Yossi Smorgick

Background/Objectives: To quantify the adjusted association of obesity with in-hospital outcomes in adult scoliosis hospitalizations involving spine deformity corrective surgery. Methods: A retrospective cohort study was conducted using the National Inpatient Sample (2016–2021), including adult hospitalizations for scoliosis undergoing corrective spine surgery. Obesity was the primary exposure. The primary outcome was a composite of in-hospital complications. Secondary outcomes included individual complications, length of stay, total hospital charges, and discharge disposition. Weighted multivariable regression models adjusted for patient- and hospital-level factors were used. Sensitivity analysis was performed excluding severity adjustment to assess potential overadjustment, as the All Patient Refined Diagnosis Related Group (APR-DRG) severity score may partially reflect in-hospital complications. Results: Among 9323 unweighted hospitalizations (representing a national estimate of 46,610 weighted hospitalizations) included (16.6% obese), obesity was associated with a 22% increase in the odds of total in-hospital complications (Odds Ratio (OR) 1.22; 95% Confidence Interval (CI) 1.04–1.43). Among individual complication categories, obesity was associated with higher odds of renal complications (OR 1.69; 95% CI 1.29–2.21), whereas no significant differences were observed in pulmonary, cardiac, Venous Thromboembolism (VTE), or sepsis complications. Additionally, obesity was associated with increased odds of non-home discharge (OR 1.28; 95% CI 1.12–1.46). In sensitivity analysis, these associations were more pronounced, with additional complication categories reaching statistical significance. Conclusions: Obesity is associated with increased in-hospital morbidity in adult scoliosis surgery, particularly higher odds of renal complications and non-home discharge. These population-level findings help optimize preoperative risk communication and anticipate post-acute discharge resource needs.

Vertebral osteoporotic fractures (VOF) are among the most frequent fractures in the elderly, often leading to an impaired lifestyle and a high economic burden. Although a reduced bone mass density is considered one of the main risk factors for VOF, its role in determining the fracture type, using the AO spine‐DGOU classification for osteoporotic thoracolumbar fractures, as well as its progression, is unknown. The current study aimed to: (1) reveal whether the bone density of the vertebral bodies of fractured and non‐fractured vertebrae predicts the type of fracture, (2) examine whether bone density is associated with the initial and progressive collapse of the vertebral body, and (3) provide predictive measures for fracture progression. The study sample included 124 patients (40 males and 84 females) with an acute osteoporotic vertebral fracture who underwent a computerized tomography scan at the time of diagnosis and an x‐ray at least 3 months later. The bone density of the fractured and adjacent (non‐fractured) vertebrae was measured at diagnosis. The magnitude of the collapse and the progression of the fracture over time were calculated from height measurements of the vertebral bodies at diagnosis and follow‐up. Age was a significant factor in predicting the fracture type and magnitude of collapse, whereas sex and bone density were not. The severity of the fracture was involved in predicting its progression, demonstrating that severe‐type fractures tended to continue to collapse after diagnosis. However, when each type was examined independently, the density of the fractured vertebra had a protective effect on fracture progression. To conclude, identifying the type of fracture is beneficial in determining patient prognosis. Furthermore, the density of the fractured vertebra, the magnitude of collapse, and patient age are valuable predictors of fracture progression.

Purpose To assess the association between 4, 5, or 6 lumbar spine vertebrae and the presence of lumbar spinal pathologies. Methods We reviewed all MRI reports and images performed between August 1st, 2018 and July 31st, 2019. Lumbar spine pathologies such as disc herniation, lytic spondylolisthesis, and spinal stenosis were recorded. The reviewer studied the T2 sagittal screening of the entire spine and counted down manually from C2 to T12 on the assumption that there are seven cervical and twelve dorsal vertebrae. We then recorded whether there were four, five, or six lumbar vertebrae. Results Our work incorporated a total of 1985 patients for whom T2-weighted entire spine sagittal MR images were obtainable. The study cohort’s average age was 52.2 ± 15.9 years, comprising 944 males and 1041 females. One hundred and thirty-three patients (6.7%) had 4 lumbar-type vertebrae; 1799 (90.6%) had 5 lumbar-type vertebrae; and 53 (2.7%) had 6 lumbar-type vertebrae. There was a statistically significant difference between the rates of 6 lumbar-type vertebrae in males versus females (p < 0.05). There was a statistically significant difference with more spinal stenosis patients in the 6 lumbar-type vertebrae compared to the 4 or 5 lumbar-type vertebrae groups (p < 0.001). Conclusion Our study shows that spinal stenosis is significantly more common in patients with 6 lumbar-type vertebrae.

Study Design: A retrospective cohort study.Purpose: The aim of this study was to determine any correlations between spinopelvic configuration and progressive collapse following acute osteoporotic compression spine fractures.Overview of Literature: Few studies have investigated the risk factors for progressive osteoporotic compression spine fractures. However, the correlation between the spinopelvic configuration, which is a crucial to optimize the management of lumbar degenerative diseases, and progressive collapse following acute osteoporotic compression spine fractures was not analyzed.Methods: We retrospectively identified all patients treated for thoracolumbar fractures in Assaf Harofe Medical Center between January 2008 and July 2013. Pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT) were measured for the pelvic parameters. For each patient, we classified the fracture according to the AOSpine Thoracolumbar Spine Injury Classification System. Height loss was measured initially and at a minimum of 3-month follow-up. The difference between initial and final height loss was documented as height loss difference.Results: The study included 124 patients comprised 86 women and 38 men. The mean patient age was 69±9.6 years. The mean length of follow-up was 14±15 months. No significant effect of the PI, PT, and SS angles on the vertebral fracture level (p >0.05) was found. Similarly, no significant relationship between the PI, PT, and SS angle and the fracture type according to the AO classification (p >0.05) was found. There was no correlation between PI, PT, and SS angles and initial height loss, final height loss and height loss difference (p> 0.05)Conclusions: The spinopelvic configuration represented by the PI, PT, and SS angle does not influence progressive collapse following acute osteoporotic compression spine fractures.

Purpose To examine the efficacy and feasibility of T2-weighted whole-spine sagittal magnetic resonance imaging (MRI) screening for all patients who undergo MRI of the lumbar spine for any indication. Methods A review of 1145 consecutive T2-weighted whole-spine sagittal MRI screening sequences performed for lumbar spine imaging was undertaken for the purposes of documenting the incidence and clinical significance of thoracic and cervical spine incidental findings, as well as to establish correlation between these pathologies and those found in the lumbar spine. Results Out of the 1145 patients included in the study, 103 (9%) patients had incidental findings thought to be significant. These findings included cervical spinal stenosis (n = 85), thoracic disc herniation (n = 9), syrinx (n = 5), intradural tumor (n = 2), and signal changes within the spinal cord (n = 2). In follow-up exams, 35 patients had clinically significant findings which included cervical myelopathy (n = 25), thoracic myelopathy (n = 3), syrinx (n = 5) and intradural tumor (n = 2). Among the 172 patients presenting with lumbar spinal stenosis, 42 (24.4%) had such incidental findings, and of those 41 (23.8%) had cervical stenosis with spinal cord compression (p < 0.0001). Conclusion T2-weighted whole-spine sagittal screening is useful in demonstrating clinically relevant incidental findings in any patients undergoing MRI of the lumbar spine. There is a statistically significant correlation between lumbar spinal stenosis and cervical spinal stenosis with spinal cord compression.

OBJECTIVE: The authors evaluated the long-term clinical outcome of a total posterior arthroplasty system in the surgical treatment of lumbar spinal stenosis with degenerative spondylolisthesis.METHODS: Between June 2006 and July 2007, 10 patients with neurogenic claudication due to spinal stenosis and single-level degenerative spondylolisthesis were enrolled in a nonrandomized prospective clinical study. The patients were evaluated with radiographs and MRI scans, the visual analog scale (VAS) for back and leg pain, the Oswestry Disability Index (ODI), and the SF-36 health survey preoperatively and at 6 weeks, 3 months, 6 months, 1 year, 2 years, 3 years, 7 years, and 11 years postoperatively.RESULTS: The mean VAS score for leg pain dropped from 83.5 before surgery to 13 at 6 weeks and 17 at 11 years after surgery. The mean VAS score for back pain dropped from 56.2 preoperatively to 12.5 at 6 weeks and 14 at 11 years after surgery. The mean ODI score decreased from 49.1 preoperatively to 13.5 at 6 weeks and 16 at 11 years after surgery. MRI at 11 years demonstrated stenosis adjacent to the stabilized segment in one patient. This patient was not symptomatic. The authors did not find evidence of progression of the spondylolisthesis in any of the cases. In one patient, conversion to posterolateral fusion was performed due to an early device malfunction.CONCLUSIONS: The results of this 11-year follow-up study demonstrate that, in patients with spinal stenosis and degenerative spondylolisthesis, decompression and posterior arthroplasty maintain clinical improvement and radiological stability.

Background: Gender differences in adolescent idiopathic scoliosis (AIS) have been documented in curve progression, response to bracing, and outcomes of surgical treatment. However, limited information is available about the relation between gender and scoliosis curve patterns and radiographic characteristics. Objectives: To evaluate the effect of gender on curve pattern and compare clinical and radiographic characteristics between male and female patients with AIS. Methods: We conducted a retrospective review of prospectively collected data that compared clinical and radiographic characteristics between male and female surgical candidates. Demographic and clinical data including age at presentation, gender, family history of scoliosis, brace treatment history, clinical coronal balance, shoulder asymmetry, and hump size were recorded. All patients graded their pain with the use of a visual analogue scale (VAS) on a scale from 0 to 10. Radiographs of the spine were reviewed to determine the type of curve according to the Lenke classification, Cobb angle, thoracic kyphosis angle, and the Risser sign. Radiologic coronal balance was recorded. Curve flexibility was determined by measuring the thoracic and lumbar curve magnitude on side-bending radiographs. Results: The study included 163 patients with AIS 35 males and 128 females. Although a trend toward more flexible major thoracic curves in females was noticed, there was no statistically significant difference between the two groups. Conclusions: In this study we were not able to demonstrate any clinical nor radiological statistical differences between male and female candidates for surgical treatment.