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Although studies have explored acute opioid use within 30 days after surgery and chronic opioid use longer than 90 days after surgery, the impact of opioid use within the subacute phase of 31-90 days after surgery has not been studied. However, this subacute postoperative period has been identified as a potential predictor of chronic opioid use. This study aims to identify factors common in opioid-naïve patients who are at a high risk of opioid use during the subacute phase of 31-90 days after discharge. Retrospective analysis. Adult opioid-naïve patients who underwent spine surgeries at a quaternary medical care center from June 2012 to December 2019. Opioid refills in the subacute postoperative period of 31-90 days following discharge. In this retrospective cohort study, the electronic medical record of adult opioid-naïve patients who underwent spine surgeries at a quaternary medical care center from June 2012 to December 2019 were analyzed. Opioid refills in the subacute postoperative period of 31-90 days following discharge were the primary study outcome. Of the study cohort consisting of 3,024 patients, 2,685 (89%) required inpatient opioids in the last 24 hours before discharge, 733 (26%) required an opioid refill 1-30 days after discharge, and 579 (19%) required opioid refill 31-90 days after discharge. Moreover, a postoperative opioid refill 1-30 days after discharge conferred the strongest risk of an opioid refill 31-90 days after discharge (OR 4.66, 95% CI 3.84-5.64). Other factors associated with the increased risk of an opioid refill 31-90 days after discharge were gabapentinoid use, discharge disposition to facilities other than home or self-care, reoperation, and female gender. Meanwhile, Asian American race was associated with the reduced risk. Those requiring opioid refills were noted to be younger, underwent longer surgeries, had extended inpatient hospital stays, required higher doses of inpatient opioids, and required higher doses of discharge opioid prescriptions for longer durations. In opioid-naïve postoperative spine patients, opioid refills 1-30 days after discharge were strongly associated with an increased risk of opioid refills 31-90 days after discharge. Factors associated with opioid refill requirements also included longer surgeries and inpatient hospital stays as well as higher doses of inpatient opioids. Overall, this study enables physicians to identify patients at a higher risk of opioid use and to intervene early during the postoperative course. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

• Patients with cervical spine disease suffer from upper limb functional impairment. • No clinical benchmarks exist that define meaningful improvement in the upper limb function following cervical spine surgery. • Disabilities of arm, shoulder, and hand (DASH) is a validated outcome measure indicating upper limb disability. • This study aimed to establish minimal clinical important difference (MCID) and substantial clinical benefit (SCB) of the DASH score following cervical spine surgery. • The MCID of the DASH was –8 points and the SCB was –18 points. These metrics can be used to evaluate minimal and substantial improvement in the upper limb function following cervical spine surgery. Patients with cervical spine disease suffer from upper limb disability. At present, no clinical benchmarks exist for clinically meaningful change in the upper limb function following cervical spine surgery. Primary: to establish clinically meaningful metrics; the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) of upper limb functional improvement in patients following cervical spine surgery. Secondary: to identify the prognostic factors of MCID and SCB of upper limb function following cervical spine surgery. Retrospective cohort study. Adult patients ≥18 years of age who underwent cervical spine surgery from 2012 to 2016. Patient-reported outcomes: Neck disability index (NDI) and Disabilities of Arm, Shoulder, and Hand (DASH). MCID was defined as minimal improvement and SCB as substantial improvement in the DASH score at last follow-up. The anchor-based methods (ROC analyses) defined optimal MCID and SCB thresholds with area under curve (AUC) in discriminating improved vs. non-improved patients. The MCID was also calculated by distribution-based methods: half standard-deviation (0.5-SD) and standard error of the mean (SEM) method. A multivariable logistic regression evaluated the impact of baseline factors in achieving the MCID and SCB in DASH following cervical spine surgery. Between 2012 and 2016, 1,046 patients with average age of 57±11.3 years, 53% males, underwent cervical spine surgery. Using the ROC analysis, the threshold for MCID was –8 points with AUC of 0.73 (95% CI: 0.67–0.79) and the SCB was –18 points with AUC of 0.88 (95% confidence interval [CI]: 0.85–0.91). The MCID was –11 points by 0.5–SD and –12 points by SEM-method. On multivariable analysis, patients with myelopathy had lower odds of achieving MCID and SCB, whereas older patients and those with ≥6 months duration of symptoms had lower odds of achieving DASH MCID and SCB respectively. In patients undergoing cervical spine surgery, MCID of –8 points and SCB of –18 points in DASH improvement may be considered clinically significant. These metrics may enable evaluation of minimal and substantial improvement in the upper extremity function following cervical spine surgery. [ABSTRACT FROM AUTHOR]

As surgical techniques for deformity correction evolve towards minimizing tissue trauma, further clarity is warranted to define differences in complication profiles between cMIS and open surgeries. To compare cMIS and open surgery reoperation rates and identify contributing etiologies to reoperation in each cohort. Prospective multicenter observational series. Database enrollment required age =18 years, adult spinal deformity and circumferential minimally invasive spine surgery. Reoperation rate, patient reported outcomes (PROMS), spinopelvic parameters, mechanical failures (defined as rod breakage/dislocation, screw breakage/loosening, set screw loosening, proximal/distal junctional kyphosis, pseudoarthrosis) and other factors contributing to re-operation such as wound infection, medial breach, nerve impingement by screw, vertebral body fracture, sagittal/coronal imbalance, and wound infection. A total of 85 patients (pts) with cMIS for ASD with 2-year follow-up (2YFU) were identified and propensity matched to 85 patients in open cohort. Propensity matching was performed based on pre-operative PT, PI-LL, BMI, and SVA. Patient demographic variables, reoperation rate, and complications contributing to reoperation were compared with uni- and multi-variate analysis at any time in each cohort (33 open, 17 cMIS). PROMS at 2YFU were compared in the reoperated cohorts. Total of 33 reoperation in the open cohort vs 17 in cMIS were identified. The reoperation rate was significantly higher in the open cohort at 39% (33/85) compared to 20% (17/85) in the cMIS cohort (P= 0.012). The reoperation rate in open cohort related to mechanical failure was 52% (17/33) compared to 35% (6/17) in cMIS cohort (P= 0.43). No significant difference was found in rates of specific etiologies contributing to complications in the cMIS vs open reoperation cohorts under uni- and multivariate analysis. The change in spinopelvic parameters among the two reoperation cohorts at 2YFU were statistically not significant (δCVA, δSVA, δPI-LL, δPT, δLL CA, δTL CA). Under univariate analysis, the following PROMS were similar: ODI, NRS Leg and Back Pain, EQ5D, EQ5D-VAS, SF-36 PCS,SF-36 MCS. However, SRS-22 in open cohort was significantly higher at 2YFU (3.55 ± 0.73 open vs. 3,10 ± 0.56 MIS, p = 0.029). Findings in our ongoing study show that cMIS procedures were associated with a significantly lower reoperation rate compared to open surgical approaches. PROMS and the change in spinopelvic parameters were similar at 2YFU in both reoperated cohorts (except for SRS-22 favored open cohort). This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Abstract: Background context: Cauda equina syndrome is caused by compression or injury to the nerve roots distal to the level of the spinal cord. This syndrome presents as low back pain, motor and sensory deficits in the lower extremities, and bladder as well as bowel dysfunction. Although various etiologies of cauda equina syndrome have been reported, a less common cause is infection. Purpose: To report a case of cauda equina syndrome caused by infection of an intradural extramedullary abscess with Staphylococcus aureus. Study design/setting: Case report and review of the literature. Methods: The literature regarding the infectious causes of cauda equina syndrome was reviewed and a case of cauda equina syndrome caused by infection of an intradural extramedullary abscess with Staphylococcus aureus was reported. Results: A 37-year-old woman, with history of intravenous drug abuse, hepatitis C, and hepatitis B, presented with low back pain lasting 2 months, lower extremity pain, left greater than right with increasing weakness and difficulty ambulating, and urinary and fecal incontinence. Her presentation was consistent with cauda equina syndrome. The patient underwent a T12–L2 laminectomy, and intradural exploration revealed an abscess. Methicillin-resistant Staphylococcus aureus was found on wound culture. Conclusions: Cauda equina syndrome, presenting as a result of spinal infection, such as the case reported here, is extremely rare but clinically important. Surgical intervention is generally the recommended therapeutic modality. [Copyright &y& Elsevier]

In potentially unstable and unstable patients with metastatic spinal tumor with Spinal Instability Neoplastic Scores (SINS) 7-12 and > 12, it is unclear if surgery improves Karnofsky Performance Score (KPS). To determine if patients with SINS 7-12 and > 12 will benefit from surgery and have improvement in their KPS score postoperatively. Retrospective, single center. Patients > 18 years old, metastatic spinal tumor, with preoperative SINS 7-12 and > 12. Change in KPS score post-operatively to assess for functional status. Total of 132 patients with metastatic spinal tumor with SINS 7-12 (N: 66) and SINS > 12 (N:66) were retrospectively reviewed with pre- and postoperative KPS. Baseline clinical characteristics including age, sex, SINS score, Bilsky compression grade, neurologic function and preoperative KPS were collected; 27/132 patients preoperatively had radiation with N: 12 in SINS 7-12 cohort and N:15 in SINS > 12. KPS scores were obtained preradiation, postradiation, preoperatively, and postoperatively. Paired, nonparametric Wilcoxon signed-rank test was used to determine significance of improvement in KPS after surgery. Ordinal logistic regression was used to identify factors associated with the change in KPS. In SINS 7-12 cohort (N:66), the median SINS score was 11 with a mean followup of 3.7 years and median followup of 2.85 years. Followup ranged from 1 month to 13 years. The survival rate was 94% at 1-year, 88% at 2-year, and 82% at 3-year. In SINS > 12 cohort (N:66), the median SINS score was 14 with a mean followup of 2.19 years. The survival rate was 85% at 1-year, 82% at 2-year and 74% at 3-year. In this cohort, postoperatively significant improvement in KPS occurred from a median of 50 to 70 (p = 0.0003). In patients who did not receive radiation preoperatively, Wilcox test showed significant improvement in KPS postoperatively (P=0.006). In patients who received radiation preoperatively, there was not any improvement in the KPS. Ordinal logistic regression showed that after surgery, patients were more likely to have higher KPS scores (ie, 70-90). This improvement in KPS was observed independent of the preoperative Bilsky grade. Further, KPS was not associated with ASIA motor improvement on univariate ordinal logistic regression and this effect was maintained after controlling for Bilsky cord compression grade on multivariate models. In SINS > 12 cohort, postoperatively significant improvement in KPS occurred from a median of 50 to 60 (p = 0.001, Wilcoxon signed-rank test). On ordinal logistic regression, Bilsky compression grade as well as ASIA motor did not predict the degree of KPS improvement. Nevertheless, patients with a preoperative Bilsky compression grade 3 had a statistically significant improvement in KPS (p = 0.001), while patients with grade 2 did not (p = 0.22). Surgical intervention can improve patient functional outcome with metastatic spinal tumor with SINS 7-12 and SINS > 12 as assessed by the change in their KPS postoperatively. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]