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Editorial. Postoperative pain control after spinal surgery: an opportunity
Zoher Ghogawala
Development and validation of a clinical prediction score for poor postoperative pain control following elective spine surgery
Michael M. H. Yang, Jay Riva-Cambrin, Jonathan Cunningham, Nathalie Jetté, Tolulope T. Sajobi, Alex Soroceanu, Peter Lewkonia, W. Bradley Jacobs, and Steven Casha
doi : 10.3171/2020.5.SPINE20347
Thirty percent to sixty-four percent of patients experience poorly controlled pain following spine surgery, leading to patient dissatisfaction and poor outcomes. Identification of at-risk patients before surgery could facilitate patient education and personalized clinical care pathways to improve postoperative pain management. Accordingly, the aim of this study was to develop and internally validate a prediction score for poorly controlled postoperative pain in patients undergoing elective spine surgery.
Consensus-based perioperative protocols during the COVID-19 pandemic
Praveen V. Mummaneni, John F. Burke, Andrew K. Chan, Julie Ann Sosa, Errol P. Lobo, Valli P. Mummaneni, Sheila Antrum, Sigurd H. Berven, Michael S. Conte, Sarah B. Doernberg, Andrew N. Goldberg, Christopher P. Hess, Steven W. Hetts, S. Andrew Josephson, Maureen P. Kohi, C. Benjamin Ma, Vaikom S. Mahadevan, Annette M. Molinaro, Andrew H. Murr, Sirisha Narayana, John P. Roberts, Marshall L. Stoller, Philip V. Theodosopoulos, Thomas P. Vail, Sandra Wienholz, Michael A. Gropper, Adrienne Green, and Mitchel S. Berger
doi : 10.3171/2020.6.SPINE20777
During the COVID-19 pandemic, quaternary-care facilities continue to provide care for patients in need of urgent and emergent invasive procedures. Perioperative protocols are needed to streamline care for these patients notwithstanding capacity and resource constraints.
Reference accuracy in spine surgery
Thiago S. Montenegro, Kevin Hines, Paul P. Partyka, and James Harrop
doi : 10.3171/2020.6.SPINE20640
The references list is an important part of a scientific article that serves to confirm the accuracy of the authors’ statements. The goal of this study was to evaluate the reference accuracy in the field of spine surgery.
Odontoid screw placement for Anderson type II odontoid fractures: how do duration from injury to surgery and clinical and radiological factors influence the union rate? A multicenter retrospective study
Luca Ricciardi, Sokol Trungu, Alba Scerrati, Pasquale De Bonis, Oriela Rustemi, Mauro Mazzetto, Giorgio Lofrese, Francesco Cultrera, Cédric Y. Barrey, Alessandro Di Bartolomeo, Amedeo Piazza, Massimo Miscusi, and Antonino Raco
doi : 10.3171/2020.6.SPINE20318
Anderson type II odontoid fractures are severe conditions, mostly affecting elderly people (? 70 years old). Surgery can be performed as a primary treatment or in cases of failed conservative management. This study aimed to investigate how duration from injury to surgery, as well as clinical, radiological, and surgical risk factors, may influence the union rate after anterior odontoid screw placement for Anderson type II odontoid fractures.
Omovertebral bone causing traumatic compression of the cervical spinal cord and acute neurological deficits in a patient with Sprengel’s deformity and Klippel-Feil syndrome: case report
Michael Pompliano, Stuart Changoor, Samuel Mease, Cyrus Emami, Kumar Sinha, and Ki Soo Hwang
doi : 10.3171/2020.6.SPINE20304
The presence of an omovertebral bone with Sprengel’s deformity and Klippel-Feil syndrome is a complex congenital anomaly that is not well understood. It most commonly manifests as cosmetic deformity, limited range of motion, and functional disability, although there are reports of the insidious development of cervical myelopathy. In this paper, the authors present the case of a 49-year-old man with acute neurological deficits after a low-energy mechanism of traumatic spinal cord compression, resulting from an impinging omovertebral bone through a traumatic laminar defect. The patient underwent resection of the omovertebral bone, laminectomy decompression of the spinal canal, and anterior stabilization. This case highlights a rarely discussed complication of undiagnosed Sprengel’s deformity and its associated conditions following even low-energy traumatic mechanisms.
An analysis of preoperative shoulder and neck balance and surgical outcome in 111 adolescent idiopathic scoliosis patients with two subtypes of Lenke 1 curves
Chris Yin Wei Chan, Chee Kidd Chiu, Yun Hui Ng, Saw Huan Goh, Xin Yi Ler, Sherwin Johan Ng, Xue Han Chian, Pheng Hian Tan, and Mun Keong Kwan
doi : 10.3171/2020.5.SPINE20397
The incidence of postoperative shoulder imbalance following posterior spinal fusion (PSF) is still high in Lenke 1 curves despite following current treatment recommendations for upper instrumented vertebra (UIV) selection. The objective of this retrospective study was to identify differences in preoperative shoulder balance and to report the surgical outcome of two subtypes of Lenke 1 curves (flexible vs stiff) in patients with adolescent idiopathic scoliosis (AIS).
A single-center retrospective analysis of 3- or 4-level anterior cervical discectomy and fusion: surgical outcomes in 66 patients
Jesse J. McClure, Bhargav D. Desai, Leah M. Shabo, Thomas J. Buell, Chun-Po Yen, Justin S. Smith, Christopher I. Shaffrey, Mark E. Shaffrey, and Avery L. Buchholz
doi : 10.3171/2020.6.SPINE20171
Anterior cervical discectomy and fusion (ACDF) is a safe and effective intervention to treat cervical spine pathology. Although these were originally performed as single-level procedures, multilevel ACDF has been performed for patients with extensive degenerative disc disease. To date, there is a paucity of data regarding outcomes related to ACDFs of 3 or more levels. The purpose of this study was to compare surgical outcomes of 3- and 4-level ACDF procedures.
Accuracy of fluoroscopic guidance with the coaxial view of the pedicle for percutaneous insertion of lumbar pedicle screws and risk factors for pedicle breach
Koichi Murata, Shunsuke Fujibayashi, Bungo Otsuki, Takayoshi Shimizu, Kazutaka Masamoto, and Shuichi Matsuda
doi : 10.3171/2020.5.SPINE20291
In this study the authors aimed to evaluate the rate of malposition, including pedicle breach and superior facet violation, after percutaneous insertion of pedicle screws using the coaxial fluoroscopic view of the pedicle, and to assess the risk factors for pedicle breach.
Health-related quality-of-life improvement with lumbar fusion in patients with lower-extremity arthritis
Mladen Djurasovic, Steven Glassman, Jeffrey L. Gum, Charles H. Crawford III, R. Kirk Owens II, and Leah Y. Carreon
doi : 10.3171/2020.6.SPINE20759
Lumbar fusion can lead to significant improvements in patient-reported outcomes (PROs) in patients with degenerative conditions. It is unknown whether the presence of hip or knee arthritis confounds the responses of patients to low-back–specific PROs. This study examined PROs with lumbar fusion in patients with concomitant lower-extremity arthritis. The purpose of the current study was to examine whether patients with significant lower-extremity arthritis who undergo lumbar fusion achieve similar improvements in low-back–specific PROs compared to patients without lower-extremity arthritis.
Factors related to postoperative coronal imbalance in adult lumbar scoliosis
Akira Matsumura, Takashi Namikawa, Minori Kato, Yusuke Hori, Noriaki Hidaka, and Hiroaki Nakamura
doi : 10.3171/2020.6.SPINE20670
The object of this study was to analyze the prevalence of postoperative coronal imbalance (CIB) and related factors in patients with adult lumbar scoliosis.
Long-term impact of obesity on patient-reported outcomes and patient satisfaction after lumbar spine surgery: an observational study
Christine Park, Alessandra N. Garcia, Chad Cook, Christopher I. Shaffrey, and Oren N. Gottfried
doi : 10.3171/2020.6.SPINE20592
Obese body habitus is a challenging issue to address in lumbar spine surgery. There is a lack of consensus on the long-term influence of BMI on patient-reported outcomes and satisfaction. This study aimed to examine the differences in patient-reported outcomes over the course of 12 and 24 months among BMI classifications of patients who underwent lumbar surgery.
Obesity may be associated with adjacent-segment degeneration after single-level transforaminal lumbar interbody fusion in spinopelvic-mismatched patients with a minimum 2-year follow-up
Ping-Guo Duan, Praveen V. Mummaneni, Minghao Wang, Andrew K. Chan, Bo Li, Rory Mayer, Sigurd H. Berven, and Dean Chou
doi : 10.3171/2020.6.SPINE20159
In this study, the authors’ aim was to investigate whether obesity affects surgery rates for adjacent-segment degeneration (ASD) after transforaminal lumbar interbody fusion (TLIF) for spondylolisthesis.
Economic analysis of 90-day return to the emergency room and readmission after elective lumbar spine surgery: a single-center analysis of 5444 patients
Marcel R. Wiley, Leah Y. Carreon, Mladen Djurasovic, Steven D. Glassman, Yehia H. Khalil, Michelle Kannapel, and Jeffrey L. Gum
doi : 10.3171/2020.6.SPINE191477
In the future, payers may not cover unplanned 90-day emergency room (ER) visits or readmissions after elective lumbar spine surgery. Prior studies using large administrative databases lack granularity and/or use a proxy for actual cost. The purpose of this study was to identify risk factors and subsequent costs associated with 90-day ER visits and readmissions after elective lumbar spine surgery.
Does the Global Alignment and Proportion score overestimate mechanical complications after adult spinal deformity correction?
Griffin R. Baum, Alex S. Ha, Meghan Cerpa, Scott L. Zuckerman, James D. Lin, Richard P. Menger, Joseph A. Osorio, Simon Morr, Eric Leung, Ronald A. Lehman Jr., Zeeshan Sardar, and Lawrence G. Lenke
doi : 10.3171/2020.6.SPINE20538
The goal of this study was to validate the Global Alignment and Proportion (GAP) score in a cohort of patients undergoing adult spinal deformity (ASD) surgery. The GAP score is a novel measure that uses sagittal parameters relative to each patient’s lumbosacral anatomy to predict mechanical complications after ASD surgery. External validation is required.
Comprehensive classification system for multirod constructs across three-column osteotomies: a reliability study
Mostafa H. El Dafrawy, Owoicho Adogwa, Adam M. Wegner, Nicholas A. Pallotta, Michael P. Kelly, Khaled M. Kebaish, Keith H. Bridwell, and Munish C. Gupta
doi : 10.3171/2020.6.SPINE20678
In this study, the authors’ goal was to determine the intra- and interobserver reliability of a new classification system that allows the description of all possible constructs used across three-column osteotomies (3COs) in terms of rod configuration and density.
Spinal cord injury in the United States Army Special Forces
Remi A. Kessler, Ansh Bhammar, Nikita Lakomkin, Raj K. Shrivastava, Jonathan J. Rasouli, Jeremy Steinberger, Joshua Bederson, Constantinos G. Hadjipanayis, and Deborah L. Benzil
doi : 10.3171/2020.7.SPINE20804
Spinal cord injury (SCI) is an area of key interest in military medicine but has not been studied among the US Army Special Forces (SF), the most elite group of US soldiers. SF soldiers make up a disproportionate 60% of all Special Operations casualties. The objective of this study was to better understand SCI incidence in the SF, its mechanisms of acquisition, and potential areas for intervention by addressing key issues pertaining to protective equipment and body armor use.
Early fixation of traumatic spinal fractures and the reduction of complications in the absence of neurological injury: a retrospective cohort study from the American College of Surgeons Trauma Quality Improvement Program
Matthew P. Guttman, Jeremie Larouche, Frank Lyons, and Avery B. Nathens
doi : 10.3171/2020.5.SPINE191440
The optimal timing of operative stabilization of patients with traumatic spinal fractures without spinal cord injury (SCI) has not been established. The challenges of early operative intervention, which may require prone positioning in a patient with multisystem injuries, must be balanced with the disadvantages of prolonged immobilization. The authors set out to define the optimal timing of surgical repair of traumatic spinal fractures in patients without SCI and the effect of delayed repair on the incidence of major complications.
The effect of simulation training on resident proficiency in thoracolumbar pedicle screw placement using computer-assisted navigation
Andrew M. Gardeck, Xuan Pu, Qiuyu Yang, David W. Polly, and Kristen E. Jones
doi : 10.3171/2020.5.SPINE2067
Residency work-hour restrictions necessitate efficient, reproducible training. Simulation training for spinal instrumentation placement shows significant benefit to learners’ subjective and objective proficiency. Cadaveric laboratories are most effective but have high cost and low availability. The authors’ goal was to create a low-cost, efficient, reproducible spinal instrumentation placement simulation curriculum for neurosurgery and orthopedic surgery residents using synthetic models and 3D computer-assisted navigation, assessing subjective and objective proficiency with placement of thoracolumbar pedicle screws.
To operate, or not to operate? Narrative review of the role of survival predictors in patient selection for operative management of patients with metastatic spine disease
Zach Pennington, Jeff Ehresman, Ethan Cottrill, Daniel Lubelski, Kurt Lehner, James Feghali, A. Karim Ahmed, Andrew Schilling, and Daniel M. Sciubba
doi : 10.3171/2020.6.SPINE20707
Accurate prediction of patient survival is an essential component of the preoperative evaluation of patients with spinal metastases. Over the past quarter of a century, a number of predictors have been developed, although none have been accurate enough to be instituted as a staple of clinical practice. However, recently more comprehensive survival calculators have been published that make use of larger data sets and machine learning to predict postoperative survival among patients with spine metastases. Given the glut of calculators that have been published, the authors sought to perform a narrative review of the current literature, highlighting existing calculators along with the strengths and weaknesses of each. In doing so, they identify two “generations” of scoring systems—a first generation based on a priori factor weighting and a second generation comprising predictive tools that are developed using advanced statistical modeling and are focused on clinical deployment. In spite of recent advances, the authors found that most predictors have only a moderate ability to explain variation in patient survival. Second-generation models have a greater prognostic accuracy relative to first-generation scoring systems, but most still require external validation. Given this, it seems that there are two outstanding goals for these survival predictors, foremost being external validation of current calculators in multicenter prospective cohorts, as the majority have been developed from, and internally validated within, the same single-institution data sets. Lastly, current predictors should be modified to incorporate advances in targeted systemic therapy and radiotherapy, which have been heretofore largely ignored.
Smart glasses display device for fluoroscopically guided minimally invasive spinal instrumentation surgery: a preliminary study
Keitaro Matsukawa and Yoshiyuki Yato
doi : 10.3171/2020.6.SPINE20644
Most surgeons are forced to turn their heads away from the surgical field to see various intraoperative support monitors. These movements may result in inconvenience to surgeons and lead to technical difficulties and potential errors. Wearable devices that can be attached to smart glasses or any glasses are novel visualization tools providing an alternative screen in front of the user’s eyes, allowing surgeons to keep their attention focused on the operative task without taking their eyes off the surgical field. The aim of the present study was to examine the feasibility of using glasses equipped with a wearable display device that transmits display monitor data during fluoroscopically guided minimally invasive spinal instrumentation surgery.
Air migration through neural foramina in pneumorrachis: case illustration
Nebojsa Lasica, Djula Djilvesi, Bojan Jelaca, and Petar Vulekovic
Letter to the Editor. The role of unilateral pallidotomy in cervical dystonia
Raghu Samala, Mohit Agrawal, Kanwaljeet Garg, and Manmohan Singh
Letter to the Editor. Alternative to the operating microscope
Kanwaljeet Garg and Manmohan Singh
