Surgical treatment for adolescent patients with femoroacetabular impingement (FAI) is increasing. The purpose of this study was to determine the clinical outcomes of FAI surgery in a multicenter cohort of adolescent patients and to identify predictors of suboptimal outcomes. One hundred twenty-six adolescent hips (114 patients < 18 years of age) undergoing surgery for symptomatic FAI were studied from a larger multicenter cohort. The group included 74 (58.7%) female and 52 male hips (41.3%) with a mean age of 16.1 (range 11.3 to 17.8). Clinical outcomes included the modified Harris Hip Score (mHHS), Hip disability and Osteoarthritis Outcome Score (5 domains), and University of California Los Angeles activity score. Failure was defined as revision surgery or clinical failure (inability to reach minimally clinical important differences or patient acceptable symptoms state for the mHHS). Statistical analysis was used to identify factors significantly associated with failure. There was clinically important improvement in all patient-reported outcomes for the overall group, but an 18.3% failure rate. This included a revision rate of 8.7%. Females were significantly more likely than males to be classified as a failure (25.7 vs. 7.7%, P =0.01), in part because of lower preoperative mHHS (59.1 vs. 67.0, P < 0.001). Mild cam deformity (alpha angle <55 degrees) was present in 42.5% of female hips compared with 17.3% male hips. Higher alpha angles were inversely correlated with failure. Alpha angles >63 have a failure rate of 8.3%, between 55 and 63 degrees, 12.0% failure rate, and <55 degrees (mild cam) failure rate of 37.5%. Patients who participated in athletics had a 10.3% failure rate compared with nonathletes at 25.0% ( P =0.03, RR (relative risk) 2.4). Adolescent patients undergoing surgical treatment for FAI generally demonstrate significant improvement. However, female sex, mild cam deformities, and lack of sports participation are independently associated with higher failure rates. These factors should be considered in surgical decision-making and during patient counseling. Level III-retrospective comparative study.

Background: Full-thickness acetabular cartilage lesions are common findings during primary surgical treatment of femoroacetabular impingement (FAI). Purpose: To evaluate clinical outcomes after acetabular microfracture performed during FAI surgery in a prospective, multicenter cohort. Study Design: Cohort Study; Level of evidence, 3. Methods: Patients with FAI who had failed nonoperative management were prospectively enrolled in a multicenter cohort. Preoperative and postoperative (mean follow-up, 4.3 years) patient-reported outcome measures were obtained with a follow-up rate of 81.6% (621/761 hips), including 54 patients who underwent acetabular microfracture. Patient characteristics, radiographic parameters, intraoperative disease severity, and operative procedures were analyzed. Propensity matching using linear regression was used to match 54 hips with microfracture to 162 control hips (1:3) to control for confounding variables. Subanalyses of hips ≤35 and >35 years of age with propensity matching were also performed. Results: Patients who underwent acetabular microfracture were more likely to be male (81.8% vs 40.9%; P < .001), be older in age (35.0 vs 29.9 years; P = .001), have a higher body mass index (27.2 vs 25.0; P = .001), and have a greater alpha angle (69.6° vs 62.3°; P < .001) compared with the nonmicrofracture cohort (n = 533). After propensity matching to control for covariates, patients treated with microfracture displayed no differences in the modified Harris Hip Score or Hip Disability and Osteoarthritis Outcome Score (P = .22-.95) but were more likely to undergo total hip arthroplasty (THA) (13% [7/54] compared with 4% [6/162] in the control group; P = .002), and age >35 years was associated with conversion to THA after microfracture. Microfracture performed at or before 35 years of age portended good outcomes with no significant risk of conversion to THA at the most recent follow-up. Conclusion: Microfracture of acetabular cartilage defects appears to be safe and associated with reliably improved short- to mid-term results in younger patients; modified expectations should be realized when full-thickness chondral lesions are identified in patients >35 years of age.

Until recently, open decompression was considered the gold standard for the management of spinal stenosis, but the evolution of minimally invasive spine instruments has brought a new dimension to the management of spinal stenosis. Full endoscopic surgery has a lot of advantages in terms of minimal soft tissue damage, less bleeding, shorter hospital length of stay, and earlier return to work. Our aim was to evaluate the efficacy of full endoscopic lumbar decompression for degenerative lumbar canal stenosis compared with classic open decompression surgery. This is a retrospective cohort study of degenerative lumbar spinal stenosis without instability, consisting of 132 open decompression and 163 full endoscopic decompression patients. We evaluated the clinical result of the pre- and postoperative visual analog scale (VAS) of leg pain, back pain, and Oswestry Disability Index (ODI). We observed the patients until 1 year after the operation. The postoperative ODI scores and VAS scores for back pain and leg pain were better than the preoperative scores. The ODI scores and VAS scores for leg pain were significantly better in both groups (P = 0.033 and 0.04, respectively). The main difference between open and full endoscopic decompression was the VAS back pain and amount of bleeding. In the full endoscopic group, the mean VAS back pain was 1.6 and the amount of bleeding was minimal. In the open decompression surgery, the mean VAS back pain was 3.5 and the amount of bleeding was around 84 mL. The length of hospital stay was shorter in the full endoscopic group, which was 1.5 days compared with 3.4 days in open decompression (P = 0.034). Full endoscopic decompression showed better early results compared with the conventional group, but a long-term study is still needed for further evaluation of the clinical results. The use of the full endoscopic technique is very promising in the management of spinal stenosis. This study provides a comparison of the efficacy of open decompression and full endoscopic decompression in degenerative lumbar canal stenosis.

<h3>BACKGROUND CONTEXT</h3> Postoperative hematoma following anterior cervical spine surgery is an uncommon but potentially fatal complication. Persistent bleeding resulting in significant hematoma displaces the larynx and trachea resulting in swallowing difficulties or airway obstruction. Due to its low incidence, risk factors and clinical outcomes data are limited. From a large database, the authors sought to identify some common characteristics in patients who developed hematoma and evaluate their clinical outcomes after undergoing anterior cervical spine surgery. <h3>PURPOSE</h3> From a large database, the authors sought to identify some common characteristics in patients who developed hematoma and evaluate their clinical outcomes after undergoing anterior cervical spine surgery. <h3>STUDY DESIGN/SETTING</h3> Ambispective (retrospective/prospective)/Multicenter collaborative. <h3>PATIENT SAMPLE</h3> Patients undergoing anterior cervical spine surgery. <h3>OUTCOME MEASURES</h3> Hematoma incidence, PROMIS-PF score, other postoperative complications. <h3>METHODS</h3> The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a statewide quality improvement initiative. Anterior cervical cases in MSSIC registry from 2014-2018 were identified and divided into two groups: Nonhematoma or Hematoma. Chi-square and t-test analyses were done to compare the two groups in terms of demographics, surgical characteristics, patient reported outcomes (baseline and postoperative PROMIS-PF score) and other postoperative symptoms or complications. All analyses were performed by using SAS 9.4. <h3>RESULTS</h3> Of the 9,958 cases, postoperative hematoma occurred in 114 (1.1%). Hematoma was associated with male gender (1.6% vs 0.7%, p .10 for all). A greater percentage of patients in the hematoma group reported dysphagia (6.9% vs 29.8%, p .05). <h3>CONCLUSIONS</h3> Postoperative hematoma after anterior cervical surgery was rare (1.1%). It was associated with male gender, increasing age, preoperative anticoagulation, prior spine surgery, inpatient procedures and surgeries involving C3-C5 and C3-C6. Hematoma was significantly associated with the adverse outcomes of dysphagia, prolonged hoarseness, and weakness - though PROMIS scores showed no difference at follow-up. Hematoma after anterior cervical surgery is rare but a serious complication. Our large database review revealed several interesting risk factors associated with hematoma. Procedures involving C3-C5 and C3-C6 had the highest rate of hematoma compared to more caudal surgeries. Difficulties with exposure as well as vascular anatomy in the upper cervical spine, the cricothyroid arteries bilaterally, could explain this finding. Thorough visual inspection to ensure hemostasis is obtained prior to closure is essential. Hematoma, if left unrecognized, can swiftly develop, and put patients at significant risk for life threatening airway obstruction or great vessel compression. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

<h3>BACKGROUND CONTEXT</h3> Length of stay (LOS) is a major component of hospital cost of inpatient care. Preoperative surgical education has shown to reduce length of stay and overall hospital cost in the orthopedic literature. This same benefit has not been widely studied in patients undergoing spine surgery. <h3>PURPOSE</h3> We sought to demonstrate that preoperative spine surgery education decreases LOS and time-to-first-ambulation after elective spinal fusion. <h3>STUDY DESIGN/SETTING</h3> This is a prospective observational cohort study. We prospectively followed consecutive patients who underwent elective minimally invasive spinal fusion in two hospitals under multiple surgeons from May 2021 through September 2021. The patient population we pulled from was all patients who underwent elective lumbar and cervical fusion including patients with auto or worker's compensation. Patients were excluded if they underwent kyphoplasty or had surgery in the thoracic, C1, pelvis or sacroilliac joint regions. <h3>PATIENT SAMPLE</h3> Four hundred and twelve patients were included. <h3>OUTCOME MEASURES</h3> Our primary outcome for this study was length of stay. Our secondary outcomes were postoperative-day-0 ambulation (POD#0) and first-ambulation distance. <h3>METHODS</h3> Multidisciplinary meetings were held to develop the preoperative spine surgery education material which included a hardcopy booklet, a video embedded in an online quiz and a designated webpage (spineclass.michiganspineandbrainsurgeons.com). This component was part of our institutional Enhanced Recovery After Surgery (ERAS) protocol. During surgical scheduling, patients viewed the video on a tablet. They were given the booklet followed by an email with links to the webpage and pdf booklet. The process measures were compliance with completing the video/quiz and a quiz score with >50% as the passing score. Patient demographics, particularly types of insurance were collected. Univariate analyses were used to compare the compliance groups and multivariable analysis was done to identify factors independently associated with length of stay; p<0.05 was considered significant. <h3>RESULTS</h3> Four hundred and twelve patients were included. Sixty-eight (16.5%) patients viewed the video and completed the online quiz. Average quiz score 79.7 ± 10.8 with a 100% passing rate. There was no significant difference in patient and operative characteristics between the two groups. Compliant patients had a significantly shorter LOS (1.4 ± 1.3, 2.1 ± 2.7, p = 0.45). Preop spine video (B: -0.64, 95% CI: -1.29 - 0, p = 0.050) education was independently associated with a significant decrease in LOS; the converse was true for age (B: 0.05, 95% CI: 0.03 - 0.07, p = <.001). <h3>CONCLUSIONS</h3> We demonstrated that preoperative spine education significantly decreased LOS. Further study to improve compliance is necessary. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

<h3>BACKGROUND CONTEXT</h3> Tranexamic Acid (TXA) has been proven safe and efficacious in procedures with large volume blood loss (joint replacement and cardiac surgery). Its role as a pharmaceutical agent for blood loss preservation for long-segment spinal fusion (complex spinal fusion, deformity cases) has also shown promising results. However, it remains unclear if the risk of potential thrombogenesis that could lead to venous thrombotic events (VTE) outweighs its benefits in shorter cases less likely to need blood transfusion. TXA is widely available in various forms, (ie, oral, topical, intravenous [IV]); consensus is lacking with regards to the optimal dosing regimen for spinal fusion. <h3>PURPOSE</h3> Our study objective is to evaluate IV TXA use in lumbar fusion. <h3>STUDY DESIGN/SETTING</h3> Retrospective/single center. <h3>PATIENT SAMPLE</h3> Patients undergoing 2-5 level lumbar fusion with instrumentation. <h3>OUTCOME MEASURES</h3> EBL, POD 1 hemoglobin, blood transfusion requirements, LOS, post-dose incidence of VTE. <h3>METHODS</h3> A total of 251 patients were included in this retrospective case series (2018-2019). Demographics, patient characteristics, estimated blood loss (EBL), postoperative day (POD) 1 hemoglobin, transfusion requirements, VTE, and length of stay (LOS) were compared between a group who received TXA (TXA) and a control group who did not (No TXA). The No TXA group are historical patients 6 months preTXA use, and those with contraindications during the treatment period (ie, history of hypersensitivity, bleeding, clotting, recent trauma or significant kidney disease). Treatment modality was 2 grams infused over 30 minutes perioperatively (1 gram prior to incision and repeated at closure). Data was analyzed with t-test (or Wilcoxon test) and Chi-squared test (or Fisher's exact test). P< 0.05 are to be considered statistically significant. <h3>RESULTS</h3> The two groups were similar in characteristics. There were no differences in age, gender, BMI and ASA score, all p>0.05. Both groups had similar smoking status (p=0711) and preoperative hemoglobin values (No TXA 13.9mg/dL ± 1.3mg/dL vs TXA 14.1± 1.5mg/dL, p=0.305). All patients had degenerative disease, approximately 10% had concurrent scoliotis. Number of levels intrumented: 2 (37%), 3 (23%), 4 (22%) and 5 (18%). No difference in the distribution in terms of primary vs revision surgery (p=0.209). Thirty-six percent (n-91) received 1-2 doses. Of the 91 treated patients, 90% (n-82) received the two doses, at preincision and closure; 99% (n-90) received a dose at preincision and 91% (n-83) at closure. With two doses, the average dose administered was 22mg/kg ±6.1mg/kg. EBL was skewed with outliers, No TXA median (IQR): 300 (150-450) vs TXA median (IQR): 250 (150-300), p=0.078. Cell saver utility by both groups were similar (No TXA 27%, TXA 24%); no difference in amount returned (p=0.739). Although the TXA group had significantly higher hemoglobin level on POD1 (No TXA 10.8±1.5 g/dL vs TXA 11.5±1.5 g/dL, p<0.001), both groups had similar low incidence of severe postoperative anemia requiring blood transfusion (No TXA 7.5% vs TXA 3.3%, p=0.268). A difference in LOS was observed (No TXA 3.5+1.3 days vs TXA 3.2+1.1 days, p=0.02). While hospitalized, one patient in the control group developed deep vein thrombosis on POD4; no VTE was reported in the TXA group. <h3>CONCLUSIONS</h3> With or without TXA, EBL was comparable in 2-5 level lumbar fusion. Patients in the TXA group, however, had a higher POD 1 hemoglobin and had shorter length of hospitalization. No VTE was reported among the TXA treated population. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

<h3>BACKGROUND CONTEXT</h3> The incidence of postoperative spinal epidural hematomas (SEH) in open lumbar decompression/fusions has been reported to be up to 89%. However, the incidence of asymptomatic SEH and the radiographic parameters predicting symptomatic SEH in minimally invasive transforaminal lumbar interbody fusions (MiTLIF) has not been established. <h3>PURPOSE</h3> To determine the incidence of asymptomatic epidural compression/SEH and the radiologic parameters which predict compression/SEH becoming symptomatic. <h3>STUDY DESIGN/SETTING</h3> Prospective comparative cohort study performed at a community hospital. <h3>PATIENT SAMPLE</h3> Forty-two consecutive patients undergoing MiTLIFs at a single institution from 2017-2018. Exclusions were >3 operative levels, revision spinal fusion, perioperative intake of Aspirin/Plavix/NSAID, abnormal clotting profile or hardware malpositioning. <h3>OUTCOME MEASURES</h3> Our primary outcome was the incidence of epidural compression/SEH and the associated radiographic parameters. <h3>METHODS</h3> The onset of pain and neurological deficits was evaluated daily. MRI was performed. <h3>RESULTS</h3> Thirty patients were enrolled in the asymptomatic group and 12 in the symptomatic group. Eight (26.67%) asymptomatic patients had postoperative thecal sac compression. Symptomatic patients had a significantly higher BMI compared to asymptomatic patients (34.6 ± 7.4 vs 28.2 ± 5.4, p=.010). Four of the asymptomatic patients had SEH (13.3%, 95%CI: 3.8–30.7). Comparing symptomatic vs asymptomatic compression, there were significant differences for the CR (0.57 ± 0.20 vs 1.08 ± 0.53, <b>Δ</b> 95%CI: -.84 - -.19, p<.001), the dural sac area at MC (0.62 ± 0.28 vs 1.3 ± 1.0, <b>Δ</b> 95%CI: -1.2 - -0.1, p=0.003). The CR of symptomatic SEH was not significantly different from asymptomatic SEH. (0.57 ± 0.20 vs 0.70 ± 0.15, <b>Δ</b> 95%CI: -0.37 - 0.09, p=.17). The length of MC of symptomatic SEH was significantly smaller when compared to asymptomatic SEH (2.3 ± 1.1 vs 5.3 ± 2.9, <b>Δ</b> 95%CI: -5.1 - -1.0, p=.030). <h3>CONCLUSIONS</h3> The incidence of early postoperative spinal epidural hematomas in asymptomatic patients following MiTLIF was lower than previously described for open lumbar surgeries. The CR can be used in evaluating the likelihood of a compression becoming symptomatic. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

A meta-analysis of 89 randomized prospective, prospective, and retrospective studies on spinal endoscopic surgery outcomes. The study aimed to provide familiar Oswestry Disability Index (ODI), visual analog scale (VAS) back, and VAS leg effect size (ES) data following endoscopic decompression for sciatica-type back and leg pain due to lumbar herniated disc, foraminal, or lateral recess spinal stenosis. Higher-grade objective clinical outcome ES data are more suitable than lower-grade clinical evidence, including cross-sectional retrospective study outcomes or expert opinion to underpin the ongoing debate on whether or not to replace some of the traditional open and with other forms of minimally invasive spinal decompression surgeries such as the endoscopic technique. A systematic search of PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials from 1 January 2000 to 31 December 2019 identified 89 eligible studies on lumbar endoscopic decompression surgery enrolling 23,290 patient samples using the ODI and VAS for back and leg pain used for the ES calculation. There was an overall mean overall reduction of ODI of 46.25 (SD 6.10), VAS back decrease of 3.29 (SD 0.65), and VAS leg reduction of 5.77 (SD 0.66), respectively. Reference tables of familiar ODI, VAS back, and VAS leg show no significant impact of study design, follow-up, or patients' age on ES observed with these outcome instruments. There was no correlation of ES with long-term follow-up (P = 0.091). Spinal endoscopy produced an overall ODI ES of 0.92 extrapolated from 81 studies totaling 12,710 patient samples. Provided study comparisons to tubular retractor microdiscectomy and open laminectomy showed an ODI ES of 0.9 (2895 patients pooled from 16 studies) and 0.93 (1188 patients pooled from 5 studies). The corresponding VAS leg ES were 0.92 (12,631 endoscopy patients pooled from 81 studies), 0.92 (2348 microdiscectomy patients pooled from 15 studies), and 0.89 (1188 open laminectomy patients pooled from 5 studies). Successful clinical outcomes can be achieved with various lumbar surgeries. ESs with endoscopic spinal surgery are on par with those found with open laminectomy and microsurgical decompression. This article is a meta-analysis on the benefit overlap between lumbar endoscopy, microsurgical decompression, laminectomy, and lumbar decompression fusion.

No-profile anterior cervical discectomy and fusion (ACDF) devices are commonplace in spinal surgery. Contained within the intervertebral margins, these devices diminish risks associated with anterior cervical plating, while also marginalizing cage migration and subsidence. However, these devices have been limited in their scope of implant material. Accordingly, a no-profile ACDF (npACDF) device supporting a machined allograft implant body with a connected load-sharing fixation interface was developed. However, it is not established in the literature whether the device supports early mechanical stability and subsequent boney fusion. The objective of this study was to assess this device in both the clinical and preclinical settings. Biomechanical Analysis: Twenty-four functional spinal units (FSUs) were divided into 4 groups (n = 6). Each group would receive a single construct: (1) npACDF device with connected polyetheretherketone (PEEK) body, (2) npACDF with connected allograft body, (3) npACDF (allograft body) with nonconnected fixation plate, and (4) standard ACDF plate and PEEK interbody cage. FSUs were subjected to pure moment loading (flexion/extension, lateral bending, and axial rotation) via a kinematic test machine in their intact state and then following instrumentation. Vertebral motion was recorded and range-of-motion (ROM) reduction, relative to intact, was calculated.Clinical Case Series: Ten patients receiving single-level ACDF with the npACDF allograft (connected) device for the treatment of persistent cervical radiculopathy or myelopathy were retrospectively reviewed at 12 months. Radiographic and patient reported outcomes were reported. No differences in ROM existed between the npACDF constructs (P ≥ 0.99). Standard ACDF achieved more ROM reduction than the npACDF constructs in all directions (P ≥ 0.04). All subjects achieved fusion at 12 months. The npACDF allograft device supported less motion reduction in comparison to traditional plating; however, case series data suggest the device provides clinically effective stability resulting in quality radiographic fusion and pain improvement. This report provides both clinical and preclinical insight into a device which offers alternative design features to traditional continuous/rigid ACDF device designs.