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Management of spine fractures among the elderly is complicated by preexisting comorbidities and increased risk of osseous nonunion. Whether operative treatment is superior for the management of thoracolumbar fractures in the aged is unknown. The purpose of this study was to investigate the rates of in-hospital medical complications after non-operative and operative treatment of thoracolumbar fractures in elderly patients. The Nationwide Inpatient Sample database from 2002 to 2011 was used to identify patients over 75 years of age with a principal discharge diagnosis of thoracolumbar fracture without spinal cord injury. Three treatment groups were compared: non-operative treatment, operative treatment, and minimally-invasive vertebroplasty/kyphoplasty (VP/KP). A total of 59,565 patients were identified; 46,962 treated non-operatively, 1,487 treated operatively, and 11,116 treated with VP/KP. Operative patients had the longest length of hospital stay (P 0.001) and the highest injury severity scores (P 0.001). The percentage of patients who developed at least one complication was highest in the operative group (16.3%), versus 8.7% in the non-operative and 8.1% in the VP/KP group (P 0.001). Even after controlling for potential confounders such as injury severity score, surgical patients had significantly higher odds of complication occurrence (P 0.001). Adjusted charges were highest for operative patients ($123,777 ± 135,997 vs. $27,116 ± 32,694 [non-operative] and $42,326 ± 31,984 [VP/KP]). Operative treatment for elderly patients has higher complication rates that need to be considered during preoperative patient counseling. Future research is necessary to elucidate the comparative rates of long-term complications and functional status outcomes for thoracolumbar fracture treatment among elderly patients.

Prolonged ventilation or reintubation are severe complications after scoliosis surgery, but there is limited data regarding their incidence and risk factors. The purpose of this study is to investigate the incidence and risk factors for prolonged ventilation and reintubation in adult spinal deformity (ASD) surgery. The American College of Surgeons National Surgical Quality Improvement Program database (2007-2013) was reviewed. Inclusion criteria were adult patients over 21years of age who underwent spinal fusion for ASD. The association between patient/operative characteristics and prolonged ventilation/reintubation was investigated via multivariate analysis. Results are presented as odds ratios (OR) with 95% confidence intervals (CI). There were 1250 patients who underwent ASD surgery and met our inclusion criteria. Among these, there were 34 patients who required prolonged ventilation (2.7%) and 22 patients who underwent reintubation (1.8%). Factors associated with prolonged ventilation after multivariate analysis were history of bleeding disorder (OR 5.67; 95% CI, 1.01-31.83) and operative time over 6h (OR 3.72; 95% CI, 1.17-11.80). For reintubation, these included older age (OR 1.06; 95% CI, 1.01-1.12), history of bleeding disorder (OR 12.21; 95% CI, 2.03-73.42), and fusion of 13 or more spinal levels (OR 9.14; 95% CI, 1.53-54.63). In conclusion, prolonged ventilation and reintubation in ASD surgery are uncommon events. Older patients, patients with bleeding disorders, and those undergoing long operations and fusion of 13 more spinal segments may be at an increased risk for these occurrences.

This article considers how religious and economic factors shape assisted reproductive technology (ART) policy in Indonesia, the world's most populous Muslim country. Infertility clinic policies are grounded on both the views of the country's powerful Islamic coalition and those of the worldwide Islamic community. Indonesian government officials, physicians, and Islamic scholars have expressed concern over who can use ART and which procedures can be performed. Indonesia has also faced economic challenges related to ART, including inadequate health insurance coverage, inequitable access to ART, and maintenance of expensive ART infrastructure. The prohibitive price of infertility treatment and regional differences in the provision of health care prohibit most Indonesians from obtaining ART. In the absence of a shift in religious mores and a rapid reduction in poverty and inequality, Indonesia will need to adopt creative means to make ART both more available and less necessary as a solution to infertility. This paper suggests policy reforms to promote more affordable treatment methods and support preventative health programmes to reduce infertility rates. This country-specific analysis of the laws and customs surrounding ART in Indonesia reveals that strategies to reduce infertility must be tailored to a country's unique religious and economic climate.

Lipomyelomeningocele (LMM) as a cause of tethered cord syndrome (TCS) commonly presents in childhood in the lumbosacral spine. Patients frequently present with cutaneous manifestations, progressive neurological deterioration, bladder dysfunction, and intractable pain. Early surgical intervention with untethering is recommended for symptomatic patients. We report an unusual case of a woman who presented with a subcutaneous lump, pain, and neurological decline found to have a cervicothoracic LMM. The patient underwent laminectomy and subtotal resection of the mass; seventeen years later she was confined to a wheelchair with severe neurological decline ultimately requiring three additional attempts at surgical excision and repair. This case emphasizes the need for early recognition of and intervention in adult patients with LMM.