OBJECTIVE: Patients with serum albumin levels < 3.5 g/dL are considered malnourished, but there is a paucity of data regarding the outcomes of patients with albumin levels > 3.5 g/dL. The objective of this study was to evaluate the effect of albumin on postoperative outcome in patients undergoing elective cervical and lumbar spine procedures.
METHODS: The Michigan Spine Surgery Improvement Collaborative database was queried for lumbar and cervical fusion surgeries between January 2020 and December 2022. Patients were grouped by preoperative serum albumin levels: < 3.5 g/dL, 3.5-3.7 g/dL, 3.8-4.0 g/dL, and > 4.0 g/dL. Primary outcomes included urinary retention, ileus, dysphagia, surgical site infection (SSI), readmission within 30 and 90 days, return to the operating room, and length of stay (LOS) ≥ 4 days. Multivariate analysis was conducted to adjust for potential confounders.
RESULTS: This study included 15,629 lumbar cases and 6889 cervical cases. Within the lumbar cohort, an albumin level of 3.5-3.7 g/dL was associated with an increased risk of readmission at 30 days (p = 0.048) and 90 days (p = 0.005) and an LOS ≥ 4 days (p < 0.001). An albumin level of 3.8-4.0 g/dL was associated with an increased risk of an LOS ≥ 4 days (p < 0.001). Within the cervical cohort, an albumin level of 3.5-3.7 g/dL was associated with an increased risk of SSI (p = 0.023), readmission at 30 days (p < 0.002) and 90 days (p < 0.001), return to the operating room (p = 0.002), and an LOS ≥ 4 days (p < 0.001). An albumin level of 3.8-4.0 g/dL was associated with an increased risk of readmission at 30 days (p = 0.012) and 90 days (p = 0.001) and an LOS ≥ 4 days (p < 0.001).
CONCLUSIONS: This study maintains that patients with hypoalbunemia undergoing spine surgery are at risk for postoperative adverse events. However, there also exist significant associations between borderline serum albumin levels of 3.5-4.0 g/dL and increased risk of postoperative adverse events.

OBJECTIVE: Myelopathy in the cervical spine can present with diverse symptoms, many of which can be debilitating for patients. Patients with radiculopathy symptoms demonstrate added complexity because of the overlapping symptoms and treatment considerations. The authors sought to assess outcomes in patients with myelopathy presenting with or without concurrent radiculopathy.
METHODS: The Quality Outcomes Database, a prospectively collected multi-institutional database, was used to analyze demographic, clinical, and surgical variables of patients presenting with myelopathy or myeloradiculopathy as a result of degenerative pathology. Outcome measures included arm (VAS-arm) and neck (VAS-neck) visual analog scale (VAS) scores, modified Japanese Orthopaedic Association (mJOA) scale score, EuroQol VAS (EQ-VAS) score, and Neck Disability Index (NDI) at 3, 12, and 24 months compared with baseline.
RESULTS: A total of 1015 patients were included in the study: 289 patients with myelopathy alone (M0), 239 with myeloradiculopathy but no arm pain (MRAP-), and 487 patients with myeloradiculopathy and arm pain (MRAP+). M0 patients were older than the myeloradiculopathy cohorts combined (M0 64.2 vs MRAP- + MRAP+ 59.5 years, p < 0.001), whereas MRAP+ patients had higher BMI and a greater incidence of current smoking compared with the other cohorts. There were more anterior approaches used in in MRAP+ patients and more posterior approaches used in M0 patients. In severely myelopathic patients (mJOA scale score ≤ 10), posterior approaches were used more often for M0 (p < 0.0001) and MRAP+ (p < 0.0001) patients. Patients with myelopathy and myeloradiculopathy both exhibited significant improvement at 1 and 2 years across all outcome domains. The amount of improvement did not vary based on surgical approach. In comparing cohort outcomes, postoperative outcome differences were associated with patient-reported scores at baseline.
CONCLUSIONS: Patients with myelopathy and those with myeloradiculopathy demonstrated significant and similar improvement in arm and neck pain scores, myelopathy, disability, and quality of life at 3 months that was sustained at 1- and 2-year follow-up intervals. More radicular symptoms and arm pain increased the likelihood of a surgeon choosing an anterior approach, whereas more severe myelopathy increased the likelihood of approaching posteriorly. Surgical approach itself was not an independent predictor of outcome.

OBJECTIVE: Lumbar decompression and/or fusion surgery is a common operation for symptomatic lumbar spondylolisthesis refractory to conservative management. Multiyear follow-up of patient outcomes can be difficult to obtain but allows for identification of preoperative patient characteristics associated with durable pain relief, improved functional outcome, and higher patient satisfaction.
UNASSIGNED: A query of the Quality Outcomes Database (QOD) low-grade spondylolisthesis module for patients who underwent surgery for grade 1 lumbar spondylolisthesis (from July 2014 to June 2016 at the 12 highest-enrolling sites) was used to identify patient satisfaction, as measured with the North American Spine Society (NASS) questionnaire, which uses a scale of 1-4. Patients were considered satisfied if they had a score ≤ 2. Multivariable logistic regression was performed to identify baseline demographic and clinical predictors of long-term satisfaction 5 years after surgery.
RESULTS: Of 573 eligible patients from a cohort of 608, patient satisfaction data were available for 81.2%. Satisfaction (NASS score of 1 or 2) was reported by 389 patients (83.7%) at 5-year follow-up. Satisfied patients were predominantly White and ambulation independent and had lower baseline BMI, lower back pain levels, lower Oswestry Disability Index (ODI) scores, and greater EQ-5D index scores at baseline when compared to the unsatisfied group. No significant differences in reoperation rates between groups were reported at 5 years. On multivariate analysis, patients who were independently ambulating at baseline had greater odds of long-term satisfaction (OR 1.12, p = 0.04). Patients who had higher 5-year ODI scores (OR 0.99, p < 0.01) and were uninsured (OR 0.43, p = 0.01) were less likely to report long-term satisfaction.
CONCLUSIONS: Lumbar surgery for the treatment of grade 1 spondylolisthesis can provide lasting pain relief with high patient satisfaction. Baseline independent ambulation is associated with a higher long-term satisfaction rate after surgery. Higher ODI scores at 5-year follow-up and uninsured status are associated with lower postoperative long-term satisfaction.

OBJECTIVE: The objective was to discern whether the cranial sagittal vertical axis (CrSVA) can best predict the trajectory of patient-reported outcome measures (PROMs) at 2 years postoperatively.
METHODS: This was a retrospective cohort study of prospectively collected adult spinal deformity patient data. CrSVA relative to the sacrum, hip (CrSVA-H), knee, and ankle was measured as the horizontal distance to the vertical plumb line from the nasion-inion midpoint, with positive values indicating an anterior cranium. Standard sagittal alignment parameters were also collected. Outcome variables were PROMs as measured by Scoliosis Research Society-22r questionnaire (SRS-22r) total and subdomain scores and the Oswestry Disability Index. Pearson\'s correlation coefficients and univariate regressions were performed to investigate associations between predictors and PROMs. Two conceptual multivariable linear regression models for each 2-year outcome measure were built after adjusting for the impact of preoperative SRS-22r scores. Model 1 assessed pre- and postoperative alignment only relative to C2 and C7, while model 2 assessed alignment relative to C2 and C7 as well as the cranium.
RESULTS: There was a total of 363 patients with 2 years of radiographic and PROM follow-up (68.0% female, mean [standard error of the mean] age 60.8 [0.78] years, BMI 27.5 [0.29], and total number of instrumented levels 12.8 [0.22]). CrSVA measures were significantly associated with the 2-year SRS-22r total and subdomain scores. In univariate regression, revision surgery, number of prior surgeries, frailty, BMI, total number of osteotomies, and lower baseline total SRS-22r score as well as postoperative sagittal alignment were significantly associated with worse 2-year SRS-22r scores. In multivariable regression, after adjusting for baseline SRS-22r scores, greater preoperative C2 to sacrum sagittal vertical axis (SVA) and C7 SVA were found to be the only independent predictors of 2-year total SRS-22r score (β = -0.011 [p = 0.0026] and β = 0.009 [p = 0.0211], respectively) when alignment was considered only relative to C2. However, in the subsequent model, CrSVA-H replaced C7 SVA as the independent factor driving postoperative SRS-22r total scores (β = -0.006, p < 0.0001). That is, when the model included alignment relative to the cranium, C2, and C7, greater or more anterior CrSVA-H resulted in worse SRS-22r scores, while smaller or more posterior CrSVA-H resulted in better scores. Similar models for subdomains again found CrSVA-H to be the best predictor of function (β = -0.0095, p < 0.0001), pain (β = -0.0091, p < 0.0001), self-image (β = -0.0084, p = 0.0004), and mental health (β = -0.0059, p = 0.0026).
CONCLUSIONS: In multivariable regression, C7 SVA was supplanted by CrSVA-H alignment as a significant, independent predictor of 2-year SRS-22r scores in patients with adult spinal deformity and should be considered as one of the standard postoperative sagittal alignment target goals.

Huntington\'s disease (HD) is a gradually severe neurodegenerative ailment characterised by an increase of a specific trinucleotide repeat sequence (cytosine-adenine-guanine, CAG). It is passed down as a dominant characteristic that worsens over time, creating a significant risk. Despite being monogenetic, the underlying mechanisms as well as biomarkers remain poorly understood. Furthermore, early detection of HD is challenging, and the available diagnostic procedures have low precision and accuracy. The research was conducted to provide knowledge of the biomarkers, pathways and therapeutic targets involved in the molecular processes of HD using informatic based analysis and applying network-based systems biology approaches. The gene expression profile datasets GSE97100 and GSE74201 relevant to HD were studied. As a consequence, 46 differentially expressed genes (DEGs) were identified. 10 hub genes (TPM1, EIF2S3, CCN2, ACTN1, ACTG2, CCN1, CSRP1, EIF1AX, BEX2 and TCEAL5) were further differentiated in the protein-protein interaction (PPI) network. These hub genes were typically down-regulated. Additionally, DEGs-transcription factors (TFs) connections (e.g. GATA2, YY1 and FOXC1), DEG-microRNA (miRNA) interactions (e.g. hsa-miR-124-3p and has-miR-26b-5p) were also comprehensively forecast. Additionally, related gene ontology concepts (e.g. sequence-specific DNA binding and TF activity) connected to DEGs in HD were identified using gene set enrichment analysis (GSEA). Finally, in silico drug design was employed to find candidate drugs for the treatment HD, and while the possible modest therapeutic compounds (e.g. cortistatin A, 13,16-Epoxy-25-hydroxy-17-cheilanthen-19,25-olide, Hecogenin) against HD were expected. Consequently, the results from this study may give researchers useful resources for the experimental validation of Huntington\'s diagnosis and therapeutic approaches.

OBJECTIVE: This study investigated the correlation between Hounsfield units (HU) of the cervical vertebrae and atrophy of the cervical deep paraspinal muscles, namely the multifidus and semispinalis cervicis (SCer), in patients diagnosed with degenerative cervical myelopathy (DCM).
METHODS: The authors retrospectively analyzed data from 136 patients aged 50-79 years (81 males and 55 females) who underwent surgical intervention for DCM. HU measurements of the cancellous bone in the C4 vertebra were acquired through standardized techniques. The authors evaluated fatty infiltration (FI); analyzed functional and vertebral cross-sectional area (CSA) of the multifidus and SCer at the C4-5, C5-6, and C6-7 levels; and analyzed the presence of Modic changes (MCs) and the incidence of axial neck pain.
RESULTS: Patients were categorized into group A (n = 56) with mean ± SD HU of 293.3 ± 15.6 and group B (n = 80) with mean ± SD HU of 389.5 ± 10.6. Both groups demonstrated significant improvements in postoperative clinical outcomes (p < 0.05); however, no statistically significant difference was observed (p > 0.05). Significant disparities in HU measurements and visual analog scale (VAS) scores for neck pain were observed between the groups (p < 0.05). The highest VAS score correlated with MCs-1 type (i.e., low signal on T1-weighted images and high signal on T2-weighted images). The functional CSA to vertebral CSA ratios of the multifidus and SCer in group A were markedly reduced compared to those of group B (p < 0.05). No significant difference was noted in functional CSA asymmetry between the groups for both muscles (p > 0.05). Lower HU measurements directly correlated with increased FI in the multifidus (p = 0.002) and SCer (p = 0.035). Furthermore, a strong positive association was found between the functional CSA to vertebral CSA ratio of the multifidus and HU values (p = 0.003), whereas HU measurements and VAS scores exhibited a negative correlation (p = 0.020).
CONCLUSIONS: Among those patients older than 50 years with DCM, those with decreased HU values demonstrated elevated FI levels in the multifidus and SCer muscles. Moreover, these patients presented with pronounced muscle atrophy, which correlated with axial neck pain. A significant relationship was also identified between MCs and diminished HU values.

OBJECTIVE: Surgical decompression is often indicated for symptomatic cases of cervical radiculopathy. In the cervical spine, minimally invasive posterior cervical foraminotomy (MIS-PCF) and the anterior transcorporeal approach (ATCA) are modern techniques available to surgeons. This systematic review and single-arm meta-analysis aimed to assess surgical and patient-reported outcomes of MIS-PCF and ATCA for cervical radiculopathy.
METHODS: A systematic review of the literature was conducted using 1) Ovid; 2) Epub Ahead of Print and In-Process, In-Data-Review & Other Non-Indexed Citations; and 3) Scopus databases, which reported outcomes following cervical decompression using MIS-PCF or the ATCA. Specifically, baseline characteristics, operative outcomes, and changes in visual analog scale (VAS) neck pain score were assessed. The quality of the studies was graded using the modified Newcastle-Ottawa Scale for observational studies.
RESULTS: Forty studies with 1661 patients were identified. The comparative analysis of both techniques revealed no significant differences in complication (7%, 95% CI 5%-10%, p = 0.75) or reoperation rates (5%, 95% CI 3%-7%, p = 0.41). Additionally, there were no significant differences in estimated blood loss (55.39, 95% CI 44.62-66.16 ml, p = 0.55) or operative time (85.15, 95% CI 65.38-104.92 minutes, p = 0.05). The ATCA showed significantly greater improvement (p < 0.01) in VAS neck pain scores following surgery (ATCA point reduction 6.7, 95% CI 6.0-7.5 points vs MIS-PCF 3.0, 95% CI 1.0-5.0 points).
CONCLUSIONS: The ATCA and MIS-PCF are effective modern techniques for the surgical treatment of radiculopathy. Both approaches showed comparable postoperative outcomes, including complication and reoperation rates. However, the ATCA was shown to provide significantly greater improvement in VAS neck pain scores.

This case report describes the successful total knee arthroplasty (TKA) in a 58-year-old female with a prior history of multiple knee surgeries. The patient had three prior surgical procedures. The first surgery of the patient was a partial knee replacement, the second surgery the patient underwent was an arthroscopic meniscectomy, and the third surgery was a high tibial osteotomy (HTO) that left her with an extensive amount of scar tissue and a change in physical structure. When scar tissue develops over or close to a joint, the surrounding tissues are pulled inward by this shrinking or contraction. A joint may experience restricted movement as a result of this tightness. Stretchy and excessively flexible joints are common in people with Ehlers-Danlos syndrome. This may become an issue if you need sutures for a wound because the skin is frequently not strong enough to support them. The patient already undergone three surgeries prior but still showed signs of severe pain, swelling, and stiffness in the knee which made the patient suffer more during rest position and also made it sometimes so difficult that it affected everyday tasks. In this situation when the patient consulted the doctors, the patient was suggested to undergo TKA. TKA is the method of orthopedic surgical technique that is most consistently successful and highly effective. Patients with end-stage degenerative knee osteoarthritis might expect reliable results from this surgery. The case demonstrates the preoperative planning, surgical methods, and postoperative care needed to successfully treat a complicated patient profile. Hospital protocols were followed, and the patient\'s surgery was done with proper care and hygiene.

OBJECTIVE: The present study compares postoperative outcomes between patients with and without sickle cell disease (SCD) undergoing 1-to 3-level lumbar spinal fusion for degenerative pathologies.
METHODS: Patients who underwent 1-to 3-level lumbar spinal fusion for degenerative pathologies from 2010 to 2021 were identified using the PearlDiver database. Patients were separated into 1) SCD and 2) non-SCD groups and were propensity-matched 1:1 for age, sex, Elixhauser Comorbidity Index, surgical approach, and various comorbidities. Complications were separately analyzed by single- and multilevel procedures using chi-squared and Mann-Whitney U testing.
RESULTS: Propensity-score matching identified 1934 SCD and non-SCD patients who underwent single-level fusion and 2094 SCD and non-SCD patients who underwent multilevel fusion. Across single-level fusions, those with SCD had a significantly higher risk of neurovascular compromise (P < 0.001), venous thromboembolism (P = 0.004), pneumonia (P = 0.032), urinary tract infections (P = 0.001), and greater postoperative opioid usage out to 12 months (P = 0.018). Across multilevel fusions, SCD carried higher risk for neurovascular compromise (P < 0.001), pneumonia (P = 0.010), and urinary tract infections (P < 0.001). All SCD patients had significantly higher opioid use at 1 month (P = 0.001) and at 6 months (P = 0.009) postoperatively.
CONCLUSIONS: Patients with SCD undergoing lumbar spinal fusion demonstrate higher risks for coagulopathic, ischemic, and infectious-related complications, as well as long-term postoperative opioid use. Awareness of the unique complication profile in SCD patients may help guide surgeons in refining perioperative management strategies to optimize outcomes in patients with SCD.

OBJECTIVE: Preoperative MR images obtained in patients with Parkinson disease (PD) undergoing deep brain stimulation (DBS) often reveal incidental radiographic abnormalities (RAs). These findings range from small changes to gross pathologies. The effect of these findings on patients\' clinical outcomes is unknown. The authors characterized RAs in patients with PD who underwent DBS and assessed clinical outcomes.
METHODS: Records of patients at the authors\' institution with PD who underwent MRI for DBS electrode implantation from 2010 through 2022 were reviewed. RAs were identified from the official preoperative MRI reports. RAs were grouped into four general categories (ischemic changes, atrophy or degenerative changes [ADCs], structural abnormalities, and tumors) and correlated with clinical outcomes (including subjective clinical response, levodopa equivalent dose [LED], and Unified Parkinson\'s Disease Rating Scale Part III [UPDRS] score) at the 1-year and last available follow-ups.
RESULTS: In this review, 160 patients were identified for initial analysis, with 135 presenting with ≥ 1 RAs. Of these 135 patients, 69.4% (111/160) had ischemic vascular changes, 39.4% (63/160) had ADCs, 16.9% (27/160) had structural changes, and 1.9% (3/160) had tumors. No differences in preoperative LED or UPDRS score were observed between these groups. After DBS, no differences in outcomes were observed between patients with RAs and those without RAs for both the 1-year and last follow-up time points, including mortality rates and times. Structural lesions were associated with lower mortality rates (OR 0.1, p = 0.04). ADCs were associated with a worse subjective clinical response at the 1-year (OR 0.50, p = 0.04) and last (OR 0.49, p = 0.03) follow-ups, but subjectively worse responses were not correlated with worse objective outcome measures.
CONCLUSIONS: Most RAs have no significant effect on clinical outcomes in PD patients undergoing DBS. Generalized ADCs may be associated with poorer subjective responses and may warrant further discussion with the patient if diagnosed on preoperative MRI.