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Background Currently, opioids are the standard of care for postoperative pain management. Avoiding unnecessary opioid exposure in patients is of current interest because of widespread abuse. Methods This is a prospective cohort study in which wide-awake, local anesthesia, no-tourniquet (WALANT) technique was used for 94 hand/upper extremity surgical patients and compared to patient cohorts undergoing similar procedures under monitored anesthesia care. Patients were not prescribed opioids postoperatively but were instead directed to use over-the-counter pain relievers. Pain scores on a visual analogue scale were collected from patients preoperatively, and on postoperative days 1 and 14. WALANT visual analogue scale scores were compared to those of the two patient cohorts who either did or did not receive postoperative opioids after undergoing similar procedures under monitored anesthesia care. Electronic medical records and New York State's prescription monitoring program, Internet System for Tracking Over-Prescribing, were used to assess prescription opioid-seeking. Information on sex, age, comorbidity burden, previous opioid exposure, and insurance coverage was also collected. Results Decreased pain was reported by WALANT patients 14 days postoperatively compared to preoperatively and 1 day postoperatively, with a total group mean pain score of 0.37. This is lower than mean scores of monitored anesthesia care patients with and without postoperative opioids. Only two WALANT patients (2.1 percent) sought opioid prescriptions from outside providers. There was little evidence suggesting factors including sex, age, comorbidity burden, previous opioid exposure, or insurance status alter these results. Conclusion WALANT may be a beneficial technique hand surgeons may adopt to mitigate use of postoperative opioids and reduce risk of abuse in patients. Clinical question/level of evidence Therapeutic, II.

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 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.

Adult neurogenesis and Alzheimer's disease Alzheimer's disease (AD) pathology destroys neurons and synapses in the brain, leading to dementia. The brain generates new neurons throughout life in the hippocampus, a process called adult hippocampal neurogenesis (AHN). Choi et al. found that blocking AHN exacerbated cognitive impairment in an AD mouse model (see the Perspective by Spires-Jones and Ritchie). Inducing neurogenesis alone did not improve cognition in AD mice, whereas inducing neurogenesis while simultaneously ameliorating the neuronal environment via exercise did. The use of genetic or pharmacological treatments that simultaneously induced neurogenesis and increased levels of brain-derived neurotrophic factor (BDNF) mimicked the benefits of exercise on cognition. Thus, inducing both neurogenesis and providing BDNF may be useful as an AD therapeutic. Science , this issue p. eaan8821 ; see also p. 975