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Study Design. Retrospective cohort study. Objective. This study compares reoperation rates and complications following single-level anterior lumbar interbody fusion (ALIF)/lateral lumbar interbody fusion (LLIF) and transforaminal lumbar interbody fusion (TLIF)/posterior lumbar interbody fusion (PLIF). Summary of Background Data. ALIF, LLIF, TLIF, and PLIF are widely used for degenerative disc disease. Lumbar interbody fusions have high rates of reoperation, primarily related to adjacent segment pathology and pseudarthrosis. Materials and Methods. The PearlDiver database was queried for patients (2010-2021) who had single-level ALIF/LLIF or TLIF/PLIF with same-day, single-level posterior instrumentation. ALIF/LLIF were combined, and similarly, TLIF/PLIF were combined, given how these operations are indistinguishable from Current Procedural Terminology coding. All patients were followed for ≥ 2 years and excluded if they had spinal traumas, fractures, infections, or neoplasms before surgery. The two cohorts, ALIF/LLIF and TLIF/PLIF, were matched 1:1 based on age, sex, Elixhausercomorbidity index, smoking status, and diabetes. The primary outcome was the incidence of all-cause subsequent lumbar operations. Secondary outcomes included 90-day surgical complications. Results. After 1:1 matching, each cohort contained 14,070 patients. All-cause subsequent lumbar operations were nearly identical at five-year follow-up (9.4% ALIF/LLIF vs. 9.5% TLIF/PLIF, P=0.91). Survival analysis using all-cause subsequent lumbar operations as the endpoint showed an equivalent 10-year survival rate of 86.0% (95%CI: 85.2-86.8). Within 90 days, TLIF/PLIF had more infections (1.3% vs. 1.7%, P=0.007) and dural injuries (0.2% vs. 0.4%, P=0.001). There was no difference in wound dehiscence, hardware complications, or medical complications. Conclusion. As utilized in real-world clinical practice, singlelevel anterolateral versus posterior approaches for interbody fusion have no effect on long-term reoperation rates. [ABSTRACT FROM AUTHOR]

Background: It is unclear how pediatric orthopedic surgeons are geographically distributed relative to their patients. The purpose of this study was to evaluate the geographic distribution of pediatric orthopedic surgeons in the United States. Materials and Methods: County-level data of actively practicing pediatric orthopedic surgeons were identified by matching several registries and membership logs. Data were used to calculate the distance between counties and nearest surgeon. Counties were categorized as "surgeon clusters" or "surgeon deserts" if the distance to the nearest surgeon was less than or greater than the national average and the average of all neighboring counties, respectively. Cohorts were then compared for differences in population characteristics using data obtained from the 2020 American Community Survey. Results: A total of 1197 unique pediatric orthopedic surgeons were identified. The mean distance to the nearest pediatric orthopedic surgeon for a patient residing in a surgeon desert or a surgeon cluster was 141.9±53.8 miles and 30.9±16.0 miles, respectively. Surgeon deserts were found to have lower median household incomes (P<.001) and greater rates of children without health insurance (P<.001). Multivariate analyses showed that higher Rural-Urban Continuum codes (P<.001), Area Deprivation Index scores (P<.001), and percentage of patients without health insurance (P<.001) all independently required significantly greater travel distances to see a pediatric orthopedic surgeon. Conclusion: Pediatric orthopedic surgeons are not equally distributed in the United States, and many counties are not optimally served. Additional studies are needed to identify the relationship between travel distances and patient outcomes and how geographic inequalities can be minimized. [Orthopedics. 2024;47(4):e204–e210.] [ABSTRACT FROM AUTHOR]

This letter to the editor responds to a study comparing the rates of adjacent segment disease (ASD) following Anterior Lumbar Interbody Fusion (ALIF) and Transforaminal Lumbar Interbody Fusion (TLIF). The authors of the letter raise concerns about the methodology and outcomes of the study, particularly regarding the definition of ASD and the use of ICD and CPT codes. They suggest that the reported rates may include all-cause subsequent surgeries rather than surgeries specifically for ASD. Additionally, they propose that the higher ASD rate associated with ALIF may be due to staged procedures and not a true reflection of the risk. The authors argue that ASD does not occur within days and recommend the use of a Kaplan-Meier curve to further analyze the data. The letter is authored by Nakul Narendran, Paal K. Nilssen, Alexander Tuchman, and David L. Skaggs from the Department of Orthopaedic Surgery and Department of Neurosurgery at Cedars-Sinai Medical Center in Los Angeles, CA. [Extracted from the article]

The thoracolumbar junction is a complex and challenging anatomical region due to its heterogeneous array of planes and structures.1 Navigating this region during a lateral approach to the spine is a challenge that requires a thorough understanding of the anatomy. We present a case of a 54-year-old woman with a 7-year history of breast cancer who presented with low back pain after running a marathon. To date, the patient had deferred medical management. Imaging revealed Stage IV differentiated invasive ductal carcinoma with extensive bony metastatic disease in multiple areas of the spine. The patient underwent a right-sided minimally invasive retrodiaphragmatic approach to the thoracolumbar junction for L1 corpectomy, placement of an expandable cage, and posterior percutaneous pedicle screw segmental fixation from T11 to L3 with robotic guidance. Patient consent was obtained for the following procedure, and IRB approval was not required for publication of this single patient case report., (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)