construct. We also measured the CSA of the psoas at L3 and at the proximal end of their future construct. Paraspinal fat percentage and muscle surface area were measured using ImageJ (National Institutes of Health, Bethesda, Maryland, USA). Fat percentage was measured by finding the average of the lowest pixel intensity values of the visceral fat ventral and dorsal to the paraspinal musculature. This value was used as the threshold to differentiate fat from other soft tissues in the paraspinal musculature. We used the paired student T-test to evaluate for statistically significant differences with p-value ≤ 0.05.</p></div><div><h3>RESULTS</h3><p>A total of 110 patients were reviewed, 55 with adjacent segment failure (experimental cohort) and 55 patients in the control group. There were 30 males and 25 females in each cohort. Average age in the experimental cohort was 61.7 vs 61.8 in the control group. Average BMI was 29.5 in the experimental group vs 29.8 in the control group. Overall, patients who underwent surgery for adjacent segment disease had 32% higher paraspinal fat percentage at L3 (13.7 ± 7.5% vs 10.4 ± 5.8%, p = 0.02). Similarly, patients with adjacent segment failure had 28% higher paraspinal fat percentage at the top end of their construct (15.8 ± 8.9% vs 12.3 ± 6.8%, p = 0.05). While there were no significant differences in psoas CSA at L3, patients without adjacent segment failure had larger psoas CSA at the proximal end of the fusion construct (1168.2 ± 512.1 mm² vs 983.6 ± 418.6 mm², p = 0.03).</p></div><div><h3>CONCLUSIONS</h3><p>Our ","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000520/pdfft?md5=8cf77da0d7e2f2443355a882139a8f2c&pid=1-s2.0-S2666548424000520-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141845879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"52. Establishing case volume benchmarks for ACGME-accredited orthopaedic surgery of the spine fellowship training","authors":"","doi":"10.1016/j.xnsj.2024.100390","DOIUrl":"10.1016/j.xnsj.2024.100390","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><p>There has been increasing scrutiny on the standardization of surgical fellowship training in the US.</p></div><div><h3>PURPOSE</h3><p>This study provides case volume benchmarks for Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopaedic spine surgery fellowship training.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>This was a retrospective cross-sectional study of fellows at ACGME-accredited orthopaedic spine surgery fellowships (2017–2022).</p></div><div><h3>PATIENT SAMPLE</h3><p>N/A</p></div><div><h3>OUTCOME MEASURES</h3><p>Reported case volume during fellowship training.</p></div><div><h3>METHODS</h3><p>Case volume percentiles were calculated across ACGME-defined case categories and temporal changes assessed via linear regression. Variability between the highest and lowest deciles by case volume was calculated as fold-differences (90^th percentile / 10^th percentile). Sensitivity analyses were performed to identify potential targets for case minimum requirements.</p></div><div><h3>RESULTS</h3><p>A total of 163 spine surgery fellows were included in this study. Total mean reported spine surgery case volume increased from 313.2±122 in 2017 to 382.0±164 in 2022 (P=0.194). Most cases were classified as adult (range, 97.2%-98.0%) over pediatric cases (range, 2.0-2.8%). An average of 322.0 cases were reported and most were classified as laminectomy (32%), posterior arthrodesis (29%), and anterior arthrodesis (20%) (Figure). Overall variability in total case volume was 2.4 and the greatest variabilities existed for posterior instrumentation (38.1), application of cage (34.6), anterior instrumentation (20.8), and fractures and dislocations (17.3). If case minimum requirements for total reported cases was assumed at 200 cases, then all spine fellows included in this study would achieve this requirement. However, if case minimum requirements were assumed at 250 total cases, then approximately thirty percent of fellows (n=49) would not achieve this requirement for graduation.</p></div><div><h3>CONCLUSIONS</h3><p>Increasingly, national societies and accrediting bodies in surgical education recognize the need for standardized training. Surgical case benchmarks can inform potential case minimum requirements and help reduce variability during spine fellowship training. Future studies are needed to establish case minimum requirements in spine surgery including establishment of competency-based assessments and learning curves for essential spine surgeries.</p></div><div><h3>FDA Device/Drug Status</h3><p>This abstract does not discuss or include any applicable devices or drugs.</p></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000830/pdfft?md5=483d9b15660faf203f82b7a811c04b11&pid=1-s2.0-S2666548424000830-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141845940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"28. Novel posterolateral vertebral tethering combined with limited apical fusion in pediatric posterior scoliosis surgery reduces the number of levels fused and preserves lumbar range of motion","authors":"","doi":"10.1016/j.xnsj.2024.100366","DOIUrl":"10.1016/j.xnsj.2024.100366","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><p>The surgical goals for pediatric scoliosis surgery are to create a balanced, stable spine, to preserve range of motion (ROM) especially in the lumbar spine, and to avoid complications such as revision surgery (RS) or adding on phenomenon (AO). We describe a posterior scoliosis surgical method using intravertebral interpedicle (IVIP) constructs for limited apical fusion within the major structural curve(s) and correction of the deformity above or below the fusion with posterolateral vertebral tethering (PLVT) utilizing polyethylene terephthalate bands.</p></div><div><h3>PURPOSE</h3><p>Our hypothesis is that this novel method is safe and results in fewer levels fused and in the preservation of lumbar ROM, both side bending (SB) and flexion/extension (F/E), in patients at or close to skeletal maturity.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>This is a prospective study whose outcome results are compared to that of matched historical control patients.</p></div><div><h3>PATIENT SAMPLE</h3><p>First 10 patients treated using the novel method with minimum 2-year follow-up.</p></div><div><h3>OUTCOME MEASURES</h3><p>The number of levels fused in the experimental group of 10 patients is compared to matched historical standard posterior fusion controls (MHSPFC). Comparison of pre-op and post-op SB range of motion (ROM) to assess preservation of lumbar spine motion. Comparison of pre-op and post-op scored SRS 22r Questionnaire.</p></div><div><h3>METHODS</h3><p>In the novel method, IVIP constructs with open lateral extenders are used for fusion and closed lateral extenders with polyethylene terephthalate bands placed through the closed heads are used for PLVT of disc levels in the compensatory curve or that correct fully with SB. This IRB approved prospective study presents minimum 2-year results of the first 10 patients treated with the IVIP method. The number of levels fused for each patient is compared to matched historical standard posterior fusion controls (MHSPFC). Radiographic measurements from X-rays at 3-month and final follow up (f/u) assess for AO and from bending X<strong>-</strong>rays at pre-op and 1- and 2-year f/u determine the ROM as the difference between the right and left SB lumbar (LCSBROM) or T12L5 (T12L5SBROM), or F/E T12L5 (FEROM) Cobb angles. Three independent observers determined the Cobb angles, ROM calculated, and the results averaged. SRS 22r Questionnaire was scored pre-op and at each f/u.</p></div><div><h3>RESULTS</h3><p>Average (avg) age was 16.4+/-2.2 years, pre-op main curve was 56^o+/-8^o, and post-op main curve was 25^o+/-8° for avg correction of 55+/-13%. Female to male ratio was 9:1. Risser stages were 3(n=2), 4(n=2) and 5(n=6). The number of levels fused (avg 4.6+/-1.3) with the IVIP method was less than the number of levels fused in the MHSPFC (avg 10.8+/-1.8) and the difference was statistically significant (p&lt;.0001). At avg of 27-month f/u (min. ","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000593/pdfft?md5=d6c71eb614d1f9b5ff4427277776e918&pid=1-s2.0-S2666548424000593-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141844608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"P5. Effect of cervical kyphosis on spinal cord biomechanics after cervical laminoplasty","authors":"","doi":"10.1016/j.xnsj.2024.100409","DOIUrl":"10.1016/j.xnsj.2024.100409","url":null,"abstract":"<div><h3>Background Context</h3><p>Cervical laminoplasty is an effective motion-preserving intervention for degenerative cervical myelopathy. However, patients with preexisting cervical kyphosis often show inferior outcomes after cervical laminoplasty as compared to those with straight or lordotic spines. Kyphotic cervical spines may show limited dorsal spinal cord shift after decompression, which can explain impaired neurological recovery. Persistent adverse spinal cord tension may also contribute to poor neurological recovery for the kyphotic patient, yet this has not been studied.</p></div><div><h3>Purpose</h3><p>To quantify the effect of cervical sagittal alignment on spinal cord stress and strain after open door laminoplasty.</p></div><div><h3>Study Design/Setting</h3><p>Finite element analysis.</p></div><div><h3>Patient Sample</h3><p>N/A.</p></div><div><h3>Outcome Measures</h3><p>Spinal cord stress and strain.</p></div><div><h3>Methods</h3><p>We used a validated 3D finite element model of the C2-T1 spine, inclusive of the spinal cord, to investigate biomechanical changes in the spinal cord after laminoplasty. We created 3 models based on the C2-C7 Cobb angle: lordosis (20°), straight (0°) and kyphosis (-9°). For each of these models, we simulated an open door laminoplasty for the C4, C5 and C6 levels with identical dorsal spinal cord shift. A full-thickness trough was created on one side of these laminae, and a partial-thickness trough on the contralateral side to form a hinge. Additionally, the interspinous ligaments and ligamentum flavum were resected at C3–4 and C6–7. The modified laminae were then repositioned using a 1-mm-thick, double-bend titanium plate, ensuring anatomical alignment and tight screw contact. We, then simulated, physiological neck flexion and extension by applying a 2Nm moment and 75N force. Spinal cord von Mises stress and maximum principal strain, and segmental range of motion were quantitatively analyzed and compared.</p></div><div><h3>Results</h3><p>Spinal cord stress and strain was highest for kyphotic curvature compared to the straight and lordotic curvature across all cervical segments despite similar segmental range of motion. At the decompressed levels, average spinal cord stress in the kyphotic spine (8.73 kPa) was 2.8 times higher than the lordotic spine (3.15 kPa) and 1.3 times higher than the straight spine (6.8 kPa). At the decompressed levels, spinal cord strain in the kyphotic spine was (5.2%) was 3.6 times higher than the lordotic spine (1.4%) and 1.4 times higher than the straight spine (3.7%). Similarly, higher spinal cord stress and strain was noted for the kyphotic spine at the superior and inferior adjacent segments.</p></div><div><h3>Conclusions</h3><p>Cervical kyphosis was associated with high spinal cord stress and strain after laminoplasty even in the presence of adequate dorsal spinal cord shift. The results also highlight the negative consequences of progressive postsurgical kyphosis which ","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424001021/pdfft?md5=3f001e1b48a2d3bad3cef420d644fb1a&pid=1-s2.0-S2666548424001021-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141849092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}