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Ossification of the posterior longitudinal ligament (OPLL) occurs as heterotopic bone forms in the posterior longitudinal ligament, resulting in neural compression, myelopathy, and radiculopathy. OPLL is most commonly observed in East Asian populations, with prevalence rates of 1.9% to 4.3% reported in Japan. OPLL rates are lower in North American and European patients, with reported prevalence of 0.1% to 1.7%. Patients typically develop symptoms due to OPLL in their cervical spines. The etiology of OPLL is multifactorial, including genetic, metabolic, and anatomic factors. Asymptomatic or symptomatic patients with OPLL can be managed nonsurgically, whereas patients with neurologic symptoms may require surgical decompression from an anterior, posterior, or combined approach. Surgical treatment can provide notable improvement in neurologic function. Surgical decision making accounts for multiple factors, including patient comorbidities, neurologic status, disease morphology, radiographic findings, and procedure complication profiles. In this study, we review OPLL epidemiology and pathophysiology, clinical features, radiographic evaluation, management, and complications.

Retrospective review of prospectively collected multicenter registry data.The aim of this study was to determine whether surgical variables and complications as graded by treatment severity impact postoperative hospital length of stay (LOS).Surgical treatment can substantially improve quality of life for patients with adult spinal deformity (ASD). However, surgical treatment is associated with high complication rates, which may impact hospital LOS. Classifying complications by severity of subsequent treatment may allow surgeons to better understand complications and predict their impact on important outcome metrics, including LOS.Patients enrolled in a multicenter, prospectively enrolled database for ASD were assessed for study inclusion. Complications were graded based on intervention severity. Associations between LOS, complication intervention severity, and surgical variables (fusion length, use of interbody fusion, use of major osteotomy, primary versus revision surgery, same day vs. staged surgery, and surgical approach), were assessed. Two multivariate regression models were constructed to assess for independent associations with LOS.Of 1183 patients meeting inclusion criteria, 708 did not and 475 did experience a perioperative complication during their index hospitalization, with 660 and 436 included in the final cohorts, respectively. Among those with complications, intervention severities included 14.9% with no intervention, 68.6% with minor, 8.9% with moderate, and 7.6% with severe interventions. Multivariate regression modeling demonstrated that length of posterior fusion, use of major osteotomy, staged surgery, and severity of intervention for complications were significantly associated with LOS.Careful selection of surgical factors may help reduce hospital LOS following surgery for ASD. Classification of complications by treatment severity can help surgeons better understand and predict the implications of complications, in turn assisting with surgical planning and patient counseling.Level of Evidence: 4.

Cervical radiculopathy (CR) is commonly treated by spine surgeons, with surgical options including anterior cervical diskectomy and fusion (ACDF) and cervical disk replacement (CDR). CDR is a motion-sparing alternative to ACDF and was approved by the US FDA in 2007. CDR utilization has increased because evidence has emerged demonstrating its long-term efficacy. Despite CDR's efficacy, studies have suggested that socioeconomic factors may influence which patients undergo CDR versus ACDF. Our objective was to determine whether gender, racial, and ethnic disparities exist in the utilization of CDR versus ACDF for CR.Patients age ≥18 years undergoing elective CDR or ACDF for CR between 2017 and 2020 were identified in the Vizient Clinical Database. Proportions of patients undergoing CDR and ACDF, as well as their comorbidities, complications, and outcomes, were compared by sex, race, and ethnicity. Bonferroni correction was done for multiple comparisons.A total of 7,384 patients, including 1,427 undergoing CDR and 5,957 undergoing ACDF, were reviewed. Black patients undergoing surgical treatment of CR were less likely to undergo CDR than ACDF, had a longer length of stay, and had higher readmission rates, while Hispanic patients had higher complication rates than non-Hispanic patients.Important racial and ethnic disparities exist in CR treatment. Interventions are necessary to ensure equal access to spine care by reducing barriers, such as underinsurance and implicit bias.IV (Case Series).

OBJECTIVE The authors’ objective was to determine whether preoperative lateral extension cervical spine radiography can be used to predict osteotomy type and postoperative alignment parameters after cervical spine deformity surgery. METHODS A total of 106 patients with cervical spine deformity were reviewed. Radiographic parameters on preoperative cervical neutral and extension lateral radiography were compared with 3-month postoperative radiographic alignment parameters. The parameters included T1 slope, C2 slope, C2–7 cervical lordosis, cervical sagittal vertical axis, and T1 slope minus cervical lordosis. Associations of radiographic parameters with osteotomy type and surgical approach were also assessed. RESULTS On extension lateral radiography, patients who underwent lower grade osteotomy had significantly lower T1 slope, T1 slope minus cervical lordosis, cervical sagittal vertical axis, and C2 slope. Patients who achieved more normal parameters on extension lateral radiography were more likely to undergo surgery via an anterior approach. Although baseline parameters were significantly different between neutral lateral and extension lateral radiographs, 3-month postoperative lateral and preoperative extension lateral radiographs were statistically similar for T1 slope minus cervical lordosis and C2 slope. CONCLUSIONS Radiographic parameters on preoperative extension lateral radiography were significantly associated with surgical approach and osteotomy grade and were similar to those on 3-month postoperative lateral radiography. These results demonstrated that extension lateral radiography is useful for preoperative planning and predicting postoperative alignment.

In this article, we reported the elaboration of a nonenzymatic glucose sensor based on the polyaniline-supported Cu-CuO core-shell structure prepared on the 316L stainless steel electrode by electrochemical methods. In the first step, polyaniline (PANI) film was electrodeposited on the 316L substrate from a solution of 0.1 M aniline and 0.5 M sulfuric acid in absolute ethanol by the cyclic voltammetry (CV) method. In the second step, the copper particles were electrodeposited on the PANI film from CuCl2·2H2O 0.01 M precursor prepared in a KCl 0.1 M solution by the CV method. In the third step, Cu particles were partially oxidized to CuO by the CV method in a NaOH 0.1 M electrolyte to form a Cu-CuO core-shell structure supported on the PANI film. The as-prepared electrode (Cu-CuO/PANI/316L) was used to detect glucose in a NaOH 0.1 M solution. The Cu-CuO/PANI/316L sensor exhibited a linear range of 0.1–5 mM (R2 = 0.995) with a detection limit of 0.1 mM (S/N = 3) and high sensitivity of (25.71 mA·mM−1·cm−2). In addition, no significant interference was observed from sucrose, maltose, lactose, and ascorbic acid. The results showed that the polyaniline-supported Cu-CuO core-shell structure has the potential to be applied as an electrode material for the nonenzymatic glucose sensor.

BACKGROUND CONTEXT Screening asymptomatic blunt trauma patients for cervical arterial injury is controversial. Vertebral artery injury (VAI) is most commonly associated with cervical spine fracture and some guidelines advocate indiscriminate screening of all cervical spine fractures. PURPOSE To determine whether the addition of computed tomography angiography (CT-A) resulted in a change in management for patients with cervical spine fractures. STUDY DESIGN/SETTING Propensity score matching cohort study. Participants of this study originated from two large academic trauma centers located in a single city. PATIENT SAMPLE Adult patients with acute cervical spine fractures sustained after blunt trauma between 2000 and 2015 were included. Patients with penetrating trauma, neoplasm and prior cervical spine surgery were excluded. There were 3,943 patients screened for inclusion and 2,831 patients eligible. OUTCOME MEASURES Recommendation for a change in management with antithrombosis was the primary outcome measure. Detection of stroke and vertebral artery injury were secondary outcomes. METHODS Demographic data, cervical spine fracture characteristics, utilization of CT-A, presence of vertebral artery injury and outcome were extracted from the medical record. Logistic regression identified factors associated with obtaining a CT-A. Propensity score matching was performed to negate the significant baseline characteristic differences including age, race, medical comorbidities, injury burden, mechanism of injury, upper cervical spine fracture, foramen transversarium involvement, multilevel involvement and associated facet dislocation. This resulted in one cohort receiving CT-A and one cohort that did not, both with 644 patients and equivalent demographic and clinical characteristics. The score matched patients who obtained CT-A with those who obtained CT alone to create two statistically equivalent cohorts. RESULTS In the matched cohorts, average age was 59 years and 57% of each cohort was male. CT-A identified definite or indeterminate VAI in 113 patients and 62 patients had antithrombosis recommended. In the cohort without CT-A, VAI was discovered in 11 patients incidentally through other imaging and eight were recommended antithrombosis. Two patients in the CT-A group had major adverse bleeding events as a result of antithrombosis initiation. There were no preventable strokes in either group. CONCLUSIONS The addition of CT-A increased the detection of VAI and antithrombosis recommendation. There was a high incidence of indeterminate CT-A findings. There were no preventable strokes in either cohort and two major adverse bleeding events as a result of recommended pharmacologic antithrombosis. Non-selective screening is not warranted and should be limited to a high-risk subset of patients. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

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