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The number of annual total joint arthroplasties (TJA) is increasing. Periprosthetic joint infections (PJI) occur when there is infection involving the prosthesis and surrounding tissue, which has the potential to develop into sepsis if left untreated. Sepsis in patients who have undergone TJA is life threatening and requires urgent treatment. If sepsis is due to PJI, the focus should be on early intravenous antibiotics with aspiration as soon as possible to diagnose the infection. Patients who develop sepsis after surgery for PJI are particularly at high risk for mortality and need to be treated in the intensive care unit.

Background: Total shoulder arthroplasty (TSA) has increased in utilization over the past several decades. Anemia is a common preoperative condition among patients undergoing TSA and has been associated with poorer outcomes in other surgical procedures. To the best of our knowledge, no study has analyzed the association between anemia severity and TSA outcomes. Therefore, the purpose of this study is to determine the effects that increasing severity of anemia may have on the postoperative outcomes in patients receiving primary TSA. Methods: A retrospective analysis was performed using the American College of Surgeons National Surgery Quality Improvement Project database from the years 2015 to 2018. Current Procedure Terminology code 23472 was used to identify all primary TSA procedures recorded during this time frame. Patients with greater than 38% preoperative hematocrit (HCT) were classified as having normal HCT levels. Patients with HCT values between 33% and 38% were classified as having mild anemia. All patients with less than 33% HCT were classified as having moderate/severe anemia. Patient demographic information, preoperative risk factors, and postoperative outcomes were compared among the 3 cohorts. A multivariate logistic regression including demographic factors and comorbidities was performed to determine whether increasing severity of anemia is independently associated with poorer postoperative outcomes. Results: Of the 15,185 patients included in this study, 11,404 had normal HCT levels, 2962 patients were mildly anemic, and 819 patients had moderate to severe anemia. With increasing severity of anemia, there was an increased average hospital length of stay (1.6 vs. 2.1 vs. 3.0 days, P

We hypothesized that magnetic resonance imaging (MRI) would more accurately diagnose small gaps (6 mm) after flexor tendon repair than static ultrasound (US) and that suture artifact would negatively impair accuracy.A laceration of the flexor digitorum profundus was created in 160 fresh-frozen cadaveric digits and randomized to either an intact repair (0-mm gap) or repairs using a locked 4-strand suture repair with either 4-0 Prolene, Ethibond, or and gaps of 2, 4,or 6 mm; or no suture in which 2-, 4-, or 6-mm gaps were created without a suture crossing the repair site. We performed 1.5T and 3T MRI and static US studies; gap widths were estimated by radiologists blinded to suture presence and true gap widths.The 1.5 and 3.0T MRI had a lower mean error than US for gap sizes 0 and 2 mm. All 3 modalities performed similarly for 4- and 6-mm gaps. Documentation of imaging artifact worsened error, and odds of seeing artifacts were 1.72 higher with MRI than with US. Suture did not worsen artifact nor impair accuracy for any of the 3 modalities. When no suture was used, all 3 modalities significantly overestimated the true gap.MRI is most accurate for small gaps less than 4 mm. Although all modalities overestimated gap sizes in specimens with a 0-mm gap (intact tendon repair), mean overestimation (2 mm) was not clinically relevant. Ultrasound overestimated 2-mm gaps (clinically intact repairs), whereas MRIs did not. We recommend MRI for evaluation of gaps after flexor tendon repair. The 1.5T has slightly better sensitivity and specificity for distinguishing clinically intact (gap3 mm) from clinically impaired (gap3 mm) repairs than the 3T.Accurate diagnosis of intact repairs or small gaps (3 mm) might prevent unnecessary exploration or allow modification of rehabilitation protocols. Diagnosis of clinically relevant gaps (3-6 mm) may allow for earlier revision surgery before significant tendon retraction and adhesions develop, possibly necessitating a staged reconstruction.

STUDY DESIGN Retrospective cohort study. OBJECTIVE The aim of this study was to evaluate the safety of two-level cervical disc replacement (CDR) in the outpatient setting. SUMMARY OF BACKGROUND DATA Despite growing interest in CDR, limited data exist evaluating the safety of two-level CDR in the outpatient setting. METHODS The National Surgical Quality Improvement Program (NSQIP) database was queried for all two-level anterior cervical discectomy and fusion (ACDF) and CDR procedures between 2015 and 2018. Demographics, comorbidities, and 30-day postoperative complication rates of outpatient two-level CDR were compared to those of inpatient two-level CDR and outpatient two-level ACDF. Radiographic data are not available in the NSQIP. RESULTS A total of 403 outpatient CDRs were compared to 408 inpatient CDRs and 4134 outpatient ACDFs. Outpatient CDR patients were older and more likely to have pulmonary comorbidities compared to inpatient CDR (P

Navicular stress fractures are multifactorial injuries due to chronic overload on the navicular, particularly in young athletes. The navicular is subject to unique stresses and has a complex blood supply, making it susceptible to stress fractures and potentially delayed union or nonunion. Expeditious diagnosis is critical to prevent a delay in treatment and a poor outcome. Advanced imaging is essential in making the diagnosis and monitoring healing. Both nonsurgical and surgical treatments have demonstrated good results. Nonsurgical management consists of a period of immobilization and nonweight bearing, and surgical management typically involves open reduction and internal fixation. Patients need to be appropriately counseled regarding expectations for these challenging injuries.

The management of Achilles tendon rupture continues to be controversial in the everyday athlete; however, there is strong evidence indicating that surgical intervention is preferred in elite athletes due to the return of greater strength and peak torque. We review the published literature, as well as our operative technique and post-operative protocol in the management of Achilles tendon injuries in elite athletes.

Study design Descriptive epidemiology study. Objective The purpose of this study was to describe the epidemiology of neck and cervical spine injuries in collegiate athletes over a 5-year period. Summary of background data The incidence and etiology of neck and cervical spine injuries in National Collegiate Athletic Association (NCAA) athletes has not been well defined in recent years. Methods The incidence and characteristics of neck and cervical spine injuries were identified utilizing the NCAA Injury Surveillance Program database. Rates of injury were calculated as the number of injuries divided by the total number of athlete-exposures (AEs). AEs were defined as any student participation in one NCAA-sanctioned practice or competition. Results Nationally, there were an estimated 11,510 neck and cervical spine injuries over the 5-year period. These occurred at a rate of 7.05 per 100,000 athlete-exposures (AEs). The rate of neck and cervical spine injuries in men was 2.66 per 100,000 AEs, while women suffered injuries at a rate of 1.95 per 100,000 AEs. In sex-comparable sports, men were 1.36 times more likely to suffer a neck or cervical spine injury compared with women. Men's football (29.09 per 100,000 AEs) and women's field hockey (11.51 per 100,000 AEs) were the sports with the highest rates of injuries. These injuries were 3.94 times more likely to occur during competition compared with practice. In-season injury rates were the highest, at 8.18 per 100,000 AEs. Conclusion The vast majority of neck and cervical spine injuries in NCAA athletes are minor and uncommon. Across all sports in both sexes, the majority of injuries were new, and occurred during in-season competitions. Most athletes returned to play within 24 hours of injury. These data can inform players, parents, coaches, athletic trainers, and physicians regarding the prevalence and rates of these injuries and potentially inform decision-making regarding injury prevention, treatment, and rehabilitation. Level of evidence 4.

Purpose To analyze the top-100 cited articles on sports-related concussions together with a bibliometric analysis to determine citations by year, level of evidence, study design, and several other factors related to the top referenced articles in sports concussions. Methods The Clarivate Analytics Web of Knowledge database was used to gather data using Boolean queries to capture all possible iterations of sports-related concussion research. Articles were organized in descending order based on the number of citations and included or excluded based on relevance to concussion. Collected information included author name, publication year, country of origin, journal name, article type, study focus, and the level of evidence. Results The top-100 articles were cited 31,197 times with an average of 312.0 citations per publication. More than one half were published in 2006 or later (52). Cohort studies and descriptive articles were the most prevalent study types (22 each). Studies with Level V evidence were the most common (33). The most common areas of study were symptomatology (short term, long term) with 17 articles, followed by epidemiology/demographics with 16 articles. The least common area of study was concussion prevention (2 articles), followed by management/treatment, diagnostics (labs, imaging) with 4 articles each. Conclusions We identified the most influential studies in sports-related concussion based on number of citations and citation density. A majority of these articles were published in the United States after 2006 and are most commonly cohort studies (Level IV evidence) and descriptive articles (Level V evidence). Current research focuses most heavily on the symptomatology and epidemiology/demographics of sports concussion. Clinical Relevance This study serves to identify the most influential articles in sports-related concussion and identify research topics with general deficiencies within the field of sports-related concussion research.

Background:In patients with femoroacetabular impingement, preoperative diagnostic injections are commonly used to establish a diagnosis of intra-articular pathology. In some cases, intra-articular steroid injections are also used for therapeutic purposes.Purpose/Hypothesis:The purpose of this study was to determine if a positive response to intra-articular steroid injection was predictive of superior outcomes after hip arthroscopy to determine if the response to intra-articular steroid injection was predictive of outcomes after hip arthroscopy. It was hypothesized that a positive response to a preoperative hip injection would be predictive of improved short- to midterm outcomes after hip arthroscopy.Study Design:Cohort study; Level of evidence, 3.Methods:This was a retrospective study of 208 patients who elected to have ultrasound-guided intra-articular steroid injection before they underwent hip arthroscopy between January 2016 and December 2016. Patients were divided into 2 groups: those who showed improvement in pain after the injection (steroid responder group) and those who showed no response (nonresponder group). The authors compared the preoperative and 2-year postoperative patient-reported outcomes (modified Harris Hip Score [mHHS] and Hip Outcome Score–Activities of Daily Living [HOS-ADL]) and radiographic findings between groups. Clinical endpoints, including rates of revision and conversion to total hip arthroplasty, were also reviewed.Results:There were 88 patients in the nonresponder group and 120 patients in the responder group, with no significant between-group differences in preoperative descriptive variables. The responder group had significantly higher 2-year mHHS and HOS-ADL, pre- to postoperative change in mHHS and HOS-ADL, percentage of patients achieving the patient acceptable symptomatic state (PASS) on the mHHS, and percentage of patients reaching the minimum clinically important difference and the PASS on the HOS-ADL. There was no difference in Tönnis grade, acetabular labrum articular disruption grade, revision rate, or conversion to total hip arthroplasty between the 2 groups.Conclusion:The response to preoperative intra-articular injection did aid in predicting 2-year patient-reported outcomes of hip arthroscopy for femoroacetabular impingement. Overall, the result of a preoperative intra-articular injection can be a helpful clinical tool for surgical decision-making and counseling patients on expected outcomes after hip arthroscopy.

BACKGROUND Accounting for less than 0.4% of disc herniations, intradural lumbar disc herniations (ILDHs) are a rare occurrence primarily described as a complication after lumbar spine surgery. It is speculated that the herniation may propagate intradurally from either an unrecognized dural defect after initial surgery or as a result of adhesions between the dura and posterior longitudinal ligament. This report explores the etiology, presentation, diagnostic evaluation, and treatment of ILDH along with a case report and microsurgery video. OBSERVATIONS A 67-year-old patient who 1 year earlier had undergone an L2–5 laminectomy and L2–3 decompression with no known complications presented with low back pain and radiating right leg, buttock, and groin pain for 1 month. Physical examination indicated no numbness or weakness. Magnetic resonance imaging demonstrated a large ILDH. A transforaminal interbody fusion was performed followed by a durotomy, ILDH removal, and dural closure. A ventral dural defect was found and repaired during the procedure. LESSONS The treatment for ILDH is laminectomy with dorsal durotomy. Because ILDH has rarely been described in literature, understanding its presentation is crucial for prompt identification and management.

Objectives: Recent research has shown that implanting a patellar osteochondral allograft with a non-matched surface morphology (i.e., Wiberg classification) does not create increased chondral surface deviation or circumferential step-off in the donor plug compared to the native patella. While much of the research on patellar osteochondral allografts has been focused on chondral surface matching, little has been done to determine if the subchondral bone alignment at the donor:native interface plays a role in graft healing, local force distribution, and long term success of the allograft transplant. Previous work in our lab demonstrated that even when the patellar cartilage surface was well matched, notable differences in subchondral bone alignment were observed. The purpose of this study was therefore to use surface contour mapping of subchondral bone to determine if differences in Wiberg classification play a role in the ability of donor patellar osteochondral allograft subchondral bone to align with the native patellar subchondral bone when treating osteochondral defects of the patellar apex. The hypothesis was that patellar surface morphology would have an effect on subchondral bone surface height deviation and circumferential step-off when performing osteochondral allograft transplants of the patellar apex. Methods: Sixty fresh frozen human patellae were acquired from a national donor procurement company. Twenty (10 Wiberg I and 10 Wiberg II/III) patellae were designated as the recipient and then nano-CT scanned. Each recipient was size-matched (within ±2mm tibial width) to both a Wiberg I and a Wiberg II/III patellar donor. A 16mm circular osteochondral “defect” centered on the central ridge of the patella was then created in the recipient patella. A randomly-ordered donor Wiberg I or Wiberg II/III plug was harvested from a homologous location and transplanted into the recipient. The recipient was then nano-CT scanner, digitally reconstructed, and superimposed on the initial nano-CT scan of the native recipient patella. After careful atraumatic removal of the first donor plug, the process was repeated using the other allograft plug. MATLAB was used to determine the root mean square (RMS) surface height deviation between the native and donor subchondral bone surfaces. Dragonfly 3D imaging software was used to measure the RMS subchondral bone step-off height at 3° increments around the circumference of the graft. Surface height deviation and circumferential step-off height were analyzed for the whole surface and by quadrant to determine if there were local differences. ANOVA was used to compare surface deviation and step-off heights between matched and unmatched grafts. Sidak’s multiple comparison test was used to complete sub-analysis between patellar graft quadrants. Comparisons were made between matched and unmatched grafts in terms of the RMS surface height deviation and step-off, as well as in the percentage of measurements that were more than 0.5mm, 1mm, and 2mm proud or sunken relative to the native surface. Results: There were no significant differences in RMS subchondral bone surface height deviation between matched and unmatched Wiberg plugs as a whole or by quadrant (RMS range = 0.69 to 0.97mm, p = 0.45 – 1.0). There was a significant difference in RMS circumferential step-off height between matched (1.14 ± 0.52mm) and unmatched (1.38 ± 0.49mm) Wiberg plugs ( p=0.015). The majority of these increased step-off measurements occurred in the lateral quadrant with lateral quadrant RMS step-off of 0.89 ± 0.43mm in matched grafts and 1.60 ± 0.78mm in unmatched grafts ( p=0.007). There was also a significant difference in the percent of step-off measurements greater than 2mm sunken in the lateral quadrant between matched and unmatched grafts (5.17 ± 20.87% matched, 24.5 ± 36.39% unmatched, p=0.028). There were no significant differences between matched and unmatched grafts for any other comparison using 0.5, 1, or 2mm cut-offs for circumferential step-off or surface height deviation. Combining all allografts, the respective proportion of surface deviation and circumferential step-off height measurements that were above the stated thresholds were as follows: 31% and 34% for a 0.5mm threshold, 15% and 21% for a 1mm threshold, and 2% and 8% for a 2mm threshold. Conclusions: While unmatched Wiberg patella osteochondral allograft implantation did not result in significantly different subchondral bone surface height deviations, there were significant differences in circumferential subchondral bone step-off heights. The majority of step-off height differences between Wiberg matched and unmatched osteochondral allografts occurred in the lateral quadrant. In comparison to previous data evaluating differences in the cartilage surface match in these patellar OCA transplants, the deviations and step-off heights in the subchondral bone identified in the current study were approximately 0.5mm greater than the differences in the cartilage surface. These findings therefore suggest there is greater variability in the alignment of the subchondral bone in these patellar osteochondral allografts than there is in the cartilage surface. Further investigation using finite element analysis modeling will help determine the implications of subchondral bone surface deviation and circumferential step-off on local cartilage:bone compression and shear force distribution. These studies may shed light on the mechanisms of failure in patellar osteochondral transplants and may help to better understand the contribution of subchondral bone alignment in OCA healing and long-term outcome.

Background: Optimal treatment for patients with severe ankle instability or failed previous ankle stabilization is not well defined, and newer techniques have limited presence in the literature. Purpose/Hypothesis: The purpose of this study was to evaluate clinical and radiographic outcomes after modified anatomic lateral ligament reconstruction using hamstring auto- or allograft in primary cases versus revision cases. We hypothesized that patients undergoing a revision procedure would demonstrate inferior patient-reported and radiographic outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent modified anatomic lateral ligament reconstruction by a single surgeon between 2010 and 2017 were identified. Indications included failure of previous ankle stabilization or severe ankle laxity. Patients completed preoperative and minimum 1-year postoperative Foot and Ankle Outcome Score (FAOS) surveys. They also underwent pre- and postoperative stress radiographs using the Telos Stress Device. Results: A total of 41 patients (42 ankles) were identified. The mean age was 32.1 years, and 36 patients (88%) were women. There were 25 primary procedures and 17 revision procedures. Hamstring autograft was utilized in 35 ankles and hamstring allograft in 7 ankles. A total of 34 patients (83%) provided postoperative patient-reported outcome scores at a mean of 26 months (range, 12-65 months). When comparing primary versus revision procedures, revision patients had significantly lower FAOS Pain (77.14 vs 90.66; P = .009), Sports (63.46 vs 82.16; P = .008), and Quality of Life (53.53 vs 76.70; P = .002) scores. In total, 34 patients (83%) had stress radiographs at a mean of 14 months (range, 3-62 months) postoperatively. Revision patients also had lower, though statistically insignificant, postoperative talar tilt measurements on average (5.73° vs 7.10°; P = .252), and pre- to postoperative change in talar tilt was not significantly different between groups (−4.94° vs −7.03°; P = .415). Conclusion: Revision procedures had significantly lower postoperative patient-reported outcome scores and lower talar tilt compared with patients undergoing a primary procedure, although the pre- to postoperative change in the talar tilt was not significantly different between groups.

Hypothesis The aim of this meta-analysis was to compare the safety, efficacy, and opioid-sparing effect of liposomal bupivacaine (LB) vs. nonliposomal local anesthetic agents (NLAs) for postoperative analgesia after shoulder surgery. Methods A systematic literature review of randomized controlled clinical studies comparing the efficacy of LB with NLAs in shoulder surgery was conducted. Seven level I and II studies were included in the meta-analysis, and shoulder surgical procedures included arthroscopic rotator cuff repair and shoulder arthroplasty. Bias was assessed using The Cochrane Collaboration's tool. The primary outcome measures were visual analog scale pain scores and opioid consumption 24 and 48 hours after shoulder surgery. Subgroup analysis was performed for the method of LB administration (interscalene nerve block vs. local infiltration). Results A total of 7 studies (535 patients) were included in the final meta-analysis comparing LB (n = 260) with NLAs (n = 275). No significant difference was found between the LB and NLA groups in terms of visual analog scale pain scores at 24 hours (95% confidence interval, –1.02 to 0.84; P = .86) and 48 hours (95% confidence interval, –0.53 to 0.71; P = .78). Both groups had comparable opioid consumption at both 24 hours (P = .43) and 48 hours (P = .78) postoperatively and with respect to length of stay (P = .87) and adverse events (P = .97). Subgroup analysis demonstrated comparable efficacy irrespective of the method of administration of LB. Conclusion LB is comparable to NLAs with respect to pain relief, the opioid-sparing effect, and adverse effects in the first 48 hours after arthroscopic rotator cuff repair and total shoulder arthroplasty.

Context Data from the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP) have indicated that ankle injuries are the most common injuries among NCAA soccer players. Objective To review 10 years of NCAA-ISP data for soccer players' ankle injuries to understand how the time period (2004–2005 through 2008–2009 versus 2009–2010 through 2013–2014), anatomical structure injured, and sex of the athlete affected the injury rate, mechanism, and prognosis. Design Descriptive epidemiology study. Setting Online injury surveillance. Main Outcome Measure(s) The NCAA-ISP was queried for men's and women's soccer ankle data from 2004 to 2014. Ankle-injury rates were calculated on the basis of injuries per 1000 athlete-exposures. Rate ratios (RRs) were used to compare injury rates. Injury proportion ratios (IPRs) were used to compare injury characteristics. Results When compared with the 2004–2005 through 2008–2009 seasons, the 2009–2010 through 2013–2014 seasons showed a similar rate of injuries (RR = 0.94, 95% confidence interval [CI] = 0.85, 1.04) but fewer days missed (P < .001) and fewer recurrent injuries (IPR = 0.55, 95% CI = 0.41, 0.74). The 4 most common ankle injuries, which accounted for 95% of ankle injuries, were lateral ligament complex tears (65.67%), tibiofibular ligament (high ankle) sprains (10.3%), contusions (10.1%), and medial (deltoid) ligament tears (9.77%). Of these injuries, high ankle sprains were most likely to cause athletes to miss ≥30 days (IPR = 1.9, 95% CI = 1.24, 2.90). Men and women had similar injury rates (RR = 1.02, 95% CI = 0.94, 1.11). Men had more contact injuries (IPR = 1.28, 95% CI = 1.16, 1.41) and contusion injuries (IPR = 1.34, CI = 1.03, 1.73) but fewer noncontact injuries (IPR = 0.86, 95% CI = 0.78, 0.95) and lateral ligamentous complex injuries (IPR = 0.92, 95% CI = 0.86, 0.98). Conclusions Although the rate of ankle injuries did not change between the 2004–2005 through 2008–2009 seasons and the 2009–2010 through 2013–2014 seasons, the prognoses improved. Among the 4 most common ankle injuries, high ankle sprains resulted in the worst prognosis. Overall, male and female NCAA soccer players injured their ankles at similar rates; however, men were more likely to sustain contact injuries.

Aging is associated with impaired tissue regeneration. Stem cell number and function have been identified as potential culprits. We first demonstrate a direct correlation between stem cell number and time to bone fracture union in a human patient cohort. We then devised an animal model recapitulating this age-associated decline in bone healing and identified increased cellular senescence caused by a systemic and local proinflammatory environment as the major contributor to the decline in skeletal stem/progenitor cell (SSPC) number and function. Decoupling age-associated systemic inflammation from chronological aging by using transgenic Nfkb1KO mice, we determined that the elevated inflammatory environment, and not chronological age, was responsible for the decrease in SSPC number and function. By using a pharmacological approach inhibiting NF-κB activation, we demonstrate a functional rejuvenation of aged SSPCs with decreased senescence, increased SSPC number, and increased osteogenic function. Unbiased, whole-genome RNA sequencing confirmed the reversal of the aging phenotype. Finally, in an ectopic model of bone healing, we demonstrate a functional restoration of regenerative potential in aged SSPCs. These data identify aging-associated inflammation as the cause of SSPC dysfunction and provide mechanistic insights into its reversal.

Background: Microfracture (MF) has been used historically to treat osteochondral lesions of the talus (OLTs), with favorable outcomes reported in approximately 80% to 85% of cases. However, MF repairs have been shown to degrade over time at long-term follow-up, suggesting that further study into optimal OLT treatment is warranted. The use of adjuvant extracellular matrix with bone marrow aspirate concentrate (ECM-BMAC) has not been extensively evaluated in the literature. We present a comparison of patient-reported and radiographic outcomes following ECM-BMAC repair vs traditional MF. Methods: Patients who underwent MF (n = 67) or ECM-BMAC (n = 62) treatment for an OLT were identified and their charts were retrospectively reviewed. Postoperative magnetic resonance imaging (MRI) was evaluated and patient-reported outcome scores, either Foot and Ankle Outcome Scores (FAOS) or Patient-Reported Measurement Information System (PROMIS) scores, were collected. MRIs were scored by a radiologist, fellowship trained in musculoskeletal radiology, using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) system. Radiographic and clinical outcomes were compared between groups. Results: On average, patients treated with ECM-BMAC demonstrated a higher total MOCART score compared to the MF group (73 ± SD 11.5 vs 54.0 ± 24.1; P = .0015). ECM-BMAC patients also had significantly better scores for the Infill, Integration, and Signal MOCART subcategories. Last, patients treated with ECM-BMAC had a lower rate of revision compared to those treated with MF (4.8% vs 20.9%; P = .007). FAOS scores were compared between groups, with no significant differences observed. Conclusion: When comparing outcomes between patients treated for an OLT with ECM-BMAC vs traditional MF, we observed superior MRI results for ECM-BMAC patients. The rate of revision surgery was higher for MF patients, although patient-reported outcomes were similar between groups. The use of ECM-BMAC as an adjuvant therapy in the treatment of OLTs may result in improved reparative tissue when compared to MF. Level of Evidence: Level III, comparative series.

The level of financial literacy varies among orthopaedic trainees. Personal finance ideally should be taught before accepting student loans; however, when this has not happened, it is imperative that trainees start taking their personal finances seriously. Many trainees are faced with large amounts of student debt and struggle with how to manage a large salary increase in their first job. This can lead to poor financial decisions including insufficient savings. The authors provide a comprehensive viewpoint on personal finance for the orthopaedic trainee. In this article, we provide future orthopaedic surgeons with a framework for personal financial management as a starting point to understanding the financial concepts of budgeting, investment, debt management, mortgage, disability insurance, and life insurance.

With the tremendous growth in the Embedded Linux Applications in the profuse sectors, the integration of Internet of Things with the Embedded Linux would be very fruitful. The utmost reason for the use of Embedded Linux are open source, platform independent as it can be used on any platforms like Advanced RISC Machine (ARM), x86, PowerPC, Microprocessor without Interlocked Pipeline Stages (MIPS). The integration of IoT, Embedded Linux and Amazon Web Services (AWS) required secure isolated environment for better work. The ubiquitous way to validate the system probity and authorization is to authenticate the OS during the boot process. The use of AWS Cloud Technologies would be very efficacious for the applications for real time monitoring of the system. The proposed paper relates to the implementation of Smart Secure Intruder System using PIR motion sensor integrating with AWS Cloud Technology with Android App Monitoring using device driver statically loaded onto the BeagleBone Black (ARM Platform) for this IoT application along with the use of Trusted Platform Model (TPM) Security for OS level entry security in the BeagleBone Black Booting Process. The Linux OS is running on the BeagleBone Black Platform. The device driver is the piece of software whose aim is to control and manage the particular hardware device and part of the kernel for efficient applications.

Lower extremity fractures in athletics are common, and can be debilitating. Treatment of these injuries vary based on location, displacement, patient age, and activity level. Given overlap of mechanisms, as well as close proximity of different structures, a high index of suspicion and detailed physical exam must be employed, along with the judicious use of advanced imaging.

BACKGROUND CONTEXT Thoracolumbar malalignment is often seen in patients presenting with cervical deformities. For operative cervical deformity (CD) patients, it is unknown when the thoracic spine should be included in the construct. PURPOSE To investigate the CD patients in whom fusion to the thoracic spine was warranted. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE A total of 72 CD patients. OUTCOME MEASURES Radiographic parameters; complications, distal junctional kyphosis [DJK], reoperation; Health-Related Quality-of-Life [HRQLs]: NDI, NRS-neck, mJOA. METHODS Included: operative CD patients (C2-C7 lordosis 35°, segmental cervical kyphosis >15° across any 3 vertebra between C2-T1, C2-C7 SVA >4cm, McGregor's slope >20°, or CBVA > 25°) with baseline (BL) and up to 2-year (2Y) data. Patients with UIV at or above C4 and LIV extending beyond C7 into the thoracic spine were isolated (CT fusions). CT fusion patients were further stratified to upper and lower thoracic LIVs: T1-T4 [Short Fusion], beyond T4 [Long Fusion]. CT fusion patients were identified as having an optimal outcome at 2-year postop if they 1) did not have DJF and 2) had Virk et al. good clinical outcome [≥2 of the following: NDI RESULTS Seventy-two cervical deformity patients with CT fusion included (60.3±9.0years, 60% F, 29.4±7.6 kg/m2, levels fused: 7.8±3.2). By approach, 61% posterior-only and 39% combined. Fifty-nine patients (82%) had CT fusions with LIV of T4 or above, while 13 patients (18%) had fusions extending below T4. Thirty-two patients (44.4%) met the optimal outcome criteria, with no difference by fusion length (p=0.171). Eight patients qualified as long fusions with treatment success, while 35 patients were classified as short fusions with treatment failure. Regression analysis identified the predictors of treatment success in patients with fusion construct extending beyond T4: baseline sacral slope ≤33.5° (OR: 15.0), not undergoing high grade (PSO or VCR) osteotomy (OR: 15.0) and being Ames descriptor type C (OR: 13.5); all p 6 (OR: 4.3), Ames descriptor type CT (OR: 11.5), Ames cSVA modifier grade 1 or 2 at BL (OR: 4.56), and Flatneck Lafage morphotype (OR: 4.5); all p CONCLUSIONS Treatment success in patients with fusion constructs extending into the thoracic spine vs treatment failure in patients with short fusions may be reliably predicted by the location of the deformity apex, measures of surgical invasiveness, and preoperative deformity severity. Specifically, treatment success in longer fusions is related to deformity apex in the cervical spine and having deformity where adequate correction does not necessitate high grade osteotomy. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Patients receiving surgery for adult spinal deformity (ASD) are often frail and may be at risk of adverse events following these intensive procedures, including proximal junctional failure (PJF). The role of physiologic age in prognosticating this outcome is not well define PURPOSE To determine if the benefits of optimal realignment on PJF development can be negated by increasing frailty as determined by physiologic age. STUDY DESIGN/SETTING Retrospective cohort study of prospective, multicenter ASD database PATIENT SAMPLE A total of 245 ASD patients. OUTCOME MEASURES Complications. METHODS Complications RESULTS A total of 245ASD patients met inclusion criteria (57yrs±15.0, 82%F, BMI: 26.3 kg/m2 ±6.0, ASD-FI: 2.9±1.6, CCI: 1.55 ±1.7). Surgical patients had a mean levels-fused of 11.4±4, LOS of 7.7 days±4.4, EBL of 1686 mL, operative time of 374 min, with 70% undergoing an osteotomy. In terms of surgical approach, 76% were posterior-only and 23.6% had a combined approach. Of the 245 patients, 138 (55%) of patients were characterized as not frail, 107 (43%) as frail. Overall rate for PJK was 49%, and 12% for PJF. The presence of PJF in the NF group was lower than in the F group, (7% vs 18%; p CONCLUSIONS Frailty is a significant independent predictor of PJF development, and while optimizing realignment may minimize this effect, frailty still remains a risk factor. The alarmingly high rates of PJF despite adequate alignment in frail patients warrants further research to determine whether operating on very frail patients with large deformity is advisable. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT The widely used definition for distal junctional kyphosis (DJK) includes the change in kyphosis between the lower instrument vertebra (LIV) and LIV-2 to be >10°. However, this cut-off has yet to be analyzed against other possible cut-offs in terms of accuracy, sensitivity, and specificity for various clinically relevant outcomes. PURPOSE Create thresholds that more accurately predict DJK than those currently used. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE Cervical deformity (CD) patients (C2-C7 Cobb >10°, CL>10°, cSVA >4cm, or CBVA >25°) with radiographic data at baseline (BL) and at least 1 year follow-up. OUTCOME MEASURES DJK reoperation, minimal clinical important difference (MCID) for Neck Disability Index (NDI) and EQ5D. METHODS Surgically treated CD patients were enrolled into a prospective, multicenter database and evaluated at a minimum of 1-year follow-up for DJK. DJK was defined by the patient's DJK angle (DJKA) >10° change in kyphosis between LIV and LIV-2 and a >10° index angle. Sensitivity (true positive [TP]/TP+false negative [FN]), precision (true negative [TN]/(TN+False Positive [FP]), and accuracy (TN+TP/TN+TP+FN+FP) metrics were calculated from different combinations of angular changes above and below the lower instrumented vertebrae (LIV) from pre- to postop. The ability of these angular changes to predict different types of DJK failure (DJKF) [(1) reoperation for DJK (2) not meeting MCID for either NDI or Eq5D] and were compared against previously published definitions of DJK including absolute and ∆DJKA>10° and ∆DJKA >20°. RESULTS A total of 160 CD patients with follow-up were included (57yrs, 29.1 kg/m2, 51.8%F). Eighteen percent of these patients developed DJK postop (33.4% 6M, 47.6% 1Y, 19% 2Y). The mean DJK angle prior to revision surgery was -1.7±7.4 (Minimum: -19.3, Maximum: 10.5). Baseline average pelvic parameters were: PT: 16.8±9.6, PI: 54.1±12.3, PI-LL: -2.0±13.5. The average cervical parameters were: TS-CL: 25.6±14.5, C2-C7: -0.9±14.4. Sensitivity, precision, and accuracy of previously used criteria of >10° to identify DJKF for outcome 1 demonstrated a sensitivity of 50%, specificity of 64.4% and an accuracy of 63.2%. For outcome 2 using this criterion resulted in a sensitivity of 55%, specificity 75.8%, and accuracy 67.3%. However, if the ∆DJKA was increased to 15.3, the predicted sensitivity for DJKF defined by reoperation was 50%, specificity 86.6% and with an accuracy of 83.6%. When DKF was defined by HRQLs the sensitivity was 35%, specificity 96.5% and accuracy of 71.4%. This newly established cut-off had greater ability to correctly identify true positives than the 20° cut-off (45.8% vs 27.1%), as well as for true negatives when compared to the 10° (39.2% vs 34.2%). A subanalysis identified 40.6% of patients with a DJKA >10° to be not clinically meaningful. When increasing the angle to the proposed 15.3° only 35.7% are not clinically meaningful. CONCLUSIONS The newly established cut-off for DJK failure (∆DJKA>15.3°) demonstrated greater sensitivity, specificity, and precision than the previously established criteria of 10° when analyzing distal junctional kyphosis failure as described by reoperations or clinical deterioration. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Robot-assisted surgical techniques are being increasingly implemented to increase surgeon accuracy and stamina; however, further investigation of the introductory phase of robot technology on surgical outcomes remains warranted. PURPOSE To assess complication rates of robotic surgery in elective spine patients. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE A total of 10,501 elective spine patients. OUTCOME MEASURES intra- and postoperative complication rates; reoperation rate. METHODS Patients ≥18 years undergoing elective spine surgery with BL to 2-year follow-up were isolated in a single-center spine database. Patients were grouped by absence or presence of robotic assistance during operation. Univariate analyses identified differences in perioperative outcomes [op time, estimated blood loss, length of stay], rates of intraoperative [durotomy, massive blood loss, neurologic deficit] and postoperative complications [cardiopulmonary, neurologic, GI, GU, infection, mechanical], and reoperation rates by 2Y postop]. Regression analysis assessed the impact of robotic surgery on outcomes. RESULTS A total of 10,501 patients met inclusion criteria (57years, 49% F, 29.0kg/m2) and underwent elective spine surgery (mean levels fused: 3.0±3.3, EBL: 375mL, op time: 206 min, mean UIV: T9, mean LIV: T12). Of these patients, 424 (4.0%) underwent operation with robotic assistance. Compared to a general cohort of elective spine surgery patients, robotic-assisted surgeries had lower levels fused (1.99 vs 3.07), longer op time (301 vs 202min), and longer LOS (4.2 vs 3.2 days); all p 0.05). Robotic and non-robotic patients did not differ in rates of intraoperative complications, including durotomy, massive blood loss, and delayed extubation (all p>0.05). Robotic patients had higher rates of postop ileus (12% vs 7%, p=0.04), but did not differ in overall postop complications, surgical site infection, cardiopulmonary, mechanical, or neurologic complication. Robotic patients had higher rate of reoperation (6% vs 4%, p=0.004). Regression analysis controlling for revision status, decompression, and approach found that robotic surgery patients had lower odds of delayed extubation (OR: 0.155 p=0.025). Robotic surgery did affect the odds for other complications, including durotomy, neurologic, cardiopulmonary, mechanical, infection, and reoperation (all p>0.05). CONCLUSIONS Robotic and non-robotic procedures for elective spine patients were equally as safe in terms of intraoperative and postoperative complications with equivocal functional outcomes up to 2-years postoperatively. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT PROMIS is a computer based adaptive test. However, there is a lack in research in whether these PROMIS scores translate into clinically relevance and applicability in patients at higher operative risk categories. PURPOSE Assess if the PROMIS metric can be utilized to establish a gradient to evaluate complication occurrence alongside ODI. STUDY DESIGN/SETTING Retrospective review of a single-center stereo-radiographic database. PATIENT SAMPLE Patients receiving spinal corrective procedures with complete baseline radiographic and PROMIS data. OUTCOME MEASURES PROMIS metrics (Pain Intensity, Physical Function, Pain Interference). METHODS Surgical patients ≥18 years old with available baseline (BL) radiographic and PROMIS data were isolated in the Quality Database. The relationship between ODI and PROMIS was assessed via linear trends to determine whether the two have discriminative power over each other. The linear trend was mapped between ODI and PROMIS, and patients were divided into quartiles via calculations of perpendicular lines at quartile points to determine whether there was a higher density of complication occurrences at the higher quartile of this association. RESULTS A total of 231 patients (58.7 years, 49.8% female, 29.3kg/m2, mean Charlson comorbidity score: 1.2) met inclusion criteria. By surgical approach: 74.5% posterior, 11.3% anterior, 14.3% combined; mean levels fused: 1.0±0.1. Of the patients included in the study, 155 had both BL ODI and PROMIS data. There were 65 patients in the upper 50th percentile of both ODI and PROMIS. This quadrant of patients experienced a significantly higher complication rate (24.6%) compared to the remainder 10.1% (p=0.016). A linear relationship for ODI vs PROMIS was established (R2=0.4548). There were 36 patients in the 0-25th percentile, 42 in the 25th-50th, 39 in the 50th-75th and 37 in the 75th-100th. Density of complication occurrence was highest at the highest percentile, as 32.4% of patients in the 75th-100th group experienced a complication compared to 2.8% of the 0-25th, 16.7% of the 25th-50th and 12.8% of 50th-75th. CONCLUSIONS Utilizing both ODI and PROMIS scoring systems can guide proper delineation of patients based on their baseline radiographic severity. Based on the results of our study, it appears that these scoring systems used in conjunction may serve as a more appropriate metric to predict postoperative complications, rather than their independent utility. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Stress fractures of the fifth metatarsal (zones 2 and 3) remain a challenging clinical problem. It has been well established that nonsurgical treatment has unacceptably high nonunion and refracture rates. Surgical fixation remains the treatment of choice in the athletic cohort, and intramedullary screw fixation with a solid screw has been established as the most predictable means of achieving a successful outcome. Recently, the use of a plantar plate has also been advocated as has been shown in some studies to be more biomechanically advantageous. The use of bone grafting at the primary surgery and morphology and screw type are also important decisions to be made when treating these patients. This review will discuss our management of both primary fractures and refractures of the fifth metatarsal in athletes.

Objectives: The aim of this study is to directly compare clinical outcomes following the treatment of medium-sized osteochondral lesions of the talus (OLTs) using a microfracture technique augmented with Extracellular Matrix and Bone Marrow Aspirate Concentrate (MFX) versus OAT to determine which treatment is superior for medium-sized lesions. Methods: Patients treated for an OLT between 2015 and 2018 by a single surgeon, fellowship-trained in sports medicine and foot and ankle, were screened for this study. Retrospective chart review determined treatment, lesion size, lesion location, concurrent injuries, and demographic information. Patients at a minimum of 12 months follow-up, treated with MFX or OAT, and lesions sized 80-165mm2 were eligible for inclusion. All surgical repairs were augmented with an adjuvant mixture of micronized cartilage extracellular matrix and bone marrow aspirate concentrate (ECM-BMAC). Patient-reported functional outcomes were collected through our institution’s prospective Registry database. Patients treated prior to March 2016 were administered preoperative Foot and Ankle Outcome Score questionnaires. Those treated after this date were administered preoperative Physical Function, Pain Interference, Global Physical Health, Global Mental Health, Depression, and Pain Intensity Patient-Reported Outcome Information System (PROMIS) domains. Both FAOS and PROMIS were administered postoperatively. Postoperative MRIs were assessed using a modified magnetic resonance observation of cartilage repair tissue (MOCART) score. Student’s paired and two-group t-tests were used to evaluate for statistically significant pre-to-postoperative change and differences between procedure groups (p less than 0.05). Results: Twenty-seven patients treated with MFX (age range, 14-58) and twenty-three patients treated using OAT (age range, 22-64) were identified. All OAT patients received a single-plug transplantation. The final average lesion size ± standard deviation (SD) for patients treated with MFX was 115.44mm2± 22.51 (range, 156-80mm2) and 121.78mm2± 23.98 (range, 165-80mm2) for those treated using OAT (p=0.34). On average, functional outcome scores improved pre-to-postoperatively across all scales within both groups. Statistically significant improvements were detected in PROMIS Physical Function (Δ=8.32, p=0.01), Pain Interference (Δ=-7.15, p=0.02), Global Physical Health (Δ=5.87, p=0.03), and Pain Intensity (Δ=-7.06, p=0.05) domains for the MFX cohort. For the OAT patient group, significant pre-to-postoperative change was seen in the FAOS subcategories of Pain (Δ=28.70, p=0.03), Sports Activities (Δ=43.12, pConclusion: The OAT group had a higher MOCART score indicating the use of a single osteochondral autograft plug may result in better structural repair than microfracture abrasion chondroplasty augmented with a mixture of adjuvant ECM-BMAC. In addition, higher average FAOS scores, better average PROMIS t-scores, and greater pre-to-postoperative change in the OAT patient group indicate functional results may be better in this group as well. Specifically, significantly lower Pain Interference and Depression domains and significantly higher Global Mental Health scores indicate patients treated using OAT experience less pain and better psychological benefits postoperatively compared to patients treated using MFX. These results suggest filling the lesion with transplanted autograft bone and native, hyaline cartilage may perform better than and the biomechanically inferior fibrocartilage produced following microfracture even when augmented with adjuvant therapy. OAT may result in better overall clinical outcomes, specifically in a population of patients with medium sized lesions (range, 80 mm2 -165 mm2).

PURPOSE OF REVIEW: This paper seeks to review the current literature and trends regarding use of hamstring autograft for lateral ankle instability. RECENT FINDINGS: Reconstruction of the lateral ankle ligaments using hamstring autograft has been found to be an effective method to treat ankle instability in terms of patient-reported outcomes and objective measures. Biomechanically, reconstruction has been shown to be stronger (load to failure) when compared with the Broström procedure. Clinical studies have demonstrated non-inferiority when compared with the Broström procedure, with one synthetic reconstruction technique demonstrating superior outcomes. SUMMARY: Reconstruction of the lateral ankle ligaments using hamstring autograft is especially useful in patients who are at high risk of failure (insufficient soft tissue available for repair, ligamentous laxity, previous failed ligament repair, ossicle > 1 cm, or in the heavier, high-demand athletes).

Iliopsoas release is a common procedure for coxa saltans interna of the hip. The possible sequelae from this surgery have not been well studied. The purpose of this study was to determine postoperative atrophy and morphology of the cut tendon. This retrospective review included patients who underwent arthroscopic iliopsoas release and had magnetic resonance imaging of the ipsilateral hip before and after surgical intervention. Cross-sectional area measurements were obtained of the iliopsoas muscle at the level of the distal anterior inferior iliac spine as well as at the L5 vertebral pedicle in patients who had imaging that included the lower lumbar spine. Patient-reported outcomes included the modified Harris Hip Score (mHHS) and the Hip Outcome Score subscales for activities of daily living (HOS ADL) and sport (HOS Sport). A total of 44 patients met inclusion criteria for this study; 26 patients had additional advanced imaging that included the lumbar spine. The cross-sectional area of the iliopsoas at the level of the anterior inferior iliac spine decreased postoperatively by a mean of 191.4 mm 2 ;, this difference was statistically significant ( P 2 on the released side and 1216.2 mm 2 on the nonoperative side ( P Orthopedics . 2020;43(3):e171–e176.]

Isolated patellofemoral arthritis is a common debilitating condition in adults older than 40 years of age. Surgical options such as patellofemoral arthroplasty exist for those who failed to respond to nonoperative treatment. However, early patellofemoral arthroplasty techniques often resulted in poor outcomes due to mal-tracking and malalignment of components. Robotic-assisted surgery recently has been introduced as an alternative to classic patellofemoral arthroplasty, with the potential to improve the anatomical fit and reproducibility of implant positioning. We present the technique for minimally invasive robotic-assisted patellofemoral arthroplasty system.

Social media is increasingly utilized as a resource in healthcare. We sought to identify perceptions of using social media as an educational tool among healthcare practitioners. An electronic survey was distributed to healthcare administrators, nurses, nurse practitioners, pharmacists, physicians, and physician assistants f hospital systems and affiliated health science schools in Georgia, Maryland, South Carolina, and Wisconsin. Survey questions evaluated respondents' use and views of social media for educational purposes and workplace accessibility using a Likert scale (1 = strongly disagree, 5 = strongly agree). Nurses (75%), pharmacists (11%), and administrators (7%) were the most frequent respondents. Facebook® (27%), Pinterest® (17%), and Instagram® (17%) were the most frequently accessed social media platforms. Nearly 85% agreed or strongly agreed that social media can be an effective tool for educational purposes. Among those who had social media platforms, 43.0% use them for educational purposes. Pinterest® (30%), Facebook® (22%), LinkedIn® (16%), and Twitter® (14%) were most frequently used for education. About 50% of respondents had limited or no access to social media at work. Administrators, those with unlimited and limited work access, and respondents aged 20-29 and 30-39 years were more likely to agree that social media is an educational tool (OR: 3.41 (95% CI 1.31 to 8.84), 4.18 (95% CI 2.30 to 7.60), 1.66 (95% CI 1.22 to 2.25), 4.40 (95% CI 2.80 to 6.92), 2.14 (95% CI 1.53 to 3.01) respectively). Residents, physicians, and those with unlimited access were less likely to agree with allowing social media access at work for educational purposes only. Healthcare practitioners frequently utilize social media, and many believe it can be an effective educational tool in healthcare.

The purpose of this study was to determine if patients undergoing hip arthroscopy for labral pathology with contralateral total hip arthroplasty (THA) have a difference in revision surgeries or patient-reported outcomes (PROs) when compared with those patients undergoing hip arthroscopy for labral pathology with a native contralateral hip. A retrospective review was performed for patients that were undergoing hip arthroscopy between 2008 and 2015. Patients were included in the study group if they met the following inclusion criteria: Tönnis Grade 0 or 1, hip labral pathology, previous contralateral THA, and greater than 2-year follow-up with completion of all PROs or conversion to a THA. Exclusion criteria included the previous surgical history on ipsilateral hip, peritrochanteric or deep gluteal space arthroscopy performed concomitantly, or dysplasia [Lateral Center Edge Angle (LCEA)

The medial patellofemoral ligament (MPFL), which is critical for both patellar stability and normal kinematics of the patellofemoral joint, is disrupted in most patellar dislocations. Consequently, MPFL reconstruction is advocated in recurrent dislocations to restore native patellar constraints. Fixation of the MPFL graft to the medial border of the patella can be achieved through various methods, each with its own benefits and drawbacks. We present a technique for MPFL fixation to the patella using all-soft suture anchors, theoretically decreasing the risk of patellar fracture and articular surface violation.

BACKGROUND Positive-pressure exhaust suits cost more than standard surgical gowns, and recent evidence suggests that they do not decrease infection risk. As a result, some hospitals and surgeons have abandoned positive-pressure exhaust suits in favor of less expensive alternatives. We propose that in addition to their original purpose of decreasing infection rates, positive-pressure exhaust suits may also improve personal protection for the surgeon and assistants, perhaps justifying their added costs. QUESTIONS/PURPOSES (1) Do positive-pressure exhaust suits decrease exposure to particulate matter during TKA? (2) What areas covered by gowning systems are at risk of exposure to particulate matter? METHODS Three surgical gowning systems were tested: (1) surgical gown, face mask, surgical skull cap, protective eyewear; (2) surgical gown, face mask, surgical protective hood, protective eyewear; and (3) positive-pressure exhaust suit. For each procedure, a cadaver knee was injected intraarticularly and intraosseously with a 5-µm fluorescent powder mixed with water (1 g/10 mL). After gowning in the standard sterile fashion, the primary surgeon and two assistants performed two TKAs with each gowning system for a total of six TKAs. After each procedure, three independent observers graded skin exposure of each surgical participant under ultraviolet light using a standardized scale from 0 (no exposure) to 4 (gross exposure). Statistical analysis was performed using Friedman's and Nemenyi tests. The interrater reliability for the independent observers was also calculated. RESULTS The positive-pressure exhaust suits had less surgeon and assistant exposure compared with other systems (p < 0.001). The median overall exposure grade for each gowning system was 4 for System 1 (range, 3-4), 2.5 for System 2 (range, 2-3), and 0 for System 3 (range, 0-0). In pairwise comparisons between gowning systems, the positive-pressure exhaust suits had less exposure than gowning System 1 (difference of medians: 4, p < 0.001) and gowning System 2 (difference of medians: 2.5, p = 0.038). There was no difference found in exposure between Systems 1 and 2 (difference of medians: 1.5, p = 0.330). When gowning Systems 1 and 2 were removed, particulate matter was found in places that were covered such as the surgeon's beard, lips, inside the nostrils, behind the protective eyewear around the surgeon's eye, and in both eyebrows and eyelashes. CONCLUSIONS The positive-pressure exhaust suits provided greater personal protection with each procedure than the other two gowning systems. CLINICAL RELEVANCE With conventional gowns, particulate matter was found in the surgeon's eyelashes, under the face mask around the mouth, and inside the nostrils. Despite recent evidence that certain types of positive-pressure exhaust suits may not decrease infection, there is a clear benefit of surgeon protection from potentially infectious and harmful patient substances. Despite their added costs, hospitals and surgeons should weigh this protective benefit when considering the use of positive-pressure exhaust suits.

Human creed is in the constant quest for energy and its storage possibilities. The fast depletion of non-renewable sources of energy and the lower power conversion efficiency of renewable sources along with the decentralized energy generation, forces the focus to highly efficient energy storage devices. In this regard, technology, industry and the supply chain of batteries and capacitors are matured and is full-fledged. A further improvement is possible with the faster charging-discharging cycles, long life time, and environmental friendly alternatives. Hence Supercapacitors (SCs) take the lead in the energy storage research arena. Depending on the mechanism exploited for storing charges, SCs are classified as pseudocapacitors, electric double layer capacitance based SCs and hybrid SCs. Each of these SCs have their own distinct advantages over the other. In this review, we compare the mechanisms related to each of these SCs. There are various factors that determine the feasibility of a SC for commercialization. This include a high specific capacitance at a given current density, high energy density, long life time, a wide potential window for operation (2 -4 V) and high active mass loading (>10 mg/cm2). A SC which can satisfy these conditions can be directly translated to mass production. In this regard, the obtained device should also be mass producible and green. This greatly depends on the type of materials used for electrodes and electrolytes. There are a wide range of materials which are being explored as SC electrodes. This include transition metal oxides, carbides, nitrides, phosphides, carbon based materials, conducting polymers and composites involving two or more of these materials. In addition to that, the microstructure of these materials are also of prime importance in deciding the electrochemical performance. Hence various strategies like different synthesis process ranging from soft chemistry, freeze drying to laser ablation, use of 3D printing, building hierarchal porous architecture, use of templates and foams are explored. Various microstructures like sheets, ribbons, flakes, intertwined structures, aerogels and many more are experimented. In this review, we focus on the various materials used as electrolytes and electrodes and their synthesis/fabrication procedure. A detailed comparison based on the materials used and the performance obtained are compared for the three basic type of SCs. The role of active mass loading and its importance are briefly discussed. Finally the current direction of supercapacitor research, commercial applications of supercapacitors and prospective future directions have been discussed. The objective of this review is to provide a bird's eye view on the various aspects of SC starting from their synthesis, processing, performance evaluation and industrial application.

BACKGROUND CONTEXT Distal junctional kyphosis (DJK) remains a primary concern for surgeons performing cervical deformity (CD) surgery. Postoperative complications from CD surgeries often render patients with worse recovery profiles which require reoperation. It is paramount to understand possible DJK recovery profiles for various types of surgical patients. PURPOSE Identify if DJK patients successfully recover from treatment/reoperation. STUDY DESIGN/SETTING Retrospective review of prospectively collected database. PATIENT SAMPLE This study included 145 cervical deformity (CD) patients with baseline and 1-year follow-up. OUTCOME MEASURES Complications;reoperations; HRQL, alignment. Methods CD patients(patients) were identified if they developed DJK. DJK angle (DJKA) was defined as >10° change in kyphosis between LIV and LIV-2 and a >10° index angle. Patients were stratified into two groups: 1) those who received a reoperation for DJK (Reop DJK) and those that did not have DJK (no DJK). Normalized HRQL scores at baseline and follow-up intervals (3 months, 6 months, 1 year, 2 years) were generated. Normalized HRQLs were plotted and area under the curve was calculated, generating one number describing overall recovery (Integrated Health State [IHS]). Results A total of 145 CD patients included. Of these patients, 32% developed DJK postop (56 years, 28.5kg/m2, 53% Female) with 12.8% of these cases being severe. By DJK occurrence: 24.2% within 3 months, 45.4% at 6 months, 31.4% by 1 year. Of these DJK patients, 25.5% received a reoperation. Upon presentation, Reop DJK patients had a worse PI-LL (-11.0 vs .11), worse NSR-Neck (8.7 vs 6.9), and a worse NDI (65.7 vs 53.9; all p 0.05). Having DJK and not receiving a reop did not have much of an effect on recovery despite DJK angle, however; when compared to DJK reop, when nonop DJK angle was greater than 20°, the IHS-score mJOA adjusted resulted in greater long-term recovery (nonReop:59.9 vs Reop: 48.4; p Conclusions Of the total DJK patients in this study, 25.5% received a reoperation. These patients had a worse pain recovery profile than non-DJK patients. However; when matched to their age-adjusted SVA, reop DJK patients were shown to have an improved short-term recovery than if they went unmatched according to their IHS-adjusted NSR-Neck. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Distal junctional kyphosis (DJK) development after cervical deformity (CD) corrective surgery is a growing concern for surgeons and patients. Although proper realignment is known to help mitigate the development of DJK, there has yet to be a study that critically analyzes under correction in certain parameters and the effects on development of DJK. PURPOSE To determine the effects of under correction in the development of DJK. STUDY DESIGN/SETTING Retrospective cohort study of single-center database. PATIENT SAMPLE This study included 195 CD patients. OUTCOME MEASURES Complications; radiographic parameters; HRQL metrics (NDI, EQ5D, mJOA, NRS Neck). METHODS Inclusion criteria: operative CD patients (cervical kyphosis >10°, with cSVA>4cm or CBVA>25°) and >18yrs with up to 2-year radiographic and HRQL follow-up. Significant differences in surgical, radiographic, and clinical factors and outcomes were determined. Under correction was defined by a deformity in TS-CL or cSVA Ames Modifier. Moderate Ames cervical lordosis deformity (CL) was TS-CL >15 and high >20, high cSVA deformity was >8cm. RESULTS A total of 195 CD patients met inclusion criteria (58.3yrs, 46% Female, 28.3 kg/m2). Overall, 40 (21%) of these patients developed DJK. At baseline patients presented with the following radiographic profile: PT (18.3), PI-LL (-.65), SVA C7-S1 (-6.54), cSVA C2-C7 (9.7), and TS-CL (24). Patients undercorrected in TS-CL developed DJK at a greater rate (28% vs 15%, p=.02), and patients undercorrected in cSVA developed more DJK (65% vs 16%) and underwent more reoperations (42% vs 17%, both p 0.05). CONCLUSIONS The TS-CL and cSVA components of Ames criteria show a strong correlation with development of distal junctional kyphosis (DJK). Thresholds for DJK development suggests even patients who fall into a mild deformity as per the Ames criteria are still at an increased risk, and more strict alignment goals may further prevent mechanical failure. cSVA was found to be the dominant radiographic parameter impacting DJK development. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Global spinal malalignment plays a vital role in cervical spinal deformity corrective surgery outcomes; however, the literature is scarce on the effects that the individual sagittal parameters have on outcomes. PURPOSE To investigate the impact of sagittal malalignment on cervical deformity patient outcomes. STUDY DESIGN/SETTING Retrospective cohort study of single-center database. PATIENT SAMPLE This study included 123 CD patients. OUTCOME MEASURES Complications; radiographic parameters; HRQL metrics (NDI, EQ5D, mJOA, NRS Neck) METHODS Inclusion criteria: operative CD patients (cervical kyphosis >10°, with cSVA >4cm or CBVA >25°) and >18yrs with up to 2Y radiographic and HRQL follow-up. Significant differences in surgical, radiographic, and clinical factors and outcomes were determined. Deformity in PT, SVA, and PILL was defined using the SRS-Schwab criteria. “Unmatched” refers to patients who were under corrected or over corrected according to the Schwab age-adjusted parameters (Lafage et al.). RESULTS A total of 123 CD patients met inclusion criteria (58.3 yrs, 46% Female, 28.3 kg/m2). Overall, 27 (24%) of these patients developed DJK. At baseline, patients presented with the following radiographic profile: PT (18.3), PILL (-.65), SVA C7-S1 (-6.54), cSVA C2-C7 (23.5), and TS-CL (25.2). Patients with DJK had a higher L1-S1 (34 vs 9.2) and T12-S1 (57 vs 35, both p 0.05). Patients with a deformity in PT at baseline developed more DJK by 2 years (26% vs 11%), had more DJF (7% vs 2%) and a higher NDI and NSR back pain. Patients with mismatch at baseline had higher rates of DJK (30% vs 22%), and patients with SVA deformity at baseline had a lower mJOA, SWAL Food selection, SWAL Communication, and a higher EQ5D. Patients with a mismatched alignment in Roussouly preoperatively had higher rates of DJK at 3M (18% vs 12%), 6M (26% vs 16%), 1Y (24% vs 14%), and 2Y (26% vs 13%, all p CONCLUSIONS Global spinal malalignments play an important role in the outcomes of cervical spinal deformity corrective surgery. The presence of abnormal global sagittal malignment at baseline is associated with higher rates of DJK development and worse clinical outcomes, while patients who maintained poor sagittal alignment up to 2Y were associated with significantly greater development of DJK and inferior neck disability index scores. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT As surgery is increasingly recommended for patients with spinal instability and neurologic deterioration secondary to central cord syndrome (CCS), it is important to investigate the impact age has on postoperative complication rates. PURPOSE Investigate associations of age and surgical decision and timing of procedure. STUDY DESIGN/SETTING Retrospective review of Health care Cost and Utilization Project's Nationwide Inpatient Sample (NIS). PATIENT SAMPLE CCS patients. OUTCOME MEASURES Surgical timing and postop complications. METHODS CCS patients (ICD-9 codes 952.03, 952.08, 952.13, 952.18) were isolated in the NIS database 2007-2016. As appropriate, analysis of variance and chi-squared tests compared demographics, and Charlson Comorbidity Index (CCI) scores. Patients were then stratified by age into 4 percentiles (1st: 13-48, 2nd: 49-50, 3rd: 59-68, 4th: 69-90). Surgical decision-making such as approach and surgical timing were analyzed for their association with postoperative complications via logistic regressions controlling for CCI. An age cutoff in relation to postop complications was identified via Receiver Operating Curve (ROC). RESULTS There were 5,725 CCS patients included (59.5years, 1.3 CCI, 26% Female). By age percentile, those that were in the lowest had greater rates of decompressions (71.8%), fusions (88.4%), combined approach (5.1%), anterior approach (64.4%), and 9+ levels fused (3.5%; all p 59 years had an increased likelihood of postoperative complication development (AUC: 0.5, p=0.002). CONCLUSIONS Age overall played a role in postoperative complications when >59 years. It also played a significant role in surgical timing and surgical approach. Adequately stratifying patients diagnosed with Central Cord Syndrome in accordance to their age profile can minimize postoperative complications. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Increasing pelvic tilt (PT) is a primary compensatory mechanism in adult spinal deformity (ASD). By SRS-Schwab criteria, PT >20° is considered pathologic. Some ASD patients improve their PT following ASD correction, while others do not. The driving forces behind this lack of PT-response are not well defined. PURPOSE To determine the perioperative characteristics associated with PT normalization after ASD corrective surgery. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE A total of 176 ASD patients. OUTCOME MEASURES Patient profile, radiographic parameters, and surgical factors associated with PT normalization. METHODS Operative ASD patients fused to S1/pelvis with full preoperative data as well as preoperative (BL), 6-week (6W), 1-year (1Y), and 2-year (2Y) postop PT measurements were included. PT normalization was assessed at 6W and 2-year follow-up. Univariate analyses were used to compare normalized (PTNorm) and non-normalized (NON) patients in terms of demographics, surgical and radiographic descriptors, postoperative alignment, and clinical outcomes. Multivariate regression and ROC curve assessed periop factors predicting 6W PT normalization. Conditional inference tree (CIT) determined thresholds for the continuous variables identified as independent predictors of PT normalization. RESULTS There were 176 ASD patients that met inclusion criteria (62.9±10.2years, 80%F, BMI 26.9±4.9 kg/m2, CCI: 1.88), and underwent surgery (levels fused 12.1±3.9, EBL: 1955mL, op time: 402min). At each time point, mean PT was as follows: BL: 25.7o, 6-week: 19.0o, 1-year: 21.2o, and 2-year: 22.3°. Patients classified as having normal PT by SRS-Schwab criteria (PT 0.05). Six weeks PTNorm patients were more likely to be overcorrected in PT, PI-LL, and SVA compared to NON patients at 6 weeks postop (all p 10, invasiveness score >109, baseline cSVA CONCLUSIONS PT normalization following ASD correction occurred in almost 40% of patients by 6 weeks postop. Normalization is more likely to occur in patients where reconstruction addresses lumbopelvic mismatch, extends above the apex of the thoracic kyphosis, and has adequate surgical invasiveness to achieve full alignment correction. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT For patients undergoing a cervical spine procedure, the effect of a shoulder injury on perioperative outcomes is not well understood. Our study aimed to investigate the impact shoulder injuries have on perioperative outcomes for elective cervical spine surgery patients. PURPOSE To evaluate the effect of concomitant shoulder injuries on perioperative outcomes of elective cervical spine surgery. STUDY DESIGN/SETTING Retrospective review of a national patient database between 2007-2017. PATIENT SAMPLE A total of 1,482,311 elective cervical spine surgery patients. OUTCOME MEASURES Comorbidity burden, invasiveness, perioperative complications, length of stay (LOS), total hospital charges. METHODS Patients undergoing elective cervical spine surgery were isolated with ICD-9 diagnosis codes. Cervical procedure (CP) patients with concurrent shoulder diagnosis(S-Dx) were further isolated. Means comparison tests compared differences in demographics, surgical, and perioperative outcomes between those who had a cervical procedure and a concurrent shoulder diagnosis (CP/S-Dx) and those who had a cervical procedure with no shoulder diagnosis (CP). Logistic regression analysis assessed the odds of complication associated with a shoulder diagnosis, controlling for age and surgical invasiveness. RESULTS 1,482,311 elective cervical spine surgery patients were included. Overall, 17,873(1.2%) patients underwent a CP and had a concurrent S-Dx. CP and S-Dx patients compared to only CP patients were significantly younger and male (both p CONCLUSIONS Patients with a concurrent shoulder diagnosis undergoing a cervical spine procedure were 30% more likely to experience a perioperative complication compared to those without a shoulder injury. Prior to proceeding with surgery, providers should consider the effect of shoulder injuries on outcomes of cervical spine procedures. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Adult spinal deformity is associated with severe pain and disability. Recent literature has shown that surgical intervention can significantly improve patients’ quality of life and lessen disease burden. As many patients requiring spine surgery are elderly and often frail, restoration of alignment targets may differ. The literature is scarce on how different frailty states affect realignment goals. PURPOSE Modify the age-adjusted alignment goals using the Frailty Index to optimize outcomes in surgical adult spinal deformity (ASD) patients. STUDY DESIGN/SETTING Retrospective cohort study of a prospective multicenter database of ASD patients. PATIENT SAMPLE This study included 245 ASD patients. OUTCOME MEASURES Complications, HRQLs (SRS-22, ODI, SF-36). METHODS Operative ASD patients (scoliosis ≥20°, SVA ≥5cm, PT ≥25°, or TK ≥60°) with available baseline and 2-year radiographic and HRQL data were included. ASD frailty index was used to stratify patients into not frail (NF) and frail (F) categories. Linear regression analysis established normative radiographic thresholds, utilizing previously published age specific US-Normative ODI values (Lafage et al) and the frailty index, based on a cohort of patients with an ideal clinical outcome (no major complications, no PJK, and an SRS-satisfaction of >4). Patients were considered “matched” if 2-year postop alignment was within 1 standard deviation (+1SD overcorrected-1SD undercorrected). RESULTS A total of 245 patients included (57±15yrs, 82% female, 26±5.14kg/m2, ASD-FI: 2.9±1.6, CCI: 1.8 ±1.7). Patients had a mean level fused of 11.1±4.4, LOS of 7.7 days±4.4, EBL of 1577 mL, operative time of 377 min, with 63% undergoing an osteotomy. In terms of surgical approach, 69.9% posterior-only, and 29.3% had a combined approach. Primary analyses demonstrated correlation between baseline frailty index, PT, PI-LL, SVA, and ODI, (p CONCLUSIONS Age-adjusted alignment by Lafage et al was the first study to recognize that older age warrants a lower degree of correction, and, the original SRS-Schwab criteria was modified accordingly. Alignment targets accounting for both frailty and age were developed with larger thresholds for increasing frailty. In this study, we found patients who were matched in these age and frailty adjusted thresholds had lower rates of PJF and significantly improved HRQL outcomes. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT With health care costs on the rise, hospitals have increasingly focused on providing economically efficient medical services. Adult spinal deformity surgery remains an expensive medical intervention with high risk for complications and revisions, especially following mechanical failure in the context of proximal junctional kyphosis (PJK). We sought to evaluate the impact of PJK on associated expenditures following an index surgery for ASD. PURPOSE To evaluate the effect of proximal junctional kyphosis on the cost effectiveness of corrective adult deformity surgery. STUDY DESIGN/SETTING Retrospective cohort study of a prospective single-center database of ASD patients. PATIENT SAMPLE A total of 147 Adult Spinal Deformity Patients. OUTCOME MEASURES Complications, HRQLs (Oswentry Disability Index [ODI]), Quality adjusted life years (QALY). METHODS Adult Spinal deformity patients with 2-year HRQL follow-up were included. Utility data was calculated using published conversion methods to convert ODI to SF-6D. QALYs utilized a 3% discount rate to account for residual decline to life expectancy (78.7 years). Costs were calculated using the PearlDiver database incorporating complications and comorbidities classified according to CMS standard definitions. Reimbursement consisted of a standardized estimate using regression analysis of Medicare pay-scales for all services rendered within a 30-day window, including estimates regarding costs of postoperative complications, outpatient health care encounters, reoperations and revisions. After accounting for all postoperative events, including mortality, cost per QALY by 2Y was calculated for revisions that occurred due to proximal junctional kyphosis. RESULTS A total of 147 adult spinal deformity patients met inclusion criteria (55.22years, 54% Female). At baseline, patients presented radiographically as: Pelvic Tilt (23.66±11.7), Pelvic Incidence- Lumbar Lordosis (-2.9±12.6), Sagittal Vertical Axis (60.5±76.8), T1 Pelvic Angle (22.6±14.3). Surgical details: EBL of 1823 mL, operative time of 327 min, with .4% undergoing an anterior approach, 90.2% posterior-only approach, and 9.3% combined approach. Overall, 54.3% of patients developed PJK within 2 years postoperatively, with 22% undergoing reoperation for PJK. Average cost of revision surgery due to PJK was $93,688 ± $21,467. The cost for PJK patients, including the cost associated with their revision surgery, was higher ($103,760 vs $71,000). Baseline ODI (39 vs 32) and 2Y ODI (39 vs 27) were higher for PJK patients, however, PJK patients did improve to a greater degree (-12 vs -10). The overall cost per QALY by 2Y was higher for PJK patients ($116,170 vs $95,347). CONCLUSIONS Patients that developed PJK had an almost $30,000 higher initial cost at 2 years. When looking at the cost per quality adjusted life years by 2Y, PJK resulted in slightly more than $20,000 in cost. These findings suggest prophylactic measures to mitigate PJK may improve the cost utility of adult spinal deformity surgery and can help policy efforts for adequate resource allocation for these complex patients. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Frailty is a dynamic measure of physiological age that is a strong predictor of a patient's surgical risk. The purpose of this study is to investigate the impact of frailty on the perioperative outcomes and costs associated with operating on frail ASD patients. PURPOSE To investigate impact of frailty on operative course, clinical outcomes, and cost utility. STUDY DESIGN/SETTING Retrospective cohort study of prospective, multicenter ASD database. PATIENT SAMPLE A total of 245 ASD patients were included. OUTCOME MEASURES Complications; health-related quality of life (HRQL): ODI. METHODS Operative ASD patients (scoliosis >20, SVA>5cm, PT>25, or TK>60) with available baseline (BL) and 2-year (2Y) radiographic and HRQL data were included. The ISSG frailty index was used to stratify patients into 2 categories: not frail (NF) ( 3). Univariate and multivariate analysis assessed differences in radiographic, surgical, and clinical factors. IHS-adjusted ODI and SRS compared recovery periods between F/NF patients. Cost utility using published methods convert ODI to SF-6D obtained Quality Adjusted Life Years (QALY). QALYs utilized a 3% discount rate for residual decline to life expectancy (78.7 years). Direct costs calculated using the PearlDiver database incorporating complications, LOS and associated health care costs. RESULTS A total of 245 ASD patients met inclusion criteria (57yrs±15.0, 82%F, BMI: 26.3 kg/m2 ±6.0, ASD-FI: 2.9±1.6, CCI: 1.55 ±1.7). Surgical patients had a mean number of levels fused of 11.4±4, LOS of 7.7 days±4.4, EBL of 1686 mL, operative time of 374 min, with 70% undergoing an osteotomy. In terms of surgical approach, 76% were posterior-only, and 23.6% had a combined approach. Frailty breakdown was: 138 (55%) NF and 107 (45%) F patients. F patients had higher mean PT (25 vs 20), PILL (21 vs 10), TK T4-T12 (-33 vs -36), SVA C7-S1 (80 vs 35), and a higher BL ODI (52 vs 27, all p CONCLUSIONS Frail patients experienced a longer LOS and higher EBL, possibly due to the increased invasiveness used to treat a more severe deformity with a worse preoperative physiological state. Although frail patients experienced more complications, the higher overall improvement in ODI contributed to a comparable cost utility despite a higher initial cost. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Surgical correction of cervical deformity (CD) has been associated with superior alignment and functional outcomes. It has not yet been determined whether baseline and postoperative T1 slope and C2 slope correlate with health-related quality of life (HRQL) metrics and radiographic complication. PURPOSE To determine the impact of T1S and C2S deformity severity on HRQL metrics and DJK development in operative cervical deformity patients. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE A total of 119 CD patients. OUTCOME MEASURES Radiographic parameters; HRQLs. METHODS Included: Operative CD patients with UIV above C7 and with pre-(BL) and up to 2-year (2Y) postop radiographic/HRQL data. Cervical deformity was defined as meeting at least one of the following radiographic parameters: C2-C7 lordosis 35°, segmental cervical kyphosis >15° across any 3 vertebra between C2-T1, C2-C7 SVA >4cm, McGregor's slope >20°, or CBVA > 25°. Spearman's rank-order correlation and linear regression analysis assessed the impact of baseline T1 slope (T1S) and C2 slope (C2S) on baseline HRQL metrics (NDI, mJOA, EQ5D, NRS Neck, NRS Back), and the impact of postoperative T1S and C2S on follow-up HRQLs. Logistic regression and conditional inference tree (CIT) machine learning were used to determine baseline radiographic thresholds for improving in ≥2 HRQL metrics from BL to 2Y, and 2Y radiographic thresholds for developing DJK or DJF by 2Y postop. RESULTS A total of 119 CD patients met inclusion criteria (61.2±10.5years, 63%F, BMI 29.0±7.5kg/m2, CCI: 1.00±1.31) and underwent surgery (levels fused 7.5±3.7, EBL 990mL, op time 547min). By approach, 19.3% anterior-only, 44.5% posterior-only, and 36.1% combined. Mean BL radiographic parameters: PT 19.6°, PI-LL 1.4°, SVA 1.9mm, T2-T12 kyphosis -46.8°, C2-C7 lordosis -9.0°, T1S 29.0°, TS-CL 38.2°, C2S 37.7°, cSVA 44.0mm, and C2-T3 -18.0°. Mean BL HRQLs were as follows: NRS back 5.0, NRS neck 6.7, NDI 47.9, mJOA 13.5, and EQ5D 0.74. Spearman correlation and linear regression identified no association between baseline T1S or C2S and HRQL metrics, or between 2Y postop T1S and HRQLs (all p>0.05). Correlation and linear regression found significant associations of higher C2S with higher NDI (p=0.042), lower mJOA (p=0.011), and lower EQ5D (p=0.009), all indicating higher degree of disability at 2Y postop. Logistic regression with CIT identified thresholds for improving in 2 or more HRQL metrics by 2Y postop: baseline T1S 45.3° (OR: 16.0) and C2S >32.5° (OR: 6.07); both p CONCLUSIONS Baseline deformity severity in terms of T1 slope and C2 slope can be predictive of postoperative functional outcomes in cervical deformity patients, while postoperative deformity in T1S and C2S can be predictive of DJK and DJF occurrence. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.