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The effects of anomalous vasculature impeding optimal exposure to an anterior lumbar interbody fusion approach are limited in literature. We present five individual, unique cases of vascular anomalies in patients undergoing two-stage anterior-posterior lumbar interbody fusion. Cases 1, 2, 4, and 5 have yet to be described in literature in context of anterior lumbar interbody fusions. Case 3 presents anomalous vasculature that has only been described in two other case reports. Case 1 presents the right internal iliac vein originating from the left common iliac vein which was transected for L4-L5 vertebral disc exposure. Case 2 presents the left internal iliac vein originating from the right common iliac vein which required an oblique approach. Case 3 presents a duplicated inferior vena cava that was taken into account but did not interfere with the anterior retroperitoneal approach. Case 4 presents large osteophytes adhering to the left common iliac vein which limited safe dissection and mobilization. Case 5 presents the left internal iliac vein with a high takeoff spanning across the L5-S1 vertebral disc space and requiring transection. This case series highlights the need for preoperative imaging and a working detailed knowledge of anatomy to avoid damaging vasculature that can potentially lead to fatal consequences. The information given in this case series should inform both spine and vascular surgeons on proper preoperative planning. To maximize operative efficiency and safety, spine surgeons and vascular surgeons should collaborate to minimize surgical complications. [ABSTRACT FROM AUTHOR]

Background: The incidence of degenerative cervical myelopathy (DCM) has increased over the years due to an increasing aging population, yet there is a dearth of recent comprehensive data evaluating the multiple facets of this degenerative condition. Recent publications have highlighted the biochemistry and biomechanics of DCM, which are paramount to understanding the degenerative nature of the condition and selecting the most optimal treatment options for improved patient outcomes. In addition, there have been recent studies establishing the superiority of surgical to non-surgical treatments for DCM, which until now was a poorly substantiated claim that has permeated the medical field for decades. The authors of this systematic review sought to collect and assess available high quality peer reviewed data to analyze the nature of DCM and gain a better understanding for its treatment choices., Methods: PubMed and Cochrane Central Register of Controlled Trials were systematically searched on January 19, 2023 with date restrictions of 2015-2023 imposed. For initial data collection, five independent searches were completed using the following keywords: pathogenesis, pathophysiology, and epidemiology of DCM; cervical spondylotic myelopathy (CSM) and DCM recent developments; management and treatment for CSM and DCM; diagnosis and management of DCM; and pathophysiology of DCM. The results were screened for their application to DCM; any study that did not directly address DCM were identified and removed through abstract assessment, such studies included those pertaining to alternative fields including cardiology and psychiatry. Studies found relevant through full-text assessment and those published in English were included in this study and unpublished studies and studies found irrelevant based on titles and keywords were excluded from this study. The 115 articles that met criteria were critically appraised independently by the 2 reviewers and the principles of Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) were applied to assess the quality of evidence from each study., Results: A total of 352 studies resulted from the original search. There were 71 duplicate articles that were removed and a total of 281 articles were screened. 166 articles were then removed based on the exclusion/inclusion criteria, title, and abstract. Of the 138 articles that remained, a final list of 115 articles was created based on the reporting measures., Conclusions: DCM is a multifactorial disease that has the potential to impair neurological function and cause significant paralysis. Although the multiple facets of this disease have not been fully elucidated, there have been significant breakthroughs in understanding the mechanisms involved in this disease process. The use of complex imaging modalities, genetic sequencing, biomarkers, and pharmacological agents has provided insight into the factors involved in the progression of DCM, which has consequently cultivated more refined approaches for diagnosis and treatment of DCM., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jss.amegroups.com/article/view/10.21037/jss-23-123/coif). The authors have no conflicts of interest to declare., (2024 Journal of Spine Surgery. All rights reserved.)

Introduction: The management of spinal neoplasia consists of surgical, radiation, and systemic options. Little data exist to guide management based on overall health status, which is particularly challenging when patients who could benefit from surgery may be too frail for it. This study's objective was to evaluate the 5-Item Modified Frailty Index (mFI-5) as a predictor of 30-day morbidity in patients undergoing instrumented resection for metastatic extradural spinal tumors., Methods: Adults undergoing extradural tumor resection from the 2011 to 2019 National Surgical Quality Improvement Program datasets were identified by Current Procedural Terminology codes 63275-63278 with an adjunct instrumentation code (22840-22843). Patients were classified into frailty levels 0, 1, or 2+ based on mFI-5 scores of 0, 1, or 2-5, respectively. The primary outcome was morbidity. Secondary outcomes were readmission and reoperation. Multivariate modeling was utilized to analyze mFI-5 as a predictor of outcomes. The Akaike information criterion (AIC) was used to compare relative-model-fit based on frailty versus individual comorbidity variables to determine the optimal model. Chi-squared and Fisher's exact tests were used to establish significance between individual complications and frailty., Results: There were 874 patients. Readmission, reoperation, and morbidity rates were 19.5%, 5.0%, 52.3%, respectively. In multivariate analyses, mFI-5=1 (OR: 1.45, SE: 0.31, p=0.036), mFI-5=2+ (OR: 1.41, SE: 0.40, p=0.036), operative time (OR: 1.18, SE: 0.03, p≤0.001), and chronic steroid use (OR: 1.56, SE: 0.42, p=0.037) independently predicted morbidity. Elective surgery (OR: 0.61) was protective. Frailty did not predict readmission or reoperation. Frailty was found to be significantly associated with respiratory complications, urinary tract infections, cardiac events, and sepsis/septic shock specifically., Conclusions: mFI-5=1 independently predicted 45% increased odds of morbidity. mFI-5=2+ independently predicted 41% increased odds of morbidity. Further, every 30 additional minutes of operative time predicted 18% increased odds of morbidity, suggesting an increased risk of site-related complication events. Taken together, the mFI-5 serves as a valid predictor of morbidity in patients with extradural tumor undergoing instrumented excision., Competing Interests: Conflicts of Interest: Dr. Jeff Silber receives teaching fees for Stryker., (Copyright © 2023 The Japanese Society for Spine Surgery and Related Research.)