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Study Design: Retrospective cohort study., Objective: To analyze the relationship of abdominal aortic calcification (AAC) and a reduction in the cross-sectional area (CSA) and the fatty infiltration (FI) of the paravertebral muscles in patients undergoing lumbar fusion surgery., Background: Both AAC and paraspinal muscle degeneration have been shown to be associated with poorer outcomes after surgical treatment of degenerative diseases of the lumbar spine. However, there is a lack of data on the association between AAC and paraspinal muscle changes in patients undergoing spine surgery., Methods: We retrospectively analyzed patients undergoing lumbar fusion for degenerative spinal pathologies. Muscular and spinal degeneration were measured on magnetic resonance imaging (MRI). AAC was classified on lateral lumbar radiographs. The association of AAC and paraspinal muscle composition was assessed by a multivariate regression analysis adjusted for age, sex, body mass index (BMI), comorbidities, and lumbar degeneration., Results: A total of 301 patients was included. Patients with AAC showed significantly higher degrees of intervertebral disc and facet joint degeneration as well as higher total endplate scores at the L3/4 level. The univariable regression analysis showed a significant positive correlation between the degree of AAC and the FI of the erector spinae (b=0.530, P<0.001) and multifidus (b=0.730, P<0.001). The multivariable regression analysis showed a significant positive correlation between the degree of AAC and the FI of the erector spinae (b=0.270, P=0.006) and a significant negative correlation between the degree of AAC and the CSA of the psoas muscle (b=-0.260, P=0.003)., Conclusion: This study demonstrates a significant and independent association between AAC and degeneration of the erector spinae and the psoas muscles in patients undergoing lumbar fusion. As both AAC and degeneration of paraspinal muscles impact postoperative outcomes negatively, preoperative assessment of AAC may aid in identifying patients at higher risk after lumbar surgery., Competing Interests: Declaration of Conflicting Interest: The Authors declare that there is no conflict of interest concerning materials or methods used in this study or the findings specified in this paper., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Study Design: Retrospective study., Objective: The aim of this study was to evaluate the association between severity and level of cervical central stenosis (CCS) and the fat infiltration (FI) of the cervical multifidus/rotatores (MR) at each subaxial levels., Summary of Background Data: The relationship between cervical musculature morphology and the severity of CCS is poorly understood., Methods: Patients with preoperative cervical magnetic resonance imaging (MRI) who underwent anterior cervical discectomy and fusion (ACDF) were reviewed. The cervical MR were segmented from C3 to C7 and the percent FI was measured using a custom-written Matlab software. The severity of the CCS at each subaxial level was assessed using a previously published classification. Grade 3, representing a loss of cerebrospinal fluid space and deformation of the spinal cord > 25%, was set as the reference and compared to the other gradings. Multivariable linear regression analyses were conducted and adjusted for age, sex, and body mass index., Results: 156 consecutive patients were recruited. A spinal cord compression at a certain level was significantly associated with a greater FI of the MR below that level. After adjustment for the above-mentioned confounders, our results showed that spinal cord compression at C3/4 and C4/5 was significantly associated with greater FI of the MR from C3 to C6 and C5 to C7, respectively. A spinal cord compression at C5/6 or C6/7 was significantly associated with greater FI of the MR at C7., Conclusion: Our results demonstrated significant correlations between the severity of CCS and a greater FI of the MR. Moreover, significant level-specific correlations were found. A significant increase in FI of the MR at the levels below the stenosis was observed in patients presenting with spinal cord compression. Given the segmental innervation of the MR, the increased FI might be attributed to neurogenic atrophy., Level of Evidence: 3., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: The modified frailty index (mFI-5) has been shown to be a reliable risk stratification tool in different spine procedures. Its usefulness to predict complications after 1-level or 2-level anterior cervical decompression and fusion (ACDF) has not been studied extensively., Purpose: We aimed to assess the usefulness of the mFI-5 in 1-level or 2-level ACDF surgery by asking the following questions: (1) Is the mFI-5 a reliable tool to predict complications after 1-level or 2-level ACDF? (2) Is the mFI-5 useful in predicting prolonged hospital stay after 1-level or 2-level ACDF? (3) Is the mFI-5 useful in predicting readmission after 1-level or 2-level ACDF?, Methods: We performed a retrospective analysis of the medical records of patients who underwent 1-level or 2-level ACDF at our institution. The mFI-5 was calculated based on the presence of 5 comorbidities: (1) congestive heart failure, (2) diabetes mellitus, (3) chronic obstructive pulmonary disease, (4) partially or totally dependent functional status, and (5) hypertension requiring medication. Patients were classified in 3 groups: not frail (mFI-5 items = 0), pre-frail (mFI-5 items = 1), and frail (mFI-5 items ≥2). Postoperative complications, length of stay, and readmission were recorded., Results: In the 662 patients included (mean age 51.4 ± 10.4 years), surgical and medical complications were not significantly different among groups. Lengths of stay and readmission rates were both significantly higher in the pre-frail group., Conclusion: Our study findings suggest that the mFI-5 might not be reliable to assess preoperative risk after 1-level or 2-level ACDF., Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Gbolabo Sokunbi, MD, reports relationships with Stryker and Camber Spine. Alexander P. Hughes, MD, reports relationships with Kuros Biosciences AG, NuVasive, Inc., and Kuros Biosciences BV. Federico P. Girardi, MD, reports relationships with Lanx, Inc., Ortho Development Corp., BCIMD, and Healthpoint Capital Partners, LP. Frank P. Cammisa, MD, reports relationships with NuVasive, Inc., Accelus, 4WEB Medical/4WEB, Inc., Healthpoint Capital Partners, LP; ISPH II, LLC; ISPH 3 Holdings, LLC; Ivy Healthcare Capital Partners, LLC; Medical Device Partners II, LLC; Medical Device Partners III, LLC; Orthobond Corporation; Spine Biopharma, LLC; Tissue Differentiation Intelligence, LLC; VBVP VI, LLC; VBVP X, LLC; Woven Orthopedics Technologies; DePuy Synthes, Spine Biopharma, LLC, Mallinckrodt Pharmaceuticals, Camber Spine, and Centinel Spine. Andrew. A. Sama, MD, reports relationships with Ortho Development, Corp., Vestia Ventures MiRUS Investment, LLC, IVY II, LLC, ISPH II, LLC, ISPH 3, LLC, HSS ASC Development Network, LLC, Centinel Spine (Vbros Venture Partners V), Depuy Synthes Products, Inc., Clariance, Inc., Kuros Biosciences AG, Ortho Development Corp., and Spinal Kinetics, Inc. The other authors declared no potential conflicts of interest., (© The Author(s) 2024.)

Objective: Opioid stewardship programs combine clinical, regulatory, and educational interventions to minimize inappropriate opioid use and prescribing for orthopedic and spine surgery. Most evaluations of stewardship programs quantify effects on prescriber behavior, whereas patient-relevant outcomes have been relatively neglected. The authors evaluated the impact of an opioid stewardship program on perioperative opioid consumption, prescribing, and related clinical outcomes after multilevel lumbar fusion., Methods: The study was based on a retrospective, quasi-experimental, pretest-posttest design in 268 adult patients who underwent multilevel lumbar fusion in 2016 (preimplementation, n = 141) or 2019 (postimplementation, n = 127). The primary outcome was in-hospital opioid consumption (morphine equivalent dose [MED], mg). Secondary outcomes included numeric rating scale pain scores (0-10), length of stay (LOS), incidence of opioid-induced side effects (gastrointestinal, nausea/vomiting, respiratory, sedation, cognitive), and preoperative and discharge prescribing. Outcomes were measured continuously during the hospital admission. Differences in outcomes between the epochs were assessed in bivariable (Wilcoxon signed-rank or Fisher's exact tests) and multivariable (Wald's chi-square test) analyses., Results: In bivariable analyses, there were significant decreases in preoperative opioid use (46% vs 28% of patients, p = 0.002), preoperative opioid prescribing (MED 30 mg [IQR 20-60 mg] vs 20 mg [IQR 11-39 mg], p = 0.003), in-hospital opioid consumption (MED 329 mg [IQR 188-575 mg] vs 199 mg [100-372 mg], p < 0.001), the incidence of any opioid-related side effect (62% vs 50%, p = 0.03), and discharge opioid prescribing (MED 90 mg [IQR 60-135 mg] vs 60 mg [IQR 45-80 mg], p < 0.0001) between 2016 and 2019. There were no significant differences in postanesthesia care unit pain scores (4 [IQR 3-6] vs 5 [IQR 3-6], p = 0.33), nursing floor pain scores (4 [IQR 3-5] vs 4 [IQR 3-5], p = 0.93), or total LOS (118 hours [IQR 81-173 hours] vs 103 hours [IQR 81-132 hours], p = 0.21). On multivariable analysis, the opioid stewardship program was significantly associated with decreased discharge prescribing (Wald's chi square = 9.45, effect size -52.4, 95% confidence interval [CI] -86 to -19.0, p = 0.002). The number of lumbar levels fused had the strongest effect on total opioid consumption during the hospital stay (Wald's chi square = 16.53, effect size = 539, 95% CI 279.1 to 799, p < 0.001), followed by preoperative opioid use (Wald's chi square = 44.04, effect size = 5, 95% CI 4 to 7, p < 0.001)., Conclusions: A significant decrease in perioperative opioid prescribing, consumption, and opioid-related side effects was found after implementation of an opioid stewardship program. These gains were achieved without adverse effects on pain scores or LOS. These results suggest the major impact of opioid stewardship programs for spine surgery may be on changing prescriber behavior.