Development of a Spine Surgical Skills and Written Assessment for Orthopaedic Surgery Residents.

OBJECTIVE: The objective of this study was to develop an assessment module for orthopaedic spine surgery residents which is cost-effective and can reliably test knowledge and surgical skills. DESIGN: A ten-question multiple choice question and hands-on spine sawbones combination assessment was prospectively administered to consenting PGY-3 and PGY-4 residents before and after their 8-week spine rotation. Pre- and postrotation scores were compared using the paired t-test. SETTING: The Department of Orthopaedics, The Ohio State University Wexner Medical Center, a large academic medical centre providing primary and tertiary care. PARTICIPANTS: Orthopaedic resident physicians. RESULTS: A total of 21 residents (15 PGY-3, 6 PGY-4) participated in the study. The mean pre- and postrotation written test score was 7.38 ± 1.53 and 9.24 ± 0.83, respectively (p < 0.001). Corresponding surgical skills assessment scores were 95.4% ± 4.7 and 97.1% ± 2.6, respectively (p = 0.10). Overall, the postrotation written and surgical scores improved and showed less variation about the mean. CONCLUSIONS: This combination assessment measured improvement in below-average scoring residents and maintenance or improvement in residents with average and above average prerotation scores.

Smoking is Associated With 1-year Suboptimal Patient-reported Outcomes After 2-level Anterior Cervical Fusion.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To study the impact of smoking on patient-reported outcomes after primary 2-level anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA: Previous studies have found suboptimal outcomes after multilevel ACDF in smoking patients. There is contrasting evidence on the negative effects of smoking in single-level ACDF, while there are no specific reports in 2-level ACDF. Adding knowledge of smoking's impact on patient-reported outcomes (PRO) will help in tailored patient counseling and preoperative education. METHODS: Patients 18 years of age or older at a single academic institution who underwent 2-level ACDF to treat cervical radiculopathy and/or myelopathy between September 2013 and September 2015 were included. PRO was studied using the neck disability index (NDI) preoperatively, and at 3, 6, 12 months. χ test for qualitative variables, and one-way analysis of variance (ANOVA) and unpaired t test for quantitative variables were used for statistical analysis. RESULTS: A total of 61 patients, of which 23 (37.7%) were classified as smokers were included. Demographic and clinical profile of patients was similar both groups. Preoperatively, smokers had a mean NDI of 62.8±12.7 with a 17.5%, 18.7%, and 27.7% decrease at 3, 6, and 12-months, respectively. Nonsmokers had a mean preoperative NDI of 45.9±15.3, with a 36.4%, 61.2% and 65.4% decrease at 3, 6, and 12-months, respectively. Despite higher baseline NDI in smokers, improvement in NDI reached significance at 3-months in nonsmokers. In smokers, the improvement in NDI was slower and reached significance at 12-months. The radiographic fusion status at latest follow-up was similar in smokers and nonsmokers (P=0.67). CONCLUSIONS: Smokers had lower improvements in NDI scores compared to nonsmokers after a 2-level ACDF. Preoperative counseling before 2-level ACDF should include education about risks of inferior clinical outcomes in smokers independent of fusion status.

Predictors of discharge to an inpatient rehabilitation facility after a single-level posterior spinal fusion procedure.

PURPOSE: To determine perioperative characteristics of patients undergoing single-level spinal fusion surgery that could help predict discharge to an inpatient rehabilitation facility (IRF). METHODS: Demographic, peri- and postoperative characteristics were reviewed for 107 patients who underwent single-level spinal fusion surgery at a high-volume level I trauma center between January 2011 and December 2013. The relationships between discharge to IRF and gender, age, body mass index (BMI), Charlson Comorbidity Index (CCI), insurance provider, length of stay (LOS), intra- and postoperative outcomes and readmission rates in patients undergoing single-level spinal fusion surgery were analyzed using unpaired and paired t testing. RESULTS: 21.5 % (n = 23) of patients were discharged to an IRF. By using unpaired and paired t tests, it was determined that age, BMI, CCI, LOS and insurance provider were all correlated with a higher probability of being discharged to an IRF. Additionally, a logistic regression model demonstrated a correlation between lower CCI and discharge to an IRF. CONCLUSIONS: Statistically significant differences were seen regarding age, BMI, CCI, LOS and insurance provider when determining the necessity of a patient being discharged to an IRF. These characteristics can be used to begin the process of setting up discharge disposition preoperatively rather than postoperatively. There were no perioperative characteristics that were statistically significant in determining discharge disposition; therefore, physicians can utilize these preoperative demographics in deciding and organizing discharge before the day of surgery, which can diminish LOS and lead to substantial health system savings.

Novel Intraoperative Technique to Visualize the Lower Cervical Spine: A Case Series.

Visualization of the lower cervical spine with a lateral radiograph poses a challenge secondary to encroachment of the shoulders. Applying traction to the arms or taping the shoulders down provides adequate visualization in most patients, but imaging the mid- to lower cervical levels presents a significant challenge in patients with stout necks. We present a variation of the lateral radiograph that is 30º oblique from horizontal and 30º cephalad from neutral and used in a series of patients with stout necks that require anterior instrumentation of the lower cervical spine. We reviewed intraoperative images of 2 patients who underwent anterior cervical spine surgery at our institution, and assessed type of procedure, body mass index, and outcome scores. Our variation provided improved visualization relative to a lateral view and was used intraoperatively to confirm correct-level hardware placement in both patients.