Search

Background: Intraoperative neuromonitoring (IONM) is frequently used during spine surgery to mitigate the risk of neurological injuries. Yet, its role in anterior cervical spine surgery remains controversial. Without consensus on which anterior cervical spine surgeries would benefit the most from IONM, there is a lack of standardized guidelines for its use in such procedures. Purpose: We sought to assess the alerts generated by each IONM modality for 4 commonly performed anterior cervical spinal surgeries: anterior cervical diskectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), cervical disk replacement (CDR), or anterior diskectomy. In doing so, we sought to determine which IONM modalities (electromyography [EMG], motor evoked potentials [MEP], and somatosensory evoked potentials [SSEP]) are associated with alert status when accounting for procedure characteristics (number of levels, operative level). Methods: We conducted a retrospective review of IONM data collected by Accurate Neuromonitoring, LLC, a company that supports spine surgeries conducted by 400 surgeons in 8 states, in an internally managed database from December 2009 to September 2018. The database was queried for patients who underwent ACCF, ACDF, anterior CDR, or anterior diskectomy in which at least 1 IONM modality was used. The IONM modalities and incidence of alerts were collected for each procedure. The search identified 8854 patients (average age, 50.6 years) who underwent ACCF (n = 209), ACDF (n = 8006), CDR (n = 423), and anterior diskectomy (n = 216) with at least 1 IONM modality. Results: Electromyography was used in 81.3% (n = 7203) of cases, MEP in 64.8% (n = 5735) of cases, and SSEP in 99.9% (n = 8844) of cases. Alerts were seen in 9.3% (n = 671), 0.5% (n = 30), and 2.7% (n = 241) of cases using EMG, MEP and SSEP, respectively. In ACDF, a significant difference was seen in EMG alerts based on the number of spinal levels involved, with 1-level ACDF (6.9%, n = 202) having a lower rate of alerts than 2-level (10.0%, n = 272), 3-level (15.2%, n = 104), and 4-level (23.4%, n = 15). Likewise, 2-level ACDF had a lower rate of alerts than 3-level and 4-level ACDF. A significant difference by operative level was noted in EMG use for single-level ACDF, with C2-C3 having a lower rate of use than other levels. Conclusions: This retrospective review of anterior cervical spinal surgeries performed with at least 1 IONM modality found that SSEP had the highest rate of use across procedure types, whereas MEP had the highest rate of nonuse. Future studies should focus on determining the most useful IONM modalities by procedure type and further explore the benefit of multimodal IONM in spine surgery.

Background It is unclear whether postoperative outcomes are associated with the cartilage regeneration after open wedge high tibial osteotomy (OWHTO) combined with microfracture. The purpose of this study was to evaluate the regeneration of the articular cartilage, radiologic, and clinical outcomes after OWHTO with and without microfracture. Methods Eighty-seven patients who underwent OWHTO from 2014 to 2015 were retrospectively included in this study. Fifty-seven OWHTOs with microfracture on medial femoral condyle (MFC) (group 1) and 30 OWHTOs without microfracture (group 2) were compared at a mean 2-year follow-up. The regeneration of the articular cartilage was evaluated using International Cartilage Repair Society (ICRS) grade on the second-look arthroscopy and the magnetic resonance observation of cartilage repair tissue (MOCART) score on magnetic resonance imaging (MRI). The weight-bearing line (WBL) ratio, hip-knee-ankle (HKA) angle, joint line convergence angle (JLCA) and Ahlbäck grade were evaluated. The clinical outcomes were evaluated using the Western Ontario and McMaster University (WOMAC) scores and the Knee Society (KS). Results The articular cartilage in the MFC were regenerated in 67.8% of group 1 (43/57) and 58.6% of group 2 (16/30), respectively (p = 0.014). However, change of the ICRS grades of the medial tibial plateau, lateral and patellofemoral compartments showed no statistical difference between the groups. Total MOCART score in group 1 was superior to that in the group 2 at postoperative 2 years (41.8 ± 18.6 vs. 31.8 ± 19.8, p = 0.023). Regarding MOCART score, microfracture was only effective in the defect filling and integration to the border zone of the MFC (p

BACKGROUND CONTEXT Outcomes after anterior cervical discectomy and fusion (ACDF) and cervical disc replacement (CDR) are likely impacted by the mental state of a patient during recovery. Psychologic factors such as anxiety/depression might negatively impact outcomes for a subset of patients. PURPOSE To elucidate whether anxiety/depression affect outcomes following 1-2 level anterior cervical surgery (ACDF or CDR) at short-term and final follow-up. STUDY DESIGN/SETTING Retrospective review of prospectively collected data. PATIENT SAMPLE Patients who underwent 1-2 level ACDF/CDR for cervical radiculopathy/myelopathy and had health related quality of life scores (HRQOLs) at 6 weeks, 3 months and 6 months out from surgery. OUTCOME MEASURES Patient-reported outcome measures (PROMs) - Neck disability index (NDI), short-form 12 physical component score (SF-12 PCS), short-form 12 mental component score (SF-12 MCS), PROMIS score, visual analog scale arm (VAS-arm) and neck (VAS-neck) pain scores. METHODS Duration of symptoms prior to surgery was recorded. HRQOLs, including NDI, SF-12 and VAS arm and neck were followed. Classic radiographic measurements of C2-C7 cob angle, cervical sagittal vertical axis (cSVA), and T1-Slope were assessed preoperatively to ensure that the cohorts were similar in terms of alignment. Patients were stratified whether they were diagnosed with anxiety/depression (A/D cohort) or not (non-A/D cohort). We compared outcome scores at each time point to determine if there was a difference in time to recovery for A/D patients.We tested normality of data using a Kolmogrov-Smirnov test. Student's t-test or Mann-Whitney test were used to compare normally and non-normally distributed HRQOLs respectively at each time point between the two cohorts. RESULTS There were 82 patients with at least 6-month follow-up (mean age 51.4±11.1 years old, 40 female). There were 16 patients in the A/D cohort. There were no significant differences in age (p=0.14), baseline radiographic parameters (all p>0.05), duration of symptoms (p=0.63) or preop HRQOLs (all p>0.77) between the A/D versus non-A/D. At 2 weeks, VAS-neck (p=0.04) and SF-12 MCS (p CONCLUSIONS The impact of anxiety/depression on outcomes after 1-2 level ACDF/CDR is minimal. Specific HRQOL measures for mental health like SF-12 MCS will likely be lower in this population as we found within our dataset. Overall outcomes for patients with anxiety/depression mirror positive outcomes for those without these comorbid conditions after 1-2 level ACDF/CDR. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Stand-alone or zero-profile devices for anterior cervical discectomy and fusion (ACDF) have become popular in the management of degenerative cervical pathology in order to mitigate some of the complications associated with anterior cervical plating. PURPOSE To determine the incidence, severity and resolution of dysphagia and odynophagia following zero-profile ACDF. STUDY DESIGN/SETTING Retrospective cohort study of prospectively collected data. PATIENT SAMPLE Patients who had undergone zero-profile ACDF between 2017-2020. OUTCOME MEASURES Patient-reported Outcome Measure (PROMs) - Patient reported responses on the Dysphagia, Odynophagia and Voice (DOV) Questionnaire. In particular, the “Swallowing” and “Pain with Swallowing” components of the DOV Questionnaire were used for this study. METHODS Patients completed the DOV Questionnaire preoperatively and postoperatively (2 weeks, 6 weeks, 12 weeks, 6 months, 1 year and 2 years). Patients selected one of five answer choices (0-4) for dysphagia and one of four choices (0-3) for odynophagia, with zero indicating no symptoms and higher point values indicating worse symptomatology. Scores of 1, 2, 3, and 4 were graded as mild, moderate, severe, and very-severe, respectively. RESULTS Forty-eight patients, with a mean age of 58.46 ± 9.74 years, mean BMI of 27.38 ± 4.76 kg/m^2 and comprised of 31 males (64.6%) and 17 females (35.4%) were included. There were 17 single-level (35.4%), 24 two-level (50.0%) and 7 three-level (14.6%) surgeries. Nine (18.8%) patients reported dysphagia preoperatively, all of whom had symptom resolution. Ten (20.8%) patients reported dysphagia at 2 weeks postoperatively, which was mild in all patients. Of these, 5 had resolution during follow-up, with a majority reporting resolution by 6 weeks. Of the 5 patients that did not report resolution, 4 did not have follow-up data available beyond 6 weeks, and 1 reported persistent dysphagia at 2 years. Seven (16.7%) patients reported new-onset dysphagia at 6 weeks, which was mild in all patients. Of these, 5 had resolution, with a majority reporting resolution by 12 weeks. Of the 2 patients that did not report resolution, 1 patient did not have long-term follow-up available, and 1 reported persistent dysphagia at 1 year. Six (12.5%) patients reported odynophagia preoperatively, all of whom had complete symptom resolution. Eleven (22.9%) patients reported odynophagia at 2 weeks postoperatively, which was mild in all patients. Of these, 8 had resolution during the available follow-up, with a majority reporting resolution by 12 weeks. The 3 patients that did not report resolution did not have long-term follow-up data available. In addition, 5 (10.4%) patients reported new-onset, odynophagia after 2 weeks postoperatively, which was mild in all patients. Of these 5 patients, 4 reported resolution while 1 reported persistent symptoms at 1 year. Further, 6/48 (12.5%) patients reported only dysphagia, 4/48 (8.3%) patients reported only odynophagia, and 11/48 (22.9%) patients reported both dysphagia and odynophagia. CONCLUSIONS All cases of postoperative dysphagia and odynophagia were mild and a majority resolved by 6-12 weeks postoperatively. Only 2 (4.2%) patients reported persistent dysphagia and only 1 (2.1%) patient reported persistent odynophagia at or after 1 year postoperatively, which was mild in all cases. FDA DEVICE/DRUG STATUS Stand-alone ACDF cage (Approved for this indication).

The present systematic review and meta-analysis were conducted to find out how effective any subsequent conversion total knee arthroplasty (TKA) would be after unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) and which is better in outcomes. A rigorous and systematic approach was used. Each of the selected studies was evaluated for methodological quality. Data were extracted by the following standardized protocol: study design, level of evidence, cases enrolled, age, sex ratio, follow-up, kind of index surgery, type of index surgery, average time to failure, mode of failure, surgical data, preclinical score, post-clinical score, and major related complications. Nineteen articles were included in the final analysis. In conversion TKA following UKA, revision components (metal augment, bone graft, and stem) were frequently used, and thicker polyethylene was used comparing to the primary TKA. In the conversion TKA following HTO, only stem was more common (relative risk of revision component UKA:HTO = 0.57:0.07). The estimated range of motions (ROM) of conversion TKA following HTO and UKA was 107.75° (101.93–113.58°) and 111.84° (108.41–115.26°), respectively (p > 0.05). The knee scores of conversion TKA following HTO and UKA were 89.10 (86.45, 91.75) and 85.48 (79.82, 91.14), respectively (p > 0.05). The function scores were 78.60 (72.44, 84.76) and 75.60 (69.85, 81.35), respectively (p > 0.05). Clinical outcome was similar between conversion TKA following HTO and UKA. However, conversion TKA after UKA required more revision components and thicker polyethylene, while conversion TKA after HTO sometimes required a stem to bypass the osteotomy gap.

BACKGROUND CONTEXT Stand-alone or zero-profile devices for anterior cervical discectomy and fusion (zero-profile ACDF) have become popular in the management of degenerative cervical spine disease in order to mitigate some of the complications associated with anterior cervical plating. Studies regarding the incidence of postoperative complications after zero-profile ACDF are limited, particularly with regard to postoperative dysphonia. PURPOSE The aim of this study is to determine the incidence and overlap of voice and swallowing symptoms in patients undergoing zero-profile ACDF. STUDY DESIGN/SETTING Retrospective cohort study of prospectively collected data. PATIENT SAMPLE Patients who had undergone zero-profile ACDF between 2017-2020. OUTCOME MEASURES Patient-reported outcome measures (PROMs) - Patient reported responses on the Dysphagia, Odynophagia and Voice (DOV) Questionnaire. METHODS Patients completed the DOV Questionnaire preoperatively and at each postoperative timepoint (2 weeks, 6 weeks, 12 weeks, 6 months, 1 year and 2 years) as standard of care. The DOV Questionnaire requires patients to select one of five scaled answer choices (0-4) for dysphagia, and one of four scaled answer choices (0-3) for voice (ie, dysphonia) and odynophagia, with zero indicating no symptoms and higher point values indicating worse symptomatology. For this study, scores of 1, 2, 3, and 4 were graded as mild, moderate, severe, and very severe, respectively. The incidence of dysphonia, dysphagia and odynophagia were assessed. RESULTS Forty-eight patients, with a mean age of 58.46 ± 9.74 years, mean BMI of 27.38 ± 4.76 kg/m^2 and comprised of 31 males (64.6%) and 17 females (35.4%) were included. There were 17 single-level (35.4%), 24 two-level (50.0%) and 7 three-level (14.6%) surgeries. Twenty-four (50.0%) patients reported either new-onset dysphonia, dysphagia or odynophagia at their 2 or 6 week postoperative visit following zero-profile ACDF. Of these, 3 patients (6.25%) reported only dysphonia, 11 patients (22.9%) reported only dysphagia/odynophagia, and 10 patients (20.8%) reported both dysphonia and dysphagia/odynophagia. All cases of dysphagia and odynophagia were mild and a majority resolved within 12 weeks. Similarly, a majority (69%) of cases of dysphonia were mild and also resolved by 12 weeks. CONCLUSIONS Half of the patients in this cohort reported either dysphonia, dysphagia or odynophagia within 6 weeks of ACDF with the use of a zero-profile implant, most of which were mild and transient, resolving by 12 weeks. About half of all patients with swallowing symptoms reported concurrent voice symptoms, whereas the other half reported dysphagia/odynophagia alone. In contrast, approximately a quarter of all patients reported dysphonia within 6 weeks of zero-profile ACDF, most of whom also reported concurrent swallowing issues. However, 6.25% of patients reported dysphonia alone, which may not be detected using outcome measures that assess dysphagia only. Future research should evaluate these findings in a larger patient cohort and identify ways to reduce these complications. FDA DEVICE/DRUG STATUS Stand-alone ACDF cage (Approved for this indication).

BACKGROUND CONTEXT For a subset of patients who catastrophize pain, communication of symptoms/disability is a challenge for themselves and for practitioners to interpret. PURPOSE To determine if patients that catastrophize pain had worse clinical outcomes after anterior cervical surgery. STUDY DESIGN/SETTING Retrospective review of prospectively collected data. PATIENT SAMPLE All patients who underwent 1- or 2-level anterior cervical discectomy and fusion (ACDF) or cervical disc replacement (CDR) for cervical radiculopathy and/or myelopathy and had 1-year follow-up were included in our study. OUTCOME MEASURES Patient-reported Outcome Measures (PROMs) - health related quality of life scores (HRQOLs), including Neck Disability Index (NDI), Short-Form 12 Physical Component Score (SF-12 PCS), Short-Form 12 Mental Component Score (SF-12 MCS), PROMIS Physical Function score, visual analog scale arm (VAS-arm) and neck (VAS-neck) pain scores were collected prospectively pre- and postoperatively (2 weeks, 6 weeks, 12 weeks, 6 months, 1 year). METHODS Patients with preoperative VAS-neck or VAS-arm score of 9-10/10 were classified as pain catastrophizing (PC cohort) and the rest as non-pain catastrophizing (non-PC cohort). HRQOLs were compared between cohorts at all time points. We compared recovery kinetics between the PC versus non-PC cohorts. This was done by normalizing all HRQOLs at each interval time point. The area under the curve (AUC) was then calculated for a plot of the normalized score versus follow-up time point as has been done in previous studies (IHS, Integrated Health State). A Mann-Whitney test or student's t-test was used to compare mean values from the two cohorts based upon whether data was normally distributed. RESULTS Forty-eight patients with a mean age of 50.0±11.8 years and comprised of 22 females were included. All patients had a minimum of 1-year follow-up. There were 13 patients in the PC cohort. There were no significant differences in age, gender and preoperative radiographic parameters. Preop VAS-arm, VAS-neck, SF-12 PCS, SF-12 MCS, NDI and PROMIS were all worse for the PC cohort (p CONCLUSIONS Our findings demonstrate that patients that catastrophize pain may have worse overall outcome scores after anterior cervical surgery (ACDF or CDR). After normalizing their outcome scores, we demonstrated that PC patients have similar rates of improvement after ACDF or CDR. Pain catastrophizing patients might communicate pain in a more extreme manner, but clinicians should counsel these patients that outcomes are positive after ACDF or CDR. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Comparative studies of patients with cervical spondylosis treated with either cervical disc replacement (CDR) or anterior cervical discectomy and fusion (ACDF) are sparse in number. Previous studies have demonstrated good outcomes in patients undergoing CDR with moderate cervical spondylosis involving the disc, uncovertebral or facet joints. PURPOSE To compare clinical outcomes in patients with moderate cervical spondylosis undergoing CDR vs, the gold standard, ACDF. STUDY DESIGN/SETTING Retrospective review of prospectively collected data. PATIENT SAMPLE Patients who underwent one or 2-level CDR or ACDF with moderate cervical spondylosis, quantified using a validated grading scale, were identified, and prospectively collected data was retrospectively reviewed. OUTCOME MEASURES Neck Disability Index (NDI), VAS-Neck, VAS-Arm and PROMIS Physical Function (PROMIS-PF) computer adaptive test score. Methods Patients who underwent one or two-level CDR or ACDF with moderate cervical spondylosis, quantified using a validated grading scale, were identified, and prospectively collected data was retrospectively reviewed. Cervical spondylosis was graded by assessing disc height, facet arthrosis, and uncovertebral joint degeneration. Each of these characteristics was given a score of 0, 1 or 2 with increasing scores correlating with more severe disease. Demographic, operative, and cervical spondylosis grades and achievement of MCID for each PRO was analyzed and compared between the two groups. Results A total of 66 patients were included in the present study, of which 35 (53%) were treated with CDR and 31 (47%) with ACDF. Average follow up was 15.5 months. Patients treated with ACDF were significantly older (58.7 vs 43.0 years-old, P Conclusions The results of the present study demonstrate that patients with moderate cervical spondylosis treated with CDR reported similar postoperative patient reported outcomes to those treated with ACDF. The use of CDR in patients with spondylosis of the uncovertebral joint, facet joint, or disc space height loss may result in similar outcomes compared to ACDF treated patients, while preserving motion and avoiding the biologic demand of obtaining a fusion across the involved cervical levels. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Several previous randomized controlled trials have documented the success of cervical disc replacement (CDR) in treating radiculopathy and/or myelopathy, but many did not systematically compare outcomes of patients with radiculopathy versus those with myelopathy. Currently, there is still controversy about whether CDR utilization in patients with components of myelopathy can result in equivalent outcomes when compared to its use in patients with only radiculopathy. PURPOSE The purpose of the present study was to compare the minimally clinically important difference (MCID) across multiple patient-reported outcomes (PROs) in patients undergoing CDR for cervical spondylotic radiculopathy versus myeloradiculopathy. STUDY DESIGN/SETTING Retrospective review of prospectively collected data. PATIENT SAMPLE Patients who underwent one or two-level CDR with radiculopathy versus myeloradiculopathy. OUTCOME MEASURES Neck Disability Index (NDI), VAS-Neck, VAS-Arm, Short Form-12 Health Survey (SF-12) Physical Component Score (PCS), SF-12 Mental Component Score (MCS), PROMIS Physical Function (PF). METHODS Demographic variables and operative characteristics were analyzed for differences between patients with radiculopathy versus myeloradiculopathy. PROs were assessed for differences between the two diagnosis groups as well as improvements within each group following surgery. An MCID analysis of PROs for each diagnosis group was performed and the percentage of patients achieving the MCID was compared between the two diagnosis groups. RESULTS A total of 85 patients were included in the present study, of which 48 (56%) had radiculopathy and 37 (44%) had myeloradiculopathy. Average follow-up was 13.4 months. There were no significant differences in preoperative demographic variables, or the number and distribution of cervical levels treated between the two diagnosis groups. There were no significant differences in preoperative NDI, Neck-VAS, Arm-VAS, SF-12 PCS, SF-12 MCS, and PROMIS PF scores between the two groups. At the final postoperative visit, there was no significant difference in each PRO assessed between the radiculopathy and myeloradiculopathy groups and both groups demonstrated statistically significant improvement in each PRO compared to preoperative values (P CONCLUSIONS This is the first study to compare the MCID across various PROs in patients with radiculopathy versus myelopathy undergoing CDR. The percentage of patients achieving the MCID was not significantly different at each postoperative period assessed in the radiculopathy and myeloradiculopathy groups. In addition, the percentage of patients achieving the MCID continued to increase from 6-weeks to final follow-up in both groups for almost all PROs assessed. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Grit, defined as perseverance and passion for long-term goals, and self-control, defined as the capacity to regulate impulses in the presence of momentarily gratifying temptations or diversion, have been shown to be important predictors for achievement in professional domains. Though grit and self-control have been well-explored in their relationship with achieving professional achievement, the association between these traits and outcomes following surgery has not been explored. PURPOSE To assess whether there is an association between grit/self-control and the achievement of minimum clinically important difference (MCID) following elective spine surgery. STUDY DESIGN/SETTING Retrospective review of prospectively collected data. PATIENT SAMPLE Consecutive patients who underwent primary elective spine surgery and had at least 1 year follow-up were included. The three surgical cohorts were: (1) anterior cervical surgery [anterior cervical discectomy and fusion (ACDF) or cervical disc replacement (CDR)], (2) Minimally invasive lumbar decompression [microdiscectomy or laminectomy (MI-D)], and (3) Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). OUTCOME MEASURES The validated 8-Question Short Grit Scale and the 10-Item Self-Scoring Self-Control Scale were used to assess grit and self-control, respectively. Both surveys are five-point scales, with five signifying the highest score (ie, more grit and self-control). Patient reported outcome measures included NDI for cervical patients and ODI for lumbar patients. Minimum Clinically Important Difference (MCID) values for each type of outcome measure were acquired from established literature. METHODS Grit and self-control scores were compared between patients who achieved MCID by a certain time-point and those who did not. The time-points were selected based on when the majority of patients in each cohort had achieved MCID. RESULTS Of the 69 patients included, 17 underwent ACDF/CDR, 28 underwent MI-D, and 24 underwent MI-TLIF. The mean grit and self-control scores for the ACDF/CDR cohort were 3.48 + 0.48 and 3.96 + 0.51, respectively. In this cohort, 64.3% of patients achieved MCID in NDI at 6 months. There were no significant differences in grit and self-control scores between patients who achieved MCID in NDI at 6 months postoperatively vs those who did not. The mean grit and self-control scores for the MI-D cohort were 3.96 + 0.57 and 3.82 + 0.61, respectively. In this cohort, 48% patients achieved MCID in ODI at 2 weeks. There were no significant differences in either score between patients who achieved MCID in ODI at 2 weeks postoperatively vs those who did not. The mean grit and self-control scores for the MI-TLIF cohort were 3.95 + 0.61 and 4.07 + 0.55, respectively. In this cohort, 59.1% of patients achieved MCID in ODI at 12 weeks. There were no significant differences in either score between patients who achieved MCID in ODI at 12-weeks vs those who did not. CONCLUSIONS Preliminary results show that grit and self-control scores are not associated with achievement of MCID following spine surgery. A larger study will need to be conducted to further evaluate the impact of grit and self-control. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Patient reported outcome measures (PROMs) and minimal clinically importance difference (MCID) thresholds have emerged as effective, reliable parameters to assess improvement and surgical success. PURPOSE To investigate the risk factors associated with failure to achieve MCID following cervical disc replacement (CDR). STUDY DESIGN/SETTING Retrospective review of prospectively collected data. PATIENT SAMPLE A total of 107 patients who had undergone primary, one-or-two level CDR by three surgeons at a single academic institution. OUTCOME MEASURES Patient-reported outcome measures - Rates of MCID achievement in neck disability index (NDI), VAS (visual analogue score) neck, and VAS-arm were calculated with the following threshold values, based on previously published studies: NDI: -15.0, VAS-neck: -2.5, and VAS-arm: -2.5. METHODS Risk factors for failure to achieve MCID were identified using multivariate logistic regression models with alternating backward stepwise elimination and forward entry of removed variables (entry: 0.05, removal: 0.10). Receiver operating characteristic (ROC) curves were generated to assess the performance of each model. RESULTS A total of 107 patients met inclusion criteria (mean age: 42.99±9. Thirteen years, mean BMI: 26.02±4.01 kg/m2). There were 99 patients who presented for a follow-up visit within three months of their operation, of which 82 (89.1%) had achieved MCID in NDI, VAS-neck, or VAS-arm. Specific to the NDI, BMI≥25 kg/m2 (OR:153.75, p=0.002), depression (OR:50.32, p=0.016), myelopathy (OR:51.44, p=0.022), degenerative disc disease/spondylosis (OR:21.54, p=0.001), and two-level procedures (OR:6.59, p=0.027) were identified as risk factors for failure to achieve MCID within the first three months. Preoperative narcotic use (OR:0.11, p=0.027) was associated with a lower risk for failure to achieve MCID in NDI within the first three months. The area under the ROC curve (AUROC) assessing the logistic regression model's performance was 0.873 (p CONCLUSIONS The large majority of patients had achieved MCID in at least one of the three PROMs. Clinical depression, myelopathy and two-level procedures were associated with failure to achieve MCID in NDI by one year and also within the early postoperative period (first three months) following CDR. BMI≥ 25 kg/m2 and spondylosis were also significant factors associated with failure to achieve MCID in NDI within the early postoperative period. Although preoperative narcotic use was associated with achievement of MCID in NDI, these patients likely presented initially with more chronic and severe symptoms, potentiating greater improvements in PROMs. Future studies with larger cohorts may provide additional insight on the true impact of the identified risk factors on outcomes following CDR. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT The postoperative recovery for anterior cervical discectomy and fusion (ACDF) and cervical disc replacement (CDR) may be impacted by affective disorders, especially depression/anxiety. The authors hypothesized that depression/anxiety may slow recovery after anterior cervical surgery (ACDF or CDR) for cervical radiculopathy/myelopathy. PURPOSE To evaluate the effect of anxiety and depression on recovery speed after ACDF or CDR. STUDY DESIGN/SETTING Retrospective review of prospectively collected data. PATIENT SAMPLE Patients who underwent 1-2 level ACDF or CDR for cervical radiculopathy/myelopathy and had at least 1-year follow-up and complete radiographic measurements and health related quality of life scores (HRQOLs) at 6 weeks, 3 months, 6 months and 1 year postoperatively. OUTCOME MEASURES Patient-reported outcome measures (PROMs) - HRQOLs including neck disability index (NDI), short-form 12 physical component score (SF-12 PCS), short-form 12 mental component score (SF-12 MCS), PROMIS score, visual analog scale arm (VAS-arm) and neck (VAS-neck) pain scores were follow. METHODS Radiographic measurements of C2-C7 Cobb angle, cervical sagittal vertical axis (cSVA) and T1-slope were assessed preoperatively to ensure that the cohorts were similar in terms of alignment. Patients were stratified based on whether they had been diagnosed with anxiety/depression (A/D cohort) or not (non-A/D cohort). We compared recovery kinetics between the A/D versus non-A/D cohort. This was done by normalizing all HRQOLs at each interval time point. The area under the curve (AUC) was then calculated for a plot of the normalized score versus follow-up time point as has been done in previous studies (IHS, Integrated Health State). We used a student's t-test to compare demographic information, radiographic parameters and HRQOLs between the A/D versus non-A/D cohort. RESULTS Forty-eight patients with a mean age of 50.0±11.8 years and comprising 22 females were included. All patients had minimum of 1-year follow-up. There were 10 patients in the A/D cohort. There were no significant differences in age (p = 0.18), baseline radiographic parameters (all p>0.10) or preop HRQOLs (all p>0.30) between the A/D versus non-A/D. After normalization there was no significant difference in terms of IHS for A/D versus non-A/D for NDI (0.66±0.38 vs 0.59±0.35, p=0.65), VAS-arm (0.55±0.40 vs 0.36±0.33, p=0.23), VAS-neck (0.55±0.28 vs 0.43±0.27, p=0.24), PROMIS (1.2±0.32 vs 1.3±0.37, p=0.48), SF-12 PCS (1.2±0.26 vs 1.2±0.28, p=0.79) or SF-12 MCS (1.1±0.17 vs 1.1±0.17, p=0.23). Final follow-up outcome scores were also similar for A/D vs non-A/D cohorts for all HRQOLs (all p>0.16). CONCLUSIONS We found no negative influence of anxiety/depression on either final-outcome scores or recovery kinetics after 1-2 level ACDF/CDR. Our analysis of IHS shows that the recovery speed after ACDF/CDR were not be impacted by a patient's comorbid anxiety/depression. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

There is little information about the management and clinical outcomes of the periprosthetic fracture after total knee arthroplasty (TKA) with a stem extension. The purposes of this study were to demonstrate management of the periprosthetic fractures after TKA with a stem extension, to report treatment outcomes, and to determine whether dual-plate fixation is superior to single-plate fixation regarding the radiographic bone union time and incidence of metal failure. This retrospective study included 15 knees with periprosthetic fractures after TKA using a stem extension. We demonstrated the fracture characteristics and management according to the fracture location and implant stability. The radiographic union time was determined. Complications, range of motion, and functional outcomes, including Western Ontario and McMaster Universities Osteoarthritis Index and Knee Society Score were assessed. Periprosthetic fractures after TKA with stem extension were 1 metaphyseal fracture without implant loosening, 7 diaphyseal fractures adjacent to the stem without implant loosening, 3 diaphyseal fractures away from the stem without implant loosening, and 4 fractures with implant loosening. Treatment included immobilization using a long leg cast, open reduction and internal fixation (ORIF), and re-revision TKA. There was no difference in functional outcomes and range of motion pre- and posttreatment. The complications included 2 cases of subsequent implant loosening. Patients in the dual-plating required a shorter bony union time than those in the single-plating (2.4 ± 1.1 vs 7.4 ± 2.2 months; P = .003). Periprosthetic fractures after TKA with stem extension could be managed individually according to the fracture location and implant stability. Complications were not uncommon even if patients were able to return to their preinjury functional level posttreatment. To avoid complications after ORIF, the dual plate was superior to the single plate, and subtle implant loosening should not be overlooked.

BACKGROUND CONTEXT There is evidence that degenerative changes in paralumbar musculature impact conditions like low back pain, and lumbar spinal stenosis. For patients undergoing spinal surgery we hypothesized that paralumbar muscle health would alter the time it took for patients to reach minimal clinically important differences (MCIDs) in health-related quality of life scores (HRQOLs). PURPOSE Determine how preoperative muscle health impacts the time to MCID for one level MIS TLIF and/or decompression. STUDY DESIGN/SETTING Retrospective review of a prospectively collected database PATIENT SAMPLE Eighty-five adult patients with lumbar spine pathology requiring MIS lumbar decompression/fusion. OUTCOME MEASURES Health-related-quality of life (HRQL) scores, lumbar indentation value (LIV). METHODS We performed a retrospective review of patients that eventually went on to undergo either a lumbar decompressive surgery or a 1-level lumbar spinal fusion. We analyzed magnetic resonance imaging (MRI) to quantify muscle health using the lumbar indentation value (LIV) which is a validated method of measuring the relative cross-sectional area of lumbar musculature. T2 axial slices from the disc space at the operative level were analyzed. We separated our cohort of patients into whether they had a lumbar decompression alone or 1-level TLIF. Health related quality of life (HRQOL) scores were collected on these patients in the pre-operative period and the post-operative period up to 1 year out from surgery. These scores included the Visual analog back and leg scores (VAS leg and VAS back), the oswestry disability index (ODI), short form 12 (SF-12) mental health scores (MHS) and physical health scores (PHS). We defined MCID as has been previously reported in the literature. We then correlated the LIV calculated off preoperative MRI and correlated this finding with time to MCID using a linear regression analysis. RESULTS A total of 85 patients were included within our analysis. The average age was 58.4+/-15.7 years old and there were 45 men and 40 women. There were 93 disc spaces operated on within this cohort. The majority of patients undergoing a lumbar decompression (LD) had a diagnosis of disc herniation (49.2%) and the majority of patients that had a lumbar fusion (LF) were diagnosed with lumbar spinal stenosis (93.1%). We found that the average LIV for LD patients was 16.2+/-6.5mm and for LF patients was 17.1+/-6.6mm. There was no statistically significant correlation between time to MCID for ODI, SF-12 MHS. SF-12 PHS, VAS leg, or VAS back scores and LIV for patients undergoing a lumbar decompression. There was a statistically significant inverse relationship between time to MCID for ODI (p =0.02) and LIV and time to MCID for SF-12 MHS (p = 0.04) and LIV (ie, higher LIV correlated with lower time to MCID for ODI and SF-12 MHS). CONCLUSIONS These results emphasize the need for evaluation of paralumbar muscle health for patients undergoing lumbar surgery. Specifically, lumbar muscle health correlates with time to MCID for ODI and SF-12 MHS for patients undergoing lumbar fusion surgery. Further investigations are needed to determine how improvement of cross-sectional area of paralumbar muscle impacts MCID for patients undergoing lumbar surgery. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Poor lumbar muscle health has been implicated as a source of disability for patients with low back/radicular pain. We wanted to evaluate the relationship between muscle health and patient reported quality of life scores. PURPOSE Determine how preoperative muscle health impacts patient reported health related quality of life scores. STUDY DESIGN/SETTING Retrospective review of imaging and outcome scores. PATIENT SAMPLE A total of 92 adult patients with lumbar spine pathology requiring MIS lumbar decompression/fusion. OUTCOME MEASURES Health-related-quality of life (HRQL) scores, paralumbar muscle cross sectional area (PL-CSA), lumbar indentation value (LIV), Goutallier classification. METHODS We performed a retrospective review of patients that had lumbar decompression and/or fusion surgery after failing nonop management for degenerative pathologies. We quantified muscle health using PL-CSA, LIV and lumbar muscle fat atrophy using the Goutallier classification. T2 MRI axial slices from the disc space at the operative level were analyzed. We graded fat atrophy on a 1-4 scale and the LIV was calculated using a published technique of measuring the distance from the tip of a spinous process and a line across the muscular fascia. We used a standardized protocol of measuring cross sectional area of the paralumbar muscle (PL-CSA). We scaled the PL-CSA by finding the ratio of PL-CSA/BMI. HRQOL scores collected included VAS leg, VAS back, ODI, SF-12 mental and physical health and PROMIS. We performed a linear regression analysis to determine the relationship of LIV, PL-CSA, PL-CSA/BMI and the HRQOLs. We performed an ANOVA analysis to identify the relationship between Goutallier classification and HRQOLs listed. We combined our measurements to create a score to quantify muscle health and determined whether this score correlated with HRQOLs based on an ANOVA analysis. RESULTS A total of 92 patients were included within our analysis. The average age was 57.9+/-14.4 years old (49 men and 43 women). There were 104 levels operated on within this cohort. The most common preoperative diagnosis was lumbar spinal stenosis (58 patients). We found that the average LIV, PL-CSA and PL-CSA/BMI was 16.1 +/-7.5 mm, 4004 +/-1210 mm^2 and 153.5 +/- 45.0 mm^2/BMI. The PL-CSA/BMI ratio significantly correlated with preop SF-12 PHS (p = 0.03), VAS back (0.007) and VAS Leg (p = 0.002). Patients with less than 130 of the PL-CSA/BMI ratio had statistically significant worse PROMIS (35.9 vs 29.7, p=0.007), ODI (39.4 vs 50.2, p=0.01), SF-12 PHS (35.5 vs 28.7, =0.001), VAS leg (7.3 vs 5.5, p=0.007) and VAS back (7.9 vs 4.9, p=0.002) scores. We combined our results and scored each patient from 1-3 based upon whether there LIV 10mm (0 or 1), Goutallier Classification >2 or 130 or CONCLUSIONS Muscle health contributes significantly to preoperative disability. When patients have combined low PL-CSA/BMI, goutallier classification and LIV this corresponds to significantly worse HRQOLs. This lumbar muscle health score is a valid screen for patients with poor muscle health which may be contributing to their disability. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Background We retrospectively reviewed the outcomes of patients who had been treated with meloxicam for the extra-abdominal desmoid tumors and evaluated the correlation between clinical outcome and clinic pathological variables. Methods Twenty patients treated with meloxicam were followed up every 3 to 6 months. Meloxicam administration was planned at 15 mg/day orally for 6 months. Results Of the 20 patients evaluated, according to Response Evaluation Criteria in Solid Tumors criteria, there were five patients with partial response (25.0%), eight with stable disease (40.0%), and seven with tumor progression (35.0%). The cumulative probability of dropping out from our nonsurgical strategy using meloxicam was 35.0% at 1 year and 35.0% at 5 years. Conclusions The present study suggests that conservative treatment would be a primary treatment option for this perplexing disease even though we were not able to determine that the use of a cyclooxygenase-2 inhibitor would have an additional influence on the natural course of a desmoid tumor.

An apparatus is described that acquires, processes, and displays cardiovascular system data continuously on a laptop computer screen. The physiologic parameters recorded by this device (heart rate, pulse wave arrival time, cutaneous pulse pressure) are based on and derived from the electrocardiogram and the cutaneous pulse pressure pattern. Sequential 2-minute periods of sitting, standing, and sitting were used to assess the subject's response to posture-induced regional displacement of blood. These physiologic data were recorded by the noninvasive instrumentation in 550 normal, uncomplicated pregnant patients selected randomly at their first prenatal visit. In addition to the above parameters, the changes observed between the initial “sit” and “stand” portions of the test were also computed. The data were plotted as medians and percentiles for the range of gestational age (12H-3 weeks) and “standard” curves generated for each parameter.