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Study Design. Retrospective case-control study.Objective. The aim of this study was to evaluate the prevalence of pseudarthrosis following antepsoas (ATP) lumbar and lumbosacral fusions. Summary of Background Data. Pseudarthrosis is a feared complication following spinal fusions and may affect their clinical outcomes. To date there are no sufficient data on the fusion rate following ATP lumbar and lumbosacral arthrodesis. Methods. This is a retrospective review of 220 patients who underwent lumbar minimally invasive antepsoas (MIS-ATP) fusions between January 2008 and February 2019 who have at least 1-year postoperative computed tomography (CT) follow-up scans. Fusion was graded using CT scans imaging and adopting a 1-4 grading scale (1, definitely fused; 2, likely fused; 3, likely not fused; 4, definitely not fused/nonunion). Grades 3 or 4 indicate pseudarthrosis. Results. A total of 220 patients (average age: 66 years, 82 males (37.2%), and 127 (57.7%) smokers) were included. Eight patients (3.6%) developed pseudarthrosis. A total of 693 discs were addressed using the ATP approach. Of those, 681 (98.3%) were considered fused (641 levels [92.5%] were ''definitely fused'' and 40 levels [5.8%] were ''Likely fused'') and 12 discs (1.7%) developed pseudarthrosis (seven levels [1.0%] were ''likely not fused'' and five levels (0.7%) were ''definitely not fused''). The highest rate of pseudarthrosis was found at L5-S1 (4.8%) compared to the L1-L5 discs (0-2%). Of 127 smokers, six developed pseudarthrosis (odds ratio ¼ 2.3, P ¼ 0.3). The fusion rates were 95.3% and 97.8% for smokers and nonsmokers, respectively. Of the eight patients who developed pseudarthrosis, only four (50%) were symptomatic, of whom two (25%) required revision surgery. Both of these patients were smokers. The overall revision rate due to pseudarthrosis was 0.9% (two of 220 patients). Conclusion. The MIS-ATP technique results in a high fusion rate (96.4% of patients; 98.3% of levels). Pseudarthrosis was noted mostly at the L5-S1 discs and in smokers.

Background/Introduction: The US opioid epidemic has received particular attention with 33091 reported deaths from narcotic overdose in 2015. A recent survey comparing US and Japanese opioid prescribing patterns from the AOA-JOA traveling fellows included 76 US orthopedic surgeons representing 8 subspecialties. We used this data to compare opioid prescribing patterns among US spine surgeons to other orthopaedic subspecialties. Materials/Methods: The survey included data based on surgeon demographics (gender, age, years in practice), patient baseline opioid use (pre/post-operative opioid use, types of opioid agents, duration of opioid use), perioperative pain management (procedure/institution factors, multimodal analgesic therapy), and responses to questions regarding opioid use attitudes. Survey responses were recorded as either categorical or semi-continuous variables. Statistical analysis was performed using chi-squared analysis for categorical responses and Kolmogorov-Smirnov testing to a statistical significance level of p < 0.05. Parameters that trended toward significance to p < 0.10 were also recorded. Statistical analysis was performed using Stata statistical analysis software [StataCorp, College Station, Texas]. Results: Spine patients were more likely using opioid medications prior to evaluation by spine surgeons compared to non-spine patients(p=0.029). Patients with spine pathologies treated non-operatively were also more likely to be prescribed opioids(p=0.006). Post-operatively, spine patients were less likely to stop opioid prescriptions on the intended time (p=0.046). Peri-operatively, spine patients were more likely to be given muscle relaxant medications, and less likely to receive local/regional anesthesia(p=0.0025). Additionally, spine patients showed a trend toward association for requesting additional opioids beyond their initial prescription(p=0.057). Spine surgeons showed a trend toward association for choice of opioid agent prescribed–spine patients were less likely to receive codeine/tramadol analogs(p=0.062). When surveyed on opinions regarding opioid use, US spine surgeons did not show significantly different opinions regarding opioid use compared to surgeons in other subspecialties. Discussion/Conclusion: Spine patients did demonstrate statistically significant patterns of opioid use, particularly regarding opioid use prior to evaluation by orthopedic surgeon and use of opioids for nonoperative pathologies. They were also less likely to stop opioid prescriptions on time. Surgeon prescription patterns and perceptions of opioid use were not significantly different for spine surgeons compared to other subspecialties.