Predicting Complications in 153 Lumbar Pedicle Subtraction Osteotomies by a Single Surgeon Over a 6-Year Period.

INTRODUCTION: Pedicle subtraction osteotomy (PSO) is a complex surgical procedure that provides correction of moderate sagittal imbalance. Surgical complications have adverse effects on patient outcomes and healthcare costs, making it imperative for clinical researchers to focus on minimizing complications. However, when it comes to risk modeling of PSO surgery, there is currently no consensus on which patient characteristics or measures should be used. This study aimed to describe complications and compare the performance of various sociodemographic characteristics, surgical variables, and established risk indices in predicting postoperative complications, infections, and readmissions after lumbar PSO surgeries. METHODS: A review was conducted on 191 patients who underwent PSO surgery at a single institution by a single fellowship-trained orthopaedic spine surgeon between January 1, 2018, and December 31, 2021. Demographic, intraoperative, and postoperative data within 30 days, 1 year, and 2 years of the index procedure were evaluated. Descriptive statistics, t-test, chi-squared analysis, and logistic regression models were used. RESULTS: Intraoperative complications were significantly associated with coronary artery disease (odds ratios [OR] 3.95, P = 0.03) and operating room time (OR 1.01, P = 0.006). 30-day complications were significantly cardiovascular disease (OR 2.68, P = 0.04) and levels fused (OR 1.10, P = 0.04). 2-year complications were significantly associated with cardiovascular disease (OR 2.85, P = 0.02). 30-day readmissions were significantly associated with sex (4.47, 0.04) and length of hospital stay (χ2 = 0.07, P = 0.04). 2-year readmissions were significantly associated with age (χ2 = 0.50, P = 0.03), hypertension (χ2 = 4.64, P = 0.03), revision surgeries (χ2 = 5.46, P = 0.02), and length of hospital stay (χ2 = 0.07, P = 0.03). DISCUSSION: This study found that patients with coronary vascular disease and longer fusions were at higher risk of postoperative complications and patients with notable intraoperative blood loss were at higher risk of postoperative infections. In addition, physicians should closely follow patients with extended postoperative hospital stays, with advanced age, and undergoing revision surgery because these patients were more likely to be readmitted to the hospital.

Item-Specific Knee Injury and Osteoarthritis Outcome Score Characterization of Patients With Medial Meniscus Root Tear.

Background: Most studies regarding medial meniscus posterior root tear (MMPRT) report total Knee injury and Osteoarthritis Outcome Score (KOOS) subscale values as important patient-reported outcomes, but there are few symptom-specific characterizations of patients with MMPRT. Purpose/Hypothesis: The purpose of this study was to characterize the prevalence and severity of symptoms and functional limitations among patients with MMPRT based on item-level KOOS responses. It was hypothesized that patients with MMPRT would show similar symptoms to those of other meniscal tear types, with items from the KOOS pain subscale forming a majority of the most severe and prevalent symptoms. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The records of 1466 patients with medial meniscus root tear between January 2017 and December 2021 at a single institution were reviewed. KOOS subscale scores and item-specific responses from initial evaluation were collected for each patient. Each KOOS item was scored on a scale from 1 (none/least severe) to 5 (extreme/most severe). Median and mean item-level responses were calculated and ranked in order of most to least severe. For statistical analysis, item-level prevalence rates were calculated as the proportion of patients reporting at least mild symptoms and ranked from most to least prevalent. Results: Included were 61 patients with MMPRT verified on magnetic resonance imaging (MRI). The most severe items according to item-level KOOS response were as follows: awareness of knee problem (mean, 4.62 [95% CI, 4.47-4.78]), difficulty jumping (mean, 4.06 [95% CI, 3.73-4.39]), difficulty twisting or pivoting (mean, 4.04 [95% CI, 3.76-4.32]), difficulty kneeling (mean, 3.98 [95% CI, 3.65-4.31]), and modification of lifestyle (mean, 3.94 [95% CI, 3.69-4.20]). The most prevalent items were knee stiffness later in the day, pain going up- or downstairs, difficulty ascending stairs, difficulty getting in and out of the car, difficulty twisting or pivoting, awareness of knee problem, and modification of lifestyle, with all patients reporting at least mild symptoms for each. Of the 11 most severe and prevalent symptoms, 8 came from the KOOS-Pain item-specific responses. Conclusion: Pain-related items made up a majority of the most severe and most prevalent symptoms as identified by the item-specific KOOS responses. However, meniscal symptoms commonly seen in other tear types, such as clicking and knee stiffness, were still quite prevalent in patients with MMPRT.

Causes of Intraoperative Neuromonitoring Events in Adult Spine Deformity Surgery: A Systematic Review.

STUDY DESIGN: Systematic review. OBJECTIVES: Intraoperative neuromonitoring (IOMN) has become a standard practice in the detection and prevention of nerve damage and postoperative deficit. While multicenter studies have addressed this inquiry, there have been no systematic reviews to date. This systematic review identifies the leading causes of IONM alerts during adult spinal deformity (ASD) surgeries. METHODS: Following PRISMA guidelines, a literature search was performed in PubMed and Embase. IONM alert causes were grouped by equivalent terms used across different studies and binned into larger categories, including surgical maneuver, Changes in blood pressure/temperature, Oxygenation, Anesthesia, Patient position, and Unknown. RESULTS: Inclusion criteria were studies on adult patients receiving ASD correction surgery using IONM with documented alert causes. 1544 references were included in abstract review, 128 in full text review, and 16 studies qualified for data extraction. From those studies, there was a total of 3945 adult patients with 299 IONM alerts. Surgical maneuver led the alert causes (258 alerts/86.3%), with signal loss most commonly occurring at correction or osteotomy (101/33.8% and 95/31.8% respectively). Pedicle screw placement caused 35 alerts (11.7%). Changes in temperature and blood pressure were the third largest category (34/11.4%). CONCLUSIONS: The most frequent causes of IONM alerts in ASD surgery were surgical maneuvers such as correction, osteotomy, and pedicle screw placement. This information provides spine surgeons with a quantitative perspective on the causes of IONM changes and show that most occur at predictable times during ASD surgery.

Does Surgical Day of the Week Affect Hospital Course and Outcomes for Patients Undergoing Adult Spinal Deformity Surgery?

STUDY DESIGN: Retrospective Cohort Analysis. OBJECTIVES: Extended hospital length of stay (LOS) poses a significant cost burden to patients undergoing adult spinal deformity (ASD) surgery. The purpose of this study is to investigate the relationship between late-week surgery and LOS in patients undergoing ASD surgery. METHODS: 256 patients who underwent ASD surgery between January 2018 and December 2021 by a single fellowship-trained orthopedic spine surgeon comprised the patient sample. Demographics, intraoperative, and perioperative data were collected for the 256 patients who underwent ASD surgery. Patients were divided into two groups based on surgical day of the week: (1) Early-week (Monday/Tuesday) n = 126 and (2) Late-week (Thursday/Friday) n = 130. Descriptive statistics, T-tests, and linear and logistic regression models were used to analyze the data. RESULTS: Surgical details and sociodemographic characteristics did not differ between the groups. When controlling for TLIF/DLIF status and PSO status there was no difference in mean length of stay between the groups. The late-week group was associated with a greater risk of 30-day readmission, but there was no difference in complications, infections, or intraoperative complications. CONCLUSIONS: We found no difference in mean length of stay between surgeries performed early in the week vs late in the week. Although late-week surgeries had higher 30-day readmission risk, all other outcomes, including complication rates, showed no significant differences. When adequate weekend post-operative care is available, we do not advise restricting ASD surgeries to specific weekdays.

A Readability Analysis of Online Spondylolisthesis and Spondylolysis Patient Resources Among Pediatric Hospital Web Pages: A US-Based Study.

INTRODUCTION: With the increasing use of the internet for health information, it is essential to prioritize resources that match the reading level of patients and parents. Limited health literacy is a notable issue in the United States, creating a financial burden and negatively affecting patient outcomes. This study aimed to assess the availability and readability of pediatric hospital web pages concerning two prevalent spine conditions in children, spondylolisthesis and spondylolysis, specifically examining whether the available resources meet the recommended sixth grade reading level. METHODS: A total of 179 pediatric hospital web pages were assessed for their availability and readability of spondylolisthesis and spondylolysis patient information. The web pages' readability was assessed using five readability formulae. Descriptive statistics and Student t-tests were performed on the collected scores with significance set at P < 0.05. RESULTS: Among the analyzed hospitals, 40.2% had no information on spondylolisthesis or spondylolysis, 20.1% mentioned treating these conditions, 7.8% had < 100 dedicated words, and only 31.8% had dedicated web pages with more than 100 words on these conditions. The average reading grade level for the evaluated web pages was 12.0, indicating a high school education level is required for comprehension. None of the web pages were written below the recommended sixth grade reading level. DISCUSSION: The readability of the limited resources was markedly higher than the recommended reading level. In addition, this study emphasizes the need for enhanced accessibility and readability of online patient information from pediatric hospitals to improve parental comprehension and informed decision-making. Physicians should consider identifying online resources that they consider of high quality and acceptable readability to support better patient understanding and outcomes.

Member Perspectives on the Role of BDSM Communities.

Bondage-discipline/Dominance-submission/sadomasochism (BDSM) is an often misunderstood and misrepresented social phenomenon warranting further discourse and study. Community-based research that engages member perspective can assist in understanding socially marginalized experiences. The current study examined the role, meaning, and function of BDSM communities from the perspective of self-identified members. Seven nominal group technique workshops were conducted representing a variety of practitioner experiences and identities. Workshops involved 48 participants and resulted in the generation of 133 unique terms describing the role of BDSM communities in their lives. Terms were coded using a five-step procedure involving both academic and community members. A total of 15 categories were identified and included domains such as acceptance, sexual expression, friendship, safety, and sharing of educational knowledge. Results underscore the multifaceted nature of the role of such communities. While results consisted of mostly positive features, participants also identified certain negative aspects, such as conflict among members. Results from the study provide a succinct, member-derived, structured inventory of the role of BDSM communities that can serve to validate and synthesize existing research, improve dissemination of community voice around BDSM, and inform future research. We conclude with a discussion of the study's implications for sex education, clinical practice, and community dissemination.

Transportation challenges for urban students with disabilities: parent perspectives.

This qualitative study explored parent perspectives of the transportation difficulties students with disabilities experienced getting to and around school. Participants were parents of predominantly African American and Latino/a high school youth with disabilities from low income neighborhoods. Content analysis of 14 meetings with 5 to 12 parents sponsored by the school district revealed five primary themes concerning transportation: the role of aides, exclusion from school programming, scheduling problems, equipment problems, and physical safety issues. Findings are discussed in regard to students' social and emotional experiences at school. Implications for school policy include improving the integration of transportation within inclusion best practice models. Incorporating parent perspectives can help school administrators and staff enrich the quality of inclusive, socially just education for students with disabilities.

Transportation and socioemotional well-being of urban students with and without disabilities.

This study explored the extent to which transportation difficulties were associated with social, psychological, and academic experiences of urban, at-risk students who recently experienced a school transition. Participants included 165 predominantly African American and Latino/a high school youth with and without disabilities, a critical population for community psychology to address given their likelihood of multiple marginalizations. Results suggested transportation problems within school predicted more school stressors and aggressive behavior. Transportation problems to and from school predicted fewer school resources, less school belonging, and more school stressors, anxiety, and depression. Greater time to get to school predicted fewer school resources, less school belonging, and more depressive symptoms. This study demonstrates the importance of including transportation in how the school day is conceptualized, and offers several implications for how transportation services can be best addressed.

Barrier removal in increasing physical activity levels in obese African American women with disabilities.

BACKGROUND: This pilot study examined the effectiveness of a telephone-based intervention to increase physical activity in obese African American women with mobility disabilities by targeting the removal of barriers to participation. METHODS: Severely obese (mean body mass index [BMI] = 49.1 kg.m²) African American women (n = 33) with mobility disabilities completed a 6-month telephone-based physical activity coaching intervention. RESULTS: The major environmental/facility barriers at preintervention were cost of the program (66.7%), lack of transportation (48.5%), not aware of fitness center in the area (45.5%), and lack of accessible facilities (45.5%). The major personal barriers were pain (63.6%), don't know how to exercise (45.5%), health concerns (39.4%), don't know where to exercise (39.4%), and lack of energy (36.4%). Despite only two personal barriers being significantly lower at posttest (don't know where to exercise and don't know how to exercise) (p < 0.01), total exercise time increased from < 6 minutes/day to 27 minutes/day at posttest (p < 0.001), and total physical activity time (structured exercise, leisure, indoor and outdoor household activity) increased from 26 minutes/day to 89 minutes/day at posttest (p < 0.001). CONCLUSIONS: Interventions aimed at increasing physical activity participation among obese African American women with mobility disabilities should start with increasing their awareness/knowledge on where and how to exercise. Other reported barriers (e.g., cost, transportation, finding an accessible facility, health concerns, pain) may not be as critical to alter/remove as identifying where participants can exercise (i.e., home, outdoors, gym) and providing them with a variety of routines that can be performed safely in their desired setting.