Incidence of Fusion Across Total Disc Replacement With Heterotopic Ossification: Are Ball and Socket Disk Replacements Fusing With and Without Radiographic Evidence.

STUDY DESIGN: This is a level III retrospective study. OBJECTIVE: The authors aim to review the outcomes and complications of ball and socket total disk replacements (TDRs). SUMMARY OF BACKGROUND DATA: TDR is a motion-preserving technique that closely reproduces physiologic kinematics of the cervical spine. However, heterotopic ossification and spontaneous fusion after implantation of the total cervical disk have been reported in several studies to decrease the range of motion postulated by in vitro and in vivo biomechanical studies. METHODS: The medical records of 117 consecutive patients undergoing cervical TDR over a 5-year period with Mobi-C, Prodisc-C, Prestige LP, and Secure-C implants were followed. Outcomes assessed included Visual Analogue Scale neck and arm and Neck Disability Index scores. The radiographic assessment looked at heterotopic ossification leading to fusion and complication rates. RESULTS: Of the 117 patients that underwent TDR, 56% were male with the group's mean age being 46.2±10.3 years and body mass index of 18.9±13.6 kg/m. The longest follow-up was 5 years with Prodisc-C group, with overall fusion noted in 16% of patients. One patient was also noted to have fusion which was not seen radiographically but noted intraoperatively for adjacent segment disease. There has been no demonstrable radiographic fusion seen in the Prestige LP group, however, the follow-up has only been 12-24 months for this group. CONCLUSION: In this study, we have demonstrated radiographic fusion anterior to the ball and socket TDR as well as the uncovertebral joint. We postulate that with the use of a mobile core disk there is an increased potential for fusion leading to a nonfunctional disk replacement.

Utility of Mobile Apps for Video Conferencing to Follow Patients at Home After Outpatient Surgery.

INTRODUCTION: Outpatient surgery has a great opportunity to demonstrate the role of using mobile video conference (VC) postoperatively. Our patients use technology to help decision making in finding physicians. The authors aim to assess patient's perception on the use of mobile apps for VC with the surgeon and/or staff. METHODS: Consenting patients completed a questionnaire of 10 questions preoperatively and postoperatively to assess the difference in opinion. RESULTS: Overall, 120 patients completed the questionnaire preoperatively with 58% female population, 71% younger than 65 years, and 67% having a GED/higher education. Fifty-two patients had surgery with 54% female population, and 60% were younger than 65 years. All patients had mobile apps for VC with 55% using WhatsApp, 40% using Facetime, and 5% other. In person, being with a trained educator at the office was the preferred method for learning about surgical procedures. Overall, four patients contacted the surgeon directly preoperatively. After surgery, 8 of 52 patients (15%) used VC to the surgeon directly, and 37 patients used the VC with the team. CONCLUSION: With advances in new technology, the use of mobile video conferencing adds a new forum for communication with patients. In the outpatient surgical setting, this forum would improve patient-physician relations.

Decreasing radiation dose with FluoroLESS Standalone Anterior Cervical Fusion.

BACKGROUND: Radiation dose continues to be a concern especially in the field of spine surgery, where anterior and posterior instrumentation is frequently utilized to treat multiple pathologies. The authors aim to demonstrate the feasibility of decreasing the radiation dose in standalone anterior cervical discectomy and fusion (ACDF). METHODS: Standalone ACDF (S-ACDF) with 48 consecutive patients (Group 1) with a comparison control group with ACDF with an anterior cervical plate (ACP) of 49 patients (Group 2). Fluoroscopy was performed for positioning, identification of level, placement of the implant, each screw, final AP and lateral images for the first 20 patients in Group 1. Screw placement could then be performed confidently based on cosine rule of cosine (Ѳ) = adj/hyp. RESULTS: Forty-eight patients in Group 1 (S-ACDF) and 49 patients in Group 2 (ACDF-ACP). Statistical significance not demonstrated for age, BMI or gender, P=0.691, 0.947 and 0.286 respectively. Mean radiation dose in group 1 of 17.9±6.6 mAs and 0.8±0.3 mSv was significantly less compared to group 2 which was 29.8±5.4 and 1.3±0.2 mSv, P<0.001. The average radiation dose for single-level fusion in Group 1 was 12.5±3.5 mAs and 0.5±0.1 mSv this is compared to Group 2 of 27.8±3.9 mAs and 1.2±0.2 mSv, P=0.001. The average radiation dose for two level fusion in Group 1 was 22.2±5.1 mAs and 0.9±0.2 mSv this is compared to Group 2 of 33.9±6.0 and 1.4±0.3 mSv, P=0.001. CONCLUSIONS: In the outpatient setting, S-ACDF has shown a statistically significant intergroup difference in overall radiation dose, as well as single and two-level fusions, (P<0.001). We conclude that S-ACDF can decrease overall radiation exposure to patients.