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Item The Global Spine Care Initiative: methodology, contributors, and disclosures(SPRINGER, 2018-01-01) Johnson, Claire D.; Haldeman, Scott; Nordin, Margareta; Chou, Roger; Cote, Pierre; Hurwitz, Eric L.; Green, Bart N.; Kopansky-Giles, Deborah; Randhawa, Kristi; Cedraschi, Christine; Ameis, Arthur; Acaroglu, Emre; Aartun, Ellen; Adjei-Kwayisi, Afua; Ayhan, Selim; Aziz, Amer; Bas, Teresa; Blyth, Fiona; Borenstein, David; Brady, O'Dane; Brooks, Peter; Camilleri, Connie; Castellote, Juan M.; Clay, Michael B.; Davatchi, Fereydoun; Dudler, Jean; Dunn, Robert; Eberspaecher, Stefan; Emmerich, Juan; Farcy, Jean Pierre; Fisher-Jeffes, Norman; Goertz, Christine; Grevitt, Michael; Griffith, Erin A.; Hajjaj-Hassouni, Najia; Hartvigsen, Jan; Hondras, Maria; Kane, Edward J.; Laplante, Julie; Lemeunier, Nadege; Mayer, John; Mior, Silvano; Mmopelwa, Tiro; Modic, Michael; Moss, Jean; Mullerpatan, Rajani; Muteti, Elijah; Mwaniki, Lillian; Ngandeu-Singwe, Madeleine; Outerbridge, Geoff; Rajasekaran, Shanmuganathan; Shearer, Heather; Smuck, Matthew; Sonmez, Erkin; Tavares, Patricia; Taylor-Vaisey, Anne; Torres, Carlos; Torres, Paola; van der Horst, Alexander; Verville, Leslie; Vialle, Emiliano; Kumar, Gomatam Vijay; Vlok, Adriaan; Watters III, William; Wong, Chung Chek; Wong, Jessica J.; Yu, Hainan; Yuksel, SelcenPurpose The purpose of this report is to describe the Global Spine Care Initiative (GSCI) contributors, disclosures, and methods for reporting transparency on the development of the recommendations. Methods World Spine Care convened the GSCI to develop an evidence-based, practical, and sustainable healthcare model for spinal care. The initiative aims to improve the management, prevention, and public health for spine-related disorders worldwideItem The Global Spine Care Initiative: model of care and implementation(SPRINGER, 2018-01-01) Johnson, Claire D.; Haldeman, Scott; Chou, Roger; Nordin, Margareta; Green, Bart N.; Cote, Pierre; Hurwitz, Eric L.; Kopansky-Giles, Deborah; Acaroglu, Emre; Cedraschi, Christine; Ameis, Arthur; Randhawa, Kristi; Aartun, Ellen; Adjei-Kwayisi, Afua; Ayhan, Selim; Aziz, Amer; Bas, Teresa; Blyth, Fiona; Borenstein, David; Brady, O'Dane; Brooks, Peter; Camilleri, Connie; Castellote, Juan M.; Clay, Michael B.; Davatchi, Fereydoun; Dudler, Jean; Dunn, Robert; Eberspaecher, Stefan; Emmerich, Juan; Farcy, Jean Pierre; Fisher-Jeffes, Norman; Goertz, Christine; Grevitt, Michael; Griffith, Erin A.; Hajjaj-Hassouni, Najia; Hartvigsen, Jan; Hondras, Maria; Kane, Edward J.; Laplante, Julie; Lemeunier, Nadege; Mayer, John; Mior, Silvano; Mmopelwa, Tiro; Modic, Michael; Moss, Jean; Mullerpatan, Rajani; Muteti, Elijah; Mwaniki, Lillian; Ngandeu-Singwe, Madeleine; Outerbridge, Geoff; Rajasekaran, Shanmuganathan; Shearer, Heather; Smuck, Matthew; Sonmez, Erkin; Tavares, Patricia; Taylor-Vaisey, Anne; Torres, Carlos; Torres, Paola; van der Horst, Alexander; Verville, Leslie; Vialle, Emiliano; Kumar, Gomatam Vijay; Vlok, Adriaan; Watters III, William; Wong, Chung Chek; Wong, Jessica J.; Yu, Hainan; Yuksel, SelcenPurpose Spine-related disorders are a leading cause of global disability and are a burden on society and to public health. Currently, there is no comprehensive, evidence-based model of care for spine-related disorders, which includes back and neck pain, deformity, spine injury, neurological conditions, spinal diseases, and pathology, that could be applied in global health care settings. The purposes of this paper are to propose: (1) principles to transform the delivery of spine careItem The Global Spine Care Initiative: care pathway for people with spine-related concerns(SPRINGER, 2018-01-01) Haldeman, Scott; Johnson, Claire D.; Chou, Roger; Nordin, Margareta; Cote, Pierre; Hurwitz, Eric L.; Green, Bart N.; Cedraschi, Christine; Acaroglu, Emre; Kopansky-Giles, Deborah; Ameis, Arthur; Adjei-Kwayisi, Afua; Ayhan, Selim; Blyth, Fiona; Borenstein, David; Brady, O'Dane; Brooks, Peter; Camilleri, Connie; Castellote, Juan M.; Clay, Michael B.; Davatchi, Fereydoun; Dunn, Robert; Goertz, Christine; Griffith, Erin A.; Hondras, Maria; Kane, Edward J.; Lemeunier, Nadege; Mayer, John; Mmopelwa, Tiro; Modic, Michael; Moss, Jean; Mullerpatan, Rajani; Muteti, Elijah; Mwaniki, Lillian; Ngandeu-Singwe, Madeleine; Outerbridge, Geoff; Randhawa, Kristi; Shearer, Heather; Sonmez, Erkin; Torres, Carlos; Torres, Paola; Verville, Leslie; Vlok, Adriaan; Watters III, William; Wong, Chung Chek; Yu, HainanPurpose The purpose of this report is to describe the development of an evidence-based care pathway that can be implemented globally. Methods The Global Spine Care Initiative (GSCI) care pathway development team extracted interventions recommended for the management of spinal disorders from six GSCI articles that synthesized the available evidence from guidelines and relevant literature. Sixty-eight international and interprofessional clinicians and scientists with expertise in spine-related conditions were invited to participate. An iterative consensus process was used. Results After three rounds of review, 46 experts from 16 countries reached consensus for the care pathway that includes five decision steps: awareness, initial triage, provider assessment, interventions (e.g., non-invasive treatmentItem The Global Spine Care Initiative: classification system for spine-related concerns(SPRINGER, 2018-01-01) Haldeman, Scott; Johnson, Claire D.; Chou, Roger; Nordin, Margareta; Cote, Pierre; Hurwitz, Eric L.; Green, Bart N.; Kopansky-Giles, Deborah; Cedraschi, Christine; Aartun, Ellen; Acaroglu, Emre; Ameis, Arthur; Ayhan, Selim; Blyth, Fiona; Borenstein, David; Brady, O'Dane; Davatchi, Fereydoun; Goertz, Christine; Hajjaj-Hassouni, Najia; Hartvigsen, Jan; Hondras, Maria; Lemeunier, Nadege; Mayer, John; Mior, Silvano; Mmopelwa, Tiro; Modic, Michael; Mullerpatan, Rajani; Mwaniki, Lillian; Ngandeu-Singwe, Madeleine; Outerbridge, Geoff; Randhawa, Kristi; Sonmez, Erkin; Torres, Carlos; Torres, Paola; Watters III, William; Yu, HainanPurpose The purpose of this report is to describe the development of a classification system that would apply to anyone with a spine-related concern and that can be used in an evidence-based spine care pathway. Methods Existing classification systems for spinal disorders were assembled. A seed document was developed through round-table discussions followed by a modified Delphi process. International and interprofessional clinicians and scientists with expertise in spine-related conditions were invited to participate. Results Thirty-six experts from 15 countries participated. After the second round, there was 95\% agreement of the proposed classification system. The six major classifications included: no or minimal symptoms (class 0)Item The Global Spine Care Initiative: resources to implement a spine care program(SPRINGER, 2018-01-01) Kopansky-Giles, Deborah; Johnson, Claire D.; Haldeman, Scott; Chou, Roger; Cote, Pierre; Green, Bart N.; Nordin, Margareta; Acaroglu, Emre; Ameis, Arthur; Cedraschi, Christine; Hurwitz, Eric L.; Ayhan, Selim; Borenstein, David; Brady, O'Dane; Brooks, Peter; Davatchi, Fereydoun; Dunn, Robert; Goertz, Christine; Hajjaj-Hassouni, Najia; Hartvigsen, Jan; Hondras, Maria; Lemeunier, Nadege; Mayer, John; Mior, Silvano; Moss, Jean; Mullerpatan, Rajani; Muteti, Elijah; Mwaniki, Lillian; Ngandeu-Singwe, Madeleine; Outerbridge, Geoff; Randhawa, Kristi; Torres, Carlos; Torres, Paola; Vlok, Adriaan; Wong, Chung ChekPurpose The purpose of this report is to describe the development of a list of resources necessary to implement a model of care for the management of spine-related concerns anywhere in the world, but especially in underserved communities and low- and middle-income countries. Methods Contents from the Global Spine Care Initiative (GSCI) Classification System and GSCI care pathway papers provided a foundation for the resources list. A seed document was developed that included resources for spine care that could be delivered in primary, secondary and tertiary settings, as well as resources needed for self-care and community-based settings for a wide variety of spine concerns (e.g., back and neck pain, deformity, spine injury, neurological conditions, pathology and spinal diseases). An iterative expert consensus process was used using electronic surveys. Results Thirty-five experts completed the process. An iterative consensus process was used through an electronic survey. A consensus was reached after two rounds. The checklist of resources included the following categories: healthcare provider knowledge and skills, materials and equipment, human resources, facilities and infrastructure. The list identifies resources needed to implement a spine care program in any community, which are based upon spine care needs. Conclusion To our knowledge, this is the first international and interprofessional attempt to develop a list of resources needed to deliver care in an evidence-based care pathway for the management of people presenting with spine-related concerns. This resource list needs to be field tested in a variety of communities with different resource capacities to verify its utility.Item The Effect of Discharging Patients with Low Hemoglobin Levels on Hospital Readmission and Quality of Life after Adult Spinal Deformity Surgery(KOREAN SOC SPINE SURGERY, 2022-01-01) Nabi, Vugar; Ayhan, Selim; Yuksel, Selcen; Adhikari, Prashant; Vila-Casademunt, Alba; Pellise, Ferran; Perez-Grueso, Francisco Sanchez; Alanay, Ahmet; Obeid, Ibrahim; Kleinstueck, Frank; Acaroglu, Emre; Grp, European Spine StudyStudy design: Retrospective cohort. Purpose: This study aims to evaluate the impact of anemia on functional outcomes, health-related quality of life (HRQoL), and early hospital readmission (EHR) rates after adult spinal deformity (ASD) surgery at the time of discharge from the hospital. Overview of literature: Concerns with risks of transfusion, insufficient evidence for its benefits, and the possibility of associated adverse outcomes have led to restrictive transfusion practices. Therefore, patients are discharged according to patient blood management programs that are implemented in hospitals nationwide to reduce unnecessary blood transfusions. However, not many comprehensive kinds of studies exist on the effect of postoperative anemia on functional life and complications. Methods: Anemia severity was defined following the 2011 World Health Organization guidelines. All patients had HRQoL tests as well as complete blood counts pre- and postoperatively. EHR is the admission within 30 days of discharge and was used as the dependent parameter. Results: This study comprised 225 surgically treated ASD patients with a median age of 62.0 years, predominantly women (80\%). Of the 225 patients, 82, 137, and six had mild, moderate, and severe anemia at the time of discharge, respectively. Seventeen of the patients (mild {[}11, 64.7\%]Item Adult Spinal Deformity Over 70 Years of Age: A 2-Year Follow-Up Study(INT SOC ADVANCEMENT SPINE SURGERY-ISASS, 2019-01-01) Karabulut, Cem; Ayhan, Selim; Yuksel, Selcen; Nabiyev, Vugar; Vila-Casademunt, Alba; Pellise, Ferran; Alanay, Ahmet; Sanchez Perez-Grueso, Francisco Javier; Kleinstuck, Frank; Obeid, Ibrahim; Acaroglu, Emre; Grp, European Spine StudyBackground: Treatment of adult spinal deformity (ASD) in elderly patients remains controversial. The aim of this study was to identify the factors leading to the surgical treatment by comparing the baseline characteristics of operative versus nonoperative patients, to evaluate the safety and efficacy of surgery, and to compare operative and nonoperative management of elderly ASD patients at the end of the 2-year follow-up period. Methods: Retrospective review of a multicenter, prospective ASD database was performed. Patients over 70 years of age with ASD who were scheduled to undergo surgical treatment and who were treated and/or followed without surgical intervention participated in the study. Demographic, clinical, surgical, and radiological characteristics and health-related quality-of-life (HRQOL) (Core Outcome Measures Index {[}COMI], Oswestry Disability Index {[}ODI], Short-Form-36 Mental Component Summary {[}SF-36 MCS], Short-Form-36 Physical Component Summary {[}SF36-PCS], and Scoliosis Research Society-22 {[}SRS-22]) parameters of such group of patients were evaluated pre-and posttreatment. Results: A total 90 patients (females: 71, males: 29Item Analysis of factors affecting baseline SF-36 Mental Component Summary in Adult Spinal Deformity and its impact on surgical outcomes(TURKISH ASSOC ORTHOPAEDICS TRAUMATOLOGY, 2018-01-01) Mmopelwa, Tiro; Ayhan, Selim; Yuksel, Selcen; Nabiyev, Vugar; Niyazi, Asli; Pellise, Ferran; Alanay, Ahmet; Perez Grueso, Francisco Javier Sanchez; Kleinstuck, Frank; Obeid, Ibrahim; Acaroglu, Emre; Grp, European Spine StudyObjectives: To identify the factors that affect SF-36 mental component summary (MCS) in patients with adult spinal deformity (ASD) at the time of presentation, and to analyse the effect of SF-36 MCS on clinical outcomes in surgically treated patients. Methods: Prospectively collected data from a multicentric ASD database was analysed for baseline parameters. Then, the same database for surgically treated patients with a minimum of 1-year follow-up was analysed to see the effect of baseline SF-36 MCS on treatment results. A clinically useful SF-36 MCS was determined by ROC Curve analysis. Results: A total of 229 patients with the baseline parameters were analysed. A strong correlation between SF-36 MCS and SRS-22, ODI, gender, and diagnosis were found (p < 0.05). For the second part of the study, a total of 186 surgically treated patients were analysed. Only for SF-36 PCS, the un-improved cohort based on minimum clinically important differences had significantly lower mean baseline SF-36 MCS (p < 0.001). SF-36 MCS was found to have an odds ratio of 0.914 in improving SF-36 PCS score (unit by unit) (p < 0.001). A cut-off point of 43.97 for SF-36 MCS was found to be predictive of SF-36 PCS (AUC = 0.631Item The Influence of Diagnosis, Age, and Gender on Surgical Outcomes in Patients With Adult Spinal Deformity(SAGE PUBLICATIONS LTD, 2018-01-01) Ayhan, Selim; Yuksel, Selcen; Nabiyev, Vugar; Adhikari, Prashant; Villa-Casademunt, Alba; Pellise, Ferran; Sanchez Perez-Grueso, Francisco; Alanay, Ahmet; Obeid, Ibrahim; Kleinstueck, Frank; Acaroglu, Emre; Grp, European Spine StudyStudy Design: Retrospective review of prospectively collected data from a multicentric database. Objectives: To determine the clinical impact of diagnosis, age, and gender on treatment outcomes in surgically treated adult spinal deformity (ASD) patients. Methods: A total of 199 surgical patients with a minimum follow-up of 1 year were included and analyzed for baseline characteristics. Patients were separated into 2 groups based on improvement in health-related quality of life (HRQOL) parameters by minimum clinically important difference. Statistics were used to analyze the effect of diagnosis, age, and gender on outcome measurements followed by a multivariate binary logistic regression model for these results with statistical significance. Results: Age was found to affect SF-36 PCS (Short From-36 Physical Component Summary) score significantly, with an odds ratio of 1.017 (unit by unit) of improving SF-36 PCS score on multivariate analysis (P < .05). The breaking point in age for this effect was 37.5 years (AUC = 58.0, P = .05). A diagnosis of idiopathic deformity would increase the probability of improvement in Oswestry Disability Index (ODI) by a factor of 0.219 and in SF-36 PCS by 0.581 times (P < .05). Gender was found not to have a significant effect on any of the HRQOL scores. Conclusions: Age, along with a diagnosis of degenerative deformity, may have positive effects on the likelihood of improvement in SF-36 PCS (for age) and ODI (for diagnosis) in surgically treated patients with ASD and the breaking point of this effect may be earlier than generally anticipated. Gender does not seem to affect results. These may be important in patient counseling for the anticipated outcomes of surgery.Item Does the Application of Topical Intrawound Vancomycin Powder Affect Deep Surgical Site Infection and the Responsible Organisms after Spinal Surgery?: A Retrospective Case Series with a Historical Control Group(KOREAN SOC SPINE SURGERY, 2020-01-01) Adhikari, Prashant; Nabiyev, Vugar Nabi; Bahadir, Sinan; Ayhan, Selim; Yuksel, Selcen; Palaoglu, Selcuk; Acaroglu, EmreStudy Design: Retrospective case series with a historical control group. Purpose: To compare the deep wound infection rates in patients undergoing spinal surgery with the application of topical intrawound vancomycin powder (TIVP) in the surgical site in addition to standard systemic prophylaxis with those in a matched historical cohort of patients for whom TIVP was not used. Overview of Literature: Surgical site infection (SSI) after spine surgery is debilitating and is responsible for a significant increase in the health care costs, hospital stay, and morbidities. Although the application of TIVP before surgical closure is a promising method for reducing the SSI rate after spine surgery, its use is controversial, and currently, research trials are focusing on identifying its safety, efficacy, and the potential patient population. Methods: A group of 88 patients who underwent posterior spinal surgery with TIVP administration (treatment group) was compared to a historical control group of 70 patients who had received only standard systemic intravenous prophylaxis (control group) for the analysis of deep SSI rate and the involved organisms. Results: The overall rate of deep SSIs was 2.5\% (4/158). All the SSIs were observed in patients who had posterior instrumentation and fusion for >= 3 levels. In the treatment group, the SSI rate was 3.4\% (3/88), and the bacteria isolated were Escherichia coli (n=2 ) and Pseudomonas aeruginosa (n=1). In the control group, the infection rate was 1.4\% (1/70), and the isolated bacteria were Morganella rnorganii and Staphylococcus epidermidis. No statistically significant association was found between the SSI rates of the treatment and control groups. Conclusions: Although the difference in the SSI rates was not statistically significant, the present results suggest that TIVP administration could not reduce the risk of deep SSIs after spinal surgery. Moreover, TIVP administration might also affect the underlying pathogens by increasing the propensity for gram-negative species.