INTRODUCTION:Unattended clinic visits, or patient no-shows, can have harmful effects on patient health and well being and an unfavorable impact on the revenue stream and financial efficiency of the health system. The objective of this study was to assess potential risk factors associated with clinic no-shows across orthopaedic subspecialties in a large, tertiary care, academic, medical center. METHODS:Clinic appointments labeled as "completed" or "no-show" between January 1, 2021 and June 30, 2023, were retrospectively collected from an outpatient orthopaedic department at a single institution. Patient demographic, socioeconomic, and visit characteristics evaluated as potential risk factors for no-shows included patient age, sex, race, social deprivation index (SDI) at the zip code level, documented social support, employment status, insurance coverage, time between appointment creation and appointment date, orthopaedic subspecialty, appointment type (ie, new versus established patient status), and referral status (ie, self-referred versus referral from a medical provider). Variable selection was done with univariate logistic regression analysis, and adjusted risk of no-shows was estimated using multivariable logistic regression. Matching was done to control for potential confounding from patient age and sex, subspecialty, and appointment type. RESULTS:Overall, 148,352 clinic appointments were included in the primary analysis. Multivariable logistic regression analysis before matching cohorts demonstrated statistically significant associations between no-show appointments and advanced age, female sex, self-identified Black or African American race, unemployment, lack of social support, and Foot and Ankle visits. After cohorts were matched, a total of 22,154 clinic appointments were included in the final analysis with an equal number of "completed" and "no-show" visits. Multivariable logistic regression modeling of the matched no-shows and completed visits demonstrated a higher odds of no-show appointments among patients self-identifying as Black/African American, lacking social support, being unemployed, being a student or retiree, having Medicare insurance, and a having a higher SDI. CONCLUSION:Higher odds of patient no-shows were determined for several patient- and visit-level variables, including Black/African American race, lack of social support, unemployment, Medicare insurance, and higher SDI. LEVEL OF EVIDENCE:III.

STUDY DESIGN:Retrospective cohort study. PURPOSE:This study aimed to examine outcomes in patients with adult spinal deformity (ASD) undergoing deformity correction with and without glucagon-like peptide-1 receptor agonist (GLP-1A) therapy. OVERVIEW OF LITERATURE:GLP-1As, widely used in diabetes management, have recently been linked to reduced postoperative complications. However, their role in spinal surgery remains underexplored. METHODS:This multicenter, retrospective cohort study was conducted using the TriNetX Global Collaborative Database (2005-2025) utilizing Current Procedural Terminology and International Classification of Diseases, 10th Revision, codes for patients undergoing spinal deformity correction because of ASD. Patients prescribed GLP-1As within 1 year of surgery were 1:1 propensity-score matched with those who were not using GLP-1As. The cohort was matched according to patient demographics and comorbidities. Surgical outcomes between groups were analyzed at 1- and 2-year intervals. Significance was defined as p <0.05. RESULTS:At 1 and 2 years following surgery, patients taking GLP-1As exhibited significantly lower odds of pseudoarthrosis, hardware failures, wound dehiscence, infections, thromboembolic events, readmissions, and mortality. CONCLUSIONS:The findings reveal a significant reduction in the rates of pseudoarthrosis, hardware failure, readmission, and mortality in patients treated with GLP-1As. These results align with the recent literature, pointing to a potential complementary therapy in ASD management. Further studies characterizing the mechanism by which GLP-1As affect postoperative spinal physiology are warranted to assess their utility in optimizing patient outcomes.

Study Design: Retrospective review.Objective:To review the traumatic spinal injuries in alpine athletes treated at a single level I trauma center. Summary of Background Data: Recreational and competitive skiers/snowboarders are prone to spinal injuries, and recent changes in the sport may have led to increases in the incidence and severity of spinal injuries. Currently, there is a paucity of data on the epidemiology of spinal injuries resulting from skiing and snowboarding. Methods: A review of patients admitted with traumatic spinal injuries from skiing/snowboarding, between January 2015 and March 2019. Data on demographics, spinal region of injury, mechanism of injury, fracture type, presence/absence of spinal cord injury, ASIA score, management, concomitant injuries, and involvement of other surgical services were collected. Results: Spinal injuries were distributed as 33.3% cervical, 57% thoracic, and 38.0% lumbosacral spine. Seventy-five percent patients injured a single region, 21.7% injured 2 regions, and 3.3% injured all 3. Single-level injuries occurred in 38% patients, II-level in 25%, III-level in 12%, and >3-levels in 28%. Twenty-seven percent patients suffered a spinal cord injury. Eighty-one percent of those had neurological compromise, with a 53.8% rate of full neurological resolution at the time of discharge. 65% fractures were compression-type. Management included operative treatment with decompression and fusion in 32% patients. Cervical spinal injuries were more likely to sustain an extension-distraction type fracture and concomitant spinal cord injury. Thoracic spine injuries were more likely to have multiple vertebral level (>3 vertebrae) involvement. Lumbosacral injuries were more likely to sustain compression type and transverse process fractures. Patients with trauma to all 3 spinal regions were more likely to have translational/rotational injuries, facet fractures, lamina and pedicle fractures, and traumatic anterolistheses. Conclusion: Skiing/snowboarding injuries can be devastating, potentially resulting in permanent neurological compromise and spinal instability. Surgeons and the general population can benefit from improving their understanding of the dangers of alpine sports as it pertains to spinal trauma.

BACKGROUND CONTEXT: Clinical outcomes are directly related to patient selection and treatment indications for improved quality of life. With emphasis on quality and value, it is essential that treatment recommendations are optimized. PURPOSE: The purpose of the North American Spine Society (NASS) Appropriate Use Criteria (AUC) is to determine the appropriate (ie, reasonable) multidisciplinary treatment recommendations for patients with metastatic neoplastic vertebral fractures across a spectrum of more common clinical scenarios. STUDY DESIGN: A Modified Delphi process. PATIENT SAMPLE: Systematic Review. OUTCOME MEASURES: Final rating for cervical fusion recommendation as either "Appropriate," "Uncertain," or "Rarely Appropriate" based on the median final rating among the raters. METHODS: The methodology was based on the AUC development process established by the Research AND Development (RAND) Corporation. The topic of neoplastic vertebral fracture was selected by NASS for its Clinical Practice Guideline development (CPG). In conjunction, the AUC work group determined key modifiers and adopted the standard definitions developed by CPG, with minimal modifications. A literature search and evidence analysis performed by the CPG were reviewed by the AUC work group. A separate multidisciplinary rating group was assembled. Based on the literature, provider experience, and group discussion, each scenario was scored on a 9-point scale on 2 separate occasions, once without discussion and then a second time following discussion based on the initial responses. The median rating for each scenario was then used to determine if indications were rarely appropriate (1-3), uncertain/maybe appropriate (4-6), or appropriate (7-9). Consensus was not mandatory. RESULTS: Medical management was essentially always appropriate. Radiation therapy was appropriate 50% of the time and uncertain otherwise, and directly related to radiosensitivity of the tumor. Ablation was never rated appropriate with agreement, and about 50% of the time was rated as uncertain. For cement augmentation, the scenarios without stenosis or neurological changes, stable fractures with less than 80% height loss and intact posterior wall, and higher VAS pain scores accounted for 88% probability of an appropriate rating. Otherwise, cement augmentation was uncertain 68% of the time. Surgery was rated as appropriate with agreement in 35%, and uncertain or appropriate with disagreement in 59% of scenarios. The most important variables determining final rating for surgery (in order) were stability, spinal stenosis, and prognosis. CONCLUSIONS: Multidisciplinary appropriate treatment criteria were generated based on the RAND methodology. Recommendations were made for medical treatment, ablation, radiation, cement augmentation, and surgery based on 432 practical clinical scenarios. This document provides comprehensive evidence-based recommendations for evaluation and treatment of metastatic neoplastic vertebral fractures. The document in its entirety will be found on the NASS website (https://www.spine.org/Research-Clinical-Care/Quality-Improvement/Appropriate-Use-Crite ria). (c) 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Degenerative cervical myelopathy (DCM) is a progressive condition that can lead to significant neurologic disability if not promptly diagnosed and treated. The presence of a neuromodulation device in the spinal canal, such as a spinal cord stimulator (SCS), can potentially hinder the diagnosis and management of DCM. Here, we report a case of a 53-year-old female patient with a history of complex regional pain syndrome being managed with a cervical SCS, who presented with DCM and rapid neurological deterioration and bilateral lower extremity paralysis. The diagnostic workup was rendered more challenging due to contraindications for MRI related to the implanted SCS. CT myelogram demonstrated multilevel cervical stenosis with cord compression; the cervical leads were believed to contribute to the central stenosis. The patient underwent anterior cervical discectomy and fusion (ACDF) from C4 to C7, resulting in immediate improvement in her motor function and an uncomplicated postoperative course. At discharge, she had regained full strength in the lower extremities. This case highlights the unique diagnostic and management challenges of DCM in patients with pre-existing cervical neuromodulation devices. A high index of suspicion and timely use of alternative imaging modalities were essential for achieving favorable outcomes in this complex patient. Further research is needed to establish evidence-based recommendations for the management of DCM in the setting of neuromodulation devices.

Background:Electronic patient portals (EPPs) facilitate communication between patients and providers, but their utilization and impact in orthopedic spine surgery are poorly defined. This study aims to quantify portal message volume and content, identified demographic predictors of high utilization, and estimated the associated administrative and financial burden. Methods:A retrospective review was conducted of 833 new patients presenting to a single tertiary-care orthopedic spine practice over 6 months (April 2-October 31, 2024). Portal messages were categorized by timeframe and subject matter. Patients were classified as low- or high-volume (HV) users, with HV defined as ≥4 messages. Demographic predictors were assessed using independent t-tests and chi-square analyses. Messages meeting Centers for Medicare and Medicaid Services (CMS) criteria for billable Evaluation and Management (E/M) services were identified and assigned reimbursement values. A Monte Carlo simulation (100,000 iterations; R v4.5.1) estimated lost revenue from unbilled encounters. Results:A total of 548 portal messages were sent (median 0 messages per patient; IQR 0-1). Common message topics included appointment scheduling (n=97), imaging-related concerns (n=94), postoperative issues (n=79), pain management (n=70), and third-party requests (n=59). High-volume utilization occurred in 43 patients (5.2%), with a mean of 5.19 messages per patient (range 3-18). Age was not associated with portal use (p=.276). Race was the only significant predictor of HV utilization (χ²=6.172, p=.046), with White/Caucasian patients overrepresented and Black/African American patients underrepresented. Only 25 messages (4.6%) met CMS billing criteria, primarily Level III E/M encounters (72%). Estimated median lost billable revenue was $7,501 (95% CI $3,845-$12,539). Conclusions:Electronic patient portal (EPP) use in orthopedic spine surgery is highly skewed, with a small subset of patients generating disproportionate message volume. Despite limited billable encounters, portal messaging represents a growing administrative burden. Observed racial disparities highlight the need to further evaluate equity in digital patient engagement.

Retrospective review. To review the traumatic spinal injuries in alpine athletes treated at a single level I trauma center. Recreational and competitive skiers/snowboarders are prone to spinal injuries, and recent changes in the sport may have led to increases in the incidence and severity of spinal injuries. Currently, there is a paucity of data on the epidemiology of spinal injuries resulting from skiing and snowboarding. A review of patients admitted with traumatic spinal injuries from skiing/snowboarding, between January 2015 and March 2019. Data on demographics, spinal region of injury, mechanism of injury, fracture type, presence/absence of spinal cord injury, ASIA score, management, concomitant injuries, and involvement of other surgical services were collected. Spinal injuries were distributed as 33.3% cervical, 57% thoracic, and 38.0% lumbosacral spine. Seventy-five percent patients injured a single region, 21.7% injured 2 regions, and 3.3% injured all 3. Single-level injuries occurred in 38% patients, II-level in 25%, III-level in 12%, and >3-levels in 28%. Twenty-seven percent patients suffered a spinal cord injury. Eighty-one percent of those had neurological compromise, with a 53.8% rate of full neurological resolution at the time of discharge. 65% fractures were compression-type. Management included operative treatment with decompression and fusion in 32% patients. Cervical spinal injuries were more likely to sustain an extension-distraction type fracture and concomitant spinal cord injury. Thoracic spine injuries were more likely to have multiple vertebral level (>3 vertebrae) involvement. Lumbosacral injuries were more likely to sustain compression type and transverse process fractures. Patients with trauma to all 3 spinal regions were more likely to have translational/rotational injuries, facet fractures, lamina and pedicle fractures, and traumatic anterolistheses. Skiing/snowboarding injuries can be devastating, potentially resulting in permanent neurological compromise and spinal instability. Surgeons and the general population can benefit from improving their understanding of the dangers of alpine sports as it pertains to spinal trauma.

STUDY DESIGN:Retrospective review. OBJECTIVE:Examine the utility of intraoperative neuromonitoring (IONM) in anterior cervical spine procedures for myelopathy in informing intraoperative interventions. SUMMARY OF BACKGROUND DATA:The routine use of IONM in anterior cervical spine procedures for myelopathy remains controversial, with poorly defined indications and limited evidence validating protocols for managing intraoperative alerts. METHODS:One hundred ninety-one anterior cervical spine cases with continuous IONM from 2021 to 2025 were included, excluding revisions and nondegenerative conditions. The incidence of IONM alert was recorded for both myelopathic (n=111) and non-myelopathy (n=80) groups. Alerts were characterized by associated surgical event, intraoperative interventions, duration and resolution, and correlation with new postoperative deficit. Patient demographic and procedural variables, including total monitoring time and blood pressure fluctuations, were assessed for confounding. RESULTS:Intraoperative alerts occurred in 42 patients, with a higher incidence of alert in the myelopathic group (28, 25.2%) than the non-myelopathic group (14, 17.5%) (P = 0.220). The most common event at the time of alert was instrumentation (30%) followed by decompression (27%) and patient positioning (21%). Intraoperative interventions in response to alerts included increased stimulation parameters, anesthetic adjustment, patient repositioning, or reversal of last surgical maneuver. Alerts in the myelopathic group were more likely to remain unresolved at closing [P = 0.007159; OR = 5.718, 95% CI (1.369, 29.523)] and associated with a lower positive predictive value for new postoperative deficit (0.29 vs. 0.50). Total monitoring time was the only variable significantly associated with alert incidence (P = 0.0004). CONCLUSIONS:Myelopathic patients experienced a higher incidence of IONM alerts and were significantly more likely to have unresolved alerts at closure. However, alerts demonstrated limited predictive value for new postoperative deficits.

Study Design:Retrospective review.Objective:To use opportunistic computed tomography (CT) screening to determine the prevalence of osteoporosis (OP) in patients presenting with spinal fractures and the rate of identification and treatment at our institution.Background:OP remains a highly underdiagnosed and undertreated disease. Opportunistic abdominopelvic CT scans offer a feasible, accessible, and cost-effective screening tool for OP.Methods:Retrospective review of 519 patients presenting as trauma activation to the emergency department of a Level 1 Trauma Center after a spinal fracture. Patients were excluded if under the age of 18 or lacking a CT scan upon arrival in the emergency department. Hounsfield Units (HU) were measured at the L1 vertebral level on CT scans to determine bone density levels. Values of <= 100 HU were considered osteoporotic, whereas 101-150 HU were osteopenic.Results:A total of 424 patients were included. The average HU was 204.8 +/- 74.3 HU. Of the patients, 16.7% were diagnosed as osteopenic and 9.9% as osteoporotic. The mean age was 65 +/- 14 years for osteopenic patients and 77 +/- 11 years for osteoporotic. A statistically significant inverse relationship was found between age and bone density. Of the patients, 42.5% with low bone density HU measurements had a previously documented history of OP/osteopenia. There was a statistically significant association between females and low bone density. Patients injured in a fall were statistically significantly more likely to have lower bone densities than those in motor vehicle accidents. Of the osteoporotic patients, 9.5% were treated by our institution's fragility fracture team.Conclusions:Our study shows that among a cohort of patients with spinal fractures, 58% of patients with radiographic signs of OP are currently undiagnosed, resulting in a low treatment rate of OP. Increasing and standardizing the use of opportunistic CT scans would allow an increase in the diagnosis and treatment of OP in patients with spinal fractures. Further, opportunistic CT scans could also be useful for a broader orthopedic population at high risk of fragility fractures.Level of Evidence:Level II-therapeutic.

Study DesignLiterature review with clinical recommendations.ObjectiveTo highlight important studies related to spinopelvic fixation and provide recommendations to practicing clinicians on interpretation and utilization of the evidence included in these studies.MethodsImportant literature related to spinopelvic fixation was reviewed and clinical recommendations were formulated. Recommendations were graded as strong or conditional.ResultsThree articles were selected and reviewed for the strength of methodology and scientific evidence. Article 1: Biomechanical analysis of lumbosacral fixation in Lumbar Fusion and Stabilization was granted conditional recommendation to consider biomechanical factors associated with different pelvic constructs. Article 2: Low profile pelvic fixation: anatomic parameters for sacral alar-iliac fixation vs traditional iliac fixation was granted strong recommendation to consider risk and benefits in choosing S2AI vs traditional iliac screw for pelvic fixation. Article 3: Rates of loosening, failure, and revision of iliac fixation in adult deformity surgery was granted a conditional recommendation, for taking into account different potential failure mechanisms in S2AI vs traditional iliac screws in pelvic fixation.ConclusionsCurrently evolving strategies have included multiple points of pelvic fixation, multiple rods to the pelvis and strategies with concomitant fusion of the sacro-iliac joints. The high mechanical failure rate at the lumbosacral junction indicates that there is still further opportunity for optimization. It is important to consider the risks and benefits of different pelvic fixation methods to optimize the outcomes for individual patients.

BACKGROUND CONTEXT:Understanding optimal training environments for future academic leaders is a topic of increasing interest in spine surgery. PURPOSE:This study determined the association between surgeon factors and future academic faculty appointment after spine surgery fellowship training. STUDY DESIGN/SETTING:This was a retrospective observational study of spine surgery fellows in the United States (2016-2017 to 2022-2023). PATIENT SAMPLE:N/A. OUTCOME MEASURES:The primary outcome of interest was future academic faculty appointment, which was assigned if the spine surgeon was employed at a teaching hospital. Demographic, bibliometric, and training characteristics of spine surgery fellows were obtained. METHODS:Bivariate analyses were performed to determine the association between surgeon factors and future academic faculty appointment. RESULTS:There were 654 spine surgery fellows and 243 were appointed to academic faculty positions (37.2%). There was no difference in the rate of future academic faculty appointment between male and female spine surgeons (36.7% vs 45.7%, p=.368). Allopathic graduates were more likely to obtain academic faculty positions than osteopathic graduates (40.6% vs 12.5%, p<.001). Compared to spine surgeons in private practice, spine surgeons in academic practice had more peer-reviewed publications during medical school (1±3 vs 0±2, p<.001) and orthopedic surgery residency training (5±13 vs 3±5, p<.001). Several characteristics of spine surgery fellowship programs were associated with future academic faculty appointment including geographic region (p=.013), Accreditation Council for Graduate Medical Education (ACGME) accreditation status (p<.001), and a greater volume of annual fellows (p=.003). CONCLUSIONS:Several factors were associated with future academic faculty appointment in spine surgery including higher scholarly output during medical school and orthopedic residency. These data may ultimately help trainees and fellowship selection committees in spine surgery align on desired academic career objectives.

Study DesignRetrospective Cohort Study.ObjectivesThe purpose of this study was to identify the role of lumbar paraspinal muscle fatty infiltration using the Goutallier classification in predicting perioperative outcomes following elective lumbar surgery.MethodsA retrospective review was conducted on patients who underwent elective one- or two-level lumbar decompressions or instrumented fusions for degenerative pathology at a single institution over a 3 year period. Patients were stratified by procedure type. Data included demographics, perioperative outcomes, and the 5-item Modified Frailty Index (MFI-5). Fatty infiltration was graded at L4-5 using the Goutallier classification (intraclass correlation coefficient = 0.908). Opportunistic osteoporosis screening used computed tomography-based Hounsfield units (HU) at L1-2. The relationships between Goutallier grade, demographics, MFI-5 score, and postoperative outcomes were analyzed using Chi-squared analyses, Fisher's exact test, Analysis of Variance, and multivariable logistic and linear regression.ResultsIn total, 314 patients met the inclusion criteria. Mean age was 68.9 ± 8.6 years; mean Goutallier score was 2.2 ± 1.1 and MFI-5 was 1.3 ± 1.0. Goutallier score significantly correlated with age, American Society of Anesthesiologists grade, steroid use, MFI-5, discharge disposition, and 180 day complications and reoperation. Subgroup analyses revealed differing associations between Goutallier score and comorbidities/outcomes across procedure types. Multivariable regression confirmed Goutallier score as predictive of 180 day complications, reoperation, non-home discharge, and frailty.ConclusionGoutallier score is a predictive marker of frailty and postoperative outcomes in lumbar spine surgery. Goutallier classification is an effective tool that can aid in risk stratification for patients undergoing lumbar spinal surgery.

BACKGROUND CONTEXT:There is a lack of consensus regarding optimal indications for treatment of patients with osteoporotic vertebral fractures. An opportunity exists to improve outcomes if these indications can be clarified. PURPOSE:The purpose of the North American Spine Society (NASS) Appropriate Use Criteria (AUC) was to determine the appropriate (ie, reasonable) multidisciplinary treatment recommendations for patients with osteoporotic vertebral fractures across a spectrum of more common clinical scenarios. STUDY DESIGN:A Modified Delphi process. PATIENT SAMPLE:Modified consensus based guideline. OUTCOME MEASURES:Final rating for treatment recommendations as either "Appropriate," "Uncertain," or "Rarely Appropriate" based on the median final rating among the raters. METHODS:The methodology was based on the AUC development process established by the Research AND Development (RAND) Corporation. The topic of osteoporotic vertebral compression fracture was selected by NASS for its Clinical Practice Guideline development (CPG). In conjunction, the AUC committee determined key modifiers and adapted the standard definitions developed by the CPG with minimal modifications. A literature search and evidence analysis performed by the CPG were reviewed by the AUC work group. A separate multidisciplinary rating group was assembled. Clinical scenarios were generated based on a matrix of the modifiers, to rate the appropriateness of medical management, cement augmentation, or surgery. Based on the literature, provider experience, and group discussion, each scenario was scored on a 9-point scale on two separate occasions: once without discussion and again following discussion of the initial responses. The median rating for each scenario and level of agreement was then used to determine final indications as rarely appropriate with agreement (1 - 3), uncertain or disagreement (4-6), or appropriate with agreement (7-9). Consensus was not mandatory. RESULTS:Medical management was appropriate across all scenarios. Cement augmentation was rarely appropriate in 60% of scenarios and uncertain or disagreement in 35% of scenarios. In the 5% of scenarios rated as appropriate with agreement for cement augmentation, high pain scores, acute duration, and simple fracture pattern were always present. Surgery was appropriate in 35% of scenarios and strongly influenced by instability and stenosis with neurological findings. Surgery was rarely appropriate in 18%, and uncertain or disagreement in 47% of scenarios. CONCLUSIONS:Multidisciplinary appropriate treatment criteria for osteoporotic vertebral fractures were generated based on the RAND methodology. This document provides comprehensive evidence-based recommendations for evaluation and treatment of osteoporotic vertebral fractures. The document in its entirety will be found on the NASS website (https://www.spine.org/Research-Clinical-Care/Quality-Improvement/Appropriate-Use-Criteria).

This case report aims to demonstrate the feasibility of performing spinal surgery in patients with a left ventricular assist device (LVAD), who are traditionally considered unsuitable candidates due to the need for anticoagulation and the challenges associated with the prone position. A case of a patient with an LVAD undergoing microdiscectomy in the left lateral decubitus position is presented. The procedure was carried out by a specialized interdisciplinary team with appropriate monitoring. The patient underwent the procedure safely, demonstrating that spinal surgery can be performed in patients with LVAD without reversing anticoagulation or resorting to the prone position. This approach mitigates the risk of thrombotic events and hemodynamic instability. This case study suggests that spinal surgery, specifically microdiscectomy, can be safely performed in patients with LVAD using the left lateral decubitus position. This finding has significant implications for patients who are unable to ambulate and therefore struggle to qualify for a heart transplant.

Background Context Despite increasing awareness, women remain underrepresented in academic spine surgery. Purpose This study assessed whether women were equitably represented among spine surgeon principle investigators (PIs) of clinical trials for degenerative spine disease research. Study Design/Setting This was a retrospective cohort study of spine surgeon principal investigators (PIs) in the United States (2015–2022). Patient Sample N/A Outcome Measures Participation-to-prevalence ratios (PPRs). Methods Clinicatrials.gov was queried for the most common diagnoses and surgeries for degenerative spine diseases. Characteristics of spine surgeon PIs were collected from academic profiles. PPRs were calculated for men and women PIs relative to their prevalence among spine surgery faculty at accredited training programs. A PPR of 0.8-1.2 indicated equitable sex representation. A PPR <0.8 was defined as underrepresentation and >1.2 as overrepresentation. Results In total, 129 spine surgeon PIs of 91 clinical trials were included in this study. Overall, there were 125 male (97%) and 4 female (3%) spine surgeon PIs. Overall, women were underrepresented among spine surgeon PIs (PPR=0.64) while men had equitable representation (PPR=1.02). From 2015 to 2018, female spine surgeons were underrepresented (PPR=0.33), but achieved equitable representation from 2019 to 2022 (PPR=0.95) (Figure 1). Male spine surgeons had consistently equitable representation across the study period (PPR range 1.00-1.03). Women had equitable representation at assistant (PPR=1.08) and associate (PPR=0.31) professor ranks but were underrepresented at the full professor rank (PPR=0) (Figure 2). PIs were funded by Industry (54%), Academic Institution (44%), and US Federal (2%) sources. There were no differences in funding sources by sex (P=0.36). Conclusions There are a limited number of female spine surgeon PIs for degenerative spine disease clinical trials, which may have negative implications on patient recruitment and workforce diversity. Future investigations are needed to understand the barriers women face in obtaining clinical trial leadership positions. FDA Device/Drug Status This abstract does not discuss or include any applicable devices or drugs.

STUDY DESIGN:Systematic review. OBJECTIVES:The study's primary objective was to determine how osteobiologic choice affects fusion rates in patients undergoing anterior cervical discectomy and fusion (ACDF). The study's secondary objectives were to 1) determine the optimal timing of fusion assessment following ACDF and 2) determine if osteobiologic type affects the timing and optimal modality of fusion assessment. METHODS:A systematic search of PubMed/MEDLINE was conducted for literature published from 2000 through October 2020 comparing anterior fusion in the cervical spine with various osteobiologics. Both comparative studies and case series of ≥10 patients were included. RESULTS:A total of 74 studies met the inclusion criteria. Seventeen studies evaluated the efficacy of autograft on fusion outcomes, and 23 studies assessed the efficacy of allograft on fusion outcomes. 3 studies evaluated the efficacy of demineralized bone matrix, and seven assessed the efficacy of rhBMP-2 on fusion outcomes. Other limited studies evaluated the efficacy of ceramics and bioactive glasses on fusion outcomes, and 4 assessed the efficacy of stem cell products. Most studies utilized dynamic radiographs for the assessment of fusion. Overall, there was a general lack of supportive data to determine the optimal timing of fusion assessment meaningfully or if osteobiologic type influenced fusion timing. CONCLUSIONS:Achieving fusion following ACDF appears to remain an intricate interplay between host biology and various surgical factors, including the selection of osteobiologics. While alternative osteobiologics to autograft exist and may produce acceptable fusion rates, limitations in study methodology prevent any definitive conclusions from existing literature.

This study aims to conduct a systematic review of the literature comparing pre-operative, intraoperative, and post-operative characteristics between adolescent idiopathic scoliosis (AIS) and young adult idiopathic scoliosis (YAdIS) patients. Following PRISMA guidelines, we conducted a search of the PubMed/Medline, EMBASE, and Cochrane Central databases to identify full-text articles in the English-language literature. Our inclusion criteria were studies that compared preoperative, intraoperative, and postoperative characteristics between AIS and YAdIS patients. We performed a meta-analysis reporting mean difference (MD) for continuous variables and Odds ratios (ORs) to assess differences in postoperative complications. Seven studies consisting of 1562 patients were included in the meta-analysis. The AIS group exhibited less intraoperative bleeding and shorter surgical procedures, with a mean difference between groups of 122.3 ml (95

BACKGROUND CONTEXT:Sex diversity in the spine surgery workforce remains limited. Accelerated efforts to recruit more female trainees into spine surgery fellowship training may help promote diversity and inclusion in the emerging spine surgery workforce. PURPOSE:This study assessed the representation of female trainees in spine surgery fellowship training and program factors associated with greater sex diversity among fellows. STUDY DESIGN/SETTING:This was a cross-sectional analysis of spine surgery fellows in the United States during the 2016-2017 to 2022-2023 academic years. PATIENT SAMPLE:N/A. OUTCOME MEASURES:Representation (%) and participation-to-prevalence ratios (PPRs) defined as the participation of female trainees in spine surgery fellowship training divided by the prevalence of female trainees in previous training cohorts. PPR values <0.8 indicated underrepresentation. METHODS:Sex diversity was assessed among spine surgery faculty, spine surgery fellows, orthopaedic surgery residents, neurosurgery residents, and allopathic medical students. Fellowship program characteristics associated with increased sex diversity were calculated with chi square tests. RESULTS:There were 693 spine surgery fellows and 41 were female (5.9%). Sex diversity in spine surgery fellowship training decreased over the study period (6.4% vs 4.1%, p=.025). Female trainee representation in spine surgery fellowship training was less than that in orthopaedic surgery residency (14.2%, PPR=0.42), neurosurgery residency (17.1%, PPR=0.35), and allopathic medical school (47.6%, PPR=0.12) training (p<.001). There were 508 faculty at 78 spine surgery fellowships and 25 were female (4.9%). There were 3 female fellowship program directors (3.8%). Fellowship program characteristics associated with increased sex diversity included the presence of female faculty (p=.020). Additional program characteristics including geographic region, accreditation status, number of faculty and fellows were not associated with sex diversity (p>.05). CONCLUSIONS:Female representation in spine surgery fellowship training decreased over the study period and remains underrepresented relative to earlier stages of medical and surgical training. There was a positive association between female faculty and increased sex diversity among fellows. Greater efforts are needed to create training environments that promote diversity, equity, and inclusion in spine surgery fellowship training.

Background: Vertebral compression fractures (VCFs) cause significant morbidity in the elderly population. This study aimed to determine the difference in pain-related outcomes in the elderly population who suffered vertebral body fractures, treated with balloon kyphoplasty at ''early'' (<4 weeks) and ''late'' (>4 weeks) stages. To the best of our knowledge, this has not been previously evaluated in a meta-analysis. Methods: We conducted a systematic literature review as per PRISMA guidelines using databases that included PubMed, EMBASE, Cochrane and Scopus.The search included adults (age 19+) who sustained osteoporotic vertebral compression fractures that were treated with BKP, grouped by time to intervention as compared to conservative treatment to determine impact on radiographic and clinical outcomes. Results: A total of 9 studies were included from a total of 139 screened records eligible for title and abstract screening after deduplication (39 PubMed, 85 EMBASE, 6 Cochrane, 50 Scopus). The total study sample size was 595. Of these, 6 studies defined their “Early” group as < 4 weeks and were included in our sub-analyses. In regard to pain scores we found a significant improvement in pain score in the early vs. late group. However, we did not find a significant correction in kyphotic correction. Conclusions: Our study suggests that early treatment of vertebral compression fractures with Balloon Kyphoplasty (BKP), defined as < 4 weeks, provides a statistically significant improvement in pain scores and kyphotic angle correction compared to late treatment (>4 weeks). However, no statistically significant differences were observed in terms of height restoration or the risk of adjacent level fractures. These findings support the benefits of early intervention for pain relief and alignment, though further research is needed to standardize methodologies and assess long-term outcomes.