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Diebo BG, Alsoof D, Lafage R, Daher M, Balmaceno-Criss M, Passias PG, Ames CP, Shaffrey CI, Burton DC, Deviren V, Line BG, Soroceanu A, Hamilton DK, Klineberg EO, Mundis GM, Kim HJ, Gum JL, Smith JS, Uribe JS, Kebaish KM, Gupta MC, Nunley PD, Eastlack RK, Hostin R, Protopsaltis TS, Lenke LG, Hart RA, Schwab FJ, Bess S, Lafage V, Daniels AH. Impact of Self-Reported Loss of Balance and Gait Disturbance on Outcomes following Adult Spinal Deformity Surgery. J Clin Med 2024; 13:2202. [PMID: 38673475 DOI: 10.3390/jcm13082202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/06/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Background: The objective of this study was to evaluate if imbalance influences complication rates, radiological outcomes, and patient-reported outcomes (PROMs) following adult spinal deformity (ASD) surgery. Methods: ASD patients with baseline and 2-year radiographic and PROMs were included. Patients were grouped according to whether they answered yes or no to a recent history of pre-operative loss of balance. The groups were propensity-matched by age, pelvic incidence-lumbar lordosis (PI-LL), and surgical invasiveness score. Results: In total, 212 patients were examined (106 in each group). Patients with gait imbalance had worse baseline PROM measures, including Oswestry disability index (45.2 vs. 36.6), SF-36 mental component score (44 vs. 51.8), and SF-36 physical component score (p < 0.001 for all). After 2 years, patients with gait imbalance had less pelvic tilt correction (-1.2 vs. -3.6°, p = 0.039) for a comparable PI-LL correction (-11.9 vs. -15.1°, p = 0.144). Gait imbalance patients had higher rates of radiographic proximal junctional kyphosis (PJK) (26.4% vs. 14.2%) and implant-related complications (47.2% vs. 34.0%). After controlling for age, baseline sagittal parameters, PI-LL correction, and comorbidities, patients with imbalance had 2.2-times-increased odds of PJK after 2 years. Conclusions: Patients with a self-reported loss of balance/unsteady gait have significantly worse PROMs and higher risk of PJK.
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Affiliation(s)
- Bassel G Diebo
- Department of Orthopedics, Warren Alpert Medical School of Brown University, East Providence, RI 02914, USA
| | - Daniel Alsoof
- Department of Orthopedics, Warren Alpert Medical School of Brown University, East Providence, RI 02914, USA
| | - Renaud Lafage
- Department of Orthopedic Surgery, Lenox Hill Northwell, New York, NY 10075, USA
| | - Mohammad Daher
- Department of Orthopedics, Warren Alpert Medical School of Brown University, East Providence, RI 02914, USA
| | - Mariah Balmaceno-Criss
- Department of Orthopedics, Warren Alpert Medical School of Brown University, East Providence, RI 02914, USA
| | - Peter G Passias
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, NY 10016, USA
| | - Christopher P Ames
- Department of Neurosurgery, University of California, San Francisco, CA 94115, USA
| | | | - Douglas C Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160, USA
| | - Vedat Deviren
- Department of Neurosurgery, University of California, San Francisco, CA 94115, USA
| | - Breton G Line
- Denver International Spine Center, Denver, CO 80218, USA
| | - Alex Soroceanu
- Department of Orthopedic Surgery, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - David Kojo Hamilton
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Eric O Klineberg
- Department of Orthopaedic Surgery, University of California, 1 Shields Ave., Davis, CA 95616, USA
| | | | - Han Jo Kim
- Hospital for Special Surgery, New York, NY 10021, USA
| | | | - Justin S Smith
- Department of Neurosurgery, University of Virginia, Charlottesville, VA 22903, USA
| | - Juan S Uribe
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA
| | - Khaled M Kebaish
- Johns Hopkins University School of Medicine, Baltimore, MD 21218, USA
| | - Munish C Gupta
- Department of Orthopedics, Washington University in St Louis, St. Louis, MO 63110, USA
| | | | | | - Richard Hostin
- Department of Orthopaedic Surgery, Baylor Scoliosis Center, 4708 Alliance Blvd #800, Plano, TX 75093, USA
| | | | - Lawrence G Lenke
- Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY 10032, USA
| | - Robert A Hart
- Swedish Neuroscience Institute, Seattle, WA 98027, USA
| | - Frank J Schwab
- Department of Orthopedic Surgery, Lenox Hill Northwell, New York, NY 10075, USA
| | - Shay Bess
- Denver International Spine Center, Denver, CO 80218, USA
| | - Virginie Lafage
- Department of Orthopedic Surgery, Lenox Hill Northwell, New York, NY 10075, USA
| | - Alan H Daniels
- Department of Orthopedics, Warren Alpert Medical School of Brown University, East Providence, RI 02914, USA
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Daher M, Alsoof D, Balmaceno-Criss M, Kuharski MJ, Criddle SL, Diebo BG, Daniels AH. Preoperative Resilience and Improvement in Patient-Reported Outcomes After Lumbar Spinal Fusion. World Neurosurg 2024:S1878-8750(24)00553-9. [PMID: 38583559 DOI: 10.1016/j.wneu.2024.03.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 03/29/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND It is incompletely understood how preoperative resilience affects 1-year postoperative outcomes after lumbar spinal fusion. METHODS Patients undergoing open lumbar spinal fusion at a single-center institution were identified between November 2019 and September 2022. Preoperative resilience was assessed using the Brief Resilience Scale. Demographic data at baseline including age, gender, comorbidities, and body mass index (BMI) were extracted. Patient-reported outcome measures including Oswestry Disability Index, PROMIS (Patient-Reported Outcomes Measurement Information System) Global Physical Health, PROMIS Global Mental Health (GMH), and EuroQol5 scores were collected before the surgery and at 3 months and 1 year postoperatively. Bivariate correlation was conducted between Brief Resilience Scale scores and outcome measures at 3 months and 1 year postoperatively. RESULTS Ninety-three patients had baseline and 1 year outcome data. Compared with patients with high resilience, patients in the low-resilience group had a higher percentage of females (69.4% vs. 43.9%; P = 0.02), a higher BMI (32.7 vs. 30.1; P = 0.03), and lower preoperative Global Physical Health (35.8 vs. 38.9; P = 0.045), GMH (42.2 vs. 49.2; P < 0.001), and EuroQol scores (0.56 vs. 0.61; P = 0.01). At 3 months postoperatively, resilience was moderately correlated with GMH (r = 0.39) and EuroQol (r = 0.32). Similarly, at 1 year postoperatively, resilience was moderately correlated with GMH (r = 0.33) and EuroQol (r = 0.34). Comparable results were seen in multivariable regression analysis controlling for age, gender, number of levels fused, BMI, Charlson Comorbidity Index, procedure, anxiety/depression, and complications. CONCLUSIONS Low preoperative resilience can negatively affect patient-reported outcomes 1 year after lumbar spinal fusion. Resiliency is a potentially modifiable risk factor, and surgeons should consider targeted interventions for at-risk patient groups.
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Affiliation(s)
- Mohammad Daher
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Daniel Alsoof
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Mariah Balmaceno-Criss
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Michael J Kuharski
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Sarah L Criddle
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
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Daher M, Nassar JE, Balmaceno-Criss M, Diebo BG, Daniels AH. Same-Day Versus Staged Spinal Fusion: A Meta-analysis of Clinical Outcomes. Spine (Phila Pa 1976) 2024:00007632-990000000-00629. [PMID: 38570919 DOI: 10.1097/brs.0000000000004999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 03/17/2024] [Indexed: 04/05/2024]
Abstract
STUDY DESIGN Meta-Analysis. OBJECTIVE This meta-analysis aims to compare same-day versus staged spine surgery, assessing their effects on patient care and healthcare system efficiency. BACKGROUND In spinal surgery, the debate between whether same-day and staged surgeries are better for patients continues, as the decision may impact patient related outcomes, healthcare resources and overall costs. While some surgeons advocate for staged surgeries citing reduced risks of complications, others proclaim same-day surgeries may minimize costs and length of hospital stays. METHODS PubMed, Cochrane and Google Scholar (Pages 1-20) were searched up until February 2024. The studied outcomes were operative room (OR) time, estimated blood loss (EBL), length of hospital stay (LOS), overall complications, venous thromboembolism (VTE), death, reoperations and non-home discharge. RESULTS Sixteen retrospective studies were included in this meta-analysis, representing a total of 2346 patients of which 644 underwent staged spinal fusion surgeries and 1702 same-day surgeries. No statistically significant difference was observed in EBL between staged and same-day surgery groups. However, the staged group exhibited a statistically significant longer OR time (P= 0.05) and LOS (P=0.004). A higher rate of overall complications (P=0.002) and VTE (P=0.0008) was significantly associated with the staged group. No significant differences were found in the rates of death, reoperations, and non-home discharge between the two groups. CONCLUSION Both staged and same-day spinal fusion surgeries showed comparable rates of death, reoperations and non-home discharges for patients undergoing spinal surgeries. However, given the increased OR time, LOS and complications associated with staged spinal surgeries, this study supports same-day surgeries when possible to minimize the burden on healthcare resources and enhance efficiency.
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Affiliation(s)
- Mohammad Daher
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
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Albright JA, Testa EJ, Ibrahim Z, Quinn MS, Chang K, Alsoof D, Diebo BG, Barrett TJ, Daniels AH. Postoperative Angiotensin Receptor Blocker Use is Associated With Decreased Rates of Manipulation Under Anesthesia, Arthroscopic Lysis of Adhesions, and Prosthesis-Related Complications in Patients Undergoing Total Knee Arthroplasty. J Arthroplasty 2024; 39:954-959.e1. [PMID: 37852448 DOI: 10.1016/j.arth.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/26/2023] [Accepted: 10/02/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND The cellular mechanisms underlying excess scar tissue formation in arthrofibrosis following total knee arthroplasty (TKA) are well-described. Angiotensin receptor blockers (ARB), particularly losartan, is a commonly prescribed antihypertensive with demonstrated antifibrotic properties. This retrospective study aimed to assess the rates of 1- and 2-year postoperative complications in patients who filled prescriptions for ARBs during the 90 days after TKA. METHODS Patients undergoing primary TKA were selected from a large national insurance database, and the impact of ARB use after TKA on complications was assessed. Of the 1,299,106 patients who underwent TKA, 82,065 had filled at least a 90-day prescription of losartan, valsartan, or olmesartan immediately following their TKA. The rates of manipulation under anesthesia (MUA), arthroscopic lysis of adhesions (LOA), aseptic loosening, periprosthetic fracture, and revision at 1 and 2 years following TKA were analyzed using multivariable logistic regressions to control for various comorbidities. RESULTS ARB use was associated with decreased rates of MUA (odds ratio [OR] = 0.94, 95% confidence interval (CI), 0.90 to 0.99), arthroscopy/LOA (OR = 0.86, 95% CI, 0.77 to 0.95), aseptic loosening (OR = 0.71, 95% CI, 0.61 to 0.83), periprosthetic fracture (OR = 0.58, 95% CI, 0.46 to 0.71), and revision (OR = 0.79, 95% CI, 0.74 to 0.85) 2 years after TKA. CONCLUSIONS ARB use throughout the 90 days after TKA is associated with a decreased risk of MUA, arthroscopy/LOA, aseptic loosening, periprosthetic fracture, and revision, demonstrating the potential protective abilities of ARBs. Prospective studies evaluating the use of ARBs in patients at risk for postoperative stiffness would be beneficial to further elucidate this association.
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Affiliation(s)
- J Alex Albright
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Edward J Testa
- Department of Orthopaedics, Brown University Warren Alpert Medical School, Providence, Rhode Island
| | - Zainab Ibrahim
- Department of Orthopaedics, Brown University Warren Alpert Medical School, Providence, Rhode Island
| | - Matthew S Quinn
- Department of Orthopaedics, Brown University Warren Alpert Medical School, Providence, Rhode Island
| | - Kenny Chang
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Daniel Alsoof
- Department of Orthopaedics, Brown University Warren Alpert Medical School, Providence, Rhode Island
| | - Bassel G Diebo
- Department of Orthopaedics, Brown University Warren Alpert Medical School, Providence, Rhode Island
| | - Thomas J Barrett
- Department of Orthopaedics, Brown University Warren Alpert Medical School, Providence, Rhode Island
| | - Alan H Daniels
- Department of Orthopaedics, Brown University Warren Alpert Medical School, Providence, Rhode Island
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Passias PG, Williamson TK, Mir JM, Lebovic JA, Dave P, Tretiakov PS, Joujon-Roche R, Imbo B, Krol O, Owusu-Sarpong S, Vira S, Schoenfeld AJ, Daniels AH, Diebo BG, Lafage R, Lafage V. Comparison of multilevel low-grade techniques versus three-column osteotomies in adult spinal deformity surgery: does harmonious correction matter? J Neurosurg Spine 2024:1-7. [PMID: 38489818 DOI: 10.3171/2024.1.spine23802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 01/08/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVE Recent debate has arisen between whether to use a three-column osteotomy (3CO) or multilevel low-grade (MLG) techniques to treat severe sagittal malalignment in adult spinal deformity (ASD) surgery. The goal of this study was to compare the outcomes of 3CO and MLG techniques performed in corrective surgeries for ASD. METHODS ASD patients who had a baseline PI-LL > 30° and 2-year follow-up data were included. Patients underwent either 3CO or MLG (thoracolumbar posterior column osteotomies at ≥ 3 levels or anterior lumbar interbody fusion at ≥ 3 levels with no 3CO). The segmental utility ratio was used to assess relative segmental correction (segmental correction divided by overall correction in lordosis divided by the number of thoracolumbar interventions [interbody fusion, thoracolumbar posterior column osteotomies, and 3CO]). The paired t-test was used to assess lordotic distribution by differences in lordosis between adjacent lumbar disc spaces (e.g., L1-2 to L2-3). Multivariate analysis, controlling for age, sex, BMI, osteoporosis, baseline pelvic incidence, and T1 pelvic angle, was used to evaluate the complication rates and radiographic and patient-reported outcomes between the groups. RESULTS A total of 93 patients were included, 53% of whom underwent MLG and 47% of whom underwent 3CO. The MLG group had a lower BMI (p < 0.05). MLG patients received fewer previous fusions than 3CO patients (31% vs 80%, p < 0.001). MLG patients had 24% less blood loss but a 22% longer operative time (565 vs 419 minutes, p = 0.008). Using adjusted analysis, the 3CO group had greater segmental and relative correction at each level (segmental utility ratio mean 69% for 3CO vs 23% for MLG, p < 0.001). However, the 3CO group had lordotic differences between two adjacent lumbar disc pairs (range -0.5° to 9.0°, p = 0.009), while MLG was more harmonious (range 2.2°-6.5°, p > 0.4). MLG patients were more likely to undergo realignment to age-adjusted standards (OR 5.6, 95% CI 1.2-46.4; p = 0.033). MLG patients were less likely to develop neurological complications or undergo reoperation (OR 0.4, 95% CI 0.1-0.9; p = 0.041). Adjusted analysis revealed that MLG patients more often met a substantial clinical benefit in the Oswestry Disability Index score (OR 5.3, 95% CI 1.1-26.8; p = 0.043). CONCLUSIONS MLG techniques showed better utility in lumbar distribution and age-adjusted global correction while minimizing neurological complications and reoperation rates by 2 years postoperatively. In selected instances, these techniques may offer the spine deformity surgeon a safer alternative when correcting severe adult spinal deformity.
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Affiliation(s)
- Peter G Passias
- 1Division of Spinal Surgery, Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, New York
| | - Tyler K Williamson
- 1Division of Spinal Surgery, Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, New York
- 2Department of Orthopaedic Surgery, University of Texas Health San Antonio, Texas
| | - Jamshaid M Mir
- 1Division of Spinal Surgery, Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, New York
| | - Jordan A Lebovic
- 3Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, New York
| | - Pooja Dave
- 1Division of Spinal Surgery, Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, New York
| | - Peter S Tretiakov
- 1Division of Spinal Surgery, Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, New York
| | - Rachel Joujon-Roche
- 1Division of Spinal Surgery, Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, New York
| | - Bailey Imbo
- 1Division of Spinal Surgery, Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, New York
| | - Oscar Krol
- 1Division of Spinal Surgery, Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, New York
| | | | - Shaleen Vira
- 4Department of Orthopaedic Surgery, Banner University/University of Arizona Medical Center, Phoenix, Arizona
| | - Andrew J Schoenfeld
- 5Department of Orthopaedic Surgery, Brigham and Women's Hospital/Harvard Medical Center, Boston, Massachusetts
| | - Alan H Daniels
- 6Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University Medical Center, Providence, Rhode Island; and
| | - Bassel G Diebo
- 6Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University Medical Center, Providence, Rhode Island; and
| | - Renaud Lafage
- 7Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, New York
| | - Virginie Lafage
- 7Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, New York
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Passias PG, Williamson TK, Joujon-Roche R, Krol O, Tretiakov P, Imbo B, Schoenfeld AJ, Owusu-Sarpong S, Lebovic J, Mir J, Dave P, McFarland K, Vira S, Diebo BG, Park P, Chou D, Smith JS, Lafage R, Lafage V. The Impact of Lumbopelvic Realignment Versus Prevention Strategies at the Upper-instrumented Vertebra on the Rates of Junctional Failure Following Adult Spinal Deformity Surgery. Spine (Phila Pa 1976) 2024; 49:E72-E78. [PMID: 37235802 DOI: 10.1097/brs.0000000000004732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/06/2023] [Indexed: 05/28/2023]
Abstract
STUDY DESIGN/SETTING Retrospective. OBJECTIVE Evaluate the surgical technique that has the greatest influence on the rate of junctional failure following ASD surgery. SUMMARY OF BACKGROUND DATA Differing presentations of adult spinal deformity(ASD) may influence the extent of surgical intervention and the use of prophylaxis at the base or the summit of a fusion construct to influence junctional failure rates. MATERIALS AND METHODS ASD patients with two-year(2Y) data and at least 5-level fusion to the pelvis were included. Patients were divided based on UIV: [Longer Construct: T1-T4; Shorter Construct: T8-T12]. Parameters assessed included matching in age-adjusted PI-LL or PT, aligning in GAP-relative pelvic version or Lordosis Distribution Index. After assessing all lumbopelvic radiographic parameters, the combination of realigning the two parameters with the greatest minimizing effect of PJF constituted a good base. Good s was defined as having: (1) prophylaxis at UIV (tethers, hooks, cement), (2) no lordotic change(under-contouring) greater than 10° of the UIV, (3) preoperative UIV inclination angle<30°. Multivariable regression analysis assessed the effects of junction characteristics and radiographic correction individually and collectively on the development of PJK and PJF in differing construct lengths, adjusting for confounders. RESULTS In all, 261 patients were included. The cohort had lower odds of PJK(OR: 0.5,[0.2-0.9]; P =0.044) and PJF was less likely (OR: 0.1,[0.0-0.7]; P =0.014) in the presence of a good summit. Normalizing pelvic compensation had the greatest radiographic effect on preventing PJF overall (OR: 0.6,[0.3-1.0]; P =0.044). In shorter constructs, realignment had a greater effect on decreasing the odds of PJF(OR: 0.2,[0.02-0.9]; P =0.036). With longer constructs, a good summit lowered the likelihood of PJK(OR: 0.3,[0.1-0.9]; P =0.027). A good base led to zero occurrences of PJF. In patients with severe frailty/osteoporosis, a good summit lowered the incidence of PJK(OR: 0.4,[0.2-0.9]; P =0.041) and PJF (OR: 0.1,[0.01-0.99]; P =0.049). CONCLUSION To mitigate junctional failure, our study demonstrated the utility of individualizing surgical approaches to emphasize an optimal basal construct. Achievement of tailored goals at the cranial end of the surgical construct may be equally important, especially for higher-risk patients with longer fusions. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Peter G Passias
- Division of Spinal Surgery,/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY
| | - Tyler K Williamson
- Division of Spinal Surgery,/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY
| | - Rachel Joujon-Roche
- Division of Spinal Surgery,/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY
| | - Oscar Krol
- Division of Spinal Surgery,/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY
| | - Peter Tretiakov
- Division of Spinal Surgery,/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY
| | - Bailey Imbo
- Division of Spinal Surgery,/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital/Harvard Medical Center, Boston, MA
| | | | - Jordan Lebovic
- Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, NY
| | - Jamshaid Mir
- Division of Spinal Surgery,/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY
| | - Pooja Dave
- Division of Spinal Surgery,/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY
| | - Kimberly McFarland
- Division of Spinal Surgery,/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY
| | - Shaleen Vira
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, New York, NY
| | - Paul Park
- Department of Neurosurgery, Semmes-Murphey Clinic, Memphis, TN
| | - Dean Chou
- Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, New York, NY
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia, Charlottesville, VA
| | - Renaud Lafage
- Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Virginie Lafage
- Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY
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7
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Shah NV, Lettieri MJ, Kim D, Zhou JJ, Pineda N, Diebo BG, Woon CYL, Naziri Q. The impact of asymptomatic human immunodeficiency virus (HIV)-positive disease status on inpatient complications following total joint arthroplasty: a propensity score-matched analysis. Eur J Orthop Surg Traumatol 2024:10.1007/s00590-024-03872-3. [PMID: 38472434 DOI: 10.1007/s00590-024-03872-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 02/16/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE The number of patients with asymptomatic human immunodeficiency virus (AHIV) is increasing as the efficacy of antiretroviral therapy improves. While there is research on operative risks associated with having HIV, there is a lack of literature describing the impact of well-controlled HIV on postoperative complications. This study seeks to elucidate the impact of AHIV on postoperative outcomes after total hip (THA) and knee (TKA) arthroplasty. METHODS The Nationwide Inpatient Sample was retrospectively reviewed for patients undergoing TKA and THA from 2005 to 2013. Subjects were subdivided into those with AHIV and those without HIV (non-HIV). Patient demographics, hospital-related parameters, and postoperative complications were all collected. One-to-one propensity score-matching, Chi-square analysis, and multivariate logistical regressions were performed to compare both cohorts. RESULTS There were no significant differences between AHIV and non-HIV patients undergoing TKA or THA in terms of sex, age, insurance status, or total costs (all, p ≥ 0.081). AHIV patients had longer lengths of stay (4.0 days) than non-HIV patients after both TKA (3.3 days) and THA (3.1 days) (p ≤ 0.011). Both TKA groups had similar postoperative complication rates (p > 0.081). AHIV patients undergoing THA exhibited an increased rate of overall surgical complications compared non-HIV patients (0 vs. 4.5%, p = 0.043). AHIV was not associated with increased complications following both procedures. CONCLUSION Despite lengthier hospital stays among AHIV patients, baseline AHIV was not associated with adverse outcomes following TKA and THA. This adds to the literature and warrants further research into the impact of asymptomatic, well-controlled HIV infection on postoperative outcomes following total joint arthroplasty.
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Affiliation(s)
- Neil V Shah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Health Sciences University, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA.
| | - Matthew J Lettieri
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Health Sciences University, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - David Kim
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Health Sciences University, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Jack J Zhou
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Health Sciences University, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | | | - Bassel G Diebo
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Health Sciences University, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
- Department of Orthopaedic Surgery, Warren Alpert Medical School at Brown University, East Providence, RI, USA
| | - Colin Y L Woon
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Health Sciences University, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Qais Naziri
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Health Sciences University, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
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Diebo BG, Balmaceno-Criss M, Lafage R, McDonald CL, Alsoof D, Halayqeh S, DiSilvestro KJ, Kuris EO, Lafage V, Daniels AH. Sagittal Alignment in the Degenerative Lumbar Spine: Surgical Planning. J Bone Joint Surg Am 2024; 106:445-457. [PMID: 38271548 PMCID: PMC10906213 DOI: 10.2106/jbjs.23.00672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
➤ Sagittal alignment of the spine has gained attention in the field of spinal deformity surgery for decades. However, emerging data support the importance of restoring segmental lumbar lordosis and lumbar spinal shape according to the pelvic morphology when surgically addressing degenerative lumbar pathologies such as degenerative disc disease and spondylolisthesis.➤ The distribution of caudal lordosis (L4-S1) and cranial lordosis (L1-L4) as a percentage of global lordosis varies by pelvic incidence (PI), with cephalad lordosis increasing its contribution to total lordosis as PI increases.➤ Spinal fusion may lead to iatrogenic deformity if performed without attention to lordosis magnitude and location in the lumbar spine.➤ A solid foundation of knowledge with regard to optimal spinal sagittal alignment is beneficial when performing lumbar spinal surgery, and thoughtful planning and execution of lumbar fusions with a focus on alignment may improve patient outcomes.
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Affiliation(s)
- Bassel G. Diebo
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Mariah Balmaceno-Criss
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Christopher L. McDonald
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Daniel Alsoof
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Sereen Halayqeh
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Kevin J. DiSilvestro
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Eren O. Kuris
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Alan H. Daniels
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
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Daniels AH, Daher M, Singh M, Balmaceno-Criss M, Lafage R, Diebo BG, Hamilton DK, Smith JS, Eastlack RK, Fessler RG, Gum JL, Gupta MC, Hostin R, Kebaish KM, Klineberg EO, Lewis SJ, Line BG, Nunley PD, Mundis GM, Passias PG, Protopsaltis TS, Buell T, Scheer JK, Mullin JP, Soroceanu A, Ames CP, Lenke LG, Bess S, Shaffrey CI, Burton DC, Lafage V, Schwab FJ. The Case for Operative Efficiency in Adult Spinal Deformity Surgery: Impact of Operative Time on Complications, Length of Stay, Alignment, Fusion Rates, and Patient-Reported Outcomes. Spine (Phila Pa 1976) 2024; 49:313-320. [PMID: 37942794 DOI: 10.1097/brs.0000000000004873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/25/2023] [Indexed: 11/10/2023]
Abstract
STUDY DESIGN Retrospective review of prospectively collected data. OBJECTIVE To analyze the impact of operative room (OR) time in adult spinal deformity (ASD) surgery on patient outcomes. BACKGROUND It is currently unknown if OR time in ASD patients matched for deformity severity and surgical invasiveness is associated with patient outcomes. MATERIALS AND METHODS ASD patients with baseline and two-year postoperative radiographic and patient-reported outcome measures (PROM) data, undergoing a posterior-only approach for long fusion (>L1-Ilium) were included. Patients were grouped into short OR time (<40th percentile: <359 min) and long OR time (>60th percentile: >421 min). Groups were matched by age, baseline deformity severity, and surgical invasiveness. Demographics, radiographic, PROM data, fusion rate, and complications were compared between groups at baseline and two years follow-up. RESULTS In total, 270 patients were included for analysis: the mean OR time was 286 minutes in the short OR group versus 510 minutes in the long OR group ( P <0.001). Age, gender, percent of revision cases, surgical invasiveness, pelvic incidence minus lumbar lordosis, sagittal vertical axis, and pelvic tilt were comparable between groups ( P >0.05). Short OR had a slightly lower body mass index than the short OR group ( P <0.001) and decompression was more prevalent in the long OR time ( P =0.042). Patients in the long group had greater hospital length of stay ( P =0.02); blood loss ( P <0.001); proportion requiring intensive care unit ( P =0.003); higher minor complication rate ( P =0.001); with no significant differences for major complications or revision procedures ( P >0.5). Both groups had comparable radiographic fusion rates ( P =0.152) and achieved improvement in sagittal alignment measures, Oswestry disability index, and Short Form-36 ( P <0.001). CONCLUSION Shorter OR time for ASD correction is associated with a lower minor complication rate, a lower estimated blood loss, fewer intensive care unit admissions, and a shorter hospital length of stay without sacrificing alignment correction or PROMs. Maximizing operative efficiency by minimizing OR time in ASD surgery has the potential to benefit patients, surgeons, and hospital systems.
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Affiliation(s)
- Alan H Daniels
- Department of Orthopedics, Warren Alpert Medical School of Brown University, East Providence, RI
| | - Mohammad Daher
- Department of Orthopedics, Warren Alpert Medical School of Brown University, East Providence, RI
| | - Manjot Singh
- Department of Orthopedics, Warren Alpert Medical School of Brown University, East Providence, RI
| | - Mariah Balmaceno-Criss
- Department of Orthopedics, Warren Alpert Medical School of Brown University, East Providence, RI
| | - Renaud Lafage
- Department of Orthopedic Surgery, Northwell, New York, NY
| | - Bassel G Diebo
- Department of Orthopedics, Warren Alpert Medical School of Brown University, East Providence, RI
| | - David K Hamilton
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Justin S Smith
- University of Virginia Health System, Charlottesville, VA
| | | | - Richard G Fessler
- Department of Neurological Surgery, Rush University Medical School, Chicago, IL
| | | | | | - Richard Hostin
- Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, TX
| | | | - Eric O Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, CA
| | - Stephen J Lewis
- Division of Orthopaedics, Toronto Western Hospital, Toronto, Canada
| | | | | | | | - Peter G Passias
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY
| | | | - Thomas Buell
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Justin K Scheer
- Department of Neurosurgery, University of California, San Francisco, CA
| | | | - Alex Soroceanu
- Department of Orthopedic Surgery, University of Calgary, Calgary, Canada
| | | | - Lawrence G Lenke
- Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Shay Bess
- Denver International Spine Center, Denver, CO
| | | | - Douglas C Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | | | - Frank J Schwab
- Department of Orthopedic Surgery, Northwell, New York, NY
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Daher M, Cronkhite S, Balmaceno-Criss M, Varona-Cocero AD, Diebo BG, Daniels AH. Burst fracture treatment caudal to long posterior spinal fusion for adolescent idiopathic scoliosis utilizing temporary lumbo-pelvic fixation with restoration of lumbar mobility after instrumentation removal. N Am Spine Soc J 2024; 17:100307. [PMID: 38264151 PMCID: PMC10803935 DOI: 10.1016/j.xnsj.2023.100307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/18/2023] [Accepted: 12/28/2023] [Indexed: 01/25/2024]
Abstract
Background Thoracolumbar burst fractures are common traumatic spinal fractures. The goals of treatment include stabilization, prevention of neurologic compromise or deformity, and preservation of mobility. The aim of this case report is to describe the occurrence and treatment of an L4 burst fracture caudal to long posterior fusion for adolescent idiopathic scoliosis (AIS). Case report A 15-year-old girl patient underwent posterior spinal fusion from T3-L3. The patient tolerated the procedure well and there were no complications. Seven years postoperatively, the patient reported to the emergency department with lumbar pain after fall from height. A burst fracture at L4 was diagnosed and temporary posterior instrumentation to the pelvis was performed. One-year postinjury, the hardware was removed with fixation replaced only into the fractured segment. Flexion/extension radiographs revealed restored motion. Conclusions Treatment of fractures adjacent to fusion constructs may be challenging. This case demonstrates that avoiding fusion may lead to satisfactory outcomes and restoration of mobility after instrumentation removal.
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Affiliation(s)
- Mohammad Daher
- Department of Orthopaedic Surgery, Brown University, Providence, Rhode Island
| | - Shelby Cronkhite
- Department of Orthopaedic Surgery, Brown University, Providence, Rhode Island
| | | | | | - Bassel G. Diebo
- Department of Orthopaedic Surgery, Brown University, Providence, Rhode Island
| | - Alan H. Daniels
- Department of Orthopaedic Surgery, Brown University, Providence, Rhode Island
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Daniels AH, Balmaceno-Criss M, Criddle SL, Deck A, Daher M, Adashi EY, Diebo BG. Spinal malalignment: the rationale for updated terminology for patients with spinal deformity. Spine J 2024:S1529-9430(24)00101-3. [PMID: 38432299 DOI: 10.1016/j.spinee.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 02/25/2024] [Indexed: 03/05/2024]
Affiliation(s)
- Alan H Daniels
- Department of Orthopedics, The Warren Alpert Medical School at Brown University, 1 Kettle Point Avenue, East Providence, RI 02914, USA.
| | - Mariah Balmaceno-Criss
- Department of Orthopedics, The Warren Alpert Medical School at Brown University, 1 Kettle Point Avenue, East Providence, RI 02914, USA
| | - Sarah L Criddle
- Department of Orthopedics, The Warren Alpert Medical School at Brown University, 1 Kettle Point Avenue, East Providence, RI 02914, USA
| | - Adrian Deck
- Department of Orthopedics, The Warren Alpert Medical School at Brown University, 1 Kettle Point Avenue, East Providence, RI 02914, USA
| | - Mohammad Daher
- Department of Orthopedics, The Warren Alpert Medical School at Brown University, 1 Kettle Point Avenue, East Providence, RI 02914, USA
| | - Eli Y Adashi
- Department of Medical Science, Brown University, Providence, RI, 029012, USA
| | - Bassel G Diebo
- Department of Orthopedics, The Warren Alpert Medical School at Brown University, 1 Kettle Point Avenue, East Providence, RI 02914, USA
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12
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Daher M, Rezk A, Baroudi M, Gregorczyk J, Balmaceno Criss M, McDermott J, Mcdonald CL, Diebo BG, Daniels AH. Management of Thoracolumbar Vertebral Fractures and Dislocations in Patients with Ankylosing Conditions of the Spine. Orthop Rev (Pavia) 2024; 16:94279. [PMID: 38435438 PMCID: PMC10908592 DOI: 10.52965/001c.94279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024] Open
Abstract
Ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH) are bone-forming spinal conditions which inherently increase spine rigidity and place patients at a higher risk for thoracolumbar fractures. Due to the long lever-arm associated with their pathology, these fractures are frequently unstable and may significantly displace leading to catastrophic neurologic consequences. Operative and non-operative management are considerations in these fractures. However conservative measures including immobilization and bracing are typically reserved for non-displaced or incomplete fractures, or in patients for whom surgery poses a high risk. Thus, first line treatment is often surgery which has historically been an open posterior spinal fusion. Recent techniques such as minimally invasive surgery (MIS) and robotic surgery have shown promising lower complication rates as compared to open techniques, however these methods need to be further validated.
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Baroudi M, Rezk A, Daher M, Balmaceno-Criss M, Gregoryczyk JG, Sharma Y, McDonald CL, Diebo BG, Daniels AH. Management of traumatic spinal cord injury: A current concepts review of contemporary and future treatment. Injury 2024; 55:111472. [PMID: 38460480 DOI: 10.1016/j.injury.2024.111472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 02/03/2024] [Accepted: 02/25/2024] [Indexed: 03/11/2024]
Abstract
Spinal Cord Injury (SCI) is a condition leading to inflammation, edema, and dysfunction of the spinal cord, most commonly due to trauma, tumor, infection, or vascular disturbance. Symptoms include sensory and motor loss starting at the level of injury; the extent of damage depends on injury severity as detailed in the ASIA score. In the acute setting, maintaining mean arterial pressure (MAP) higher than 85 mmHg for up to 7 days following injury is preferred; although caution must be exercised when using vasopressors such as phenylephrine due to serious side effects such as pulmonary edema and death. Decompression surgery (DS) may theoretically relieve edema and reduce intraspinal pressure, although timing of surgery remains a matter of debate. Methylprednisolone (MP) is currently used due to its ability to reduce inflammation but more recent studies question its clinical benefits, especially with inconsistency in recommending it nationally and internationally. The choice of MP is further complicated by conflicting evidence for optimal timing to initiate treatment, and by the reported observation that higher doses are correlated with increased risk of complications. Thyrotropin-releasing hormone may be beneficial in less severe injuries. Finally, this review discusses many options currently being researched and have shown promising pre-clinical results.
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Affiliation(s)
- Makeen Baroudi
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Anna Rezk
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Mohammad Daher
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Mariah Balmaceno-Criss
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jerzy George Gregoryczyk
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Yatharth Sharma
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Christopher L McDonald
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Bassel G Diebo
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Alan H Daniels
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
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14
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Singh M, Balmaceno-Criss M, Anderson G, Parhar K, Daher M, Gregorczyk J, Liu J, McDonald CL, Diebo BG, Daniels AH. Anterior cervical discectomy and fusion versus cervical disc arthroplasty: an epidemiological review of 433,660 surgical patients from 2011 to 2021. Spine J 2024:S1529-9430(24)00081-0. [PMID: 38408519 DOI: 10.1016/j.spinee.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/06/2024] [Accepted: 02/21/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND CONTEXT Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are commonly performed operations to address cervical radiculopathy and myelopathy. Trends in utilization and revision surgery rates warrant investigation. PURPOSE To explore the epidemiology, postoperative complications, and reoperation rates of ACDF and CDA DESIGN: Retrospective cohort study. PATIENT SAMPLE A total of 433,660 patients who underwent ACDF or CDA between 2011 and 2021 were included in this study. OUTCOME MEASURES The following data were observed for all cases: patient demographics, complications, and revisions. METHODS The PearlDiver database was queried to identify patients who underwent ACDF and CDA between 2011 and 2021. Epidemiological analyses were performed to examine trends in cervical procedure utilization by age group and year. After matching by age, sex, Charlson Comorbidity Index (CCI), levels of operation, and reason for surgery, the early postoperative (2-week), short-term (2-year), and long-term (5-year) complications of both cervical procedures were examined. RESULTS In total, 404,195 ACDF and 29,465 CDA patients were included. ACDF utilization rose by 25.25% between 2011 and 2014 while CDA utilization rose by 654.24% between 2011-2019 followed by relative plateauing in both procedures. Mann-Kendall trend test confirmed a significant but small rise in ACDF and large rise in CDA procedures from 2011 to 2021 (p<.001). After matching, ACDF and CDA had an overall complication rate of 12.20% and 8.77%, respectively, with the most common complications being subsequent anterior revision (4.96% and 3.35%) and dysphagia (3.70% and 2.98%). The ACDF cohort, especially multilevel ACDF patients, generally had more complications and higher revision rates than the CDA cohort (p<.05). CONCLUSIONS While ACDF utilization has plateaued since 2014, CDA rates have risen by a staggering 654.24% over the past decade. ACDF and CDA complication and revision rates were relatively low in comparison to previously published values, with significantly lower rates in CDA. Although a lack of radiographic data in this study limits its power to recommend either procedure for individual patients with cervical radiculopathy or myelopathy, CDA may be associated with minor improvement in the complication and revision profile.
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Affiliation(s)
- Manjot Singh
- Warren Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02903, USA
| | - Mariah Balmaceno-Criss
- Warren Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02903, USA; Department of Orthopedics, Brown University, 1 Kettle Point Ave, Providence, RI 02914, USA
| | - George Anderson
- Warren Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02903, USA
| | - Kanwar Parhar
- Elson S. Floyd College of Medicine, Washington State University, 412 E Spokane Falls Blvd, Spokane, WA 99202, USA
| | - Mohammad Daher
- Department of Orthopedics, Brown University, 1 Kettle Point Ave, Providence, RI 02914, USA
| | - Jerzy Gregorczyk
- Department of Orthopedics, Brown University, 1 Kettle Point Ave, Providence, RI 02914, USA
| | - Jonathan Liu
- Department of Orthopedics, Brown University, 1 Kettle Point Ave, Providence, RI 02914, USA
| | - Christopher L McDonald
- Department of Orthopedics, Brown University, 1 Kettle Point Ave, Providence, RI 02914, USA
| | - Bassel G Diebo
- Department of Orthopedics, Brown University, 1 Kettle Point Ave, Providence, RI 02914, USA
| | - Alan H Daniels
- Department of Orthopedics, Brown University, 1 Kettle Point Ave, Providence, RI 02914, USA.
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Balmaceno-Criss M, Lafage R, Alsoof D, Daher M, Hamilton DK, Smith JS, Eastlack RK, Fessler RG, Gum JL, Gupta MC, Hostin R, Kebaish KM, Klineberg EO, Lewis SJ, Line BG, Nunley PD, Mundis GM, Passias PG, Protopsaltis TS, Buell T, Scheer JK, Mullin JP, Soroceanu A, Ames CP, Lenke LG, Bess S, Shaffrey CI, Schwab FJ, Lafage V, Burton DC, Diebo BG, Daniels AH. Impact of Hip and Knee Osteoarthritis on Full Body Sagittal Alignment and Compensation for Sagittal Spinal Deformity. Spine (Phila Pa 1976) 2024:00007632-990000000-00585. [PMID: 38375611 DOI: 10.1097/brs.0000000000004957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 01/26/2024] [Indexed: 02/21/2024]
Abstract
STUDY DESIGN Retrospective review of prospectively collected data. OBJECTIVE To investigate the effect of lower extremity osteoarthritis on sagittal alignment and compensatory mechanisms in adult spinal deformity (ASD). BACKGROUND Spine, hip, and knee pathologies often overlap in ASD patients. Limited data exists on how lower extremity osteoarthritis impacts sagittal alignment and compensatory mechanisms in ASD. METHODS 527 pre-operative ASD patients with full body radiographs were included. Patients were grouped by Kellgren-Lawrence grade of bilateral hips and knees and stratified by quartile of T1-Pelvic Angle (T1PA) severity into low-, mid-, high-, and severe-T1PA. Full body alignment and compensation were compared across quartiles. Regression analysis examined the incremental impact of hip and knee osteoarthritis severity on compensation. RESULTS The mean T1PA for low-, mid-, high-, and severe-T1PA groups was 7.3°, 19.5°, 27.8°, 41.6°, respectively. Mid-T1PA patients with severe hip osteoarthritis had an increased sagittal vertical axis and global sagittal alignment (P<0.001). Increasing hip osteoarthritis severity resulted in decreased pelvic tilt (P=0.001) and sacrofemoral angle (P<0.001), but increased knee flexion (P=0.012). Regression analysis revealed with increasing T1PA, pelvic tilt correlated inversely with hip osteoarthritis and positively with knee osteoarthritis (r2=0.812). Hip osteoarthritis decreased compensation via sacrofemoral angle (β-coefficient=-0.206). Knee and hip osteoarthritis contributed to greater knee flexion (β-coefficients=0.215, 0.101; respectively). For pelvic shift, only hip osteoarthritis significantly contributed to the model (β-coefficient=0.100). CONCLUSIONS For the same magnitude of spinal deformity, increased hip osteoarthritis severity was associated with worse truncal and full body alignment with posterior translation of the pelvis. Patients with severe hip and knee osteoarthritis exhibited decreased hip extension and pelvic tilt, but increased knee flexion. This examines sagittal alignment and compensation in ASD patients with hip and knee arthritis and may help delineate whether hip and knee flexion is due to spinal deformity compensation or lower extremity osteoarthritis.
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Affiliation(s)
- Mariah Balmaceno-Criss
- Department of Orthopedics, Warren Alpert Medical School of Brown University, East Providence, Rhode Island, USA
| | - Renaud Lafage
- Department of Orthopedic Surgery, Northwell, New York, NY
| | - Daniel Alsoof
- Department of Orthopedics, Warren Alpert Medical School of Brown University, East Providence, Rhode Island, USA
| | - Mohammad Daher
- Department of Orthopedics, Warren Alpert Medical School of Brown University, East Providence, Rhode Island, USA
| | - D Kojo Hamilton
- Department of Neurological Surgery, University of Pittsburgh
| | - Justin S Smith
- University of Virginia Health System, Charlottesville, VA
| | | | - Richard G Fessler
- Department of Neurological Surgery, Rush University Medical School, Chicago, IL
| | | | | | - Richard Hostin
- Department of Orthopaedic Surgery, Baylor Scoliosis Center, TX, US
| | | | - Eric O Klineberg
- Department of Orthopaedic Surgery, University of Texas Health, Houston TX, USA
| | - Stephen J Lewis
- Division of Orthopaedics, Toronto Western Hospital, Toronto, Canada
| | - Breton G Line
- Denver International Spine Center, Denver, Colorado, USA
| | | | | | - Peter G Passias
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, NY, USA
| | | | - Thomas Buell
- Department of Neurological Surgery, University of Pittsburgh
| | - Justin K Scheer
- Department of Neurosurgery, University of California, San Francisco, CA, USA
| | | | - Alex Soroceanu
- Department of Orthopedic Surgery, University of Calgary, Canada
| | - Christopher P Ames
- Department of Neurosurgery, University of California, San Francisco, CA, USA
| | - Lawrence G Lenke
- Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Shay Bess
- Denver International Spine Center, Denver, Colorado, USA
| | | | - Frank J Schwab
- Department of Orthopedic Surgery, Northwell, New York, NY
| | | | - Douglas C Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160, USA
| | - Bassel G Diebo
- Department of Orthopedics, Warren Alpert Medical School of Brown University, East Providence, Rhode Island, USA
| | - Alan H Daniels
- Department of Orthopedics, Warren Alpert Medical School of Brown University, East Providence, Rhode Island, USA
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Singh M, Balmaceno-Criss M, Knebel A, Kuharski M, Sakr I, Daher M, McDonald CL, Diebo BG, Czerwein JK, Daniels AH. Sacroplasty for Sacral Insufficiency Fractures: Narrative Literature Review on Patient Selection, Technical Approaches, and Outcomes. J Clin Med 2024; 13:1101. [PMID: 38398413 PMCID: PMC10889545 DOI: 10.3390/jcm13041101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/25/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
Sacral insufficiency fractures commonly affect elderly women with osteoporosis and can cause debilitating lower back pain. First line management is often with conservative measures such as early mobilization, multimodal pain management, and osteoporosis management. If non-operative management fails, sacroplasty is a minimally invasive intervention that may be pursued. Candidates for sacroplasty are patients with persistent pain, inability to tolerate immobilization, or patients with low bone mineral density. Before undergoing sacroplasty, patients' bone health should be optimized with pharmacotherapy. Anabolic agents prior to or in conjunction with sacroplasty have been shown to improve patient outcomes. Sacroplasty can be safely performed through a number of techniques: short-axis, long-axis, coaxial, transiliac, interpedicular, and balloon-assisted. The procedure has been demonstrated to rapidly and durably reduce pain and improve mobility, with little risk of complications. This article aims to provide a narrative literature review of sacroplasty including, patient selection and optimization, the various technical approaches, and short and long-term outcomes.
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Affiliation(s)
- Manjot Singh
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Mariah Balmaceno-Criss
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Ashley Knebel
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Michael Kuharski
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Itala Sakr
- Department of Orthopedic Surgery, Hotel Dieu de France, Beirut 166830, Lebanon
| | - Mohammad Daher
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Christopher L. McDonald
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Bassel G. Diebo
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - John K. Czerwein
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Alan H. Daniels
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
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Kasthuri VS, Glueck J, Pham H, Daher M, Balmaceno-Criss M, McDonald CL, Diebo BG, Daniels AH. Assessing the Accuracy and Reliability of AI-Generated Responses to Patient Questions Regarding Spine Surgery. J Bone Joint Surg Am 2024:00004623-990000000-01013. [PMID: 38335266 DOI: 10.2106/jbjs.23.00914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
BACKGROUND In today's digital age, patients increasingly rely on online search engines for medical information. The integration of large language models such as GPT-4 into search engines such as Bing raises concerns over the potential transmission of misinformation when patients search for information online regarding spine surgery. METHODS SearchResponse.io, a database that archives People Also Ask (PAA) data from Google, was utilized to determine the most popular patient questions regarding 4 specific spine surgery topics: anterior cervical discectomy and fusion, lumbar fusion, laminectomy, and spinal deformity. Bing's responses to these questions, along with the cited sources, were recorded for analysis. Two fellowship-trained spine surgeons assessed the accuracy of the answers on a 6-point scale and the completeness of the answers on a 3-point scale. Inaccurate answers were re-queried 2 weeks later. Cited sources were categorized and evaluated against Journal of the American Medical Association (JAMA) benchmark criteria. Interrater reliability was measured with use of the kappa statistic. A linear regression analysis was utilized to explore the relationship between answer accuracy and the type of source, number of sources, and mean JAMA benchmark score. RESULTS Bing's responses to 71 PAA questions were analyzed. The average completeness score was 2.03 (standard deviation [SD], 0.36), and the average accuracy score was 4.49 (SD, 1.10). Among the question topics, spinal deformity had the lowest mean completeness score. Re-querying the questions that initially had answers with low accuracy scores resulted in responses with improved accuracy. Among the cited sources, commercial sources were the most prevalent. The JAMA benchmark score across all sources averaged 2.63. Government sources had the highest mean benchmark score (3.30), whereas social media had the lowest (1.75). CONCLUSIONS Bing's answers were generally accurate and adequately complete, with incorrect responses rectified upon re-querying. The plurality of information was sourced from commercial websites. The type of source, number of sources, and mean JAMA benchmark score were not significantly correlated with answer accuracy. These findings underscore the importance of ongoing evaluation and improvement of large language models to ensure reliable and informative results for patients seeking information regarding spine surgery online amid the integration of these models in the search experience.
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Affiliation(s)
- Viknesh S Kasthuri
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jacob Glueck
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Han Pham
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Mohammad Daher
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Mariah Balmaceno-Criss
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Christopher L McDonald
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Bassel G Diebo
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Alan H Daniels
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Passias PG, Pierce KE, Mir JM, Krol O, Lafage R, Lafage V, Line B, Uribe JS, Hostin R, Daniels A, Hart R, Burton D, Shaffrey C, Schwab F, Diebo BG, Ames CP, Smith JS, Schoenfeld AJ, Bess S, Klineberg EO. Development of a modified frailty index for adult spinal deformities independent of functional changes following surgical correction: a true baseline risk assessment tool. Spine Deform 2024:10.1007/s43390-023-00808-5. [PMID: 38305990 DOI: 10.1007/s43390-023-00808-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 12/16/2023] [Indexed: 02/03/2024]
Abstract
PURPOSE To develop a simplified, modified frailty index for adult spinal deformity (ASD) patients dependent on objective clinical factors. METHODS ASD patients with baseline (BL) and 2-year (2Y) follow-up were included. Factors with the largest R2 value derived from multivariate forward stepwise regression were including in the modified ASD-FI (clin-ASD-FI). Factors included in the clin-ASD-FI were regressed against mortality, extended length of hospital stay (LOS, > 8 days), revisions, major complications and weights for the clin-ASD-FI were calculated via Beta/Sullivan. Total clin-ASD-FI score was created with a score from 0 to 1. Linear regression correlated clin-ASD-FI with ASD-FI scores and published cutoffs for the ASD-FI were used to create the new frailty cutoffs: not frail (NF: < 0.11), frail (F: 0.11-0.21) and severely frail (SF: > 0.21). Binary logistic regression assessed odds of complication or reop for frail patients. RESULTS Five hundred thirty-one ASD patients (59.5 yrs, 79.5% F) were included. The final model had a R2 of 0.681, and significant factors were: < 18.5 or > 30 BMI (weight: 0.0625 out of 1), cardiac disease (0.125), disability employment status (0.3125), diabetes mellitus (0.0625), hypertension (0.0625), osteoporosis (0.125), blood clot (0.1875), and bowel incontinence (0.0625). These factors calculated the score from 0 to 1, with a mean cohort score of 0.13 ± 0.14. Breakdown by clin-ASD-FI score: 51.8% NF, 28.1% F, 20.2% SF. Increasing frailty severity was associated with longer LOS (NF: 7.0, F: 8.3, SF: 9.2 days; P < 0.001). Frailty independently predicted occurrence of any complication (OR: 9.357 [2.20-39.76], P = 0.002) and reop (OR: 2.79 [0.662-11.72], P = 0.162). CONCLUSIONS Utilizing an existing ASD frailty index, we proposed a modified version eliminating the patient-reported components. This index is a true assessment of physiologic status, and represents a superior risk factor assessment compared to other tools for both primary and revision spinal deformity surgery as a result of its immutability with surgery, lack of subjectivity, and ease of use.
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Affiliation(s)
- Peter G Passias
- Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, NYU Langone Medical Center, Orthopaedic Hospital - NYU School of Medicine, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA.
| | - Katherine E Pierce
- Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, NYU Langone Medical Center, Orthopaedic Hospital - NYU School of Medicine, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Jamshaid M Mir
- Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, NYU Langone Medical Center, Orthopaedic Hospital - NYU School of Medicine, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Oscar Krol
- Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, NYU Langone Medical Center, Orthopaedic Hospital - NYU School of Medicine, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Breton Line
- Department of Spine Surgery, Denver International Spine Clinic, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO, USA
| | - Juan S Uribe
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Richard Hostin
- Department of Orthopaedic Surgery, Baylor Scoliosis Center, Dallas, TX, USA
| | - Alan Daniels
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Robert Hart
- Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, WA, USA
| | - Douglas Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Frank Schwab
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
| | - Andrew J Schoenfeld
- Department of Orthopedic Surgery, Brigham and Women's Center for Surgery and Public Health, Boston, MA, USA
| | - Shay Bess
- Department of Spine Surgery, Denver International Spine Clinic, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO, USA
| | - Eric O Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Davis, CA, USA
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Williamson TK, Dave P, Mir JM, Smith JS, Lafage R, Line B, Diebo BG, Daniels AH, Gum JL, Protopsaltis TS, Hamilton DK, Soroceanu A, Scheer JK, Eastlack R, Kelly MP, Nunley P, Kebaish KM, Lewis S, Lenke LG, Hostin RA, Gupta MC, Kim HJ, Ames CP, Hart RA, Burton DC, Shaffrey CI, Klineberg EO, Schwab FJ, Lafage V, Chou D, Fu KM, Bess S, Passias PG. Persistent Lower Extremity Compensation for Sagittal Imbalance After Surgical Correction of Complex Adult Spinal Deformity: A Radiographic Analysis of Early Impact. Oper Neurosurg (Hagerstown) 2024; 26:156-164. [PMID: 38227826 DOI: 10.1227/ons.0000000000000901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/06/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Achieving spinopelvic realignment during adult spinal deformity (ASD) surgery does not always produce ideal outcomes. Little is known whether compensation in lower extremities (LEs) plays a role in this disassociation. The objective is to analyze lower extremity compensation after complex ASD surgery, its effect on outcomes, and whether correction can alleviate these mechanisms. METHODS We included patients with complex ASD with 6-week data. LE parameters were as follows: sacrofemoral angle, knee flexion angle, and ankle flexion angle. Each parameter was ranked, and upper tertile was deemed compensation. Patients compensating and not compensating postoperatively were propensity score matched for body mass index, frailty, and T1 pelvic angle. Linear regression assessed correlation between LE parameters and baseline deformity, demographics, and surgical details. Multivariate analysis controlling for baseline deformity and history of total knee/hip arthroplasty evaluated outcomes. RESULTS Two hundred and ten patients (age: 61.3 ± 14.1 years, body mass index: 27.4 ± 5.8 kg/m2, Charlson Comorbidity Index: 1.1 ± 1.6, 72% female, 22% previous total joint arthroplasty, 24% osteoporosis, levels fused: 13.1 ± 3.8) were included. At baseline, 59% were compensating in LE: 32% at hips, 39% knees, and 36% ankles. After correction, 61% were compensating at least one joint. Patients undercorrected postoperatively were less likely to relieve LE compensation (odds ratio: 0.2, P = .037). Patients compensating in LE were more often undercorrected in age-adjusted pelvic tilt, pelvic incidence, lumbar lordosis, and T1 pelvic angle and disproportioned in Global Alignment and Proportion (P < .05). Patients matched in sagittal age-adjusted score at 6 weeks but compensating in LE were more likely to develop proximal junctional kyphosis (odds ratio: 4.1, P = .009) and proximal junctional failure (8% vs 0%, P = .035) than those sagittal age-adjusted score-matched and not compensating in LE. CONCLUSION Perioperative lower extremity compensation was a product of undercorrecting complex ASD. Even in age-adjusted realignment, compensation was associated with global undercorrection and junctional failure. Consideration of lower extremities during planning is vital to avoid adverse outcomes in perioperative course after complex ASD surgery.
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Affiliation(s)
- Tyler K Williamson
- Departments of Orthopaedic and Neurological Surgery, NYU Langone Orthopaedic Hospital, New York Spine Institute, New York, New York, USA
| | - Pooja Dave
- Departments of Orthopaedic and Neurological Surgery, NYU Langone Orthopaedic Hospital, New York Spine Institute, New York, New York, USA
| | - Jamshaid M Mir
- Departments of Orthopaedic and Neurological Surgery, NYU Langone Orthopaedic Hospital, New York Spine Institute, New York, New York, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Renaud Lafage
- Department of Orthopaedics, Hospital for Special Surgery, New York, New York, USA
| | - Breton Line
- Department of Spine Surgery, Denver International Spine Clinic, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, Colorado, USA
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, New York, New York, USA
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Jeffrey L Gum
- Department of Orthopaedic Surgery, Norton Leatherman Spine Center, Louisville, Kentucky, USA
| | | | - D Kojo Hamilton
- Departments of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Alex Soroceanu
- Department of Orthopaedic Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Justin K Scheer
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA
| | - Robert Eastlack
- Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, USA
| | - Michael P Kelly
- Department of Orthopaedic Surgery, Rady Children's Hospital, San Diego, California, USA
| | - Pierce Nunley
- Spine Institute of Louisiana, Shreveport, Louisiana, USA
| | - Khaled M Kebaish
- Department of Orthopaedic Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Stephen Lewis
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Lawrence G Lenke
- Department of Orthopaedic Surgery, Columbia College of Physicians and Surgeons, New York, New York, USA
| | - Richard A Hostin
- Department of Orthopaedic Surgery, Baylor Scoliosis Center, Dallas, Texas, USA
| | - Munish C Gupta
- Department of Orthopaedic Surgery, Washington University of St Louis, St Louis, Missouri, USA
| | - Han Jo Kim
- Department of Spine Surgery, Denver International Spine Clinic, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, Colorado, USA
| | - Christopher P Ames
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA
| | - Robert A Hart
- Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, Washington, USA
| | - Douglas C Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Christopher I Shaffrey
- Spine Division, Departments of Neurosurgery and Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Eric O Klineberg
- Department of Orthopedic Surgery, University of California Davis, Sacramento, California, USA
| | - Frank J Schwab
- Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, New York, USA
| | - Virginie Lafage
- Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, New York, USA
| | - Dean Chou
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Kai-Ming Fu
- Department of Neurological Surgery, Weill Cornell Medicine Brain and Spine Center, New York, New York, USA
| | - Shay Bess
- Department of Orthopaedics, Hospital for Special Surgery, New York, New York, USA
| | - Peter G Passias
- Departments of Orthopaedic and Neurological Surgery, NYU Langone Orthopaedic Hospital, New York Spine Institute, New York, New York, USA
- Rocky Mountain Scoliosis and Spine, Denver, Colorado, USA
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20
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Passias PG, Williamson TK, Krol O, Joujon-Roche R, Imbo B, Tretiakov P, Ahmad S, Bennett-Caso C, Lebovic J, Owusu-Sarpong S, Park P, Chou D, Vira S, Diebo BG, Schoenfeld AJ. Patient-Centered Outcomes Following Prone Lateral Single-Position Approach to Same-Day Circumferential Spine Surgery. Spine (Phila Pa 1976) 2024; 49:174-180. [PMID: 36972128 DOI: 10.1097/brs.0000000000004648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE Evaluate surgical characteristics and postoperative 2-year results of the PL approach to spinal fusion. SUMMARY OF BACKGROUND DATA Prone-lateral(PL) single positioning has recently gained popularity in spine surgery due to lower blood loss and operative time but has yet to be examined for other notable outcomes, including realignment and patient-reported measures. MATERIALS AND METHODS We included circumferential spine fusion patients with a minimum one-year follow-up. Patients were stratified into groups based on undergoing PL approach versus same-day staged (Staged). Mean comparison tests identified differences in baseline parameters. Multivariable logistic regression, controlling for age, levels fused, and Charlson Comorbidity Index were used to determine the influence of the approach on complication rates, radiographic and patient-reported outcomes up to two years. RESULTS One hundred twenty-two patients were included of which 72(59%) were same-day staged and 50(41%) were PL. PL patients were older with lower body mass index (both P <0.05). Patients undergoing PL procedures had lower estimated blood loss and operative time (both P <0.001), along with fewer osteotomies (63% vs. 91%, P <0.001). This translated to a shorter length of stay (3.8 d vs. 4.9, P =0.041). PL procedures demonstrated better correction in both PT (4.0 vs. -0.2, P =0.033 and pelvic incidence and lumbar lordosis (-3.7 vs. 3.1, P =0.012). PL procedures were more likely to improve in GAP relative pelvic version (OR: 2.3, [1.5-8.8]; P =0.003]. PL patients suffered lesser complications during the perioperative period and greater improvement in NRS-Back (-6.0 vs. -3.3, P =0.031), with less reoperations (0.0% vs. 4.8%, P =0.040) by two years. CONCLUSIONS Patients undergoing PL single-position procedures received less invasive procedures with better correction of pelvic compensation, as well as earlier discharge. The prone lateral cohort also demonstrated greater clinical improvement and a lower rate of reoperations by two years following spinal corrective surgery. LEVEL OF EVIDENCE Level-III.
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Affiliation(s)
- Peter G Passias
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York, NY
- New York Spine Institute, New York, NY
| | - Tyler K Williamson
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York, NY
- New York Spine Institute, New York, NY
| | - Oscar Krol
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York, NY
- New York Spine Institute, New York, NY
| | - Rachel Joujon-Roche
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York, NY
- New York Spine Institute, New York, NY
| | - Bailey Imbo
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York, NY
- New York Spine Institute, New York, NY
| | - Peter Tretiakov
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York, NY
- New York Spine Institute, New York, NY
| | - Salman Ahmad
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York, NY
- New York Spine Institute, New York, NY
| | - Claudia Bennett-Caso
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York, NY
- New York Spine Institute, New York, NY
| | - Jordan Lebovic
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York, NY
- New York Spine Institute, New York, NY
| | - Stephane Owusu-Sarpong
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York, NY
- New York Spine Institute, New York, NY
| | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI
| | - Dean Chou
- Department of Neurosurgery, Columbia University, New York, NY
| | - Shaleen Vira
- Departments of Orthopaedic and Neurosurgery, UT Southwestern Medical Center, Dallas, TX
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, New York, NY
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Kasthuri VS, Alsoof D, Balmaceno-Criss M, Daher M, McDonald CL, Diebo BG, Kuris EO, Daniels AH. Variability in expenses related to spine oncology care: comparison of payer-negotiated rates at National Cancer Institute-Designated Cancer Centers. Spine J 2024; 24:304-309. [PMID: 38440969 DOI: 10.1016/j.spinee.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/01/2023] [Accepted: 10/14/2023] [Indexed: 03/06/2024]
Abstract
BACKGROUND As of 2021, the Centers for Medicare and Medicaid Services (CMS) requires all hospitals to publish their commercially negotiated prices. To our knowledge, price variation of spine oncology diagnosis and treatments has not been previously investigated. PURPOSE The aim of this study is to characterize the availability and variation of prices for spinal oncology services among National Cancer Institute-Designated Cancer Centers (NCI-DCC). STUDY DESIGN Cross-sectional analysis. METHODS Cancer centers were identified; those that did not provide patient care or participate in Medicare's Inpatient Prospective System were excluded. A cross-sectional analysis was conducted to gather commercially negotiated prices by searching online for "[center name] price transparency OR machine-readable file OR chargemaster." Data obtained was queried using 44 current procedural terminology (CPT) codes for imaging, procedures, and surgeries relevant to spine oncology. Comparison of prices was achieved by normalizing the median price for each service at each center to the estimated 2022 Medicare reimbursement for the center's Medicare Administrator Contractor. The ratios between the lowest and highest median commercial negotiated price within a center and across all centers were defined as "within-center ratio" and "across-center ratio" respectively. RESULTS In total, 49 centers disclosed commercial payer-negotiated rates. Mean rate (±SD) for cervical corpectomy was $9,134 (±$10,034), thoracic laminectomy for neoplasm excision was $5,382 (±$5502), superficial bone biopsy was $1,853 (±$1,717), and single-photon emission computerized tomography (SPECT) was $813 (±$232). Within-center ratios ranged from 5.0 (SPECT scan) to 17.8 (radiofrequency bone ablation). Across-center ratios (for codes with > 10 centers reporting) ranged from 9.0 (corpectomy, thoracic, lateral extra-cavitary) to 418.7 (anterior approach cervical corpectomy). CONCLUSIONS Price transparency for spinal oncology remains elusive despite recent CMS regulatory oversight, with marked heterogeneity in the quality of published rates complicating patients' ability to "shop" for care. Additionally, there continues to be significant variation in commercial rates for spine oncology diagnosis and treatment. CLINICAL SIGNIFICANCE Despite regulation by CMS, prices for spinal oncology services are not uniformly available to patients and vary between NCI-DCC. The findings of this manuscript present potential barriers for patients to compare and obtain affordable care.
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Affiliation(s)
- Viknesh S Kasthuri
- Warren Alpert Medical School of Brown University, 1 Kettle Point Ave, East Providence, RI, 02914, USA
| | - Daniel Alsoof
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, 1 Kettle Point Ave, East Providence, RI, 02914, USA
| | - Mariah Balmaceno-Criss
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, 1 Kettle Point Ave, East Providence, RI, 02914, USA
| | - Mohammad Daher
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, 1 Kettle Point Ave, East Providence, RI, 02914, USA
| | - Christopher L McDonald
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, 1 Kettle Point Ave, East Providence, RI, 02914, USA
| | - Bassel G Diebo
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, 1 Kettle Point Ave, East Providence, RI, 02914, USA
| | - Eren O Kuris
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, 1 Kettle Point Ave, East Providence, RI, 02914, USA
| | - Alan H Daniels
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, 1 Kettle Point Ave, East Providence, RI, 02914, USA.
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Diebo BG, Balmaceno-Criss M, Lafage R, Daher M, Singh M, Hamilton DK, Smith JS, Eastlack RK, Fessler R, Gum JL, Gupta MC, Hostin R, Kebaish KM, Lewis S, Line BG, Nunley PD, Mundis GM, Passias PG, Protopsaltis TS, Turner J, Buell T, Scheer JK, Mullin J, Soroceanu A, Ames CP, Bess S, Shaffrey CI, Lenke LG, Schwab FJ, Lafage V, Burton DC, Daniels AH. Lumbar Lordosis Redistribution and Segmental Correction in Adult Spinal Deformity (ASD): Does it Matter? Spine (Phila Pa 1976) 2024:00007632-990000000-00569. [PMID: 38270393 DOI: 10.1097/brs.0000000000004930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/01/2024] [Indexed: 01/26/2024]
Abstract
STUDY DESIGN Retrospective analysis of prospectively collected data. OBJECTIVE Evaluate the impact of correcting to normative segmental lordosis values on post-operative outcomes. BACKGROUND Restoring lumbar lordosis magnitude is crucial in adult spinal deformity surgery, but the optimal location and segmental distribution remains unclear. METHODS Patients were grouped based on offset to normative segmental lordosis values, extracted from recent publications. Matched patients were within 10% of the cohort's mean offset, less than or over 10% were under- and over-corrected. Surgical technique, PROMs, and surgical complications were compared across groups at baseline and 2-year. RESULTS 510 patients with an average age of 64.6, mean CCI 2.08, and average follow-up of 25 months. L4-5 was least likely to be matched (19.1%), while L4-S1 was the most likely (24.3%). More patients were overcorrected at proximal levels (T10-L2; Undercorrected, U: 32.2% vs. Matched, M: 21.7% vs. Overcorrected, O: 46.1%) and undercorrected at distal levels (L4-S1: U: 39.0% vs. M: 24.3% vs. O: 36.8%). Postoperative ODI was comparable across correction groups at all spinal levels except at L4-S1 and T10-L2/L4-S1, where overcorrected patients and matched were better than undercorrected (U: 32.1 vs. M: 25.4 vs. O: 26.5, P=0.005; U: 36.2 vs. M: 24.2 vs. O: 26.8, P=0.001; respectively). Patients overcorrected at T10-L2 experienced higher rates of proximal junctional failure (PJF) (U: 16.0% vs. M: 15.6% vs. O: 32.8%, P<0.001) and had greater posterior inclination of the upper instrumented vertebra (UIV) (U: -9.2±9.4° vs. M: -9.6±9.1° vs. O: -12.2±10.0°, P<0.001), whereas undercorrection at these levels led to higher rates of revision for implant failure (U: 14.2% vs. M: 7.3% vs. O: 6.4%, P=0.025). CONCLUSIONS Patients undergoing fusion for adult spinal deformity suffer higher rates of PJF with overcorrection and increased rates of implant failure with undercorrection based on normative segmental lordosis. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Bassel G Diebo
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Mariah Balmaceno-Criss
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Renaud Lafage
- Department of Orthopedic Surgery, Lenox Hill Hospital, Northwell Health, New York, New York
| | - Mohammad Daher
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Manjot Singh
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - D Kojo Hamilton
- Department of Neurological Surgery, University of Pittsburgh
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Robert K Eastlack
- Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, California
| | | | - Jeffrey L Gum
- Norton Leatherman Spine Center, Louisville, Kentucky
| | - Munish C Gupta
- Department of Orthopedic Surgery, Washington University, St. Louis, Missouri
| | - Richard Hostin
- Department of Orthopaedic Surgery, Southwest Scoliosis Center, Dallas, Texas
| | - Khaled M Kebaish
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephen Lewis
- Department of Orthopedics, University of Toronto, Toronto, Canada
| | - Breton G Line
- Department of Spine Surgery, Denver International Spine Center, Denver, Colorado
| | | | - Gregory M Mundis
- Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, California
| | - Peter G Passias
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, New York
| | | | - Jay Turner
- Barrow Brain and Spine, Phoenix, Arizona
| | - Thomas Buell
- Department of Neurological Surgery, University of Pittsburgh
| | - Justin K Scheer
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York
| | - Jeffery Mullin
- Department of Neurosurgery, University of Buffalo, Amherst, New York, New York
| | - Alex Soroceanu
- Department of Orthopedic Surgery, University of Calgary, Canada
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Shay Bess
- Department of Spine Surgery, Denver International Spine Center, Denver, Colorado
| | | | - Lawrence G Lenke
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York
| | - Frank J Schwab
- Department of Orthopedic Surgery, Lenox Hill Hospital, Northwell Health, New York, New York
| | - Virginie Lafage
- Department of Orthopedic Surgery, Lenox Hill Hospital, Northwell Health, New York, New York
| | - Douglas C Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Alan H Daniels
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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23
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Van Halm-Lutterodt N, Albright JA, Storlie NR, Mesregah MK, Ansari K, Balmaceno-Criss M, Daher M, Bartels-Mensah M, Xu Y, Diebo BG, Hai Y, Chandler DR, Daniels AH. Cannabis use Disorder and Complications After Anterior Cervical Diskectomy and Fusion. World Neurosurg 2024; 181:e1001-e1011. [PMID: 37956902 DOI: 10.1016/j.wneu.2023.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVE The aim of this study, a retrospective database analysis, was to assess the impact of baseline cannabis use disorder (CUD) on perioperative complication outcomes in patients undergoing primary 1- to 2-level anterior cervical diskectomy and fusion (ACDF) surgery. METHODS The PearlDiver Database was queried from January 2010 to December 2021 for patients who underwent primary 1- to 2-level ACDF surgery for degenerative spine disease. Patients with CUD diagnosis 6 months before the index ACDF surgery (i.e., CUD) were propensity matched with patients without CUD (i.e., control in a ratio of 1:1, employing age, gender, and Charlson Comorbidity Index as matching covariates). Univariate and multivariable analysis models with adjustment of confounding variables were used to evaluate the risk of CUD on perioperative complications between the propensity-matched cohorts. RESULTS The 1:1 matched cohort included 838 patients in each group. Following multivariate analysis, CUD was demonstrated to be associated with an increased incidence of hospital readmission at 90 days (odds ratio [OR] = 2.64, 95% confidence interval: [1.19 to 6.78], [P = 0.027]) and revision surgery at 1 year postoperative (OR = 3.36, 95% confidence interval: [1.17 to 14.18], [P = 0.049]). CUD was additionally associated with reduced risk of overall medical complications at both 6 months and 1 year postoperative (OR = 0.55, [P = 0.021], and OR = 0.54, [P = 0.015], respectively). CONCLUSIONS These findings indicate that isolated baseline CUD is associated with an increased risk of hospital readmission at 90 days postoperative and cervical spine reoperation at 1 year after primary 1- to 2-level ACDF surgery with a decrease in overall medical complications, cardiac arrhythmias, and acute renal failure.
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Affiliation(s)
- Nicholas Van Halm-Lutterodt
- Department of Orthopedics Surgery, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA; School of Public Health and Professional Studies, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA; Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Neurological Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Orthopedics Surgery, Keck Medical Center of the University of Southern California, Los Angeles, California, USA
| | - J Alex Albright
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | | | - Mohamed Kamal Mesregah
- Department of Orthopedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, Egypt
| | - Kashif Ansari
- Department of Orthopedics Surgery, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA; Department of Economics, Brown University, Providence, Rhode Island, USA
| | - Mariah Balmaceno-Criss
- Department of Orthopedics Surgery, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA; The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Mohammad Daher
- Department of Orthopedics Surgery, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
| | - Mercy Bartels-Mensah
- Department of Clinical Sciences, University of Debrecen School of Medicine, Debrecen, Hungary
| | - Yulun Xu
- Department of Neurological Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bassel G Diebo
- Department of Orthopedics Surgery, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
| | - Yong Hai
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - David Ray Chandler
- School of Public Health and Professional Studies, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA; Andrews Institute of Orthopedics and Sports Medicine, Gulf Breeze, Florida, USA
| | - Alan H Daniels
- Department of Orthopedics Surgery, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA.
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24
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Passias PG, Ahmad W, Williamson TK, Lebovic J, Kebaish K, Lafage R, Lafage V, Line B, Schoenfeld AJ, Diebo BG, Klineberg EO, Kim HJ, Ames CP, Daniels AH, Smith JS, Shaffrey CI, Burton DC, Hart RA, Bess S, Schwab FJ, Gupta MC. Efficacy of Varying Surgical Approaches on Achieving Optimal Alignment in Adult Spinal Deformity Surgery. Spine (Phila Pa 1976) 2024; 49:22-28. [PMID: 37493057 DOI: 10.1097/brs.0000000000004784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/21/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND The Roussouly, SRS-Schwab, and Global Alignment and Proportion (GAP) classifications define alignment by spinal shape and deformity severity. The efficacy of different surgical approaches and techniques to successfully achieve these goals is not well understood. PURPOSE Identify the impact of surgical approach and/or technique on meeting complex realignment goals in adult spinal deformity (ASD) corrective surgery. STUDY DESIGN/SETTING Retrospective study. MATERIALS AND METHODS Included patients with ASD fused to pelvis with 2-year data. Patients were categorized by: (1) Roussouly: matching current and theoretical spinal shapes, (2) improving in SRS-Schwab modifiers (0, +, ++), and (3) improving GAP proportionality by 2 years. Analysis of covariance and multivariable logistic regression analyses controlling for age, levels fused, baseline deformity, and 3-column osteotomy usage compared the effect of different surgical approaches, interbody, and osteotomy use on meeting realignment goals. RESULTS A total of 693 patients with ASD were included. By surgical approach, 65.7% were posterior-only and 34.3% underwent anterior-posterior approach with 76% receiving an osteotomy (21.8% 3-column osteotomy). By 2 years, 34% matched Roussouly, 58% improved in GAP, 45% in SRS-Schwab pelvic tilt (PT), 62% sagittal vertical axis, and 70% pelvic incidence-lumbar lordosis. Combined approaches were most effective for improvement in PT [odds ratio (OR): 1.7 (1.1-2.5)] and GAP [OR: 2.2 (1.5-3.2)]. Specifically, anterior lumbar interbody fusion (ALIF) below L3 demonstrated higher rates of improvement versus TLIFs in Roussouly [OR: 1.7 (1.1-2.5)] and GAP [OR: 1.9 (1.3-2.7)]. Patients undergoing pedicle subtraction osteotomy at L3 or L4 were more likely to improve in PT [OR: 2.0 (1.0-5.2)] and pelvic incidence-lumbar lordosis [OR: 3.8 (1.4-9.8)]. Clinically, patients undergoing the combined approach demonstrated higher rates of meeting SCB in Oswestry Disability Index by 2 years while minimizing rates of proximal junctional failure, most often with an ALIF at L5-S1 [Oswestry Disability Index-SCB: OR: 1.4 (1.1-2.0); proximal junctional failure: OR: 0.4 (0.2-0.8)]. CONCLUSIONS Among patients undergoing ASD realignment, optimal lumbar shape and proportion can be achieved more often with a combined approach. Although TLIFs, incorporating a 3-column osteotomy, at L3 and L4 can restore lordosis and normalize pelvic compensation, ALIFs at L5-S1 were most likely to achieve complex realignment goals with an added clinical benefit and mitigation of junctional failure.
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Affiliation(s)
- Peter G Passias
- Departments of Orthopedic and Neurologic Surgery, NYU Langone Orthopedic Hospital and New York Spine Institute, New York, NY
| | - Waleed Ahmad
- Departments of Orthopedic and Neurologic Surgery, NYU Langone Orthopedic Hospital and New York Spine Institute, New York, NY
| | - Tyler K Williamson
- Departments of Orthopedic and Neurologic Surgery, NYU Langone Orthopedic Hospital and New York Spine Institute, New York, NY
| | - Jordan Lebovic
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY
| | - Khaled Kebaish
- Department of Orthopedic Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD
| | - Renaud Lafage
- Department of Orthopedics, Hospital for Special Surgery, New York, NY
| | - Virginie Lafage
- Department of Orthopedics, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Breton Line
- Department of Spine Surgery, Denver International Spine Clinic, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO
| | - Andrew J Schoenfeld
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Bassel G Diebo
- Department of Orthopedic Surgery, SUNY Downstate Medical Center, New York, NY
| | - Eric O Klineberg
- Department of Orthopedic Surgery, University of California Davis, Sacramento, CA
| | - Han Jo Kim
- Department of Orthopedics, Hospital for Special Surgery, New York, NY
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
| | - Alan H Daniels
- Department of Orthopedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia, Charlottesville, VA
| | - Christopher I Shaffrey
- Departments of Neurosurgery and Orthopedic Surgery, Spine Division, Duke University School of Medicine, Durham, NC
| | - Douglas C Burton
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Robert A Hart
- Department of Orthopedic Surgery, Swedish Neuroscience Institute, Seattle, WA
| | - Shay Bess
- Department of Spine Surgery, Denver International Spine Clinic, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO
| | - Frank J Schwab
- Department of Orthopedics, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Munish C Gupta
- Department of Orthopedic Surgery, Washington University, St. Louis, MO
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Halayqeh S, Glueck J, Balmaceno-Criss M, Alsoof D, McDonald CL, Diebo BG, Daniels AH. Delayed cerebrospinal fluid (CSF) leak following anterior cervical discectomy and fusion surgery. N Am Spine Soc J 2023; 16:100271. [PMID: 37771759 PMCID: PMC10522904 DOI: 10.1016/j.xnsj.2023.100271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/18/2023] [Accepted: 08/18/2023] [Indexed: 09/30/2023]
Abstract
Background An uncommon complication of anterior cervical discectomy and fusion (ACDF) is dura tear, which may be further complicated by cerebral spinal fluid (CSF) leak. Dural tears with CSF leak can lead to catastrophic neurologic outcomes and should be recognized early. Case Description This case report describes a 43-year-old female patient with history of Ehlers-Danlos syndrome who presented 1-year post-ACDF with positional headaches and lightheadedness. Imaging revealed ACDF plate subsidence and CSF leak with inferior displacement of the cerebellar tonsils. Outcome The patient underwent a revision procedure with removal of index screws and CSF repair using epidural blood patch, fat graft, and Tisseel. The original bicortical screws were replaced with shorter larger diameter unicortical screws. Post-operative imaging at 2 and 6 weeks confirmed resolution of CSF leak. Conclusions Healthcare professionals and patients undergoing spinal surgery should be aware of late presentation CSF leaks which can represent gradual decline in neurological function. Surgical candidates at risk to develop CSF leaks should be counseled about possible complications in preoperative planning.
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Affiliation(s)
- Sereen Halayqeh
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, 1 Kettle Point Ave East Providence, RI, 02914 United States
| | - Jacob Glueck
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, 1 Kettle Point Ave East Providence, RI, 02914 United States
- Warren Alpert Medical School, Brown University, 222 Richmond St., RI, 02903 United States
| | - Mariah Balmaceno-Criss
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, 1 Kettle Point Ave East Providence, RI, 02914 United States
- Warren Alpert Medical School, Brown University, 222 Richmond St., RI, 02903 United States
| | - Daniel Alsoof
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, 1 Kettle Point Ave East Providence, RI, 02914 United States
- Warren Alpert Medical School, Brown University, 222 Richmond St., RI, 02903 United States
| | - Christopher L. McDonald
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, 1 Kettle Point Ave East Providence, RI, 02914 United States
| | - Bassel G. Diebo
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, 1 Kettle Point Ave East Providence, RI, 02914 United States
| | - Alan H. Daniels
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, 1 Kettle Point Ave East Providence, RI, 02914 United States
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26
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Alsoof D, Kasthuri V, McDonald C, Cusano J, Anderson G, Diebo BG, Kuris E, Daniels AH. How much are patients willing to pay for spine surgery? An evaluation of attitudes toward out-of-pocket expenses and cost-reducing measures. Spine J 2023; 23:1886-1893. [PMID: 37619868 DOI: 10.1016/j.spinee.2023.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND CONTEXT With rising healthcare expenditures in the United States, patients and providers are searching to maintain quality while reducing costs. PURPOSE The aim of this study was to investigate patient willingness to pay for anterior cervical discectomy and fusion (ACDF), degenerative lumbar spinal fusions (LF), and adult spine deformity (ASD) surgery. STUDY DESIGN/SETTING A survey was developed and distributed to anonymous respondents through Amazon Mechanical Turk (MTurk). METHODS The survey introduced 3 procedures: ACDF, LF, and ASD surgery. Respondents were asked sequentially if they would pay at each increasing price option. Respondents were then presented with various cost-saving methods and asked to select the options that made them most uncomfortable, even if those would save them out-of-pocket costs. RESULTS In total, 979 of 1,172 total responses (84%) were retained for analysis. The average age was 36.2 years and 44% of participants reported a household income of $50,000 to 100,000. A total of 63% used Medicare and 13% used Medicaid. A total of 40% stated they had high levels of financial stress. A total of 30.1% of participants were willing to undergo an ACDF, 30.3% were willing to undergo a LF, and 29.6% were willing to undergo ASD surgery for the cost of $3,000 (p=.98). Regression demonstrated that for ACDF surgery, a $100 increase in price resulted in a 2.1% decrease in willingness to pay. This is comparable to degenerative LF surgery (1.8% decrease), and ASD surgery (2%). When asked which cost-saving measures participants were least comfortable with for ACDF surgery, 60% stated "Use of the older generation implants/devices" (LF: 51%, ASD: 60%,), 61% stated "Having the surgery performed at a community hospital instead of at a major academic center" (LF: 49%, ASD: 56%), and 55% stated "Administration of anesthesia by a nurse anesthetist" (LF: 48.01%, ASD: 55%). Conversely, 36% of ACDF patients were uncomfortable with a "Video/telephone postoperative visit" to cut costs (LF: 51%, ASD: 39%). CONCLUSIONS Patients are unwilling to contribute larger copays for adult spinal deformity correction than for ACDF and degenerative lumbar spine surgery, despite significantly higher procedural costs and case complexity/invasiveness. Patients were most uncomfortable forfeiting newer generation implants, receiving the operation at a community rather than an academic center, and receiving care by physician extenders. Conversely, patients were more willing to convert postoperative visits to telehealth and forgo neuromonitoring, indicating a potentially poor understanding of which cost-saving measures may be implemented without increasing the risk of complications.
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Affiliation(s)
- Daniel Alsoof
- Department of Orthopedics, Brown University Warren Alpert Medical School, 1 Kettle Point Ave, East Providence, RI 02914, USA
| | - Viknesh Kasthuri
- The Warren Alpert Medical School of Brown University, 222 Richmond St, East Providence, RI 02903, USA
| | - Christopher McDonald
- Department of Orthopedics, Brown University Warren Alpert Medical School, 1 Kettle Point Ave, East Providence, RI 02914, USA
| | - Joseph Cusano
- Department of Orthopedics, Brown University Warren Alpert Medical School, 1 Kettle Point Ave, East Providence, RI 02914, USA
| | - George Anderson
- The Warren Alpert Medical School of Brown University, 222 Richmond St, East Providence, RI 02903, USA
| | - Bassel G Diebo
- Department of Orthopedics, Brown University Warren Alpert Medical School, 1 Kettle Point Ave, East Providence, RI 02914, USA
| | - Eren Kuris
- Department of Orthopedics, Brown University Warren Alpert Medical School, 1 Kettle Point Ave, East Providence, RI 02914, USA
| | - Alan H Daniels
- Department of Orthopedics, Brown University Warren Alpert Medical School, 1 Kettle Point Ave, East Providence, RI 02914, USA.
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27
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Shah NV, Moattari CR, Lavian JD, Gedailovich S, Krasnyanskiy B, Beyer GA, Condron N, Passias PG, Lafage R, Jo Kim H, Schwab FJ, Lafage V, Paulino CB, Diebo BG. The Impact of Isolated Preoperative Cannabis Use on Outcomes Following Cervical Spinal Fusion: A Propensity Score-Matched Analysis. Iowa Orthop J 2023; 43:117-124. [PMID: 38213849 PMCID: PMC10777691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Background Cannabis is the most commonly used recreational drug in the USA. Studies evaluating cannabis use and its impact on outcomes following cervical spinal fusion (CF) are limited. This study sought to assess the impact of isolated (exclusive) cannabis use on postoperative outcomes following CF by analyzing outcomes like complications, readmissions, and revisions. Methods The New York Statewide Planning and Research Cooperative System (SPARCS) was queried for patients who underwent CF between January 2009 and September 2013. Inclusion criteria were age ≥18 years and either a minimum 90-day (for complications and readmissions) or 2-year (for revisions) follow-up surveillance. Patients with systemic disease, osteomyelitis, cancer, trauma, and concomitant substance or polysubstance abuse/dependence were excluded. Patients with a preoperative International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) diagnosis of isolated cannabis abuse (Cannabis) or dependence were identified. The primary outcome measures were 90-day complications, 90-day readmissions, and two-year revisions following CF. Cannabis patients were 1:1 propensity score-matched by age, gender, race, Deyo score, surgical approach, and tobacco use to non-cannabis users and compared for outcomes. Multivariate binary stepwise logistic regression models identified independent predictors of outcomes. Results 432 patients (n=216 each) with comparable age, sex, Deyo scores, tobacco use, and distribution of anterior or posterior surgical approaches were identified (all p>0.05). Cannabis patients were predominantly Black (27.8% vs. 12.0%), primarily utilized Medicaid (29.6% vs. 12.5%), and had longer LOS (3.0 vs. 1.9 days), all p≤0.001. Both cohorts experienced comparable rates of 90-day medical and surgical, as well as overall complications (5.6% vs. 3.7%) and two-year revisions (4.2% vs. 2.8%, p=0.430), but isolated cannabis patients had higher 90-day readmission rates (11.6% vs. 6.0%, p=0.042). Isolated cannabis use independently predicted 90-day readmission (Odds Ratio=2.0), but did not predict any 90-day complications or two year revisions (all p>0.05). Conclusion Isolated baseline cannabis dependence/abuse was associated with increased risk of 90-day readmission following CF. Further investigation of the physiologic impact of cannabis on musculoskeletal patients may elucidate significant contributory factors. Level of Evidence: III.
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Affiliation(s)
- Neil V. Shah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Cameron R. Moattari
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Joshua D. Lavian
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Samuel Gedailovich
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Benjamin Krasnyanskiy
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - George A. Beyer
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Nolan Condron
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Peter G. Passias
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, New York, USA
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, New York, USA
| | - Han Jo Kim
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Frank J. Schwab
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, New York, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, New York, USA
| | - Carl B. Paulino
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
- Department of Orthopaedic Surgery, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA
| | - Bassel G. Diebo
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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28
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Singh M, Balmaceno-Criss M, Alsoof D, Burch MB, Sakr I, Diebo BG, McDonald C, Basques B, Kuris EO, Daniels AH. Reduction of adolescent grade IV L5-S1 spondylolisthesis with anterior joystick manipulation during a combined anterior and posterior surgical approach: A case report. N Am Spine Soc J 2023; 16:100263. [PMID: 37711284 PMCID: PMC10497841 DOI: 10.1016/j.xnsj.2023.100263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/04/2023] [Accepted: 08/04/2023] [Indexed: 09/16/2023]
Abstract
Background High-grade isthmic spondylolisthesis poses a clinical challenge in the pediatric and adolescent population. Current surgical management using posterior-based approaches may lead to incomplete reduction and restoration of listhesis, disc height, and lordosis. Combined anterior and posterior approach addresses these issues but has been infrequently reported, mainly in the treatment of low-grade isthmic spondylolisthesis. Neither offers good disc space visualization and control of spinal alignment during reduction. Case Description A healthy 17-year-old female presented with 9 months of progressively worsening lower back pain radiating down the left lower extremity and 3 inches of height loss. Diagnosis of grade IV L5-S1 spondylolisthesis was made using plain radiographs, CT, and MRI. Management with combined anterior and posterior fusion, involving the manual manipulation of segments using an anterior pedicle screw joystick, was pursued. Outcome Satisfactory alignment, solid arthrodesis, no complications, and improved patient reported outcomes. Conclusions Combined anterior and posterior fusion with anterior joystick manipulation allowed for full reduction of grade IV spondylolisthesis and restoration of disc/foraminal height and L5-S1 segmental lordosis without neurological complication. Although less commonly performed in children and adolescents, this surgical approach can assist in restoring optimal alignment in isthmic spondylolisthesis.
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Affiliation(s)
- Manjot Singh
- Warren Alpert Medical School, Brown University, Kettle Point Avenue. East Providence, RI 02914, United States
| | - Mariah Balmaceno-Criss
- Warren Alpert Medical School, Brown University, Kettle Point Avenue. East Providence, RI 02914, United States
| | - Daniel Alsoof
- Department of Orthopedics, Warren Alpert Medical School, Brown University, Kettle Point Avenue. East Providence, RI 02914, United States
| | - M. Benjamin Burch
- Department of Orthopedics, Warren Alpert Medical School, Brown University, Kettle Point Avenue. East Providence, RI 02914, United States
| | - Itala Sakr
- Department of Orthopedics, Hotel Dieu de France, Boulevard Alfred Neccache, Achrafieh, Beirut, Lebanon BP, 16630, Lebanon
| | - Bassel G. Diebo
- Warren Alpert Medical School, Brown University, Kettle Point Avenue. East Providence, RI 02914, United States
- Department of Orthopedics, Warren Alpert Medical School, Brown University, Kettle Point Avenue. East Providence, RI 02914, United States
| | - Christopher McDonald
- Warren Alpert Medical School, Brown University, Kettle Point Avenue. East Providence, RI 02914, United States
- Department of Orthopedics, Warren Alpert Medical School, Brown University, Kettle Point Avenue. East Providence, RI 02914, United States
| | - Bryce Basques
- Department of Orthopedics, Warren Alpert Medical School, Brown University, Kettle Point Avenue. East Providence, RI 02914, United States
| | - Eren O. Kuris
- Department of Orthopedics, Warren Alpert Medical School, Brown University, Kettle Point Avenue. East Providence, RI 02914, United States
| | - Alan H. Daniels
- Warren Alpert Medical School, Brown University, Kettle Point Avenue. East Providence, RI 02914, United States
- Department of Orthopedics, Warren Alpert Medical School, Brown University, Kettle Point Avenue. East Providence, RI 02914, United States
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29
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Passias PG, Pierce KE, Dave P, Lafage R, Lafage V, Schoenfeld AJ, Line B, Uribe J, Hostin R, Daniels A, Hart R, Burton D, Kim HJ, Mundis GM, Eastlack R, Diebo BG, Gum JL, Shaffrey C, Schwab F, Ames CP, Smith JS, Bess S, Klineberg E, Gupta MC, Hamilton DK. When not to Operate in Spinal Deformity: Identifying Subsets of Patients With Simultaneous Clinical Deterioration, Major Complications, and Reoperation. Spine (Phila Pa 1976) 2023; 48:1481-1485. [PMID: 37470375 DOI: 10.1097/brs.0000000000004778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 06/15/2023] [Indexed: 07/21/2023]
Abstract
STUDY DESIGN Retrospective review of a prospectively enrolled adult spinal deformity (ASD) database. OBJECTIVE To investigate what patient factors elevate the risk of sub-optimal outcomes after deformity correction. BACKGROUND Currently, it is unknown what factors predict a poor outcome after adult spinal deformity surgery, which may require increased preoperative consideration and counseling. MATERIALS AND METHODS Patients >18 yrs undergoing surgery for ASD(scoliosis≥20°, SVA≥5 cm, PT≥25°, or TK≥60°). An unsatisfactory outcome was defined by the following categories met at two years: (1) clinical: deteriorating in ODI at two years follow-up (2) complications/reoperation: having a reoperation and major complication were deemed high risk for poor outcomes postoperatively (HR). Multivariate analyses assessed predictive factors of HR patients in adult spinal deformity patients. RESULTS In all, 633 adult spinal deformity (59.9 yrs, 79% F, 27.7 kg/m 2, CCI: 1.74) were included. Baseline severe Schwab modifier incidence (++): 39.2% pelvic incidence and lumbar lordosis, 28.8% sagittal vertical axis, 28.9% PT. Overall, 15.5% of patients deteriorated in ODI by two years, while 7.6% underwent reoperation and had a major complication. This categorized 11 (1.7%) as HR. HR were more comorbid in terms of arthritis (73%), heart disease (36%), and kidney disease (18%), P <0.001. Surgically, HR had greater EBL (4431ccs) and underwent more osteotomies (91%), specifically Ponte(36%) and Three Column Osteotomies(55%), which occurred more at L2(91%). HR underwent more PLIFs (45%) and had more blood transfusion units (2641ccs), all P <0.050. The multivariate regression determined a combination of a baseline Distress and Risk Assessment Method score in the 75th percentile, having arthritis and kidney disease, a baseline right lower extremity motor score ≤3, cSVA >65 mm, C2 slope >30.2°, CTPA >5.5° for an R2 value of 0.535 ( P <0.001). CONCLUSIONS When addressing adult spine deformities, poor outcomes tend to occur in severely comorbid patients with major baseline psychological distress scores, poor neurologic function, and concomitant cervical malalignment.
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Affiliation(s)
- Peter G Passias
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY
| | - Katherine E Pierce
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY
| | - Pooja Dave
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY
| | - Renaud Lafage
- Department of Orthopedics, Hospital for Special Surgery, New York, NY
| | - Virginie Lafage
- Department of Orthopedics, Hospital for Special Surgery, New York, NY
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Breton Line
- Department of Spine Surgery, Denver International Spine Clinic, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO
| | - Juan Uribe
- Department of Neurosurgery, University of South Florida, Tampa, FL
| | - Richard Hostin
- Department of Orthopaedic Surgery, Baylor Scoliosis Center, Dallas, TX
| | - Alan Daniels
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI
| | - Robert Hart
- Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, WA
| | - Douglas Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Han Jo Kim
- Department of Orthopedics, Hospital for Special Surgery, New York, NY
| | | | - Robert Eastlack
- Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI
| | - Jeffrey L Gum
- Department of Orthopaedic Surgery, Norton Leatherman Spine Center, Louisville, KY
| | - Christopher Shaffrey
- Departments of Neurosurgery and Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Frank Schwab
- Department of Orthopedics, Hospital for Special Surgery, New York, NY
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia, Charlottesville, VA
| | - Shay Bess
- Department of Spine Surgery, Denver International Spine Clinic, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO
| | - Eric Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Davis, CA
| | - Munish C Gupta
- Department of Orthopaedic Surgery, Washington University of St Louis, St. Louis, MO
| | - D Kojo Hamilton
- Departments of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA
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Daniels AH, Alsoof D, McDonald CL, Diebo BG, Kuris EO. Clinical Examination of the Cervical Spine. N Engl J Med 2023; 389:e34. [PMID: 37888918 DOI: 10.1056/nejmvcm2204780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Affiliation(s)
- Alan H Daniels
- From the Department of Orthopedics, Warren Alpert Medical School, Brown University, Providence, RI
| | - Daniel Alsoof
- From the Department of Orthopedics, Warren Alpert Medical School, Brown University, Providence, RI
| | - Christopher L McDonald
- From the Department of Orthopedics, Warren Alpert Medical School, Brown University, Providence, RI
| | - Bassel G Diebo
- From the Department of Orthopedics, Warren Alpert Medical School, Brown University, Providence, RI
| | - Eren O Kuris
- From the Department of Orthopedics, Warren Alpert Medical School, Brown University, Providence, RI
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Balmaceno-Criss M, Alsoof D, Lafage R, Diebo BG, Daniels AH, Schwab F, Lafage V. Proximal Junctional Kyphosis Prevention Strategies Focused on Alignment. Int J Spine Surg 2023; 17:S38-S46. [PMID: 37364936 PMCID: PMC10626131 DOI: 10.14444/8513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
Adult spinal deformity (ASD) is a complex pathology associated with spinal malalignment in the coronal, sagittal, and axial planes. Proximal junction kyphosis (PJK) is a complication of ASD surgery, affecting 10%-48% of patients, and can result in pain and neurological deficit. It is defined radiographically as a greater than 10° Cobb angle between the upper instrumented vertebrae and the 2 vertebrae proximal to the superior endplate. Risk factors are classified according to the patient, surgery, and overall alignment, but it is important to consider the interplay between various factors. This article reviews the risk factors of PJK and considers alignment-focused prevention strategies.
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Affiliation(s)
- Mariah Balmaceno-Criss
- Department of Orthopedics, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Daniel Alsoof
- Department of Orthopedics, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Renaud Lafage
- Department of Orthopedics, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Bassel G Diebo
- Department of Orthopedics, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Alan H Daniels
- Department of Orthopedics, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Frank Schwab
- Department of Orthopedics, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Virginie Lafage
- Department of Orthopedics, Lenox Hill Hospital, Northwell Health, New York, NY, USA
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Chee A, Çeliker P, Basedow K, Islam M, Baksh N, Shah NV, Eldib AM, Eldib H, Diebo BG, Naziri Q. A call to "own the bone": osteoporosis is a predictor for adverse two-year outcomes following total hip and knee arthroplasty. Eur J Orthop Surg Traumatol 2023; 33:2889-2894. [PMID: 36894707 DOI: 10.1007/s00590-023-03499-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/05/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE While bone health is instrumental in orthopedic surgery, few studies have described the long-term outcomes of osteoporosis (OP) in patients undergoing total hip (THA) or knee (TKA) arthroplasties. METHODS Using the New York State statewide planning and research cooperative system database, all patients who underwent primary TKA or THA for osteoarthritis from 2009 to 2011 with minimum 2-year follow-up were identified. They were divided based on their OP status (OP and non-OP) and 1:1 propensity score matched for age, sex, race, and Charlson/Deyo index. Cohorts were compared for demographics, hospital-related parameters, and 2-year postoperative complications and reoperations. Multivariate binary logistic regression was utilized to identify significant independent associations with 2-year medical and surgical complications and revisions. RESULTS A total of 11,288 TKA and 8248 THA patients were identified. OP and non-OP TKA patients incurred comparable overall hospital charges for their surgical visit and hospital length of stay (LOS) (both, p ≥ 0.125). Though OP and non-OP THA patients incurred similar mean hospital charges for their surgical visit, they experienced longer hospital LOS (4.3 vs. 4.1 days, p = 0.035). For both TKA and THA, OP patients had higher rates of overall and individual medical and surgical complications (all, p < 0.05). OP was independently associated with the 2-year occurrence of any overall, surgical, and medical complications, and any revision in TKA and THA patients (all, OR ≥ 1.42, p < 0.001). CONCLUSION Our study found OP was associated with a greater risk of 2-year adverse outcomes following TKA or THA, including medical, surgical, and overall complications as well as revision operations compared to non-OP patients.
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Affiliation(s)
- Alexander Chee
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Pelin Çeliker
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Kayla Basedow
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Mahee Islam
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Nayeem Baksh
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Neil V Shah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Ahmed M Eldib
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Hassan Eldib
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Bassel G Diebo
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Qais Naziri
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA.
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Krol O, McFarland K, Owusu-Sarpong S, Sagoo N, Williamson T, Joujon-Roche R, Tretiakov P, Imbo B, Dave P, Mir J, Lebovic J, Onafowokan OO, Schoenfeld AJ, De la Garza Ramos R, Janjua MB, Sciubba DM, Diebo BG, Vira S, Smith JS, Lafage V, Lafage R, Passias PG. Impact of Frailty on the Development of Proximal Junctional Failure: Does Frailty Supersede Achieving Optimal Realignment? Spine (Phila Pa 1976) 2023; 48:1348-1353. [PMID: 37199421 DOI: 10.1097/brs.0000000000004719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 12/31/2022] [Indexed: 05/19/2023]
Abstract
BACKGROUND Patients undergoing surgery for adult spinal deformity (ASD) are often elderly, frail, and at elevated risk of adverse events perioperatively, with proximal junctional failure (PJF) occurring relatively frequently. Currently, the specific role of frailty in potentiating this outcome is poorly defined. PURPOSE To determine if the benefits of optimal realignment in ASD, with respect to the development of PJF, can be offset by increasing frailty. STUDY DESIGN Retrospective cohort. MATERIALS AND METHODS Operative ASD patients (scoliosis >20°, SVA>5 cm, pelvic tilt>25°, or TK>60°) fused to the pelvis or below with available baseline and 2-year (2Y) radiographic and HRQL data were included. The Miller Frailty Index (FI) was used to stratify patients into 2 categories: Not Frail (FI <3) and Frail (>3). Proximal Junctional Failure (PJF) was defined using the Lafage criteria. "Matched" and "unmatched" refers to ideal age-adjusted alignment postoperatively. Multivariable regression determined the impact of frailty on the development of PJF. RESULTS Two hundred eighty-four ASD patients met inclusion criteria [62.2yrs±9.9, 81%F, BMI: 27.5 kg/m 2 ±5.3, ASD-FI: 3.4±1.5, Charlson Comorbidity Index (CCI): 1.7±1.6]. Forty-three percent of patients were characterized as Not Frail (NF) and 57% were characterized as Frail (F). PJF development was lower in the NF group compared with the F group (7% vs . 18%; P =0.002). F patients had 3.2 × higher risk of PJF development compared to NF patients (OR: 3.2, 95% CI: 1.3-7.3, P =0.009). Controlling for baseline factors, F unmatched patients had a higher degree of PJF (OR: 1.4, 95% CI:1.02-1.8, P =0.03); however, with prophylaxis, there was no increased risk. Adjusted analysis shows F patients, when matched postoperatively in PI-LL, had no significantly higher risk of PJF. CONCLUSIONS An increasingly frail state is significantly associated with the development of PJF after corrective surgery for ASD. Optimal realignment may mitigate the impact of frailty on eventual PJF. Prophylaxis should be considered in frail patients who do not reach ideal alignment goals.
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Affiliation(s)
- Oscar Krol
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY
| | - Kimberly McFarland
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY
| | | | - Navraj Sagoo
- Departments of Orthopaedic and Neurosurgery, UT Southwestern Medical Center, Dallas, TX
| | - Tyler Williamson
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY
| | - Rachel Joujon-Roche
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY
| | - Peter Tretiakov
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY
| | - Bailey Imbo
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY
| | - Pooja Dave
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY
| | - Jamshaid Mir
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY
| | - Jordan Lebovic
- Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, NY
| | - Oluwatobi O Onafowokan
- Exeter Spine Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital/Harvard Medical Center, Boston, MA
| | - Rafael De la Garza Ramos
- Departments of Orthopaedic and Neurosurgery, UT Southwestern Medical Center, Dallas, TX
- Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | | | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore MD
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, New York, NY
| | - Shaleen Vira
- Departments of Orthopaedic and Neurosurgery, UT Southwestern Medical Center, Dallas, TX
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia, Charlottesville, VA
| | - Virginie Lafage
- Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Renaud Lafage
- Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Peter G Passias
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY
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Berreta RS, Zhang H, Alsoof D, Khatri S, Casey J, McDonald CL, Diebo BG, Kuris EO, Basques BA, Daniels AH. Adult Spinal Deformity Correction in Patients with Parkinson Disease: Assessment of Surgical Complications, Reoperation, and Cost. World Neurosurg 2023; 178:e331-e338. [PMID: 37480985 DOI: 10.1016/j.wneu.2023.07.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Parkinson disease (PD) is a neurodegenerative disorder that manifests with postural instability and gait imbalance. Correction of spinal deformity in patients with PD presents unique challenges. METHODS The PearlDiver database was queried between 2010 and 2020 to identify adult patients with spinal deformity before undergoing deformity correction with posterior spinal fusion. Two cohorts were created representing patients with and without a preoperative diagnosis of PD. Outcome measures included reoperation rates, surgical technique, cost, surgical complications, and medical complications. Multivariable logistic regression adjusting for Charlson Comorbidity Index, age, gender, 3-column osteotomy, pelvic fixation, and number of levels fused was used to assess rates of reoperation and complications. RESULTS In total, 26,984 patients met the inclusion criteria and were retained for analysis. Of these patients, 725 had a diagnosis of PD before deformity correction. Patients with PD underwent higher rates of pelvic fixation (odds ratio [OR], 1.33; P < 0.001) and 3-column osteotomies (OR, 1.53; P < 0.001). On adjusted regression, patients with PD showed increased rates of reoperation at 1 year (OR, 1.37; P < 0.001), 5 years (OR, 1.32; P < 0.001), and overall (OR, 1.33; P < 0.001). Patients with PD also experienced an increased rate of medical complications within 30 days after deformity correction including deep venous thrombosis (OR, 1.60; P = 0.021), pneumonia (OR, 1.44; P = 0.039), and urinary tract infections (OR, 1.54; P < 0.001). Deformity correction in patients with PD was associated with higher 90-day cost (P = 0.007). CONCLUSIONS Patients with PD undergoing long fusion for deformity correction are at significantly increased risk of 30-day medical complications and revision procedures after 1 year, controlling for comorbidities, age, and invasiveness. Surgeons should consider the risk of complications, subsequent revision procedures, and increased cost.
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Affiliation(s)
| | - Helen Zhang
- Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Daniel Alsoof
- Department of Orthopedics, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Surya Khatri
- Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Jack Casey
- Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Christopher L McDonald
- Department of Orthopedics, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Bassel G Diebo
- Department of Orthopedics, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Eren O Kuris
- Department of Orthopedics, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Bryce A Basques
- Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Alan H Daniels
- Department of Orthopedics, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA.
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Diebo BG, Tataryn Z, Alsoof D, Lafage R, Hart RA, Passias PG, Ames CP, Scheer JK, Lewis SJ, Shaffrey CI, Burton DC, Deviren V, Line BG, Soroceanu A, Hamilton DK, Klineberg EO, Mundis GM, Kim HJ, Gum JL, Smith JS, Uribe JS, Kelly MP, Kebaish KM, Gupta MC, Nunley PD, Eastlack RK, Hostin R, Protopsaltis TS, Lenke LG, Schwab FJ, Bess S, Lafage V, Daniels AH. Height Gain Following Correction of Adult Spinal Deformity. J Bone Joint Surg Am 2023; 105:1410-1419. [PMID: 37478308 DOI: 10.2106/jbjs.23.00031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Abstract
BACKGROUND Height gain following a surgical procedure for patients with adult spinal deformity (ASD) is incompletely understood, and it is unknown if height gain correlates with patient-reported outcome measures (PROMs). METHODS This was a retrospective cohort study of patients undergoing ASD surgery. Patients with baseline, 6-week, and subanalysis of 1-year postoperative full-body radiographic and PROM data were examined. Correlation analysis examined relationships between vertical height differences and PROMs. Regression analysis was utilized to preoperatively estimate T1-S1 and S1-ankle height changes. RESULTS This study included 198 patients (mean age, 57 years; 69% female); 147 patients (74%) gained height. Patients with height loss, compared with those who gained height, experienced greater increases in thoracolumbar kyphosis (2.81° compared with -7.37°; p < 0.001) and thoracic kyphosis (12.96° compared with 4.42°; p = 0.003). For patients with height gain, sagittal and coronal alignment improved from baseline to postoperatively: 25° to 21° for pelvic tilt (PT), 14° to 3° for pelvic incidence - lumbar lordosis (PI-LL), and 60 mm to 17 mm for sagittal vertical axis (SVA) (all p < 0.001). The full-body mean height gain was 7.6 cm, distributed as follows: sella turcica-C2, 2.9 mm; C2-T1, 2.8 mm; T1-S1 (trunk gain), 3.8 cm; and S1-ankle (lower-extremity gain), 3.3 cm (p < 0.001). T1-S1 height gain correlated with the thoracic Cobb angle correction and the maximum Cobb angle correction (p = 0.002). S1-ankle height gain correlated with the corrections in PT, PI-LL, and SVA (p < 0.001). T1-ankle height gain correlated with the corrections in PT (p < 0.001) and SVA (p = 0.03). Trunk height gain correlated with improved Scoliosis Research Society (SRS-22r) Appearance scores (r = 0.20; p = 0.02). Patient-Reported Outcomes Measurement Information System (PROMIS) Depression scores correlated with S1-ankle height gain (r = -0.19; p = 0.03) and C2-T1 height gain (r = -0.18; p = 0.04). A 1° correction in a thoracic scoliosis Cobb angle corresponded to a 0.2-mm height gain, and a 1° correction in a thoracolumbar scoliosis Cobb angle resulted in a 0.25-mm height gain. A 1° improvement in PI-LL resulted in a 0.2-mm height gain. CONCLUSIONS Most patients undergoing ASD surgery experienced height gain following deformity correction, with a mean full-body height gain of 7.6 cm. Height gain can be estimated preoperatively with predictive ratios, and height gain was correlated with improvements in reported SRS-22r appearance and PROMIS scores. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Bassel G Diebo
- Department of Orthopedics, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Daniel Alsoof
- Department of Orthopedics, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Renaud Lafage
- Department of Orthopedic Surgery, Lenox Hill Northwell, New York, NY
| | | | - Peter G Passias
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, NY
| | | | - Justin K Scheer
- University of California-San Francisco, San Francisco, California
| | - Stephen J Lewis
- Division of Orthopaedics, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Douglas C Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Vedat Deviren
- University of California-San Francisco, San Francisco, California
| | - Breton G Line
- Department of Orthopedic Surgery, Denver International Spine Center, Denver, Colorado
| | - Alex Soroceanu
- Department of Orthopedic Surgery, University of Calgary, Calgary, Alberta, Canada
| | - D Kojo Hamilton
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Eric O Klineberg
- Department of Orthopaedic Surgery, University of California-Davis, Davis, California
| | | | - Han Jo Kim
- Hospital for Special Surgery, New York, NY
| | - Jeffrey L Gum
- Norton Leatherman Spine Center, Louisville, Kentucky
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Juan S Uribe
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Michael P Kelly
- Division of Orthopedics & Scoliosis at Rady Children's Hospital-San Diego, San Diego, California
| | - Khaled M Kebaish
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | - Richard Hostin
- Department of Orthopaedic Surgery, Southwest Scoliosis Institute, Dallas, Texas
| | | | - Lawrence G Lenke
- Department of Orthopaedic Surgery, The Och Spine Hospital/Columbia University Irving Medical Center, New York, NY
| | - Frank J Schwab
- Department of Orthopedic Surgery, Lenox Hill Northwell, New York, NY
| | - Shay Bess
- Department of Orthopedic Surgery, Denver International Spine Center, Denver, Colorado
| | - Virginie Lafage
- Department of Orthopedic Surgery, Lenox Hill Northwell, New York, NY
| | - Alan H Daniels
- Department of Orthopedics, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Agaisse T, Thomson C, Balmaceno-Criss M, McCluskey L, Diebo BG, Kuris E, Daniels AH. Acute spinal cord compression in the setting of chronic extramedullary hematopoiesis of the thoracic spine. N Am Spine Soc J 2023; 15:100260. [PMID: 37649971 PMCID: PMC10462891 DOI: 10.1016/j.xnsj.2023.100260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/06/2023] [Accepted: 07/30/2023] [Indexed: 09/01/2023]
Abstract
Background Though rare, pathologic extramedullary hematopoiesis (EMH) can occur in response to myeloproliferative disorders and may present as paravertebral masses. Case Description We describe a 63-year-old female with unspecified thalassemia, hemochromatosis, and known asymptomatic extramedullary hematopoiesis of the thoracic spine who acutely developed severe spinal cord compression and a T9 vacuum phenomenon fracture 7 months after her initial diagnosis. Outcome The patient was treated with urgent decompression and T9 kyphoplasty, which resulted in complete resolution of her neurological deficits. Conclusions The timeline of symptomatology in the case suggests that asymptomatic patients with T-spine extramedullary hematopoiesis can develop progressive neurologic deterioration and atraumatic compression fractures culminating in acute spinal cord injury. While it may be appropriate to treat asymptomatic patients conservatively, surgical decompression must always remain a consideration.
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Affiliation(s)
- Ty Agaisse
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, 1 Kettle Point Ave, East Providence, RI 02914, United States
| | - Cameron Thomson
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, 1 Kettle Point Ave, East Providence, RI 02914, United States
| | - Mariah Balmaceno-Criss
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, 1 Kettle Point Ave, East Providence, RI 02914, United States
| | - Leland McCluskey
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, 1 Kettle Point Ave, East Providence, RI 02914, United States
| | - Bassel G. Diebo
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, 1 Kettle Point Ave, East Providence, RI 02914, United States
| | - Eren Kuris
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, 1 Kettle Point Ave, East Providence, RI 02914, United States
| | - Alan H. Daniels
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, 1 Kettle Point Ave, East Providence, RI 02914, United States
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Tretiakov PS, Lafage R, Smith JS, Line BG, Diebo BG, Daniels AH, Gum J, Protopsaltis T, Hamilton DK, Soroceanu A, Scheer JK, Eastlack RK, Mundis G, Nunley PD, Klineberg EO, Kebaish K, Lewis S, Lenke L, Hostin R, Gupta MC, Ames CP, Hart RA, Burton D, Shaffrey CI, Schwab F, Bess S, Kim HJ, Lafage V, Passias PG. Calibration of a comprehensive predictive model for the development of proximal junctional kyphosis and failure in adult spinal deformity patients with consideration of contemporary goals and techniques. J Neurosurg Spine 2023; 39:311-319. [PMID: 37310039 DOI: 10.3171/2023.4.spine221412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 04/17/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The objective of this study was to calibrate an updated predictive model incorporating novel clinical, radiographic, and prophylactic measures to assess the risk of proximal junctional kyphosis (PJK) and failure (PJF). METHODS Operative patients with adult spinal deformity (ASD) and baseline and 2-year postoperative data were included. PJK was defined as ≥ 10° in sagittal Cobb angle between the inferior uppermost instrumented vertebra (UIV) endplate and superior endplate of the UIV + 2 vertebrae. PJF was radiographically defined as a proximal junctional sagittal Cobb angle ≥ 15° with the presence of structural failure and/or mechanical instability, or PJK with reoperation. Backstep conditional binary supervised learning models assessed baseline demographic, clinical, and surgical information to predict the occurrence of PJK and PJF. Internal cross validation of the model was performed via a 70%/30% cohort split. Conditional inference tree analysis determined thresholds at an alpha level of 0.05. RESULTS Seven hundred seventy-nine patients with ASD (mean 59.87 ± 14.24 years, 78% female, mean BMI 27.78 ± 6.02 kg/m2, mean Charlson Comorbidity Index 1.74 ± 1.71) were included. PJK developed in 50.2% of patients, and 10.5% developed PJF by their last recorded visit. The six most significant demographic, radiographic, surgical, and postoperative predictors of PJK/PJF were baseline age ≥ 74 years, baseline sagittal age-adjusted score (SAAS) T1 pelvic angle modifier > 1, baseline SAAS pelvic tilt modifier > 0, levels fused > 10, nonuse of prophylaxis measures, and 6-week SAAS pelvic incidence minus lumbar lordosis modifier > 1 (all p < 0.015). Overall, the model was deemed significant (p < 0.001), and internally validated receiver operating characteristic analysis returned an area under the curve of 0.923, indicating robust model fit. CONCLUSIONS PJK and PJF remain critical concerns in ASD surgery, and efforts to reduce the occurrence of PJK and PJF have resulted in the development of novel prophylactic techniques and enhanced clinical and radiographic selection criteria. This study demonstrates a validated model incorporating such techniques that may allow for the prediction of clinically significant PJK and PJF, and thus assist in optimizing patient selection, enhancing intraoperative decision making, and reducing postoperative complications in ASD surgery.
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Affiliation(s)
- Peter S Tretiakov
- 1Department of Orthopaedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York, New York
- 8Department of Orthopaedic Surgery, New York Spine Institute, New York, New York
| | - Renaud Lafage
- 2Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, New York
| | - Justin S Smith
- 3Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Breton G Line
- 4Department of Spine Surgery, Denver International Spine Center, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, Colorado
| | - Bassel G Diebo
- 5Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Alan H Daniels
- 5Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Jeffrey Gum
- 6Norton Leatherman Spine Center, Louisville, Kentucky
| | - Themistocles Protopsaltis
- 1Department of Orthopaedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York, New York
| | - D Kojo Hamilton
- 7Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Alex Soroceanu
- 7Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Justin K Scheer
- 9Department of Neurological Surgery, University of California, San Francisco, California
| | - Robert K Eastlack
- 10Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, California
| | - Gregory Mundis
- 10Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, California
| | | | - Eric O Klineberg
- 12Department of Orthopaedic Surgery, University of California, Davis, California
| | - Khaled Kebaish
- 13Department of Orthopaedic Surgery, Johns Hopkins Medical Center, Baltimore, Maryland
| | - Stephen Lewis
- 14Division of Orthopaedic Surgery, University of Toronto, Ontario, Canada
| | - Lawrence Lenke
- 15Department of Orthopaedic Surgery, Columbia University, New York, New York
| | - Richard Hostin
- 16Department of Orthopaedic Surgery, Southwest Scoliosis Center, Dallas, Texas
| | - Munish C Gupta
- 17Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri
| | - Christopher P Ames
- 9Department of Neurological Surgery, University of California, San Francisco, California
| | - Robert A Hart
- 18Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, Washington
| | - Douglas Burton
- 19Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Christopher I Shaffrey
- 20Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina; and
| | - Frank Schwab
- 2Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, New York
| | - Shay Bess
- 4Department of Spine Surgery, Denver International Spine Center, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, Colorado
| | - Han Jo Kim
- 21Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Virginie Lafage
- 2Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, New York
| | - Peter G Passias
- 1Department of Orthopaedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York, New York
- 8Department of Orthopaedic Surgery, New York Spine Institute, New York, New York
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McDonald CL, Berreta RAS, Alsoof D, Homer A, Molino J, Ames CP, Shaffrey CI, Hamilton DK, Diebo BG, Kuris EO, Hart RA, Daniels AH. Treatment of adult deformity surgery by orthopedic and neurological surgeons: trends in treatment, techniques, and costs by specialty. Spine J 2023; 23:1365-1374. [PMID: 37236366 DOI: 10.1016/j.spinee.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/16/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND CONTEXT Surgery to correct adult spinal deformity (ASD) is performed by both neurological surgeons and orthopedic surgeons. Despite well-documented high costs and complication rates following ASD surgery, there is a dearth of research investigating trends in treatment according to surgeon subspeciality. PURPOSE The purpose of this investigation was to perform an analysis of surgical trends, costs and complications of ASD operations by physician specialty using a large, nationwide sample. STUDY DESIGN/SETTING Retrospective cohort study using an administrative claims database. PATIENT SAMPLE A total of 12,929 patients were identified with ASD that underwent deformity surgery performed by neurological or orthopedic surgeons. OUTCOME MEASURES The primary outcome was surgical case volume by surgeon specialty. Secondary outcomes included costs, medical complications, surgical complications, and reoperation rates (30-day, 1-year, 5-year, and total). METHODS The PearlDiver Mariner database was queried to identify patients who underwent ASD correction from 2010 to 2019. The cohort was stratified to identify patients who were treated by either orthopedic or neurological surgeons. Surgical volume, baseline characteristics, and surgical techniques were examined between cohorts. Multivariable logistic regression was employed to assess the cost, rate of reoperation and complication according to each subspecialty while controlling for number of levels fused, rate of pelvic fixation, age, gender, region and Charlson Comorbidity Index (CCI). Alpha was set to 0.05 and a Bonferroni correction for multiple comparisons was utilized to set the significance threshold at p ≤.000521. RESULTS A total of 12,929 ASD patients underwent deformity surgery performed by neurological or orthopedic surgeons. Orthopedic surgeons performed most deformity procedures accounting for 64.57% (8,866/12,929) of all ASD operations, while the proportion treated by neurological surgeons increased 44.2% over the decade (2010: 24.39% vs 2019: 35.16%; p<.0005). Neurological surgeons more frequently operated on older patients (60.52 vs 55.18 years, p<.0005) with more medical comorbidities (CCI scores: 2.01 vs 1.47, p<.0005). Neurological surgeons also performed higher rates of arthrodesis between one and six levels (OR: 1.86, p<.0005), three column osteotomies (OR: 1.35, p<.0005) and navigated or robotic procedures (OR: 3.30, p<.0005). Procedures performed by orthopedic surgeons had significantly lower average costs as compared to neurological surgeons (orthopedic surgeons: $17,971.66 vs neurological surgeons: $22,322.64, p=.253). Adjusted logistic regression controlling for number of levels fused, pelvic fixation, age, sex, region, and comorbidities revealed that patients within neurosurgical care had similar odds of complications to orthopaedic surgery. CONCLUSIONS This investigation of over 12,000 ASD patients demonstrates orthopedic surgeons continue to perform the majority of ASD correction surgery, although neurological surgeons are performing an increasingly larger percentage over time with a 44% increase in the proportion of surgeries performed in the decade. In this cohort, neurological surgeons more frequently operated on older and more comorbid patients, utilizing shorter-segment fixation with greater use of navigation and robotic assistance.
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Affiliation(s)
- Christopher L McDonald
- Department of Orthopedics, Brown University Warren Alpert Medical School, 1 Kettle Point Avenue, East Providence, Providence, 02914, RI, USA
| | - Rodrigo A Saad Berreta
- Department of Orthopedics, Brown University Warren Alpert Medical School, 1 Kettle Point Avenue, East Providence, Providence, 02914, RI, USA
| | - Daniel Alsoof
- Department of Orthopedics, Brown University Warren Alpert Medical School, 1 Kettle Point Avenue, East Providence, Providence, 02914, RI, USA
| | - Alex Homer
- Department of Orthopedics, Brown University Warren Alpert Medical School, 1 Kettle Point Avenue, East Providence, Providence, 02914, RI, USA
| | - Janine Molino
- Department of Orthopedics, Biostatistics Division, Brown University Warren Alpert Medical School, Grads Dorm Building 3rd Floor, Rhode Island Hospital 593 Eddy St, 02903, Providence, RI, USA
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, Eighth Floor, 400 Parnassus Ave, CA 94143, San Francisco, California
| | - Christopher I Shaffrey
- Department of Neurosurgery and Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - D Kojo Hamilton
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, 200 Lothrop Street, A402 UPMC Presbyterian, PA 15213, Pittsburgh, Pennsylvania
| | - Bassel G Diebo
- Swedish Neuroscience Institute, 550 17th Avenue, James Tower, Suite 500, 98122, Seattle, WA
| | - Eren O Kuris
- Department of Orthopedics, Brown University Warren Alpert Medical School, 1 Kettle Point Avenue, East Providence, Providence, 02914, RI, USA
| | - Robert A Hart
- Swedish Neuroscience Institute, 550 17th Avenue, James Tower, Suite 500, 98122, Seattle, WA
| | - Alan H Daniels
- Department of Orthopedics, Brown University Warren Alpert Medical School, 1 Kettle Point Avenue, East Providence, Providence, 02914, RI, USA.
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Diebo BG, Balmaceno-Criss M, Daher M, Daniels AH. Bilateral psoas release for long standing hip-spine syndrome: surgical technique and case report. N Am Spine Soc J 2023; 15:100247. [PMID: 37636341 PMCID: PMC10458283 DOI: 10.1016/j.xnsj.2023.100247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/13/2023] [Accepted: 07/23/2023] [Indexed: 08/29/2023]
Abstract
Background Severe positive sagittal malalignment can potentially lead to shortening and contracture of the psoas and joint capsule in a flexed spinopelvic position. The utilization of bilateral psoas release to supplement sagittal spinal deformity correction in the same hospitalization was not reported in the literature. Case presentation A 66-year-old patient presented with a 5-year history of severe global spinal deformity (sagittal vertical axis 220 mm, 60° spinopelvic mismatch) that did not improve on supine radiographs, and a modified Thomas test with more than 30° flexion contracture of bilateral hips. A 3-stage operation utilizing posterior spinal column osteotomies, anterior lumbar interbody fusion, and bilateral psoas releases was performed. Outcome Her postoperative alignment significantly improved and she was pleased with her new posture and the ability to stand up straight. Conclusions This report is the first to demonstrate safe and substantial correction of severe spinal deformities associated with bilateral hip flexion contracture in 1 hospitalization.
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Affiliation(s)
- Bassel G. Diebo
- Department of Orthopaedic Surgery, Brown University, Providence, RI, United States
- Spine surgery division, University Orthopedics Inc, 1 Kettle Point Ave, East Providence, RI, 02914, United States
| | - Mariah Balmaceno-Criss
- Department of Orthopaedic Surgery, Brown University, Providence, RI, United States
- Spine surgery division, University Orthopedics Inc, 1 Kettle Point Ave, East Providence, RI, 02914, United States
| | - Mohammad Daher
- Department of Orthopaedic Surgery, Brown University, Providence, RI, United States
- Spine surgery division, University Orthopedics Inc, 1 Kettle Point Ave, East Providence, RI, 02914, United States
| | - Alan H. Daniels
- Department of Orthopaedic Surgery, Brown University, Providence, RI, United States
- Spine surgery division, University Orthopedics Inc, 1 Kettle Point Ave, East Providence, RI, 02914, United States
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40
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Daniels AH, Alsoof D, McDonald CL, Zhang AS, Diebo BG, Eberson CP, Kuris EO, Lavelle W, Ames CP, Shaffrey CI, Hart RA. Longitudinal Assessment of Modern Spine Surgery Training: 10-Year Follow-up of a Nationwide Survey of Residency and Spine Fellowship Program Directors. JB JS Open Access 2023; 8:e23.00050. [PMID: 37533873 PMCID: PMC10393084 DOI: 10.2106/jbjs.oa.23.00050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Abstract
Spine surgeons complete training through residency in orthopaedic surgery (ORTH) or neurosurgery (NSGY). A survey was conducted in 2013 to evaluate spine surgery training. Over the past decade, advances in surgical techniques and the changing dynamics in fellowship training may have affected training and program director (PD) perceptions may have shifted. Methods This study is a cross-sectional survey distributed to all PDs of ORTH and NSGY residencies and spine fellowships in the United States. Participants were queried regarding characteristics of their program, ideal characteristics of residency training, and opinions regarding the current training environment. χ2 tests were used to compare answers over the years. Results In total, 241 PDs completed the survey. From 2013 to 2023, NSGY increased the proportion of residents with >300 spine cases (86%-100%) while ORTH remained with >90% of residents with < 225 cases (p < 0.05). A greater number of NSGY PDs encouraged spine fellowship even for community spine surgery practice (0% in 2013 vs. 14% in 2023, p < 0.05), which continued to be significantly different from ORTH PDs (∼88% agreed, p > 0.05). 100% of NSGY PDs remained confident in their residents performing spine surgery, whereas ORTH confidence significantly decreased from 43% in 2013 to 25% in 2023 (p < 0.05). For spinal deformity, orthopaedic PDs (92%), NSGY PDs (96%), and fellowship directors (95%), all agreed that a spine fellowship should be pursued (p = 0.99). In both 2013 and 2023, approximately 44% were satisfied with the spine training model in the United States. In 2013, 24% of all PDs believed we should have a dedicated spine residency, which increased to 39% in 2023 (fellowship: 57%, ORTH: 38%, NSGY: 21%) (p < 0.05). Conclusion Spine surgery training continues to evolve, yet ORTH and neurological surgery training remains significantly different in case volumes and educational strengths. In both 2013 and 2023, less than 50% of PDs were satisfied with the current spine surgery training model, and a growing minority believe that spine surgery should have its own residency training pathway. Level of Evidence IV.
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Affiliation(s)
- Alan H. Daniels
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Daniel Alsoof
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Christopher L. McDonald
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Andrew S. Zhang
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Orthopedic Surgery, LSU Shreveport, Shreveport, Louisiana
| | - Bassel G. Diebo
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Craig P. Eberson
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Eren O. Kuris
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - William Lavelle
- Department of Orthopedic Surgery, Upstate University Hospital, Syracuse, New York
| | - Christopher P. Ames
- Department of Neurosurgery, University of California-San Francisco, San Francisco, California
| | | | - Robert A. Hart
- Department of Orthopedic Surgery, Swedish Neuroscience Institute, Seattle, Washington
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Passias PG, Joujon-Roche R, Mir JM, Williamson TK, Tretiakov PS, Imbo B, Krol O, Passfall L, Ahmad S, Lebovic J, Owusu-Sarpong S, Lanre-Amos T, Protopsaltis T, Lafage R, Lafage V, Park P, Chou D, Mummaneni PV, Fu KMG, Than KD, Smith JS, Janjua MB, Schoenfeld AJ, Diebo BG, Vira S. Natural history of adult spinal deformity: how do patients with suboptimal surgical outcomes fare relative to nonoperative counterparts? J Neurosurg Spine 2023; 39:92-100. [PMID: 37060316 DOI: 10.3171/2023.2.spine22559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 02/20/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVE Management of adult spinal deformity (ASD) has increasingly favored operative intervention; however, the incidence of complications and reoperations is high, and patients may fail to achieve idealized postsurgical results. This study compared health-related quality of life (HRQOL) metrics between patients with suboptimal surgical outcomes and those who underwent nonoperative management as a proxy for the natural history (NH) of ASD. METHODS ASD patients with 2-year data were included. Patients who were offered surgery but declined were considered nonoperative (i.e., NH) patients. Operative patients with suboptimal outcome (SOp)-defined as any reoperation, major complication, or ≥ 2 severe Scoliosis Research Society (SRS)-Schwab modifiers at follow-up-were selected for comparison. Propensity score matching (PSM) on the basis of baseline age, deformity, SRS-22 Total, and Charlson Comorbidity Index score was used to match the groups. ANCOVA and stepwise logistic regression analysis were used to assess outcomes between groups at 2 years. RESULTS In total, 441 patients were included (267 SOp and 174 NH patients). After PSM, 142 patients remained (71 SOp 71 and 71 NH patients). At baseline, the SOp and NH groups had similar demographic characteristics, HRQOL, and deformity (all p > 0.05). At 2 years, ANCOVA determined that NH patients had worse deformity as measured with sagittal vertical axis (36.7 mm vs 21.3 mm, p = 0.025), mismatch between pelvic incidence and lumbar lordosis (11.9° vs 2.9°, p < 0.001), and pelvic tilt (PT) (23.1° vs 20.7°, p = 0.019). The adjusted regression analysis found that SOp patients had higher odds of reaching the minimal clinically important differences in Oswestry Disability Index score (OR [95% CI] 4.5 [1.7-11.5], p = 0.002), SRS-22 Activity (OR [95% CI] 3.2 [1.5-6.8], p = 0.002), SRS-22 Pain (OR [95% CI] 2.8 [1.4-5.9], p = 0.005), and SRS-22 Total (OR [95% CI] 11.0 [3.5-34.4], p < 0.001). CONCLUSIONS Operative patients with SOp still experience greater improvements in deformity and HRQOL relative to the progressive radiographic and functional deterioration associated with the NH of ASD. The NH of nonoperative management should be accounted for when weighing the risks and benefits of operative intervention for ASD.
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Affiliation(s)
- Peter G Passias
- 1Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York
| | - Rachel Joujon-Roche
- 1Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York
| | - Jamshaid M Mir
- 1Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York
| | - Tyler K Williamson
- 1Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York
| | - Peter S Tretiakov
- 1Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York
| | - Bailey Imbo
- 1Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York
| | - Oscar Krol
- 1Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York
| | - Lara Passfall
- 1Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York
| | - Salman Ahmad
- 1Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York
| | - Jordan Lebovic
- 1Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York
| | - Stephane Owusu-Sarpong
- 1Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York
| | - Tomi Lanre-Amos
- 1Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York
| | - Themistocles Protopsaltis
- 1Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York
| | | | - Virginie Lafage
- 3Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, New York
| | - Paul Park
- 4University of Michigan, Ann Arbor, Michigan
| | - Dean Chou
- 5Department of Neurological Surgery, UCSF Medical Center, San Francisco, California
| | - Praveen V Mummaneni
- 5Department of Neurological Surgery, UCSF Medical Center, San Francisco, California
| | - Kai-Ming G Fu
- 6Department of Neurosurgery, Cornell University School of Medicine, New York, New York
| | - Khoi D Than
- 7Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Justin S Smith
- 8Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - M Burhan Janjua
- 9Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri
| | - Andrew J Schoenfeld
- 10Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Bassel G Diebo
- 11Deparment of Orthopedic Surgery, SUNY Downstate, New York, New York; and
| | - Shaleen Vira
- 12Department of Orthopedic Surgery, UT Southwestern, Dallas, Texas
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Passias PG, Williamson TK, Krol O, Tretiakov PS, Joujon-Roche R, Imbo B, Ahmad S, Bennett-Caso C, Owusu-Sarpong S, Lebovic JB, Robertson D, Vira S, Dhillon E, Schoenfeld AJ, Janjua MB, Raman T, Protopsaltis TS, Maglaras C, O'Connell B, Daniels AH, Paulino C, Diebo BG, Smith JS, Schwab FJ, Lafage R, Lafage V. Should Global Realignment Be Tailored to Frailty Status for Patients Undergoing Surgical Intervention for Adult Spinal Deformity? Spine (Phila Pa 1976) 2023; 48:930-936. [PMID: 36191091 DOI: 10.1097/brs.0000000000004501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/21/2022] [Indexed: 02/04/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE Assess whether modifying spinal alignment goals to accommodate frailty considerations will decrease mechanical complications and maximize clinical outcomes. SUMMARY OF BACKGROUND DATA The Global Alignment and Proportion (GAP) score was developed to assist in reducing mechanical complications, but has had less success predicting such events in external validation. Higher frailty and many of its components have been linked to the development of implant failure. Therefore, modifying the GAP score with frailty may strengthen its ability to predict mechanical complications. MATERIALS AND METHODS We included 412 surgical ASD patients with two-year follow-up. Frailty was quantified using the modified Adult Spinal Deformity Frailty Index (mASD-FI). Outcomes: proximal junctional kyphosis and proximal junctional failure (PJF), major mechanical complications, and "Best Clinical Outcome" (BCO), defined as Oswestry Disability Index<15 and Scoliosis Research Society 22-item Questionnaire Total>4.5. Logistic regression analysis established a six-week score based on GAP score, frailty, and Oswestry Disability Index US Norms. Logistic regression followed by conditional inference tree analysis generated categorical thresholds. Multivariable logistic regression analysis controlling for confounders was used to assess the performance of the frailty-modified GAP score. RESULTS Baseline frailty categories: 57% not frail, 30% frail, 14% severely frail. Overall, 39 of patients developed proximal junctional kyphosis, 8% PJF, 21% mechanical complications, 22% underwent reoperation, and 15% met BCO. The mASD-FI demonstrated a correlation with developing PJF, mechanical complications, undergoing reoperation, and meeting BCO at two years (all P <0.05). Regression analysis generated the following equation: Frailty-Adjusted Realignment Score (FAR Score)=0.49×mASD-FI+0.38×GAP Score. Thresholds for the FAR score (0-13): proportioned: <3.5, moderately disproportioned: 3.5-7.5, severely disproportioned: >7.5. Multivariable logistic regression assessing FAR score demonstrated associations with mechanical complications, reoperation, and meeting BCO by two years (all P <0.05), whereas the original GAP score was only significant for reoperation. CONCLUSION This study demonstrated adjusting alignment goals in adult spinal deformity surgery for a patient's baseline frailty status and disability may be useful in minimizing the risk of complications and adverse events, outperforming the original GAP score in terms of prognostic capacity. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Peter G Passias
- Division of Spinal Surgery/Department of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY
| | - Tyler K Williamson
- Division of Spinal Surgery/Department of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY
| | - Oscar Krol
- Division of Spinal Surgery/Department of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY
| | - Peter S Tretiakov
- Division of Spinal Surgery/Department of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY
| | - Rachel Joujon-Roche
- Division of Spinal Surgery/Department of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY
| | - Bailey Imbo
- Division of Spinal Surgery/Department of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY
| | - Salman Ahmad
- Division of Spinal Surgery/Department of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY
| | - Claudia Bennett-Caso
- Division of Spinal Surgery/Department of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY
| | | | - Jordan B Lebovic
- Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, NY
| | - Djani Robertson
- Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, NY
| | - Shaleen Vira
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX
| | - Ekamjeet Dhillon
- Department of Orthopaedic Surgery, University of Washington Medical Center, Seattle, WA
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital/Harvard Medical Center, Boston, MA
| | - Muhammad B Janjua
- Department of Neurosurgery, Washington University of St Louis, St Louis, MO
| | - Tina Raman
- Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, NY
| | | | - Constance Maglaras
- Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, NY
| | - Brooke O'Connell
- Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, NY
| | - Alan H Daniels
- Department of Orthopedic Surgery, Warren Alpert School of Medicine/Brown University, Providence, RI
| | - Carl Paulino
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, New York, NY
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, New York, NY
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia, Charlottesville, VA
| | - Frank J Schwab
- Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Renaud Lafage
- Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Virginie Lafage
- Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY
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Kasthuri V, Homer A, Alsoof D, Hong J, McDonald CL, Diebo BG, Daniels AH. Modern internet search analytics and spine: what are patients asking and reading online? N Am Spine Soc J 2023; 14:100214. [PMID: 37214263 PMCID: PMC10192655 DOI: 10.1016/j.xnsj.2023.100214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 05/24/2023]
Abstract
Background Google's People Also Ask feature uses various machine learning algorithms to distill the most frequently asked questions and link users to potential answers. The aim of this study is to investigate the most frequently asked questions related to commonly performed spine surgeries. Methods This is an observational study utilizing Google's People Also Ask feature. A variety of search terms were entered into Google for anterior cervical discectomy and fusion (ACDF), discectomy, and lumbar fusion. Frequently asked questions and linked websites were extracted. Questions were categorized by topic based on Rothwell's Classification system, and websites were categorized by type. Pearson's chi-squared and Student t tests were performed as appropriate. Results A total of 576 unique questions (181 ACDF, 148 discectomy, 309 lumbar fusion) were extracted with 372 unique websites and 177 domains. The most common website types were medical practice (41%), social media (22%), and academic (15%). The most popular question topics were specific activities & restrictions (22%), technical details (23%), and evaluation of surgery (17%). Questions related to technical details were more common in discectomy vs lumbar fusion (33% vs 24%, p=.03) and lumbar fusion vs ACDF (24% vs 14%, p=.01). Questions related to specific activities & restrictions were more common in ACDF vs discectomy (17% vs 8%, p=.02) and ACDF vs lumbar fusion (28% vs 19%, p=.016). Questions related to risks & complications were more common in ACDF vs lumbar fusion (10% vs 4%, p=.01). Conclusions The most frequently asked questions on Google regarding spine surgery are related to technical details and activity restrictions. Surgeons may emphasize these domains in consultations and direct patients to reputable sources of further information. Much of the linked information provided originates from nonacademic and nongovernment sources (72%), with 22% from social media websites.
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Affiliation(s)
- Viknesh Kasthuri
- Warren Alpert Medical School, Brown University, 1 Kettle Point Ave, East Providence, RI, 02914, United States
| | - Alexander Homer
- Warren Alpert Medical School, Brown University, 1 Kettle Point Ave, East Providence, RI, 02914, United States
| | - Daniel Alsoof
- Department of Orthopedics, Warren Alpert Medical School, Brown University, 1 Kettle Point Ave, East Providence, RI, 02914, United States
| | - James Hong
- Department of Orthopedics, Warren Alpert Medical School, Brown University, 1 Kettle Point Ave, East Providence, RI, 02914, United States
| | - Christopher L McDonald
- Department of Orthopedics, Warren Alpert Medical School, Brown University, 1 Kettle Point Ave, East Providence, RI, 02914, United States
| | - Bassel G Diebo
- Department of Orthopedics, Warren Alpert Medical School, Brown University, 1 Kettle Point Ave, East Providence, RI, 02914, United States
| | - Alan H Daniels
- Department of Orthopedics, Warren Alpert Medical School, Brown University, 1 Kettle Point Ave, East Providence, RI, 02914, United States
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McDonald CL, Alsoof D, Glueck J, Osorio C, Stone B, McCluskey L, Diebo BG, Daniels AH, Basques BA. Adjacent Segment Disease After Spinal Fusion. JBJS Rev 2023; 11:01874474-202306000-00007. [PMID: 37307327 DOI: 10.2106/jbjs.rvw.23.00028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
» Adjacent segment disease is characterized by a degenerative process adjacent to a previously fused spine segment, with new onset of clinical symptoms such as radiculopathy, myelopathy, or instability.» Etiology is related to the natural history of the disease process, increased biomechanical stress at adjacent segments, clinical factors specific to the individual patient, intraoperative factors, and malalignment.» Treatment is usually nonoperative, but surgical intervention can be indicated. Decompression and fusion remain the mainstay of operative treatment, and isolated decompression should be considered in specific cases.» Further randomized controlled trials are needed to establish how the treatment should progress, particularly with the development of minimally invasive and endoscopic surgery.
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Affiliation(s)
- Christopher L McDonald
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Daniel Alsoof
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Jacob Glueck
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Camilo Osorio
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Benjamin Stone
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Leland McCluskey
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Bassel G Diebo
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Alan H Daniels
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Bryce A Basques
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
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Alsoof D, McDonald CL, Durand WM, Diebo BG, Kuris EO, Daniels AH. Radiomics in Spine Surgery. Int J Spine Surg 2023:8501. [PMID: 37193607 DOI: 10.14444/8501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
Radiomics is an emerging approach to analyze clinical images with the purpose of revealing quantitative features that are unvisible to the naked eye. Radiomic features can be further combined with clinical data and genomic information to formulate prediction models using machine learning algorithms or manual statistical analysis. While radiomics has been classically applied to tumor analysis, there is promising research in its application to spine surgery, including spinal deformity, oncology, and osteoporosis detection. This article reviews the fundamental principles of radiomic analysis, the current literature relating to the spine, and the limitations of this approach.
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Affiliation(s)
- Daniel Alsoof
- Department of Orthopedic Surgery, Alpert Medical School of Brown University, Providence, RI, USA
| | - Christopher L McDonald
- Department of Orthopedic Surgery, Alpert Medical School of Brown University, Providence, RI, USA
| | - Wesley M Durand
- Department of Orthopedic Surgery, Johns Hopkins, Baltimore, MA, USA
| | - Bassel G Diebo
- Department of Orthopedic Surgery, Alpert Medical School of Brown University, Providence, RI, USA
| | - Eren O Kuris
- Department of Orthopedic Surgery, Alpert Medical School of Brown University, Providence, RI, USA
| | - Alan H Daniels
- Department of Orthopedic Surgery, Alpert Medical School of Brown University, Providence, RI, USA
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Williamson TK, Lebovic J, Schoenfeld AJ, Imbo B, Joujon-Roche R, Tretiakov P, Krol O, Bennett-Caso C, Owusu-Sarpong S, Dave P, McFarland K, Mir J, Dhillon E, Koller H, Diebo BG, Vira S, Lafage R, Lafage V, Passias PG. A Hierarchical Approach to Realignment Strategies in Adult Cervical Deformity Surgery. Clin Spine Surg 2023; 36:106-111. [PMID: 36920359 DOI: 10.1097/bsd.0000000000001442] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/25/2023] [Indexed: 03/16/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE Construct an individualized cervical realignment strategy based on patient parameters at the presentation that results in superior 2-year health-related quality of life metrics and decreased rates of junctional failure and reoperation following adult cervical deformity surgery. SUMMARY OF BACKGROUND DATA Research has previously focused on adult cervical deformity realignment thresholds for maximizing clinical outcomes while minimizing complications. However, realignment strategies may differ based on patient presentation and clinical characteristics. METHODS We included adult cervical deformity patients with 2-year data. The optimal outcome was defined as meeting good clinical outcomes without distal junctional failure or reoperation. Radiographic parameters assessed included C2 Slope, C2-C7, McGregor's slope, TS-CL, cSVA, T1 slope, and preoperative lowest-instrumented vertebra (LIV) inclination angle. Conditional inference trees were used to establish thresholds for each parameter based on achieving the optimal outcome. Analysis of Covariance and multivariable logistic regression analysis, controlling for age, comorbidities, baseline deformity and disability, and surgical factors, assessed outcome rates for the hierarchical approach within each deformity group. RESULTS One hundred twenty-seven patients were included. After correction, there was a significant difference in meeting the optimal outcome when correcting the C2 slope below 10 degrees (85% vs. 34%, P <0.001), along with lower rates of distal junctional failure (DJF) (7% vs. 42%, P <0.001). Next, after isolating patients below the C2 slope threshold, the selection of LIV with an inclination between 0 and 40 degrees demonstrated lower rates of distal junctional kyphosis and higher odds of meeting optimal outcome(OR: 4.2, P =0.011). The best third step was the correction of cSVA below 35 mm. This hierarchical approach (11% of the cohort) led to significantly lower rates of DJF (0% vs. 15%, P <0.007), reoperation (8% vs. 28%, P <0.001), and higher rates of meeting optimal outcome (93% vs. 36%, P <0.001) when controlling for age, comorbidities, and baseline deformity and disability. CONCLUSION Our results indicate that the correction of C2 slope should be prioritized during cervical deformity surgery, with the selection of a stable LIV and correction of cervical SVA below the idealized threshold. Among the numerous radiographic parameters considered during preoperative planning for cervical deformity correction, our determinations help surgeons prioritize those realignment strategies that maximize the health-related quality of life outcomes and minimize complications. LEVEL OF EVIDENCE Level-III.
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Affiliation(s)
- Tyler K Williamson
- Departments of Orthopaedic and Neurological Surgery, NYU Langone Orthopaedic Hospital; New York Spine Institute, New York, NY
| | - Jordan Lebovic
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, New York, NY
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Bailey Imbo
- Departments of Orthopaedic and Neurological Surgery, NYU Langone Orthopaedic Hospital; New York Spine Institute, New York, NY
| | - Rachel Joujon-Roche
- Departments of Orthopaedic and Neurological Surgery, NYU Langone Orthopaedic Hospital; New York Spine Institute, New York, NY
| | - Peter Tretiakov
- Departments of Orthopaedic and Neurological Surgery, NYU Langone Orthopaedic Hospital; New York Spine Institute, New York, NY
| | - Oscar Krol
- Departments of Orthopaedic and Neurological Surgery, NYU Langone Orthopaedic Hospital; New York Spine Institute, New York, NY
| | - Claudia Bennett-Caso
- Departments of Orthopaedic and Neurological Surgery, NYU Langone Orthopaedic Hospital; New York Spine Institute, New York, NY
| | | | - Pooja Dave
- Departments of Orthopaedic and Neurological Surgery, NYU Langone Orthopaedic Hospital; New York Spine Institute, New York, NY
| | - Kimberly McFarland
- Departments of Orthopaedic and Neurological Surgery, NYU Langone Orthopaedic Hospital; New York Spine Institute, New York, NY
| | - Jamshaid Mir
- Departments of Orthopaedic and Neurological Surgery, NYU Langone Orthopaedic Hospital; New York Spine Institute, New York, NY
| | - Ekamjeet Dhillon
- Department of Orthopaedic Surgery, University of Washington-Harborview Medical Center, Seattle, WA
| | - Heiko Koller
- Department of Neurosurgery, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, Warren Alpert Medical School/Brown University Medical Center, Providence, RI
| | - Shaleen Vira
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Renaud Lafage
- Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Virginie Lafage
- Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Peter G Passias
- Departments of Orthopaedic and Neurological Surgery, NYU Langone Orthopaedic Hospital; New York Spine Institute, New York, NY
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Diebo BG, Kovoor M, Alsoof D, Beyer GA, Rompala A, Balmaceno-Criss M, Mai DH, Segreto FA, Shah NV, Lafage R, Passias PG, Aaron RK, Daniels AH, Paulino CB, Schwab FJ, Lafage V. Metabolic Bone Disorders Are Predictors for 2-year Adverse Outcomes in Patients Undergoing 2-3 Level Anterior Cervical Discectomy and Fusion for Cervical Radiculopathy or Myelopathy. Clin Spine Surg 2023; 36:120-126. [PMID: 36864582 DOI: 10.1097/bsd.0000000000001452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 01/25/2023] [Indexed: 03/04/2023]
Abstract
STUDY DESIGN Retrospective cohort study utilizing the New York statewide planning and research cooperative system. STUDY OBJECTIVE To investigate postoperative complications of patients with metabolic bone disorders (MBDs) who undergo 2-3 levels of anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA MBDs and cervical degenerative pathologies, including cervical radiculopathy (CR) and cervical myelopathy (CM), are prevalent in the aging population. Complications with ACDF procedures can lead to increased hospitalization times, more expensive overhead, and worse patient outcomes. METHOD Patients with CM/CR who underwent an ACDF of 2-3 vertebrae from 2009 to 2011 with a minimum 2-year follow-up were identified. Patients diagnosed with 1 or more MBD at baseline were compared with a control cohort without any MBD diagnosis. Cohorts were compared for demographics, hospital-related parameters, and 2-year medical, surgical, and overall complications. Binary multivariate logistic regression was used to identify independent predictors. RESULTS A total of 22,276 patients were identified (MBD: 214; no-MBD: 22,062). Among MBD patients, the majority had vitamin D deficiency (n = 194, 90.7%). MBD patients were older (53.0 vs 49.7 y, P < 0.001), and with higher Deyo index (1.0 vs 0.5, P < 0.001). MBD patients had higher rates of medical complications, including anemia (6.1% vs 2.3%), pneumonia (4.7% vs 2.1%), hematoma (3.3% vs 0.7%), infection (2.8% vs 0.9%), and sepsis (3.7% vs 0.9%), as well as overall medical complications (23.8% vs 9.6%) (all, P ≤0.033). MBD patients also experienced higher surgical complications, including implant-related (5.7% vs 1.9%), wound infection (4.2% vs 1.2%), and wound disruption (0.9% vs 0.2%), and overall surgical complications (9.8% vs 3.2%) (all, P ≤0.039). Regression analysis revealed that a baseline diagnosis of MBD was independently associated with an increased risk of 2-year surgical complications (odds ratio = 2.10, P < 0.001) and medical complications (odds ratio = 1.84, P = 0.001). CONCLUSIONS MBD as a comorbidity was associated with an increased risk of 2-year postoperative complications after 2-3 level ACDF for CR or CM.
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Affiliation(s)
- Bassel G Diebo
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, East Providence, Rhode Island
| | - Matthew Kovoor
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, East Providence, Rhode Island
| | - Daniel Alsoof
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, East Providence, Rhode Island
| | | | | | - Mariah Balmaceno-Criss
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, East Providence, Rhode Island
| | - David H Mai
- Department of Orthopedics, SUNY Downstate, Brooklyn
| | | | - Neil V Shah
- Department of Orthopedics, SUNY Downstate, Brooklyn
| | | | | | - Roy K Aaron
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, East Providence, Rhode Island
| | - Alan H Daniels
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, East Providence, Rhode Island
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Whitaker CD, Stone BK, Gregorczyk JA, Alsoof D, Hardacker K, Diebo BG, Daniels A, Basques B. Nonsurgical Interventional Spine Pain Procedures: Outcomes and Complications. JBJS Rev 2023; 11:01874474-202304000-00003. [PMID: 37058581 DOI: 10.2106/jbjs.rvw.22.00235] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
» Nonsurgical interventional spine pain procedures provide an additional treatment option for lower back pain at the traditional bifurcation of conversative vs. operative management. » Transforaminal epidural steroid injections, radiofrequency ablations, intrathecal drug delivery, and spinal cord stimulation were found to be effective and safe techniques when applied to their specific indication. » Thermal annuloplasty and minimally invasive lumbar decompression showed mixed support. » Discography, sacroiliac joint injections, and spinous process spacers lacked sufficient evidence to support efficacy. » Medial branch blocks and facet joint injections were found to be useful diagnostic tools.
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Affiliation(s)
- Colin D Whitaker
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Benjamin K Stone
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | | | - Daniel Alsoof
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Kyle Hardacker
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Bassel G Diebo
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Alan Daniels
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Bryce Basques
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
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Passias PG, Joujon-Roche R, Williamson TK, Tretiakov PS, Imbo B, Krol O, Lebovic J, Diebo BG, Vira S. 181 Costs of Surgery in Adult Spinal Deformity: Do Higher Cost Surgeries Lead to Better Outcomes? Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
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Saad Berreta R, Zhang H, Alsoof D, McDonald CL, Diebo BG, Kuris E, Daniels AH. Beta-lactam-resistant Staphylococcus aureus in spinal osteomyelitis and spondylodiscitis: current landscape in antibiotic resistance, treatment, and complications. J Neurosurg Spine 2023:1-6. [PMID: 36933262 DOI: 10.3171/2023.2.spine221353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/14/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVE Spinal osteomyelitis and spondylodiscitis (SD) are infections of the vertebral body and disc, respectively, with more than 50% associated with Staphylococcus aureus. Methicillin-resistant S. aureus (MRSA) has become a pathogen of interest in cases of SD due to increasing prevalence. The purpose of this investigation was to characterize the current epidemiological and microbiological landscape in SD cases, in addition to medical and surgical challenges in treating these infections. METHODS The PearlDiver Mariner database was queried for ICD-10 codes to identify cases of SD from 2015 to 2021. The initial cohort was stratified by offending pathogens, including methicillin-sensitive S. aureus (MSSA) and MRSA. Primary outcome measures included epidemiological trends, demographics, and rates of surgical management. Secondary outcomes included length of hospital stay, rate of reoperation, and complications associated with surgical cases. Multivariable logistic regression was used to control for age, gender, region, and Charlson Comorbidity Index (CCI). RESULTS Nine thousand nine hundred eighty-three patients met the inclusion criteria and were retained for this study. Approximately half (45.5%) of SD cases resulting from S. aureus infections each year were resistant to beta-lactam antibiotics. The proportion of cases that were managed surgically was 31.02%. Among the cases that involved surgical intervention, 21.83% underwent revision operations within 30 days of the original procedure and 37.29% of cases returned to the operating room within 1 year. Substance abuse, specifically alcohol, tobacco, and drug use, were strong predictors for surgical intervention in cases of SD (all p < 0.001), in addition to obesity (p = 0.002), liver disease (p < 0.001), and valvular disease (p = 0.025). After adjusting for age, gender, region, and CCI, cases of MRSA were more likely to undergo surgical management (OR 1.19, p = 0.003). MRSA SD also exhibited higher rates of reoperation within 6 months (OR 1.29, p = 0.001) and 1 year (OR 1.36, p < 0.001). Surgical cases resulting from MRSA infections also exhibited higher morbidity and significant rates of transfusion (OR 1.47, p = 0.030), acute kidney injury (OR 1.35, p = 0.001), pulmonary embolism (OR 1.44, p = 0.030), pneumonia (OR 1.49, p = 0.002), and urinary tract infection (OR 1.45, p = 0.002) compared with MSSA SD infections. CONCLUSIONS More than 45% of cases of S. aureus SD in the US are resistant to beta-lactam antibiotics, presenting obstacles in treatment. Cases of MRSA SD are more likely to be managed surgically and have higher rates of complications and reoperations. Early detection and prompt operative management are imperative to reduce the risk of complications.
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Affiliation(s)
| | - Helen Zhang
- 1The Warren Alpert Medical School of Brown University, Providence; and
| | - Daniel Alsoof
- 2Department of Orthopaedics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Christopher L McDonald
- 2Department of Orthopaedics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Bassel G Diebo
- 2Department of Orthopaedics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Eren Kuris
- 2Department of Orthopaedics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Alan H Daniels
- 2Department of Orthopaedics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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