» Dropped head syndrome is a group of disorders with diverse etiologies involving different anatomical components of the neck, ultimately resulting in a debilitating, flexible, anterior curvature of the cervical spine.» Causes of dropped head syndrome include myasthenia gravis, amyotrophic lateral sclerosis, Parkinson disease, radiation therapy, and cumulative age-related changes. Idiopathic cases have also been reported.» Nonoperative treatment of dropped head syndrome includes orthotic bracing and physical therapy.» Surgical treatment of dropped head syndrome consists of cervical spine fusion to correct the deformity.» The limited data available examining the clinical and radiographic outcomes of surgical intervention indicate a higher rate of complications with the majority having favorable outcomes in the long term.

Staphylococcus aureus and Streptococcus agalactiae (Group B streptococcus, GBS) are common causes of deep musculoskeletal infections (MSKI) and result in significant patient morbidity and cost to the healthcare system. One of the major challenges with MSKI is the lack of faithful diagnostics to correctly identify the primary pathogen, as standard culture-based assays are prone to false positives in the case of polymicrobial infections, and false negatives due to limitations in sample acquisition and antibiotic use before presentation. To improve upon our current diagnostic methods for MSKI, we developed a multiplex immunoassay for antigenspecific IgGs in serum (Luminex), and medium enriched for newly synthesized antibodies (MENSA) for anti-S. aureus and GBS generated from cultured peripheral blood mononuclear cells (PBMCs) of orthopedic infection patients undergoing surgical treatment. Samples were obtained from 110 MSKI patients: 80 diabetic foot ulcer, 21 periprosthetic joint infection, 5 septic arthritis, 2 spine, 1 hand, and 1 fracture-related infection (FRI). Anti-S. aureus and anti-GBS antibody titers were compared to culture results to assess their concordance in identifying the pathogens. Immunoassay, particularly MENSA, showed high diagnostic potential for monomicrobial S. aureus and GBS orthopedic infections (AUC > 0.95). MENSA also demonstrated diagnostic potential for GBS polymicrobial orthopedic infection and for GBS DFU (AUC > 0.83 for both). Serum showed high diagnostic potential for S. aureus PJI (AUC > 0.95). Taken together, these findings support the development of species-specific immunoassays for the identification of causal pathogens in active MSKI, especially in conjunction with standard culture.

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Study Design. Retrospective cross-sectional analysis.Objective. The aim of this study was to establish the strength of relationship between the Patient-reported Outcomes Measurement Information System (PROMIS) Adult Depression (AD), Physical Function (PF), and Pain Interference (PI) with the Swiss Spinal Stenosis Questionnaire (SSSQ) in assessing lumbar spinal stenosis (LSS). Summary of Background Data. In 2009, there were >35,000 surgeries for LSS, which amounted to $1.65 billion in health care cost. By 2021, there will be >2.4 million people in the United States with symptomatic LSS. There is an increasing emphasis on patient-reported outcomes (PROs) to define value in medicine. Therefore, it would be beneficial to compare PROMIS, a universal PRO, against the SSSQ, the ''criterion standard'' for assessing LSS. Methods. Eighty-two patients with LSS completing the PROMIS and SSSQ were enrolled. Per existing institutional protocol, PROMIS AD, PF, and PI were completed at every clinic visit. Linear regression analysis was then performed to evaluate how well the SSSQ and PROMIS scores correlated to each other. Results. When linear regression was performed for pretreatment values, the R 2 value for the SSSQ PF versus PROMIS PF was 0.14 (P ¼ 0.0008), whereas the R 2 value for the SSSQ symptom severity versus PROMIS PI was 0.03 (P ¼ 0.13). The R 2 value for the combined SSSQ physical function and symptom severity versus PROMIS AD was 0.07 (P ¼ 0.02). When post-treatment SSSQ satisfaction scores were correlated to postoperative PROMIS AD, PI, and PF scores, the R 2 values for a good linear fit were 0.13, 0.25, and 0.18 respectively (P values: 0.01, 0.003, and 0.003). Conclusion. Pre-treatment PROMIS scores do not adequately capture the disease-specific impact of spinal stenosis, but postoperative PROMIS scores better reflect outcomes after surgery for LSS. PROMIS scores should not be used in isolation to assess outcomes in patients with LSS.

Category: Diabetes; Other Introduction/Purpose: The incidence of Streptococcus agalactiae (Group B Streptococcus, GBS) infection in diabetic foot ulcers (DFU) has been on the rise. Severe soft tissue damage, which often leads to septicemia and amputation, has been reported in many cases. With the paucity of literature, we aimed to investigate the clinical outcome of GBS infected DFU patients. We hypothesize that GBS patients have a greater severity of infection as indicated by elevated inflammatory markers, more frequent wound complication, and a higher rate of unplanned readmission and reoperation. Methods: Data was retrospectively collected in a single academic orthopedic surgeon’s practice from February 2015 to October 2019. Seventy-eight patients with infected DFUs who underwent surgical treatment formed the basis of this study. Infected bone samples were obtained intraoperatively and sent for standard culture. The microbe data, demographic data (age, gender, race, ethnicity, and BMI), comorbidities, and initial lab values (HgA1C, CRP, ESR, WBC, and glucose) were recorded for all patients. Sixteen GBS infected DFU patients (20.5%) were identified. Among them, GBS infection occurred in 9 acute (<2 wks), 2 subacute (4-6 wks), and 5 chronic (>6 wks) DFUs. Clinical outcome was assessed by surgical outcome, wound healing status, post-operative complications, unplanned readmission, and unplanned reoperation within 3 months following initial surgery. Mean, standard deviation, percentage and range were calculated for patient demographics and inflammatory markers. Statistical significance of inflammatory markers between patients with and without GBS was also calculated. Results: The initial procedures were irrigation and debridement (n=11), toe amputation (n=1), ray amputation (n=2), transmetatarsal amputation (n=1), and a partial calcanectomy (n=1). Five GBS patients (31.3%), as compared to eighteen (29%) DFU patients without GBS, developed post-surgical complications (wound dehiscence, recurrent infection, septicemia) which required unplanned readmission and reoperation. Repeat operations were irrigation and debridement (n=1), metatarsal ray amputation (n=1), ray amputation (n=1), and below knee amputation (n=2) with average number of 2 repeat operations (range: 1 - 5). Hemoglobin A1C (p=.0067) was statistically higher in GBS patients. When comparing acute GBS ulcers (n=9) and acute ulcers without GBS (n=18), CRP (p=.037), HgA1C (p=.026), and blood glucose (p=.046) were all found to be significantly higher in patients with GBS DFUs. Conclusion: GBS infected DFU patients generally showed more extensive and severe soft tissue inflammation, as indicated by higher inflammatory markers at initial presentation. Compared to other patients with DFUs, GBS patients had significantly higher HgA1C values, and in those experiencing acute ulcers, had higher CRP, HgA1C, and blood glucose values. They have higher rates of post-operative complications that required unplanned readmission and reoperation at more proximal level. Surgeons should consider time sensitive and aggressive surgical treatment for GBS infected DFUs and counsel patients on the high risk of post- operative complications and repeat surgery. [Table: see text]