Measuring Spine Surgeon Performance: A Scoping Review of Assessment Metrics and Evaluation Methods Used to Assess Surgeon Competency.

Study Design: This is a scoping review.

Objective: To systematically review and synthesize the performance metrics used to assess surgical competency during spine surgery training.

Summary Of Background Data: The complexity of spine surgery requires prolonged training and careful competency evaluation.

Intraoperative Conversion of Primary Cervical Total Disc Replacement to Fusion: Incidence and Reasons.

Study Design: This was a retrospective study.

Objective: The purpose of the study was to determine the incidence and reasons of intraoperative conversion from planned cervical total disc replacement (TDR) to anterior cervical discectomy and fusion (ACDF).

Summary Of Background Data: TDR currently offers an alternative treatment with results similar or superior to ACDF.

Physical and Virtual Simulation in Spine Surgery Training.

Study Design: Narrative review of the literature related to physical and virtual simulation in spine surgery training.

Objective: The purpose of this narrative review was to provide an overview of the development of simulated spine surgery, its current role, and future potential use in the training of surgical skills.

Summary Of Background Data: Residents and fellows are expected to become proficient in an ever-increasing number of spine surgery techniques.

Cervical Disc Arthroplasty for the Treatment of Adjacent Segment Disease After Anterior Cervical Discectomy and Fusion.

Study Design: A retrospective chart review was conducted at a single institution.

Objective: The purpose of this study was to investigate the clinical outcomes of cervical disc arthroplasty (CDA) used for the treatment of symptomatic adjacent segment disease (ASD) developed after anterior cervical discectomy and fusion (ACDF).

Background: A major clinical concern following ACDF is the development of ASD.

Five-year Follow-up of a Prospective Food and Drug Administration Investigational Device Exemption Trial Evaluating a PEEK-on-Ceramic Cervical Disk Replacement.

Study Design: Prospective trial comparing the investigation group to propensity-matched historic control group.

Objective: To evaluate five-year results of single-level PEEK-on-ceramic cervical total disc replacement (TDR) compared with a propensity-matched anterior cervical discectomy and fusion (ACDF) control group.

Summary Of Background Data: Cervical TDR has gained acceptance as a treatment for symptomatic disk degeneration.

Treatment of failed cervical total disc replacements in a series of 53 cases and description of a management strategy.

Purpose: To describe modes of failure of cervical TDR, their related treatment strategies, and to describe a management strategy for the treatment of failed cervical TDR.

Methods: This retrospective study was based on a consecutive series of 53 cervical TDR patients who underwent removal or revision surgery. Chart review was conducted to collect general descriptive data, reasons for TDR removal/revision, duration from index implantation to re-operation, and the subsequent procedure performed.

Clinical Outcome of Lumbar Hybrid Surgery in a Consecutive Series of Patients With Long-term Follow-up.

Study Design: This was a retrospective study combined with attempted prospective patient contact to collect current data.

Objective: The purpose of this study was to investigate the long-term clinical outcomes of patients undergoing lumbar hybrid surgery (total disk replacement (TDR) at one level and fusion at an adjacent level.

Summary Of Background Data: Many patients with symptomatic lumbar disk degeneration are affected at more than one level.

Removals and Revisions of Cervical Total Disc Replacement Devices in a Consecutive Series of 1626 Patients Beginning With the First Case Experience in 2003.

Study Design: Retrospective cohort study.

Objective: The purpose of this study was to investigate the rate of cervical total disc replacement (TDR) device removal or revision.

Background: Cervical TDR has gained acceptance as an alternative to anterior cervical discectomy and fusion in appropriately selected patients.

Is the Use of Intraoperative Neuromonitoring Justified During Lumbar Anterior Approach Surgery?

Background: Intraoperative neuromonitoring (IONM) became widely used in spine surgery to reduce the risk of iatrogenic nerve injury. However, the proliferation of IONM has fallen into question based on effectiveness and costs, with a lack of evidence supporting its benefit for specific spine surgery procedures. The purpose of this study was to evaluate the use of IONM and the rate of neurological injury associated with anterior lumbar spinal surgery.

Lumbar Total Disk Replacement Device Removals and Revisions Performed During a 20-Year Experience with 2141 Patients.

Study Design: This was a retrospective study with prospective patient contact attempted to collect current data.

Objective: The purpose was to investigate the incidence and reasons for lumbar total disk replacement (TDR) removal or revision.

Summary Of Background Data: A concern regarding lumbar TDR was safety, particularly the need for device removal or revision.

Evaluating alternatives to dual-energy x-ray absorptiometry for assessing bone quality in patients undergoing spine surgery.

Objective: The purpose of this study was to compare and contrast lumbar bone quality and osteoporosis/osteopenia screening results via dual-energy x-ray absorptiometry (DEXA), CT, and MRI.

Methods: A consecutive series of 426 candidates screened for lumbar disc replacement over a 5-year period beginning in 2018 was reviewed. Patients with a preoperative lumbar spine DEXA scan and a CT and/or MRI scan were included.

Assessing lumbar vertebral bone quality: a methodological evaluation of CT and MRI as alternatives to traditional DEXA.

Purpose: The purpose of this study was to investigate the impact of various methods on the assessment of vertebral bone quality.

Methods: A consecutive series of 427 candidates for lumbar disc replacement with lumbar DEXA and MRI and/or CT scans were included. Two measurement techniques were used on CTs-a sagittal and axial.

The use of a new high-speed shielded curved drill is associated with improved intraoperative and clinical outcomes after cervical corpectomy and fusion procedures: a retrospective case series.

Background: Anterior cervical corpectomy and fusion (ACCF) is an effective technique to address multi-level degenerative cervical myelopathy. However, as the number of surgical levels increases, the outcomes worsen with respect to complication rates, range of motion and length of surgery. This study aimed to determine the clinical outcome of ACCF procedures performed using a new distally curved and shielded drilling device.

Impact of previous lumbar spine surgery on the outcome of lumbar total disc replacement: analysis of prospective 5-year follow-up study data.

Purpose: It is sometimes anticipated that patients with prior spine surgery will have a compromised outcome from future procedures. The purpose of this study was to compare TDR outcomes in patients with prior lumbar spine surgery to those with no previous surgery.

Methods: Post hoc analysis was performed on 5-year follow-up data collected prospectively in the multi-centre FDA-regulated trial for the activL® Artificial Disc which involved 376 patients treated for single-level symptomatic disc degeneration.

Evaluation of Anterior Lumbar Interbody Fusion Performed Using a Stand-Alone, Integrated Fusion Cage.

Background: Anterior lumbar interbody fusion (ALIF) has been performed for many years. Often, posterior supplemental fixation has been used to provide additional stability to the operated segment. Interbody implants have evolved to incorporate unique designs, polyetheretherketone, integrated screws, and surface texture.

In which cases do surgeons specializing in total disc replacement perform fusion in patients with symptomatic lumbar disc degeneration?

Purpose: The purpose of this study was to investigate reasons and their frequency for why spine surgeons subspecializing in total disc replacement (TDR) performed lumbar fusion rather than TDR.

Methods: The study was based on a consecutive series of 515 patients undergoing lumbar TDR or fusion during a 5-year period by three surgeons specializing in TDR. For each fusion patient, the reason for not performing TDR was recorded.

Prospective, multicenter study of 2-level cervical arthroplasty with a PEEK-on-ceramic artificial disc.

Objective: The purpose of this study was to evaluate the safety and efficacy of a PEEK-on-ceramic cervical total disc replacement (cTDR) device for the treatment of 2-level cervical disc disease with radiculopathy and/or myelopathy.

Methods: The study was a prospective, nonrandomized, historically controlled FDA investigational device exemption trial evaluating the Simplify Cervical Artificial Disc for use at 2 levels. The anterior cervical discectomy and fusion (ACDF) control group was derived from a propensity score-matched (using subclassification) cohort of patients who participated in an earlier prospective trial in which similar indications were used.

Cervical Total Disk Replacement: Available Implant Size Matters.

Study Design: This study was a post hoc analysis of data collected from 2 Food and Drug Administration (FDA) Investigational Device Exemption (IDE) trials.

Objective: The purposes of this study were to: (1) measure disk space heights adjacent to the level to be treated with a total disk replacement (TDR); (2) analyze cervical disk space heights to be replaced with TDR; and (3) investigate the frequency of use of a smaller height TDR when available.

Summary Of Background Data: Cervical TDR produces outcomes noninferior or superior to anterior cervical discectomy and fusion.

Indirect Decompression for the Treatment of Degenerative Lumbar Stenosis.

Background: Surgical treatment of symptomatic lumbar stenosis has traditionally included laminectomy for direct decompression. With increasing options for lumbar interbody fusion, there has been growing interest in indirect decompression to treat degenerative stenosis. The primary purpose of this study was to determine whether indirect decompression via anterior lumbar interbody fusion (ALIF) can provide symptomatic relief in patients with lumbar spinal stenosis.

Incidence and Resolution Strategies for Early-Onset Postoperative Leg Pain Following Lumbar Total Disc Replacement.

Background: Lumbar total disc replacement (TDR) has produced results similar or superior to fusion in treating symptomatic disc degeneration. Some patients have reported onset of leg pain early after surgery. Little information is available specifically on this problem.

Cervical Total Disc Replacement: Novel Devices.

This article reviews the available literature for novel cervical total disc replacement devices, including ones which are available inside and outside of the United States. It includes biomechanical consideration as well as design characteristics and clinical data when available.

Single-Level Cervical Disc Replacement Using a PEEK-on-Ceramic Implant: Results of a Multicenter FDA IDE Trial With 24-Month Follow-up.

Background: Many early cervical total disc replacements (TDRs) produced motion through a ball-and-socket action, with metal endplates articulating with a plastic core. Polyetheretherketone (PEEK) is used increasingly for spinal implants due to its mechanical properties and lack of artifacts on imaging. A TDR was designed with titanium-coated PEEK endplates and a ceramic core.