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Editorial. Training the next generation of spine surgeons: an orthopedic and neurosurgical collaboration with historical precedence
Christopher I. Shaffrey MD1 and Thomas J. Buell MD1
doi : 10.3171/2020.12.SPINE201849
Volume 35: Issue 5, page: 549–551
An ACGME-based comparison of neurosurgical and orthopedic resident training in adult spine surgery via a case volume and hours-based analysis
Meeki Lad MPH1, Raghav Gupta MD1,2, Ashok Para MD1, Arjun Gupta1, Michael D. White MD3, Nitin Agarwal MD3, Justin M. Moore MD, PhD4, and Robert F. Heary MD5
doi : 10.3171/2020.10.SPINE201066
Volume 35: Issue 5, page: 553–563
In a 2014 analysis of orthopedic and neurological surgical case logs published by the Accreditation Council for Graduate Medical Education (ACGME), it was reported that graduating neurosurgery residents performed more than twice the number of spinal procedures in their training compared with graduating orthopedic residents. There has, however, been no follow-up assessment of this trend. Moreover, whether this gap in case volume equates to a similar gap in procedural hours has remained unstudied. Given the association between surgical volume and outcomes, evaluating the status of this disparity has value. Here, the authors assess trends in case volume and procedural hours in adult spine surgery for graduating orthopedic and neurological surgery residents from 2014 to 2019.
Does lumbar spine fusion predispose patients to future total hip replacement?
Sean Pirkle BA1, Sarah Bhattacharjee BS1, Srikanth Reddy BA3, Hector Castillo MD1, Lewis L. Shi MD2, Michael J. Lee MD2, and Mostafa El Dafrawy MBBCh2
doi : 10.3171/2020.12.SPINE201735
Volume 35: Issue 5, page: 564–570
Hip-spine syndrome has been well studied since it was first described by Offierski and MacNab in 1983. Today, strong evidence links symptoms of hip and spine pathology to postsurgical outcomes. Recent studies have reported increased rates of hip dislocation in patients previously treated with total hip arthroplasty (THA) who had undergone lumbar fusion procedures. However, the effect of this link on native hip-joint degeneration remains an area of ongoing research. The purpose of this study was to characterize the relationship between use of lumbar fusion procedures and acceleration of hip pathology by analyzing the rate of future THA in patients with preexisting hip osteoarthritis.
Overlapping single-level lumbar fusion and adverse short-term outcomes
Ali S. Farooqi BA1, Donald K. E. Detchou BA1, Gregory Glauser MBA1, Krista Strouz BS2,3, Scott D. McClintock PhD3, and Neil R. Malhotra MD1
doi : 10.3171/2020.12.SPINE201861
Volume 35: Issue 5, page: 571–582
There is a paucity of research on the safety of overlapping surgery. The purpose of this study was to evaluate the impact of overlapping surgery on a homogenous population of exactly matched patients undergoing single-level, posterior-only lumbar fusion.
Incidence and risk factors for prolonged postoperative opioid use following lumbar spine surgery: a cohort study
Anshit Goyal MBBS, MS1, Stephanie Payne2, Lindsey R. Sangaralingham MPH2, Molly Moore Jeffery PhD2, James M. Naessens ScD2, Halena M. Gazelka MD3, Elizabeth B. Habermann PhD4, William Krauss MD1, Robert J. Spinner MD1, and Mohamad Bydon MD1
doi : 10.3171/2021.2.SPINE202205
Volume 35: Issue 5, page: 583–591
Sustained postoperative opioid use after elective surgery is a matter of growing concern. Herein, the authors investigated incidence and predictors of long-term opioid use among patients undergoing elective lumbar spine surgery, especially as a function of opioid prescribing practices at postoperative discharge (dose in morphine milligram equivalents [MMEs] and type of opioid).
Surgery versus nonsurgery for lumbar spinal stenosis: an in-depth analysis of the 2016 Cochrane analysis, the studies included for analysis, and Cochrane methodology
Richard G. Fessler MD, PhD1
doi : 10.3171/2021.1.SPINE201894
Volume 35: Issue 5, page: 592–600
Depth of vertebral screw insertion using a cortical bone trajectory technique in lumbar spinal fusion: radiological significance of a long cortical bone trajectory
Keitaro Matsukawa MD, PhD1, Yoshihide Yanai MD1, Kanehiro Fujiyoshi MD, PhD1, Takashi Kato MD1, and Yoshiyuki Yato MD, PhD1
doi : 10.3171/2021.2.SPINE202229
Volume 35: Issue 5, page: 601–606
Contrary to original cortical bone trajectory (CBT), “long CBT” directed more anteriorly in the vertebral body has recently been recommended because of improved screw fixation and load sharing within the vertebra. However, to the authors’ knowledge there has been no report on the clinical significance of the screw length and screw insertion depth used with the long CBT technique. The aim of the present study was to investigate the influence of the screw insertion depth in the vertebra on lumbar spinal fusion using the CBT technique.
The impact of frailty on patient-reported outcomes after elective thoracolumbar degenerative spine surgery
Philippe Beauchamp-Chalifour MD, MSc1, Alana M. Flexman MD, FRCPC2, John T. Street MD, FRCSI, PhD3, Charles G. Fisher MD, FRCSC, MHSC3, Tamir Ailon MD, FRCSC, MPH3, Marcel F. Dvorak MD, FRCSC3, Brian K. Kwon MD, FRCSC, PhD3, Scott J. Paquette MD, FRCSC, MEd3, Nicolas Dea MD, MSc, FRCSC3, and Raphaële Charest-Morin MD, FRCSC3
doi : 10.3171/2021.2.SPINE201879
Volume 35: Issue 5, page: 607–615
Frailty has been shown to be a risk factor of perioperative adverse events (AEs) in patients undergoing various types of spine surgery. However, the relationship between frailty and patient-reported outcomes (PROs) remains unclear. The primary objective of this study was to determine the impact of frailty on PROs of patients who underwent surgery for thoracolumbar degenerative conditions. The secondary objective was to determine the associations among frailty, baseline PROs, and perioperative AEs.
Understanding sagittal compensation in adult spinal deformity patients: relationship between pelvic tilt and lower-extremity position
Takayoshi Shimizu MD, PhD1,2, Meghan Cerpa MPH1, and Lawrence G. Lenke MD1
doi : 10.3171/2021.1.SPINE201660
Volume 35: Issue 5, page: 616–623
In adult spinal deformity (ASD), quantifying preoperative lower-extremity (LE) compensation is important in formulating an operative plan to achieve optimal global sagittal alignment. Whole-body radiographs are not always available. This study evaluated the possibility of estimating LE compensation without whole-body radiographs.
Impact of morphological restoration of the spinal cord from the preoperative to early postoperative periods on C5 palsy development
Masahiro Mizutani MD1, Takashi Fujishiro MD, PhD1, Takuya Obo MD1, Atsushi Nakano MD, PhD1, Yoshiharu Nakaya MD, PhD1, Sachio Hayama MD, PhD1, Yoshitada Usami MD1, Keiichiro Kino MD1, and Masashi Neo MD, PhD1
doi : 10.3171/2021.2.SPINE201955
Volume 35: Issue 5, page: 624–632
C5 palsy (C5P) is a known complication of cervical decompression surgery. The tethering effect of the C5 nerve root following the posterior shift of the spinal cord is the most accepted pathologic mechanism for C5P development; however, this mechanism cannot fully explain C5P by itself in clinical practice. Separately, some studies have suggested that preoperative severe spinal cord compression and postoperative morphological changes in the spinal cord affect C5P development; however, no previous study has quantitatively addressed these possibilities. The aim of this study was to examine whether spinal cord morphology and morphological restoration after surgery affect C5P development.
Open-door laminoplasty with stand-alone autologous bone spacers: evaluation of enlarged laminar arch with CT–multiplanar reconstruction
Hiroshi Kono MD, PhD1, Hideki Matsuda MD1, Takafumi Maeno MD, PhD1, Masayoshi Iwamae MD1, and Hiroaki Nakamura MD, PhD2
doi : 10.3171/2021.1.SPINE201633
Volume 35: Issue 5, page: 633–637
The authors aimed to determine the efficacy of open-door laminoplasty with stand-alone autologous bone spacer for preserving enlarged lamina in patients with cervical myelopathy.
A significant association between C5 nerve sheath tumors and new postoperative weakness
Anthony L. Mikula MD1, Brandon W. Smith MD1, Nikita Lakomkin MD1, Matthew K. Doan BS2, Megan M. Jack MD, PhD1, Mohamad Bydon MD1, and Robert J. Spinner MD1
doi : 10.3171/2021.2.SPINE202139
Volume 35: Issue 5, page: 638–643
The objective of this study was to determine if patients with nerve sheath tumors affecting the C5 spinal nerve are at greater risk for postoperative weakness than those with similar tumors affecting other spinal nerves contributing to the brachial plexus.
Posterior fusion for fragility type 2 odontoid fractures
Vincent C. Traynelis MD1, Ricardo B. V. Fontes MD, PhD1, Kingsley O. Abode-Iyamah MD2, Efrem M. Cox MD3, and Jeremy D. Greenlee MD4
doi : 10.3171/2021.2.SPINE201645
Volume 35: Issue 5, page: 644–650
The purpose of this study was to evaluate the outcomes of elderly patients with type 2 odontoid fractures treated with an instrumented posterior fusion.
Prognostic factors and nomogram prediction of survival probability in primary spinal cord astrocytoma patients
Chenghua Yuan MD1,2,3, Qingyu Yao MD1,2,3, Lei Cheng MD1,2,3, Can Zhang MD1,2,3, Longbing Ma MD1,2,3, Jian Guan MD1,2,3, and Fengzeng Jian MD1,2,3
doi : 10.3171/2021.1.SPINE202017
Volume 35: Issue 5, page: 651–662
Knowledge on the management of spinal cord astrocytoma (SCA) remains scarce. Here, the authors constructed and validated a predictive nomogram, often used for individualized prognosis and evaluations, to estimate cancer-specific survival (CSS) and overall survival (OS) for patients with SCA.
Influence of tranexamic acid use on venous thromboembolism risk in patients undergoing surgery for spine tumors
Zach Pennington MD1, Jeff Ehresman MD1, Andrew Schilling AB1, James Feghali MD1, Andrew M. Hersh AB1, Bethany Hung BS1, Eleni N. Kalivas PharmD2, Daniel Lubelski MD1, and Daniel M. Sciubba MD1
doi : 10.3171/2021.1.SPINE201935
Volume 35: Issue 5, page: 663–673
Patients with spine tumors are at increased risk for both hemorrhage and venous thromboembolism (VTE). Tranexamic acid (TXA) has been advanced as a potential intervention to reduce intraoperative blood loss in this surgical population, but many fear it is associated with increased VTE risk due to the hypercoagulability noted in malignancy. In this study, the authors aimed to 1) develop a clinical calculator for postoperative VTE risk in the population with spine tumors, and 2) investigate the association of intraoperative TXA use and postoperative VTE.
High-dose hypofractionated stereotactic body radiotherapy for spinal chordoma
Xuguang Chen MD, PhD1, Sheng-Fu L. Lo MD, MHS2, Chetan Bettegowda MD, PhD2, Daniel M. Ryan II MD3, John M. Gross MD, MS4, Chen Hu PhD5, Lawrence Kleinberg MD1, Daniel M. Sciubba MD2, and Kristin J. Redmond MD, MPH1
doi : 10.3171/2021.2.SPINE202199
Volume 35: Issue 5, page: 674–683
Spinal chordoma is locally aggressive and has a high rate of recurrence, even after en bloc resection. Conventionally fractionated adjuvant radiation leads to suboptimal tumor control, and data regarding hypofractionated regimens are limited. The authors hypothesized that neoadjuvant stereotactic body radiotherapy (SBRT) may overcome its intrinsic radioresistance, improve surgical margins, and allow preservation of critical structures during surgery. The purpose of this study is to review the feasibility and early outcomes of high-dose hypofractionated SBRT, with a focus on neoadjuvant SBRT.
Letter to the Editor. The INSPIRE studies for spinal cord injury
Marios C. Papadopoulos MD, FRCS(SN)1 and Samira Saadoun PhD2
doi : 10.3171/2021.4.SPINE21451
Volume 35: Issue 5, page: 684–685
