Alexander Tuchman

Study Design: Retrospective , Single-center. Objective: To evaluate preoperative cervical range-of-motion via cervical flexion-extension radiographs and its relation to the development of PJK/PJF following ASD correction in patients with a UIV in the upper thoracic spine. Methods: Patients with an UIV between T1-T4, preoperative cervical flexion/extension radiographs and instrumented to the pelvis, and minimum 1yr follow-up were included. Cervical measurements included range-of-motion (ROM), flexion, extension and cervical SVA (cSVA). Patients were stratified into 3 groups: No-PJK, asymptomatic PJK (A-PJK) and symptomatic PJK including PJF (S-PJK/PJF). Results: 151 patients were included: Mean age 59.6 ± 8.0 yrs, BMI of 25.1 ± 4.5, 88.7% (n = 134) were female. PJK status: No PJK = 111 (73.5%) patients, A-PJK = 21 (13.9%), S-PJK/PJF = 19 (12.6%). S-PJK/PJF patients, however, were more likely to be diagnosed with osteopenia/osteoporosis(S-PJK/PJF: 68.4% vs A-PJK: 23.8% vs No PJK: 52.3%, P = 0.0138). S-PJK/PJF patients had significantly less cervical flexion (No PJK: 19.5 ± 14.2 vs A-PJK: 19.9 ± 10.9 vs S-PJK/PJF: 7.7 ± 11.9, P = 0.0029) and ROM than the other groups (No PJK: 52.8 ± 17.7 vs A-PJK: 53.1 ± 14.5 vs S-PJK/PJF: 39.2 ± 17.9, P = 0.0085). On multivariable models for the development of S-PJK/PJF, reduced baseline cervical flexion and ROM were independent risk factors yielding threshold values of 22.8° and 48.2°, respectively. Conclusion: Multivariable models for the development of S-PJK/PJF demonstrated that reduced baseline cervical ROM and flexion were independent risk factors yielding threshold values of 48.2° and 22.8°, respectively. All of S-PJK/PJF patients had preop flexion <22.8°. Flexion-extension radiographs provide a quick and easy option at a relatively low cost to offer additional information that may aid in surgical planning and shared decision making with the patient regarding potential outcomes.

Bone health is a key determinant of success in spine surgery, making preoperative assessment of bone quality essential to optimal surgical risk stratification. Magnetic resonance imaging (MRI)-based vertebral bone quality (VBQ) score offers a novel approach to assess bone health in spine surgery candidates. The ability of MRI to assess bone quality without exposure to ionizing radiation makes it a potentially advantageous alternative to other traditional measures of bone density. VBQ has additionally shown potential to predict adverse outcomes, such as fragility fractures, instrumentation failure, subsidence and proximal junctional kyphosis. Variations of VBQ, such as endplate bone quality, S1 VBQ, and cervical VBQ, provide targeted insights at specific anatomical regions and potentially enhance the predictive accuracy of VBQ. However, clinical application of VBQ is limited by variability in MRI systems, patient-specific factors, and lack of standardized threshold values. This review aims to critically evaluate VBQ scores as an opportunistic, MRI-based assessment of bone health and its potential role in predicting surgical outcomes. While VBQ may provide some valuable insights into bone health, its role in preoperative risk assessment likely remains supplementary and requires further research to establish clinical validity and optimal cutoffs.

Study Design: Retrospective Administrative Database Analysis. Objective: The purpose of this study was to compare the rate of subsequent cervical fusion surgery between patients that received cervical laminectomy and cervical laminoplasty for degenerative cervical disease. Methods: The PearlDiver database for years 2010 to 2021 was queried for patients who received either a posterior cervical laminectomy or a cervical laminoplasty for a diagnosis of degenerative cervical disease. A matched analysis was performed using the significant variables. Rates of subsequent fusion surgery were determined for each cohort for 2-year, 5-year, and 10-year after surgery. Survival analysis was performed. Results: A total of 4406 patients (Laminectomy: 2258; Laminoplasty: 2148) were included in this study. In the matched analysis, the rate of subsequent fusion surgery for laminectomy at 2-year, 5-year, and 10-year were 3.2%, 5.0%, and 5.7%, respectively. The rate of subsequent fusion surgery for laminoplasty at 2-year, 5-year, and 10-year were 2.2%, 3.2%, and 3.5%, respectively. There was no significant difference between the 2 groups at 2-year after surgery ( P = 0.07). Patients who received cervical laminectomy had a higher rate of subsequent fusion surgery than cervical laminoplasty at 5-year ( P < 0.01), and 10-year ( P < 0.01) after surgery. Conclusions: In patients with degenerative cervical disease, cervical laminectomy had a significantly higher rate of subsequent fusion surgery than cervical laminoplasty at 5-year and 10-year post-surgery. This is the largest study comparing laminectomy to laminoplasty to date.

Study Design.: Retrospective cohort study. Objective.: This study aims to evaluate reoperation rates following single-level lumbar discectomy. Background.: Reoperation rates following single-level lumbar discectomy are debated, with reports ranging from 5% to 24%. Accurately characterizing these rates is essential for provider and patient education. Materials and Methods.: A retrospective analysis was conducted using the PearlDiver database. Patients aged 18 or older with a minimum of 5 years follow-up after a single-level lumbar discectomy were included. The primary outcome was subsequent lumbar surgery rate at 5 years. Secondary analysis evaluated subsequent lumbar surgery following revision discectomy, lumbar fusion rate after primary or revision discectomy, and risk factors for subsequent lumbar surgery. Kaplan-Meier analysis and Cox regression models were employed. Results.: There were 308,979 patients included in this study. The 5-year subsequent lumbar surgery rate was 14.4%, and the 5-year subsequent lumbar fusion rate was 6.1%. There were 67,098 patients who received revision discectomy. Of those, 5-year subsequent lumbar surgery rate was 18.2%, and subsequent lumbar fusion rate was 12.4%. Kaplan-Meier curves demonstrated that the probability of avoiding subsequent lumbar surgery decreased more rapidly within the first year following both index and revision discectomy. Cox regression identified obesity (hazard ratio = 1.12, 95% CI = 1.097, 1.141) and higher Elixhauser Comorbidity Index (hazard ratio = 1.06, 95% CI = 1.060, 1.068) as significant predictors of subsequent lumbar surgery following index discectomy. Conclusion.: Five-year subsequent lumbar surgery rate following single-level lumbar discectomy was 14.4%, with a higher rate of 18.2% following revision discectomy. This is the largest cohort to date studying reoperation rates after single-level lumbar discectomy. Patients should be counseled regarding the significant risk of subsequent surgeries, particularly after revision discectomy. Fusion procedures were more frequently performed after revision discectomy, underscoring the need to carefully consider surgical planning and patient selection in recurrent lumbar disc herniation cases.

Purpose: To perform a large-scale assessment of reoperation risk among spine deformity patients undergoing thoracic to pelvis surgery. Methods: The PearlDiver database was queried for spinal deformity patients (scoliosis, kyphosis, spondylolisthesis, sagittal plane deformity) undergoing at minimum, a T12-pelvis operation (2010–2020). CPT codes identified lumbar arthrodesis procedures that included pelvic fixation and ≥ 7 levels of posterior instrumentation on the same day. Minimum follow-up was 2 years. Reoperations included subsequent arthrodesis, decompression, osteotomy, device insertion, and pelvic fixation procedures. Multivariable regression analysis described associations between variables and reoperation risk. Results: 7,062 patients met criteria. Overall reoperation rate was 23.2%. Reoperation rate at 2- and 5-year was 16.9% and 22.1% respectively. 10-year reoperation-free probability was 73.7% (95% CI: 72.4–74.9%). Multivariable analysis revealed higher reoperation risk for patients with kyphosis and ≥ 13 levels of posterior instrumentation. Patients who received interbody cages had a lower reoperation risk. No association was found between the presence or absence of osteotomy procedures and reoperation risk. Lastly, linear regression analyses revealed no significant relationship between age or ECI and risk for subsequent operations did not independently influence reoperation. Conclusions: This study, representing a real-world cohort of over six times the largest current prospective data set, found a 2-year reoperation rate of 17%, similar to previous studies, suggesting study group findings are applicable to a broader population. Preoperative kyphosis and ≥ 13 levels of posterior instrumentation was associated with higher reoperation risk, while the use of interbody cages was protective. Age, medical comorbidities, and osteotomies did not predict reoperations.

OBJECTIVE: Long-term meta-analysis of cervical disc arthroplasty (CDA) trials report lower rates of subsequent cervical spine surgical procedures with CDA compared with anterior cervical discectomy and fusion (ACDF). The objective of this study was to compare the rate of subsequent cervical spine surgery in single-level CDA–treated patients to that of a matched cohort of single-level ACDF–treated patients by using records from 2010 to 2021 included in a large national administrative claims database (PearlDiver). METHODS: This retrospective matched-cohort study used a large national insurance claims database; 525,510 patients who had undergone a single-level ACDF or CDA between 2010 and 2021 were identified. Patients with other same-day spine procedures, as well as those for trauma, infection, or tumor, were excluded, yielding 148,531 patients. ACDF patients were matched 2:1 to CDA patients on the basis of clinical and demographic characteristics. The primary outcome was the overall incidence of all-cause cervical reoperation after index surgery. Secondary outcomes included readmission, any adverse event within 90 days, and overall reintervention after index surgery. Multivariable logistic regression analyses were adjusted for covariates and were employed to estimate the effect of the index ACDF or CDA procedure on patient outcomes. Survival was assessed using Kaplan-Meier estimation, and differences between ACDF- and CDA-treated patients were compared using log-rank tests. RESULTS: After the patients were matched, 28,795 ACDF patients to 14,504 CDA patients were included. ACDF patients had higher rates of 90-day adverse events (18.4% vs 14.6%, adjusted odds ratio [aOR] 0.77, 95% CI 0.73–0.82, p < 0.001) and readmission (11.5% vs 9.7%, aOR 0.87, 95% CI 0.81–0.93, p < 0.001). Over a mean 4.3 years of follow-up, 5.0% of ACDF patients and 5.4% of CDA patients underwent reoperation (aOR 1.09, 95% CI 1.00–1.19, p = 0.059). The rate of aggregate reintervention was higher in CDA patients than in ACDF patients (11.7% vs 10.7%, aOR 1.10, p = 0.002). The Kaplan-Meier 10-year reoperation-free survival rate was worse for CDA than ACDF (91.0% vs 92.0%, p = 0.05), as was the rate of reintervention-free survival (81.2% vs 82.0%, p = 0.003). CONCLUSIONS: Single-level CDA was associated with a similar rate of reoperation and higher rate of subsequent injections when compared with a matched cohort that underwent single-level ACDF. CDA was associated with lower rates of 90-day adverse events and readmissions.

Study Design: Retrospective Cohort. Objectives: Most data regarding cervical disc arthroplasty (CDA) outcomes are from highly controlled clinical trials with strict inclusion/exclusion criteria. This study aimed to identify risk factors for CDA reoperation, in “real world” clinical practice using a national insurance claims database. Methods: The PearlDiver database was queried for patients (2010-2020) who underwent a subsequent cervical procedure following a single-level CDA. Patients with less than 2 years follow-up were excluded. Primary outcome was to evaluate risk factors for reoperation. Secondary outcome was to evaluate the types of reoperations. Risk factors were compared using descriptive statistics. Multivariate regression analyses were used to ascertain the association among risk factors and reoperation. Results: Of 14,202 patients who met inclusion criteria, 916 (6.5%) underwent reoperation. Patients undergoing reoperation were slightly older with higher Elixhauser Comorbidity Index (ECI) scores, however both were not risk factors for reoperation. Patients with diagnoses such as smoking, myelopathy, inflammatory disorders, spinal deformity, trauma, or a history of prior cervical surgery were at greater risk for reoperation. No association was found between the year of index surgery and reoperation risk. The most common reoperation procedure was cervical fusion. Conclusions: As billed for in the United States since 2010, CDA was associated with a 6.5% reoperation rate over a mean follow-up time of 5.3 years. Smoking, myelopathy, inflammatory disorders, spinal deformity, and a history of prior cervical surgery or trauma are risk factors for reoperation following CDA. Though patients who underwent a reoperation were older, age was not found to be an independent risk factor for a subsequent procedure.