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Background:  Leaders in Informatics, Quality, and Systems (LInQS) is a non-ACGME (Accreditation Council for Graduate Medical Education)-accredited 2-year training program developed to enhance training in the fields of health care delivery, quality improvement (QI), clinical informatics, and leadership., Methods:  This single-institution 2-year longitudinal training program grounded in QI and informed by leadership and clinical informatics includes didactics, coaching, and mentorship, all centered around individualized QI projects. The program has been available to sub-specialty fellows, advanced practice providers, and physicians., Results:  From 2019 to 2023, 32 fellows have been accepted into the program with 13 graduates and 16 currently enrolled. Fellows have been predominately female, physicians, and from multiple specialties but predominantly hospital medicine. Fellows' evaluations of the fellowship are highly positive, rating the didactics and mentorship aspects of the curriculum most favorably. Most fellows' projects utilized informatics solutions including clinical decision support tools to increase quality of care, improve patient outcomes, and reduce costs of care resulting in manuscript publications, national presentations, and a national specialty society award. Since matriculation, 50% of fellows received certification as Epic Physician Builders and 34% received leadership positions in clinical informatics, quality, and education., Conclusion:  Our experience supports the need to provide health care providers more expansive training in the areas of QI, clinical informatics, and leadership for improving health care delivery. Additional in-depth knowledge and experience in these fields may produce and benefit leaders in these fields., Competing Interests: None declared., (Thieme. All rights reserved.)

Study Design: This was a retrospective cohort study., Objective: This study evaluates the patient-reported Health Related Quality of Life outcomes and radiographic parameters of patients who underwent a single level transforaminal lumbar interbody fusion with either a polyetheretherketone (PEEK) or titanium interbody cage., Summary of Background Data: Spinal stenosis with instability is a common diagnosis that is often treated with interbody fusion, in particular transforaminal lumbar interbody fusion. Titanium and PEEK interbody cage properties have been extensively studied to understand their effect on fusion rates and subsidence., Materials and Methods: A retrospective cohort study was conducted from a single, high volume, academic hospital. Health Related Quality of Life outcomes were obtained from Outcomes Based Electronic Research Database and electronic medical record chart review. Subsidence was defined as a loss of 2 mm or more in the anterior or posterior disk height. Spinopelvic alignment parameters measured were sacral slope, pelvic tilt, pelvic incidence, lumbar lordosis, segmental lordosis, and pelvic incidence-lumbar lordosis mismatch. Fusion rates were assessed by the Brantigan-Steffee criteria., Results: The study included a total of 137 patients (108 PEEK, 29 titanium). Overall, no significant changes were noted between the 2 groups at 3 month or 1-year follow-up. Perioperatively, patients did report improvement in all outcome parameters within the PEEK and titanium groups. No significant difference was noted in subsidence rate between the 2 groups. Segmental lordosis significantly increased within the PEEK (+4.8 degrees; P<0.001) and titanium (+4.6 degrees; P=0.003) cage groups, however no difference was noted between groups. No significant difference was noted in fusion between the PEEK and titanium cage cohorts (92.6% vs. 86.2%; P=0.36)., Conclusion: Overall, while PEEK and titanium cages exhibit unique biomaterial properties, our study shows that there were no significant differences with respect to patient-reported outcomes or radiographic outcomes between the 2 groups at the 1-year follow-up time point., Level of Evidence: Level III., Competing Interests: D.G.A.: Cervical Spine Research Society, Society for Minimally Invasive Spinal Surgery: Board or committee member; DePuy, A Johnson & Johnson Company: IP royalties; Paid consultant; Integrity Medical: Paid consultant; ISD: Stock or stock Options; K2M: Paid consultant; PST: Stock or stock Options; Thieme: Publishing royalties, financial or material support. J.A.R.: Cervical Spine Research Society: Board or committee member; Globus Medical: Paid consultant; North American Spine Society: Board or committee member; The Spine Journal: Editorial or governing board; XTANT Medical: Stock or stock Options. M.F.K.: Clinical Spine Surgery: Editorial or governing board; Duratap LLC: Stock or stock Options; Innovative Surgical Designs: Research support; ISASS: Board or committee member. A.S.H.: AAOS Board member or committee member; Amedica: IP royalties; Biomet: IP royalties; Paradigm spine: Stock or stock options. C.K.K.: Biomet: Research support; Clinical spine surgery: Editorial or governing board; Medtronic: Research support; Pfizer: Research support; Regeneration; Technologies Inc.: Research support. A.R.V.: Advanced Spinal Intellectual Properties: Stock or stock Options; Aesculap: IP royalties; AO Spine: Board membership; Atlas Spine: IP royalties; Paid consultant; Avaz Surgical: Stock or stock Options; Bonovo Orthopaedics: Stock or stock Options; Clinical Spine Surgery: Editorial or governing board; Computational Biodynamics: Stock or stock Options; Cytonics: Stock or stock Options; DePuy, A Johnson & Johnson Company: Paid consultant; Dimension Orthotics LLC: Stock or stock Options; Electrocore: Stock or stock Options; Elsevier: Publishing royalties, financial or material support; Flagship Surgical: Stock or stock Options; FlowPharma: Stock or stock Options; Franklin Bioscience: Stock or stock Options; Gamma Spine: Stock or stock Options; Gerson Lehrman Group: Paid consultant; Globus Medical: IP royalties; Paid consultant; Stock or stock Options; Guidepoint; Global: Paid consultant; Innovative Surgical Design: Paid consultant; Stock or stock Options; Insight Therapeutics: Stock or stock Options; Jaypee: Publishing royalties, financial or material support; Medtronic: IP royalties; Paid consultant; none: Other financial or material support; Nuvasive: Paid consultant; Stock or stock Options; Orthobullets: Paid consultant; Paradigm Spine: Stock or stock Options; Parvizi Surgical Innovations: Stock or stock Options; Prime Surgeons: Stock or stock Options; Progressive Spinal Technologies: Stock or stock Options; Replication Medica: Stock or stock Options; Spine Journal: Editorial or governing board; Spine Medica: Stock or stock Options; SpineWave: IP royalties; Paid consultant; Spinology: Stock or stock Options; Stout Medical: Paid consultant; Stock or stock Options; Stryker: IP royalties; Paid consultant; Taylor Franics/Hodder & Stoughton: Publishing royalties, financial or material support; Thieme: Publishing royalties, financial or material support; Vertiflex: Stock or stock Options; Sentryx: Board membership. G.D.S.: Advance Medical: Paid consultant; AOSpine: Other financial or material support; Medtronic: Other financial or material support; Medtronic Sofamor Danek: Research support; Stryker: Paid consultant; Wolters Kluwer Health—Lippincott Williams & Wilkins: Editorial or governing board; Zimmer: Paid consultant. J.K.L.: DePuy, A Johnson & Johnson Company: Paid presenter or speaker; Stryker: Paid presenter or speaker. For the remaining authors there are no conflict of interest or other disclosures., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To examine the effect of static versus expandable polyether ether ketone (PEEK) cages on both clinical and radiographic outcomes., Methods: A retrospective cohort study was conducted on patients who underwent one-level transforaminal lumbar interbody fusion with either a static or expandable PEEK cage. Patient outcomes were obtained from chart review and radiographic outcomes were measured using standing, lateral radiographs. Recovery ratios and the proportion of patients achieving the minimally clinically important difference were calculated for Oswestry Disability Index (ODI), Physical Component Score-12, Mental Component Score-12, visual analogue scale for back, and visual analogue scale for leg at 1 year and compared between groups. Multivariate linear regression analysis was performed to determine the effect of cage type on the change in patient-reported outcome measures, controlling for demographic factors., Results: A total of 240 patients (137 static, 103 expandable) were included in the final analysis. ΔPhysical Component Score-12 scores at 3 months were significantly greater for the static group (16.0 vs. 10.0, P = 0.043) compared with the expandable group. Multivariate regression demonstrated that use of an expandable cage was associated with greater improvements in ΔODI (β: -7.82, P = 0.048) at 1 year. No differences were found in the perioperative change in sagittal spinal alignment within or between groups at 1 year. Subsidence rates failed to show any statistically significant difference between the 2 groups., Conclusions: Transforaminal lumbar interbody fusion with an expandable PEEK cage is an independent predictor of improved ODI scores at 1 year. Our study showed no significant differences in subsidence rates or changes in sagittal spinal alignment between static and expandable PEEK cages., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: We compared the long-term clinical and radiographic outcomes after 3- and 4-level anterior cervical discectomy and fusion (ACDF) in a retrospective cohort study., Methods: Patients who had undergone primary 3- or 4-level ACDF were retrospectively identified. The demographic data and patient-reported outcome measures (PROMs) were collected through a review of the medical records. PROM surveys were administered preoperatively for baseline measurements and at 1 year postoperatively. The surveys included the Neck Disability Index, 12-item short-form physical component summary, 12-item short-form mental component summary, and visual analog scale (VAS) scores for neck and arm pain. The cervical sagittal alignment parameters included C2-C7 lordosis, segmental lordosis, the sagittal vertical axis (SVA), and the T1 slope. Multivariate regression models were used to compare the changes in the PROMs and radiographic measurements over time between 3- and 4-level ACDF. Correlation coefficients were calculated to compare the delta scores for the PROMs and radiographic measurements., Results: The VAS scores for neck and arm pain had significantly improved from baseline in both cohorts. Only the 3-level group showed significant improvements perioperatively in the Neck Disability Index and 12-item short-form physical component summary. No significant differences were found in the improvement in clinical outcomes between the 2 groups. The pooled results demonstrated a significant negative correlation between the perioperative changes in segmental lordosis and VAS scores for arm pain. A significant negative correlation was also found between the perioperative changes in the SVA and 12-item short-form mental component summary and VAS scores for neck pain. C2-C7 lordosis significantly increased postoperatively only in the 3-level ACDF group., Conclusions: Patients undergoing both 3- and 4-level ACDF experienced significant clinical improvement without significant differences between the 2 groups. The radiographic measures of segmental lordosis and SVA also correlated with the changes in clinical outcomes., (Copyright © 2021 Elsevier Inc. All rights reserved.)