Study design: Invited narrative review. Objectives: The aim of this review was to summarize current literature regarding risk factors that surgeons can optimize in the preoperative setting in the spinal surgery patient, in order to reduce complications and improve patient-reported outcomes. Methods: Review of the relevant literature by the authors. Results: Modifiable risk factors identified relative to the patient include obesity, malnutrition/nutrient deficiency, diabetes/hyperglycemia, preoperative anemia, vitamin D/DEXA (dual-energy radiograph absorptiometry), nicotine use/smoking, and opioid use/psychosocial factors. Conclusion: By maximizing a patient’s physiological and psychological status prior to elective spine surgery, we may move closer to achieving the goals of value-based care: improving patient-reported outcomes while decreasing the cost of care.

The human gut microbiome represents a complex ecosystem comprising numerous microorganisms critical to basic physiological processes. The gut microbiome’s composition and functionality influence surgical outcomes following orthopedic procedures. The purpose of this study was to evaluate the gut microbiota on critical aspects of orthopedic surgical outcomes. A comprehensive literature search was conducted via PubMed, the Cumulative Index for Nursing and Allied Health Literature (CINAHL), Google Scholar, Cochrane Library, Medline, and Web of Science. A total of 18 research articles of the 599 retrieved results were included in this study. Significant correlations were identified between microbial composition and surgical outcomes, including infection rates, inflammatory responses, and postoperative complications. Bacterial genera like Alistipes and Helicobacter increased postoperative cognitive dysfunction (POCD) risk, while short-chain fatty acid (SCFA)-producing bacteria showed negative correlations with inflammatory markers. Probiotic interventions reduced POCD incidence from 16.4% to 5.1% and modulated inflammatory responses. Additionally, bacterial composition was associated with critical surgical parameters such as bone healing, infection rate, and recovery trajectory. Inflammation, healing processes, and recovery trajectories are influenced by microbial composition in surgical settings. Targeted interventions, such as probiotics, show promise in reducing surgical risks and improving patient recovery.

This study is the first biomechanical research of headless compression screws for fixation of vertical shear fractures of the medial malleolus, a promising alternative that potentially offers several advantages for fixation.Vertical shear fractures were simulated by osteotomies in 20 synthetic distal tibiae. Models were randomly assigned to fixation with either 2 parallel

Traumatic atlanto-occipital dislocations (AOD) and atlanto-axial dislocations (AAD) are catastrophic injuries of the craniovertebral junction associated with high mortality and long-term morbidity. These injuries' outcomes are often poor due to severe neurological damage and challenges in management. This study aims to provide a comprehensive analysis of AOD and AAD cases at a level one trauma center in the Southwestern United States, in regard to injury characteristics, management strategies, and patient outcomes. A retrospective review was conducted on traumatic AOD and AAD patients admitted to a single trauma center between January 1, 2018, and November 14, 2023. Data included demographics, injury mechanism, clinical course, and post-injury outcomes. Patients were categorized into dislocation and subluxation groups. Statistical analyses were performed using Chi-square and independent t-tests when appropriate. The cohort included 8 dislocations and 13 subluxation patients, with a mean age of 39.25 years. Motor vehicle collisions were the predominant injury mechanism (42.86 %). Patients with dislocations had significantly higher mortality rates compared to subluxations (p = 0.0195). Dislocation patients also had higher rates of concurrent traumatic brain injury (p = 0.024) and cardiorespiratory arrest (p = 0.0014). Survivors often required long-term care, with 0 dislocation patients discharged home post-hospitalization. This study emphasizes the severity of AOD and AAD traumatic injuries. Despite advances in management, these injuries remain highly lethal and result in significant disability for survivors. Our findings emphasize the need for improved diagnostic protocols and early intervention strategies. Future research should focus on multicenter studies to validate current literature and explore novel therapeutic approaches to improve patient outcomes.