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Bone mineral density assessment is essential for spinal fusion surgical planning, but gold standard dual energy X-ray absorptiometry (DEXA) is affected by degeneration often resulting in falsely elevated scores. The opportunistic measurement of Hounsfield units on computed tomography (CTHU) is gaining in popularity given the access to preoperative CTs obtained for instrumentation guidance systems and the ability to evaluate the region of interest while avoiding adjacent degenerative structures. Emerging studies suggest that lower CTHUs predict interbody cage subsidence, yet cutoff values vary, and lack standardization. To determine if the value CTHU<135 is associated with interbody cage subsidence in the lumbar spine and to compare the predictive performance of subsidence between CTHU and DEXA. Single-center, multisurgeon, retrospective cohort study. Circumferential lumbar fusions ≤ 5 interbody levels with perioperative DEXA, CTs, and X-rays. CTHU at L1, lowest DEXA T-score, and postoperative change in disc space height (cage migration) on X-ray. Circumferential lumbar fusions were retrospectively enrolled if DEXA, CT, and x-rays were available, and minimum follow up was one year. Interbody fusions were analyzed for subsidence ≥ 2mm by validated motion detection software. Lowest DEXA any and DEXA spine T-scores were recorded and categorized (normal ≥ -1.0, -1.0 > osteopenia > -2.5, osteoporosis ≤ -2.5) and L1 CTHUs were measured. Statistical analysis determined the association between CTHU<135 and subsidence. Univariate and multivariate binary logistic regression compared the predictive performance of subsidence between CTHU and DEXA. The 127-patient cohort had 96.9% degenerative pathologies, 54.3% were females, median age was 60 (IQR 51-69) years, 2.4% had osteoporosis, 44.1% had CTHU<135, median length of follow-up was 17 (IQR 12-24) months, and 13.4% developed subsidence on or before the last follow up. CTHU<135 (p=0.004) and age (p=0.016) were significantly associated with subsidence; DEXA lowest T-score (p=0.550) was not. The odds of subsidence were significant if CTHU<135 on crude and adjusted (OR=4.0, 95% CI 1.2-13.9, p=0.029) comparisons. The odds of subsidence were not significant if lowest T-score < -1.0 for DEXA any and DEXA spine (OR=1.8, 95% CI 0.6-4.9, p=0.284 and OR=1.1, 95% CI 0.3-4.1, p=0.920, respectively). CTHU<135 was associated with subsidence while DEXA lowest T-score was not in patients with degenerative pathologies. The odds of subsidence were 4.0 times higher for CTHU<135 after controlling for known risks, supporting this cutoff value. This study suggests that CTHU is a more reliable predictor of subsidence than DEXA when assessing degenerative spinal pathologies and is a useful tool for assessing bone quality when planning lumbar surgery. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Chronic low back pain is one of the leading causes of disability and poor quality of life in the US and worldwide. A common cause of chronic low back pain is degenerative disc disease. Current nonsurgical treatments for degenerative disc disease-associated low back pain are typically effective. However, for patients who fail these treatments, surgical fusion is often used as last line treatment. Surgical treatment is associated with higher health care expenditures and a more invasive procedure. As such, there is growing interest in the field of regenerative medicine and stem cell therapy as a less invasive treatment for low back pain. The purpose of this study was to investigate the effect of autologous bone marrow aspirate concentrate (BMAC) on patients with symptomatic lumbar degenereative disc disease at one year. Single institution prospective cohort study. A total of 32 adult patients. Mean ODI, EQ-5D-5L, VAS back pain, and VAS leg pain scores. A total of 32 consecutive patients over the age of 18 years diagnosed with discogenic low back pain clinically or by discography who underwent injection of autologous intradiscal BMAC at a single multi surgeon orthopedic spine center were included in this study. Active smokers and patients who had pain generators other than purely discogenic pain were excluded. For primary analysis, patients completed baseline and 1 year post-injection ODI, VAS back, VAS leg, and EQ-5D-5L questionnaires; their scores were compared over time. Preprocedural lumbar MRIs were reviewed for Modic changes and assigned a Pfirrmann grade. Thirteen postprocedural MRIs were available and reviewed using the same parameters. Thirty-two patients (56.3% male) with a mean age of 45.9 (range 19-65) underwent BMAC injection between 1 and 6 levels completed 1 year follow up. Mean VAS back and leg scores improved from 54.0 to 30.4 (p < 0.001) and 27.9 to 13.3 (p=0.005), respectively. Mean ODI scores decreased from 33.5 to 21.1 (p < 0.001), and EQ-5D-5L scores improved from 0.69 to 0.78 (p=0.001). Using established minimum clinically important difference values, 59.4% of patients saw a clinically significant improvement in VAS back pain, 43.8% in VAS leg pain, and 56.3% in ODI scores. On pre-procedural MRIs, 62.5% of patients had a Modic score of 1 or 2 and 93.8% had a Pfirrmann grade of 3 or higher. Postprocedural MRIs were available for 13 patients, and 61.5% had no measurable change in Pfirrmann grade. Three patients worsened by one Pfirrmann grade and one improved by 1 grade. Intradiscal injection of autologous BMAC was shown to significantly improve pain and quality of life at one year. Additionally, this study meets 88% of recently published AAOS reporting standards for studies relating to mesenchymal stem cells. The results of this study suggest that intradiscal injection of autologous BMAC has the potential to be an effective non-surgical treatment for chronic discogenic low back pain. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Preoperative and postoperative sagittal plane assessment is crucial in both spinal deformity and degenerative pathologies. Sagittal malalignment is a well-established cause of poor patient reported outcomes. There is a growing need for an automated analysis tool that measures pelvic parameters with speed, precision and reproducibility without relying on user identified landmarks. A new AI algorithm has been developed to measure important radiographic parameters independently. The analysis of sagittal alignment by measuring spinopelvic parameters has been widely adopted among spine surgeons globally. The currently available spine measurement software programs require users to identify several landmarks prior to calculating parameters, making them time consuming and more reliant upon user experience. This study evaluates and demonstrates that an algorithm based on artificial intelligence (AI) can independently determine spinopelvic parameters. This allows for precise radiographic measurement without time-intensive human input. We hypothesize that the novel, fully automatic method will have a high agreement with human measurements for lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS). Evaluation of the inter-rater reliability and mean error between radiographic measurements of the AI algorithm and expert human raters. Radiographs were retrospectively reviewed from a single site, multisurgeon center. In this study, preoperative and postoperative X-rays were evaluated in 100 patients undergoing a lumbar fusion procedure. From a total of 200 lateral lumbar radiographs (preoperative and postoperative images from 100 patients undergoing fusion) 5 independent observers (4 spinal surgeons, 1 senior researcher) digitally measured LL, PI, PT and SS. Their parameters were compared with AI algorithm generated parameters. Mean error (95% confidence interval, standard deviation) and inter-rater reliability were assessed using 2-way mixed, single-measure intraclass correlation (ICC). ICC values larger than 0.75 were considered excellent. The novel algorithm's spinopelvic parameter ICC values were excellent in 98% of preoperative and in 95% of postoperative radiographs (PreOp range: 0.85–0.92, PostOp range: 0.81–0.87). Exemplarily, mean errors are smallest for the PI (PreOp: -0.5° [95%-CI: -1.5°–0.6°]; PostOp: 0.0° [-1.1°–1.2°]) and largest for LL (1.3° [0.3°–2.4°]; 3.8° [2.5°–5.0°]). Novel AI algorithm automated spinopelvic parameter measurements from spine radiographs have a high degree of accuracy comparable to digital measurements by experts. This algorithm can improve physician workflow efficiency and reduce inter-rater and intra-rater measurement errors This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Evidence-based enhanced surgical recovery (ESR) programs integrate a multidimensional approach to optimize patients during the pre-, intra-, and postoperative phases of surgery. Smaller studies have shown benefits of ESR in spine surgery, but there is a lack of evidence demonstrating the effects of ESR programs related to spine surgery on a larger scale. This study aims to evaluate the effects of ESR adoption for thoracolumbar surgery on a national scale. Retrospective case-control study of a prospectively adopted health care system ESR program. A total of 51,236 thoracolumbar (TL) fusion cases were identified between 2018 and 2021 across 138 centers; 24,391 participated in an ESR program and 26,845 did not. Daily morphine milligram equivalents (MME), length of hospital stay (LOS, hours), and 30-day hospital readmission (READMIT) rate. Data from TL spine fusion procedures performed in a large health care system were extracted from hospital-based electronic medical records. Patients were divided into two cohorts, ESR or non-ESR, based on enrollment into an ESR program defined by (1) preoperative patient education, (2) multimodal analgesia, (3) intraoperative fluid optimization, (4) opioid-sparing anesthesia and (5) early postoperative nutrition and ambulation. Study exclusion criteria were: unknown ESR status, age <18 yrs, and/or surgery for tumor, infection or trauma. Impact of ESR upon postoperative MME, LOS and READMIT was evaluated for single-level TL fusions, multilevel TL fusions and all TL fusions using multivariable linear and logistic regression models. ESR and non-ESR groups were demographically similar. For single level TL fusions, ESR was associated with decreased MME (β= -8.76, p <0.001), LOS (β= -8.85, p <0.001), and READMIT (OR=0.77, 95% CI: 0.67-0.88). For multilevel TL fusions, ESR was associated with decreased MME (β= -7.32, p <0.001) and LOS (β= -12.14, p <0.001), and for all TL fusions, ESR was associated with decreased MME (β= -7.94, p<0.001), LOS (β= -10.54, p<0.001), and READMIT (OR=0.91, 95% CI: 0.84-0.98). This national healthcare system analysis of over 50,000 TL spine fusion cases by over 1,350 surgeons at 138 centers across the United States confirms that ESR adoption is associated with decreased daily MME, LOS, and READMIT. Surgeons should consider adoption of ESR programs to improve patient care. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]