What’s New in Spine Surgery

Abstract

Over the past 2 years, the COVID-19 pandemic has impacted the entire health-care profession, and spinal surgery had to adjust along with it. Although it may take years to truly assess the overall effect, early trends have clearly pointed toward a patient demand for telemedicine. Additionally, as COVID strained our hospitals and diverted critical resources away from elective surgical procedures, non-time-sensitive cases have been increasingly pushed out to outpatient surgical centers. Decreased inpatient elective surgical capability has also forced more patients to pursue extended nonoperative treatment modalities. Although it remains too early to determine the long-term impact of these shifts, we expect future studies to examine these issues extensively. This annual update on spine surgery includes an examination of peer-reviewed literature for all spinal conditions, in addition to abstracts presented at annual society meetings, over the past year. We chose these articles due to their potential to impact and advance our profession, with a preference toward the highest levels of evidence. Spondylotic Cervical Myelopathy Several interesting studies published recently added to our understanding of optimal surgical treatment for spondylotic cervical myelopathy. In the Cervical Spondylotic Myelopathy Surgical (CSM-S) randomized clinical trial, Ghogawala et al. compared the impact of anterior surgery with that of posterior surgery on patient outcomes1. In a select population in which clinical equipoise existed (exclusion of patients with kyphosis of >5°, ossification of the posterior longitudinal ligament, or segmental kyphotic deformity), 1-year and 2-year Short Form-36 (SF-36) Physical Component Summary (PCS) scores were not different between the 2 groups. The authors did identify a higher complication rate in the anterior surgery group, with dysphagia predominating. The major complication rates did not differ. Interestingly, in the nonrandomized analysis comparing laminoplasty, posterior cervical fusion, and anterior cervical fusion, the patients who underwent laminoplasty fared significantly better in physical function, complication rate, and resource utilization. Posterior cervical fusion is more commonly performed in the United States, and a recent study demonstrated that laminoplasty is likely underutilized despite growing evidence for improved performance metrics2. Current literature has mixed results with regard to determination of the optimal lower instrumented vertebra (LIV) in long posterior cervical fusions. In addressing the question of crossing the cervicothoracic junction, Truumees et al.3 evaluated patient-reported outcomes, radiographic outcomes, and revision rates in fusions stopping at C6/7 or T1/2 in a retrospective analysis of 264 patients with at least a 2-year follow-up. Patient-reported outcome measures improved equally in both groups. Radiographic outcomes were similar between groups, with both groups demonstrating similar improvement in cervical lordosis. The study did not detect a difference in revision rates, but was not powered to do so. Patients who underwent fusions into the thoracic spine did have more blood loss and longer operative time. Similarly, in a retrospective cohort study with a 4-year follow-up, Guppy et al. did not identify a difference in reoperation rates for adjacent segment disease4 or pseudarthrosis5 when cervical fusions were stopped at C7 or T1/T2. In the absence of extenuating factors, stopping at C7 may be a reasonable option given the lower morbidity and complication rate, although further work is needed in this area. Cervical Radiculopathy Numerous studies have been published comparing cervical disc arthroplasty with anterior cervical discectomy and fusion (ACDF). However, many of these studies may have been biased by industry sponsorship and a lack of blinded outcome assessment. The Norwegian Cervical Arthroplasty Trial (NORCAT) was designed as a blinded and randomized clinica