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Study Design. Retrospective cohort analysis.Objective. The aim of this study was to compare postoperative outcomes of Coflex interspinous device versus laminectomy. Summary of Background Data. Coflex Interlaminar Stabilization device (CID) is indicated for one-or two-level lumbar stenosis with grade 1 stable spondylolisthesis in adult patients, as an alternative to laminectomy, or laminectomy and fusion. CID provides stability against progressive spondylolisthesis, retains motion, and prevents further disc space collapse. Methods. Patients !18 years' old with lumbar stenosis and grade 1 stable spondylolisthesis who underwent either primary single-level decompression and implantation of CID, or singlelevel laminectomy alone were included with a minimum 90-day follow-up at a single academic institution. Clinical characteristics, perioperative outcomes, and postoperative complications were reviewed until the latest follow-up. x 2 and independent samples t tests were used for analysis. Results. Eighty-three patients (2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019) were included: 37 cases of single-level laminectomy (48.6% female) were compared to 46 single-level CID (50% female). CID cohort was older (CID 69.0 AE 9.4 vs. laminectomy 64.2 AE 11.0, P ¼ 0.042) and had higher American Society of Anesthesiologists (ASA) grade (CID 2.59 AE 0.73 vs. laminectomy 2.17 AE 0.48, P ¼ 0.020). CID patients had higher estimated blood loss (EBL) (97.50 AE 77.76 vs. 52.84 AE 50.63 mL, P ¼ 0.004), longer operative time (141.91 AE 47.88 vs. 106.81 AE 41.30 minutes, P ¼ 0.001), and longer length of stay (2.0 AE 1.5 vs. 1.1 AE 1.0 days, P ¼ 0.001). Total perioperative complications (21.7% vs. 5.4%, P ¼ 0.035) and instrumentation-related complication was higher in CID (10.9% vs. 0% laminectomy group, P ¼ 0.039). There were no other significant differences between the groups in demographics or outcomes. Conclusion. Single-level CID devices had higher perioperative 90-day complications, longer operative time, length of stay, higher EBL compared to laminectomies alone. Similar overall revision and neurologic complication rates were noted compared to laminectomy at last follow-up.

Background: There is controversy as to whether fusions should have the upper instrumented vertebrae (UIV) end in the upper lumbar spine or cross the thoracolumbar junction. This study compares outcomes and reoperation rates for thoracolumbar fusions to the sacrum or pelvis with UIV in the lower thoracic versus lumbar spine to determine if there is an increased reoperation rate depending on UIV selection.Methods: A retrospective review of prospectively collected data was conducted from a single-center database on adult patients with degeneration and deformity who underwent primary and revision fusions with a caudal level of S1 or ilium between 2012 and 2018. Fusions were classified as anterior, posterior, or combination approach. Revision fusions included patients who had spinal surgery at another institution prior to their revision surgery at the center. Patients were categorized into 1 of 3 groups based on UIV: T9-T11, upper lumbar region (L1-L2), and lower lumbar region (L3-L5). Inclusion criteria was age 18 years or older and at least 1 year of clinical follow-up. Patients were excluded from analysis if they had tumors, infections, or less than 1 year of follow-up after the index procedure.Results: The reoperation rates for the UIV groups in the thoracic (28%) and upper lumbar (27%) spine were nearly equal in magnitude and were both significantly higher than the reoperation rate in the lower lumbar group (18%, P ¼ .046). Reoperation for the diagnosis of adjacent segment disease was 8.3% in the upper lumbar spine and statistically significantly higher than the reoperation rates for adjacent segment disease in the thoracic (1%) or lower lumbar (4.5%, P ¼ .042) spine. Reoperations for pseudoarthrosis and proximal junctional kyphosis were 13% and 4%, respectively, in the thoracic spine, both of which were statistically significantly different (pseudoarthrosis, P ¼ .035; proximal junctional kyphosis, P ¼ .002) from the reoperation rates for the same diagnoses in the upper lumbar spine (4.6% and 1%) or lower lumbar spine (6.2% and 0%). A multivariate logistical regression model at 2-year follow up did not show a statistically significant difference between reoperation rates between the thoracic and upper lumbar spine UIV groups.Conclusion: Constructs with UIV in the thoracic spine suffer from higher rates of proximal junctional kyphosis and pseudoarthrosis, whereas those with UIV in the upper lumbar spine have higher rates of adjacent segment disease. Given this tradeoff, there is no certain recommendation on what UIV will result in a lower reoperation rate in thoracolumbar fusion constructs to the sacrum or pelvis. Surgeons must evaluate patient characteristics and risks to make the optimal decision. Lumbar Spine

Background Glenoid component positioning is an important and challenging aspect of total shoulder arthroplasty. The use of freehand technique with standard instrumentation or preoperative planning based on 2-dimensional computed tomography (CT) scans provides an opportunity for improvement in terms of component accuracy, precision, and deformity correction. These techniques have produced varying outcomes. Methods Preoperative planning software (PPS), patient specific instrumentation (PSI), and intraoperative navigation (NAV) have been developed to improve the accuracy of implant placement and deformity correction with the ultimate goals of improved patient outcomes and implant longevity. Literature search was conducted on published and available studies comparing the accuracy of glenoid component placement and improvements in surgical and patient outcomes amongst the aforementioned techniques. Results PPS, PSI, and NAV have demonstrated improved accuracy over freehand techniques with standard instrumentation. However, data demonstrating the clinical benefit and cost effectiveness of these new technologies are lacking. Discussion In this paper, we reviewed the evidence available to answer the question of whether or not advanced shoulder arthroplasty technologies have been beneficial and reviewed future technologies in development such as virtual/mixed-reality and robotic assisted shoulder surgery. Level of Evidence 4.