Sasha Vaziri

Transforaminal lumbar interbody fusion (TLIF) is a common approach and results in varying degrees of lordosis correction. The purpose of this study is to determine preoperative radiographic spinopelvic parameters that predict change in postoperative segmental and lumbar lordosis after TLIF. This study is a single surgeon retrospective review of one-level and two-level TLIFs from L3-S1. All patients underwent bilateral facetectomies, 10 mm TLIF cage (non-lordotic) insertions, and bilateral pedicle screw-rod construct placements. Pre- and post-operative X-rays were assessed for preoperative segmental lordosis (SL), lumbar lordosis (LL), and pelvic incidence (PI). Univariate and multi-predictor linear regression analyses were performed to determine the relationships between preoperative radiographic findings and change in early postoperative segmental and lumbar lordosis. Ninety-seven patients contributing 128 intervertebral segments were examined. The mean change in SL after TLIF was 7.3 (range: 0.10-28.9°, SD 6.39°). The mean change in LL after TLIF was 5.5˚ (range: -14.8-39.2°, standard deviation (SD) 7.16°). Greater preoperative LL predicted less postoperative LL correction, while greater preoperative PI predicted more postoperative SL and LL correction. Greater anterior disk height was noted to be associated with a decreased change in SL (∆SL). An annular tear on preoperative magnetic resonance imaging (MRI) predicted a 2.7° decrease in ∆SL. A Schmorl's node on preoperative MRI predicted a 4.0° decrease in change in LL (∆LL). A greater preoperative lordosis and a lower spinopelvic mismatch lessen the potential for an increase in the postoperative SL and LL after a TLIF, which is likely due to a ‘ceiling’ effect of an otherwise optimized spinal alignment. A greater anterior disk height and the presence of an annular tear are associated with decreased ∆SL.

Background: Spontaneous intracerebral hemorrhage (ICH) is a significant cause of morbidity and mortality worldwide. The development of venous thromboembolism (VTE), including deep venous thrombosis or pulmonary embolism, is correlated with negative outcomes following ICH. Due to the risk of hematoma expansion associated with the use of VTE chemoprophylaxis, there remains significant debate about the optimal timing for its initiation following ICH. We analyzed the risk of early chemoprophylaxis on hematoma expansion following ICH. Methods: We performed a retrospective analysis of patients presenting with spontaneous ICH at single institution between 2011 and 2018. The rate of hematoma expansion was compared between patients that received early chemoprophylaxis (on admission) and those that received conventional chemoprophylaxis (>24 h). Results: Data for 235 patients were available for analysis. Eleven patients (7.5%) in the early prophylaxis cohort and seven patients (8.0%) in the conventional prophylaxis cohort developed VTE (P = 0.9). Hematoma expansion also did not differ significantly (early 19%, conventional 23%, P = 0.5). Conclusion: The use of early chemoprophylaxis against venous thromboembolic events following ICH appears safe in our patient population without increasing the risk of hematoma expansion. Given the increased risk of poor outcome in the setting of VTE, early VTE chemoprophylaxis should be considered in patients who present with ICH. Larger, prospective, and randomized studies are necessary to better elucidate the risk of early chemoprophylaxis and potential reduction in venous thromboembolic events.

Starting in the 1960s, ossification of the posterior longitudinal ligament (OPLL) became more commonly diagnosed in Japan. The disease is characterized by a gradual increase in calcification of the posterior longitudinal ligament with the eventual sequelae of cervical canal stenosis and myelopathy. Surgical interventions to relieve stenosis and neurologic symptoms are performed to decompress the cervical canal. Studies demonstrate continued ossification of the OPLL in both nonsurgical and surgically treated patients. In this review, the authors evaluate the epidemiology, pathophysiology, and literature regarding disease progression in OPLL after cervical fusion.

OBJECTIVE: The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) universal Surgical Risk Calculator is an online decision-support tool that uses patient characteristics to estimate the risk of adverse postoperative events. Further validation of this risk calculator in the neurosurgical population is needed; therefore, the object of this study was to assess the predictive performance of the ACS NSQIP Surgical Risk Calculator in neurosurgical patients treated at a tertiary care center.METHODS: A single-center retrospective review of 1006 neurosurgical patients treated in the period from September 2011 through December 2014 was performed. Individual patient characteristics were entered into the NSQIP calculator. Predicted complications were compared with actual occurrences identified through chart review and administrative quality coding data. Statistical models were used to assess the predictive performance of risk scores. Traditionally, an ideal risk prediction model demonstrates good calibration and strong discrimination when comparing predicted and observed events.RESULTS: The ACS NSQIP risk calculator demonstrated good calibration between predicted and observed risks of death (p = 0.102), surgical site infection (SSI; p = 0.099), and venous thromboembolism (VTE; p = 0.164) Alternatively, the risk calculator demonstrated a statistically significant lack of calibration between predicted and observed risk of pneumonia (p = 0.044), urinary tract infection (UTI; p < 0.001), return to the operating room (p < 0.001), and discharge to a rehabilitation or nursing facility (p < 0.001). The discriminative performance of the risk calculator was assessed using the c-statistic. Death (c-statistic 0.93), UTI (0.846), and pneumonia (0.862) demonstrated strong discriminative performance. Discharge to a rehabilitation facility or nursing home (c-statistic 0.794) and VTE (0.767) showed adequate discrimination. Return to the operating room (c-statistic 0.452) and SSI (0.556) demonstrated poor discriminative performance. The risk prediction model was both well calibrated and discriminative only for 30-day mortality.CONCLUSIONS: This study illustrates the importance of validating universal risk calculators in specialty-specific surgical populations. The ACS NSQIP Surgical Risk Calculator could be used as a decision-support tool for neurosurgical informed consent with respect to predicted mortality but was poorly predictive of other potential adverse events and clinical outcomes.