Objective: To evaluate the reasons for transfer as well as the 90-day outcomes of patients who were transferred from a high-volume orthopedic specialty hospital (OSH) following elective spine surgery. Materials and Methods: All patients admitted to a single OSH for elective spine surgery from 2014 to 2021 were retrospectively identified. Ninety-day complications, readmissions, revisions, and mortality events were collected and a 3:1 propensity match was conducted. Results: Thirty-five (1.5%) of 2351 spine patients were transferred, most commonly for arrhythmia ( n = 7; 20%). Thirty-three transferred patients were matched to 99 who were not transferred, and groups had similar rates of complications (18.2% vs. 10.1%; P = 0.228), readmissions (3.0% vs. 4.0%; P = 1.000), and mortality (6.1% vs. 0%; P = 0.061). Conclusion: Overall, this study demonstrates a low transfer rate following spine surgery. Risk factors should continue to be optimized in order to decrease patient risks in the postoperative period at an OSH.

Case: A patient presented with acute paralysis in the setting of undiagnosed Lemierre's syndrome. Streptococcus pyogenes was the causative organism leading to internal jugular vein thrombosis, sternocleidomastoid abscess, vertebral osteomyelitis, and epidural phlegmon. The patient was treated both surgically, with abscess evacuation, hemicorpectomy, and fusion, and medically, with antibiotics and anticoagulation. Postoperatively, the patient regained upper extremity strength and lower extremity sensation, but the paraplegia remained. Conclusion: Lemierre's syndrome is a rare complication of oropharyngeal infection with a constellation of findings including jugular thrombophlebitis, metastatic abscesses, and frequent involvement of anaerobic pathogens that may present acutely with paralysis.

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The initiation of illegal opioid use often stems from legal prescriptions, emphasizing the pivotal role of healthcare practitioners, particularly physicians, in addressing this crisis. Opioid medications are frequently prescribed after surgeries, with orthopedic and neurosurgery procedures demonstrating higher rates of opioid utilization. Notably, spine surgeries exhibit the highest rates of long-term opioid prescription usage. Preoperative opioid use is prevalent among patients undergoing spine surgery and is associated with an increased risk of opioid dependence one year after the procedure. It is crucial to consider specific surgical characteristics when deciding on postoperative opioid use, as fewer intensive procedures tend to have a higher likelihood of discontinuing opioid use compared to lumbar interbody arthrodesis. Orthopedic spine surgeons must address unique pain management challenges, considering preoperative opioid use and focusing on multimodal pain relief methods to improve patients’ quality of life.