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.

Post-operative infection after instrumented spinal fusion surgery is a devastating complication for patients. Short- and long-term clinical outcomes are affected but also patients consume valuable hospital resources and often require prolonged intravenous antibiotic treatment. The Wiltse/paramedian approach has been shown to decrease infection rates significantly in prior work compared to the traditional midline approach (1). There are few studies to prospectively evaluate post-operative infection as a primary outcome between the two approaches. The primary objective of this study was to compare the infection rates between the Wiltse and midline approaches to the lumbar spine. Secondarily, we sought to determine the feasibility of recruitment for a larger, multi-centre trial and compare other patient reported outcomes and re-operation rates for both procedures. A single-center, pilot RCT was conducted to compare patients undergoing native primary single or two level posterior interbody fusion surgery from 2017 to September 2023. Participants were randomly assigned to either the Wiltse or midline surgical incision study group (1:1). All patients returned to follow-up at two weeks, six weeks, three months, one year, and two years. All adverse events were recorded. Incidence of adverse events were statistically analyzed using STATA software. Seventy-five patients with degenerative conditions of the lumbar spine were included in the study. The average follow-up time was 1.9 years. Thirty-seven patients were randomly assigned to the Wiltse surgical incision group and 38 assigned to the midline incision group. The number of deep post-operative infections was higher in the midline group (5/38, 13.2%) versus the Wiltse group (2/37, 5.4%) but this was not statistically significant (p = 0.430). Rates of revision surgery were also higher in the midline group compared to the Wiltse group (p = 0.065). Ten of the 38 patients in the midline group underwent reoperation (four patients undergoing irrigation/debridement for deep infection, four returning for hardware failure, one for pseudarthrosis, and one for adjacent segment degeneration) (10/38, 26.3%). Three of 37 patients in the Wiltse group underwent re-operation (one for hematoma, one for irrigation/debridement, and one for screw revision) (3/37, 8.1%). The Wiltse group had a greater incidence of superficial wound infection (6/37, 16.2%) versus midline (1/38, 2.6%) (p = 0.056). The overall number of adverse events for each group were similar (16 midline versus 13 Wiltse). Patients who underwent the Wiltse approach had a non-statistically significant difference in deep and superficial wound infection rates, and a decreased risk of requiring revision surgery. There were no differences in the number of post-operative complications or adverse events between the two groups. These results highlight the potential value of a multi-centre RCT comparing the deep infection rate and number of adverse events of the Wiltse versus midline approaches for single and two level posterior interbody fusions of the lumbar spine.

Learner mistreatment remains a pervasive challenge in medical education, particularly within the surgical learning environment. In medical education scholarship, surgical culture is often cited both as an explanation, and at times, a justification for learner mistreatment in surgery. In this critical qualitative study, informed by constructivist grounded theory, we conducted 20 interviews with surgical faculty, representing 10 different surgical disciplines at a Canadian institution. Surgeons were invited to reflect on their encounters with mistreatment throughout their medical careers. While many surgeons recounted instances of mistreatment during their own training, few recalled witnessing learner mistreatment in their current roles as surgical faculty. This paper utilizes Pierre Bourdieu's concept of habitus as an analytical tool to enhance our understanding of surgeons' perspectives and move beyond reductionist explanations that regard mistreatment as an inherent aspect of surgical culture. Through an exploration of how aspects of surgical culture are embodied and reproduced through the cultivation of a surgical habitus, we provide insights into why learner mistreatment persists in surgery.

STUDY DESIGN:Multicenter observational cohort study. OBJECTIVE:To quantify upper extremity sensory recovery following surgical decompression for degenerative cervical myelopathy (DCM), identify predictors of sensory improvement, and evaluate its association with postoperative health-related quality of life (HRQoL). SUMMARY OF BACKGROUND DATA:Sensory dysfunction is a hallmark feature of DCM. However, prior studies have focused on overall neurological improvement rather than domain-specific outcomes, leaving the trajectory and impact of sensory recovery poorly characterized. METHODS:We used prospectively collected data from the Canadian Spine Outcomes and Research Network (CSORN). Sensory function was assessed using the modified Japanese Orthopedic Association (mJOA) sensory subdomain at baseline, 3 months, and 12 months postoperatively. Changes in sensory score were categorized as improved, stable, or worsened. HRQoL was evaluated using the SF-12 Physical and Mental Component Scores (PCS and MCS). Multivariable linear regression was performed to assess the independent association between sensory improvement and 12-month PCS and MCS. Multivariable logistic regression identified predictors of sensory improvement. RESULTS:Among 682 patients with baseline sensory deficits, 490 had 12-month follow-up data. Of these, 245 (50%) demonstrated sensory improvement, 226 (46%) remained stable, and 19 (4%) worsened ( P <0.001). Patients who improved experienced significant increases in PCS (from 31.4 to 40.5, P <0.001) and MCS (from 42.7 to 48.0, P <0.001). In adjusted models, sensory improvement was independently associated with higher PCS (+1.98, P =0.016) and MCS (+2.34, P =0.007), while worse baseline upper and lower extremity motor scores predicted greater odds of recovery (ORs 0.78 and 0.75, respectively). CONCLUSIONS:Sensory improvement after surgical decompression for DCM is common and independently associated with meaningful HRQoL gains. Patients with more severe baseline motor deficits are more likely to improve. These findings highlight the prognostic value of baseline function and support incorporating sensory outcomes into preoperative counseling.

Background: Our prior six-year review (n=2165) revealed 24% of patients undergoing posterior decompression surgeries (laminectomy or discectomy) sought emergency department (ED) care within three months post-surgery. We established an integrated Spine Assessment Clinic (SAC) to enhance patient outcomes and minimize unnecessary ED visits through pre-operative education, targeted QI interventions, and early post-operative follow-up. Methods: We reviewed 13 months of posterior decompression data (n=205) following SAC implementation. These patients received individualized, comprehensive pre-operative education and follow-up phone calls within 7 days post-surgery. ED visits within 90 days post-surgery were tracked using provincial databases and compared to our pre-SAC implementation data. Results: Out of 205 patients, 24 (11.6%) accounted for 34 ED visits within 90 days post-op, showing a significant reduction in ED visits from 24% to 11.6%, and decreased overall ED utilization from 42.1% to 16.6% (when accounting for multiple visits by the same patient). Early interventions including wound monitoring, outpatient bloodwork, and prescription adjustments for pain management, helped mitigate ED visits. Patient satisfaction surveys (n=62) indicated 92% were “highly satisfied” and 100% would recommend the SAC. Conclusions: The SAC reduced ED visits after posterior decompression surgery by over 50%, with pre-operative education, focused QI initiatives, and its individualized, proactive approach.

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.

The impact of spine surgery on Health-Related Quality-of-Life (HRQoL) outcomes across common spinal degenerative diagnoses is not well characterised. A prospective observational study of patients enrolled in the Canadian Spine Outcomes and Research Network (CSORN) registry was performed. Baseline and 1-year post-operative Short Form-12 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were collated and compared to normative values from the Canadian General Population (CGP). The percentage of patients achieving the PCS Minimum Clinically Important Difference (MCID) was quantified. 5049 patients were included in the analysis. The mean pre-operative SF-12 PCS was 29.5 and MCS was 44.1. This improved to a mean PCS of 40.5 ( p < 0.001) and MCS of 49.3 ( p < 0.0001) at 1-year post-operatively. The mean pre-operative PCS was over 2 standard deviations (SD) lower than the normative mean of the CGP; this improved to being close to 1-SD from the normative CGP mean at 1-year post-operatively. Findings were similar across age- and sex-stratified subgroups. Across all conditions, 70–75% of patients achieved the PCS MCID. Fewer patients with cervical myelopathy achieved the PCS MCID (59%). In a surgical cohort, patients with degenerative spinal conditions demonstrate a profound reduction in PCS compared to their peers in the CGP. Spinal surgery was impactful in improving physical function HRQoL outcomes in the majority, but not typically to average population norms.

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.

Emergency department (ED) crowding has become an epidemic in Canada and the assessment of post-operative “bounce backs” after spinal surgery is a critical aspect of both quality assurance and improvement efforts. Laminectomies and discectomies are among the most common surgical interventions for various spinal pathologies. Our primary objective was to identify “bounce back” patterns and potential areas for improvement in patient education and management, ultimately reducing the likelihood of presentation to the ED. All provincial ED datasets (EDIS, STAR & Meditech) were queried over 6 fiscal years identifying patients presenting within 90 days of spine surgery. Identification of surgical procedures was completed using the Canadian Classification of Health Interventions codes (1SC80 and 1SE87). A detailed chart review was conducted for each patient who rebounded to any provincial ED within 90 days of a laminectomy/discectomy. The reason for presentation to the ED was categorized as unrelated (medical) or related (surgical) to the procedure. Between April 1, 2016 – March 31, 2022, a total of 1032 laminectomies and 1133 discectomies were performed on 990 and 1036 patients, respectively. A total of 912 ED visits (n=448 post-laminectomy and n=464 post-discectomy) occurred within 90 days of 2165 surgeries. Reasons for ED visits were categorized as medical (42.6%) or surgical (57.4%). For ED visits related to their surgery, wound care (28.0%), pain management (26.5%) and bladder issues (17.9%) were the most common reasons for presentation. Drainage from the incision (serous or blood) and routine wound checks accounted for 59.1% and surgical site infections account for 27.2% of visits related to the wound. Patients presenting with pain as a primary complaint were discharged home with additional pain medications in 69.1% of cases, whereas 26.0% of patients presented in a pain crisis requiring hospital admission. A significant number of patients present to the ED following spine surgery. Multiple areas of care improvement have been identified. Immediate initiatives should be focused on post-operative education, pain management and system change to facilitate wound management outside of the ED.

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.

OBJECTIVE Despite efforts toward achieving gender-based equality in clinical trial enrollment, females are frequently underrepresented and gender-specific data analysis is lacking. Identifying and addressing gender bias in medical decision-making and outcome reporting may facilitate more equitable healthcare delivery. This study aimed to determine if gender differences exist in the clinical evaluation and surgical management of patients with degenerative lumbar conditions. METHODS Consecutive adult patients undergoing spinal surgery for degenerative lumbar conditions (disc herniation [DH], spinal canal stenosis [SCS], and degenerative spondylolisthesis [DS]) were prospectively enrolled across 16 tertiary academic centers. Outcome domains included pain, disability, health-related quality of life (HRQOL), expectations of surgery, and satisfaction with surgical outcome. Covariates pertaining to the preoperative use of healthcare resources, diagnostic testing, and visits to healthcare providers were compared between genders before and after propensity score matching for 13 baseline demographic and procedural variables. RESULTS Data were analyzed for 5038 patients (2396 female, 2642 male) with degenerative spinal pathologies including SCS (40.2%), DS (33.2%), and DH (26.6%). Surgical treatment effect was similar for both genders. For all conditions, female patients had worse pre- and postoperative pain, disability, and HRQOL. Significant gender differences were identified for marital status, education, employment status, exercise activities, and disability claims. Female patients were more likely to use select medications, diagnostic imaging tests, and nonsurgical therapeutic interventions, and access various healthcare providers. Findings were similar following post hoc propensity score matching. CONCLUSIONS In this multicenter, prospective, observational cohort study, male and female patients benefitted similarly from surgery for degenerative lumbar spine disease. However, female patients had worse preoperative clinical assessment scores and were more likely to use select healthcare resources.

BACKGROUND CONTEXT Acute spinal cord injury (SCI) often leaves patients with significant morbidity and even mortality, and for those who do survive, it is unclear what their long-term outcomes may look like. Older patients in particular are at greater risk for poor outcomes, making treatment decisions difficult when their short- and long-term outcomes are challenging to determine. In recent years, frailty indices have been used to help determine the odds of success when providing surgery and are beneficial for shared decision making between health care staff and patients and their families. PURPOSE To develop a frailty index (FI) as a measure of deficits from routine lab values collected for patients following acute SCI. We used this FI to determine if it could be an indicator for short-term and long-term mortality for patients following acute injury. STUDY DESIGN/SETTING This was a retrospective chart review. PATIENT SAMPLE All patients aged 50 and older who were involved in a traumatic SCI within our catchment and were enrolled in the Rick Hansen Spinal Cord Injury Registry were included. OUTCOME MEASURES Mortality in hospital, at 1-year follow-up and at 5-years. Discharge destination. METHODS A FI as a measure of deficits was developed from 38 laboratory and EKG values, with the index ranging from 0-1, with values closer to 1 representing increased frailty. Sequential binary logistic regressions were performed for the outcome of mortality while in-hospital, and at 1-year and 5-year follow-up. Age, sex, the ASIA motor score, and the FI were used as covariates in the model. Significance was obtained at the level of p<0.05. RESULTS A total of 120 patients were identified in this study, with an average age of 67.03 +/-10.23, and 88 patients were men. In hospital, 12 patients died, with mortality increasing to 32 patients within one-year, and 50 within 5-years. Increasing frailty significantly contributed to increased odds or mortality during all follow-ups (p=0.003 in-hospital, p=0.007 at one-year and p=0.028 at 5-years). Only the FI contributed to increased odds of mortality while in hospital, whereas at 1-year follow-up, increasing age (p<0.001) also significantly contributed to increased odds of mortality. At 5-years, increased age (p<0.001) and lower ASIA motor score (p=0.029) also contributed to an increased risk of mortality. For those who survived, 12.5% went to long-term care, with the rest going home. A lower ASIA motor score (p=0.015) and higher FI (p=0.004) contributed to an increased odds of discharge to long-term care. CONCLUSIONS A FI as a measure of deficits from routinely collected lab values can contribute to determining the odds a patient may die, or need long-term care following a SCI. This work can contribute to shared decision making between caretakers and surgeons when it comes to providing appropriate care for patients who experience SCI, as this index can help provide a clearer picture of what long-term outcomes may look like. FDA Device/Drug Status This abstract does not discuss or include any applicable devices or drugs.

Study Design Retrospective cohort study. Objectives The impact of delayed access to operative treatment on patient reported outcomes (PROs) for lumbar degenerative conditions remains unclear. The goal of this study is to evaluate the association between wait times for elective lumbar spine surgery and post-operative PROs. Methods This study is a retrospective analysis of patients surgically treated for a degenerative lumbar conditions. Wait times were calculated from primary care referral to surgery, termed the cumulative wait time (CWT). CWT benchmarks were created at 3, 6 and 12 months. A multivariable logistic regression model was used to measure the associations between CWT and meeting the minimally clinically important difference (MCID) for the Oswestry Disability Index (ODI) score at 12 months post-operatively. Results A total of 2281 patients were included in the study cohort. The average age was 59.4 years (SD 14.8). The median CWT was 43.1 weeks (IQR 17.8 – 60.6) and only 30.9% had treatment within 6 months. Patients were more likely achieve the MCID for the ODI at 12 months post-operatively if they had surgery within 6 months of referral from primary care (OR 1.22; 95% CI 1.11 – 1.34). This relationship was also found at a benchmark CWT time of 3 months (OR 1.33; 95% CI 1.15 – 1.54) though not at 12 months (OR 1.08; 95% CI 0.97 – 1.20). Conclusions Patients who received operative treatment within a 3- and 6-month benchmark between referral and surgery were more likely to experience noticeable improvement in post-operative function.

OBJECTIVE Surgical treatment of degenerative lumbar spondylolisthesis (DLS) reliably improves patient-reported quality of life; however, patient population heterogeneity, in addition to other factors, ensures ongoing equipoise in choosing the ideal surgical treatment. Surgeon preference for fusion or decompression alone influences surgical treatment decision-making. Meanwhile, at presentation, patient-reported outcome measures (PROMs) differ considerably between females and males. The aims of this study were to determine whether there exists a difference in the rates of decompression and fusion versus decompression alone based on patient-reported sex, and to determine if widely accepted indications for fusion justify any observed differences or if surgeon preference plays a role. METHODS This study is a retrospective cohort analysis of patients enrolled in the Canadian Spine Outcomes Research Network (CSORN) DLS study, a multicentered Canadian prospective study, investigating the surgical management and outcome of DLS. Decompression and fusion rates, patient characteristics, preoperative PROMs, and radiographic measures were compared between males and females before and after propensity score matching. RESULTS In the unmatched cohort, female patients were more likely to undergo decompression and fusion than male patients. Females were more likely to have the recognized indications for fusion, including kyphotic disc angle, higher spondylolisthesis grade and slip percentage, and patient-reported back pain. Other radiographic findings associated with the decision to fuse, including facet effusion, facet distraction, or facet angle, were not more prevalent in females. After propensity score matching for demographic and radiographic characteristics, similar proportions of male and female patients underwent decompression and fusion and decompression alone. CONCLUSIONS Although it remains unclear who should or should not undergo fusion, in addition to surgical decompression of DLS, female patients undergo fusion at a higher rate than their male counterparts. After matching baseline radiographic factors indicating fusion, this analysis showed that the decision to fuse was not biased by sex differences. Rather, the higher proportion of females undergoing fusion is largely explained by the radiographic and clinical indications for fusion, suggesting that specific clinical and anatomical features of this condition are indeed different between sexes.

Background: Canadian Emergency Departments (EDs) are overburdened. Understanding the drivers for postoperative patients to attend the ED allows for targeted interventions thereby reducing demand. We sought to identify “bounce back” patterns for subsequent QI initiatives. Methods: From April 1, 2016 to March 31, 2022, all provincial ED datasets (EDIS, STAR, Meditech) identified patients presenting within 90 days post-spine surgery. Using Canadian Classification of Health Interventions codes, laminectomies (1SC80) and discectomies (1SE87) demonstrated the highest ED visit rates. Comprehensive chart reviews were conducted identifying surgical and medical reasons for presentation within this timeframe. Results: Reviewing a cohort of 2165 post-decompression patients, 42.1% presented to the ED (n=912) with 62.8% of these directly related to surgery. Primary reasons included wound care (31.6%), pain management (31.6%), and bladder issues (retention or UTI, 11.0%). Simple wound evaluation constituted 49.7% of wound-related visits, with surgical site infection 37.6% and dehiscence 6.6% accounting for the remainder. Pain-related presentations resulted in 72.3% discharge with additional medications, and 27.7% necessitating hospital admission. New or worsening neurologic deficits were reported in 8.9% of ED visits. Conclusions: These findings illuminate crucial aspects of postoperative care and ED utilization patterns. Prioritizing patient education, pain management, and wound care could help alleviate the national ED crisis.