Background: Despite numerous operative and non-operative treatment modalities, patients with glioblastoma (GBM) have a dismal prognosis. Identifying predictors of survival and recurrence is an essential strategy for guiding treatment decisions, and existing literature demonstrates associations between hematologic data and clinical outcomes in cancer patients. As such, we provide a novel analysis that examines associations between preoperative hematologic data and postoperative outcomes following GBM resection.Methods: We performed a retrospective analysis of patients who underwent GBM resection from January 2016 to December 2020. Standard demographic and clinical variables were collected, including pre-operative complete blood count (CBC), and inferential analyses were performed to analyze associations between CBC parameters and postoperative outcomes.Results: One hundred and eighty nine (189) patients met inclusion criteria, with a mean age of 60.7 years. On multivariate regression analysis, controlling for age, gender, and performance status, we observed trends suggesting anemic patients may have longer lengths of stay (t statistic = 3.23, p = 0.0015) and higher rates of discharge to inpatient facilities [OR 3.01 (1.09–8.13), p = 0.029], though these associations did not reach statistical significance after correction for multiple comparisons (Bonferroni-corrected significance threshold p < 0.01).Conclusion: Preoperative anemia may be a useful pre-operative predictor of postsurgical GBM outcomes. Further study is required to determine whether pre-operative hemoglobin optimization can improve postoperative clinical outcomes, and whether other hematologic and inflammatory markers are predictive of postoperative recovery and functional status.

Study Design: Retrospective single-center cohort study; exploratory feasibility analysis. Objective: To describe the feasibility and 12-month clinical and radiographic outcomes of posterior spinal fusion (PSF) for adult spinal deformity (ASD) with versus without lower limb arthroplasty performed during the same hospital admission, as a hypothesis-generating basis for a subsequent prospective study. Background: Hip-spine and knee-spine syndromes describe the biomechanical interdependence of the lower extremities and the spine. Sequential surgical management is well described, but outcomes when arthroplasty and spinal fusion are performed during a single hospitalization remain poorly characterized. Materials and Methods: We retrospectively reviewed 45 consecutive adult patients who underwent T12–pelvis PSF for ASD at a single academic center between January 2019 and December 2023. All patients received a standardized T12–pelvis construct with selective laminectomies at symptomatic levels. Patients who underwent concurrent lower limb arthroplasty under the same anesthetic event (concurrent group, n = 18; 16 TKA, 2 THA) were compared descriptively with those who underwent PSF alone (spine-only group, n = 27). Clinical outcomes (Oswestry Disability Index, VAS Back and Leg pain) and radiographic sagittal parameters (PI, LL, PT, SS, TK, TPA, SVA) were assessed at baseline and 12 months. Paired within-patient change was analyzed by the Wilcoxon signed-rank; between-group comparisons used Mann–Whitney U for continuous and Fisher exact for categorical variables. A sensitivity ordinary least-squares regression adjusting for age was prespecified. Exact denominators are reported at every time point. Results: The concurrent group was significantly older (74.1 ± 6.1 vs . 65.6 ± 10.2 yr, P = 0.003) with similar BMI and comorbidity profile. Anesthesia time (291.5 ± 84.8 vs . 306.6 ± 99.4 min, P = 0.57) and length of stay (5.8 ± 2.1 vs . 6.2 ± 3.7 d, P = 0.90) did not differ. Among patients with available 12-month radiographs (24/45, 53%), all were assessed as fused. Within-patient paired change in ODI was −18.0 (n = 5) in concurrent vs . −7.7 (n = 14) in spine-only (between-group P = 0.150). ΔVAS Leg reached nominal significance in unadjusted paired analysis (−4.4 vs . −1.5, P = 0.037) but was not significant after adjustment for age (β = −2.5, 95% CI: −6.0 to +1.1, P = 0.17). Structured complications were comparable between groups: proximal junctional failure occurred in 1/18 (6%) concurrent and 2/26 (8%) spine-only patients ( P = 1.00); screw loosening in 3/18 (17%) and 4/21 (19%) respectively ( P = 1.00). No radiographic parameter differed significantly between groups after adjustment. Conclusions: Concurrent lower limb arthroplasty with PSF under a single anesthetic event was feasible in this small ASD cohort, with comparable anesthesia time, length of stay, fusion rates among assessed patients, and structured complication rates. No statistically significant advantage was detected for clinical or radiographic outcomes after adjustment for age. These exploratory findings are hypothesis-generating and require confirmation in prospective multi-institutional studies before any comparative effectiveness inference can be drawn. Level of Evidence: Level III, therapeutic.

Study design: Retrospective cohort study. Objectives: To identify distinct ligamentum flavum (LF) thickness phenotypes in adult spinal deformity (ASD) using measurement-level clustering and to characterize their association with traditional spinopelvic parameters in a proof-of-concept analysis. Methods: LF thickness was measured on preoperative MRI in 44 consecutive ASD patients (2018–2023), yielding 1,250 measurements; complete clinical and radiographic data were available in 40. K-means clustering ( k = 3) was performed at the measurement level, treating thickness regimes as exploratory and unsupervised. Patients were assigned to a dominant phenotype, and all inferential comparisons were performed at the patient level. Between-phenotype differences in spinopelvic parameters were assessed with independent-samples t -tests and Mann–Whitney U -tests, with Hedges g effect sizes. Preliminary clinical and radiological outcomes were reported descriptively. Results: Three measurement-level thickness regimes were identified: Low LF (2.21 ± 0.51 mm, n = 619 measurements), Medium LF (3.92 ± 0.56 mm, n = 499), and High LF (6.11 ± 0.90 mm, n = 132). High-cluster measurements were distributed across 32 patients, but only one patient had High LF as a dominant phenotype and was excluded from comparisons (43 patients analyzed; 25 Low, 18 Medium). Lumbar lordosis differed significantly between Low and Medium phenotypes (Low: −44.6 ± 12.0° vs. Medium: −32.5 ± 8.9°; p = 0.003; Hedges g = −1.10, 95% CI −1.81 to −0.39), a large effect that was robust to nonparametric testing. Cluster purity was higher in Low LF (61.9% vs. 53.3%, p = 0.027; g = 0.70). Principal component analysis of standard parameters showed that mean LF thickness was moderately correlated with the dominant pelvic-morphology component ( r = −0.44, p = 0.008), indicating that LF thickness is partially related to, rather than independent of, traditional parameters. Intra-rater reliability, assessed by blinded re-measurement of 15 patients, was moderate [ICC(2,1) = 0.632, 95% CI 0.242–0.855; Cohen kappa for phenotype = 0.524], and sensitivity analysis showed that the phenotype-lordosis association does not survive substitution of the re-read values ( p = 0.005 to p = 0.245). In contrast, the continuous rank correlation does (rho = + 0.496, p = 0.0015). Conclusions: Measurement-level clustering identifies distinct LF thickness phenotypes in ASD that are associated with lumbar lordosis. These exploratory findings establish a methodological foundation and motivate larger, outcome-based studies with formal measurement-reliability assessment to determine clinical utility.