Browsing by Author "Smith, JS"
Now showing 1 - 20 of 29
- Results Per Page
- Sort Options
Item Open Access 166 Predictive Modeling of Length of Hospital Stay Following Adult Spinal Deformity Correction: Analysis of 653 Patients With an Accuracy of 75% Within 2 Days(Neurosurgery, 2016-08-01) Scheer, JK; Ailon, TT; Smith, JS; Hart, R; Burton, DC; Bess, S; Neuman, BJ; Passias, PG; Miller, E; Shaffrey, CI; Schwab, F; Lafage, V; Klineberg, E; Ames, CPINTRODUCTION: The length of stay (LOS) following adult spinal deformity (ASD) surgery is a critical time period allowing for recovery to levels safe enough to return home or to rehabilitation. Thus, the goal is to minimize it for conserving hospital resources and third-party payer pressure. Factors related to LOS have not been studied nor has a predictive model been created. The goal of this study was to construct a preadmission predictive model based on patients' baseline variables and modifiable surgical parameters.Item Open Access Adult Spinal Deformity Surgeons Are Unable to Accurately Predict Postoperative Spinal Alignment Using Clinical Judgment Alone(Spine Deformity, 2016-07-01) Ailon, T; Scheer, JK; Lafage, V; Schwab, FJ; Klineberg, E; Sciubba, DM; Protopsaltis, TS; Zebala, L; Hostin, R; Obeid, I; Koski, T; Kelly, MP; Bess, S; Shaffrey, CI; Smith, JS; Ames, CPObject Adult spinal deformity (ASD) surgery seeks to reduce disability and improve quality of life through restoration of spinal alignment. In particular, correction of sagittal malalignment is correlated with patient outcome. Inadequate correction of sagittal deformity is not infrequent. The present study assessed surgeons' ability to accurately predict postoperative alignment. Methods Seventeen cases were presented with preoperative radiographic measurements, and a summary of the operation as performed by the treating physician. Surgeon training, practice characteristics, and use of surgical planning software was assessed. Participants predicted if the surgical plan would lead to adequate deformity correction and attempted to predict postoperative radiographic parameters including sagittal vertical axis (SVA), pelvic tilt (PT), pelvic incidence to lumbar lordosis mismatch (PI-LL), thoracic kyphosis (TK). Results Seventeen surgeons participated: 71% within 0 to 10 years of practice; 88% devote >25% of their practice to deformity surgery. Surgeons accurately judged adequacy of the surgical plan to achieve correction to specific thresholds of SVA 69% ± 8%, PT 68% ± 9%, and PI-LL 68% ± 11% of the time. However, surgeons correctly predicted the actual postoperative radiographic parameters only 42% ± 6% of the time. They were more successful at predicting PT (61% ± 10%) than SVA (45% ± 8%), PI-LL (26% ± 11%), or TK change (35% ± 21%; p <.05). Improved performance correlated with greater focus on deformity but not number of years in practice or number of three-column osteotomies performed per year. Conclusion Surgeons failed to correctly predict the adequacy of the proposed surgical plan in approximately one third of presented cases. They were better at determining whether a surgical plan would achieve adequate correction than predicting specific postoperative alignment parameters. Pelvic tilt and SVA were predicted with the greatest accuracy.Item Open Access Anaplastic extramedullary cervical ependymoma with leptomeningeal metastasis.(Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia, 2015-12) Pomeraniec, IJ; Dallapiazza, RF; Sumner, HM; Lopes, MB; Shaffrey, CI; Smith, JSWe present a rare extramedullary ependymoma with diffuse spinal metastatic disease, and review the previous reports of extramedullary spinal ependymomas. Ependymomas are the most common intramedullary spinal cord tumor in adults. These tumors rarely present as extramedullary masses. We treated a 23-year-old man with a history of progressive neck, shoulder and arm pain, with sensory and motor symptoms in the C7 dermatome. MRI of the cervical spine demonstrated a ventral contrast-enhancing lesion with evidence of enhancement along the dura and spinal cord of the upper cervical spine, thoracic spine, and cauda equina. He underwent a tumor debulking procedure without complications. Following surgery, he received craniospinal radiation to treat the remaining tumor and diffuse leptomeningeal disease. The final pathology of the tumor revealed that is was a World Health Organization Grade III anaplastic ependymoma. At the 1 year follow-up, the patient had stable imaging and had returned to his preoperative functional status. Of the 19 reported patients with primary intradural, extramedullary spinal ependymomas, two had extradural components and seven had anaplastic grades. Only one tumor with an anaplastic grade resulted in metastatic disease, but without spinal recurrence. To our knowledge, this is the first report of an intradural, extramedullary spinal ependymoma with an anaplastic grade, presenting with concomitant diffuse, nodular leptomeningeal metastasis involving the upper cervical spine, thoracic spine, conus medullaris, and cauda equina. Similar to the treatment of intramedullary ependymomas with metastasis, this patient underwent an aggressive debulking procedure followed by radiation therapy to the entire neuroaxis.Item Open Access Assessment of impact of standing long-cassette radiographs on surgical planning for lumbar pathology: An international survey of spine surgeons(Journal of Neurosurgery: Spine, 2015-11-01) Maggio, D; Ailon, TT; Smith, JS; Shaffrey, CI; Lafage, V; Schwab, F; Haid, RW; Protopsaltis, T; Klineberg, E; Scheer, JK; Bess, S; Arnold, PM; Chapman, J; Fehlings, MG; Ames, COBJECT: The associations among global spinal alignment, patient-reported disability, and surgical outcomes have increasingly gained attention. The assessment of global spinal alignment requires standing long-cassette anteroposterior and lateral radiographs; however, spine surgeons routinely rely only on short-segment imaging when evaluating seemingly isolated lumbar pathology. This may prohibit adequate surgical planning and may predispose surgeons to not recognize associated pathology in the thoracic spine and sagittal spinopelvic malalignment. The authors used a case-based survey questionnaire to evaluate if including long-cassette radiographs led to changes to respondents' operative plans as compared with their chosen plan when cases contained standard imaging of the involved lumbar spine only. METHODS: A case-based survey was distributed to AOSpine International members that consisted of 15 cases of lumbar spine pathology and lumbar imaging only. The same 15 cases were then shuffled and presented a second time with additional long-cassette radiographs. Each case required participants to select a single operative plan with 5 choices ranging from least to most extensive. The cases included 5 "control" cases with normal global spinal alignment and 10 "test" cases with significant sagittal and/or coronal malalignment. Mean scores were determined for each question with higher scores representing more invasive and/or extensive operative plans. RESULTS: Of 712 spine surgeons who started the survey, 316 (44%) completed the entire series, including 68% of surgeons with spine fellowship training and representation from more than 40 countries. For test cases, but not for control cases, there were significantly higher average surgical invasiveness scores for cases presented with long-cassette radiographs (4.2) as compared with those cases with lumbar imaging only (3.4; p = 0.002). The addition of long-cassette radiographs resulted in 82.1% of respondents recommending instrumentation up to the thoracic spine, a 23.2% increase as compared with the same cases presented with lumbar imaging only (p = 0.008). CONCLUSIONS: This study demonstrates the importance of maintaining a low threshold for performing standing long-cassette imaging when assessing seemingly isolated lumbar pathology. Such imaging is necessary for the assessment of spinopelvic and global spinal alignment, which can be important in operative planning. Deformity, particularly positive sagittal malalignment, may go undetected unless one maintains a high index of suspicion and obtains long-cassette radiographs. It is recommended that spine surgeons recognize the prevalence and importance of such deformity when contemplating operative intervention.Item Open Access Clinically Significant Thromboembolic Disease in Adult Spinal Deformity Surgery: Incidence and Risk Factors in 737 Patients(Global Spine Journal, 2018-05-01) Kim, HJ; Iyer, S; Diebo, BG; Kelly, MP; Sciubba, D; Schwab, F; Lafage, V; Mundis, GM; Shaffrey, CI; Smith, JS; Hart, R; Burton, D; Bess, S; Klineberg, EOStudy Design: Retrospective cohort study. Objectives: Describe the rate and risk factors for venous thromboembolic events (VTEs; defined as deep venous thrombosis [DVT] and/or pulmonary embolism [PE]) in adult spinal deformity (ASD) surgery. Methods: ASD patients with VTE were identified in a prospective, multicenter database. Complications, revision, and mortality rate were examined. Patient demographics, operative details, and radiographic and clinical outcomes were compared with a non-VTE group. Multivariate binary regression model was used to identify predictors of VTE. Results: A total of 737 patients were identified, 32 (4.3%) had VTE (DVT = 14; PE = 18). At baseline, VTE patients were less likely to be employed in jobs requiring physical labor (59.4% vs 79.7%, P <.01) and more likely to have osteoporosis (29% vs 15.1%, P =.037) and liver disease (6.5% vs 1.4%, P =.027). Patients with VTE had a larger preoperative sagittal vertical axis (SVA; 93 mm vs 55 mm, P <.01) and underwent larger SVA corrections. VTE was associated with a combined anterior/posterior approach (45% vs 25%, P =.028). VTE patients had a longer hospital stay (10 vs 7 days, P <.05) and higher mortality rate (6.3% vs 0.7%, P <.01). Multivariate analysis demonstrated osteoporosis, lack of physical labor, and increased SVA correction were independent predictors of VTE (r2 =.11, area under the curve = 0.74, P <.05). Conclusions: The incidence of VTE in ASD is 4.3% with a DVT rate of 1.9% and PE rate of 2.4%. Osteoporosis, lack of physical labor, and increased SVA correction were independent predictors of VTE. Patients with VTE had a higher mortality rate compared with non-VTE patients.Item Open Access Complications of surgical intervention in adult lumbar scoliosis(Current Reviews in Musculoskeletal Medicine, 2016-09-01) Christiansen, PA; LaBagnara, M; Sure, DR; Shaffrey, CI; Smith, JSIf nonoperative measures are unsuccessful in managing the pain and disability of adult spinal deformities, surgical correction may provide the potential for significant improvement in a patient’s quality of life. However, these procedures have a relatively high risk of complications. Identifying patients that may benefit from surgical intervention requires a thorough understanding of potential complications and managing the risks of any individual patient. Complications do not necessarily result in poor outcomes, and good outcomes are not always complication free. Higher risk patients potentially have more to gain, even if they experience complications. With the rapidly expanding senior population and expanded capabilities to manage high-risk patients, it is helpful to consider the lessons provided by ever expanding databases of outcome measures to refine the surgical decision-making process.Item Open Access Dorsal thoracic arachnoid web and the "scalpel sign": a distinct clinical-radiologic entity.(AJNR. American journal of neuroradiology, 2013-05) Reardon, MA; Raghavan, P; Carpenter-Bailey, K; Mukherjee, S; Smith, JS; Matsumoto, JA; Yen, C-P; Shaffrey, ME; Lee, RR; Shaffrey, CI; Wintermark, MArachnoid webs are intradural extramedullary bands of arachnoid tissue that can extend to the pial surface of the spinal cord, causing a focal dorsal indentation of the cord. These webs tend to occur in the upper thoracic spine and may produce a characteristic deformity of the cord that we term the "scalpel sign." We describe 14 patients whose imaging studies demonstrated the scalpel sign. Ten of 13 patients who underwent MR imaging demonstrated T2WI cord signal-intensity changes, and 7 of these patients also demonstrated syringomyelia adjacent to the level of indentation. Seven patients underwent surgery, with 5 demonstrating an arachnoid web as the cause of the dorsal indentation demonstrated on preoperative imaging. Although the webs themselves are rarely demonstrated on imaging, we propose that the scalpel sign is a reliable indicator of their presence and should prompt consideration of surgical lysis, which is potentially curative.Item Open Access Expanding lateral access spine surgery(Neurosurgical Focus: Video, 2022-07-01) Snyder, LA; Erickson, M; Smith, JS; Mummaneni, PVItem Open Access Impact of obesity on complications, infection, and patient-reported outcomes in adult spinal deformity surgery(Journal of Neurosurgery: Spine, 2015-11-01) Soroceanu, A; Burton, DC; Diebo, BG; Smith, JS; Hostin, R; Shaffrey, CI; Boachie-Adjei, O; Mundis, GM; Ames, C; Errico, TJ; Bess, S; Gupta, MC; Hart, RA; Schwab, FJ; Lafage, VOBJECT: Adult spinal deformity (ASD) surgery is known for its high complication rate. This study examined the impact of obesity on complication rates, infection, and patient-reported outcomes in patients undergoing surgery for ASD. METHODS: This study was a retrospective review of a multicenter prospective database of patients with ASD who were treated surgically. Patients with available 2-year follow-up data were included. Obesity was defined as having a body mass index (BMI) ≥ 30 kg/m2. Data collected included complications (total, minor, major, implant-related, radiographic, infection, revision surgery, and neurological injury), estimated blood loss (EBL), operating room (OR) time, length of stay (LOS), and patient-reported questionnaires (Oswestry Disability Index [ODI], Short Form-36 [SF-36], and Scoliosis Research Society [SRS]) at baseline and at 6 weeks, 1 year, and 2 years postoperatively. The impact of obesity was studied using multivariate modeling, accounting for confounders. RESULTS: Of 241 patients who satisfied inclusion criteria, 175 patients were nonobese and 66 were obese. Regression models showed that obese patients had a higher overall incidence of major complications (IRR 1.54, p = 0.02) and wound infections (odds ratio 4.88, p = 0.02). Obesity did not increase the number of minor complications (p = 0.62), radiographic complications (p = 0.62), neurological complications (p = 0.861), or need for revision surgery (p = 0.846). Obesity was not significantly correlated with OR time (p = 0.23), LOS (p = 0.9), or EBL (p = 0.98). Both groups experienced significant improvement over time, as measured on the ODI (p = 0.0001), SF-36 (p = 0.0001), and SRS (p = 0.0001) questionnaires. However, the overall magnitude of improvement was less for obese patients (ODI, p = 0.0035; SF-36, p = 0.0012; SRS, p = 0.022). Obese patients also had a lower rate of improvement over time (SRS, p = 0.0085; ODI, p = 0.0001; SF-36, p = 0.0001). CONCLUSIONS: This study revealed that obese patients have an increased risk of complications following ASD correction. Despite these increased complications, obese patients do benefit from surgical intervention; however, their improvement in health-related quality of life (HRQL) is less than that of nonobese patients.Item Open Access In response(Spine, 2012-02-01) Williams, BJ; Smith, JS; Shaffrey, CIItem Open Access Intraoperative neuromonitoring has a poor correlation with postoperative neurological deficits in noncord level adult deformity surgery(Spine Journal, 2024-09-01) Sardar, Z; Swamy, G; Yoshida, G; Kelly, MP; Strantzas, S; Basu, S; Kwan, K; Smith, JS; Pellise, F; Gupta, MC; Jones, KE; Charalampidis, A; Rocos, B; Lewis, SJ; Lenke, LGBACKGROUND CONTEXT: Intraoperative neuromonitoring (IONM) is routinely used during spinal deformity surgery. While it is highly effective at detecting spinal cord level changes, the utility for surgery at a noncord level is less known. The purpose of this study is to evaluate rates of new neural deficits relative to IONM alerts in noncord-level spinal deformity surgery. PURPOSE: In noncord-level spinal deformity surgery, postop neural deficits are incompletely associated with IONM alerts. The purpose of this study was to assess the efficacy of neuromonitoring in detecting and preventing neurological deficits. STUDY DESIGN/SETTING: Prospective, international, multicenter cohort. PATIENT SAMPLE: A total of 197 adult patients undergoing spinal deformity surgery at a noncord level. OUTCOME MEASURES: IONM changes defined as loss of amplitude>50% in SSEP or MEP from baseline or sustained EMG activity lasting>10 seconds were recorded. Postoperative new neurological deficits were recorded. Other outcomes measured were baseline demographics, radiographic alignment parameters, events leading to and following IONM alerts. METHODS: Twenty international centers prospectively documented IONM (EMG, SSEP and MEP), demographics, radiographic findings, and surgical events of patients (10-80 years) undergoing spinal deformity surgery. Inclusion criteria: neurologically intact, spinal deformity correction with major Cobb>80° or involving any osteotomy. IONM change was defined as loss of amplitude>50% in SSEP or MEP from baseline or sustained EMG activity lasting>10 seconds. RESULTS: Of 197 patients, 22 (11.2%) had an IONM alert. More patients were undergoing revision surgery during an alert compared to those with no alert (40.9% vs 18.9%, p = 0.026). IONM alerts did not correlate with coronal cobb angle, deformity angular ratio, sagittal vertical axis, or coronal vertical axis. There were a total of 26 alerts in 22 patients - 4 patients (18.2%) had 2 IONM alerts, while the other 18 (81.8%) had 1 alert. MEPs were affected in 21 of 26 alerts (80.8%) and 15 (71.4%) of those were recovered. Isolated MEP changes were seen in 16 of 26 alerts (61.5%). SSEPs were affected in 8 of 26 alerts (30.8%). Isolated SSEP changes were seen in 3 (11.5%). Lastly, EMGs were affected in only 2 (7.7%) and were isolated. Five of 21 MEP alerts (23.8%) were bilateral, whereas 16 (76.2%) were unilateral. The most frequent event preceding an MEP change was an osteotomy in 6 (28.6%) of 21 patients. The most frequent nonsurgical event preceding an MEP alert was technical in 5 (23.8%), followed by systemic (low blood pressure/anemia) and anesthetic in 3 patients each (14.3%). Thirty-three of 197 patients (16.8%) developed a new postop neural deficit. Of these patients, 24 (72.7%) had no IONM alert. In the presence of an IONM alert 9 of 22 (40.9%) had a new neural deficit. IONM alert and development of new neural deficit had a crude negative predictive value (NPV) of 86.1%. CONCLUSIONS: In noncord-level spinal deformity surgery, IONM alerts occurred in 11.2% of patients, with osteotomy being the most frequent preceding surgical event. A new postop neural deficit was observed in 16.8% of all patients, and in 41% of patients with a IONM alert. A surprisingly high 73% of postop neural deficits occurred in patients who did not have an alert. This highlights the need for further refinement of IONM techniques and alert criteria for noncord-level surgery. FDA Device/Drug Status: This abstract does not discuss or include any applicable devices or drugs.Item Open Access Introduction: Video Illustrations of Techniques and Strategies for Adult and Pediatric Spinal Deformity Surgery(Neurosurgical Focus: Video, 2020-01-01) Smith, JS; Shaffrey, CI; Wang, M; Bydon, M; Lenke, LItem Open Access Outcomes of Operative and Nonoperative Treatment for Adult Spinal Deformity(Neurosurgery, 2016-09) Smith, JS; Lafage, V; Shaffrey, CItem Open Access Outcomes, Expectations, and Complications Overview for the Surgical Treatment of Adult and Pediatric Spinal Deformity(Spine Deformity, 2012-09-01) Smith, JS; Kasliwal, MK; Crawford, A; Shaffrey, CIThe aim of this article was to summarize current literature on surgical treatment of pediatric and adult spinal deformity with regard to clinical outcomes and surgical complications. When surgery is considered for treatment of spinal deformity, it is important for both the physician and patient to appreciate the outcome objectives, have reasonable expectations, and understand the potential for adverse events. We conducted a comprehensive search of the English literature from the years 2000–2011 using Medline for articles related to the surgical treatment of spinal deformity, using selected terms. We reviewed abstracts and restricted them to those focused on surgical treatment of spinal deformity. We included clinical outcomes measures and overall complications rates, and reviewed corresponding manuscripts. For pediatric and adult spinal deformity, we identified 8 and 17 manuscripts, respectively, that included preoperative and postoperative assessments of outcomes measures. The vast majority of reported studies demonstrated that operative treatment has the potential to produce significant improvement of health-related quality of life. Surgical treatment of pediatric scoliosis, including idiopathic, neuromuscular, and congenital, had reported complication rates ranging from 4.4% to 15.4%, 17.9% to 48.1%, and 8.3% to 31%, respectively. Surgical treatment of adult scoliosis had reported overall complication rates ranging from 10.5% to 96%. The number of high-quality studies that provide assessment of the outcomes of surgery for pediatric and adult scoliosis remains limited; further study is needed. Available studies suggest that in selected patients, surgical treatment offers potential for improvement of health-related quality of life. The current literature also demonstrates the risks that accompany surgical procedures for the correction of spinal deformity. It is important that spinal deformity patients considering surgical treatment have appropriate expectations not only of the potential benefits it may offer, but also of the risks inherent to such procedures.Item Open Access Preoperative dysphonia and dysphagia improve following cervical deformity surgery(Spine Journal, 2024-09-01) Soroceanu, A; Gum, JL; Protopsaltis, TS; Hamilton, DK; Passias, PG; Lafage, R; Smith, JS; Kebaish, KM; Eastlack, RK; Klineberg, EO; Gupta, MC; Lafage, V; Schwab, FJ; Shaffrey, CI; Bess, S; Burton, DC; Ames, CPBACKGROUND CONTEXT: Twenty-five percent of adult cervical deformity patients undergoing deformity correction have impairment due to a voice problem prior to surgery. Prior work has shown that these patients tend to be more frail and more likely to report preoperative dysphagia. We hypothesized that these patients could be at increased risk of post operative dysphonia and dysphagia. PURPOSE: The purpose of this study was to quantify how patients with preoperative dysphonia differ from their counterparts in terms postoperative dysphagia, dysphonia and HRQOL 6 weeks post surgery. STUDY DESIGN/SETTING: Retrospective analysis of a prospective multicenter cervical deformity database. PATIENT SAMPLE: Adult cervical deformity patients with preop dysphonia undergoing deformity correction. OUTCOME MEASURES: Voice handicap index-10 (VHI-10). METHODS: Retrospective analysis of a prospective multicenter cervical deformity database. The voice handicap index-10 (VHI-10) was used to assess patient's perception of impairment due to problems with their voice prior to surgery. A score ≥11 was considered indicative of dysphonia. Patients were divided into two groups: normalVHI group (VHI-10 score <11) and highVHI group (VHI score ≥11). The two groups were compared in terms of baseline demographics, alignment, surgical metrics, and 6-week dysphagia (measured on the EAT-10 questionnaire), and post operative outcomes. T-tests and chi2 tests were performed, as appropriate. The significance level was p<0.05. RESULTS: There were 74 ACD patients included: NormalVHI (n=58, average VHI score 2.77) and HighVHI (n=16, average VHI score 16.37). The groups were similar in terms of baseline demographics and preoperative alignment. There was no statistically significant difference in terms of surgical metrics between the two groups (revision surgery p=0.21, anterior approach p=0.92, use of osteotomies p=0.71, and OR time p=0.15). The two groups had a similar rate of in hospital adverse events (12.2% vs 7.7%, p=0.64), and similar improvements on the NDI, mJOA, and NRS neck and arm pain. HighVHI patients showed significant improvement on the VHI score 6 weeks post-surgery (11.18 vs 16.37, p=0.01). The HighVHI group also showed postoperative improvement on the EAT-10 questionnaire, compared to NormalVHI patients (-3.68 vs 4.03, p=0.003). CONCLUSIONS: Twenty-five percent of adult cervical deformity patients undergoing deformity correction have impairment due to a voice problem prior to surgery. Contrary to our initial hypothesis, these patients exhibited improvement in dysphonia and dysphagia scores 6 weeks post surgery, with 81% reporting improvement in symptoms of dysphonia, and 69% reporting improvement in symptoms of oropharyngeal dysphagia. FDA Device/Drug Status: This abstract does not discuss or include any applicable devices or drugs.Item Open Access Presentation and Outcomes After Medical and Surgical Treatment Versus Medical Treatment Alone of Spontaneous Infectious Spondylodiscitis: A Systematic Literature Review and Meta-Analysis(Global Spine Journal, 2018-12-01) Taylor, DG; Buchholz, AL; Sure, DR; Buell, TJ; Nguyen, JH; Chen, CJ; Diamond, JM; Washburn, PA; Harrop, J; Shaffrey, CI; Smith, JSStudy Design: Systematic literature review. Objectives: The aims of this study were to (1) describe the clinical features, disabilities, and incidence of neurologic deficits of pyogenic spondylodiscitis prior to treatment and (2) compare the functional outcomes between patients who underwent medical treatment alone or in combination with surgery for pyogenic spondylodiscitis. Methods: A systematic literature review was performed using PubMed according to PRISMA guidelines. No year restriction was put in place. Statistical analysis of pooled data, when documented in the original report (ie, number of patients with desired variable and number of patients evaluated), was conducted to determine the most common presenting symptoms, incidence of pre- and postoperative neurologic deficits, associated comorbidities, infectious pathogens, approach for surgery when performed, and duration of hospitalization. Outcomes data, including return to work status, resolution of back pain, and functional recovery were also pooled among all studies and surgery-specific studies alone. Meta-analysis of studies with subgroup analysis of pain-free outcome in surgical and medical patients was performed. Results: Fifty of 1286 studies were included, comprising 4173 patients undergoing either medical treatment alone or in combination with surgery. Back pain was the most common presenting symptom, reported in 91% of patients. Neurologic deficit was noted in 31% of patients. Staphylococcus aureus was the most commonly reported pathogen, seen in 35% of reported cases. Decompression and fusion was the most commonly reported surgical procedure, performed in 80% of the surgically treated patients. Combined anterior-posterior procedures and staged surgeries were performed in 33% and 26% of surgeries, respectively. The meta-analysis comparing visual analog scale score at follow-up was superior among patients receiving surgery over medical treatment alone (mean difference −0.61, CI −0.90 to −0.25), while meta-analysis comparing freedom from pain in patients receiving medical treatment alone versus combined medical and surgical treatment demonstrated superior pain-free outcomes among surgical series (odds ratio 5.35, CI 2.27-12.60, P <.001), but was subject to heterogeneity among studies (I 2 = 56%, P =.13). Among all patients, freedom from pain was achieved in 79% of patients, and an excellent outcome was achieved in 73% of patients. Conclusion: Medical management remains first-line treatment of infectious pyogenic spondylodiscitis. Surgery may be indicated for progressive pain, persistent infection on imaging, deformity or neurologic deficits. If surgery is required, reported literature shows potential for significant pain reduction, improved neurologic function and a high number of patients returning to a normal functional/work status.Item Open Access Quantifying the importance of upper cervical extension reserve in adult cervical deformity surgery and its impact on baseline presentation and outcomes(Spine Journal, 2024-09-01) Passias, PG; Mir, J; Smith, JS; Lafage, V; Lafage, R; Diebo, BG; Daniels, AH; Onafowokan, O; Line, B; Eastlack, RK; Mundis, GM; Kebaish, KM; Soroceanu, A; Scheer, JK; Kelly, MP; Protopsaltis, TS; Kim, HJ; Hostin, RA; Gupta, MC; Riew, KD; Burton, DC; Schwab, FJ; Bess, S; Shaffrey, CI; Ames, CPBACKGROUND CONTEXT: Hyperextension of the upper cervical spine is a prominent compensatory mechanism to maintain horizontal gaze and balance in adult cervical deformity (ACD) patients, akin to pelvic tilt in spinal deformity. The relaxation of ER and its impact on postoperative outcomes is not well understood. PURPOSE: To evaluate upper cervical ER impact on postoperative disability and outcomes. STUDY DESIGN/SETTING: Retrospective cohort study. PATIENT SAMPLE: Adult cervical deformity. OUTCOME MEASURES: ER, HRQLs. METHODS: ACD patients undergoing subaxial cervical fusion with 2Y data were included. Upper cervical extension reserve (ER) was defined as: C0-C2 sagittal Cobb angle between neutral and extension. Relaxation of ER was defined as the ER normative mean in those that met the ideal in all Passias ACD modifiers. Outcomes were defined as "good" if meeting ≥2 of the three: (1) NDI <20 or meeting MCID, (2) mild myelopathy (mJOA≥14), and (3) NRS-Neck ≤5 or improved by ≥2 points from baseline. Controlled analysis was conducted with ANCOVA and multivariable logistic regressions. Conditional inference tree (CIT) analysis determined thresholds. RESULTS: A total of 108 ACD patients met inclusion. (Age 61.4 ± 12.3, 61% F, BMI 29.4 ± 7.5 kg/m2, mCD-FI .24 ±.12, CCI 0.97 ± 1.30). Radiographic alignment is depicted in Table 1. Preoperative C0-C2 ER was 8.7 ±9.0 ±, and at the last follow-up was 10.3 ± 11.1. ER in those meeting all ideal CD modifiers at 2Y was 12.9 ± 9.0. Preoperatively 29% had adequate ER, while 59.7% had improvement in ER postoperatively, with 50% of patients achieving adequate ER at 2Y. Higher ER significantly correlated with lower cervical deformity (p<.05). Preoperatively, greater ER was predictive of lower preoperative disability, with worse baseline mobility, pain, and anxiety (EQ5D) (B = -6.1, -2.9, -2.9 respectively; R2 =0.212, p<.001). Improvement of ER depicted a higher rate of MCID for NDI (64% vs 39%, p=.008), and meeting good clinical outcomes (72% vs 54%, p=.04). Controlling for baseline deformity and demographic factors found resolution of inadequate ER to have 7x higher likelihood of meeting MCID for NDI (6.941 [1.378-34.961], p=.019) and 4x higher odds of achieving good outcomes (4.022 [1.017-15.900], p=.047). Isolating those with inadequate preoperative ER, found postoperative resolution having 5x odds of good outcomes (p<.05). In those with inadequate ER at baseline, the preoperative C2-C7 of <-18 and TS-CL of >59 for TS-CL was predictive of ER resolution (p<.05). In those with preoperative C2-C7 >-18, a T1PA of >13 was predictive of postoperative return of ER (p<.05). Independently TS-CL of >59, was significant for predicting ER return postoperatively, highlighting its compensatory role for proximal spinal deformities (all p<.05). Surgical correction of C2-C7 by >16 from baseline was found to be predictive of ER return. CONCLUSIONS: Increased preoperative utilization of the extension reserve in the upper cervical spine in cervical deformity was associated with worse baseline regional and global alignment while impacting health-related measures. The majority of patients had relaxation of extension reserve postoperatively, however, in those who didn't, there was a decreased likelihood of achieving good outcomes. FDA Device/Drug Status: This abstract does not discuss or include any applicable devices or drugs.Item Open Access Radiographic outcomes of adult spinal deformity correction: A critical analysis of variability and failures across deformity patterns(Spine Deformity, 2014-01-01) Moal, B; Schwab, F; Ames, CP; Smith, JS; Ryan, D; Mummaneni, PV; Mundis, GM; Terran, JS; Klineberg, E; Hart, RA; Boachie-Adjei, O; Shaffrey, CI; Skalli, W; Lafage, VStudy Design Multicenter, prospective, consecutive, surgical case series from the International Spine Study Group. Objectives To evaluate the effectiveness of surgical treatment in restoring spinopelvic (SP) alignment. Summary of Background Data Pain and disability in the setting of adult spinal deformity have been correlated with global coronal alignment (GCA), sagittal vertical axis (SVA), pelvic incidence/lumbar lordosis mismatch (PI-LL), and pelvic tilt (PT). One of the main goals of surgery for adult spinal deformity is to correct these parameters to restore harmonious SP alignment. Methods Inclusion criteria were operative patients (age greater than 18 years) with baseline (BL) and 1-year full-length X-rays. Thoracic and thoracolumbar Cobb angle and previous mentioned parameters were calculated. Each parameter at BL and 1 year was categorized as either pathological or normal. Pathologic limits were: Cobb greater than 30°, GCA greater than 40 mm, SVA greater than 40 mm, PI-LL greater than 10°, and PT greater than 20°. According to thresholds, corrected or worsened alignment groups of patients were identified and overall radiographic effectiveness of procedure was evaluated by combining the results from the coronal and sagittal planes. Results A total of 161 patients (age, 55 ± 15 years) were included. At BL, 80% of patients had a Cobb angle greater than 30°, 25% had a GCA greater than 40 mm, and 42% to 58% had a pathological sagittal parameter of PI-LL, SVA, and/or PT. Sagittal deformity was corrected in about 50% of cases for patients with pathological SVA or PI-LL, whereas PT was most commonly worsened (24%) and least often corrected (24%). Only 23% of patients experienced complete radiographic correction of the deformity. Conclusions The frequency of inadequate SP correction was high. Pelvic tilt was the parameter least likely to be well corrected. The high rate of SP alignment failure emphasizes the need for better preoperative planning and intraoperative imaging. © 2014 Scoliosis Research Society.Item Open Access Rapid response during spinal deformity surgery can successfully save spinal cord function using intraoperative monitoring.(Spine Journal, 2024-09-01) Theologis, AA; Gupta, MC; Swamy, G; Yoshida, G; Kelly, MP; Strantzas, S; Basu, S; Kwan, K; Smith, JS; Pellise, F; Kato, S; Sardar, Z; Ames, CP; Jones, KE; Charalampidis, A; Rocos, B; Lenke, LG; Lewis, SJThis abstract contains content that is significantly similar to the authors' previously published abstract in the Global Spine Journal Rapid Fire. For access to the original publication, please visit the following DOI: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11086046/pdf/10.1177_21925682241239518.pdf.Item Open Access Redefining Clinically Significant Blood Loss in Complex Adult Spine Deformity Surgery(Spine, 2024-01-01) Daher, M; Xu, A; Singh, M; Lafage, R; Line, BG; Lenke, LG; Ames, CP; Burton, DC; Lewis, SM; Eastlack, RK; Gupta, MC; Mundis, GM; Gum, JL; Hamilton, KD; Hostin, R; Lafage, V; Passias, PG; Protopsaltis, TS; Kebaish, KM; Schwab, FJ; Shaffrey, CI; Smith, JS; Bess, S; Klineberg, EO; Diebo, BG; Daniels, AHStudy Design. Retrospective analysis of prospectively-collected data Objective. This study aims to define clinically relevant blood loss in adult spinal deformity (ASD) surgery. Background. Current definitions of excessive blood loss following spine surgery are highly variable and may be suboptimal in predicting adverse events (AE). Methods. Adults undergoing complex ASD surgery were included. Estimated blood loss (EBL) was extracted for investigation, and estimated blood volume loss (EBVL) was calculated by dividing EBL by the preoperative blood volume utilizing Nadler's formula. LASSO regression was performed to identify five variables from demographic and peri-operative parameters. Logistic regression was subsequently performed to generate a receiver operating characteristics (ROC) curve and estimate an optimal threshold for EBL and EBVL. Finally, the proportion of patients with AE plotted against EBL and EBVL to confirm the identified thresholds. Results. In total 552 patients were included with a mean age of 60.7±15.1 years, 68% females, mean CCI was 1.0±1.6, and 22% experienced AEs. LASSO regression identified ASA score, baseline hypertension, preoperative albumin, and use of intra-operative crystalloids as the top predictors of an AE, in addition to EBL/EBVL. Logistic regression resulted in ROC curve which was used to identify a cut-off of 2.3 liters of EBL and 42% for EBVL. Patients exceeding these thresholds had AE rates of 36% (odds-ratio: 2.1, 95% CI [1.2-3.6]) and 31% (odds-ratio: 1.7, 95% CI [1.1-2.8]), compared to 21% for those below the thresholds of EBL and EBVL, respectively. Conclusion. In complex ASD surgery, intraoperative EBL of 2.3 liters and an EBVL of 42% are associated with clinically-significant AEs. These thresholds may be useful in guiding preoperative-patient-counseling, healthcare system quality initiatives, and clinical perioperative bloodloss management strategies in patients undergoing complex spine surgery. Additionally, similar methodology could be performed in other specialties to establish procedure-specific clinically-relevant bloodloss thresholds.