Introduction: This is a retrospective study of consecutive patients undergoing transforaminal lumbar interbody fusion (TLIF) at a single institution. The objective of this study was to compare the long-term results associated with cortical bone trajectory (CBT) and traditional pedicle screw (TPS) via posterolateral approach in TLIF. Methods: Consecutive patients treated from November 2014 to March 2019 were included in the CBT TLIF group, while consecutive patients treated from October 2010 to August 2017 were included in the TPS TLIF group. Inclusion criteria comprised single-level or two-level TLIF for degenerative spondylolisthesis with stenosis and at least one year of clinical and radiographic follow-up. Variables of interest included pertinent preoperative, perioperative, and postoperative data. Non-parametric evaluation was performed using the Wilcoxon test. Fisher’s exact test was used to assess group differences for nominal data. Results: Overall, 140 patients met the inclusion criteria; 69 patients had CBT instrumentation (mean follow-up 526 days) and 71 patients underwent instrumentation placement via TPS (mean follow-up 825 days). Examination of perioperative and postoperative outcomes demonstrate comparable results between the groups with perioperative complications, length of stay, discharge destination, surgical revision rate, and fusion rates all being similar between groups (p = 0.1; p = 0.53; p = 0.091; p = 0.61; p = 0.665, respectively). Conclusions: CBT in the setting of TLIF offer equivalent outcomes to TPS with TLIF at both short- and long-term intervals of care.

Clinics around the world are adapting to the novel coronavirus 2019 (COVID-19) pandemic employing telemedicine to serve the needs of their patients. Traditionally, telemedicine has been driven by providing healthcare to rural, underserved populations and has involved medical specialties that are thought to be more suitable for remote consultation, like psychiatry and dermatology.1 During the COVID-19 pandemic, surgeons have started to implement remote clinic visits to meet the needs of their patients while practicing social distancing. Our aim is to discuss the unique challenges of caring for neurosurgical spine patients via telemedicine during the COVID-19 pandemic, and to define the opportunities for telemedicine as an outpatient care adjunct in the post-COVID-19 world. Neurosurgical telemedicine literature is sparse and primarily relates to triaging trauma in rural settings,2 managing routine follow-up patients,3 and analyzing the socioeconomic benefit for patients traveling long distances.4 To meet the needs of the spine patient population, we must learn how to best incorporate telemedicine into spine care by (1) defining regulatory requirements, (2) implementing system-wide protocols centered around appropriate telemedicine technology, (3) structuring the clinic visit to best optimize telemedicine technology, and (4) understanding the benefits and limitations of telemedicine.

Novel coronavirus 2019 (COVID-19) has had a drastic impact upon our ability to impart neurosurgical care for our patients, as others have highlighted in a recently published letter in your journal.1 The Centers for Disease Control and Prevention (CDC) has declared the COVID-19 outbreak a pandemic.2 National and international governing bodies have embraced “social distancing” and “shelter-in-place” paradigms to lower the rate of person-to-person transmission of COVID-19, and “flatten the curve” of new diagnoses.3-5 However, despite aggressive attempts to lower viral transmission, epidemiologists expect a long-term disruption of our “normal” pattern of delivering medical care, on the order of months to years.6 Additionally, hospitals have redeployed surgical residents into critical care and emergency medicine practices to increase access to care.7,8 While the 7 yr of residency and fellowship is long; even 3 mo of change to the existing state of neurosurgical care will have far-reaching effects on resident and fellow training. We wish to share our initial experience at Emory University Medical Center, a high-volume, tertiary, urban medical center in providing the sometime competing needs to (1) protect residents and fellows from illness, (2) provide emergent and urgent neurosurgical care, (3) utilize Telemedicine to maintain continuity of care, (4) assist the larger medical community, and (5) continue neurosurgical education in novel ways.

OBJECTIVE: The use of stand-alone 2-level anterior lumbar interbody fusion (ALIF) for degenerative lumbar disease has been increasing as an alternative to routinely augmenting these constructs with posterior fixation or fusion. Despite the potential benefits of a stand-alone approach (decreased cost and operative time, decreased pain and early mobilization), there is a paucity of information regarding these operations in the literature. This investigation aimed to determine the safety profile, radiographic outcomes including fusion rates, improvement in preoperative pain, and spinopelvic parameter modification, for patients undergoing stand-alone 2-level ALIF. METHODS: This retrospective case series involved a chart review of all patients undergoing 2-level stand-alone ALIF at a single tertiary hospital from 2008 to 2018. Data included patient demographics, hospitalization, complications and radiological studies. Visual analog scale (VAS) back and leg scores were measured via patient-administered surveys preoperatively and up to 18 weeks postoperatively. RESULTS: Forty-one patients who underwent L4-S1 stand-alone ALIF were included. Sixteen (39%) of patients had undergone previous posterior lumbar surgery. Length of stay averaged 4.2 days. Complication rates were comparable to 1-level ALIF. Two patients required reoperation. Fusion rates were 100% for L4-5 and 94.4% for L5-S1. There was no significant change in lumbar lordosis (LL) or LL-pelvic incidence (PI), but there was improved segmental lordosis (SL) and disc height at L4-S1 on final follow-up imaging. There was also modest but statistically significant improvement in VAS back and leg scores. CONCLUSIONS: Stand-alone 2-level ALIF is an option for a surgeon to perform in the absence of significant instability, even in the setting of prior posterior surgery. These procedures increase SL and disc height, but do not have the same effect on LL or LL-PI.