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Background Anterior cervical discectomy and fusion (ACDF) is well-tolerated by most patients and commonly necessitates only a short hospital admission. Surgical delay after hospital admission, however, may result in longer hospital stays, consequently increasing hospital resource utilization. The current study evaluates risk factors for surgical delay in patients undergoing elective ACDF. Methods A retrospective analysis of ACS-NSQIP data from 2006-2015 was performed. Patients undergoing elective ACDF were selected using current procedural terminology (CPT) codes (22251, 22252, 22554). A surgical delay was defined as surgery that occurred one day or later after initial hospital admission. Differences in outcomes between the non-delayed and delayed cohorts were evaluated with univariate analysis. Multivariate logistic regression was performed to identify risk factors for surgical delay. Results There were a total of 771 (2.0%) surgical delays out of 39,371 patients undergoing elective ACDF from 2006-2015. Multider given a rising incidence of cervical fusions in the Medicare population, a wide variation in costs, and increasing popularity of bundled-payment models. Level of Evidence 3. 2019 Journal of Spine Surgery. All rights reserved.Background Conflicting reports exist regarding mortality and morbidity of early surgical decompression in the setting of acute central cord syndrome (ACS) in multisystem trauma despite evidence of improved neurological outcomes. Consequently, optimal decompression timing in ACS in multisystem trauma patients remains controversial. This study aims to determine the association between early surgery for acute traumatic central cord and all-cause mortality among multisystem trauma patients in the National Trauma Data Bank (NTDB) using propensity score matching. Methods We used the NTDB (years 2011-2014) to perform a retrospective cohort study, which included patients >18 years, with ACS (identified using ICD-9 coding). Collected patient data included demographics, surgery timing (≤24 hours, >24 hours), injury mechanism, Charlson comorbidity index (CCI), injury severity score (ISS), serious adverse events (SAE). Logistic regression and propensity matching were used to investigate the relationship between surgery tng comorbidities and multisystem trauma, rather than surgical timing. Delaying definitive surgical care may predispose patients to worsened greater neurological morbidity. 2019 Journal of Spine Surgery. All rights reserved.Background Pedicle screw malposition may result in neurological complications following posterolateral lumbar fusions (PLF). While computer-assisted navigation (NAV) and intraoperative neuromonitoring (ION) have been shown to improve safety in deformity surgeries, their use in routine PLFs remain controversial. This study assesses the risk of complications and reoperation for pedicle screw revision following PLF with and without ION and/or NAV surgery. Methods Retrospective analyses were performed using the Truven Health MarketScan® databases to identify patients that had primary PLF with and without NAV and/or ION for degenerative lumbar disorders from years 2007-2015. Patients undergoing concomitant interbody fusions, spinal deformity surgery or fusion to the thoracic spine were excluded. Complications and reoperation for pedicle screw revision within 90 days of surgery were assessed. Results During the study period, 67,264 patients underwent PLFs. NAV only was used in 3.5% of patients, ION only in 17.9% and both NAV and ION in 0.8% of patients. In univariate analyses, there was a difference in the risk of neurological injuries among groups (NAV only 1.4%, ION only 0.8%, NAV and ION 0.5%, No NAV or ION 0.6%, P less then 0.001). In multivariable models, the use of NAV was associated with a higher risk of neurological complications when compared to ION only or no ION or NAV [NAV vs. ION only odds ratio (OR) and 95% confidence interval (CI) =2.1 (1.4, 3.2), P=0.002; NAV vs. no ION or NAV OR and 95% CI =2.5 (1.7, 3.5), P less then 0.001]. There was no difference in reoperation rates among the groups (P=0.135). Conclusions Although the overall risk of neurological complications following PLFs is low, the use of NAV only was associated with an increased risk of neurological complications. No differences were observed in the rates of pedicle screw revision among groups. 2019 Journal of Spine Surgery. All rights reserved.Background Adult spinal deformity (ASD) is a prevalent condition in individuals over the age of 65; leading to impaired standing balance and abnormal gait patterns. This functional impairment may be due to the fixed sagittal or coronal malalignment; associated spinal stenosis or deconditioning. The Berg balance scale (BBS) was developed to measure balance by assessing the performance of functional tasks. The purpose of this study is to determine if BBS is a useful metric for evaluating functional status in ASD patients. Methods ASD patients who required fusion from the thoracic spine to the pelvis from 2014 to 2016 were enrolled and asked to complete the BBS prior to and six months after surgery. BBS were obtained by a certified physical therapist. Standard demographic; radiographic and surgical data were collected. The Oswestry disability index (ODI), EuroQOL-5D and numeric rating scales (0 to 10) for back and leg pain were assessed at baseline and post-intervention. Results Of 21 patients enrolled; 19 completed pre- and post-surgery BBS. The mean age was 59.8±13.3 years with 14 females. selleck chemicals There was a statistically significant improvement in all outcome scores and radiographic parameters after surgery; but no difference in BBS. Only one patient had a BBS score low enough to be considered a medium fall risk. There was no difference in the pre-op BBS scores in the four patients that had revision surgery compared to those that did not. Conclusions In this small pilot study; BBS did not appear to be associated with measures of clinical and radiographic improvement in ASD patients. The test was also potentially problematic in that it has a ceiling effect and required significant time with a trained physical therapist for administration. Continued effort to identify a viable measure of balance dysfunction in ASD patients is warranted. 2019 Journal of Spine Surgery. All rights reserved.
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