Showing papers in "Spine in 2019"

Trends in Lumbar Fusion Procedure Rates and Associated Hospital Costs for Degenerative Spinal Diseases in the United States, 2004 to 2015

Abstract: Study Design.Analysis of National Inpatient Sample (NIS), 2004 to 2015.Objective.Describe recent trends in US rates of lumbar fusion procedures and associated costs, by surgical indication.Summary of Background Data.Spinal fusion is appropriate for spinal deformity and instability, but evidence of e

Artificial intelligence and machine learning in spine research.

Abstract: Artificial intelligence (AI) and machine learning (ML) techniques are revolutionizing several industrial and research fields like computer vision, autonomous driving, natural language processing, and speech recognition. These novel tools are already having a major impact in radiology, diagnostics, and many other fields in which the availability of automated solution may benefit the accuracy and repeatability of the execution of critical tasks. In this narrative review, we first present a brief description of the various techniques that are being developed nowadays, with special focus on those used in spine research. Then, we describe the applications of AI and ML to problems related to the spine which have been published so far, including the localization of vertebrae and discs in radiological images, image segmentation, computer-aided diagnosis, prediction of clinical outcomes and complications, decision support systems, content-based image retrieval, biomechanics, and motion analysis. Finally, we briefly discuss major ethical issues related to the use of AI in healthcare, namely, accountability, risk of biased decisions as well as data privacy and security, which are nowadays being debated in the scientific community and by regulatory agencies.

Pedicle Screw Placement Using Augmented Reality Surgical Navigation With Intraoperative 3D Imaging: A First In-Human Prospective Cohort Study.

Abstract: Study design Prospective observational study. Objective The aim of this study was to evaluate the accuracy of pedicle screw placement using augmented reality surgical navigation (ARSN) in a clinical trial. Summary of background data Recent cadaveric studies have shown improved accuracy for pedicle screw placement in the thoracic spine using ARSN with intraoperative 3D imaging, without the need for periprocedural x-ray. In this clinical study, we used the same system to place pedicle screws in the thoracic and lumbosacral spine of 20 patients. Methods The study was performed in a hybrid operating room with an integrated ARSN system encompassing a surgical table, a motorized flat detector C-arm with intraoperative 2D/3D capabilities, integrated optical cameras for augmented reality navigation, and noninvasive patient motion tracking. Three independent reviewers assessed screw placement accuracy using the Gertzbein grading on 3D scans obtained before wound closure. In addition, the navigation time per screw placement was measured. Results One orthopedic spinal surgeon placed 253 lumbosacral and thoracic pedicle screws on 20 consenting patients scheduled for spinal fixation surgery. An overall accuracy of 94.1% of primarily thoracic pedicle screws was achieved. No screws were deemed severely misplaced (Gertzbein grade 3). Fifteen (5.9%) screws had 2 to 4 mm breach (Gertzbein grade 2), occurring in scoliosis patients only. Thirteen of those 15 screws were larger than the pedicle in which they were placed. Two medial breaches were observed and 13 were lateral. Thirteen of the grade 2 breaches were in the thoracic spine. The average screw placement time was 5.2 ± 4.1 minutes. During the study, no device-related adverse event occurred. Conclusion ARSN can be clinically used to place thoracic and lumbosacral pedicle screws with high accuracy and with acceptable navigation time. Consequently, the risk for revision surgery and complications could be minimized. Level of evidence 3.

Design and Implementation of an Enhanced Recovery After Surgery (ERAS) Program for Minimally Invasive Lumbar Decompression Spine Surgery: Initial Experience.

Abstract: Study Design.A retrospective cohort study of prospectively collected data.Objective.The aim of this study was to describe the development of and early experience with an evidence-based enhanced recovery after surgery (ERAS) pathway for lumbar decompression.Summary of Background Data.ERAS protocols h

Measurement Techniques and Utility of Hounsfield Unit Values for Assessment of Bone Quality Prior to Spinal Instrumentation: A Review of Current Literature.

Abstract: Study Design.A systematic review.Objective.The aim of this study was to evaluate the clinical utility of assessing bone quality using computed tomography (CT) attenuation in Hounsfield units (HU).Summary of Background Data.Assessing bone quality before spine instrumentation is an essential step of p

Personal and Societal Impact of Low Back Pain: The Groningen Spine Cohort.

Abstract: Study Design. Cross-sectional study. Objective. The aim of this study was to study the personal and societal impact of low back pain (LBP) in patients admitted to a multidisciplinary spine center. Summary of Background Data. The socioeconomic burden of 113P is very high. A minority of patients visit secondary or tertiary care because of severe and long-lasting complaints. This subgroup may account for a major part of disability and costs, yet could potentially gain most from treatment. Currently, little is known about the personal and societal burden in patients with chronic complex LBP visiting secondary/tertiary care. Methods. Baseline data were acquired through patient-reported questionnaires and health insurance claims. Primary outcomes were LBP impact (Impact Stratification, range 8-50), functioning (Pain Disability Index, PDI; 0-70), quality of life (EuroQol-5D, EQ5D; -0.33 to 1.00), work ability (Work Ability Score, WAS; 0 10), work participation, productivity costs (Productivity Cost Questionnaire), and healthcare costs 1 year before baseline. Healthcare costs were compared with matched primary and secondary care LBP samples. Descriptive and inferential statistics were applied. Results. In total, 1502 patients (age 46.3 +/- 12.8 years, 57% female) were included. Impact Stratification was 35.2 +/- 7.5 with severe impact (>= 35) for 58% of patients. PDI was 38.2 +/- 14.1, EQ5D 0.39 (interquartile range, IQR: 0.17-0.72); WAS 4.0 (IQR: 1.0-6.0) and 17% were permanently work-disabled. Mean total health care costs ((sic)4875, 95% confidence interval [CI]: 4309-5498) were higher compared to the matched primary care sample (n =4995) ((sic)2365, 95% CI: 2219-2526, P <0.001), and similar to the matched secondary care sample (n -4993) ((sic)4379, 95% CI: 4180-4590). Productivity loss was estimated at (sic)4315 per patient (95% CI: 3898 4688) during 6 months. Conclusion. In patients seeking multidisciplinary spine care, the personal and societal impact of LBP is very high. Specifically, quality of life and work ability are poor and health care costs are twice as high compared to patients seeking primary LBP care.

Ten-year Outcomes of Cervical Disc Replacement With the BRYAN Cervical Disc: Results From a Prospective, Randomized, Controlled Clinical Trial

Abstract: Study Design.A prospective, randomized multicenter IDE trial between May 2002 and October 2004.Objective.The aim of this study was to report on the 10-year safety and efficacy of BRYAN cervical disc arthroplasty (CDA).Summary of Background Data.Cervical disc arthroplasty (CDA) is a potential alterna

Preoperative Risk Stratification in Spine Tumor Surgery: A Comparison of the Modified Charlson Index, Frailty Index, and ASA Score.

Abstract: Study Design.A retrospective review of prospectively collected data.Objective.The purpose of this study is to compare and validate several preoperative scores for predicting outcomes following spine tumor resection.Summary of Background Data.Preoperative risk assessment for patients undergoing spina

Comparative Analysis of Two Transforaminal Lumbar Interbody Fusion Techniques: Open TLIF Versus Wiltse MIS TLIF.

Abstract: Study Design.A retrospective cohort study at a single institution.Objective.The aim of this study was to analyze the perioperative and postoperative outcomes of patients who underwent open transforaminal lumbar interbody fusion (O-TLIF) and bilateral minimally invasive surgery (MIS) Wiltse approach

Preoperative Opioids and 1-year Patient-reported Outcomes After Spine Surgery

Abstract: Study Design.Longitudinal Cohort Study.Objective.Determine 1-year patient-reported outcomes associated with preoperative chronic opioid therapy and high-preoperative opioid dosages in patients undergoing elective spine surgery.Summary of Background Data.Back pain is the most disabling condition worl

Opioid-free Analgesia for Posterior Spinal Fusion Surgery Using Erector Spinae Plane (Esp) Blocks in a Multimodal Anesthetic Regimen

Abstract: Study Design.A case report.Objective.The aim of this study was to report the use of erector spinae plane (ESP) blocks as part of an opioid-free multimodal anesthetic regimen and its impact on postoperative pain and opioid requirements following spine surgery.Summary of Background Data.Posterior spin

Augmented and Virtual Reality Instrument Tracking for Minimally Invasive Spine Surgery: A Feasibility and Accuracy Study.

Abstract: Study design Cadaveric animal laboratory study. Objective To evaluate the feasibility and accuracy of pedicle cannulation using an augmented reality surgical navigation (ARSN) system with automatic instrument tracking, yielding feedback of instrument position in relation to deep anatomy. Summary of background data Minimally invasive spine surgery (MISS) has the possibility of reducing surgical exposure resulting in shorter hospital stays, lower blood loss and infection rates compared with open surgery but the drawback of limiting visual feedback to the surgeon regarding deep anatomy. MISS is mainly performed using image-guided 2D fluoroscopy, thus exposing the staff to ionizing radiation. Methods A hybrid operating room (OR) equipped with a robotic C-arm with integrated optical cameras for augmented reality instrument navigation was used. In two pig cadavers, cone beam computed tomography (CBCT) scans were performed, a 3D model generated, and pedicle screw insertions were planned. Seventy-eight insertions were performed. Technical accuracy was assessed on post-insertion CBCTs by measuring the distance between the navigated device and the corresponding pre-planned path as well as the angular deviations. Drilling and hammering into the pedicle were also compared. Navigation time was measured. An independent reviewer assessed a simulated clinical accuracy according to Gertzbein. Results The technical accuracy was 1.7 ± 1.0 mm at the bone entry point and 2.0 ± 1.3 mm at the device tip. The angular deviation was 1.7 ± 1.7° in the axial and 1.6 ± 1.2° in the sagittal plane. Navigation time per insertion was 195 ± 93 seconds. There was no difference in accuracy between hammering and drilling into the pedicle. The clinical accuracy was 97.4% to 100% depending on the screw size considered for placement. No ionizing radiation was used during navigation. Conclusion ARSN with instrument tracking for MISS is feasible, accurate, and radiation-free during navigation. Level of evidence 3.

The 5-Item Modified Frailty Index Is Predictive of Severe Adverse Events in Patients Undergoing Surgery for Adult Spinal Deformity.

Abstract: STUDY DESIGN A retrospective review of 281 consecutive cases of adult spine deformity (ASD) surgery (age 55 ± 19 yrs, 91% female, follow-up 4.3 ± 1.9 yrs) from a multicenter database. OBJECTIVE To compare the value and predictive ability of the 5-item modified frailty index (mFI-5) to the conventional 11-item modified frailty index (mFI-11) for severe adverse events (SAEs). SUMMARY OF BACKGROUND DATA Several recent studies have described associations between frailty and surgical complications. However, the predictive power and usefulness of the mFI-5 have not been proven. METHODS SAEs were defined as: Clavien-Dindo grade >3, reoperation required, deterioration of motor function at discharge, or new motor deficit within 2 years. The patients' frailty was categorized by the mFI-5 and mFI-11 (robust, prefrail, or frail). Spearman's rho was used to assess correlation between the mFI-5 and mFI-11. Univariate and multivariate Poisson regression analyses were conducted to analyze the relative risk of mFI-5 and mFI-11 as a predictor for SAEs in ASD surgery. Age, sex, and baseline sagittal alignment (Schwab-SRS classification subcategories) were used to adjust the baseline variance of the patients. RESULTS Of the 281 patients, 63 (22%) had developed SAE at 2 years. The weighted Kappa ratio between the mFI-5 and mFI-11 was 0.87, indicating excellent concordance across ASD surgery. Frailty was associated with increased total complications, perioperative complications, implant-related complications, and SAEs. Adjusted and unadjusted models showed similar c-statistics for mFI-5 and mFI-11 and a strong predictive ability for SAEs in ASD surgery. As the mFI-5 increased from 0 to ≥2, the rate of SAEs increased from 17% to 63% (P < 0.01), and the relative risk was 2.2 (95% CI: 1.3-3.7). CONCLUSION The mFI-5 and the mFI-11 were equally effective predictors of SEA development in ASD surgery. The evaluation of patient frailty using mFI-5 may help surgeons optimize procedures and counsel patients. LEVEL OF EVIDENCE 4.

Artificial Intelligence Based Hierarchical Clustering of Patient Types and Intervention Categories in Adult Spinal Deformity Surgery: Towards a New Classification Scheme that Predicts Quality and Value.

Abstract: Study Design.Retrospective review of prospectively-collected, multicenter adult spinal deformity (ASD) databases.Objective.To apply artificial intelligence (AI)-based hierarchical clustering as a step toward a classification scheme that optimizes overall quality, value, and safety for ASD surgery.Su

Alert Timing and Corresponding Intervention With Intraoperative Spinal Cord Monitoring for High-Risk Spinal Surgery.

Abstract: Study Design.Prospective multicenter study.Objective.To analyze the incidence of intraoperative spinal neuromonitoring (IONM) alerts and neurological complications, as well as to determine which interventions are most effective at preventing postoperative neurological complications following IONM al

Enhanced Perioperative Care for Major Spine Surgery.

Abstract: STUDY DESIGN The enhanced perioperative care (EPOC) program is an institutional quality improvement initiative. We used a historically controlled study design to evaluate patients who underwent major spine surgery before and after the implementation of the EPOC program. OBJECTIVE To determine whether multidisciplinary EPOC program was associated with an improvement in clinical and financial outcomes for elective adult major spine surgery patients. SUMMARY OF BACKGROUND DATA The enhanced recovery after surgery (ERAS) programs successfully implemented in hip and knee replacement surgeries, and improved clinical outcomes and patient satisfaction. METHODS We compared 183 subjects in traditional care (TRDC) group to 267 intervention period (EPOC) in a single academic quaternary spine surgery referral center. One hundred eight subjects in no pathway (NOPW) care group was also examined to exclude if the observed changes between the EPOC and TRDC groups might be due to concurrent changes in practice or population over the same time period. Our primary outcome variables were hospital and intensive care unit lengths of stay and the secondary outcomes were postoperative complications, 30-day hospital readmission and cost. RESULTS In this highly complex patient population, we observed a reduction in mean hospital length of stay (HLOS) between TRDC versus EPOC groups (8.2 vs. 6.1 d, standard deviation [SD] = 6.3 vs. 3.6, P < 0.001) and intensive care unit length of stay (ILOS) (3.1 vs. 1.9 d, SD = 4.7 vs. 1.4, P = 0.01). The number (rate) of postoperative intensive care unit (ICU) admissions was higher for the TRDC n = 109 (60%) than the EPOC n = 129 (48%) (P = 0.02). There was no difference in postoperative complications and 30-day hospital readmissions. The EPOC spine program was associated with significant average cost reduction-$62,429 to $53,355 (P < 0.00). CONCLUSION The EPOC program has made a clinically relevant contribution to institutional efforts to improve patient outcomes and value. We observed a reduction in HLOS, ILOS, costs, and variability. LEVEL OF EVIDENCE 3.

Predictive Factors of Postoperative Dysphagia in Single-Level Anterior Cervical Discectomy and Fusion

Abstract: Study Design.Retrospective review of prospectively collected data.Objective.To investigate if zero profile devices offer an advantage over traditional plate/cage constructs for dysphagia rates in single level anterior cervical discectomy and fusion (ACDF).Summary of Background Data.Dysphagia rates f

Incidence, Risk Factors, and Clinical Implications of Postoperative Hematoma Requiring Reoperation Following Anterior Cervical Discectomy and Fusion.

Abstract: STUDY DESIGN Retrospective study of prospectively collected data. OBJECTIVE To determine the incidence, timing, risk factors, and clinical implications of postoperative hematoma requiring reoperation after anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA Postoperative hematomas requiring reoperation are rare but potentially catastrophic complications after ACDF. However, there has been a lack of large cohort studies investigating these complications in the ACDF population despite increasing outpatient procedure volume. METHODS Patients who underwent ACDF in the 2012 to 2016 National Surgical Quality Improvement Program database were identified. The primary outcome was an occurrence of hematoma requiring reoperation within 30 days postoperatively. Risk factors for this outcome were identified using multivariate regression. Postoperative length of stay, subsequent complications, and mortality were compared between patients who did and did not develop a hematoma requiring reoperation. RESULTS A total of 37,261 ACDF patients were identified, of which 148 (0.40%) developed a hematoma requiring reoperation (95% confidence interval [CI], 0.33%-0.46%). Of the cases that developed this complication, 37% occurred after discharge. Risk factors for the development of hematoma requiring reoperation were multilevel procedures (most notably ≥3 levels, relative risk [RR] = 3.14, 95% CI = 1.86-5.32, P 1.2 (RR = 2.85, 95% CI = 1.42-5.71, P = 0.006), lower BMI (notably body mass index ≤24, RR = 2.11, 95% CI = 1.21-3.67, P = 0.008), American Society of Anesthesiologists classification ≥3 (RR = 2.07, 95% CI = 1.47-2.91, P < 0.001), preoperative anemia (RR = 1.71, 95% CI = 1.12-2.63, P = 0.027), and male sex (RR = 1.67, 95% CI = 1.18-2.37, P = 0.004). In addition, patients who developed a hematoma requiring reoperation before discharge had a longer length of stay. Further, those who developed a hematoma requiring reoperation were at higher risk for subsequent ventilator requirement, deep wound infection, pneumonia, and reintubation. CONCLUSION Postoperative hematoma requiring reoperation occurred in approximately 1 in 250 patients after ACDF. High-risk patients should be closely monitored through the perioperative period. LEVEL OF EVIDENCE 3.

Utilization and Outcomes for Spine Surgery in the United States and Canada.

Abstract: STUDY DESIGN A retrospective cohort study. OBJECTIVE The aim of this study was to examine variation in spine surgery utilization between the province of Ontario and state of New York among all patients and pre-specified patient subgroups. SUMMARY OF BACKGROUND DATA Spine surgery is common and costly. Within-country variation in utilization is well studied, but there has been little exploration of variation in spine surgery utilization between countries. METHODS We used population-level administrative data from Ontario (years 2011-2015) and New York (2011-2014) to identify all adults who underwent inpatient spinal decompression or fusion surgery using relevant procedure codes. Patients were stratified according to age and surgical urgency (elective vs. emergent). We calculated standardized utilization rates (procedures per-10,000 population per year) for each jurisdiction. We compared Ontario and New York with respect to patient demographics and the percentage of hospitals performing spine surgery. We compared utilization rates of spinal decompression and fusion surgery in Ontario and New York among all patients and after stratifying by surgical urgency and patient age. RESULTS Patients in Ontario were older than patients in New York for both decompression (mean age 58.8 vs. 51.3 years; P < 0.001) and fusion (58.1 vs. 54.9; P < 0.001). A smaller percentage of hospitals in Ontario than New York performed decompression (26.1% vs. 54.9%; P < 0.001) or fusion (15.2% vs. 56.7%; P < 0.001). Overall, utilization of spine surgery (decompression plus fusion) in Ontario was 6.6 procedures per-10,000 population per-year and in New York was 16.5 per-10,000 per-year (P < 0.001). Ontario-New York differences in utilization were smaller for emergent cases (2.0 per 10,000 in Ontario vs. 2.5 in New York; P < 0.001), but larger for elective cases (4.6 vs. 13.9; P < 0.001). The lower utilization in Ontario was particularly large among younger patients (age <60 years). CONCLUSION We found significantly lower utilization of spine surgery in Ontario than in New York. These differences should inform policy reforms in both jurisdictions. LEVEL OF EVIDENCE 3.

The Relationship Between Endplate Pathology and Patient-reported Symptoms for Chronic Low Back Pain Depends on Lumbar Paraspinal Muscle Quality.

Abstract: STUDY DESIGN Cross-sectional cohort study of chronic low back pain (CLBP) patients and matched controls. OBJECTIVE To explore the interplay between vertebral endplate damage and adjacent paraspinal muscle (PSM) quality, and to test their association in a cohort of patients with CLBP and matched controls. SUMMARY OF BACKGROUND DATA Nonspecific CLBP is challenging to diagnose, in part, due to uncertainty regarding the source of pain. Delineating interactions among potential CLBP mechanisms may enhance diagnosis and treatment customization. METHODS We collected advanced MRI imaging on 52 adult subjects, including 38 CLBP patients and 14 age- and sex-matched asymptomatic control subjects. Mean multifidus and erector spinae fat fraction (FF) was measured throughout the spine using an IDEAL MRI sequence. Presence of cartilage endplate (CEP) defects was determined at each disc level using UTE MRI. Logistic regression was used to test association of PSM FF, CEP defects, modic changes (MC), disc degeneration, and their interplay. RESULTS We observed that CEP defects were the strongest predictor of nonspecific CLBP (OR: 14.1, P < 0.01) even after adjusting for MC and disc degeneration (OR: 26.1, P = 0.04). PSM quality did not independently distinguish patient and control groups, except for patients with high self-reported disability.At specifically L4L5, CEP damage was most prevalent and CEP damage was significantly associated with CLBP (OR: 3.7, 95% CI: 1.2-21.5, P = 0.03). CEP damage at L4L5 was predictive of CLBP when adjacent to PSMs with greater FF (MF, OR 14.7, P = 0.04; ES, OR: 17.3, P = 0.03), but not when PSM FF was lower and comparable to values in control, asymptomatic subjects. CONCLUSION These results demonstrate the clinically important reciprocity between passive and dynamic spinal stabilizers, and support the notion that therapies targeting the PSMs may provide clinical benefit even in the presence of other spinal pathologies. LEVEL OF EVIDENCE 4.

Health Care Costs and Opioid Use Associated With High-impact Chronic Spinal Pain in the United States.

Abstract: Study design A descriptive analysis of secondary data. Objective The aim of this study was to estimate health care costs and opioid use for those with high-impact chronic spinal (back and neck) pain. Summary of background data The US National Pain Strategy introduced a focus on high-impact chronic pain-that is, chronic pain associated with work, social, and self-care restrictions. Chronic neck and low-back pain are common, costly, and associated with long-term opioid use. Although chronic pain is not homogenous, most estimates of its costs are averages that ignore severity (impact). Methods We used 2003 to 2015 Medical Expenditures Panel Survey (MEPS) data to identify individuals with chronic spinal pain, their health care expenditures, and use of opioids. We developed prediction models to identify those with high- versus moderate- and low-impact chronic spinal pain based on the variables available in MEPS. Results We found that overall and spine-related health care costs, and the use and dosage of opioids increased significantly with chronic pain impact levels. Overall and spine-related annual per person health care costs for those with high-impact chronic pain ($14,661 SE: $814; and $5979 SE: $471, respectively) were more than double that of those with low-impact, but still clinically significant, chronic pain ($6371 SE: $557; and $2300 SE: $328). Those with high-impact chronic spinal pain also use spine-related opioids at a rate almost four times that of those with low-impact pain (48.4% vs. 12.4%), and on average use over five times the morphine equivalent daily dose (MEDD) in mg (15.3 SE: 1.4 vs. 2.7 SE: 0.6). Opioid use and dosing increased significantly across years, but the increase in inflation-adjusted health care costs was not statistically significant. Conclusion Although most studies of chronic spinal pain do not differentiate participants by the impact of their chronic pain, these estimates highlight the importance of identifying chronic pain levels and focusing on those with high-impact chronic pain. Level of evidence 3.

Minimum Clinically Important Difference and Patient Acceptable Symptom State of Japanese Orthopaedic Association Score in Degenerative Cervical Myelopathy Patients.

Abstract: Study Design.A retrospective analysis.Objective.The aim of this study was to elucidate the psychometric properties of the original Japanese Orthopaedic Association (JOA) score, including the minimum detectable change (MDC), minimum clinically important difference (MCID), and patient-accepted symptom

Comparative Analysis of Utilization of Epidural Procedures in Managing Chronic Pain in the Medicare Population: Pre and Post Affordable Care Act.

Abstract: Study Design.A retrospective cohort study of utilization patterns of epidural injections.Objective.The aim of this study was to assess patterns of utilization and variables of in chronic spinal pain in the fee-for-service (FFS) Medicare population, with a comparative analysis of pre- and post-Afford

Minimally Invasive Posterior Cervical Foraminotomy as an Alternative to Anterior Cervical Discectomy and Fusion for Unilateral Cervical Radiculopathy: A Systematic Review and Meta-analysis.

Abstract: Study Design.Systematic review and meta-analysis.Objective.The aim of this study was to evaluate clinical outcomes, complications, and reoperations of minimally invasive posterior cervical foraminotomy (MI-PCF) for unilateral cervical radiculopathy without myelopathy, in comparison to anterior cervi

Epidemiology of Spinal Fractures in a Level One Trauma Center in the Netherlands: A 10 Years Review

Abstract: Study Design.Retrospective epidemiological study.Objective.To describe the epidemiology of spinal fractures over a 10 years period in a level one trauma center in the Netherlands.Summary of Background Data.Spinal fractures may have large socioeconomic consequences. The prevalence and outcomes likely change over the years owing to improved traffic safety, increasing population age and improved medical treatment. This is the first study to address the epidemiology of spinal fractures over a large period in the Netherlands.Methods.All patients with a cervical, thoracic, or lumbar spine fracture admitted to a level one trauma center from 2007 to 2016 were prospective registered and retrospectively analyzed. In addition to patient, accident, and associated injury characteristics, radiological and surgery data were obtained from the hospital's Electronic Patient File system.Results.Between 2007 and 2016, 1479 patients with a total of 3029 spinal fractures were admitted. Approximately 40.8% were female and 59.2% were male, with a mean age of 52.0 years; 4.9% of fractures occurred at a juvenile age (0-18 years) and 63.6% at the age of 19 to 64 years. Most fractures occurred in the thoracic spine, followed by the lumbar and cervical spine. The most common cause of injury was a fall from height, followed by traffic accidents. Spinal cord injury occurred in 8.5% and associated injuries were reported in 73% of the patients. Sixteen percent of the admitted patients were treated operatively. Over time, there was a larger increase in amount of spine fractures in elderly (≥65 years) compared with younger people.Conclusion.The total amount of spine fractures per year increased over time. In addition, there was a larger increase in amount of spine fractures in patients over 65 years of age compared with younger patients. Despite this increase, a considerable amount of spine fractures still occur in the age-group of 19 to 64 years. Most fractures were located in the thoracic spine. This study might stimulate development of policy on precautionary actions to prevent spine fractures.Level of Evidence: 4.

Geography of Lumbar Paravertebral Muscle Fatty Infiltration: The Influence of Demographics, Low Back Pain, and Disability

Abstract: Study Design.Cross-sectional.Objective.We quantified fatty infiltration (FI) geography of the lumbar spine to identify whether demographics, temporal low back pain (LBP), and disability influence FI patterns.Summary of Background Data.Lumbar paravertebral muscle FI has been associated with age, sex, LBP, and disability; yet, FI accumulation patterns are inadequately described to optimize interventions.Methods.This cross-sectional study employed lumbar axial T1-weighted magnetic resonance imaging in 107 Southern-Chinese adults (54 females, 53 males). Single-slices at the vertebral inferior end-plate per lumbar level were measured for quartiled-FI, and analyzed against demographics, LBP, and disability (Oswestry Disability Index).Results.Mean FI% was higher in females, on the right, increased per level caudally, and from medial to lateral in men (P 0.05).Conclusion.Lumbar paravertebral muscle FI predominates in the lower lumbar spine, notably for those aged 40 to 65, and depends more on sagittal than transverse distribution. Higher FI in females and differences of mean FI between sexes for BMI, LBP, and disabling Oswestry Disability Index suggest sex-differential accumulation patterns. Our study contradicts pain models rationalizing lumbar muscle FI and may reflect a normative sex-dependent feature of the natural history of lumbar paravertebral muscles.Level of Evidence: 2.

An Insight Into the Health-Related Quality of Life of Adolescent Idiopathic Scoliosis Patients Who Are Braced, Observed, and Previously Braced.

Abstract: Study Design.Prospective cross-sectional study.Objective.To determine the health-related quality of life (HRQoL) of adolescent idiopathic scoliosis (AIS) patients undergoing bracing, previously braced and observation only.Summary of Background Data.HRQoL is an important treatment outcome measure for

Negative Effects of Long-duration Spaceflight on Paraspinal Muscle Morphology.

Abstract: Study Design.Prospective case series.Objective.Determine the extent of paraspinal muscle cross-sectional area (CSA) and attenuation change after long-duration spaceflight and recovery on Earth. Determine association between in-flight exercise and muscle atrophy.Summary of Background Data.Long-durati

Comparison of Stand-alone Lateral Lumbar Interbody Fusion Versus Open Laminectomy and Posterolateral Instrumented Fusion in the Treatment of Adjacent Segment Disease Following Previous Lumbar Fusion Surgery.

Abstract: Study Design.Retrospective cohort study.Objective.The aim of this study was to compare clinical and radiographic outcomes of patients who underwent stand-alone lateral lumbar interbody fusion (LLIF) to those who underwent posterolateral fusion (PLF) for symptomatic adjacent segment disease (ASD).Sum

Syndromic Scoliosis: National Trends in Surgical Management and Inpatient Hospital Outcomes: A 12-Year Analysis.

Abstract: STUDY DESIGN Retrospective cohort study. OBJECTIVE Evaluate the trends in management and inpatient outcomes in patients with syndromic scoliosis undergoing spinal deformity correction. SUMMARY OF BACKGROUND DATA Syndromic scoliosis (SS) refers to scoliosis that is most commonly associated with systemic disease including Ehler Danhlos syndrome (EDS), Marfan syndrome (MF), Down syndrome (DS), Achondroplasia (AP), and Prader-Willi syndrome (PWS). Limited data exist evaluating hospital outcomes in patients with SS undergoing spinal deformity correction. METHODS The Kids' Inpatient Database (KIDS) was queried from 2001 to 2012 to identify all pediatric patients with scoliosis undergoing spinal fusion. These patients were then sub-divided into two cohorts: (1) patients with idiopathic scoliosis (IS) and (2) patients with syndromic scoliosis. Trends in surgical management, and postoperative morbidity and mortality were assessed. Length of stay and total hospital charges were additionally analyzed. A sub-analysis to characterize outcomes in each syndrome was also performed. RESULTS An estimated 1071 patients with SS were identified and compared with 24,989 pediatric patients with IS. MF (36.8%), Down syndrome (16.0%), and PWS (14.9%) were the most common diagnoses among patients with SS. Between 2001 and 2012, there was a significant decline in the number of anterior procedures performed in both cohorts. Conversely, the number of posterior based procedures increased. SS was associated with increased major complications (2.7% compared with 1.0% in IS; P < 0.001) and minor complication rates (41.0% compared with 28.5% in IS; P < 0.001). Patients with AP incurred the highest rate of major complications (10.7%), minor complications (60.8%), and intraoperative durotomies (6.1%). Total hospital charges increased significantly over the 12-year span. CONCLUSION Trends in management of syndromic scoliosis have paralleled that of idiopathic scoliosis. Syndromic scoliosis is associated with increased risks with surgical deformity correction. Further prospective studies are warranted to evaluate the reasons for these differences. LEVEL OF EVIDENCE 3.