Study Design. Retrospective review of patients who underwent multilevel posterior cervical interfacet distraction and fusion (PCIDF) using cages for cervical spondylotic radiculopathy (CSR). Objective. To determine clinical and radiographic outcomes following multilevel PCIDF. Summary of Background Data. Anterior cervical discectomy and fusion has long been the standard of treatment for CSR. Advancements in surgery have employed minimally invasive techniques such as endoscopic discectomy, foraminotomy, and PCIDF. Studies on single-level PCIDF have reported good clinical outcomes, short hospital stays, and rare complications, but its application in multilevel disease is still evolving. Methods. Patients with CSR and confirmed radiologic evidence of multilevel foraminal stenosis without central canal stenosis were reviewed. Two-year outcomes of multilevel PCIDF included Neck Disability Index, neck and arm Visual Analogue Scale (VAS), radiographic cervical alignment parameters, evidence of fusion, and incidence of adjacent segment degeneration were compared at different time points. Results. Thirty patients (mean age 54.6 AE 8.3) were included in the study with an average of 3.4 AE 0.8 levels treated. Mean surgical duration and intraoperative blood loss was 143.2 AE 69.7 minutes and 27.7 AE 28.7 mL, respectively, with an average length of stay at 1.8 AE 1.5 days. Neck Disability Index, VAS-neck, and VAS-arm all significantly improved at 2 weeks (P < 0.001) and was maintained until 2 years postoperatively. A significant decrease in segmental and C2-C7 lordosis, with a corresponding increase in sagittal vertical axis, was observed at 3 months postoperatively (P < 0.001) but did not deteriorate further on subsequent visits. Successful fusion was achieved in 90% of patients after 2 years. There was a 13.3% incidence of adjacent segment degeneration in the study cohort and one perioperative complication (3.3%). Conclusion. Our study suggests that multilevel PCIDF is safe and effective for CSR caused by foraminal stenosis. However, its potential to cause kyphosis and clinical impact on global sagittal alignment requires further scrutiny and long-term evaluation.

Background: Remdesivir has shown a positive impact on patient's clinical improvement with COVID-19 and could represent and future viral infections.Results: 16 out of 37 patients presented bradycardia, 4 of these patients had QTc > 450 ms. Infusion for 3 days or more of infusion had a higher incidence of bradycardia (12 vs 4 patients). Overall, patients without bradycardia had a longer hospitalization (20.5 vs 15.5 days); 7 patients died, 2 of them had bradycardia. Conclusion:Our results have shown clear evidence of bradycardia after remdesivir infusion. Prospective, double-blinded, and randomized studies with an evident representative sample size with various ethnicities and races are highly needed earlier than later to establish these important findings.

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Background/Purpose The high prevalence of hypovitaminosis D among trauma patients have been related to risk of fractures, falls, non-union and poor operative outcomes. There is limited evidence that ties up Vitamin D levels with fracture severity. The objective of this study is to determine the association of pre-operative Vitamin D levels and fracture severity. Methods This was a retrospective, cross-sectional study of patients with extremity fractures classified according to the AO Trauma classification system with baseline pre-operative vitamin D levels. The association between vitamin D levels and fracture severity of surgically treated trauma patients were analyzed. Sub-group analysis was performed on patients without osteoporosis and those patients who suffered from low-energy trauma. Results Ninety-six (96) patients were included. Those with severe fractures (AO -C fractures, 31B1.3/B2.3 and 31A3) were associated with lower Vitamin D levels (µ  =  17.87 µg/mL) (p < 0.001). There was a strong, positive significant correlation ( rs (4)  =  .426, p  =  < 0.001) between hypovitaminosis D and increasing fracture severity. This significant association of hypovitaminosis D with worse fracture patterns remains in the patient sub-group without osteoporosis ( p  =  0.030), and in those who sustained low-mechanism injuries (­ p­ < 0.001). Conclusion We present initial evidence that low pre-operative Vitamin D level is associated with increasing fracture severity at the time of injury. Early detection, surveillance and management of low vitamin D levels can lead to drastic changes in the holistic approach to fracture prevention and treatment.