No abstract

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.

No abstract

Twenty-two low lumbar burst fractures (L3-L5) were treated, with an average follow up of 56.2 and 39.0 months in the conservative and surgically treated groups, respectively. Twenty patients were available for review; seven were treated conservatively and 13 were stabilized surgically. All patients were evaluated clinically for work status, activity level, residual pain, and subsequent development of neurologic symptoms. Roentgenograms were reviewed for severity of initial fracture, canal compromise, and maintenance of initial correction. In general, neurologically intact patients in both groups returned to similar postinjury employment levels. Persistent back pain was found to be more disabling in the surgically treated group, in which a fusion incorporating four or five lumbar segments was performed. There was no evidence of significant loss of initial reduction, and no patients experienced late neurological compromise in the surgical group. An average follow-up kyphosis of 9.2° and 31% loss of vertebral height were observed in the conservative group, while a follow-up lordosis of 1° and 19% loss of vertebral height were observed in the surgical group. Conservative treatment of low lumbar burst fracture is a viable option in neurologically intact patients, but loss of lordosis and vertebral height may persist. Biomechanical and anatomic characteristics of the low lumbar spine differ from the thoracolumbar region and may account for the inherent stability of these injuries. If surgery is chosen, a long fusion with distraction instrumentation should be avoided in the low lumbar spine. A short rigid fixation with pedicular instrumentation may be of greater benefit.

Study Design. Retrospective review of a single-center spine database.Objective. Investigate the intersections of chronological age and physiological age via frailty to determine the influence of surgical invasiveness on patient outcomes Summary of Background Data. Frailty is a well-established factor in preoperative risk stratification and prediction of postoperative outcomes. The surgical profile of operative patients with adult spinal deformity (ASD) who present as elderly and not frail (NF) has yet to be investigated. Our aim was to examine the surgical profile and outcomes of patients with ASD who were NF and elderly. Methods. Patients with ASD 18 years or older, four or greater levels fused, with baseline (BL) and follow-up data were included. Patients were categorized by ASD frailty index: NF, Frail (F), severely frail (SF]. An elderly patient was defined as 70 years or older. Patients were grouped into NF/elderly and F/elderly. SRS-Schwab modifiers were assessed at BL and 1 year (0, þ, þþ). Logistic regression analysis assessed the relationship between increasing invasiveness, no reoperations, or major complications, and improvement in SRS-Schwab modifiers [Good Outcome]. Decision tree analysis assessed thresholds for an invasiveness risk/benefit cutoff point. Results. A total of 598 patients with ASD included (55.3 yr, 59.7% F, 28.3 kg/m 2 ). 29.8% of patients were older than 70 years. At BL, 51.3% of patients were NF, 37.5% F, and 11.2% SF. Sixtysis (11%) patients were NF and elderly. About 24.2% of NFelderly patients improved in SRS-Schwab by 1 year and had no reoperation or complication postoperatively. Binary regression analysis found a relationship between worsening SRS-Schwab, postop complication, and reoperation with invasiveness score (odds ratio: 1.056 [1.01-1.102], P ¼ 0.011). Risk/benefit cut-off was 10 (P ¼ 0.004). Patients below this threshold were 7.9 (2.2-28.4) times more likely to have a Good Outcome. 156 patients were elderly and F/SF with 16.7% having good outcome, with a risk/benefit cut-off point of less than 8 (4.4 [2.2-9.0], P < 0.001). Conclusion.Frailty status impacted the balance of surgical invasiveness relative to operative risk in an inverse manner, whereas the opposite was seen amongst elderly patients with a frailty status less than their chronologic age. Surgeons should perhaps consider incorporation of frailty status over age status when determining realignment plans in patients of advanced age.