Yu-Po Lee

Study Design: Retrospective propensity score-matched cohort study. Objective: To evaluate the association between preoperative gabapentinoid use postoperative pseudoarthrosis, reoperation, and medical complications following adult spinal deformity (ASD) surgery. Summary of Background Data: Gabapentinoids are increasingly prescribed for neuropathic and radicular pain and have demonstrated inhibitory effects on bone metabolism and spinal fusion formation in preclinical models. While prior studies have examined chronic gabapentinoid use in short-segment lumbar fusion, no study has evaluated their impact in ASD surgery, where construct length and baseline pseudoarthrosis are substantially greater. Materials and Methods: Adult patients undergoing ASD correction between 2015 and 2022 were identified using the TriNetX Research Network. Patients with preoperative gabapentinoid prescription within 90 days before surgery were compared with nonusers. Exclusion criteria included trauma, neoplasm, infection, prior fusion, revision surgery, and preoperative opioid use. One-to-one propensity score matching was performed on demographics, comorbidities, and medication use. Primary outcomes included pseudoarthrosis and reoperation at one-year, two-year, and three-year follow-up. Secondary outcomes included 90-day medical complications, including venous thromboembolism, surgical site infection, acute kidney injury, pneumonia, stroke, and myocardial infarction. Results: After propensity score matching, 477 gabapentinoid users were matched to 477 nonusers. Baseline demographics and surgical complexity were well balanced between cohorts. No significant differences were observed in 90-day medical complications or reoperation rates at any time point. However, preoperative gabapentinoid use was associated with significantly increased pseudoarthrosis rates at all follow-up intervals. Pseudoarthrosis occurred in 18.18% versus 9.70% of patients at one year and 23.08% versus 11.74% at three years among gabapentinoid users versus nonusers, respectively (all P <0.0001). Conclusion: Preoperative gabapentinoid use was associated with an approximately two-fold increased risk of pseudoarthrosis following ASD surgery without corresponding increases in perioperative complications or reoperation. These findings suggest gabapentinoid exposure may represent an underrecognized modifiable risk factor for failed fusion in ASD surgery and warrants prospective investigation.

Study Design: A total of 20 patients with degenerative cervical myelopathy (DCM) and a plan for surgical decompression were recruited in this pilot study to assess a new outcome measure. Patients were evaluated preoperatively and 3 months, 6 months, and 1 year postoperatively using a 3-dimensional motion-tracking application (reachable workspace) to calculate an upper extremity (UE) relative surface area (RSA) and standard measurements [modified Japanese Orthopedic Association (mJOA), 12-Item Short Form Health Survey (SF-12), and visual analog pain (VAP) score]. Baseline demographic data were collected. Objective: To assess the validity and comparativeness of a new measurement tool in DCM. Summary of Background Data: Currently, no universally accepted outcome measure exists for DCM. Traditionally used assessment scales are subjective and lack sensitivity. The reachable workspace, a graphical representation of UE spatial surface area using motion-sensor technology, can be used as an objective adjuvant assessment tool in DCM. Methods: The Welch t test was performed to assess UE RSA differences between DCM patients and healthy controls (HC). Concurrent validity and effect size of the RSA were compared to the standard measurements. A P =0.05 was accepted as statistically significant. Results: DCM patients had significantly reduced RSA of all quadrants compared to controls, with the largest reductions in the upper quadrants ( P P P P P <0.005). Patients with symptoms <1 year before surgery showed improved function via significant increases in total RSA and mJOA score. A stronger effect size was seen with RSA. Conclusion: The reachable workspace shows potential to track DCM UE function with accuracy, reliability, and sensitivity to change. Given the promise of this pilot study, a larger study to increase power and substantiate our results will be performed in the future.

Introduction: Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are common treatments for cervical radiculopathy and myelopathy. While ACDF remains the gold standard, CDA is gaining popularity due to the benefit of motion preservation. However, national trends in outcomes between these procedures remain unclear. Methods: A retrospective analysis was performed using the American College of Surgeons National Surgical Quality Improvement Program database to identify patients aged >18 who underwent ACDF or CDA between 2012 and 2022, using CPT codes 22551 and 22856. Annual rates of demographics, comorbidities, and 30-day complications were analyzed. Univariate analysis evaluated outcomes including readmission, reoperation, and length of stay (LOS). Results: We identified 93,989 ACDF and 8708 CDA patients. From 2012 to 2022, the proportion of ACDF cases declined from 96.3% to 90.2%, while CDA cases increased from 3.7% to 9.9%. ACDF patients were older (55.7 vs. 46.8 years) and had higher body mass index (30.6 vs. 29.6) ( P < 0.001). Diabetes increased in both cohorts (ACDF: 15.3%–20.7%; CDA: 5.9%–11.3%), as did hypertension (ACDF: +8.7%; CDA: +5.4%) ( P < 0.001). Steroid use (+2.2%, P < 0.001) and chronic obstructive pulmonary disease (+1.0%, P = 0.021) rose in ACDF only. LOS decreased in ACDF (1.94–1.76 days, P < 0.001) but rose in CDA (1.10–1.15 days, P = 0.023). Readmissions increased in both (ACDF: 2.9%–3.25%; CDA: 0.74%–1.01%, P < 0.001). Conclusion: CDA continues to show favorable short-term outcomes compared to ACDF but remains less utilized overall. These trends may guide surgical planning and patient counseling in cervical spine care.

Background: Although posterior lumbar fusions (PLFs) have risen in popularity due to minimally invasive techniques and favorable outcomes, complications still arise. Studies show relatively constant rates of postoperative complications from 2006 to 2016, but there are limited studies evaluating outcomes after 2016. Consequently, we aim to investigate trends in postoperative complications for PLFs from 2009 to 2022. Methods: The American College of Surgeons National Surgical Quality Improvement Program was queried for single-level PLFs between 2006 and 2022. Patients between 2006 and 2008 were excluded due to limited sample size. Inclusion criteria included >18 years old and Current Procedural Terminology code 22612. Baseline demographics and comorbidities were recorded. Annual 30-day complication rates of wound infection, readmission, reoperation, length of stay, intraoperative blood transfusions (IBTs), and mortality were recorded. Analysis of variance and multivariable Poisson log-linear regression were performed to compare complication rates between years and outcomes between 2020–2022 and 2017–2019. Results: Wound infection rates declined from 3.7% in 2009 to 2.7% in 2019, with an increase to 3.0% by 2022 (P = 0.015). IBT decreased significantly, from 20.58% in 2010 to 9.40% in 2022 (P < 0.001). Sepsis rates fell from 2.15% in 2009 to 0.88% in 2022 (P = 0.017). The average length of stay decreased from 2009 to 2019 (P < 0.001). Wound infection (P = 0.006) and pneumonia (P = 0.039) rates significantly increased between 2020 and 2022. Conclusion: Rates of older age, diabetes, and hypertension increased among PLF patients between 2009 and 2022, while most complication rates remained constant. Rates of wound infection, IBT, sepsis, and average length of stay have improved since 2009 despite an increase in wound infection and pneumonia from 2020 to 2022.

Background: Endoscopic spine surgery has recently grown in popularity due to the potential benefits of reduced pain and faster recovery time as compared to open surgery. Biportal spinal endoscopy has been successfully applied to lumbar disc herniations and lumbar spinal stenosis. Obesity is associated with increased risk of complications in spine surgery. Few prior studies have investigated the impact of obesity and associated medical comorbidities with biportal spinal endoscopy. Methods: This study was a prospectively collected, retrospectively analyzed comparative cohort design. Patients were divided into cohorts of normal body weight (Bone Mass Index (BMI)18.0–24.9), overweight (BMI 25.0–29.9) and obese (BMI > 30.0) as defined by the World Health Organization (WHO). Patients underwent biportal spinal endoscopy by a single surgeon at a single institution for treatment of lumbar disc herniations and lumbar spinal stenosis. Demographic data, surgical complications, and patient-reported outcomes were analyzed. Statistics were calculated amongst treatment groups using analysis of variance and chi square where appropriate. Statistical significance was determined as p < 0.05. Results: Eighty-four patients were followed. 26 (30.1%) were normal BMI, 35 (41.7%) were overweight and 23 (27.4%) were obese. Patients with increasing BMI had correspondingly greater American Society of Anesthesiologist (ASA) scores. There were no significant differences in VAS Back, VAS Leg, and ODI scores, or postoperative complications among the cohorts. There were no cases of surgical site infections in the cohort. All cohorts demonstrated significant improvement up to 1 year postoperatively. Conclusions: This study demonstrates that obesity is not a risk factor for increased perioperative complications with biportal spinal endoscopy and has similar clinical outcomes and safety profile as compared to patients with normal BMI. Biportal spinal endoscopy is a promising alternative to traditional techniques to treat common lumbar pathology.

Background: Preoperative optimization in patients undergoing posterior spinal fusion is essential to limit the number and severity of postoperative complications. Here, we, additionally, evaluated the impact of hypoalbuminemia on morbidity and mortality after posterior spinal fusion surgery. Methods: This retrospective analysis was performed using data from a prospective multicentric database (ACSNSQIP:2015–2020) regarding patients undergoing posterior spinal fusions. Factors studied included; baseline demographics and 30-day postoperative complications (i.e., reoperations, readmissions, and mortality rates). Results: There were 6805 patients who met the inclusion criteria. They averaged 62 years of age and had an average BMI of 30.2. Within the 30-day postoperative period, 634 (9.3%) sustained complications; 467 (6.9%) were readmitted, 263 (3.9%) required reoperations, and 37 (0.5%) expired. Although multiple preoperative risk factors were analyzed, hypoalbuminemia, severe hypoalbuminemia, and dialysis were the strongest independent risk factors associated with complications (i.e., reoperations, readmissions, and mortality). Conclusion: Hypoalbuminemia, severe hypoalbuminemia, and dialysis were significant predictors for morbidity and mortality after posterior spinal fusion surgery.

Background: The costs of cervical spine surgery have steadily increased. We performed a 5-year propensity scoring-matched analysis of 276 patients undergoing anterior versus posterior cervical surgery at one institution. Methods: We performed propensity score matching on financial data from 276 patients undergoing 1–3 level anterior versus posterior cervical fusions for degenerative disease (2015–2019). Results: We found no significant difference between anterior versus posterior approaches for hospital costs ($42,529.63 vs. $45,110.52), net revenue ($40,877.25 vs. $34,036.01), or contribution margins ($14,230.19 vs. $6,312.54). Multivariate regression analysis showed variables significantly associated with the lower contribution margins included age (β = −392.3) and length of stay (LOS; β = −1151). Removing age/LOS from the analysis, contribution margins were significantly higher for the anterior versus posterior approach ($17,824.16 vs. $6,312.54, P = 0.01). Conclusion: Anterior cervical surgery produced higher contribution margins compared to posterior approaches, most likely because posterior surgery was typically performed in older patients requiring longer LOS.

Background: We analyzed the role of hypoalbuminemia, dialysis, and other risk factors that increase morbidity/ mortality following surgery for primary pyogenic spinal infections (PSIs). The American College of Surgeons’ National Surgical Quality Improvement Program (ACS-NSQIP) that included 627 patients was utilized as our database. Methods: Primary spinal surgery for spondylodiscitis was evaluated in a ACS-NSQIP database involving 627 patients between 2010 and 2019. Outcome assessment included evaluation of 30-day postoperative morbidity, and mortality rates. Results: Within 30 postoperative days, complications occurred in 14.6% (92/627) of patients; 59 (9.4%) required readmission, and 39 (6.2%) required additional surgery. The most common complications were: wound infections, pneumonia, septic shock, and death (1.8%). Hypoalbuminemia (i.e., significantly associated with unplanned readmission and reoperation), and dialysis were the two major risk factors contributing to increased perioperative morbidity and mortality. Conclusion: Among 627 ACS-NSQIP patients undergoing primary surgery for PSIs, hypoalbuminemia and dialysis were associated with higher risks of major perioperative morbidity (i.e., within 30 postoperative days – mostly readmissions and reoperations) and mortality.