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Study Design: Prospective cohort study. Objectives: To identify patient trajectories of recovery defined by change in health-related quality of life (HRQOL) following surgery for adolescent idiopathic scoliosis (AIS). To explore possible predictors of trajectory membership. Methods: Adolescent patients scheduled to undergo spinal fusion for AIS were enrolled in the Post-Operative Recovery following Spinal Correction: Home Experience (PORSCHE) study. Responses to the Pediatric Quality of Life Inventory–version 4 (PedsQL–4.0) were collected prior to surgery and 4 to 6 weeks, 3, 6, and 12 months post-operatively. Latent class growth analyses identified patient subgroups based on their unique trajectories of physical health (PH) and psychosocial health (PSH) outcomes using the PedsQL–4.0 subscale scores. Predictors included demographic, clinical, and psychosocial factors. Results: Data from up to 190 patients were included (87.4% female; mean±SD age = 14.6 ± 1.9 years). Three trajectory subgroups were identified for PH and 4 trajectories were found for PSH, with a majority of patients scoring within the established range of healthy adolescents 12 months post-surgery. Increased child and parent pain catastrophizing, child trait anxiety and previous hospitalizations were associated with poorer PH outcomes, whereas increased child and parent pain catastrophizing, child state and trait anxiety, and parent state and trait anxiety were associated with poorer PSH trajectories. Conclusions: The PH and PSH trajectories identified in this study and the factors associated with their membership may inform surgical decision-making for AIS while facilitating patient and family counselling regarding peri-operative recovery and expectations. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective cohort. Objectives: To compare outcomes of minimally invasive surgery (MIS) vs open surgery (OPEN) for lumbar spinal stenosis (LSS) in patients with diabetes. Methods: Patients with diabetes who underwent spinal decompression alone or with fusion for LSS within the Canadian Spine Outcomes and Research Network (CSORN) database were included. MIS vs OPEN outcomes were compared for 2 cohorts: (1) patients with diabetes who underwent decompression alone (N = 116; MIS n = 58 and OPEN n = 58), (2) patients with diabetes who underwent decompression with fusion (N = 108; MIS n = 54 and OPEN n = 54). Modified Oswestry Disability Index (mODI) and back and leg pain were compared at baseline, 6–18 weeks, and 1-year post-operation. The number of patients meeting minimum clinically important difference (MCID) or minimum pain/disability at 1-year was compared. Results: MIS approaches had less blood loss (decompression alone difference 100 mL, P =.002; with fusion difference 244 mL, P <.001) and shorter length of stay (LOS) (decompression alone difference 1.2 days, P =.008; with fusion difference 1.2 days, P =.026). MIS compared to OPEN decompression with fusion had less patients experiencing adverse events (AEs) (difference 13 patients, P =.007). The MIS decompression with fusion group had lower 1-year mODI (difference 14.5, 95% CI [7.5, 21.0], P <.001) and back pain (difference 1.6, 95% CI [.6, 2.7], P =.002) compared to OPEN. More patients in the MIS decompression with fusion group exceeded MCID at 1-year for mODI (MIS 75.9% vs OPEN 53.7%, P =.028) and back pain (MIS 85.2% vs OPEN 70.4%, P =.017). Conclusions: MIS approaches were associated with more favorable outcomes for patients with diabetes undergoing decompression with fusion for LSS. [ABSTRACT FROM AUTHOR]

Four patients (0.9%) with idiopathic, 1 patient (2.6%) with neuromuscular, 1 patient with congenital and 1 patient (1.2%) with syndromic scoliosis presented implant failures. Analysis of complication rates in cervical spine surgery between older patients... Background An ambispective review was conducted of consecutive cervical spine surgery patients enrolled by the Canadian Spine Outcomes and Research Network (CSORN) between January 2015 and September 2019. Impact of undergoing thoracolumbar spine surgery on patient psychosocial health Background The objective of this study was to investigate the impact of thoracolumbar spine surgery on patients' psychosocial profiles. Results Sixty patients were treated conservatively, 28 patients required occipitocervical fusion, 18 patients needed transarticular screws and 2 patients were treated with C1-C2 separate fixation. Comparison of a general (NSQIP) and spine specific (SAVES) database for the ide... Background This project compares the general National Surgical Quality Improvement Program (NSQIP) and spine surgery specific Spine Adverse Events Severity System (SAVES) for identification of adverse events (AE's) and per-patient rates for AEs for adult patients undergoing major spine surgery. [Extracted from the article]

Study Design: Prospective cohort study., Objective: Investigate the impact of thoracolumbar surgery on patients' psychosocial profiles., Methods: A prospective cohort study of thoracolumbar surgery patients (N = 177). Measures of interest collected at baseline and 24-months after surgery were: modified Oswestry Disability Index (mODI), Numerical Rating Scores for Back Pain (NRS-B), Leg Pain (NRS-L), Pain Catastrophizing Scale (PCS), Tampa Scale of Kinesiophobia (TSK), Chronic Pain Acceptance Questionnaire-8 (CPAQ-8), Multidimensional Scale of Perceived Social Support (MSPSS), Mental Component Summary (MCS) and patient expectations for surgery impacts on mental well-being. Cohorts were separated based on attaining meaningful change defined as either 30% improvement or minimal scores in NRS-B, NRS-L and mODI. Mixed measures ANOVAs were run (α = .05)., Results: Patients who showed meaningful change had significant improvements in PCS, TSK and CPAQ-8 scores but not in MSPSS scores. Patients had improvement in MCS scores over 24-months follow-up, but this change was not significantly different based on attainment of meaningful change. Overall, 75.9% of patients reported their mental well-being expectations were met. Patients who did not achieve meaningful change showed no change on any psychosocial measures with only 55.9% reporting their mental well-being expectations met., Conclusion: Thoracolumbar surgery results in significant improvement of psychosocial variables for patients who experienced meaningful change for pain and disability. Worsening of psychosocial health was not evident in patients who did not attain meaningful change.

Objective: Anterior cervical discectomy and fusion (ACDF) is often described as the gold standard surgical technique for cervical spondylotic radiculopathy. Although outcomes are considered favorable, there is little prognostic evidence to guide patient selection for ACDF. This study aimed to 1) describe the 24-month postoperative trajectories of arm pain, neck pain, and pain-related disability; and 2) identify perioperative prognostic factors that predict trajectories representing poor clinical outcomes., Methods: In this retrospective cohort study, patients with cervical spondylotic radiculopathy who underwent ACDF at 1 of 12 orthopedic or neurological surgery centers were recruited. Potential outcome predictors included demographic, health, clinical, and surgery-related prognostic factors. Surgical outcomes were classified by trajectories of arm pain intensity, neck pain intensity (numeric pain rating scales), and pain-related disability (Neck Disability Index) from before surgery to 24 months postsurgery. Trajectories of postoperative pain and disability were estimated with latent class growth analysis, and prognostic factors associated with poor outcome trajectory were identified with robust Poisson models., Results: The authors included data from 352 patients (mean age 50.9 [SD 9.5] years; 43.8% female). The models estimated that 15.5%-23.5% of patients followed a trajectory consistent with a poor clinical outcome. Lower physical and mental health-related quality of life, moderate to severe risk of depression, and longer surgical wait time and procedure time predicted poor postoperative trajectories for all outcomes. Receiving compensation and smoking additionally predicted a poor neck pain outcome. Regular exercise, physiotherapy, and spinal injections before surgery were associated with a lower risk of poor disability outcome. Patients who used daily opioids, those with worse general health, or those who reported predominant neck pain or a history of depression were at greater risk of poor disability outcome., Conclusions: Patients who undergo ACDF for cervical spondylotic radiculopathy experience heterogeneous postoperative trajectories of pain and disability, with 15.5%-23.5% of patients experiencing poor outcomes. Demographic, health, clinical, and surgery-related prognostic factors can predict ACDF outcomes. This information may further assist surgeons with patient selection and with setting realistic expectations. Future studies are needed to replicate and validate these findings prior to confident clinical implementation.