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Purpose Airway obstruction after post-operative extubation is a dreaded but uncommon complication in patients undergoing circumferential cervical spine surgery(CCSS).The cuff leak test(CLT)has been utilized to assess air leak around the endotracheal tube(ETT) which may reflect airway swelling.In this prospective observational study,we analyze the temporal evolution of CLT and perioperative factors that may influence it. Methods Twenty patients undergoing single-stage CCSS were managed according to our extubation protocol.Patients were maintained intubated overnight following surgery.They were extubated if a CLT>200mL and both ICU and Neurosurgery teams agreed that it was safe.Patients extubated in the first postoperative day(8/20) comprised the Early group,and the remaining patients(12/20) the Delayed group.Patient and operative data were analyzed as a single group and comparing both groups. Results The main indication for surgery was cervical deformity.Median number of levels fused was 5 anteriorly (range,1-6) and 6(range,1-13) posteriorly.Patients were kept intubated for an average of 73.6(range,26-222) hours and stayed in the ICU for 119.1 (range, 36-360) hours.There were four failed extubations and three patients(15%) required a tracheostomy.Patient profiles between both groups were very similar across most patient variables but differed significantly regarding infraglottic luminal area(p less then .05).Patients with larger preoperative cuff leak values tended to have a shorter intubation period(p=.053). Conclusion This study objectively demonstrates the difficulties in airway management following CCSS and provides useful insight for preoperative planning and counseling. Local anatomic factors influence airway outcome more than operative factors.The study format does not allow for testing of interventions but we suggest that patients with favorable anatomy(larger infraglottic luminal area) may benefit from a less strict airway management protocol.Objective Conventional techniques for atlantoaxial fixation and fusion typically pass cables or wires underneath C1 lamina to secure the bone graft between the posterior elements of C1-2, which leads to complications such as cerebrospinal fluid (CSF) leak and neurological injury. With the evolution of fixation hardware, we propose a novel C1-2 fixation technique that avoids the morbidity and complications associated with sublaminar cables and wires. Methods This technique entails wedging and anchoring a structural iliac crest graft between C1 and C2 for interlaminar arthrodesis and securing it using a 0-Prolene suture at the time of C1 lateral mass and C2 pars interarticularis screw fixation. Results We identified 32 patients who underwent surgery for atlantoaxial with our technique. A 60% improvement in pain-related disability from pre-operative baseline was demonstrated by Neck Disability Index (p less then 0.001). There were no neurologic deficits. Complications included 2 patients CSF leaks related to presenting trauma, 1 patient with surgical site infection, and 1 patient with transient dysphagia. The rate of radiographic atlantoaxial fusion was 96.8% at 6-months, with no evidence of instrumentation failure, graft dislodgement, or graft related complications. Conclusion We demonstrate a novel technique for C1-2 arthrodesis that is a safe and effective option for atlanto-axial fusion.Purpose The oblique lateral lumbar interbody fusion (OLIF) can be done with either fluoroscopy or navigation. However, it's unclear how navigation affects the overall flow of the procedure. We wished to report on the accuracy of this technique using navigation and on how navigation affects surgical time and complications. Methods A retrospective review was undertaken to evaluate patients who underwent OLIF using spinal navigation at our hospital. Data collected were demographic variables, peri-operative variables, and radiographic images. Postoperative lateral radiographs were analyzed for accuracy of cage placement. The disc space was divided into four quadrants from anterior to posterior, zone 1 being anterior, and zone 4 being posterior. The accuracy of cage placement was assessed by placement. Epigenetic inhibitor nmr Results There were 214 patients who met the inclusion criteria. A total of 350 levels were instrumented from L1 to L5 using navigation. The mean follow up time was 17.42 months. The mean surgical time was 211 minutes, and the average surgical time per level was 129.01 minutes. After radiographic analysis, 94.86% of cages were placed within quartiles 1 to 3. One patient (0.47%) underwent revision surgery because of suboptimal cage placement. For approach related complications, transient neurological symptoms were 10.28%, there was no vascular injury. Conclusion The use of navigation to perform OLIF from L1 to L5 resulted in a cage placement accuracy rate of 94.86% in 214 patients.Purpose Assess preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) physical function (PF) scores and differences between preoperative and postoperative PROMIS-PF scores for patients undergoing Anterior Cervical Discectomy and Fusion (ACDF). Methods After institutional review board approval, a prospectively maintained surgical registry was retrospectively reviewed for elective spine surgeries of non-traumatic, degenerative pathology between 2015-2018. Inclusion criteria were primary or revision, single-level ACDF procedures. Multi-level procedures and patients without preoperative surveys were excluded. A preoperative PROMIS score cutoff of 35 divided patients into PROMIS-PF score categories (e.g., ≥ 35.0, less then 35.0). Categorical and continuous variables were evaluated with chi-squared tests and t-tests. Linear regression analyzed PROMIS-PF score improvement. Results 86 patients were selected, the high and low PROMIS-PF subgroups only differed in mean age (49.1 vs. 41.3, p=0.002). Significant differences in PROMIS-PF scores were observed among high and low preoperative PROMIS-PF score subgroups at 6-weeks (p=0.006), 12-weeks (p=0.006), and 6-months (p=0.014). Mean differences between preoperative and postoperative PROMIS-PF scores were significantly different between the high and low PROMIS-PF subgroups at 6-weeks (p=0.041) and 1-year (p=0.038). A significant negative association was observed between preoperative PROMIS scores and magnitude of improvement at the 6-week postoperative time point (slope = -0.6291, p less then 0.001). Conclusion Patients with low preoperative PROMIS-PF scores demonstrated greater improvements at 6-weeks and 1-year. Clinicians should consider patients with low preoperative PROMIS-PF scores to be in the unique position to potentially experience larger postoperative improvement magnitudes than patients with higher preoperative PROMIS-PF scores.
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