Background: While racial and ethnic disparities in postoperative outcomes for total hip and knee arthroplasty (THA/TKA) are well-documented, a significant gap remains in understanding patient-reported barriers to care. This study investigates racial and ethnic disparities in self-reported barriers to health care among THA/TKA patients. Methods: This cross-sectional study used data from the All of Us Research Program. Adult patients undergoing THA or TKA were identified using Current Procedural Terminology codes. Multivariable logistic regression was used to analyze 11 self-reported barriers across racial/ethnic groups (non-Hispanic White, Black, Hispanic, and Other). Odds ratios (ORs) were calculated from models after adjusting for age, sex, and/or neighborhood-level Community Deprivation Index (CDI). Results: A total of 4,419 patients were analyzed: 3,706 (83.9%) White, 325 (7.4%) Black, 235 (5.3%) Hispanic, and 153 (3.5%) Other. After adjusting for age, sex, and CDI, Black patients had significantly higher odds of delaying care because of cost of follow-up (OR 2.01, 95% confidence interval [CI] 1.26-3.21), general visits (OR 2.07, 95% CI 1.24-3.47), and co-pays (OR 2.31, 95% CI 1.44-3.71). Both Black (OR 1.99, 95% CI 1.32-2.98) and Hispanic (OR 1.79, 95% CI 1.13-2.82) patients had significantly higher odds of experiencing transportation-related delays. Conclusion: Significant racial and ethnic disparities in affordability and access persist among THA/TKA patients, even after controlling for neighborhood-level socioeconomic deprivation. Black and Hispanic patients experience multifaceted barriers, underscoring that interventions should address not only individual patient circumstances but also structural community-level factors to achieve equitable arthroplasty care. Level of Evidence: Level III. See Instructions for Authors for a complete description of levels of evidence.

Tourette Disorder (TD) is a prevalent neurodevelopmental condition characterized by chronic motor and vocal tics. A mechanistic understanding of both the genetic etiology and brain pathophysiology remains poor. To gain insight into the molecular underpinnings of TD, we have generated a novel mouse model expressing an orthologous human mutation in CELSR3, a high-confidence TD risk gene. This putative damaging de novo variant, R774H, causes an amino acid substitution within the fifth cadherin repeat. Unlike previous Celsr3 TD models and Celsr3 constitutive null mice, mice homozygous for the R774H amino acid substitution are viable. They have grossly normal forebrain development and no changes to the density of cortical and striatal interneuron subpopulations. However, 3D geometric analysis of cortical pyramidal neurons revealed changes to dendritic patterning and the types and distributions of spines. Furthermore, patch clamp recordings in cholinergic interneurons located within the sensorimotor striatum uncovered mild intrinsic hyperexcitability and changes to spine density. Despite these changes, Celsr3^R774H homozygous mice do not show repetitive motor behaviors at baseline nor motor learning impairments. However, Celsr3^R774H homozygous males have sensorimotor gating deficits, a behavioral phenotype observed in both humans with TD and previously reported mouse models. Our findings suggest human mutations in CELSR3 may affect dendritic patterning, spine formation and/or turnover, and the firing properties of neurons within cortico-striatal circuits.

Background/Objectives: Cervical spine disease requiring surgical intervention is a major cause of disability. Anterior cervical discectomy and fusion (ACDF) is a well-established procedure for treating cervical pathology; however, there remains no consensus on whether 1-level versus 2-level ACDF yields comparable outcomes. This study compares 1-level versus 2-level ACDF by evaluating surgery-related and postoperative outcomes, radiographic parameters, and patient-reported outcome measures (PROMs). Methods: PubMed, Embase, Scopus, and Cochrane Library were searched through 10 July 2024. Studies comparing 1-level with 2-level ACDF were included. Data on operating room (OR) time, estimated blood loss (EBL), length of hospital stay (LOS), complications, and PROMs, including Neck Disability Index (NDI) and Visual Analogue Scale (VAS) for neck and arm pain, were extracted. Results: Thirteen studies met our inclusion criteria, comprising 2091 patients (1078 undergoing 1-level and 1013 2-level ACDF). No statistically significant differences were observed in EBL or LOS between the cohorts. However, the 2-level ACDF group showed significantly longer OR times (p-value < 0.001) and higher odds of developing dysphagia (p-value = 0.05). Patients undergoing 2-level ACDF showed greater correction in cervical lordosis. Both cohorts reported similar statistically and clinically significant improvements in VAS neck and NDI scores at final follow-up. There was no difference in adjacent segment disease or revision surgery at final follow-up. Conclusions: Both 1-level and 2-level ACDF improve clinical and radiographic outcomes. The choice should be tailored to the patient’s pathology and anatomy while considering the higher dysphagia risk with additional fusion levels. This study highlights the importance of individualized surgical planning to optimize postoperative outcomes while minimizing complications.

Hollow viscus perforation following spine surgery is uncommon but associated with substantial morbidity and mortality when diagnosis is delayed. Early recognition is challenging because presenting symptoms frequently overlap with expected postoperative bowel dysfunction, and imaging findings may initially be subtle. Despite its clinical significance, the literature remains fragmented across case reports and small series, and a consolidated, mechanism-based framework specific to spine surgery is lacking. We performed a single-institution case series of five patients who developed hollow viscus perforation or significant postoperative intra-abdominal pathology after spine surgery, combined with a comprehensive review of the published literature. Data were analyzed to identify common mechanisms of injury, clinical presentation patterns, diagnostic pathways, management strategies, and preventive considerations. Hollow viscus perforation after spine surgery occurred through four principal mechanisms: direct mechanical injury, functional distension related to acute colonic pseudo-obstruction physiology, delayed hardware or graft migration, and medication-associated ulceration or diverticular perforation. Early clinical findings frequently overlapped with expected postoperative bowel dysfunction, contributing to delayed recognition. Diagnosis depended on identifying deviations from expected recovery trajectories and obtaining timely computed tomography imaging. Preventive strategies included recognition of preoperative abdominal risk factors, meticulous exposure-specific surgical technique, optimization of postoperative bowel function, and judicious use of medications that impair gastrointestinal motility or tissue integrity. Hollow viscus perforation following spine surgery is an uncommon but potentially catastrophic complication arising from distinct mechanical, functional, hardware-related, and medication-associated pathways. Because early signs are often nonspecific, a low threshold for imaging and general surgical evaluation is essential. Improved preoperative risk stratification, intraoperative vigilance, and structured postoperative monitoring may reduce delays in diagnosis and improve outcomes in this high-risk population.

Background: Anterior Lumbar Interbody and Fusion (ALIF) is particularly effective for improving radiographic alignment and functional outcomes. However, it also introduces distinct technical challenges, even for surgeons who are highly experienced with other lumbar fusion approaches. This study analyzes the effect of surgeon experience on clinical outcomes, radiographic parameters, and operative metrics in patients with degenerative lumbar disc disease undergoing single-level L5-S1 anterior lumbar interbody fusion. Methods: Adult patients who underwent L5-S1 ALIF with or without posterior fixation for degenerative disc disease between June 2017 and December 2024 were included. Patients were stratified into Early (from 2017 to December 2020), Middle (January 2021 to December 2022), and Recent (January 2023 to December 2024) groups. Demographics, radiographic alignment, in-hospital outcomes, and 2-year complication and reoperation rates were compared based on time of surgery. Multivariate logistic and linear regression adjusted for age, sex, BMI, comorbidities, prior fusion, and posterior instrumentation was conducted to assess the effect of accumulation of surgeon experience. Results: A total of 203 ALIFs were performed (mean age: 57.6 years; 50.7% female; mean Charlson Comorbidity Index: 2.1). Recent cases showed greater PT reduction (Early = 0.9°, Middle = −1.5°, Recent = −2.2°, p = 0.039), improved PI-LL mismatch correction (−0.4°, −4.8°, −5.4°, p = 0.007), higher L5-S1 lordotic correction (6.7°, 8.4°, 11.4°, p = 0.003), lower estimated blood loss (21.9 mL, 13.8 mL, 10.0 mL, p = 0.006), shorter OR time (107.4 min, 86.6 min, 75.2 min, p < 0.001), and fewer mechanical complications (39.3% vs. 13.7%, p < 0.001) and reoperations (10.7% vs. 2.1%, p = 0.023). Regression showed that each additional year of experience predicted improved alignment, lower blood loss and OR time, and reduced odds of complications (OR = 0.54, p < 0.001) and reoperations (OR = 0.49, p = 0.015). Conclusions: In this single-surgeon, single-center cohort, increasing ALIF-specific experience over time was associated with improvements in sagittal alignment, operative efficiency, and lower complication and reoperation rates. These findings describe the longitudinal learning curve of one surgeon and should be interpreted within this context.