Study Design.: Retrospective Cohort Study Objective.: This study aimed to compare postoperative outcomes between patients of varying nutritional deficiency status as measured by the CONUT score undergoing posterior cervical decompression and fusion (PCDF). Summary of Background Data.: Malnutrition is an established risk factor for poor postoperative outcomes. The COntrolling NUTritional status (CONUT) score has emerged as a novel method of assessing a patient’s nutritional status. Methods.: Adult patients undergoing primary, elective PCDF (2017-2023) were identified. Patients were included if they had components of the CONUT score, specifically deficiencies in serum albumin, total cholesterol, or lymphocyte counts, within 6 months preoperatively. Data regarding modified 5-item frailty index, demographic/surgical variables, and postoperative outcomes were collected. Results.: 206 patients were included and stratified into normal nutritional status, mild nutritional deficiency, and moderate/severe nutritional deficiency. Age, Charlson Comorbidity Index (CCI), and Distressed Community Index differed between cohorts. Length of stay (LOS) correlated with CONUT score (normal: 4.77, mild: 6.20, moderate/severe: 10.0 days; P =0.001). Frequency of inpatient complications (normal: 8.7%, mild: 11.8%, moderate/severe: 33.3%; P =0.017), discharge to home (normal: 84.8%, mild: 82.8%, moderate/severe: 38.1%; P <0.001), and 31-90 day readmissions (normal: 6.52%, mild: 7.53%, moderate/severe: 38.1%; P =0.001) differed between cohorts. Proportion of frail patients (normal: 79.3%, mild: 86.0%, moderate/severe: 100%; P =0.041) and frailty scores (normal: 1.28, mild: 1.70, moderate/severe: 2.38; P <0.001) differed between cohorts. A multivariable regression controlling for CONUT nutritional status, frailty score, CCI Age score, DCI, and discharge to SNF found that only moderate/severe nutritional deficiency was associated with 90-day readmissions (OR: 4.99, 95% CI: 1.40-18.75; P =0.014). Discussion: In patients undergoing PCDF, moderate/severe nutritional deficiency was associated with 90-day readmissions independent of comorbidity burden and frailty score. Thus, further investigation of optimizing nutritional status prior to PCDF may be warranted to minimize postoperative healthcare utilization.

Purpose: To examine whether clinical outcomes and patient-reported outcomes (PROMs) differ when patients are stratified by operative level in 3-level ACDF procedures. Methods: In this retrospective single-institution cohort study, patients undergoing 3-level ACDF (2014–2020) were reviewed for demographics, clinical outcomes, and PROMs. Patients with operative indications of infection/cancer/trauma/deformity were excluded. Patients with incomplete preoperative or 1-year postoperative PROMs were also excluded. PROMs, including SF-12, VAS Neck, VAS Arm, mJOA, and NDI, were assessed preoperatively and at 3, 6, and 12 months postoperatively. One-year MCID achievement was calculated using established thresholds. Patients were stratified and compared by construct level (C3-C6, C4-C7, and C5-T1). Results: Patients undergoing C3–C6 fusions were older than those in the C4–C7 group (62.7 versus 58.1 years, P = 0.007). The C5–T1 cohort had a higher 2-year reoperation rate compared to the C4–C7 cohort (18.2% versus 0.77%, P = 0.048). Baseline VAS Arm scores were worse in the C4–C7 group, with greater improvement at 1 year compared to the C3–C6 group (–3.45 versus − 2.27, P = 0.047). A transient difference in NDI at 3 months resolved by 6 months. MCID achievement rates across all PROMs did not differ significantly between groups. Conclusion: In patients undergoing 3-level ACDF, the operative level was associated with reoperation rates and baseline symptom profiles. However, the likelihood of achieving clinically meaningful improvements was similar across levels. Our findings support the need for construct-specific preoperative counseling while reinforcing the overall efficacy of 3-level ACDF across cervical levels.

Study Design.: Retrospective Cohort Study Objective.: This study aimed to: (1) identify demographic differences based on the interval between surgeries; (2) compare differences in perioperative outcomes; (3) determine whether the interval between hip/spine surgery influences patient-reported outcomes (PROMs). Summary of Background Data.: The presence of concurrent hip and spine disease in hip-spine syndrome creates a unique challenge in surgical decision-making given overlapping disease, with ideal timing between index spine and hip procedures remaining unclear. Methods.: A retrospective review was performed at a tertiary care center (2002-2025). Patients were included if they had undergone primary total hip arthroplasty and primary lumbar fusion in any sequence with an available 12-month HOOS score. Patients were divided based on the interval between surgery (1-year). Outcomes included patient reported outcomes (PROMs), number of revision surgeries, and time between procedures. Bivariate comparisons were made using t-tests and chi-square tests as appropriate. Results.: 179 patients (119>1-year, 60<1-year) were included, with no significant differences in demographics. Patients undergoing surgery within 1-year were more likely to have severe hip osteoarthritis and less likely to have mild disease compared to those whose procedures were greater than 1-year apart( P =0.003). There were no differences in revision rates. Order of surgery was associated with interval between procedures (P< 0.001). Patients in the <1-year group were more likely to receive spine surgery first ( P <0.001), started off with higher baseline ODI ( P= 0.034), and showed greater improvement after 12 months ( P= 0.004). HOOS scores improved in both groups, with most patients achieving MCID regardless of surgical interval. Conclusion.: In patients with hip-spine syndrome, those treated within 1-year experienced larger improvements in ODI scores and similar 12-month PROMs compared with those treated more than 1-year part. These findings suggest that there may be a benefit to a shorter interval between surgeries in hip-spine syndrome patients, especially in patients with severe hip osteoarthritis.

Study Design.: Retrospective Cohort Study Objective.: This study aimed to: (1) compare demographic differences between spine-first and hip-first patients; (2) identify differences in perioperative outcomes; (3) determine whether surgical sequencing between hip and spine surgery influences patient reported outcomes (PROMS). Summary of Background Data.: Hip-spine syndrome refers to coexisting lumbar degenerative stenosis and hip osteoarthritis. Surgical counseling remains challenging due to the symptomatic overlap between hip and spine disease, and there is no clear consensus on which disease should be addressed first. Methods.: A retrospective review of a tertiary care center was performed (2002-2025). Patients were included if they had undergone a lumbar spinal fusion and a total hip arthroplasty in any sequence with an available 12-month Hip Disability and Osteoarthritis Outcome Score (HOOS). Patients were excluded if they had a history of spine revision surgery prior to hip surgery or hip revision surgery prior to spine surgery. HOOS scores were the primary outcome. Descriptive statistics were performed, and bivariate comparisons were made as appropriate. Multivariable analysis was performed to identify predictors of 1-year improvement in HOOS scores. Results.: 179 patients (116 Spine-first, 63 Hip-first) were included. Overall, there were no significant demographic differences between groups. A greater number of patients with severe hip osteoarthritis underwent spine surgery first rather than hip surgery (66 vs. 18, P= 0.006). There were no significant differences regarding hip and spine revision surgeries between both groups. Spine-first patients underwent their second surgery in less time compared to hip-first patients (2.24 y vs. 4.03 y, P< 0.001). Furthermore, spine-first patients were more likely to have their second surgery within 1-year (45.7% vs. 11.1%), P< 0.001). Regarding PROMS, spine-first patients reported better 1-year improvement in HOOS scores (37.6 vs. 30.2, P= 0.045). Multivariable analysis revealed that undergoing spine surgery first was an independent predictor of 1-year HOOS improvement (β: 8.04 [0.47-15.60], P= 0.039). Conclusion.: In this retrospective cohort, undergoing spine surgery first was associated with a modest 1-year HOOS improvement in hip-spine syndrome patients. It is important to note that these findings cannot speak towards causality, and further work is needed to validate these findings in prospective settings.