Texas Back Institute

Cervical total disc replacement (TDR) is intended to preserve motion and reduce adjacent segment degeneration compared to anterior cervical discectomy and fusion (ACDF). The Simplify Cervical Disc (Globus Medical, Audubon, Pennsylvania), a polyetheretherketone (PEEK)-on-ceramic device with titanium-coated endplates, was approved following encouraging short-term outcomes. However, emerging registries and the Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) reports suggest an increase in device failures and revision surgeries, raising concerns about the device's long-term durability and biological compatibility. We reviewed publicly available FDA MAUDE adverse event reports related to the Simplify disc replacement and the published literature on PEEK-on-ceramic wear mechanisms and titanium coating delamination. Representative clinical cases revised to ACDF procedures were also examined. Device bench testing data from the FDA summary were compared with real-world failure modes. Reported complications were categorized into wear, subsidence, migration, osteolysis, and revision outcomes. Analysis of 96 MAUDE reports revealed diverse complications: osteolysis, device migration, persistent or worsening pain, and intraoperative retrieval difficulties. Histological evaluation of revision specimens demonstrated benign bone and fibrocartilage with foreign material, consistent with PEEK, titanium, and zirconia wear debris, an associated inflammatory reaction, and osteolysis. In vitro data confirm that PEEK-on-ceramic couples generate volumetric wear rates of 0.7-2.1mm³/Mc, with titanium coating delamination further contributing to particulate load. Bench testing demonstrated mechanical adequacy under idealized conditions. However, retrieval findings highlight wear, coating failure, and osteolysis as potential failure pathways in real-world applications. Clinical outcomes after ACDF revision were favorable, suggesting effective salvage treatment. Despite promising early trial results, the Simplify disc demonstrates concerning failure mechanisms, including PEEK wear, titanium coating delamination, and subsequent osteolysis. The discrepancy between bench testing and retrieval analysis underscores the limitations of preclinical simulation in predicting in vivo wear. Vigilant post-market surveillance, independent registry reporting, and further long-term outcome studies are essential. Until durability is confirmed, cautious patient selection and readiness for revision remain critical in clinical practice.

Study Design: A questionnaire study. Objective: To characterize spine surgeons’ opinions regarding treating elite athletes with cervical disc arthroplasty (CDA) and assess current recommendations regarding time to return to training and competition. Summary of Background Data: CDA is increasingly recommended to elite athletes as a surgical treatment option for degenerative cervical conditions but remains controversial due to limited research on indications and return to play guidelines. Methods: Surveys were designed to obtain spine surgeons’ opinions regarding treating elite athletes with CDA, including sport-specific considerations and current recommendations regarding time to return to training and competition. The surveys were administered electronically to members of the Cervical Spine Research Society (CSRS) via their membership listserv. Survey data was analyzed to identify patterns in recommendations for the use of CDA as a treatment option for elite athletes. Results: Sixty surgeons responded to the survey. Surgeons generally agreed (93.3%) that being an elite athlete was not a contraindication to a single-level disc arthroplasty. Some surgeons (73.3%) did report at least one absolute contraindication for CDA in elite athletes. Respectively, 53.3% and 66.7% of surgeons reported they would consider 2-level CDA or hybrid procedures for elite athletes. Opinions varied on the safety of returning to specific sports based on the number of CDAs surgeons perform annually. Surgeons recommended different timelines for resuming activity, most commonly advising clearance at 2 weeks for light cardio, 6 weeks for full cardio and strength training, and twelve weeks for sport-specific training and full competition. A total of 46.7% of surgeons were still concerned about either litigation or criticism in offering CDA to elite athletes. Conclusions: CDA as a treatment option for elite athletes has increased in recent years, and many surgeons feel quite comfortable with allowing return to most sports after a one-level CDA.

Introduction: Intraoperative neuromonitoring (IONM) was integrated into most types of spine surgery to help prevent intraoperative nerve injury. Concern has been raised for the actual benefit provided by IONM, particularly in the current era of navigation and robotic guided surgery. The purpose of this study was to investigate IONM changes and postoperative neurologic deficits during lateral lumbar interbody fusion (LLIF).Methods: This was a cross-sectional study on a consecutive series of 202 patients who underwent LLIF procedures from January 2022 to September 2022. Patients were included if 18 years of age or older and underwent fusion at one, two, or three levels. Data were collected from patient chart review and operative reports, including intraoperative changes in neuromonitoring. Postoperative clinic notes were reviewed for up to approximately three months postoperatively for indication of neurologic injury. IONM was conducted using somatosensory evoked potential (SSEP).Results: There were two false negatives in this cohort (1.00%), involving no IONM change but exhibiting a neurologic deficit postoperatively. There was one true positive (0.50%) involving a reported IONM change and postoperative neurologic deficit; however, the IONM change occurred just after the patient was flipped prone for the posterior instrumentation portion of the LLIF procedure. The surgeon confirmed through new imaging that the fusion cage was in the appropriate position.Conclusion: This study found that changes in IONM were rare (0.50%). In the case of the one true positive, this occurred during repositioning, and the IONM change was not successful as a preventative measure. These results indicate that the use of SSEPs may not be supported for the LLIF approach. While medico-legal concerns promote its usage, the low rates of neurologic deficits and costs associated with IONM should be considered, leading to a reexamination of its use in LLIF spinal surgery.

This was a retrospective study. The purpose of the study was to determine the incidence and reasons of intraoperative conversion from planned cervical total disc replacement (TDR) to anterior cervical discectomy and fusion (ACDF). TDR currently offers an alternative treatment with results similar or superior to ACDF. Once individual surgeons become comfortable using a device, they will typically expand indications for its use, however, patient safety must remain at the forefront. To reduce reoperations, surgeons must use strict selection criteria to determine which patients are most appropriate to receive TDR. Despite those criteria, situations may arise when surgeons convert from TDR to ACDF intraoperatively. A comprehensive surgery log was reviewed to identify cases of planned TDR converted intraoperatively to ACDF. All cases were performed at a single institution by 28 attending surgeons beginning with the first case experience in November, 2003 and ending with cases performed in November, 2023. Retrospective chart review was performed to collect demographic data and determine reasons for conversion. During the 20-year period, a total of 2188 consecutive cases of planned TDR were examined. The total number of planned TDR levels was 2939. The rate of intraoperative conversion of TDR to ACDF was 0.55% (12/2188 cases; 95% CI: 0.30%-0.90%). With respect to the number of operated levels, the intraoperative rate of conversion was 0.48% (14/2939 levels; 95% CI: 0.30%-0.80%). There was a very low incidence of intraoperative conversion of cervical TDR to ACDF. However, surgeons performing this procedure should be prepared for the possibility of intraoperative conversion from TDR to ACDF and educate patients of this possibility.

Abstract Purpose: Professional female basketball players are at risk for spinal pathology although there is limited information on the impact of surgical intervention on postoperative performance. Our focus was to assess athletes in the WNBA who underwent surgical intervention for spinal pathologies and how these injuries influence return-to-play statistics and performance metrics. Methods: A retrospective case series of WNBA players undergoing spine surgery from 2007 and 2020 that were identified via publicly available injury reports and player profiles. Athletes' information collected included age , position , years of service in WNBA , height, body mass index. Statistics were collected for 1 season prior to surgical intervention and 2 seasons postoperatively and the player efficiency rating was calculated. Results: The mean age of the players was 31.5 years at the time of spinal surgical intervention with an average of the 8 years in the WNBA. It was observed a non-significant decline in the average player efficiency rating (PER) by 6.2 and 6.3 in the first and second seasons post-surgery. Of the six subjects, five underwent surgery for activity-related injuries, while one player underwent surgery for schwannoma removal. Notably, age above 33 correlated with a significant decrease in PER after spinal surgery (p<0.001), while taller players demonstrated a significant increase in PER following surgery ( p<0.001,). Discussion: These findings suggest that older athletes may face challenges in returning to pre-injury performance levels, while taller individuals may experience more favorable post-surgery performance outcomes. Limited sample size warrants caution, emphasizing the need for larger cohorts for validation and expansion of findings. These insights provide a helpful starting point in exploring the impact of surgical intervention in treating spinal injuries for female athletes.

Cement-augmented pedicle screw instrumentation procedures are performed for stabilization in patients with surgical spinal conditions with poor bone quality at the target levels. Although this is done to combat the risk of failure due to loosening, cutting out or pulling out of the screws, failure may still occur. The purpose of this study was to identify the modalities and rates of failure of CAPSI constructs to better predict occurrence of failure. We retrospectively reviewed clinical data of patients who underwent CAPSI fusion procedures between 2010 and 2022. We collected pre, intra and post-operative clinical and radiographic data. 621 pedicle screws in 319 levels were augmented out of 1333 screws in 809 instrumented levels in 120 patients. F:M = 3:1; mean age 68.6years and mean BMI 27.10. The mean length of follow up overall was 2.2years (Range 7days-11years). The most common surgical indications were degenerative scoliosis and osteoporotic fractures. Construct failure occurred in 32 cases; seven cases were associated with trauma and 11 cases presented with a neurologic deficit. The most common modality of failure was osteonecrotic collapse (20 cases); proximal construct failure occurred in 22 cases; there was evidence of haloing at the screw-bone-cement interfaces in 23 out 32 cases. 21 out of 32 cases required revision surgical procedures within an average of 453days. Failure of CAPSI constructs occurred in 26.7% of patients. High occurrence of osteonecrotic collapse and haloing at the screw-cement-bone interfaces likely represents a relationship with construct failure.

Full endoscopic spine surgery (FESS) champions a rapid recovery and a low rate of overall complications. However, its efficacy in geriatric patients that might yield additional benefits from minimized invasiveness remains underexplored. A multi-institutional prospective cohort study was conducted involving patients undergoing elective lumbar FESS. Participants were categorized into nongeriatric (18-69 years old) and geriatric (≥70 years old) groups. Studied variables included demographics, medical comorbidities, operative details, visual analog scale (VAS) for back and leg pain, and Oswestry Disability Index (ODI). A mobile application was leveraged to collect real-time data pre- and postoperatively. One hundred and sixty-four patients were included and divided into nongeriatric (N = 125) and geriatric (N = 39) cohorts. No group differences were observed between sex (P = 0.404), body mass index (P = 0.372), procedure duration (P = 0.350), or blood loss (P = 0.384). Nongeriatric patients received discectomy more frequently (P < 0.001), while older patients underwent more decompressive procedures (P < 0.001). Characterization of pain and functional outcome revealed that nongeriatric and geriatric patients follow a similar recovery trajectory and both appreciate significant improvements from baseline to 3 months postoperatively (P < 0.001 for VAS back, VAS leg, and ODI). There were no differences in the rate of improvement between age groups at any time point (P > 0.05 for VAS back, VAS leg, and ODI). FESS significantly improves pain and function in both geriatric and nongeriatric adults with degenerative lumbar conditions, with no difference in the degree of improvement between groups. These findings underscore the efficacy of FESS as a minimally invasive surgical option for elderly patients. Mobile application technology is useful for collecting patient-reported data in spine surgery clinical research.

IntroductionSocial media platforms have changed the way society communicates and collaborates. Prior research in healthcare discusses how social media can empower patients, dispel health-related misinformation, and help maintain a patient-centered practice. The goal of this study was to evaluate the use of #endoscopicspinesurgery on Instagram and create a blueprint for creating engaging posts on the social media platform.MethodologyPublic Instagram posts (n = 171) that utilized #endoscopicspinesurgery were collected over three months in 2022. Each post was assessed for photo and caption content, likes, comments, number of followers, and hashtag information. Engagement rates were calculated for each post to assess the active interaction of post characteristics and content.ResultsThe majority of posts were published by medical professionals (72/171, 42.1%) and industry-related user accounts (55/171, 32.2%). Content related to training, conferences, and the operating room garnered the highest average engagement. Post characteristics (number of hashtags and number of post photos) were significantly associated with engagement.ConclusionsResults highlighted general trends in creating engaging social media posts, such as using hashtags intentionally to increase searchability and visibility, having higher numbers of photos in a post and using high-quality photos, and understanding the dynamic social media algorithms that may affect post viewership. When structuring social media posts, users should be aware of the audience they want to attract and construct their content accordingly.

Intraoperative neuromonitoring (IONM) became widely used in spine surgery to reduce the risk of iatrogenic nerve injury. However, the proliferation of IONM has fallen into question based on effectiveness and costs, with a lack of evidence supporting its benefit for specific spine surgery procedures. The purpose of this study was to evaluate the use of IONM and the rate of neurological injury associated with anterior lumbar spinal surgery. This was a retrospective study on a consecutive series of 359 patients undergoing lumbar anterior approach surgery for anterior lumbar interbody fusion (ALIF), total disc replacement (TDR), or hybrid (ALIF with TDR) for the treatment of symptomatic disc degeneration. Patients undergoing any posterior spine surgery were excluded. Operative notes were reviewed to identify any changes in IONM and the surgeon's response. Clinic notes were reviewed up to 3 months postoperatively for indications of iatrogenic nerve injury. There were 3 aberrant results with respect to IONM. Changes in IONM of a lower extremity occurred for 1 patient (0.3%). The surgeon evaluated the situation and there was no observable reason for the IONM change. Upon waking, the patient was found to have no neurological deficit. There were 2 cases of neurologic deficits in this population, which were classified as false-negatives of IONM (0.56%, 95% CI: 0.1% to 1.8%). In both cases, the patients were found to have a foot drop after the anterior approach surgery. In this study, there was 1 false-positive and 2 false-negative results of IONM. These data suggest that IONM is not beneficial in this population. However, many surgeons may feel obligated to use IONM for medicolegal reasons. There is a need for future studies to delineate cases in which IONM is beneficial and the type of monitoring to use, if any, for specific spine surgery types. This study questions the routine use of IONM in anterior lumbar approach surgery for the treatment of symptomatic disc degeneration. This has significant implications related to the cost of this practice.