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Systematic review of telemedicine in spine surgery
John Paul G. Kolcun, Won Hyung A. Ryu, and Vincent C. Traynelis
doi : 10.3171/2020.6.SPINE20863
Volume 34: Issue 2.Page Range: 161–170
The use of telemedicine (TM) has long been available, but recent restrictions to hospitals due to the coronavirus disease 2019 (COVID-19) pandemic have accelerated the global implementation of TM. However, evidence on the effectiveness of this technology for the care of spine surgery patients is limited. In this systematic review the authors aimed to examine the current utilization of TM for spine surgery.
Prognostic significance of C1–C2 facet malalignment after surgical decompression in adult Chiari malformation type I: a pilot study based on the Chicago Chiari Outcome Scale
Michael Lumintang Loe, Tito Vivas-Buitrago, Ricardo A. Domingo, Johan Heemskerk, Shashwat Tripathi, Bernard R. Bendok, Mohamad Bydon, Alfredo Quinones-Hinojosa, and Kingsley Abode-Iyamah
doi : 10.3171/2020.6.SPINE20544
Volume 34: Issue 2.Page Range: 171–177
The authors assessed the prognostic significance of various clinical and radiographic characteristics, including C1–C2 facet malalignment, in terms of surgical outcomes after foramen magnum decompression of adult Chiari malformation type I.
Risk factors for determining length of intensive care unit and hospital stays following correction of cervical deformity: evaluation of early severe adverse events
Rushikesh S. Joshi, Darryl Lau, Alexander F. Haddad, Vedat Deviren, and Christopher P. Ames
doi : 10.3171/2020.6.SPINE20826
Volume 34: Issue 2.Page Range: 178–189
Correction of rigid cervical deformities can be associated with high complication rates and result in prolonged intensive care unit (ICU) and hospital stays. In this study, the authors aimed to examine the risk factors contributing to length of stay (LOS) in both the hospital and ICU following adult cervical deformity (ACD) surgery and to identify severe adverse events that occurred in this setting.
Is the Goutallier grade of multifidus fat infiltration associated with adjacent-segment degeneration after lumbar spinal fusion?
Ping-Guo Duan, Praveen V. Mummaneni, Jeremy M. V. Guinn, Joshua Rivera, Sigurd H. Berven, and Dean Chou
doi : 10.3171/2020.6.SPINE20238
Volume 34: Issue 2.Page Range: 190–195
The aim of this study was to investigate whether fat infiltration of the lumbar multifidus (LM) muscle affects revision surgery rates for adjacent-segment degeneration (ASD) after L4–5 transforaminal lumbar interbody fusion (TLIF) for degenerative spondylolisthesis.
Assessing changes in cervical epidural pressure during biportal endoscopic lumbar discectomy
Taewook Kang, Si Young Park, Soon Hyuck Lee, Jong Hoon Park, and Seung Woo Suh
doi : 10.3171/2020.6.SPINE20586
Volume 34: Issue 2.Page Range: 196–202
Biportal endoscopic spinal surgery has been performed for several years, and its effectiveness is well known; however, no studies on its safety, specifically intracranial pressure, have been conducted to date. The authors sought to evaluate the effect of biportal endoscopic lumbar discectomy on intracranial pressure by monitoring cervical epidural pressure (CEP) changes throughout the procedure.
The short-term outcomes of minimally invasive decompression surgery in patients with lumbar ossification or calcification of the ligamentum flavum
Koji Tamai, Kunikazu Kaneda, Masayoshi Iwamae, Hidetomi Terai, Hiroshi Katsuda, Nagakazu Shimada, and Hiroaki Nakamura
doi : 10.3171/2020.6.SPINE20946
Volume 34: Issue 2.Page Range: 203–210
Although minimally invasive endoscopic surgery techniques are established standard treatment choices for various degenerative conditions of the lumbar spine, the surgical indications of such techniques for specific cases, such as segments with ossification of the ligamentum flavum (OLF) or calcification of the ligamentum flavum (CLF), remain under investigation. Therefore, the authors aimed to demonstrate the short-term outcomes of minimally invasive endoscopic surgery in patients with degenerative lumbar disease with CLF or OLF.
Bilateral paraspinal muscle flap closure technique for reduction of wound complications from posterior thoracolumbar spinal fusion: results of a series of 716 patients
John K. Houten, Gila R. Weinstein, Michael J. Collins, and Daniel Komlos
doi : 10.3171/2020.6.SPINE20755
Volume 34: Issue 2.Page Range: 211–217
Wound complications such as surgical site infection (SSI) and dehiscence are among the most common complications of thoracolumbar spinal fusion surgery and are particularly prevalent in patients with risk factors such as obesity, diabetes, smoking, malignancy, and multilevel and/or revision procedures.
Practical answers to frequently asked questions for shared decision-making in adult spinal deformity surgery
Yoji Ogura, Jeffrey L. Gum, Alex Soroceanu, Alan H. Daniels, Breton Line, Themistocles Protopsaltis, Richard A. Hostin, Peter G. Passias, Douglas C. Burton, Justin S. Smith, Christopher I. Shaffrey, Virginie Lafage, Renaud Lafage, Eric O. Klineberg, Han Jo Kim, Andrew Harris, Khaled Kebaish, Frank Schwab, Shay Bess, Christopher P. Ames, Leah Y. Carreon, and the International Spine Study Group (ISSG)
doi : 10.3171/2020.6.SPINE20363
Volume 34: Issue 2.Page Range: 218–227
The shared decision-making (SDM) process provides an opportunity to answer frequently asked questions (FAQs). The authors aimed to present a concise list of answers to FAQs to aid in SDM for adult spinal deformity (ASD) surgery.
A long-term follow-up study of spinal abnormalities and pain in adults with cerebral palsy and spastic diplegia more than 25 years after selective dorsal rhizotomy
Berendina E. Veerbeek, Robert P. Lamberts, A. Graham Fieggen, Ncedile Mankahla, Richard V. P. de Villiers, Elsabe Botha, and Nelleke G. Langerak
doi : 10.3171/2020.6.SPINE20751
Volume 34: Issue 2.Page Range: 228–235
The main purpose of selective dorsal rhizotomy (SDR) is to reduce spasticity in the lower extremities of children diagnosed with cerebral palsy (CP) and spastic diplegia. The potential for developing spinal abnormalities and pain is a concern, especially in the aging CP population. Therefore, the aim of this study was to evaluate spinal abnormalities, level of pain, and disability (due to back or leg pain) in adults with CP, and associations with participant characteristics, more than 25 years after SDR.
Ultra–high-molecular-weight polyethylene sublaminar tape as semirigid fixation or pedicle screw augmentation to prevent failure in long-segment spine surgery: an ex vivo biomechanical study
Remco J. P. Doodkorte, Ricardo Belda, Alex K. Roth, Bert van Rietbergen, Jacobus J. Arts, L. M. Arno Lataster, Lodewijk W. van Rhijn, and Paul C. Willems
doi : 10.3171/2020.6.SPINE20605
Volume 34: Issue 2.Page Range: 236–244
Complications after adult spinal deformity surgery are common, with implant-related complications occurring in up to 27.8% of cases. Sublaminar wire fixation strength is less affected by decreasing trabecular bone density in comparison to pedicle screw (PS) fixation due to the predominant cortical bone composition of the lamina. Sublaminar fixation may thus aid in decreasing implant-related complications. The goal of this study was to compare fixation characteristics of titanium sublaminar cables (SCs), ultra–high-molecular-weight polyethylene (UHMWPE) tape, PSs, and PSs augmented with UHMWPE tape in an ex vivo flexion–bending setup.
The risks, reasons, and costs for 30- and 90-day readmissions after fusion surgery for adolescent idiopathic scoliosis
Nathan J. Lee, Michael W. Fields, Venkat Boddapati, Meghan Cerpa, Jalen Dansby, James D. Lin, Zeeshan M. Sardar, Ronald Lehman Jr., and Lawrence Lenke
doi : 10.3171/2020.6.SPINE20197
Volume 34: Issue 2.Page Range: 245–253
With the continued evolution of bundled payment plans, there has been a greater focus within orthopedic surgery on quality metrics up to 90 days of care. Although the Centers for Medicare and Medicaid Services does not currently penalize hospitals based on their pediatric readmission rates, it is important to understand the drivers for unplanned readmission to improve the quality of care and reduce costs.
Autograft-derived spinal cord mass in the cervical spine following transplantation with olfactory mucosa cells for traumatic spinal cord injury: case report
Theresa L. Williamson, Andrew Cutler, Mary I. Cobb, Shervin Rahimpour, Eric R. Butler, Stephen C. Harward, Thomas J. Cummings, and Allan H. Friedman
doi : 10.3171/2020.6.SPINE20251
Volume 34: Issue 2.Page Range: 254–258
This study describes a patient with an autograft-derived spinal cord mass following transplantation of olfactory mucosa for treatment of cervical spine injury. The authors report the case of a 35-year-old man who suffered a complete spinal cord injury (SCI) at C5–6 in 2001. The patient underwent an olfactory mucosal cell implantation at the location of injury 4 years following initial trauma.
Postoperative changes in spinal cord signal intensity in patients with spinal cord injury without major bone injury: comparison between preoperative and postoperative magnetic resonance images
Masaaki Machino, Kei Ando, Kazuyoshi Kobayashi, Hiroaki Nakashima, Shunsuke Kanbara, Sadayuki Ito, Taro Inoue, Hidetoshi Yamaguchi, Hiroyuki Koshimizu, Keigo Ito, Fumihiko Kato, Naoki Ishiguro, and Shiro Imagama
doi : 10.3171/2020.6.SPINE20761
Volume 34: Issue 2.Page Range: 259–266
Although increased signal intensity (ISI) on MRI is observed in patients with cervical spinal cord injury (SCI) without major bone injury, alterations in ISI have not been evaluated. The association between postoperative ISI and surgical outcomes remains unclear. This study elucidated whether or not the postoperative classification and alterations in MRI-based ISI of the spinal cord reflected the postoperative symptom severity and surgical outcomes in patients with SCI without major bone injury.
Stereotactic body radiation therapy for spinal metastases: a novel local control stratification by spinal region
Roman O. Kowalchuk, Michael R. Waters, K. Martin Richardson, Kelly Spencer, James M. Larner, William H. McAllister, Jason P. Sheehan, and Charles R. Kersh
doi : 10.3171/2020.6.SPINE20861
Volume 34: Issue 2.Page Range: 267–276
This study evaluated a large cohort of patients treated with stereotactic body radiation therapy for spinal metastases and investigated predictive factors for local control, local progression-free survival (LPFS), overall survival, and pain response between the different spinal regions.
A multidisciplinary approach to complex oncological spine coverage in high-risk patients
Minh H. Nguyen, Krishna Patel, Julie West, Thomas Scharschmidt, Matthew Chetta, Steven Schulz, Ehud Mendel, and Ian L. Valerio
doi : 10.3171/2020.6.SPINE2024
Volume 34: Issue 2.Page Range: 277–282
The consequences of failed spinal hardware secondary to wound complications can increase the burden on the patient while also significantly escalating the cost of care. The objective of this study was to demonstrate the effectiveness of a protocol-based multidisciplinary approach in optimizing wound outcome in complex oncological spine care patients.
The use of autologous free vascularized fibula grafts in reconstruction of the mobile spine following tumor resection: surgical technique and outcomes
Michiel E. R. Bongers, Paul T. Ogink, Katrina F. Chu, Anuj Patel, Brett Rosenthal, John H. Shin, Sang-Gil Lee, Francis J. Hornicek, and Joseph H. Schwab
doi : 10.3171/2020.6.SPINE20521
Volume 34: Issue 2.Page Range: 283–292
Reconstruction of the mobile spine following total en bloc spondylectomy (TES) of one or multiple vertebral bodies in patients with malignant spinal tumors is a challenging procedure with high failure rates. A common reason for reconstructive failure is nonunion, which becomes more problematic when using local radiation therapy. Radiotherapy is an integral part of the management of primary malignant osseous tumors in the spine. Vascularized grafts may help prevent nonunion in the radiotherapy setting. The authors have utilized free vascularized fibular grafts (FVFGs) for reconstruction of the spine following TES.
Patient outcomes and tumor control in single-fraction versus hypofractionated stereotactic body radiation therapy for spinal metastases
Christine Park, Elizabeth P. Howell, Vikram A. Mehta, Luis Ramirez, Meghan J. Price, Scott R. Floyd, John P. Kirkpatrick, Jordan Torok, Muhammad M. Abd-El-Barr, Isaac O. Karikari, and C. Rory Goodwin
doi : 10.3171/2020.6.SPINE20349
Volume 34: Issue 2.Page Range: 293–302
Stereotactic body radiation therapy (SBRT) offers efficient, noninvasive treatment of spinal neoplasms. Single-fraction (SF) high-dose SBRT has a relatively narrow therapeutic window, while hypofractionated delivery of SBRT may have an improved safety profile with similar efficacy. Because the optimal approach of delivery is unknown, the authors examined whether hypofractionated SBRT improves pain and/or functional outcomes and results in better tumor control compared with SF-SBRT.
A comprehensive epidemiological review of spinal astrocytomas in the United States
Jianning Shao, Jaes Jones, Patrick Ellsworth, Ghaith Habboub, Gino Cioffi, Nirav Patil, Quinn T. Ostrom, Carol Kruchko, Jill S. Barnholtz-Sloan, Varun R. Kshettry, and Pablo F. Recinos
doi : 10.3171/2020.6.SPINE191532
Volume 34: Issue 2.Page Range: 303–309
Spinal cord astrocytoma (SCA) is a rare tumor whose epidemiology has not been well defined. The authors utilized the Central Brain Tumor Registry of the United States (CBTRUS) to provide comprehensive up-to-date epidemiological data for this disease.
Metachronous spinal pial arteriovenous fistulas: case report
Ramez N. Abdalla, Tahaamin Shokuhfar, Michael C. Hurley, Sameer A. Ansari, Babak S. Jahromi, Matthew B. Potts, H. Hunt Batjer, and Ali Shaibani
doi : 10.3171/2020.6.SPINE20600
Volume 34: Issue 2.Page Range: 310–315
Spinal pial arteriovenous fistulas (spAVFs) are believed to be congenital lesions, and the development of a de novo spAVF has not been previously described. A 49-year-old female with a childhood history of vascular malformation–induced right lower-extremity hypertrophy presented in 2004 with progressive pain in her right posterior thigh and outer foot. Workup revealed 3 separate type IV spAVFs, which were treated by combined embolization and resection, with final conventional angiography showing no residual spinal vascular lesion in 2005. Ten years later, the patient returned with new right lower-extremity weakness, perineal pain, and left plantar foot numbness. Repeat spinal angiography demonstrated 2 de novo intertwined conus medullaris spAVFs.
A cadaveric precision and accuracy analysis of augmented reality–mediated percutaneous pedicle implant insertion
Camilo A. Molina, Frank M. Phillips, Matthew W. Colman, Wilson Z. Ray, Majid Khan, Emanuele Orru’, Kornelis Poelstra, and Larry Khoo
doi : 10.3171/2020.6.SPINE20370
Volume 34: Issue 2.Page Range: 316–324
Augmented reality–mediated spine surgery (ARMSS) is a minimally invasive novel technology that has the potential to increase the efficiency, accuracy, and safety of conventional percutaneous pedicle screw insertion methods. Visual 3D spinal anatomical and 2D navigation images are directly projected onto the operator’s retina and superimposed over the surgical field, eliminating field of vision and attention shift to a remote display. The objective of this cadaveric study was to assess the accuracy and precision of percutaneous ARMSS pedicle implant insertion.
Systematic review and meta-analysis of the clinical utility of Enhanced Recovery After Surgery pathways in adult spine surgery
Zach Pennington, Ethan Cottrill, Daniel Lubelski, Jeff Ehresman, Nicholas Theodore, and Daniel M. Sciubba
doi : 10.3171/2020.6.SPINE20795
Volume 34: Issue 2.Page Range: 325–347
Spine surgery has been identified as a significant source of healthcare expenditures in the United States. Prolonged hospitalization has been cited as one source of increased spending, and there has been drive from providers and payors alike to decrease inpatient stays. One strategy currently being explored is the use of Enhanced Recovery After Surgery (ERAS) protocols. Here, the authors review the literature on adult spine ERAS protocols, focusing on clinical benefits and cost reductions. They also conducted a quantitative meta-analysis examining the following: 1) length of stay (LOS), 2) complication rate, 3) wound infection rate, 4) 30-day readmission rate, and 5) 30-day reoperation rate.
Letter to the Editor. Understanding the anatomy of the dura mater
Naci Balak
doi : 10.3171/2020.8.SPINE201586
Volume 34: Issue 2.Page Range: 348–349
Letter to the Editor. Critical points for consideration on minimally invasive surgery decompression alternatives for craniocervical junction–related syringomyelia
Tao Fan
doi : 10.3171/2020.7.SPINE201143
Volume 34: Issue 2.Page Range: 349–350
