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INTRODUCTION: Osteoporotic vertebral compression fracture (OVCF) is a growing health care problem in today’s aging population. Since the advent of kyphoplasty and vertebroplasty, these interventions have been commonly utilized in the treatment of symptomatic OVCF. However, the use of these interventions varies because there is not a standard of care for the management of OVCF. There remain disparities in the use of these procedures as treatment for OVCFs in the United States. METHODS: The 2012 to 2016 Nationwide Inpatient Sample was queried for all patients admitted for OVCF. These patients were then grouped based on whether they received conservative vs surgical (kyphoplasty/vertebroplasty) management and compared with respect to various socioeconomic factors including race, insurance coverage, income quartile, hospital control, and geography. Propensity score matching was utilized to control for potential baseline confounders as well as the influence of other endpoints. RESULTS: The search criteria identified 35,199 patients admitted with OVCF, of whom 7900 (22.4%) received spine augmentation. Blacks/African Americans (risk ratios [RR] = 0.79, P < 0.001), Hispanics/Latinos (RR = 0.82, P < 0.001), Asians/Pacific Islanders (RR = 0.81, P = 0.048), and unknown/other races (RR = 0.88, P = 0.037) were less likely to receive surgical management than whites/Caucasians. When compared with Medicare patients, those with Medicaid (RR = 0.76, P < 0.001) were less likely to receive surgery while privately insured patients were more likely (RR = 1.06, P = 0.42). Patients in the West (RR = 0.90, P < 0.001) were less likely to receive surgery for OVCF than those in the Northeast. CONCLUSIONS: A wide variety of socioeconomic disparities exists in the use of spinal augmentation for the management of OVCF in the United States, limiting patient access to a potentially beneficial procedure. CLINICAL RELEVANCE: Retrospective Analysis. LEVEL OF EVIDENCE: 3.

Mandana Behbahani,1,2 Nathan Shlobin,1,2 Colleen Rosen,1 Elizabeth Yerkes,3,4 Vineeta Swaroop,5,6 Sandi Lam,1,2 Robin Bowman1,2 1Division of Pediatric Neurosurgery, Ann and Robert H Lurie Children’s Hospital of Chicago, Chicago, IL, USA; 2Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; 3Division of Pediatric Urology, Ann and Robert H Lurie Children’s Hospital of Chicago, Chicago, IL, USA; 4Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; 5Division of Pediatric Orthopedic Surgery, Ann and Robert H Lurie Children’s Hospital of Chicago, Chicago, IL, USA; 6Department of Orthopedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USACorrespondence: Robin BowmanDivision of Pediatric Neurosurgery, Director of Spina Bifida Program, Lurie Children’s Hospital, 225 E. Chicago Ave., Chicago, IL 60611, USATel +1 312 227 4220Fax +1 312 227 9679Email rbowman@luriechildrens.orgIntroduction: Multidisciplinary care for patients with tethered spinal cord syndrome (TCS) is valuable in ensuring comprehensive evaluation, timely follow-up, optimal functional outcome, and patient-centered care. The family-centered focus aims to minimize patient and parental burdens associated with care coordination. We present our first-year institutional experience in operationalizing a multidisciplinary, patient-centered, pediatric tethered cord clinic (TCC) to manage routine, long-term surgical follow-up for children with non-myelomeningocele-related tethered spinal cords.Methods: TCC is composed of three surgical services: orthopedic surgery, neurosurgery, urology. A retrospective chart review of patients seen in the TCC from January 2019 to January 2020 was conducted. Patients enrolled in the clinic were intended for long-term follow-up. Demographic and outcome variables were collected.Results: Fifty-nine patients were seen in TCC. Types of tethered spinal cords amongst these patients were the following: fatty filum (62.7%), dermal sinus tract (15.2%), meningocele manqué (8.4%), lipomyelomeningocele (6.7%), low lying conus medullaris (5.1%), and sacral arachnoid cyst (1.7%). Age at diagnosis was 1.31 ± 2.21 (median: 0.25 years) and at follow-up was 9.0 ± 5.18 years (median: 8 years). A total of 50.9% of patients were female, and 93.2% had a prior untethering procedure. Of all patients, 6.8% have no surgical intervention and continue to be monitored conservatively for evidence of decline. All three services evaluated 84.8% of patients during the same clinic session, while 15.3% of patients were seen by two of the services, and 20.3% of patients were able to schedule related imaging or diagnostic testing during the same visit.Conclusion: We describe successful implementation of a multidisciplinary pediatric TCC and document the first year of experience. The TCC streamlines care, decreases burden on families, and reduces those lost to follow-up. Complex disease pathologies, even when clinically stable, require long-term follow-up with multiple subspecialties and benefit from multidisciplinary clinics.Keywords: neural tube defect, tethered cord, pediatric spine, neurogenic bladder, multidisciplinary care, ambulatory efficiency

sj-docx-1-gsj-10.1177_2192568220951137 for Disparities in Rates of Fusions in Lumbar Disc Pathologies by Soobin Kim, James S. Ryoo, Philip B. Ostrov, Abhinav K. Reddy, Mandana Behbahani and Ankit I. Mehta in Global Spine Journal

It is of special significance to find a safe and effective vaccine against coronavirus disease 2019 (COVID-19) that can induce T cell and B cell -mediated immune responses. There is currently no vaccine to prevent COVID-19. In this project, a novel multi-epitope vaccine for COVID-19 virus based on surface glycoprotein was designed through application of bioinformatics methods. At the first, seventeen potent linear B-cell and T-cell binding epitopes from surface glycoprotein were predicted in silico, then the epitopes were joined together via different linkers. The immunogenicity of these epitopes was identified using IFN-γ ELIspot assays. The IFN-γ producing T cell variation ranged from 11.1 ±1.2 SFU to 38.2 ± 2.1 SFU per 10 6 PBMCs. One final vaccine was constructed which composed of 398 amino acids and attached to 50S ribosomal protein L7/L12 as adjuvant. Physicochemical properties, as well as antigenicity in the proposed vaccines, were checked for defining the vaccine stability and its ability to induce cell-mediated immune responses. Three-dimensional structure of the mentioned vaccine was subjected to the molecular docking studies with MHC-I and MHC-II molecules. The results proposed that the multi-epitope vaccine with 50S ribosomal protein L7/L12 was very stable with high aliphatic content and high antigenicity.

Supplementary_Material for Disparities in Rates of Fusions in Lumbar Disc Pathologies by Soobin Kim, James S. Ryoo, Philip B. Ostrov, Abhinav K. Reddy, Mandana Behbahani and Ankit I. Mehta in Global Spine Journal