Study Design. A retrospective study with prospectively-collected data. Objective. To determine how type, location, and size of endplate lesions on magnetic resonance imaging (MRI) may be associated with symptoms and clinical outcomes after anterior cervical discectomy and fusion (ACDF). Summary of Background Data. Structural endplate abnormalities are important, yet understudied, phenomena in the cervical spine. ACDF is a common surgical treatment for degenerative disc disease; however, adjacent segment degeneration/disease (ASD) may develop. Methods. Assessed the imaging, symptoms and clinical outcomes of 861 patients who underwent ACDF at a single center. MRI and plain radiographs of the cervical spine were evaluated. Endplate abnormalities on MRI were identified and stratified by type (atypical, typical), location, relation to operative levels, presence at the adjacent level, and size. These strata were assessed for association with presenting symptoms, patient-reported, and postoperative outcomes. Results. Of 861 patients (mean follow-up: 17.4 months), 57.3% had evidence of endplate abnormalities, 39.0% had typical abnormalities, while 18.2% had atypical abnormalities. Patients with any endplate abnormality had greater odds of myelopathy irrespective of location or size, while sensory deficits were associated with atypical lesions (P = 0.016). Typical and atypical abnormalities demonstrated differences in patient-reported outcomes based on location relative to the fused segment. Typical variants were not associated with adverse surgical outcomes, while atypical lesions were associated with ASD (irrespective of size/location; P = 0.004) and reoperations, when a large abnormality was present at the proximal adjacent level (P = 0.025). Conclusion. This is the first study to examine endplate abnormalities on MRI of the cervical spine, demonstrating distinct risk profiles for symptoms, patient-reported, and surgical outcomes after ACDF. Patients with typical lesions reported worsening postoperative pain/disability, while those with atypical abnormalities experienced greater rates of ASD and reoperation. This highlights the relevance of a degenerative spine phenotypic assessment, and suggests endplate abnormalities may prognosticate clinical outcomes after surgery. Level of Evidence: 3

No abstract

Introduction:Orthogeriatric care models have been introduced within many health-care facilities to improve outcomes for hip fracture patients. This study aims to evaluate differences in care between 3 models, an orthopedic model, a geriatric model, and a comanaged model.Materials and Methods:A retrospective analysis was conducted for hip fracture patients treated at Western Health between November 2012 and March 2014. All patients aged 65 years or older were included in the analysis.Results:There were 183 patients in the orthopedic model, 137 in the geriatric model, and 126 in the comanaged model. Demographics and clinical characteristics were similar across the 3 models. Length of stay, mortality, and discharge destination were also consistent across the 3 groups. However, groups involving geriatricians were more likely to receive preoperative medical assessments, have greater recognition of postoperative medical problems, and have implementation of long-term osteoporosis management.Conclusion:The involvement of geriatricians in perioperative care models resulted in more comprehensive medical care without impacting length of stay, mortality, or discharge destination.

OBJECTIVE Anterior lumbar interbody fusion (ALIF) and lateral lumbar interbody fusion (LLIF) are alternative and less invasive techniques to stabilize the spine and indirectly decompress the neural elements compared with open posterior approaches. While reoperation rates have been described for open posterior lumbar surgery, there are sparse data on reoperation rates following these less invasive procedures without direct posterior decompression. This study aimed to evaluate the overall rate, cause, and timing of reoperation procedures following anterior or lateral lumbar interbody fusions without direct posterior decompression. METHODS This was a retrospective cohort study of all consecutive patients indicated for an ALIF or LLIF for lumbar spine at a single academic institution. Patients who underwent concomitant posterior fusion or direct decompression surgeries were excluded. Rates, causes, and timing of reoperations were analyzed. Patients who underwent a revision decompression were matched with patients who did not require a reoperation, and preoperative imaging characteristics were analyzed to assess for risk factors for the reoperation. RESULTS The study cohort consisted of 529 patients with an average follow-up of 2.37 years; 40.3% (213/529) and 67.3% (356/529) of patients had a minimum of 2 years and 1 year of follow-up, respectively. The total revision rate was 5.7% (30/529), with same-level revision in 3.8% (20/529) and adjacent-level revision in 1.9% (10/529) of patients. Same-level revision patients had significantly shorter time to revision (7.14 months) than adjacent-level revision patients (31.91 months) (p < 0.0001). Fifty percent of same-level revisions were for a posterior decompression. After further analysis of decompression revisions, an increased preoperative canal area was significantly associated with a lower risk of further decompression revision compared to the control group (p = 0.015; OR 0.977, 95% CI 0.959–0.995). CONCLUSIONS There was a low reoperation rate after anterior or lateral lumbar interbody fusions without direct posterior decompression. The majority of same-level reoperations were due to a need for further decompression. Smaller preoperative canal diameters were associated with the need for revision decompression.

Background: The pharmacy profession continues to evolve and shape itself with increasing complexity. With this escalating complexity, pharmacist clinical competency needs to be addressed within each healthcare practice setting. The objectives of this study were to describe a unique pharmacist competency program and evaluate its satisfaction at two community hospitals. Methods:Long Beach Memorial and Miller Children's Hospital of Long Beach are tertiary community hospitals with 308 total beds for Millers Children's Hospital and 462 total beds for Long Beach Memorial. A unique and intensive pharmacist competency program has been established at these hospitals for over 20 years. The content of this program was assessed and a survey was conducted in March 2011 to ascertain pharmacist satisfaction. Results:The unique pharmacist competency program was structured in the form of age-related, hospital-wide and unit specific modules, pharmacy-regulated therapies (PRT), and a Pharmacy Skills Day that provide updates on PRT and other pharmacy-related topics. Forty-two of 61 (69%) pharmacists responded to the survey. Mean age of pharmacists was 38.8 ± 11.5 years, 36% were male, 86% completed residency training, and 12% were board-certified pharmacotherapy specialists. Over 80% of pharmacists agreed that the program was informative and supportive of their daily patient care activities. Although the program was well-received by the pharmacists, there were facets of the program that needed improvement, including resources for continuing education opportunities and additional modules for competency. Conclusion:A unique pharmacist competency program at two community hospitals was described. The program was well-received by the pharmacists, and, more importantly, ensured continuous professional development in pharmacy practice.

Study Design: Retrospective cohort study. Objectives: This study aimed to address the prevalence, distribution, and clinical significance of cervical high-intensity zones (HIZs) on magnetic resonance imaging (MRI) with respect to pain and other patient-reported outcomes in the setting of patients that will undergo an anterior cervical discectomy and fusion (ACDF) procedure. Methods: A retrospective cohort study of ACDF patients surgically treated at a single center from 2008 to 2015. Based on preoperative MRI, HIZ subtypes were identified as either traditional T2-hyperintense, T1-hypointense (“single-HIZs”), or combined T1- and T2-hyperintense (“dual-HIZs”), and their level-specific prevalence was assessed. Preoperative symptoms, patient-reported outcomes, and disc degeneration pathology were assessed in relation to HIZs and HIZ subtypes. Results: Of 861 patients, 58 demonstrated evidence of HIZs in the cervical spine (6.7%). Single-HIZs and dual-HIZs comprised 63.8% and 36.2% of the overall HIZs, respectively. HIZs found outside of the planned fusion segment reported better preoperative Neck Disability Index (NDI; P = .049) and Visual Analogue Scale (VAS) Arm ( P = .014) scores relative to patients without HIZs. Furthermore, patients with single-HIZs found inside the planned fusion segment had worse VAS Neck ( P = .045) and VAS Arm ( P = .010) scores. In general, dual-HIZ patients showed no significant differences across all clinical outcomes. Conclusions: This is the first study to evaluate the clinical significance of HIZs in the cervical spine, noting level-specific and clinical outcome–specific variations. Single-HIZs were associated with significantly more pain when located inside the fusion segment, while dual-HIZs showed no associations with patient-reported outcomes. The presence of single-HIZs may correlate with concurrent spinal pathologies and should be more closely evaluated.

No abstract

Study Design: This was a retrospective comparative study. Objective: To compare the likelihood of approach-related complications for patients undergoing single-level lateral lumbar interbody fusion (LLIF) at L4–L5 to those undergoing the procedure at upper lumbar levels. Summary of Background Data: LLIF has been associated with a number of advantages when compared with traditional interbody fusion techniques. However, potential risks with the approach include vascular or visceral injury, thigh dysesthesias, and lumbar plexus injury. There are concerns of a higher risk of these complications at the L4–L5 level compared with upper lumbar levels. Materials and Methods: A retrospective cohort review was completed for consecutive patients undergoing single-level LLIF between 2004 and 2019 by a single surgeon. Indication for surgery was symptomatic degenerative lumbar stenosis and/or spondylolisthesis. Patients were divided into 2 cohorts: LLIF at L4–L5 versus a single level between L1 and L4. Baseline characteristics, intraoperative complications, postoperative approach-related neurological symptoms, and patient-reported outcomes were compared and analyzed between the cohorts. Results: A total of 122 were included in analysis, of which 58 underwent LLIF at L4–L5 and 64 underwent LLIF between L1 and L4. There were no visceral or vascular injuries or lumbar plexus injuries in either cohort. There was no significant difference in the rate of postoperative hip pain, anterior thigh dysesthesias, and/or hip flexor weakness between the cohorts (53.5% L4–L5 vs. 37.5% L1–L4; P=0.102). All patients reported complete resolution of these symptoms by 6-month postoperative follow-up. Discussion: LLIF surgery at the L4–L5 level is associated with a similar infrequent likelihood of approach-related complications and postoperative hip pain, thigh dysesthesias, and hip flexor weakness when compared with upper lumbar level LLIF. Careful patient selection, meticulous use of real-time neuromonitoring, and an understanding of the anatomic location of the lumbar plexus to the working corridor are critical to success.