Surgical invasiveness, reoperation, and preoperative depression are predictive of super-utilization in adult spinal deformity surgery.

Purpose: A subset of adult spinal deformity (ASD) patients undergoing corrective surgery receive a disproportionate level of medical resources and incur greater costs. We examined the characteristics of such super-utilizers of health care resources among ASD patients.

Methods: This prospective, multicenter study analyzed data from ASD patients with > 4 levels of spinal fusion and a minimum 2-year follow-up.

Listhesis and Spinopelvic Inclination of Upper Instrumented Vertebra Region and the Implications on Proximal Junctional Kyphosis.

Study Design: Retrospective analysis of prospective data.

Objective: Evaluate the impact of radiographic and morphologic configuration of the uppermost instrumented vertebrae (UIV) region on proximal junctional kyphosis (PJK) rates.

Background: Literature is limited on evaluation of the preoperative landing zone (UIV-1 to UIV +2 levels) and its impact on development of PJK.

Are we Getting Better at Achieving Optimal Lumbar Segmental Sagittal Alignment in Complex Adult Spine Deformity Surgery?

Study Design: Retrospective Multi-Center Study.

Objective: To investigate how advances in spine realignment have impacted lumbar segmental alignment.

Summary Of Background Data: The understanding of spine alignment and Adult Spinal Deformity (ASD) management continues to advance.

Self-Image in Adult Spinal Deformity: The Critical Link Between Baseline Disability, Treatment Choice, and Surgical Satisfaction.

Study Design: Prospective, multi-center analysis.

Objective: Evaluate the impact that self-image has upon operative vs. nonoperative treatment choice for adult spine deformity (ASD) patients, and evaluate the association of post-treatment self-image with treatment satisfaction.

The role of posterior column osteotomies versus lumbar decompressions in improving lower extremity motor strength in adult spinal deformity patients with preoperative motor impairment.

Objective: The aim of this study was to determine if there are any specific procedural, demographic, and/or radiographic factors that are associated with an improved postoperative lower extremity (LE) motor score (LEMS) among patients with adult spinal deformity (ASD) and abnormal baseline LEMS undergoing surgical correction.

Methods: Patients with ASD enrolled in an observational prospective study from 2018 to 2023 at 13 spinal deformity centers in North America were queried. Eligible participants met at least one of the following radiographic and/or procedural inclusion criteria: pelvic incidence minus lumbar lordosis mismatch ≥ 25°, T1 pelvic angle ≥ 30°, SVA ≥ 15 cm, thoracic scoliosis ≥ 70°, thoracolumbar scoliosis ≥ 50°, global coronal malalignment ≥ 7 cm, underwent 3-column osteotomy (3CO), spinal fusion ≥ 12 levels, and/or age ≥ 65 years with ≥ 7 levels of instrumentation.

Quantifying the Importance of Upper Cervical Extension Reserve in Adult Cervical Deformity Surgery and Its Impact on Baseline Presentation and Outcomes.

Background And Objectives: The concept of upper cervical (C0-C2) extension reserve (ER) capacity, ER relaxation, and their impact on outcomes following surgical correction of adult cervical deformity (ACD) has not been extensively studied. We aimed to evaluate the impact of upper cervical ER on postoperative disability and outcomes.

Methods: Patients with ACD, from a retrospective cohort study of a prospectively collected multicenter database, undergoing subaxial cervical fusion with 2-year (2Y) follow-up data were included.

Impact of thoracolumbar inflection point on outcomes and complications in adult spinal deformity.

Objective: Existing literature on the impact of alignment parameters relative to the thoracolumbar inflection point remains sparse. The authors aimed to investigate the influence of the inflection point, lumbar lordosis apex (LLA), and other alignment parameters on complications, reoperations, and clinical outcomes.

Methods: Patients with adult spinal deformity who underwent fusion of the lower thoracic spine (T7-12) to pelvis, for whom 2-year data were available, were included.

Comparative Analysis of Biological Aging and Inflammatory Profiles in Adult Spinal Deformity Patients Between Japan and the United States: A Correlative Study.

Study Design: Retrospective matched cohort study.

Objective: Understanding biological aging in adult spinal deformity (ASD) across different populations offers insights into its impact on aging and potential interventions.

Summary Of Background Data: ASD significantly impacts physiological health and may accelerate biological aging.

Proximal Junctional Kyphosis and Failure Prophylaxis Improves Cost Efficacy, While Maintaining Optimal Alignment, in Adult Spinal Deformity Surgery.

Background And Objectives: To investigate the cost-effectiveness and impact of prophylactic techniques on the development of proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) in the context of postoperative alignment.

Methods: Adult spinal deformity patients with fusion to pelvis and 2-year data were included. Patients receiving PJK prophylaxis (hook, tether, cement, minimally-invasive surgery approach) were compared to those who did not.

Operative vs Nonoperative Treatment for Adult Symptomatic Lumbar Scoliosis at 8-Year Follow-Up: A Nonrandomized Clinical Trial.

Importance: Long-term follow-up studies of operative and nonoperative treatment of adult symptomatic lumbar scoliosis (ASLS) are needed to assess benefits and durability.

Objective: To assess the durability of treatment outcomes for operative vs nonoperative treatment of ASLS.

Design, Setting, And Participants: The Adult Symptomatic Lumbar Scoliosis 1 (ASLS-1) study was a multicenter, prospective study with randomized and observational cohorts designed to assess operative vs nonoperative ASLS treatment.

Risk factors for detection of Pseudomonas aeruginosa in clinical samples upon hospital admission.

Background/introduction: Antipseudomonal antibiotics are frequently used in patients admitted to hospitals. Many of these substances are classified as a reserve or watch status by the WHO. Inappropriate risk assessment of invasive detection of P.

Iatrogenic posterior translation of the construct at the uppermost instrumented vertebrae is associated with proximal junctional kyphosis.

Purpose: To determine if iatrogenic posterior translation (UIV SPi) at the upper instrumented vertebrae (UIV) is associated with increased mechanical complications and secondarily to generate and validate a UIV SPi threshold for increased complications.

Methods: Two patient databases were utilized: one for generating a UIV SPi threshold and another for validation. Patients with a UIV between T8-L1 and a LIV at ilium were included.

Long-term follow-up of non‑neurologic and neurologic complications after complex adult spinal deformity surgery: results from the Scoli-RISK-1 study.

Purpose: To report all complications that occurred during the 2 to 5-year postoperative period, describe reoperations during this time period, and compare patients who did and did not have major, surgery-related complications and/or reoperations during this time period.

Methods: The Scoli-RISK-1 study enrolled 272 ASD patients undergoing surgery from 15 centers. Inclusion criteria were Cobb angle of > 80°, corrective osteotomy for congenital/revision deformity, and/or 3-column osteotomy.

A Pilot Study of the Gut Microbiota in Spine Fusion Surgery Patients.

Background: The microbiome has been identified as a contributor to bone quality. As skeletal health is critical to success of orthopedic surgery, the gut microbiome may be a modifiable factor associated with postoperative outcomes. For spine fusion surgery in particular, bone formation and sufficient bone mineral density are essential for successful outcomes.

Surveillance of Clostridioides difficile on hospital admission and outpatient antibiotic use in Germany-a 9 year ecological analysis.

Background: Antibiotic consumption is considered an important risk factor for Clostridioides difficile infection (CDI). This ecological analysis investigates the influence of outpatient antibiotic prescriptions in statutory health insurance (SHI) on the admission prevalence of CDI in German hospitals participating in voluntary CDI surveillance through the hospital infection surveillance system (Krankenhaus-Infektions-Surveillance-System; KISS).

Methods: The annual CDI admission prevalence of a hospital at the federal state level was associated with the outpatient antibiotic consumption of the corresponding federal state.

Restorative Neurostimulation Therapy Compared to Optimal Medical Management: A Randomized Evaluation (RESTORE) for the Treatment of Chronic Mechanical Low Back Pain due to Multifidus Dysfunction.

Introduction: Many interventional strategies are commonly used to treat chronic low back pain (CLBP), though few are specifically intended to target the distinct underlying pathomechanisms causing low back pain. Restorative neurostimulation has been suggested as a specific treatment for mechanical CLBP resulting from multifidus dysfunction. In this randomized controlled trial, we report outcomes from a cohort of patients with CLBP associated with multifidus dysfunction treated with restorative neurostimulation compared to those randomized to a control group receiving optimal medical management (OMM) over 1 year.

Identifying Predictors of Extended Intensive Care Unit Stay Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis: An Analysis of 101 ACS NSQIP Pediatric Participating Centers.

Background: While prolonged operative time and increased levels fused have been shown to increase the risk of prolonged intensive care unit (ICU) length-of-stay (LOS), studies are limited in guiding decision-making regarding the need for intensive care postoperatively. This is especially the case among the cohort of adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal fusion (PSF); associations between comorbidities and ICU LOS are not well-delineated.

Methods: AIS patients who underwent PSF from January 1st, 2016 to December 1st, 2016 at 101 participating centers were identified using the American College of Surgeons (ACS) National Surgical Quality Im-provement Project (NSQIP) Pediatric database.

Comparison of clinical and radiological outcomes of 3-column lumbar osteotomies with and without interbody cages for adult spinal deformity.

Background Context: Correcting sagittal malalignment in adult spinal deformity (ASD) is a challenging task, often requiring complex surgical interventions like pedicle subtraction osteotomies (PSOs). Different types of 3-column osteotomies (3COs), including Schwab 3, Schwab 4, Schwab 4 with interbody cages, and the "sandwich" technique, aim to optimize alignment and fusion outcomes. The role of interbody cages in enhancing fusion and segmental correction remains unclear.

Comparative Analysis of Outcomes in Adult Spinal Deformity Patients with Proximal Junctional Kyphosis or Failure Initially Fused to Upper Versus Lower Thoracic Spine.

Patients with proximal junctional kyphosis (PJK) or failure (PJF) may demonstrate disparate outcomes and recovery when fused to the upper (UT) versus lower (LT) thoracic spine. Few studies have distinguished the reoperation and recovery abilities of patients with PJK or PJF when fused to the upper (UT) versus lower (LT) thoracic spine. Adult spine deformity patients ≥ 18 yrs with preoperative and 5-year (5Y) data fused to the sacrum/pelvis were included.

The gap between surgeon goal and achieved sagittal alignment in adult cervical spine deformity surgery.

Objective: Malalignment following cervical spine deformity (CSD) surgery can negatively impact outcomes and increase complications. Despite the growing ability to plan alignment, it remains unclear whether preoperative goals are achieved with surgery. The objective of this study was to assess how good surgeons are at achieving their preoperative goal alignment following CSD surgery.

Redefining Clinically Significant Blood Loss in Complex Adult Spine Deformity Surgery.

Study Design: Retrospective analysis of prospectively collected data.

Objective: This study aims to define clinically relevant blood loss in adult spinal deformity (ASD) surgery.

Background: Current definitions of excessive blood loss after spine surgery are highly variable and may be suboptimal in predicting adverse events (AEs).

Have We Made Advancements in Optimizing Surgical Outcomes and Enhancing Recovery for Patients With High-Risk Adult Spinal Deformity Over Time?

Background And Objectives: The spectrum of patients requiring adult spinal deformity (ASD) surgery is highly variable in baseline (BL) risk such as age, frailty, and deformity severity. Although improvements have been realized in ASD surgery over the past decade, it is unknown whether these carry over to high-risk patients. We aim to determine temporal differences in outcomes at 2 years after ASD surgery in patients stratified by BL risk.