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Background: Degenerative Cervical Myelopathy is a debilitating condition and current recommendations encourage shared decision-making between surgeons and patients. However, there is limited data on patients' values and preferences for surgical decision making. This study aimed to quantify and compare the relative importance of neurologic function, risk of future surgery, and complications to patients with cervical stenosis. Methods: Patients with cervical stenosis presenting for surgical evaluation, or post-operative cervical decompression patients, were recruited to participate. Demographic information including modified Japanese Orthopedic Association (mJOA) score, type of surgery, and complications were recorded and anonymized to study ID. Patients then completed an online discrete-choice experiment survey. In a series of 10 questions, respondents chose between two hypothetical health states defined in terms of five attributes, or "decision factors": (i) upper extremity neurologic function, (ii) lower extremity neurologic function, (iii) risk of cervical spine surgery, (iv) dysphagia, and (v) C5 palsy. Participants were asked to choose which 'life' they preferred, and a regression model was used to quantify the importance of each decision factor. Results: We report three key findings that can aid clinicians in shared decision-making conversations: (i) all patients regard lower extremity neurologic function as the most important decision factor, (ii) dysphagia, a complication, and upper extremity neurologic function are equally important, and (iii) patients who have undergone surgery weigh neurologic function as less important, and complications as more important than patients who have not undergone surgery. Conclusions: Patient preferences for management of degenerative cervical myelopathy are influenced by several considerations including the experience of surgery itself. Communication of benefits and harms associated with surgical and conservative care can optimize shared decision making. Further research should be conducted to evaluate for decisional regret and the impact of complications to inform treatment conversations. [ABSTRACT FROM AUTHOR]

Purpose: We examined positive behavioral resources and characteristics that might distinguish resilient personality prototypes among persons with chronic spinal cord injury/disorder (SCID). Positive psychology variables with clear linkages to existing psychological interventions were examined as potential mediators of the resilience–well-being relationship. Research Method and Design: A cross-sectional, self-report study was conducted. Two hundred and ninety-eight consenting members of the Paralyzed Veterans of America (268 male; 236 self-identified as white) provided useable survey data for analysis (including 161 veterans with tetraplegia, 107 with paraplegia, 30 with cauda equina). Cluster analysis of Big Five personality traits identified resilient and nonresilient personality profiles. Tests of mean differences between resilient and nonresilient participants on behavioral resources and characteristics were performed. Path models predicting well-being and health-related quality of life (HRQL) were conducted. Results: One hundred and sixty-three respondents had resilient personality profiles and 135 had nonresilient profiles. Resilient individuals reported significantly more optimal scores on every positive psychology variable, and greater well-being and HRQL than nonresilient respondents. Path models found the relationship of resilience to well-being was explained through its beneficial associations with psychological flexibility, use of personal strengths, meaning in life (MIL), and gratitude. Psychological flexibility also mediated the resilience–HRQL relationship. Cauda equina was significantly associated with higher pain interference and lower HRQL. Conclusions: Higher gratitude, MIL, use of personal strengths, and psychological flexibility appear to characterize resilience and well-being among persons with chronic SCID. Further studies are needed to understand the impact of pain interference on HRQL among individuals with cauda equina. Impact and Implications: The present study documents several positive behavioral resources and characteristics that typify resilience among persons with chronic spinal cord injury/disorder. The results should prompt rehabilitation psychologists to consider further study of the positive psychology variables examined in this paper, and the potential use of the existing interventions associated with each one. [ABSTRACT FROM AUTHOR]

Objective: To determine frequency that ED visits are needed, and the most common chief complaints and medications prescribed to Veterans with spinal cord injuries and disorders (SCI/D)., Methods: The Veterans Health Administration (VHA) SCI and Disorders (SCI/D) Registry (VHA SCIDR) was used to identify Veterans with SCI/D over a five-year period (fiscal years 2018-2022). The primary outcome was the proportion of Veterans with SCI/D who had visits to the ED during the study period. Secondary outcomes included diagnostic codes and medications prescribed in the ED, and other healthcare encounters., Results: Overall, 18,464 Veterans with SCI/D, including 80,661 patient-years were included. Of these Veterans, 10,234 (55.4%) had at least one ED visit and 8230 (44.6%) did not. ED visits were consistent, ranging from 33.5% to 36.4% annually. The number of in-person healthcare encounters decreased over the study period. The most common ED diagnostic codes were paraplegia or quadriplegia, discharge counseling, UTI, neuromuscular dysfunction of the bladder and low back pain. The most common medications prescribed in the ED were analgesics (e.g., acetaminophen, ketorolac), antimicrobials (e.g., ceftriaxone, vancomycin) and ondansetron. Antibiotics were among the most prescribed discharge medications, including ciprofloxacin, sulfamethoxazole/trimethoprim, cephalexin, and doxycycline., Conclusion: This national study of Veterans with SCI/D characterized ED healthcare utilization. Overall, more than half of Veterans with SCI/D required an ED visit during the five-year study period and over one third of Veterans in each fiscal year required an ED visit. Interventions to target prevention of ED visits and subsequent hospitalizations could focus on these areas., Competing Interests: Declaration of competing interest We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome. We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us. We confirm that we have given due consideration to the protection of intellectual property associated with this work and that there are no impediments to publication, including the timing of publication, with respect to intellectual property. In so doing we confirm that we have followed the regulations of our institutions concerning intellectual property. We understand that the Corresponding Author is the sole contact for the Editorial process (including Editorial Manager and direct communications with the office). He/she is responsible for communicating with the other authors about progress, submissions of revisions and final approval of proofs. We confirm that no AI tools were used to write the manuscript., (Published by Elsevier Inc.)

Background Content: Cervical laminoplasty (LP) and laminectomy and fusion (LF) are commonly used surgical techniques for cervical spondylotic myelopathy (CSM). Several recent studies have demonstrated superior perioperative metrics and decreased overall costs with LP, yet LF is performed far more often in the United States.Purpose: To determine the percentage of patients with CSM who are radiographically candidates for LP.Study Design: Retrospective comparative cohort study.Patient Sample: Patients >18 years old who underwent LF or LP for CSM at 2 large academic institutions from 2017 to 2019.Outcome Measures: Candidacy for LP based on radiographic criteria.Methods: Radiographs were assessed by 2 spine surgeons not involved in the care of the patients to determine the C2-C7 Cobb angle and the presence and extent of cervical instability. Patients with kyphosis >13°, > 3.5 mm of listhesis on static imaging, or > 2.5 mm of motion on flexion-extension or standing-supine films were not considered candidates for LP. Intraclass coefficient (ICC) was calculated to assess the interobserver reliability of angular measurements and the presence of instability. The percentage of patients for whom LP was contraindicated was calculated.Results: One hundred eight patients underwent LF while 142 underwent LP. Of the 108 patients who underwent LF, 79.6% were radiographically deemed candidates for LP, as were all 142 patients who underwent LP. The ICC for C2-C7 alignment was 0.90; there was 97% agreement with respect to the presence of instability.Conclusions: In 250 patients with CSM, 228 (91.2%) were radiographically candidates for LP. These data suggest that LP may be an underutilized procedure for the treatment for CSM. [ABSTRACT FROM AUTHOR]

Spinal epidural lipomatosis (SEL) is a rare pathologic growth of histologically normal nonencapsulated adipose tissue in the epidural space. It can cause myelopathy or radiculopathy. Etiologies include chronic exposure to endogenous or exogenous steroids and obesity. Idiopathic forms are much infrequent. We present a case of lumbar SEL compressing the thecal sac in a 50-year-old female patient. [ABSTRACT FROM AUTHOR]

Neck pain from cervical spine disorders is the second-leading cause of musculoskeletal disorders. Neck pain can exist alone or with the presence of upper extremity symptoms. This review of evidence-based guidelines assists the provider in identifying and treating various cervical disorders. [ABSTRACT FROM AUTHOR]

Context/objective: Our objective was to describe early participation in Whole Health programs across the Veterans Health Administration (VHA) Spinal Cord Injuries and Disorders (SCI/D) System of Care., Design: Retrospective analysis of VHA administrative data., Setting: The VHA SCI/D System of Care., Participants: Veterans with SCI/D included in the FY2019 cumulative VHA SCI/D Registry cohort with living status during FY2017, FY2018, and FY2019., Interventions: N/A., Outcome Measures: We assessed the number of encounters and unique Veterans with SCI/D, and the percent of Veterans with SCI/D, who utilized each Whole Health (WH) program available in VA., Results: Utilization of WH Pathway and well-being Programs increased from 62 encounters to 1703 encounters between FY2017 and FY2019 (representing 0.09% to 3.13% of Veterans with SCI/D). Utilization of chiropractic care rose from 130 encounters to 418 encounters during the same time period. Similarly, utilization of complementary and integrative health programs increased from 886 encounters to 2655 encounters (representing 1.09% to 3.11% of Veterans; FY2017 to 2019). We also report utilization of specific WH programs., Conclusion: Participation in WH services has been increasing among Veterans with SCI/D who receive health care from the VHA SCI/D System of Care. However, utilization among Veterans with SCI/D remains low overall, and targeted efforts to increase WH program reach are needed. Additional information about the relative effectiveness of different strategies to support WH implementation is also needed, to ensure strategies likely to have the most impact are prioritized.

Objective: The Veterans Health Administration (VHA), the largest single provider of spinal cord injury and disorder (SCI/D) care in the United States, currently mandates that every patient receives a screening urine culture during the annual evaluation, a yearly comprehensive history and physical examination. This testing has shown in a small subset of patients to overidentify asymptomatic bacteriuria that is then inappropriately treated with antibiotics. The objective of the current analysis was to assess the association of the annual evaluation on urine testing and antibiotic treatment in a national sample of Veterans with SCI/D., Design/method: A retrospective cohort study using national VHA electronic health record data of Veterans with SCI/D seen between October 1, 2017-September 30, 2019 for their annual evaluation., Results: There were 9447 Veterans with SCI/D who received an annual evaluation; 5088 (54%) had a urine culture obtained. 2910 cultures (57%) were positive; E. coli was the most common organism obtained (12.9% of total urine cultures). Of the patients with positive urine cultures, 386 were prescribed antibiotics within the 7 days after that encounter (13%); of the patients with negative cultures (n = 2178), 121 (6%) were prescribed antibiotics; thus, a positive urine culture was a significant driver of antibiotic use (p < 0.001)., Conclusion: The urine cultures ordered at the annual exam are often followed by antibiotics; this practice may be an important target for antibiotic stewardship programs in SCI., (© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Study Design: Retrospective review.Objective: To identify and compare the incidences of fragility fractures amongst three elderly populations: the general population, patients with surgically treated cervical spondylotic myelopathy (CSM), and patients with CSM not surgically treated.Summary Of Background Data: CSM is a common disease in the elderly. Progression of myelopathic symptoms, including gait imbalance, can be a source of morbidity as it can lead to increased falls.Methods: Records of elderly patients with Medicare insurance from 2005 to 2014 were retrospectively reviewed. Three mutually exclusive populations of patients were identified for analysis, including a cohort of patients with a diagnosis of CSM who were not treated with surgery; a cohort of patients with CSM who were treated with surgery; and a group of control patients who had never been treated with cervical spine surgery nor were diagnosed with CSM. Incidence of fractures of the distal radius, proximal humerus, proximal femur, and lumbar spine were assessed and compared between cohorts, adjusted by age, sex, osteoporosis, dementia, cerebrovascular disease, and Charlson Comorbidity Index.Results: A total of 891,864 patients were identified, of which 60,332 had a diagnosis of CSM and 24,439 underwent cervical spine surgery. Compared to general population controls, the 12-month adjusted odds of experiencing at least one fragility fracture were 1.59 times higher in patients with CSM who were not treated with surgery (P < 0.001). The analogous odds ratio was 1.34 (P < 0.001) at 3 years. Compared to nonsurgically treated patients with CSM, the odds of experiencing at least one fragility fracture were reduced to 0.89 in surgically treated patients (P = 0.008).Conclusion: Fragility fractures are a significant source of morbidity and mortality in elderly patients. CSM is associated with increased rates of fragility fractures, although surgical management of CSM may be protective against risk of fragility fracture.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Context/objective: Online patient portals like the Veteran Health Administration's (VA) My Health e Vet (MHV) may be particularly useful for Veterans with spinal cord injuries/disorders (SCI/D), many of whom experience barriers to care. The objective of this analysis was to examine MHV use among Veterans with SCI/D., Design: Retrospective database analysis., Setting: VA SCI/D System of Care., Participants: Veterans with SCI/D who utilize VA care., Interventions: N/A., Outcome Measures: MHV registration and use of key portal features among Veterans who newly registered for MHV. Veteran characteristics associated with registration and use of portal features using multiple logistic regression., Results: 14.6% of Veterans with SCI/D in our sample registered to use MHV. 48.7% used the medication refill feature, 28.7% used the appointment view feature, 25.0% sent or read at least one secure message and 10.8% used the Blue Button feature. Adjusted analyses indicate that having a C5-8 (OR: 1.36, CI95%: 1.06-1.76, P < 0.05) or T1-S5 (OR: 1.41, CI95%: 1.13-1.78, P < 0.01) (vs. C1-C4), having (vs. not having) neurogenic bladder (OR: 1.45, CI95%: 1.18-1.77, P < 0.01), being married (vs. not married) (OR: 2.00, CI95%: 1.67-2.39, P < 0.01), and increased healthcare utilization in the third (OR: 1.71, CI95%: 1.31-2.24, P < 0.01) and fourth (OR: 1.73, CI95%: 1.27-2.34, P < 0.01) quartiles (vs. first quartile) were associated with increased odds of MHV registration. We also identified factors associated with use of key MHV features., Conclusions: Our results suggest that MHV registration and use of key portal features was limited among Veterans with SCI/D. Effort to increase portal use in this population are warranted.

Study Design: Retrospective review of adult spinal deformity patients in a multiethnic database.Objective: To investigate the role of ethnicity on recruitment of compensatory mechanisms for sagittal spinal deformity.Summary Of Background Data: While the impacts of age, sex, and pelvic morphology on the ability to compensate for sagittal malalignment have been investigated, the role of ethnicity in compensatory mechanism recruitment is poorly understood.Methods: Patients from USA (85% Caucasian) >25 y/o were propensity matched by age, sex, and pelvic incidence with patients from Korea and Japan. Only primary patients or those with existing fusion below T12 were retained for analysis. Groups were subclassified by deformity severity (aligned: sagittal vertical axis (SVA) <50 mm; moderate malalignment: SVA 50-100 mm; severe malalignment: SVA >100 mm). Radiographic measurements including pelvic retroversion, thoracic kyphosis, loss of lumbar lordosis (PI minus LL), cervical lordosis, and cervical SVA were compared between the groups.Results: There were 288 patients (96 each in USA, KOR, JPN), with similar age (64-67 yr) and PI (49-53°). USA had smaller pelvic incidence minus lumbar lordosis in every alignment group (P <0.05). In moderate malalignment, JPN had more pelvic retroversion than USA (30° vs. 20°), and KOR had more thoracic hypokyphosis than USA (15 vs. 31°). In severe malalignment, JPN had more pelvic retroversion than USA (39° vs. 27°), and KOR had more thoracic hypokyphosis than USA (15° vs. 31°). KOR had smaller cSVA than USA in both aligned (11 vs. 27 mm) and moderate (19 vs. 31 mm) malalignment. In severe malalignment, KOR had less cervical lordosis (13° KOR vs. 15° USA vs. 27° JPN). All differences with P <0.05.Conclusion: Compensation for sagittal is ethnicity dependent. Korean patients favor thoracic compensation via hypokyphosis, and Japanese patients favor pelvic compensation via retroversion. Patient ethnicity should be considered when evaluating the sagittal plane and surgical correction strategies.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective database review.Objective: To compare complication and reoperation rates after anterior cervical discectomy and fusion (ACDF), posterior cervical fusion (PCFs), and anterior cervical corpectomy and fusion (ACCF) for cervical spondylotic myelopathy (CSM) using a large national database of Medicare beneficiaries.Summary Of Background Data: CSM is the most common cause of myelopathy in patients over 55 years and is considered the most common cause of spinal cord dysfunction in the world. Surgical treatment includes ACDF, PCF, or ACCF procedures.Methods: The PearlDiver database (2005-2012) was utilized to determine revision rates after surgical treatment of CSM by one of the aforementioned surgical treatments. Specifically, 1 to 2 level ACDF, ACCF, and PCF and 3+ level PCF cohorts were included. Each cohort was stratified by the age of 65 years. Survivorship curves were graphed and compared.Results: Of the patients younger than 65 years of age, there were 10,557 patients treated with 1 to 2 level ACDF procedures, 1319 patients with 1 to 2 level PCF procedures, 1203 patients with 1 to 2 level ACCF procedures, and 2312 patients treated with 3+ level PCF procedures. Of the elderly patients, 24,310 patients were treated with 1 to 2 level ACDFs, 4776 with 1 to 2 level PCF procedures, 3109 with 1 to 2 level ACCFs, and 7760 with 3+ level PCFs. Patients younger than 65 years of age were significantly more likely to have a reoperation procedure, than those 65 years or older when analyzing ACCF, ACDF, and 3+ level PCF procedures. ACCFs were significantly more likely than ACDFs to require reoperation. Patients treated with PCF were consistently more likely to have nondysphagia-related complications than those treated with ACDF. Rates of transfusion, dysphagia, and hematoma/seroma formation were significantly increased with ACCF compared with ACDF within the elderly population.Conclusion: The elderly are significantly less likely to have a revision surgery after surgical treatment for CSM. Patients treated with ACCF are more likely to need a revision than those treated with ACDF.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Purpose: Studies have examined infection rates following spine surgery and their relationship to post-operative complications and increased length of stay. Few studies, however, have investigated predictors of infection, specifically in the setting of operative intervention for cervical spondylotic myelopathy (CSM). This study aims to identify the incidence and factors predictive of infection amongst this cohort.Methods: This study performed a retrospective review of the prospectively collected American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Patients included those treated surgically for CSM (ICD-9 code 721.1) from 2010 to 2012. Patient demographics and surgical data were collected with outcome variables including the occurrence of one of the following surgical site infections (SSIs) within 30 days of index operation: superficial SSI, deep incisional SSI, and organ/space SSI.Results: 3057 patients were included in this analysis. Overall infection rate was 1.15 % (35/3057), of which 54.3 % (19/35) were superficial SSIs, 28.6 % (10/35) were deep incisional SSI, and 20 % (7/35) were peri-spinal SSI. Logistic regression revealed factors associated with SSI included: higher BMI [OR 1.162 (CI 1.269-1.064), p = 0.001] and operative time ≥208 min [OR 4.769 (CI 20.220-1.125), p = 0.034].Conclusions: The overall SSI rate for the examined CSM cohort was 1.15 %. This study identified increased BMI and operative time ≥208 min as predictors of infection in surgical CSM patients. This information should be carefully considered in delivering patient education and future efforts to optimize risk in CSM patients indicated for surgical intervention. [ABSTRACT FROM AUTHOR]

Study Design: A retrospective review.Objective: Isthmic spondylolisthesis (ISY) is a common orthopedic condition. Our objective was to identify trends in the surgical management of adult ISY in the United States and to evaluate trends in the surgical techniques utilized.Summary Of Background Data: Various surgical approaches have been described for ISY but preferred trends are not known.Methods: Using the Nationwide Inpatient Sample (NIS), 47,132 adult patients (≥ 18 years) with ISY undergoing lumbar spine fusion from 1998 to 2011 were identified. Our primary outcome of interest was the national trend in use of anterior (ASF), posterior (PSF), posterior with interbody (P/TLIF), and combined anterior-posterior fusion (A/PSF) surgeries for ISY patients. Poisson regression, modified Wald's test, and linear and logistic regression analysis with P < 0.05 were used for statistical analysis.Results: The annual rate of fusion surgeries for ISY increased 4.33 times-from 28.31 surgeries in 1998 to 122.69 surgeries per million US adults per year in 2011. Over the study period, annual rates of ASFs increased 2.65 times (P < 0.001), PSFs increased 1.03 times (P = 0.24), P/TLIFs increased 4.33 times (P < 0.001), and A/PSF increased 2.93 times (P < 0.001). In 2010 to 2011, the complication rate was significantly higher for A/PSF (18.86%, P < 0.001). PSFs had a higher complication rate of 3.61% and P/TLIFs (2.58%). The risk of complications was lower for females, elective admissions, and in hospitals in the South. Mean hospitalization charges adjusted to 2011 dollars were significantly higher for A/PSF ($157,560; 95% CI [95% confidence interval]: 14,480-170,360; P <  .001), followed by P/TLIFs ($103,700; 95% CI: 9840-109,030) and PSFs had lower mean hospitalization charges ($87,420; 95% CI: 8210-92,770).Conclusion: Use of fusion for ISY has significantly increased and interbody fusion has become the most preferred approach over the study period. Hospital charges and complications were highest for combined anterior-posterior fusions. [ABSTRACT FROM AUTHOR]

Background: Multilevel anterior cervical discectomy and fusion (mACDF) is the gold standard for multilevel spinal disease; although safe and effective, mACDF can limit regular spinal motion and contribute to adjacent segment disease (ASD). Hybrid surgery, composed of ACDF and cervical disc arthroplasty, has the potential to reduce ASD by retaining spinal mobility. This study examined the safety of hybrid surgery by utilizing administrative claims data to compare real-world rates of subsequent surgery and post-procedural hospitalization within populations of patients undergoing hybrid surgery versus mACDF for multilevel spinal disease., Methods: This observational, retrospective analysis used the MarketScan Commercial and Medicare Database from July 2013 through June 2020. Propensity score matched cohorts of patients who received hybrid surgery or mACDF were established based on the presence of spinal surgery procedure codes in the claims data and followed over a variable post-period. Rates of subsequent surgery and post-procedural hospitalization (30- and 90-day) were compared between hybrid surgery and mACDF cohorts., Results: A total of 430 hybrid surgery patients and 2,136 mACDF patients qualified for the study; average follow-up was approximately 2 years. Similar rates of subsequent surgery (Hybrid: 1.9 surgeries/100 patient-years; mACDF: 1.8 surgeries/100 patient-years) were observed for the two cohorts. Hospitalization rates were also similar across cohorts at 30 days post-procedure (Hybrid: 0.67% hospitalized/patient-year; mACDF: 0.87% hospitalized/patient-year). At 90 days post-procedure, hybrid surgery patients had slightly lower rates of hospitalization compared to mACDF patients (0.23% versus 0.42% hospitalized/patient-year; p < 0.05)., Conclusions: Findings of this real-world, retrospective cohort study confirm prior reports indicating that hybrid surgery is a safe and effective intervention for multilevel spinal disease which demonstrates non-inferiority in relation to the current gold standard mACDF. The use of administrative claims data in this analysis provides a unique perspective allowing the inclusion of a larger, more generalizable population has historically been reported on in small cohort studies., (© 2023. The Author(s).)

Study Design: Retrospective multicenter database review.Objective: The aim of this study was to evaluate national postoperative outcomes and hospital characteristics trends from 2001 to 2010 for advanced age CSM patients.Summary Of Background Data: Recent studies show increases in US cervical spine surgeries and CSM diagnoses. However, few have compared national outcomes for elderly and younger CSM patients.Methods: A Nationwide Inpatient Sample (NIS) analysis from 2001 to 2010, including CSM patients 25+ who underwent anterior and/or posterior cervical fusion or laminoplasty. Fractures, 9+ levels fused, or any cancers were excluded. Measures included demographics, outcomes, and hospital-related data for 25 to 64 versus 65+ and 65 to 75 versus 76+ age groups. Univariate and logistic regression modeling evaluated procedure-related complications risk in 65+ and 76+ age groups (OR[95% CI]).Results: Discharges for 35,319 patients in the age range of 25 to 64 years and 19,097 at the age 65+ years were identified. Average comorbidity indices for patients at 65+ years were higher compared to the 25 to 64 years age group (0.79 vs. 0.0.44, P < 0.0001), as was the total complications rate (11.39% vs. 5.93%, P < 0.0001) and charges ($57,449.94 vs. $49,951.11, P < 0.0001). Hospital course for aged 65+ patients was longer (4.76 vs. 3.26 days, P < 0.0001). Mortality risk was higher in the 65+ cohort (3.38[2.93-3.91]), adjusted for covariates. 65+ patients had increased risk of all complications except device-related, for which they had decreased risk (0.61[0.56-0.67]). Patients 76+ years displayed increased hospital charges ($59,197.60 vs. $56,601.44, P < 0.001) and courses (5.77 vs. 4.28 days, P < 0.001) compared to those in the age group 65 to 75 years. These same patients presented with increased Deyo scores (0.83 vs. 0.77, P < 0.001), had increased total complications rate (13.87% vs. 10.20%, P < 0.001), and displayed increased risk for postoperative shock (6.34 [11.16-3.60], P < 0.001), digestive system (1.92 [2.40-1.54], P < 0.001), and wound dehiscence (1.71 [2.56-1.15], P < 0.001).Conclusion: Patients aged 65+ years undergoing CSM surgical management have a higher mortality risk, more procedure-related complications, higher comorbidity burden, longer hospital course, and higher charges. This study provides clinically useful data for surgeons to educate patients and to improve outcomes. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to report and quantify the associated factors for morbidity and mortality following surgical management of cervical spondylotic myelopathy (CSM).Methods: The Nationwide Inpatient Sample (NIS) database was use to retrospectively review all patients over 25 years of age with a diagnosis of CSM who underwent anterior and/or posterior cervical fusion or laminoplasty between 2001 and 2010. The main outcome measures were total procedure-related complications and mortality. Multivariate regression analysis was used to identify demographic, comorbidity, and surgical parameters associated with increased morbidity and mortality risk [reported as: OR (95% CI)].Results: A total of 54,348 patients underwent surgical intervention for CSM with an overall morbidity rate of 9.83% and mortality rate of 0.43%. Comorbidities found to be associated with an increased complication rate included: pulmonary circulation disorders [6.92 (5.91-8.12)], pathologic weight loss [3.42 (3.00-3.90)], and electrolyte imbalance [2.82 (2.65-3.01)]. Comorbidities found to be associated with an increased mortality rate included: congestive heart failure [4.59 (3.62-5.82)], pulmonary circulation disorders [11.29 (8.24-15.47)], and pathologic weight loss [5.43 (4.07-7.26)]. Alternatively, hypertension [0.56 (0.46-0.67)] and obesity [0.36 (0.22-0.61)] were found to confer a decreased risk of mortality. Increased morbidity and mortality rates were also identified for fusions of 4-8 levels [morbidity: 1.55 (1.48-1.62), mortality: 1.80 (1.48-2.18)] and for age >65 years [morbidity: 1.65 (1.57-1.72), mortality: 2.74 (2.25-3.34)]. An increased morbidity rate was found for posterior-only [1.55 (1.47-1.63)] and combined anterior and posterior fusions [3.20 (2.98-3.43)], and an increased mortality rate was identified for posterior-only fusions [1.87 (1.40-2.49)]. Although revision fusions were associated with an increased morbidity rate [1.81 (1.64-2.00)], they were associated with a decreased rate of mortality [0.24 (0.10-0.59)].Conclusion: The NIS database was used to provide national estimates of morbidity and mortality following surgical management of CSM in the United States. Several comorbidities, as well as demographic and surgical parameters, were identified as associated factors. [ABSTRACT FROM AUTHOR]

Study Design: The thoracolumbar injury classification system (TLICS) was evaluated in 20 consecutive pediatric spine trauma cases.Objective: The purpose of this study was to determine the reliability and validity of the TLICS in pediatric spine trauma.Summary Of Background Data: The TLICS was developed to improve the categorization and management of thoracolumbar trauma. TLICS has been shown to have good reliability and validity in the adult population.Methods: The clinical and radiographical findings of 20 pediatric thoracolumbar fractures were prospectively presented to 20 surgeons with disparate levels of training and experience with spinal trauma. These injuries were consecutively scored using the TLICS. Cohen unweighted κ coefficients and Spearman rank order correlation values were calculated for the key parameters (injury morphology, status of posterior ligamentous complex, neurological status, TLICS total score, and proposed management) to assess the inter-rater reliabilities. Five surgeons scored the same cases 3 months later to assess the intra-rater reliability. The actual management of each case was then compared with the treatment recommended by the TLICS algorithm to assess validity.Results: The inter-rater κ statistics of all subgroups (injury morphology, status of the posterior ligamentous complex, neurological status, TLICS total score, and proposed treatment) were within the range of moderate to substantial reproducibility (0.524-0.958). All subgroups had excellent intra-rater reliability (0.748-1.000). The various indices for validity were calculated (80.3% correct, 0.836 sensitivity, 0.785 specificity, 0.676 positive predictive value, 0.899 negative predictive value). Overall, TLICS demonstrated good validity.Conclusion: The TLICS has good reliability and validity when used in the pediatric population. The inter-rater reliability of predicting management and indices for validity are lower than those in adults with thoracolumbar fractures, which is likely due to differences in the way children are treated for certain types of injuries. TLICS can be used to reliably categorize thoracolumbar injuries in the pediatric population; however, modifications may be needed to better guide treatment in this specific patient population.Level Of Evidence: 4. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective database analysis.Objective: To determine the incidence of durotomy in primary short-segment lumbar fusion and assess its clinical and economic impacts.Summary Of Background Data: The incidence of durotomy during primary lumbar fusion and its economic impact are not well described.Methods: The Nationwide Inpatient Sample was queried for all primary 1- or 2-level lumbar fusions performed in adults for lumbar spinal stenosis between 2009 and 2011; only elective cases without concurrent diagnoses of vertebral infection, fracture, or tumor were included. χ and t-tests were used as appropriate to compare categorical and continuous variables, respectively. Multivariate regression analysis was performed to identify factors independently associated with incidental durotomy, as well as total hospital charges, costs, and length of stay.Results: Among 17,232 cases, 802 incidental durotomies were identified (rate 4.65%). The multivariate odds of durotomy in the oldest patients (age ≥ 73) were 2.4 times greater than the odds of durotomy in the youngest patients (age ≤ 56; P < 0.0001). Durotomy was associated with increased neurological complications and longer hospital stay. Length of stay was a significant driver of cost. The multivariate odds of dural tears in teaching hospitals was significantly higher compared with nonteaching hospitals (odds ratio 1.27; 95% confidence interval, 1.06-1.52; P < 0.005). Durotomy was associated with a $10,885 increase in total hospital charges, and a $3,873 increase in estimated total costs (compared with no durotomy group with P < 0.0001).Conclusion: Increasing age is a risk factor for durotomy in primary lumbar fusion. Durotomy is associated with neurological complications, increased length of stay, greater healthcare costs, and is more common in teaching hospitals. Length of stay is an independent driver of cost and complications.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Study Design: A multicenter, prospective review of surgical patients with adult spine deformity.Objective: Assessment of the incidence, risk factor, and impact of radiographical and implant-related complications (RIC) on health-related quality of life measures.Summary Of Background Data: This study provides assessment of the incidence of RIC in adult spinal deformity surgery and impact of these complications on need for reoperation. Risk factors for development of RIC are also assessed, as well as the impact of these complications on health-related quality of life (HRQOL) outcomes measures.Methods: A multicenter, prospective database of surgical patients with adult spinal deformity was reviewed. All patients with complete 2-year follow-up were included. HRQOL was measured using the Oswestry Disability Index, General Health Survey (36-Item Short Form Health Survey [SF-36]), and Scoliosis Research Society-22 (SRS-22r) at baseline, 6 weeks, 1 year, and 2 years postoperatively. Univariate testing was performed as appropriate. Multivariate logistic regression modeling was used to determine independent predictors of RIC. Multivariate repeated-measures mixed models were used to examine HRQOL, accounting for confounders.Results: A total of 245 patients met inclusion criteria. The incidence of RIC was 31.7% and 52.6% of those patients required reoperation. Rod breakage accounted for 47% of the implant-related complications, and proximal junctional kyphosis accounted for 54.5% of radiographical complications. Univariate analysis identified the following potential risk factors for RIC: weight, American Society of Anesthesiologists score, revision, stopping the fusion in the lower thoracic spine, worse SRS-Schwab classification modifiers (pelvic tilt++, pelvic incidence minus lumbar lordosis++, sagittal vertical axis++), higher T1 spinopelvic inclination, and higher T1 slope. Independent predictors of RIC as identified on multivariate logistic regression included American Society of Anesthesiologists (odds ratio: 1.75, P = 0.029) and sagittal vertical axis modifier ++ (odds ratio 3.43, P = 0.0001). The RIC and no RIC groups each experienced significant improvement over time, as measured on the Oswestry Disability Index (P = 0.0001), SF-36 (P = 0.0001), and SRS-22r (P = 0.0001). However, the rate of improvement over time was less for patients with RIC (SRS-22r P = 0.043, SF-36 P = 0.0001).Conclusion: This study identified that nearly one-third of patients undergoing adult spinal deformity surgery experienced a radiographical or implant-related complication, and that just more than one-half of these patients experiencing complication required a reoperation within 2 years of surgery. These complications significantly affected HRQOL measures. Baseline patient characteristics and parameters of the SRS-Schwab classification can be used to help identify those patients at greater risk.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

The American College of Radiology has published appropriateness criteria to help guide when to use MRI. Many health insurance carriers use proprietary clinical guidelines for prior authorization of imaging studies. The purpose of this study was to compare the specific criteria in those guidelines, for neck pain both with and without radicular symptoms. An online search was conducted to identify the guidelines for authorization of cervical spine MRI used by the largest commercial insurance carriers in the United States by market share. Guidelines were analyzed for neck pain with and without radiculopathy. Cervical trauma, myelopathy, infection, neoplasm, multiple sclerosis, and postprocedural care were excluded. The remaining criteria were broken down into categories including clinical symptoms, conservative therapy, other required radiologic studies, and clinical re-evaluation. Individual criteria within each of the categories were compared. After evaluation of the top 56 insurance companies in the United States, 30 companies using four main utilization management companies remained for analysis. After direct comparison of publicly available guidelines documents, notable discrepancies existed between the four companies in all subcategories analyzed. In addition, varying amounts of evidence-based literature was identified to support criteria requirements for prior authorization. This study demonstrates that the guidelines used by private health insurance companies for cervical MRI authorization in the setting of neck pain with and without cervical radiculopathy are inconsistent and use objective measures that have not been validated in the literature. We think this warrants additional scrutiny and investigation., Competing Interests: The authors have no financial or academic conflicts of interest to disclose. We did not receive any funding to complete this study from National Institutes of Health (NIH), Wellcome Trust, and Howard Hughes Medical Institute (HHMI)., (Copyright © 2022 by the American Academy of Orthopaedic Surgeons.)

Latino migrants in Houston mobilize in myriad ways to defend their rights in the current context of increased enforcement and restrictive laws. Through an exploration of the mobilization strategies of Living Hope Wheelchair Association, an organization of Latino migrants with spinal cord injuries, this article considers the ways this organization reframes migration as an issue of human rights and social justice rather than one of criminalization. It explores Living Hope's demands for rights as its members are excluded from the nation and the city based on immigration status, ethnicity, and physical disability as well as the ways the association's claims for rights addresses the profoundly unequal relationships between the United States and Latin American nations. [ABSTRACT FROM AUTHOR]

It is widely recognized that the dramatic increase in health care costs in the United States has not led to a corresponding improvement in the health care experience of patients or the clinical outcomes of medical care. In no area of medicine is this more true than in the area of spine related disorders (SRDs). Costs of medical care for SRDs have skyrocketed in recent years. Despite this, there is no evidence of improvement in the quality of this care. In fact, disability related to SRDs is on the rise. We argue that one of the key solutions to this is for the health care system to have a group of practitioners who are trained to function as primary care practitioners for the spine. We explain the reasons we think a primary spine care practitioner would be beneficial to patients, the health care system and society, some of the obstacles that will need to be overcome in establishing a primary spine care specialty and the ways in which these obstacles can be overcome. [ABSTRACT FROM AUTHOR]

Background: Until quite recently spinal disorder problems in the U.S. have been operated by fusing cervical vertebrae instead of replacement of the cervical disc with an artificial disc. Cervical disc replacement is a recently approved procedure in the U.S. It is one of the most challenging surgical procedures in the medical field due to the deficiencies in available diagnostic tools and insufficient number of surgical practices For physicians and surgical instrument developers, it is critical to understand how to successfully deploy the new artificial disc replacement systems. Without proper understanding and practice of the deployment procedure, it is possible to injure the vertebral body. Mixed reality (MR) and virtual reality (VR) surgical simulators are becoming an indispensable part of physicians' training, since they offer a risk free training environment. In this study, MR simulation framework and intricacies involved in the development of a MR simulator for the rasping procedure in artificial cervical disc replacement (ACDR) surgery are investigated. The major components that make up the MR surgical simulator with motion tracking system are addressed. Findings: A mixed reality surgical simulator that targets rasping procedure in the artificial cervical disc replacement surgery with a VICON motion tracking system was developed. There were several challenges in the development of MR surgical simulator. First, the assembly of different hardware components for surgical simulation development that involves knowledge and application of interdisciplinary fields such as signal processing, computer vision and graphics, along with the design and placements of sensors etc. Second challenge was the creation of a physically correct model of the rasping procedure in order to attain critical forces. This challenge was handled with finite element modeling. The third challenge was minimization of error in mapping movements of an actor in real model to a virtual model in a process called registration. This issue was overcome by a two-way (virtual object to real domain and real domain to virtual object) semi-automatic registration method. Conclusions: The applicability of the VICON MR setting for the ACDR surgical simulator is demonstrated. The main stream problems encountered in MR surgical simulator development are addressed. First, an effective environment for MR surgical development is constructed. Second, the strain and the stress intensities and critical forces are simulated under the various rasp instrument loadings with impacts that are applied on intervertebral surfaces of the anterior vertebrae throughout the rasping procedure. Third, two approaches are introduced to solve the registration problem in MR setting. Results show that our system creates an effective environment for surgical simulation development and solves tedious and time-consuming registration problems caused by misalignments. Further, the MR ACDR surgery simulator was tested by 5 different physicians who found that the MR simulator is effective enough to teach the anatomical details of cervical discs and to grasp the basics of the ACDR surgery and rasping procedure [ABSTRACT FROM AUTHOR]

Study design:Cross-sectional.Objectives:The objective of this study was to examine the association between the characteristics of individuals with spinal cord injury (SCI) and self-reported health-related quality of life (HRQoL).Setting:The United States.Methods:Questions from the Behavioral Risk Factor Surveillance System (BRFSS) survey were sent to veterans with SCI. The analyses included 2302 respondents. Logistic regression analysis was used to examine the association between subject characteristics and the following four measures of HRQoL: frequent physical distress (FPD), frequent mental distress (FMD), frequent depressive symptoms (FDS) and poor or fair self-reported health.Results:Approximately 19% of the respondents reported FMD, 27% reported FPD, 17% reported FDS and 29% reported poor or fair health. Veterans who self-reported chronic illnesses, had higher odds of reporting FPD, FMD, FDS and poor or fair health than veterans who did not report chronic illnesses. Smoking was significantly associated with decreased HRQoL. Older veterans had higher odds of reporting poor or fair health and FPD than younger veterans. Higher levels of education were associated with lower odds of FMD, FDS and poor or fair health.Conclusions:Chronic illnesses and smoking have a substantial effect on HRQoL for persons with SCI, suggesting the importance of continued efforts to improve smoking cessation methods and to treat and prevent chronic conditions.Spinal Cord (2008) 46, 507–512; doi:10.1038/sc.2008.2; published online 5 February 2008 [ABSTRACT FROM AUTHOR]

Study design:Cross-sectional; survey.Objectives:To describe the utilization, accessibility and satisfaction of primary and preventive health-care services to individuals with long-term spinal cord injuries, and compare results among three countries: the United States, Canada and the United Kingdom.Setting:The Canadian sample was obtained from the Canadian Paraplegic Association – Ontario and Manitoba Divisions. The British sample was recruited from the Northwest Regional Spinal Injuries Centre in Southport and National Spinal Injuries Centre at Stoke Mandeville Hospital in Aylesbury. The American sample was recruited through Craig Hospital in Englewood, CO, USA.Method:A total sample of 373 individuals aging with a spinal cord injury participated in a mailed survey. The Health Care Questionnaire was used to measure utilization, access and satisfaction with primary care and preventive services.Results:In total, 93% of individuals reported having a family doctor, 63% had a spinal injuries specialist and 56% had both a family doctor and spinal injuries specialist. Considerable duplication of services occurred for general medical and preventive services, although lifestyle and emotional issues were not addressed for over 75% of the participants. Significant differences were found in utilization among Canada, US and UK, with Canadians most likely to receive health care from family physicians and Americans most likely to receive care from specialists. Access to and satisfaction with health services was not significantly different among countries.Conclusion:People with long-standing spinal cord injuries develop complex maps by which they seek out appropriate primary health-care and preventive services. Given the differences among countries, it is clear that the health delivery model plays an important role in how and where individuals receive health services.Spinal Cord (2007) 45, 25–36. doi:10.1038/sj.sc.3101933; published online 30 May 2006 [ABSTRACT FROM AUTHOR]

The article presents a study that determines the hospitalization and mortality rate of persons associated with spinal cord injury and diseases after the occurrence of acute respiratory infections (ARI) in the U.S. Respiratory illnesses were noted to be the leading cause of death of persons affected with spinal injury. Such disorders included upper respiratory infections (URI), acute bronchitis, pneumonia, and influenza. Hospitalization rates were found to be 49 percent while mortality rate was 2.9 percent. It was revealed that spinal injury and acute bronchitis greatly affect the rate of hospital admission and death.

STUDY DESIGN:: Survey research methods. OBJECTIVES:: To assess patient satisfaction with the annual comprehensive preventative health evaluation (CPHE) and to determine if the patient's needs were being met. SETTING:: Department of Veterans Affairs National Survey, United States. METHODS:: A total of 853 subjects with spinal cord injuries participated in a mailed survey regarding the annual CPHE. Subjects were asked about satisfaction with the examination, preferences on how the examination is conducted and whether their needs were being met with the examination. RESULTS:: In all, 76% of the subjects that responded to the survey had completed a CPHE within the previous year. Subjects cited getting their medication and supplies refilled and talking to the doctor as the top two reasons for completing the evaluation. Subjects indicated that they would most like to discuss their muscle strength and weakness, bladder care, chronic pain, digestion and bowel care issues, and equipment problems during their evaluation. The majority of subjects (81%) indicated that they were satisfied with the CPHE. Subjects that were satisfied with the CPHE were also more satisfied with other aspects of care as well. CONCLUSION:: The majority of respondents had completed a CPHE within the previous year. Most respondents cite health issues related to the spinal cord injury as areas they would most like to discuss during the evaluation. The majority of subjects were satisfied with the conduct of the CPHE.Spinal Cord (2005) 43, 366–374. doi:10.1038/sj.sc.3101708 Published online 1 February 2005 [ABSTRACT FROM AUTHOR]

In the USA, substantial geographic variation in health care utilization exists in the Department of Veterans Affairs (VA) health care system. Utilization of health care services is especially important for veterans with spinal cord injuries and disorders (SCI&D) who are often at high risk for secondary complications related to their SCI&D. Due to impaired mobility, access to health care for veterans with SCI&D may be even more challenging. The goal of this cross-sectional study was to describe health care utilization relative to SCI&D veteran residential geographic proximity to VA health care facilities. A negative binomial regression model was used to examine VA outpatient utilization. Veterans with SCI&D utilized outpatient services less frequently when VA facilities were farther away from their residences (). Female (), older (), and non-white veterans (), and veterans with history of respiratory (), kidney/urinary tract (), circulatory (), or digestive system diseases () were more likely to utilize outpatient care during the study period. A Poisson model was used to examine inpatient utilization. Inpatient utilization decreased when travel distance to VA facility increased (). Contrary to outpatient, age did not significantly affect veterans’ likelihood of using inpatient health care. Marital status, gender, race, and level of injury were not related to inpatient utilization. However, history of prior illnesses including respiratory (), kidney/urinary tract (), circulatory (), digestive system (), or skin/subcutaneous tissue/breast-related illnesses () were associated with a greater likelihood of inpatient utilization. Geographic proximity and other factors on health care use must be considered in order to meet the health care demand patterns of veterans with SCI&D. [Copyright &y& Elsevier]

The Baby Boomers were essentially the last generation of children in the U.S. to be affected by poliomyelitis, also known as infantile paralysis. Polio has been eradicated from nearly every country in the world since the Sulk (1955) and Sabin (1962) vaccines. By the late 1970s, however, polio survivors were noting new problems of fatigue, pain, and additional weakness. Less than a decade later, these new problems were recognized as having a pattern, and post-polio syndrome (PPS) emerged as a diagnosis. PPS is a condition that affects polio survivors anywhere from 10 to 40 years after recovery from polio. PPS is characterized by a further weakening of muscles that were previously affected by the polio infection. Symptoms include fatigue, slowly progressive muscle weakness and, at times, muscular shrinkage. Joint pain and increasing skeletal deformities are common. Some patients experience only minor symptoms, while others develop more extensive problems. Although chronic, PPS is rarely life-threatening. This paper describes Web sites that provide information useful to suspected or diagnosed post-polio syndrome sufferers and their families. [ABSTRACT FROM AUTHOR]

Context/Objective: Provisions of the Affordable Care Act (ACA) potentially increase insurance options for Veterans with disabilities. We examined Veterans with spinal cord injuries and disorders (SCI/D) to assess whether the ACA was associated with changes in healthcare utilization from Department of Veterans Affairs (VA) healthcare facilities. Design: Using national VA data, we investigated impacts on VA healthcare utilization pre- (2012/13) and post-ACA (2014/15) implementation with negative binomial regression models. Setting: VA healthcare facilities. Participants: 8,591 VA users with SCI/D. Veterans with acute myelitis, Guillain-Barré syndrome, multiple sclerosis, or amyotrophic lateral sclerosis were excluded as were patients who died during the study period. Interventions: We assessed VA healthcare utilization before and after ACA implementation. Outcome Measures: Total numbers of VA visits for SCI/D care, diagnostic care, primary care, specialty care, and mental health care, and VA admissions. Results: The number of VA admissions was 7% higher in the post than pre-ACA implementation period (P < 0.01). The number of VA visits post-implementation increased for SCI/D care (8%; P < 0.01) and specialty care (12%; P < 0.001). Conversely, the number of mental health visits was 17% lower in the post-ACA period (P < 0.001). Veterans with SCI/D who live <5 miles from their nearest VA facility received VA care more frequently than those ≥40 miles from VA (P < 0.001). Conclusion: Counter to expectations, results suggest that Veterans with SCI/D sought more frequent VA care after ACA implementation, indicating Veterans with SCI/D continue to utilize the lifelong, comprehensive care provided at VA.

The article reports on the high incidence of spinal pathology of feebleminded patients in the U.S. A possible diagnosis is not always possible with feebleminded children. The familial type of oligophrenia shows very often anomalies of the spinal cord and of the spina. Anomalies often grow on the back in the lumbar region or in between the scapulae.

Background: Individuals with spinal cord injuries and disorders (SCI/D) require frequent interdisciplinary health care to address impairments in mobility, autonomic function, and secondary complications. Telehealth has the capacity to substantially transform health care delivery and improve care by increasing access and communication. However, relatively little is known about telehealth use in this specific population. Here we attempt to fill part of this gap., Objective: To investigate the frequency and characteristics associated with telehealth use in Veterans with SCI/D., Design: Cross-sectional, descriptive project., Setting: Veterans Health Administration (VHA) facilities., Participants: A total of 15 028 Veterans living with SCI/D who received services from the VHA SCI/D System of Care., Intervention: Not applicable., Outcome Measures: Frequency and characteristics associated with VHA telehealth utilization., Results: Of the 15 028 Veterans with SCI/D included in the evaluation, 17% used some form of telehealth in VHA Fiscal Year (FY)2017. Veterans older than 65 years of age had lower odds (odds ratio [OR] = 0.88, P < .05, confidence interval [CI] 0.80-0.98) of using telehealth. Being Caucasian (OR = 1.29, P < .01, CI 1.09-1.52), living in rural areas (OR = 1.16, P < .01, CI 1.05-1.28), living greater distances away from the VHA (P < .01 for all distances), and being in priority group 8, meaning that Veterans have higher copayment requirements (OR = 1.46, P < .001, CI 1.19-1.81), were all significantly associated with greater odds of telehealth use. The most frequent types of telehealth used were real-time clinical video and store-and-forward between a provider and patient within the same hub network., Conclusion: There are opportunities to increase telehealth adoption in the SCI/D arena. The findings from this project highlight which Veterans are currently using telehealth services, as well as gaps regarding telehealth adoption in this population., (© 2020 American Academy of Physical Medicine and Rehabilitation.)

Provides information on magnetic resonance (MR) imaging of the brain and spine. Advantages and disadvantages of MR imaging; Significance of MR imaging in the detection of lesions in the posterior fossa and the spine.

Objectives: Describe an interdisciplinary spinal cord injury home care program (SCIHCP), sample demographics for the veteran participants, and initial impact of SCIHCP on health care utilization and mortality., Design: Retrospective review., Setting: SCIHCP of the Spinal Cord Injury Center, VA North Texas Health Care System (VANTHCS)., Participants: Patients with SCI/D enrolled in the SCIHCP during January 6, 2006 through January 9, 2012, whose injury occurred at least one year prior to enrollment(n = 125)., Main Outcome Measures: VANTHCS hospital admissions, length of stay (LOS), and emergency department (ED) visits evaluated one year before and one year after SCIHCP enrollment; mortality evaluated one-year post-enrollment., Results: There were no significant changes in number of ED visits, number of hospital admissions, or LOS over time. More home care visits and more mental health comorbidities predicted more hospital admissions. Older patients and those with more mental health comorbidities were more likely to experience increases in LOS. These prediction models were significant after adjusting for injury level, age, race, time since SCI, and number of medical comorbidities. More home care visits were associated with lower likelihood of mortality post-enrollment., Conclusions: Inpatient and ED utilization did not change one year after enrollment, but more SCIHCP visits predicted more hospital admissions and lower likelihood of mortality in the post-evaluation year. The support, education, and care continuity SCIHCP generates might be related to increased inpatient access and lower mortality rate. Veterans with increased mental health comorbidities used inpatient services more, and might need additional support.

BACKGROUND CONTEXT Degenerative cervical myelopathy (DCM) is the leading cause of spinal cord injury and a major source of disability globally; however, data on the national trends of DCM incidence are limited. PURPOSE To evaluate contemporary trends in DCM incidence and healthcare resource utilization in the United States. STUDY DESIGN/SETTING Determination of epidemiological estimates of DCM using population-based survey data from the United States AHRQ HCUP National Inpatient Sample (NIS) for years 2002 through 2014. PATIENT SAMPLE A total of 618,323 patients who underwent surgery for DCM in the United States between 2002 and 2014. OUTCOME MEASURES Overall and age- and sex-stratified incidences of surgically-treated DCM; surgical techniques utilized, hospitalization charges and costs, and inpatient complications and mortality for treatment of DCM. METHODS Patients who underwent surgery for DCM were identified from the NIS using ICD-9-CM codes based on a diagnosis code for cervical spondylosis and/or OPLL plus cervical myelopathy, plus a procedure code for anterior or posterior decompression plus or minus fusion, or disc replacement. Data pertaining to patient-, treatment-, admission-, and hospital-related factors and outcomes were collected. Patient-specific discharge weights were used to obtain national estimates. We calculated standard errors and 95% confidence intervals (CIs) using strata and cluster variables to account for hospital-level clustering of patients and the sampling design. We calculated overall and age- and sex-stratified incidences of surgically-treated DCM per 100,000 persons for each year using population estimates from the U.S. Census Bureau. These were compared to incidences of acute traumatic SCI and three very common neurosurgical procedures: (1) evacuation of subdural hematoma (SDH) (including acute, subacute, and chronic); (2) craniotomy for tumor (including primary and metastatic); and (3) clipping or endovascular coiling of cerebral aneurysm. Hospitalization charges and costs were indexed to year 2008 to adjust for inflation using Consumer Price Index (CPI) data from the U.S. Bureau of Labor Statistics. Trends were analyzed by joinpoint regression analysis for incidences to determine the average annual percent change (AAPC), the Cochrane–Armitage trend test for categorical variables, and linear regression for continuous variables. RESULTS The overall incidence of surgical DCM rose from 10.3 per 100,000 persons in 2002 to 21.1 per 100,000 persons in 2014, representing an AAPC of 5.9% (95% CI 5.5%–6.3%). The highest incidence (61.1/100,000) and growth rate (AAPC 7.4%) were seen in the 65 to 84-year-old age group. Age-adjusted incidence and annual growth rates for DCM exceeded those of acute traumatic SCI (5.0/100,000; −0.5%), evacuation of SDH (8.2/100,000; 0.4%), craniotomy for brain tumor (14.2/100,000; 1.1%), and clipping or coiling of cerebral aneurysm (7.2/100,000; 2.4%). Cumulative hospital charges and costs for DCM rose from $0.99 billion and $0.29 billion in 2002 to $5.13 billion and $1.32 billion in 2014, respectively. The proportion of cases for which Medicare was the primary payer increased from 30.5% in 2002 to 43.6% in 2014. CONCLUSIONS DCM is the leading indication for operation on the central nervous system. The incidence of, and healthcare dollars spent on, surgery for DCM has steadily risen over the past decade likely owing both to an aging population and increasing recognition of the role of surgical management in these patients. [ABSTRACT FROM AUTHOR]

BACKGROUND CONTEXT Lumbar fusion surgery for degenerative disease has been subject to increased scrutiny by payers. The procedure is not indicated for primary disc herniation or spinal stenosis without segmental instability, and is controversial for chronic back pain attributed to degenerative disc disease. Evidence has supported fusion for spondylolisthesis, but this indication has been called into question by two randomized trials. PURPOSE We sought to examine the impact of developing clinical evidence on US population rates of lumbar fusion, and associated costs, by surgical indication. STUDY DESIGN/SETTING Retrospective analysis of the Agency for Healthcare Research and Quality's National Inpatient Sample from 2004 to 2013, a nationally representative discharge registry. PATIENT SAMPLE We identified adults (age 20+) undergoing lumbar fusion operations for elective degenerative spinal diagnoses in the US OUTCOME MEASURES US population-based rates of hospital discharges for lumbar fusion, by indication, and associated hospital costs. METHODS Surgical indications were grouped as degenerative scoliosis, degenerative spondylolisthesis, spinal stenosis without deformity, disc herniation and disc degeneration. Age- and sex-adjusted rates of lumbar fusion operation per 100,000 US adult residents, by indication, were reported using Poisson regression. Generalized linear regression was used to estimate trends in hospital costs, adjusted for age, sex, indication, comorbidity and inflation. RESULTS The total number of elective lumbar fusion operations for degenerative diagnoses increased 51.3% (or a 28.4% increase in rate per 100,000 US adults), from 127,453 cases (62.3 per 100,000) in 2004 to 192,860 (80.0 per 100,000) in 2013. Increases were greatest among those age 65 or older, increasing 67.3%, from 100.0 per 100,000 (95% CI: 98.9-101.0) in 2004 to 167.3 (95% CI: 166.1-168.4) in 2013. Although the largest increases were for spondylolisthesis and scoliosis, disc degeneration, herniation and stenosis combined to account for 44.8% of total elective lumbar fusions in 2013. Hospital costs more than doubled during the 10-year study, exceeding $9 billion in 2013, averaging nearly $50,000 per admission. CONCLUSIONS Although the rate of fusion for disc herniation, disc degeneration, or spinal stenosis decreased in recent years, nearly half of all elective lumbar fusions in the US were performed for these indications. The rate of elective lumbar fusion surgery in the United States increased most for spondylolisthesis and scoliosis, indications with relatively well-supported evidence of effectiveness. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

This article cites a research study focusing on the use of a spinal cord stimulator (SCS) in the treatment of chronic pain. An SCS provides low levels of electrical energy to the spinal cord to interfere with the sensation of pain. It is suitable to help a patient with chronic pain who has not responded to other forms of treatment. An SCS controls pain and reduces opioid use and makes the patient comfortable, active and productive. An SCS seems to work best for neuropathic pain. SCS has been approved by the U.S. Food and Drug Administration to treat chronic intractable pain in the trunk and limbs.

The article discusses the prevalence of paralytic poliomyelitis in the United States in 1965. A total of 61 known cases of paralytic poliomyelitis were reported to the Poliomyelitis Surveillance Unit of the Communicable Disease Center during 1965. Approximately one-half of the patients were children under five years of age, and eight of these were infants under one year of age. Five deaths occurred, two in adult males and three in female children. Of the polio viruses identified, 19 were type K, eight were type II, and 11 were type III. Of the eight type II isolates during 1965, three came from individuals who had a known contact with a person proved to be excreting type II virus or with a person recently vaccinated with trivalent oral poliovaccine.

The author reflects on the results of the study showing an increase in spinal surgery rates in the U.S. He discusses possible arguments about the definition of fusion as the standard treatment for many spinal cord diseases. He expresses concern that the increase in rates for fusion surgery may be difficult to sustain and that the trend towards complex procedures would not mean it is the most effective route to take.