GLP-1 Receptor Agonists in Orthopaedic Surgery: Implications for Perioperative Care and Outcomes: An Orthopaedic Surgeon's Perspective.

➢ Glucagon-like peptide-1 (GLP-1) receptor agonists are a promising tool for preoperative weight loss in the patient who is undergoing orthopaedic surgery and has concomitant obesity and type-2 diabetes mellitus.➢ With regard to the perioperative management of GLP-1 receptor agonists for the orthopaedic surgeon, the American Society of Anesthesiologists (ASA) recommends withholding daily-dose GLP-1 therapy on the day of the elective surgical procedure and withholding weekly-dose therapy for the week prior to the procedure.➢ The ASA recommends postponing surgery or proceeding with "full stomach precautions" if the patient undergoing an orthopaedic procedure and taking GLP-1 therapy exhibits gastrointestinal symptoms on the day of the elective procedure.

The Impact of High Depressive Burden on Outcomes after Anterior Cervical Discectomy and Fusion.

Study Design: Retrospective chart review of a single institution's ACDF patients.

Objective: To evaluate how depressive burden impacts outcomes after anterior cervical discectomy and fusion (ACDF).

Summary Of Background Data: Poor mental health is associated with worse outcomes after spine surgery.

How are we defining preoperative anemia? A comparison of various anemia thresholds among patients undergoing short-construct lumbar spinal fusion.

Background: Anemia is a risk factor for increased transfusions. However, various definitions of anemia have been described in scientific literature and a consensus on how to appropriately diagnose anemia or who to preoperatively optimize is lacking. We aimed to compare multiple anemia definitions and evaluate if any threshold best predicts transfusion requirements and surgical outcomes following spinal fusion.

The impact of operative level on patient-reported outcome measures following single-level posterior lumbar decompression for disc herniation.

Objective: To compare the impact of upper versus lower lumbar decompression on patient-reported outcome measures (PROMs).

Materials And Methods: Patients undergoing L1-L2, L2-L3, L4-L5, or L5-S1 single-level elective decompression with 1-year PROMs were identified. Included PROMs were the Oswestry Disability Index (ODI), visual analog scale (VAS) back and leg, and Short Form-12 physical (PCS) and mental (MCS) component scores.

A Comparative Analysis of Return to Driving Ability after Elective Anterior Cervical Discectomy and Fusion Amongst Patients with Myelopathy versus Radiculopathy.

Study Design: Retrospective cohort study.

Objective: To investigate the influence of preoperative myelopathy versus radiculopathy on timing of return to driving following anterior cervical discectomy and fusion (ACDF).

Summary Of Background Data: ACDF is among the most common spinal procedures performed; however, a gap exists in the literature concerning postoperative recovery timelines.

Does the Presence of Preoperative Myelomalacia Impact Outcomes Following ACDF?

Study Design: Retrospective cohort.

Objective: To compare outcomes after ACDF amongst patients with versus without preoperative myelomalacia.

Summary Of Background Data: Evidence correlating preoperative myelomalacia with postoperative patient-reported outcome measures (PROMs) after anterior cervical discectomy and fusion (ACDF) is limited.

Narrative Review of Perioperative Glucagon-like Peptide-1 (GLP-1) Agonists in Spine Surgery.

Spine surgeons are increasingly likely to encounter patients taking glucagon-like peptide-1 (GLP-1) receptor agonists for glycemic control and/or weight loss. GLP-1 receptor agonists present an attractive option for helping patients meet hemoglobin A1C and body mass index goals before elective surgeries and have already been implemented for these purposes. It is imperative for spine surgeons to understand the potential risks and benefits of these drugs during the perioperative period and their influence on patient outcomes.

Predictors of successful early discharge in revision lumbar fusion.

Background Context: Reducing length of hospital stay (LOS) and establishing earlier discharge goals are critically important in terms of improving patient satisfaction and maximizing value in spine surgery. Revision lumbar fusion is associated with higher costs and longer inpatient stays compared to primary surgery. Identifying factors that correlate with safe early discharge in this population can inform efforts to improve the value of care.

Evaluation of the Congruency of National Surgical Quality Improvement Program Outcomes With a Propensity Matched Anterior Cervical Discectomy and Fusion, Posterior Lumbar Decompression and Fusion Cohort From an Institutional Registry.

Study Design: Retrospective cohort.

Objective: To compare institutional and National Surgical Quality Improvement Program (NSQIP) patients who underwent either anterior cervical discectomy and fusion (ACDF) or posterior lumbar decompression and fusion (PLDF) to determine the congruency of baseline characteristics and postoperative outcomes.

Background: Large database studies have grown in prominence owing to their inexpensive nature, and ability to draw on large sample sizes.

Does Postoperative Physical Therapy Impact Pain, Opioid Consumption, and Clinical Outcomes after Single-Level Lumbar Fusion?

Study Design: Retrospective Cohort.

Objective: To determine the impact of physical therapy (PT) on opioid consumption, surgical outcomes, and patient-reported outcome measures (PROMs) following single-level lumbar fusion.

Summary Of Background Data: Physical therapy following lumbar fusion surgery is variably prescribed, with the goals of pain relief and return to activity.

AO Spine Knowledge Forums Promote Collaboration and Elevate the Impact of Research: A Bibliometric Analysis.

Study DesignBibliometric analysis.ObjectivesThis study used bibliometric analyses to characterize the effect of AO Spine Knowledge Forum (KF) participation on publication trends among members. We examined associations of membership in KF organizations with academic productivity, collaboration, and scientific impact.

Effect of Surgical Approach on Patient-reported Outcomes of Lumbar Fusion for Degenerative Spondylolisthesis: Should Grade Influence Approach?

Study Design: Retrospective cohort study.

Objective: The present study aims to compare outcomes for patients undergoing spinal fusion through PLDF and TLIF and determine whether specific radiographic characteristics, based upon both the CARDS and Meyerding classifications, might influence optimal fusion technique.

Summary Of Background Data: Despite the significant prevalence and high disease burden of degenerative spondylolisthesis (DS), consensus regarding surgical management is still lacking.

Investigating the Impact of Home Care Services after Lumbar Fusion on Readmission, Reoperation, and Patient Reported Outcomes.

Study Design: Retrospective cohort.

Objective: Investigate how home care (HC) services impact utilization of postoperative resources and outcomes after lumbar fusion.

Summary Of Background Data: Utilization of spinal fusion has increased over the past decade-it has become important to coordinate postoperative discharge that maximizes rehabilitation and cost-effectiveness.

The AO Spine Knowledge Forums: A Decade of Impactful Spine Research.

The AO Spine Knowledge Forums are independent expert-driven global study groups dedicated to improving patient care by publishing evidence-based recommendations and conducting high-impact clinical studies. Five Knowledge Forums represent 6 spine pathologies: tumor, deformity, spinal cord injury, degeneration, trauma, and infection. A summary highlighting their most impactful research achievements over the past 10 years is provided.

Readability of online patient education materials for cervical disc replacement.

Purpose: Patients frequently utilize internet-based resources to seek information. Cervical disc replacement (CDR) is extensively marketed on the internet and patients may research their condition in preference to a fusion. Previous literature has recommended that the readability of patient education materials (PEM) should not exceed the 6th-grade(11-12 years old) United States reading level to optimize health literacy.

Characterizing the Representation of Different Global Regions and National Income-Levels Amongst Invited Speakers and Committee Members at Major International Spine Surgery Conferences.

Study DesignObservational study.ObjectiveTo evaluate representation of countries and gross national income (GNI) at major international spine conferences.MethodsThe 50 most attended spine conferences were identified via ChatGPT.

Comparison of Restricted Versus Liberal Postsurgical Ambulation Protocols on Outcomes After Lumbar Fusion Surgery.

Study Design: Retrospective cohort study.

Objective: The objective of this study was to explore the impact of different hospital-based ambulation protocols on mobility and surgical outcomes after lumbar fusion surgery.

Summary Of Background Data: Previous research has highlighted the value of early ambulation after surgery; still some hospitals choose to adopt a more conservative ambulation approach due to concern for patient safety.

Serotonin-norepinephrine reuptake inhibitor and gabapentinoid use independently predict greater postoperative opioid consumption in lumbar fusion patients.

Purpose: Treatment of preoperative depression has been shown to reduce pain perception and disability after spine surgery, which encouraged utilizing antidepressants as a treatment for pain. Though opioid consumption after spine surgery has been well studied, few studies have investigated its association with medications such as antidepressants and gabapentinoids. Therefore, our study investigated the relationship between antidepressants, gabapentinoids and opioid consumption after lumbar fusion.

Patients on antidepressants are more likely to be discharged to inpatient rehabilitation after lumbar fusion.

Purpose: The purpose of this study was to investigate the association between antidepressant use and inpatient physical therapy performance, as well as discharge disposition after surgery.

Methods: Patients undergoing primary 1-3 level lumbar fusion at a single, tertiary care institution from 2017 to 2021 were retrospectively identified. Patient characteristics, surgical details, and surgical outcomes were collected via chart review.

Mild Changes in Sternocleidomastoid Muscle Quality Predict Pseudarthrosis after Anterior Cervical Discectomy and Fusion.

Study Design: Retrospective cohort.

Objective: To investigate the impact of cervical paraspinal muscle mass and quality on the rate of pseudarthrosis and patient-reported outcome measures (PROMs) after anterior cervical discectomy and fusion (ACDF).

Summary Of Background Data: Poor muscle quality has been shown to correlate with inferior outcomes in spine surgery.

Biceps involvement and degree of motor deficit at diagnosis are independently predictive of timing of postoperative C5 palsy recovery.

Background Context: C5 palsy is a debilitating complication following cervical spine surgery. This is the largest single-institution study evaluating C5 palsy and is specifically aimed at risk factors predictive of recovery timing.

Purpose: To assess the impact of demographic, radiographic, and surgical factors on C5 palsy recovery timing.

Gender Differences in Outcomes in Patients Treated for Thoracolumbar Burst Fractures Without Neurological Deficits: Prospective International Multicenter Study.

Background And Objectives: Exploring gender differences in outcomes after spinal surgery is essential. We aimed to assess gender differences in patients treated for thoracolumbar burst fractures without neurological deficit regarding Oswestry Disability Index (ODI) improvement. Secondarily, we assessed baseline characteristics, treatment selection, and other patient-reported outcomes.

The AO Spine Upper Cervical Injury Classification System (AO UCIC) - An Umbrella Review of Traumatic Axis Injuries Factors that May Affect Treatment Decision.

Study designAn umbrella systematic review.ObjectiveTo identify historically recognized injury characteristics that may affect treatment decisions of traumatic C2 injuries and help improve the description of the "modifiers" presented in the AO Upper Cervical Injury Classification (UCIC).MethodsWe performed an umbrella review of systematic reviews evaluating studies about the management of axis fractures that identify potential modifiers in the treatment of these injuries.

External performance of the spinal infection treatment evaluation (SITE) score and spinal instability spondylodiscitis score (SISS) in predicting operative intervention for de novo spinal infections.

Background Context: As the incidence of de novo spinal infections has risen with increasing global medical complexity and intravenous drug use, so has the uncertainty around standard of care and surgical decision making. Nonoperative management has increased in popularity albeit with frequent failure rates in up to one-third of patients. Although clinical decision making has largely been guided by clinician experience and institutional preference, two recent scoring system-the Spinal Instability Spondylodiscitis Score (SISS) and the Spinal Infection Treatment Evaluation score (SITE) provide a promising potential avenue towards evidence-based pathways.

Clinical Outcomes of Revision Lumbar Fusion in the Aging Population.

Study Design: Retrospective cohort.

Objective: To examine the profile of older patients undergoing revision lumbar fusion and to evaluate the impact that advancing age may have on outcomes following revision lumbar fusion.

Background: The proportion of older patients undergoing revision lumbar fusion is increasing; however, the benefit of revision lumbar fusion in an aging demographic is not well documented.