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BACKGROUND CONTEXT Increasing pelvic tilt (PT) is a primary compensatory mechanism in adult spinal deformity (ASD). By SRS-Schwab criteria, PT >20° is considered pathologic. Some ASD patients improve their PT following ASD correction, while others do not. The driving forces behind this lack of PT-response are not well defined. PURPOSE To determine the perioperative characteristics associated with PT normalization after ASD corrective surgery. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE A total of 176 ASD patients. OUTCOME MEASURES Patient profile, radiographic parameters, and surgical factors associated with PT normalization. METHODS Operative ASD patients fused to S1/pelvis with full preoperative data as well as preoperative (BL), 6-week (6W), 1-year (1Y), and 2-year (2Y) postop PT measurements were included. PT normalization was assessed at 6W and 2-year follow-up. Univariate analyses were used to compare normalized (PTNorm) and non-normalized (NON) patients in terms of demographics, surgical and radiographic descriptors, postoperative alignment, and clinical outcomes. Multivariate regression and ROC curve assessed periop factors predicting 6W PT normalization. Conditional inference tree (CIT) determined thresholds for the continuous variables identified as independent predictors of PT normalization. RESULTS There were 176 ASD patients that met inclusion criteria (62.9±10.2years, 80%F, BMI 26.9±4.9 kg/m2, CCI: 1.88), and underwent surgery (levels fused 12.1±3.9, EBL: 1955mL, op time: 402min). At each time point, mean PT was as follows: BL: 25.7o, 6-week: 19.0o, 1-year: 21.2o, and 2-year: 22.3°. Patients classified as having normal PT by SRS-Schwab criteria (PT 0.05). Six weeks PTNorm patients were more likely to be overcorrected in PT, PI-LL, and SVA compared to NON patients at 6 weeks postop (all p 10, invasiveness score >109, baseline cSVA CONCLUSIONS PT normalization following ASD correction occurred in almost 40% of patients by 6 weeks postop. Normalization is more likely to occur in patients where reconstruction addresses lumbopelvic mismatch, extends above the apex of the thoracic kyphosis, and has adequate surgical invasiveness to achieve full alignment correction. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Adult spinal deformity is associated with severe pain and disability. Recent literature has shown that surgical intervention can significantly improve patients’ quality of life and lessen disease burden. As many patients requiring spine surgery are elderly and often frail, restoration of alignment targets may differ. The literature is scarce on how different frailty states affect realignment goals. PURPOSE Modify the age-adjusted alignment goals using the Frailty Index to optimize outcomes in surgical adult spinal deformity (ASD) patients. STUDY DESIGN/SETTING Retrospective cohort study of a prospective multicenter database of ASD patients. PATIENT SAMPLE This study included 245 ASD patients. OUTCOME MEASURES Complications, HRQLs (SRS-22, ODI, SF-36). METHODS Operative ASD patients (scoliosis ≥20°, SVA ≥5cm, PT ≥25°, or TK ≥60°) with available baseline and 2-year radiographic and HRQL data were included. ASD frailty index was used to stratify patients into not frail (NF) and frail (F) categories. Linear regression analysis established normative radiographic thresholds, utilizing previously published age specific US-Normative ODI values (Lafage et al) and the frailty index, based on a cohort of patients with an ideal clinical outcome (no major complications, no PJK, and an SRS-satisfaction of >4). Patients were considered “matched” if 2-year postop alignment was within 1 standard deviation (+1SD overcorrected-1SD undercorrected). RESULTS A total of 245 patients included (57±15yrs, 82% female, 26±5.14kg/m2, ASD-FI: 2.9±1.6, CCI: 1.8 ±1.7). Patients had a mean level fused of 11.1±4.4, LOS of 7.7 days±4.4, EBL of 1577 mL, operative time of 377 min, with 63% undergoing an osteotomy. In terms of surgical approach, 69.9% posterior-only, and 29.3% had a combined approach. Primary analyses demonstrated correlation between baseline frailty index, PT, PI-LL, SVA, and ODI, (p CONCLUSIONS Age-adjusted alignment by Lafage et al was the first study to recognize that older age warrants a lower degree of correction, and, the original SRS-Schwab criteria was modified accordingly. Alignment targets accounting for both frailty and age were developed with larger thresholds for increasing frailty. In this study, we found patients who were matched in these age and frailty adjusted thresholds had lower rates of PJF and significantly improved HRQL outcomes. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT With health care costs on the rise, hospitals have increasingly focused on providing economically efficient medical services. Adult spinal deformity surgery remains an expensive medical intervention with high risk for complications and revisions, especially following mechanical failure in the context of proximal junctional kyphosis (PJK). We sought to evaluate the impact of PJK on associated expenditures following an index surgery for ASD. PURPOSE To evaluate the effect of proximal junctional kyphosis on the cost effectiveness of corrective adult deformity surgery. STUDY DESIGN/SETTING Retrospective cohort study of a prospective single-center database of ASD patients. PATIENT SAMPLE A total of 147 Adult Spinal Deformity Patients. OUTCOME MEASURES Complications, HRQLs (Oswentry Disability Index [ODI]), Quality adjusted life years (QALY). METHODS Adult Spinal deformity patients with 2-year HRQL follow-up were included. Utility data was calculated using published conversion methods to convert ODI to SF-6D. QALYs utilized a 3% discount rate to account for residual decline to life expectancy (78.7 years). Costs were calculated using the PearlDiver database incorporating complications and comorbidities classified according to CMS standard definitions. Reimbursement consisted of a standardized estimate using regression analysis of Medicare pay-scales for all services rendered within a 30-day window, including estimates regarding costs of postoperative complications, outpatient health care encounters, reoperations and revisions. After accounting for all postoperative events, including mortality, cost per QALY by 2Y was calculated for revisions that occurred due to proximal junctional kyphosis. RESULTS A total of 147 adult spinal deformity patients met inclusion criteria (55.22years, 54% Female). At baseline, patients presented radiographically as: Pelvic Tilt (23.66±11.7), Pelvic Incidence- Lumbar Lordosis (-2.9±12.6), Sagittal Vertical Axis (60.5±76.8), T1 Pelvic Angle (22.6±14.3). Surgical details: EBL of 1823 mL, operative time of 327 min, with .4% undergoing an anterior approach, 90.2% posterior-only approach, and 9.3% combined approach. Overall, 54.3% of patients developed PJK within 2 years postoperatively, with 22% undergoing reoperation for PJK. Average cost of revision surgery due to PJK was $93,688 ± $21,467. The cost for PJK patients, including the cost associated with their revision surgery, was higher ($103,760 vs $71,000). Baseline ODI (39 vs 32) and 2Y ODI (39 vs 27) were higher for PJK patients, however, PJK patients did improve to a greater degree (-12 vs -10). The overall cost per QALY by 2Y was higher for PJK patients ($116,170 vs $95,347). CONCLUSIONS Patients that developed PJK had an almost $30,000 higher initial cost at 2 years. When looking at the cost per quality adjusted life years by 2Y, PJK resulted in slightly more than $20,000 in cost. These findings suggest prophylactic measures to mitigate PJK may improve the cost utility of adult spinal deformity surgery and can help policy efforts for adequate resource allocation for these complex patients. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Frailty is a dynamic measure of physiological age that is a strong predictor of a patient's surgical risk. The purpose of this study is to investigate the impact of frailty on the perioperative outcomes and costs associated with operating on frail ASD patients. PURPOSE To investigate impact of frailty on operative course, clinical outcomes, and cost utility. STUDY DESIGN/SETTING Retrospective cohort study of prospective, multicenter ASD database. PATIENT SAMPLE A total of 245 ASD patients were included. OUTCOME MEASURES Complications; health-related quality of life (HRQL): ODI. METHODS Operative ASD patients (scoliosis >20, SVA>5cm, PT>25, or TK>60) with available baseline (BL) and 2-year (2Y) radiographic and HRQL data were included. The ISSG frailty index was used to stratify patients into 2 categories: not frail (NF) ( 3). Univariate and multivariate analysis assessed differences in radiographic, surgical, and clinical factors. IHS-adjusted ODI and SRS compared recovery periods between F/NF patients. Cost utility using published methods convert ODI to SF-6D obtained Quality Adjusted Life Years (QALY). QALYs utilized a 3% discount rate for residual decline to life expectancy (78.7 years). Direct costs calculated using the PearlDiver database incorporating complications, LOS and associated health care costs. RESULTS A total of 245 ASD patients met inclusion criteria (57yrs±15.0, 82%F, BMI: 26.3 kg/m2 ±6.0, ASD-FI: 2.9±1.6, CCI: 1.55 ±1.7). Surgical patients had a mean number of levels fused of 11.4±4, LOS of 7.7 days±4.4, EBL of 1686 mL, operative time of 374 min, with 70% undergoing an osteotomy. In terms of surgical approach, 76% were posterior-only, and 23.6% had a combined approach. Frailty breakdown was: 138 (55%) NF and 107 (45%) F patients. F patients had higher mean PT (25 vs 20), PILL (21 vs 10), TK T4-T12 (-33 vs -36), SVA C7-S1 (80 vs 35), and a higher BL ODI (52 vs 27, all p CONCLUSIONS Frail patients experienced a longer LOS and higher EBL, possibly due to the increased invasiveness used to treat a more severe deformity with a worse preoperative physiological state. Although frail patients experienced more complications, the higher overall improvement in ODI contributed to a comparable cost utility despite a higher initial cost. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Hospital acquired conditions (HACs) were established in the Affordable Care Act, and are defined as reasonably preventable complications that are nonreimbursable. In high risk patient populations for HACs, such as frail surgical spine patients, preoperative evaluation should consider modifiable factors. PURPOSE To identify if optimizing the modifiable factors in the frailty index reduce the risk of developing HACs in population of surgical spine patients. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE This study included 196,523 elective spine surgery patients in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). OUTCOME MEASURES Modifiable patient frailty factors: hypertension and diabetes mellitus; rates of HACs, superficial or deep surgical site infection (SSI), deep venous thromboembolism (VTE) and urinary tract infection (UTI), across frailty scores. METHODS Patients >18 years who underwent elective spine surgery were identified in ACS-NSQIP database from 2005-2016. HACs identified: SSI, VTE, and UTI. Patient frailty was assessed utilizing the modified NSQIP 5-factor frailty index. The modified frailty score (mFI-5) is assessed on a scale between 0 and 1 (no frailty [NF] 0.5). Descriptive analysis quantified rates of patient characteristics, operative details, and HAC prevalence. Stepwise linear regression models determined significant predictors of baseline frailty using controllable patient factors. HACs were compared between ‘optimized’ and ‘non-optimized’ frailty status in the cohort. Level of significance was set to P RESULTS A total of 196,523 patients (57±14.2 years, 30.4 kg/m2, 48%F) met inclusion criteria. Overall, 5,720 (2.9%) of patients developed an HAC, the most common was an SSI (1.3%), followed by UTI (1.1%). When stratified by the mFI-5 frailty severity groups at baseline, 83.6% of patients were categorized NF, 15.1% MF and 1.3% SF. Within the frailty severity groups, prevalence of overall HACs increased significantly (NF: 2.64%, MF: 4.17%, 5.93%, p CONCLUSIONS Stepwise linear regression models determined that hypertension and diabetes account for 89.7% of variance in baseline mFI-5 score. Patients with these optimal controllable factors had reduced incidence of all hospital acquired conditions. In order to optimize hospital resources and treatment outcomes, physicians and patients should be aware of the modifiable factors that contribute to a patient's frailty that can ultimately impact acquiring HACs. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT The impact of neuromuscular disorders such as multiple sclerosis (MS) on outcomes following anterior cervical discectomy and fusion (ACDF) is underreported. PURPOSE Identify the impact of MS on two-year (2Y) postoperative complications and revisions following 2-3-level ACDF for cervical radiculopathy (CR) or myelopathy (CM). STUDY DESIGN/SETTING Retrospective review of the New York State Statewide Planning and Research Cooperative System (SPARCS) database. PATIENT SAMPLE Patients undergoing 2-3 level ACDF for CR/CM. OUTCOME MEASURES Two-year postoperative complications and reoperations. METHODS Patients undergoing 2-3 level ACDF for CR/CM were identified from SPARCS. Patients with a baseline diagnosis of MS were also identified. Patients with infectious/traumatic/neoplastic were excluded. The remaining patients were 1:1 propensity score-matched (MS to no-MS) for age, sex, race, Deyo index and compared for rates of 2Y postoperative complications and reoperations. Logistic regression models were utilized to determine significant predictors of these outcomes. RESULTS A total of 302 total patients were identified (MS, n=151; non-MS, n=151). MS patients were more frequently female (72.8% vs 27.2%, p 0.05. MS patients had similar rates of 2Y revisions (6.6% vs 5.3%, p=0.627). MS was not associated with medical, surgical, or overall complications or revisions at minimum 2Y follow-up. CONCLUSIONS Despite differences in demographics and higher rates of postoperative DVT, MS patients experienced comparable postoperative course with respect to other individual and overall complications and revisions following 2-3-level CF for degenerative spinal pathologies. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT With a heightened focus on prescription narcotic use in the United States, concern among surgeons has increased regarding preoperative and postoperative usage. However, the literature is scarce on outcomes of preoperative and prolonged opioid usage in adult spinal deformity (ASD) patients. PURPOSE Investigate effect of preoperative opioid usage on prolonged opioid use postoperatively and rates of reoperations. STUDY DESIGN/SETTING Retrospective review of the PearlDiver Database 2008-2013. PATIENT SAMPLE A total of 7,661 ASD patients. OUTCOME MEASURES Reoperations, 90-day complications, comorbidity burden, prolonged opioid usage METHODS ASD patients undergoing a fusion were isolated in the PearlDiver database between the years 2008-2013 using ICD-9 and CPT codes. Patients were stratified by prescription preoperative opioid use 3 months prior to surgery: (1) high frequency (>4 refills); (2) low frequency (1-3 refills); (3) opioid naive. Means comparison tests compared differences in demographics, complications, and reoperation rates. Logistic regression assessed the odds of complication and reoperations associated with preoperative frequency and prolonged opioid use (3 to 6 months postop), controlling for age, sex, and comorbidities. RESULTS A total of 7,661 ASD patients were isolated; 2,342 patients were high frequency preop opioid users, 2,247 low frequency preop opioid users, and 3,072 opioid naive. At BL, high frequency preop opioid users had higher rates of obesity, diabetes mellitus, CHF, COPD, hypertension, smoking and alcohol use (all p CONCLUSIONS Patients with high frequency preoperative opioid use are at increased risk of major complications within 90 days of surgery, prolonged use postoperatively, and increased risk of reoperations within two years. During preoperative risk assessment, providers should consider the effect of pre- and postoperative opioid usage on patient outcomes. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT While neurological complications are known to occur following cervical fusions, few studies with sufficient power have quantified the difference in neurological outcomes as posterior cervical fusion (PCF) surgical invasiveness increases. PURPOSE Compare longer vs shorter PCF complication rates. STUDY DESIGN/SETTING Retrospective review of the New York State Statewide Planning and Research Cooperative System (SPARCS) database. PATIENT SAMPLE All patients undergoing ≥2 level PCF. OUTCOME MEASURES Ninety-day neurological or medical complications status post short-cervical (SC), long-cervical (LC), or long cervicothoracic (LCT). METHODS From the NYS Statewide Planning and Research Cooperative System (SPARCS) database, retrospective review of all patients who underwent ≥2 level PCF from 2009-13 with ≤ 90-day follow-up were identified and stratified by levels fused: 2-3 (SC), 4-8 (LC), and ≥ 9 (LCT). Data on demographics, hospital-related parameters, and 90-day neurological and other complications, readmissions, and revisions were collected. Regression analysis identified independent predictors of neurologic and overall complications. RESULTS A total of 6,981 patients were included (SC, n=2,964, LC, n=3,899, LCT, n=118). LC patients were older than SC and LCT (60.8 vs 58.2 and 56.1), while LCT patients were more often female (59.3% vs LC 42.1% and SC 44%) and had higher total charges ($187,996 vs LC $99,020 and SC $82,239) and LOS (12.4 vs 6.1 and 6.9 days), all p CONCLUSIONS Compared to 2-3 levels, longer PCF had higher C5-C7 nerve palsy rates (3.3%) and 70% increased odds of sustaining ≥1 neurological complication. Longer PCF was also associated with increased rates of medical and total complications. This data can improve the ability to counsel patients regarding the risks and expectations of potential adverse outcomes preceding cervical fusion via posterior or combined anterior-posterior approach. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Vascular stenting is a common intervention for patients afflicted with coronary artery disease. For elective spine fusion patients with a history of coronary artery disease, a stent provides a less invasive surgical intervention allowing patients to move forward with spinal surgery. However, the impact of an initially less invasive cardiac intervention on outcomes of future surgical spine procedures has been understudied. PURPOSE Investigate effect of coronary stents on postoperative outcomes in an elective spine fusion cohort. STUDY DESIGN/SETTING Retrospective review of the PearlDiver database between the years 2006-2013. PATIENT SAMPLE A total of 726,061 elective spine fusion patients. OUTCOME MEASURES Comorbidity burden, 30-day and 90-day complications (myocardial infarction, pneumonia, sepsis, death, would complications, transfusions), length of stay. METHODS Elective spine fusion patients were isolated with ICD-9 and CPT procedures codes in the PearlDiver database. Patients were stratified by number of coronary stents: (1) 1-2 stents (ST12); (2) 3-4 stents (ST34); (3) no stents. Means comparison tests compared differences in demographics, diagnoses, comorbidities, 30-day and 90-day complication outcomes. Logistic regression assessed the odds of complication associated with coronary stents, controlling for levels fused, age, sex, and comorbidities (odds ratio [95% confidence interval]). Statistical significance was set p RESULTS A total of 726,061 elective spine fusion patients were isolated; 707,396 patients had no stent, 17,087 ST12 and 1,578 ST34. At BL, ST12 patients had higher rates of morbid obesity, chronic kidney disease, CHF, COPD, and diabetes mellitus compared to no stent and ST34 (all p CONCLUSIONS Cardiac stents failed to normalize risk profile of patients with coronary artery disease. Postoperatively at 90 days, elective spine fusion patients with 3 or more stents were significantly at risk of mortality compared to patients with fewer or no stents. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Spinal fusion is increasingly considered for management of patients with osteoporosis (OP) and degenerative disc disease (DDD). Little data is available regarding long-term outcomes in OP patients undergoing short-segment, lumbar fusion for DDD. PURPOSE Analyze the impact of OP on long-term outcomes in patients who have had 2-3-level lumbar fusions for degenerative disc disease. STUDY DESIGN/SETTING Retrospective review of the New York State Statewide Planning and Research Cooperative System (NYS SPARCS) database. PATIENT SAMPLE Patients with DDD undergoing 2-3-level lumbar fusion. OUTCOME MEASURES Frequency of 2-year medical and surgical complications and reoperations. METHODS Utilizing SPARCS, all patients from 2009-2011 with ICD-9 codes for DDD who underwent 2-3-level lumbar fusion were identified. Patients with bone mineralization disorders, systemic and endocrine disorders affecting bone quality were excluded. Surgical indications of trauma, systemic disease(s), and infection were excluded. Patients with and without OP were compared for demographics, hospital-related parameters, and 2-year complications and reoperations. Logistic regression models were utilized to identify predictors of complications. RESULTS A total of 29,028 patients (OP=1,353 (4.7%), No-OP=27,675) were included. OP patients were older (66.9 vs 52.6 years) as well as more often female (85.1% vs 48.4%) and white (82.8% vs 73.5%), all p CONCLUSIONS Patients with OP undergoing 2-3-level lumbar fusion for DDD were at higher risk of 2-year medical and surgical complications, and 3.4% of OP patients experienced implant-related complication. These findings highlight the importance of rigorous preoperative metabolic workup prior to spinal surgery. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Surgical intervention of the cervical spine is a challenging procedure that can present postoperative complications such as dysphagia, swelling, and reoperations. However, the risk of reoperation can possibly be mitigated with the use of biologics to enhance fusion. There is paucity in the literature on long-term incidence of reoperations after application of BMP during ACDF. PURPOSE To evaluate if bone morphogenetic protein usage during anterior cervical discectomy and fusion will decrease reoperation rates. STUDY DESIGN/SETTING Retrospective review of the PearlDiver database between 2006-2014. PATIENT SAMPLE Matched cohort of 35,544 ACDF patients. OUTCOME MEASURES Reoperations. METHODS Patients undergoing an anterior cervical discectomy and fusion between the years 2006-2014 were isolated in the PearlDiver database. Patients receiving BMP operatively and a control with no BMP were matched for baseline demographics including age, sex, and comorbidities. A Kaplan Meier Survival analysis assessed five-Year Reoperation-Free Survival between BMP patients and controls. Statistical significance was set to p RESULTS A matched cohort of 35,544 ACDF patients was isolated. A total of 17,772 patients received BMP while undergoing cervical fusion and 17,772 did not receive any BMP during surgery. Patients did not differ in age, sex or comorbidities (p>0.05). Kaplan Meier survival analysis showed patients receiving BMP during cervical fusion were significantly more likely to remain reoperation free five years after index surgery (p CONCLUSIONS For patients receiving bone morphogenetic protein during anterior cervical discectomy and fusion, Kaplan-Meier survival analysis following five years post index surgery had showed a 91.3% reoperation-free survivorship. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT The risk assessment of elective spine fusion patients with a previous history of cardiac intervention, particularly a coronary artery bypass graft (CABG), has been understudied. This study aimed to assess postoperative outcomes of elective spine fusion patients with a prior history of single- to multilevel coronary artery bypass grafting. PURPOSE Investigate effect of revascularization on 30-day and 90-day outcomes in elective spine fusion patients. STUDY DESIGN/SETTING Retrospective review of the PearlDiver database between the years 2006-2013. PATIENT SAMPLE A total of 733,007 elective spine fusion patients. OUTCOME MEASURES Comorbidity burden, 30-day and 90-day complications (myocardial infarction, pneumonia, sepsis, death, would complications, transfusions), readmission. METHODS Elective spine fusion patients were isolated with ICD-9 and CPT procedures codes in the PearlDiver database. Patients were stratified by number of coronary arteries grafted during a coronary artery bypass grafting procedure prior to spine fusion: (1) 1-2 grafts (G12); (2) 3-4 grafts (G34); (3) no grafts. Means comparison tests compared differences in demographics, diagnoses, comorbidities, and 30-day complication outcomes. Logistic regression assessed the odds of complication associated with number of arteries grafted, controlling for levels fused, age, sex, and comorbidities (odds ratio [95% confidence interval]). RESULTS A total of 733,007 elective spine fusion patients were isolated;723,606 pts had no grafts, 5,356 were G12, and 4,045 were G34. G12 patients at baseline had higher rates of morbid obesity, PVD, chronic kidney disease, CHF, and COPD (p 0.05). Overall, G34 patients had higher rates of 30-day and 90-day readmissions (p CONCLUSIONS Compared to patients who had no history of cardiac intervention, patients who had single or multivessel coronary artery bypass graft had an increase in 30-day complications. However, comparing between groups that had 1-2 or 3-4 level grafts, there were no significant differences in major and minor complications 30 days postoperatively. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Considering rapidly advancing HIV care and medications, very little is reported regarding how HIV-positive patients with asymptomatic, well-controlled disease (AHIV) fare postoperatively following spinal fusion for degenerative disc disease (DDD). PURPOSE Evaluate the impact of AHIV status on postoperative outcomes in DDD patients. STUDY DESIGN/SETTING Retrospective review of the National Inpatient Sample (NIS) database. PATIENT SAMPLE Adult patients undergoing 2-3-level spinal fusion for DDD. OUTCOME MEASURES Frequency of postoperative medical, surgical, and total complications. METHODS The NIS was reviewed from 2005-13 to identify all ≥18-year-old patients who underwent 2- to 3-level spinal fusion for DDD. Subsequently, those diagnosed with AHIV (ICD V08) were identified and 1:1 propensity score-matched to patients without any HIV disease by age, sex, race, and insurance status. All other HIV diagnoses were excluded, as were surgical indications for other reasons. Univariate comparison of postop medical/surgical/total complications was performed. Multivariate logistic regressions identified independent predictors of these outcomes. RESULTS Included were 570 patients (n=285 each). Age, sex, race and insurance status were comparable between AHIV and no-HIV cohorts, as were length of stay (4 vs 3.8 days), total charges (97,194 vs $89,877), and in-hospital mortality (0.4 vs 0%), p>0.05. AHIV cohort experienced higher postoperative respiratory complications (4.3 vs 0.4%, p 0.05. Regression revealed that AHIV status was not a predictor for postoperative respiratory, medical, surgical, or total complications, all p>0.05. CONCLUSIONS Aside from respiratory complications, AHIV status did not adversely impact the overall perioperative course of DDD patients undergoing spinal fusion. This data highlights that control of active HIV infection to establish an asymptomatic status may be protective against poor outcomes in this patient population. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Osteoporosis (OP) is a common condition affecting nearly 200 million individuals globally. Similarly, adult spinal deformity has a peak prevalence of 65% of the adult population. While bone health is instrumental in orthopaedic surgery, few studies have described the long-term outcomes of osteoporosis following surgery for ASD. PURPOSE We sought to evaluate the impact of OP on two-year postoperative complication rates when compared to patients without OP. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE Utilizing the New York State Statewide Planning and Research Cooperative System (SPARCS), we identified all patients who underwent ≥4-level fusion with ICD-9 codes diagnostic for ASD (progressive idiopathic scoliosis and degenerative lumbar disease) from 2009-2011 with ≥2-year follow-up. Patients with osteoporosis (OP) and without OR were identified following exclusions. OUTCOME MEASURES Patient demographics, hospital-related parameters, postoperative complications and reoperations. METHODS Using SPARCS, we identified all patients who underwent ≥4-level fusion with ICD-9 codes diagnostic for ASD (progressive idiopathic scoliosis and degenerative lumbar disease) from 2009-2011 for ≥2-year minimum follow-up. Patients with osteoporosis (OP) and without OP were identified. Any patients with bone mineralization disorders (osteomalacia, rickets, hyperparathyroidism [primary, secondary, tertiary], vitamin D deficiency) and other systemic (fibrous dysplasia, sickle cell disease, renal osteodystrophy) and endocrine disorders (thyroid hypo- or hyperfunctioning disorders, adrenal insufficiency, adrenal hyperplastic syndromes) affecting bone quality or production were excluded, as were patients with surgical indications of trauma, systemic disease, infection, or cancer. The two cohorts were compared for demographics, hospital-related parameters, and 2-year postoperative complications and reoperations. Multivariate binary stepwise logistic regressions was utilized to identify significant predictors of these outcomes (covariates: OP, age, sex, race, and Charlson/Deyo). RESULTS A total of 6,132 patients were identified (OP, n=490 (7.99%); No-OP, n=5,642). OP patients were older (67.6 vs 56.7 years), more often female (83.7% vs 46.2%) and white (84.3% vs 79.1%), and had higher comorbidity scores (Charlson/Deyo: 0.72 vs 0.61), all p CONCLUSIONS Osteoporosis was associated with two-year postoperative complications in ASD patients. Aside from being an etiology of ASD due to vertebral fracture, osteoporosis should be considered as a comorbidity that needs to be optimized and managed perioperatively. Furthermore, this data is a call to every spine surgeon to consider metabolic bone disorders screening prior to any spinal deformity surgery. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Cannabis is the most commonly used illicit drug in the United States with 4 million Americans meeting clinical criteria for cannabis dependence or abuse in 2015. With recent state-level legalization efforts and changing public perception, its use is expected to grow. Considering these changes and the reported medicinally beneficial effects, studies evaluating cannabis use and its impact on outcomes following cervical fusion (CF) are quite limited; further detailed study is warranted. PURPOSE This study sought to identify if adverse outcomes, such as complications, readmissions, and revisions, are comparable between cannabis users and noncannabis users undergoing CF. We compared 90-day complication and readmission rates and 2-year revision rates between baseline cannabis users and nonusers following CF. STUDY DESIGN/SETTING Retrospective cohort study of a prospectively collected database. PATIENT SAMPLE All patients who underwent CF between January 2009 and September 2013 in the New York Statewide Planning and Research Cooperative System (SPARCS) were identified. Patients were included if they had ≤90-day follow-up for complications and readmissions, or ≥2-year follow-up for revisions. Patients with a preoperative ICD-9-CM diagnosis of cannabis abuse (Cannabis) or dependence were identified. Patients were excluded for systemic disease, osteomyelitis, cancer, trauma, or concomitant substance or polysubstance abuse/dependence. OUTCOME MEASURES Demographic information, fusion approach, fusion levels, complications, readmissions, and revisions. METHODS All patients aged ≥18y who underwent CF from 2009-13 were identified via the SPARCS database and included if they had ≤90D follow-up for complications and readmissions or 2Y follow-up for revisions. Pts with preoperative cannabis abuse/dependence identified (Cannabis). Pts were excluded for systemic disease, osteomyelitis, cancer, trauma, or concomitant substance or polysubstance abuse/dependence. Following patient selection in the SPARCS database, Cannabis patients were 1:1 propensity score-matched by age, gender, race, Deyo score, fusion levels and approach, and tobacco use to nonusers (Non-Cannabis). These groups were compared for hospital-related parameters, rates of 90-day complications and readmissions, and 2-year revisions. Multivariate binary stepwise logistic regression models identified independent predictors of these outcomes. RESULTS A total of 432 pts (n=216 each) were identified, with comparable age, sex, Deyo scores, tobacco use rates, and distribution of anterior or posterior approach (all p>0.05). Cannabis patients were more frequently African American (27.8% vs 12.0%), primarily utilized Medicaid (29.6% vs 12.5%), and incurred longer lengths of stay (3.0 vs 1.9 days), all p≤0.001. Both cohorts experienced comparable rates of 90-day medical, surgical and overall complications (5.6% vs 3.7%) and 2-year revisions (4.3% vs 2.8%), p≤0.430. Cannabis users experienced higher 90-day readmission rates (11.6% vs 6.0%, p=0.042). Cannabis use was an independent predictive factor of 90-day readmission (OR=2.0, 95%CI, 1.0-4.1, p=0.049), but did not predict any 90-day complications or 2-year revisions (all p>0.05). CONCLUSIONS Baseline cannabis dependence/abuse was associated with increased 90-day readmission odds following CF. Further investigation of the physiologic impact of cannabis on musculoskeletal patients may identify what measurable or overlooked patient factors contribute to this association. FDA DEVICE/DRUG STATUS Unavailable from authors at time of publication.

BACKGROUND CONTEXT Cannabis is the most commonly used illicit drug in the United States, and with changing state legislation, the use of cannabis is expected to expand. Although other literature has noted potentially medicinally beneficial effects of cannabis, there is limited literature evaluating the impact of cannabis on outcomes for patients following spinal surgery. With shifting public sentiment, expanding decriminalization, and a dearth of knowledge on the potential surgical implications of cannabis, it is imperative we take a closer, objective look at how cannabis dependence or abuse impacts the outcomes of common orthopedic procedures, such as thoracolumbar fusion. PURPOSE To determine if adverse outcomes would be comparable between baseline cannabis users and non-cannabis users undergoing thoracolumbar spinal fusion. We compared the rates of 90-day outcomes and complications and 2-year revisions between baseline cannabis users and non-users following thoracolumbar spinal fusion. STUDY DESIGN/SETTING Retrospective cohort study of a prospectively-collected database. PATIENT SAMPLE The New York State Statewide Planning and Research Cooperative System (SPARCS) was queried to identify all patients from January 2009 to September 2013 who underwent thoracolumbar spinal fusion. Patients were included if they had ≤90-day follow-up for complications and readmissions or ≥2-year follow-up for revisions. Patients with preoperative cannabis abuse/dependence were identified. Patients were excluded for systemic disease, osteomyelitis, cancer, trauma, or concomitant substance or polysubstance abuse/dependence. OUTCOME MEASURES Demographic information, fusion approach, fusion levels, complications, readmissions, and revisions. METHODS The NYS SPARCS database was queried to identify all patients ≥18y who underwent thoracolumbar spinal fusion from 2009-13. Patients were included if they had ≤90D FU for complications and readmissions or 2Y FU for revisions. Patients with preoperative cannabis abuse/dependence were identified. Patients were excluded for systemic disease, osteomyelitis, cancer, trauma, or concomitant substance or polysubstance abuse/dependence. Following patient identification in the SPARCS database, patients with ICD-9-CM diagnosed cannabis use were 1:1 propensity score-matched by age, gender, race, Deyo score, fusion levels and approach and tobacco use to non-cannabis users. These groups were compared for hospital-related parameters, rates of 90-day complications and readmissions and 2-year revisions. Multivariate binary stepwise logistic regression models identified independent predictors of outcomes. RESULTS A total of 628 patients (n=314 each) were identified and included; patients had comparable age, gender, fusion approaches and fusion levels distribution. More cannabis patients were African American (19.7 vs 7.6%) and primarily utilized Medicaid (24.2% vs 11.5%), all p≤0.001. Non-cannabis patients incurred lower 90-day overall and medical complication rates (5.1% vs 12.1%; 4.5% vs 9.9%), all p CONCLUSIONS Cannabis was a protective factor against postoperative anemia and any medical complication, and baseline cannabis use was not associated with increased surgical or overall 90-day complications and readmissions or 2-year revision rates. These findings underscore that baseline cannabis use in the absence of acute intoxication may not necessarily require delays in preoperative clearance. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT MHD prevalence in patients with substance abuse history has been well-described. However, the impact of current or historical substance abuse/dependence in adolescent idiopathic scoliosis (AIS) patients on risk of subsequent development of new-onset mental health disorders (MHDs) is unknown. PURPOSE This study evaluated the: (1) demographics and (2) new-onset diagnosis of MHD among AIS patients with baseline substance abuse/dependence. The goal of this study was to determine whether substance abuse among AIS patients increases the odds of subsequent new-onset development of a MHD. STUDY DESIGN/SETTING Retrospective review of prospectively collected data. PATIENT SAMPLE Using the NYS Statewide Planning and Research Cooperative System (SPARCS), we identified age, gender, race, and Charlson/Deyo-index propensity-score matched cohorts of AIS patients with or without prior/current substance abuse. AIS patients with comorbid substance abuse were included from 2009-11, with minimum 2-year follow-up. A total of 386 AIS patients (n=193 in each group) were included. OUTCOME MEASURES Demographic information, length of stay, hospital charges, new-onset MHD diagnosis at 2-year follow-up METHODS The NYS Statewide Planning and Research Cooperative System was reviewed to identify all 10-25 year-old AIS patients with prior or concurrent substance abuse (AIS-Sub: alcohol, tobacco, cannabis, amphetamine, opioid or polysubstance) from 2009-11 to ensure two-year follow-up. Patients with prior or concurrent MHD(s) were excluded. AIS-Sub were 1:1 propensity score-matched by age, sex, race and Charlson/Deyo index to AIS patients without substance abuse (AIS-NoSub). Cohorts were compared for subsequent incidence/development of individual and overall MHDs (depressive, anxiety, stress, sleep and/or eating disorder). Binary stepwise logistic regressions were utilized to calculate odds ratios (OR) of developing individual or any MHDs based on baseline substance abuse. RESULTS A total of 386 AIS patients were included (n=193 each in AIS-Sub and AIS-NoSub). AIS-Sub and AIS-NoSub patients had comparable age (both 20.8 years), sex (62.2 vs 62.7% male), race (54.9 vs 52.8% white), insurance (55.4 v 45.6% Medicaid), and Charlson-Deyo (0.29 vs 0.37) respectively. AIS-Sub patients had higher rates of new-onset subsequent overall MHDs (16.1% vs 3.6%), with only depressive disorder higher among individual MHDs (10.9% vs 0.5%), both p CONCLUSIONS AIS patients with prior or current substance abuse/dependence were at increased two-year risk of developing any new-onset MHD, specifically depressive disorders. This data may guide preoperative screening and optimization efforts for scoliosis surgeons, as MHDs have been associated with poor outcomes following spine surgery. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Fractures of the spine cause significant disturbances in patient lives and functioning, yet the causes and epidemiological trends of both cervical and thoracic spine fractures have not been well delineated with sufficiently powered studies. PURPOSE This study sought to investigate the epidemiology of cervical and thoracic spine fractures over a 10-year period in the United States. Specifically, we evaluated these fractures by location, levels injured, and mechanism of injury and identified temporal trends in patient demographics and disposition in the United States. STUDY DESIGN/SETTING Retrospective review of prospectively-collected data. PATIENT SAMPLE All patients who visited the emergency department (ED) between January 1, 2007 and December 31, 2016 and were diagnosed with a cervical and/or thoracic spine fracture from the National Electronic Injury Surveillance System (NEISS) database. OUTCOME MEASURES Demographics, mechanism of injury, levels involved, nationwide estimation of frequency and incidence rates by age, sex, and race, and temporal trends. METHODS The National Electronic Injury Surveillance System (NEISS) database was used to identify all patients who visited the emergency department (ED) between January 1, 2007 and December 31, 2016 and were diagnosed with a cervical and/or thoracic spine fracture. The data were stratified by demographic variables and mechanism of injury. The nationwide estimation of frequency and incidence rates by age, sex, and race were determined using NEISS weight calculations and 2007-2016 US census data. Temporal trends of injuries were analyzed using descriptive statistics and linear regression. RESULTS An estimated total of 131,176 fractures were identified, with approximately 95.4% involving the thoracic region, 4.7% involving the cervical region, and 1.2% involving both. Of the total cases, 91.1% were reported as single-level fractures, while 8.86% were reported as multilevel fractures. The annual estimated number of these type of fractures increased from 10,020 in 2007 to 18,168 in 2016 (beta=0.89, p CONCLUSIONS During the last decade, the incidence of fractures of the cervical and thoracic spine increased significantly. The most common mechanism of injury was due to falls. The majority of these injury fractures occurred between ages 80 and 89 and occurred more often in females. The incidence rate of these fractures was highest among whites, compared to blacks and other. Hospital admissions for these fractures were observed to have increased over the time period, though this was not statistically significant. Understanding these patterns can help improve recognition of cervical and thoracic spine fractures. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Orthopaedic surgeons and neurosurgeons both perform anterior cervical discectomy and fusions (ACDF) but there is little evidence comparing outcomes between these two specialties for ACDF. It is possible that one specialty achieves superior postoperative complication, reoperation, or readmission rates following ACDF. PURPOSE This study evaluated the: (1) demographics, (2) complications, (3) operative time, (4) length of stay, (5) reoperations and (6) readmissions of patients following ACDF. We hypothesized that orthopedic surgeons and neurosurgeons achieve similar 30-day postoperative outcomes in complications, reoperations and readmissions following ACDF surgery. STUDY DESIGN/SETTING Retrospective review of a prospectively collected database. PATIENT SAMPLE All patients who underwent elective ACDF surgery between 2008 and 2016 and were eligible for at least 30-day follow-up were identified from the National Surgical Quality Improvement Program (NSQIP) database. A total of 77,071 patients were identified, 33.1% of which were treated by orthopaedic surgeons and 66.9% treated by neurosurgeons. OUTCOME MEASURES Demographic information, complications, operative time, length of stay, reoperations and readmissions METHODS The National Surgical Quality Improvement Program (NSQIP) database was utilized to identify all elective ACDFs performed from 2008 to 2016 by ICD-9-CM code. This cohort was grouped by surgeon specialty (orthopedic surgeon and neurosurgeon). Demographics including age, sex, race and Charlson or Deyo score, as well as comorbidities, labs, perioperative factors and 30-day postoperative complication, reoperation and readmission rates were collected for all patients. The groups were then compared with univariate analysis. Regression models were developed to identify potential predictive factors for 30-day postoperative outcomes. RESULTS A total of 77,071 ACDF patients were included. Of these, 33.1% of patients were treated by orthopedic surgeons and 66.9% by neurosurgeons. Orthopedic patients were older (56.0vs. 55.8 years) and had lower rates of smokers (23.7vs. 26.8%), diabetes mellitus (15.0vs. 16.1%) and COPD (3.9vs. 4.5%) (all p CONCLUSIONS This study compared 30-day postoperative outcomes between orthopedic surgeons and neurosurgeons in ACDF patients. Neurosurgeons performed ACDF more often than orthopedic surgeons but their outcomes were comparable for 30-day complications, reoperations and readmissions. Orthopedic patients had longer length of stay but orthopedic specialty was also a predictor for lower 30-day readmission rate.Orthopedic surgeons may be under-performing ACDF surgeries despite largely comparable outcomes to neurosurgeons.

BACKGROUND CONTEXT Parkinson's disease (PD) is a neuromuscular disorder that affects both mobility and resting tone. This may make patients susceptible to spine malalignment and frequent candidates for surgical interventions. However, there is little evidence comparing the outcomes of PD patients in cervical spinal fusion (CF). PURPOSE This study evaluated the: (1) demographics; (2) complications (medical and surgical); (3) length of stay; (4) hospital charges; (5) reoperations; and (6) readmissions following cervical spine surgery. We hypothesized that patients who have Parkinson's Disease will experience similar postoperative outcomes to other CF patients. STUDY DESIGN/SETTING Retrospective review. PATIENT SAMPLE All patients with cervical radiculopathy and myelopathy who underwent any cervical spinal fusion (anterior or posterior) between 2009 and 2011 and were eligible for at least 2-year follow-up were identified from the New York Statewide Planning and Research Cooperative System (SPARCS). Patients with Parkinson's disease were identified and propensity score matched by age, sex, and DEYO index. A total of 134 propensity score matched patients with and without PD were included. OUTCOME MEASURES Demographic information, complications, length of stay, reoperations, and readmissions. METHODS The New York Statewide Planning and Research Cooperative System (SPARCS) database was used to identify all patients with cervical radiculopathy and myelopathy who underwent any cervical spinal fusion (anterior and posterior) from 2009 to 2011 with 2-year follow-up surveillance. Patients with PD were then identified and propensity matched at a 1:1 ratio with patients without PD based on demographics and DEYO index. Demographics, insurance status, and hospital-related parameters were compared between the two groups. Logistic regression was performed to identify any predictive factors for postoperative outcomes. RESULTS There were a total of 134 CF patients included, with 67 patients in the PD group and 67 patients in the nonPD group. PD patients were less commonly white (74.6vs. 91.0%, p=.024) but all other demographics were comparable between the groups. PD patients had significantly longer length of stay (7.3vs. 3.6days, p=.004) and higher total hospital charges ($77,439.13vs. $45,761.24, p=.008) compared to nonPD patients. Overall (41.8vs. 40.3%, p=.861), medical (38.8vs. 31.3%, p=.365) and surgical (11.9vs. 11.9%, p=1) complication rates were comparable between PD and nonPD patients, respectively. However, PD patients did have higher rates of altered mental status (6.0vs. 0%, p=.042) than nonPD patients. PD patients also had comparable reoperation (14.9vs. 13.4, p=.804) and readmission (85.1vs. 74.6%, p=.132) rates as nonPD patients. Regression analysis revealed that Deyo index was the lone significant predictor of higher two-year complication (OR1.936, p .05). CONCLUSIONS This study compared 2-year outcomes between Parkinsonrs Disease and nonPD patients following cervical spinal fusion. PD patients and nonPD patients had comparable rates of complications, reoperations and readmissions at least two years after CF. PD was also not a significant predictor for any adverse outcomes. This study suggested that spine surgeons should not preclude PD patients from undergoing cervical spinal fusion because of a pre-existing PD diagnosis.

BACKGROUND CONTEXT Spinal and body balance are active processes requiring a thorough understanding of the harmony between static posture and dynamic motion. Our understanding of patients’ function is lacking a more objective and quantified mechanism of assessment. The Dubousset Functional Test (DFT) is a four-component, novel, multidomain physical function and balance assessment proposed by Dr. Jean Dubousset. PURPOSE To identify normative baseline/reference values for DFT in asymptomatic, healthy subjects, establish test feasibility, and identify correlations between demographics and DFT performance in the general population. STUDY DESIGN/SETTING Prospective single-center. PATIENT SAMPLE Sixty-five asymptomatic volunteers (mean age: 42.4±15.4 years; 42% female, mean BMI 26±4.8kg/m2). OUTCOME MEASURES Demographics, DFT components: Up-and-Walking Test (UWT), Steps Test (ST), Down-and-Sitting Test (DST), Dual-Tasking Test (DTT). METHODS Asymptomatic volunteers were screened and recruited to participate in the 4 DFT components at a single center from 2017-2018. These include: (1) UWT (Up-and-Walking Test): unassisted sit-to-stand, walk forward/backward 5 m (no turn), unassisted sit; (2) ST (Steps Test): ascend 3 steps, turn, descend 3 steps; (3) DST (Down-and-Sitting Test): stand-to-ground sit-to-stand, assistance as needed; (4) DTT (Dual-Tasking Test): walk 5 m forth and back while counting down from 50 by 2. All subjects were given standardized verbal instructions and a physical demonstration for each DFT test. Trials were video recorded and timed, with scores assigned by time required to complete the test. All trials were conducted and all tests were scored by the same rater. Univariate and multivariate analysis were utilized to analyze durations of test components against demographics. RESULTS 65 subjects were included (mean age, 42.4±15.4 years); 42% were female, and mean BMI was 26±4.8 kg/m^2. The racial breakdown of the cohort was 34% White, 25% Black, 15% Asian, 9% Indian, 6% Latino, 10% other. Evaluating the four components of the DFT, the mean and standard deviations of each test component were as follows: mean duration in seconds and 95% confidence interval of each DFT test: UWT: 14.8s (14.0-15.6s), ST: 6.3s (6.0-6.6s), DST: 6.0s (5.4-6.6s), and DTT: 12.8s (12.1-13.6s). There were no differences between males and females in time taken to perform any of the tests. There were significant correlations between age and DST (r=0.529), UWT (r=0.429), and ST (r=0.356) (all p CONCLUSIONS The DFT is a quick and feasible test that was performed safely in a cohort of healthy subjects. Age and BMI, but not gender, were found to influence all DFT tests. Physical and verbal pausing were reported in about 1/10 and 1/3 patients, respectively, with the majority of pausing occurring during the turning phase of the test. Utilization of this test in patients with spinal pathologies may help us to determine the offset from norms as well as understand the impact of preoperative DFT performance on surgical outcomes. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Bariatric surgery for morbid obesity helps to address common comorbidity burdens, including decreasing rates of myocardial infarction and stroke. The increased mechanical stresses on the spine caused by morbid obesity predispose patients to various spinal pathologies and are concerning for spinal surgeons, with previous studies suggesting poorer outcomes than the general population. The effects of bariatric surgery on diminishing spinal complaints or symptoms have yet to be elucidated in the literature. PURPOSE To assess the rate in which various spinal symptoms diminish after bariatric surgery. STUDY DESIGN/SETTING Retrospective analysis of the prospectively collected New York State Inpatient Database (NYSID) years (2004-2013). PATIENT SAMPLE A total of 4,351 patients who underwent bariatric surgery with at least one identified spinal diagnosis present before bariatric surgery. OUTCOME MEASURES Time from bariatric surgery until disappearance of specific spinal complaint, percentage of unresolved spinal complaints with 2-year follow-up. METHODS Retrospective analysis of the prospectively collected (NYSID) years 2004-2013. Patient linkage codes allow identification of multiple and return inpatient stays within the time frame analyzed (720 days). Inclusion criteria were bariatrics surgery patients with one or more visits prior to and after bariatric procedure (excluding pts with RESULTS A total of 4,351 bariatric surgery pts with a preop spinal diagnosis by ICD-9 were analyzed. Lumbar pts: 1,049 had stenosis, 774 spondylosis, 648 degeneration, 249 spondylolisthesis, 72 disc herniation. Cervical pts: 581 disc herniation, 376 had stenosis, 366 spondylosis, 236 degeneration. Cumulative resolution rates at 90-day, 180-day, 360-day, and 720-day follow-up were as follows: lumbar stenosis (48%,67.6%,79%,91%), lumbar herniation (61%,77%,86%,93%), lumbar spondylosis (47%,65%,80%,93%), lumbar spondylolisthesis (37%,58%,70%,87%), lumbar degeneration (37%,56%,72%,86%). By cervical region: cervical stenosis (48%,70%,84%,94%), cervical herniation (39%,58%,74%,87%), cervical spondylosis (46%, 70%,83%, 94%), cervical degeneration (44%,64%,78%,89%). Lumbar herniation pts saw significantly higher 90d-resolution than cervical herniation pts (p CONCLUSIONS Over 50% of bariatric patients diagnosed with a cervical or lumbar pathology before weight-loss surgery no longer sought inpatient care for their respective spinal diagnosis by 180 days postop. Lumbar herniation had significantly higher resolution than cervical herniation by 90d, whereas cervical degeneration and stenosis resolved at higher rates than corresponding lumbar pathologies by 180d and 1-year follow-up, respectively. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Orthopedic surgeons and neurosurgeons both perform lumbar total disc replacements (LTDR). However, there is little evidence comparing outcomes between these two specialties for LTDR. It is possible that one specialty achieves superior postoperative complication, reoperation, or readmission rates following LTDR. PURPOSE This study evaluated the: (1) demographics; (2) complications; (3) operative time; (4) length of stay; (5) reoperations; and (6) readmissions of patients following LTDR. We hypothesized that orthopedic surgeons and neurosurgeons achieve similar 30-day postoperative outcomes in complications, reoperations, and readmissions following LTDR surgery. STUDY DESIGN/SETTING Retrospective review of a prospectively collected database. PATIENT SAMPLE All patients who underwent elective lumbar total disc replacement surgery between 2008 and 2016 and were eligible for at least 30-day follow-up were identified from the National Surgical Quality Improvement Program (NSQIP) database. A total of 581 patients were identified, 42.9% of whom were treated by orthopedic surgeons and 57.1% treated by neurosurgeons. OUTCOME MEASURES Demographic information, complications, operative time, length of stay, reoperations, and readmissions. METHODS The National Surgical Quality Improvement Program (NSQIP) database was utilized to identify all elective lumbar total disc replacements performed from 2008 to 2016 by ICD-9-CM code. This cohort was grouped by surgeon specialty (orthopedic surgeon and neurosurgeon). Demographics including age, sex, race, and Charlson or Deyo score, as well as comorbidities, labs, perioperative factors, and 30-day postoperative complication, reoperation, and readmission rates were collected for all patients. The groups were then compared with univariate analysis. Regression models were developed and attempted to identify potential predictive factors for 30-day postoperative complications. RESULTS A total of 581 LTDR patients were included. 42.9% of patients were treated by orthopedic surgeons and 57.1% were treated by neurosurgeons. Orthopedic patients were younger (44.71vs. 47.51years, p=.008) and had lower rates of hypertension (26.9vs. 37.1%, p=.010). Otherwise, the groups were largely comparable in comorbidities and lab values. Orthopedic patients had comparable operative time (159.3vs. 140.0 minutes, p=.731) and but slightly longer length of stay (2.59vs. 2.26days, p=.044) compared to neurosurgery patients. The orthopedic patient group had comparable 30-day complication (6.4vs. 9.3%, p=.203), readmission (1.8vs. 5.0%, p=.052) and reoperation (0.9vs. 1.6%, p=.473) rates compared to neurosurgery patients. Regression analysis revealed patient age was the lone significant predictor for higher overall complication rate (OR 1.04, p CONCLUSIONS This study compared 30-day outcomes between orthopedic surgeons and neurosurgeons in lumbar total disc replacement patients. Neurosurgeons performed lumbar total disc replacements more often than orthopedic surgeons but their outcomes were comparable for 30-day complication, reoperation and readmission rates. Orthopedic surgery patients had slightly longer length of stay. Surgeon specialty was not a significant predictor for 30-day complication rates. Orthopedic surgeons may be under-performing lumbar total disc replacement surgeries despite similar outcomes to neurosurgeons.

BACKGROUND CONTEXT Cervical spinal fusion (CF) is employed for treating degenerative spine diseases, which are age-related conditions. Despite the age-dependent nature of these conditions, there is little evidence comparing the outcomes of elderly adults to active adults. It is possible that patient age has a significant effect on postoperative outcomes following cervical spinal fusion. PURPOSE This study evaluated the: (1) demographics, (2) complications, (3) length of stay, (4) hospital charges, (5) reoperations and (6) readmissions following cervical spinal fusion. We hypothesized that elderly patients will experience poorer outcomes compared to younger adults after cervical spinal fusion. STUDY DESIGN/SETTING Retrospective review. PATIENT SAMPLE All patients 45-64years and ≥80years of age who underwent elective cervical spinal fusion between 2009 and 2011 and were eligible for at least two year follow-up were identified from the New York Statewide Planning and Research Cooperative System (SPARCS). A total of 14,578 patients were included, 3.4% of which were ≥80years old and 96.6% of which were 45-64years old. OUTCOME MEASURES Demographic information, complications, length of stay, hospital charges, reoperations and readmissions METHODS The New York Statewide Planning and Research Cooperative System (SPARCS) database was utilized to identify all elective cervical spinal fusions performed from 2009 to 2011 by ICD-9-CM code. Demographics including age, sex and race as well as perioperative factors, and two year postoperative complication, reoperation and readmission rates were collected for all patients. This cohort was then placed in two groups based on age: 45-64years and ≥80years. Patients outside of these ages were excluded. These two groups were then compared with univariate analysis. Regression models were developed and attempted to identify potential predictive factors for two-year postoperative outcomes. RESULTS A total of 14,578 patients were included, with 96.6% 45-64years (Younger) and 3.4% ≥ 80years (Older) old at time of surgery. Older patients were more commonly male (54.0vs. 50.1%, p CONCLUSIONS This study compared outcomes between patients ≥80years old and patients 45-64years old following cervical spinal fusion. The older patient group had higher two-year complication and reoperation rates. Patient age was a significant predictor for higher complication and revision rates. This study should assist spine surgeons preoperatively in risk-stratifying and counseling patients for postoperative outcomes after cervical spinal fusion.

BACKGROUND CONTEXT Fractures of the lumbar spine are often associated with bone insufficiency or high-energy traumatic mechanisms. However, studies reporting on lumbar spinal fracture epidemiology often lack power and are not recent. PURPOSE This study sought to investigate the epidemiology of lumbar spine fractures over a 10-year period in the United States. Specifically, we evaluated these fractures by levels injured as well as identified temporal trends in number of fractures, fractures by gender, and disposition in the United States. STUDY DESIGN/SETTING Retrospective review of a prospectively-collected database. PATIENT SAMPLE All patients who visited the emergency department (ED) between January 1, 2007 and December 31, 2016 and were diagnosed with a lumbar spine fracture were identified in the National Electronic Injury Surveillance System (NEISS) database. OUTCOME MEASURES Demographics, mechanism of injury, nationwide estimates of frequency and incidence rates, temporal injury trends across 10-year period. METHODS The National Electronic Injury Surveillance System (NEISS) was used to identify all patients who visited the Emergency Department (ED) between January 1, 2007 and December 31, 2016 and were diagnosed with a lumbar spine fracture. The data were stratified by demographic variables and mechanism of injury. The nationwide estimation of frequency and incidence rates by age, sex, and race were determined using NEISS weight calculations and 2007-2016 US Census data. Temporal trends of injuries were analyzed using descriptive statistics and linear regression. RESULTS An estimated total of 36,296 lumbar spine fractures were identified. Of these, 82.5% were single-level fractures and 17.5% were multi-level fractures. The annual estimated number of these type of fractures increased from 2,148 in 2007 to 4,301 in 2016 (beta=0.83, p=.003). The mean patient age was 60.9 years, and 22.6% of these injury types occurred between 80 and 89 years old. Of the total number of injuries, 59.3% occurred in females (incidence rate, 0.061 per 10,000 person-years), and 40.7% occurred in males (incidence rate, 0.022 per 10,000 person-years). Annual trends of injuries showed increases in number of fractures for males (beta=0.37, p=.29) and females (beta=0.82, p=.004). Race data were available in 77.2% of cases: 69.2% of injuries occurred in whites with an incidence rate 0.103 of per 10,000 person-years, and 2.7% of injuries occurred in blacks with an incidence rate of 0.024 per 10,000 person-years. The percentage of patients who were admitted to the hospital for lumbar spine injuries decreased slightly from 39.9% in 2007 to 36.8% in 2016, but this was not significant (beta=0.16, p=.67). 82.1% of injuries were due to falls. CONCLUSIONS During the last decade, the incidence of lumbar spine fractures has doubled in the United States. The overwhelming majority of lumbar spine injuries were single-level fractures. The majority of these factures occurred between ages 80 and 89 and occurred more often in females. Moreover, there was a significant increase of lumbar spine fractures for females for the 10-year period but not for males. Hospital admissions remained constant over the past decade. Falls were the most common cause of lumbar spine injuries. Understanding these patterns can help improve recognition of lumbar spine fractures. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Anterior cervical discectomy and fusion (ACDF) is a procedure used to treat cervical myelopathy and radiculopathy. During the surgical approach, the sternocleidomastoid muscle and the carotid sheath are retracted laterally. Complications related to compression and retraction of the artery is infrequent. However, to our knowledge, there have been no studies that have evaluated carotid artery retraction and the development of a postoperative stroke in patients who have carotid artery stenosis. PURPOSE The purpose of this study was to determine the incidence of postoperative strokes after ACDF in patients with carotid artery stenosis. STUDY DESIGN/SETTING This study utilized the Statewide Planning and Research Cooperative System (SPARCS) database from 2009 to 2013. PATIENT SAMPLE Patients who underwent ACDF between 2009 and 2013. Patients less than age 18 years and patients who had a previous history of a stroke that predated the ACDF were excluded. OUTCOME MEASURES Primary outcome was the incidence of postoperative stroke after ACDF in patients with and without carotid artery stenosis. Secondary outcomes included other postoperative complications, lengths of stay (LOS), and total hospital charges. METHODS Patient demographics included age, sex, race, insurance provider, Charlson/Deyo scores, and total hospital charges for each visit. Using the ACDF cohort, patients who had a preoperative diagnosis of carotid stenosis were identified, and were propensity score matched in a 1:1 ratio to those without a diagnosis of carotid stenosis based on age, sex, and Charlson/Deyo scores. We evaluated postoperative complications, including the incidence of a postoperative stroke. There were 61 patients in the carotid stenosis cohort and 61 patients without carotid stenosis. In terms of the demographics, compared to the patients without carotid stenosis, the carotid stenosis cohort was older (68 vs. 60 years, p RESULTS The incidence of postoperative stroke in the carotid artery stenosis cohort was significantly higher compared to those without carotid artery stenosis (6.6 vs. 0%, p CONCLUSIONS Patients with carotid artery stenosis who underwent ACDF had a significantly greater incidence of developing a postoperative stroke, among other complications, compared to patients without carotid stenosis. These patients could potentially benefit from medical or surgical optimization of their carotid stenosis prior to undergoing ACDF.

BACKGROUND CONTEXT Outcomes following Anterior Cervical Discectomy and Fusion (ACDF) and Total Disc Replacement (TDR) procedures are known to be satisfactory; however, following ACDF, morbidity may be as high as 19%, and reoperation rates for TDR as high as 3%. Factors that may predict risks of developing complications are under-reported, with limited existing data. PURPOSE Therefore, this study sought to determine how complications varied among ACDF, TDR, and combined ACDF-TDR as well as what variables significantly impacted development of postoperative complications. STUDY DESIGN/SETTING Retrospective review. PATIENT SAMPLE All patients who underwent ACDF and/or TDR from 2009 to 2011 with minimum 2-year follow-up were identified from the New York Statewide Planning and Research Cooperative System (SPARCS). A total of 20,487 patients were included. OUTCOME MEASURES Demographics, hospital-related parameters, mortality, and postoperative outcomes (complications, readmissions, and revisions). METHODS The New York Statewide Planning and Research Cooperative System (SPARCS) was used to identify all patients who underwent ACDF or TDR from 2009 to 2011 with minimum 2-year follow-up surveillance, and three cohorts were formed: ACDF, TDR, or combined ACDF-TDR. Primary data points collected included patient demographics, hospital-related parameters, mortality, and postoperative outcomes (complications, readmissions, and revisions). Multivariate logistic regression models identified independent predictors of these outcomes. RESULTS A total of 20,487 patients identified, 19,808 underwent ACDF only, 449 underwent TDR, and 230 underwent a combined ACDF and TDR. There was a significant difference in age across the cohorts, the youngest of which was TDR (44.1 vs. ACDF 51.3 and ACDF-TDR 48.46 years, p CONCLUSIONS There were significant differences in the patient cohorts that underwent ACDF, TDR, or both procedures, where TDR patients were younger but incurred the least amount of hospital charges. Total Disc Replacement patients could expect increased rates of surgical complications and revisions in comparison to the other cohorts, and the procedure was found to predict surgical complications. This study of a large cohort of patients can provide surgeons and their patients with evidence to better individualize and optimize procedure choice for each patient.

BACKGROUND CONTEXT Recently, there has been increased recognition of the interplay between degenerative conditions of the hip and spine (Hip-Spine Syndrome, HiSS). Loss of lumbar lordosis (LL) of more than 10° in proportion to the pelvic incidence (PI), PI-LL mismatch, has been emphasized as a marker of sagittal spinal malalignment. The impact of positive spinal sagittal malalignment on increased hip extension (pelvic posterior tilt in spinal literature) and subsequently the acetabular version is established. Communication between adult hip reconstruction and spinal deformity surgeons regarding HiSS is ineffective without common language, an established definition, or mutual radiographic imaging protocols. PURPOSE This study aimed to characterize various presentations of HiSS and suggest a simple method to distinguish between them. STUDY DESIGN/SETTING Retrospective review of a prospectively collected adult spinal deformity database. PATIENT SAMPLE A total of 1,389 patients who presented to a single center with orthopaedic complaints between 2013 and 2016. OUTCOME MEASURES Demographics, parameters related to spinopelvic alignment (PI, PT, LL, PI-LL), global spinal alignment (TPA, SVA, GSA), and lower extremities (SFA, KF, pelvic shift) from full-body sagittal radiographic imaging, and Kellgren–Lawrence grade. METHODS Demographic information was collected and full-body (FB) sagittal radiographs were analyzed using dedicated software to measure spinopelvic, global sagittal spinal alignment, lower extremity, and FB sagittal radiographic parameters. FB coronal radiographs were analyzed by two reviewers to assess hip osteoarthritis (HOA) via Kellgren–Lawrence grade. Patients were grouped based on their sagittal spinal alignment (PI-LL mismatch) and HOA into: HiSS None (PI LL 10°, HOA Grade 0; n=297), or HiSS Hip-Spine (PI-LL>10°, HOA Grades 3–4; n=30). All radiographic parameters were compared between the groups. P-values were Bonferroni method-adjusted. Significance level was set at p RESULTS A total of 1,389 patients were included with a mean age of 62.5±11.1 years and mean BMI of 27.6±5.7kg/m2. A total of 62% of the study population was female. HiSS Hip-Spine (n=30) had significantly greater pelvic posterior tilt (sagittal retroversion) in comparison to HiSS Hip (n=78) and HiSS None Types (n=444) (25.2° vs. 11.3° and 16.5°, respectively; p .05). CONCLUSIONS This study proposes a novel HiSS categorization system based on established spinal deformity and HOA classification methods. Radiographically, HiSS Hip-Spine Type patients can be distinguished by Adult Reconstructive Surgeons by measuring pelvic tilt angle. Increased PT>25° in HOA patients is a marker for sagittal spinal deformity that has the potential to impact acetabular version.