OBJECTIVE:The aim of this study was to compare patient-reported outcome measures among patients with degenerative lumbar spondylolisthesis (DLS) who underwent either decompression alone (DA) or decompression and fusion (DF) stratified by preoperative lumbar lordosis distribution index (LDI). METHODS:Patients with DLS from 2 of the 7 centers enrolled in the Canadian Spine Outcomes and Research Network prospective study between 2015 and 2022 were retrospectively analyzed. Patients were stratified into an LDI < 50% and an LDI 50%-80% cohort, and whether they underwent DF or DA. Radiographic parameters were obtained from preoperative radiographs and included global lumbar lordosis, lower lumbar lordosis, and the LDI. The primary outcomes included achieving the minimal clinically important difference (MCID) for the numeric rating scale (NRS) score for back pain, the NRS score for leg pain, and the Oswestry Disability Index (ODI) at 24 months postoperatively. RESULTS:One hundred seventy-nine patients were available for analysis. There were 73 patients with a preoperative LDI < 50% (32 with DA, 41 with DF), while 106 patients had a preoperative LDI 50%-80% (51 with DA, 55 with DF). In the LDI < 50% group, the MCID for back pain was achieved at 24 months in significantly more patients with DF than with DA (85.7% vs 48.3%, p = 0.002) and for the ODI (91.4% vs 62.1%, p = 0.006). These differences were not observed in the LDI 50%-80% group. After multivariate analysis, in the LDI < 50% cohort DF was associated with improved odds of achieving the MCID at 24 months for back pain (OR 12.614, 95% CI 1.899-83.767; p = 0.009) and ODI (OR 10.479, 95% CI 1.423-77.156; p = 0.021) scores compared to DA. These differences were not found in the LDI 50%-80% cohort. CONCLUSIONS:In patients with DLS, a preoperative LDI < 50% may be helpful in identifying those who may benefit from DF over DA.

The increased use of hybrid spinal implants combining dissimilar metals raises concerns for galvanic corrosion, which can affect metal ion release and implant longevity. This study examines the variation in post-fusion metal ion concentrations among different hybrid implant constructs. In this prospective multicenter observational study, patients undergoing elective surgery for idiopathic or neuromuscular scoliosis received either cobalt-chromium (CoCr/Ti) or stainless steel (SS/Ti) rods with titanium screw implants. Blood metal ion concentrations were measured preoperatively and at 3, 12 and 24 months. Longitudinal data were analyzed using linear mixed-effects models adjusted for repeated measures. A total of 37 patients were enrolled in the CoCr/Ti group and 35 in the SS/Ti group, with a majority of females (68

BACKGROUND CONTEXT:Patients' perspectives are central measures of success in healthcare delivery. The association of postoperative changes in patient-reported outcome measures (PROM) and expectation fulfillment is not well established. PURPOSE:This study's primary objective was to assess the association between changes in PROMs (eg, Oswestry Disability Index [ODI] or EQ-5D) and patient multidimensional expectations fulfillment at 1 year following elective lumbar spine surgery. The secondary objectives included measuring changes in PROMs across various levels of expectation fulfillment and identifying the PROM instrument that explains the highest variability in each expectation domain. STUDY DESIGN:Retrospective cohort study from the prospectively collected registry data. PATIENT SAMPLE:Data were obtained from the Canadian Spine Outcome Research Network registry, which prospectively enrolls adults undergoing elective spine surgery in Canada. We included adults who underwent elective lumbar spine surgery between January 2015 and December 2022. OUTCOME MEASURES:The study's primary outcome was the extent of expectation fulfillment at 1-year follow-up in surgical patients. METHODS:Demographic, lifestyle, clinical, and multidimensional expectation data were collected using the North American Spine Society Lumbar Spine Questionnaire. Postoperative changes in PROMs were the primary exposure variables. Baseline sociodemographic and clinical characteristics were summarized descriptively, and ordinal logistic regression was used to examine associations between expectation fulfillment and changes in PROMs, adjusting for confounders. RESULTS:We included 6,260 patients. Females represented 50% of the study sample, and the median age was 62 years. The median change in postoperative leg pain scores (Numeric Rating Scale) was -6 (-8, -4), -3 (-5, -1), and -1 (-2, 1) points for patients whose expectations were completely met, somewhat met, and unmet, respectively. ODI changed by -28 (-40, -16), -15 (-26, -4), and -4 (-4, 4); p<.001 for those whose expectations were completely met, somewhat met, and unmet, respectively. Physical Component Summary scores changed by 16.6 (8.6, 24.1), 8.7 (2.2, 15.2), and 2 (-3.7, 8.6); p<.001 for patients with expectations that were completely met, somewhat met, and unmet, respectively. A similar association was observed between changes in PROMs and expectation fulfillment in other expectation domains. Changes in the leg pain and back pain score were strongly associated with expectation fulfillment regarding reduction in Leg pain and Back pain, respectively. Similarly, changes in ODI, EQ-5D, and SF-12 Physical Component Summary scores were strongly associated with expectation fulfillment for Improvement in General Physical Capacity. CONCLUSIONS:Postoperative changes in PROMs are strongly associated with patient expectation fulfillment following elective lumbar spine surgery at 1-year follow-up. Changes in PROMs may provide insights into patients' perceived postoperative outcome. Different PROM instruments reflect distinct aspects of patient experience, with domain-specific alignment between measured outcomes and perceived benefit. While PROM improvements closely mirror patient-perceived success, they do not fully capture expectation fulfillment in all cases.

Study design. Prospective cohort study Objective. Our primary objective was to determine the effects of all classes of obesity (BMI ≥30) on patient-reported disability at one year of follow-up among patients undergoing surgery for degenerative lumbar conditions, with particular attention given to the effects of severe obesity (BMI ≥40). Secondary objectives were to determine effects on health-related quality of life, back pain, leg pain, and adverse events. Summary of Background Data. The importance of obesity among patients undergoing spine surgery has been well-established, but effects according to severity of obesity remain poorly understood. Methods. Patients were prospectively enrolled in the Canadian Spine Outcomes and Research Network between 2015 and 2024. We used logistic regression and propensity score matching to compare outcomes while adjusting for potential confounders. Results. Among 6,242 patients, 2309 (37%) had obesity including 1448 (23%) with Class I (BMI 30 to <35), 571 (9%) with Class II (BMI 35 to <40) and 290 (5%) with Class III (BMI ≥40, “severe” obesity). Patients with any class of obesity were significantly less likely to achieve the Minimum Clinically Important Difference (MCID) for the Oswestry Disability Index, and the effect most pronounced for those with Class III obesity (Odds Ratio (OR) 0.83, 95% CI 0.76 to 0.90, P <0.01). Rates of incidental durotomy (OR 1.20, 95% CI 1.05 to 1.38, P <0.01), surgical site infection (OR 1.49, 95% CI 1.25 to 1.78, P <0.01), and wound dehiscence (OR 2.21, 95% CI 1.59 to 3.07, P <0.01) were all significantly higher among patients with Class III obesity. Conclusions. Patients with obesity were less likely to experience improvement of disability after surgery for degenerative lumbar conditions and severe obesity was particularly associated with greater odds adverse events. These findings inform shared clinical decision-making and suggest that obesity management prior to surgery may be of benefit.

STUDY DESIGN:Prospective cohort study. OBJECTIVE:Our primary objective was to determine the effects of all classes of obesity (BMI ≥30) on patient-reported disability at one year of follow-up among patients undergoing surgery for degenerative lumbar conditions, with particular attention given to the effects of severe obesity (BMI ≥40). Secondary objectives were to determine effects on health-related quality of life, back pain, leg pain, and adverse events. SUMMARY OF BACKGROUND DATA:The importance of obesity among patients undergoing spine surgery has been well-established, but effects according to severity of obesity remain poorly understood. METHODS:Patients were prospectively enrolled in the Canadian Spine Outcomes and Research Network between 2015 and 2024. We used logistic regression and propensity score matching to compare outcomes while adjusting for potential confounders. RESULTS:Among 6,242 patients, 2309 (37%) had obesity including 1448 (23%) with Class I (BMI 30 to <35), 571 (9%) with Class II (BMI 35 to <40) and 290 (5%) with Class III (BMI ≥40, "severe" obesity). Patients with any class of obesity were significantly less likely to achieve the Minimum Clinically Important Difference (MCID) for the Oswestry Disability Index, and the effect most pronounced for those with Class III obesity (Odds Ratio (OR) 0.83, 95% CI 0.76 to 0.90, P<0.01). Rates of incidental durotomy (OR 1.20, 95% CI 1.05 to 1.38, P<0.01), surgical site infection (OR 1.49, 95% CI 1.25 to 1.78, P<0.01), and wound dehiscence (OR 2.21, 95% CI 1.59 to 3.07, P<0.01) were all significantly higher among patients with Class III obesity. CONCLUSIONS:Patients with obesity were less likely to experience improvement of disability after surgery for degenerative lumbar conditions and severe obesity was particularly associated with greater odds adverse events. These findings inform shared clinical decision-making and suggest that obesity management prior to surgery may be of benefit.

BACKGROUND CONTEXT: Preoperative patient factors determining expectation fulfillment from elective lumbar surgeries are poorly defined. PURPOSE: To identify preoperative factors associated with the levels of expectation fulfillment following elective lumbar spine surgery. STUDY DESIGN/ SETTING: This retrospective cohort study used the Canadian Spine Outcome Research Network (CSORN) registry data with participants enrolled between January 2015 and December 2020. The registry prospectively enrolled surgical patients to treat spinal disorders from 23 sites. Participating patients completed preoperative and follow-up questionnaires, including information on surgery expectations. Patients recorded their levels of expectation fulfillment on a Likert scale of 1 to 5, with responses ranging from Completely met (5) to Not applicable (1) in 7 expectation dimensions. PATIENT SAMPLE: Consecutive patients with 4 lumbar conditions (spinal stenosis, disc herniation, degenerative disc disease, or degenerative spondylolisthesis) and those with complete 1-year follow-up questionnaires were included. Patients treated for thoracic or cervical pathologies and nonelective lumbar conditions were excluded. A total of 5389 patients who underwent surgery and completed 1-year follow-up questionnaires out of 6971 eligible patients were included. Patients' socio-demographics, lifestyle, health status, and clinical factors were examined. OUTCOME MEASURES: The primary outcome was the association between expectation fulfillment and preoperative patient factors. METHODS: Patient factors were described for the expectation fulfillment categories using descriptive statistics. Bivariable and multivariable associations between patient factors and expectation fulfillment were estimated with ordinal logistic regression models. Point estimates represented as odd ratios, and 95% CIs were reported. RESULTS: The mean age of the participants was 59.5 years, with 49.8% (2683) of them being women. Unmet expectations ranged from 6.7% to 25.7%, with improvement in general physical capacity being the most important expectation fulfilled from surgery for 20% of patients. Factors such as longer symptom duration (OR: 0.74; 95% CI: 0.63-0.86), previous lumbar spine surgery (OR: 0.63; 95% CI: 0.46, 0.89), and reoperations (OR: 0.36; 95% CI: 0.2, 0.63) were associated with higher unmet expectations in the leg pain reduction dimension. Similar results were noted across all other expectation dimensions. CONCLUSION: Utilizing information on the preoperative factors in presurgical consultations can improve patient satisfaction and expectations from surgery. (c) 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

BACKGROUND CONTEXT: Degenerative cervical myelopathy (DCM) is the most common cause of acquired nontraumatic spinal cord injury worldwide. Surgery is a common treatment for DCM; however, outcomes often vary across patients. PURPOSE: To inform preoperative education and counseling, we performed a responder analysis to identify factors associated with treatment response. STUDY DESIGN/SETTING: An observational cohort study was conducted utilizing prospectively collected data from the Canadian Spine Outcomes Research Network (CSORN) registry collected between 2015-2022. PATIENT SAMPLE: We included all surgically treated DCM patients with complete 12-month follow-up and patient-reported outcomes (PROs) available at 1-year. OUTCOME MEASURES: Treatment response was measured using the minimal clinically important difference (MCID) in PROs including the Neck Disability Index (NDI) and EuroQol-5D (EQ5D) at 12 months postsurgery. METHODS: A Least Absolute Shrinkage and Selection Operator (LASSO) machine learning model was used to identify significant associations between 14 preoperative patient factors and likelihood of treatment response measured by achievement of the MCID in NDI, and EQ-5D. Variable importance was measured using standardized coefficients. To test robustness of findings we trained a separate XGBOOST model, with variable importance measured using SHAP values. RESULTS: Among the 554 DCM patients included, 229 (41.3%) and 330 (59.6%) patients responded to treatment by meeting or surpassing MCID thresholds for NDI and EQ-5D at 1-year, respectively. LASSO regression for likelihood of treatment response measured through NDI found the variable importance rank order to be baseline NDI (OR 1.06 per 1 point increase; 95% CI 1.04 - 1.07), then symptom duration (OR 0.65; 95% CI 0.44-0.97). For EQ-5D, the variable importance rank order was baseline EQ-5D (OR 0.16 per 0.1-point increase; 95% CI 0.03-0.78), living independently (OR 2.17; 95% CI 1.22-3.85), symptom duration (OR 0.62; 95% CI 0.40-0.97), then number of levels affected (OR 0.80 per additional level; 95% CI 0.67-0.96). A separate XGBoost model of treatment response measured through NDI, corroborated findings that patients with higher baseline NDI, and shorter symptom duration were more likely to respond to treatment, and additionally found older patients, and those with kyphosis on baseline upright X-ray were less likely to respond. Similarly, an XGBoost model for treatment response measured through EQ-5D corroborated findings that patients with higher baseline EQ-5D, shorter symptom duration, living independently, with fewer affected levels were more likely to respond to treatment, and additionally found older patients were less likely to respond. CONCLUSIONS: Our findings suggest patients with shorter symptom duration, higher baseline patient NDI, lower EQ-5D, younger age, living independently, without kyphosis on preoperative X-ray, and fewer affected levels are more likely to respond to treatment. Timing of surgery with respect to patient symptoms is underscored as a crucial and modifiable patient factor associated with improved surgical outcomes in DCM. (c) 2024 Published by Elsevier Inc.

Aims:The aim of this study was to compare outcomes of combined fusion and decompression with decompression alone in patients with lumbar degenerative sponylolisthesis. Traditional cost-effectiveness analysis was avoided due to the prospective nature of the two groups of patients. Methods:A cost-consequence analysis using prospective, multicentred, observational cohort data from the Canadian Spine Outcomes and Research Network database was performed from a limited societal perspective. The patients' out-of-pocket expenses were estimated from diaries. Institutional costs were estimated from case costing data from the site with greatest enrolment. Cost-effectiveness was not assessed. Instead, the outcomes and costs associated with each form of treatment are presented independently. The Oswestry Disability Index (ODI), quality-adjusted life years (QALYs) from EuroQol five-dimension questionnaire (EQ-5D-5L), and the 12-Item Short-Form Health Survey questionnaire (SF-12) were recorded as the health outcomes. The potential effects of confounding variables on outcomes were controlled using augmented inverse probability of treatment weighting. Results:There were a total of 332 patients: 248 (75%) had a fusion and decompression and 84 (25%) underwent decompression alone, between August 2015 and February 2020. There were no statistically significant differences in ODI, SF-12, and QALY scores in either the unadjusted or the adjusted models at two years between the two groups, although the baseline patient-reported outcome measures (PROMs) were significantly worse for those who underwent fusion and decompression. Fusion and decompression (CAD$13,534) was more costly compared with decompression alone ($6,540) at year one. The overall revision rate was increased in those who underwent fusion and decompression (9%) compared with decompression alone (4%). Conclusion:Fusion and decompression was more costly than decompression alone. The PROMs were similar postoperatively in the two groups despite differences at baseline. Thus, fusion and decompression for most patients with lumbar degenerative sponylolisthesis would seem not to be justified financially, and future work is required to determine the baseline characteristics of the patients which would justify the increased costs.

BACKGROUND CONTEXT:While abundant literature supports the clinical benefits of surgery for degenerative cervical myelopathy (DCM), limited evidence exists regarding the extent to which patients' preoperative expectations are met postoperatively. PURPOSE:This study primarily aimed to report the fulfillment of preoperative expectations 12 months postsurgery. Secondary objectives included identifying predictors of expectation fulfillment and overall patient satisfaction following surgical intervention for DCM. STUDY DESIGN/SETTING:We conducted a multicenter analysis of spine surgery patients enrolled in the Canadian Spine Outcomes and Research Network (CSORN)-DCM prospective cohort. PATIENT SAMPLE:Patients who underwent surgical treatment for DCM between April 2015 and September 2022 were included. OUTCOME MEASURES:Patients completed a preoperative 11-domain expectation questionnaire, quantifying their expected clinical changes in each domain. At 12 months postoperatively, patients reported the extent to which their preoperative expectations were met in each domain, as well as their overall satisfaction with surgical outcomes. METHODS:Multivariable logistic regression models were employed to identify and validate variables associated with expectation fulfillment and satisfaction. RESULTS:Among the 490 patients included, 49.2% had all their expectations met and 3.7% had none of their expectations met. The expectations that were most frequently met were prevention of neurological decline (87.5%) and maintaining of independence (86.7%). There were 83% of patients who were satisfied at 12 months. Multivariable logistic regression identified preoperative variables (not smoking, not using pain medication presurgery, having lower levels of depressive symptoms (PHQ-8)), surgical variables (anterior and posterior nonfusion approaches), the absence of peri‑operative adverse events and improvement in pain and Health-Related Quality of life scores at 12 months (NRS neck-pain, SF12 PCS and SF-12 MCS scores) as predictors of expectation fulfillment. Improvement in the mJOA score was not a predictor of expectation fulfillment. Having preoperative expectations met was a strong predictor of being satisfied with the surgery (p<.01). CONCLUSIONS:The majority of patients undergoing surgery for degenerative cervical myelopathy (DCM) reported satisfaction with their outcomes, with nearly half experiencing complete fulfillment of their preoperative expectations. Importantly, we identified 9 independent predictors of expectation fulfillment, which in turn emerged as a strong determinant of overall patient satisfaction. These findings highlight the critical role of personalized preoperative counseling in optimizing surgical outcomes. By aligning patients' expectations with realistic goals through individualized care strategies, clinicians may significantly enhance patient satisfaction and the perceived value of surgical intervention in DCM.

ObjectiveWe examined the impact of consenting to the Rick Hansen Spinal Cord Injury Registry on outcomes: acute length of stay, in-hospital mortality, medical complications (pressure injuries and pneumonia), and the final discharge destination following a spinal cord injury using the national Rick Hansen Spinal Cord Injury Registry dataset.DesignA retrospective cohort study was conducted using Rick Hansen Spinal Cord Injury Registry participant data from 2014 to 2019. Participants approached for enrollment were grouped into 1) PC: provided full consent including community follow-up interviews, 2) DWC: declined community follow-up interviews but accepted minimal data collection that may include initial/final interviews and/or those who later withdrew consent, and 3) DC: declined consent to any participation. As no data was collected for the DC group, descriptive, bivariate, and multivariable regression analysis was limited to the PC and DWC groups.ResultsOf 2811 participants, 2101 (74.7%) were PC, 553 (19.7%) were DWC, and 157 (5.6%) were DC. DWC participants had significantly longer acute length of stay, more acute pneumonias/pressure injuries, and were less likely to be discharged home than PC participants. All these associations-except pneumonia-remained significant in the multivariable analyses.ConclusionsNot participating fully in Rick Hansen Spinal Cord Injury Registry was associated with more complications and longer hospital stays.

Study DesignIn-vitro biomechanical study.ObjectivesInjuries or degenerative conditions can lead to atlantoaxial instability requiring fixation. We aim to assess and compare the biomechanics of a C1-C2 posterior arch and translaminar screw construct against the Harms procedure for posterior atlantoaxial fixation on a human cadaveric model.MethodsNine human cadaveric cervical specimens from occiput to C3 (C0-C3) were used for range of motion (ROM) testing. Each specimen was tested for 4 configurations: 1. Intact, 2. Destabilized, 3. Harms construct, 4. C1-C2 posterior arch screw (PAS) construct. A pure moment of 1.5 Nm was applied, and ROM of the C1-C2 segment was measured in flexion-extension, lateral bending, and axial rotation.ResultsThe Harms group showed a decrease in ROM in all modes (P < 0.021), and the PAS group showed a decrease in ROM in flexion-extension and lateral bending (P < 0.002), but not in lateral bending (P = 0.176). Compared to the intact condition, Harms showed increased ROM for flexion-extension (P = 0.012), and PAS did not (P = 0.258). In lateral bending, both constructs did not significantly reduce ROM (P > 0.058). In axial rotation, both constructs showed a significant increase in ROM (P < 0.002). There was no significant difference in ROM when comparing Harms with PAS in flexion-extension (P = 1.000), lateral bending (P = 0.163), or axial rotation (P = 1.000).ConclusionsThe study demonstrates that a C1-C2 PAS construct restores or increases biomechanical stability compared to the intact condition. C1-C2 PAS offers similar biomechanical stability compared to the Harms construct.

OBJECTIVE:The objective of this study was to determine minimal clinically important difference (MCID) values for patient-reported outcomes (PROs) including the 12-Item Short-Form Health Survey (SF-12) Physical Component Summary (PCS), SF-12 Mental Component Summary (MCS), and Neck Disability Index (NDI) in patients with degenerative cervical myelopathy (DCM) undergoing surgery, and to assess whether MCID values vary by baseline disease severity. METHODS:The authors retrospectively analyzed prospectively collected data from the Canadian Spine Outcomes and Research Network for DCM patients treated surgically between 2015 and 2023. Inclusion required a baseline modified Japanese Orthopaedic Association (mJOA) score and 3- or 12-month follow-up PROs with domain-specific anchor responses. Patients were stratified by baseline mJOA score into mild (score ≥ 15), moderate (score 12-14), and severe (score < 12) groups. MCID values for the SF-12 PCS, SF-12 MCS, and NDI were calculated using anchor-based receiver operating characteristic curve analysis, with responder status defined by anchor questions. Discriminative performance was assessed via area under the curve, and 95% confidence intervals were estimated by bootstrapping. RESULTS:Among 290 patients meeting inclusion criteria, 77 (26.6%) were classified as having mild myelopathy, 120 (41.4%) moderate, and 93 (32.1%) severe. In the overall cohort, the MCID values were estimated as 8.9 (95% CI 7.5-10.9) for SF-12 PCS, 4.3 (95% CI 2.3-5.6) for SF-12 MCS, and 13.5 (95% CI 11.5-15.5) for NDI. Stratified SF-12 PCS MCID values increased from an estimated 4.8 (95% CI 1.1-7.7) in mild cases to 8.4 (95% CI 6.1-11.3) in moderate and 14.8 (95% CI 10.4-17.7) in severe cases. The NDI MCID values similarly rose from 10.5 (95% CI 6.5-12.5) to 15.0 (95% CI 10.5-19.0) to 17.5 (95% CI 14.5-21.0) across the mild, moderate, and severe groups, respectively. In contrast, the SF-12 MCS MCID values were 4.5 (95% CI 1.4-7.4) for mild, 3.8 (95% CI 0.4-5.8) for moderate, and 4.4 (95% CI 1.9-8.3) for severe patients, which did not differ significantly across severities. CONCLUSIONS:MCID values for PROs in DCM patients undergoing surgery increase with baseline severity. These findings indicate the importance of stratifying patients by disease severity to enhance the clinical relevance of MCID values, facilitate personalized treatment goals, and improve outcome assessments.

The objective of this study was to determine if the degree of pelvic incidence (PI) influenced the difficulty of surgery in patients undergoing treatment for degenerative spondylolisthesis. This is a retrospective cohort study of patients enrolled between 2015 - 2021 in the Canadian Spine Outcomes and Research Network (CSORN) multi-centred prospective study on the assessment and management of DLS who underwent decompression or decompression and fusion, and who had baseline radiographic measures. Patients were divided into two groups based on a preoperative PI of >60° or < 6 0°. Baseline demographic, clinical, radiographic, and procedure factors were compared between the groups stratified by procedure type (decompression vs. decompression and fusion). Of the patients that had a decompression alone, 85 had PI 60°. Demographic factors, chief complaint, grade of spondylolisthesis, and preoperative patient-rated outcome measures (PROM) were similar between the two groups. Blood loss was similar in both groups, but patients with a high PI had significantly longer operative times (96 minutes vs. 82 minutes). Of the patients that had a decompression and fusion, 193 had PI 60°. Demographics and preoperative PROMs were similar between the groups except more females were in the high PI group (71% vs 60%). Patients in the high PI group were also more likely to have grade II spondylolisthesis (41% vs. 26%) and were less likely to have minimally invasive surgery (16% vs. 29%). Operating time was similar between groups; however, blood loss was significantly increased in the patients that had a high PI (M = 400 vs. 300 mL). Intraoperative complications and length of stay were not different between groups, regardless of procedure. Overall, this study demonstrates that high PI is associated with increased operative time and blood loss, indicating there may be unique challenges with this population. Technical difficulties may arise due to larger exposures required and challenging angles seen in patients with a high PI. Thus, operative difficulties should be anticipated when treating patients with a PI >60°.

BACKGROUND AND OBJECTIVES:Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in adults. The natural history of mild DCM is not fully understood, and both operative and nonoperative strategies have been proposed as treatment modalities. The aim of this study was to analyze the outcome of patients with mild DCM treated nonoperatively and identify risk factors for neurological deterioration and conversion to surgery. METHODS:All patients with mild DCM (modified Japanese Orthopaedic Association [mJOA] score 15-17), enrolled between 2015 and 2023, who were initially treated nonoperatively, as part of an ongoing prospective, multicenter observational cohort study were included. Neurological function (mJOA), patient-reported outcomes (neck disability index, EuroQol-5D, short form-12, numeric rating scale [NRS]), and radiographic findings at enrollment and 1 year were assessed. Progression of disease was defined as neurological deterioration by ≥2 mJOA. Conversion to surgery was a secondary end point. RESULTS:One hundred forty patients with mild DCM were initially treated nonoperatively. The mean mJOA score was 16.8 ± 0.8, with no clinically significant change after 1 year (16.5 ± 1.3; P = .031). Improved EuroQol-5D, relief in the NRS arm, and neck pain below the minimal clinically important difference level were noted after 1 year. A drop of ≥2 mJOA points occurred in 13.3% (n = 14). Seventeen patients (12.1%) crossed over to surgical treatment at an average time of 3.4 years. Patients who crossed over had lower baseline mJOA scores (16.2 ± 1.0 vs 16.7 ± 0.9; P = .03), but otherwise comparable patient-reported outcomes at baseline ( P > .05). Delayed surgery improved NRS neck pain (5.0 ± 3.1 vs 1.9 ± 1.4; P = .02). CONCLUSION:Neurological deterioration or the need for surgery is relatively uncommon in patients with conservatively treated mild DCM. A deterioration rate of 13.3% at 1 year and a conversion rate of 12.1% over 3.4 years with no clear risk factors were noted. Crossover patients presented with worse mJOA. No other clinically significant parameter was found to be a risk factor for neurological deterioration nor a driver for crossover.

Study Design Retrospective analysis of randomized controlled trial. Objectives Surgical site infection (SSI) after spine surgery has severe negative health and financial consequences. Surgical antibiotic prophylaxis (SAP) is a routinely used method to prevent SSIs in the spine patient population. The most commonly used antibiotic is cefazolin, with vancomycin often being substituted in the case of penicillin or cephalosporin allergy. Vancomycin as SAP has been associated with increased SSI in the joint replacement literature, but this is not yet well defined in the spinal surgery population. The purpose of this study was to determine whether vancomycin SAP compared to cefazolin SAP is associated with increased risk of SSI. Methods 535 patients, aged 16 years or older, underwent elective multi-level open posterior spinal fusion surgery at the thoracic, thoracolumbar, or lumbar levels. Demographic and operative characteristics as well as post-operative outcomes were compared between the following groups: (1) noninfected-cefazolin, (2) noninfected-vancomycin, (3) infected-cefazolin, and (4) infected-vancomycin. Primary outcomes were superficial and complicated (deep and organ/space) infections. Results The following risk factors for SSI were identified in a logistic regression analysis: vancomycin (OR 2.498, 95% CI, 1.085-5.73, P = 0.031), increasing operating time (OR 1.006, 95% CI, 1.001-1.010 P = 0.010), weight (OR 1.020, 95% CI 1.006-1.034, P = 0.005), revision procedure (OR 2.343, 95% CI 1.283-4.277, P = 0.006), and depression (OR 2.366, 95% CI 1.284-4.360, P = 0.006). Conclusions In open posterior approach spinal fusion surgery, vancomycin SAP is associated with increased risk of infection compared to cefazolin SAP.

STUDY DESIGN:Prospective cohort study. OBJECTIVE:The aims of this study were primarily to evaluate the association between patient-reported symptom duration and postoperative outcomes in patients with degenerative cervical myelopathy (DCM). Secondly, to identify factors associated with the extended duration of symptoms before surgical consultation for DCM. SUMMARY OF BACKGROUND DATA:Surgery is the gold standard treatment for progressive or at least moderate DCM; however, the impact of extended symptom duration on patient outcomes remains unknown. MATERIALS AND METHODS:This study analyzed patients enrolled in the Canadian Spine Outcomes and Research Network (CSORN) from 2015 to 2023. Patients with mild to severe DCM with 1-year follow-up were included. During initial assessment, surgeons recorded symptom duration as reported by patients categorically with six choices, which were then dichotomized as a binary variable using a 1-year threshold. Differences between groups were analyzed using unadjusted bivariate analysis, and the associations between symptom duration on achievement of minimally clinically important differences (MCID) of PROMs were assessed using multivariable logistic regression analysis. RESULTS:A total of 483 patients (227 with symptoms less than 1 year and 256 with symptoms 1 year or greater) were included. At baseline, BMI (mean=28.2 vs . 29.5, P <0.008), number of comorbidities (2.8 vs . 3.1, P <0.029), and proportion of tobacco users (51% vs . 82%, P <0.027) were significantly higher among those with symptoms 1 year or greater, who also had higher baseline mJOA scores (12.5 vs . 13.2, P <0.002) and worse neck pain (5.63 vs . 4.92, P <0.004). Symptom duration of less than 1 year was associated with higher odds of achieving MCID for the outcomes Neck Disability Index (OR=1.64, 95% CI=1.05-2.55, P <0.030), SF-12 PCS (OR=1.98, 95% CI=1.22-3.19, P <0.005), and EQ-5D (OR=2.08, 1.30-3.33, P <0.002) at 12 months after surgery. The odds of reaching the MCID for the mJOA did not significantly differ by symptom duration (OR=1.41, 95% CI=0.88-2.24, P <0.153). CONCLUSION:Patients with symptom durations1 year or greater at the time of consulting a spine surgeon experienced inferior postoperative outcomes for disability and health-related quality of life compared with patients with symptom durations of less than 1 year, despite similar neurological outcomes. Smoking was among the factors associated with a prolonged duration of symptoms. These results suggest that efforts to prioritize early diagnosis by primary care physicians and timely referral for surgery are warranted. LEVEL OF EVIDENCE:Level 3.

BACKGROUND CONTEXT:Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in adults. While surgical intervention is widely recognized as the primary treatment to halt disease progression and improve neurological function, its effectiveness in alleviating neck pain remains poorly understood. PURPOSE:The aims of this study were to identify DCM patients that presented with severe neck pain and to compare their baseline characteristics and surgical outcomes to those who presented with less severe neck pain. STUDY DESIGN/SETTING:This is a prospective, multicenter observational cohort study of the Canadian Spine Outcomes and Research Network (CSORN). SAMPLE:Patients surgically treated for DCM between 2015 and 2022 were enrolled. OUTCOME MEASURE:Baseline demographics, clinical/surgical details, PROs and mJOA were assessed. METHODS:Baseline demographics, clinical/ surgical details, preoperative PROs and mJOA were compared between the patients with severe patient-rated neck pain (NP, defined as NRS-NP ≥ 8), and those with less severe NP. Between group improvements at 12 months were assessed using ANCOVA to adjust for any baseline significant differences between groups. RESULTS:We included data from 725 DCM patients, 31.7 % (n=230) of whom presented with severe NP. Patients with severe NP were significantly more likely to be younger, smokers, unemployed, working rather than retired, unmarried, using pain medication, have a history of depression, have more comorbidities, and be physically less active (all p<.05). Baseline PROs (NRS AP and NP, NDI, SF-12 MCS and PCS and EQ5D) were significantly worse (p<.01), but mJOA scores were similar to those without severe NP. Among patients with severe NP, mean NRS-NP improved from 8.6 (SD 0.8) to 3.9 (SD 2.9, p<.01) at 12 months after surgery. Patients with severe NP were more likely to achieve MCID for neck pain in comparison to those without severe NP (74% vs 33%, p<.01), but mean NRS-NP remained worse in this subgroup (3.9 vs 2.6, p<.01) at 1 year after surgery. When adjusted for baseline characteristics, there were no differences between the 2 groups for the following PROs at 12 months postoperatively: NRS arm pain, NDI, SF-12 PCS, EQ5D. SF-12 MCS remained significantly worse among patients who presented with severe NP (p<.05). There was no significant difference in mJOA scores (report data) at 1 year after surgery. CONCLUSION:Severe neck pain affects about a third of the DCM population. Most patients who presented with severe neck pain experienced substantial improvement of their neck pain after surgery. Except for mental health scores which remained worse, patients with severe neck pain experienced similar improvements in other outcome measures such as neurological function and health-related quality of life when compared to those with less severe neck pain. These findings suggest that surgical treatment not only addresses the structural causes of DCM but also provides meaningful improvements across multiple domains, underscoring its value in managing both the physical and psychosocial burdens of the disease.

Study Design: Retrospective cohort study. Objective: The primary objective is to compare foraminal height (FH) and disk height (DH) differences in posterolateral (PLF) and transforaminal interbody fusions (TLIFs) and secondarily correlate these measurements with patient-reported outcomes. Background: The impact FH has on patient outcomes in degenerative lumbar spinal fusion surgery is unknown. Postoperative FH change and how it relates to patient-reported outcomes in posteriorly based procedures has not been well evaluated. Methods: A retrospective review of a subset of patients from a prospective cohort from the Canadian Spine Outcomes and Research Network was undertaken. Radiographic assessment preoperatively, at 3 months and 1 year, with standing lumbar spine radiographs were completed. FH and DH were recorded at each time interval, differences between groups were compared, and correlations with patient-reported outcomes were assessed. Results: One hundred nine patients were included (23 PLF and 86 TLIF). At 3-month follow-up, the change in FH was greater in the TLIF group (mean difference =2.3; 95% CI: 0.8–3.5, P =0.002). The change in FH remained significantly different at 12 months (mean difference=1.6, 95% CI: 0.2, 3.0 mm, P =0.028). The change in DH was greater in the TLIF group, with a mean difference between groups of 4.1 mm (95% CI: 2.5, 5.7, P <0.001) and 3.6 mm (95% CI: 2.0, 5.3, P <0.001). A positive change in FH correlated with less back pain, less disability, and improved physical function in the TLIF group ( P <0.05). Conclusions: Patients treated with PLF lost FH over time. An increased difference in FH at 1 year was associated with improved function and less back pain in the TLIF group.