The Duration of Symptoms Influences Outcomes After Lumbar Microdiscectomies: A Michigan Spine Surgery Improvement Collaborative.

STUDY DESIGN: Retrospective Cohort. OBJECTIVE: We investigate whether duration of symptoms a patient experiences prior to lumbar microdiscectomy affects pain, lifestyle, and return to work metrics after surgery. METHODS: A retrospective review of patients with a diagnosis of lumbar radiculopathy undergoing microdiscectomy was conducted using a statewide registry. Patients were grouped based on self-reported duration of symptoms prior to surgical intervention (Group 1: symptoms less than 3 months; Group 2: symptoms between 3 months and 1 year; and Group 3: symptoms greater than 1 year). Radicular pain scores, PROMIS PF Physical Function measure (PROMIS PF), EQ-5D scores, and return to work rates at 90 days, 1 year, and 2 years after surgery were compared using univariate and multivariate analysis. RESULTS: There were 2408 patients who underwent microdiscectomy for lumbar disc herniation for radiculopathy with 532, 910, and 955 in Groups 1, 2, and 3, respectively. Postoperative leg pain was lower for Group 1 at 90 days, 1 year, and 2 years compared to Groups 2 and 3 (P < .05). Postoperative PROMIS PF and EQ-5D scores were higher for Group 1 at 90 days, 1 year, and 2 years compared to Groups 2 and 3 (P < .05). CONCLUSION: Patients with prolonged symptoms prior to surgical intervention experience smaller improvements in postoperative leg pain, PROMIS PF, and EQ-5D than those who undergo surgery earlier. Patients undergoing surgery within 3 months of symptom onset have the highest rates of return to work at 1 year after surgery.

Anterior Cervical Discectomy and Fusions Supplemented With Cellular or Noncellular Allografts Have Similar Radiographic Fusion and Clinical Outcomes.

STUDY DESIGN: A retrospective, single-center study. OBJECTIVE: The aim of this study was to assess radiographic fusion after anterior cervical discectomy and fusion (ACDF) supplemented with either demineralized bone matrix or ViviGen in a polyetheretherketone biomechanical interbody cage. SUMMARY OF BACKGROUND DATA: Cellular and noncellular allografts are utilized as adjuncts in attempts to improve fusion after ACDF. The purpose of this study was to assess radiographic fusion and clinical outcomes after ACDF supplemented with cellular or noncellular allografts. MATERIALS AND METHODS: A single surgeon's clinical practice database was interrogated for consecutive patients who underwent a primary ACDF using cellular or noncellular allograft from 2017 to 2019. These subjects were matched by age, sex, body mass index, smoking status, and levels operated. Patient demographic and preoperative and postoperative patient-reported outcome measures (PROMs) including Visual Analog Scale Pain, Neck Disability Index, EuroQol-5 Dimension (EQ-5D), Patient-Reported Outcomes Measurement Information System (PROMIS), and Eating Assessment Tool 10 were collected preoperatively and at 3, 6, and 12 months postoperatively. Radiographic evidence of fusion was determined by <2 mm motion between spinous processes on flexion and extension radiographs and assessing bony bridging at 3, 6, and 12 months postoperatively. RESULTS: There were 68 total patients, with 34 patients in each group, and 69 and 67 operative levels in the cellular and noncellular allograft groups, respectively. There was no difference in age, sex, body mass index, or smoking status between groups ( P >0.05). There was no difference in number of 1-level, 2-level, 3-level, or 4-level ACDFs between cellular and noncellular groups ( P >0.05). At 3, 6, and 12 months postoperatively, there was no difference in the percent of operated levels with <2 mm motion between spinous processes, complete bony bridging, or both <2 mm motion and complete bony bridging in the cellular and noncellular groups ( P >0.05). There was no difference in the number of patients fused at all operated levels at 3, 6, or 12 months postoperatively ( P >0.05). No patient required revision ACDF for symptomatic pseudarthrosis. There was no significant difference in PROMs between the cellular and noncellular groups at 12 months postoperatively except for improved EQ-5D and PROMIS-physical in the cellular compared with noncellular group ( P =0.03). CONCLUSIONS: Similar radiographic fusion rates were achieved with cellular and noncellular allografts at all operated levels with similar PROMs in the cellular and noncellular groups at 3, 6, and 12 months postoperatively. Thus, ACDFs supplemented with cellular allograft demonstrate adequate radiographic fusion rates when compared with noncellular allografts with similar patient outcomes. LEVEL OF EVIDENCE: Level III.

Effect of Instrumented Spine Surgery on Length of Stay.

INTRODUCTION: Total joint arthroplasty studies have identified that surgeries that take place later in the week have a longer length of stay compared with those earlier in the week. This has not been demonstrated in studies focused on anterior cervical diskectomy and fusions or minimally invasive lumbar laminectomies. All-inclusive instrumented spine surgeries, however, have not been analyzed. The purpose of this study was to determine whether day of surgery affects length of stay and whether there are predictive patient characteristics that affect length of stay in instrumented spine surgery. METHODS: All instrumented spine surgeries in 2019 at a single academic tertiary center were retrospectively reviewed. Patients were categorized for surgical day and discharge disposition to home or a rehabilitation facility. Differences by patient characteristics in length of stay and discharge disposition were compared using Kruskal-Wallis and chi square tests along with multiple comparisons. RESULTS: Seven hundred six patients were included in the analysis. Excluding Saturday, there were no differences in length of stay based on the day of surgery. Age older than 75 years, female, American Society of Anesthesiology (ASA) classification of 3 or 4, and an increased Charlson Comorbidity Index were all associated with a notable increase in length of stay. While most of the patients were discharged home, discharge to a rehabilitation facility stayed, on average, 4.7 days longer (6.8 days compared with 2.1 days, on average) and were associated with an age older than 66 years old, an ASA classification of 3 or 4, and a Charlson Comorbidity Index of 1 to 3. CONCLUSIONS: Day of surgery does not affect length of stay in instrumented spine surgeries. Discharge to a rehabilitation facility, however, did increase the length of stay as did age older than 75 years, higher ASA classification, and increased Charlson Comorbidity Index classification.

Dysphagia Weakly Correlates With Other Patient-Reported Outcomes After Anterior Cervical Discectomy and Fusion.

Introduction Dysphagia is a common complication after anterior cervical discectomy and fusion (ACDF), but it is not a routinely asked question in legacy patient-reported outcome measures (PROMs). This study analyzes whether there are associations between dysphagia and legacy outcome measures. Methods We retrospectively reviewed 168 patients who underwent ACDF surgery from 2017 to 2019 at a single institution. Demographics, anthropometric data, Neck Disability Index (NDI), Visual Analog Scale (VAS)-Arm and VAS-Neck Pain scores, Patient-Reported Outcomes Measurement Information System (PROMIS)-Physical and PROMIS-Mental scores, Charlson Comorbidity Index (CCI), and Eating Assessment Tool-10 (EAT-10) were obtained for each patient preoperatively and at one, three, six, and 12 months postoperatively. Pearson's correlation coefficients were used to evaluate the bivariate correlations between legacy, PROMIS, and EAT-10 measures. Results Significant but weak correlations existed between NDI and EAT-10 at one, three, and six months postoperatively (correlation coefficient (R) = 0.31, 0.42, and 0.34 at one, three, and six months, p < 0.001) and VAS-Neck Pain and EAT-10 scores at one, three, and six months postoperatively (R = 0.27, 0.30, and 0.28 at one, three, and six months, p ≤ 0.004). Both PROMIS-Physical and PROMIS-Mental scores showed significant but weak correlations with EAT-10 scores at three and six months postoperatively (R = -0.29 and -0.25, p ≤ 0.01, at three months and R = -0.25 and -0.28, p < 0.01, at six months). In all comparisons of EAT-10 scores with legacy outcome measures, the significance of correlations disappeared by 12 months postoperatively. In addition, there was a positive association between CCI and EAT-10 score (ß = 0.37, p < 0.05). Conclusion Weak correlations exist between self-reported dysphagia scores and legacy patient-reported outcome measures in patients undergoing ACDF. The correlation strength decreases over time; therefore, dysphagia scores should be reported separately when looking at outcomes after ACDF. Patients with more comorbidities are also at increased risk for dysphagia.

Abnormal Anatomical and Radiological Changes in a Rare Presentation of Adult Developmental Dysplasia of the Hip.

Adult presentation of bilateral dysplasia and dislocation is an extremely rare presentation. The management of adult hip dysplasia is to preserve the hip and reduce pain through surgical intervention. Hence, early diagnosis provides more options as the treatment dilemma with the late presentation is very complicated with debatable prognosis. The case presented is a 53-year old woman who complained of persistent pain in the hip region. On radiology, dysplasia and dislocation of both the hip joints were observed along with soft tissue abnormalities around the joint. In this case report, we discuss the underlying pathophysiology that might have led to the abnormal radiological and anatomical changes in the hip region and the possible treatment options in a conservatively managed case of developmental dysplasia of the hip (DDH).