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Surgeons have increasingly adopted robotic-assisted lumbar spinal fusion due to indications that robotic-assisted surgery can reduce pedicle screw misplacement. However, the impact of robotic-assisted spinal fusion on patient outcomes is less clear.This study aimed to compare rates of perioperative complications between robotic-assisted and conventional lumbar spinal fusion.Retrospective cohort study.A total of 520 patients undergoing lumbar fusion were analyzed. The average ages of patients in the robotic-assisted versus conventional groups were 60.33 and 60.31, respectively (p=.987). Patients with a diagnosis of fracture, traumatic spinal cord injury, spina bifida, neoplasia, or infection were excluded.This study compared the rates perioperative major and minor complications for elective lumbar fusion between each cohort.This study screened hospital discharges in the United States from 2010 to 2014 using the National Inpatient Sample and the Nationwide Inpatient Sample (NIS). The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes were used to identify 209,073 patients who underwent conventional lumbar fusion (ICD 81.04-8) and 279 patients who underwent robotic-assisted lumbar fusion (ICD 81.04-8 and ICD 17.41, 17.49). Major and minor complications were identified using ICD-9-CM diagnosis codes. The robotic-assisted and conventional fusion groups were statistically matched on age, year, sex, indication, race, hospital type, and comorbidities. Univariate and multivariate logistic regression were used to compare risks of major and minor complications.We matched 257 (92.11%) robotic-assisted patients with an equal number of patients undergoing conventional lumbar fusion. Minor complications occurred in 16.73% of cases in the conventional group and 31.91% of cases in the robotic-assisted group (p.001). Major complications occurred in 6.61% of the conventional cases compared to 8.17% of robotic-assisted cases (p=.533). For robotic-assisted fusion, multivariate analysis revealed that there was no difference in the likelihood of major complications (OR=0.834, 95% CI=0.214-3.251) or minor complications (OR = 1.450, 95% CI=0.653-3.220).In a statistically matched cohort, patients who underwent robotic-assisted lumbar fusion had similar rates of major and minor complications compared to patients who underwent conventional lumbar fusion.

Adult spinal deformity is a common disorder with an increasing clinical and societal impact based on the aging demographic throughout the world. Adult spinal deformity in the adult population has a significant and measurable impact on health-related quality of life. A significant proportion of this affected populace will require treatment in some form or another. In general, the first-line of treatment is non-operative, but a subset will require operative intervention. Once surgical intervention is chosen, there are numerous methods that may provide surgeons with adequate tools for successful outcomes. The purpose of this review article is to discuss the importance of adult deformity in the spectrum of disorders that affect the spine, to define specific considerations that are useful in guiding an evidence-based approach to care, and to elaborate on the variety of surgical techniques for which to address the issue of spinal deformity.

BACKGROUND CONTEXT Conflicting reports exist in spine literature regarding short-term outcomes following cervical laminoplasty and posterior laminectomy and fusion. PURPOSE The objective of this study was to compare the 30-day outcomes for these two treatment groups for multilevel cervical pathology. STUDY DESIGN/SETTING Retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database years 2010-2015. PATIENT SAMPLE A total of 3,796 patients were included: 2,397 (63%) underwent cervical laminectomy and fusion and 1,399 (37%) underwent cervical laminoplasty. OUTCOME MEASURES Patient demographics, comorbidities, complications and outcomes compared between patients undergoing cervical laminoplasty or laminectomy and fusion. METHODS Patients who underwent cervical laminoplasty or posterior laminectomy and fusion were identified in the NSQIP database from 2010 to 2015 based on Current Procedural Terminology (CPT) code. Laminoplasty CPT codes included 63050 and 63051. Posterior cervical laminectomy CPT codes included 63015, 63045, and instrumentation was denoted by CPT code 22842. Patients with preoperative sepsis, wound infection, pneumonia, cancer, emergency cases and trauma, and surgery within the last 30days were excluded. Patient demographics and comorbidities were compared using bivariate logistic regression. Propensity-adjusted multivariate regressions were performed to assess differences in postoperative length of stay, adverse events, discharge disposition and readmission. RESULTS A total of 3,796 patients were included: 2,397 (63%) underwent cervical laminectomy and fusion and 1,399 (37%) underwent cervical laminoplasty. Both groups were similar in age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) score and Charlson Comorbidity Index (CCI) (P>.05 for all). Both groups had similar rates of malnutrition, chronic kidney disease (CKD), diabetes, chronic obstructive pulmonary disease, and history for steroid use. Age >70 and age .05 for all). Compared with laminoplasty patients, laminectomy and fusion patients had increased lengths of stay (LOS) (4.5vs. 3.7days, P .05 for all). Patients with CKD that underwent laminectomy and fusion had higher rates of transfusion (6.8vs. 20.4%, P=.05). Patients older than 70 that underwent laminectomy and fusion experienced high rates of urinary tract infection (6.4vs. 2.6%, P=.02). CONCLUSIONS Posterior cervical laminectomy and fusion patients were found to have increased LOS, readmissions, and complications despite having similar preoperative demographics and comorbidities. Patients and surgeons should consider these risks when considering surgical treatment for cervical pathology.

BACKGROUND CONTEXT Intra-wound application of vancomycin powder has demonstrated dramatic reductions of infection rate following lumbar laminectomy and fusion. The economic benefit of this prophylactic protocol has been previously validated for laminectomy and fusion, but the cost-effectiveness is less clear for lumbar laminectomy alone. PURPOSE The goal of this study is to demonstrate that application of vancomycin powder is a cost-effective method for preventing infection following lumbar laminectomy. STUDY DESIGN/SETTING Break-even cost analysis. OUTCOME MEASURES This study determined the magnitude by which the rate of infection following lumbar laminectomy alone and lumbar laminectomy and fusion would need to be reduced by in order to make application of vancomycin powder cost effective. METHODS The product cost of vancomycin powder was obtained from our institution's purchasing records. Total charges for lumbar laminectomy and lumbar laminectomy and fusion, rates of infection, and cost of revision were obtained from the literature. A break-even analysis [break-even infection rate=(initial infection rate−cost of protocol)/cost of treatment] was then performed to determine the absolute risk reduction (ARR) in infection rate to make prophylactic application of vancomycin powder cost effective. RESULTS Costing $3.06 per gram at our institution, vancomycin powder was determined to be cost-effective in lumbar laminectomy if the infection rates of 4.2% decreased by an ARR of 0.015%. Laminectomy and fusion was also determined to be cost effective at the same cost of vancomycin powder if the infection rate of 8.5% decreased by an ARR of 0.0034%. At the current highest cost reported in the literature, $44.00 per gram of vancomycin powder remained cost-effective with respective ARRs of 0.21% and 0.048% for laminectomy and laminectomy and fusion. Varying the baseline infection rate did not influence the ARR for either procedure when the analysis was performed using the product cost of vancomycin at our institution. CONCLUSIONS This break-even analysis demonstrates that prophylactic intra-wound application of vancomycin powder can be highly cost effective not only for lumbar laminectomy and fusion, but also for laminectomy alone. At our institution's price point, use of vancomycin powder is economically justified if it prevents at least one infection out of 6,700 lumbar laminectomy surgeries. 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 the most common surgical treatment for cervical disc pathology. However, recent evidence has demonstrated superior outcomes with cervical disc arthroplasty (CDA). PURPOSE This study aims to compare inpatient cost and length of stay (LOS) between cervical disc arthroplasty and anterior cervical discectomy and fusion. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE A total of 676 patients were analyzed (338 ACDF and 338 CDA). The average patient ages for ACDF and CDA were 49.15 years and 49.11 years, respectively (p=.957). Only elective hospital admissions were included in this sample. Patients in the ACDF group were limited to those with one to two level fusions. OUTCOME MEASURES This study compared the ACDF and CDA cohorts on high-end hospital charges and prolonged inpatient length of stay. METHODS This study screened over 35 million hospital discharges in the United States from 2010 to 2014 using the National Inpatient Sample and the Nationwide Inpatient Sample. The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes were used to identify 75,377 patients who underwent ACDF of two or three vertebrae (ICD 81.02 and 81.62), and 387 patients who underwent CDA (ICD 84.62). The ACDF and CDA groups were statistically matched based on age, year of procedure, sex, indication for surgery, race, hospital type, and comorbidities. Mean hospital charges and LOS for each cohort were calculated and compared using the Kruskal Wallis H test. Univariate and multivariate logistic regression were used to compare high-end cost and prolonged LOS between the cohorts, defined as patients with LOS and total hospital charges greater than the 75th percentile of the respective means. RESULTS We matched 338 (87.34%) CDA patients with patients who underwent ACDF. The average LOS was greater for CDA (x=1.56, SD=0.946) compared to ACDF (x=1.43, SD=1.12; p=.001). Additionally, the average inpatient hospital charges for CDA were $21,320 (SD=10,854) compared to $16,123 (SD=8,499) for ACDF (p CONCLUSIONS Patients who underwent ACDF had significantly lower LOS and hospital charges than a statistically matched CDA cohort. This conclusion directly contradicts recent findings in the literature, although this study is the first to use a large cohort-matched analysis. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Surgeons have increasingly adopted robotic-assisted lumbar spinal fusion due to indications that robotic-assisted surgery can reduce the percentage of misplaced screws. However, the impact of robotic-assisted spinal fusion on patient outcomes is less clear. PURPOSE This study aims to compare rates of perioperative complications between robotic-assisted and conventional lumbar spinal fusion. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE A total of 520 patients undergoing lumbar fusion were analyzed. The average ages of patients in the robotic-assisted versus conventional groups were 60.33 and 60.31, respectively (p=.987). Patients with a diagnosis of fracture, traumatic spinal cord injury, spina bifida, neoplasia, or infection were excluded. OUTCOME MEASURES This study compared the rates perioperative major and minor complications for elective lumbar fusion between each cohort. METHODS This study screened over 35 million hospital discharges in the United States from 2010 to 2014 using the National Inpatient Sample and the Nationwide Inpatient Sample (NIS). The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes were used to identify 209,073 patients who underwent conventional lumbar fusion (ICD 81.04-8) and 279 patients who underwent robotic-assisted lumbar fusion (ICD 81.04-8 and ICD 17.41, 17.49). Major and minor perioperative complications were identified using ICD-9-CM diagnosis codes. Patient mortality was determined using the uniform bill patient disposition. The robotic-assisted and conventional fusion groups were statistically matched on age, year of procedure, sex, surgical indication, race, hospital type, and comorbidities. Mean hospital cost and length of stay (LOS) for each cohort were calculated and compared using the Kruskal Wallis H test. Univariate and multivariate logistic regression were used to compare risks of major and minor complications between the cohorts. RESULTS We matched 260 (93.19%) robotic-assisted patients with patients undergoing conventional lumbar fusion. Too few patients in each cohort died to report the mortality rate based on NIS minimum reporting standards. Minor complications occurred in 16.9% of the conventional group and 32.7% of the robotic-assisted group (p CONCLUSIONS In a statistically matched cohort, patients undergoing robotic-assisted elective lumbar fusion had similar rates of major and minor complications compared to patients who underwent conventional lumbar fusion. Additionally, patients in the robotic-assisted cohort had significantly longer LOS and incurred greater hospital costs. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.