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Alasadi H, Rajjoub R, Alasadi Y, Wilczek A, Lonner BS. Vertebral body tethering for adolescent idiopathic scoliosis: a review. Spine Deform 2024:10.1007/s43390-023-00806-7. [PMID: 38285164 DOI: 10.1007/s43390-023-00806-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/09/2023] [Indexed: 01/30/2024]
Abstract
PURPOSE Adolescent Idiopathic Scoliosis (AIS) remains the most common type of pediatric scoliosis, mostly affecting children between ages 10 and 18. Vertebral body tethering (VBT) offers a non-fusion alternative to the gold standard spinal fusion that permits flexibility and some growth within instrumented segments. This article will serve as a comprehensive literature review of the current state-of-the-art of VBT in relation to radiographic and clinical outcomes, complications, and the learning curve associated with the procedure. METHODS A systematic literature review was conducted on PubMed, Scopus, and Web of Science from April 2002 to December 2022. Studies were included if they discussed VBT and consisted of clinical studies in which a minimum 2-years follow-up was reported, and series that included anesthetic considerations, learning curve, and early operative morbidity. RESULTS Forty-nine studies spanning the period from April 2002 to December 2022 were reviewed. CONCLUSION This article illustrates the potential benefits and challenges of the surgical treatment of AIS with VBT and can serve as a basis for the further study and refinement of this technique ideally as a living document that will be updated regularly.
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Affiliation(s)
- Husni Alasadi
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rami Rajjoub
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yazan Alasadi
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ashley Wilczek
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Baron S Lonner
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Chief of Minimally Invasive Scoliosis Surgery and Pediatric Spine, Department of Orthopaedic Surgery, Mount Sinai Hospital, Icahn School of Medicine, 5 E 98th St., 4th Floor, New York, NY, 10029, USA.
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Pitaro NL, Herrera MM, Alasadi H, Shah KC, Kiani SN, Stern BZ, Zubizarreta N, Chen DD, Hayden BL, Poeran J, Moucha CS. Sleep Disturbance Trends in the Short-Term Postoperative Period for Patients Undergoing Total Joint Arthroplasty. J Am Acad Orthop Surg 2023; 31:e859-e867. [PMID: 37523691 DOI: 10.5435/jaaos-d-23-00059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/21/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Patients undergoing total joint arthroplasty (TJA) often experience preoperative/postoperative sleep disturbances. Although sleep quality generally improves > 6 months after surgery, patterns of sleep in the short-term postoperative period are poorly understood. This study sought to (1) characterize sleep disturbance patterns over the 3-month postoperative period and (2) investigate clinical and sociodemographic factors associated with 3-month changes in sleep. METHODS This retrospective analysis of prospectively collected data included 104 primary elective TJA patients. Patients were administered the PROMIS Sleep Disturbance questionnaire preoperatively and at 2 weeks, 6 weeks, and 3 months postoperatively. Median sleep scores were compared between time points using Wilcoxon signed-rank tests, stratified by preoperative sleep impairment. A multivariable logistic regression model identified factors associated with 3-month clinically improved sleep. RESULTS The percentage of patients reporting sleep within normal limits increased over time: 54.8% preoperatively and 58.0%, 62.5%, and 71.8% at 2 weeks, 6 weeks, and 3 months post-TJA, respectively. Patients with normal preoperative sleep experienced a transient 4.7-point worsening of sleep at 2 weeks ( P = 0.003). For patients with moderate/severe preoperative sleep impairment, sleep significantly improved by 5.4 points at 2 weeks ( P = 0.002), with improvement sustained at 3 months. In multivariable analysis, patients undergoing total hip arthroplasty (versus knee; OR: 3.47, 95% CI: 1.06 to 11.32, P = 0.039) and those with worse preoperative sleep scores (OR: 1.13, 95% CI: 1.04 to 1.23, P = 0.003) were more likely to achieve clinically improved sleep from preoperatively to 3 months postoperatively. DISCUSSION Patients experience differing patterns in postoperative sleep changes based on preoperative sleep disturbance. Hip arthroplasty patients are also more likely to experience clinically improved sleep by 3 months compared with knee arthroplasty patients. These results may be used to counsel patients on postoperative expectations and identify patients at greater risk of impaired postoperative sleep. STUDY DESIGN Retrospective analysis of prospectively collected data.
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Affiliation(s)
- Nicholas L Pitaro
- From the Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY (Pitaro, Herrera, Alasadi, Shah, Kiani, Stern, Zubizarreta, Chen, Hayden, Poeran, and Moucha), the Department of Population Health Science and Policy, Institute for Health Care Delivery Science, Icahn School of Medicine at Mount Sinai (Stern, Zubizarreta and Poeran), and the Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (Poeran)
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Ali M, Asghar N, Hannah T, Schupper AJ, Li A, Dreher N, Murtaza-Ali M, Vasan V, Nakadar Z, Alasadi H, Lin A, Hrabarchuk E, Quinones A, McCarthy L, Asfaw Z, Dullea J, Gometz A, Lovell M, Choudhri T. A multicenter, longitudinal survey of headaches and concussions among youth athletes in the United States from 2009 to 2019. J Headache Pain 2023; 24:6. [PMID: 36755244 PMCID: PMC9909942 DOI: 10.1186/s10194-022-01528-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/17/2022] [Indexed: 02/10/2023] Open
Abstract
OBJECTIVE/ BACKGROUND Chronic headaches and sports-related concussions are among the most common neurological morbidities in adolescents and young adults. Given that the two can overlap in presentation, studying the effects of one on another has proven difficult. In this longitudinal study, we sought to assess the relationship between chronic headaches and concussions, analyzing the role of historic concussions on chronic headaches, as well as that of premorbid headaches on future concussion incidence, severity, and recovery. METHODS This multi-center, longitudinal cohort study followed 7,453 youth athletes who were administered demographic and clinical surveys as well as a total of 25,815 Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) assessments between 2009 and 2019. ImPACT was administered at baseline. Throughout the season concussions were examined by physicians and athletic trainers, followed by re-administration of ImPACT post-injury (PI), and at follow-up (FU), a median of 7 days post-concussion. Concussion incidence was calculated as the total number of concussions per patient years. Concussion severity and recovery were calculated as standardized deviations from baseline to PI and then FU in Symptom Score and the four neurocognitive composite ImPACT scores: Verbal Memory, Visual Memory, Processing Speed, and Reaction Time. Data were collected prospectively in a well-organized electronic format supervised by a national research-oriented organization with rigorous quality assurance. Analysis was preformed retrospectively. RESULTS Of the eligible athletes, 1,147 reported chronic headaches (CH) at the start of the season and 6,306 reported no such history (NH). Median age of the cohort was 15.4 ± 1.6 years, and students were followed for an average of 1.3 ± 0.6 years. A history of concussions (OR 2.31, P < 0.0001) was associated with CH. Specifically, a greater number of past concussions (r2 = 0.95) as well as concussions characterized by a loss of consciousness (P < 0.0001) were associated with more severe headache burden. The CH cohort had a greater future incidence of concussion than the NH cohort (55.6 vs. 43.0 per 100 patient-years, P < 0.0001). However, multivariate analysis controlling for demographic, clinical, academic, and sports-related variables yielded no such effect (OR 0.99, P = 0.85). On multivariable analysis the CH cohort did have greater deviations from baseline to PI and FU in Symptom Score (PI OR per point 1.05, P = 0.01, FU OR per point 1.11, P = 0.04) and Processing Speed (OR per point 1.08, P = 0.04), suggesting greater concussion severity and impaired symptomatic recovery as compared to the NH cohort. CONCLUSION A history of concussions was a significant contributor to headache burden among American adolescents and young adults. However, those with chronic headaches were not more likely to be diagnosed with a concussion, despite presenting with more severe concussions that had protracted recovery. Our findings not only suggest the need for conservative management among youth athletes with chronic headaches, they also indicate a potential health care gap in this population, in that those with chronic headaches may be referred for concussion diagnosis and management at lower rates than those with no such comorbidity.
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Affiliation(s)
- Muhammad Ali
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 10021, NY, USA.
| | - Nek Asghar
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 10021, NY, USA
| | - Theodore Hannah
- Department of Neurosurgery, Lewis Katz School of Medicine at Temple University, 19140, Philadelphia, PA, USA
| | - Alexander J Schupper
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 10021, NY, USA
| | - Adam Li
- Department of Neurosurgery, University of Rochester School of Medicine and Dentistry, 14642, Rochester, NY, USA
| | - Nickolas Dreher
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, 10032, NY, USA
| | - Muhammad Murtaza-Ali
- Department of Anthropology, State University of New York at Binghamton, 13902, NY, USA
| | - Vikram Vasan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 10021, NY, USA
| | - Zaid Nakadar
- Department of Neurosurgery, State University of New York Downstate Health Sciences University, 11203, NY, USA
| | - Husni Alasadi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 10021, NY, USA
| | - Anthony Lin
- Department of Pathology, Joan & Sanford I. Weill Medical College of Cornell University, 10021, NY, USA
| | - Eugene Hrabarchuk
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 10021, NY, USA
| | - Addison Quinones
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 10021, NY, USA
| | - Lily McCarthy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 10021, NY, USA
| | - Zerubabbel Asfaw
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 10021, NY, USA
| | - Jonathan Dullea
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 10021, NY, USA
| | - Alex Gometz
- Concussion Management of New York, 10021, NY, USA
| | - Mark Lovell
- Department of Neurology, The University of Pittsburgh Medical Center, 15260, Pittsburgh, PA, USA
| | - Tanvir Choudhri
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 10021, NY, USA
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Raymond HE, Alasadi H, Zubizarreta N, Hayden BL, Chen D, Burnett GW, Park C, DeMaria S, Poeran J, Moucha CS. Primary spoken language and regional anaesthesia use in total joint arthroplasty. Reg Anesth Pain Med 2023:rapm-2022-103828. [PMID: 36697030 DOI: 10.1136/rapm-2022-103828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 01/14/2023] [Indexed: 01/26/2023]
Affiliation(s)
- Hayley E Raymond
- Department of Orthopaedic Surgery, Mount Sinai Health System, New York, New York, USA
| | - Husni Alasadi
- Department of Orthopaedic Surgery, Mount Sinai Health System, New York, New York, USA
| | - Nicole Zubizarreta
- Department of Orthopaedic Surgery, Mount Sinai Health System, New York, New York, USA
| | - Brett L Hayden
- Department of Orthopaedic Surgery, Mount Sinai Health System, New York, New York, USA
| | - Darwin Chen
- Department of Orthopaedic Surgery, Mount Sinai Health System, New York, New York, USA
| | - Garrett W Burnett
- Department of Anesthesiology, Perioperative and Pain Medicine, Mount Sinai Health System, New York, New York, USA
| | - Chang Park
- Department of Anesthesiology, Perioperative and Pain Medicine, Mount Sinai Health System, New York, New York, USA
| | - Samuel DeMaria
- Department of Anesthesiology, Perioperative and Pain Medicine, Mount Sinai Health System, New York, New York, USA
| | - Jashvant Poeran
- Department of Orthopaedic Surgery, Mount Sinai Health System, New York, New York, USA
| | - Calin S Moucha
- Department of Orthopaedic Surgery, Mount Sinai Health System, New York, New York, USA
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El-Achkar A, Alasadi H, El-Asmar J, Armache A, Abu-Hijlih R, Abu-Hijle F, Al-Ibraheem A, Khzouz J, Salah S, Shahait M. Clinical characteristics and treatment outcomes of germ cell tumor in Jordan: A tertiary center experience. Arab J Urol 2023; 21:233-239. [PMID: 38178954 PMCID: PMC10763583 DOI: 10.1080/2090598x.2022.2163473] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/25/2022] [Indexed: 01/04/2023] Open
Abstract
Objective In the Middle East, there is a paucity of data regarding germ cell tumor characteristics and treatment outcomes. Herein, we aim to present the largest series in Jordan reporting our cancer center experience managing GCT. Methods Between 2010 and 2020, a total of 241 patients with a pathological diagnosis of GCT were treated at our cancer center. Demographic, epidemiologic, and pathological data were retrospectively collected. In addition, survival and relapse outcomes based on tumor stage and adjuvant treatment were collected. Results A total of 241 patients were diagnosed with GCT, of whom 108 (44.8%) had seminoma and 133 (55.2%) had non-seminoma tumors (NSGCT). Median age (interquartile range) at diagnosis was 31 years (25-36). Patients with seminoma (68.5%) had pT1 disease post orchiectomy, while only 37.5% of patients with NSGCT had pT1 on final pathology. Elevated tumor markers such as beta-human chorionic gonadotropin were present in 10% of seminomas. Following radical orchiectomy and staging, 88 (36.5%) went for active surveillance while 153 patients (63.5%) received adjuvant treatment. With regard to pathology slides read outside, rereading by our genitourinary pathologist yielded a discrepancy on GCT type in 41 (19.3%) out of 212 patients. The median follow-up was 36 (24-48) months. Twenty-two patients relapsed after an average follow-up time of 39 months. The 5-year overall survival for stage I, II, and III was 98%, 94%, and 87%, respectively, and 3-year recurrence-free survival for stage I, II, and III was 94.8%, 78%, and 67%, respectively. Conclusion Our data on testicular GCT including demographic, histological, and treatment outcomes were comparable to that of developed countries. In light of the pathology discrepancy rate revealed in our study, authors recommend a second review by expert genitourinary pathologists to ensure proper classification and management of GCT.
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Affiliation(s)
- A. El-Achkar
- Department of Surgery, Division of Urology, American University of Beirut, Beirut, Lebanon
| | - H. Alasadi
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - J. El-Asmar
- Department of Surgery, Division of Urology, American University of Beirut, Beirut, Lebanon
| | - A. Armache
- Department of Surgery, Division of Urology, American University of Beirut, Beirut, Lebanon
| | - R. Abu-Hijlih
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - F. Abu-Hijle
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - A. Al-Ibraheem
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - J. Khzouz
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - S. Salah
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - M. Shahait
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
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