Comparison of cervical, thoracic, and lumbar vertebral bone quality scores for increased utility of bone mineral density screening.

PURPOSE: To evaluate the associations among the validated lumbar vertebral bone quality (VBQ) score, and cervical and thoracic VBQ scores. METHODS: Radiographic records of 100 patients who underwent synchronous MRI of the cervical, thoracic, and lumbar spine were retrieved. DEXA-validated lumbar VBQ was calculated using median signal intensity (MSI) of the L1-L4 vertebrae and L3 CSF. VBQ was derived as the quotient of MSIL1-L4 divided by MSICSF. Cervical and thoracic VBQ were similarly obtained using C3-C6 and C5 CSF, and T5-T8 and T7 CSF, respectively. Paired sample t-tests were used to evaluate differences among regional VBQ scores. Independent sample t-tests were used to identify sex differences in VBQ. Regression models with one-way analysis of variance (ANOVA) were constructed to identify associations among all permutations of anthropometric and regional VBQ measures. RESULTS: Mean cervical, thoracic, and lumbar VBQ scores were 3.06 ± 0.89, 2.60 ± 0.77, and 2.47 ± 0.61, respectively. Mean differences of .127 (p = 0.045) and - 0.595 (p < 0.001) were observed between thoracic and lumbar, and cervical and lumbar VBQ scores. Correlations of 0.324, 0.356, and 0.600 (p < 0.001) were found between cervical and lumbar, cervical and thoracic, and thoracic and lumbar VBQ scores. Regression with ANOVA predicting lumbar VBQ in relation to cervical and thoracic VBQ demonstrated R Square values of 0.105 and 0.360 (p < 0.001), and ß coefficient values of 0.471 and 0.217 (p < 0.001), respectively. CONCLUSION: Thoracic VBQ provides values representative of the validated lumbar VBQ score. Cervical VBQ scores are distinct from lumbar VBQ scores and do not provide adequate surrogate values of lumbar VBQ.

Patients Follow-up for Spinal Epidural Abscess as a Critical Treatment Plan Consideration.

INTRODUCTION:  Spinal epidural abscess (SEA) is a rare process with significant risk for morbidity and mortality. Treatment includes an extended course of antibiotics with or without surgery depending on the clinical presentation. Both non-operative and surgically treated patients require close follow-up to ensure the resolution of the infection without recurrence and/or progression of neurologic deficits. No previous study has looked specifically at follow-up in the SEA population, but the review of the literature does show evidence of varying degrees of difficulty with follow-up for this patient population. METHODS:  This retrospective review looked at follow-up for 147 patients with SEA at a single institution from 2012 to 2021. Statistical analyses were performed to assess differences between groups of surgical versus non-surgical patients and those with adequate versus inadequate follow-up. RESULTS: Sixty-two of 147 (42.2%) patients had inadequate follow-up (less than 90 days) with their surgical team, and 112 of 147 (76.2%) patients had inadequate follow-up (less than 90 days) with infectious disease (ID). The primary statistically significant difference between patients with adequate versus inadequate follow-up was found to be surgical status with those treated surgically more likely to have adequate follow-up than those treated non-operatively. CONCLUSION: Improved follow-up in surgical patients should be considered as a factor when deciding on surgical versus non-operative treatment in the SEA patient population. Extra efforts coordinating follow-up care should be made for SEA patients.

Allograft Versus Autograft in Anterior Cervical Discectomy and Fusion: A Propensity-Matched Analysis.

Objective To compare the 30-day complication rate associated with allograft versus autograft in anterior cervical discectomy and fusion (ACDF) and to determine preoperative factors that may influence complication rate. Methods The American College of Surgeons National Surgical Quality Improvement Program database was retrospectively queried from 2014 to 2017 for all procedures with CPT codes for ACDF (22551). Patients undergoing ACDF with either autograft or allograft were matched by propensity scores based on age, sex, body mass index, and comorbidities. The incidence of adverse events in the 30-day postoperative period was compared. Results A total of 21,588 patients met the inclusion and exclusion criteria. Following the 10:1 propensity match, 17,061 remained in the study (1,551 autograft and 15,510 allograft). The overall adverse event rate was 3.18%; 3.48% for autograft and 3.15% for allograft (P=0.494). Autograft had a significantly greater incidence of extended length of stay (>2 d) (LOS) (48.9% vs 34.8%; P<0.001). Multivariate analysis suggested that autograft selection was associated with extended LOS (OR 1.4; 95% CI 1.3-1.5). Conclusion The results of this study provide information regarding how graft selection can relate to extended hospital LOS and influence postoperative complications. Extended LOS may be associated with worse patient outcomes and increase the overall cost of care. Further study should be performed to determine which patients would benefit from autograft versus allograft with regards to long-term outcomes, in consideration of these increased short-term complications.