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BACKGROUND CONTEXT The principle of indirect decompression via lateral and anterior interbody fusion has been investigated previously. Many patients respond well after such an approach, with good improvement in their pain and function. However, there is a group of patients in whom direct decompression may still be necessary. It remains unclear which patients will respond most favorably to indirect decompression. PURPOSE This study aims to investigate our hypothesis that preoperative improvement of leg pain at rest is predictive of pain relief via indirect decompression after anterior lumbar (ALIF) or lateral lumbar interbody fusion (LLIF). STUDY DESIGN/SETTING Retrospective review of prospectively collected data at a single institution between 2017 and 2018. PATIENT SAMPLE During the study period, 453 patients underwent ALIF or LLIF. Patients who lacked preoperative leg pain, those who underwent multilevel surgery, direct decompression and/or those who lacked three-month postop patient reported outcome measures were excluded. 43 patients met the inclusion criteria. OUTCOME MEASURES Patient-reported leg and back pain intensity via the numeric rating scale (NRS) and low back pain related disability scores via the Oswestry Disability Index (ODI) were analyzed. METHODS A linear regression model was used to determine whether improvement in leg pain at rest predicted improvements in pain using the NRS and low back pain-related ODI scores at 3 months and 1 year, adjusting for each individual's baseline values. RESULTS Forty-three patients (22M, 21F) with a mean age of 66±13 years underwent LLIF (n=34) or ALIF (n=9) with concomitant pedicle screw fixation. Mean NRS scores for preop leg and back pain were 6.2±2.5 and 6.8±2.2, respectively. Mean preop ODI was 44.6±17.6. Mean 3-month NRS leg and back pain scores were 2.0+2.4 and 3.8+2.3 respectively. Mean ODI at 3 months was 28.2+20.6. Preop leg pain improvement at rest was a significant predictor for postop reduction in pain at the 3-month time point when using indirect decompression (p=0.023). When adjusting for preop pain levels, individuals with preop leg pain improvement at rest demonstrated a 2.3±1.0 point greater improvement in NRS leg pain compared to those without preop leg pain improvement at rest (4.3±3.6 vs 1.8±2.3). Results did not differ when correcting for surgery type. Preop leg pain improvement at rest did not predict 1-year pain levels, or changes in disability at either timepoint (p>0.352). CONCLUSIONS In this study, improvement in leg pain at rest before surgery was a significant predictor of those patients who were successfully managed via indirect decompression with ALIF or LLIF. Preoperative improvement in leg pain at rest may be used as an important predictive tool for short-term success using indirect decompression. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

This study seeks to establish a method for opportunistic evaluation of sacral bone mineral density. This is a retrospective review of 109 scans from 109 patients who had renal-protocol computed tomography (CT) scans performed for any indication during a 3-month period at a single academic institution in 2014. In the collected CT scans, sacral CT-attenuation in multiple regions of interest (ROI) was compared to the L1 CT-attenuation, an internal reference standard, to determine if a correlation existed. The sacral ROI were analyzed to determine regions of higher and lower attenuation. All sacral ROI had strong correlations with lumbar spine attenuation values, and these values became even stronger when transitional vertebrae were excluded. Sacral attenuation values varied predictably by location, and matched relationships were shown by prior volumetric bone mineral density studies. We conclude that sacral CT-attenuation can be used in opportunistic CT scans to determine sacral bone mineral density. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:160-166, 2017.

High-grade dysplastic spondylolisthesis (HGDS) is a subset of L5-S1 spondylolisthesis that occurs due to dysmorphic anatomy at the lumbosacral junction, often resulting in sagittal imbalance. Enhanced understanding of global sagittal alignment has led many to preferentially treat HGDS with reduction and fusion to restore sagittal balance. The purpose of this article is to review published surgical techniques for obtaining sagittal correction in HGDS and to evaluate the current evidence regarding the associated surgical complications.

Purpose This study seeks to evaluate the need for preoperative antibiotics for wrist arthroscopy. Methods A retrospective review of 576 consecutive wrist arthroscopies was performed over a 10-year period at a single ambulatory surgery center. The chart of each included patient was reviewed for postoperative infections following the National Nosocomial Infections Surveillance criteria for diagnosis. Results Of the 576 wrist arthroscopies reviewed, 324 met the inclusion criteria. Preoperative antibiotics were administered in 209 cases (65%) and not administered in 115 cases (35%). There were 116 cases (36%) with concomitant open soft tissue procedures. We identified 2 infections (0.6% overall infection rate), both of which were in patients who had received preoperative antibiotics. Both of these patients underwent concomitant percutaneous pinning of carpal bones with Kirschner wires, which were buried beneath the skin. Conclusions Administering preoperative antibiotics for routine wrist arthroscopy does not appear to lower the surgical site infection rate. The rate of surgical site infection is so low in both cohorts that a meaningful difference cannot be determined between the 2 groups. This study adds to the current body of literature suggesting that it is acceptable practice to withhold preoperative antibiotics for surgeries that have a very low rate of infection. Type of study/level of evidence Therapeutic IV.

An elite-level 13-year-old female overhead athlete, with a previous history of bone cyst and fracture at age 8, presented with a humeral length discrepancy of 75 mm which had increased to 81 mm within 1 year. Antegrade correction with a motorized lengthening nail was considered but declined due to risk of shoulder damage and pain. In an off-label manner, a femoral motorized lengthening nail was modified and utilized with retrograde placement. Lengthening instructions were modified weekly to account for rapid humeral growth, to minimize soft-tissue tension, and to maximize regenerate quality. By 11 weeks, humeral length was clinically corrected. Three weeks after ceasing lengthening, full range of motion of the shoulder and elbow returned. Once the site had formed new cortex on all four sides, the nail was removed, and return to full activity occurred 4 months later.

IntroductionSacral bone mineral density may play a role in the rate successful sacroiliac and lumbosacral fusions. There are currently no easy methods for evaluation of sacral bone mineral density. Lumbar CTattenuation has previously been shown to relate to bone mineral density as assessed by DXA. This study aims to establish an accessible method for sacral bone mineral density analysis.Study Design/SettingA retrospective review of renalprotocol CT scans performed for any indication over a three-month period in 2014. CTattenuation was analyzed at several regions of interest within each scan.Materials and MethodsA retrospective review of renalprotocol CT scans performed for any indication over a three-month period in 2014. A series of 223 consecutive renalprotocol CT scans were analyzed using basic image viewing software. Sacral CTattenuation at multiple regions of interest (ROI) were compared with the L1 attenuation to determine if a correlation existed. The sacral ROI were analyzed to determine regions o...