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Introduction: Surgical simulation is increasingly being accepted as a training platform to promote skill development and a safe surgical technique. Preliminary investigations in spine surgery show that simulation paired with educational intervention can markedly improve trainee performance. This study used a newly developed thoracolumbar fusion rod bending model to assess the effect of a novel educational curriculum and simulator training on surgical trainee rod bending speed and proficiency., Methods: Junior (PGY1 to 2) and senior (PGY3-fellow) surgical trainees at a single academic institution were prospectively enrolled in a rod bending simulation using a T7-pelvis spinal fusion model. Participants completed two simulations, with 1 month between first and second attempts. Fifty percent of surgeons in each training level were randomized to receive an educational curriculum (rod bending technique videos and unlimited simulator practice) between simulation attempts. Rod bending simulation proficiency was determined by the percentage of participants who completed the task (conclusion at 20 minutes), time to task completion or conclusion, and number of incomplete set screws at task conclusion. Participants completed a preparticipation and postparticipation survey. Univariate analysis compared rod bending proficiency and survey results between education and control cohorts., Results: Forty trainees (20 junior and 20 senior) were enrolled, with 20 participants randomized to the education and control cohorts. No notable differences were observed in the first simulation rod bending proficiency or preparticipation survey results between the education and control cohorts. In the second simulation, the education versus the control cohort demonstrated a significantly higher completion rate ( P = 0.01), shorter task time ( P = 0.009), fewer incomplete screws ( P = 0.003), and greater experience level ( P = 0.008) and comfort level ( P = 0.002) on postparticipation survey., Discussion: Trainees who participated in a novel educational curriculum and simulator training relative to the control cohort improved markedly in rod bending proficiency and comfort level. Rod bending simulation could be incorporated in existing residency and fellowship surgical skills curricula., Level of Evidence: I., (Copyright © 2023 by the American Academy of Orthopaedic Surgeons.)

Study Design: This was a retrospective cohort study., Objective: The present study is the first to investigate whether cervical paraspinal sarcopenia is associated with cervicothoracic sagittal alignment parameters after posterior cervical fusion (PCF)., Summary of Background Data: Few studies have investigated the association between sarcopenia and postoperative outcomes after cervical spine surgery., Methods: We retrospectively reviewed patients undergoing PCF from C2-T2 at a single institution between the years 2017-2020. Two independent reviewers utilized axial cuts of T2-weighted magnetic resonance imaging sequences to perform Goutallier classification of the bilateral semispinalis cervicis (SSC) muscles. Cervical sagittal alignment parameters were compared between subgroups based upon severity of SSC sarcopenia., Results: We identified 61 patients for inclusion in this study, including 19 patients with mild SSC sarcopenia and 42 patients with moderate or severe SSC sarcopenia. The moderate-severe sarcopenia subgroup demonstrated a significantly larger change in C2-C7 sagittal vertical axis (+6.8 mm) from the 3-month to 1-year postoperative follow-up in comparison to the mild sarcopenia subgroup (-2.0 mm; P =0.02). The subgroup of patients with moderate-severe sarcopenia also demonstrated an increase in T1-T4 kyphosis (10.9-14.2, P =0.007), T1 slope (28.2-32.4, P =0.003), and C2 slope (24.1-27.3, P =0.05) from 3-month to 1-year postoperatively and a significant decrease in C1-occiput distance (6.3-4.1, P =0.002) during this same interval., Conclusions: In a uniform cohort of patients undergoing PCF from C2-T2, SSC sarcopenia was associated with worsening cervicothoracic alignment from 3-month to 1-year postoperatively., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Study Design: Retrospective cohort study., Objective: The present study is the first to assess the impact of paraspinal sarcopenia on patient-reported outcome measures (PROMs) following posterior cervical decompression and fusion (PCDF)., Summary of Background Data: While the impact of sarcopenia on PROMs following lumbar spine surgery is well-established, the impact of sarcopenia on PROMs following PCDF has not been investigated., Materials and Methods: We performed a retrospective review of patients undergoing PCDF from C2 to T2 at a single institution between the years 2017 and 2020. Two independent reviewers who were blinded to the clinical outcome scores utilized axial cuts of T2-weighted magnetic resonance imaging sequences to assess fatty infiltration of the bilateral multifidus muscles at the C5-C6 level and classify patients according to the Fuchs Modification of the Goutalier grading system. PROMs were then compared between subgroups., Results: We identified 99 patients for inclusion in this study, including 28 patients with mild sarcopenia, 45 patients with moderate sarcopenia, and 26 patients with severe sarcopenia. There was no difference in any preoperative PROM between the subgroups. Mean postoperative Neck Disability Index scores were lower in the mild and moderate sarcopenia subgroups (12.8 and 13.4, respectively) than in the severe sarcopenia subgroup (21.0, P <0.001). A higher percentage of patients with severe multifidus sarcopenia reported postoperative worsening of their Neck Disability Index (10 patients, 38.5%; P =0.003), Visual Analog Scale Neck scores (7 patients, 26.9%; P =0.02), Patient-Reported Outcome Measurement Information System Physical Component Scores (10 patients, 38.5%; P =0.02), and Patient-Reported Outcome Measurement Information System Mental Component Scores (14 patients, 53.8%; P =0.02)., Conclusion: Patients with more severe paraspinal sarcopenia demonstrate less improvement in neck disability and physical function postoperatively and are substantially more likely to report worsening PROMs postoperatively., Level of Evidence: 3., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To compare patient-reported outcomes measures (PROMs) following posterior cervical decompression and fusion (PCDF) based on changes in perioperative cervical sagittal alignment., Methods: We reviewed patients who underwent PCDF from C2 to T2 between the years 2015 and 2020. C2 sagittal vertical axis (SVA) and C2-C7 lordosis were assessed preoperatively and 1-year postoperatively. Neck Disability Index (NDI) and visual analog scale (VAS) Neck scores were collected preoperatively, 3 months' postoperatively, and 1-year postoperatively. PROMs were compared based on perioperative radiographic parameters., Results: Eighty-five patients were included in this study. Patients with preoperative C2 SVA <40 mm had a larger improvement in VAS Neck pain scores at 3 months' postoperatively (-4.9 vs. -3.0, P = 0.03) and a larger decrease in NDI scores at 1-year postoperatively (7.2 vs. 3.1, P = 0.04) than patients with C2 SVA ≥40 mm. Patients with postoperative C2 SVA <40 mm demonstrated lower VAS Neck pain scores at 3 months' postoperatively (2.0 vs. 3.4, P = 0.049). The cohort of patients with a decrease of C2 SVA by ≥5 mm demonstrated lower NDI at 3 months' postoperatively but not at 1-year postoperatively in comparison with patients whose C2 SVA increased or remained unchanged (11.7 vs. 23.8 vs. 18.2; P < 0.001). Patients in whom both C2 SVA and C2-C7 lordosis improved demonstrated superior NDI (P < 0.001) and VAS Neck (P = 0.007) at 3 months' but not at 1-year postoperatively., Conclusions: In a uniform cohort of patients undergoing PCDF from C2 to T2, improvements in C2 SVA and C2-C7 lordosis were associated with improved early postoperative PROMs., (Copyright © 2022 Elsevier Inc. All rights reserved.)