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To investigate the effect of surgical stabilization for patients with metastatic spinal disease on objective mobility metrics. A retrospective chart review identified patients who had mechanical back pain from metastatic spinal disease and underwent spinal stabilization during 2017. Mobility metrics, the Activity Measure for Post-Acute Care (AM-PAC) inpatient mobility short form (IMSF) and the Johns Hopkins Highest Level of Mobility (JH-HLM), were reviewed. A total of 26 patients were included in the analysis with median hospital stay of 8 days. Preoperative JH-HLM scores were available for 17 patients with a mean score of 5.4, increasing to mean score of 6.6 at last follow-up (P = 0.036). Preoperative AM-PAC IMSF scores were available for 14 patients with a mean score of 19.4, decreasing slightly to a mean score of 18.7 at last follow-up (P = 0.367). Last follow-up with mobility metrics occurred a median of 6.5 days postoperatively (range: 3–66 days). Multivariable analysis showed that American Spinal Injury Association and Karnofsky Performance Status scores were significantly associated with both JH-HLM and AM-PAC mobility scores at last follow-up. A higher JH-HLM or AM-PAC score was significantly associated with direct home discharge and a higher AM-PAC score was associated with shorter hospital stay. Surgical stabilization for patients with mechanical back pain secondary to metastatic spinal disease might lead to an objective improvement in JH-HLM score. JH-HLM and AM-PAC scores may be correlated with length of hospital stay and discharge disposition. Future studies are encouraged to further characterize the role of these mobility metrics in the management plan of these patients. [ABSTRACT FROM AUTHOR]

Existing literature demonstrates well-identified racial disparities in spine surgery outcomes. However, previous studies are of significant limitations. To investigate the association of race with 30-day perioperative complication rates of elective posterior spinal fusions (PSF) for adolescent idiopathic scoliosis (AIS). Retrospective cohort study. All pediatric patients with AIS who underwent PSF between 2012-2018 were reviewed from the (ACS-NSQIP) pediatric database. Thirty-day postoperative morbidity and mortality outcomes were analyzed. Complications included perioperative blood transfusion, venous thromboembolism, unplanned intubation, pneumonia, urinary tract infection, surgical site infection, sepsis, return to operating room, and death. Hospital course data, including operative time, the total length of hospital stay, the proportion of patients needed ICU admission, the proportion of patients discharged to other than home and discharged after the 4th postoperative day were also noted. Readmission data was included. These outcome variables are predefined in the ACS-NSQIP pediatric database, except for the discharge event after the 4th postoperative day, which was considered to be any discharge event occurring after a total hospital stay of 120 hours. Propensity score matching was used to determine whether race (ie, black vs white) had an influence on 30-day perioperative complications. A total of 4,051 PSF for AIS cases met inclusion criteria and were reviewed. Of these, 3221 (79.5%) patients were white and 830 (20.5%) were black. Patients in the black cohort were more likely to have higher BMI (23.8 vs 21.1), be of female gender (78.2% vs 74.5%), have an ASA class 3 or more (13.7% vs 11.1%), have asthma (8.3% vs 4.9%), have cardiac risk factors (5.1% vs 2.6%), use steroids (3.8% vs 1.1%). In the black cohort, 8% of the cases had up to 6 vertebral segments fused, 64.4% had 7-12 vertebral segments fused and 27.6% had 13 or more vertebral segments fused. In the white cohort, 15.9% of the cases had up 6 vertebral segments fused, 57.2% had 7-12 vertebral segments fused and 26.9% had 13 or more vertebral segments fused. After controlling for differences in baseline factors, except for the higher incidence of venous thromboembolism in the black cohort (2.8% vs 0.1%), (p <0.001), there were no significant differences in morbidity and mortality between the black and white cohorts. In contrast to prior literature, our analysis did not identify black race as an independent risk factor for higher perioperative morbidity or mortality in patients undergoing PSF for AIS, except for the higher incidence of venous thromboembolism. We believe that these results are important findings for clinicians and spine surgeons while counseling patients undergoing these types of procedures. It is important to address patient's concerns and to explain that the previously reported inferior perioperative morbidity and mortality outcomes in black patients might be due differences in baseline health status, and not due to the race difference itself. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Background: C5 palsy affects approximately 5% to 10% of patients undergoing cervical spine surgery. It has a significant negative impact on patient quality-of-life outcomes and healthcare costs. Although >80% of patients improve, some are left with persistent, debilitating deficits. Our objective was to examine if electrodiagnostic testing could be used to successfully identify patients likely to experience complete, partial, and no recovery.Methods: Patients undergoing posterior cervical decompression and fusion at a single institution over a 10-year period were identified. Those experiencing postoperative C5 palsy were included. Outcomes examined included motor recovery of the affected deltoid as a function of time, and changes in electrodiagnostic testing as a function of time since injury. Electrodiagnostic testing included electromyography and was sub-analyzed by time of acquisition postinjury. Deltoid strength was graded on manual motor testing using the 5-point medical research council grading system.Results: Of 77 patients experiencing C5 palsy, 29 had postoperative electrodiagnostic testing. Patients experiencing complete recovery on average achieved functional (4/5) strength by 6-weeks post injury and 4+ per 5 strength by 6-months. Those experiencing partial recovery only achieved antigravity strength (3/5) by 6-weeks and low-function (4-/5) strength by 6-months. Electrodiagnostic testing performed 6-weeks to 6-months postinjury demonstrated that those experiencing complete recovery were more likely to have normal motor unit (MU) recruitment than those experiencing partial (p<.001) or no recovery (p=.008). The presence of ≥2+ fibrillation on tests acquired ≤6-weeks of injury identified patients unlikely to experience any recovery with a positive predictive value (PPV) of 88.9%. The presence of normal MU recruitment on tests acquired 6-weeks to 6-months postinjury identified patients likely to experience complete recovery with a PPV of 87.5%.Conclusions: Electrodiagnostic testing may be a valuable means of differentiating between patients with C5 palsy likely to experience complete, partial, or no recovery. Testing between 6-weeks and 6-months post onset may aid in identifying those least likely to have a complete recovery. No MUs at 4 to 6-months, or reduced units with strength that is not improving, portends a poor long-term outcome. In this population, peripheral nerve transfers may be considered sooner. [ABSTRACT FROM AUTHOR]

Vertebral bone quality had a significant impact on postoperative outcomes in spinal fusion surgery. New magnetic resonance imaging−based measures, such as the Vertebral Bone Quality (VBQ) score, may allow for bone quality assessment without the radiation associated with conventional testing. In the present study, we sought to assess the intrarater and interrater reliability of VBQ scores calculated by medical professionals and trainees. Thirteen reviewers of various specialties and levels of training were recruited and asked to calculate VBQ scores for 30 patients at 2 time points separated by 2 months. Scored volumes were acquired from patients treated for both degenerative and oncologic indications. Intrarater and interrater agreement, quantified by intraclass correlation coefficient (ICC), was assessed using 2-way random effects modeling. Square-weight Cohen κ and Kendall Tau-b were used to determine whether raters assigned similar scores during both evaluations. All raters showed moderate to excellent reliability for VBQ score (ICC 0.667−0.957; κ0.648−0.921) and excellent reliability for all constituent components used to calculate VBQ score (ICC all ≥0.97). Interrater reliability was also found to be good for VBQ score on both the first (ICC = 0.818) and second (ICC = 0.800) rounds of assessment; scores for the constituent component all had ICC values ≥0.97 for the constituent components. The VBQ score appears to have both good intrarater and interrater reliability. In addition, there appeared to be no correlation between score reliability and level of training. External validation and further investigations of its ability to accurately model bone biomechanical properties are necessary. [ABSTRACT FROM AUTHOR]