Total knee arthroplasty can substantially affect global lower limb alignment. However, its specific impacts on ankle and subtalar joint alignment remain poorly understood. This study investigates changes in ankle and subtalar alignment following varying degrees of varus/valgus knee correction in order to further our understanding of this association. This retrospective study included 100 patients who underwent surgery for primary osteoarthritis. Patients diagnosed with conditions other than primary knee OA and those with incomplete or poor-quality imaging were excluded. Patients were categorized into four groups by the degree of intraoperative coronal knee alignment correction: Group 1 (< 10° varus, n = 37), Group 2 (≥ 10° varus, n = 30), Group 3 (< 10° valgus, n = 18), and Group 4 (≥ 10° valgus, n = 15). Hip-knee-ankle angle, tibial plafond inclination, talar inclination, tibiotalar tilt, and subtalar varus-valgus angle, were measured preoperatively and postoperatively on full-length, standing, anteroposterior X-ray images. TKA resulted in postoperative changes in all measured angles regardless of the degree of varus/valgus correction. Notably, ≥ 10° valgus correction led to statistically significant postoperative alterations in ankle and subtalar alignment: tibial plafond inclination from 84.9 to 89.5° (Δ 4.6, range,1.5–7.8, P <.01), tibiotalar tilt from 83.1 to 89.3° (Δ 6.2, range,1.1–9.6, P =.02), and subtalar varus-valgus angle from 66.4 to 72.6° (Δ 6.2, range,1.9–12.1, P <.01). While knee deformity correction during TKA generally realigns the ankle and subtalar joint, our study has shown that large valgus knee correction (≥ 10°) during TKA significantly alters ankle and subtalar joint alignment. Thus, potentially leading to unfavorable postoperative outcomes in patients with abnormal or stiff joints. We recommend that future studies investigate the long-term effects of large valgus knee corrections during TKA on ankle and subtalar joint alignment and their impact on postoperative outcomes.

OBJECTIVE The present study utilized recently developed in -construct measurements in simulations of cervical deformity surgery in order to assess undercorrection and predict distal junctional kyphosis (DJK). METHODS A retrospective review of a database of operative cervical deformity patients was analyzed for severe DJK and mild DJK. C2-lower instrumented vertebra (LIV) sagittal angle (SA) was measured postoperatively, and the correction was simulated in the preoperative radiograph in order to match the C2-LIV by using the planning software. Linear regression analysis that used C2 pelvic angle (CPA) and pelvic tilt (PT) determined the simulated PT that matched the virtual CPA. Linear regression analysis was used to determine the C2-T1 SA, C2-T4 SA, and C2-T10 SA that corresponded to DJK of 20 degrees and cervical sagittal vertical axis (cSVA) of 40 mm. RESULTS Sixty-nine cervical deformity patients were included. Severe and mild DJK occurred in 11 (16%) and 22 (32%) patients, respectively; 3 (4%) required DJK revision. Simulated corrections demonstrated that severe and mild DJK patients had worse alignment compared to non-DJK patients in terms of cSVA (42.5 mm vs 33.0 mm vs 23.4 mm, p < 0.001) and C2-LIV SVA (68.9 mm vs 57.3 mm vs 36.8 mm, p < 0.001). Linear regression revealed the relationships between in -construct measures (C2-T1 SA, C2-T4 SA, and C2-T10 SA), cSVA, and change in DJK (all R > 0.57, p < 0.001). A cSVA of 40 mm corresponded to C2-T4 SA of 10.4 degrees and C2-T10 SA of 28.0 degrees. A DJK angle change of 10 degrees corresponded to C2-T4 SA of 5.8 degrees and C2-T10 SA of 20.1 degrees. CONCLUSIONS Simulated cervical deformity corrections demonstrated that severe DJK patients have insufficient corrections compared to patients without DJK. In -construct measures assess sagittal alignment within the fusion separate from DJK and subjacent compensation. They can be useful as intraoperative tools to gauge the adequacy of cervical deformity correction.

Preoperative planning of total hip arthroplasty (THA) using two-dimensional low-dose (2DLD) full-body imaging has gained popularity in recent years. The low-dose imaging system is said to produce a calibrated image with constant 1:1 magnification. However, the planning software used in conjunction with those images may introduce variations in the degree of magnification in 2DLD imaging, and this has not yet been investigated. The purpose of the present study was to quantify any variation in 2DLD image to assess the need for image calibration when using conventional planning software. Postoperative 2DLD images from 137 patients were retrospectively evaluated. Only patients who underwent THA for primary osteoarthritis were included in the study cohort. The femoral head diameter was measured by two independent observers using both Orthoview™ and TraumaCad™ planning software programs. Actual sizes of the femoral head implants were extracted from surgical reports to calculate image magnification. Magnification measurement reliability was calculated with the intra-class correlation coefficient (ICC) index. Image magnification varied among cases (mean 133%, range 129–135%). There was no statistical difference in mean image magnification among the various implant sizes (p = 0.8). Mean observer and inter-observer reliability was rated excellent. THA planning with 2DLD imaging is subject to variation in magnification as analyzed with conventional planning software in this series. This finding is of paramount importance for surgeons using 2DLD imaging in preparation for THA since errors in magnification could affect the accuracy of preoperative planning and ultimately the clinical outcome.

BACKGROUND CONTEXT:The management of trauma patients with ankylosing spinal disorders has become an issue of increasing interest. Geriatric patients frequently sustain unstable extension type vertebral fractures with ankylosed spines. In this population, studies have shown that early surgery for other injuries such as hip fractures may reduce patient complications and mortality. These studies have changed patient care protocols in many medical centers worldwide.PURPOSE:We aim to assess the relationship between the timing of surgery for unstable vertebral fractures in ankylosed spines in the geriatric population and patient outcomes.STUDY DESIGN/SETTING:Retrospective clinical study conducted in a tertiary hospital.PATIENT SAMPLE:Patients included were those diagnosed with isolated thoracolumbar extension type fractures and a spinal ankylosing disorder over 65 years old following minor trauma and with no additional injuries or neurological deficit.OUTCOME MEASURES:Primary outcome measures included postoperative medical complications and mortality at 1 and 6 months. Secondary outcome measures included rehospitalization rates, length of stay, and surgical site infections.METHODS:We searched our department's database for all that met our inclusion criteria who underwent surgery. The difference in patient outcomes that underwent early surgery defined as less than 72 hours from diagnosis as opposed to those that underwent later surgery was assessed.RESULTS:A total of 82 patients underwent surgery following a diagnosis of an extension type thoracolumbar fracture at our institution between 2015 and 2021. Of these, 50 met inclusion criteria. Nineteen patients underwent surgery less than 72 hours from diagnosis and 31 more than 72 hours from diagnosis. No difference was found in age, functional status, and Elixhauser comorbidity scores between the groups. A statistically significant difference in perioperative patient complications between the early and the late groups (p=.005) was found. Mortality at six-months was significantly different between the groups as well (p=.035). There was no statistically significant difference between the groups when comparing surgical site infections, length of hospital stay, rehospitalization within a month, and perioperative mortality.CONCLUSIONS:Time to surgery affects complication rates and six-month mortality in geriatric patients with spinal ankylosing disorders presenting with an isolated unstable hyperextension type thoracolumbar fracture. Early surgery of less than 72 hours from presentation in this patient population is recommended.

Study Design Single-center retrospective cohort study Objectives To evaluate inpatient MME administration associated with different lumbar spinal fusion surgeries Methods Patients ≥18 years of age with a diagnosis of Grade I or II spondylolisthesis, stenosis, degenerative disc disease or pars defect who underwent one-level Transforaminal Lumbar Interbody Fusion (TLIF) or one-level Anterior Lumbar Interbody Fusion (ALIF) or Lateral Lumbar Interbody Fusion (LLIF) through traditional MIS, anterior-posterior position or single position approaches between L2-S1. Outcome measures included patient demographics, surgical procedure and approach, perioperative clinical characteristics, incidence of ileus and inpatient MME. Statistical analysis included one-way ANOVA with a post-hoc Tukey Test and Kruskal–Wallis Test with post-hoc Mann–Whitney test. MME was calculated as per the Centers for Medicare and Medicaid Services and previous literature. Significance set at P < .05. Results Mean age differed significantly between MIS TLIF (55.6 ± 12.5 years) and all other groups (Open TLIF 57.1 ± 12.5, SP ALIF/LLIF 57.9 ± 9.9, TP ALIF/LLIF 50.9 ± 12.7, Open ALIF/LLIF 58.4 ± 15.5). MIS TLIF had the shortest LOS compared to all groups except SP ALIF/LLIF. Total MME was significantly different between MIS TLIF and Open ALIF/LLIF (172.5 MME vs 261.1 MME, P = .044) as well as MIS TLIF and TP ALIF/LLIF (172.5 MME vs 245.4 MME, P = .009). There were no significant differences in MME/hour and incidence of ileus between all groups. Conclusion Patients undergoing MIS TLIF had lower inpatient opioid intake compared to TP and SP ALIF/LLIF, as well as shorter LOS compared to all groups except SP ALIF/LLIF. Thus, it appears that the advantages of minimally invasive surgery are seen in minimally invasive TLIFs.

The knee–hip–spine syndrome has been well elucidated in the literature in recent years. The aim of this study was to evaluate the effect of total knee arthroplasty (TKA) on spinopelvic sagittal alignment in patients with and without pre-TKA lumber spinal fusion. This is a retrospective cohort study of 113 patients who underwent TKA for primary osteoarthritis. Patients were stratified into the following three groups: (1) patients who had pre-TKA spinal fusion (SF, n = 19), (2) patients who had no spinal fusion but experienced pre-TKA flexion contracture (FC, n = 20), and (3) patients without flexion contracture or spinal fusion before TKA (no SF/FC, n = 74). Spinopelvic sagittal alignment parameters, including pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), and plumb line-sacrum distance (SVA) were measured preoperatively and 3 months postoperatively on lateral standing full-body low-dose images. TKA resulted in significant pre- to postoperative changes in pelvic tilt (average ∆ PT = − 8.6°, p = 0.018) and sacral slope (average ∆ SS = 8.6°, p = 0.037) in the spinal fusion (SF) group. Non-significant changes in spinopelvic sagittal alignment parameters (PT, SS, LL, TK, SVA) were noted postoperatively in all patients in the FC and the no SF/FC groups. TKA can lead to meaningful changes in spinopelvic alignment in patients with prior lumbar fusion compared to those without spinal fusion. Patients with spinal fusion who are candidates for both hip and knee replacements should consider undergoing TKA first since changes in spinopelvic sagittal alignment can increase the risk of future complications. Retrospective Cohort Study.

BACKGROUND:The effect of total knee arthroplasty (TKA) on the ankle joint is not entirely clear. The purpose of this study is to assess postoperative changes in the coronal alignment of the ankle joint in patients undergoing TKA for various degrees of knee deformity.METHODS:This retrospective study included 107 patients who had undergone TKA for primary osteoarthritis. In all cases, preoperative coronal alignment deformity of the knee was corrected in an attempt to restore the native mechanical axis of the knee. Patients were stratified into 3 groups according to the degree of knee coronal alignment correction achieved intraoperatively: group 1 (<10° varus/valgus correction, n = 60), group 2 (≥10° varus correction, n = 30), and group 3 (≥10° valgus correction, n = 17). Knee/ankle alignment angles were measured on full-length, standing anteroposterior imaging preoperatively and postoperatively and included the following: hip-knee-ankle angle, tibial plafond inclination (TPI), talar inclination (TI), and tibiotalar tilt angle.RESULTS:Significant changes in ankle alignment, specifically with regard to TPI (9.5° ± 6.9°, P < .01) and TI (8.8° ± 8.8°, P = .03) were noted in the ≥10° valgus correction group compared to the other 2 groups. Regardless of the degree of knee deformity correction, TKA did not lead to significant changes in the tibiotalar tilt angle.CONCLUSION:A correction of ≥10° in a genu valgum deformity can affect ankle joint alignment, leading to alterations in TPI and TI. These findings need to be taken into consideration in assessing candidates for TKA as a possible cause of postoperative ankle pain.

Abundant literature exists describing the incidence of dysphagia following anterior cervical surgery; however, there is a paucity of literature detailing the incidence of dysphagia following posterior cervical procedures. Further characterization of this complication is important for guiding clinical prevention and management. Patients >= 18 years of age underwent posterior cervical fusion with laminectomy or laminoplasty between C1-T1. Pre-and post-operative dysphagia was assessed by a speech language pathologist. The patient cohort was categorized by approach: Laminectomy + Fusion (LF) and Laminoplasty (LP). Patients were excluded from radiographic analyses if they did not have both baseline and follow-up imaging. The study included 147 LF and 47 LP cases. There were no differences in baseline demographics. There were three patients with new-onset dysphagia in the LF group (1.5% incidence) and no new cases in the LP group (p = 1.000). LF patients had significantly higher rates of post-op complications (27.9% LF vs. 8.5% LP, p = 0.005) but not intra-op compli-cations (6.1% LF vs. 2.1% LP, p = 0.456). Radiographic analysis of the entire cohort showed no significant changes in cervical lordosis, cSVA, or T1 slope. Both group comparisons showed no differences in incidence of dysphagia pre and post operatively. Based on this study, the likelihood of developing dysphagia after LF or LP are similarly low with a new onset dysphagia rate of 1.5%.

BACKGROUND CONTEXT Patients with diabetes mellitus (DM) undergoing posterior spinal fusion (PSF) with elevated HbA1cs are at higher risk of postoperative complications than those with lower HbA1cs. DM patients with an HbA1c >7.05% are prone to postoperative complications such as wound complications (WC). Pseudarthrosis (PA) is another complication for PSF and requires further insight in determining risk factors for DM. PURPOSE To determine if DM patients with higher preoperative HbA1c levels will have higher rates of WC and PA. STUDY DESIGN/SETTING Single-center retrospective cohort study. PATIENT SAMPLE This study included 229 DM patients. OUTCOME MEASURES Patient demographics, osteopenia, preoperative HbA1c, WC, PA, and levels-fused (LF). METHODS Included: DM patients undergoing thoracolumbar PSF from 2014-2019 with preoperative HbA1C levels, and a minimum 1-year postoperative follow-up. PA was defined by the treating surgeon via clinical presentation, radiographs and postoperative CT scan with minimum 1-year postoperative interval. WC included dehiscence, seroma requiring aspiration or infection of the surgical site. Excluded: Patients undergoing LLIFs and ALIFs or diagnosed with prior pars fracture, spinal tumor, ankylosing spondylitis, fracture and infection. Relationships between complications and HbA1c were determined using t-test, chi-squared analyses and multivariate regressions (α=0.05). In risk factors, the cutoff HbA1C value as a predictor for multiple postoperative complications was identified via receiver operating characteristic (ROC) analyses using Youden's index. RESULTS A total of 229 patients met these criteria. Age (Normal: 65.4±11.0, PA: 63.0±8.2, p=0.249; Normal: 65.2±10.6, WC: 64.5±9.7, p=0.753), CCI (Normal: 4.6±2.0, PA: 4.0±1.2, p=0.06; Normal: 4.6±1.9., WC: 4.6±1.7, p=0.761), gender, percent female, (Normal: 57%, PA: 47%, p=0.286; Normal: 55%, WC: 58%, p=0.829), osteopenia (Normal: 3%, PA:3%, p=0.968; Normal: 3%, WC: 0.0%, p=0.377), and smoker status (Normal: 11%, PA: 16%, p=0.44; Normal: 11%, WC: 12%, p=0.915) did not have a significant impact in the tested postoperative complications. Mean HbA1c (7.6±1.5%, p=0.001), LF (3.9±3.2, p=0.024) and BMI (35.8±7.4, p=0.004) in patients with WC were significantly higher than those without WC (HbA1C: 6.8±1.0%; LF: 2.5±2.9 BMI: 31.7±6.7). HbA1c (OR: 1.7 [1.2-2.5], p=0.005), BMI (OR: 1.1 [1.0-1.2], p=0.007) and LF (OR: 1.1[1.1-1.3], p=0.031) was an independent risk factor WC. In those with PA, mean HbA1c (7.0±1.3, p=0.289) was not significantly higher than those without PA (HbA1C:7.0±1.1). HbA1c (OR: 1.039 [0.73-1.478], p=0.831) was not an independent risk factor for PA.ROC analyses demonstrated HbA1c>7.05% (AUC: 0.693[0.587-0.800], p=0.001], BMI>32.92 (AUC: 0.664[0.555-0.772], p=0.007) and >1.5 LF (AUC: 0.626[0.502-0.750], p=0.036) as fair predictive models for WC. CONCLUSIONS Preoperative HbA1C>7.05%, BMI>32.92 and LF>1.5 are independent risk factors of WC; however, neither of these are predictors for PA in diabetics who had PSF. Regardless, DM patients undergoing PSF should strive to lower their HbA1c<7.05% and BMI<32.92 before surgery. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. Patients with diabetes mellitus (DM) undergoing posterior spinal fusion (PSF) with elevated HbA1cs are at higher risk of postoperative complications than those with lower HbA1cs. DM patients with an HbA1c >7.05% are prone to postoperative complications such as wound complications (WC). Pseudarthrosis (PA) is another complication for PSF and requires further insight in determining risk factors for DM. To determine if DM patients with higher preoperative HbA1c levels will have higher rates of WC and PA. Single-center retrospective cohort study. This study included 229 DM patients. Patient demographics, osteopenia, preoperative HbA1c, WC, PA, and levels-fused (LF). Included: DM patients undergoing thoracolumbar PSF from 2014-2019 with preoperative HbA1C levels, and a minimum 1-year postoperative follow-up. PA was defined by the treating surgeon via clinical presentation, radiographs and postoperative CT scan with minimum 1-year postoperative interval. WC included dehiscence, seroma requiring aspiration or infection of the surgical site. Excluded: Patients undergoing LLIFs and ALIFs or diagnosed with prior pars fracture, spinal tumor, ankylosing spondylitis, fracture and infection. Relationships between complications and HbA1c were determined using t-test, chi-squared analyses and multivariate regressions (α=0.05). In risk factors, the cutoff HbA1C value as a predictor for multiple postoperative complications was identified via receiver operating characteristic (ROC) analyses using Youden's index. A total of 229 patients met these criteria. Age (Normal: 65.4±11.0, PA: 63.0±8.2, p=0.249; Normal: 65.2±10.6, WC: 64.5±9.7, p=0.753), CCI (Normal: 4.6±2.0, PA: 4.0±1.2, p=0.06; Normal: 4.6±1.9., WC: 4.6±1.7, p=0.761), gender, percent female, (Normal: 57%, PA: 47%, p=0.286; Normal: 55%, WC: 58%, p=0.829), osteopenia (Normal: 3%, PA:3%, p=0.968; Normal: 3%, WC: 0.0%, p=0.377), and smoker status (Normal: 11%, PA: 16%, p=0.44; Normal: 11%, WC: 12%, p=0.915) did not have a significant impact in the tested postoperative complications. Mean HbA1c (7.6±1.5%, p=0.001), LF (3.9±3.2, p=0.024) and BMI (35.8±7.4, p=0.004) in patients with WC were significantly higher than those without WC (HbA1C: 6.8±1.0%; LF: 2.5±2.9 BMI: 31.7±6.7). HbA1c (OR: 1.7 [1.2-2.5], p=0.005), BMI (OR: 1.1 [1.0-1.2], p=0.007) and LF (OR: 1.1[1.1-1.3], p=0.031) was an independent risk factor WC. In those with PA, mean HbA1c (7.0±1.3, p=0.289) was not significantly higher than those without PA (HbA1C:7.0±1.1). HbA1c (OR: 1.039 [0.73-1.478], p=0.831) was not an independent risk factor for PA.ROC analyses demonstrated HbA1c>7.05% (AUC: 0.693[0.587-0.800], p=0.001], BMI>32.92 (AUC: 0.664[0.555-0.772], p=0.007) and >1.5 LF (AUC: 0.626[0.502-0.750], p=0.036) as fair predictive models for WC. Preoperative HbA1C>7.05%, BMI>32.92 and LF>1.5 are independent risk factors of WC; however, neither of these are predictors for PA in diabetics who had PSF. Regardless, DM patients undergoing PSF should strive to lower their HbA1c<7.05% and BMI<32.92 before surgery.

BACKGROUND CONTEXT The treatment of patients with spinal ankylosing disorders (SAD) continues to pose a unique challenge for the practitioner. This population is especially susceptible to vertebral column fractures, specifically unstable extension type fractures even from minor trauma. An increase in geriatric patients with unstable extension type vertebral fractures may be especially anticipated due to change in patient demographics including an increase in age and prevalence of associated comorbidities. In the geriatric population, studies have shown that early surgery for other injuries such as hip fractures may reduce patient complications and mortality. These studies have changed patient care protocols in many medical centers worldwide. PURPOSE In this study, we aim to assess the relationship between the timing of surgery for vertebral fractures in this population and patient complications, rehospitalization rates, length of hospital stays and mortality. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE Patients included were those diagnosed with thoracolumbar extension type fractures and a SAD, over 65 years old, following minor trauma and with no prior spinal instrumentation. OUTCOME MEASURES Patient complications, surgical site infections, rehospitalization rates, length of hospital stays and perioperative mortality. METHODS We searched our department's database for all patients that met our inclusion criteria. Difference in patient outcomes that underwent early surgery of less than 72 hours from diagnosis as opposed to those that underwent later surgery was assessed. RESULTS A total of 85 patients were diagnosed with extension type thoracolumbar fractures at our institution between 2016-2020. Of these, 47 met the inclusion criteria for this study. Nineteen patients underwent surgery less than 72 hours from diagnosis and 28 more than 72 hours from diagnosis. No difference was found in age and Elixhauser comorbidity scores between the groups. A statistically significant difference in perioperative patient complications between the early and the late groups (p=0.0003) was found. There was no statistically significant difference between the groups when comparing surgical site infections, length of hospital stay, rehospitalization within a month and perioperative mortality. CONCLUSIONS Time to surgery may affect complication rates in patients of the elderly population with spinal ankylosing disorders presenting with unstable hyperextension type thoracolumbar fractures. Early surgery in this patient population should be considered. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. The treatment of patients with spinal ankylosing disorders (SAD) continues to pose a unique challenge for the practitioner. This population is especially susceptible to vertebral column fractures, specifically unstable extension type fractures even from minor trauma. An increase in geriatric patients with unstable extension type vertebral fractures may be especially anticipated due to change in patient demographics including an increase in age and prevalence of associated comorbidities. In the geriatric population, studies have shown that early surgery for other injuries such as hip fractures may reduce patient complications and mortality. These studies have changed patient care protocols in many medical centers worldwide. In this study, we aim to assess the relationship between the timing of surgery for vertebral fractures in this population and patient complications, rehospitalization rates, length of hospital stays and mortality. Retrospective cohort study. Patients included were those diagnosed with thoracolumbar extension type fractures and a SAD, over 65 years old, following minor trauma and with no prior spinal instrumentation. Patient complications, surgical site infections, rehospitalization rates, length of hospital stays and perioperative mortality. We searched our department's database for all patients that met our inclusion criteria. Difference in patient outcomes that underwent early surgery of less than 72 hours from diagnosis as opposed to those that underwent later surgery was assessed. A total of 85 patients were diagnosed with extension type thoracolumbar fractures at our institution between 2016-2020. Of these, 47 met the inclusion criteria for this study. Nineteen patients underwent surgery less than 72 hours from diagnosis and 28 more than 72 hours from diagnosis. No difference was found in age and Elixhauser comorbidity scores between the groups. A statistically significant difference in perioperative patient complications between the early and the late groups (p=0.0003) was found. There was no statistically significant difference between the groups when comparing surgical site infections, length of hospital stay, rehospitalization within a month and perioperative mortality. Time to surgery may affect complication rates in patients of the elderly population with spinal ankylosing disorders presenting with unstable hyperextension type thoracolumbar fractures. Early surgery in this patient population should be considered.

Distal junctional kyphosis (DJK) is a major concern following cervical deformity (CD) correction, leading to failed realignment and revision surgery. In this chapter, we describe our approach to the treatment of cervical deformity and the steps taken to minimize the risk of DJK post-operatively by tailoring the construction to the individual patient. In this chapter, we describe our approach to the treatment of cervical deformity and the steps taken to minimize the risk of DJK post-operatively by tailoring the construction to the individual patient. First we focus on characterization of the baseline deformity. Secondly, we assess our patients clinically. Thirdly, we simulate the correction with the use of novel in-construct measurements. The fourth step is to develop a DJK prevention strategy tailored to the individual. The last step is to perform surgery and check correction during the operation.

BACKGROUND CONTEXT Patient Reported Outcome Information System (PROMIS) provides a tailored ability to compare different procedures. This study compares PROMIS results for patients undergoing common single-level spinal surgery, total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedures with minimum 1 Year Follow-Up (FU). PURPOSE To evaluate the efficacy of spine surgery compared to adult reconstructive surgery. STUDY DESIGN/SETTING Single-center retrospective cohort study PATIENT SAMPLE A total of 98 spine patients (32 Laminectomy, 22 MLD, 44 TLIF) and 147 RECON patients (50 THA and 97 TKA). OUTCOME MEASURES Patient demographics, Physical-Function (PF), Pain-Intensity (PI) and Pain-Interference (P-IF). METHODS Included: Patients>18 years old who underwent single level spine surgery (Lami, MLD, TLIF) or RECON surgery with Baseline (BL) & 1Y PROMIS scores of PF, P-IF, and PI, which were grouped based on surgery type. Excluded: patients who underwent both single level spine and RECON surgeries. Paired t-tests calculated differences in BL, 1Y, and change in PROMIS scores for spine vs each RECON procedure. RESULTS Age and gender were similar between spine (Age=58.92±13.69; 45.91% Female) and RECON (Age=65.9±8.6; 63.95% Female) patients. Spine patients undergoing Laminectomy(PF: 13.3±15.4, P-IF: 90.9±7.3, PI:56.2±6.6), MLD (PF:9.8±16.1,P-IF:94.2±6.4,PI:61.2±6.5) , or TLIF (PF:10.6±10.9,P-IF:91.8±13.0,PI:56.4±6.5) had more disability and pain at BL than either THA(PF: 36.0±4.7,P-IF:64.0±5.5,PI:54.2±6.2) or TKA(PF:35.5±3.9,P-IF:63.6±6.2,PI:53.3±6.6)patients according to all 3 PROMIS categories. When assessing all lumbar surgery patients with RECON, spine patients had greater improvements in PF (15.5±21 vs 6.8±6.3, p<0.001) and P-IF (-17.2±21.3 vs -10.0±9.5, p=0.002) domains except PI (-7.2±9.9 vs -9.8±9.5,p=0.038). CONCLUSIONS Patients undergoing single level spinal surgery had worse baseline disability and pain compared to those undergoing recon surgery. PROMIS improvement is equivalent, and often greater in the spine patients compared to RECON. Although patients undergoing spine surgery had lower initial PROMIS scores than RECON patients, spine patients showed at least as good or better improvement at a 1Y postoperative time point. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. Patient Reported Outcome Information System (PROMIS) provides a tailored ability to compare different procedures. This study compares PROMIS results for patients undergoing common single-level spinal surgery, total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedures with minimum 1 Year Follow-Up (FU). To evaluate the efficacy of spine surgery compared to adult reconstructive surgery. Single-center retrospective cohort study A total of 98 spine patients (32 Laminectomy, 22 MLD, 44 TLIF) and 147 RECON patients (50 THA and 97 TKA). Patient demographics, Physical-Function (PF), Pain-Intensity (PI) and Pain-Interference (P-IF). Included: Patients>18 years old who underwent single level spine surgery (Lami, MLD, TLIF) or RECON surgery with Baseline (BL) & 1Y PROMIS scores of PF, P-IF, and PI, which were grouped based on surgery type. Excluded: patients who underwent both single level spine and RECON surgeries. Paired t-tests calculated differences in BL, 1Y, and change in PROMIS scores for spine vs each RECON procedure. Age and gender were similar between spine (Age=58.92±13.69; 45.91% Female) and RECON (Age=65.9±8.6; 63.95% Female) patients. Spine patients undergoing Laminectomy(PF: 13.3±15.4, P-IF: 90.9±7.3, PI:56.2±6.6), MLD (PF:9.8±16.1,P-IF:94.2±6.4,PI:61.2±6.5) , or TLIF (PF:10.6±10.9,P-IF:91.8±13.0,PI:56.4±6.5) had more disability and pain at BL than either THA(PF: 36.0±4.7,P-IF:64.0±5.5,PI:54.2±6.2) or TKA(PF:35.5±3.9,P-IF:63.6±6.2,PI:53.3±6.6)patients according to all 3 PROMIS categories. When assessing all lumbar surgery patients with RECON, spine patients had greater improvements in PF (15.5±21 vs 6.8±6.3, p<0.001) and P-IF (-17.2±21.3 vs -10.0±9.5, p=0.002) domains except PI (-7.2±9.9 vs -9.8±9.5,p=0.038). Patients undergoing single level spinal surgery had worse baseline disability and pain compared to those undergoing recon surgery. PROMIS improvement is equivalent, and often greater in the spine patients compared to RECON. Although patients undergoing spine surgery had lower initial PROMIS scores than RECON patients, spine patients showed at least as good or better improvement at a 1Y postoperative time point.

BACKGROUND CONTEXT: The COVID-19 pandemic caused nationwide suspensions of elective surgeries due to reallocation of resources to the care of COVID-19 patients. Following resumption of elective cases, a significant proportion of patients continued to delay surgery, with many yet to reschedule, potentially prolonging their pain and impairment of function and causing detrimental long-term effects. PURPOSE: The aim of this study was to examine differences between patients who have and have not rescheduled their spine surgery procedures originally cancelled due to the COVID-19 pandemic, and to evaluate the reasons for continued deferment of spine surgeries even after the lifting of the mandated suspension of elective surgeries. Study design/setting: Retrospective case series at a single institution PATIENT SAMPLE: Included were 133 patients seen at a single institution where spine surgery was canceled due to a state-mandated suspension of elective surgeries from March to June, 2020. OUTCOME MEASURES: The measures assessed included preoperative diagnoses and neurological dysfunction, surgical characteristics, reasons for surgery deferment, and PROMIS scores of pain intensity, pain interference, and physical function. METHODS: Patient electronic medical records were reviewed. Patients who had not rescheduled their canceled surgery as of January 31, 2021, and did not have a reason noted in their charts were called to determine the reason for continued surgery deferment. Patients were divided into three groups: early rescheduled (ER), late rescheduled (LR), and not rescheduled (NR). ER patients had a date of surgery (DOS) prior to the city's Phase 4 reopening on July 20, 2020; LR patients had a DOS on or after that date. Statistical analysis of the group findings included analysis of variance with Tukey's honestly significant difference (HSD) post-hoc test, independent samples T-test, and chi-square analysis with significance set at p <=.05. RESULTS: Out of 133 patients, 47.4% (63) were in the ER, 15.8% (21) in the LR, and 36.8% (49) in the NR groups. Demographics and baseline PROMIS scores were similar between groups. LR had more levels fused (3.6) than ER (1.6), p= .018 on Tukey HSD. NR (2.1) did not have different mean levels fused than LR or ER, both p= >.05 on Tukey HSD. LR had more three column osteotomies (14.3%) than ER and (1.6%) and NR (2.0%) p=.022, and fewer lumbar microdiscectomies (0%) compared to ER (20.6%) and NR (10.2%), p=.039. Other surgical characteristics were similar between groups. LR had a longer length of stay than ER (4.2 vs 2.4, p=.036). No patients in ER or LR had a nosocomial COVID-19 infection. Of NR, 2.0% have a future surgery date scheduled and 8.2% (4) are acquiring updated exams before rescheduling. 40.8% (20; 15.0% total cohort) continue to defer surgery over concern for COVID-19 exposure and 16.3% (8) for medical comorbidities. 6.1% (3) permanently canceled for symptom improvement. 8.2% (4) had follow-up recommendations for non-surgical management. 4.1% (2) are since deceased. CONCLUSION: Over 1/3 of elective spine surgeries canceled due to COVID-19 have not been performed in the 8 months from when elective surgeries resumed in our institution to the end of the study. ER patients had less complex surgeries planned than LR. NR patients continue to defer surgery primarily over concern for COVID-19 exposure. The toll on the health of these patients as a result of the delay in treatment and on their lives due to their inability to return to normal function remains to be seen. (C) 2021 Elsevier Inc. All rights reserved.

BACKGROUND CONTEXT Unconstrained cervical disc replacements prostheses (UCDR) have become more commonly used among surgeons performing cervical disc arthroplasty (CDA). CDR have favorable outcomes in treating cervical radiculopathy and restoring normative motion in the spine. More recently, UCDR have become popular due to their ease of insertion, however the unconstrained design's effect on segmental range of motion (ROM) has not been evaluated. PURPOSE To evaluate the unconstrained design's effect on segmental ROM. STUDY DESIGN/SETTING Single-center retrospective cohort study. PATIENT SAMPLE A total of 148 patients (58 single-level, 90 two-level). OUTCOME MEASURES Patient demographics, implant characteristics, baseline (BL) ROM, and follow-up ROM. Methods Patients diagnosed with cervical radiculopathy who underwent a primary 1- or 2- level UCDA from 2015-2019 with pre- and postoperative flexion-extension radiographs. Segmental sagittal measurements were taken to determine baseline (BL) and follow-up segmental ROM from the flex-extension views. Hypermobility was classified as ≥11.0° in ROM from BL to follow-up &/or >3mm translation. Mean BL and follow-up ROM were compared at each level using t-test analyses (α=0.05). Relationships between patient and implant demographics and hypermobility were determined using multivariate logistic regressions. Results A total of 148 (58 single-level, 90 two-level) patients met the criteria. Age, gender and BMI were similar between normal (Age: 42.7±8.7, gender [% female]: 41%, BMI: 28.1±5.5) and hypermobile groups (Age: 44.4±9.4, p=0.272; gender [% female]: 41%, p=0.98; BMI: 29.6±12.6, p=0.309); however, hypermobile patients (0.9±1.0) had a significantly higher CCI than the normal groups (0.4±0.8, p=0.003). Single-level patients: 23 (40%) developed hypermobility at follow-up. Follow-up ROM (12.2±6.8°, p=0.003) was significantly higher compared to the average BL ROM (9.2±4.9°). C5-C6 had significantly higher follow-up ROM (C5-C6: 13.7±6.9°, p=0.003) than BL ROM (C5-C6: 9.2±4.9°). Two-level patients: Although there was no significant difference between follow-up ROM (6.12±6.95°, p=0.749) and BL ROM (7.87±10.54°), 21(23.3%) cephalad and 20 (22.2%) caudal implants developed hypermobility postoperatively. Multivariate regression analysis of implant factors, patient demographics and disc level demonstrated no risk factors for hypermobility except a slightly shorter implant depth (13.6±0.9 mm vs 14.3±1.2 mm, p=0.004; OR:0.565, p=0.005). Conclusions UCDR on average increased segmental ROM with more than forty-percent of these implants being hypermobile at follow-up. Furthermore, shorter implant depth (AP) was indicated to be a risk factor for hypermobility. Patients and surgeons should be aware of the prevalence of hypermobility of UCDR and consider the long-term outcomes of the procedure. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. Unconstrained cervical disc replacements prostheses (UCDR) have become more commonly used among surgeons performing cervical disc arthroplasty (CDA). CDR have favorable outcomes in treating cervical radiculopathy and restoring normative motion in the spine. More recently, UCDR have become popular due to their ease of insertion, however the unconstrained design's effect on segmental range of motion (ROM) has not been evaluated. To evaluate the unconstrained design's effect on segmental ROM. Single-center retrospective cohort study. A total of 148 patients (58 single-level, 90 two-level). Patient demographics, implant characteristics, baseline (BL) ROM, and follow-up ROM. Patients diagnosed with cervical radiculopathy who underwent a primary 1- or 2- level UCDA from 2015-2019 with pre- and postoperative flexion-extension radiographs. Segmental sagittal measurements were taken to determine baseline (BL) and follow-up segmental ROM from the flex-extension views. Hypermobility was classified as ≥11.0° in ROM from BL to follow-up &/or >3mm translation. Mean BL and follow-up ROM were compared at each level using t-test analyses (α=0.05). Relationships between patient and implant demographics and hypermobility were determined using multivariate logistic regressions. A total of 148 (58 single-level, 90 two-level) patients met the criteria. Age, gender and BMI were similar between normal (Age: 42.7±8.7, gender [% female]: 41%, BMI: 28.1±5.5) and hypermobile groups (Age: 44.4±9.4, p=0.272; gender [% female]: 41%, p=0.98; BMI: 29.6±12.6, p=0.309); however, hypermobile patients (0.9±1.0) had a significantly higher CCI than the normal groups (0.4±0.8, p=0.003). Single-level patients: 23 (40%) developed hypermobility at follow-up. Follow-up ROM (12.2±6.8°, p=0.003) was significantly higher compared to the average BL ROM (9.2±4.9°). C5-C6 had significantly higher follow-up ROM (C5-C6: 13.7±6.9°, p=0.003) than BL ROM (C5-C6: 9.2±4.9°). Two-level patients: Although there was no significant difference between follow-up ROM (6.12±6.95°, p=0.749) and BL ROM (7.87±10.54°), 21(23.3%) cephalad and 20 (22.2%) caudal implants developed hypermobility postoperatively. Multivariate regression analysis of implant factors, patient demographics and disc level demonstrated no risk factors for hypermobility except a slightly shorter implant depth (13.6±0.9 mm vs 14.3±1.2 mm, p=0.004; OR:0.565, p=0.005). UCDR on average increased segmental ROM with more than forty-percent of these implants being hypermobile at follow-up. Furthermore, shorter implant depth (AP) was indicated to be a risk factor for hypermobility. Patients and surgeons should be aware of the prevalence of hypermobility of UCDR and consider the long-term outcomes of the procedure.

BACKGROUND CONTEXT This pandemic has further shifted medicine toward a reliance and adoption of technology with a steep learning curve. The pandemic created a need to interact with patients without immediate in-person contact. Due to the COVID-19, our division transitioned from 0% telehealth visits (TV) to 100% TV in the matter of 1-2 weeks. The inexperience of patients and providers with TV could potentially impact the quality of care for spine patients. Further insight is required to determine how effective this mode of care is for spine surgeons. PURPOSE To evaluate the efficacy of TV as a modality of treatment in spine surgery. STUDY DESIGN/SETTING Single-center retrospective cohort study. PATIENT SAMPLE This study included 85 patients (43 TV only and 42 with TV and OV). OUTCOME MEASURES Patient demographics, treated pathologies, changes in diagnosis, updated MRI imaging, and changes in surgical plans. METHODS Included: patients undergoing spinal surgery who received either a TV-only or TV and an office visit (OV) prior to surgery post-March 2020. Excluded: patients who received TV and OV by two separate providers, providers outside of the spine service, or patients with an initial OV in the time frame. The cohort was separated into patients who only had a TV or had an initial TV and subsequent OV (TV+OV) prior to surgery. The rates of patients scheduled for surgery through TV alone vs TV and in-person visit were analyzed. Changes in diagnosis and surgical plans from in-person vs telehealth were assessed. Relationships between spine pathologies treated and efficacy of the TV alone were established using chi-squared analyses (α=0.05). RESULTS A total of 85 patients (43 TV-only and 42 with TV+OV) met these criteria. There is no significant difference in age, gender, BMI, and patient status between patients with TV-only (age: 55.7±15.6, % female: 47%, BMI: 27.0±4.8, and % new patients: 16.3%) and those with both TV and OV (age: 55.4±15.3, p=0.919; % female: 55%, 0.453; BMI: 28.9±5.9, p=0.122; % new patients: 33.3%, p=0.220). TV-only had significantly more patients treated for cervical or lumbar radiculopathy than those with both OV+TV (69.8% vs 57.1%, p=0.003). TV-only had a significantly higher percentage of patients that have MRIs prior to their visit than those with both TV and OV (95.8% vs 76.2%, p<0.001). Of total patients, 11.9% with both TV and OV had a change in surgical plans from the initial TV to the subsequent OV. The cases with changes in surgical plans were all associated with updated imaging. CONCLUSIONS With TV-alone, common spine pathologies are identifiable through history, TV physical examination, and advanced imaging. Although TV seemed concordant with OV in times of emergency, the authors recommend confirmation of the examination prior to undertaking operative procedures. Further insight in the outcomes of the procedures with TV only and TV+OV can be compared through change in PROMIS from baseline to 1 year. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. This pandemic has further shifted medicine toward a reliance and adoption of technology with a steep learning curve. The pandemic created a need to interact with patients without immediate in-person contact. Due to the COVID-19, our division transitioned from 0% telehealth visits (TV) to 100% TV in the matter of 1-2 weeks. The inexperience of patients and providers with TV could potentially impact the quality of care for spine patients. Further insight is required to determine how effective this mode of care is for spine surgeons. To evaluate the efficacy of TV as a modality of treatment in spine surgery. Single-center retrospective cohort study. This study included 85 patients (43 TV only and 42 with TV and OV). Patient demographics, treated pathologies, changes in diagnosis, updated MRI imaging, and changes in surgical plans. Included: patients undergoing spinal surgery who received either a TV-only or TV and an office visit (OV) prior to surgery post-March 2020. Excluded: patients who received TV and OV by two separate providers, providers outside of the spine service, or patients with an initial OV in the time frame. The cohort was separated into patients who only had a TV or had an initial TV and subsequent OV (TV+OV) prior to surgery. The rates of patients scheduled for surgery through TV alone vs TV and in-person visit were analyzed. Changes in diagnosis and surgical plans from in-person vs telehealth were assessed. Relationships between spine pathologies treated and efficacy of the TV alone were established using chi-squared analyses (α=0.05). A total of 85 patients (43 TV-only and 42 with TV+OV) met these criteria. There is no significant difference in age, gender, BMI, and patient status between patients with TV-only (age: 55.7±15.6, % female: 47%, BMI: 27.0±4.8, and % new patients: 16.3%) and those with both TV and OV (age: 55.4±15.3, p=0.919; % female: 55%, 0.453; BMI: 28.9±5.9, p=0.122; % new patients: 33.3%, p=0.220). TV-only had significantly more patients treated for cervical or lumbar radiculopathy than those with both OV+TV (69.8% vs 57.1%, p=0.003). TV-only had a significantly higher percentage of patients that have MRIs prior to their visit than those with both TV and OV (95.8% vs 76.2%, p<0.001). Of total patients, 11.9% with both TV and OV had a change in surgical plans from the initial TV to the subsequent OV. The cases with changes in surgical plans were all associated with updated imaging. With TV-alone, common spine pathologies are identifiable through history, TV physical examination, and advanced imaging. Although TV seemed concordant with OV in times of emergency, the authors recommend confirmation of the examination prior to undertaking operative procedures. Further insight in the outcomes of the procedures with TV only and TV+OV can be compared through change in PROMIS from baseline to 1 year.

BACKGROUND CONTEXT History, physical exams (PE) and imaging are used to diagnose spine pathology. There is limited data on differences in telehealth physical exam findings when compared to in person physical examinations in the same patient. Further analysis is required to determine differences in telehealth visits (TV) and office visits (OV) examinations and the clinical significance of these differences. PURPOSE To determine differences in TV and OV examinations and the clinical significance of these differences. STUDY DESIGN/SETTING Single-center retrospective cohort study. PATIENT SAMPLE This study included 296 patients (247 surgical and 49 non-surgical). OUTCOME MEASURES Tibialis anterior (TA) deficit, hand grip (HG), hand intrinsic (HI), bilateral lower extremity motor deficits, bilateral upper extremity motor deficits, tandem gait (TG) abnormalities, straight legged raise (SLR) abnormalities, and extremity sensation (ES) abnormalities. METHODS Included: patients with spine pathologies who received an initial TV and a subsequent OV post-March 2020. Excluded: patients who received telehealth and office visit by two separate providers, providers outside of the spine service, or patients with an initial office visit in the timeframe. The cohort was further analyzed by pathologies. Motor exam results were categorized dichotomously as "full-strength: antigravity" or deficit and other physical exam findings were classified as abnormal and normal. False positives (FP) were classified as abnormalities detected only in TV and false negatives (FN) were categorized as abnormalities detected only in OV. Relationships between the TV and OV exam findings were established using chi-squared analyses (α=0.05). RESULTS The total cohort's average age is 56.5, BMI=28.6, and 50% female. Among the cohort, 8.9% of lumbar radiculopathy (LR) patients' TV (w/ 5.1% being FP and 12.7% being FN) recorded a TA deficit, but 16.5% reported deficit in OV (p=0.048). Thus, TV either missed or falsely recorded 17.7% TA deficits. No deficits (0%) were recorded in both HG and HI in MY TV, but 12.5% and 15.6% had reported HG and HI deficits in OV, respectively. For tandem gait (TG), 21.9% MY (w/ 6.3% FP and 15.6% FN) patients' TV reported an abnormal tandem TG, but in OV, 31.3% (p=0.009) reported abnormalities. For straight-leg raise (SLR), 16.5% LR (w/ 5.1% FP and 7.6% FN) reported abnormal SLR in TV but 13.9% had abnormalities in OV (p<0.001). For extremity sensations, 8.9% LR TVs reported abnormalities and 8.9% LR OV reported abnormalities; however, there were 6.3% FP and 6.3% FN (p=0.046). CONCLUSIONS TA, TG, SLR, and motor sensation have the highest rates of FP and NP in the spine telehealth examination. There should be a low threshold for an OV in the setting of equivocal testing. During a pandemic, surgeons should rely on the TV history/examination and imaging to make a diagnosis. OV is appropriate in cases in which an accurate TA, TG, SLR, and ES is required. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. History, physical exams (PE) and imaging are used to diagnose spine pathology. There is limited data on differences in telehealth physical exam findings when compared to in person physical examinations in the same patient. Further analysis is required to determine differences in telehealth visits (TV) and office visits (OV) examinations and the clinical significance of these differences. To determine differences in TV and OV examinations and the clinical significance of these differences. Single-center retrospective cohort study. This study included 296 patients (247 surgical and 49 non-surgical). Tibialis anterior (TA) deficit, hand grip (HG), hand intrinsic (HI), bilateral lower extremity motor deficits, bilateral upper extremity motor deficits, tandem gait (TG) abnormalities, straight legged raise (SLR) abnormalities, and extremity sensation (ES) abnormalities. Included: patients with spine pathologies who received an initial TV and a subsequent OV post-March 2020. Excluded: patients who received telehealth and office visit by two separate providers, providers outside of the spine service, or patients with an initial office visit in the timeframe. The cohort was further analyzed by pathologies. Motor exam results were categorized dichotomously as "full-strength: antigravity" or deficit and other physical exam findings were classified as abnormal and normal. False positives (FP) were classified as abnormalities detected only in TV and false negatives (FN) were categorized as abnormalities detected only in OV. Relationships between the TV and OV exam findings were established using chi-squared analyses (α=0.05). The total cohort's average age is 56.5, BMI=28.6, and 50% female. Among the cohort, 8.9% of lumbar radiculopathy (LR) patients' TV (w/ 5.1% being FP and 12.7% being FN) recorded a TA deficit, but 16.5% reported deficit in OV (p=0.048). Thus, TV either missed or falsely recorded 17.7% TA deficits. No deficits (0%) were recorded in both HG and HI in MY TV, but 12.5% and 15.6% had reported HG and HI deficits in OV, respectively. For tandem gait (TG), 21.9% MY (w/ 6.3% FP and 15.6% FN) patients' TV reported an abnormal tandem TG, but in OV, 31.3% (p=0.009) reported abnormalities. For straight-leg raise (SLR), 16.5% LR (w/ 5.1% FP and 7.6% FN) reported abnormal SLR in TV but 13.9% had abnormalities in OV (p<0.001). For extremity sensations, 8.9% LR TVs reported abnormalities and 8.9% LR OV reported abnormalities; however, there were 6.3% FP and 6.3% FN (p=0.046). TA, TG, SLR, and motor sensation have the highest rates of FP and NP in the spine telehealth examination. There should be a low threshold for an OV in the setting of equivocal testing. During a pandemic, surgeons should rely on the TV history/examination and imaging to make a diagnosis. OV is appropriate in cases in which an accurate TA, TG, SLR, and ES is required.

BACKGROUND CONTEXT One of the reported advantages of MIS spine surgery is less postoperative pain and less postoperative opioid consumption. Traditional lumbar approaches (open TLIF, percutaneous ALIF with flip, and percutaneous LLIF with flip) were compared to minimally invasive (MIS TLIF) and single position (lateral decubitus) anterior posterior surgery (SPS ALIF, SPS LLIF) to evaluate for differences in postoperative opioid consumption. PURPOSE To evaluate inpatient MME administration for different lumbar spinal fusion surgeries. STUDY DESIGN/SETTING Single-center retrospective cohort study. PATIENT SAMPLE A total of 447 single level lumbar spinal fusion procedures from 2013 to 2020: 125 open TLIF, 110 MIS TLIF, 122 Traditional Percutaneous (TP) ALIF/LLIF, and 45 SPS ALIF/LLIF. OUTCOME MEASURES Patient demographics, surgical procedure and approach, perioperative clinical characteristics, incidence of ileus and inpatient MME. METHODS Patients ≥ 18 years of age who underwent one level TLIF or one level ALIF or LLIF with percutaneous posterior instrumentation between L2-S1. All groups included patients with a diagnosis of Grade I spondylolisthesis, stenosis, degenerative disc disease or pars defect. Statistical analysis included independent samples t-tests and chi-square analyses. Propensity score matching (PSM) was used when comparing SPS ALIF/LLIF vs TP ALIF/LLIF to control for age. MME was calculated as per the Centers for Medicare & Medicaid Services. To adjust for differences in length of stay (LOS), inpatient MME was quantified as a rate per hour. Significance set at p<0.05. RESULTS There were no differences in demographics except the MIS TLIF group was older (55.9±12.5 vs 51.6±13.1, p=0.011) than TP ALIF/LLIF. After a PSM for age, SPS ALIF/LLIF had shorter op times (202.3±71.0 vs 271.8±77.7 min, p=0.000) and showed no differences in total MME (322.4 ± 397.8 vs 342.5 ± 243.7, p=0.463) or rates of ileus (both 0%) compared to TP ALIF/LLIF. MIS TLIF had a shorter LOS compared to open TLIF (2.6±1.4 vs 3±1.7 days, p=0.000), lower total MME administration (214.1±235.4 vs 310.3±373.4, p=0.021) but no difference in total MME per hour (3.2±2.4 vs 3.7±2.8, p=0.198). MIS TLIF had shorter op time (212.1±66.4 vs 271.8 ±77.7 min, p=0.000), LOS (2.6±1.4 vs 3.5±1.6 days, p=0.000) and total MME (214.1±235.3 vs 342.5±243.7, p=0.000) than TP ALIF/LLIF. MIS TLIF also had shorter LOS (2.6±1.4 vs 3.3±2.1days, p=0.017), lower total MME (214.1±235.4 vs 322.4±397.8, p=0.037) and similar rates of ileus (0.9% vs 0.0%, p=0.521) compared to SPS ALIF/LLIF. CONCLUSIONS Patients undergoing MIS TLIF had lower inpatient opioid intake compared to open TLIF, single level TP ALIF/LLIF, and single level SPS. When propensity score matching for age, there was no difference in opioid administration post operatively in patients undergoing TP ALIF/LLIF or SPS ALIF/LLIF. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. One of the reported advantages of MIS spine surgery is less postoperative pain and less postoperative opioid consumption. Traditional lumbar approaches (open TLIF, percutaneous ALIF with flip, and percutaneous LLIF with flip) were compared to minimally invasive (MIS TLIF) and single position (lateral decubitus) anterior posterior surgery (SPS ALIF, SPS LLIF) to evaluate for differences in postoperative opioid consumption. To evaluate inpatient MME administration for different lumbar spinal fusion surgeries. Single-center retrospective cohort study. A total of 447 single level lumbar spinal fusion procedures from 2013 to 2020: 125 open TLIF, 110 MIS TLIF, 122 Traditional Percutaneous (TP) ALIF/LLIF, and 45 SPS ALIF/LLIF. Patient demographics, surgical procedure and approach, perioperative clinical characteristics, incidence of ileus and inpatient MME. Patients ≥ 18 years of age who underwent one level TLIF or one level ALIF or LLIF with percutaneous posterior instrumentation between L2-S1. All groups included patients with a diagnosis of Grade I spondylolisthesis, stenosis, degenerative disc disease or pars defect. Statistical analysis included independent samples t-tests and chi-square analyses. Propensity score matching (PSM) was used when comparing SPS ALIF/LLIF vs TP ALIF/LLIF to control for age. MME was calculated as per the Centers for Medicare & Medicaid Services. To adjust for differences in length of stay (LOS), inpatient MME was quantified as a rate per hour. Significance set at p<0.05. There were no differences in demographics except the MIS TLIF group was older (55.9±12.5 vs 51.6±13.1, p=0.011) than TP ALIF/LLIF. After a PSM for age, SPS ALIF/LLIF had shorter op times (202.3±71.0 vs 271.8±77.7 min, p=0.000) and showed no differences in total MME (322.4 ± 397.8 vs 342.5 ± 243.7, p=0.463) or rates of ileus (both 0%) compared to TP ALIF/LLIF. MIS TLIF had a shorter LOS compared to open TLIF (2.6±1.4 vs 3±1.7 days, p=0.000), lower total MME administration (214.1±235.4 vs 310.3±373.4, p=0.021) but no difference in total MME per hour (3.2±2.4 vs 3.7±2.8, p=0.198). MIS TLIF had shorter op time (212.1±66.4 vs 271.8 ±77.7 min, p=0.000), LOS (2.6±1.4 vs 3.5±1.6 days, p=0.000) and total MME (214.1±235.3 vs 342.5±243.7, p=0.000) than TP ALIF/LLIF. MIS TLIF also had shorter LOS (2.6±1.4 vs 3.3±2.1days, p=0.017), lower total MME (214.1±235.4 vs 322.4±397.8, p=0.037) and similar rates of ileus (0.9% vs 0.0%, p=0.521) compared to SPS ALIF/LLIF. Patients undergoing MIS TLIF had lower inpatient opioid intake compared to open TLIF, single level TP ALIF/LLIF, and single level SPS. When propensity score matching for age, there was no difference in opioid administration post operatively in patients undergoing TP ALIF/LLIF or SPS ALIF/LLIF.