Leah Yacat Carreon

Study Design.: Multisurgeon, single-institution retrospective observational cohort. Objectives.: Compare complications and outcomes between patients less than 70 years (P =0.347), smoking status, proportion of revision surgeries, and number of levels fused. Surgical time and estimated blood loss were similar between the two cohorts. Nonhome discharge was significantly more frequent in the older cohort (33% vs. 10%, P =0.001). There was no difference in overall complication rates or at any individual interval: in-hospital, 30-day, 90-day, and 1-year. Conclusions.: In a propensity-matched cohort undergoing anterior-posterior lumbar fusion, elderly patients had similar intraoperative, 30-day, 90-day, and 1-year complications and length of hospitalization, suggesting baseline co-morbidity burden rather than age alone may account for much of the observed excess risk. Age alone should not preclude consideration of circumferential fusion when clinically indicated.

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Introduction: Durability of surgical treatment is important to patients, providers, and payors. In addition to its effect on clinical outcomes and patient satisfaction, durability is a critical factor in evaluating the cost-effectiveness of care. One- and two-level lumbar fusion surgeries are among the most common spine procedures. The purpose of this study was to determine the prevalence, timing, and indications for revision surgery following short-segment lumbar fusions. Methods: A single-institution, multisurgeon database was retrospectively reviewed for patients who underwent one- or two-level lumbar fusion between 2014 and 2018, with a minimum of four years of follow-up. Patients with surgery for trauma, tumor, or infection were excluded. Of the 5051 consecutive patients included, 64.5% (n = 3258) underwent one-level and 35.5% (n = 1793) underwent two-level fusion. Demographic data, surgical characteristics, and indications for revision surgery were collected through electronic medical record review. Results: A total of 772 patients (15%) underwent unplanned lumbar revision surgery. The most common indications were adjacent segment disease (n = 288, 6%) at a mean of 1053 days postoperatively and nonunion (n = 207, 4%) at a mean of 649 days. Other causes of revision surgery included infection (2%), implant reposition (P = 0.073). Conclusion: One- and two-level lumbar fusion procedures demonstrated high durability with an overall revision surgery rate of 15%. The most common indications for revision surgery are adjacent segment disease and nonunion. These findings may inform surgical planning, guide preoperative counseling, and support future quality-improvement efforts.

» Traditional metallic implants used in spinal surgery, such as stainless steel, cobalt chrome, and titanium (Ti), can generate artifacts during magnetic resonance imaging and computed tomography, impeding visualization of the adjacent anatomy and impacting clinical decision-making. » Carbon fiber–reinforced polyether ether ketone (CFR-PEEK) spinal instrumentation is now commercially available. The reported benefits include minimal artifact with radiographic imaging while providing similar biomechanical properties when compared with traditional metallic implants. » CFR-PEEK may be beneficial, following spinal separation surgery, by allowing more precise delivery of high-dose therapeutic radiation (stereotactic body radiation therapy) to the remaining tumor margins and avoid overdosing of the spinal cord. » Long-term follow-up is needed to better understand the clinical durability of these newly available implants.

Longitudinal cohort study. Coccydynia is a painful condition affecting primary women, while sitting, prolonged standing and during defecation and intercour

Study Design.: Retrospective cohort study. Objectives.: To evaluate the clinical utility of confirmatory Navigational CT (NavCT) spins after pedicle screw placement in one- to two-level posterior lumbar fusions. Summary of Background Data.: Navigational CT improves pedicle screw accuracy and reduces blood loss; however, some surgeons perform an additional confirmatory CT spin after screw placement to verify trajectory prior to closure. Confirmatory imaging increases operative time, cost, and radiation exposure, and its benefit in routine lumbar fusion remains unclear. Methods.: Adult patients undergoing one- to two-level posterior instrumented lumbar fusion between January 2020 and June 2021 were identified and stratified into three cohorts: no navigation (NoNav), navigation only (NavCT), and navigation with confirmatory spin (NavCT+C). Primary outcomes included intraoperative screw repositioning and return to the operating room for screw revision. Secondary outcomes included operative duration, estimated blood loss (EBL), discharge disposition, perioperative complications, and one-year follow-up events. Results.: A total of 339 patients were included (117 NoNav, 162 NavCT, 60 NavCT+C). Screw-related complications were rare; intraoperative repositioning (1 vs. 2 vs. 0, P =0.683) and reoperation for screw revision (1 vs. 1 vs. 0, P =0.780) did not differ across groups. The absolute risk reduction for reoperation with confirmatory imaging was 0.72%, yielding an NNT of 138.5. Operative time differed significantly (199.3 vs. 176.5 vs. 205.4 min, P =0.01). EBL was significantly lower in both NavCT groups compared with NoNav ( P <0.001). Perioperative complications and length of stay were similar. Confirmatory imaging increased radiation exposure and operative duration without improving screw-related outcomes. Conclusion.: In one- to two-level lumbar fusions, confirmatory NavCT spins provide minimal additional clinical value. Given increased radiation, time, and cost with no observed improvement in screw accuracy or reoperation rates, confirmatory imaging should be used selectively rather than routinely.