Delve into the Science of NASS 2024: Wednesday Best Paper Q&As
SpineLine is proud to present a series that brings our readers closer to the cutting-edge research and clinical advancements recognized at the NASS Annual Meeting. This year's NASS 2024 meeting continues its tradition of excellence by showcasing groundbreaking studies that drive the field forward. In the upcoming three Best Paper Q&A installments, we will delve into the insights and innovations of the Best Paper authors, whose work exemplifies the highest standards of scientific inquiry and clinical application. The NASS Annual Meeting Best Papers are a tangible demonstration of the exceptional quality of research present in the NASS community. These distinguished papers are selected for their potential to significantly impact spine care practices and improve patient outcomes. Through this series, SpineLine aims to provide an in-depth look at the ideas and implications behind these award-winning studies, offering our readers a unique opportunity to engage with the forefront of spine research. In this first installment, we feature Wednesday’s Best Papers authors. These researchers have demonstrated outstanding contributions in areas ranging from surgical techniques to innovative therapeutic approaches and exploring the efficacy of new technologies. Their responses to our questions offer valuable perspectives on the challenges and breakthroughs in spine care, underscoring the dedication and ingenuity that drive their work. Join us as we explore the pioneering research presented at NASS 2024, beginning with the Wednesday Best Paper authors. Their insights not only highlight the importance of their findings but also inspire continued excellence and collaboration within the spine care community. Through these Q&As, we aim to foster a deeper understanding of the advances that shape our field and to celebrate the achievements of those at its forefront.
1. Does an improvement in intraoperative neuromonitoring cord data indicate a reduced risk for postoperative deficit in spine deformity surgery?
Corresponding Author: Nathan Lee
What question is your research attempting to answer?
Given the significant risk for neurologic complications in spinal deformity surgery, intraoperative neuromonitoring (IONM) is considered a valuable tool which can provide immediate feedback on potential neurologic changes throughout surgery. The efficacy of IONM and risk factors for neurologic deficit have been extensively studied in prior literature. However, it remains unclear what the implications of cord-level IONM data improvement has on actual postoperative exam for spinal deformity surgery. We hypothesized that IONM not only provides greater clarity for when IONM loss occurs, but also can reassure surgeons that IONM recovery after an intraoperative intervention indicates a reduced risk for neurologic deficit. Please summarize your key findings and comment on the clinical significance.
In this study of 1,106 pediatric and adult spinal deformity patients, the overall rate of cord-level IONM loss was 4.8%. In comparison, the incidence of new postoperative day 1 (POD1) and day of discharge motor deficit was 1.6% and 0.9%, respectively. The difference in rates between IONM loss and actual postoperative exam can be explained by the IONM data improvement observed in 85% of patients who had data loss and all patients with IONM loss underwent an intraoperative intervention. Furthermore, both full and partial improvements in IONM data after intraoperative intervention were significantly associated with lower risk for POD1 deficit with an absolute risk reduction of 89% and 59%, respectively. However, all patients without any IONM improvement by closure sustained a new POD1 deficit. On the day of discharge, 88% of these patients without any IONM improvement continued to have a postoperative motor deficit compared to preoperative exam. Most cord alerts occurred during a thoracic level 3-Column Osteotomy (3CO) (N=23/53 (43%); decompression=12, compression=7, exposure=4) and rod placement (N=14). Interventions were performed in all 53 patients with cord-level IONM loss. Common interventions included removing rods/less correction (N=11), increasing mean arterial pressure alone (N=10), and further decompression with 3CO (N=9). After intervention, IONM data improved in 45 (84.9%) of patients: full improvement: N=28 (53%); partial improvement: 17 (32%); no improvement 8 (15%). For those with full and partial IONM improvement, a new POD1 motor deficit was seen in 10.7% (3/28) and 41.2% (7/17) of patients, respectively. On the day of hospital discharge, the rates for new motor deficits were 3.6% (1/28) and 11.8% (2/17), respectively. For those without any IONM improvement (15.1%, 8/53) by closure, 100% (8/8) had a new POD1 deficit, P<0.001. By day of discharge, 87.5% (7/8) of those without any IONM improvement continued to have a postoperative motor deficit compared to their preoperative exam, P<0.001. The timing of motor evoked potential (MEP) improvement after an intervention appears bimodal in distribution, where cases with a full IONM improvement typically occurred within 60 minutes after an intervention (85.7%, 24/28). In contrast, most cases with only partial improvement occurred beyond 60 minutes (58.8%, 10/17). When comparing the rates for POD1 deficit by timing of IONM improvement (less than 60 minutes versus greater than 60 minutes), no significant difference was observed (P=0.931). What is surprising/exciting/different about your research results? (For example, do they affirm or debunk any existing spine treatment or diagnosis?)
Our findings demonstrate that the majority of IONM alerts can improve with appropriate intraoperative interventions. Furthermore, either a full or partial improvement in IONM data after intraoperative intervention can significantly lower the risk for early postoperative deficit with an absolute risk reduction of 89.3% and 58.8%, respectively. Only 3/45 (6.7%) of these patients had a new motor deficit at hospital discharge. However, for those without any IONM return, all awoke with a new neurologic deficit which persisted to hospital discharge in all but one patient (7/8, 88%) In what ways do you envision your research influencing or shaping future directions in spine-related research, clinical practice, or health policy?
To the author’s knowledge, this is the largest single surgeon consecutive patient series examining the utility of cord-level IONM in adult and pediatric spinal deformity with correlative postoperative neurologic function. Our findings demonstrate that the majority of IONM alerts can improve with appropriate intraoperative interventions. Furthermore, either a full or partial improvement in IONM data after intraoperative intervention can significantly lower the risk for early postoperative deficit with an absolute risk reduction of 89.3% and 58.8%, respectively. Only 3/45 (6.7%) of these patients had a new motor deficit at hospital discharge. However, for those without any IONM return, all awoke with a new neurologic deficit which persisted to hospital discharge in all but one patient (7/8, 88%). Future studies will need to involve large prospective multicenter studies with standardized neuromonitoring practices to validate these findings.
2. Neurologic adverse events following three-column osteotomy: a prospective multicenter study
Corresponding Author: Andrew Kim, BS, Johns Hopkins Hospital
What question is your research attempting to answer?
Our research study aims to identify the rate of neurologic complications following adult spinal deformity (ASD) surgery and to characterize the differences in incidence between patients with and without three-column osteotomy (3CO). Please summarize your key findings and comment on the clinical significance.
ASD patients who underwent 3CO were more likely to be revision patients, present with sagittal deformity, and have greater operating room time and estimated blood loss compared to those without 3CO. There was a greater overall incidence of early postoperative adverse neurologic events among patients with 3CO compared to patients without 3CO (15.4% vs 23.1%). Interestingly, no difference in lower extremity motor strength (LEMS) was observed at 1-year follow-up or 1-year change from baseline between the two cohorts. What is surprising/exciting/different about your research results? (For example, do they affirm or debunk any existing spine treatment or diagnosis?
3CO is considered to have a high rate of neurologic complications. Although our study demonstrated that patients undergoing 3CO had a higher incidence of adverse neurologic events in the early postoperative period, change in LEMS from baseline to 1-year follow-up demonstrated no significant difference between the two cohorts. While rates of neurologic complications and patient-reported outcomes have been previously reported following 3CO, to our knowledge, this is the first study to compare and characterize sensory and motor complications between ASD patients with and without 3CO. How can this research ultimately apply to or benefit spine patients? (Will it make diagnosis/treatment/payment any easier/less expensive/better in the future?)
This study aims to provide a comprehensive characterization of anticipated neurologic complication rates among ASD patients undergoing 3CO. It also demonstrates that patients with and without 3CO achieved motor recovery in LEMS by 1-year follow-up. In what ways do you envision your research influencing or shaping future directions in spine-related research, clinical practice, or health policy?
Among ASD patients, risk of complication should not be considered a contraindication to performing 3CO as our study demonstrates no changes in LEMS or neurologic deficits at 1-year follow-up. Surgeons should choose the procedure that they feel is the best to correct a patient’s spinal deformity based on the individual patient’s risk profile and surgeon experience. Do you have any photos or images that could help a reporter understand this research and explain it to their audience?
Figure 1. Radiographs of a 62-year old male undergoing revision posterior fusion with extension, 3-column osteotomy at L3, bilateral pelvic fixation using S2AI screws, lateral extra-cavitary fusion at L2-L3, and anterior lumbar interbody fusion at L5-S1. A. Preoperative EOS - AP. B. Preoperative EOS - lateral. C. 1-year EOS - AP. D. 1-year EOS - lateral.
3. Two-year revision and adjacent segment disease after degenerative spinal fusion and impact of segmental lordosis restoration
Senior Author: Alan Daniels, MD
What question is your research attempting to answer?
This investigation aimed to assess the rate of reoperation and adjacent segment disease in patients undergoing transforaminal lumbar body fusion (TLIF) for lumbar degenerative spine pathology. A secondary aim was to determine if there was an association between reoperation for adjacent segment pathology and suboptimal restoration of proper lumbar spinal alignment. Please summarize your key findings and comment on the clinical significance.
Following TLIF, our cohort’s rates of reoperation and adjacent segment pathology were 16% and 28%, respectively. In patients well aligned between L4-S1, the rate of adjacent segment disease was 5.2% compared with 29.7% in patients who were malalignment in these segments. These results suggest that restoring and/or maintaining proper sagittal alignment is important to improve outcomes in short segment lumbar fusion. What is surprising/exciting/different about your research results? (For example, do they affirm or debunk any existing spine treatment or diagnosis?
There is a significant body of research that supports restoring and maintaining lumbar spine alignment to improve patient outcomes following surgery for adult spinal deformity. Despite this, similar evidence has been somewhat elusive in degenerative spinal pathology. This study highlights an association between spinal alignment and outcomes following short segment fusion. How can this research ultimately apply to or benefit spine patients? (Will it make diagnosis/treatment/payment any easier/less expensive/better in the future?)
These finding suggest that careful restoration of spinal alignment, even during 1- or 2-level fusion may reduce future reoperation, and thereby reduce future financial costs to the patient and healthcare system. In what ways do you envision your research influencing or shaping future directions in spine-related research, clinical practice, or health policy?
This data will encourage carefully restoring and maintaining proper alignment at indicated levels whenever possible.
4. The Impact of Cannabis on Opioid Use and Postoperative Complications in Cervical Fusion: A Population-based Longitudinal Cohort Study
Corresponding Author: Mohammed S. Abdullah, MD
What question is your research attempting to answer?
Our research is driven by a critical question: How does cannabis use impact perioperative complications and postoperative opioid use in patients undergoing primary 1- to 2-level fusion? Given the rising prevalence of cannabis use, understanding its implications in surgical settings is paramount. Please summarize your key findings and comment on the clinical significance.
- Increased Hospital Readmission: We found that patients with cannabis use had a significantly higher likelihood of being readmitted to the hospital after postoperative day 7 (OR 1.796, p < 0.0001). This suggests that cannabis use may complicate recovery, necessitating closer postoperative monitoring.
- Opioid Use: Alarmingly, patients with cannabis use had higher rates of postoperative opioid use (OR 1.492, p < 0.0001), challenging existing literature that may suggest perioperative cannabis use may be a useful adjunct.
- Emergency Department Visits: Cannabis users experienced a notable increase in ED visits (OR 1.376, p = 0.0129), suggesting that these patients may experience more complications or require additional care.
These findings underscore the importance of preoperative screening for cannabis use and tailored perioperative care strategies to mitigate risks and improve patient outcomes.
What is surprising/exciting/different about your research results? (For example, do they affirm or debunk any existing spine treatment or diagnosis?
What stands out in our research is the comprehensive analysis of cannabis use's impact on surgical outcomes, an area that has been largely overlooked. Our findings challenge the notion that cannabis is a benign substance in the context of surgery, revealing significant risks that necessitate a reevaluation of preoperative care protocols. This is both exciting and crucial as it opens new avenues for improving patient safety and surgical outcomes. How can this research ultimately apply to or benefit spine patients? (Will it make diagnosis/treatment/payment any easier/less expensive/better in the future?)
By incorporating cannabis use into preoperative assessments, healthcare providers can better anticipate and manage potential complications. This proactive approach can lead to reduced hospital readmissions, lower opioid dependency, and overall better recovery experiences for patients, ultimately making spine surgery safer and more effective. In what ways do you envision your research influencing or shaping future directions in spine-related research, clinical practice, or health policy?
This study paves the way for future research to delve deeper into the mechanisms by which cannabis affects surgical outcomes. Clinically, it advocates for the development of specific guidelines for managing patients who use cannabis, ensuring they receive the best possible care. On a policy level, it highlights the need for cannabis use to be a standard consideration in preoperative evaluations, potentially influencing health policies to improve patient safety and outcomes.
5. Does cervicothoracic flexibility affect clinical outcomes in patients undergoing multi-level posterior cervical fusions?
Senior Author: Eeric Truumees, MD, FAOA, FAAOS; Attending Spine Surgeon, Ascension Seton Medical Center, Professor of Orthopaedic and Neurological Surgery, University of Texas, Dell Medical School; Co-Director, Ascension Texas Spine Program
What question is your research attempting to answer?
The outcomes of patients undergoing long (3+) level posterior cervical fusions for cervical myelopathy are strongly impacted by their ultimate sagittal balance (cSVA). A positive spinal imbalance, the head lying ahead of the body’s center of gravity, makes the head relatively heavier leading to muscle fatigue and strain, possible muscle fascia failure, pain, and decreased quality of life. Over time, useful tools for planning lumbar surgery have evolved to help surgeons optimize the patient’s final alignment. In previous studies, we have found that a successful cervical fusion can “lock in” lordosis of the cervical spine itself, but overall malalignment can still occur due, apparently, to flexibility of the thoracic spine. We sought to explore the relationship between thoracic flexibility and final cervical alignment and, secondarily, the relationship between that alignment and clinical outcome. Please summarize your key findings and comment on the clinical significance.
We measured thoracic alignment, as reflected by the T1 slope, when supine and when upright. In patients with more flexible thoracic curves, much greater positive sagittal cervical imbalance (head forward positioning) was noted. This finding was also associated with significantly higher pain and disability. This finding may allow surgeons to select more appropriate surgeries to optimize outcomes in these patients. What is surprising/exciting/different about your research results? (For example, do they affirm or debunk any existing spine treatment or diagnosis?
The importance of spinal balance has been increasing over recent years. However, much of the initial emphasis has been in the thoracolumbar spine and then in patients presenting for cervical deformity conditions. This work extends this understanding in patients with more common, cervical degenerative disease (arthritis) leading to spinal cord compression (myelopathy). In the spine world, many see the thoracic spine as relatively rigid, due to the presence of the rib cage. In reality, the thoracic spine can be flexible, and that flexibility can affect the results of a number of different types of surgeries. How can this research ultimately apply to or benefit spine patients? (Will it make diagnosis/treatment/payment any easier/less expensive/better in the future?)
While assessing thoracic flexibility may add some complexity to a surgeon’s pre-operative decision making, these data will be useful in reviewing various treatment options with patients. In some, higher risk patients, smaller or all anterior procedures may be preferred. In others, longer surgery to better restore cervical alignment may be needed. This work is iterative. Our ongoing work, and others working in this space, seek to offer patients and surgeons tools that will focus decision making, improve outcomes and reduce complications. In what ways do you envision your research influencing or shaping future directions in spine-related research, clinical practice, or health policy?
Our ultimate goal is to improve the pain and function of patients undergoing cervical spine surgery for cord compression. Historically, we focused on getting a good decompression of the cord as safely as we could. This remains the major goal of surgery. However, we now know that we can also improve or maintain neck alignment. When we carefully assess pre-operative parameters, our surgical decision making improves. This research needs to be expanded, ideally in larger, prospective studies with narrow inclusion criteria. Our group is seeking partner hospitals and universities to move these studies forward. Do you have any photos or images that could help a reporter understand this research and explain it to their audience?
Included are images from a patient in our group 1 (low difference between T1 slope when upright and simulated T1 slope when supine). The first image is the pre-operative lateral. The second is the MRI. The third is a follow-up film showing well maintained cervical alignment. The second 3 images represent a patient from group 3 (high difference between T1 slope when upright and simulated T1 slope when supine). In this patient, while the cervical curvature itself was maintained by the fusion and instrumentation, a marked loss of alignment with the head moving far forward was noted.
Included are images from a patient in our group 1 (low difference between T1 slope when upright and simulated T1 slope when supine). The first image is the pre-operative lateral. The second is the MRI. The third is a follow-up film showing well maintained cervical alignment. The second 3 images represent a patient from group 3 (high difference between T1 slope when upright and simulated T1 slope when supine). In this patient, while the cervical curvature itself was maintained by the fusion and instrumentation, a marked loss of alignment with the head moving far forward was noted.
6. Effect of elective cervical spine surgery on mental health of patients with degenerative cervical myelopathy (DCM): a CSORN study
Corresponding Author: Khaled Skaik, BHSc; Medical Student at McGill University; Primary Author: Philippe Phan, Orthopedic Spine Surgeon at The Ottawa Hospital
What question is your research attempting to answer?
Main question: Does mental health status improve following cervical spine surgery in patients with degenerative cervical myelopathy?
Context: We know from previous studies that degenerative spine pathologies such as degenerative cervical myelopathy (DCM) can affect the quality of life in patients. We also know that mental health conditions such as depression may be exacerbated by, or incited, by the experience of disability and/or chronic pain caused by spine pathologies. So, we asked whether mental health status improves following cervical spine surgery. If so, is there a difference in improvements between preoperatively depressed and non-depressed patients? Please summarize your key findings and comment on the clinical significance.
Main findings:
a) One-year post-surgery, patients were found to have improved mental health status accompanied with improved health-related quality of life measures.
b) The degree of improvement in mental health and quality of life measures did not vary depending on the severity of the cervical disease.
c) Mental health improvements were evident solely when a minimal clinically important difference (MCID) was seen in DCM improvement. Conversely, when the MCID for DCM improvement was not achieved, mental health status worsened.
d) The degree of improvement in mental health was higher in preoperatively depressed patients compared to nondepressed patients. In fact, patients suffering from depression preoperatively were found to have higher odds of improvements in mental health following cervical surgery.
All the above findings are statistically significant with p<0.0001. What is surprising/exciting/different about your research results? (For example, do they affirm or debunk any existing spine treatment or diagnosis?
What’s surprising is that when the MCID for DCM improvement was not achieved, mental health status worsens significantly! An improvement in mental status was only observed when MCID for DCM improvement is achieved. How can this research ultimately apply to or benefit spine patients? (Will it make diagnosis/treatment/payment any easier/less expensive/better in the future?)
Given our observation that preoperatively depressed patients exhibit greater odds of experiencing improvements in mental health, it follows that a more compelling recommendation for cervical surgery should be given to patients suffering from depression preoperatively with DCM. In what ways do you envision your research influencing or shaping future directions in spine-related research, clinical practice, or health policy?
A more compelling recommendation for cervical surgery can be given to patients suffering from depression preoperatively with DCM.
Figure 1. mJOA stands for modified Japanese Orthopaedic Association, which is a score used to evaluate the severity of DCM. MCS stands for Mental component score which is a score used to evaluate mental health status.
9. Addressing the challenge of spine patient triage: development of a simple algorithm for identification of potential surgical candidate
Corresponding Author: Justin Turcotte, PhD, MBA
What question is your research attempting to answer?
In this study we aimed to answer the question, “What characteristics of newly presenting spine patients are predictive of surgical treatment?” Using this data, we developed a simple algorithm for identifying patients most likely to require surgical management of spine conditions that could be used to appropriately triage this population to spine surgeons. Please summarize your key findings and comment on the clinical significance.
Key Findings: Using a combination of machine learning and traditional statistical analysis techniques, we identified 5 patient characteristics that were most predictive of requiring surgery: a patient goal of interest in learning about spine surgery, history of spine injections, difficulty walking over a mile, primarily radicular symptoms, and age over 60 years. Notably, each of these factors can be easily assessed by phone or internet self-scheduling platforms in advance of the first appointment, making them applicable in clinical practice. Using the odds ratios from the multivariable model as “points” for a positive response to each question, the final algorithm was generated. The decision support tool yielded a sensitivity of 60.0%, specificity of 76.6%, likelihood ratio of 2.56, positive predictive value of 17.2%, and negative predictive value of 96.0% for predicting surgery, with an AUC of 0.683.
Clinical Significance: The global demand for spine care is expected to increase over the next decade. Spine care providers -- including spine surgeons – will be tasked to provide value-based care with efficient use of resources. By implementing a decision support model such as the one developed in this study, multidisciplinary spine care providers can streamline care by quickly matching patients to the most appropriate surgical or non-surgical specialist. What is surprising/exciting/different about your research results? (For example, do they affirm or debunk any existing spine treatment or diagnosis?
While prior studies have developed models for predicting which patients will undergo surgery, there are limitations to their translatability into practice. These include a narrow focus on a specific condition; the use of clinical and imaging data that cannot be determined or interpreted in advance of the initial evaluation; and reliance on sophisticated machine learning techniques. The most exciting finding from our results is that a simplified model yielded predictive accuracy that is largely in alignment with these prior studies. This approach can be easily incorporated into practice using existing workflows already in place at most institutions. How can this research ultimately apply to or benefit spine patients? (Will it make diagnosis/treatment/payment any easier/less expensive/better in the future?)
Spine patients are a heterogeneous population, making initial triage to the most appropriate provider among a multidisciplinary care team extremely difficult. Multiple visits among multiple subspecialists is not only frustrating and dissatisfying to patients, but is an inefficient and costly use of resources. By implementing the basic decision support tool developed in this study, we hope to improve value to both patients and the healthcare system by more accurately triaging patients and reducing unnecessary visits within the same, multidisciplinary team. However, this study only scratches the surface of this challenging issue. Much work remains to be done to improve the efficiency of care delivered to non-surgical patients which comprised over 90% of our study population. In what ways do you envision your research influencing or shaping future directions in spine-related research, clinical practice, or health policy?
In our experience, the use of predictive analytics in daily clinical practice is in its infancy at this point in time. With the rapid expansion of artificial intelligence, the integration of more complex triage models and other decision support tools into electronic health records and operational systems will likely proliferate in the near future. While our study generated an approach that can be used broadly across institutions immediately, we look forward to developing and evaluating more sophisticated models as the resources required to deploy these in practice become more accessible. Do you have any photos or images that could help a reporter understand this research and explain it to their audience?
10. Outcomes of 3-level cervical disc arthroplasty comparing with 3-level ACDF
Corresponding Author: Hanzi Leo Yang, Medical Student, University of Virginia School of Medicine
What question is your research attempting to answer?
At present, FDA approval for cervical disc arthroplasty (CDA) devices is limited to 1- to 2-level disc pathologies. Limited information exists for CDA beyond 2 levels, which is carried out as off-label procedure and considered experimental. This research aims to bridge this knowledge gap and investigate the short- and mid-term outcomes of 3-level CDA versus 3-level anterior cervical discectomy and fusion (ACDF). Please summarize your key findings and comment on the clinical significance.
This study highlights that patient who underwent 3-level CDA had significantly lower rates of postoperative complications, including dysphagia, pneumonia, wound complications, surgical site infections, emergency department visits, and readmissions within 90 days compared to those who underwent 3-level ACDF. In the mid-term follow-up, CDA also demonstrated fewer instrumentation failures at 2 years and reduced overall revision surgeries at four years. These findings suggest that 3-level CDA is a safer and noninferior alternative to ACDF, with potential advantages in reducing postoperative complications. What is surprising/exciting/different about your research results? (For example, do they affirm or debunk any existing spine treatment or diagnosis?
The study provides substantial evidence that 3-level CDA can have better postoperative outcomes than 3-level ACDF, particularly in reducing dysphagia and readmissions, as well as other complications. These results reinforce the growing belief that CDA, despite being relatively new compared to ACDF, presents promising results and could be an effective alternative treatment for multilevel cervical disc pathologies. How can this research ultimately apply to or benefit spine patients? (Will it make diagnosis/treatment/payment any easier/less expensive/better in the future?)
This research evaluated the potential of 3-level CDA as a standard treatment option, offering patients fewer postoperative complications, lower readmission rates, and a reduced need for revision surgery compared to ACDF. This could also lead to better quality of life post-surgery, as well as reduced healthcare costs due to less expensive surgery, reduced complications and fewer readmissions. In what ways do you envision your research influencing or shaping future directions in spine-related research, clinical practice, or health policy?
This research could prompt further studies on 3-level CDA to validate its long-term efficacy and safety. Clinically, these findings could promote more surgeons to consider CDA as a viable alternative to ACDF for treating multilevel cervical disc conditions. Health policy might eventually recognize the benefits of CDA, which could influence insurance coverage and reimbursement practices, thereby improving patient access to this treatment. Is there anything else you would like readers to know about this paper?
The paper represents the largest comparative study to date focusing on the outcomes of 3-level CDA and ACDF. While the results are promising, our research calls for further research to validate the long-term safety and efficacy of 3-level CDA. Do you have any photos or images that could help a reporter understand this research and explain it to their audience?
Significant findings are presented in the bar graph below.
Responses not available at time of publication:
7. The dreaded false negatives - when intraoperative neuromonitoring fails to detect neural deficits associated with complex, noncord-level spinal deformity corrections
8. AJCC score and hormone receptor status predicts 1-, 2-, and 5-year mortality rates in patients who undergo spine surgery for metastatic breast cancer to the spine