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Study Design. Retrospective cohort study. Objective. Assess trends in sports-related cervical spine trauma using a pediatric inpatient database. Summary of Background Data. Injuries sustained from sports participation may include cervical spine trauma such as fractures and spinal cord injury (SCI). Large database studies analyzing sports-related cervical trauma in the pediatric population are currently lacking. Methods. The Kid Inpatient Database was queried for patients with external causes of injury secondary to sports-related activities from 2003 to 2012. Patients were further grouped for cervical spine injury (CSI) type, including C1–4 and C5–7 fracture with/without spinal cord injury (SCI), dislocation, and SCI without radiographic abnormality (SCIWORA). Patients were grouped by age into children (4–9), pre-adolescents (Pre, 10–13), and adolescents (14–17). Kruskall-Wallis tests with post-hoc Mann-Whitney U's identified differences in CSI type across age groups and sport type. Logistic regression found predictors of TBI and specific cervical injuries. Results. A total of 38,539 patients were identified (12.76 years, 24.5% F). Adolescents had the highest rate of sports injuries per year (P < 0.001). Adolescents had the highest rate of any type of CSI, including C1–4 and C5–7 fracture with and without SCI, dislocation, and SCIWORA (all P < 0.001). Adolescence increased odds for C1-4 fracture w/o SCI 3.18×, C1-4 fx w/ SCI by 7.57×, C5-7 fx w/o SCI 4.11×, C5-7 w/SCI 3.63×, cervical dislocation 1.7×, and cervical SCIWORA 2.75×, all P < 0.05. Football injuries rose from 5.83% in 2009 to 9.14% in 2012 (P < 0.001), and were associated with more SCIWORA (1.6% vs. 1.0%, P = 0.012), and football injuries increased odds of SCI by 1.56×. Concurrent TBI was highest in adolescents at 58.4% (pre: 26.6%, child: 4.9%, P < 0.001), and SCIWORA was a significant predictor for concurrent TBI across all sports (odds ratio: 2.35 [1.77–3.11], P < 0.001). Conclusion. Adolescent athletes had the highest rates of upper/lower cervical fracture, dislocation, and SCIWORA. Adolescence and SCIWORA were significant predictors of concurrent TBI across sports. The increased prevalence of CSI with age sheds light on the growing concern for youth sports played at a competitive level, and supports recently updated regulations aimed at decreasing youth athletic injuries. Level of Evidence: 3

BACKGROUND CONTEXT: The COVID-19 pandemic caused nationwide suspensions of elective surgeries due to reallocation of resources to the care of COVID-19 patients. Following resumption of elective cases, a significant proportion of patients continued to delay surgery, with many yet to reschedule, potentially prolonging their pain and impairment of function and causing detrimental long-term effects. PURPOSE: The aim of this study was to examine differences between patients who have and have not rescheduled their spine surgery procedures originally cancelled due to the COVID-19 pandemic, and to evaluate the reasons for continued deferment of spine surgeries even after the lifting of the mandated suspension of elective surgeries. STUDY DESIGN/SETTING: Retrospective case series at a single institution PATIENT SAMPLE: Included were 133 patients seen at a single institution where spine surgery was canceled due to a state-mandated suspension of elective surgeries from March to June, 2020. OUTCOME MEASURES: The measures assessed included preoperative diagnoses and neurological dysfunction, surgical characteristics, reasons for surgery deferment, and PROMIS scores of pain intensity, pain interference, and physical function. METHODS: Patient electronic medical records were reviewed. Patients who had not rescheduled their canceled surgery as of January 31, 2021, and did not have a reason noted in their charts were called to determine the reason for continued surgery deferment. Patients were divided into three groups: early rescheduled (ER), late rescheduled (LR), and not rescheduled (NR). ER patients had a date of surgery (DOS) prior to the city's Phase 4 reopening on July 20, 2020; LR patients had a DOS on or after that date. Statistical analysis of the group findings included analysis of variance with Tukey's honestly significant difference (HSD) post-hoc test, independent samples T-test, and chi-square analysis with significance set at p≤.05. RESULTS: Out of 133 patients, 47.4% (63) were in the ER, 15.8% (21) in the LR, and 36.8% (49) in the NR groups. Demographics and baseline PROMIS scores were similar between groups. LR had more levels fused (3.6) than ER (1.6), p= .018 on Tukey HSD. NR (2.1) did not have different mean levels fused than LR or ER, both p= >.05 on Tukey HSD. LR had more three column osteotomies (14.3%) than ER and (1.6%) and NR (2.0%) p=.022, and fewer lumbar microdiscectomies (0%) compared to ER (20.6%) and NR (10.2%), p=.039. Other surgical characteristics were similar

Introduction:The aim of this study was to evaluate the association of available cervical alignment components through the Ames cervical deformity (CD) classification parameters with the Patient-Reported Outcomes Measurement Information System (PROMIS) physical health domain metrics.Methods:Surgical CD patients (C2–C7 Cobb >10° or C2–C7 sagittal vertical axis [cSVA] >4 cm or T1 slope minus cervical lordosis (TS-CL) >15°) ≥18 years with available baseline (BL) radiographic and PROMIS were isolated in a single-center spine database. Patients were classified according to the Ames CD modifiers for cSVA and TS-CL (low deformity [Low], moderate deformity [Mod], and severe deformity [Sev]). Descriptives and univariate analyses compared population-weighted PROMIS scores for Pain Intensity (PI), Physical Function (PF), and Pain Interference (Int) across CD modifiers. Conditional tree analysis with logistic regression sampling determined the threshold of PROMIS scores for which the correlation with Ames radiographic cutoffs was most significant. Reported cutoff values for Mod (cSVA: 4–8 cm; TS-CL: 15–20°) and Sev (cSVA: >8 cm; TS-CL: >20°) disabilities were used.Results:Two hundred and eight patients (58.8 years, female: 51%, 29.6 kg/m2, Charlson Comorbidity Index: 1.19). BL cSVA modifier by severity: 83.2% Low, 16.8% Mod. No patients met criteria for severe cSVA. BL TS-CL modifier by severity: 18.8% Low, 22.1% Mod, 59.1% Sev. Mean baseline PROMIS scores were as follows: PI score: 89.6 ± 15.4, PF score: 11.9 ± 13.1, Int score: 56.9 ± 6.8. PI did not differ between cSVA and TS-CL severity. Mod cSVA patients and Mod/Sev TS-CL modifier groups trended toward lower PF scores and higher Int scores. A PI score of >96 (odds ratio [OR]: 0.658 [0.303–1.430]), a PF score of <14 (OR: 1.864 [0.767–4.531]), and an Int score of > 57.4 (OR: 1.878 [0.889–3.967]) were predictors of Mod cSVA. A PI score of >87 (OR: 1.428 [0.767–2.659]), a PF score of <14 (OR: 1.551 [0.851–2.827]), and an Int score of >56.5 (OR: 1.689 [0.967–2.949]) were predictors of Sev TS-CL.Conclusions:PROMIS physical health domains were related to the Ames CD classification. Certain BL PROMIS thresholds can be connected to the severity of CD.

Study Design. Retrospective review. Objective. Identify co-occurring perioperative complications and associated predictors in a population of patients undergoing surgery for adult spinal deformity (ASD). Summary of Background Data. Few studies have investigated the development of multiple, co-occurring complications following ASD-corrective surgery. Preoperative risk stratification may benefit from identification of factors associated with multiple, co-occurring complications. Methods. Elective ASD patients in National Surgical Quality Improvement Program (NSQIP) 2005 to 2016 were isolated; rates of co-occurring complications and affected body systems were assessed via cross tabulation. Random forest analysis identified top patient and surgical factors associated with complication cooccurrence, using conditional inference trees to identify significant cutoff points. Binary logistic regression indicated effect size of top influential factors associated with complication co-occurrence at each factor's respective cutoff point. Results. Included: 6486 ASD patients. The overall perioperative complication rate was 34.8%; 28.5% of patients experienced one complication, 4.5% experienced two, and 1.8% experienced 3þ.Overall, 11% of complication co-occurrences were pulmonary/ cardiovascular, 9% pulmonary/renal, and 4% integumentary/ renal. By complication type, the most common co-occurrences were transfusion/urinary tract infection (UTI) (24.3%) and transfusion/pneumonia (17.7%). Surgical factors of operative time !400 minutes and fusion !9 levels were the strongest factors associated with the incidence of co-occurring complications, followed by patient-specific variables like American Society of Anesthesiologists (ASA) physical status classification grade !2 and age !65 years. Regression analysis further showed associations between increasing complication number and longer length of stay (LOS), (R 2 ¼ 0.202, P < 0.001), non-home discharge (R 2 ¼ 0.111, P ¼ 0.001), and readmission (R 2 ¼ 0.010, P < 0.001). Conclusion. For surgical ASD patients, the overall rate of cooccurring perioperative complications was 6.3%. Body systems most commonly affected by complication co-occurrences were pulmonary and cardiovascular, and common co-occurrences included transfusion/UTI (24.3%) and transfusion/pneumonia (17.7%). Increasing number of perioperative complications was associated with greater LOS, non-home discharge, and readmission, highlighting the importance of identifying risk factors for complication co-occurrences.

Study Design. Retrospective cohort analysis.Objective. The aim of this study was to compare postoperative outcomes of Coflex interspinous device versus laminectomy. Summary of Background Data. Coflex Interlaminar Stabilization device (CID) is indicated for one-or two-level lumbar stenosis with grade 1 stable spondylolisthesis in adult patients, as an alternative to laminectomy, or laminectomy and fusion. CID provides stability against progressive spondylolisthesis, retains motion, and prevents further disc space collapse. Methods. Patients !18 years' old with lumbar stenosis and grade 1 stable spondylolisthesis who underwent either primary single-level decompression and implantation of CID, or singlelevel laminectomy alone were included with a minimum 90-day follow-up at a single academic institution. Clinical characteristics, perioperative outcomes, and postoperative complications were reviewed until the latest follow-up. x 2 and independent samples t tests were used for analysis. Results. Eighty-three patients (2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019) were included: 37 cases of single-level laminectomy (48.6% female) were compared to 46 single-level CID (50% female). CID cohort was older (CID 69.0 AE 9.4 vs. laminectomy 64.2 AE 11.0, P ¼ 0.042) and had higher American Society of Anesthesiologists (ASA) grade (CID 2.59 AE 0.73 vs. laminectomy 2.17 AE 0.48, P ¼ 0.020). CID patients had higher estimated blood loss (EBL) (97.50 AE 77.76 vs. 52.84 AE 50.63 mL, P ¼ 0.004), longer operative time (141.91 AE 47.88 vs. 106.81 AE 41.30 minutes, P ¼ 0.001), and longer length of stay (2.0 AE 1.5 vs. 1.1 AE 1.0 days, P ¼ 0.001). Total perioperative complications (21.7% vs. 5.4%, P ¼ 0.035) and instrumentation-related complication was higher in CID (10.9% vs. 0% laminectomy group, P ¼ 0.039). There were no other significant differences between the groups in demographics or outcomes. Conclusion. Single-level CID devices had higher perioperative 90-day complications, longer operative time, length of stay, higher EBL compared to laminectomies alone. Similar overall revision and neurologic complication rates were noted compared to laminectomy at last follow-up.

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