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Study Design.: Retrospective cohort study. Objective.: To determine the relationship between preoperative physical therapy (PT) and postoperative mobility, adverse events (AEs), and length of stay (LOS) among patients with low normalized total psoas area (NTPA) undergoing adult spinal deformity (ASD) surgery. Background.: Sarcopenia, as defined by low NTPA, has been shown to predict poor perioperative outcomes of ASD surgery. However, there is limited evidence correlating the benefits of PT within the patient population with sarcopenic. Materials and Methods.: NTPA was analyzed at the L3 and L4 mid-vertebral bodies on preoperative magnetic resonance imaging. Receiver operating characteristic curve analysis was used to determine sex-specific NTPA cutoff values for predicting perioperative AEs. Patients were categorized as having low NTPA if both L3 and L4 NTPA were below these cutoff values. Perioperative outcomes were compared between patients with low NTPA who underwent documented formal PT within 6 months before ASD surgery with those who did not. Results.: A total of 103 patients (42 males, 61 females) met the criteria for low NTPA for inclusion in the study, of which 42 underwent preoperative PT and 61 did not. The preoperative PT group had a shorter LOS (111.2 ± 37.5 vs. 162.1 ± 97.0 h, P < 0.001), higher ambulation distances (feet) on postoperative day (POD) 1 (61.7 ± 50.3 vs. 26.1 ± 69.0, P < 0.001), POD 2 (113.2 ± 81.8 vs. 62.1 ± 73.1, P = 0.003), and POD 3 (126.0 ± 61.2 vs. 91.2 ± 72.6, P = 0.029), and lower rates of total AEs (31.0% vs. 54.1%, P = 0.003) when excluding anemia requiring transfusion. Multivariable analysis found preoperative PT to be the most significant predictor of decreased LOS (odds ratio: 0.32, P = 0.013). Conclusion.: Patients with sarcopenia may benefit from formal preoperative PT before undergoing ASD surgery to improve early postoperative mobility, decrease adverse eveents, and reduce length of stay. Level of Evidence.: Level III. [ABSTRACT FROM AUTHOR]

Background: Recent studies assessing the importance of various preoperative factors on postoperative outcomes following spine surgery have uncovered several important variables that influence subjective and objective outcomes following cervical spine surgery, but it is still unclear which patients are most likely to benefit from operative management. Purpose: The objective of this study was to assess whether preoperative patient-reported outcome measures (PROMs) can be used to predict which patients achieve "normal" levels of pain and function after surgery. Study Design: This was a prospective cohort study. Patient Sample: This study included all adult patients undergoing cervical spine surgery by 1 of 7 senior spine surgeons at our institution between 2016 and 2018. Of the 164 patients who were eligible for 6-month follow-up at the time that study data were collected, 139 had available follow-up data and were included in our analysis. Outcomes Measures: Patients completed the Neck Disability Index (NDI) as well as the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference computer adaptive tests preoperatively and at 6 months postoperatively. Methods: Patients who achieved postoperative patient-acceptable symptom state (PASS) for NDI (=17) and the normative mean (50) for PROMIS were identified. The relationship between preoperative PROMs and the probability of achieving PASS and the normative mean was assessed. Results: One hundred thirty-nine patients met inclusion criteria with diagnoses of myelopathy (n = 36), radiculopathy (n = 48), and myeloradiculopathy (n = 49). For NDI, a 1-point worsening in the preoperative score resulted in an OR of achieving PASS of 0.96 (P < 0.001) in the overall population. This association held true for patients with radiculopathy (OR 0.96; P = 0.022) but not myelopathy (OR 0.98; P = 0.35). For PROMIS PF, a 1-point improvement in the preoperative score resulted in an OR of achieving the normative mean of 1.10 (P < 0.001). This association held true for patients with radiculopathy (OR 1.14; P = 0.033) but did not reach statistical significance for patients with myelopathy (OR 1.03; P = 0.515). Conclusions: Preoperative PROMs can predict postoperative benefit for patients undergoing cervical spine surgery, with worse baseline function associated with a lower likelihood of attaining PASS for NDI and the normative mean for PROMIS PF, especially for patients with radiculopathy. Clinical Relevance: Baseline symptoms and function, including myelopathy or radiculopathy-dominant symptoms and preoperative PROMs, may predict postoperative outcomes. [ABSTRACT FROM AUTHOR]

Study Design: Cross-sectional radioanatomic study. Objective: To determine the feasibility of performing an anterior column realignment (ACR) using an anterior-to-psoas (ATP) approach at L1-L5. Methods: Axial magnetic resonance images (MRI) of the L1-L5 disc levels obtained at a single institution were obtained and analyzed. The feasibility of performing an ACR was assessed using a combination of the size of the left oblique corridor (OC), the psoas morphology using the modified Moro classification, and the anterior disc edge to great vessel distance. Results: Three hundred MRI studies obtained from 300 patients were included. All patients had a measurable left OC at the L1-L4 levels. Twenty patients (6.7%) had no measurable OC at the L4-L5 level. According to the modified Moro's classification, a high-rising psoas was seen in 4 patients (1.3%) at the L3-L4 level and 57 patients (19.0%) at the L4-L5 level. An ALL release was considered high risk due to no measurable space between the anterior disc edge and the great vessels in 54 patients (18.0%) at the L1-L2 level, 39 patients (13.0%) at the L2-L3 level, 119 patients (39.7%) at the L3-L4 level, and 226 patients (75.3%) at the L4-L5 level. Conclusion: ACR using an ATP approach is the most radioanatomically feasible at L2-L3. The L4-L5 level has the highest risk with regards to both the ATP approach and the ALL release for an ACR due to high rates of unmeasurable left OC and space between the anterior disc edge and the great vessels. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective review of a prospectively collected national database Objectives: To determine the association between preoperative serum albumin levels and perioperative adverse events (AEs) following vertebral corpectomy and posterior stabilization for metastatic spine disease. Methods: The 2010 to 2019 American College of Surgeons' National Surgical Quality Improvement (ACS-NSQIP) database was used to identify all patients undergoing vertebral corpectomy and posterior stabilization for metastatic spine disease. Receiver operative characteristic (ROC) curve analysis was used to determine preoperative serum albumin cut-off values for predicting perioperative AEs. Low preoperative serum albumin was defined as serum albumin below this cut-off value. Results: A total of 301 patients were included in the study. ROC curve analysis demonstrated serum albumin < 3.25 g/dL as a cut-off value for predicting perioperative AEs. The low serum albumin group had a higher overall perioperative AEs (P =.041), longer post-operative LOS (P <.001), higher 30-day reoperation rate (P =.014), and a higher in-hospital mortality rate (P =.046). Multivariate analysis demonstrated that low preoperative serum albumin was associated with higher perioperative AEs. Conclusions: Low serum albumin level is associated with higher perioperative AEs, longer postoperative LOS, and higher rates of 30-day reoperation and in-hospital mortality among patients undergoing vertebral corpectomy and posterior stabilization for metastatic spine disease. Strategies to improve preoperative nutritional status in patients undergoing this procedure may improve these perioperative outcome measures within this surgical population. Level of Evidence: III [ABSTRACT FROM AUTHOR]