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Zhao E, Hirase T, Kim AG, Du JY, Amen TB, Araghi K, Subramanian T, Kamil R, Shahi P, Fourman MS, Asada T, Simon CZ, Singh N, Korsun M, Tuma OC, Zhang J, Lu AZ, Mai E, Kim AYE, Allen MRJ, Kwas C, Dowdell JE, Sheha ED, Qureshi SA, Iyer S. The Impact of Posterior Intervertebral Osteophytes on Patient-Reported Outcome Measures After L5-S1 Anterior Lumbar Interbody Fusion and Transforaminal Lumbar Interbody Fusion. Spine (Phila Pa 1976) 2024; 49:652-660. [PMID: 38193931 DOI: 10.1097/brs.0000000000004904] [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: 09/08/2023] [Accepted: 12/11/2023] [Indexed: 01/10/2024]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE (1) To develop a reliable grading system to assess the severity of posterior intervertebral osteophytes and (2) to investigate the impact of posterior intervertebral osteophytes on clinical outcomes after L5-S1 decompression and fusion through anterior lumbar interbody fusion (ALIF) and minimally-invasive transforaminal lumbar interbody fusion (MIS-TLIF). BACKGROUND There is limited evidence regarding the clinical implications of posterior lumbar vertebral body osteophytes for ALIF and MIS-TLIF surgeries and there are no established grading systems that define the severity of these posterior lumbar intervertebral osteophytes. PATIENTS AND METHODS A retrospective analysis of patients undergoing L5-S1 ALIF or MIS-TLIF was performed. Preoperative and postoperative patient-reported outcome measures of the Oswestry Disability Index (ODI) and leg Visual Analog Scale (VAS) at 2-week, 6-week, 12-week, and 6-month follow-up time points were assessed. Minimal clinically important difference (MCID) for ODI of 14.9 and VAS leg of 2.8 were utilized. Osteophyte grade was based on the ratio of osteophyte length to foraminal width. "High-grade" osteophytes were defined as a maximal osteophyte length >50% of the total foraminal width. RESULTS A total of 70 consecutive patients (32 ALIF and 38 MIS-TLIF) were included in the study. There were no significant differences between the two cohorts in patient-reported outcome measures or achievement of MCID for Leg VAS or ODI preoperatively or at any follow-ups. On multivariate analysis, neither the surgical approach nor the presence of high-grade foraminal osteophytes was associated with leg VAS or ODI scores at any follow-up time point. In addition, neither the surgical approach nor the presence of high-grade foraminal osteophytes was associated with the achievement of MCID for leg VAS or ODI at 6 months. CONCLUSION ALIF and MIS-TLIF are both valid options for treating degenerative spine conditions and lumbar radiculopathy, even in the presence of high-grade osteophytes that significantly occupy the intervertebral foramen. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Eric Zhao
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
- Department of Spine Surgery, Weill Cornell Medicine, New York, NY
| | - Takashi Hirase
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Andrew G Kim
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Jerry Y Du
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Troy B Amen
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Kasra Araghi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Tejas Subramanian
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
- Department of Spine Surgery, Weill Cornell Medicine, New York, NY
| | - Robert Kamil
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Pratyush Shahi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | | | - Tomoyuki Asada
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Chad Z Simon
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Nishtha Singh
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Maximilian Korsun
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Olivia C Tuma
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Joshua Zhang
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Amy Z Lu
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
- Department of Spine Surgery, Weill Cornell Medicine, New York, NY
| | - Eric Mai
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
- Department of Spine Surgery, Weill Cornell Medicine, New York, NY
| | - Ashley Yeo Eun Kim
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
- Department of Spine Surgery, Weill Cornell Medicine, New York, NY
| | - Myles R J Allen
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Cole Kwas
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - James E Dowdell
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Evan D Sheha
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Sheeraz A Qureshi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Sravisht Iyer
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
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Subramanian T, Kaidi A, Shahi P, Asada T, Hirase T, Vaishnav A, Maayan O, Amen TB, Araghi K, Simon CZ, Mai E, Tuma OC, Eun Kim AY, Singh N, Korsun MK, Zhang J, Allen M, Kwas CT, Kim ET, Sheha ED, Dowdell JE, Qureshi SA, Iyer S. Practical Answers to Frequently Asked Questions in Anterior Cervical Spine Surgery for Degenerative Conditions. J Am Acad Orthop Surg 2024:00124635-990000000-00952. [PMID: 38709837 DOI: 10.5435/jaaos-d-23-01037] [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: 11/08/2023] [Accepted: 03/15/2024] [Indexed: 05/08/2024] Open
Abstract
INTRODUCTION Surgical counseling enables shared decision making and optimal outcomes by improving patients' understanding about their pathologies, surgical options, and expected outcomes. Here, we aimed to provide practical answers to frequently asked questions (FAQs) from patients undergoing an anterior cervical diskectomy and fusion (ACDF) or cervical disk replacement (CDR) for the treatment of degenerative conditions. METHODS Patients who underwent primary one-level or two-level ACDF or CDR for the treatment of degenerative conditions with a minimum of 1-year follow-up were included. Data were used to answer 10 FAQs that were generated from author's experience of commonly asked questions in clinic before ACDF or CDR. RESULTS A total of 395 patients (181 ACDF, 214 CDR) were included. (1, 2, and 3) Will my neck/arm pain and physical function improve? Patients report notable improvement in all patient-reported outcome measures. (4) Is there a chance I will get worse? 13% (ACDF) and 5% (CDR) reported worsening. (5) Will I receive a significant amount of radiation? Patients on average received a 3.7 (ACDF) and 5.5 mGy (CDR) dose during. (6) How long will I stay in the hospital? Most patients get discharged on postoperative day one. (7) What is the likelihood that I will have a complication? 13% (8% minor and 5% major) experienced in-hospital complications (ACDF) and 5% (all minor) did (CDR). (8) Will I need another surgery? 2.2% (ACDF) and 2.3% (CDR) of patients required a revision surgery. (9 & 10) When will I be able to return to work/driving? Most patients return to working (median of 16 [ACDF] and 14 days [CDR]) and driving (median of 16 [ACDF] and 12 days [CDR]). CONCLUSIONS The answers to the FAQs can assist surgeons in evidence-based patient counseling.
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Affiliation(s)
- Tejas Subramanian
- From the Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY (Subramanian, Kaidi, Shahi, Asada, Hirase, Vaishnav, Maayan, Amen, Araghi, Simon, Mai, Tuma, Eun Kim, Singh, Korsun, Zhang, Allen, Kim, Sheha, Dowdell, Qureshi, and Iyer), and the Weill Cornell Medicine, New York, NY (Subramanian, Mai, Eun Kim, Qureshi, and Iyer)
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Mai E, Kim E, Kaidi A, Subramanian T, Simon CZ, Asada T, Kwas C, Zhang J, Araghi K, Singh N, Tuma O, Korsun M, Allen M, Heuer A, Sheha ED, Dowdell J, Huang RC, Albert TJ, Qureshi SA, Iyer S. Impact of Preoperative Symptom Duration on Patient-Reported Outcomes Following Cervical Disc Replacement for Cervical Radiculopathy. Spine (Phila Pa 1976) 2024:00007632-990000000-00648. [PMID: 38679871 DOI: 10.1097/brs.0000000000005020] [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: 03/14/2024] [Accepted: 04/05/2024] [Indexed: 05/01/2024]
Abstract
STUDY DESIGN Retrospective review of prospectively collected data. OBJECTIVE To determine the impact of preoperative symptom duration on postoperative functional outcomes following cervical disc replacement (CDR) for radiculopathy. SUMMARY OF BACKGROUND DATA CDR has emerged as a reliable and efficacious treatment option for degenerative cervical spine pathologies. The relationship between preoperative symptom duration and outcomes following CDR is not well established. METHODS Patients with radiculopathy without myelopathy who underwent primary 1- or 2-level CDRs were included and divided into shorter (<6 mo) and prolonged (≥6 mo) cohorts based on preoperative symptom duration. Patient-reported outcome measures (PROMs) included Neck Disability Index (NDI), Visual Analog Scale (VAS) Neck and Arm. Change in PROM scores and minimal clinically important difference (MCID) rates were calculated. Analyses were conducted on the early (within 3 mo) and late (6 mo-2 y) postoperative periods. RESULTS A total of 201 patients (43.6±8.7 y, 33.3% female) were included. In both early and late postoperative periods, the shorter preoperative symptom duration cohort experienced significantly greater change from preoperative PROM scores compared to the prolonged symptom duration cohort for NDI, VAS-Neck, and VAS-Arm. The shorter symptom duration cohort achieved MCID in the early postoperative period at a significantly higher rate for NDI (78.9% vs. 54.9%, P=0.001), VAS-Neck (87.0% vs. 56.0%, P<0.001), and VAS-Arm (90.5% vs. 70.7%, P=0.002). Prolonged preoperative symptom duration (≥6 mo) was identified as an independent risk factor for failure to achieve MCID at the latest timepoint for NDI (OR: 2.9, 95% CI: 1.2-6.9, P=0.016), VAS-Neck (OR: 9.8, 95% CI: 3.7-26.0, P<0.001), and VAS-Arm (OR: 7.5, 95% CI: 2.5-22.5, P<0.001). CONCLUSIONS Our study demonstrates improved patient-reported outcomes for those with shorter preoperative symptom duration undergoing CDR for radiculopathy, suggesting delayed surgical intervention may result in poorer outcomes and greater postoperative disability. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Eric Mai
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
- Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA
| | - Eric Kim
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Austin Kaidi
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Tejas Subramanian
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
- Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA
| | - Chad Z Simon
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Tomoyuki Asada
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Cole Kwas
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Joshua Zhang
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Kasra Araghi
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Nishtha Singh
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Olivia Tuma
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Maximilian Korsun
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Myles Allen
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Annika Heuer
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Evan D Sheha
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - James Dowdell
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Russel C Huang
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Todd J Albert
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Sheeraz A Qureshi
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Sravisht Iyer
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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Nakarai H, Simon CZ, Adida S, Samuel J, Araghi K, Kim HJ, Lovecchio FC. Reliability of Vertebral Pelvic Angles in Assessment of Spinal Alignment. Global Spine J 2024:21925682241235607. [PMID: 38382044 DOI: 10.1177/21925682241235607] [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] [Indexed: 02/23/2024] Open
Abstract
STUDY DESIGN Reliability analysis. OBJECTIVES Vertebral pelvic angles (VPA) are gaining popularity given their ability to describe the shape of the spine. Understanding the reliability and minimal detectable change (MDC) is necessary to determine how these measurement tools should be used in the manual assessment of spine radiographs. Our aim is to assess intra- and interobserver intraclass correlation coefficients (ICC) and the MDC in the use of VPA for assessing alignment in adult spinal deformity (ASD). METHODS Three independent examiners blindly measured T1, T4, T9, L1, and L4PA twice in ASD patients with a 4-week window after the initial measurements. Patients who had undergone hip or shoulder arthroplasty, fused or transitional vertebrae, or whose hip joints were not visible on radiographs were excluded. Power analysis calculated a minimum sample size of 19. Both intra- and interobserver ICC and MDC, which denotes the smallest detectable change in a true value with 95% confidence, were calculated. RESULTS Out of the 193 patients, 39 were ultimately included in the study, and 390 measurements were performed by 3 raters. Intraobserver ICC values ranged from .90 to .99. The interobserver ICC was .97, .97, .96, .95, and .92, and the MDC was 5.3°, 5.1°, 4.8°, 4.9°, and 4.1° for T1, T4, T9, L1, and L4PA, respectively. CONCLUSION All VPAs showed excellent intra- and interobserver reliability, however, the MDC is relatively high compared to typical ranges for VPA values. Therefore, surgeons must be aware that substantial alignment changes may not be detected by a single VPA.
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Affiliation(s)
- Hiroyuki Nakarai
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopaedic Surgery, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan
| | - Chad Z Simon
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Samuel Adida
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Justin Samuel
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Kasra Araghi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Han Jo Kim
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Francis C Lovecchio
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
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Asada T, Simon CZ, Singh N, Tuma O, Subramanian T, Araghi K, Lu AZ, Mai E, Kim YE, Allen MRJ, Korsun M, Zhang J, Kwas C, Singh S, Dowdell J, Sheha ED, Qureshi SA, Iyer S. Limited Improvement with Minimally Invasive Lumbar Decompression Alone for Degenerative Scoliosis with Cobb Angle over 20 Degrees: The Impact of Decompression Location. Spine (Phila Pa 1976) 2024:00007632-990000000-00601. [PMID: 38375684 DOI: 10.1097/brs.0000000000004968] [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: 12/05/2023] [Accepted: 01/24/2024] [Indexed: 02/21/2024]
Abstract
STUDY DESIGN Retrospective review of a prospectively collected multi-surgeon registry. OBJECTIVE To evaluate the outcomes of minimally invasive (MI) decompression in patients with severe degenerative scoliosis (DS) and identify factors associated with poorer outcomes. SUMMARY OF BACKGROUND CONTEXT MI decompression has gained widespread acceptance as a treatment option for patients with lumbar canal stenosis and DS. However, there is a lack of research regarding the clinical outcomes and the impact of MI decompression location in patients with severe DS exhibiting a Cobb angle exceeding 20 degrees. MATERIALS AND METHODS Patients who underwent MI decompression alone were included and categorized into the DS or control groups based on Cobb angle (>20 degrees). Decompression location was labeled as "scoliosis-related" when the decompression levels were across or between end vertebrae, and "outside" when the operative levels did not include the end vertebrae. The outcomes including Oswestry Disability Index (ODI) were compared between the propensity score-matched groups for improvement and minimal clinical importance difference (MCID) achievement at ≥1 year postoperatively. Multivariable regression analysis was conducted to identify factors contributing to the non-achievement of MCID in ODI of the DS group at the ≥1 year timepoint. RESULTS A total of 253 patients (41 DS) were included in the study. Following matching for age, gender, osteoporosis status, psoas muscle area, and preoperative ODI, the DS groups exhibited a significantly lower rate of MCID achievement in ODI (DS: 45.5% vs. control 69.0%, P=0.047). The "scoliosis-related" decompression (Odds ratio: 9.9, P=0.028) was an independent factor of non-achievement of MCID in ODI within the DS group. CONCLUSION In patients with a Cobb angle>20 degrees, lumbar decompression surgery, even in the MI approach, may result in limited improvement of disability and physical function. Caution should be exercised when determining a surgical plan, especially when decompression involves the level between or across the end vertebrae. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Tomoyuki Asada
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
- University of Tsukuba, Institute of Medicine, Dept. of Orthopaedic Surgery, Tsukuba, Japan
| | - Chad Z Simon
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
| | - Nishtha Singh
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
| | - Olivia Tuma
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
| | - Tejas Subramanian
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
- Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA
| | - Kasra Araghi
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
| | - Amy Z Lu
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
- Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA
| | - Eric Mai
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
- Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA
| | - Yeo Eun Kim
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
- Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA
| | - Myles R J Allen
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
| | | | - Joshua Zhang
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
| | - Cole Kwas
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
| | - Sumedha Singh
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
| | - James Dowdell
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
| | - Evan D Sheha
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
| | | | - Sravisht Iyer
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
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Simon CZ, Du JY, Parel P, Adida S, Miller PM, Qureshi S. Hypoglossal and Glossopharyngeal Nerve Palsy After Anterior Cervical Decompression and Fusion: A Case Report. JBJS Case Connect 2024; 14:01709767-202403000-00028. [PMID: 38340356 DOI: 10.2106/jbjs.cc.23.00372] [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] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
CASE A 69-year-old man underwent a C3-4 anterior cervical discectomy and fusion and developed postoperative hypoglossal and glossopharyngeal palsies that resolved with symptomatic treatment. CONCLUSION Cranial nerve palsy is a rare and possibly under-reported injury after higher-level cervical spine surgery. Conscientious positioning and awareness of these nerves during surgical exposure are crucial to minimizing cranial nerve palsies. Proper workup to identify these palsies and differentiate them from other complications is necessary to guide proper treatment.
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Affiliation(s)
- Chad Z Simon
- Hospital for Special Surgery, New York City, New York
| | - Jerry Y Du
- Hospital for Special Surgery, New York City, New York
| | - Philip Parel
- Hospital for Special Surgery, New York City, New York
| | - Samuel Adida
- Hospital for Special Surgery, New York City, New York
| | - Payton M Miller
- Division of General Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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Asada T, Simon CZ, Lu AZ, Adida S, Dupont M, Parel PM, Zhang J, Bhargava S, Morse KW, Dowdell JE, Iyer S, Qureshi SA. Robot-navigated pedicle screw insertion can reduce intraoperative blood loss and length of hospital stay: analysis of 1,633 patients utilizing propensity score matching. Spine J 2024; 24:118-124. [PMID: 37704046 DOI: 10.1016/j.spinee.2023.09.004] [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: 07/31/2023] [Revised: 08/14/2023] [Accepted: 09/06/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND CONTEXT Navigation and robotic technologies have emerged as an alternative option to conventional freehand techniques for pedicle screw insertion. However, the effectiveness of these technologies in reducing the perioperative complications of spinal fusion surgery remains limited due to the small cohort size in the existing literature. PURPOSE To investigate whether utilization of robotically navigated pedicle screw insertion can reduce the perioperative complications of spinal fusion surgery-including reoperations-with a sizeable cohort. STUDY DESIGN Retrospective study. PATIENT SAMPLE Patients who underwent primary lumbar fusion surgery between 2019 and 2022. OUTCOME MEASURES Perioperative complications including readmission, reoperation, its reasons, estimated blood loss, operative time, and length of hospital stay. METHODS Patients' data were collected including age, sex, race, body mass index, upper-instrumented vertebra, lower-instrumented vertebra, number of screws inserted, and primary procedure name. Patients were classified into the following two groups: freehand group and robot group. The variable-ratio greedy matching was utilized to create the matched cohorts by propensity score and compared the outcomes between the two group. RESULTS A total of 1,633 patients who underwent primary instrumented spinal lumbar fusion surgery were initially identified (freehand 1,286; robot 347). After variable ratio matching was performed with age, sex, body mass index, fused levels, and upper instrumented vertebrae level, 694 patients in the freehand group and 347 patients in robot groups were selected. The robot group showed less estimated blood loss (418.9±398.9 vs 199.2±239.6 ml; p<.001), shorter LOS (4.1±3.1 vs 3.2±3.0 days; p<.001) and similar operative time (212.5 vs 222.0 minutes; p=.151). Otherwise, there was no significant difference in readmission rate (3.6% vs 2.6%; p=.498), reoperation rate (3.2% vs 2.6%; p=.498), and screw malposition requiring reoperation (five cases, 0.7% vs one case, 0.3%; p=1.000). CONCLUSIONS Perioperative complications requiring readmission and reoperation were similar between fluoroscopy guided freehand and robotic surgery. Robot-guided pedicle screw insertion can enhance surgical efficiency by reducing intraoperative blood loss and length of hospital stay without extending operative time.
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Affiliation(s)
- Tomoyuki Asada
- Hospital for Special Surgery, 535 E. 70th St, New York, NY 10021, USA; Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Chad Z Simon
- Hospital for Special Surgery, 535 E. 70th St, New York, NY 10021, USA
| | - Amy Z Lu
- Hospital for Special Surgery, 535 E. 70th St, New York, NY 10021, USA
| | - Samuel Adida
- Hospital for Special Surgery, 535 E. 70th St, New York, NY 10021, USA
| | - Marcel Dupont
- Hospital for Special Surgery, 535 E. 70th St, New York, NY 10021, USA
| | - Philip M Parel
- Hospital for Special Surgery, 535 E. 70th St, New York, NY 10021, USA
| | - Joshua Zhang
- Hospital for Special Surgery, 535 E. 70th St, New York, NY 10021, USA
| | - Satyaj Bhargava
- Hospital for Special Surgery, 535 E. 70th St, New York, NY 10021, USA
| | - Kyle W Morse
- Hospital for Special Surgery, 535 E. 70th St, New York, NY 10021, USA
| | - James E Dowdell
- Hospital for Special Surgery, 535 E. 70th St, New York, NY 10021, USA
| | - Sravisht Iyer
- Hospital for Special Surgery, 535 E. 70th St, New York, NY 10021, USA
| | - Sheeraz A Qureshi
- Hospital for Special Surgery, 535 E. 70th St, New York, NY 10021, USA.
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Subramanian T, Shinn DJ, Korsun MK, Shahi P, Asada T, Amen TB, Maayan O, Singh S, Araghi K, Tuma OC, Singh N, Simon CZ, Zhang J, Sheha ED, Dowdell JE, Huang RC, Albert TJ, Qureshi SA, Iyer S. Recovery Kinetics After Cervical Spine Surgery. Spine (Phila Pa 1976) 2023; 48:1709-1716. [PMID: 37728119 DOI: 10.1097/brs.0000000000004830] [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: 07/13/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023]
Abstract
STUDY DESIGN Retrospective review of a prospectively maintained multisurgeon registry. OBJECTIVE To study recovery kinetics and associated factors after cervical spine surgery. SUMMARY OF BACKGROUND DATA Few studies have described return to activities cervical spine surgery. This is a big gap in the literature, as preoperative counseling and expectations before surgery are important. MATERIALS AND METHODS Patients who underwent either anterior cervical discectomy and fusion (ACDF) or cervical disk replacement (CDR) were included. Data collected included preoperative patient-reported outcome measures, return to driving, return to working, and discontinuation of opioids data. A multivariable regression was conducted to identify the factors associated with return to driving by 15 days, return to working by 15 days, and discontinuing opioids by 30 days. RESULTS Seventy ACDF patients and 70 CDR patients were included. Overall, 98.2% of ACDF patients and 98% of CDR patients returned to driving in 16 and 12 days, respectively; 85.7% of ACDF patients and 90.9% of CDR patients returned to work in 16 and 14 days; and 98.3% of ACDF patients and 98.3% of CDR patients discontinued opioids in a median of seven and six days. Though not significant, minimal (odds ratio (OR)=1.65) and moderate (OR=1.79) disability was associated with greater odds of returning to driving by 15 days. Sedentary work (OR=0.8) and preoperative narcotics (OR=0.86) were associated with decreased odds of returning to driving by 15 days. Medium (OR=0.81) and heavy (OR=0.78) intensity occupations were associated with decreased odds of returning to work by 15 days. High school education (OR=0.75), sedentary work (OR=0.79), and retired/not working (OR=0.69) were all associated with decreased odds of discontinuing opioids by 30 days. CONCLUSIONS Recovery kinetics for ACDF and CDR are comparable. Most patients return to all activities after ACDF and CDR within 16 days. These findings serve as an important compass for preoperative counseling.
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Affiliation(s)
- Tejas Subramanian
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
- Weill Cornell Medicine, New York, NY
| | - Daniel J Shinn
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
- Weill Cornell Medicine, New York, NY
| | - Maximilian K Korsun
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Pratyush Shahi
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Tomoyuki Asada
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Troy B Amen
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Omri Maayan
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
- Weill Cornell Medicine, New York, NY
| | - Sumedha Singh
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Kasra Araghi
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Olivia C Tuma
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Nishtha Singh
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Chad Z Simon
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Joshua Zhang
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Evan D Sheha
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
- Weill Cornell Medicine, New York, NY
| | - James E Dowdell
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
- Weill Cornell Medicine, New York, NY
| | - Russel C Huang
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Todd J Albert
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Sheeraz A Qureshi
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
- Weill Cornell Medicine, New York, NY
| | - Sravisht Iyer
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
- Weill Cornell Medicine, New York, NY
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