Background: Early diagnosis of degenerative cervical myelopathy (DCM) is often challenging due to subtle, non-specific symptoms, limited disease awareness and a lack of definitive diagnostic criteria. As primary care physicians are typically the first to encounter patients with early DCM, equipping them with effective screening tools is crucial for reducing diagnostic delays and improving patient outcomes. This systematic review evaluates the efficacy of quantitative screening methods for DCM that can be implemented in primary care settings. Methods: A systematic search following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted across PubMed, Embase and Cochrane Library up to July 2024 using keywords relevant to DCM screening. Studies were included if they evaluated the sensitivity and specificity of DCM screening tools applicable to primary care settings. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Results: The search identified 14 studies evaluating 18 screening methods for DCM. Questionnaires consistently showed high diagnostic accuracy, with Youden indices exceeding 0.60, while only three out of nine conventional physical performance tests met the same threshold. Sensor-assisted tests, particularly those using advanced technology like finger-wearable gyro sensors, exhibited the highest diagnostic accuracy but present challenges related to accessibility and learning curves. Conclusion: This review highlights the potential of quantitative screening methods for early DCM detection in primary care. While questionnaires and conventional tests are effective and accessible, sensor-assisted tests offer greater accuracy but face implementation challenges. A tailored, multifaceted approach is crucial for improving outcomes. Future research should focus on validating these tools in diverse populations and standardising diagnostic criteria.

Objective: This study analyzed Medicare utilization and reimbursement trends for endoscopic discectomy and microdiscectomy from 2017 to 2021 to assess the adoption of endoscopic discectomy, the potential effect on microdiscectomy volume, and the impact of healthcare policy changes on these procedures. This analysis will help shape future economic reimbursement models for lumbar disc herniation surgeries.Methods: Medicare Part B data for endoscopic discectomy (Current Procedural Terminology [CPT] code 62380) and microdiscectomy (CPT code 63030) from 2017 to 2021 were analyzed. Long-term trends were reviewed using 2000–2016 microdiscectomy data. Total percent changes for procedural volume and mean reimbursement per procedure were evaluated, adjusting all financial figures to 2021 United States dollars using the Consumer Price Index. Trends were assessed using simple linear regression.Results: From 2017 to 2021, Medicare documented 2,344 endoscopic discectomies and 126,501 microdiscectomies. Endoscopic discectomy volume increased by 8.58%, while microdiscectomy volume decreased by 27.78%, with a significant declining trend (p=0.006). The negative trend in microdiscectomy volume trend from 2017 to 2021 reflected an ongoing decline from 2000 to 2021. The inflation-adjusted mean reimbursement per endoscopic discectomy decreased by 27.51%, whereas the mean reimbursement per microdiscectomy marginally increased by 1.54%.Conclusion: Since the introduction of the endoscopic discectomy CPT code, endoscopic discectomy has had limited adoption and decreasing reimbursement, while microdiscectomy volume declined despite reimbursements aligning with inflation—a decrease not explained by increased endoscopic use. The alignment of microdiscectomy reimbursement with inflation has required repeated legislative interventions. Further research is essential to optimize future spinal surgery reimbursement strategies.

Introduction: Anterior cervical discectomy and fusion (ACDF) is a common procedure for cervical degenerative disc disease, with a growing shift toward outpatient surgery. Despite advancements enabling shorter hospital stays, same-day discharge remains a complex decision influenced by factors such as case timing and surgeon-specific practices. This study aims to identify patient and operational factors associated with same-day discharge following ACDF.Methods: We retrospectively analyzed all elective ACDF procedures performed by 24 different surgeons across 3 affiliated hospitals within a large urban health system between January 2021 and December 2022. Patient and clinical factors, case timing, and surgeon-specific practices were compared between patients who received same-day discharge and those who were admitted on the same day following ACDF.Results: Among the 530 elective ACDF procedures analyzed, 18.5% resulted in same-day discharge. Same-day discharge occurred significantly more frequently in procedures involving fewer operative levels, no surgical drain, and lower estimated blood loss (EBL). In contrast, factors such as age, Charlson Comorbidity Index, American Society of Anesthesiologists score, and preoperative antiplatelet or anticoagulation use did not significantly impact discharge rates. Earlier case completion times were strongly associated with same-day discharge, with 69.4% of such discharges occurring in cases completed before 14:00. Surgeon preference emerged as a key determinant, with the 15 surgeons who performed 10 or more procedures falling into 3 distinct categories: those who never, rarely, or routinely discharged patients on the same day.Conclusions: Surgeon preference plays a critical role in shaping discharge decisions following ACDF. Alongside case complexity, EBL, drain usage, and timing, surgeon preference strongly influences whether a patient is discharged on the same day. Identifying and understanding the concerns underlying variable surgeon practice patterns will help promote standardization of discharge criteria, optimize selection for same-day discharge, and improve healthcare resource utilization.

Study Design: Retrospective cohort study. Objectives: We aimed to identify factors associated with mortality and morbidity in geriatric patients with complete cervical spinal cord injury (cSCI) and compare outcomes to middle-aged patients using national trauma data. Methods: We conducted a retrospective cohort study of 1147 patients aged ≥40 with complete cSCI from the 2019-2021 American College of Surgeons Trauma Quality Program. Patients were grouped as middle-aged (40-69 years, n = 798) or geriatric (≥70 years, n = 349). Those with severe head trauma or pre-admission death were excluded. Outcomes included in-hospital mortality, complications, intensive care unit (ICU) length of stay, and ventilator duration. Multivariate logistic and linear regression models assessed factors associated with each outcome. Results: Geriatric patients had significantly higher mortality (60.7%) compared to middle-aged patients (23.2%, P < 0.001). Surgical management was associated with reduced mortality in both groups (OR 0.2, P < 0.001) but was less frequently performed in geriatric patients (59.9% vs 81.0%, P < 0.001). Complications were more common in middle-aged patients (47.6% vs 36.4%, P < 0.001), with surgery predicting increased complication risk. Geriatric patients had shorter ICU stays (11.2 vs 17.0 days, P < 0.001) and ventilator duration (11.6 vs 18.1 days, P < 0.001). Conclusions: Geriatric patients with complete cSCI had higher mortality and were less likely to undergo surgery, despite its association with improved survival. Lower morbidity in this group may reflect earlier mortality or less aggressive care. Individualized surgical decision-making is essential to ensure equitable treatment for older patients.

Background: Paediatric cervical spinal cord injuries (cSCIs) from motor vehicle crashes (MVCs) are rare but often devastating. This study aimed to characterise injury patterns, restraint use and inpatient outcomes among paediatric passengers with cSCI. Methods: A retrospective cohort analysis was conducted using the American College of Surgeons Trauma Quality Programme database from 2019 to 2021. Paediatric patients (<18 years) with cSCIs sustained as passengers in MVCs were identified using International Classification of Diseases, Tenth Revision diagnosis and external cause codes. Data included protective device use, demographics, injury mechanisms, SCI severity and hospital outcomes. χ ² and Monte Carlo simulations were used for categorical comparisons, with significance set at p<0.05. Results: A total of 233 paediatric MVC passengers with cSCI were included. The cohort was 21.0% aged 0–3 years, 42.1% aged 4–12 years and 36.9% aged 13–17 years, with 51.9% males and 53.2% White. Restraint use was documented in 58.4% of patients, and 46.4% experienced airbag deployment. Complete cSCI occurred in 34.3% of patients, and 60.3% of these involved C3 or above. Dislocations were more common in younger children, while fractures and cervical spine surgery occurred more frequently in older patients (p<0.001). In-hospital mortality was 20.6% overall but significantly lower in the oldest group (p=0.002). Nearly half (48.9%) were discharged to institutional care. Conclusions: cSCI patterns varied significantly by age group. Restraints were used in only 58.4% of cases, highlighting a critical gap in safety implementation. Given potential confounders, associations with injury severity should be interpreted cautiously.