Combined Targeted Muscle Reinnervation With Regenerative Peripheral Nerve Interfaces Decreases Long-Term Narcotic Use in Amputees: A Case Control Study.

PURPOSE: Combined targeted muscle reinnervation with regenerative peripheral nerve interfaces ("TMRpni") is a recently described nerve management strategy that leverages beneficial elements of targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) techniques. This study aimed to evaluate the effect of TMRpni on long-term opioid consumption after amputation. We hypothesize that TMRpni decreases chronic opioid consumption in amputees. METHODS: This is a retrospective cohort study of all patients who underwent TMRpni between 2019 and 2021. These patients were age-matched at a 1:1 ratio with a control group of patients who underwent amputation without TMRpni. Statistical analysis was performed using SPSS Version 28.0. RESULTS: Thirty-one age-matched pairs of patients in the TMRpni and control groups were included. At 30 days after surgery, there was no significant difference in number of patients who required an additional refill of their opioid prescriptions (45% vs 55%, P = 0.45) or patients who continued to actively use opioids (36% vs 42%, P = 0.60). However, at 90 days after surgery, there was a significantly lower number of patients from the TMRpni group who reported continued opioid use compared with the control group (10% vs 32%, P = 0.03). CONCLUSIONS: This study demonstrates that TMRpni may translate to decreased rates of chronic opiate use. Continued study is indicated to optimize TMRpni techniques and patient selection and to determine its long-term efficacy.

Outcomes of Calvarial and Soft-Tissue Reconstruction with Latissimus Dorsi-Rib Osteomyocutaneous Free Flap.

BACKGROUND: The latissimus dorsi-rib osteomyocutaneous free flap (LDRF) has been used for autologous reconstruction of large composite calvarial and scalp defects. In this study, the authors aim to present clinical and patient-reported outcomes after LDRF reconstruction. METHODS: An anatomical study was conducted to evaluate the distribution of the connecting perforators between the thoracodorsal and intercostal systems. An institutional review board-approved retrospective review of 10 patients who underwent LDRF with one or two ribs for treatment of cranial defects was conducted. Patient-reported outcomes regarding quality of life, neurologic status, and functional status were evaluated using validated surveys. One-way analysis of variance and post hoc Tukey tests were used for anatomical outcomes. Preoperative and postoperative scores were compared using paired t tests. RESULTS: The tenth rib (4.65 ± 2.01) followed by the ninth rib (3.7 ± 1.63) had the highest number of perforators. A combination of the ninth and eleventh ribs exhibited maximal perforator number and pedicle length. All patients had stable LDRF reconstructions. Eight patients completed both preoperative and postoperative questionnaires; Median clinical follow-up was 48 months (range, 34 to 70 months). Scores trended toward improvement but did not reach statistical significance on the Karnofsky Performance Scale ( P = 0.22), the Functional Independence Measure (Motor, P = 0.52; Cognitive, P = 0.55), or the Headache Disability Index ( P = 0.38). The minimum clinically important difference was surpassed, demonstrating improvement of function for 71% of patients on the Barthel Index and 63% on the Selective Functional Movement Assessment test. CONCLUSION: The LDRF can improve cognitive and physical functional status in complex patients with prior failed reconstructions for composite scalp and skull defects. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Tissue adjuncts in primary cleft palate reconstruction: A systematic review.

BACKGROUND: Tissue adjunct is non-palatal tissue used to manage tension at the defect site by providing additional coverage. This review aimed to compare outcomes of various adjuncts employed in primary palatoplasty. METHODS: A literature search was conducted of MEDLINE, EMBASE, and Cochrane Library with keywords cleft palate, palatoplasty, surgical flaps, and allografts. Data extracted included demographics, cleft severity, primary/adjunctive techniques, outcomes, and follow-up periods. Logistic regression analyses and chi-squared tests were performed to investigate associations among variables. RESULTS: A total of 1332 patients (aged 3 months-5 years) with follow-up of 1 month to 21 years were included. Cleft severity included submucous cleft (1.7%), Veau I/II (33.3%), Veau III (46.3%), and Veau IV (15.1%). Most reported techniques were Furlow (52%) and intravelar veloplasty (14.3%) for soft palate, Bardach (27.2%), and V-Y Pushback (11.1%) for hard palate. Buccal myomucosal flap (BMMF) was performed in 45.4% of cases, followed by buccal fat pad flap/graft (BFP) in 40.8% and acellular dermal matrix (ADM) in 14%. Severe clefts (Veau III/IV) were repaired more frequently with BMMF compared with ADM (p = 0.003) and BFP (p = 0.01). Oronasal fistula occurred in 3.1% of patients, and velopharyngeal insufficiency (VPI) in 4%, both associated with Veau IV (fistula: p = 0.002, VPI: p = 0.0002). No significant differences were found in fistula (p = 0.79) or VPI (p = 0.14) rates between adjuncts. In severe clefts (Veau III/IV), ADM was associated with fistula formation (p = 0.03). CONCLUSIONS: Adjuncts in primary palatoplasty may mitigate unfavorable outcomes associated with severe clefts. BMMF is superior, given its inherent tissue properties, whereas BFP is effective in reducing fistula formation.

Temporalis Myofascial Flap and Conchal Bowl Cartilage Grafting for Temporomandibular Joint Arthritis.

Temporomandibular joint (TMJ) arthritis arises from a multitude of etiologies; however, there is no consensus definitive treatment. The complication profile of artificial TMJs is well known, and outcomes are variable and are reserved for salvage attempts. This case details a patient with persistent traumatic TMJ pain, arthritis, and single-photon emission computed tomography scan of potential nonunion. The present study reports on the first novel use of an alternative composite myofascial flap to help arthritic TMJ pain. This study details the successful use of a temporalis myofascial flap and conchal bowl autologous cartilage graft in posttraumatic TMJ degeneration.

Preinjury Social Determinants of Health Disparities Predict Postinjury Psychosocial Conditions in Adult Traumatic Brachial Plexus Injuries.

BACKGROUND: Adult traumatic brachial plexus injuries (TBPIs) are life-altering events that can have detrimental effects on a patient's quality of life. OBJECTIVE: To examine how social determinants of health (SDOH) disparities influence the risk of developing new psychosocial conditions after TBPIs in previously psychiatric-naïve patients. METHODS: Between January 2010 and June 2019, a retrospective analysis was performed using PearlDiver's Mariner, an all-payer claims database, to create 3 cohorts: TBPI disparity cohort: patients with TBPI and presence of at least 1 SDOH disparity before injury, TBPI without disparity cohort: patients with TBPI and the absence of any SDOH disparity, and control cohort: patients without TBPIs. RESULTS: The matched population analyzed in this study consisted of 1176 patients who were equally represented in the TBPI disparity cohort (n = 392, 33.33%), TBPI without disparity cohort (n = 392, 33.33%), and control cohort (n = 392, 33.33%). A total of 301 patients developed any psychosocial condition with 4 years of their injury. Patients in the TBPI disparity cohort had significantly higher rates of developing any psychosocial condition (31.12%, P < .0005), depression (22.70%, P = .0032), anxiety (18.62%, P = .0203), drug abuse (7.91%, P = .0060), and alcohol abuse (4.85%, P = .03499) when compared with the other cohorts. Furthermore, the disparity cohort carried a significantly increased risk of developing any psychosocial condition (hazard ratio 1.42, 95% CI 1.09-1.86). The rates of suicide attempt, post-traumatic stress disorder, and divorce did not significantly differ between groups. CONCLUSION: TBPI patients with SDOH disparities are at increased risk of developing new-onset psychosocial conditions, such as depression, anxiety, drug abuse, and alcohol abuse. Level of Evidence: Prognostic Level III.

Surgical Trigger Finger Release Is Associated With New-Onset Dupuytren Contracture in the Short-Term Postoperative Period: A Matched Analysis.

BACKGROUND: This article compares the rates and time-to-development of new-onset Dupuytren disease in patients with trigger finger treated by steroid injection, surgical release, or both. METHODS: PearlDiver's Mariner 30 database was queried to identify patients with trigger finger between January 2010 and June 2019. One-to-one exact matching based on baseline patient demographics allowed us to create 4 identical groups defined by the type of trigger finger intervention received. RESULTS: The matched population analyzed in this study consisted of 85 944 patients who were equally represented in the steroid injection cohort (n = 21 486, 25.00%), surgical release cohort (n = 21 486, 25.00%), steroids prior to surgery cohort (n = 21 486, 25.00%), and no intervention (control) cohort (n = 21 486, 25.00%). A new Dupuytren diagnosis after trigger finger treatment occurred in 1 in 128 patients overall, 1 in 156 patients treated with steroid injection, and 1 in 126 patients treated with surgical release. Trigger fingers treated by steroid injection only had the lowest rates of Dupuytren disease overall (n = 137, 0.64%, P = .0424) and treatment with fasciectomy (n = 14, 0.07%, P < .0005). In all, 171 patients in the surgery cohort developed Dupuytren disease 1 year after undergoing surgical trigger finger release. Furthermore, this cohort had the highest rates of fasciectomy (n = 55, 0.26%, P < .0005) and the lowest rates of no intervention (n = 103, 0.48%, P = .0471). Trigger fingers managed by surgical release developed Dupuytren disease (mean, 56.11 days; SD, 80.93 days, log-rank P = .02) and underwent fasciectomy (mean, 49.74 days; SD, 62.27 days; log-rank P < .0005) more quickly than all other cohorts. CONCLUSIONS: Patients solely undergoing surgical release of their trigger finger had significantly higher odds and expedited rate of developing new-onset Dupuytren disease overall and undergoing subsequent treatment by fasciectomy compared with trigger fingers managed by other interventions.

Patients prescribed antithrombotic medication in elective implant-based breast reconstruction are high risk for major thrombotic complications.

INTRODUCTION: Implant-based reconstruction (IBR) is the most frequently performed breast reconstruction procedure in the USA. As the US population ages, an increasing number of these patients suffer from comorbidities requiring the use of chronic antithrombotic therapy. Outcomes following IBR in patients prescribed these medications are not well understood. MATERIALS/PATIENTS AND METHODS: An all-payor administrative claims database (52 million patients) was queried for patients undergoing IBR from 2010 through 2018. Patients who were prescribed therapeutic antithrombotic therapy, and those who were not, were matched in a one-to-one fashion for comorbidities independently associated with bleeding and thrombo-ischemic events following first-stage IBR. Cox proportional hazards models investigated the 90-day risk of bleeding and major thrombo-ischemic events following IBR. RESULTS: Of the 36,379 patients found to have undergone IBR, 2,024 patients were perfectly matched for age and high-risk comorbidities. Patients prescribed antithrombotic drugs had increased 90-day risk for all thrombo-ischemic complications (HR: 5.62, 95% CI: 3.53-8.95, p < 0.0001), as well as a significantly increased risk for 90-day DVT, 90-day PE, 90-day myocardial infarction, and 90-day stroke. Patients specifically prescribed antiplatelet drugs, direct oral anticoagulants (DOAC), and warfarin had a significantly increased risk for transfusion. CONCLUSION: Patients prescribed antithrombotic therapy had a significantly increased risk for life-threatening thrombotic events and transfusion following elective IBR. This suggests a role for further monitoring and a potential role for multi- and interdisciplinary interventions to help mitigate this risk. These interventions can be the subject of future prospective studies.

Materials Used in Cranial Reconstruction: A Systematic Review and Meta-Analysis.

BACKGROUND: Cranioplasty is a common neurologic procedure, with complication rates ranging from 20% to 50%. It is hypothesized that the risks of various complications are affected by which material is used for cranioplasty. OBJECTIVE: To evaluate the literature comparing rates of complications after cranioplasty using different materials including autologous bone, hydroxyapatite, methyl methacrylate, demineralized bone matrix, polyetheretherketone, titanium, or composite materials. METHODS: The PubMed/MEDLINE database was searched for relevant articles published between 2010 and 2020. After screening, 35 articles were included. Outcomes included infection, wound problems, poor cosmesis, overall complications, duration of surgery, and length of stay. For each outcome, a frequentist network meta-analysis was conducted to compare materials used. RESULTS: The risk of infection was 1.62 times higher when methyl methacrylate was used compared with autologous bone (relative risk, 1.62; 95% confidence interval [CI], 1.07-2.45). Length of stay after cranioplasty was on average 3.62 days shorter when titanium was used compared with autologous bone (95% CI, 6.26 to -0.98). The networks constructed for other outcomes showed moderate to substantial between-study heterogeneity, wide CIs, and no significant differences between materials. CONCLUSIONS: The quality of existing literature on this topic is relatively poor, almost exclusively comprising single-center retrospective studies. There is not strong enough evidence available to make comprehensive conclusions regarding the risk profiles of various cranioplasty materials across multiple outcomes. Prospective randomized trials are necessary to confirm the significant results found in this analysis and to further elucidate the differential risks of various cranioplasty materials.

American Society of Plastic Surgeons Evidence-Based Clinical Practice Guideline Revision: Reduction Mammaplasty.

SUMMARY: A multidisciplinary work group involving stakeholders from various backgrounds and societies convened to revise the guideline for reduction mammaplasty. The goal was to develop evidence-based patient care recommendations using the new American Society of Plastic Surgeons guideline methodology. The work group prioritized reviewing the evidence around the need for surgery as first-line treatment, regardless of resection weight or volume. Other factors evaluated included the need for drains, the need for postoperative oral antibiotics, risk factors that increase complications, a comparison in outcomes between the two most popular techniques (inferior and superomedial), the impact of local anesthetic on narcotic use and other nonnarcotic pain management strategies, the use of epinephrine, and the need for specimen pathology. A systematic literature review was performed, and an established appraisal process was used to rate the quality of relevant scientific research (Grading of Recommendations Assessment, Development and Evaluation methodology). Evidence-based recommendations were made and strength was determined based on the level of evidence and the assessment of benefits and harms.

Social determinants of health and their impact on rates of postoperative complications among patients undergoing vertical sleeve gastrectomy.

BACKGROUND: Vertical sleeve gastrectomy is one of the most common bariatric procedures worldwide, but the impact of social determinants of health on postoperative outcomes for this procedure has not been well characterized. The objective of this study was to analyze the impact that social determinants of health have on postoperative outcomes after vertical sleeve gastrectomy. METHOD: This was a population-based study using the MARINER-15 database, an all-payer claims database. The primary endpoint of this study was the development of any complication, including cardiac complication, acute kidney injury, deep vein thrombosis, wound complication, hematoma, pneumonia, pulmonary embolism, transfusion, or urinary tract infection within 60 days, 30- and 90-day all-cause mortality, or readmission within 30 or 90 days in patients undergoing vertical sleeve gastrectomy procedures. RESULTS: Individuals in the social determinants of health cohort had a significantly longer length of stay when compared with those without social determinants of health (3.07 days vs 1.582 days, P < .001). These patients were more likely to develop any complication within 60 days after surgery (hazard ratio 1.20, 95% confidence interval 1.03-1.40) but were less likely to return for readmission within 30 and 90 days (hazard ratio 0.80, 95% confidence interval 0.66-0.96; hazard ratio 0.85 95% confidence interval 0.72-0.99). CONCLUSION: Vertical sleeve gastrectomy is an effective treatment for morbid obesity and its associated comorbidities. Although patients with social determinants of health are more likely to develop any of the analyzed postoperative complications within 60 days, they are less likely to return for readmission, highlighting the importance of focused follow-up and other measures to avoid lapses in care and eliminate further barriers to care in this population.

The Effects of Obesity and Bariatric Surgery on Rates of Upper Extremity Compression Neuropathies.

Objectives: To estimate the effects of obesity on all types of upper extremity compression neuropathies (UECN) (carpal tunnel syndrome and other median nerve, radial nerve, and ulnar nerve compression neuropathies) and to assess whether bariatric surgery modifies these effects. Background: UECN are increasingly prevalent and decrease the quality of life of affected individuals. Studies suggest obesity as a risk factor for carpal tunnel syndrome, the most common type of UECN. Methods: A retrospective cohort study was conducted using the PearlDiver Mariner Database, an all-payor claims database containing claims for over 53 million patients from 2010 to 2019 in all 50 US states. Rates and odds of all types of UECN were compared between 1:1:1 exact matched cohorts of obese patients who were medically managed, obese patients who underwent bariatric surgery, and nonobese patients (111,967 patients in each cohort). Results: Compared with nonobese patients, patients with obesity were significantly more likely to develop any UECN (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.09-1.18), carpal tunnel syndrome (OR, 1.15; 95% CI, 1.10-1.30), and 2 or more UECN (OR, 1.34; 95% CI, 1.20-1.48). Compared with obese patients who were managed medically, obese patients who underwent bariatric surgery were significantly less likely to develop any UECN (OR, 0.87; 95% CI, 0.84-0.91) and carpal tunnel syndrome (OR, 0.85; 95% CI, 0.81-0.89). Conclusions: Obese patients have higher odds of both single and concomitant UECN, specifically carpal tunnel syndrome, compared with nonobese patients. Bariatric surgery decreases the odds of developing UECN compared with obese patients not undergoing surgical intervention.

Association of Bariatric Surgery and Risk of Cancer in Patients With Morbid Obesity.

OBJECTIVE: This study investigates the rates of obesity-related cancers in patients undergoing vertical sleeve gastrectomy (VSG), Roux-en-Y gastric bypass (RYGB), or no surgical intervention. SUMMARY BACKGROUND DATA: Obesity has been previously associated with increased rates of cancers; however, weight loss surgeries have not been explored to demonstrate their potential risk reduction impact. METHODS: Patients meeting bariatric eligibility criteria between January 2010 and December 2018 were identified. Exact 1:1:1 matching based on baseline patient demographics and comorbidities was used to create 3 groups with identical covariates: patients undergoing VSG, RYGB, and no surgery. RESULTS: A total of 28, bariatric-eligible patients equally split into patients undergoing VSG (n = 9636, 33.3%), RYGB (n = 9636, 33.3%), and those with no surgical intervention (n = 9636, 33.3%). Bariatric-eligible patients that did not undergo surgical intervention had significantly higher rates and odds of developing numerous cancer types included in our study when compared to either surgical cohorts, with any cancer type (4.61%), uterine (0.86%), colorectal (0.57%), and lung cancers (0.50%) being most common. Individuals undergoing RYGB were significantly less likely to develop colorectal cancer compared to patients without any surgical intervention [odds ratio (OR) 0.47, 95% confidence interval (CI) 0.30-0.75]. Additionally, those undergoing VSG were significantly less likely to develop lung cancer than the bariatric eligible no surgery cohort (OR 0.42, 95% CI 0.25-0.70). CONCLUSION: Postoperative rates of any cancer type, lung, ovarian, and uterine cancer were significantly lower in obese patients undergoing either vertical sleeve gastrectomy (VSG) or RYGB compared to bariatric-eligible patients without any surgical intervention.

Outcomes following percutaneous endoscopic gastrostomy versus fluoroscopic procedures in the Medicare population.

BACKGROUND: In the United States, few high-quality manuscripts have directly compared the complication profiles of percutaneous endoscopic versus fluoroscopic gastrostomy. Thus, it is our goal to compare these 2 common procedures to better understand their efficacy and complication profiles. MATERIALS AND METHODS: A retrospective analysis of patient records from Medicare parts A/B from 2007 to 2012 was used to identify percutaneous fluoroscopic gastrostomy and percutaneous endoscopic gastrostomy procedures. Patient demographics were stratified by age, sex, comorbidities, and complications. RESULTS: A total of 258,641 patients were found to have either percutaneous fluoroscopic gastrostomy (26,477, 10.2%) or percutaneous endoscopic gastrostomy (232,164, 89.8%). Percutaneous fluoroscopic gastrostomy experienced greater rates for all complications queried. Multivariate analysis revealed that the percutaneous fluoroscopic gastrostomy cohort had statistically significant increased odds for short-term complications, such as ileus (odds ratio 1.4, 95% confidence interval 1.22-1.54), mechanical (odds ratio 2.4, 95% confidence interval 2.28-2.58), wound infection (odds ratio 1.4, 95% confidence interval 1.24-1.52), persistent fistula after tube removal (odds ratio 1.9, 95% confidence interval 1.78-2.12), and other complications (odds ratio 2.2, 95% confidence interval 2.03-2.37), and long-term complications, including abdominal wall pain (odds ratio 1.4, 95% confidence interval 1.33-1.44), wound infection (odds ratio 1.1, 95% confidence interval 1.01-1.15), and persistent fistula after tube removal (odds ratio 1.8, 95% confidence interval 1.72-1.87). CONCLUSION: Gastrostomy tubes are more frequently being placed via percutaneous endoscopic and fluoroscopic methods. This study suggests that those undergoing fluoroscopic placement have higher odds of developing short- and long-term postoperative complications.

Outcomes following port-a-catheter placement in the Medicare population.

BACKGROUND: We aimed to evaluate the long-term complication profile associated with port-a-catheter placement. METHODS: Patients undergoing port-a-catheter placement from 2007 to 2012 with 5-year follow up were identified. Descriptive statistics, χ2 tests, and multivariate regression models were analyzed. RESULTS: Any complication occurring within 5 years postoperatively was common (59.04%, n = 53,353). Arrhythmogenic (32.66%, n = 30,625) and thrombovascular (36.80%, n = 34,499) complications were more common than infection (17.86%, n = 16,745) and mechanical (10.31%, n = 9,670) complications. Multivariate analysis demonstrated that history of atrial fibrillation is a risk factor for developing any complication (odds ratio 7.99, 95% confidence interval 7.29-8.77). CONCLUSION: Patients with history of atrial fibrillation have increased odds of developing infectious, thrombovascular, mechanical, and arrhythmogenic complications with port-a-catheter placement. This study is the first to show that postprocedure arrhythmias occur at significant rates within the 5-year follow-up period. We caution that development of new arrhythmia should be monitored throughout a prolonged follow-up period. We hope our analysis encourages multidisciplinary coordination of patients with ports so that implants are promptly removed when they are no longer needed to avoid these complications.

Laparoscopic-Assisted Versus Mini-Open Laparotomy for Ventriculoperitoneal Shunt Placement in the Medicare Population.

BACKGROUND: Placement of the distal shunt catheter into the peritoneum during ventriculoperitoneal shunt (VPS) surgery can be done with either laparoscopic assistance or laparotomy. OBJECTIVE: To compare outcomes in laparoscopic-assisted vs laparotomy for placement of VPS in the Medicare population. METHODS: Patients undergoing VPS placement, between 2004 and 2014, were identified by International Classification of Disease, Ninth Revision and Current Procedural Terminology codes in the Medicare database. Demographic data including age, sex, comorbidities, and indications were collected. Six- and twelve-month complication rates were analyzed. RESULTS: A total of 1966 (3.2%) patients underwent laparoscopic-assisted VPS and 60 030 (96.8%) patients underwent nonlaparoscopic-assisted VPS placement. Compared with traditional open VPS placement, the laparoscopic approach was associated with decreased odds of distal revision at 6- and 12-mo postoperatively (6 mo: odds ratio [OR] = 0.41, 95% confidence interval [CI]: 0.21-0.74; 12 mo: OR = 0.60, 95% CI: 0.39-0.94). At 6- and 12-mo postoperatively, multivariable regression analysis demonstrated increased odds of distal revision in patients with a body mass index (BMI) > 30 Kg/M2, history of open abdominal surgery, and history of laparoscopic abdominal surgery. Additionally, history of prior abdominal surgery and BMI > 30 Kg/M2 were significantly associated with increase odds of shunt infection at 6 and 12-mo, respectively. CONCLUSION: In the largest retrospective analysis to date, patients with a history of abdominal surgery and obesity were found to be at increased risk of infection and distal revision after VPS placement. However, the laparoscopic approach for abdominal placement of the distal catheter was associated with reduced rates of distal revision in this population, suggesting an avenue for reducing complications in well-selected patients.

Association Between Social Determinants of Health and Postoperative Outcomes in Patients Undergoing Single-Level Lumbar Fusions: A Matched Analysis.

STUDY DESIGN: Retrospective cohort. OBJECTIVE: The aim of this study was to analyze association between social determinants of health (SDH) disparity on postoperative complication rates, and 30-day and 90-day all-cause readmission in patients undergoing single-level lumbar fusions. SUMMARY OF BACKGROUND DATA: Decreasing postoperative complication rates is of great interest to surgeons and healthcare systems. Postoperative complications are associated with poor convalescence, inferior patient reported outcomes measures, and increased health care resource utilization. Better understanding of the association between Social Determinants of Health (SDH) on postoperative outcomes maybe helpful to decrease postoperative complication rates. METHODS: MARINER 2020, an all-payer claims database, was utilized to identify patients undergoing single-level lumbar fusions between 2010 and 2018. The primary outcomes were the rates of any postoperative complication, symptomatic pseudarthrosis, need for revision surgery, or 30-day and 90-day all-cause readmission. RESULTS: The exact matched population analyzed in this study contained 16,560 patients (8280 [50.0%] patients undergoing single-level lumbar fusion with an SDH disparity; 8280 [50.0%] patients undergoing single-level lumbar fusion without a disparity). Both patient groups were balanced at baseline. The rate of symptomatic pseudarthrosis (1.0% vs. 0.6%, P < 0.05) or any postoperative complication (16.3% vs. 10.4%, P < 0.05) in the matched analysis was higher in the disparity group. The presence of a disparity was associated with 70% increased odds of developing any complication (OR 1.7, 95% CI 1.53-1.84) or symptomatic pseudarthrosis (OR 1.7, 95% CI 1.17-2.37). Unadjusted and adjusted sensitivity analyses yielded similar results as the primary analysis. CONCLUSION: Social Determinants of Health affect outcomes in spine surgery patients and are associated with an increased risk of developing postoperative complications following lumbar spine fusion.Level of Evidence: 3.

Pharmacologic and cellular therapies in the treatment of traumatic spinal cord injuries: A systematic review.

OBJECTIVE: The objective of this review is to synthesize and consolidate the existing literature on the treatment of SCI, focusing on drugs in development and cellular therapeutics, including stem-cell treatments. METHODS: Studies were identified through a systemic search of PubMed, Ovid MEDLINE, Embase and the Cochrane database from their respective inceptions through January 1, 2020. We used the keywords "spinal cord injuries", "therapeutics", "stem cells", and "pharmacology." STUDY SELECTION: Studies that assessed treatment strategies for SCI were included. DATA EXTRACTION AND SYNTHESIS: Data on SCIs were processed according to the Preferred Reporting Items for Systematic Reviews and meta-Analyses (PRISMA) guidelines. FINDINGS: In total, 62 articles were found in the literature search and 13 clinical trials were identified and included in this study. This review article discusses the management and treatment of SCI with an emphasis on the pharmacology, molecular approaches, and the use of stem cells. Presently, none of the treatments examined has shown to be clearly effective. CONCLUSIONS: Present management strategies of SCI are focused on improving spinal cord perfusion and decreasing secondary injuries such as hypoxia, inflammation, edema, excitotoxicity and disturbances of ion homeostasis. This review hopes to demonstrate the significant advances made in the field of SCI and the new methodologies and practices being employed by researchers to improve our knowledge of the pathology. Our hope is that by consolidating the past and current research, improvements can be made in the management, treatment, and outcomes for these patients and other who suffer from spinal pathologies.

Association of osteopenia and osteoporosis with higher rates of pseudarthrosis and revision surgery in adult patients undergoing single-level lumbar fusion.

OBJECTIVE: Patients with osteopenia or osteoporosis who require surgery for symptomatic degenerative spondylolisthesis may have higher rates of postoperative pseudarthrosis and need for revision surgery than patients with normal bone mineral densities (BMDs). To this end, the authors compared rates of postoperative pseudarthrosis and need for revision surgery following single-level lumbar fusion in patients with normal BMD with those in patients with osteopenia or osteoporosis. The secondary outcome was to investigate the effects of pretreatment with medications that prevent bone loss (e.g., teriparatide, bisphosphonates, and denosumab) on these adverse outcomes in this patient cohort. METHODS: Patients undergoing single-level lumbar fusion between 2007 and 2017 were identified. Based on 1:1 propensity matching for baseline demographic characteristics and comorbidities, 3 patient groups were created: osteopenia (n = 1723, 33.3%), osteoporosis (n = 1723, 33.3%), and normal BMD (n = 1723, 33.3%). The rates of postoperative pseudarthrosis and revision surgery were compared between groups. RESULTS: The matched populations analyzed in this study included a total of 5169 patients in 3 groups balanced at baseline, with equal numbers (n = 1723, 33.3%) in each group: patients with a history of osteopenia, those with a history of osteoporosis, and a control group of patients with no history of osteopenia or osteoporosis and with normal BMD. A total of 597 complications were recorded within a 2-year follow-up period, with pseudarthrosis (n = 321, 6.2%) being slightly more common than revision surgery (n = 276, 5.3%). The odds of pseudarthrosis and revision surgery in patients with osteopenia were almost 2-fold (OR 1.7, 95% CI 1.26-2.30) and 3-fold (OR 2.73, 95% CI 1.89-3.94) higher, respectively, than those in patients in the control group. Similarly, the odds of pseudarthrosis and revision surgery in patients with osteoporosis were almost 2-fold (OR 1.92, 95% CI 1.43-2.59) and > 3-fold (OR 3.25, 95% CI 2.27-4.65) higher, respectively, than those in patients in the control group. Pretreatment with medications to prevent bone loss prior to surgery was associated with lower pseudarthrosis and revision surgery rates, although the differences did not reach statistical significance. CONCLUSIONS: Postoperative pseudarthrosis and revision surgery rates following single-level lumbar spinal fusion are significantly higher in patients with osteopenia and osteoporosis than in patients with normal BMD. Pretreatment with medications to prevent bone loss prior to surgery decreased these complication rates, although the observed differences did not reach statistical significance.