Faculty Bibliography

STUDY DESIGN/METHODS:Retrospective cohort study. OBJECTIVE:To assess the relationship between preoperative HbA1c and postoperative complications up to 180 days in prediabetic and diabetic patients undergoing anterior cervical discectomy and fusion. SUMMARY OF BACKGROUND DATA/BACKGROUND:Diabetes mellitus has been associated with an increased complication rate and poor postoperative outcomes in patients undergoing elective spine surgeries, but few publications have fully analyzed the effect of preoperative HbA1c on postoperative complications in the cervical spine. METHODS:Patients diagnosed with prediabetes or diabetes who underwent anterior cervical discectomy and fusion between 2018 and 2022. Patients were categorized based on their preoperative HbA1c levels: category I with HbA1c levels from 5% to 6.5%, category II from 6.6% to 8%, and category III>8%. Demographics, preoperative glucose and HbA1c levels, and postoperative complications were collected. Postoperative complications were categorized as revision, dysphagia, wound, and other. Pearson χ 2 tests and regression models/analyses were used. RESULTS:The current study included 75 patients. Within 30 days postoperatively, there was 1 patient in category I, 1 in category II, and 2 in category III with documented complications. At 31-90 days, only 1 patient in category III reported a complication. There were no complications 91-180 days postoperatively. There was no statistically significant difference in complication or revision rates among the categories at all postoperative time intervals. CONCLUSIONS:In the current study, no statistically significant difference was found between elevated HbA1c level and complication rates between diabetics categorized by HbA1c levels at all postoperative time intervals. Future studies are necessary to develop a multifactorial approach to medical clearance in diabetic patients that qualify for cervical spine surgeries.

BACKGROUND:The aim of the current study was to compare the incidence of postoperative complications among minimally invasive surgery (MIS) tubular, endoscopic, and robot-assisted transforaminal lumbar interbody fusion (TLIF) techniques. METHODS:We studied consecutive patients who underwent single-level or multilevel TLIF between 2020 and 2022. Preoperative and postoperative patient-reported outcomes (Visual Analog Scale leg score and Oswestry Disability Index), demographic, and intraoperative variables were recorded. One-way analysis of variance with Bartlett's equal-variance and Pearson chi-squared tests were used. RESULTS:The study included 170 TLIF patients: 107 (63%) tubular, 42 (25%) endoscopic, and 21 (12%) robot assisted. All 3 TLIF techniques had similar complication rates: tubular 6 (5.6%), endoscopic 2 (4.8%), and robot assisted 1 (4.8%) all occurring within the first 2 weeks. Tubular TLIF reported the lowest incidence of new-onset neurologic symptoms, primarily radiculitis or numbness/tingling, at 2 weeks postoperatively (P < 0.05) with 21 (20%) tubular, 17 (41%) endoscopic, and 9 (43%) robot-assisted patients. There were 2 revisions in the robot-assisted group, while tubular and endoscopic each had one within 1 year. There was no statistical difference in preoperative or postoperative patient-reported outcomes between the TLIF groups. CONCLUSIONS:The current study demonstrated that tubular, endoscopic, and robot-assisted TLIF procedures had similar complication rates. The tubular MIS TLIF reported fewer new neurologic symptoms compared with endoscopic and robot-assisted TLIF procedures at 2 weeks postoperative, with all groups declining in symptom persistency at later time intervals. Average Visual Analog Scale scores continuously improved up to 1 year postoperatively among all groups.