Study Design. Retrospective comparative study. Objective. The purpose of this study was to investigate whether preoperative depressive symptoms, measured by mental component score of the Short Form-12 survey (MCS-12), influence patient-reported outcome measurements (PROMs) following an anterior cervical discectomy and fusion (ACDF) surgery for cervical degeneration. Summary of Background Data. There is a paucity of literature regarding preoperative depression and PROMs following ACDF surgery for cervical degenerative disease. Methods. Patients who underwent an ACDF for degenerative cervical pathology were identified. A score of 45.6 on the MCS-12 was used as the threshold for depression symptoms, and patients were divided into two groups based on this value: depression (MCS-12 ≤45.6) and nondepression (MCS-12 >45.6) groups. Outcomes including Neck Disability Index (NDI), physical component score of the Short Form-12 survey (PCS-12), and Visual Analogue Scale Neck (VAS Neck), and Arm (VAS Arm) pain scores were evaluated using independent sample t test, recovery ratios, percentage of patients reaching the minimum clinically important difference, and multiple linear regression – controlling for factors such as age, sex, and BMI. Results. The depression group was found to have significantly worse baseline pain and disability than the nondepression group in NDI (P < 0.001), VAS Neck pain (P < 0.001), and VAS Arm pain (P < 0.001) scores. Postoperatively, both groups improved to a similar amount with surgery based on the recovery ratio analysis. The depression group continued to have worse scores than the nondepression group in NDI (P = 0.010), PCS-12 (P = 0.026), and VAS Arm pain (P = 0.001) scores. Depression was not a significant predictor of change in any PROMs based on regression analysis. Conclusion. Patients who presented with preoperative depression reported more pain and disability symptoms preoperatively and postoperatively; however, both groups achieved similar degrees of improvement. Level of Evidence: 3

Study Design. Retrospective study. Objective. To elucidate an association between preoperative lumbar epidural corticosteroid injections (ESI) and infection after lumbar spine surgery. Summary of Background Data. ESI may provide diagnostic and therapeutic benefit; however, concern exists regarding whether preoperative ESI may increase risk of postoperative infection. Methods. Patients who underwent lumbar decompression alone or fusion procedures for radiculopathy or stenosis between 2000 and 2017 with 90 days follow-up were identified by ICD/CPT codes. Each cohort was categorized as no preoperative ESI, less than 30 days, 30 to 90 days, and greater than 90 days before surgery. The primary outcome measure was postoperative infection requiring reoperation within 90 days of index procedure. Demographic information including age, sex, body mass index (BMI), Charlson Comorbidity Index (CCI) was determined. Comparison and regression analysis was performed to determine an association between preoperative ESI exposure, demographics/comorbidities, and postoperative infection. Results. A total of 15,011 patients were included, 5108 underwent fusion and 9903 decompression only. The infection rate was 1.95% and 0.98%, among fusion and decompression patients, respectively. There was no association between infection and preoperative ESI exposure at any time point (1.0%, P = 0.853), ESI within 30 days (1.37%, P = 0.367), ESI within 30 to 90 days (0.63%, P = 0.257), or ESI > 90 days (1.3%, P = 0.277) before decompression surgery. There was increased risk of infection in those patients undergoing preoperative ESI before fusion compared to those without (2.68% vs. 1.69%, P = 0.025). There was also increased risk of infection with an ESI within 30 days of surgery (5.74%, P = 0.005) and when given > 90 days (2.9%, P = 0.022) before surgery. Regression analysis of all patients demonstrated that fusion (P < 0.001), BMI (P < 0.001), and CCI (P = 0.019) were independent predictors of postoperative infection, while age, sex, and preoperative ESI exposure were not. Conclusion. An increased risk of infection was found in patients with preoperative ESI undergoing fusion procedures, but no increased risk with decompression only. Fusion, BMI, and CCI were predictors of postoperative infection. Level of Evidence: 3

No abstract

Introduction: Radial nerve palsies with humeral shaft fractures have historically been treated with expectant management. A previous systematic review by Shao et al, based on studies published from 1964 to 2004, purported no difference in the rate of recovery between patients treated with early surgical intervention versus expectant treatment. However, the authors combined expectant treatment to include patients treated nonsurgically and those with delayed surgery. To better understand the effect of surgery and its timing on radial nerve recovery, an updated analysis was performed with stricter treatment definitions. Methods: An updated systematic review of the published literature was undertaken. An electronic database search was performed to identify publications that met specific inclusion criteria. A total of 23 articles published since 2000 met our eligibility requirements. Data were abstracted from these articles and analyzed in conjunction with the results of the systematic review by Shao et al. Results: The overall prevalence of radial nerve palsy was 12.3% (890/7,262). Patients with radial nerve palsy treated nonsurgically had a rate of spontaneous radial nerve recovery of 77.2%. Patients who failed nonsurgical management and underwent nerve exploration more than 8 weeks after their injury had a rate of recovery of 68.1%. Patients treated with early (within 3 weeks of the injury) surgical exploration and fracture repair had a rate of recovery of 89.8%. Discussion: From the published data from 1964 to 2017, patients who underwent surgical exploration within 3 weeks of injury had a significantly higher likelihood of regaining radial nerve function than patients who underwent nonsurgical management with or without late surgical exploration.

Study Design: Narrative review. Objectives: To provide an updated overview of the management of acute traumatic central cord syndrome (ATCCS). Methods: A comprehensive narrative review of the literature was done to identify evidence-based treatment strategies for patients diagnosed with ATCCS. Results: ATCCS is the most commonly encountered subtype of incomplete spinal cord injury and is characterized by worse sensory and motor function in the upper extremities compared with the lower extremities. It is most commonly seen in the setting of trauma such as motor vehicles or falls in elderly patients. The operative management of this injury has been historically variable as it can be seen in the setting of mechanical instability or preexisting cervical stenosis alone. While each patient should be evaluated on an individual basis, based on the current literature, the authors’ preferred treatment is to perform early decompression and stabilization in patients that have any instability or significant neurologic deficit. Surgical intervention, in the appropriate patient, is associated with an earlier improvement in neurologic status, shorter hospital stay, and shorter intensive care unit stay. Conclusions: While there is limited evidence regarding management of ATCCS, in the presence of mechanical instability or ongoing cord compression, surgical management is the treatment of choice. Further research needs to be conducted regarding treatment strategies and patient outcomes.

Purpose of Review Minimally invasive spine surgery (MIS) and robotic technology are growing in popularity and are increasing utilized in combination. The purpose of this review is to identify the current successes, potential drawbacks, and future directions of robotic guidance for MIS compared to traditional techniques. Recent Findings Recent literature highlights successful incorporation of robotic guidance in MIS as a consistently accurate method for pedicle screw placement. With a short learning curve and low complication rates, robot guidance may also reduce the use of fluoroscopy, operative time, and length of hospital stay. Summary Recent literature suggests that incorporating robotic guidance in MIS improves the accuracy of pedicle screw insertion and may have added benefits both intra-and postoperatively for the patient and provider. Future research should focus on direct comparison between MIS with and without robotic guidance.

3.

Category: Sports Introduction/Purpose: Chronic exertional compartment syndrome (CECS) occurs as the result of increasing pressure in a closed muscular compartment, typically in the leg, as the result of repetitive activity. Physiologic changes in myofibril size during exercise increase muscle volume leading to higher compartmental pressures, which can result in neurologic and vascular changes. CECS has been estimated to cause 27%-33% of exertional leg pain and frequently leads to a decrease in athletic training and competition. CECS affects males and females equally but is especially common in young athletes, particularly competitive runners, as well as soccer, field hockey and lacrosse players and in military personnel. The purpose of this study is to evaluate patient- reported outcomes and return to sport (RTS) after open fasciotomy for lower extremity CECS. Methods: A retrospective review of patients that underwent lower extremity fasciotomy for CECS by a single surgeon was performed. All patients had a diagnosis confirmed by pre- and post-exercise compartment pressure testing. Two-incision technique was used with lateral and anterior compartments released through a lateral incision, while deep and superficial posterior compartments were released through a medial approach when indicated. Patients that underwent a fasciotomy for trauma, infection, or an acute pathologic process were excluded. Patient outcome measures were recorded for each patient including the Foot and Ankle Ability Measure-Sport subscale (FAAM-Sport), FAAM-Sport Single Assessment Numeric Evaluation (SANE), and Visual Analog Scale (VAS) for pain. A novel RTS questionnaire was designed and implemented. Patient demographic information was included. Outcome analysis was performed using Student’s t-test and chi-square testing. RTS was compared using Mann-Whitney U testing, and regression analysis was used to identify independent risk factors for failure to RTS. Results: 59 patients that underwent 63 procedures were included. Average age was 26.6 years (range, 15-55), 59.3% were female, and average follow-up was 58.8 months (range, 12-115). 37 patients underwent simultaneous bilateral fasciotomies, 8 had staged bilateral fasciotomies and 18 underwent unilateral fasciotomy. Four-compartment fasciotomy was performed 14 times and 49 fasciotomies involved one or two compartments. Significant postoperative improvement was seen in the FAAM-Sport, Sport SANE and the VAS for pain compared to preoperative scores (p<0.001). Overall 93.2% (55/59) of patients were able to return to sport, 78.1% (43/55) returned to the same level of sport, and 21.9% (12/54) returned to a lower level of competition. Bivariate regression analysis demonstrated that higher preoperative BMI (p=0.049) was associated with a lower likelihood of return to sport. Conclusion: CECS is a relatively common problem seen in young athletes and can cause significant change in athletic participation and ability. This cohort of patients who underwent lower extremity fasciotomies for CECS is larger than any previously published. This study demonstrates that lower extremity fasciotomy for CECS results in improvement of patient-reported outcomes and returns athletes back to competition at a high rate.