Internal Rotation Measurements: Correlation between Vertebral Body Level and Goniometer Measurements on Functional Outcome Scores.

Objectives: Reverse total shoulder arthroplasty (rTSA) has shown success in the treatment of end-stage glenohumeral pathology. However, one major shortcoming has been the lack of internal rotation (IR), which can have significant functional consequences. Much research has been conducted to maximize IR after rTSA, but the literature is unclear which measurement of IR represents the "gold standard" between vertebral level and goniometer-based measurements. Methods: Patients were prospectively enrolled into one of three groups: postoperative from rTSA, subacromial pain (SA), and normal. IR measurements were obtained either by the vertebral body level, by which radiographic markers indicated the highest level that the patient was able to reach on the body midline; or by using a goniometer while the shoulder was in 90-degree abduction as the patient stood upright. Results: Comparisons between the radiographic vertebral level and goniometer IR measurements showed significant correlations within the normal (r = - 0.43, P = 0.02) and SA pain groups (r = - 0.44, P = 0.02). The rTSA group did not quite reach statistical significance (P = 0.11), but had a moderate correlation coefficient (r = - 0.33). Accuracy of visual IR measurements was also significant. All rTSA group vertebral level measurements were within two vertebral levels, while only 84.6% of IR measurements by goniometer were within 15 degrees. Visual vertebral level measurements were found to be more accurate for the SA pain group (86.2 vs 66.7%). Conclusion: A comparison of the two primary IR measurement methods for shoulders was shown to have a correlation. This would allow for direct comparison of different literature using only one measurement method. While the correlation is not yet strong enough to allow for conversion between the two measurement types, creating a matched cohort taking into account other factors may lead to the correlation reaching this point.

Outpatient versus inpatient shoulder arthroplasty outcomes using an updated patient-selection algorithm: minimum 2-year follow-up.

BACKGROUND: Previous studies have demonstrated the safety and cost-effectiveness of outpatient total shoulder arthroplasty (TSA), with the majority of studies focusing on 90-day outcomes and complications. Patient selection algorithms have helped appropriately choose patients for an outpatient TSA setting. This study aimed to determine the outcomes of TSA between outpatient and inpatient cohorts with at least a 2-year follow-up. METHODS: A retrospective review identified patients older than 18 years who underwent a TSA with a minimum of 2-year follow-up in either an inpatient or outpatient setting. Using a previously published outpatient TSA patient-selection algorithm, patients were allocated into three groups: outpatient, inpatient due to insurance requirements, and inpatient due to not meeting algorithm criteria. Outcomes evaluated included visual analog scale pain, American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation score, range of motion (ROM), strength, complications, readmissions, and reoperations. Analysis was performed between the outpatient and inpatient groups to demonstrate the safety and efficacy of outpatient TSA with midterm follow-up. RESULTS: A total of 779 TSA were included in this study, allocated into the outpatient (N = 108), inpatient due to insurance (N = 349), and inpatient due to algorithm (N = 322). The average age between these groups was significantly different (59.4 ± 7.4, 66.5 ± 7.5, and 72.5 ± 8.7, respectively; P < .0001). All patient groups demonstrated significant improvements in preoperative to final patient-outcomes scores, ROM, and strength. Analysis between cohorts showed similar final follow-up outcome scores, ROM, and strength, with few significant differences that are likely not clinically different, regardless of surgical location, insurance status, or meeting patient-selection algorithm. Complications, reoperations, and readmissions between all three groups were not significantly different. CONCLUSION: This study reaffirms prior short-term follow-up literature. Transitioning appropriate patients to outpatient TSA results in similar outcomes and complications compared to inpatient cohorts with midterm follow-up.

Perioperative Management of Comorbidities in Spine Surgery.

The number of spinal operations performed in the United States has significantly increased in recent years. Along with these rising numbers, there has been a corresponding increase in the number of patient comorbidities. The focus of this article is to review comorbidities in Spine surgery patients and outline strategies to optimize patients and avoid complications.

17beta-estradiol is protective in spinal cord injury in post- and pre-menopausal rats.

The neuroprotective effects of 17 beta -estradiol have been shown in models of central nervous system injury, including ischemia, brain injury, and more recently, spinal cord injury (SCI). Recent epidemiological trends suggest that SCIs in elderly women are increasing; however, the effects of menopause on estrogen-mediated neuroprotection are poorly understood. The objective of this study was to evaluate the effects of 17beta-estradiol and reproductive aging on motor function, neuronal death, and white matter sparing after SCI of post- and pre-menopausal rats. Two-month-old or 1- year-old female rats were ovariectomized and implanted with a silastic capsule containing 180 microg/mL of 17beta-estradiol or vehicle. Complete crush SCI at T8-9 was performed 1 week later. Additional animals of each age group were left ovary-intact but were spinal cord injured. The Basso, Beattie, Bresnahan (BBB) locomotor test was performed. Spinal cords were collected on post-SCI days 1, 7, and 21, and processed for histological markers. Administration of 17beta-estradiol to ovariectomized rats improved recovery of hind-limb locomotion, increased white matter sparing, and decreased apoptosis in both the post- and pre-menopausal rats. Also, ovary-intact 1-year-old rats did worse than ovary-intact 2-month-old rats, suggesting that endogenous estrogen confers neuroprotection in young rats, which is lost in older animals. Taken together, these data suggest that estrogen is neuroprotective in SCI and that the loss of endogenous estrogen-mediated neuroprotective seen in older rats can be attenuated with exogenous administration of 17beta-estradiol.