Background/Objectives: The etiology of lumbar spine revision surgery is multifactorial, involving mechanical, biological, and clinical factors that challenge sustained spinal stability. Comparative analysis reveals significantly higher complication rates, prolonged hospital stays, and increased costs for revision surgeries compared to primary fusions, despite low mortality rates. Leveraging a comprehensive dataset of 456,750 patients, this study identifies predictors of revision surgery and provides actionable insights to enhance patient outcomes and optimize healthcare resource allocation. Methods: A total of 456,750 patients registered in the National Inpatient Sample (NIS) database from 2016 to 2019 were identified as having undergone single-level lumbar fusion surgery (primary fusion: 99.5%; revision fusion: 0.5%). Multivariable logistic regression models adjusted for patient demographics, clinical comorbidities, and hospital characteristics were constructed to evaluate clinical outcomes and postoperative complications. Results: Patients undergoing revision lumbar fusion surgery were significantly younger compared to those undergoing primary fusion procedures (53.92 ± 20.65 vs. 61.87 ± 12.32 years, p < 0.001); among the entire cohort, 56.4% were women. Compared with patients undergoing primary lumbar fusion, those undergoing revision fusion surgery were significantly more likely to experience surgical site infections (odds ratio [OR] 27.10; 95% confidence interval [95% CI] 17.12–42.90; p < 0.001), urinary tract infections (OR 2.15; 95% CI 1.39–3.33; p < 0.001), and prolonged length of stay (OR 1.53; 95% CI 1.24–1.89; p < 0.001). Revision surgery patients had significantly lower odds of incurring high-end hospital charges (OR 0.65; 95% CI 0.51–0.83; p < 0.001). Other complications, including respiratory complications, dural tears, thromboembolic events, and acute renal failure, showed no statistically significant differences between the two groups. In-hospital mortality rates were low and did not differ significantly between groups (revision: 0.2% vs. primary: 0.1%, OR 3.29; 95% CI 0.45–23.84; p = 0.23). Conclusions: Patients undergoing revision lumbar fusion surgeries face significantly higher risks of surgical site infections, urinary tract infections, and prolonged hospital stays compared to primary fusion procedures. These findings highlight the need for targeted interventions to improve perioperative management and reduce complications in revision lumbar fusion surgery.

Spinal cord ischemic reperfusion injury is characterized by an abrupt decline in neurological function and only a few cases have been published in literature. Herein, we present a white cord syndrome following anterior decompression cervical fusion. A 54-year-old Jewish male patient was diagnosed with disc herniation among the intervertebral discs at C2, C3, C4, C6, and C7, along with ossification of the posterior longitudinal ligament, pressuring more to the right side of the spinal canal, ruling-out cervical myelopathy. Under general anesthesia and multimodal intraoperative monitoring, he underwent laminectomy surgery from C3 to C6 and cervical fixation from C3 to C7. No blood pressure fluctuations occurred during surgery, and complete pressure release was achieved on the spinal cord and the nerve roots. In addition, neuromonitoring did not indicate any nerve damage during the surgery. A neurologic exam in the post-anesthesia care unit revealed weakness in his right hand and leg. A brain computed tomography scan ruled out cerebrovascular accident, neck computed tomography revealed optimal implant position, and magnetic resonance imaging ruled out spinal cord distress or injury. We treated him with intravenous fluids, steroids, painkillers, and anticoagulants. Following surgery, we involved the occupational therapy department. After a few days, we observed a significant improvement in motor function in the right leg; however, there was no change in the right hand. White cord syndrome likely arises from reperfusion injury subsequent to surgical decompression of a compressed spinal cord segment. Although infrequent, it is imperative for spine surgeons to recognize this potential complication and apprise patients of it prior to the procedure.

Background/Objectives: Reverse total shoulder arthroplasty (RTSA) is increasingly common, but large-scale studies on age-related differences in outcomes are limited. This study aims to evaluate epidemiological trends, clinical indications, and postoperative outcomes in patients under 65 undergoing RTSA. Methods: We analyzed data from the Nationwide Inpatient Sample (NIS) from 2016–2021, including 48,460 patients aged 35–64 undergoing shoulder arthroplasty. Patients were stratified into three age groups: 35–45, 46–55, and 56–65 years. We assessed trends, clinical indications, comorbidities, hospital stay metrics, and postoperative complications using chi-square tests, ANOVA, and multivariate logistic regression. Results: Procedure volumes increased from 2016 to 2019, peaking at 2007 cases, but declined in 2020 and 2021 (924 cases). The 56–65 age group consistently comprised the majority of procedures (81.7% in 2016 to 88.3% in 2021). Comorbidities like type 2 diabetes (5.9% to 22.8%), hypertension (27.9% to 55.3%), and dyslipidemia (10.3% to 40.5%) increased with age (p < 0.001). Rotator cuff tears were more prevalent in older patients (25% to 48.5%, p < 0.001), while instability was higher in the youngest group (8.8%, p < 0.001). Osteoarthritis was the most common indication, increasing with age (56.6% to 62.5%, p < 0.001). Cardiac complications increased with age (2.2% to 5.1%, p = 0.04). Female gender (OR = 1.548, p < 0.001), private insurance (OR = 1.570, p < 0.001), and small hospital size were associated with higher odds of cardiac complications. Native American race showed lower odds (OR = 0.308, p = 0.009) compared to White patients. Conclusions: Significant age-related differences exist in comorbidities, clinical indications, and postoperative complications following RTSA. Older patients had higher rates of comorbidities and cardiac complications, while younger patients presented with instability. These findings highlight the importance of age-specific perioperative management to optimize outcomes.

Background: Ankle arthrodesis (AA), or ankle fusion, is a surgical procedure used to treat severe ankle pathologies, particularly in patients with chronic pain and reduced mobility due to conditions like osteoarthritis, posttraumatic arthritis, and Charcot arthropathy. Diabetic patients undergoing AA often face higher risks of complications due to comorbidities such as dyslipidemia and hypertension. This study aims to compare the outcomes of AA in diabetic vs nondiabetic patients, using data from the Nationwide Inpatient Sample (NIS) from 2016 to 2019. Methods: Using the Nationwide Inpatient Sample database, 12 325 patients who underwent ankle arthrodesis were identified from 2016 to 2019 based on ICD-10 procedure codes. χ² tests and t tests were used for univariate analysis, followed by multivariate logistic regression to assess complications between diabetic and nondiabetic patients. Temporal trends in surgical volume were analyzed using linear regression models, and risk ratios were calculated for perioperative complications during the index hospital stay. Results: Primary osteoarthritis was the most common cause, accounting for 55.4% of AA procedures. Multivariate logistic regression revealed that diabetes mellitus (DM) was significantly associated with increased risks of blood loss (odds ratio [OR] 1.59, 95% CI 1.23-2.05, P = .004), infection (OR 3.12, 95% CI 2.55-3.82, P < .001), heart failure (OR 1.35, 95% CI 1.06-1.73, P = .01), and acute kidney injury (OR 2.42, 95% CI 1.57-3.75, P = .001). No significant association was observed between DM and pneumonia (OR 2.27, 95% CI 1.645-4.605, P = .20). Conclusion: Diabetic patients undergoing AA have higher rates of comorbidities and postoperative complications, leading to longer hospital stays. These findings highlight the need for comprehensive preoperative and postoperative care to improve outcomes in this population. Level of Evidence: Level III, retrospective study.

Background: End-stage ankle osteoarthritis (OA) severely limits function and quality of life. Total ankle arthroplasty (TAA) and ankle arthrodesis (AA) are key surgical interventions when conservative treatment fails. This study compares TAA and AA outcomes using a national dataset to inform patient-centered care. Methods: A retrospective analysis of 27,595 patients undergoing TAA or AA from 2016–2019 was conducted using the National Inpatient Sample. Propensity score matching addressed baseline differences. Results: Primary OA was more prevalent in TAA (85.9%) than in AA (55.4%). TAA utilization rose from 73% to 78% (p < 0.0001), while AA declined. TAA patients were older (65.6 vs. 59.7 years), more often Medicare-insured, and predominantly Caucasian. AA patients had higher rates of comorbidities, including diabetes, obesity, lung disease, and mental disorders (all p < 0.0001). Conclusions: TAA and AA cater to distinct patient profiles. TAA is increasingly favored and associated with lower immediate risks, though procedure choice should be individualized based on comorbidities and risk profiles. These insights support evidence-based decision-making in end-stage ankle OA management.