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Background/UNASSIGNED:Adolescent idiopathic scoliosis (AIS) is a common cause of spinal deformity in adolescents. AIS can be associated with certain intraspinal anomalies such as syringomyelia (SM). This study assessed the rate o f SM in AIS patients and compared trends in surgical approach and postoperative outcomes in AIS patients with and without SM. Methods/UNASSIGNED:-tests and Chi-squared tests for categorical and discrete variables, respectively. Results/UNASSIGNED:< 0.001). Conclusions/UNASSIGNED:These results indicate that patients concordant with AIS and SM may be treated more cautiously (lower invasiveness score and less fusions) than those without SM.

STUDY DESIGN/METHODS:Retrospective cohort study. OBJECTIVE:Assess trends in sports-related cervical spine trauma using a pediatric inpatient database. SUMMARY OF BACKGROUND DATA/BACKGROUND:Injuries sustained from sports participation may include cervical spine trauma such as fractures and spinal cord injury(SCI). Large database studies analyzing sports-related cervical trauma in the pediatric population are currently lacking. METHODS:KID was queried for patients with external causes of injury secondary to sports-related activities from 2003-2012. Patients were further grouped for cervical spine injury type, including C1-4 & C5-7 fracture with/without spinal cord injury (SCI), dislocation, and SCI without radiographic abnormality (SCIWORA). Patients were grouped by age into Children(4-9),Pre-Adolescents(Pre,10-13),and Adolescents(14-17). Kruskall-Wallis tests with post-hoc Mann-Whitney-U's identified differences in cervical spine injury type across age groups and sport type. Logistic regression found predictors of TBI and specific cervical injuries. RESULTS:38,539pts identified(12.76yrs,24.5%F). Adolescents had the highest rate of sports injuries per year(p < 0.001). Adolescents had the highest rate of any type of cervical spine injury, including C1-4 and C5-7 fracture with and without SCI, dislocation, and SCIWORA(all p < 0.001). Adolescence increased odds for C1-4 fracture w/o SCI 3.18x, C1-4 fx w/ SCI by 7.57x, C5-7 fx w/o SCI 4.11x, C5-7 w/SCI 3.63x, cervical dislocation 1.7x, and cervical SCIWORA 2.75x, all p < 0.05. Football injuries rose from 5.83% in 2009 to 9.14% in 2012 (p < 0.001), and were associated with more SCIWORA(1.6%vs1.0%,p = 0.012), and football injuries increased odds of SCI by 1.56x. Concurrent TBI was highest in Adolescents at 58.4%(Pre:26.6%,Child:4.9%,p < 0.001), and SCIWORA was a significant predictor for concurrent TBI across all sports(OR: 2.35[1.77-3.11], p < 0.001). CONCLUSIONS:Adolescent athletes had the highest rates of upper/lower cervical fracture, dislocation, and SCIWORA. Adolescence and SCIWORA were significant predictors of concurrent TBI across sports. The increased prevalence of cervical spine injury with age sheds light on the growing concern for youth sports played at a competitive level, and supports recently updated regulations aimed at decreasing youth athletic injuries. LEVEL OF EVIDENCE/METHODS:3.

BACKGROUND CONTEXT/BACKGROUND:Expandable cages (EXP) are being more frequently utilized in transforaminal lumbar interbody fusions (TLIF). EXP were designed to reduce complications related to neurological retraction, enable better lordosis restoration, and improve ease of insertion, particularly in the advent of minimally invasive surgical (MIS) techniques, however they are exponentially more expensive than the nonexpandable (NE) alternative. PURPOSE/OBJECTIVE:To investigate the clinical results of expandable cages in single level TLIF. STUDY DESIGN/SETTING/METHODS:Retrospective review at a single institution. PATIENT SAMPLE/METHODS:Two hundred and fifty-two single level TLIFs from 2012 to 2018 were included. OUTCOME MEASURES/METHODS:Clinical characteristics, perioperative and neurologic complication rates, and radiographic measures. METHODS:Patients ≥18 years of age who underwent single level TLIF with minimum 1 year follow-up were included. OUTCOME MEASURES/METHODS:clinical characteristics, perioperative and neurologic complications. Radiographic analysis included pelvic incidence-lumbar lordosis (PI-LL) mismatch, segmental lumbar lordosis (LL) mismatch, disc height restoration, and subsidence ≥2 mm. Statistical analysis included independent t tests and chi-square analysis. For nonparametric variables, Mann-Whitney U test and Spearman partial correlation were utilized. Multivariate regression was performed to assess relationships between surgical variables and recorded outcomes. For univariate analysis significance was set at p<.05. Due to the multiple comparisons being made, significance for regressions was set at p<.025 utilizing Bonferroni correction. RESULTS:Two hundred and fifty-two TLIFs between 2012 and 2018 were included, with 152 NE (54.6% female, mean age 59.28±14.19, mean body mass index (BMI) 28.65±5.38, mean Charlson Comorbidity Index (CCI) 2.20±1.89) and 100 EXP (48% female, mean age 58.81±11.70, mean BMI 28.68±6.06, mean CCI 1.99±1.66) with no significant differences in demographics. Patients instrumented with EXP cages had a shorter length of stay (3.11±2.06 days EXP vs. 4.01±2.64 days NE; Z=-4.189, p<.001) and a lower estimated blood loss (201.31±189.41 mL EXP vs. 377.82±364.06 mL NE; Z=-6.449, p<.001). There were significantly more MIS-TLIF cases and bone morphogenic protein (BMP) use in the EXP group (88% MIS, p<.001 and 60% BMP, p<.001) as illustrated in Table 1. There were no significant differences between the EXP and NE groups in rates of radiculitis and neuropraxia. In multivariate regression analysis, EXP were not associated with a difference in perioperative outcomes or complications. Radiographic analyses demonstrated that the EXP group had a lower PI-LL mismatch than the NE cage group at baseline (3.75±13.81° EXP vs. 12.75±15.81° NE; p=.001) and at 1 year follow-up (3.81±12.84° EXP vs. 8.23±12.73° NE; p=.046), but change in regional and segmental alignment was not significantly different between groups. Multivariate regression demonstrated that EXP use was a risk factor for intraoperative subsidence (2.729[1.185-6.281]; p=.018). CONCLUSIONS:Once technique was controlled for, TLIFs utilizing EXP do not have significantly improved neurologic or radiographic outcomes compared with NE. EXP increase risk of intraoperative subsidence. These results question the value of the EXP given the higher cost.

BACKGROUND CONTEXT: Recombinant human bone morphogenetic protein 2 (rhBMP-2) is a popular biologic product used in transforaminal lumbar interbody fusion (TLIF) surgeries to promote fusion and avoid the morbidity associated with iliac crest autograft. However, use of rhBMP-2 and its effect on pseudarthrosis rates in TLIFs remains unknown. PURPOSE: To assess the rates of pseudarthrosis in open and MIS TLIF patients, with and without concurrent rhBMP-2 use. STUDY DESIGN/SETTING: Retrospective cohort study at a single academic institution. PATIENT SAMPLE: Included: 317 single level TLIF patients. Consisting of 157 open TLIF (OTLIF), 115 bilateral Wiltse MIS TLIF (WTLIF), and 45 hybrid midline MIS with percutaneous pedicle or cortical screws (MTLIF). OUTCOME MEASURES: Clinical characteristics, perioperative and postoperative outcomes, surgical procedure, rates of pseudarthrosis diagnosis, and revision for pseudarthrosis.
METHOD(S): Patients >=18 years old undergoing 1-level TLIF with minimum 1-year of clinical and radiographic follow up were included. Pseudarthrosis was determined using both radiographic and clinical evaluations. Differences between groups were assessed by ANOVA and chi squared analyses. Demographic and perioperative characteristics were analyzed by multivariate logistic regression.
RESULT(S): The cohort included 317 patients (mean age 59.68+/-13.29, F 52.7%). There was no significant difference in gender, BMI, or smoking status among groups (all p>.05). WTLIF had the lowest EBL (ml) (192.16+/-177.11mL vs 302.73+/-246.51 vs 363.85+/-370.49, respectively p=<0.001) and LOS (days) (2.88+/-1.76 vs 4.16+/-3.94 vs 4.03+/-1.97, respectively p=<0.001) compared to MTLIF and OTLIF. Further, MTLIF had the highest fluoroscopic dose (mGy) compared to WTLIF and OTLIF (52.85+/-40.49 vs 52.80+/-52.77 vs 15.21 +/- 24.53, respectively p=<0.001). MTLIF was also associated with the lowest BMP use compared to OTLIF and MTLIF (13.3% vs 23.6% vs 67.8%, respectively p=<.001). At minimum 1-year follow-up, there was no significant difference between the three different approaches with regards to pseudarthrosis rates (WTLIF 6.1%, MTLIF 8.9%, OTLIF 3.2%, p=0.249) or returns to the OR for pseudarthrosis (WTLIF 3.5%, MTLIF 6.7%, OTLIF 3.2%, p=0.546). Pseudarthrosis rates in patients treated with BMP was 5% (p = 0.881) for the cohort. There was no difference in reoperation for pseudarthrosis between patients who received BMP (2.5%) versus those who did not receive BMP (4.6%, P = 0.338). Multivariate Logistic regression analysis demonstrated no reduction in pseudarthosis related to BMP use (Odds Ratio 1.07 [CI 95% 0.228-5.04], p=0.929). Current or past smoking did not have an effect on use of BMP (p = 0.369) or significantly increase the rate of pseudarthrosis (p = 0.214), regardless of BMP use.
CONCLUSION(S): MP use did not reduce the rate of pseudarthrosis or the number of reoperations for pseudarthrosis in this cohort. No difference in pseudarthrosis rates between the three TLIF approaches was noted. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Recombinant human bone morphogenetic protein 2 (BMP) is increasingly utilized in minimally invasive (MIS) transforaminal lumbar interbody fusions (TLIF) in order to increase rate of fusion by promoting bone growth through the induction of osteoblast differentiation, awhile reducing morbidity related to iliac crest autograft. Despite these benefits, BMP use is still controversial due to its pro-inflammatory mechanism of action and potential to cause radiculitis. PURPOSE: To assess whether BMP is a risk factor for postoperative radiculitis in TLIF. STUDY DESIGN/SETTING: Single-center retrospective cohort study. PATIENT SAMPLE: A total of 397 TLIFs from June 2012 to December 2018. OUTCOME MEASURES: Perioperative clinical characteristics, post-operative risk of radiculitis and complication, and future reoperation rates.
METHOD(S): Patients >= 18 years-old undergoing elective single-level TLIFs from 2012 to 2018 were included. Outcome measures included perioperative clinical characteristics, postoperative risk of radiculitis and complication, and future reoperation rates. Radiculitis was defined the delayed onset of radicular symptoms postoperatively in patients whom had initial resolution of radicular symptoms immediately postoperatively, in the absence of persistent neurological compression on postoperative imaging. Statistical analyses included independent t-tests and chi-square analysis. Propensity score matching was utilized to control for demographic differences between the groups. Independent predictors for post-operative radiculitis were assessed by multivariate logistic regression. Significance set at p<0.05.
RESULT(S): A total of 397 cases were included in the study (59.33 +/- 13.49 mean age, 28.98 +/- 6.29 mean BMI, 52.90% female, 2.29 +/- 1.92 average Charleston comorbidity Index). There were 223 open procedures and 174 MIS. For the entire cohort, 238 cases utilized BMP and 159 did not, with 102 MIS pairing with BMP use. The MIS TLIFs had a higher percentage of BMP use than open TLIFs (58.6% vs 25.7%, p<0.001), lower estimated blood loss (212.28 +/- 193.79 mL vs 410.91 +/- 337.98 mL, p<0.001) higher fluoroscopy dosage (52.43 +/- 48.61mGy vs 16.77 +/- 27.84mGy, p<0.001), and a lower length of stay (3.20 +/- 2.55 days vs 4.11 +/- 2.52 days, p<0.001). There were no other differences in perioperative clinical characteristics. There was a significantly higher rate of postoperative radiculitis in the MIS TLIFs compared to open (12.6% vs 6.8%, p=0.046) and use of BMP compared to no BMP (13.2% vs 6.7%, p=0.029). There was a 15.7% radiculitis rate when MIS was paired with BMP use. There were no other notable differences in complication rates or rates of reoperation. Individually, MIS had a 12.6% radiculitis rate (p=0.046) and BMP use had a 13.2% rate (p=0.029). Propensity score match controlled for the significant difference in CCI between the MIS and open groups (N=168 each). Multivariate regression indicated that MIS (p=0.314) and BMP (p=0.109) were not independent predictors individually when controlling for age, gender, and BMI. When technique was paired with biologic use the regression revealed MIS + BMP is a risk factor of post-operative radiculitis (2.265(4.753-1.079), p=0.031).
CONCLUSION(S): While BMP and MIS technique were not independent risk factors for postoperative radiculitis, there is an increased risk of radiculitis when using BMP in MIS TLIF. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Recent studies have suggested that for patients with chronic neck pain, both psychological and physical symptoms need to be addressed. Studies have shown that psychological distress is associated with poor outcomes in these patients. The fear avoidance model has been used to explain how maladaptive thoughts and behaviors contribute to chronicity and disability. Cognitive behavioral therapy (CBT) addresses these risk factors through education about pain, modification of maladaptive beliefs, and increasing patient's self-efficacy. PURPOSE: Determine the effectiveness of brief psychological intervention on psychological outcomes in cervical spine surgery. STUDY DESIGN/SETTING: Prospective, blind, and placebo-controlled trial. PATIENT SAMPLE: A total of 42 symptomatic Cervical Degenerative Disorders patients. OUTCOME MEASURES: Distress and Risk Assessment Method (DRAM), Fear Avoidance Beliefs Questionnaire (FABQ), Pain Catastrophizing Scale (PCS), Outcome Expectation Question (OEQ). Neck Disability Index (NDI), modified Japanese Orthopedic Association (mJOA).
METHOD(S): Forty-two patients age >18 with symptomatic cervical degenerative disease have been enrolled in the study. If patients met psychological distress criteria, they were in the treatment group: DRAM >17 and <33, FABQ >49/66, PCS >30/52 or OEQ <=2 (randomized to CBT or Placebo). CBT and Placebo treatment groups had 6 sessions prior to surgery. The control group had no intervention prior to surgery. Baseline and 1-year (1Y) changes were assessed for all outcome measures.
RESULT(S): Forty-two patients were enrolled (53.6 years, BMI 29.4 kg/m2); 23 patients met psychological distress criteria and were randomized into a treatment group (14 CBT vs 9 placebo). Ten patients were in the control group, with nine exceeding DRAM scores to be CBT candidates. At enrollment, the CBT group had greater EQ5D scores (CBT: 10.8, Placebo: 9.5, Control: 7.5, DRAM:8.7) while the Placebo group had greater PCS scores (Placebo: 33.1, CBT: 32.4, Control:18.6, DRAM: 30.8; all p<0.05). From BL to 1Y postop, the CBT patients improved in all psychological-related questionnaires (NDI: 29.2 to 2, PCS: 32.4 to 20.7, FABQ:41.3 to 32.3, mJOA: 2.3 to 3.4, DRAM:12.9 to 16.6). Placebo patients also improved post-operatively, but to a lesser degree in NDI (26.6 to 2), PCS (33.1 to 28.3), and worsened in FABQ (40.4 to 54.1), mJOA(12.5 to 11.8), and DRAM (36.6 to 31.6). In contrast, patients in the control group showed improvement to a much lesser degree than CBT and Placebo patients (NDI: 18.1 to 2, PCS:18.6 to 3.2, FABQ:26.2 to 17.6, mJOA: 15.3 to 16.4). DRAM patients showed minimal changes in psychological- and spine-related questionnaires. Comparing treatment groups at 1Y, CBT pts had significantly lower FABQ scores than Placebo pts (32.3 vs 54.1; p<0.05). CBT pts also had better DRAM scores than the control group at 1Y (30.3 vs 11.4; p=0.03).
CONCLUSION(S): Cognitive behavior treatment can be beneficial in patients undergoing cervical surgery as it was identified in our study to minimize fear avoidance beliefs more than the Placebo group. This type of professional treatment has also shown a steady improvement in all psychological questionnaires and spine related neck disability from baseline to 1-year postoperatively. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: The thoracolumbar junction poses increased risk for high stress on upper lumbar discs when not adequately fused. However, controversy persists. This study evaluates outcomes of upper instrumented vertebrae (UIV) selection in the thoracic versus the upper lumbar spine when fusing to the sacrum. PURPOSE: To compare revision rates for thoracolumbar fusions to the sacrum and pelvis at 1- and 2-year follow-up, stratified by UIV selection. STUDY DESIGN/SETTING: Retrospective cohort study at a single institution. PATIENT SAMPLE: A total of 968 patients who had thoracolumbar fusion surgery between 2012-2018 with at least one year of postoperative follow-up. OUTCOME MEASURES: Reoperation rates from 1 and 2 years after revision surgery, reoperation diagnoses, body mass index (BMI), gender, Charleston Comorbidity Index (CCI), perioperative complications, ASA grade (ASA), operative time (OT), and blood loss (EBL).
METHOD(S): A retrospective review of patients undergoing revision spinal fusion with lower instrumented vertebra of S1 or pelvis between 2012-2018 at a single institution was performed. Patients with less than 1 year of follow-up after their index procedure were excluded from the analysis. Patients were categorized based on UIV into 6 groups: T9-T11, L1, L2, L3, L4, and L5. Demographic and operative data were collected and compared between the different UIV groups in each cohort using chi-squared and ANOVA tests. Revision rates at 1- and 2-year follow-up and the reasons for revision were compared between groups.
RESULT(S): There were 168 revision spinal fusions that reached 1-year follow-up, with 54 having UIV at T9-T11, 2 fusions L1 to sacrum, 26 fusions L2 to sacrum, 25 fusions L3 to sacrum, 36 fusions L4 to sacrum, 23 fusions L5 to sacrum. There was significant difference in patient age, with oldest in the L1 group (65.5+/-3.5) and youngest in the L5 group (51+/-15.4 p<0.001). There was significant difference in gender as both cases in L2 was female and L5 fusions only had 39.1% females (p = 0.006). There were no differences in BMI, CCI, and ASA. EBL (1891.6mL+/-1226.9mL p <0.001) and length of stay (7.7+/-3.0 p <0.001) was highest in the T9-11 UIV group. Operative time was highest in the L1 (464.5+/-174.7 p<0.001) UIV group. Levels added on top of prior fusion were calculated by subtracting UIV of index fusion to past UIV. Adding on 2 levels had a 1-year revision rate of 14.3% (p = 0.032), while adding on 1 level had a 0% 1-year revision rate. Adding on 4 levels had a revision rate of 12.5%, and adding on 7 levels had a 50% 1-year revision rate. At 2 years, adding on 1 level had revision rate of 25% and adding on 2 levels had a revision rate of 20% (p = 0.769). There is no statistically significant difference in perioperative complication rates between UIV groups (p = 0.114). The reoperation rate at 1 year for all levels was 9% and highest in UIV at L1 (50%, p=0.06). At 2-year follow-up, the reoperation rate for the total cohort was 32.34% with the highest revision rate for fusion from L2 to sacrum (53.85%) followed by (T9-T11 sacrum fusion 42.31%, L4 to sacrum31.71%, L3 to sacrum 30%, L5 to sacrum 25.04%, L1 to sacrum 25%, p=0.195). Grouping the UIV into lower thoracic (T9-T11), upper lumbar (L2-L3), and lower lumbar (L4-L5) showed similar revision rates at one year (p=0.697). At two years, lower thoracic group had a revision rate of 40% versus, 23.3% in the upper lumbar group (p =0.399).
CONCLUSION(S): There is no statistically significant difference in reoperation rates for revision thoracolumbar fusions to the sacrum/pelvis associated with different UIV selection. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Frailty is a baseline measure of disability that transcends age alone and has been determined a strong predictor of outcomes following adult spinal deformity (ASD) surgery. This postop impact calls for investigation of unique adjustment of Global Alignment and Proportion (GAP) scores accounting for frailty. This adjustment in spinal proportion may help surgical planning for individualized, optimal postop outcomes. PURPOSE: Modify the GAP score with frailty to optimize outcomes in surgical ASD patients. STUDY DESIGN/SETTING: Retrospective review of a single-surgeon comprehensive ASD database PATIENT SAMPLE: A total of 140 ASD patients OUTCOME MEASURES: Frailty-adjusted GAP scores; Health Related Quality of Life scores (HRQLs): ODI, SRS-22 METHODS: Surgical ASD patients (SVA>=5cm, PT>=25degree, or TK >=60degree, >3 levels fused) >=18 years old with available baseline (BL) radiographic data were isolated in the single-center Comprehensive Spine Quality Database (Quality). Patients were dichotomized by the ASD frailty index, F (Not Frail, Frail). Linear regression analysis established radiographic equations for frailty-adjusted GAP Scores at baseline and 2-years involving relative pelvic version, relative lumbar lordosis, lordosis distribution index, relative spinopelvic alignment, and an age factor to formulate a sagittal plane score. Patients were restratified into frailty-adjusted proportionality groups: Proportional (<5.8), Moderately Disproportional (MD) (5.8-7), Severely Disproportional (SD) (>7). Frailty-adjusted GAP proportionality at 2-years were compared to adjusted-BL to determine whether patients improved, deteriorated or remained the same in their spine proportion.
RESULT(S): A total of 140 patients were included (55.5+/-16.4 yrs, 77.5% female, 25.2+/-4.7 kg/m2). BL frailty: 32.8% not frail, 67.2% frail. Primary analyses demonstrated correlation between BL frailty score and BL and 2-year GAP scores(P<0.001). Linear regression analysis(p<0.001) developed a frailty-adjusted GAP threshold equation: 4.4 + 0.93*(frailty score). Adjusted-baseline scores were taken and re-stratified based distribution and placed 26.4% of patients in Proportional, 26.6% MD, and 44% SD. BL adjusted GAP scores by frailty group: 5.3 Not Frail, 7.5 Frail; p<0.001. At 2-years, GAP scores were grouped into the frailty-adjusted proportionality groups: 66.2% Proportional, 10.8% MD, and 23.1% SD. Patients who were 2-year MD/SD underwent significantly more reoperations (>33.5%) compared to Proportional (12.8%), p=0.015. SD 2-year patients developed increased PJK at the 1-year mark (40%, Proportional: 13.9%, MD:7.1%, p=0.003), as well as had worse 2-year ODI and SRS-22 satisfaction scores(p<0.050). 47.5% improved in GAP (63.4% of frail patients), 12.3% deteriorated, and 40.2% remained in the same proportionality group at 2-year follow up.
CONCLUSION(S): Significant associations exist between frailty and spinal proportion. By adjusting the GAP proportionality groups accounting for baseline frailty contributed to improved outcomes and minimized reoperations. The adjusted GAP groups appeal for less rigorous spine proportion goals in severely frail patients. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Screw placement in transforaminal interbody fusion (TLIF) and anterior lumbar interbody fusion (ALIF) can be done with open free hand (FH), fluoroscopy-guided (FG), spinal navigation (NAV), or robotic guided (RG) techniques. Varied techniques may affect perioperative (periop) outcomes. Few studies compare all four guidance techniques. PURPOSE: Compare the perioperative outcomes between FH, FG, NAV, and RG TLIF and ALIF. STUDY DESIGN/SETTING: Single center retrospective cohort study PATIENT SAMPLE: A total of 1,646 patients who underwent 1-2 level TLIF or 1-3 level ALIF from 2012-2019. OUTCOME MEASURES: Outcomes: registration failure, operative time (OT), radiation dosage (RD), estimated blood loss (EBL), length of stay (LOS), and periop complications, and retursn to OR up to 90 days.
METHOD(S): Patients undergoing 1-2 level TLIF or 1-3 level ALIF were included. Analysis of variance (ANOVA) and chi2test were used to analyze differences in outcomes with significance set at p<0.05. Post hoc Tukey (PHT) and Bonferroni (PHB) analysis were conducted when ANOVA or chi2 showed significance. RD was propensity matched for BMI. TLIFs underwent PSM for levels fused.
RESULT(S): A total of 1,202 1-2 level TLIFs were included (843 FH, 175 FG, 40 NAV, 144 RG) TLIFS. 444 1-3 level ALIFs were included: 337 FH, 25 FG, and 80 RG ALIFs. Demographics were similar amongst ALIF cohorts except significantly more FH-ALIF smokers and TLIF cohorts after propensity matching for levels fused. Amongst the TLIF Cohorts: OT and LOS longest in NAV (291.67+/-89.85 min; p <0.001 and 5.38+/-1.66 days p<0.001); EBL most in FG (482.43+/-530.79mL p=0.006). After PSM for BMI, there was no significant difference in RD. RG TLIF registration failed in 2.8% of cases. There were significantly more intraop (11.1%, p=0.008), and postop (45.8%; p<0.001) complications in the RG cohort, which showed high durotomy rates (6.9%; p=0.05) and instrumentation failure rates approaching significance (3.5%; p=0.058). The NAV group had the highest rate of SSI (2.5%; p = 0.045). Among the ALIF cohorts: RD, EBL, and LOS were similar; OT was longest in FG (395.7+/-113.7 p=0.001). There were significantly more intra- and postop complications in RG group (26.3%, p<0.001; 30%, p<0.001) and 13.8% of RG failed registration. Instrumentation failure was highest in FG (4.0% p=0.676), along with return to OR for instrumentation (8%, p = 0.183). Other periop complications and returns to OR were not significantly different.
CONCLUSION(S): NAV-TLIF had significantly differences in EBL, RD, periop complications, and return to OR 30 days. PSM for levels fused show postop complications rate remain significant with other factors and radiographic dosage remaining significant. RG TLIF and RG ALIF had the worst perioperative complications. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Frailty is an increasingly recognized characteristic that has been validated across many studies as influencing operative risk. Utilization of frailty indices can allow for its identification of which spine patients may be too high risk for surgical intervention. This may be especially useful when it comes to surgeries that are minimally invasive and are supposed to have decrease perioperative outcomes. PURPOSE: Identify MIS techniques effects in postoperative outcomes in TLIF patients. STUDY DESIGN/SETTING: Retrospective review of a prospective database. PATIENT SAMPLE: TLIF spine patients. OUTCOME MEASURES: Complications, length of stay (LOS), estimated blood loss (EBL).
METHOD(S): Pts that underwent a lumbar spine procedure in a single-center Comprehensive Spine Quality Database. Pts were stratified based on procedural approach (Open [OP] and Minimally invasive Surgery [MIS]). Frailty was then calculated for each resultant group by using 30 variables with a validated method. Based on these scores, pts were categorized no frailty [NF]: <0.09, frail [F]: 0.09-0.18, and severe frailty [SF] >0.18. Groups were then controlled for surgical invasiveness. Chi-squared tests identified the relationship between complications and length of stay among various frailty states given surgical approach (OP vs MIS). These patients were propensity score matched for levels fused. Hospital acquired complications (HACs) were identified based on frailty groups through the use of chi-squared and t-tests for other surgical factors. A logistic regression analysis identified the association between frailty status and surgical, regarding postoperative (postop) outcomes.
RESULT(S): A total of 1,300 TLIF spine patients were isolated (59yrs, 29.3kg/m2). After PSM for levels fused, there were 338 pts for both MIS and OP. MIS pts were older (56.1 vs 53.3; p<0.05) than Op pts and had similar BMI's (29.1 vs 29.7; respectively). However, OP received more posterior approaches and less anterior approaches than MIS pts (p<0.05). By surgical factors: MIS and OP patients had similar LOS (3 vs 2.9days) and EBL (282.8 vs 251.5cc) but differed by Op time (195.7 vs 247.1; p<0.05) respectively. Further breakdown by frailty displayed statistical significance between MIS and OP patients with MIS pts having more F (16% vs 12%) and SF pts (4.3% vs 1.9%) than OP (all p<0.05). FMIS patients had lower postop neurologic complications as compared to FOP pts (4.63% vs 14.8%). However, SFMIS patiens had more post-operative complications than SFOP pts (55.2% vs 23.1%) and increased a pt's likelihood of being SFMIS by 5.4x's (all p<0.05).
CONCLUSION(S): This study displays that when frailty status is taken into account, TLIF MIS patients benefit from this procedure type when analyzed against neurologic complications. However, these patients were seen to suffer more from postop complications but did not differ on any other specific complications or surgical variables. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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