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Introduction: The Coronavirus disease 2019 pandemic ushered a paradigm shift in medical education, accelerating the transition to virtual learning in select cases. The Virtual Global Spine Conference (VGSC), launched at the height of the pandemic, is a testament to this evolution, providing an independent educational series for spine care professionals worldwide. This study assesses VGSC's 3-year performance, focusing on accessibility, engagement, and educational value., Methodology: Through retrospective data analysis from April 2020 to August 2023, we examined our social media metrics to measure VGSC's reach and impact., Results: Over the study period, VGSC's webinars successfully attracted 2337 unique participants, maintaining an average attendance of 47 individuals per session. The YouTube channel demonstrated significant growth, amassing over 2693 subscribers and releasing 168 videos. These videos collectively garnered 112,208 views and 15,823.3 hours of watch time. Viewer demographics reveal a predominant age group of 35-44 years, representing 56.81% of the audience, closely followed by the 25-34 age group at 40.2%. Male participants constituted 78.95% of the subscriber base. Geographically, the viewership primarily originates from the United States, with India, Canada, South Korea, and the United Kingdom also contributing substantial audience numbers. The VGSC's presence on the "X account" has grown to 2882 followers, significantly enlarging the digital community and fostering increased engagement., Conclusions: The VGSC has demonstrated significant value as a virtual educational tool in spine education. Its diverse content and ease of access will likely enable it to drive value well into the post-pandemic years. Maintaining and expanding engagement, beyond North America in particular, remains a priority., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: As of May 4, 2020, the coronavirus disease 2019 (COVID-19) pandemic has affected >3.5 million people and touched every inhabited continent. Accordingly, it has stressed health systems worldwide, leading to the cancellation of elective surgical cases and discussions regarding health care resource rationing. It is expected that rationing of surgical resources will continue even after the pandemic peak and may recur with future pandemics, creating a need for a means of triaging patients for emergent and elective spine surgery., Methods: Using a modified Delphi technique, a cohort of 16 fellowship-trained spine surgeons from 10 academic medical centers constructed a scoring system for the triage and prioritization of emergent and elective spine surgeries. Three separate rounds of videoconferencing and written correspondence were used to reach a final scoring system. Sixteen test cases were used to optimize the scoring system so that it could categorize cases as requiring emergent, urgent, high-priority elective, or low-priority elective scheduling., Results: The devised scoring system included 8 independent components: neurologic status, underlying spine stability, presentation of a high-risk postoperative complication, patient medical comorbidities, expected hospital course, expected discharge disposition, facility resource limitations, and local disease burden. The resultant calculator was deployed as a freely available Web-based calculator (https://jhuspine3.shinyapps.io/SpineUrgencyCalculator/)., Conclusions: We present the first quantitative urgency scoring system for the triage and prioritizing of spine surgery cases in resource-limited settings. We believe that our scoring system, although not all encompassing, has potential value as a guide for triaging spine surgical cases during the COVID pandemic and post-COVID period., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Preoperative malnutrition is associated with increased postoperative complication rate and hospital length of stay. However, the degree to which these risks can be mitigated by nutritional consultation has not been well described. To address this, we sought to determine if a preoperative nutrition consult was associated with decreased 30-day complication rate and hospital length of stay., Methods: Adult patients who underwent neurosurgical intervention for spinal metastases at a tertiary care institution between 2008 and 2016 were retrospectively reviewed. Stepwise multivariable linear regression analyses were used to identify associations with 30-day complication rate and hospital length of stay., Results: Among 95 patients who met inclusion criteria, the average length of stay was 8.9 days and 40 patients (42.1%) experienced one or more postoperative complications. On multivariable analysis, 30-day complication rates were higher in patients with the absence of a preoperative nutrition consult, a Modified Charlson Comorbidity Index score of greater than 2 points, greater operative blood loss, and malnutrition (Nutritional Risk Index score <97.5). Furthermore, hospitalization duration was increased with the absence of a nutrition consult, malnutrition, congestive heart failure, and prior systemic therapy in the multivariable analysis., Conclusions: On multivariable analysis, receipt of a preoperative nutrition consult was associated with both decreased 30-day complication rate and shorter hospitalization. We therefore posit that greater implementation of nutritional counseling may help to decrease complication rates and expedite discharge in patients undergoing surgical intervention for spinal metastases., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: The Spinal Instability Neoplastic Score (SINS) is widely used to assess mechanical instability in metastatic spine disease. We sought to identify a cutoff within the "potentially unstable" category, above which lesions were more likely than not to be stabilized., Methods: We retrospectively reviewed all patients consulted for metastatic spine disease over a 1-year period. Patients were included if they were neurologically intact and had complete medical records, including preoperative imaging of every tumor-involved level. Examined variables included epidural spinal cord compression, SINS, revised Tokuhashi grade, age at consultation, and Karnofsky Performance Status. The primary endpoint was whether or not the lesions were stabilized., Results: The study cohort comprised 51 patients (average age, 61 ± 2 years) with a total of 436 lesions; 50.5% were lytic, and 31.4% were blastic. The most common primaries were lung (n = 12), breast (n = 10) and prostate (n = 8). The median SINS across all lesions was 5. In both lesion- and patient-based analysis, a SINS ≥10 portended a >50% probability of undergoing stabilization; only 11% of all patients with a SINS ≤9 underwent instrumented fusion. Multivariable analysis demonstrated that SINS (odds ratio [OR], 2.44; P < 0.01) and Karnofsky Performance Status (OR, 1.10; P < 0.01) were independent predictors of stabilization., Conclusions: For vertebrae affected by metastatic disease, the decision to stabilize remains dependent on both the radiographic lesion properties and the patient's clinical picture. However, our results suggest that lesions with a SINS of ≤9 might not require stabilization., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Postoperative C5 palsy affects 8% of patients undergoing posterior cervical decompression. It is associated with a period functional disability that may exceed 12 months and increase direct care costs > $2000., Methods: All patients undergoing posterior cervical decompression at a single tertiary-care facility for degenerative conditions were evaluated for preoperative imaging, clinical presentation, surgical operation, and postoperative course. We sought to identify those variables predictive of postoperative C5 palsy., Results: Of 221 included patients (mean age, 63 years; 54% male), 12.2% experienced C5 palsy. On univariate analysis, C5 palsy was associated with foraminal diameter (P = 0.0005), spinal cord cross-sectional area (P = 0.11), number of levels undergoing laminectomy (P = 0.14), and clinical presentation of dropping objects (P = 0.07), hand clumsiness (P = 0.13), or paresthesias in the upper extremities (P = 0.08). Foraminal diameter (odds ratio, 0.31 per mm increase; 95% confidence interval, 0.16-0.60; P < 0.001) and patient report of gait disturbance (odds ratio, 0.53; 95% confidence interval, 0.33-0.85; P = 0.008) were the only significant predictors on multivariate analysis. A foraminal diameter <2 mm had 2-fold greater odds of postoperative C5 palsy. A receiver operating curve for the multivariate logistic model had an associated C-statistic of 0.7818. The absolute error of this model was 9.3% on internal validation., Conclusions: Foraminal stenosis most strongly predicted postoperative C5 palsy. A proof-of-concept model incorporating foramen size, as well as clinical complaints of paresthesias, hand clumsiness, and gait abnormality, successfully predicts the occurrence of postoperative palsy with an overall accuracy of 78%., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Preoperative endovascular embolization of atypical hemangiomas of the spine can reduce intraoperative blood loss. One frequent concern raised about embolizing these tumors is a possible association with arteries feeding the spinal cord, such as the artery of Adamkiewicz. This study aimed to elucidate a relationship between spinal levels affected by atypical spinal hemangiomas and radiculomedullary arteries., Methods: This was a retrospective review of 8 patients undergoing preoperative embolization of atypical spinal hemangiomas. We evaluated 54 spinal levels by angiography during embolization procedures. Each spinal level was categorized on the basis of the presence or absence of tumor and radiculomedullary artery., Results: Six of 15 (40%) affected levels had an associated radiculomedullary artery. Four of 39 (10.2%) unaffected levels had an associated cord feeding artery. The relative risk of affected spinal levels having an associated radiculomedullary artery was 3.9 (95% confidence interval 1.28-11.91). The attributable risk was 0.40 (95% CI 0.12-0.76). The chi-squared statistic was 6.35, with a P value of 0.01. Six of 8 patients (75%) had a radiculomedullary artery at a level of disease and embolization., Conclusions: In this study, spinal levels affected by atypical hemangiomas requiring surgery were associated with radiculomedullary arteries. When performing preoperative embolization, great care must be taken to identify and preserve arteries supplying the spinal cord., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Preoperative endovascular embolization of hypervascular metastatic spine tumors can reduce intraoperative blood loss. One frequent objection to embolizing these tumors is the concern for associated arteries feeding the spinal cord, such as the artery of Adamkiewicz. This study aimed to elucidate a relationship between spinal levels affected by hypervascular spine metastases and associated radiculomedullary arteries (RMAs)., Methods: A retrospective review of 46 patients who underwent preoperative embolization of hypervascular metastatic spine tumors was conducted. A total of 484 spinal levels were evaluated by diagnostic spinal angiography during embolization procedures. Each spinal level was categorized based on the presence or absence of tumor and RMA., Results: No statistically significant associations were found. The relative risk of affected spinal levels having an associated RMA was 1.10 (95% confidence interval, 0.66-1.85). The attributable risk was 0.01 (-0.01 to 0.02). Chi-squared statistic was 0.13, with a P value of 0.7. Subgroup analysis in renal cell patients was also statistically insignificant, with a relative risk of 0.97 (95% confidence interval, 0.43-2.16). Chi-square statistic was 0.01, with a P value 0.94. A total of 32 patients (69.6%) had an RMA identified on their regional angiogram. Seventeen patients (37%) had an RMA at an embolized level., Conclusions: In this study, no association was found between spinal levels affected by hypervascular metastatic spine tumors and RMAs feeding the spinal cord by diagnostic spinal angiography. This suggests that these tumors have little intrinsic affinity for spinal levels with an RMA. However, given that tumor embolization frequently requires accessing multiple levels, the risk of encountering an RMA during embolization remains significant., (Copyright © 2019 Elsevier Inc. All rights reserved.)

The heavy metal cadmium is a widespread environmental contaminant that has gained public attention due to the global increase in cadmium-containing electronic waste. Human exposure to cadmium is linked to the pathogenesis of osteoporosis. We previously reported cadmium induces apoptosis and decreases alkaline phosphatase mRNA expression via extracellular signal-regulated protein kinase (ERK) activation in Saos-2 bone-forming osteoblasts. This study examines the mechanisms of cadmium-induced osteotoxicity by investigating roles of Ca +2 /calmodulin-dependent protein kinase (CAMK) pathways. Saos-2 or MG-63 cells were treated for 24 or 48h with 5μM CdCl 2 alone or in combination with calmodulin-dependent phosphodiesterase (PDE) inhibitor CGS-9343β; calmodulin-dependent kinase kinase (CAMKK) inhibitor STO-609; or calmodulin-dependent kinase II (CAMKII) inhibitor KN-93. CGS-9343β protected against cadmium-induced toxicity and attenuated ERK activation; STO-609 enhanced toxicity and exacerbated ERK activation, whereas KN-93 had no detectable effect on cadmium-induced toxicity. Furthermore, CGS-9343β co-treatment attenuated cadmium-induced apoptosis; but CGS-9343β did not recover cadmium-induced decrease in ALP activity. The major findings suggest the calmodulin-dependent PDE pathway facilitates cadmium-induced ERK activation leading to apoptosis, whereas the CAMKK pathway plays a protective role against cadmium-induced osteotoxicity via ERK signaling. This research distinguishes itself by identifying pleiotropic roles for CAMK pathways in mediating cadmium's toxicity in osteoblasts., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)