Early Gender Differences in Pain and Functional Recovery Following Thoracolumbar Spinal Arthrodesis

Background: To analyze gender differences regarding the recovery experience (pain, function, complications) after spinal arthrodesis surgery. Methods: Pre-operative and post-operative gender-based differences in patient-reported outcomes for open posterior spinal arthrodesis at 6 weeks, 3 months, 6 months, and 1 year were studied, including age, comorbidities, body mass index (BMI), diagnosis, number of vertebrae fused, type of surgery, primary vs. revision surgery, and complications. Statistical analysis included the use of Student’s t-test, Chi square, linear regression, Mann–Whitney U test, and Spearman’s rho. Results: Primary or revision posterior arthrodesis was performed on 1931 consecutive adults (1219 females, 712 males) for deformity and degenerative pathologies. At surgery, females were older than males (61.7 years vs. 59.7 years, p < 0.01), had slightly more comorbidities (1.75 vs. 1.5, p < 0.01), and were more likely to undergo deformity correction (38% vs. 22%, p < 0.01). Females described more pre-op pain (female VAS = 6.54 vs. male VAS = 6.41, p < 0.01) and lower pre-op function (female ODI = 49.73 vs. male ODI = 46.52, p < 0.01). By 3 months post-op, there was no significant gender difference in VAS or ODI scores. Similar pain and function scores between males and females continued through 6 months and 12 months. Conclusion: Although females have more pain and dysfunction before undergoing spinal surgery, the differences in these values do not reach the Minimum Clinically Important Difference (MCID). Post-operatively, there is no difference in pain and function scores among males and females at 3, 6, and 12 months.

Nonaccidental Trauma Managed with Open Spinal Fixation and Instrumentation and a Review of the Literature

Nonaccidental trauma (NAT), causing spinal injury is rare and occurs in up to 3% of cases. Management of these injuries is typically conservative, and thus surgical management is not widely reported in the literature. In this case report, we presented three patients to review the effectiveness of spinal instrumentation and posterior fusion in pediatric patients due to NAT. All patients recovered well and were neurologically intact at last follow-up with no postprocedural complications noted. Spinal arthrodesis is a safe, effective way to manage spinal injuries due to NAT in cases of fracture-dislocation, distraction injuries, as well as cases involving neurologic compromise.

The Impact of Instrumentation and Implant Surface Technology on Cervical and Thoracolumbar Fusion

Spinal fusion has undergone significant evolution and improvement over the past 50 yr. Historically, spine fusion was noninstrumented and arthrodesis was based entirely on autograft. Improved understanding of spinal anatomy and materials science ushered in a new era of spinal fusion equipped with screw-based technologies and various interbody devices. Osteobiologics is another important realm of spine fusion, and the evolution of various osteobiologics has perhaps undergone the most change within the past 20 yr. A new element to spinal instrumentation has recently gained traction—namely, surface technology. New data suggest that surface treatments play an increasingly well-recognized role in inducing osteogenesis and successful fusion. Until now, however, there has yet to be a unified resource summarizing the existing data and a lack of consensus exists on superior technology. Here, authors provide an in-depth review on surface technology and its impact on spinal arthrodesis.