Background: Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) is increasingly centralized and performed at high-volume specialized centers. Centralization often requires long-distance travel, but its effect on postoperative outcomes after MI-TLIF is unknown. Purpose: We sought to identify whether travel distance affects outcomes after 1- to 2-level MI-TLIF. Methods: We conducted a retrospective cohort study utilizing data from a prospectively collected registry at a single academic institution. We included adult patients who underwent primary 1- or 2-level MI-TLIF surgery between April 2017 and April 2025 by 3 board-certified orthopedic spine surgeons. Patients with <3 months of follow-up were excluded. Patients residing >50 miles from the hospital were classified as travelers. Outcome measures included Oswestry Disability Index, Visual Analog Scale, 12-Item Short Form Survey, and Patient-Reported Outcomes Measurement Information System, and their minimal clinically important difference (MCID) attainment, evaluated at ≤3 and ≥6 months. Other outcomes included 90 day and 1 year readmission and reoperation. Univariate analyses used t -tests and χ 2 /Fisher’s exact tests. Multivariable logistic regression identified predictors of long-term MCID non-achievement. Results: Of the 408 patients included, 139 (34.1%) were travelers (mean distance 440.6 vs 19.5 miles for locals). No differences were observed between travelers and locals in all primary patient-reported outcome measures or MCID attainment at both timepoints. Multivariable analysis demonstrated travel distance was not an independent predictor of long-term MCID non-achievement for any outcome 90 day and 1 year readmission and reoperation rates were similar. Conclusions: Our retrospective analysis found that in patients who underwent 1- to 2-level MI-TLIF at our institution, traveling >50 miles was not associated with inferior short- or long-term patient-reported outcomes, likelihood of achieving MCID, or rates of readmission or reoperation through 1 year follow-up. These findings suggest that patients may safely access specialized spine care at high-volume centers without outcome disadvantage from travel burden. Level of Evidence: Level III, retrospective cohort study.
Background: Lumbar sagittal realignment induces compensatory changes throughout the thoracic and cervical spine. Purposes: Given the role of cervical musculature in head posture, we sought to evaluate whether preoperative cervical muscle morphology is associated with immediate cervical alignment changes following lumbar pedicle subtraction osteotomy (PSO). Methods: We conducted a retrospective cohort study in which lumbar PSO patients with preoperative and immediate postoperative (1-30 days) standing whole-spine radiographs were reviewed. C2 to 7 sagittal vertical axis (cSVA) was measured. For muscle analysis, a subset with preoperative cervical MRI was included. At C3, anterior muscle group (AG) and trapezius (TP) functional cross-sectional area (fCSA) and fatty infiltration (FI) were obtained. Results: Ninety-nine patients were included in the initial analysis. Mean cSVA significantly decreased from 30.4 to 26.7 mm. Twenty-two patients had a preoperative cervical MRI available for muscle analysis. Spearman correlation analysis showed that greater TP fCSA correlated with larger postoperative reductions in cSVA, whereas greater TP FI correlated with smaller reductions in cSVA. Larger AG fCSA also correlated with smaller reductions in cSVA. Conclusion: Preoperative cervical muscle morphology was associated with reciprocal cervical alignment changes after PSO. Greater TP fCSA correlated with larger postoperative reductions in cSVA, whereas greater TP FI correlated with smaller reductions. Larger AG fCSA also correlated with smaller immediate cervical alignment changes. Together, these findings suggest that the relative balance between posterior stabilizing and anterior cervical muscle quality may influence the magnitude of acute cervical decompensation following thoracolumbar realignment. Level of Evidence: Level IV, retrospective cohort study.
Background: Older adults undergoing hip fracture surgery may differ substantially from one another in baseline function, cognitive status, living situation, and perioperative risk. Such differences can complicate patients’ needs postoperatively. Purposes: This study aimed to identify clinically-usable postoperative care-need phenotypes among older adults undergoing hip fracture surgery. Methods: This retrospective cohort study used data from the national registry-based UK National Hip Fracture Database to identify 63 108 older adults who underwent hip fracture surgery between 2016 and 2021. Nursing-actionable variables, including age, pre-fracture residence, pre-fracture mobility, cognitive impairment or dementia, and American Society of Anesthesiologists (ASA) grade, were used to identify clinically-interpretable care-need phenotypes: low-care-need, mobility-limited, and cognitive-institutional high-care-need. The primary outcome was failure to return home after hip fracture surgery, which reflects the combined effects of functional recovery, care dependency, rehabilitation need, and discharge planning. Results: Using data from the 63 108 patients included, phenotypes were categorized: low-care-need (n = 25 842; 41.0%), mobility-limited (n = 22 671; 35.9%), and cognitive-institutional high-care-need (n = 14 595; 23.1%). Failure to return home increased from 18.4% in the low-care-need phenotype to 39.5% in the mobility-limited phenotype and 73.8% in the cognitive-institutional high-care-need phenotype. The mobility-limited and cognitive-institutional high-care-need phenotypes were also associated with higher adjusted odds of prolonged length of stay of over 21 days, discharge to residential or nursing care, and 30 day mortality. Conclusion: This retrospective database analysis found that identified distinct postoperative care-need phenotypes for older adults after hip fracture surgery. These phenotypes were strongly associated with failure to return home, prolonged hospitalization, institutional care, and mortality. Such risk stratification may help nursing teams and multidisciplinary hip fracture services align rehabilitation, discharge planning, and post-acute care coordination with patient-level recovery needs. Level of Evidence: Prognostic study level III.
Background: The direct muscular trauma caused by the trans-psoas approach of a lateral lumbar interbody fusion (LLIF) is a potential reason for its high rates of postoperative psoas weakness. Purpose: We sought to compare preoperative and postoperative psoas muscle parameters to evaluate iatrogenic psoas atrophy following LLIF. Methods: We conducted a retrospective case series including patients who underwent primary LLIF at a single tertiary academic center between 2012 and 2024. Exclusion criteria included history of spinal deformity, spine surgery, neuromuscular disorders, or LLIF indicated for infection or malignancy. Participants had both preoperative and postoperative magnetic resonance imaging (MRI) scans; the latter were obtained at least 3 months postoperatively. Psoas muscle atrophy was assessed using MRI measurements of cross-sectional area (CSA), anteroposterior (AP) and mediolateral diameters, and Goutallier classification for fatty infiltration. Paired and Welch’s t -tests compared postoperative to preoperative and contralateral values. Subgroup analysis compared patients with and without postoperative hip flexor weakness. Results: Forty patients met inclusion criteria (mean follow-up: 25 months). The ipsilateral psoas demonstrated significant reduction in CSA (−117 vs −22.7 mm 2 ) and AP diameter (−2.43 vs 0.34 mm) compared with the contralateral side. Six patients (15%) had persistent hip flexor weakness. On multivariate analysis, male sex and body mass index (BMI) were risk factors for psoas atrophy. Diabetes and length of stay predicted postoperative hip flexor weakness. Conclusions: This retrospective study identified evidence of long-term ipsilateral psoas atrophy following LLIF, potentially contributing to postoperative hip flexor weakness. Male sex, BMI, diabetes, and length of hospital stay were identified as predictors of psoas atrophy or weakness, highlighting the importance of postoperative rehabilitation focusing on psoas preservation. Future studies are warranted to further evaluate potential risk factors for postoperative hip flexor weakness following LLIF. Level of Evidence: Level IV: retrospective case series.
Background: Polyethylene wear-induced synovitis and osteolysis are well-recognized complications following total knee arthroplasty (TKA) and have been of particular concern in the setting of recalled Exactech implants. While knee arthroscopy (KA) has been proposed as a minimally invasive option to address intra-articular debris and synovitis, its effectiveness in preventing disease progression and implant failure remains unclear. Purposes: The purpose of this study was to evaluate the clinical and radiographic outcomes of KA in patients with recalled Exactech TKA presenting with polyethylene wear-induced synovitis. Specifically, we assessed rates of reoperation, revision arthroplasty, and progression of osteolysis following arthroscopic intervention. Methods: A retrospective chart review was conducted on 38 patients who underwent KA after primary TKA with recalled Exactech implants between January 2022 and January 2023. Patient demographics, clinical outcomes, and radiographic and magnetic resonance imaging (MRI) findings were analyzed by a high-volume, fellowship-trained arthroplasty surgeon. Results: Within 1 year of follow-up, 4/38 patients (10.5%) underwent revision TKA, 4/38 (10.5%) patients underwent repeat KA, and 6/38 patients (15.8%) demonstrated progressive osteolysis on follow-up radiographs, resulting in an overall failure rate of 14/38 patients (36.8%). Of the remaining 30 patients who had not undergone revision TKA or repeat KA, 29 of 30 patients (96.7%) had one of the following findings: possible component loosening (5/30), progressive radiolucent lines (25/30), and worsening osteolysis on follow-up radiographs (15/30). Additionally, upon review of patient post-arthroscopy MRIs, 28/30 patients (93.3%) had documentation of persistent/progressive polymeric-induced synovitis or persistent/progressive osteolysis. Conclusion: The high failure rate reported in the current study suggests that KA with debridement is not an appropriate treatment for patients with polyethylene wear-induced synovitis and osteolysis following the implantation of a recalled Exactech TKA. Delay of the surgery can result in more severe bone defects. In patients with wear-induced synovitis but without osteolysis or implant loosening, a polyethylene insert exchange is the preferred alternative treatment. Level of Evidence: Prognostic study level IV.
