The Impact of Preoperative Dehydration on Outcomes after Single-Level Lumbar Fusion.

Background Context: Preoperative laboratory testing can identify patients with health conditions that increase perioperative risk and represent opportunities for optimization.

Purpose: To assess the effect of preoperative and postoperative day 1 (POD1) hydration status on outcomes after single-level lumbar fusion surgery.

Study Design/setting: Retrospective Cohort.

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.

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.

Does BMI Impact Spinopelvic Alignment after Lumbar Fusion Surgery?

Study Design: Retrospective cohort.

Objective: Evaluating the impact of elevated BMI on perioperative sagittal alignment parameters amongst patients undergoing single-level lumbar fusion.

Summary Of Background Data: Sagittal malalignment affects postoperative outcomes after fusion for spine deformity.

Impact of Chronic Preoperative Gabapentinoid Exposure on Surgical and Patient Reported Outcome Measures following Lumbar Fusion.

Study Design: Retrospective cohort.

Objective: To assess the relationship between long-term gabapentinoid use and outcomes after lumbar fusion.

Summary Of Background Data: Gabapentinoids, which include gabapentin and pregabalin, are commonly prescribed for radiculopathic pain.

Assessing the variation and drivers of cost in 1-level lumbar fusion: a time-driven activity-based costing analysis.

Background Context: As value-based health care arrangements gain traction in spine care, understanding the true cost of care becomes critical. Historically, inaccurate cost proxies have been used, including negotiated reimbursement rates or list prices. However, time-driven activity-based costing (TDABC) allows for a more accurate cost assessment, including a better understanding of the primary drivers of cost in 1-level lumbar fusion.

Practice Variation Within a Single Institution in Management of Degenerative Spondylolisthesis.

Study Design: This was a retrospective cohort study.

Objective: The objective of this study was to assess variation in care for degenerative spondylolisthesis (DS) among surgeons at the same institution, to establish diagnostic and therapeutic variables contributing to this variation, and to determine whether variation in care changed over time.

Summary Of Background Data: Like other degenerative spinal disorders, DS is prone to practice variation due to the wide array of treatment options.

Laminoplasty-an underutilized procedure for cervical spondylotic myelopathy.

Background Content: Cervical laminoplasty (LP) and laminectomy and fusion (LF) are commonly used surgical techniques for cervical spondylotic myelopathy (CSM). Several recent studies have demonstrated superior perioperative metrics and decreased overall costs with LP, yet LF is performed far more often in the United States.

Purpose: To determine the percentage of patients with CSM who are radiographically candidates for LP.

Development of prediction models for clinically meaningful improvement in PROMIS scores after lumbar decompression.

Background: The ability to preoperatively predict which patients will achieve a minimal clinically important difference (MCID) after lumbar spine decompression surgery can help determine the appropriateness and timing of surgery. Patient-Reported Outcome Measurement Information System (PROMIS) scores are an increasingly popular outcome instrument.

Purpose: The purpose of this study was to develop algorithms predictive of achieving MCID after primary lumbar decompression surgery.

Surgeon-level variance in achieving clinical improvement after lumbar decompression: the importance of adequate risk adjustment.

Background Context: Patient-Reported Outcome Measurement Information System (PROMIS) scores are increasingly utilized in clinical care. However, it is unclear if PROMIS can discriminate surgeon performance on an individual level.

Purpose: The purpose of this study was to examine surgeon-level variance in rates of achieving minimal clinically important difference (MCID) after lumbar decompression.

Laminoplasty versus laminectomy and fusion for cervical spondylotic myelopathy: a cost analysis.

Background Context: Laminectomy with fusion (LF) and laminoplasty (LP) are commonly used to treat cervical spondylotic myelopathy (CSM). The decision regarding which procedure to perform is largely a matter of surgeon's preference, while financial implications are rarely considered.

Purpose: We aimed to better understand the financial considerations of LF compared to LP in the treatment of CSM.

Development of machine learning and natural language processing algorithms for preoperative prediction and automated identification of intraoperative vascular injury in anterior lumbar spine surgery.

Background: Intraoperative vascular injury (VI) may be an unavoidable complication of anterior lumbar spine surgery; however, vascular injury has implications for quality and safety reporting as this intraoperative complication may result in serious bleeding, thrombosis, and postoperative stricture.

Purpose: The purpose of this study was to (1) develop machine learning algorithms for preoperative prediction of VI and (2) develop natural language processing (NLP) algorithms for automated surveillance of intraoperative VI from free-text operative notes.

Patient Sample: Adult patients, 18 years or age or older, undergoing anterior lumbar spine surgery at two academic and three community medical centers were included in this analysis.

Can natural language processing provide accurate, automated reporting of wound infection requiring reoperation after lumbar discectomy?

Background: Surgical site infections are a major driver of morbidity and increased costs in the postoperative period after spine surgery. Current tools for surveillance of these adverse events rely on prospective clinical tracking, manual retrospective chart review, or administrative procedural and diagnosis codes.

Purpose: The purpose of this study was to develop natural language processing (NLP) algorithms for automated reporting of postoperative wound infection requiring reoperation after lumbar discectomy.

Predicting prolonged opioid prescriptions in opioid-naïve lumbar spine surgery patients.

Importance: Preoperative determination of the potential for postoperative opioid dependence in previously naïve patients undergoing elective spine surgery may facilitate targeted interventions.

Objective: The purpose of this study was to develop supervised machine learning algorithms for preoperative prediction of prolonged opioid prescription use in opioid-naïve patients following lumbar spine surgery.

Design: Retrospective review of clinical registry data.

Natural language processing for automated detection of incidental durotomy.

Background: Incidental durotomy is a common intraoperative complication during spine surgery with potential implications for postoperative recovery, patient-reported outcomes, length of stay, and costs. To our knowledge, there are no processes available for automated surveillance of incidental durotomy.

Purpose: The purpose of this study was to develop natural language processing (NLP) algorithms for automated detection of incidental durotomies in free-text operative notes of patients undergoing lumbar spine surgery.

Discharge Disposition After Anterior Cervical Discectomy and Fusion.

Objective: Age and comorbidity burden of patients going anterior cervical discectomy and fusion (ACDF) have increased significantly over the past 2 decades, resulting in increased expenditures. Non-home discharge after ACDF contributes to increased direct and indirect costs of postoperative care. The purpose of this study was to identify independent prognostic factors for discharge disposition in patients undergoing ACDF.

Normal intervertebral segment rotation of the subaxial cervical spine: An study of dynamic neck motions.

Background: Accurate knowledge of the intervertebral center of rotation (COR) and its corresponding range of motion (ROM) can help understand development of cervical pathology and guide surgical treatment.

Methods: Ten asymptomatic subjects were imaged using MRI and dual fluoroscopic imaging techniques during dynamic extension-flexion-extension (EFE) and axial left-right-left (LRL) rotation. The intervertebral segment CORs and ROMs were measured from C34 to C67, as the correlations between two variables were analyzed as well.

Development of machine learning algorithms for prediction of prolonged opioid prescription after surgery for lumbar disc herniation.

Background Context: Spine surgery has been identified as a risk factor for prolonged postoperative opioid use. Preoperative prediction of opioid use could improve risk stratification, shared decision-making, and patient counseling before surgery.

Purpose: The primary purpose of this study was to develop algorithms for prediction of prolonged opioid prescription after surgery for lumbar disc herniation.

Sagittal spinal parameters after en bloc resection of mobile spine tumors.

Background Context: En bloc resection and reconstruction (EBR) in patients with spinal malignancy aims to achieve local disease control. This is an invasive procedure with significant alterations of the physiological anatomy and subsequently, the spino-pelvic alignment. Sagittal spinal parameters are useful measurements to objectively identify disproportionate alignment on a radiograph.

Development of a machine learning algorithm predicting discharge placement after surgery for spondylolisthesis.

Purpose: We aimed to develop a machine learning algorithm that can accurately predict discharge placement in patients undergoing elective surgery for degenerative spondylolisthesis.

Methods: The National Surgical Quality Improvement Program (NSQIP) database was used to select patients that underwent surgical treatment for degenerative spondylolisthesis between 2009 and 2016. Our primary outcome measure was non-home discharge which was defined as any discharge not to home for which we grouped together all non-home discharge destinations including rehabilitation facility, skilled nursing facility, and unskilled nursing facility.

Machine learning for prediction of sustained opioid prescription after anterior cervical discectomy and fusion.

Background Context: The severity of the opioid epidemic has increased scrutiny of opioid prescribing practices. Spine surgery is a high-risk episode for sustained postoperative opioid prescription.

Purpose: To develop machine learning algorithms for preoperative prediction of sustained opioid prescription after anterior cervical discectomy and fusion (ACDF).