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Rampersaud YR, Sundararajan K, Docter S, Perruccio AV, Gandhi R, Adams D, Briggs N, Davey JR, Fehlings M, Lewis SJ, Magtoto R, Massicotte E, Sarro A, Syed K, Mahomed NN, Veillette C. Hospital spending and length of stay attributable to perioperative adverse events for inpatient hip, knee, and spine surgery: a retrospective cohort study. BMC Health Serv Res 2023; 23:1150. [PMID: 37880706 PMCID: PMC10598977 DOI: 10.1186/s12913-023-10055-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 09/23/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND The incremental hospital cost and length of stay (LOS) associated with adverse events (AEs) has not been well characterized for planned and unplanned inpatient spine, hip, and knee surgeries. METHODS Retrospective cohort study of hip, knee, and spine surgeries at an academic hospital in 2011-2012. Adverse events were prospectively collected for 3,063 inpatient cases using the Orthopaedic Surgical AdVerse Event Severity (OrthoSAVES) reporting tool. Case costs were retrospectively obtained and inflated to equivalent 2021 CAD values. Propensity score methodology was used to assess the cost and LOS attributable to AEs, controlling for a variety of patient and procedure factors. RESULTS The sample was 55% female and average age was 64; 79% of admissions were planned. 30% of cases had one or more AEs (82% had low-severity AEs at worst). The incremental cost and LOS attributable to AEs were $8,500 (95% confidence interval [CI]: 5100-11,800) and 4.7 days (95% CI: 3.4-5.9) per admission. This corresponded to a cumulative $7.8 M (14% of total cohort cost) and 4,290 bed-days (19% of cohort bed-days) attributable to AEs. Incremental estimates varied substantially by (1) admission type (planned: $4,700/2.4 days; unplanned: $20,700/11.5 days), (2) AE severity (low: $4,000/3.1 days; high: $29,500/11.9 days), and (3) anatomical region (spine: $19,800/9 days; hip: $4,900/3.8 days; knee: $1,900/1.5 days). Despite only 21% of admissions being unplanned, adverse events in these admissions cumulatively accounted for 59% of costs and 62% of bed-days attributable to AEs. CONCLUSIONS This study comprehensively demonstrates the considerable cost and LOS attributable to AEs in orthopaedic and spine admissions. In particular, the incremental cost and LOS attributable to AEs per admission were almost five times as high among unplanned admissions compared to planned admissions. Mitigation strategies focused on unplanned surgeries may result in significant quality improvement and cost savings in the healthcare system.
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Affiliation(s)
- Y Raja Rampersaud
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada.
- Krembil Research Institute, University Health Network, Toronto, ON, Canada.
- Department of Surgery, University of Toronto, Toronto, ON, Canada.
- Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada.
| | - Kala Sundararajan
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Shgufta Docter
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
| | - Anthony V Perruccio
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Rajiv Gandhi
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Diana Adams
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
| | - Natasha Briggs
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
| | - J Rod Davey
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Michael Fehlings
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
| | - Stephen J Lewis
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
| | - Rosalie Magtoto
- Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
| | - Eric Massicotte
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
| | - Angela Sarro
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
| | - Khalid Syed
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Nizar N Mahomed
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Christian Veillette
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
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Gui C, Rocos B, Lohkamp LN, Cheung A, Bleakney R, Massicotte E. Utility of the spinal instability neoplastic score to identify patients with Gorham-Stout disease requiring spine surgery. Surg Neurol Int 2021; 12:227. [PMID: 34221558 PMCID: PMC8247937 DOI: 10.25259/sni_311_2021] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 04/19/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Gorham-Stout disease (GSD) is a rare syndrome presenting with progressive osteolysis which in the spine can lead to cord injury, instability, and deformity. Here, the early spine surgery may prevent catastrophic outcomes. Case Description: A 25-year-old male with GSD involving the T2 to T6 levels presented with acute traumatic kyphoscoliosis at T3 and T4 and left lower extremity paraparesis. The CT scan 4 weeks before this showed progressing osteolysis versus the CT 5 years ago. Unfortunately, the patient underwent delayed treatment resulting in permanent neurological sequelae. Surgery included a laminectomy and vertebrectomy of T3/T4 with instrumented fusion from T1-10. The use of the spinal instability neoplastic score (SINS) is a useful tool to prompt early referral to spine surgeons. Conclusion: We recommend using the SINS score in GSD patients who develop spinal lesions to prompt early referral for consideration of surgery.
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Affiliation(s)
- Chloe Gui
- Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Brett Rocos
- Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Laura-Nanna Lohkamp
- Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Angela Cheung
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Robert Bleakney
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Eric Massicotte
- Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
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Kalsi-Ryan S, Riehm LE, Tetreault L, Martin AR, Teoderascu F, Massicotte E, Curt A, Verrier MC, Velstra IM, Fehlings MG. Characteristics of Upper Limb Impairment Related to Degenerative Cervical Myelopathy: Development of a Sensitive Hand Assessment (Graded Redefined Assessment of Strength, Sensibility, and Prehension Version Myelopathy). Neurosurgery 2020; 86:E292-E299. [PMID: 31792501 PMCID: PMC7018615 DOI: 10.1093/neuros/nyz499] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 09/04/2019] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Degenerative cervical myelopathy (DCM) involves spinal cord compression, which causes neurological decline. Neurological impairment in DCM is variable and can involve complex upper limb dysfunction including loss of manual dexterity, hyperreflexia, focal weakness, and sensory impairment. The modified Japanese Orthopaedic Association (mJOA) score relies on the patients’ subjective perceptions, whereas existing objective measures such as strength and sensory testing do not capture subtle changes in dexterity and function. OBJECTIVE 1) To characterize arm and hand function in DCM; and 2) To develop and validate Graded Redefined Assessment of Strength, Sensibility, and Prehension Version-Myelopathy (GRASSP-M), a clinical assessment that quantifies upper limb impairment. METHODS A total of 148 DCM patients (categorized into mild, moderate, and severe based on mJOA grade) and 21 healthy subjects were enrolled. A complete neurological exam, the mJOA, the QuickDASH, grip dynamometry, and the GRASSP-M were administered. RESULTS Strength, sensation, and manual dexterity significantly declined with increasing DCM severity (P ≤ .05). Impairment in hand dexterity showed better discrimination between mild, moderate, and severe DCM categories than strength or sensation. The GRASSP-M was found to be both a reliable (intraclass correlation coefficient >0.75 for intra- and inter-rater reliability) and valid (with both concurrent and construct validity) tool. CONCLUSION These results demonstrate that patients’ subjective reporting of functional status, especially in the mild DCM category, may underrepresent the extent of functional impairment. The GRASSP-M is an objective tool designed to characterize patients’ functional impairment related to the upper limb, which proves useful to diagnose and quantify mild dysfunction, monitor patients for deterioration, and help determine when patients should be treated surgically.
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Affiliation(s)
- Sukhvinder Kalsi-Ryan
- Department of Physical Therapy, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,KITE-UHN, Toronto Rehab Institute, Department of Physical Therapy, University of Toronto
| | - Lauren E Riehm
- Division of Neurosurgery, Spinal Program, Toronto Western Hospital, University Health Network, Toronto, Canada
| | | | - Allan R Martin
- Division of Neurosurgery, Spinal Program, Toronto Western Hospital, University Health Network, Toronto, Canada.,Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Florentina Teoderascu
- Division of Neurosurgery, Spinal Program, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Eric Massicotte
- Division of Neurosurgery, Spinal Program, Toronto Western Hospital, University Health Network, Toronto, Canada.,Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Armin Curt
- University Hospital, Balgrist, Zurich Switzerland
| | | | | | - Michael G Fehlings
- Department of Physical Therapy, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Division of Neurosurgery, Spinal Program, Toronto Western Hospital, University Health Network, Toronto, Canada.,Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada
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Missiuna P, Shen J, Nahle I, Shen J, Alanazi M, Rutges J, Rocos B, Miyanji F, Lohkamp L, Grootjen L, Hachem L, Aldebeyan S, Machida M, Padhye K, Rushton P, Jentzsch T, Jentzsch T, Lewis S, Passias P, Pierce K, Lewis S, Passias P, Nielsen C, Glennie A, Crawford E, Schneider N, Ayling O, Christie S, Greene R, Singh S, Beauchamp-Chalifour P, Balasuberamaniam P, Singh S, Mercure-Cyr R, Wilson J, Evaniew N, Martin A, Rienmueller A, Martin A, Karim M, Martin A, Cheung A, Badhiwala J, Diotalevi L, Jaja B, Fallah N, Badhiwala J, Wasim A, Manson N, Lasry O, Crawford E, Brown A, MacLean MA, Khan O, Badhiwala J, Odai KG, Bailly N, Khan O, Evaniew N, Yamamoto S, Singh M, Kashigar A, Persad A, Fernandes RJR, Malakoutian M, Ahuja C, Morris S, Stukas S, Chen T, Babadagli E, Xu M, Nater A, Oitment C, Karim M, Aziz M, Pahuta M, Versteeg A, Sundararajan K, Tanguay R, Stratton A, Cushnie D, Correale M, Sadiq I, Badhiwala J, Passias P, Badhiwala J, McGregor S, Passias P, Badhiwala J, Chen T, Singh S, Ayling O, Bond M, Rienmueller A, Chen T, Lasry O, Lyons F, Ahmed U, Inglis T, Waheed Z, Wilson J, Nater A, Pahuta M, Klein G, McKibben N, Kassam F, Clement A, Kanawati A, Shaikh N, Kanawati A, Alshammari A, Kanawati A, Yamamoto S, Hamilton K, Huschi Z, Peng YN, Huschi Z, Filgueira É, Goulet J, Kashigar A, Chen T, Hadgaonkar S, MacLean M, Chen T, Kerr HL, Meagher J, Wilson J, Stevens M, Rocos B, Pai A, Kingwell S, Thibault J, Touchette C, Moskven E, Greene R, DeVries Z, Sarraj M, Bosakhar B, Thornley P, Donnellan J, Kishta W, Darby P, Nahle I, Alzakri A, Roy-Beaudry M, Joncas J, Turgeon I, Parent S, Shen J, Alzakri A, Roy-Beaudry M, Joncas J, Turgeon I, Parent S, Samson N, Lamontagne-Proulx J, Soulet D, Tremblay Y, Praud JP, Parent S, Parent S, Gross D, Renkens J, Schlösser T, Stadhouder A, Kruyt M, Mostert A, Tee J, de Klerk L, De Kleuver M, Castelein R, Zeller R, Lewis S, Tan T, Lebel D, Rushton P, Petcharaporn M, Samdani A, Newton P, Marks M, Drake J, Dirks P, Rutka J, Kulkarni A, Ibrahim G, Taylor M, Dewan M, Zeller R, Donze S, Damen L, Rutges J, Hokken-Koelega A, Mathieu F, Lamberti-Pasculi M, Hanak B, Zeller R, Kulkarni A, Drake J, Ibrahim G, Rushton P, Ghag R, Miyanji F, Zeller R, Lewis S, Lebel D, Peiro-Garcia A, Benavides B, Parsons D, Ferri-de-Barros F, Aldebeyan S, Ghag R, Miyanji F, Kutschke L, Laux C, Kabelitz M, Schüpbach R, Böni T, Farshad M, Nielsen C, Lewis S, Lenke L, Shaffrey C, Cheung K, Berven S, Qiu Y, Matsuyama Y, Pellisé-Urquiza F, Polly D, Sembrano J, Dahl B, Kelly M, de Kleuver M, Spruit M, Alanay A, Alas H, Kim HJ, Lafage R, Soroceanu A, Hockley A, Ames C, Klineberg E, Burton D, Diebo B, Bess S, Line B, Shaffrey C, Smith J, Schwab F, Lafage V, Passias P, Lafage R, Soroceanu A, Hockley A, Line B, Klineberg E, Bess S, Protopsaltis T, Shaffrey C, Schwab F, Scheer J, Smith J, Lafage V, Ames C, Lenke L, Shaffrey C, Cheung K, Berven S, Qiu Y, Matsuyama Y, Pellisé-Urquiza F, Polly D, Sembrano J, Dahl B, Kelly M, de Kleuver M, Spruit M, Alanay A, Bortz C, Pierce K, Alas H, Brown A, Soroceanu A, Hockley A, Vira S, Ahmad W, Naessig S, Diebo B, Raman T, Protopsaltis T, Buckland A, Gerling M, Lafage R, Lafage V, Lewis S, Lenke L, Shaffrey C, Cheung K, Berven S, Qiu Y, Matsuyama Y, Pellisé-Urquiza F, Polly D, Sembrano J, Dahl B, Kelly M, de Kleuver M, Spruit M, Alanay A, Bailey C, Rampersaud R, Fisher C, Chen T, McIntosh G, Rampersaud R, Karim M, Urquhart J, Fisher C, Street J, Dvorak M, Paquette S, Charest-Morin R, Ailon T, Glennie A, Manson N, Rampersaud R, Thomas K, Rasoulinejad P, Bailey C, Ailon T, Fisher C, Greene R, Glennie A, Duquette D, LeBlanc D, Martell B, Schmidt M, Christie S, Wong DBT, Di Paola C, Ailon T, Charest-Morin R, Dea N, Dvorak M, Fisher C, Kwon B, Paquette S, Street J, Street J, Flexman A, Charest-Morin R, Wasim A, Schwartz C, Stark R, Shrikumar M, Finkelstein J, Gara A, Banaszek D, Wong T, Ailon T, Bryce E, Charest-Morin R, Dea N, Dvorak M, Fisher C, Kwon B, Paquette S, Street J, Persad A, Spiess M, Wu A, Woo A, Hnenny L, Fourney D, Joshi H, Khan O, Badhiwala J, Rampersaud R, Lewis S, Massicotte E, Fehlings M, Cadotte D, Bailey C, Christie S, Dea N, Fisher C, Paquet J, Soroceanu A, Thomas KC, Rampersaud YR, Wilson J, Manson N, Johnson M, Hall H, McIntosh G, Jacobs B, Kalsi-Ryan S, Akbar MA, Badhiwala J, Wilson J, Tetreault L, Nouri A, Rienmuller A, Massicotte E, Fehlings M, Kalsi-Ryan S, Riehm L, Martin A, Badhiwala J, Akbar M, Massicotte E, Fehlings M, Kalsi-Ryan S, Akbar MA, Badhiwala J, Wilson J, Tetreault L, Nouri A, Rienmuller A, Massicotte E, Fehlings M, Jacobs B, Johnson M, Bailey C, Christie S, Paquet J, Nataraj A, Cadotte D, Wilson J, Manson N, Hall H, Thomas K, Rampersaud R, McIntosh G, Fisher C, Dea N, Wilson J, Jentzsch T, Jiang F, Badhiwala J, Moghaddamjou A, Akbar MA, Nater A, Rienmuller A, Ganau M, Massicotte E, Fehlings M, Tu L, Manouchehri N, Kim KT, So K, Webster M, Fisk S, Tigchelaar S, Dalkilic S, Sayre E, Streijger F, Macnab A, Kwon B, Shadgan B, Wilson J, Fehlings M, Bailly N, Wagnac E, Mac-Thiong JM, Goulet J, Petit Y, Badhiwala J, Grossman R, Geisler F, Fehlings M, Wilson J, Rivers C, Kwon B, Waheed Z, Buenaventura J, Humphreys S, Noonan V, Evaniew N, Dvorak M, Wilson J, Fehlings M, Shrikumar M, Balasuberamaniam P, Rapkin B, Schwartz C, Stark R, Finkelstein J, Bigney E, Darling M, Richardson E, El-Mughayyar D, Abraham E, Street J, Radomski L, Rampersaud R, Pierce K, Bortz C, Alas H, Naessig S, Ahmad W, Vira S, Diebo B, Sciubba D, Hassanzadeh H, Hockley A, Soroceanu A, Protopsaltis T, Buckland A, Passias P, Greene R, Christie SD, Badhiwala J, Fehlings M, Witiw C, Wilson J, Fehlings M, Nessek H, Wai E, Phan P, Diotalevi L, Beauséjour MH, Wagnac E, Mac-Thiong JM, Petit Y, Badhiwala J, Fehlings M, Mazlouman S, Belley-Côté E, Jacobs B, Kwon B, Malakoutian M, Theret M, Street J, Brown S, Rossi F, Oxland T, Singh P, Chandra S, Laratta J, Carreon L, Bisson E, Ghogawala Z, Yew A, Mkorombindo T, Mummaneni P, Glassman S, Kindrachuk M, Hnenny L, Wu A, Norton J, Fourney D, Gee A, Kerr HL, Kanawati A, Zdero R, Gurr K, Bailey C, Rasoulinejad P, Yamamoto S, Sadaram S, Speidel J, Liu J, Street J, Brown S, Oxland T, Khazaei M, Walji I, Dadabhoy M, Gulati N, Aiyar N, Ostmeier S, Hasan A, Senthilnathan V, Punjani N, Yao Y, Yue S, Ozdemir G, Lou Z, Luong W, Post A, Tootsi A, Chan P, Fehlings M, Yung A, George S, Prevost V, Bauman A, Kozlowski P, Samadi F, Fournier C, Parker L, Dong K, Streijger F, Moore W, Laule C, Kwon B, Gill J, Cooper J, Dong K, Streijger F, Street J, Paquette S, Ailon T, Charest-Morin R, Fisher C, Dvorak M, Dhall S, Mac-Thiong JM, Parent S, Bailey C, Christie S, Wellington C, Kwon B, Crawford E, Zhang Y, Hardisty M, Finkelstein J, Kureshi N, Julien L, Abidi R, Christie S, Parashin S, Gascoyne T, Goytan M, Chuang J, Liu K, Quraishi N, Pasku D, Wilson J, Fehlings M, Bozzo A, Reinmuller A, Martin A, Hananel SY, Thornley P, Gazendam A, Aoude A, Nielsen C, Rampersaud R, Dea N, Versteeg A, Sahgal A, Verlaan JJ, Morin RC, Rhines L, Sciubba D, Schuster J, Weber M, Lazary A, Fehlings M, Clarke M, Arnold P, Boriani S, Laufer I, Gokaslan Z, Fisher C, Rosenzweig D, Weber M, Fisk F, Versteeg A, Fisher C, Sahgal A, Gokaslan Z, Rhines L, Boriani S, Bettegowda C, Dea N, Gal R, Charest-Morin R, Verlaan JJ, Verkooijen L, Fisher C, Perruccio A, Rampersaud R, Eckenswiller D, Yu A, Klassen K, Lewkonia P, Thomas K, Jacobs B, Miller N, Swamy G, Yang M, Soroceanu A, Phan P, Wai E, Kingwell S, Moravek D, Tierney S, Street J, Sundararajan K, Bosma R, Faclier G, Di Renna T, Rampersaud R, Frederick A, Kassam F, Nicholls F, Swamy G, Lewkonia P, Thomas K, Jacobs B, Miller N, Tanguay R, Soroceanu A, Platt A, Traynelis V, Witiw C, Horn S, Weiser-Horwitz S, Bortz C, Segreto F, Pierce K, Lafage R, Hockley A, Vira S, Lafage V, Witiw C, Wilson J, Nassiri F, da Costa L, Nathens A, Fehlings M, Jacobs B, Alas H, Pierce K, Brown A, Bortz C, Hockley A, Soroceanu A, Vira S, Naessig S, Ahmad W, Lafage R, Lafage V, Witiw C, Wilson J, da Costa L, Nathens A, Fehlings M, Crawford E, McIntosh G, Rampersaud R, Fisher C, Manson N, Thomas K, Hall H, Rampersaud R, Dea N, McIntosh G, Charest-Morin R, Investigators CSORN, Ailon T, Fisher C, Evaniew N, Aldebeyan S, Thomas K, Sundararajan K, Oitment C, Lewis S, Perruccio A, Rampersaud R, Christie S, Yee A, Fisher C, Jarzem P, Roy JF, Bouchard J, Evans D, Kwon B, Splawinski J, Warren D, Street J, Morris S, Costello J, Farrell M, Humphreys S, Kurban D, Rivers C, Jeffrey M, Juutilainen S, Casha S, Christie S, Clarke T, Drew B, Ethans K, Fehlings M, Fox R, Linassi G, Marion T, O’Connell C, Paquet J, Reid J, Scott L, Fourney D, Schouten R, Rivers C, Chen M, Nunnerley J, Croot T, Young L, Patel A, Dvorak M, Kwon B, Rivers C, Buenaventura J, Humphreys S, Noonan V, Fallah N, Evaniew N, Dvorak M, Cronin S, Badhiwala J, Ginsberg H, Fehlings M, Kwon B, Jaglal S, Wilson J, Fehlings M, Fisk F, Versteeg A, Fisher C, Sahgal A, Gokaslan Z, Rhines L, Boriani S, Bettegowda C, Dea N, Martel A, Sahgal A, Finkelstein J, Whyne C, Hardisty M, Baksh N, Nguyen T, Brown S, Jaboin J, Lin C, Yach J, Hardisty M, Whyne C, Fernandez R, Gee A, Urquhart J, Bailey C, Rasoulinejad P, Zhang H, Shewchuk J, Street J, Wilson D, Oxland T, Fernandez R, Gee A, Urquhart J, Bailey C, Rasoulinejad P, Algarni N, Aljarboa N, Jarzem P, Fernandez R, Gee A, Urquhart J, Bailey C, Rasoulinejad P, Whyte T, Van Toen C, Melnyk A, Shewchuk J, Street J, Cripton P, Oxland T, Avila M, Hurlbert RJ, Neuburger L, Ahmed SU, Cheng Y, Fourney D, Hsu HC, Kao CH, Neuburger L, Ahmed SU, Cheng Y, Fourney D, Meves R, de Oliveira AI, da Silva HC, Richard-Denis A, Petit Y, Diotalevi L, Mac-Thiong JM, Laratta J, Bisson E, Carreon L, Yew A, Mkorombindo T, Glassman S, Christie S, Bouchard J, Fisher C, Roy JF, Yee A, Jarzem P, Khurjekar K, Kothari A, Zawar A, Sanchetui P, Shyam A, Touchette C, Han JH, Christie S, Pickett G, Yee A, Bouchard J, Christie S, Fisher C, Jarzem P, Roy JF, Hashem L, Urquhart J, Rasoulinejad P, Gurr K, Siddiqi F, Bailey C, Attabib N, Bigney E, Richardson E, El-Mughayyar D, Darling M, Manson N, Abraham E, Badhiwala J, Jiang F, Wilson J, Fehlings M, Dunning C, Oxner W, Stewart S, Glennie A, Hutchinson J, Oxland T, Zhang H, Shewchuk J, Wilson D, Street J, Wilk S, Wai E, Phan P, Stratton A, Mohammed S, Tsai E, Alkerayf F, Michalowski W, Phan P, Wai E, Hoda M, MacLean M, Brunette-Clément T, Abduljabba F, Weber M, Fourney D, Charest-Morin R, Flexman A, Street J, Frey M, Mackey S, De Carvalho D, Barrowman N, Smit K, Tice A, Mervitz D, Jarvis J, Kingwell S. Canadian Spine SocietyPresentation CPSS1: Spinal insufficiency fracture in the geriatric pediatric spinePresentation CPSS2: The clinical significance of tether breakages in anterior vertebral body growth modulation: a 2-year postoperative analysisPresentation CPSS3: Anterior vertebral body growth modulation for idiopathic scoliosis: early, mid-term and late complicationsPresentation CPSS4: Ovine model of congenital chest wall and spine deformity with alterations of respiratory mechanics: follow-up from birth to 3 monthsPresentation CPSS5: Test–retest reliability and minimum detectable change of the English translation of the Italian Spine Youth Quality of Life questionnaire in adolescents with idiopathic scoliosisPresentation B1. Abstract 31: Incidence of delayed spinal cord injury in pediatric spine deformity surgery seems to be higher than previously assumedPresentation B2. Abstract 155: What is the optimal surgical method for achieving successful symptom relief in pediatric high-grade spondylolisthesis?Presentation B3. Abstract 47: Vertebral body tethering: Truly motion preserving or rather limiting?Presentation B4. Abstract 180: Fusion rates in pediatric patients after posterior cervical spine instrumentationPresentation B5. Abstract 102: Effects of 8 years of growth hormone treatment on the onset and progression of scoliosis in children with Prader–Willi syndromePresentation B6. Abstract 144: Klippel–Feil syndrome: clinical phenotypes associated with surgical treatmentPresentation B7. Abstract 123: Anterior release for idiopathic scoliosis: Is it necessary for curve correction?Presentation B8. Abstract 62: Severe scoliosis: Do we know a better way? A retrospective comparative studyPresentation B9. Abstract 21: Intraoperative skull femoral traction in adolescent idiopathic scoliosis: the correlation of traction with side-bending radiographsPresentation B10. Abstract 147: What is the effect of intraoperative halo-femoral traction on correction of adolescent idiopathic scoliosis?Presentation B11. Abstract 174: Extreme long-term outcome of surgically versus non-surgically treated patients with adolescent idiopathic scoliosisPresentation B12. Abstract 172: The influence of multilevel spinal deformity surgery on the clinical outcome in the elderly: a prospective, observational, multicentre studyPresentation B13. Abstract 49: Demographics of a prospective evaluation of elderly deformity surgery: a prospective international observational multicentre studyPresentation B14. Abstract 119: Timing of conversion to cervical malalignment and proximal junctional kyphosis following surgical correction of adult spinal deformityPresentation B15. Abstract 44: Prioritization of realignment associated with superior clinical outcomes for surgical cervical deformity patientsPresentation B16. Abstract 50: Outcome of multilevel spinal deformity surgery in patients over 60 years of age: a multicentre international prospective studyPresentation B17. Abstract 122: A simpler, modified frailty index weighted by complication occurrence correlates to pain and disability for adult spinal deformity patientsPresentation B18. Abstract 75: Change in Oswestry Disability Index at 24 months following multilevel spinal deformity surgery in patients over 60 years of age: a multicentre international prospective studyPresentation C19. Abstract 19: A prospective cohort study evaluating trends in the surgical treatment of degenerative spondylolisthesis in Canada and the utility of a novel surgical decision aidPresentation C20. Abstract 154: Decompression compared with decompression and fusion for degenerative lumbar spondylolisthesis: a Canadian Spine Outcomes and Research Network (CSORN) studyPresentation C21. Abstract ID 77: Lumbar degenerative spondylolisthesis: factors impacting decision to fusePresentation C22. Abstract 27: Patient-reported outcomes following surgery for lumbar disc herniation: comparison of a universal and multitier health care systemPresentation C23. Abstract 151: Do patients with recurrent lumbar disc herniations fair worse with discectomy than primary operations? A retrospective analysis from the Canadian Spine Outcomes and Research NetworkPresentation C24. Abstract 136: A province-wide assessment of the appropriateness of lumbar spine MRIPresentation D25. Abstract 32: Surgical site infection reduction — a 10-year quality improvement journeyPresentation D26. Abstract 34: The impact of frailty on patient-reported outcome measures following elective thoraco-lumbar spine surgeryPresentation D27. Abstract 8: Moving toward better health: exercise practice is associated with improved outcomes after spine surgeryPresentation D28. Abstract 33: Preoperative decolonization does not adversely affect the microbiologic spectrum of spine surgical site infectionPresentation D29. Abstract 61: Feedback: reducing after-hours spine cases using an encrypted messaging systemPresentation D30. Abstract 177: Complex spine surgery is safe and effective in the extremely elderly age group: results from an ambispective study of 722 patients over 75 years old from a single institutionPresentation E31. Abstract 38: Clinical predictors of achieving minimal clinically important difference after surgery for cervical spondylotic myelopathy: an external validation study from the Canadian Spine Outcomes and Research NetworkPresentation E32. Abstract 66: The natural history of degenerative cervical myelopathy: an ambispective longitudinal cohort studyPresentation E33. Abstract 159: Quantitative assessment of gait characteristics in degenerative cervical myelopathy (DCM): a prospective studyPresentation E34. Abstract 130: Prognostic factors in degenerative cervical myelopathy (DCM) for patients managed operatively and nonoperativelyPresentation E35. Abstract 175: Efficacy of surgical decompression in patients with cervical spondylotic myelopathy: results of a Canadian prospective multicentre studyPresentation E36. Abstract 67: Interobserver reliability of the modified Japanese Orthopedic Association (mJOA) score in degenerative cervical myelopathyPresentation F37. Abstract 128: Continuous optical monitoring of spinal cord hemodynamics during the first 7 days after injury in a porcine model of acute spinal cord injuryPresentation F38. Abstract 106: Development of a prediction model for central cord syndrome: an evaluation of motor recovery and the effectiveness of early surgery in a prospective, multicentre cohortPresentation F39. Abstract 135: Spinal cord dynamics under different clinical configurations of thoracolumbar burst fractures through numerical simulationsPresentation F40. Abstract 60: Predicting the heterogeneity of outcome following sensorimotor complete cervical spinal cord injury: trajectory-based analysis of 655 prospectively enrolled patientsPresentation F41. Abstract 167: Mortality in the year following discharge to the community from inpatient care for acute traumatic spinal cord injury: When and why?Presentation F42. Abstract 104: A novel method to classify patients with cervical incomplete spinal cord injury based on potential for recovery: a group-based trajectory analysis using prospective, multicentre data from over 800 patientsPresentation G43. Abstract 7: Responsiveness of standard spine outcome tools: Do they measure up?Presentation G44. Abstract 142: Patient outcomes: important psychological measuresPresentation G45. Abstract 84: Accuracy of surveillance for surgical site infections after spine surgery: a Bayesian latent class analysis using 4 independent data sourcesPresentation G46. Abstract 169: Econometric modelling: development of a surgical cost calculator for degenerative conditions of the lumbar spinePresentation G47. Abstract 124: The economic impact of nonreimbursable events in open, minimally invasive and robot-assisted lumbar fusion surgeryPresentation G48. Abstract 164: Are there sex differences in preoperative health status and health care delivery for patients undergoing scheduled lumbar surgery? An analysis from the Canadian Spine Outcomes and Research NetworkPresentation H49. Abstract 41: Patient phenotypes associated with functional outcomes after spinal cord injury: a principal component analysis in 1119 patientsPresentation H50. Abstract 103: Early versus late surgical decompression for acute traumatic spinal cord injury: a pooled analysis of prospective, multicentre data in 1548 patientsPresentation H51. Abstract 79: Clinical outcome correlation of diffusion tensor imaging and magnetic resonance imaging values: a systematic reviewPresentation H52. Abstract 137: A numerical study on the pathogenesis of central cord syndromePresentation H53. Abstract 42: Feasibility and utility of machine learning in prediction of bladder outcomes after spinal cord injury: analysis of 1250 patients from the European Multicenter Study about Spinal Cord Injury (EMSCI) registryPresentation H54. Abstract 18: Interventions to optimize spinal cord perfusion in patients with acute traumatic spinal cord injuries: a systematic reviewPresentation i55. Abstract 55: The effect of posterior lumbar spinal surgery on passive stiffness of rat paraspinal muscles 13 weeks post-surgeryPresentation i56. Abstract 43: A computed tomographic based morphometric analysis of the axis in adult populationPresentation i57. Abstract 92: Is there value to flexion–extension x-rays for degenerative spondylolisthesis? A multicentre retrospective studyPresentation i58. Abstract 98: The novel “7/20 EMG protocol” in combination with O-arm image-guided navigation for accurate lumbar pedicle placement while minimizing diagnostic radiation exposurePresentation i59. Abstract 148: Comparative biomechanical study of 2 types of transdiscal fixation implants for high-grade L5/S1 spine spondylolisthesis in a porcine modelPresentation i60. Abstract 85: The effects of fibre bundle size and vertebral level on passive stiffness of the lumbar paraspinal muscles in a rat modelPresentation J61. Abstract 157: A self-assembling peptide biomaterial to enhance human neural stem cell-based regeneration of the injured spinal cordPresentation J62. Abstract 162: Measuring demyelination, axonal loss and inflammation after human spinal cord injury with quantitative magnetic resonance imaging and histopathologyPresentation J63. Abstract 179: Characterization of ubiquitin C-terminal hydrolase L1 (UCH-L1) as a fluid biomarker of human traumatic spinal cord injuryPresentation J64. Abstract 13: Utility and role of virtual reality based simulation models in spinal decompression trainingPresentation J65. Abstract 160: Investigating the determinants for predicting surgical patient outcomes through the application of machine learning methodsPresentation J66. Abstract 143: Comparison of screw design and technique on cervical lateral mass screw fixationPresentation K67. Abstract 57: Development of clinical prognostic models for postoperative survival and quality of life in patients with surgically treated metastatic epidural spinal cord compressionPresentation K68. Abstract 170: Sarcomas of the spine: a 20-year survey of disease and treatment strategy in Ontario, CanadaPresentation K69. Abstract 15: Metastatic spine disease: Should patients with short life expectancy be denied surgical care? An international retrospective cohort studyPresentation K70. Abstract 29: Nanoparticle-functionalized polymethyl methacrylate bone cement for sustained chemotherapeutic drug deliveryPresentation K71. Abstract 90: Development of the Spine Oncology Study Group Outcomes Questionnaire – 8 Domain (SOSGOQ-8D)Presentation K72. Abstract 6: Treatment expectations of patients with spinal metastases: What do we tell our patients?Presentation L73. Abstract 48: Factors related to risk of opioid abuse in primary care patients with low back painPresentation L74. Abstract 65: QI/QA of a transitional outpatient pain program for spinePresentation L75. Abstract 168: The effect of preoperative opioid use on hospital length of stay in patients undergoing elective spine surgeryPresentation L76. Abstract 163: Disability or pain: Which best predicts patient satisfaction with surgical outcome? A Canadian Spine Outcomes and Research Network (CSORN) studyPresentation L77. Abstract 58: Rapid access to interventional pain management for lumbar nerve root pain through collaborative interprofessional provider networksPresentation L78. Abstract 63: Chronic preoperative opioid use associated with higher perioperative resource utilization and complications in adult spinal deformity patientsPresentation M79. Abstract 108: Cervical disc arthroplasty versus anterior cervical discectomy and fusion: a longitudinal analysis of reoperationsPresentation M80. Abstract 46: Preliminary results of randomized controlled trial investigating the role of psychological distress on cervical spine surgery outcomes: a baseline analysisPresentation M81. Abstract 110: Operative versus nonoperative treatment of geriatric odontoid fractures: a study of North American trauma centresPresentation M82. Abstract 74: Clinical outcome of posterior cervical foraminotomy versus anterior cervical discectomy and fusionPresentation M83. Abstract 45: “Reverse Roussouly”: ratios of cervical to thoracic shape curvature in an adult cervical deformity populationPresentation M84. Abstract 109: Treatment of acute traumatic central cord syndrome: a study of North American trauma centresPresentation N85. Abstract 118: Comparing minimally invasive versus traditional open lumbar decompression and fusion surgery: a Canadian Spine Outcomes and Research Network (CSORN) studyPresentation N86. Abstract 54: Time to return to work after lumbar spine surgeryPresentation N87. Abstract 28: Patient-reported outcomes following surgery for lumbar spinal stenosis: comparison of a universal and multitier health care systemPresentation N88. Abstract 93: Outcomes of surgery in older adults with lumbar spinal stenosisPresentation N89. Abstract 162: Functional objective assessment using the TUG test is a useful tool to evaluate outcome in lumbar spinal stenosisPresentation N90. Abstract 36: A Canadian Spine Outcomes and Research Network (CSORN) matched-cohort study comparing lumbar fusion and disk arthroplastyPresentation o91. Abstract 171: Development of clinical practice guidelines for the management of traumatic spinal column and cord injuries in British Columbia: an approach to standardizing care of spine trauma patientsPresentation o92. Abstract 22: Notes from a small island: stemming the tide of a spinal deluge. The use of encrypted software applications to ensure accountability, quality control and surgical consensus in a national acute adult spinal surgery centrePresentation o93. Abstract 129: Traumatic spinal cord injuries among Aboriginal and non-Aboriginal populations in Canada: an ambispective outcomes studyPresentation o94. Abstract 132: Traumatic spinal cord injury in New Zealand and Canada: a comparative analysisPresentation o95. Abstract 150: Exploring the reasons for readmission following traumatic spinal cord injuryPresentation o96. Abstract 59: Exploring the epidemiology and impact of spinal cord injury in the elderly: a 15-year Canadian population-based cohort studyPresentation P1. Abstract 139: Incidence and management of spinal metastasis in Ontario: a population-based studyPresentation P2. Abstract 91: A general population utility valuation study for the Spine Oncology Study Group Outcomes Questionnaire – 8DPresentation P3. Abstract 158: Metastatic vertebrae segmentation by augmented 3D convolutional neural networkPresentation P4. Abstract 73: Risk factors for failure of radiation therapy for spinal metastasesPresentation P5. Abstract 68: Significance of extracanalicular cement extravasation in thoracolumbar kyphoplastyPresentation P6. Abstract 120: Modelling fracture in osteoblastic vertebraePresentation P7. Abstract 97: The development of novel 2-in-1 patient-specific, 3D-printed laminar osteotomy guides with integrated pedicle screw guidesPresentation P8. Abstract 56: Effect of pelvic retroversion on pelvic geometry and muscle morphometry from upright magnetic resonance imagingPresentation P9. Abstract 161: Anatomic relationship between the accessory process of the lumbar spine and the pedicle screw entry pointPresentation P10. Abstract 20: Novel chair to measure lumbar spine extensors strength in adultsPresentation P11. Abstract 95: Error measurement between human spine, 3D scans, CT-based models, and 3D-printed modelsPresentation P12. Abstract 52: The diagnostic precision of computed tomography for traumatic cervical spine injury: an in vitro investigationPresentation P13. Abstract 94: Epidural abscess causing spinal cord infarctionPresentation P14. Abstract 83: The nerve root sedimentation sign on magnetic resonance imaging is not only correlated with neurogenic claudication: association with all types of leg-dominant mechanical painPresentation P15. Abstract 3: Accuracy of robot-assisted compared with freehand pedicle screw placement in spine surgery: a meta-analysis of randomized controlled trialsPresentation P16. Abstract 82: A positive nerve root sedimentation sign on magnetic resonance imaging is associated with improved surgical outcomes in patients with back dominant painPresentation P17. Abstract 16: Thoracolumbar burst fracture: McCormack load-sharing classification —systematic review and single-arm meta-analysisPresentation P18. Abstract 86: Morphological features of thoracolumbar burst fractures associated with neurologic recovery after thoracolumbar traumatic spinal cord injuryPresentation P19. Abstract 89: Radiographic parameters of listhesis and instability are not associated with health status or clinical outcomes in grade 1 degenerative spondylolisthesisPresentation P20. Abstract 37: Predictive socioeconomic factors following lumbar disk arthroplasty: a Canadian Spine Outcomes and Research Network (CSORN) studyPresentation P21. Abstract 25: Effect of in situ fusion in lumbar spondylolisthesis on clinical outcomes and spino-pelvic sagittal balancingPresentation P22. Abstract 10: Sex differences in the surgical management of lumbar degenerative disease: a systematic reviewPresentation P23. Abstract 35: Two-year results of lumbar disk arthroplasty: a Canadian Spine Outcomes and Research Network (CSORN) studyPresentation P24. Abstract 78: Does disc morphology affect the success of nonoperative treatment of chronic sciatica from a lumbar disc herniation?Presentation P25. Abstract 141: Opioid prescribing patterns: preliminary investigationPresentation P26. Abstract 133: Frailty is a better predictor of complications than age alone after surgical treatment of degenerative cervical myelopathy: an ambispective study of 5107 elderly patients from the National Surgical Quality Improvement Program databasePresentation P27. Abstract 26: Pathway analysis in spine surgery: a model for evaluating length of stayPresentation P29. Abstract 156: Patients with adolescent idiopathic scoliosis (AIS) have different cervical lordosis than the normal populationPresentation P31. Abstract 64: Investigation of thoracic spinal muscle morphology with upright magnetic resonance imagingPresentation P32. Abstract 80: Postoperative complication prediction between spinal surgeons and a machine learning model: a comparative studyPresentation P33. Abstract 81: Is using a simplified procedural classification as accurate as using current procedural terminology codes to predict future complications in spinal surgery?Presentation P34. Abstract 88: Preoperative patient performance status and frailty phenotype as predictive factors of outcome in surgically treated patients with metastatic spinal disease: a systematic literature reviewPresentation P35. Abstract 101: The measurements of frailty and their application to spine surgeryPresentation P36. Abstract 131: The effect of prolonged sitting on muscle reflexes of the low backPresentation P37. Abstract 87: Implementing a rapid discharge pathway for adolescent idiopathic scoliosis in Canada. Can J Surg 2020. [DOI: 10.1503/cjs.014720] [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: 11/01/2022] Open
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Wright E, Ricciardi F, Arts M, Buchowski JM, Chung CK, Coppes M, Crockard A, Depreitere B, Fehlings M, Kawahara N, Lee CS, Leung Y, Martin-Benlloch A, Massicotte E, Mazel C, Oner C, Peul W, Quraishi N, Tokuhashi Y, Tomita K, Ulbricht C, Verlaan JJ, Wang M, Choi D. Metastatic Spine Tumor Epidemiology: Comparison of Trends in Surgery Across Two Decades and Three Continents. World Neurosurg 2018; 114:e809-e817. [PMID: 29572177 DOI: 10.1016/j.wneu.2018.03.091] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [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: 01/25/2018] [Accepted: 03/12/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Indications for surgery for symptomatic spinal metastases have become better defined in recent years, and suitable outcome measures have been established against a changing backdrop of patient characteristics, tumor behavior, and oncologic treatments. Nonetheless, variations still exist in the local management of patients with spinal metastases. In this study, we aimed to review global trends and habits in the surgical treatment of symptomatic spinal metastases, and to examine how these have changed over the last 25 years. METHODS In this cohort study of consecutive patients undergoing surgery for symptomatic spinal metastases, data were collected using a secure Internet database from 22 centers across 3 continents. All patients were invited to participate in the study, except those unable or unwilling to give consent. RESULTS There was a higher incidence of colonic, liver, and lung carcinoma metastases in Asian countries, and more frequent presentation of breast, prostate, melanoma metastases in the West. Trends in surgical technique were broadly similar across the centers. Overall survival rates after surgery were 53% at 1 year, 31% at 2 years, and 10% at 5 years after surgery (standard error 0.013 for all). Survival improved over successive time periods, with longer survival in patients who underwent surgery in 2011-2016 compared with those who underwent surgery in earlier time periods. CONCLUSIONS Surgical habits have been fairly consistent among countries worldwide and over time. However, patient survival has improved in later years, perhaps due to medical advances in the treatment of cancer, improved patient selection, and operating earlier in the course of disease.
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Affiliation(s)
- Ernest Wright
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, University College London, London, United Kingdom
| | - Federico Ricciardi
- Department of Statistical Science, University College London, London, United Kingdom
| | - Mark Arts
- Department of Neurosurgery, Medical Center Haaglanden, Haaglanden, The Netherlands
| | - Jacob M Buchowski
- Departments of Orthopedic and Neurological Surgery, Washington University, St. Louis, Missouri, USA
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Maarten Coppes
- Department of Neurosurgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Alan Crockard
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, University College London, London, United Kingdom
| | - Bart Depreitere
- Division of Neurosurgery, University Hospital Leuven, Leuven, Belgium
| | - Michael Fehlings
- Division of Neurosurgery and Spinal Program, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada
| | - Norio Kawahara
- Department of Orthopedic Surgery, Kanazawa Medical University Hospital, Kanazawa, Japan
| | - Chong Suh Lee
- Spine Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Yee Leung
- Department of Orthopaedics, Musgrove Park Hospital, Taunton, United Kingdom
| | | | - Eric Massicotte
- Division of Neurosurgery and Spinal Program, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada
| | - Christian Mazel
- Department of Orthopedic Surgery, Institut Mutualiste Montsouris, Paris, France
| | - Cumhur Oner
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wilco Peul
- Department of Neurosurgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Nasir Quraishi
- Centre for Spine Studies and Surgery, Queens Medical Centre, Nottingham, United Kingdom
| | - Yasuaki Tokuhashi
- Department of Orthopedic Surgery, Nihon University School of Medicine, Japan
| | - Katsuro Tomita
- Department of Orthopedic Surgery, Kanazawa University, Kanazawa, Japan
| | - Christian Ulbricht
- Department of Neurosurgery, Charing Cross Hospital, London, United Kingdom
| | - Jorrit-Jan Verlaan
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mike Wang
- Department of Neurosurgery, University of Miami Hospital, Miami, Florida, USA
| | - David Choi
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, University College London, London, United Kingdom.
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Sirois K, Tousignant B, Boucher N, Achim A, Beauchamp MH, Bedell G, Massicotte E, Vera-Estay E, Jackson PL. The contribution of social cognition in predicting social participation following moderate and severe TBI in youth. Neuropsychol Rehabil 2017; 29:1383-1398. [DOI: 10.1080/09602011.2017.1413987] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- K. Sirois
- École de psychologie, Université Laval, Quebec City, QC, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Quebec City, QC, Canada
- Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale – site-Institut de Réadaptation en déficience Physique de Québec (IRDPQ), Quebec City, QC, Canada
| | - B. Tousignant
- École de psychologie, Université Laval, Quebec City, QC, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Quebec City, QC, Canada
- Centre de recherche CERVO, Quebec City, QC, Canada
| | - N. Boucher
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Quebec City, QC, Canada
| | - A.M. Achim
- Centre de recherche CERVO, Quebec City, QC, Canada
- Département de psychiatrie et neurosciences, Université Laval, Quebec City, QC, Canada
| | - M. H. Beauchamp
- Département de Psychologie, Université de Montréal, Montreal, QC, Canada
- Centre de recherche de l’Hôpital Ste-Justine, Montreal, QC, Canada
| | - G. Bedell
- Department of Occupational Therapy, Tufts University, Medford, Massachusetts, USA
| | - E. Massicotte
- École de psychologie, Université Laval, Quebec City, QC, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Quebec City, QC, Canada
- Centre de recherche CERVO, Quebec City, QC, Canada
| | - E. Vera-Estay
- Département de Psychologie, Université de Montréal, Montreal, QC, Canada
| | - P. L. Jackson
- École de psychologie, Université Laval, Quebec City, QC, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Quebec City, QC, Canada
- Centre de recherche CERVO, Quebec City, QC, Canada
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Oh T, Lafage R, Lafage V, Protopsaltis T, Challier V, Shaffrey C, Kim HJ, Arnold P, Chapman J, Schwab F, Massicotte E, Yoon T, Bess S, Fehlings M, Smith J, Ames C. Comparing Quality of Life in Cervical Spondylotic Myelopathy with Other Chronic Debilitating Diseases Using the Short Form Survey 36-Health Survey. World Neurosurg 2017; 106:699-706. [DOI: 10.1016/j.wneu.2016.12.124] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/26/2016] [Accepted: 12/27/2016] [Indexed: 01/02/2023]
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Fehlings MG, Tetreault LA, Wilson JR, Aarabi B, Anderson P, Arnold PM, Brodke DS, Burns AS, Chiba K, Dettori JR, Furlan JC, Hawryluk G, Holly LT, Howley S, Jeji T, Kalsi-Ryan S, Kotter M, Kurpad S, Marino RJ, Martin AR, Massicotte E, Merli G, Middleton JW, Nakashima H, Nagoshi N, Palmieri K, Singh A, Skelly AC, Tsai EC, Vaccaro A, Yee A, Harrop JS. A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury and Central Cord Syndrome: Recommendations on the Timing (≤24 Hours Versus >24 Hours) of Decompressive Surgery. Global Spine J 2017; 7:195S-202S. [PMID: 29164024 PMCID: PMC5684850 DOI: 10.1177/2192568217706367] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To develop recommendations on the timing of surgical decompression in patients with traumatic spinal cord injury (SCI) and central cord syndrome. METHODS A systematic review of the literature was conducted to address key relevant questions. A multidisciplinary guideline development group used this information, along with their clinical expertise, to develop recommendations for the timing of surgical decompression in patients with SCI and central cord syndrome. Based on GRADE, a strong recommendation is worded as "we recommend," whereas a weak recommendation is presented as "we suggest." RESULTS Conclusions from the systematic review included (1) isolated studies reported statistically significant and clinically important improvements following early decompression at 6 months and following discharge from inpatient rehabilitation; (2) in one study on acute central cord syndrome without instability, a marginally significant improvement in total motor scores was reported at 6 and 12 months in patients managed with early versus late surgery; and (3) there were no significant differences in length of acute care/rehabilitation stay or in rates of complications between treatment groups. Our recommendations were: "We suggest that early surgery be considered as a treatment option in adult patients with traumatic central cord syndrome" and "We suggest that early surgery be offered as an option for adult acute SCI patients regardless of level." Quality of evidence for both recommendations was considered low. CONCLUSIONS These guidelines should be implemented into clinical practice to improve outcomes in patients with acute SCI and central cord syndrome by promoting standardization of care, decreasing the heterogeneity of management strategies, and encouraging clinicians to make evidence-informed decisions.
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Affiliation(s)
- Michael G. Fehlings
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,University of Toronto, Toronto, Ontario, Canada,Michael G. Fehlings, MD, PhD, FRCSC, FACS, Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst Street (SCI-CRU, 11th Floor McLaughlin Pavilion), Toronto, Ontario M5T 2S8, Canada.
| | - Lindsay A. Tetreault
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,University College Cork, Cork, Ireland
| | - Jefferson R. Wilson
- University of Toronto, Toronto, Ontario, Canada,St. Michael’s Hospital, Toronto, Ontario, Canada
| | | | | | - Paul M. Arnold
- University of Kansas Medical Center, The University of Kansas, Kansas City, KS, USA
| | | | - Anthony S. Burns
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | | | | | | | | | | | - Susan Howley
- Christopher & Dana Reeve Foundation, Short Hills, NJ, USA
| | - Tara Jeji
- Ontario Neurotrauma Foundation, Toronto, Ontario, Canada
| | | | | | | | | | - Allan R. Martin
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Eric Massicotte
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Geno Merli
- Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | | | - Narihito Nagoshi
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,Keio University, Keio, Japan
| | | | - Anoushka Singh
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | | | - Eve C. Tsai
- University of Ottawa, Ottawa, Ontario, Canada
| | - Alexander Vaccaro
- Department of Orthopedic Surgery, Jefferson Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Albert Yee
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Fehlings MG, Tetreault LA, Aarabi B, Anderson P, Arnold PM, Brodke DS, Burns AS, Chiba K, Dettori JR, Furlan JC, Hawryluk G, Holly LT, Howley S, Jeji T, Kalsi-Ryan S, Kotter M, Kurpad S, Kwon BK, Marino RJ, Martin AR, Massicotte E, Merli G, Middleton JW, Nakashima H, Nagoshi N, Palmieri K, Singh A, Skelly AC, Tsai EC, Vaccaro A, Wilson JR, Yee A, Harrop JS. A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Type and Timing of Anticoagulant Thromboprophylaxis. Global Spine J 2017; 7:212S-220S. [PMID: 29164026 PMCID: PMC5684841 DOI: 10.1177/2192568217702107] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The objective of this study is to develop evidence-based guidelines that recommend effective, safe and cost-effective thromboprophylaxis strategies in patients with spinal cord injury (SCI). METHODS A systematic review of the literature was conducted to address key questions relating to thromboprophylaxis in SCI. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as "we recommend," whereas a weaker recommendation is indicated by "we suggest." RESULTS Based on conclusions from the systematic review and expert panel opinion, the following recommendations were developed: (1) "We suggest that anticoagulant thromboprophylaxis be offered routinely to reduce the risk of thromboembolic events in the acute period after SCI;" (2) "We suggest that anticoagulant thromboprophylaxis, consisting of either subcutaneous low-molecular-weight heparin or fixed, low-dose unfractionated heparin (UFH) be offered to reduce the risk of thromboembolic events in the acute period after SCI. Given the potential for increased bleeding events with the use of adjusted-dose UFH, we suggest against this option;" (3) "We suggest commencing anticoagulant thromboprophylaxis within the first 72 hours after injury, if possible, in order to minimize the risk of venous thromboembolic complications during the period of acute hospitalization." CONCLUSIONS These guidelines should be implemented into clinical practice in patients with SCI to promote standardization of care, decrease heterogeneity of management strategies and encourage clinicians to make evidence-informed decisions.
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Affiliation(s)
- Michael G. Fehlings
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,University of Toronto, Toronto, Ontario, Canada,Michael G. Fehlings, MD, PhD, FRCSC, FACS, Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst Street (SCI-CRU, 11th Floor McLaughlin Pavilion), Toronto, Ontario M5T 2S8, Canada.
| | - Lindsay A. Tetreault
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,School of Medicine, University College Cork, Cork, Ireland
| | - Bizhan Aarabi
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | | | - Anthony S. Burns
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | | | | | - Julio C. Furlan
- University of Toronto, Toronto, Ontario, Canada,Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | | | | | - Susan Howley
- Christopher & Dana Reeve Foundation, Short Hills, NJ, USA
| | - Tara Jeji
- Ontario Neurotrauma Foundation, Toronto, Ontario, Canada
| | | | | | | | - Brian K. Kwon
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Allan R. Martin
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Eric Massicotte
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Geno Merli
- Sidney Kimmel Medical College, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | | | | | - Narihito Nagoshi
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,Keio University School of Medicine, Keio, Japan
| | | | - Anoushka Singh
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | | | - Eve C. Tsai
- University of Ottawa, Ottawa, Ontario, Canada
| | | | - Jefferson R. Wilson
- University of Toronto, Toronto, Ontario, Canada,Li Ka Shing Knowledge Institute, St. Michael s Hospital, Toronto, Ontario, Canada
| | - Albert Yee
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Fehlings MG, Tetreault LA, Aarabi B, Anderson P, Arnold PM, Brodke DS, Chiba K, Dettori JR, Furlan JC, Harrop JS, Hawryluk G, Holly LT, Howley S, Jeji T, Kalsi-Ryan S, Kotter M, Kurpad S, Kwon BK, Marino RJ, Martin AR, Massicotte E, Merli G, Middleton JW, Nakashima H, Nagoshi N, Palmieri K, Singh A, Skelly AC, Tsai EC, Vaccaro A, Wilson JR, Yee A, Burns AS. A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Type and Timing of Rehabilitation. Global Spine J 2017; 7:231S-238S. [PMID: 29164029 PMCID: PMC5684839 DOI: 10.1177/2192568217701910] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION The objective of this study is to develop guidelines that outline the appropriate type and timing of rehabilitation in patients with acute spinal cord injury (SCI). METHODS A systematic review of the literature was conducted to address key questions related to rehabilitation in patients with acute SCI. A multidisciplinary guideline development group used this information, and their clinical expertise, to develop recommendations for the type and timing of rehabilitation. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as "we recommend," whereas a weaker recommendation is indicated by "we suggest. RESULTS Based on the findings from the systematic review, our recommendations were: (1) We suggest rehabilitation be offered to patients with acute spinal cord injury when they are medically stable and can tolerate required rehabilitation intensity (no included studies; expert opinion); (2) We suggest body weight-supported treadmill training as an option for ambulation training in addition to conventional overground walking, dependent on resource availability, context, and local expertise (low evidence); (3) We suggest that individuals with acute and subacute cervical SCI be offered functional electrical stimulation as an option to improve hand and upper extremity function (low evidence); and (4) Based on the absence of any clear benefit, we suggest not offering additional training in unsupported sitting beyond what is currently incorporated in standard rehabilitation (low evidence). CONCLUSIONS These guidelines should be implemented into clinical practice to improve outcomes and reduce morbidity in patients with SCI by promoting standardization of care, decreasing the heterogeneity of management strategies and encouraging clinicians to make evidence-informed decisions.
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Affiliation(s)
- Michael G. Fehlings
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,University of Toronto, Toronto, Ontario, Canada,Michael G. Fehlings, MD, PhD, FRCSC, FACS, Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst Street (SCI-CRU, 11th Floor McLaughlin Pavilion), Toronto, Ontario M5T 2S8, Canada.
| | - Lindsay A. Tetreault
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,University College Cork, Cork, Ireland
| | - Bizhan Aarabi
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | | | | | | | - Julio C. Furlan
- University of Toronto, Toronto, Ontario, Canada,Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | | | | | | | - Susan Howley
- Christopher & Dana Reeve Foundation, Short Hills, NJ, USA
| | - Tara Jeji
- Ontario Neurotrauma Foundation, Toronto, Ontario, Canada
| | | | | | | | - Brian K. Kwon
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Allan R. Martin
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Eric Massicotte
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Geno Merli
- Sidney Kimmel Medical College, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | | | | | - Narihito Nagoshi
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,Keio University School of Medicine, Keio, Japan
| | | | - Anoushka Singh
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | | | - Eve C. Tsai
- University of Ottawa, Ottawa, Ontario, Canada
| | | | - Jefferson R. Wilson
- University of Toronto, Toronto, Ontario, Canada,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Albert Yee
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Anthony S. Burns
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
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Fehlings MG, Wilson JR, Tetreault LA, Aarabi B, Anderson P, Arnold PM, Brodke DS, Burns AS, Chiba K, Dettori JR, Furlan JC, Hawryluk G, Holly LT, Howley S, Jeji T, Kalsi-Ryan S, Kotter M, Kurpad S, Kwon BK, Marino RJ, Martin AR, Massicotte E, Merli G, Middleton JW, Nakashima H, Nagoshi N, Palmieri K, Skelly AC, Singh A, Tsai EC, Vaccaro A, Yee A, Harrop JS. A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Use of Methylprednisolone Sodium Succinate. Global Spine J 2017; 7:203S-211S. [PMID: 29164025 PMCID: PMC5686915 DOI: 10.1177/2192568217703085] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The objective of this guideline is to outline the appropriate use of methylprednisolone sodium succinate (MPSS) in patients with acute spinal cord injury (SCI). METHODS A systematic review of the literature was conducted to address key questions related to the use of MPSS in acute SCI. A multidisciplinary Guideline Development Group used this information, in combination with their clinical expertise, to develop recommendations for the use of MPSS. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as "we recommend," whereas a weaker recommendation is indicated by "we suggest." RESULTS The main conclusions from the systematic review included the following: (1) there were no differences in motor score change at any time point in patients treated with MPSS compared to those not receiving steroids; (2) when MPSS was administered within 8 hours of injury, pooled results at 6- and 12-months indicated modest improvements in mean motor scores in the MPSS group compared with the control group; and (3) there was no statistical difference between treatment groups in the risk of complications. Our recommendations were: (1) "We suggest not offering a 24-hour infusion of high-dose MPSS to adult patients who present after 8 hours with acute SCI"; (2) "We suggest a 24-hour infusion of high-dose MPSS be offered to adult patients within 8 hours of acute SCI as a treatment option"; and (3) "We suggest not offering a 48-hour infusion of high-dose MPSS to adult patients with acute SCI." CONCLUSIONS These guidelines should be implemented into clinical practice to improve outcomes and reduce morbidity in SCI patients.
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Affiliation(s)
- Michael G. Fehlings
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,University of Toronto, Toronto, Ontario, Canada,Michael G. Fehlings, MD, PhD, FRCSC, FACS, Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst Street (SCI-CRU, 11th Floor McLaughlin Pavilion), Toronto, Ontario M5T 2S8, Canada.
| | - Jefferson R. Wilson
- University of Toronto, Toronto, Ontario, Canada,Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Lindsay A. Tetreault
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,University College Cork, Cork, Ireland
| | | | | | - Paul M. Arnold
- University of Kansas Medical Center, The University of Kansas, Kansas City, KS, USA
| | | | - Anthony S. Burns
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | | | | | - Julio C. Furlan
- University of Toronto, Toronto, Ontario, Canada,Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | | | | | - Susan Howley
- Christopher & Dana Reeve Foundation, Short Hills, NJ, USA
| | - Tara Jeji
- Ontario Neurotrauma Foundation, Toronto, Ontario, Canada
| | | | | | | | - Brian K. Kwon
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Allan R. Martin
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Eric Massicotte
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Geno Merli
- Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | | | - Narihito Nagoshi
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,Keio University, Keio, Japan
| | | | | | - Anoushka Singh
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Eve C. Tsai
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Albert Yee
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Fehlings MG, Martin AR, Tetreault LA, Aarabi B, Anderson P, Arnold PM, Brodke D, Burns AS, Chiba K, Dettori JR, Furlan JC, Hawryluk G, Holly LT, Howley S, Jeji T, Kalsi-Ryan S, Kotter M, Kurpad S, Kwon BK, Marino RJ, Massicotte E, Merli G, Middleton JW, Nakashima H, Nagoshi N, Palmieri K, Singh A, Skelly AC, Tsai EC, Vaccaro A, Wilson JR, Yee A, Harrop JS. A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Role of Baseline Magnetic Resonance Imaging in Clinical Decision Making and Outcome Prediction. Global Spine J 2017; 7:221S-230S. [PMID: 29164028 PMCID: PMC5684845 DOI: 10.1177/2192568217703089] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION The objective of this guideline is to outline the role of magnetic resonance imaging (MRI) in clinical decision making and outcome prediction in patients with traumatic spinal cord injury (SCI). METHODS A systematic review of the literature was conducted to address key questions related to the use of MRI in patients with traumatic SCI. This review focused on longitudinal studies that controlled for baseline neurologic status. A multidisciplinary Guideline Development Group (GDG) used this information, their clinical expertise, and patient input to develop recommendations on the use of MRI for SCI patients. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as "we recommend," whereas a weaker recommendation is indicated by "we suggest." RESULTS Based on the limited available evidence and the clinical expertise of the GDG, our recommendations were: (1) "We suggest that MRI be performed in adult patients with acute SCI prior to surgical intervention, when feasible, to facilitate improved clinical decision-making" (quality of evidence, very low) and (2) "We suggest that MRI should be performed in adult patients in the acute period following SCI, before or after surgical intervention, to improve prediction of neurologic outcome" (quality of evidence, low). CONCLUSIONS These guidelines should be implemented into clinical practice to improve outcomes and prognostication for patients with SCI.
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Affiliation(s)
- Michael G. Fehlings
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- Michael G. Fehlings, MD, PhD, FRCSC, FACS, Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst Street (SCI-CRU, 11th Floor McLaughlin Pavilion), Toronto, Ontario M5T 2S8, Canada.
| | - Allan R. Martin
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Lindsay A. Tetreault
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- University College Cork, Cork, Ireland
| | | | | | - Paul M. Arnold
- University of Kansas Medical Center, The University of Kansas, Kansas City, KS, USA
| | | | - Anthony S. Burns
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | | | | | - Julio C. Furlan
- University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | | | | | - Susan Howley
- Christopher & Dana Reeve Foundation, Short Hills, NJ, USA
| | - Tara Jeji
- Ontario Neurotrauma Foundation, Toronto, Ontario, Canada
| | | | | | | | - Brian K. Kwon
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Eric Massicotte
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Geno Merli
- Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | | | - Narihito Nagoshi
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Keio University, Keio, Japan
| | | | - Anoushka Singh
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | | | - Eve C. Tsai
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Jefferson R. Wilson
- University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Albert Yee
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Iu J, Massicotte E, Li SQ, Hurtig MB, Toyserkani E, Santerre JP, Kandel RA. * In Vitro Generated Intervertebral Discs: Toward Engineering Tissue Integration. Tissue Eng Part A 2017; 23:1001-1010. [PMID: 28486045 DOI: 10.1089/ten.tea.2016.0433] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The intervertebral disc (IVD) is composed of nucleus pulposus (NP) surrounded by multilamellated annulus fibrosus (AF), and is located between the vertebral bodies. Current treatments for chronic neck or low back pain do not completely restore the functionality of degenerated IVDs. Thus, developing biological disc replacements is an approach of great interest. Given the complex structure of the IVD, tissue engineering of the individual IVD components and then combining them together may be the only way to achieve this. The engineered disc must then be able to integrate into the host spine to ensure mechanical stability. The goal of this study was to generate an integrated model of an IVD in vitro. Multilamellated AF tissues were generated in vitro using aligned nanofibrous polycarbonate urethane scaffolds and AF cells. After 3 weeks in culture, it was placed around NP tissue formed on and integrated with a porous bone substitute material (calcium polyphosphate). The two tissues were cocultured to fabricate the IVD model. The AF tissue composed of six lamellae containing type I collagen-rich extracellular matrix (ECM) and the NP tissue had type II collagen- and aggrecan-rich ECM. Immunofluorescence studies showed both type I and II collagen at the AF-NP interface. There was evidence of integration of the tissues. The peel test for AF lamellae showed an interlamellar shear stress of 0.03 N/mm. The AF and NP were integrated as the pushout test demonstrated that the AF-NP interface had significantly increased mechanical stability by 2 weeks of coculture. To evaluate if these tissues remained integrated, allogeneic IVD model constructs were implanted into defects freshly made in the NP-inner AF and bone of the bovine coccygeal spine. One month postimplantation, the interfaces between the AF lamellae remained intact and there was integration with the host AF tissue. No inflammatory reaction was noted at this time period. In summary, an engineered IVD implant with mechanically stable integration between AF lamellae and AF-NP can be generated in vitro. Further study is required to scale up the size of this construct and evaluate its ability to serve as a biological disc replacement.
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Affiliation(s)
- Jonathan Iu
- 1 Institute of Biomaterials and Biomedical Engineering, University of Toronto , Toronto, Canada .,2 BioEngineering of Skeletal Tissues Team, Pathology and Laboratory Medicine, Mount Sinai Hospital, Lunenfeld Tanenbaum Research Institute, University of Toronto , Toronto, Canada
| | - Eric Massicotte
- 3 Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital , Toronto, Canada
| | - Shu-Qiu Li
- 3 Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital , Toronto, Canada
| | - Mark B Hurtig
- 4 Ontario Veterinary College, University of Guelph , Guelph, Canada
| | - Ehsan Toyserkani
- 5 Mechanical and Mechatronics Engineering, University of Waterloo , Waterloo, Canada
| | - J Paul Santerre
- 1 Institute of Biomaterials and Biomedical Engineering, University of Toronto , Toronto, Canada
| | - Rita A Kandel
- 1 Institute of Biomaterials and Biomedical Engineering, University of Toronto , Toronto, Canada .,2 BioEngineering of Skeletal Tissues Team, Pathology and Laboratory Medicine, Mount Sinai Hospital, Lunenfeld Tanenbaum Research Institute, University of Toronto , Toronto, Canada
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Aleem I, Xu Y, Rampersaud YR, Pahuta M, St-Pierre GH, Crawford E, Zarrabian M, St-Pierre GH, Yang M, Scheer J, St-Pierre GH, Lou E, Malleck S, Soroceanu A, Soroceanu A, White B, Holtz KA, Fallah N, Noonan V, Finkelstein J, Rivers C, Tee J, Paquet J, Rutges J, Martin AR, Martin AR, Jack A, Malakoutian M, Kwon B, St-Pierre GH, Nater A, Versteeg A, Pahuta M, Fenton E, Nagoshi N, Tetreault L, Witiw C, Santaguida C, Aziz M, Khashan M, Tomkins-Lane C, Miyanji F, Johnson M, Tee J, Roffey DM, Evaniew N, Nouri A, Tetreault L, Arnold P, Tetreault L, Fehlings M, Wilson J, Smith JS, Charest-Morin R, Charest-Morin R, Marion T, Marion T, Kato S, Miyanji F, Enright A, Daly E, Fehlings M, Dakson A, Dakson A, Leck E, Khashan M, Abraham E, Manson N, Pahuta M, Duncan J, Ahmed A, Eck J, Rhee J, Currier B, Nassr A, Yen D, Johnson A, Bidos A, Schultz S, Fanti C, Young B, Drew B, Puskas D, Henry D, Frombach A, Mitera G, Coyle D, Werier J, Wai E, Hurlbert J, Ravinsky R, Bidos A, Rampersaud YR, Bidos A, Fanti C, Young B, Drew B, Puskas D, Rampersaud R, Yang M, Hurlbert J, Thomas K, St-Pierre GH, Duplessis S, Ailon T, Smith J, Shaffrey C, Klineberg E, Schwab F, Ames C, Yang M, Hurlbert J, Thomas K, Nataraj A, Zheng R, Hill D, Moreau M, Hedden D, Southon S, Johnson M, Goytan M, Passmore S, McIntosh G, Smith J, Lafage V, Klineberg E, Ailon T, Ames C, Shaffrey C, Gupta M, Kebaish K, Scubbia D, Hart R, Hostin R, Schwab F, Kelly M, Smith J, Scheer J, Lafage V, Protopsaltis T, Lafage R, Hostin R, Kebaish K, Gupta M, Hart R, Schwab F, Ames C, Dea N, Street J, Dvorak M, Lipson R, Noonan VK, Kwon BK, Mills PB, Noonan V, Shum J, Rivers C, Street J, Park SE, Chan E, Plashkes T, Dvorak M, Fallah N, Bedi M, Chan E, Rivers C, Street J, Plashkes T, Dvorak M, Noonan V, Fallah N, Ho C, Tsai E, Rivers C, Truchon C, Linassi AG, O’Connell C, Townson A, Ahn H, Drew B, Dvorak M, Fehlings MG, Schwartz C, Noreau L, Warner F, Noonan V, Fallah N, Fisher C, O’Connell C, Tsai E, Ahn H, Attabib N, Christie S, Drew B, Finkelstein J, Fourney D, Paquet J, Parent S, Kuerban D, Dvorak M, Paquet J, Noonan V, Kwon B, Tsai E, Christie S, Rivers C, Kuerban D, Ahn H, Attabib N, Bailey C, Drew B, Fehlings M, Finkelstein J, Fourney D, Hurlbert RJ, Parent S, Fisher C, Dvorak M, Noonan V, Kwon B, Tsai E, Christie S, Rivers C, Ahn H, Attabib N, Bailey C, Drew B, Fehlings M, Finkelstein J, Fourney D, Hurlbert RJ, Parent S, Kuerban D, Dvorak M, Kwon B, Dvorak M, Aleksanderek I, Cohen-Adad J, Cadotte DW, Kalsi-Ryan S, De Leener B, Wang J, Crawley A, Mikulis DJ, Ginsberg H, Fehlings MG, Aleksanderek I, Cohen-Adad J, Tarmohamed Z, Tetreault L, Smith N, Cadotte DW, Crawley A, Ginsberg H, Mikulis DJ, Fehlings MG, Nataraj A, Fouad K, Street J, Wilke HJ, Stavness I, Dvorak M, Fels S, Oxland T, Streijger F, Fallah N, Noonan V, Paquette S, Boyd M, Ailon T, Street J, Fisher C, Dvorak M, Hurlbert J, Fehlings M, Tetreault L, Kopjar B, Arnold P, Dekutoski M, Finkelstein J, Fisher C, France J, Gokaslan Z, Massicotte E, Rhines L, Rose P, Sahgal A, Schuster J, Vaccaro A, Dea N, Boriani S, Varga PP, Luzzati A, Fehlings M, Bilsky M, Rhines L, Reynolds J, Dekutoski M, Gokaslan Z, Germscheid N, Fisher C, van Walraven C, Coyle D, Werier J, Wai E, Mercier P, Bains I, Jacobs WB, Tetreault L, Nakashima H, Nouri A, Fehlings M, Kopjar B, Wilson J, Arnold P, Fehlings M, Tetreault L, Kopjar B, Massicotte E, Fehlings M, Fehlings M, Kopjar B, Arnold P, Defino H, Kale S, Yoon ST, Barbagallo G, Bartels R, Zhou Q, Vaccaro A, Johnson M, Passmore S, Goytan M, Glazebrook C, Golan J, McIntosh G, Barker J, Weber M, Hu R, Norden J, Sinha A, Smuck M, Desai S, Samdani AF, Shah SA, Asghar J, Yaszay B, Shufflebarger HL, Betz RR, Newton P, Passmore S, McCammon J, Goytan M, McIntosh G, Fisher C, Alfasi A, Hashem EL, Papineau GD, Kingwell SP, Wai EK, Belley-Côté EP, Fallah N, Noonan VK, Rivers CS, Dvorak MF, Tetreault L, Dalzell K, Zamorano JJ, Fehlings M, Shamji M, Rhee J, Wilson J, Andersson I, Dembek A, Pagarigan K, Dettori J, Fehlings M, Kopjar B, Tetreault L, Nakashima H, Fehlings M, Kopjar B, Arnold P, Kotter M, Fehlings M, Wilson J, Arnold P, Shaffrey C, Shamji M, Mroz T, Skelly A, Chapman J, Tetreault L, Aarabi B, Casha S, Jaglal S, Voth J, Yee A, Fehlings M, Klineberg E, Shaffrey CI, Lafage V, Schwab FJ, Protopsaltis T, Scheer JK, Ailon T, Ramachandran S, Daniels A, Mundis G, Gupta M, Deviren V, Ames CP, Street J, Stobart L, Ryerson CJ, Flexman A, Street J, Flexman A, Rivers C, Kuerban D, Cheng C, Noonan V, Dvorak M, Fisher C, Kwon B, Street J, Ailon T, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, Street J, Lewis S, Reilly C, Shah SA, Clements DH, Samdani AF, Desai S, Lonner BS, Shufflebarger HL, Betz RR, Newton P, Johnson M, Passmore S, Goytan M, Manson N, Bigney E, Wagg K, Abraham E, Nater A, Tetreault L, Kopjar B, Arnold P, Dekutoski M, Finkelstein J, Fisher C, France J, Gokaslan Z, Massicotte E, Rhines L, Rose P, Sahgal A, Schuster J, Vaccaro A, Leck E, Christie S, Leck E, Christie S, Dakson A, Christie S, Weber M, McIntosh G, Barker J, Golan J, Wagg K, Armstrong M, Bigney E, Daly E, Manson N, Bigney E, Wagg K, Daly E, Abraham E, Perruccio A, Badley E, Rampersaud R. 2016 Canadian Spine Society Abstracts. Can J Surg 2016; 59:S39-63. [PMID: 27240290 DOI: 10.1503/cjs.006916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Fehlings MG, Nater A, Tetreault L, Kopjar B, Arnold P, Dekutoski M, Finkelstein J, Fisher C, France J, Gokaslan Z, Massicotte E, Rhines L, Rose P, Sahgal A, Schuster J, Vaccaro A. Survival and Clinical Outcomes in Surgically Treated Patients With Metastatic Epidural Spinal Cord Compression: Results of the Prospective Multicenter AOSpine Study. J Clin Oncol 2015; 34:268-76. [PMID: 26598751 DOI: 10.1200/jco.2015.61.9338] [Citation(s) in RCA: 134] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Although surgery is used increasingly as a strategy to complement treatment with radiation and chemotherapy in patients with metastatic epidural spinal cord compression (MESCC), the impact of surgery on health-related quality of life (HRQoL) is not well established. We aimed to prospectively evaluate survival, neurologic, functional, and HRQoL outcomes in patients with MESCC who underwent surgical management. PATIENTS AND METHODS One hundred forty-two patients with a single symptomatic MESCC lesion who were treated surgically were enrolled onto a prospective North American multicenter study and were observed at least up to 12 months. Clinical data, including Brief Pain Inventory, ASIA (American Spinal Injury Association) impairment scale, SF-36 Short Form Health Survey, Oswestry Disability Index, and EuroQol 5 dimensions (EQ-5D) scores, were obtained preoperatively, and at 6 weeks and 3, 6, 9, and 12 months postoperatively. RESULTS Median survival time was 7.7 months. The 30-day and 12-month mortality rates were 9% and 62%, respectively. There was improvement at 6 months postoperatively for ambulatory status (McNemar test, P < .001), lower extremity and total motor scores (Wilcoxon signed rank test, P < .001), and at 6 weeks and 3, 6, and 12 months for Oswestry Disability Index, EQ-5D, and pain interference (paired t test, P < .013). Moreover, at 3 months after surgery, the ASIA impairment scale grade was improved (Stuart-Maxwell test P = .004). SF-36 scores improved postoperatively in six of eight scales. The incidence of wound complications was 10% and 2 patients required a second surgery (screw malposition and epidural hematoma). CONCLUSION Surgical intervention, as an adjunct to radiation and chemotherapy, provides immediate and sustained improvement in pain, neurologic, functional, and HRQoL outcomes, with acceptable risks in patients with a focal symptomatic MESCC lesion who have at least a 3 month survival prognosis.
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Affiliation(s)
- Michael G Fehlings
- Michael G. Fehlings, Anick Nater, Lindsay Tetreault, and Eric Massicotte, University of Toronto; Joel Finkelstein and Arjun Sahgal, Sunnybrook Health Sciences Center, Toronto, Ontario; Charles Fisher, University of British Columbia and Vancouver Coastal Health, Vancouver, British Columbia, Canada; Branko Kopjar, University of Washington, Seattle, WA; Paul Arnold, University of Kansas, Kansas City, KS; Mark Dekutoski, The CORE Institute, Sun City West, AZ; John France, West Virginia University, Morgantown, WV; Ziya Gokaslan, Johns Hopkins University School of Medicine, Baltimore, MD; Laurence Rhines, MD Anderson Cancer Center, Houston, TX; Peter Rose, Mayo Clinic, Rochester, MN; James Schuster, University of Pennsylvania; and Alexander Vaccaro, Thomas Jefferson University, Philadelphia, PA.
| | - Anick Nater
- Michael G. Fehlings, Anick Nater, Lindsay Tetreault, and Eric Massicotte, University of Toronto; Joel Finkelstein and Arjun Sahgal, Sunnybrook Health Sciences Center, Toronto, Ontario; Charles Fisher, University of British Columbia and Vancouver Coastal Health, Vancouver, British Columbia, Canada; Branko Kopjar, University of Washington, Seattle, WA; Paul Arnold, University of Kansas, Kansas City, KS; Mark Dekutoski, The CORE Institute, Sun City West, AZ; John France, West Virginia University, Morgantown, WV; Ziya Gokaslan, Johns Hopkins University School of Medicine, Baltimore, MD; Laurence Rhines, MD Anderson Cancer Center, Houston, TX; Peter Rose, Mayo Clinic, Rochester, MN; James Schuster, University of Pennsylvania; and Alexander Vaccaro, Thomas Jefferson University, Philadelphia, PA
| | - Lindsay Tetreault
- Michael G. Fehlings, Anick Nater, Lindsay Tetreault, and Eric Massicotte, University of Toronto; Joel Finkelstein and Arjun Sahgal, Sunnybrook Health Sciences Center, Toronto, Ontario; Charles Fisher, University of British Columbia and Vancouver Coastal Health, Vancouver, British Columbia, Canada; Branko Kopjar, University of Washington, Seattle, WA; Paul Arnold, University of Kansas, Kansas City, KS; Mark Dekutoski, The CORE Institute, Sun City West, AZ; John France, West Virginia University, Morgantown, WV; Ziya Gokaslan, Johns Hopkins University School of Medicine, Baltimore, MD; Laurence Rhines, MD Anderson Cancer Center, Houston, TX; Peter Rose, Mayo Clinic, Rochester, MN; James Schuster, University of Pennsylvania; and Alexander Vaccaro, Thomas Jefferson University, Philadelphia, PA
| | - Branko Kopjar
- Michael G. Fehlings, Anick Nater, Lindsay Tetreault, and Eric Massicotte, University of Toronto; Joel Finkelstein and Arjun Sahgal, Sunnybrook Health Sciences Center, Toronto, Ontario; Charles Fisher, University of British Columbia and Vancouver Coastal Health, Vancouver, British Columbia, Canada; Branko Kopjar, University of Washington, Seattle, WA; Paul Arnold, University of Kansas, Kansas City, KS; Mark Dekutoski, The CORE Institute, Sun City West, AZ; John France, West Virginia University, Morgantown, WV; Ziya Gokaslan, Johns Hopkins University School of Medicine, Baltimore, MD; Laurence Rhines, MD Anderson Cancer Center, Houston, TX; Peter Rose, Mayo Clinic, Rochester, MN; James Schuster, University of Pennsylvania; and Alexander Vaccaro, Thomas Jefferson University, Philadelphia, PA
| | - Paul Arnold
- Michael G. Fehlings, Anick Nater, Lindsay Tetreault, and Eric Massicotte, University of Toronto; Joel Finkelstein and Arjun Sahgal, Sunnybrook Health Sciences Center, Toronto, Ontario; Charles Fisher, University of British Columbia and Vancouver Coastal Health, Vancouver, British Columbia, Canada; Branko Kopjar, University of Washington, Seattle, WA; Paul Arnold, University of Kansas, Kansas City, KS; Mark Dekutoski, The CORE Institute, Sun City West, AZ; John France, West Virginia University, Morgantown, WV; Ziya Gokaslan, Johns Hopkins University School of Medicine, Baltimore, MD; Laurence Rhines, MD Anderson Cancer Center, Houston, TX; Peter Rose, Mayo Clinic, Rochester, MN; James Schuster, University of Pennsylvania; and Alexander Vaccaro, Thomas Jefferson University, Philadelphia, PA
| | - Mark Dekutoski
- Michael G. Fehlings, Anick Nater, Lindsay Tetreault, and Eric Massicotte, University of Toronto; Joel Finkelstein and Arjun Sahgal, Sunnybrook Health Sciences Center, Toronto, Ontario; Charles Fisher, University of British Columbia and Vancouver Coastal Health, Vancouver, British Columbia, Canada; Branko Kopjar, University of Washington, Seattle, WA; Paul Arnold, University of Kansas, Kansas City, KS; Mark Dekutoski, The CORE Institute, Sun City West, AZ; John France, West Virginia University, Morgantown, WV; Ziya Gokaslan, Johns Hopkins University School of Medicine, Baltimore, MD; Laurence Rhines, MD Anderson Cancer Center, Houston, TX; Peter Rose, Mayo Clinic, Rochester, MN; James Schuster, University of Pennsylvania; and Alexander Vaccaro, Thomas Jefferson University, Philadelphia, PA
| | - Joel Finkelstein
- Michael G. Fehlings, Anick Nater, Lindsay Tetreault, and Eric Massicotte, University of Toronto; Joel Finkelstein and Arjun Sahgal, Sunnybrook Health Sciences Center, Toronto, Ontario; Charles Fisher, University of British Columbia and Vancouver Coastal Health, Vancouver, British Columbia, Canada; Branko Kopjar, University of Washington, Seattle, WA; Paul Arnold, University of Kansas, Kansas City, KS; Mark Dekutoski, The CORE Institute, Sun City West, AZ; John France, West Virginia University, Morgantown, WV; Ziya Gokaslan, Johns Hopkins University School of Medicine, Baltimore, MD; Laurence Rhines, MD Anderson Cancer Center, Houston, TX; Peter Rose, Mayo Clinic, Rochester, MN; James Schuster, University of Pennsylvania; and Alexander Vaccaro, Thomas Jefferson University, Philadelphia, PA
| | - Charles Fisher
- Michael G. Fehlings, Anick Nater, Lindsay Tetreault, and Eric Massicotte, University of Toronto; Joel Finkelstein and Arjun Sahgal, Sunnybrook Health Sciences Center, Toronto, Ontario; Charles Fisher, University of British Columbia and Vancouver Coastal Health, Vancouver, British Columbia, Canada; Branko Kopjar, University of Washington, Seattle, WA; Paul Arnold, University of Kansas, Kansas City, KS; Mark Dekutoski, The CORE Institute, Sun City West, AZ; John France, West Virginia University, Morgantown, WV; Ziya Gokaslan, Johns Hopkins University School of Medicine, Baltimore, MD; Laurence Rhines, MD Anderson Cancer Center, Houston, TX; Peter Rose, Mayo Clinic, Rochester, MN; James Schuster, University of Pennsylvania; and Alexander Vaccaro, Thomas Jefferson University, Philadelphia, PA
| | - John France
- Michael G. Fehlings, Anick Nater, Lindsay Tetreault, and Eric Massicotte, University of Toronto; Joel Finkelstein and Arjun Sahgal, Sunnybrook Health Sciences Center, Toronto, Ontario; Charles Fisher, University of British Columbia and Vancouver Coastal Health, Vancouver, British Columbia, Canada; Branko Kopjar, University of Washington, Seattle, WA; Paul Arnold, University of Kansas, Kansas City, KS; Mark Dekutoski, The CORE Institute, Sun City West, AZ; John France, West Virginia University, Morgantown, WV; Ziya Gokaslan, Johns Hopkins University School of Medicine, Baltimore, MD; Laurence Rhines, MD Anderson Cancer Center, Houston, TX; Peter Rose, Mayo Clinic, Rochester, MN; James Schuster, University of Pennsylvania; and Alexander Vaccaro, Thomas Jefferson University, Philadelphia, PA
| | - Ziya Gokaslan
- Michael G. Fehlings, Anick Nater, Lindsay Tetreault, and Eric Massicotte, University of Toronto; Joel Finkelstein and Arjun Sahgal, Sunnybrook Health Sciences Center, Toronto, Ontario; Charles Fisher, University of British Columbia and Vancouver Coastal Health, Vancouver, British Columbia, Canada; Branko Kopjar, University of Washington, Seattle, WA; Paul Arnold, University of Kansas, Kansas City, KS; Mark Dekutoski, The CORE Institute, Sun City West, AZ; John France, West Virginia University, Morgantown, WV; Ziya Gokaslan, Johns Hopkins University School of Medicine, Baltimore, MD; Laurence Rhines, MD Anderson Cancer Center, Houston, TX; Peter Rose, Mayo Clinic, Rochester, MN; James Schuster, University of Pennsylvania; and Alexander Vaccaro, Thomas Jefferson University, Philadelphia, PA
| | - Eric Massicotte
- Michael G. Fehlings, Anick Nater, Lindsay Tetreault, and Eric Massicotte, University of Toronto; Joel Finkelstein and Arjun Sahgal, Sunnybrook Health Sciences Center, Toronto, Ontario; Charles Fisher, University of British Columbia and Vancouver Coastal Health, Vancouver, British Columbia, Canada; Branko Kopjar, University of Washington, Seattle, WA; Paul Arnold, University of Kansas, Kansas City, KS; Mark Dekutoski, The CORE Institute, Sun City West, AZ; John France, West Virginia University, Morgantown, WV; Ziya Gokaslan, Johns Hopkins University School of Medicine, Baltimore, MD; Laurence Rhines, MD Anderson Cancer Center, Houston, TX; Peter Rose, Mayo Clinic, Rochester, MN; James Schuster, University of Pennsylvania; and Alexander Vaccaro, Thomas Jefferson University, Philadelphia, PA
| | - Laurence Rhines
- Michael G. Fehlings, Anick Nater, Lindsay Tetreault, and Eric Massicotte, University of Toronto; Joel Finkelstein and Arjun Sahgal, Sunnybrook Health Sciences Center, Toronto, Ontario; Charles Fisher, University of British Columbia and Vancouver Coastal Health, Vancouver, British Columbia, Canada; Branko Kopjar, University of Washington, Seattle, WA; Paul Arnold, University of Kansas, Kansas City, KS; Mark Dekutoski, The CORE Institute, Sun City West, AZ; John France, West Virginia University, Morgantown, WV; Ziya Gokaslan, Johns Hopkins University School of Medicine, Baltimore, MD; Laurence Rhines, MD Anderson Cancer Center, Houston, TX; Peter Rose, Mayo Clinic, Rochester, MN; James Schuster, University of Pennsylvania; and Alexander Vaccaro, Thomas Jefferson University, Philadelphia, PA
| | - Peter Rose
- Michael G. Fehlings, Anick Nater, Lindsay Tetreault, and Eric Massicotte, University of Toronto; Joel Finkelstein and Arjun Sahgal, Sunnybrook Health Sciences Center, Toronto, Ontario; Charles Fisher, University of British Columbia and Vancouver Coastal Health, Vancouver, British Columbia, Canada; Branko Kopjar, University of Washington, Seattle, WA; Paul Arnold, University of Kansas, Kansas City, KS; Mark Dekutoski, The CORE Institute, Sun City West, AZ; John France, West Virginia University, Morgantown, WV; Ziya Gokaslan, Johns Hopkins University School of Medicine, Baltimore, MD; Laurence Rhines, MD Anderson Cancer Center, Houston, TX; Peter Rose, Mayo Clinic, Rochester, MN; James Schuster, University of Pennsylvania; and Alexander Vaccaro, Thomas Jefferson University, Philadelphia, PA
| | - Arjun Sahgal
- Michael G. Fehlings, Anick Nater, Lindsay Tetreault, and Eric Massicotte, University of Toronto; Joel Finkelstein and Arjun Sahgal, Sunnybrook Health Sciences Center, Toronto, Ontario; Charles Fisher, University of British Columbia and Vancouver Coastal Health, Vancouver, British Columbia, Canada; Branko Kopjar, University of Washington, Seattle, WA; Paul Arnold, University of Kansas, Kansas City, KS; Mark Dekutoski, The CORE Institute, Sun City West, AZ; John France, West Virginia University, Morgantown, WV; Ziya Gokaslan, Johns Hopkins University School of Medicine, Baltimore, MD; Laurence Rhines, MD Anderson Cancer Center, Houston, TX; Peter Rose, Mayo Clinic, Rochester, MN; James Schuster, University of Pennsylvania; and Alexander Vaccaro, Thomas Jefferson University, Philadelphia, PA
| | - James Schuster
- Michael G. Fehlings, Anick Nater, Lindsay Tetreault, and Eric Massicotte, University of Toronto; Joel Finkelstein and Arjun Sahgal, Sunnybrook Health Sciences Center, Toronto, Ontario; Charles Fisher, University of British Columbia and Vancouver Coastal Health, Vancouver, British Columbia, Canada; Branko Kopjar, University of Washington, Seattle, WA; Paul Arnold, University of Kansas, Kansas City, KS; Mark Dekutoski, The CORE Institute, Sun City West, AZ; John France, West Virginia University, Morgantown, WV; Ziya Gokaslan, Johns Hopkins University School of Medicine, Baltimore, MD; Laurence Rhines, MD Anderson Cancer Center, Houston, TX; Peter Rose, Mayo Clinic, Rochester, MN; James Schuster, University of Pennsylvania; and Alexander Vaccaro, Thomas Jefferson University, Philadelphia, PA
| | - Alexander Vaccaro
- Michael G. Fehlings, Anick Nater, Lindsay Tetreault, and Eric Massicotte, University of Toronto; Joel Finkelstein and Arjun Sahgal, Sunnybrook Health Sciences Center, Toronto, Ontario; Charles Fisher, University of British Columbia and Vancouver Coastal Health, Vancouver, British Columbia, Canada; Branko Kopjar, University of Washington, Seattle, WA; Paul Arnold, University of Kansas, Kansas City, KS; Mark Dekutoski, The CORE Institute, Sun City West, AZ; John France, West Virginia University, Morgantown, WV; Ziya Gokaslan, Johns Hopkins University School of Medicine, Baltimore, MD; Laurence Rhines, MD Anderson Cancer Center, Houston, TX; Peter Rose, Mayo Clinic, Rochester, MN; James Schuster, University of Pennsylvania; and Alexander Vaccaro, Thomas Jefferson University, Philadelphia, PA
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Bailey C, Stratton A, Manson N, Layne E, McKeon M, Harris S, McIntosh G, DellaMora L, McIntosh G, Miyanji F, Joukhadar N, Miyanji F, Miyanji F, Miyanji F, Miyanji F, Larouche J, Aoude A, Hardy-St-Pierre G, Roffey D, Evaniew N, Fazli G, Lin C, Dea N, Flood M, Glennie RA, Millstone DB, Nater A, Witiw C, Maggio D, Harris S, Collings D, Yee A, Tetreault L, Street J, Phillips J, Cochran M, Bigney E, Bouchard J, Jack A, Shamji M, Shamji M, Nakashima H, Chaudhary BR, Johnson M, Manson N, Tetreault L, Glennie RA, Evaniew N, Morris S, Spurway A, Bateman A, Abduljabbar F, Shamji M, McLachlin S, Manson N, Palkovsky R, Ailon T, Tetreault L, Johnson M, Street J, Street J, Bourassa-Moreau E, Nouri A, McIntosh G, Contreras A, Phan P, Hardy-St-Pierre G, Jarzem P, Wu H, Parsons D, Chukwunyerenwa C, Nadeau M, Bailey S, Rosas-Arellano P, Dehens S, Sequeira K, Miller T, Watson J, Siddiqi F, Gurr K, Urquhart J, Thomas K, McIntosh G, Hirsch L, Abraham E, Green A, McIntosh G, Roffey D, Wilson C, Kingwell S, Wai E, Manson N, Abraham E, Taylor E, Murray J, Albert W, Rampersaud R, Hall H, Carter T, Gregg C, Perruccio AV, Badley EM, Rampersaud YR, Steenstra I, Hall H, Carter T, Bastrom T, Samdani A, Yaszay B, Clements D, Shah S, Marks M, Betz R, Shufflebarger H, Newton P, Skaggs D, Heflin J, Yasin M, El-Hawary R, Bastrom T, Samdani A, Yaszay B, Asghar J, Shah S, Betz R, Shufflebarger H, Newton P, Reilly C, Choi J, Mok J, Nitikman M, Desai S, Reilly C, Desai S, Doddabasappa S, Reilly C, Nitikman M, Desai S, Paquette S, Fisher C, Domisse I, Wadey V, Hall H, Finkelstein J, Bouchard J, Hurlbert J, Broad R, Fox R, Hedden D, Nataraj A, Carey T, Bailey C, Chapman M, Moroz P, Chow D, Wai E, Tsai E, Christie S, Lundine K, Paquet J, Splawinski J, Wheelock B, Goytan M, Ahn H, Massicotte E, Fehlings M, Yee A, Alhamzah H, Fortin M, Jarzem P, Ouellet J, Weber M, Jack A, Thomas KC, Nataraj A, Coyle M, Kingwell S, Wai E, van der Watt L, Bhandari M, Ghert M, Aleem I, Drew B, Guyatt G, Jeyaratnam J, Nandlall N, Coyte P, Rampersaud R, Witiw C, Sundararajan K, Rampersaud YR, Fisher C, Batke J, Street J, Abraham E, Green A, Manson N, Ailon T, Batke J, Dea N, Street J, Perruccio AV, Badley EM, Rampersaud YR, Fehlings M, Tetreault L, Kopjar B, Fisher C, Vaccaro A, Arnold P, Schuster J, Finkelstein J, Rhines L, Dekutoski M, Gokaslan Z, France J, Rose P, Lin C, Sundararajan K, Rampersaud YR, Ailon T, Smith J, Shaffrey C, Lafage V, Schwab F, Haid R, Protopsaltis T, Klineberg E, Scheer J, Bess S, Arnold P, Chapman J, Fehlings M, Ames C, Rampersaud R, Nutt L, Urquhart J, Kuska L, Siddiqi F, Gurr K, Bailey C, Burch S, Sahgal A, Chow E, Niu C, Fisher C, Whyne C, Akens M, Bisland S, Wilson B, Nouri A, Cote P, Fehlings M, Mendelsohn D, Strelzow J, Batke J, Dvorak M, Fisher C, Urquhart J, Tallon C, Gurr K, Siddiqi F, Bailey S, Bailey C, Abraham E, Green A, Manson N, Manson NA, Green AJ, Abraham EP, Hurlbert J, Mogadham K, Swamy G, Tsahtsarlis A, Siddiqui M, Pierre GHS, Nataraj A, Mohanty C, Massicotte E, Fehlings M, Shcharinsky A, Tetreault L, Nagoshi N, Aria N, Fehlings M, Amritanand R, Rampersaud YR, Passmore S, McIntosh G, Abraham E, Green A, McIntosh G, Kopjar B, Cote P, Fehlings M, Arnold P, Batke J, Dea N, Dvorak M, Noonan V, Street J, Khan M, Drew B, Kwok D, Bhandari M, Ghert M, Howard J, Rasmusson D, El-Hawary R, Kishta W, Chukwunyerenwa C, El-Hawary R, Balkovec C, Akens M, Harrison R, McGill S, Yee A, Al-Jurayyan A, Alqahtani S, Sardar Z, Saluja RS, Ouellet J, Weber M, Steffen T, Beckman L, Jarzem P, Tu Y, Salter M, Polley B, Beig M, Larouche J, Whyne C, Green A, McIntosh G, Abraham E, Nicholls F, Burch S, Wagner P, Zhou H, Egge N, Harrigan M, Lapinsky A, Connoly P, Street J, DiPaola C, Kopjar B, Tan G, Cote P, Fehlings M, Passmore S, Street J, Fisher C, McIntosh G, Perlus IR, Kennedy J, Lenehan B, Strelzow J, Mendelsohn D, Dea N, Dvorak M, Fisher C, Mac-Thiong JM, Parent S, Li A, Thompson C, Tetreault L, Zamorano J, Dalzell K, Davis A, Mikulis D, Yee A, Fehlings M, Hall H, Carter T, Gregg C, Batke J, Dea N, Dvorak MF, Fisher CG, Street J, Le V(B, Roffey D, Kingwell S, MacPherson P, Desjardins M, Wai E, Siddiqui M, Henderson RL, Nataraj A, Simoes L, Assaker R, Ritter-Lang K, Vardon D, Litrico S, Fuentes S, Putzier M, Frank J, Guigui P, Nakach G, Le Huec JC, Pennington A, Batke J, Yang K, Fisher CG, Dvorak MF, Street J, Da Cunha R, Al Sayegh S, LaMothe J, Letal M, Johal H, Ferri-de-Barros F, El-Hawary R, Gauthier L, Spurway A, Johnston C, McClung A, Batke J, Lauscher HN, Fischer C, Street J. Canadian spine society 15th annual scientific conference. Can J Surg 2015; 58:S43-70. [PMID: 26011856 DOI: 10.1503/cjs.005515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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van West H, Hodgson B, Parent E, Samuel S, Hodgson B, Ferland C, Soroceanu A, Soroceanu A, Protopsaltis T, Protopsaltis T, Radovanovic I, Amritanand R, Shamji M, Haugo K, Malham G, Jarzem P, Rampersaud Y, Tomkins-Lane C, Manson N, Malham G, Rampersaud Y, Malham G, Malham G, King V, Goldstein C, Fisher C, Fehlings M, Fisher C, Wong E, Sardar Z, Christie S, Patel A, Pinkoski C, Ahn H, Drew B, Dvorak M, Pezeshki P, Altaf F, Wilde P, Rampersaud Y, Sparrey C, Tetreault L, Fehlings M, Tetreault L, Rampersaud R, Jack A, Johnstone R, Fernandes A, Urquhart J, Morokoff A, Manson N, Tomkins-Lane C, Phan P, Evaniew N, Shamji M, Manson J, Rampersaud Y, Nault ML, St-Pierre GH, Larouche J, Lewis S, Wilgenbusch C, Lewis S, Rampersaud Y, Johnson R, Cushnie D, Sridharan S, Street J, Gregg C, Missiuna P, Abraham E, Abraham E, Manson N, Huang E, Passmore S, Mac-Thiong JM, Labelle H, Moulin D, Turgeon I, Roy-Beaudry M, Bourassa N, Petit Y, Parent. S, Chabot S, Westover L, Hill D, Moreau M, Hedden D, Lou E, Adeeb. S, Smith M, Bridge C, Hsu B, Gray. R, Group PORSCHES, Saran N, Mac-Thiong JM, Stone L, Ouellet. J, Protopsaltis T, Terran J, Bronsard N, Smith J, Klineberg E, Mundis G, Hostin R, Hart R, Shaffrey C, Bess S, Ames C, Schwab F, Lafage. V, Schwab F, Lafage V, Protopsaltis T, Ames C, Bess S, Smith J, Errico. T, Schwab F, Soroceanu A, Bronsard N, Smith J, Klineberg E, Mundis G, Hostin R, Hart R, Burton D, Ames C, Shaffrey C, Bess S, Errico T, Lafage. V, Terran J, Soroceanu A, Bronsard N, Smith J, Klineberg E, Mundis G, Kim HJ, Hostin R, Hart R, Shaffrey C, Bess S, Ames C, Schwab F, Lafage. V, Urquhart J, Gananapathy V, Siddiqi F, Gurr K, Bailey C, Ravi B, David K, Rampersaud. R, Tu Y, Salter. M, Nichol H, Fourney D, Kelly. M, Parker R, Ellis N, Blecher C, Chow F, Claydon. M, Sardar Z, Alexander D, Oxner W, Plessis SD, Yee A, Wai. E, Lewis S, Davey J, Gandhi R, Mahomed. N, Hu R, Thomas K, Hepler C, Choi K, Rowed K, Haig. A, Lam. K, Parker R, Blecher C, Seex. K, Perruccio A, Gandhi R, Program. UHNA, Ellis N, Parker R, Goss B, Blecher C, Ballok. Z, Parker R, Ellis N, Chan P, Varma. D, Swart A, Winder M, Varga PP, Gokaslan Z, Boriani S, Luzzati A, Rhines L, Fisher C, Chou D, Williams R, Dekutoski M, Quraishi N, Bettegowda C, Kawahara N, Fehlings. M, Versteeg A, Boriani S, Varga PP, Dekutoski M, Luzzati A, Gokaslan Z, Williams R, Reynolds J, Fehlings M, Bettegowda C, Rhines. L, Zamorano J, Nater A, Tetrault L, Varga P, Gokaslan Z, Boriani S, Fisher C, Rhines L, Bettegowda C, Kawahara N, Chou. D, Fehlings M, Kopjar B, Vaccaro A, Arnold P, Schuster J, Finkelstein J, Rhines L, Dekutoski M, Gokaslan Z, France. J, Whyne C, Singh D, Ford. M, Aldebeyan W, Ouellet J, Steffen T, Beckman L, Weber M, Jarzem. P, Kwon B, Ahn H, Bailey C, Fehlings M, Fourney D, Gagnon D, Tsai E, Tsui D, Parent S, Chen J, Dvorak M, Noonan V, Rivers C, Network RHSCIR, Batke J, Lenehan B, Fisher C, Dvorak M, Street. J, Fox R, Nataraj A, Bailey C, Christie S, Duggal N, Fehlings M, Finkelstein J, Fourney D, Hurlbert R, Kwon B, Townson A, Tsai E, Attabib N, Chen J, Dvorak M, Noonan V, Rivers C, Network. RHSCIR, Fehlings M, Paquet J, Ahn H, Attabib N, Bailey C, Christie S, Duggal N, Finkelstein J, Fourney D, Hurlbert R, Johnson M, Kwon B, Parent S, Tsai E, Dvorak M, Noonan V, Rivers C, Shen T, Network. RHSCIR, Fisher C, Kwon B, Drew B, Fehlings M, Paquet J, Ahn H, Attabib N, Bailey C, Christie S, Duggal N, Finkelstein J, Fourney D, Hurlbert R, Johnson M, Mac-Thiong JM, Parent S, Tsai E, Fallah N, Noonan V, Rivers C, Network RHSCIR, Davidson S, McCann C, Akens M, Murphy K, Whyne C, Sherar M, Yee. A, Belanger L, Ronco J, Dea N, Paquette S, Boyd M, Street J, Fisher C, Dvorak M, Kwon B, Gonzalvo A, Fitt G, Liew S, de la Harpe D, Turner P, Rogers M, Bidos A, Fanti C, Young B, Drew B, Puskas. D, Tam H, Manansala S, Nosov V, Delva M, Alshafai N, Kopjar B, Tan G, Arnold P, Fehlings. M, Kopjar B, Arnold P, Ibrahim A, Tetrault. L, Kopjar B, Arnold P, Fehlings. M, Sundararajan K, Eng. S, St-Pierre G, Nataraj A, Urquhart J, Rosas-Arellano P, Tallon C, Gurr K, Siddiqi F, Bailey S, Bailey C, Sundararajan K, Rampersaud. R, Rosa-Arellano P, Tallon C, Bailey S, Gurr K, Bailey. C, Parker R, Milili L, Goss B, Malham. G, Green A, McKeon M, Abraham. E, Lafave L, Parnell J, Rempel J, Moriartey S, Andreas Y, Wilson P, Hepler C, Ray H, Hu. R, Ploumis A, Hess K, Wood. K, Yarascavitch B, Madden K, Ghert M, Drew B, Bhandari M, Kwok D, Tu YS, Salter. M, Hadlow. A, Tso P, Walker K, Lewis S, Davey J, Mahomed N, Coyte. P, Mac-Thiong JM, Roy-Beaudry M, Turgeon I, Labelle H, deGuise J, Parent. S, Jack A, Fox R, Nataraj A, Paquette S, Leroux T, Yee A, Ahn H, Broad R, Fisher C, Hall H, Nataraj A, Hedden D, Christie S, Carey T, Mehta V, Fehlings M, Wadey. V, Dear T, Hashem. M, Fourney D, Goldstein S, Bodrogi A, Lipkus M, Dear T, Keshen S, Veillette C, Gandhi R, Adams D, Briggs N, Davey J, Fehlings M, Lau J, Lewis S, Magtoto R, Marshall K, Massicotte E, Ogilvie-Harris D, Sarro A, Syed K, Mohamed. N, Perera S, Taha A, Urquhart J, Gurr K, Siddiqi F, Bailey C, Thomas K, Cho R, Swamy G, Power C, Henari S, Lenehan. B, McIntosh G, Hall H, Hoffman. C, Karachi A, Pazionis T, AlShaya O, Green A, McKeon M, Manson. N, Green A, McKeon M, Manson. N, Green A, McKeon M, Murray J, Abraham. E, Thomas K, Suttor S, Goyal T, Littlewood J, Bains I, Bouchard J, Hu R, Jacobs B, Cho R, Swamy G, Johnson M, Pelleck V, Amad Y, Ramos E, Glazebrook C. Combined Spine Conference of the Canadian Spine Society New Zealand Orthopaedic Spine Society, Spine Society of Australia: Fairmont Château Lake Louise, Lake, Louise, Alberta, Tuesday, Feb. 25 to Saturday, Mar. 1, 20141.1.01 The use of suspension radiographs to predict LIV tilt.1.1.02 Surgical correction of adolescent idiopathic scoliosis without fusion: an animal model.1.1.03 Are full torso surface topography postural measurements more sensitive to change than back only parameters in adolescents with idiopathic scoliosis and a main thoracic curve?1.2.04 Restoration of thoracic kyphosis in adolescent idiopathic kyphosis: comparative radiographic analysis of round versus rail rods.1.2.05 Scoliosis surgery in spastic quadriplegic cerebral palsy: Is fusion to the pelvis always necessary? A 4–18-year follow-up study.1.2.06 Identification and validation of pain-related biomarkers surrounding spinal surgery in adolescents.1.3.07 Cervical sagittal deformity develops after PJK in adult throacolumbar deformity correction: radiographic analysis using a novel global sagittal angular parameter, the CTPA.1.3.08 Impact of obesity on complications and patient-reported outcomes in adult spinal deformity surgery.1.3.09 The T1 pelvic angle, a novel radiographic measure of sagittal deformity, accounts for both pelvic retroversion and truncal inclination and correlates strongly with HRQOL.1.4.10 Determining cervical sagittal deformity when it is concurrent with thoracolumbar deformity.1.4.11 The influence of sagittal balance and pelvic parameters on the outcome of surgically treated patients with degenerative spondylolisthesis.1.4.12 Predictors of degenerative spondylolisthesis and loading translation in surgical lumbar spinal stenosis patients.2.1.13 Mechanical allodynia following disc herniation requires intraneural macrophage infiltration and can be blocked by systemic selenium delivery or attenuation of BDNF activity.2.1.14 The effect of alanyl-glutamine on epidural fibrosis in a rat laminectomy model.2.1.15 Anterior lumbar interbody fusion using recombinant human bone morphogenetic protein-2: a prospective study of complications.2.2.16 2-year results of a Canadian, multicentre, blinded, pilot study of a novel peptide in promoting lumbar spine fusion.2.2.17 Comparative outcomes and cost-utility following surgical treatment of focal lumbar spinal stenosis compared with osteoarthritis of the hip or knee: long-term change in health-related quality of life.2.2.18 Changes in objectively measured walking performance, function, and pain following surgery for spondylolisthesis and lumbar spinal stenosis.2.3.19 A prospective multicentre observational data-monitored study of minimally invasive fusion to treat degenerative lumbar disorders: complications and outcomes at 1-year follow-up.2.3.20 Assessment and classification of subsidence in lateral interbody fusion using serial computed tomography.2.3.21 Predictors of willingness to undergo spinal and orthopaedic surgery after surgical consultation.2.4.22 Indirect foraminal decompression is independent of facet arthropathy in extreme lateral interbody fusion.2.4.23 Cervical artificial disc replacement with ProDisc-C: clinical and radiographic outcomes with long-term follow-up.2.4.24 Tantalum trabecular metal implants in anterior cervical corpectomy and fusion.3.1.25 Hemangiomas of the spine: results of surgical management and prognostic variables for local recurrence and mortality in a multicentre study.3.1.26 Chondrosarcomas of the spine: prognostic variables for local recurrence and mortality in a multicentre study.3.1.27 Risk factors for recurrence of surgically treated spine schwannomas: analysis of 169 patients from a multicentre international database.3.2.28 Survival pattern and the effect of surgery on health related quality of life and functional outcome in patients with metastatic epidural spinal cord compression from lung cancer — the AOSpine North America prospective multicentre study.3.2.29 A biomechanical assessment of kyphoplasty as a stand-alone treatment in a human cadaveric burst fracture model.3.2.30 What is safer in incompetent vertebrae with posterior wall defects, kyphoplasty or vertebroplasty: a study in vertebral analogs.3.3.31 Feasibility of recruiting subjects for acute spinal cord injury (SCI) clinical trials in Canada.3.3.32 Prospective analysis of adverse events in elderly patients with traumatic spinal cord injury.3.3.33 Does traction before surgery influence time to neural decompression in patients with spinal cord injury?3.4.34 Current treatment of individuals with traumatic spinal cord injury: Do we need age-specific guidelines?3.4.35 Current surgical practice for traumatic spinal cord injury in Canada.3.4.36 The importance of “time to surgery” for traumatic spinal cord injured patients: results from an ambispective Canadian cohort of 949 patients.3.5.37 Assessment of a novel coil-shaped radiofrequency probe in the porcine spine.3.5.38 The effect of norepinephrine and dopamine on cerebrospinal fluid pressure after acute spinal cord injury.3.5.39 The learning curve of pedicle screw placement: How many screws are enough?4.1.40 Preliminary report from the Ontario Inter-professional Spine Assessment and Education Clinics (ISAEC).4.1.41 A surrogate model of the spinal cord complex for simulating bony impingement.4.1.42 Clinical and surgical predictors of specific complications following surgery for the treatment of degenerative cervical myelopathy: results from the multicentre, prospective AOSpine international study on 479 patients.4.2.43 Outcomes of surgical management of cervical spondylotic myelopathy: results of the prospective, multicentre, AOSpine international study in 479 patients.4.2.44 A clinical prediction rule for clinical outcomes in patients undergoing surgery for degenerative cervical myelopathy: analysis of an international AOSpine prospective multicentre data set of 757 subjects.4.2.45 The prevalence and impact of low back and leg pain among aging Canadians: a cross-sectional survey.4.3.46 Adjacent segment pathology: Progressive disease course or a product of iatrogenic fusion?4.3.47 Natural history of degenerative lumbar spondylolisthesis in patients with spinal stenosis.4.3.48 Changes in self-reported clinical status and health care utilization during wait time for surgical spine consultation: a prospective observational study.4.3.49 The Canadian surgical wait list for lumbar degenerative spinal stenosis has a detrimental effect on patient outcomes.4.3.50 Segmental lordosis is independent of interbody cage position in XLIF.4.3.51 Elevated patient BMI does not negatively affect self-reported outcomes of thoracolumbar surgery.1.5.52 The Spinal Stenosis Pedometer and Nutrition Lifestyle Intervention (SSPANLI): development and pilot.1.5.53 Study evaluating the variability of surgical strategy planning for patients with adult spinal deformity.1.5.54 Atlantoaxial instability in acute odontoid fractures is associated with nonunion and mortality.1.5.55 Peripheral hypersensitivity to subthreshold stimuli persists after resolution of acute experimental disc-herniation neuropathy.1.5.56 Radiation induced lumbar spinal osteonecrosis: case report and literature review.1.5.57 Comparative outcomes and cost-utility following surgical treatment of focal lumbar spinal stenosis compared with osteoarthritis of the hip or knee: Part 2 — estimated lifetime incremental cost-utility ratios.1.5.58 A predictive model of progression for adolescent idiopathic scoliosis based on 3D spine parameters at first visit.1.5.59 Development of a clinical prediction model for surgical decision making in patients with degenerative lumbar spine disease.2.5.60 Canadian spine surgery fellowship education: evaluating opportunity in developing a nationally based training curriculum.2.5.61 Pedicle subtraction osteotomy for severe proximal thoracic junctional kyphosis.2.5.62 A comparison of spine surgery referrals triaged through a multidisciplinary care pathway versus conventional referrals.2.5.63 Results and complications of posterior-based 3 column osteotomies in patients with previously fused spinal deformities.2.5.64 Orthopaedic Surgical AdVerse Event Severity (Ortho-SAVES) system: identifying opportunities for improved patient safety and resource utilization.2.5.65 Spontaneous spinal extra-axial haematomas — surgical experience in Otago and Southland 2011–2013.2.5.66 Obesity and spinal epidural lipomatosis in cauda equina syndrome.2.5.67 Factors affecting restoration of lumbar lordosis in adult degenerative scoliosis patients treated with lateral trans-psoas interbody fusion.3.6.68 Systematic review of complications in spinal surgery: a comparison of retrospective and prospective study design.3.6.69 Postsurgical rehabilitation patients have similar fear avoidance behaviour levels as those in nonoperative care.3.6.70 Outcomes of surgical treatment of adolescent spondyloptosis: a case series.3.6.71 Surgical success in primary versus revision thoracolumbar spine surgery.3.6.72 The effect of smoking on subjective patient outcomes in thoracolumbar surgery.3.6.73 Modelling patient recovery to predict outcomes following elective thoracolumbar surgery for degenerative pathologies.3.6.74 Outcomes from trans-psoas versus open approaches in the treatment of adult degenerative scoliosis.3.6.75 Lumbar spinal stenosis and presurgical assessment: the impact of walking induced strain on a performance-based outcome measure. Can J Surg 2014. [DOI: 10.1503/cjs.005614] [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: 11/01/2022] Open
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Al-Omair A, Masucci L, Masson-Cote L, Campbell M, Atenafu EG, Parent A, Letourneau D, Yu E, Rampersaud R, Massicotte E, Lewis S, Yee A, Thibault I, Fehlings MG, Sahgal A. Surgical resection of epidural disease improves local control following postoperative spine stereotactic body radiotherapy. Neuro Oncol 2014; 15:1413-9. [PMID: 24057886 DOI: 10.1093/neuonc/not101] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [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: 11/12/2022] Open
Abstract
BACKGROUND Spine stereotactic body radiotherapy (SBRT) is increasingly being applied to the postoperative spine metastases patient. Our aim was to identify clinical and dosimetric predictors of local control (LC) and survival. METHODS Eighty patients treated between October 2008 and February 2012 with postoperative SBRT were identified from our prospective database and retrospectively reviewed. RESULTS The median follow-up was 8.3 months. Thirty-five patients (44%) were treated with 18-26 Gy in 1 or 2 fractions, and 45 patients (56%) with 18-40 Gy in 3-5 fractions. Twenty-one local failures (26%) were observed, and the 1-year LC and overall survival (OS) rates were 84% and 64%, respectively. The most common site of failure was within the epidural space (15/21, 71%). Multivariate proportional hazards analysis identified systemic therapy post-SBRT as the only significant predictor of OS (P = .02) and treatment with 18-26 Gy/1 or 2 fractions (P = .02) and a postoperative epidural disease grade of 0 or 1 (0, no epidural disease; 1, epidural disease that compresses dura only, P = .003) as significant predictors of LC. Subset analysis for only those patients (n = 48/80) with high-grade preoperative epidural disease (cord deformed) indicated significantly greater LC rates when surgically downgraded to 0/1 vs 2 (P = .0009). CONCLUSIONS Postoperative SBRT with high total doses ranging from 18 to 26 Gy delivered in 1-2 fractions predicted superior LC, as did postoperative epidural grade.
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Affiliation(s)
- Ameen Al-Omair
- Corresponding Author: Dr Arjun Sahgal, MD, Department of Radiation Oncology, Sunnybrook Health Sciences Centre and Princess Margaret Cancer Centre, University of Toronto, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada.
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Massicotte E. The role of minimally invasive techniques in the management of spinal neoplastic disease: a review. J Neurosurg Sci 2013; 57:193-201. [PMID: 23877266] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This review article provides a general overview of the role of minimal access spine surgery (MASS) in the context of spinal neoplastic disease. Illustrative cases included outline advances in new techniques with a focus on improved patient outcome. The article challenges the traditional indication for surgical decompression by considering the objective of better local control of tumor. MASS can be used to improve focused environments in which the delivery of a higher and safer dose of radiation can be accomplished. This combination of treatment has the purpose of better overall survival for some cancer patients by positively influencing local control. The role of surgical intervention in the context of managing cancer patients is continuously being redefined for this challenging population. The modern surgeon must stay abreast of all advances in their field in order to provide the best care for their patients.
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Affiliation(s)
- E Massicotte
- Toronto Western Hospital, Krembil Neuroscience Program, University of Toronto, Toronto, Canada -
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Shamji M, Moon ES, Glennie R, Soroceanu A, Lin C, Bailey C, Simmonds A, Fehlings M, Dodwell E, Dold A, El-Hawary R, Hashem M, Dold A, Dold A, Jones S, Bailey C, Karadimas S, Whitehurst D, Norton J, Norton J, Manson N, Kesani A, Bednar D, Lundine K, Hartig D, Fichadi A, Fehlings M, Kim S, Harris S, Lin C, Gill J, Abraham E, Shamji M, Choi S, Goldstein C, Wang Z, McCabe M, Noonan V, Nadeau M, Ferrara S, Kelly A, Melnyk A, Arora D, Quateen A, Dea N, Ranganathan A, Zhang Y, Casha S, Rajamanickam K, Santos A, Santos A, Wilson J, Wilson J, Street J, Wilson J, Lewis R, Noonan V, Street J, El-Hawary R, Egge N, Lin C, Schouten R, Lin C, Kim A, Kwon B, Huang E, Hwang P, Allen K, Jing L, Mata B, Gabr M, Richardson W, Setton L, Karadimas S, Fehlings M, Fleming J, Bailey C, Gurr K, Bailey S, Siddiqi F, Lawendy A, Sanders D, Staudt M, Canacari E, Brown E, Robinson A, McGuire K, Chrysostoum C, Rampersaud YR, Dvorak M, Thomas K, Boyd M, Gurr K, Bailey S, Nadeau M, Fisher C, Batke J, Street J, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, Vaccaro A, Chapman J, Arnold P, Shaffrey C, Kopjar B, Snyder B, Wright J, Lewis S, Zeller R, El-Hawary R, Moroz P, Bacon S, Jarzem P, Hedden D, Howard J, Sturm P, Cahill P, Samdani A, Vitale M, Gabos P, Bodin N, d’Amato C, Harris C, Smith J, Parent E, Hill D, Hedden D, Moreau M, Mahood J, Lewis S, Bodrogi A, Abbas H, Goldstein S, Bronstein Y, Bacon S, Chua S, Magana S, Van Houwelingen A, Halpern E, Jhaveri S, Lewis S, Lim A, Leelapattana P, Fleming J, Siddiqqi F, Bailey S, Gurr K, Moon ES, Satkunendrarajah K, Fehlings M, Noonan V, Dvorak M, Bryan S, Aronyk K, Fox R, Nataraj A, Pugh J, Elliott R, McKeon M, Abraham E, Fleming J, Gurr K, Bailey S, Siddiqi F, Bailey C, Davis G, Rogers M, Staples M, Quan G, Batke J, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, Street J, Shamji M, Hurlbert R, Jacobs W, Duplessis S, Casha S, Jha N, Hewson S, Massicotte E, Kopjar B, Mortaz S, Coyte P, Rampersaud Y, Rampersaud Y, Goldstein S, Andrew B, Modi H, Magana S, Lewis S, Roffey D, Miles I, Wai E, Manson N, Eastwood D, Elliot R, McKeon M, Bains I, Yong E, Sutherland G, Hurlbert R, Rampersaud Y, Chan V, Persaud O, Koshkin A, Brull R, Hassan N, Petis S, Kowalczuk M, Petrisor B, Drew B, Bhandari M, DiPaola C, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, Street J, McLachlin S, Bailey S, Gurr K, Bailey C, Dunning C, Fehlings M, Vaccaro A, Wing P, Itshayek E, Biering-Sorensen F, Dvorak M, McLachlin S, Bailey S, Gurr K, Dunning C, Bailey C, Bradi A, Pokrupa R, Batke J, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, Street J, Kelly A, Wen T, Kingwell S, Chak J, Singh V, Cripton P, Fisher C, Dvorak M, Oxland T, Wali Z, Yen D, Alfllouse A, Alzahrani A, Jiang H, Mahood J, Kortbeek F, Fox R, Nataraj A, Street J, Boyd M, Paquette S, Kwon B, Batke J, Dvorak M, Fisher C, Reddy R, Rampersaud R, Hurlbert J, Yong W, Casha S, Zygun D, McGowan D, Bains I, Yong V, Hurlbert R, Mendis B, Chakraborty S, Nguyen T, Tsai E, Chen A, Atkins D, Noonan V, Drew B, Tsui D, Townson A, Dvorak M, Chen A, Atkins D, Noonan V, Drew B, Dvorak M, Craven C, Ford M, Ahn H, Drew B, Fehlings M, Kiss A, Vaccaro A, Harrop J, Grossman R, Frankowski R, Guest J, Dvorak M, Aarabi B, Fehlings M, Noonan V, Cheung A, Sun B, Dvorak M, Vaccaro A, Harrop J, Massicotte E, Dvorak M, Fisher C, Rampersaud R, Lewis S, Fehlings M, Marais L, Noonan V, Queyranne M, Fehlings M, Dvorak M, Atkins D, Hurlbert R, Fox R, Fourney D, Johnson M, Fehlings M, Ahn H, Ford M, Yee A, Finkelstein J, Tsai E, Bailey C, Drew B, Paquet J, Parent S, Christie S, Dvorak M, Noonan V, Cheung A, Sun B, Dvorak M, Sturm P, Cahill P, Samdani A, Vitale M, Gabos P, Bodin N, d’Amato C, Harris C, Smith J, Lange J, DiPaola C, Lapinsky A, Connolly P, Eck J, Rabin D, Zeller R, Lewis S, Lee R, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, DiPaola C, Street J, Bodrogi A, Goldstein S, Sofia M, Lewis S, Shin J, Tung K, Ahn H, Lee R, Batke J, Ghag R, Noonan V, Dvorak M, Goyal T, Littlewood J, Bains I, Cho R, Thomas K, Swamy G. Canadian Spine Society abstracts1.1.01 Supraspinal modulation of gait abnormalities associated with noncompressive radiculopathy may be mediated by altered neurotransmitter sensitivity1.1.02 Neuroprotective effects of the sodium-glutamate blocker riluzole in the setting of experimental chronic spondylotic myelopathy1.1.03 The effect of timing to decompression in cauda equina syndrome using a rat model1.2.04 Intraoperative waste in spine surgery: incidence, cost and effectiveness of an educational program1.2.05 Looking beyond the clinical box: the health services impact of surgical adverse events1.2.06 Brace versus no brace for the treatment of thoracolumbar burst fractures without neurologic injury: a multicentre prospective randomized controlled trial1.2.07 Adverse event rates in surgically treated spine injuries without neurologic deficit1.2.08 Functional and quality of life outcomes in geriatric patients with type II odontoid fracture: 1-year results from the AOSpine North America Multi-Center Prospective GOF Study1.3.09 National US practices in pediatric spinal fusion: in-hospital complications, length of stay, mortality, costs and BMP utilization1.3.10 Current trends in the surgical treatment of adolescent idiopathic scoliosis in Canada1.3.11 Sagittal spinopelvic parameters help predict the risk of proximal junctional kyphosis for children treated with posterior distraction-based implants1.4.12 Correlations between changes in surface topography and changes in radiograph measurements from before to 6 months after surgery in adolescents with idiopathic scoliosis1.4.13 High upper instrumented vertebra (UIV) sagittal angle is associated with UIV fracture in adult deformity corrections1.4.14 Correction of adult idiopathic scoliosis using intraoperative skeletal traction1.5.01 Cauda equina: using management protocols to reduce delays in diagnosis1.5.02 Predicting the need for tracheostomy in patients with acute traumatic spinal cord injury1.5.03 A novel animal model of cervical spondylotic myelopathy: an opportunity to identify new therapeutic targets1.5.04 A review of preference-based measures of health-related quality of life in spinal cord injury research1.5.05 Predicting postoperative neuropathic pain following surgery involving nerve root manipulation based on intraoperative electromyographic activity1.5.06 Detecting positional injuries in prone spinal surgery1.5.07 Percutaneous thoracolumbar stabilization for trauma: surgical morbidity, clinical outcomes and revision surgery1.5.08 Systemic inflammatory response syndrome in spinal cord injury patients: Does its presence at admission affect patient outcomes?2.1.15 One hundred years of spine surgery — a review of the evolution of our craft and practice in the spine surgical century [presentation]2.1.16 Prevalence of preoperative MRI findings of adjacent segment disc degeneration in patients undergoing anterior cervical discectomy and fusion2.1.17 Adverse event rates of surgically treated cervical spondylopathic myelopathy2.1.18 Morphometricand dynamic changes in the cervical spine following anterior cervical discectomy and fusion and cervical disc arthroplasty2.1.19 Is surgery for cervical spondylotic myelopathy cost-effective? A cost–utility analysis based on data from the AO Spine North American Prospective Multicentre CSM Study2.2.20 Cost–utility of lumbar decompression with or without fusion for patients with symptomatic degenerative lumbar spondylolisthesis (DLS)2.2.21 Minimally invasive surgery lumbar fusion for low-grade isthmic and degenerative spondylolisthesis: 2- to 5-year follow-up2.2.22 Results and complications of posterior-only reduction and fusion for high-grade spondylolisthesis2.3.23 Fusion versus no fusion in patients with central lumbar spinal stenosis and foraminal stenosis undergoing decompression surgery: comparison of outcomes at baseline and follow-up2.3.24 Two-year results of interspinous spacers (DIAM) as an alternative to arthrodesis for lumbar degenerative disorders2.3.25 Treatment of herniated lumbar disc by sequestrectomy or conventional discectomy2.4.26 No sustained benefit of continuous epidural analgesia for minimally invasive lumbar fusion: a randomized double-blinded placebo controlled study2.4.27 Evidence and current practice in the radiologic assessment of lumbar spine fusion2.4.28 Wiltse versus midline approach for decompression and fusion of the lumbar spine2.5.09 The effect of soft tissue restraints following type II odontoid fractures in the elderly — a biomechanical study2.5.10 Development of an international spinal cord injury (SCI) spinal column injury basic data set2.5.11 Evaluation of instrumentation techniques for a unilateral facet perch and fracture using a validated soft tissue injury model2.5.12 Decreasing neurologic consequences in patients with spinal infection: the testing of a novel diagnostic guideline2.5.13 Prospective analysis of adverse events in surgical treatment of degenerative spondylolisthesis2.5.14 Load transfer characteristics between posterior fusion devices and the lumbar spine under anterior shear loading: an in vitro investigation2.5.15 Preoperative predictive clinical and radiographic factors influencing functional outcome after lumbar discectomy2.5.16 A Thoracolumbar Injury Classification and Severity Score (TLICS) of 4: What should we really do?3.1.29 Adverse events in emergent oncologic spine surgery: a prospective analysis3.1.30 En-bloc resection of primary spinal and paraspinal tumours with critical vascular involvement3.1.31 The treatment impact of minocycline on quantitative MRI in acute spinal cord injury3.1.32 Benefit of minocycline in spinal cord injury — results of a double-blind randomized placebo-controlled study3.2.33 Improvement of magnetic resonance imaging correlation with unilateral motor or sensory deficits using diffusion tensor imaging3.2.34 Comparing care delivery for acute traumatic spinal cord injury in 2 Canadian centres: How do the processes of care differ?3.2.35 Improving access to early surgery: a comparison of 2 centres3.3.36 The effects of early surgical decompression on motor recovery after traumatic spinal cord injury: results of a Canadian multicentre study3.3.37 A clinical prediction model for long-term functional outcome after traumatic spinal cord injury based on acute clinical and imaging factors3.3.38 Effect of motor score on adverse events and quality of life in patients with traumatic spinal cord injury3.4.39 The impact of facet dislocation on neurologic recovery after cervical spinal cord injury: an analysis of data on 325 patients from the Surgical Trial in Acute Spinal Cord Injury Study (STASCIS)3.4.40 Toward a more precise understanding of the epidemiology of traumatic spinal cord injury in Canada3.4.41 Access to care (ACT) for traumatic SCI: a survey of acute Canadian spine centres3.4.42 Use of the Spine Adverse Events Severity (SAVES) instrument for traumatic spinal cord injury3.5.17 Does the type of distraction-based growing system for early onset scoliosis affect postoperative sagittal alignment?3.5.18 Comparison of radiation exposure during thoracolumbar fusion using fluoroscopic guidance versus anatomic placement of pedicle screws3.5.19 Skeletal traction for intraoperative reduction in adolescent idiopathic scoliosis3.5.20 Utility of intraoperative cone-beam computed tomography (O-ARM) and stereotactic navigation in acute spinal trauma surgery3.5.21 Use of a central compression rod to reduce thoracic level spinal osteotomies3.5.22 ICD-10 coding accuracy for spinal cord injured patients3.5.23 Feasibility of patient recruitment in acute SCI trials3.5.24 Treatment of adult degenerative scoliosis with DLIF approaches. Can J Surg 2012. [DOI: 10.1503/cjs.012212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Massicotte E, Foote M, Reddy R, Sahgal A. Minimal Access Spine Surgery (MASS) for Decompression and Stabilization Performed as an Out-Patient Procedure for Metastatic Spinal Tumours Followed by Spine Stereotactic Body Radiotherapy (SBRT): First Report of Technique and Preliminary Outcomes. Technol Cancer Res Treat 2012; 11:15-25. [DOI: 10.7785/tcrt.2012.500230] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report a novel approach in the treatment of spinal metastases with epidural disease and mechanical instability using a combined minimal access spine surgery (MASS) technique followed by spine stereotactic body radiotherapy (SBRT). This study was performed as a retrospective review of the first ten consecutive patients treated with this combined approach. The MASS technique was based on a tubular retraction system to gain access for decompression and mechanical stabilization achieved using methyl-methacrylate (MMA) applied under direct visualization. SBRT consisted of one to five image-guided high dose per fraction treatments. Eight patients were symptomatic at baseline. Pain, disability, and quality of life (QOL) were prospectively determined using the visual analogue score (VAS), Oswestry Disability Index (ODI), and Short-Form-36 version 2, respectively. The median follow-up was 13 months (range, 3–18). MASS successfully decompressed each patient. The median blood loss was 335 ml. Following MASS, the median time to SBRT treatment planning was 6.5 days and subsequent median time to treatment was 7 days. Local control was observed in 7 of the 10 patients. Improvements in VAS, ODI and QOL were observed post-SBRT. We report preliminary efficacy for our MASS-SBRT combined approach for patients with spinal metastases, mechanical pain and epidural disease.
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Affiliation(s)
- Eric Massicotte
- Division of Neurosurgery and Krembil Neuroscience-Spinal Program, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Matthew Foote
- Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Rajesh Reddy
- Division of Neurosurgery and Krembil Neuroscience-Spinal Program, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Masucci G, Masson-Cote L, Letourneau D, Atenafu E, Massicotte E, Lewis S, Rampersaud R, Laperriere N, Fehlings M, Sahgal A. Local Control With Stereotactic Body Radiation Therapy (SBRT) For Spinal Metastasis: Is It Dose Or Biology That Matters? Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.1768] [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: 11/25/2022]
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Foote M, Letourneau D, Hyde D, Massicotte E, Rampersaud R, Fehlings M, Fisher C, Lewis S, Macchia NL, Yu E, Laperriere NJ, Sahgal A. Technique for stereotactic body radiotherapy for spinal metastases. J Clin Neurosci 2010; 18:276-9. [PMID: 21147535 DOI: 10.1016/j.jocn.2010.04.033] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 04/07/2010] [Accepted: 04/08/2010] [Indexed: 11/25/2022]
Abstract
Stereotactic body radiotherapy (SBRT) is an emerging technique for spinal tumours that is a natural succession to brain radiosurgery. The spine is an ideal site for SBRT due to its relative immobility and the potential clinical benefits of high dose delivery, particularly to optimise local control and avoid disease progression that can result in spinal cord compression. However, the proximity of the tumour to the spinal cord, with the potential for radiation myelopathy if the dose is delivered inaccurately or if the spinal cord dose limit is set too high, demands technical accuracy with radiation myelopathy a feared complication. Spine SBRT has been delivered with either a robotic-based linac system such as the Cyberknife, or with linac-based systems equipped with a multileaf collimator and image guidance system. Regardless of the technology, spine SBRT demands sophisticated treatment planning and delivery. This case-based technical review outlines the SBRT apparatus, planning and treatment delivery in use at the University of Toronto, Toronto, Canada.
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Affiliation(s)
- Matthew Foote
- Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada
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Ma A, Qi S, Song L, Hu Y, Dun H, Massicotte E, Dupuis M, Daloze P, Chen H. Adoptive transfer of CD4+CD25+ regulatory cells combined with low-dose sirolimus and anti-thymocyte globulin delays acute rejection of renal allografts in Cynomolgus monkeys. Int Immunopharmacol 2010; 11:618-29. [PMID: 21094689 DOI: 10.1016/j.intimp.2010.11.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2010] [Revised: 09/13/2010] [Accepted: 11/01/2010] [Indexed: 12/17/2022]
Abstract
Although donor alloantigen specific Treg cells play an important role in transplant tolerance, therapeutic applications are limited by their low frequency. In this study, isolated Tregs from Cynomolgus monkeys were efficiently expanded by a co-culture system, and maintained suppressive function on the proliferation of CD4(+) effector cells in vitro. Adoptive transfer of expanded donor alloantigen specific Tregs without any immunosuppressants could prolong survival of MHC-mismatched allografts in Cynomolgus monkeys. To reach the feasibility of clinical transplantation, our objectives focused on whether exposure of monkey Tregs to immunosuppressants could preserve suppressive function in vitro and in vivo. The results showed that low-dose sirolimus selectively expanded Tregs, increased the expression of CD25(bright) and Foxp3 markers, and suppressed TCR- or allo-antigens induced CD4(+) T cell proliferation in vitro. In vivo, after pre-treated with anti-thymocyte globulin (ATG) for consecutive 3days, a 14-day therapy of adoptive infusion of donor alloantigen-specific Tregs combined with low-dose sirolimus delayed acute rejection of renal allografts in Cynomolgus monkeys, showing an MST of 48.5days as compared with those of untreated and sirolimus-treated monkeys (7days and 22days). The frequencies of CD4(+)CD25(bright) T cells were significantly elevated in mesenteric lymph nodes vs. those in inguino lymph nodes and peripheral blood. In summary, expanded donor alloantigen specific Tregs exposed to sirolimus can preserve inhibition in vitro and in vivo. Tregs are more resistant to sirolimus than other T cells. Expanded donor alloantigen specific Tregs combined with sirolimus and ATG prolongs renal allograft survival in monkeys, suggesting that sirolimus might be one of the best synergists for Tregs therapy.
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Affiliation(s)
- Anlun Ma
- Laboratory of Experimental Surgery, Research Centre, Center Hospitalier de l'Université de Montréal-Hôpital Notre-Dame, Department of Surgery, University of Montreal, Montréal, Québec, Canada
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Ma A, Qi S, Wang Z, Massicotte E, Dupuis M, Daloze P, Chen H. Combined therapy of CD4+CD25+ regulatory T cells with low-dose sirolimus, but not calcineurin inhibitors, preserves suppressive function of regulatory T cells and prolongs allograft survival in mice. Int Immunopharmacol 2009; 9:553-63. [DOI: 10.1016/j.intimp.2009.01.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Accepted: 01/22/2009] [Indexed: 10/21/2022]
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Prabhu A, Wong D, Chakraborty S, Massicotte E, Tan G, Cooper R. Radiographic evaluation of cervical spine movement during flexible videobronchoscopy & LO-PRO glidescope; a randomised controlled trial. Can J Anaesth 2007. [DOI: 10.1007/bf03019966] [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: 11/25/2022] Open
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Rampersaud R, Fehlings M, Harrop J, Kuklo T, Massicotte E, Salonen D, Shaffrey C, Vaccaro A. Validation of Digital Radiology Measurement Tools for Quantitative Spinal Imaging. Top Spinal Cord Inj Rehabil 2006. [DOI: 10.1310/64p8-r0wj-qd9j-xbb7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Pheng SR, Auger C, Chakrabarti S, Massicotte E, Lamontagne L. Sensitivity to methylmercury-induced autoimmune disease in mice correlates with resistance to apoptosis of activated CD4+ lymphocytes. J Autoimmun 2003; 20:147-60. [PMID: 12657528 DOI: 10.1016/s0896-8411(02)00115-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 10/27/2022]
Abstract
The sensitivity of splenic lymphoid cells to apoptosis induced by low concentrations of methylmercury (MeHgCl) has been examined in C57BL/6 and SJL mice, which are, respectively, resistant and sensitive to a genetically determined autoimmune disease induced by subtoxic doses of MeHgCl. To determine the implications of subtoxic doses of MeHgCl in the susceptibility of SJL mice to autoimmune disease, Concanavalin A (ConA) stimulated spleen cells from both mouse strains were treated in vitro with MeHgCl concentrations varying between 0.001 and 1.0 microM for 48h. Results have shown that ConA-activated splenic lymphoid cells from SJL mice increased in the presence of low concentrations of MeHgCl while the number of lymphoid cells from C57BL/6 mice rather decreased. Flow cytometric analysis of the cells showing a typical lymphoid forward scatter (FSC)/side scatter (SSC) pattern (region R1), and those characterized by a lower FSC and a higher SSC parameters (region R2), morphologically corresponding to apoptotic cells, revealed that lymphoid cells from C57BL/6 mice suffered a dose-dependent shift from region R1 toward region R2 when treated with concentrations ranging between 0.01 and 1 microM of MeHgCl. However, SJL splenic lymphoid cells cultured in the presence of low concentrations of MeHgCl proved more resistant to apoptosis. The level of apoptosis induced by MeHgCl in both regions was verified by AnnexinV-propidium iodide (PI) and TdT-mediated dUTP nick end labeling (TUNEL) immunolabelings. Phenotyping of lymphoid cells from both mouse strains cultured in the presence of low concentrations of MeHgCl and stimulated with ConA, indicated that CD4+ T cells from SJL mice increased while the corresponding cell subset from C57BL/6 mice became apoptotic. The resistance to apoptosis of ConA-activated lymphoid cells from SJL mice seemed related to an increase of CD4+ cells induced by the lower concentrations of MeHgCl (0.001 and 0.01 microM). However, these SJL cells were sensitive to anti-Fas-mediated apoptosis while residual anti-Fas-resistant cells from C57BL/6 mice were, themselves, sensitive to MeHgCl-induced apoptosis. The in vivo significance of these results has been confirmed by an observed increase in splenic cellularity and in the percentage of activated CD4+ cells from SJL mice. These increases were not observed in C57BL/6 mice.
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Affiliation(s)
- Say-Ry Pheng
- Département de Médecine du Travail et d'Hygiène du Milieu, Faculté de Médecine, Université de Montréal, Québec, Montréal, Canada
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Lamontagne L, Massicotte E, Page C. Intrahepatic alpha beta-TcRintermediate LFA-1high T cells are stimulated during mouse hepatitis viral infection. Adv Exp Med Biol 1998; 440:479-83. [PMID: 9782318 DOI: 10.1007/978-1-4615-5331-1_61] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Mouse hepatitis virus type 3 (MHV3), a coronavirus, is an excellent animal model for the study of thymic and extrathymic T cell subpopulation disorders induced during the viral hepatitis. To understand local hepatic immune responses, the phenotypes of resident hepatic lymphocytes were determined and compared that of splenic and thymic T cell subpopulations during the acute viral hepatitis induced by MHV3 in susceptible C57BL/6 mice. Single positive (SP) CD4+ or CD8+ cells strongly increased in the liver. A specific cell population, the double positive (CD4+ C8+) cells, normally present in liver and thymic cell preparations, decreased in C57BL/6 mice following the viral infection. alpha beta-TcRintermediate T cells shifted toward alpha beta-TcRhigh T cells in the liver and thymus of infected mice, but not in their spleen. The specific alpha beta-TcRint or high lymphocytes occurring in the liver of MHV3-infected mice expressed higher levels of leukocyte function antigen-1 (LFA-1) and Pgp-1 (CD44) activation markers, suggesting that they were either activated or antigen-experienced during the viral infection. No significant changes in T cell subpopulations were detected in the spleen. These observations suggest that MHV3 infection could induce an early in situ stimulation of resident hepatic T cells, despite a peripheral immunodeficiency in the thymus and spleen.
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Affiliation(s)
- L Lamontagne
- Département des Sciences Biologiques, Université du Québec à Montréal, Canada
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Lamontagne L, Massicotte E, Page C. Mouse hepatitis viral infection induces an extrathymic differentiation of the specific intrahepatic alpha beta-TCRintermediate LFA-1high T-cell population. Immunology 1997; 90:402-11. [PMID: 9155648 PMCID: PMC1456597 DOI: 10.1111/j.1365-2567.1997.00402.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Mouse hepatitis virus type 3 (MHV3), a coronavirus, is an excellent model for the study of thymic and extrathymic T-cell subpopulation disorders induced during viral hepatitis. It was recently reported that, in addition to the intrathymic T-cell differentiation pathway, an extrathymic differentiation pathway of alpha beta-T-cell receptor (TCR) T lymphocytes exists in the liver, and becomes important under pathological situations such as autoimmune diseases, malignancies or hepatic bacterial infections. In the present study, we compared the phenotypes of resident hepatic, splenic or thymic T-cell subpopulations during the acute viral hepatitis induced by HMV3 in susceptible C57BL/6 mice. The number of liver-resident mononuclear cells (MNC) increased during the viral infection, while cellularity decreased. Single positive (SP) CD4+ cells strongly increased in both the liver and thymus, while double positive (DP) (CD4+ CD8+) cells, present in the liver and thymus of mock-infected mice, decreased in C57BL/6 mice during the viral infection. A shift of alpha beta-TCRintermediate T cells toward alpha beta-TCRhigh was evidenced in the liver and thymus of infected mice, but not in the spleen. The few alpha beta-TCRint double negative (DN) (CD4-CD8-) cells also decreased following viral infection. alpha beta-TCRint or high lymphocytes expressing high levels of leucocyte function antigen-1 (LFA-1) increased in the liver of MHV3-infected mice. In addition, liver-resident T cells expressed strongly the CD44 (Pgp-1) activation marker, suggesting that they were either activated or antigen experienced during the viral infection. No significant change in T-cell subpopulations was detected in the spleen, suggesting that MHV3 infection could induce an early in situ differentiation of resident hepatic T cells rather than a recruitment of lymphocytes from peripheral lymphoid organs.
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Affiliation(s)
- L Lamontagne
- Département des Sciences Biologiques, Université du Québec à Montréal, Canada
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