Preoperative Time Points Research Articles

Single-level TLIF Versus LLIF at L4-5: A Comparison of Patient-reported Outcomes and Recovery Ratios.

Both transforaminal lumbar interbody fusion (TLIF) and lateral lumbar interbody fusion (LLIF) are suitable for achievement of lumbar arthrodesis. Comparative studies have observed complications and outcomes without stratification by lumbar level. This study aims to assess patient-reported outcome measures (PROMs) and recovery in TLIF and LLIF at L4-5. Patients undergoing primary, elective, single-level, TLIF or LLIF procedures at L4-5 were grouped. Demographics, perioperative characteristics, and postoperative complication rates were collected. PROMs included Patient-Reported Outcome Measurement Information System Physical Function, visual analog scale (VAS) back and leg, Oswestry Disability Index, and 12-Item Short-Form Physical Component Summary, and Mental Component Summary and were collected at preoperative, 6-week, 12-week, 6-month, 1-year, and 2-year time points. Delta values and recovery ratios (RRs) were calculated for all PROMs at all time points. Demographics, perioperative characteristics, and postoperative complications were compared using chi-squared and Student t-test for categorical and continuous variables, respectively. Differences in mean PROMs, delta values, and RR at each time point were evaluated using unpaired Student's t-test. Three hundred sixty TLIF and 46 LLIF patients were included. Most (54.3%) were men, mean age 56.3 years, and mean body mass index 30.8 kg/m2. Body mass index and insurance significantly differed (P ≤ 0.045, all). TLIF showed significantly greater mean operative time, length of stay, and postoperative narcotic consumption (P < 0.033, all) and greater postoperative nausea/vomiting (P = 0.004). No preoperative PROMs significantly differed. TLIF cohort had significantly greater VAS back at 6 months and VAS leg at 12 weeks and 6 months (P < 0.034, all). No mean delta PROMs or RRs significantly differed. LLIF demonstrated significantly reduced length of stay, postoperative narcotic consumption, and postoperative nausea/vomiting and significantly improved VAS back at 6 months and VAS leg at 12 weeks and 6 months versus TLIF. Although 2-year PROMs and RRs did not significantly differ, our findings may suggest improved midterm follow-up pain scores for LLIF patients.

Laterally Placed Expandable Interbody Spacers With and Without Adjustable Lordosis Improve Radiographic and Clinical Outcomes: A Two-Year Follow-Up Study.

IntroductionInterbody spacers are necessary for achieving disc height restoration when surgical intervention is used for the treatment of severe degenerative disc disease. Minimally invasive lateral lumbar interbody fusion (MIS LLIF) is a popular surgical approach that historically uses large static interbody spacers through a lateral approach. However, static spacers have been associated with iatrogenic distraction and excessive impaction forces, which may increase the risk of subsidence and loss of lordosis, compromising stability. Expandable interbody spacers with or without adjustable lordosis may help address these concerns by maximizing segmental lordosis and aiding in sagittal balance correction. This study describes the clinical and radiographic outcomes of patients treated with expandable interbody spacers with or without adjustable lordosis, for MIS LLIF.Materials and methodsThis is retrospective, single-surgeon Institutional Review Board-exempt chart review was of 103 consecutive patients who had undergone MIS LLIF at one to two contiguous level(s) utilizing expandable interbody spacers with or without adjustable lordosis (66/103 patients had adjustable lordosis spacers). Collection of clinical and radiographic functional outcomes occurred at preoperative and postoperative time points through 24 months.ResultsOne-hundred and three consecutive patients were evaluated-average age, 58.2 ± 12.1 years; 42.1% (45/107) were female. There were 78.6% (81/103) one-level cases and 21.4% (22/103) two-level cases for a total of 125 levels; 44.8% (56/125) were performed at L4-5 and 34.4% (43/125) at L3-4. The average estimated blood loss was 24.6 ± 12.3cc. Mean operative time was 61.0 ± 19.1 min, and mean fluoroscopic time was 28.2 ± 14.6 sec. Visual Analog Scale (VAS) back and leg pain scores decreased significantly by an average of 7.1 ± 1.0 points at 24 months (p<0.001). Oswestry Disability Index (ODI) scores significantly decreased by a mean of 67.4 ± 8.9 points at 24 months (p<0.001). Lumbar lordosis significantly improved by a mean of 3.1 ± 8.8° at 24 months (p=0.001). Anterior, middle, and posterior disc height significantly increased at 24 months by averages of 4.7 ± 3.1, 4.0 ± 3.0, and 2.1 ± 2.2mm, respectively (p<0.001). Neuroforaminal height had significantly increased at 24 months by a mean of 3.0 ± 3.6mm (p<0.001). Segmental lordosis significantly improved by 3.7 ± 2.9° at 24 months (p<0.001). There were 51 patients with abnormal preoperative Pelvic Incidence-Lumbar Lordosis (PI-LL) measurements that significantly improved by 9.1 ± 4.9° (p<0.001) and 52 patients with normal preoperative PI-LL measurements that improved by 0.2 ± 4.6° (p=0.748) at 24 months. One-hundred percent fusion occurred at all levels, and no findings of radiolucency were observed. One case of subsidence (1/125, 0.8%) was reported at 24 months. No implanted-related complications were reported, with 0% pseudoarthrosis and no secondary surgery required at the operative levels.ConclusionIndirect decompression and sagittal correction were achieved and maintained through a 24-month follow-up. Functional clinical outcomes significantly improved based on decreased VAS pain and ODI scores at 24 months. This study resulted in positive clinical and radiographic outcomes for patients who underwent MIS LLIF with expandable interbody spacers with or without adjustable lordosis.

Recovery of Physical Function Based on Body Mass Index Following Anterior Cervical Discectomy and Fusion.

Body mass index (BMI) serves as a risk factor for complications and poorer outcomes following anterior cervical discectomy and fusion (ACDF). This study investigates the association between BMI and Patient Reported Outcomes Measurement Information System physical function (PROMIS-PF) following ACDF. A prospectively maintained surgical registry was retrospectively reviewed for cervical spine surgeries between 2015 and 2019. Included patients underwent elective primary, single, or multilevel ACDF and were excluded for missing preoperative PROMIS-PF. Patients were stratified into 4 groups based on BMI score. Associations of demographic and perioperative characteristics with BMI groups were analyzed using either χ2 test or t test. PROMIS-PF was evaluated preoperatively and 6 weeks, 12 weeks, 6 months, 1 year, and 2 years postoperatively using linear regression. Delta improvement in PROMIS-PF was evaluated at all time points. The 128 study cohort had 74 patients the nonobese, 27 in the Obese I, 19 in the Obese II, and 8 in the Obese III groups. The mean age was 50.0 years and 57.0% were male. Gender, diabetic status, and Charlson Comorbidity Index (CCI) significantly differed by BMI groups but did not differ by perioperative characteristics. Preoperative PROMIS-PF did not significantly differ by group. Obese II and III groups had decreased PROMIS-PF compared to Obese I and nonobese groups at 1 year and 2 years. BMI groups had significantly different delta improvement at the 12 weeks (4.1 vs 10.1 vs 1.8 vs 4.3; P = 0.044) and 2 years (9.9 vs 7.1 vs 2.3 vs 3.0; P = 0.048). Among the assessed BMI subgroups, all experienced similar physical function scores during the preoperative and short-term time points. Patients with higher BMI demonstrated diminished physical function at long-term time points. While this study focused on evaluating obesity, longitudinal tracking of high-risk patients during the postoperative period remains important for optimal rehabilitation. 4. High BMI may predispose patients to lengthier recovery of physical function following ACDF.

The Effect of Pre-operative Exercise Intervention on Patient Outcomes Following Bariatric Surgery: a Systematic Review and Meta-analysis.

This systematic review aimed to assess the effect of a pre-operative exercise intervention on short- and long-term health and clinical outcomes for adult patients undergoing bariatric surgery (BS). We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), SPORTDiscus and reference lists of relevant papers, through March 2021. Five randomised controlled trials were included (n = 199 patients). Modest increases in cardiorespiratory fitness (VO2max) were found at both pre-operative (0.73 mL kg-1 min-1, P ≤ 0.001) and maximum follow-up time points (0.98 mL kg-1 min-1, P ≤ 0.04). There was no significant effect of an exercise intervention on percentage total weight loss (%TWL). Pre-operative exercise can induce significant short- and long-term improvements in fitness in individuals with obesity. There is insufficient evidence to determine whether pre-operative training impacts other post-operative clinical outcomes.

Hip Joint Kinematic Covariation During Gait Before and 1-Year After Hip Arthroscopic Surgery for Femoroacetabular Impingement Syndrome.

The primary aim of this study was to determine if the three-dimensional (3D) hip joint motion coordination during gait changes after arthroscopic surgery for femoroacetabular impingement syndrome (FAIS). Three-dimensional hip joint kinematic data were collected with a 12-camera motion capture system. Five trials of level walking were collected preoperatively (PRE) and at 1-year postoperatively (POST) in 8 patients diagnosed with FAIS and at a single time point in 8 healthy controls. Planar covariation analysis was performed to quantify the 3D hip joint motion coordination strategy during gait. Independent sample's t-test were used to determine differences between the FAIS group at the preoperative time point (PRE) and healthy controls. Paired samples t-tests were used to determine differences between the PRE and POST time points within the FAIS group. The %VAF by PC 1 for the FAIS group at the PRE time point was significantly less than that of healthy controls (PRE: 77.2 ± 8.7% vs. Control: 96.1 ± 2.8%; p = 0.0001), and the % VAF of the second PC (PC2) was significantly greater [PRE: 22.8 (8.7)%; Control: 3.9 (2.8)%; p = 0.0001]. No differences in %VAF were found between the PRE and POST time points within the FAIS group for PC1 [PRE: 77.2 (8.7)% vs. POST: 79.3 (11.1)%; p = 0.472] or PC2 [PRE: 22.7 (8.7)%; POST: 20.7 (11.1)%; p = 0.472]. Significant differences in the plane specific contribution to the 3D motion coordination strategy were found between the FAIS patients at the PRE and POST time points for the sagittal plane [PRE: 5.6 (2.7) vs. POST: 0.91 (6.1); p = 0.012] and frontal plane [PRE: −10.4 (2.2) and −1.5 (6.3); p = 0.005]. Patients with FAIS demonstrated a more complex coordination strategy of 3D hip joint motion than controls and this strategy remains unchanged after hip arthroscopic surgery despite changes in the plane specific contribution to this strategy. These findings indicate that motor control impairments in FAIS patients do exist and seem to persist for at least 1 year after hip arthroscopic surgery.

155. Dual role of neck disability index in assessment of quality of life in cervical spine patients

<h3>BACKGROUND CONTEXT</h3> Neck disability index (NDI) is a reliable measure for disability in patients with cervical myeloradiculopathy. Few studies have examined the relationship between NDI and mental health outcomes following anterior cervical discectomy and fusion (ACDF). <h3>PURPOSE</h3> To determine the correlation between NDI and mental health outcome measures following ACDF. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort. <h3>PATIENT SAMPLE</h3> A total of 225 patients undergoing primary, single or multi-level ACDF procedures. <h3>OUTCOME MEASURES</h3> Demographic and perioperative characteristics, NDI, 12-Item Short Form Mental Component Summary (SF-12 MCS) and Patient Health Questionnaire-9 (PHQ-9) <h3>Methods</h3> A prospectively maintained surgical registry was retrospectively reviewed for consecutive elective ACDF procedures from December 2013 to December 2019. Inclusion criteria were patients undergoing elective, primary, single or multi-level ACDF. Procedures indicated for infectious, traumatic or malignant etiologies were excluded. Demographic characteristics such as age, gender, body mass index (BMI), ethnicity, smoking and diabetic status, and insurance type were collected preoperatively. Medical comorbidities and classifications were preoperatively collected as American Society of Anesthesiologists physical classification (ASA) and Charlson comorbidity index (CCI). Preoperative characteristics including spinal pathology, operative time, blood loss, length of postoperative stay and day of discharge were also collected. Primary outcomes of interest were NDI and mental health outcome measures, SF-12 MCS and PHQ-9. Outcomes were collected at the preoperative timepoint as well as postoperative timepoints (6-weeks, 12-weeks, 6-months, 1-year, 2-years). Postoperative improvement for all outcomes was evaluated using a paired Student's t-test. Correlations between NDI and mental health outcomes were evaluated using Pearson's correlation analysis. Strength of association was determined using the following criteria: weak (0.1 ≤ |r| < 0.3); moderate (0.3 ≤ |r| < 0.5); strong (|r| ≥ 0.5). <h3>Results</h3> A total of 225 patients were included in this study. Mean age was 49.8 years with majority being male (57.8%) and nonobese (60.0%). Majority of patients had a single level procedure (55.6%), a spinal pathology of recurrent herniated nucleus pulposus (79.1%) and had a mean procedure time of 56.1 minutes, length of stay of 13.9 hours, and were typically discharged by postoperative day 0. NDI demonstrated significant improvements through 2-years compared to preoperative baseline values (all p<0.001). Similarly, SF-12 MCS and PHQ-9 significantly improved through 1-year postoperatively (all p≤0.010), but was not maintained at 2-years (p=0.835; p=0.128). NDI demonstrated a significant but moderate correlation with SF-MCS at the preoperative timepoint (|r| = 0.447), but a strong correlation was observed at all postoperative timepoints (all p≤0.001). A significant and strong correlation between NDI and PHQ-9 was demonstrated at all timepoints (all p≤0.002). <h3>Conclusions</h3> NDI demonstrated significant and strong correlations with mental health outcome measures at all postoperative timepoints. NDI is an effective measure to assess neck disability from cervical myeloradiculopathy, but it may also capture the impact on mental health following ACDF. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Patients Require Less Time to Complete Preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) Than Legacy Patient-Reported Outcome Measures

PurposeTo analyze time to completion of preoperative legacy patient-reported outcomes (PROs) and more recent computer adaptive Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires in patients with symptomatic femoroacetabular impingement syndrome undergoing primary hip arthroscopy.MethodsA retrospective analysis was conducted on patients undergoing hip arthroscopy by a single fellowship-trained hip arthroscopist. Inclusion criteria were patients undergoing primary arthroscopic hip surgery and completion of at least 1 legacy PRO or PROMIS questionnaire at the preoperative time point. Exclusion criteria were history of contralateral or ipsilateral hip surgery, non–English-speaking patients, patients who completed PROs by phone or by paper form, and patients who did not complete preoperative PROs. Legacy PROs included modified Harris Hip Score (mHHS), Hip Outcome Score (HOS), International Hip Outcome Tool (iHOT-12), and Hip Pain Visual Analog Scale (VAS-Pain). PROMIS PROs included Physical Function (PROMIS-PF), Pain Interference (PROMIS-PI), and Depression (PROMIS-D). Only preoperative PROs were included in the analysis. Completion time was calculated using the questionnaire start and stop time reported by the survey collecting software. The median and interquartile range of each PRO were reported for analysis of central tendency and statistical dispersion, respectively.ResultsA total of 1,901 patients and 269 patients were included in the legacy and PROMIS groups, respectively. The median time required for completion of each PRO in (minutes: seconds) format was as follows: mHHS (1:29), HOS (3:58), iHOT (2:11), VAS-Pain (0:32), PROMIS-PF (0:46), PROMIS-PI (0:37), and PROMIS-D (0:43). The interquartile range of the middle 50% of respondents was as follows; mHHS (0:58), HOS (2:46), iHOT (1:22), VAS-Pain (0:28), PROMIS-PI (0:19), PROMIS-D (0:29), and PROMIS-PF (0:20).ConclusionsThis study supports that preoperative PROMIS forms require less time to complete than preoperative legacy PROs and are not significantly influenced by age, race, or workers compensation status.Level of EvidenceLevel IV, case series.

P70. Completion rates for PROMIS-PF compared with legacy PROMs

<h3>BACKGROUND CONTEXT</h3> Patient-Reported Outcomes Measurement Information System (PROMIS) utilizes computer adaptive testing (CAT) to accurately and efficiently assess patient improvement. Previous studies have highlighted the benefits of PROMIS over traditional "legacy" patient reported outcome measures (PROMs). However, literature comparing completion rates of PROMIS to those of legacy PROMs is scarce. <h3>PURPOSE</h3> To compare completion rates for PROMIS physical function (PF) with rates of legacy PROM completion following cervical spine procedures. <h3>STUDY DESIGN/SETTING</h3> Retrospective Cohort. <h3>PATIENT SAMPLE</h3> A total of 302 patients who underwent cervical spine procedures were included. <h3>OUTCOME MEASURES</h3> Perioperative characteristics including operative duration (from skin incision to closure), estimated blood loss (EBL), and postoperative length of stay were reported. Legacy PROMs such as Visual Analogue Scale (VAS) neck, VAS arm, neck disability index (NDI), and 12-Item Short-Form physical component summary (SF-12 PCS), as well as PROMIS-PF were included. <h3>METHODS</h3> A retrospective review was conducted of a prospectively maintained registry for cervical spine procedures from May 2015 to June 2020. Patients were excluded for procedures that were revisions or indicated for trauma, infection or malignancy. Patient demographics, preoperative medical conditions and spinal pathologies were collected. Perioperative characteristics including operative duration (from skin incision to closure), estimated blood loss (EBL), and postoperative length of stay were reported. Legacy PROMs such as Visual Analogue Scale (VAS) neck, VAS arm, neck disability index (NDI), and 12-Item Short-Form physical component summary (SF-12 PCS), as well as PROMIS-PF were administered at preoperative and postoperative (6-week, 12-week, 6-month, 1-year, and 2-year) timepoints. Descriptive statistics were performed for all preoperative and perioperative characteristics. McNemar's test was used to compare completion rates for each legacy PROM and PROMIS-PF at each timepoint. The overall percentage of surveys patients completed from the preoperative timepoint to 2-years for PROMIS-PF was compared with that of each legacy PROM using a paired t-test. <h3>RESULTS</h3> A total of 302 patients who underwent cervical spine procedures were included. The study cohort had a mean age of 50.0 years, was majority male (63.3%), non-obese (BMI <30 kg/m2; 57.6%), of White ethnicity (75.4%), and private insurance coverage (73.2%). The most common preoperative spinal pathology was central stenosis (63.6%). Mean perioperative variables were as follows: operative time 67.4 minutes, EBL 46.9 mL, length of stay 15.3 hours. Rates of survey completion were significantly lower for PROMIS-PF than for each legacy PROM from the preoperative timepoint through 6-months (all p<0.001). Survey completion rates did not significantly differ at 1-year. Rates of survey completion were greater for PROMIS-PF than for legacy PROMs at 2-years (p<0.001). The overall percentage of surveys completed was significantly lower for PROMIS-PF than for all legacy PROMs (p<0.001). <h3>CONCLUSIONS</h3> A greater proportion of cervical spine patients completed legacy PROMs at preoperative and earlier postoperative measurements. However, this difference was resolved by 1-year postoperatively and reversed by 2-years. Overall, patients completed a smaller percentage of assigned PROMIS-PF surveys than legacy PROMs. Although overall completion rates were lower for PROMIS-PF, patients may be more likely to complete PROMIS than legacy PROMs at long-term follow-up. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

93. Differences in patient reported outcomes between patients who do and do not complete PROMIS surveys

<h3>BACKGROUND CONTEXT</h3> Patient-Reported Outcomes Measurement Information System (PROMIS) has been well validated as a tool for assessing patient reported outcomes in spine surgery. However, as with any self-reported survey, PROMIS is vulnerable to response bias. There is currently a dearth of literature assessing differences in patients who do and do not complete PROMIS surveys. <h3>PURPOSE</h3> To characterize differences in patient reported outcome measure (PROM) scores between patients who do and do not complete PROMIS physical function (PF) surveys following lumbar spine surgery. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort. <h3>PATIENT SAMPLE</h3> A total of 983 patients undergoing primary lumbar spine procedures. <h3>OUTCOME MEASURES</h3> Demographic and perioperative characteristics, Patient Health Questionnaire (PHQ-9), visual analog score (VAS) back and leg, Oswestry Disability Index (ODI) and 12-Item Short Form Physical Composite Summary (SF-12 PCS) <h3>METHODS</h3> A prospectively maintained surgical database was retrospectively reviewed for primary lumbar spine procedures from May 2015 to July 2020. Procedures indicated for traumatic, infectious, or malignant etiologies were excluded. Patient demographic and operative data were collected. Outcome measures for PHQ-9, VAS back and leg, ODI and SF-12 PCS were recorded at both pre- and postoperative (6-week, 12-week, 6-month, 1-year, 2-year) timepoints. Completion rates for PROMIS PF surveys were recorded for each of the above timepoints. PROMIS PF survey dates that were before or after the window when patients could have potentially completed the survey (eg, ≤1 year after study start or before study end for 1-year PROMIS surveys) were excluded from this analysis. Descriptive statistics were performed for demographic and operative variables. Patients were categorized into groups at each timepoint based on whether or not PROMIS PF was completed. A t-test for independent samples was used to determine differences in mean scores for each PROM at each timepoint between groups. <h3>RESULTS</h3> A total of 983 patients were included in this study with an average age of 48.8 years. A majority were male (66.5%), had a body mass index <30 kg/m2 (60.0%), and were nonsmokers (88.3%). The most common spinal pathology was recurrent herniated nucleus pulposus at 53.2%. Means values for operative variables were 86.6 minutes for operative time, 42.8mL for estimated blood loss, and 18.0 hours for length of stay. No significant differences were observed for all outcome measures between PROMIS completion groups at the preoperative timepoint. PHQ-9 and VAS back scores differed significantly between groups through 1-year (all p<0.05). Significant differences in VAS leg and ODI scores were demonstrated through 6-months (all p<0.05), but not at 1-year. SF-12 PCS differed significantly between PROMIS completion groups only at 6-weeks (p=0.018). <h3>CONCLUSIONS</h3> Patients who did not complete PROMIS PF surveys had significantly poorer outcomes than those that did in terms of postoperative depressive symptoms, pain, and disability. These results suggest that patents completing PROMIS questionnaires may represent a healthier cohort than the overall lumbar spine population. Interestingly, these differences were not observed for preoperative scores and to a lesser extent for physical function. This finding may be reassuring, since PROMIS PF's primary function is to assess patient physical function. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

65. Subsidence after minimally invasive transforaminal lumbar interbody fusion with expandable cage: Rates and clinical impact

<h3>BACKGROUND CONTEXT</h3> Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) is commonly used to treat lumbar spinal stenosis with degenerative disc disease. Expandable cage technology has been increasingly adopted and has demonstrated successful results, offering a larger footprint and intraoperative height adjustment, enabling more precise dialing in of sagittal alignment and disc height. While many advances have been made, endplate violation and postoperative cage subsidence can still be seen. <h3>PURPOSE</h3> To determine the rate and clinical implications of subsidence after expandable cage use in MI-TLIF. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study. <h3>PATIENT SAMPLE</h3> Patients undergoing MI-TLIF for degenerative disc disease using articulating, expandable cages. <h3>OUTCOME MEASURES</h3> Patient-reported outcome measures (PROMs), including the Oswestry Disability Index (ODI), visual analog scale (VAS) for back/leg pain, Short Form-12 (SF-12), and PROMIS physical function (PF). <h3>METHODS</h3> Patients undergoing MI-TLIF for degenerative disc disease using articulating, expandable cages from 2017-2019 were retrospectively studied. AP and lateral radiographs were reviewed and evaluated for the presence or absence of subsidence intraoperatively and at follow-up times including 2 weeks, 6 weeks, 12 weeks, 6 months and 1 year postoperatively. Each of the four corners of the implant was evaluated, and subsidence was determined to have occurred if there was endplate violation ≥3mm at any corner. Patient-reported outcome measures, including the ODI, VAS for back/leg pain, SF-12 and PROMIS PF were recorded at the preoperative and follow-up time points. Fusion was assessed 1-year postoperatively via CT. <h3>RESULTS</h3> A total of 87 patients were included, with mean age 58.3 years (SD,13.4). Of 87 total patients, 13 (14.9%) demonstrated subsidence, with the majority (84.6%) of cases occurring within the first 12 weeks. Patients who had subsidence were older (67.2 vs 56.7 yrs; p=0.009), had lower bone quality (p=0.049), and were more likely to have 2-level surgery compared to those without (p=0.032). On multiple regression analysis, age was the only variable which retained significance when comparing the subsidence and no subsidence groups (p=0.04). There were significant differences in subsidence rate with greater implant height (p=0.013) and smaller width (p=0.026). With the exception of SF-12 PCS at 1-year postoperative, there were no significant differences in any patient-reported outcomes between the 2 groups. The overall fusion rate was 90.5% (57/63 levels) at 1-year postoperative, with no significant difference in fusion rate between the subsidence and no subsidence groups. <h3>CONCLUSIONS</h3> The rate of subsidence after MI-TLIF was 14.9%, with the majority of cases occurring within the first 12 weeks postoperatively. Patients who had subsidence were older with lower bone quality, had cages with greater height and smaller width, and were more likely to have 2-level surgery. With the exception of SF-12 PCS at 1 year, there were no significant differences in any of the PROMs between the groups. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

28. Does loss of spondylolisthesis reduction impact clinical and radiographic outcomes after minimally invasive transforaminal lumbar interbody fusion?

<h3>BACKGROUND CONTEXT</h3> Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) is the workhorse minimally invasive treatment for patients with degenerative lumbar stenosis and spondylolisthesis refractory to nonoperative care. While the basic tenets of surgical treatment do not differ between minimally invasive and open techniques, surgeons performing MI-TLIF are more likely to attempt reduction of spondylolisthesis in order to optimize restoration of canal dimensions due to a greater reliance on indirect decompression, which has been shown to be effective. While intraoperative reduction is often successful, postoperative loss of reduction and slip recurrence can be seen. <h3>PURPOSE</h3> To determine the rate and clinical impact of slip recurrence after MI-TLIF with expandable cage technology. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study. <h3>PATIENT SAMPLE</h3> Patients undergoing MI-TLIF for degenerative spondylolisthesis using an articulating, expandable cage <h3>OUTCOME MEASURES</h3> Patient-reported outcome measures (PROMs), including the Oswestry Disability Index (ODI), visual analog scale (VAS) for back/leg pain, Short Form-12 (SF-12) and PROMIS Physical Function (PF) <h3>METHODS</h3> Patients undergoing MI-TLIF for degenerative spondylolisthesis using articulating, expandable cages from 2017-2019 were retrospectively studied. Lateral radiographs were reviewed and evaluated for the presence or absence of spondylolisthesis preoperatively, intraoperatively, and at follow-up times including 2 weeks, 6 weeks, 12 weeks, 6 months and 1-year postoperatively. Spondylolisthesis was measured from the posterior inferior corner of the cephalad vertebra to the posterior superior corner of the caudal vertebral, with any measurement >1mm classified as spondylolisthesis, and Meyerding grade was noted. Intraoperative reduction was measured and loss of reduction was defined as >1mm increase in spondylolisthesis comparing follow-up imaging to intraoperative films. PROMs were recorded at the preoperative and follow-up time points. Fusion was assessed 1-year postoperatively via CT. <h3>RESULTS</h3> A total of 63 patients and 70 levels were included, with mean age 59.8 years (SD,13.8). Nineteen levels (27.1%) had complete reduction intraoperatively, 40 (57.1%) had partial reduction and 11 (15.7%) had no reduction. Of the 30 levels with loss of reduction (50.8%), 20 (66.7%) occurred by 2 weeks postoperatively and 28 (93.3%) occurred by 12 weeks postoperatively. At 6 months, there were significant differences between those who had loss of reduction and those who did not in VAS back pain (3.0 vs 0.9, p=0.017) and SF-12 PCS (41.5 vs 50.0, p=0.035), but no differences were found between the groups for any instruments at any other time points. The overall fusion rate was 89.5% (34/38) at 1 year postoperatively. There was no significant difference in fusion rate between the loss of reduction (16/18) and no loss of reduction (18/20) groups. Patients with loss of reduction had no difference in reoperation rate (1/28) compared to those without loss of reduction (2/24). <h3>CONCLUSIONS</h3> While a majority of patients demonstrated reduction intraoperatively, 51% had loss of reduction, most commonly in the acute postoperative period. There were few differences in PROMs between patients who had loss of reduction and those who did not, suggesting that radiographic loss of reduction after MI-TLIF in the setting of degenerative spondylolisthesis may not be clinically meaningful. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

5. Impact of racial and ethnic disparities on health outcomes following cervical spine surgery

<h3>BACKGROUND CONTEXT</h3> Evidence suggests that Black non-Hispanic individuals are 39% to 44% more likely to have postoperative complications and prolonged length of stay after cervical spine surgery compared to White non-Hispanics. The long-term recovery of patient-reported health outcomes after cervical spine surgery among Hispanic and other non-Hispanic minorities (ie, Asian) remains unclear. Examining the postoperative recovery trajectory of Hispanic, Asian non-Hispanic, and Black non-Hispanic populations is important for identifying whether strategies are needed to reduce outcome disparities. <h3>PURPOSE</h3> The purpose of this study was to investigate the association of race and ethnicity with patient-reported health outcomes after cervical spine surgery. <h3>STUDY DESIGN/SETTING</h3> Retrospective analysis of data from the cervical module of a national spine registry, the Quality Outcomes Database (QOD). <h3>PATIENT SAMPLE</h3> Data from 14,136 QOD participants (mean±SD; age=56.8±11.5 years; BMI=30.2±6.4 kg/m2 and 49% females) across 28 states in the Unites States who underwent elective surgery for degenerative cervical spine disease and completed 1-year follow-up were analyzed. Participants self-identified as Hispanic (n=343), non-Hispanic Black (n=1,191), Asian (n=112) or White (n=12,490). <h3>OUTCOME MEASURES</h3> Patient-reported outcome measures (PROs) were used for assessing disability (Neck Disability Index: NDI), neck and arm pain (11-point Numeric Rating Scale), and health-related quality of life (EuroQol EQ-5D) at the preoperative and 1-year time point after surgery. Minimal symptom state at 1-year was defined as achieving a score of ≤20 on NDI, and neck and arm pain scores ≤2. Satisfaction was assessed using a single item question at 1-year after surgery (NASS scale). <h3>METHODS</h3> Multivariable linear and logistic regression analyses were conducted to compute effect estimates 95% confidence interval (CI) to determine the association of racial/ethnic groups with PROs. Covariates included sociodemographic items (eg, age, sex, BMI, insurance, education, employment status), US census regions, surgical variables (eg, surgical approach, pathology), opioid use and preop PROs. Multiple imputation using predictive mean matching was used to impute missing demographic characteristics (<5% missing). <h3>RESULTS</h3> Of the 14,136 participants, 48% achieved minimal symptom state at 1-year. Black non-Hispanic had 57% (odds ratio [95%CI]: 1.57 [1.37, 1.81]) and Hispanics had 31% (1.31 [1.02, 1.69]) higher odds of not achieving minimal symptom state at 1-year follow-up compared to White non-Hispanic. Similar findings for Black or Hispanics vs White groups were observed for other PROs and satisfaction. There were no differences in any outcome measures between Asian and White. <h3>CONCLUSIONS</h3> Comparatively, White and Asian groups did not have increased likelihood, but Hispanics and Black groups did have increased likelihood of reporting poor outcomes following cervical spine surgery, even after adjusting for potential confounders. The findings of this study suggest the need to account for inherent racial and ethnic disparities to better understand the recovery trajectories following cervical spine surgery. Also, strategies to minimize racial and ethnic disparities are needed to ensure equitable access to postoperative care in this surgical population. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

64. Impact of depression on patient reported outcomes following primary vs revision ACDF

<h3>BACKGROUND CONTEXT</h3> Depression has been associated with poorer outcomes following anterior cervical discectomy and fusion (ACDF). However, research examining the relationship between depression and patient reported outcome measures (PROMs) in revision ACDF procedures is limited. <h3>PURPOSE</h3> To assess the relationship of depressive symptoms with PROMs in patients undergoing either primary or revision ACDF procedures. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort. <h3>PATIENT SAMPLE</h3> 143 patients undergoing primary or revision, single- or multilevel ACDF procedures. <h3>OUTCOME MEASURES</h3> Demographic and perioperative characteristics, Patient Health Questionnaire-9 (PHQ-9), visual analog scale (VAS), Neck Disability Index (NDI). <h3>METHODS</h3> A prospective database was retrospectively reviewed for primary or revision, single- or multi-level ACDF procedures from 2016 to 2020. Patients lacking preoperative PHQ-9 surveys were excluded. Demographic and perioperative characteristics were recorded and analyzed using Fisher's exact test or t-test. Patient-reported outcome measures were collected preoperatively and postoperatively. Postoperative improvement from baseline scores (ΔPROM) was calculated at all postoperative timepoints. Differences in mean PROM and ΔPROM between groups and changes from baseline PROM scores within groups were assessed using student's t-test. Linear regression analyzed the impact of preoperative PHQ-9 on ΔPROM among primary and revision patients. <h3>RESULTS</h3> A total of 143 patients (121 primary and 22 revision) were included. Significant differences between groups were demonstrated at the preoperative timepoint for NDI (p=0.022). ΔPROM values did not significantly differ between groups. Regression analysis revealed significant relationships between preoperative PHQ-9 and ΔPHQ-9 at all timepoints, ΔVAS neck at 6-weeks and 6-months, ΔVAS arm at 6-months, and ΔNDI at 6-weeks and 6-months for the primary group (all p<0.05). Regression analysis revealed no significant associations for the revision group. <h3>CONCLUSIONS</h3> Primary or revision ACDF procedures did not significantly differ in depressive symptoms through 1-year. Primary ACDF patients significantly improved in all PROMs through all timepoints, while revision patients had limited improvement in PROMs. Preoperative depression may have a stronger association on postoperative outcomes for primary procedures. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Pain and quality of life are impaired in adults with hip dysplasia undergoing periacetabular osteotomy: a systematic review and meta-analysis

Purpose: In adults with hip dysplasia (i) evaluate pre to post- operative changes in pain, function and quality of life following Periacetabular Osteotomy (PAO); (ii) evaluate differences in pain, function and quality of life in those undertaking PAO and healthy controls; and (iii) evaluate differences in pain, function and quality of life in those with mild versus severe dysplasia, as defined by the Lateral Centre Edge Angle (LCEA) LCEA. Methods: A comprehensive, reproducible search strategy was performed on the following databases MEDLINE CINAHL, EMBASE, Sports Discuss, and PsychINFO from inception until 11th July 2019. Studies were eligible for inclusion if they used a hip-specific patient-reported outcome measure (PROM) and reported Level IV evidence or above. Participants: People aged 15 years and older with hip dysplasia undertaking PAO. Intervention: Studies utilising PAO surgery as primary intervention for Hip Dysplasia. The terms “Bernese Osteotomy” and “Ganz Osteotomy” were considered interchangeable with ‘Periacetabular Osteotomy’. Studies were ineligible if the PAO was reported to be a ‘rotational’ or ‘”curved” procedure. Comparator: Studies using sham treatment, no treatment or other treatment as the comparator/control treatment were included. We also included studies where no control group was present. Outcomes: Primary outcomes of interest were pain, function and quality of life. The hip-specific PROMs included: Hip Dysfunction and Osteoarthritis Outcome Score (HOOS), Western Ontario and McMaster universities osteoarthritis Index (WOMAC), the International Hip Outcome Tool (iHOT), the Copenhagen Hip and Groin Outcome Score (HAGOS), NAHS (Non-arthritic Hip Score), and the Oxford Hip Score (OHS). A modified version of the Downs and Black checklist was used to assess the quality of included studies. Quality Evaluation and Data Extraction was performed by two independent reviewers with any disagreements discussed in a consensus meeting and an independent arbitrator was employed when consensus could not be met. A hierarchy of PROMs was decided on between authors to prioritise data extraction where more than one had been used. The order of the hierarchy was based on the established level of validity and reliability of the PROM for young people with hip pain, and applicability to people with hip dysplasia undergoing PAO. In order of selection the hierarchy was HOOS, WOMAC, IHOT, HAGOS, NAHS, OHS. Results: The search yielded 4065 titles and abstracts for screening, with 51 studies included in the final analyses. The methodological quality scores ranged from 50% to 94%, with an overall mean (SD) rating of 71% (11.6%). Sample sizes of the PAO groups ranged from 16 patients to 391 patients. The ages for patients in the included studies ranged from 20 years to 45 years. All included studies used a PROM. Seventeen studies used the HOOS, 34 studies used the WOMAC, five studies used the iHOT, 4 studies used the HAGOS and 3 studies used the NAHS.Two studies, one prospective cohort study and a retrospective cohort study, compared subscale scores (pain, symptoms, activities of daily living (ADL), sport & recreation, and quality of life) pre-operatively versus post-operatively. For the pain subscale (Fig. 1) a significant improvement was found between pre-surgery and the one-year timepoint (SMC (95% CI): 1.50; 1.33 to 1.67) and this improvement was maintained at the two-year timepoint (1.43; 1.16 to 1.70). This also occurred in the symptoms subscale at one-year (1.21; 1.06 to 1.36) and two-years (1.08; 0.82 to 1.34); ADL at one-year (1.21; 1.06 to 1.36) and two-years (1.11; 0.98 to 1.23); sport & recreation at one-year (1.41; 1.25 to 1.57) and two-years (1.32; 0.88 to 1.75); and quality of life at one-year (1.38; 1.22 to 1.54) and two-years (1.31; 1.04 to 1.57). These results provide low-level evidence that patients experience clinical improvements across all subgroups at one year after PAO, compared to pre-surgery, and this is maintained at the two-year timepoint. Two studies compared outcomes between PAO patients and healthy participants, one high-quality prospective cohort study and one high quality cross-sectional study. Meta-analysis of the pre-operative time point showed significantly worse outcomes in the PAO group with large effect sizes across all subgroups. This included pain (Fig. 2) (SMD (95% CI): -3.84; -4.73 to -2.95), symptoms (-3.84; -4.36 to -3.29), ADL (-2.81, -3.89 to -1.74), sport & recreation (-3.47; -3.79 to -3.16), and quality of life (-4.10; -4.43 to -3.77). This result provides low-level evidence that PAO patients have significantly worse outcomes across all subgroups when compared to healthy participants. This occurs both pre-operatively and postoperatively and 6, 12 and 32 months. Conclusions: Before undergoing PAO surgery, adults with hip dysplasia have worse levels of pain, symptoms, ADL, sport and recreation and quality of life compared to healthy participants. These levels improve over two years following PAO, but do not reach the same level as their asymptomatic peersView Large Image Figure ViewerDownload Hi-res image Download (PPT)

Use of Parathyroid Hormone and Rehabilitation Reduces Subsequent Vertebral Body Fractures after Balloon Kyphoplasty.

Study DesignRetrospective cohort study.PurposeTo evaluate the efficacy of our current prophylactic strategy by investigating the incidence of subsequent vertebral body fractures (SVBFs) following balloon kyphoplasty (BKP).Overview of LiteratureAlthough extensive studies have investigated the risk factors for SVBFs after BKP, few have reported on postoperative therapies to prevent SVBFs and have evaluated their effectiveness.MethodsThis study enrolled 273 patients who underwent an initial BKP. To treat osteoporosis, parathyroid hormone (PTH) administration was started 1–2 weeks before BKP and continued for at least 6 months postoperatively. Corsets were applied for 3 months after the procedure. Rehabilitative interventions, including hip range-of-motion training, muscle strengthening exercises, and motion/posture instruction, were started from the preoperative assessment time point and resumed 3 hours postoperatively. Corsets were used in all patients. Therefore, no grouping based on corset use was performed. PTH was used in 180 patients, and they were divided into the following two groups: PTH user group and PTH nonuser group. Rehabilitative interventions were provided to all patients for a median duration of 17 days. Patients who underwent rehabilitative intervention for <17 and ≥17 days were included in the short-term and long-term intervention groups, respectively. The incidences of SVBFs for these four groups were compared.ResultsSVBF occurred in 29 patients (10.6%). The SVBF incidence among patients who were prescribed all three prophylactic measures was 6.2%. The PTH user group had a significantly lower incidence of distant vertebral body fractures as compared to the PTH nonuser group. The long-term rehabilitation group had a significantly lower incidence of SVBFs and adjacent vertebral body fractures within 50 postoperative days than the short-term group.ConclusionsA 17-day or longer rehabilitative intervention may lower the risk of early adjacent vertebral body fractures, and the use of PTH may reduce the risk of distant vertebral body fractures.

Does loss of spondylolisthesis reduction impact clinical and radiographic outcomes after minimally invasive transforaminal lumbar interbody fusion?

Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) is a common operative approach to address degenerative lumbar stenosis and spondylolisthesis which has failed nonoperative care. Compared to open TLIF, MI-TLIF relies to a greater extent on indirect decompression resulting in a heightened awareness of spondylolisthesis reduction among MI surgeons. To what extent intraoperative reduction is achieved as well as the rate and clinical impact of loss or reduction and slip recurrence remain unknown. To determine the rate and clinical impact of slip recurrence after MI-TLIF with expandable cage technology STUDY DESIGN/SETTING: Retrospective Cohort Study PATIENT SAMPLE: Patients undergoing MI-TLIF for degenerative spondylolisthesis using an articulating, expandable cage OUTCOME MEASURES: Patient-reported outcome measures (PROMs), including the Oswestry Disability Index (ODI), visual analog scale (VAS) for back/leg pain, Short Form-12 (SF-12), and PROMIS Physical Function (PF) METHODS: Patients undergoing MI-TLIF for degenerative spondylolisthesis using articulating, expandable cages from 2017 to 2019 were retrospectively studied. Lateral radiographs were reviewed and evaluated for the presence or absence of spondylolisthesis preoperatively, intraoperatively, and at follow-up times including 2 weeks, 6 weeks, 12 weeks, 6 months, and 1 year postoperatively. Spondylolisthesis was measured from the posterior inferior corner of the cephalad vertebra to the posterior superior corner of the caudal vertebra, with any measurement >1 mm classified as spondylolisthesis, and Meyerding grade was noted. Intraoperative reduction was measured, and loss of reduction was defined as >1 mm increase in spondylolisthesis comparing follow-up imaging to intraoperative films. PROMs were recorded at the preoperative and follow-up time points. Fusion was assessed at 1 year postoperatively via CT. A total of 63 patients and 70 levels were included, with mean age 59.8 years (SD,13.8). 19 levels (27.1%) had complete reduction intraoperatively, 40 (57.1%) had partial reduction, and 11 (15.7%) had no reduction. Of the 30 levels with loss of reduction (50.8%), 20 (66.7%) occurred by 2 weeks postoperatively and 28 (93.3%) occurred by 12 weeks postoperatively. At 6 months, there were significant differences between those who had loss of reduction and those who did not in VAS back pain (3.0 vs. 0.9, p=.017) and SF-12 PCS (41.5 vs. 50.0, p=.035), but no differences were found between the groups for any instruments at any other time points. The overall fusion rate was 82.1% (32/39) at 1 year postoperatively. There was no significant difference in fusion rate between the loss of reduction (16/20) and no loss of reduction (20/23) groups. Patients with loss of reduction had no difference in reoperation rate (1/28) compared to those without loss of reduction (2/24). While a majority of patients demonstrated reduction intraoperatively, 51% had loss of reduction, most commonly in the acute postoperative period. There were few differences in PROMs between patients who had loss of reduction and those who did not, suggesting that radiographic loss of reduction after MI-TLIF in the setting of degenerative spondylolisthesis may not be clinically meaningful.

Preoperative Evaluation of the Lower Extremity-Specific PROMIS Mobility Bank in Patients with ACL Tears

PurposeThe purpose of this study was to preoperatively assess the Patient-Reported Outcomes Measurement Information System (PROMIS) Item Bank v2.0–Mobility in patients with anterior cruciate ligament (ACL) tears to (1) determine construct validity by correlating with legacy patient-reported outcomes (PROs), (2) evaluate test burden, (3) determine the presence of floor or ceiling effects, and (4) revisit the conventional threshold for inclusiveness (floor/ceiling effects) in the modern era of computer adaptive testing (CAT)–based PROs.MethodsPatients at a large academic musculoskeletal specialty center diagnosed with ACL tears indicated for surgery were administered the following outcomes measures before surgery: PROMIS Mobility CAT, PROMIS Pain Interference CAT (PROMIS PI), International Knee Documentation Committee (IKDC), the Marx Knee Activity Rating Scale (Marx), and Single Assessment Numeric Evaluation (SANE). Construct validity was evaluated using Spearman correlation coefficients. Correlation strengths were defined as high (≥0.7), high-moderate (0.61-0.69), moderate (0.4-0.6), moderate-weak (0.31-0.39) and weak (≤0.3). Number of questions to completion were recorded as a marker of test burden. The percentage of patients scoring at the extreme high (ceiling) or low (floor) of each measure was recorded to measure inclusivity.ResultsA total of 1126 patients were evaluated. The mean number of questions answered (± standard deviation) was 4.7 ± 2.1 for PROMIS Mobility and 4.5 ± 1.9 for PROMIS PI. PROMIS Mobility demonstrated a high correlation with IKDC, (r = 0.81, P < .001), a high-moderate correlation with PROMIS PI (r = −0.63), and a moderate correlation with SANE (r = 0.46, P < .01). Neither PROMIS Mobility nor PROMIS PI met conventional criteria for floor or ceiling effects (>15%).ConclusionsThe PROMIS Mobility measure maintains construct validity, because its scores correlate strongly with other PROs measuring physical function with high efficiency among preoperative patients with ACL injuries. Although ceiling effects of PROMIS Mobility CAT were below the conventional significance threshold of 15% at the preoperative timepoint in this population, this study provides critical feedback for redesigning the Mobility bank.Level of EvidenceLevel III (Diagnostic study).

Unilateral Limited Laminectomy for Debridement to Treat Localized Short-Segment Lumbosacral Spinal Tuberculosis: A Retrospective Case Series.

ObjectiveThis study aimed to investigate the clinical effects of surgically treating lumbosacral tuberculosis with a modified posterior unilateral limited laminectomy method for debridement.MethodsThis retrospective study enrolled a total of 26 patients who were administered in our institution from January 2010 to December 2016, diagnosed with lumbosacral tuberculosis at the L5/S1 level, and underwent one‐stage posterior unilateral limited laminectomy as surgical treatment for debridement, allograft of cortical bone grafting, and fixation. The erythrocyte sedimentation rate (ESR), C‐reactive protein (CRP) level, visual analog scale (VAS) score, Oswestry Disability Index (ODI), and lumbosacral angle (LA, Cobb's method) were statistically compared, and the American Spinal Injury Association Impairment (ASIA) Scale was compared between the preoperative and postoperative time points to evaluate the clinical outcomes.ResultsAll 26 patients were observed during the follow‐up period, and the mean follow‐up time was 1.3 ± 0.42 years. The mean age was 56 ± 7.4 years old. The average operation time was 118.1 ± 17.5 min, and the mean bleeding volume was 513.0 ± 79.6 mL. There were no intraoperative complications or tuberculous sinus, and two cases experienced hypostatic pneumonia during hospitalization, which resolved with responsive antibiotics and symptomatic supportive treatment. At the final follow‐up, there was no recurrence of tuberculosis, and the ESR (11.8 ± 1.8 mm/h) and CRP (3.0 ± 1.0 mg/L) levels in all patients had returned to normal. The patients with neurologic deficits had improved, and the mean ODI was 79.9 ± 10.6 (87–62) preoperatively and significantly decreased to 20.5 ± 5.7 (11–29) at the final follow‐up (P < 0.01). ASIA scale scores were improved by 1~2 grades at the last follow‐up. The patients' pain levels were significantly alleviated; the mean VAS score declined to 1.2 ± 0.4 (0–2.5) at the final follow‐up compared to 7.5 ± 1.6 (6.5–8.5) preoperatively (P < 0.01). All patients achieved bony graft fusion at an average time of 6.8 ± 1.2 months. Physiological lumbar lordosis was significantly improved, and the mean LA before operation was 17.6° ± 2.1°, which was significantly different from the postoperative LA (29.3° ± 7.4°, P < 0.01) at the final follow up. The LA (27.1° ± 5.5°, P = 0.15) slightly rebounded but without significance compared to the postoperative level.ConclusionOnly posterior approach by unilateral limited laminectomy for debridement could be served as an effective and safe method to treat short‐segment lumbosacral tuberculosis without extensive anterior sacral and gravitation abscesses.

Total ankle arthroplasty: Strength, pain, and motion

BackgroundWhile outcomes such as pain and ankle motion are well researched, information regarding the effect of total ankle arthroplasty on ankle plantarflexion strength is extraordinarily limited. The purpose of this study was to evaluate ankle plantarflexion strength before and after total ankle arthroplasty, and examine the interplay of pain, motion, and strength. MethodsThis prospective case-control study included 19 patients with end-stage ankle arthritis who received a total ankle arthroplasty and 19 healthy control participants matched for age, sex, and body mass index. Pain was measured with a numeric pain rating scale. Passive sagittal plane ankle range of motion (°) and isokinetic ankle plantarflexion torque (Nm/kg) at 60 and 120°/s were measured with an instrumented dynamometer. t-tests or non-parametric tests were used to evaluate outcomes across time and between groups. Bivariate correlations were performed to evaluate the interplay of postoperative pain, motion, and torque. FindingsPatient pain and motion improved between the preoperative and six-month postoperative time points (d ≥ 0.7). Ankle plantarflexion torque was not different across time (d ≤ 0.5), but was lower than control group values postoperatively (d ≥ 1.4). Significant correlations between pain and motion (r = −0.48), but not torque (−0.11 ≤ r ≤ 0.13), were observed. InterpretationUnchanged following surgery, impairments in muscle performance following total ankle arthroplasty do not appear to be changed by improved pain or motion. These findings provide impetus for postoperative strengthening interventions.

Impact of Depression on Patient Reported Outcomes Following Primary Versus Revision ACDF.

Retrospective cohort. To assess the relationship of depressive symptoms with patient reported outcome measures (PROMs) in patients undergoing either primary or revision anterior cervical discectomy and fusion (ACDF) procedures. Depression has been associated with poorer outcomes following ACDF. However, research examining the relationship between depression and PROMs in revision ACDF procedures is limited. A prospective database was retrospectively reviewed for primary or revision, single- or multilevel ACDF procedures from 2016 to 2019. Patients lacking preoperative Patient Health Questionnaire-9 (PHQ-9) surveys were excluded. Demographic and perioperative characteristics were recorded and analyzed using Fisher's exact test or t test. Patient-reported outcome measures were collected preoperatively and postoperatively. Postoperative improvement from baseline scores (ΔPROM) was calculated at all postoperative timepoints. Differences in mean PROM and ΔPROM between groups and changes from baseline PROM scores within groups were assessed using Student's t test. Linear regression analyzed the impact of preoperative PHQ-9 on ΔPROM. A total of 143 patients (121 primary and 22 revision) were included. Significant differences between groups were demonstrated at the preoperative timepoint for Neck Disability Index (NDI) (P = 0.022). ΔPROM values did not significantly differ between groups. Regression analysis revealed significant relationships between preoperative PHQ-9 and ΔPHQ-9 at all timepoints, ΔVAS neck at 6-weeks and 6-months, ΔVAS arm at 6-months, and ΔNDI at 6-weeks and 6-months for the primary group (all P < 0.05). Regression analysis revealed no significant associations for the revision group. Primary or revision ACDF procedures did not significantly differ in depressive symptoms through 1-year. Primary ACDF patients significantly improved in all PROMs through all timepoints, while revision patients had limited improvement in PROMs. Preoperative depression may have a stronger association on postoperative outcomes for primary procedures.Level of Evidence: 3.