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Objectives To understand the prognostic value of laboratory markers at presentation on post-treatment survival of patients 50 and older following cervical spine fracture. Patients and Methods We obtained clinical data on patients 50 and older treated for cervical spine fracture in a single healthcare system (2006–2016). Our primary outcome consisted of 1-year mortality, with mortality within 3-months of presentation considered secondarily. Our primary predictors included serum glucose, serum creatinine, platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR) at presentation. We used multivariable logistic regression to adjust for confounding from sociodemographic and clinical characteristics. Point estimates and 95 % confidence intervals (CI) from the final model were refined using Bayesian regression techniques. Results We included 1781 patients in this analysis, with an average age of 75.3 (SD 12.0). The mortality rate at 3-months was 12 % and 17 % at 1-year. In multivariable testing, neither elevated PLR or NLR were significant predictors of 1-year mortality. Elevated serum creatinine was associated with increased mortality at 1-year (OR 1.89; 95 % CI 1.30, 2.74), as was hyperglycemia (OR 1.50; 95 % CI 1.06, 2.13). Elevated serum creatinine remained influential (OR 1.64; 95 % CI 1.06, 2.54) on mortality at 3-months. Conclusions This is the first study to evaluate laboratory values at presentation in conjunction with survival following cervical fractures. The results can be used to help forecast natural history and in expectation management. They may also help formulate treatment plans, especially when the need for surgical intervention is not clearly defined.

Significant benefits for private practice employment exist in today’s medical landscape, despite continued downward pressures against this model. These include freedom of schedule, case volume and/or selection, access to ancillary revenue streams, and control of office personnel. While entering into a private practice exposes a surgeon to more financial risk than hospital or academic employment, it also holds potential for greater entrepreneurial fulfillment, especially for more business-minded physicians. With the constantly evolving medical landscape, it is our belief that there will always be a role for private practice models in delivering quality and economic healthcare for future generations. This chapter serves to outline the potential benefits, as well as risks, of a private practice employment model.

Cervical disc arthroplasty (CDA) was developed to decrease the rate of symptomatic adjacent-level disease while preserving motion in the cervical spine. The objectives of this paper are to provide criteria for proper patient selection as well as to present a comprehensive literature review of the current evidence for CDA, including randomized studies, the most recent meta-analysis findings, and long-term follow-up clinical trials as well. Currently, there are several prospective randomized controlled studies of level I of evidence attesting to the safety and efficacy of CDA in the management of cervical spondylotic disease (CSD) for one- or two-level degenerative diseases. These as well as recent meta-analyses suggest that CDA is potentially similar or even superior to anterior cervical discectomy and fusion (ACDF) when considering several outcomes, including dysphagia and re-operation rate over medium-term follow-up. Less robust studies have also reported satisfactory clinical and radiological outcomes of CDA for hybrid procedures (ACDF combined with CDA), non-contiguous disease, and even for multilevel disease (more than 2 levels). Based on this evidence we conclude that CDA is a safe and effective alternative to ACDF in properly selected patients for one- or two-level diseases. Defining superiority of specific implants and detailing optimal surgical indications will require further well-designed long-term studies.

Study Design: Literature review. Objective: The aim of this study was to provide an overview of the available intraoperative monitoring techniques and the evidence around their efficacy in vertebral column resection. Methods: The history of neuromonitoring and evolution of the modalities are reviewed and discussed. The authors’ specific surgical techniques and preferred methods are outlined in detail. In addition, the authors’ experience and the literature regarding vertebral column resection and surgical mitigation of neurologic alarms are discussed at length. Results: Risk factors for signal changes have been identified, including preoperative neurologic deficit, severe kyphosis, increased curve magnitude, and significant cord shortening. Even though no evidence-based treatment algorithm exist for signal changes, strategies are discussed that can help prevent alarms and address them appropriately. Conclusion: Through implementation of multimodal intraoperative monitoring techniques, potential neurologic injuries are localized and managed in real time. Intraoperative monitoring is a valuable tool for improving the safety and outcome of spinal deformity surgery.

Various common injuries in the pelvis and lower extremity are investigated in this chapter. Significant attention is paid not only to proper diagnostic examination and imaging, but also to optimal nonoperative and operative treatment options to manage these conditions.

Various common injuries in the foot and ankle are investigated in this section. Significant attention is paid not only to proper diagnostic examination and imaging, but also to optimal nonoperative and operative treatment options to manage these conditions.

Initial management of trauma begins with the primary survey before orthopedic intervention is performed. All trauma patients are assumed to have cervical spine injury until proven otherwise. The decision between early definitive surgical treatment and initial damage control orthopedics hinges on the physiologic state of unstable or polytrauma patients.

There are very few true orthopedic emergencies. Several conditions such as open fractures, once thought to be emergent, have been shown in the literature to be urgencies that should be tended to in prompt rather than emergent fashion. Some notable emergencies are hemodynamically unstable pelvis fractures, necrotizing fasciitis, and compartment syndrome.

Various common injuries in the shoulder, humerus, and elbow are investigated in this section. Significant attention is paid not only to proper diagnostic examination and imaging, but also to optimal non-operative and operative treatment options to manage these conditions.

Various common injuries in the wrist and hand are investigated in this chapter. Significant attention is paid not only to proper diagnostic examination and imaging, but also to optimal nonoperative and operative treatment options to manage these conditions.

There are very few true orthopedic emergencies. Several conditions such as open fractures, once thought to be emergent, have been shown in the literature to be urgencies that should be tended to in prompt rather than emergent fashion. Some notable emergencies are hemodynamically unstable pelvis fractures, necrotizing fasciitis, and compartment syndrome.

Various common injuries in the pelvis and lower extremity are investigated in this chapter. Significant attention is paid not only to proper diagnostic examination and imaging, but also to optimal nonoperative and operative treatment options to manage these conditions.

Various common injuries in the foot and ankle are investigated in this section. Significant attention is paid not only to proper diagnostic examination and imaging, but also to optimal nonoperative and operative treatment options to manage these conditions.

Various common injuries in the wrist and hand are investigated in this chapter. Significant attention is paid not only to proper diagnostic examination and imaging, but also to optimal nonoperative and operative treatment options to manage these conditions.

Various common injuries in the pelvis and lower extremity are investigated in this chapter. Significant attention is paid not only to proper diagnostic examination and imaging, but also to optimal nonoperative and operative treatment options to manage these conditions.

Various common injuries in the shoulder, humerus, and elbow are investigated in this chapter. Significant attention is paid not only to proper diagnostic examination and imaging, but also to optimal nonoperative and operative treatment options to manage these conditions.

Management of the spine trauma patient requires thorough neurologic and radiographic evaluation. While a majority of spine traumatic conditions can be managed non-operatively, high index of suspicion must be maintained to avoid missing critical injuries that could lead to immediate or delayed neurologic deterioration.

Various common injuries in the foot and ankle are investigated in this section. Significant attention is paid not only to proper diagnostic examination and imaging, but also to optimal nonoperative and operative treatment options to manage these conditions.

Management of the spine trauma patient requires thorough neurologic and radiographic evaluation. While a majority of spine traumatic conditions can be managed nonoperatively, high index of suspicion must be maintained to avoid missing critical injuries that could lead to immediate or delayed neurologic deterioration.

Management of the spine trauma patient requires thorough neurologic and radiographic evaluation. While a majority of spine traumatic conditions can be managed non-operatively, high index of suspicion must be maintained to avoid missing critical injuries that could lead to immediate or delayed neurologic deterioration.

Management of athletes often requires attention to not only musculoskeletal injuries but also to medical conditions. Those who oversee athletic competitions should be able to understand the basic management of conditions ranging from asthma to sudden cardiac arrest, and also be able to assess patients with concussions, metabolic derangements, frostbite, and heat illness.

Various common injuries in the shoulder, humerus, and elbow are investigated in this section. Significant attention is paid not only to proper diagnostic examination and imaging, but also to optimal non-operative and operative treatment options to manage these conditions.