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OBJECTIVE Anterior cervical discectomy and fusion (ACDF) is often described as the gold standard surgical technique for cervical spondylotic radiculopathy. Although outcomes are considered favorable, there is little prognostic evidence to guide patient selection for ACDF. This study aimed to 1) describe the 24-month postoperative trajectories of arm pain, neck pain, and pain-related disability; and 2) identify perioperative prognostic factors that predict trajectories representing poor clinical outcomes. METHODS In this retrospective cohort study, patients with cervical spondylotic radiculopathy who underwent ACDF at 1 of 12 orthopedic or neurological surgery centers were recruited. Potential outcome predictors included demographic, health, clinical, and surgery-related prognostic factors. Surgical outcomes were classified by trajectories of arm pain intensity, neck pain intensity (numeric pain rating scales), and pain-related disability (Neck Disability Index) from before surgery to 24 months postsurgery. Trajectories of postoperative pain and disability were estimated with latent class growth analysis, and prognostic factors associated with poor outcome trajectory were identified with robust Poisson models. RESULTS The authors included data from 352 patients (mean age 50.9 [SD 9.5] years; 43.8% female). The models estimated that 15.5%–23.5% of patients followed a trajectory consistent with a poor clinical outcome. Lower physical and mental health–related quality of life, moderate to severe risk of depression, and longer surgical wait time and procedure time predicted poor postoperative trajectories for all outcomes. Receiving compensation and smoking additionally predicted a poor neck pain outcome. Regular exercise, physiotherapy, and spinal injections before surgery were associated with a lower risk of poor disability outcome. Patients who used daily opioids, those with worse general health, or those who reported predominant neck pain or a history of depression were at greater risk of poor disability outcome. CONCLUSIONS Patients who undergo ACDF for cervical spondylotic radiculopathy experience heterogeneous postoperative trajectories of pain and disability, with 15.5%–23.5% of patients experiencing poor outcomes. Demographic, health, clinical, and surgery-related prognostic factors can predict ACDF outcomes. This information may further assist surgeons with patient selection and with setting realistic expectations. Future studies are needed to replicate and validate these findings prior to confident clinical implementation.

OBJECTIVE In multilevel posterior cervical instrumented fusion, extension of fusion across the cervicothoracic junction (CTJ) at T1 or T2 has been associated with decreased rates of reoperation and pseudarthrosis but with longer surgical time and increased blood loss. The impact on patient-reported outcomes (PROs) remains unclear. The primary objective was to determine whether extension of fusion through the CTJ influenced PROs at 3, 12, and 24 months after surgery. The secondary objective was to compare the number of patients who reached the minimal clinically important differences (MCIDs) for the PROs, modified Japanese Orthopaedic Association (mJOA) score, operative time, intraoperative blood loss, length of stay, discharge disposition, adverse events (AEs), reoperation within 24 months of surgery, and patient satisfaction. METHODS This was a retrospective observational cohort study of prospectively collected multicenter data of patients with degenerative cervical myelopathy. Patients who underwent posterior instrumented fusion of 4 levels or greater (between C2 and T2) between January 2015 and October 2020 and received 24 months of follow-up were included. PROs (scores on the Neck Disability Index [NDI], EQ-5D, physical component summary and mental component summary of SF-12, and numeric rating scale for arm and neck pain) and mJOA scores were compared using ANCOVA and adjusted for baseline differences. Patient demographic characteristics, comorbidities, and surgical details were abstracted. The proportions of patients who reached the MCIDs for these outcomes were compared with the chi-square test. Operative duration, intraoperative blood loss, AEs, reoperation, discharge disposition, length of stay, and satisfaction was compared by using the chi-square test for categorical variables and the independent-samples t-test for continuous variables. RESULTS A total of 198 patients were included in this study (101 patients with fusion not crossing the CTJ and 97 with fusion crossing the CTJ). Patients with a construct extending through the CTJ were more likely to be female and have worse baseline NDI scores (p > 0.05). When adjusted for baseline differences, there were no statistically significant differences between the two groups in terms of the PROs and mJOA scores at 3, 12, and 24 months. Surgical duration was longer (p < 0.001) and intraoperative blood loss was greater in the group with fusion extending to the upper thoracic spine (p = 0.013). There were no significant differences between groups in terms of AEs (p > 0.05). Fusion with a construct crossing the CTJ was associated with reoperation (p = 0.04). Satisfaction with surgery was not significantly different between groups. The proportions of patients who reached the MCIDs for the PROs were not statistically different at any time point. CONCLUSIONS There were no statistically significant differences in PROs between patients with a posterior construct extending to the upper thoracic spine and those without such extension for as long as 24 months after surgery. The AE profiles were not significantly different, but longer surgical time and increased blood loss were associated with constructs extending across the CTJ.

Background: Non-penetrating head and neck trauma is associated with extracranial traumatic vertebral artery injury (eTVAI) in approximately 1–2% of cases. Most patients are initially asymptomatic but have an increased risk for delayed stroke and mortality. Limited evidence is available to guide the management of asymptomatic eTVAI. As such, we sought to investigate national practice patterns regarding screening, treatment, and follow-up domains. Methods: A cross-sectional, electronic survey was distributed to members of the Canadian Neurosurgical Society and Canadian Spine Society. We presented two cases of asymptomatic eTVAI, stratified by injury mechanism, fracture type, and angiographic findings. Screening questions were answered prior to presentation of angiographic findings. Survey responses were analyzed using descriptive statistics. Results: One hundred-eight of 232 (46%) participants, representing 20 academic institutions, completed the survey. Case 1: 78% of respondents would screen for eTVAI with computed topography angiography (CTA) (97%), immediately (88%). The majority of respondents (97%) would treat with aspirin (89%) for 3–6 months (46%). Respondents would follow up clinically (89%) or radiographically (75%), every 1–3 months. Case 2: 73% of respondents would screen with CTA (96%), immediately (88%). Most respondents (94%) would treat with aspirin (50%) for 3–6 months (35%). Thirty-six percent of respondents would utilize endovascular therapy. Respondents would follow up clinically (97%) or radiographically (89%), every 1–3 months. Conclusion: This survey of Canadian practice patterns highlights consistency in the approach to screening, treatment, and follow-up of asymptomatic eTVAI. These findings are relevant to neurosurgeons, spinal surgeons, stroke neurologists, and neuro-interventionalists.

Patient satisfaction is an important indicator used to monitor quality of care and outcomes after spine surgery.To examine the complex relationship between preoperative expectations, fulfillment of expectations, postsurgical outcomes, and satisfaction after spine surgery.In this national study of patients undergoing elective surgery for degenerative spinal conditions from the Canadian Spine Outcomes and Research Network Registry, we used logistic regression to examine the relationships between patient satisfaction with surgery (1-5 scale), preoperative expectation score (0 = none to 100 = highest), fulfillment of expectations, and disability and pain improvement.Fifty-eight percent of patients were extremely satisfied, and 3% were extremely dissatisfied. Expectations were variable and generally high (mean 79.5 of 100) while 17.3% reported that none of their expectations were met, 49.8% reported that their most important expectation was met, and 32.9% reported that their most important expectation was not met but others were. The results from the fully adjusted ordinal logistic model for satisfaction indicate that satisfaction was higher among patients with higher preoperative expectations (odds ratio [OR] [95% CI]: 1.11, [1.04-1.19]), reporting important improvements in disability (OR [95% CI]: 2.52 [1.96-3.25]) and pain (OR [95% CI]: 1.64 [1.25-2.15]) and reporting that expectations were fulfilled (OR = 80.15, for all expectations were met). The results were similar for lumbar and cervical patients.Given the dominant impact of expectation fulfillment on satisfaction level, there is an opportunity for improving overall patient satisfaction by specifically assessing and mitigating the potential discrepancies between patients' preoperative expectations and likely surgical outcomes. The findings are likely relevant across elective surgical populations.

Study design Retrospective cohort study. Objectives The primary objective was to evaluate the impact of the upper instrumented level (UIV) being at C2 vs C3 in posterior cervical construct on patient reported outcomes (PROs) up to 24 months after surgery for cervical degenerative myelopathy (DCM). Secondary objectives were to compare operative time, intra-operative blood loss (IOBL), length of stay (LOS), adverse events (AEs) and re-operation. Methodology Patients who underwent a posterior cervical instrumented fusion (3 and + levels) with a C2 or C3 UIV, with 24 months follow-up were analyzed. PROs (NDI, EQ5D, SF-12 PCS/MCS, NRS arm/neck pain) were compared using ANCOVA. Operative duration, IOBL, AEs, and re-operation were compared. Subgroup analysis was performed on patient presenting with pre-operative malalignment (cervical sagittal vertical axis ≥40 mm and/or T1slope- cervical lordosis >15°). Results 173 patients were included, of which 41 (24%) had a C2 UIV and 132 (76%) a C3 UIV. There was no statistically significant difference between the groups for the changes in PROs up to 24 months. Subgroup analysis of patients with pre-operative malalignment showed a trend towards greater improvement in the NDI at 12 months with a C2 UIV ( P = .054). Operative time, IOBL and peri-operative AEs were more in C2 group ( P < .05). There was no significant difference in LOS and re-operation ( P > .05). Conclusion In this observational study, up to 24 months after surgery for posterior cervical fusion in DCM greater than 3 levels, PROs appear to evolve similarly.

Introduction:Delayed cerebral ischemia (DCI) is a complication of aneurysmal subarachnoid hemorrhage (aSAH) and is associated with significant morbidity and mortality. There is little high-quality evidence available to guide the management of DCI. The Canadian Neurosurgery Research Collaborative (CNRC) is comprised of resident physicians who are positioned to capture national, multi-site data. The objective of this study was to evaluate practice patterns of Canadian physicians regarding the management of aSAH and DCI.Methods:We performed a cross-sectional survey of Canadian neurosurgeons, intensivists, and neurologists who manage aSAH. A 19-question electronic survey (Survey Monkey) was developed and validated by the CNRC following a DCI-related literature review (PubMed, Embase). The survey was distributed to members of the Canadian Neurosurgical Society and to Canadian members of the Neurocritical Care Society. Responses were analyzed using quantitative and qualitative methods.Results:The response rate was 129/340 (38%). Agreement among respondents was limited to the need for intensive care unit admission, use of clinical and radiographic monitoring, and prophylaxis for the prevention of DCI. Several inconsistencies were identified. Indications for starting hyperdynamic therapy varied. There was discrepancy in the proportion of patients who felt to require IV milrinone, IA vasodilators, or physical angioplasty for treatment of DCI. Most respondents reported their facility does not utilize a standardized definition for DCI.Conclusion:DCI is an important clinical entity for which no homogeneity and standardization exists in management among Canadian practitioners. The CNRC calls for the development of national standards in the definition, identification, and treatment of DCI.

OBJECTIVEDespite efforts toward achieving gender equality in clinical trial enrollment, females are often underrepresented, and gender-specific data analysis is often unavailable. Identifying and reducing gender bias in medical decision-making and outcome reporting may facilitate equitable healthcare delivery. Gender disparity in the utilization of surgical therapy has been exemplified in the orthopedic literature through studies of total joint arthroplasty. A paucity of literature is available to guide the management of lumbar degenerative disease, which stratifies on the basis of demographic factors. The objective of this study was to systematically map and synthesize the adult surgical literature regarding gender differences in pre- and postoperative patient-reported clinical assessment scores for patients with lumbar degenerative disease (disc degeneration, disc herniation, spondylolisthesis, and spinal canal stenosis).METHODSA systematic scoping review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. MEDLINE, Embase, and the Cochrane Registry of Controlled Trials were searched from inception to September 2018. Study characteristics including patient demographics, diagnoses, procedures, and pre- and postoperative clinical assessment scores (pain, disability, and health-related quality of life [HRQoL]) were collected.RESULTSThirty articles were identified, accounting for 32,951 patients. Six studies accounted for 84% of patients; 5 of the 6 studies were published by European groups. The most common lumbar degenerative conditions were disc herniation (59.0%), disc degeneration (20.3%), and spinal canal stenosis (15.9%). The majority of studies reported worse preoperative pain (93.3%), disability (81.3%), and HRQoL (75%) among females. The remainder reported equivalent preoperative scores between males and females. The majority of studies (63.3%) did not report preoperative duration of symptoms, and this represents a limitation of the data. Eighty percent of studies found that females had worse absolute postoperative scores in at least one outcome category (pain, disability, or HRQoL). The remainder reported equivalent absolute postoperative scores between males and females. Seventy-three percent of studies reported either an equivalent or greater interval change for females.CONCLUSIONSFemale patients undergoing surgery for lumbar degenerative disease (disc degeneration, disc herniation, spondylolisthesis, and spinal canal stenosis) have worse absolute preoperative pain, disability, and HRQoL. Following surgery, females have worse absolute pain, disability, and HRQoL, but demonstrate an equal or greater interval change compared to males. Further studies should examine gender differences in preoperative workup and clinical course.

A retrospective study. This study assessed the clinical utility of the Spinal Instability Neoplastic Score (SINS) in relation to the surgical treatment of spinal epidural metastasis and factors important for surgical decision-making. These factors include epidural spinal cord compression (ESCC), patient prognosis and neurologic status. Queen Elizabeth II Health Sciences Centre, Halifax, Canada. We identified 285 patients with spinal metastatic disease. Data were extracted through a retrospective review. SINS and ESCC were scored based on CT and MRI, respectively. Patients were grouped into stable (35%), potentially unstable (52%), and unstable (13%) groups. The overall incidence of metastatic spinal deformity was 9%. Surgical interventions were performed in 21% of patients, including decompression and instrumented fusion (70%), decompression alone (17%), percutaneous vertebral augmentation (9%), and instrumented vertebral augmentation (5%). The use of spinal instrumentation was significantly associated with unstable SINS (p = 0.005). Grade 3 ESCC was also significantly associated with unstable SINS (p

OBJECTIVE Degenerative cervical myelopathy (DCM) is an important public health issue. Surgery is the mainstay of treatment for moderate and severe DCM. Delayed discharge of patients after DCM surgery is associated with increased healthcare costs. There is a paucity of data regarding predictive factors for discharge destination after scheduled surgery for patients with DCM. The purpose of this study was to identify factors predictive of home versus nonhome discharge after DCM surgery. METHODS Patients undergoing scheduled DCM surgery who had been enrolled in a prospective DCM substudy of the Canadian Spine Outcomes and Research Network registry between January 2015 and October 2020 were included in this retrospective analysis. Patient data were evaluated to identify potential factors predictive of home discharge after surgery. Logistic regression was used to identify independent factors predictive of home discharge. A multivariable model was then used as a final model. RESULTS Overall, 639 patients were included in the initial analysis, 543 (85%) of whom were discharged home. The mean age of the entire cohort was 60 years (SD 11.8 years), with a BMI of 28.9 (SD 5.7). Overall, 61.7% of the patients were female. The mean length of stay was 2.72 days (SD 1.7 days). The final internally validated bootstrapped multivariable model revealed that younger age, higher 9-Item Patient Health Questionnaire score, lower Neck Disability Index scores, fewer operated levels, mJOA scores indicating mild disease, anterior cervical discectomy and fusion procedure, and no perioperative adverse effects were predictive of home discharge. CONCLUSIONS Younger age, less neck-related disability, fewer operated levels, more significant depression, less severe myelopathy, anterior cervical discectomy and fusion procedure, and no perioperative adverse effects are predictive of home discharge after surgery for DCM. These factors can help to guide clinical decision-making and optimize postoperative care pathways.

Anthropogenic environmental change negatively effects human health and is increasing health-care system demand. Paradoxically, the provision of health care, which itself is a substantial contributor to environmental degradation, is compounding this problem. There is increasing willingness to transition towards sustainable health-care systems globally and ensuring that strategy and action are informed by best available evidence is imperative. In this Personal View, we present an interactive, open-access database designed to support this effort. Functioning as a living repository of environmental impact assessments within health care, the HealthcareLCA database collates 152 studies, predominantly peer-reviewed journal articles, into one centralised and publicly accessible location, providing impact estimates (currently totalling 3671 numerical values) across 1288 health-care products and processes. The database brings together research generated over the past two decades and indicates exponential field growth.

The origin of second harmonic generation (SHG) signal in otoconia was investigated. SHG signal intensity from otoconia was compared to pure calcite crystals, given calcite is the primary component of otoconia and is known to emit surface SHG. The SHG intensity from calcite was found to be ∼41× weaker than the SHG intensity from otoconia signifying that the SHG signal from otoconia is likely generated from the organic matrix. Furthermore, the SHG intensity from otoconia increased when treated with a chelating agent known to dissolve calcite which confirms that calcite is not the source of SHG. Additionally, polarization-resolved SHG microscopy imaging revealed that the arrangement of the SHG emitters is radial and can form highly ordered domains.

Surgical decompression is usually offered for improvement of neurogenic claudication in patients with symptomatic lumbar canal stenosis. These patients often have associated low back pain (LBP) and little is known about the effect of decompression on this symptom.The goal of the present study is to specifically quantify the improvement in LBP following surgical decompression for lumbar canal stenosis and to identify factors associated with changes in LBP in this population.This is a multicenter, retrospective review of consecutive spine surgery patients enrolled by the Canadian Spine Outcomes and Research Network.Consecutive patients who underwent surgical treatment for symptomatic lumbar spine stenosis without instability between 2014 and 2017.Change in LBP on the Numeric Rating Scale (NRS).Patient-reported outcomes were collected at baseline and at 3, 12, and 24 months after surgery. The primary outcome was change in LBP on the NRS. Multivariable logistic regression was used to model the relationship between the outcome and potential factors associated with achieving minimal clinical important difference in back pain using a backward selection procedure.In all, 1,221 patients were included in the analysis. Mean age was 64 years and 58% were males. Baseline back pain scores were available in 1,133 patients and follow-up evaluations were available in 968/1,133 (85%) patients at 3 months, 649/903 (72%) patients at 12 months, and 331/454 (73%) at 24 months. LBP significantly improved 3 months after surgery and the improvement was sustained at 24 months (p.001). We found that 74% of patients reached the minimal clinical important difference in back pain. Predictive factors for sustained improvement (12 and 24 months) in LBP after surgical intervention were absence of narcotic usage or compensation claims and increased severity of LBP before surgery (high NRS).Alleviation of clinically significant LBP was observed at 3 months after lumbar decompression surgery for neurogenic claudication and was maintained at 12 and 24 months after surgery in the majority of patients.

BACKGROUND CONTEXT Traumatic cauda equina injury (TCEI) is usually caused by spine injury at L1 or below, and can result in motor and/or sensory impairments and/or neurogenic bowel and bladder. PURPOSE This study was undertaken to examine the factors that can potentially predict motor, sensory, bowel, and bladder function to aid in prognosis and optimal management. STUDY DESIGN/SETTING Prospective cohort study. PATIENT SAMPLE The study cohort included individuals with any neurological severity of injury (American Spinal Injury Association Impairment Scale [AIS] A to D) and single neurological levels from L1 up to and including S3 at admission to acute care at an RHSCIR facility as assessed using the International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI). Patients were not required to have bowel and/or bladder dysfunction at admission to acute care. OUTCOME MEASURES Lower extremity motor score (LEMS), neurological level of injury, and voluntary anal contraction (VAC) were obtained from the admission and discharge International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) examination. Change in bowel and bladder function was assessed by the Functional Independence Measure (FIM), and walking status was assessed by either FIM or Spinal Cord Independence (SCIM) at admission and discharge. METHODS Multiple logistic regression analysis was used to determine which of the following variables were associated with independent walking in a predictive model: age at the time of injury, sex, neurological level of injury (categorized as 3 groups), time from injury to surgery, LOS in an acute care facility, LOS in a rehabilitation facility, and rehabilitation onset. Multiple linear regression analyses were performed to determine which of the above variables were associated with the following dependent variables: (a) change in LEMS; and (b) change in bowel and bladder scores. Stepwise variable selection methods (p-values for a variable to enter and stay in the model set to 0.30 and 0.10 respectively) were applied to all regression models. Four final models obtained included significant predictors from stepwise variable. RESULTS The cohort included 214 participants who were predominantly male (76.6%) with a mean age of 39.9±17.3 years who mostly had a fall-related injury (48.8%) at the L1 neurological level (48.1%). Multiple logistic regression analysis indicated that independent walking at discharge was associated with male sex, surgery later than 24 hours from injury, and longer length of stay (LOS) in the acute and rehabilitation facilities. Multiple linear regression analysis showed that shorter time from injury to rehabilitation facilities and longer rehabilitation LOS were significant independent predictors of improvement in bowel function. Further, older age, female sex, and longer rehabilitation LOS were associated with improvement in bladder function. Greater LEMS improvement was associated with having a spine injury at the L1 level (vs L3-S3). CONCLUSIONS Our results suggest that independent walking after TCEI is associated with sex, time of surgery, and in-patient LOS. Bowel and bladder function recovery was improved in those with longer rehabilitation LOS, and bladder function recovery was improved in females. Older age and longer time to surgery were associated with improved bladder function. This study provides key information for rehabilitation goal planning and communication with individuals and their families with regards to prognostication. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction internationally; however, few studies have evaluated return to work (RTW) after CSM surgery. PURPOSE Our goals were to determine rates and predictors of postoperative RTW and to compare postoperative rates to a lumbar spondylolisthesis cohort. STUDY DESIGN/SETTING Retrospective review of prospectively-collected data. PATIENT SAMPLE Non-retired patients undergoing surgical decompression for CSM. OUTCOME MEASURES Return to work (ie, active employment) at 1-year following surgery. METHODS Data were derived from the CSORN prospective, multi-center surgical CSM registry. From this cohort, we included all non-retired patients with at least 1-year follow-up. RTW rate was defined as the proportion of patients with active employment at 1-year from the time of surgery. Bivariable and multivariable logistic regression were used to identify patient, disease and treatment variables predicting RTW. RESULTS Of 211 surgically treated CSM patients with 1-year follow-up, 102 (48.3%) were considered non-retired preoperatively, with 54.5% working and 45.5% not working in the immediate period before surgery. At 1-year, 60 patients (58.8%) had returned to work, while 42 (41.2%) were not working. In bivariable analyses, while working preoperatively predicted postoperative RTW(p 0.05). In multivariable analyses, only preoperative employment status predicted RTW, with those working pre-op having 12 times greater odds of working at 12 months postoperative (OR:12.1,95%CI:2.2,66.5). For comparison, the 1-year post-surgical RTW rate in the CSORN lumbar spondylolisthesis study cohort was 70.0%. CONCLUSIONS The majority (58.8%) of non-retired patients undergoing surgery for CSM had returned to work 12 months postoperative; preoperative work status was the only significant predictor of RTW in this analysis. RTW rates appear to be lower in CSM compared to lumbar spondylolisthesis. These results will help to inform preoperative patient counseling, enable economic analyses and serve as a focus for future quality improvement efforts. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT As the incidence of traumatic spinal cord injury (tSCI) in the elderly rises, clinicians are frequently faced with difficult decisions regarding the goals of management and the need to discuss prognosis with the patient and their families. Traumatic spinal cord injury can have potentially devastating consequences, particularly in an elderly population. PURPOSE The objectives of this study were to determine the specific factors associated with mortality in the elderly following tSCI and develop a simple clinical tool to predict mortality in the acute setting. STUDY DESIGN/SETTING A single quaternary spinal referral center. PATIENT SAMPLE All patients from our prospectively collected database with traumatic SCI aged >65 years, from 2007-2014. OUTCOME MEASURES The main outcome measure was in-hospital mortality with data also collected on patient demographics, injury factors and treatment course. METHODS Prospectively collected data of all elderly patients (≥65 years) within the national Rick Hansen SCI registry from 2004 to 2017 were analyzed using bivariate and multivariate analyses to determine what factors were associated with in-hospital patient mortality. RESULTS A total of 1,382 patients were divided into three groups: 65-69 years, 70-74 years and ≥75 years of age. Overall in-hospital mortality was 15.8% with 218 deaths. The factors associated with mortality included age, injury severity (AIS grade), level of injury, and ISS. Mortality rates were highest in the most elderly (65-69 yrs 7.8%, 70-74yrs 10.6%, ≥75yrs 24%). Those with AIS A injuries had a mortality of 30.6% (OR 6.0, p 25 was strongly associated with mortality (p 25 were twice as likely to die in hospital. Of the survivors, only 37% were discharged home. CONCLUSIONS Increasing age, level of injury and AIS grade are strongly associated with mortality in elderly tSCI patients. Using these factors, we can establish a tool for predicting in-patient mortality that may help surgeons with decision-making around goals of management and with communication of prognosis to patients and their families. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Recent evidence suggests that sagittal alignment may play a role in the presentation and management of patients with cervical spondylotic myelopathy (CSM) but its importance has not been fully established. PURPOSE Our objectives were to evaluate the extent to which (1) preoperative sagittal alignment is associated with baseline function and symptoms, (2) surgery leads to changes in sagittal alignment, and (3) postoperative sagittal alignment is associated with function and symptoms at follow-up. STUDY DESIGN/SETTING We performed an observational cohort study using prospectively collected data from the Canadian Spine Outcomes and Research Network (CSORN). PATIENT SAMPLE We included consecutive patients who were diagnosed with CSM by participating surgeons at seven centers between 2015 and 2017. OUTCOME MEASURES mJOA, NDI, VAS, SF12 and EQ5D. METHODS We measured sagittal alignment using two methods: surgeon classification and Ishihara's Cervical Curvature Index (ICCI). We measured function and symptoms with multiple Patient Reported Outcome Measures (PROMs), and we adjusted for age, gender, severity, and comorbidities using multiple linear regression. RESULTS Among 474 patients, baseline alignment was neutral in 196 (41%), lordotic in 190 (40%), and kyphotic in 88 (19%). In unadjusted analyses, baseline kyphosis was associated with significantly worse EuroQol 5D (p CONCLUSIONS In patients with CSM, baseline alignment is not associated with differences in impairment of health-related quality of life after adjusting for potential confounders. Surgery for CSM increases lordosis and improves symptoms and function regardless of baseline alignment, but postoperative sagittal alignment does not seem to be associated with final patient-reported outcomes. Our findings suggest that sagittal alignment restoration may not be critical for improving PROMs in the surgical management of patients with CSM, and that surgeons may prioritize the technical goals of neurological decompression and stabilization. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT The importance of sagittal balance and spinopelvic parameters are recognized in the management and outcomes of adult spinal deformity and isthmic spondylolisthesis, but less is known regarding their role in degenerative lumbar spondylolisthesis (DLS). The purpose of this study is to determine the influence of baseline sagittal balance and spinopelvic parameters on pain, function, and health-related quality of life (HRQOL) of patients presenting with DLS. PURPOSE The purpose of this study is to determine the influence of baseline sagittal balance and spinopelvic parameters on pain, function, and health-related quality of life (HRQOL) of patients presenting with DLS. STUDY DESIGN/SETTING Prospective, multi-center study from the Canadian Spine Outcome and Research Network (CSORN). PATIENT SAMPLE Patients with DLS were enrolled in a prospective, multi-center study between 2015 and 2017. Inclusion into this study required DLS at 1 or 2 levels and symptoms of neurogenic claudication or radicular pain with our without back pain. Patients were excluded if they had previous lumbar spine surgery or the presence of another condition which significantly affected function OUTCOME MEASURES Patient-rated outcome measures included the Numeric Pain Rating Scale (NPRS) for back pain and leg pain, Oswestry Disability Index (ODI), SF-12 Physical Component Summary score (PCS) and Mental Component Summary score (MCS), EQ-5D. Pelvic parameter measurements included: sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), sagittal vertical axis (SVA), lumbar lurdosis (LL), thoracic kyphosis (TK), T1 spino-pelvic inclination (T1 SPI), and T9 spino-pelvic inclination (T9 SPI). METHODS Baseline patient demographics, radiographic spinopelvic parameters, and sagittal alignment were analyzed for possible correlation to HRQOL using Pearson correlations. RESULTS A total of 154 patients were analyzed (mean age: 65.8, BMI: 29.1) with grade I (72%) or II (28%) DLS, of which 95 were females. Primary symptoms were related to neurogenic claudication (80%), radiculopathy (15.3%) or back pain (4.7%). On average, symptom duration was greater than 2 years in 71% of patients. Patients had moderate to severe symptoms and disability (mean NRS back: 7.2, NRS leg: 7.3, ODI: 45.6, PCS-12: 33.2, MCS-12: 49.6, EQ-5D: 0.54). Baseline measurements of radiographic alignment included sacral slope (SS=34.9±16.7°), pelvic tilt (PT=24.8±9.5°), pelvic incidence (PI=57.4±13.8°), sagittal vertical axis (SVA=35.8±40.8mm), lumbar lordosis (LL=45.7±13.6°), thoracic kyphosis (TK=36.8±13.0°), T9-spinopelvic inclination (T9SPI=9.62±4.0°), and T1-spinopelvic inclination (T1SPI=4.43±10.4°). There were 54% of patients who had an insufficient lumbar lordosis based on the relationship between PI and LL (LL CONCLUSIONS Patients with DLS have global sagittal misalignment compared to published normative controls, highlighted by less lumbar lordosis, a PI to LL mismatch, and increased PT. Spinopelvic alignment was not associated with patient outcomes, although positive sagittal balance may also be influenced by spinal stenosis. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Cervical spondylotic myelopathy (CSM) is the leading cause of spinal cord impairment. Prompt surgical intervention halts clinical deterioration and results in clinical improvement in most patients; however, in a public health care system, wait times to see a spine specialist and eventually access surgical treatment may be substantial. PURPOSE The goals of this study were to assess the consultation wait time (CWT) and the surgical wait time (SWT), as well as to identify predictors of wait time length in this population. STUDY DESIGN/SETTING Consecutive patients enrolled in the Canadian Spine Outcomes and Research Network (CSORN) prospective, observational CSM study from March 2015 to July 2017 were included. Predictors of CWT and SWT were assessed using survival analysis. Results were stratified by disease severity based on the mJOA. A data-splitting technique was used to develop and test the multivariable models looking at potential predictive factors. PATIENT SAMPLE We conducted a multicentre, ambispective review of consecutive spine surgery patients enrolled by the CSORN between March 2015 and July 2017. OUTCOME MEASURES Symptom duration, pain, spinal cord compression and the physical components of SF-12. METHODS Predictors of CWT and SWT were assessed using survival analysis. Results were stratified by disease severity based on the mJOA. A data-splitting technique was used to develop and test the multivariable models looking at potential predictive factors. RESULTS CSORN query returned 264 CSM patients for CWT (88 female and 176 male). Mean age was 59.4years. The median CWT was 46days. There were 31% mild, 35% moderate and 33% severe CSM. There was a statistically significant difference in median CWT between moderate and severe groups. There were 207 patients who underwent surgical treatment. Median SWT was 42days. There was a statistically significant difference between mild or moderate and severe groups. Short symptom duration, less pain, radiologic cord compression, lower BMI and lower PCS scores were predictive of shorter CWT. On the other hand, SWT was mainly affected by pain and symptom duration. Both CWT and SWT were shorter for CSM patients compared to lumbar stenosis patients (P CONCLUSIONS CSM patients with more severe symptoms had a shorter CWT and SWT. Patients with short symptom duration, less pain and spinal cord compression waited less to see a spine specialist in Canada. Patients with less pain, and symptom duration less than a year had shorter SWT.

Oxidative stress leading to lipid peroxidation is a major cause of secondary injury following spinal cord injury (SCI). The objectives of this study were to determine the duration of lipid peroxidation following acute SCI and the efficacy of short-and long-term administration of methylprednisolone on decreasing lipid peroxidation.A total of 226 female Wistar rats underwent clip-compression induced SCI. In the first part of the study, spinal cords of untreated rats were assayed colorimetrically for malondialdehyde (MDA) to determine lipid peroxidation levels at various time points between 0 and 10 days. In the second part of the study, animals were treated with methylprednisolone for either 24 hours or 7 days. Control animals received equal volumes of normal saline. Treated and control rats were killed at various time points between 0 and 7 days.The MDA levels initially peaked 4 hours postinjury. By 12 hours, the MDA levels returned to baseline. A second increase was observed from 24 hours to 5 days. Both peak values differed statistically from the trough values (p0.008). The methylprednisolone reduced MDA levels (p0.04) within 12 hours of injury. No effect was seen at 24 hours or later.The results of this study indicate that oxidative stress persists for 5 days following SCI in rats, and although methylprednisolone reduces MDA levels within the first 12 hours, it has no effect on the second lipid peroxidation peak.

Management of upper thoracic spinal fractures continues to be a challenging task for spinal surgeons. Appropriate treatment depends on a variety of factors, including the nature of the fracture, the need for neural decompression, and the need for spinal stabilization. A number of surgical approaches have been developed to address these lesions. Each approach carries its own inherent advantages and disadvantages and an understanding of each is required to optimize the treatment of any individual patient. As our surgical experience and expertise continues to grow in the field of minimally invasive surgery, these techniques and novel approaches will provide alternatives for our patients that will maintain the current quality of care but minimize surgical trauma and improve recovery times.

trans-[FeIII(cyclam)][{Fc(CO2)2}2H], 1, (cyclam = 1,4,8,11-tetraazacyclotetradecane; [Fc(CO2)2]2–= 1,1′-ferrocenedicarboxylate) strictly self-assembles via FeIII–carboxylate covalent bonds and hydrogenbiscarboxylate hydrogen bonds to form a one-dimensional polymer that contains the first crystallographically characterized FeIIIN4O2 chromopore.