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Study Design: Retrospective cohort study., Purpose: The impact of neuromuscular disorders such as multiple sclerosis (MS) on outcomes following long segment fusion is underreported. This study evaluates the impact of MS on two-year (2Y) postoperative complications and revisions following ≥ 4-level fusion for adult spinal deformity (ASD)., Methods: Patients undergoing ≥ 4-level fusion for ASD were identified from a statewide database. Patients with a baseline diagnosis of MS were also identified. Patients with infectious/traumatic/neoplastic indications were excluded. Subjects were 1:1 propensity score-matched (MS to no-MS) based on age, sex and race and compared for rates of 2Y postoperative complications and reoperations. Logistic regression models were utilized to determine risk factors for adverse outcomes at 2Y., Results: 86 patients were included overall (n = 43 per group). Age, sex, and race were comparable between groups (p > 0.05). MS patients incurred higher charges for their surgical visit ($125,906 vs. $84,006, p = 0.007) with similar LOS (8.1 vs. 5.3 days, p > 0.05). MS patients experienced comparable rates of overall medical complications (30.1% vs. 25.6%) and surgical complications (34.9% vs. 30.2%); p > 0.05. MS patients had similar rates of 2Y revisions (16.3% vs. 9.3%, p = 0.333). MS was not associated with medical, surgical, or overall complications or revisions at minimum 2Y follow-up., Conclusion: Patients with MS experienced similar postoperative course compared to those without MS following ≥ 4-level fusion for ASD. This data supports the findings of multiple previously published case series' that long segment fusions for ASD can be performed relatively safely in patients with MS., (© 2024. The Author(s), under exclusive licence to Scoliosis Research Society.)

Background: While prolonged operative time and increased levels fused have been shown to increase the risk of prolonged intensive care unit (ICU) length-of-stay (LOS), studies are limited in guiding decision-making regarding the need for intensive care postoperatively. This is especially the case among the cohort of adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal fusion (PSF); associations between comorbidities and ICU LOS are not well-delineated., Methods: AIS patients who underwent PSF from January 1st, 2016 to December 1st, 2016 at 101 participating centers were identified using the American College of Surgeons (ACS) National Surgical Quality Im-provement Project (NSQIP) Pediatric database. Patients were subsequently grouped by ICU LOS 0-1 day; 2-3 days; and >3 days. Multivariate regression identified predictors of increased ICU LOS., Results: 2,346 AIS patients were included. The >3 days and 2-3 days groups had higher asthma rates compared to 0-1 day. The >3 days group had higher rates of structural airway abnormalities and he-matologic disorders. Cognitive impairment rates were highest for >3-day ICU LOS. Hematologic dis-orders, structural airway abnormalities, asthma and cognitive impairment were associated with prolonged ICU LOS., Conclusion: These results help inform targets for optimization of acute short-term postoperative care as well as assisting in risk stratification to improve outcomes and reduce costs for ICU-level care of AIS patients at ACS NSQIP Pediatric program-participating hospitals. Level of Evidence: III ., Competing Interests: Disclosures: Marine Coste - Stock or stock Options - Johnson & Johnson, Roche, Sanofi-Aventis, Shire. Vincent Challier - Paid presenter or speaker - AOSPINE, SMAIO SA; Research support - CLARI-ANCE SA; Stock or stock Options - FOLLOW SA. Virginie Lafage - Paid consultant - Alphatec Spine DePuy, Stryker; Paid presenter or speaker - John-son & Johnson Company; Editorial or governing board - European Spine Journal; Paid consultant - Globus Medical; Board or committee member - International Spine Study Group; IP royalties – NuVa-sive; Board or committee member - Scoliosis Research Society. Frank J. Schwab - Research support – DePuy. A Johnson & Johnson Company; IP royalties - K2M, Medtronic Sofamor, Danek, Zimmer; Paid Consultant - Mainstay Medical, Medtronic, Zimmer; Re-search Support – NuVasive, Stryker; Board or committee member - Scoliosis Research Society; VP of International Spine Society Group (ISSG); Stock or stock Options - See Spine LLC, VFT Solutions; Editorial or governing board - spine deformity. Carl B. Paulino - Paid presenter or speaker - DePuy, A Johnson & Johnson Company, Ethicon. The remaining authors have no disclosures to report. The manuscript submitted does not contain information about medical device(s)/drug(s)., (Copyright © The Iowa Orthopaedic Journal 2024.)

Introduction: Osteoporosis affects nearly 200 million individuals worldwide. There are little available data regarding outcomes in patients with osteoporosis who undergo short-segment lumbar fusion for degenerative disk disease (DDD). We sought to identify a relationship between osteoporosis and risk of adverse outcomes in patients with DDD undergoing short-segment lumbar fusion., Methods: Using the New York State Statewide Planning and Research Cooperative System, all patients with DDD who underwent 2- to 3-level lumbar fusion from 2009 through 2011 were identified. Patients with bone mineralization disorders and other systemic and endocrine disorders and surgical indications of trauma, systemic disease(s), and infection were excluded. Patients were stratified by the presence or absence of osteoporosis and compared for demographics, hospital-related parameters, and 2-year complications and revision surgeries. Multivariate binary logistic regression models were used to identify notable predictors of complications., Results: A total of 29,028 patients (osteoporosis = 1,353 [4.7%], nonosteoporosis = 27,675 [95.3%]) were included. Patients with osteoporosis were older (66.9 vs 52.6 years), more often female (85.1% vs 48.4%), and White (82.8% vs 73.5%) (all P < 0.001). The Charlson/Deyo comorbidity index did not significantly differ between groups. Hospital lengths of stay and total charges were higher for patients with osteoporosis (4.9 vs 4.1 days; $74,484 vs $73,724; both P < 0.001). Medical complication rates were higher in patients with osteoporosis, including acute renal failure and deep-vein thrombosis (both P < 0.01). This cohort also had higher rates of implant-related (3.4% vs 1.9%) and wound (9.8% vs 5.9%) complications (both P < 0.01). Preoperative osteoporosis was strongly associated with 2-year medical and surgical complications (odds ratios, 1.6 and 1.7) as well as greater odds of revision surgeries (odds ratio, 1.3) (all P < 0.001)., Conclusion: Patients with osteoporosis undergoing 2- to 3-level lumbar fusion for DDD were at higher risk of 2-year medical and surgical complications, especially implant-related and wound complications. These findings highlight the importance of rigorous preoperative metabolic workup and patients' optimization before spinal surgery., (Copyright © 2022 by the American Academy of Orthopaedic Surgeons.)

Prematurity is associated with surgical complications. This study sought to determine the risk of prematurity on 30-day complications, reoperations, and readmissions following ≥7-level PSF for AIS which has not been established. Utilizing the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP)-Pediatric dataset, all AIS patients undergoing ≥7-level PSF from 2012–2016 were identified. Cases were 1:1 propensity score-matched to controls by age, sex, and number of spinal levels fused. Prematurity sub-classifications were also evaluated: extremely (<28 weeks), very (28–31 weeks), and moderate-to-late (32–36 weeks) premature. Univariate analysis with post hoc Bonferroni compared demographics, hospital parameters, and 30-day outcomes. Multivariate logistic regression identified independent predictors of adverse 30-day outcomes. 5531 patients (term = 5099; moderate-to-late premature = 250; very premature = 101; extremely premature = 81) were included. Premature patients had higher baseline rates of multiple individual comorbidities, longer mean length of stay, and higher 30-day readmissions and infections than the term cohort. Thirty-day readmissions increased with increasing prematurity. Very premature birth predicted UTIs, superficial SSI/wound dehiscence, and any infection, and moderate-to-late premature birth predicted renal insufficiency, deep space infections, and any infection. Prematurity of AIS patients differentially impacted rates of 30-day adverse outcomes following ≥7-level PSF. These results can guide preoperative optimization and postoperative expectations. [ABSTRACT FROM AUTHOR]

Anterior, posterior, or combined surgical approach is commonly employed for cervical fusion, yet comparative rates of postoperative neurological complications are not well delineated. We compared and identified predictors of 90-day neurological and other complications across anterior cervical discectomy and fusion (ACDF), posterior cervical fusion (PCF), and combined anterior-posterior approach (ACDF-PCF). To determine whether when compared to ACDF, both PCF and combined approaches are associated with higher risks of complications and readmissions. Retrospective cohort study. New York Statewide Planning and Research Cooperative System (SPARCS). Neurological complications. Patients who underwent 2-3-level anterior cervical discectomy and fusion (ACDF), posterior cervical fusion (PCF), or ACDF-PCF with ≤90-day follow-up from 2009-13 were identified using SPARCS. Demographics, 90-day neurological and medical/surgical complications, readmissions and revisions were compared between cohorts. Multivariate logistic regression was used to identify independent predictors (covariates: surgical approach, age, sex, Charlson/Deyo index, and race). The study included a total of 40,035 patients (ACDF=35355, PCF=2964; combined=1716). PCF vs combined and ACDF had highest C5-C7 nerve palsy (1.8% vs 1.1% and 0.49%), rates of damage to the recurrent laryngeal nerve (0.1% vs 0.5% and 0.05%), damage to peripheral nerves of the neck (0.1% vs 0% and 0.01%; p=0.03), overall neurological complications rates (2.3% vs 2.0% and 0.8%), rates of implant-related complications (5.5% vs 2.7% and 0.7%; p<0.005), overall surgical complications (6.7% vs 5.6% and 1.4%), rate of total complications (20.3% vs 20.0% and 6.7%), readmissions (23.1% vs 23.0% and 7.6%),and revisions (25.8% vs 12.8% and 5.6%), all p<0.001, unless otherwise noted. Combined vs PCF and ACDF had the highest rate of med complications (15.8% vs 13.8% and 5.6%; p<0.001). When considering ACDF as a reference, PCF and combined were associated with increased odds of 90-day neurological complications (Odds Ratio [OR]=2.0 vs 1.9) and revisions (OR=4.2 vs 2.3), while combined was more strongly associated with surgical complications (OR=3.9 vs 3.5), total complications (OR=2.6 vs 2.5), med complications (OR=2.34 vs 2.35), and readmissions (OR=2.0 vs 3.0), all p<0.001. When compared to ACDF, both PCF and combined approaches were associated with higher risks of global complications and readmissions. Awareness of differential postoperative adverse outcomes could better inform individualized surgical planning. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

The impact of neuromuscular disorders such as multiple sclerosis (MS) on outcomes following long segment (4+ level) fusion is underreported. To identify the impact of MS on two-year (2Y) postoperative complications and revisions following 4 level fusion for ASD. Retrospective cohort. Patients undergoing 4+ level fusion for ASD were identified from the New York State Statewide Planning and Research Cooperative System. Two-year postoperative complications and reoperations. Patients undergoing 4-level fusion for ASD were identified from the New York Statewide Planning and Research Cooperative System. Patients with a baseline diagnosis of MS were also identified. Patients with infectious/traumatic/neoplastic indications were excluded. Subjects were 1:1 propensity score-matched (MS to no-MS) by age, sex, and race and compared for rates of 2-year postoperative complications and reoperations. Logistic regression models were utilized to determine risk factors for adverse outcomes at 2 years. A total of 86 patients were included (n=43 per group). Age (50.1 vs 50.1 years, p=0.225), sex and race were comparable between groups. MS pts incurred higher charges for their surgical visit ($125,906 vs $84,006, p=0.007) with similar LOS (8.1 vs 5.3 days, p>0.05). MS patients experienced comparable rates of overall medical complications (30.1% vs 25.6%) and surgical complications (34.9% vs 30.2%) all p>0.05. MS pts had similar rates of 2-year revisions (16.3% vs 9.3%, p=0.333). MS was not associated with medical, surgical or overall complications or revisions at minimum 2-year follow-up. Patients with MS experienced similar postoperative course compared to those without MS following 4-level fusion for ASD. This data supports the findings of multiple previously published case series' that long segment fusions for ASD can be performed relatively safely in patients with MS. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]