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Long-segment posterior cervical decompression and fusion: does caudal level affect revision rate?
Kevin Hines, Zachary T. Wilt, Daniel Franco, Aria Mahtabfar, Nicholas Elmer, Glenn A. Gonzalez, Thiago S. Montenegro, Lohit Velagapudi, Parthik D. Patel, Maxwell Detweiler, Umma Fatema, Gregory D. Schroeder, and James Harrop
doi : 10.3171/2020.10.SPINE201385
Volume 35: Issue 1 (Jul 2021)Page Range: 1–7
Posterior cervical decompression and fusion (PCDF) is a commonly performed procedure to address cervical myelopathy. A significant number of these patients require revision surgery for adjacent-segment disease (ASD) or pseudarthrosis. Currently, there is no consensus among spine surgeons on the inclusion of proximal thoracic spine instrumentation. This study investigates the benefits of thoracic extension in long-segment cervical fusions and the potential drawbacks. The authors compare outcomes in long-segment subaxial cervical fusion for degenerative cervical myelopathy with caudal vertebral levels of C6, C7, and T1.
Gap between flexion and extension ranges of motion: a novel indicator to predict the loss of cervical lordosis after laminoplasty in patients with cervical spondylotic myelopathy
Takashi Fujishiro, Sachio Hayama, Takuya Obo, Yoshiharu Nakaya, Atsushi Nakano, Yoshitada Usami, Satoshi Nozawa, Ichiro Baba, and Masashi Neo
doi : 10.3171/2020.10.SPINE201723
Volume 35: Issue 1 (Jul 2021)Page Range: 8–17
Kyphotic deformity resulting from the loss of cervical lordosis (CL) is a rare but serious complication after cervical laminoplasty (CLP), and it is essential to recognize the risk factors. Previous studies have demonstrated that a greater flexion range of motion (fROM) and smaller extension ROM (eROM) in the cervical spine are associated with the loss of CL after CLP. Considering these facts together, one can hypothesize that an indicator representing the gap between fROM and eROM (gROM) is highly useful in predicting postoperative CL loss. In the present study, the authors aimed to investigate the risk factors of marked CL loss after CLP for cervical spondylotic myelopathy (CSM), including the gROM as a potential predictor.
Abnormal spinal cord motion at the craniocervical junction in hypermobile Ehlers-Danlos patients
Petra M. Klinge, Abigail McElroy, John E. Donahue, Thomas Brinker, Ziya L. Gokaslan, and Michael D. Beland
doi : 10.3171/2020.10.SPINE201765
Volume 35: Issue 1 (Jul 2021)Page Range: 18–24
The craniocervical junction (CCJ) is anatomically complex and comprises multiple joints that allow for wide head and neck movements. The thecal sac must adjust to such movements. Accordingly, the thecal sac is not rigidly attached to the bony spinal canal but instead tethered by fibrous suspension ligaments, including myodural bridges (MDBs). The authors hypothesized that pathological spinal cord motion is due to the laxity of such suspension bands in patients with connective tissue disorders, e.g., hypermobile Ehlers-Danlos syndrome (EDS).
Identifying patients at risk for nonroutine discharge after surgery for cervical myelopathy: an analysis from the Quality Outcomes Database
doi : 10.3171/2020.11.SPINE201442
Volume 35: Issue 1 (Jul 2021)Page Range: 25–33
Optimizing patient discharge after surgery has been shown to impact patient recovery and hospital/physician workflow and to reduce healthcare costs. In the current study, the authors sought to identify risk factors for nonroutine discharge after surgery for cervical myelopathy by using a national spine registry.
The impact of pathoanatomical diagnosis on elective spine surgery patient expectations: a Canadian Spine Outcomes and Research Network study
doi : 10.3171/2020.11.SPINE201490
Volume 35: Issue 1 (Jul 2021)Page Range: 34–41
Patients undergoing spine surgery generally have high expectations for improvement postoperatively. Little is known about how these expectations are affected by the diagnosis. The purpose of this study was to examine whether preoperative expectations differ based on diagnostic pathoanatomical patterns in elective spine surgery patients.
Patient-reported outcome improvements at 24-month follow-up after fusion added to decompression for grade I degenerative lumbar spondylolisthesis: a multicenter study using the Quality Outcomes Database
doi : 10.3171/2020.9.SPINE201082
Volume 35: Issue 1 (Jul 2021)Page Range: 42–51
The ideal surgical management of grade I lumbar spondylolisthesis has not been determined despite extensive prior investigations. In this cohort study, the authors used data from the large, multicenter, prospectively collected Quality Outcomes Database to bridge the gap between the findings in previous randomized trials and those in a more heterogeneous population treated in a typical practice. The objective was to assess the difference in patient-reported outcomes among patients undergoing decompression alone or decompression plus fusion.
Responsiveness of the self-measured 6-minute walking test and the Timed Up and Go test in patients with degenerative lumbar disorders
doi : 10.3171/2020.11.SPINE201621
Volume 35: Issue 1 (Jul 2021)Page Range: 52–59
The 6-minute walking test (6WT) and the Timed Up and Go (TUG) test are two of the most commonly applied standardized measures of objective functional impairment that help support clinical decision-making for patients undergoing surgery for degenerative lumbar disorders. This study correlates smartphone-app–based 6WT and TUG results to evaluate their responsiveness.
Reasons for revision following stand-alone anterior lumbar interbody fusion and lateral lumbar interbody fusion
doi : 10.3171/2020.10.SPINE201239
Volume 35: Issue 1 (Jul 2021)Page Range: 60–66
Anterior lumbar interbody fusion (ALIF) and lateral lumbar interbody fusion (LLIF) are alternative and less invasive techniques to stabilize the spine and indirectly decompress the neural elements compared with open posterior approaches. While reoperation rates have been described for open posterior lumbar surgery, there are sparse data on reoperation rates following these less invasive procedures without direct posterior decompression. This study aimed to evaluate the overall rate, cause, and timing of reoperation procedures following anterior or lateral lumbar interbody fusions without direct posterior decompression.
Operative versus nonoperative treatment for adult symptomatic lumbar scoliosis at 5-year follow-up: durability of outcomes and impact of treatment-related serious adverse events
doi : 10.3171/2020.9.SPINE201472
Volume 35: Issue 1 (Jul 2021)Page Range: 67–79
Although short-term adult symptomatic lumbar scoliosis (ASLS) studies favor operative over nonoperative treatment, longer outcomes are critical for assessment of treatment durability, especially for operative treatment, because the majority of implant failures and nonunions present between 2 and 5 years after surgery. The objectives of this study were to assess the durability of treatment outcomes for operative versus nonoperative treatment of ASLS, to report the rates and types of associated serious adverse events (SAEs), and to determine the potential impact of treatment-related SAEs on outcomes.
Predictors of indirect neural decompression in minimally invasive transpsoas lateral lumbar interbody fusion
doi : 10.3171/2020.8.SPINE20676
Volume 35: Issue 1 (Jul 2021)Page Range: 80–90
An advantage of lateral lumbar interbody fusion (LLIF) surgery is the indirect decompression of the neural elements that occurs because of the resulting disc height restoration, spinal realignment, and ligamentotaxis. The degree to which indirect decompression occurs varies; no method exists for effectively predicting which patients will respond. In this study, the authors identify preoperative predictive factors of indirect decompression of the central canal.
Disparities in outcomes after spine surgery: a Michigan Spine Surgery Improvement Collaborative study
doi : 10.3171/2020.10.SPINE20914
Volume 35: Issue 1 (Jul 2021)Page Range: 91–99
Most studies on racial disparities in spine surgery lack data granularity to control for both comorbidities and self-assessment metrics. Analyses from large, multicenter surgical registries can provide an enhanced platform for understanding different factors that influence outcome. In this study, the authors aimed to determine the effects of race on outcomes after lumbar surgery, using patient-reported outcomes (PROs) in 3 areas: the North American Spine Society patient satisfaction index, the minimal clinically important difference (MCID) on the Oswestry Disability Index (ODI) for low-back pain, and return to work.
Safety of lateral access to the concave side for adult spinal deformity
doi : 10.3171/2020.10.SPINE191270
Volume 35: Issue 1 (Jul 2021)Page Range: 100–104
Minimally invasive surgery (MIS) techniques, particularly lateral lumbar interbody fusion (LLIF), have become increasingly popular for adult spinal deformity (ASD) correction. Much discussion has been had regarding theoretical and clinical advantages to addressing coronal curvature from the convex versus concave side of the curve. In this study, the authors aimed to broadly evaluate the clinical outcomes of addressing ASD with circumferential MIS (cMIS) techniques while accessing the lumbar coronal curvature from the concave side.
Clinical photographs in the assessment of adult spinal deformity: a comparison to radiographic parameters
doi : 10.3171/2020.11.SPINE201732
Volume 35: Issue 1 (Jul 2021)Page Range: 105–109
The goal of this study was to reliably predict sagittal and coronal spinal alignment with clinical photographs by using markers placed at easily localized anatomical landmarks.
The utility of supine radiographs in the assessment of thoracic flexibility and risk of proximal junctional kyphosis
doi : 10.3171/2020.11.SPINE201565
Volume 35: Issue 1 (Jul 2021)Page Range: 110–116
Supine radiographs have successfully been used for preoperative planning of lumbar deformity corrections. However, they have not been used to assess thoracic flexibility, which has recently garnered attention as a potential contributor to proximal junctional kyphosis (PJK). The purpose of this study was to compare supine to standing radiographs to assess thoracic flexibility and to determine whether thoracic flexibility is associated with PJK.
Comparison of operator and patient radiation exposure during fluoroscopy-guided vertebroplasty and kyphoplasty: a systematic review and meta-analysis
doi : 10.3171/2020.9.SPINE201525
Volume 35: Issue 1 (Jul 2021)Page Range: 117–126
Percutaneous vertebroplasty (PV) and balloon kyphoplasty (BK) are two minimally invasive techniques used to treat mechanical pain secondary to spinal compression fractures. A concern for both procedures is the radiation exposure incurred by both operators and patients. The authors conducted a systematic review of the available literature to examine differences in interventionalist radiation exposure between PV and BK and differences in patient radiation exposure between PV and BK.
Patient factors that matter in predicting spine surgery outcomes: a machine learning approach
doi : 10.3171/2020.10.SPINE201354
Volume 35: Issue 1 (Jul 2021)Page Range: 127–136
There is an increasing recognition of the importance of predictive analytics in spine surgery. This, along with the addition of personalized treatment, can optimize treatment outcomes. The goal of this study was to examine the value of clinical, demographic, expectation, and cognitive appraisal variables in predicting outcomes after surgery.
Letter to the Editor. Patient self-rated health and rating of their spine surgeon
doi : 10.3171/2021.1.SPINE21166
Volume 35: Issue 1 (Jul 2021)Page Range: 137
