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Heard JC, Kohli M, Ezeonu T, Lee Y, Lambrechts MJ, Narayanan R, Kirkpatrick Q, Kern N, Canseco JA, Kurd MF, Kaye ID, Hilibrand AS, Vaccaro AR, Schroeder GD, Kepler CK. The Effect of Muscle Quality on Outcomes after Microdiscectomy. World Neurosurg 2024; 183:e687-e698. [PMID: 38184224 DOI: 10.1016/j.wneu.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/01/2024] [Indexed: 01/08/2024]
Abstract
OBJECTIVES To investigate the relationship between muscle quality and 1) patient-reported outcomes and 2) surgical outcomes after lumbar microdiscectomy surgery. METHODS Adult patients (≥18 years) who underwent lumbar microdiscectomy from 2014 to 2021 at a single academic institution were identified. Outcomes were collected during the preoperative, 3-month, 6-month, and 1-year postoperative periods. Those included were the Oswestry Disability Index (ODI), Visual Analog Scale Back and Leg (VAS-Back and VAS-Leg, respectively), and the mental and physical component of the short-form 12 survey (MCS and PCS). Muscle quality was determined by 2 systems: the normalized total psoas area (NTPA) and a paralumbar-based grading system. Surgical outcomes including 90-day surgical readmissions and 1-year reoperations were also collected. RESULTS Of the 218 patients identified, 150 had good paralumbar muscle quality and 165 had good psoas muscle quality. Bivariant analysis demonstrated no difference between groups regarding surgical outcomes (P > 0.05). Multivariable analysis demonstrated that better paralumbar muscle quality was not associated with any consistent changes in patient reported outcomes. Higher NTPA was associated with improved PCS at 6 months (est. = 6.703, [95% CI: 0.759-12.646], P = 0.030) and 12 months (est. = 6.625, [95% CI: 0.845-12.405], P = 0.027). There was no association between muscle quality and surgical readmissions or reoperations. CONCLUSIONS Our analysis demonstrated that higher psoas muscle quality was associated with greater physical improvement postoperatively. Muscle quality did not affect surgical readmissions or reoperations. Additional studies are needed for further assessment of the implications of muscle quality on postoperative outcomes.
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Affiliation(s)
- Jeremy C Heard
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Meera Kohli
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Teeto Ezeonu
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Yunsoo Lee
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mark J Lambrechts
- Department of Orthopedic Surgery, Washington University in St. Loius, St. Louis, Missouri, USA
| | - Rajkishen Narayanan
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
| | - Quinn Kirkpatrick
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nathaniel Kern
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mark F Kurd
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ian D Kaye
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Lee Y, Heard JC, Lambrechts MJ, Kern N, Wiafe B, Goodman P, Mangan JJ, Canseco JA, Kurd MF, Kaye ID, Hilibrand AS, Vaccaro AR, Kepler CK, Schroeder GD, Rihn JA. Significance of Facet Fluid Index in Anterior Cervical Degenerative Spondylolisthesis. Asian Spine J 2024; 18:94-100. [PMID: 38287666 PMCID: PMC10910141 DOI: 10.31616/asj.2023.0090] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/28/2023] [Accepted: 06/12/2023] [Indexed: 01/31/2024] Open
Abstract
STUDY DESIGN Retrospective cohort study. PURPOSE To correlate cervical facet fluid characteristics to radiographic spondylolisthesis, determine if facet fluid is associated with instability in cervical degenerative spondylolisthesis, and examine whether vertebral levels with certain facet fluid characteristics and spondylolisthesis are more likely to be operated on. OVERVIEW OF LITERATURE The relationship between facet fluid and lumbar spondylolisthesis is well-documented; however, there is a paucity of literature investigating facet fluid in degenerative cervical spondylolisthesis. METHODS Patients diagnosed with cervical degenerative spondylolisthesis were identified from a hospital's medical records. Demographic and surgical characteristics were collected through a structured query language search and manual chart review. Radiographic measurements were made on preoperative MRIs for all vertebral levels diagnosed with spondylolisthesis and adjacent undiagnosed levels between C3 and C6. The facet fluid index was calculated by dividing the facet fluid measurement by the width of the facet. Bivariate analysis was conducted to compare facet characteristics based on radiographic spondylolisthesis and spondylolisthesis stability. RESULTS We included 154 patients, for whom 149 levels were classified as having spondylolisthesis and 206 levels did not. The average facet fluid index was significantly higher in patients with spondylolisthesis (0.26±0.07 vs. 0.23±0.08, p <0.001). In addition, both fluid width and facet width were significantly larger in patients with spondylolisthesis (p <0.001 each). Cervical levels in the fusion construct demonstrated a greater facet fluid index and were more likely to have unstable spondylolisthesis than stable spondylolisthesis (p <0.001 each). CONCLUSIONS Facet fluid index is associated with cervical spondylolisthesis and an increased facet size and fluid width are associated with unstable spondylolisthesis. While cervical spondylolisthesis continues to be an inconclusive finding, vertebral levels with spondylolisthesis, especially the unstable ones, were more likely to be included in the fusion procedure than those without spondylolisthesis.
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Affiliation(s)
- Yunsoo Lee
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - Jeremy C. Heard
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - Mark J. Lambrechts
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO,
USA
| | - Nathaniel Kern
- Sydney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - Bright Wiafe
- Sydney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - Perry Goodman
- Sydney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - John J. Mangan
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - Jose A. Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - Mark F. Kurd
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - Ian D. Kaye
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - Alan S. Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - Alexander R. Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - Christopher K. Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - Gregory D. Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - Jeffrey A. Rihn
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
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3
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Heard JC, Lee YA, Lambrechts M, Brush P, Issa TZ, Kanhere A, Bodner J, Purtill C, Reddy YC, Patil S, Somers S, D'Antonio ND, Mangan JJ, Canseco JA, Woods BR, Kaye ID, Rihn JA, Hilibrand AS, Vaccaro AR, Kepler CK, Schroeder GD. The Impact of Physical Therapy After Lumbar Fusion Surgery. Clin Spine Surg 2023; 36:419-425. [PMID: 37491717 DOI: 10.1097/bsd.0000000000001483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 05/17/2023] [Indexed: 07/27/2023]
Abstract
STUDY DESIGN Retrospective Cohort. OBJECTIVE To determine if outcomes varied between patients based on physical therapy (PT) attendance after lumbar fusion surgery. SUMMARY OF BACKGROUND DATA The literature has been mixed regarding the efficacy of postoperative PT to improve disability and back pain, as measured by patient-reported outcome measures. Given the prevalence of PT referrals and lack of high-quality evidence, there is a need for additional studies investigating the efficacy of PT after lumbar fusion surgery to aid in developing robust clinical guidelines. METHODS We retrospectively identified patients receiving lumbar fusion surgery by current procedural terminology codes and separated them into 2 groups based on whether PT was prescribed. Electronic medical records were reviewed for patient and surgical characteristics, PT utilization, and surgical outcomes. Patient-reported outcome measures (PROMs) were identified and compared preoperatively, at 90 days postoperatively and one year postoperatively. RESULTS The two groups had similar patient characteristics and comorbidities and demonstrated no significant differences between readmission, complication, and revision rates after surgery. Patients that attended PT had significantly more fused levels (1.41 ± 0.64 vs. 1.32 ± 0.54, P =0.027), longer operative durations (234 ± 96.4 vs. 215 ± 86.1 min, P =0.012), and longer postoperative hospital stays (3.35 ± 1.68 vs. 3.00 ± 1.49 days, P =0.004). All groups improved similarly by Oswestry Disability Index, short form-12 physical and mental health subsets, and back and leg pain by Visual Analog Scale at 90-day and 1-year follow-up. CONCLUSION Our data suggest that physical therapy does not significantly impact PROMs after lumbar fusion surgery. Given the lack of data suggesting clear benefit of PT after lumbar fusion, surgeons should consider more strict criteria when recommending physical therapy to their patients after lumbar fusion surgery. LEVEL OF EVIDENCE Level-Ⅲ.
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Affiliation(s)
- Jeremy C Heard
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Yunsoo A Lee
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Mark Lambrechts
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Parker Brush
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Tariq Z Issa
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Arun Kanhere
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - John Bodner
- Sydney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Caroline Purtill
- Sydney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Yashas C Reddy
- Sydney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Sanath Patil
- Sydney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Sydney Somers
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Nicholas D D'Antonio
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - John J Mangan
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Barrett R Woods
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Ian D Kaye
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Jeff A Rihn
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
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Heard JC, Lee Y, Lambrechts MJ, Ezeonu T, Dees AN, Wiafe BM, Wright J, Toci GR, Schwenk ES, Canseco JA, Kaye ID, Kurd MF, Hilibrand AS, Vaccaro AR, Schroeder GD, Kepler CK. Risk Factors for Postoperative Urinary Retention After Lumbar Fusion Surgery: Anesthetics and Surgical Approach. J Am Acad Orthop Surg 2023; 31:1189-1196. [PMID: 37695724 DOI: 10.5435/jaaos-d-23-00172] [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: 02/24/2023] [Accepted: 07/20/2023] [Indexed: 09/13/2023] Open
Abstract
INTRODUCTION Postoperative urinary retention (POUR) after lumbar fusion surgery can lead to longer hospital stays and thus increased risk of developing other postoperative complications. Therefore, we aimed to determine the relationship between POUR and (1) surgical approach and (2) anesthetic agents, including sugammadex and glycopyrrolate. METHODS After institutional review board approval, L4-S1 single-level lumbar fusion surgeries between 2018 and 2021 were identified. A 3:1 propensity match of patients with POUR to those without was conducted, controlling for patient age, sex, diabetes status, body mass index, smoking status, history of benign prostatic hyperplasia, and the number of levels decompressed. POUR was defined as documented straight catheterization yielding >400 mL. We compared patient demographic, surgical, anesthetic, and postoperative characteristics. A bivariant analysis and backward multivariable stepwise logistic regression analysis ( P -value < 0.200) were performed. Significance was set to P < 0.05. RESULTS Of the 899 patients identified, 51 met the criteria for POUR and were matched to 153 patients. No notable differences were observed between groups based on demographic or surgical characteristics. On bivariant analysis, patients who developed POUR were more likely to have been given succinylcholine (13.7% vs. 3.92%, P = 0.020) as an induction agent. The independent predictors of POUR identified by multivariable analysis included the use of succinylcholine {odds ratio (OR), 4.37 (confidence interval [CI], 1.26 to 16.46), P = 0.022} and reduced postoperative activity (OR, 0.99 [CI, 0.993 to 0.999], P = 0.049). Factors protective against POUR included using sugammadex as a reversal agent (OR, 0.38 [CI, 0.17 to 0.82], P = 0.017). The stepwise regression did not identify an anterior surgical approach as a notable predictor of POUR. CONCLUSION We demonstrate that sugammadex for anesthesia reversal was protective against POUR while succinylcholine and reduced postoperative activity were associated with the development of POUR. In addition, we found no difference between the anterior or posterior approach to spinal fusion in the development of POUR.
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Affiliation(s)
- Jeremy C Heard
- From the Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA (Heard, Lee, Ezeonu, Dees, Wiafe, Wright, Toci, Canseco, Kaye, Kurd, Hilibrand, Vaccaro, Schroeder, and Kepler), the Department of Orthopaedic Surgery, Washington University, St. Louis, MO (Lambrechts), and the Department Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, PA (Schwenk)
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5
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Heard JC, Lee Y, Ezeonu T, Lambrechts MJ, Issa TZ, Yalla GR, Tran K, Singh A, Purtill C, Somers S, Becsey A, Canseco JA, Kurd MF, Kaye ID, Hilibrand AS, Vaccaro AR, Schroeder GD, Kepler CK. Does the Severity of Foraminal Stenosis Impact Outcomes of Lumbar Decompression Surgery? World Neurosurg 2023; 179:e296-e304. [PMID: 37633493 DOI: 10.1016/j.wneu.2023.08.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 08/28/2023]
Abstract
OBJECTIVE To establish the relationship between the magnitude of foraminal stenosis and 1) improvement in patient-reported outcomes, 2) improvement in motor function after lumbar decompression surgery, and 3) difference in surgical outcomes. METHODS Patients who underwent one-level posterior lumbar decompression for radiculopathy were retrospectively identified. Patient demographics and surgical characteristics were collected through a query search and manual chart review of the electronic medical records. Foraminal stenosis was determined on magnetic resonance imaging and graded using Lee et al.'s validated methodology as none, mild, moderate, or severe. Surgical outcomes, motor function, and patient-reported outcome measures (PROMs) were compared based on the amount of stenosis (mild vs. moderate vs. severe). Bivariant and multivariant analyses were performed. RESULTS Severe stenosis demonstrated more 90-day readmissions (0.00% vs. 0.00% vs. 8.57%, respectively, P = 0.019), though this effect did not remain significant on multivariate analysis (P = 0.068). There was no association between stenosis severity and the degree of functional impairment or PROMs preoperatively. Patients with moderate or severe preoperative foraminal stenosis showed improvement in all PROMs after surgery (P < 0.05) except the mental component of the Short Form 12 survey. Notably, central stenosis grade was insignificantly different between groups (P = 0.358). Multivariable logistic regression analysis did not identify any significant independent predictors of surgical outcomes or changes in PROMs. CONCLUSIONS We demonstrated that regardless of foraminal stenosis severity preoperatively, patients have a similar improvement in PROMs, surgical outcomes, and restoration of motor function after lumbar decompression surgery for radiculopathy.
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Affiliation(s)
- Jeremy C Heard
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Yunsoo Lee
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
| | - Teeto Ezeonu
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mark J Lambrechts
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Tariq Z Issa
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Goutham R Yalla
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Khoa Tran
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Akash Singh
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Caroline Purtill
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sydney Somers
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alexander Becsey
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mark F Kurd
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ian D Kaye
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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6
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Heard JC, Siegel N, Yalla GR, Lambrechts MJ, Lee Y, Sherman M, Wang J, Dambly J, Baker S, Bowen G, Mangan JJ, Canseco JA, Kurd MF, Kaye ID, Hilibrand AS, Vaccaro AR, Kepler CK, Schroeder GD. Predictors of Blood Transfusion in Patients Undergoing Lumbar Spinal Fusion. World Neurosurg 2023; 176:e493-e500. [PMID: 37257651 DOI: 10.1016/j.wneu.2023.05.087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/20/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To determine risk factors for perioperative blood transfusion after lumbar fusion surgery. METHODS After institutional review board approval, a retrospective cohort study of adult patients who underwent lumbar fusion at a single, urban tertiary academic center was retrospectively retrieved. Our primary outcome, blood transfusion, was collected via chart query. A receiver operating characteristic curve was used to evaluate the regression model. A P-value < 0.05 was considered statistically significant. RESULTS Of the 3,842 patients, 282 (7.3%) required a blood transfusion. For patients undergoing posterolateral decompression and fusion, predictors of transfusion included age (P < 0.001) and more levels fused (P < 0.001). A higher preoperative hemoglobin level (P < 0.001) and revision surgery (P = 0.005) were protective of blood transfusion. For patients undergoing transforaminal lumbar interbody fusion, greater Elixhauser comorbidity index (P < 0.001), longer operative time (P = 0.040), and more levels fused (P = 0.030) were independent predictors of the need for blood transfusion. Patients with a higher body mass index (P = 0.012) and preoperative hemoglobin level (P < 0.001) had a reduced likelihood of receiving a transfusion. For circumferential fusion, greater age (P = 0.006) and longer operative times (P = 0.015) were independent predictors of blood transfusion, while a higher preoperative hemoglobin level (P < 0.001) and male sex (P = 0.002) were protective. CONCLUSIONS Our analysis identified older age, lower body mass index, greater Elixhauser comorbidity index, longer operative duration, more levels fused, and lower preoperative hemoglobin levels as independent predictors of requiring a blood transfusion following lumbar spinal fusion. Different surgical approaches were not found to be associated with transfusion.
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Affiliation(s)
- Jeremy C Heard
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Nicholas Siegel
- Department of Orthopaedic Surgery, Johns Hopkins University Hospital, Baltimore, Maryland, USA
| | - Goutham R Yalla
- Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Mark J Lambrechts
- Department of Orthopaedic Surgery, Washington University at St. Louis, St. Louis, Missouri, USA
| | - Yunsoo Lee
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
| | - Matthew Sherman
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Jasmine Wang
- Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Julia Dambly
- Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Sydney Baker
- Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Grace Bowen
- Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - John J Mangan
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Mark F Kurd
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Ian D Kaye
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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7
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Yeung CM, Heard JC, Lee Y, Lambrechts MJ, Somers S, Singh A, Bloom E, D'Antonio ND, Trenchfield D, Labarbiera A, Mangan JJ, Canseco JA, Woods BI, Kurd MF, Kaye ID, Lee JK, Hilibrand AS, Vaccaro AR, Kepler CK, Schroeder GD. The Implication of Preoperative Central Stenosis on Patient Reported Outcomes After Lumbar Decompression Surgery. World Neurosurg 2023:S1878-8750(23)00806-9. [PMID: 37343674 DOI: 10.1016/j.wneu.2023.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE To assess the impact of central stenosis severity on patient-reported outcomes after lumbar decompression. METHODS Patient diagnosis, demographics, and surgical characteristics were collected via query search and manual chart review of electronic medical records. The inclusion criteria were posterior lumbar decompressions from 2014-2020, with accessible MRI reports. As previously validated by Lee et al., central stenosis was determined on magnetic resonance imaging and graded as none, mild, moderate, or severe. Patients were dichotomized into two groups to improve statistical power for comparisons: none or mild central stenosis and moderate or severe central stenosis. PROMs were compared between cohorts at one year postoperatively. Statistical significance was set at p < 0.05. RESULTS On bivariant analysis, no significant differences were noted between cohorts with regard to preoperative, one-year postoperative, and ΔPROMs. In addition, no significant difference in the number of patients attaining minimal clinically important difference (MCID) for each PROM was noted between cohorts. With the exception of MCS-12, all intragroup preoperative to postoperative PROMs indicated significant improvement (all p<0.05) after lumbar decompression surgery. Multivariate regression identified moderate or severe central canal stenosis as a significant independent predictor of improvement in VAS-back (estimate=-1.464, p=0.045). CONCLUSION We demonstrate that patients with moderate or severe central spinal stenosis may have more improvement in back pain than those with mild or no central stenosis after lumbar spine decompression surgery.
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Affiliation(s)
- Caleb M Yeung
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA 19107
| | - Jeremy C Heard
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA 19107
| | - Yunsoo Lee
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA 19107.
| | - Mark J Lambrechts
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO
| | - Sydney Somers
- Sydney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Akash Singh
- Sydney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Evan Bloom
- Sydney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Nicholas D D'Antonio
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA 19107
| | - Delano Trenchfield
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA 19107
| | - Anthony Labarbiera
- Sydney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA
| | - John J Mangan
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA 19107
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA 19107
| | - Barrett I Woods
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA 19107
| | - Mark F Kurd
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA 19107
| | - Ian D Kaye
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA 19107
| | - Joseph K Lee
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA 19107
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA 19107
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA 19107
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA 19107
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA 19107
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8
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McDonnell JM, Evans SR, Ahern DP, Cunniffe G, Kepler C, Vaccaro A, Kaye ID, Morrissey PB, Wagner SC, Sebastian A, Butler JS. Risk factors for distal junctional failure in long-construct instrumentation for adult spinal deformity. Eur Spine J 2022; 31:3654-3661. [PMID: 36178547 DOI: 10.1007/s00586-022-07396-4] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/02/2022] [Accepted: 09/19/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of this study is to identify risk factors associated with postoperative DJF in long constructs for ASD. METHODS A retrospective review was performed at a tertiary referral spine centre from 01/01/2007 to 31/12/2016. Demographic, clinical and radiographic parameters were collated for patients with DJF in the postoperative period and compared to those without DJF. Survival analyses were performed using univariate logistic regression to identify variables with a p value < 0.05 for inclusion in multivariate analysis. Spearman's correlations were performed where applicable. RESULTS One hundred two patients were identified. 41 (40.2%) suffered DJF in the postoperative period, with rod fracture being the most common sign of DJF (13/65; 20.0%). Mean time to failure was 32.4 months. On univariate analysis, pedicle subtraction osteotomy (p = 0.03), transforaminal lumbar interbody fusion (p < 0.001), pre-op LL (p < 0.01), pre-op SVA (p < 0.01), pre-op SS (p = 0.02), postop LL (p = 0.03), postop SVA (p = 0.01), postop PI/LL (p < 0.001), LL correction (p < 0.001), SVA correction (p < 0.001), PT correction (p = 0.03), PI/LL correction (p < 0.001), SS correction (p = 0.03) all proved significant. On multivariate analysis, pedicle subtraction osteotomy (OR 27.3; p = 0.03), postop SVA (p < 0.01) and LL correction (p = 0.02) remained statistically significant as independent risk factors for DJF. CONCLUSION Recently, DJF has received recognition as its own entity due to a notable postoperative incidence. Few studies to date have evaluated risk factors for DJF. The results of our study highlight that pedicle subtraction osteotomy, poor correction of lumbar lordosis, and sagittal vertical axis are significantly associated with postoperative occurrence of DJF.
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Affiliation(s)
- Jake M McDonnell
- Royal College of Surgeons in Ireland, Dublin, Ireland. .,National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland.
| | - Shane R Evans
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Daniel P Ahern
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Gráinne Cunniffe
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Christopher Kepler
- Department of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Alexander Vaccaro
- Department of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Ian D Kaye
- Department of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, USA
| | | | - Scott C Wagner
- Department of Orthopaedics, Walter Reed National Military Medical Center, Washington, DC, USA
| | | | - Joseph S Butler
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
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9
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Pinter ZW, Karamian B, Bou Monsef J, Mao J, Xiong A, Bowles DR, Conaway WK, Reiter DM, Honig R, Currier B, Nassr A, Freedman BA, Bydon M, Elder BD, Kaye ID, Kepler C, Schroeder G, Vaccaro A, Wagner S, Sebastian AS. Cervical Alignment and Proximal and Distal Junctional Failure in Posterior Cervical Fusion: A Multicenter Comparison of 2 Surgical Approaches. Clin Spine Surg 2022; 35:E451-E456. [PMID: 34907934 DOI: 10.1097/bsd.0000000000001281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/15/2021] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN This was a multicenter retrospective cohort study. OBJECTIVE The purpose of this study was to compare the surgical and radiographic outcomes of patients undergoing posterior cervical fusion (PCF) with constructs extending from C2 to T2 to patients with constructs extending from C3 to T1. SUMMARY OF BACKGROUND DATA Limited evidence exists regarding the appropriate level of proximal and distal extension of PCF constructs. METHODS A multicenter retrospective cohort study of patients who underwent PCF between 2012 and 2020 was performed. Surgical and radiographic outcomes were compared between those who had C3-T1 or C2-T2 constructs. RESULTS A total of 155 patients were included in the study (C2-T2: 106 patients, C3-T1: 49 patients). There were no significant differences in demographics or preoperative symptoms between cohorts. Fusion rates were significantly higher in the C2-T2 (93%) than the C3-T1 (80%, P=0.040) cohort. When comparing the C2-T2 to the C3-T1 cohort, the C3-T1 cohort had a significantly greater rate of proximal junctional failure (2% vs. 10%, P=0.006), distal junctional failure (1% vs. 20%, P<0.001) and distal screw loosening (4% vs. 15%, P=0.02). Although ∆C2-C7 sagittal vertical axis increased significantly in both cohorts (C2-T2: 6.2 mm, P=0.04; C3-T1: 8.4 mm, P<0.001), correction did not significantly differ between groups (P=0.32). The C3-T1 cohort had a significantly greater increase in ∆C2 slope (8.0 vs. 3.1 degrees, P=0.03) and ∆C0-C2 Cobb angle (6.4 vs. 1.2 degrees, P=0.04). CONCLUSION In patients undergoing PCF, a C2-T2 construct demonstrated lower rates of pseudarthrosis, distal junctional failure, proximal junctional failure, and compensatory upper cervical hyperextension compared with a C3-T1 construct.
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Affiliation(s)
| | - Brian Karamian
- Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Jad Bou Monsef
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Jennifer Mao
- Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Ashley Xiong
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Daniel R Bowles
- Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA
| | - William K Conaway
- Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA
| | - David M Reiter
- Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Rachel Honig
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | | | - Ahmad Nassr
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | | | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| | | | - Ian D Kaye
- Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Christopher Kepler
- Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Gregory Schroeder
- Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Alexander Vaccaro
- Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Scott Wagner
- Walter Reed National Military Medical Center, Bethesda, MD
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10
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Divi SN, Goyal DK, Woods BI, Nicholson KJ, Salmons HI, Galetta MS, Qureshi MA, Lam ME, DiMatteo AL, Greg Anderson D, Kurd MF, Rihn JA, Kaye ID, Kepler CK, Hilibrand AS, Vaccaro AR, Radcliff KE, Schroeder GD. How Do Patients With Predominant Neck Pain Improve After Anterior Cervical Discectomy and Fusion for Cervical Radiculopathy? Int J Spine Surg 2022; 16:240-246. [PMID: 35273114 PMCID: PMC9930673 DOI: 10.14444/8212] [Citation(s) in RCA: 2] [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] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The presence of predominant pain in the arm vs the neck as a predictor of postoperative outcomes after anterior cervical discectomy and fusion (ACDF) has been seldom reported; therefore, the purpose of this study was to determine whether patients with predominant neck pain improve after surgery compared to patients with predominant arm pain or those with mixed symptoms in patients undergoing ACDF for radiculopathy. METHODS A retrospective cohort study was conducted on patients who underwent ACDF at a single center from 2016 to 2018. Patients were split into groups based on preoperative neck and arm pain scores: neck (N) pain dominant group (visual analog scale [VAS] neck ≥ VAS arm by 1.0 point); neutral group (VAS neck < VAS arm by 1.0 point); or arm (A) pain dominant group (VAS arm ≥ VAS neck by 1.0 point), using a threshold difference of 1.0 point. Subsequently, individuals were substratified into 2 groups based on the arm to neck pain ratio (ANR): non-arm pain dominant defined as ANR ≤1.0 and arm pain dominant (APD) defined as ANR >1.0. Patient-reported outcome measurements including Neck Disability Index (NDI), Physical Component Score-12, and Mental Component Score (MCS-12) were compared between groups. RESULTS No significant differences between groups when stratifying patients using a threshold difference of 1.0 point. When stratifying patients using the ANR, those in the APD group had significantly higher postoperative MCS-12 (P = 0.008) and NDI (P = 0.011) scores. In addition, the APD group showed a greater magnitude of improvement for MCS-12 and NDI scores (P = 0.043 and P = 0.038, respectively). Multiple linear regression showed that the A and the APD groups were both independent predictors of improvement in NDI. CONCLUSION Patients with dominant arm pain showed significantly greater improvement in terms of MCS-12 and NDI scores compared to patients with dominant neck pain. CLINICAL RELEVANCE To compare the impact of ACDF on arm and neck pain in the context of cervical radiculopathy using patient-reported outcome measures as an objective measurement. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Srikanth N. Divi
- Department of Orthopaedic Surgery, Rothman Institute Thomas Jefferson University, Philadelphia, PA, USA
| | - Dhruv K.C. Goyal
- Department of Orthopaedic Surgery, Rothman Institute Thomas Jefferson University, Philadelphia, PA, USA
| | - Barrett I. Woods
- Department of Orthopaedic Surgery, Rothman Institute Thomas Jefferson University, Philadelphia, PA, USA
| | - Kristen J. Nicholson
- Department of Orthopaedic Surgery, Rothman Institute Thomas Jefferson University, Philadelphia, PA, USA
| | - Harold I. Salmons
- Department of Orthopaedic Surgery, Rothman Institute Thomas Jefferson University, Philadelphia, PA, USA
| | - Matthew S. Galetta
- Department of Orthopaedic Surgery, Rothman Institute Thomas Jefferson University, Philadelphia, PA, USA
| | - Mahir A. Qureshi
- Department of Orthopaedic Surgery, Rothman Institute Thomas Jefferson University, Philadelphia, PA, USA
| | - Meghan E. Lam
- Department of Orthopaedic Surgery, Rothman Institute Thomas Jefferson University, Philadelphia, PA, USA
| | - Andrew L. DiMatteo
- Department of Orthopaedic Surgery, Rothman Institute Thomas Jefferson University, Philadelphia, PA, USA
| | - D. Greg Anderson
- Department of Orthopaedic Surgery, Rothman Institute Thomas Jefferson University, Philadelphia, PA, USA
| | - Mark F. Kurd
- Department of Orthopaedic Surgery, Rothman Institute Thomas Jefferson University, Philadelphia, PA, USA
| | - Jeffrey A. Rihn
- Department of Orthopaedic Surgery, Rothman Institute Thomas Jefferson University, Philadelphia, PA, USA
| | - Ian D. Kaye
- Department of Orthopaedic Surgery, Rothman Institute Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher K. Kepler
- Department of Orthopaedic Surgery, Rothman Institute Thomas Jefferson University, Philadelphia, PA, USA
| | - Alan S. Hilibrand
- Department of Orthopaedic Surgery, Rothman Institute Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexander R. Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute Thomas Jefferson University, Philadelphia, PA, USA
| | - Kristen E. Radcliff
- Department of Orthopaedic Surgery, Rothman Institute Thomas Jefferson University, Philadelphia, PA, USA
| | - Gregory D. Schroeder
- Department of Orthopaedic Surgery, Rothman Institute Thomas Jefferson University, Philadelphia, PA, USA
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11
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Sebastian AS, Wagner SC, Kaye ID, Kepler CK. Achieving Lumbar Fusion: An Evidence-Based Approach to Selecting Technique, Implants, and Biologics. Instr Course Lect 2022; 71:427-438. [PMID: 35254799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Many options currently exist for achieving lumbar fusion. A variety of techniques have been described. The challenge for spine surgeons is choosing which approach is ideal for the given circumstances, and to do this, a good understanding of the available evidence is necessary. The evidence regarding fusion approach, interbody cage utilization, bone grafting, biologics, and osteoporosis is reviewed.
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12
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McDonnell JM, Ahern DP, Wagner SC, Morrissey PB, Kaye ID, Sebastian AS, Butler JS. A Systematic Review of Risk Factors Associated With Distal Junctional Failure in Adult Spinal Deformity Surgery. Clin Spine Surg 2021; 34:347-354. [PMID: 34232153 DOI: 10.1097/bsd.0000000000001224] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 06/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The surgical management of adult spinal deformity (ASD) is a major surgical undertaking associated with considerable perioperative risk and a substantial complication profile. Although the natural history and risk factors associated with proximal junctional kyphosis (PJK) and proximal junctional failure are widely reported, distal junctional failure (DJF) is less well understood. STUDY DESIGN A systematic review was carried out. OBJECTIVES The primary objective is to identify the risk factors associated with DJF. The secondary objective is to delineate the incidence rate and causative factors associated with DJF. METHODS A systematic review of articles in Medline/PubMed and The Cochrane Library databases was performed according to preferred reporting items for systematic reviews and meta-analyses guidelines. Data was collated to determine the prevalence of DJF and overall revision rates, and identify potential risk factors for development of DJF. RESULTS Twelve studies were included for systematic review. There were 81/2261 (3.6%) cases of DJF. Overall, DJF represented 27.3% of all revision surgeries. Anterior-posterior surgery had a reduced incidence of postoperative DJF [5.0% vs. 8.7%; P=0.08; relative risk (RR)=1.73], as did patients below 60 years of age at the time of surgery (2.9% vs. 3.9%; P=0.09; RR=1.34). There was a higher incidence of DJF among those patients who received interbody fusion (9.9% vs. 5.1%; P=0.06; RR=1.93) compared with those who did not. However, none of these findings reached statistical significance. There were significantly more rates of DJF for fusions ending on L5 compared with constructs fused to the sacrum (11.7% vs. 3.6%; P=0.02; RR=3.28). CONCLUSIONS Cohorts 60 years and above of age at the time of surgery and patients managed with posterior-only fusion or interbody fusion have increased incidences of DJF. Fusion to L5 instead of the sacrum significantly influences DJF rates. However, the quality of available evidence is low and further high-quality studies are required to more robustly analyze the clinical, radiographic, and surgical risk factors associated with the development of DJF after ASD surgery.
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Affiliation(s)
| | - Daniel P Ahern
- School of Medicine, Trinity College Dublin
- National Spinal Injuries Unit, Department of Trauma and Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Scott C Wagner
- Division of Orthopedics, Walter Reed National Military Medical Center, Washington, DC
| | - Patrick B Morrissey
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, CA
| | - Ian D Kaye
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | | | - Joseph S Butler
- National Spinal Injuries Unit, Department of Trauma and Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
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13
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Divi SN, Woods BI, Goyal DKC, Galetta MS, Nicholson KJ, Dimatteo AL, Lam ME, Qureshi MA, Anderson DG, Kurd MF, Rihn JA, Kaye ID, Kepler CK, Hilibrand AS, Vaccaro AR, Radcliff KE, Schroeder GD. Do Patients with Back Pain-Dominant Symptoms Improve After Lumbar Surgery for Radiculopathy or Claudication? Int J Spine Surg 2021; 15:780-787. [PMID: 34266928 DOI: 10.14444/8100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/20/2022] Open
Abstract
BACKGROUND Currently, few studies have examined whether patients with back or leg pain-predominant symptoms fare better clinically after lumbar spine surgery; therefore, the purpose of this study was to determine whether patients with back pain-dominant symptoms improved to a similar degree as patients with mixed or leg pain-dominant symptoms after lumbar surgery. METHODS A retrospective cohort study was conducted at a single academic center, in which patients were stratified into three groups: (1) back pain-dominant group (B) (visual analog score [VAS] back - VAS leg ≥ 1.0 point), (2) neutral group (N) (VAS back - VAS leg < 1.0 point), or (3) leg pain-dominant group (L) (VAS leg - VAS back ≥ 1.0 point), using a VAS threshold difference of 1.0 point. As a secondary analysis, the VAS leg-to-back pain (LBR) ratio was used to further stratify patients: (1) nonleg pain-dominant (NLPD) group (LBR ≤ 1.0) or (2) leg pain-dominant (LPD) group (LBR > 1.0). Patient outcomes, including physical component score of the short form-12 survey (PCS-12), mental component score of the short form-12 survey (MCS-12), and Oswestry Disability Index (ODI), were identified and compared between groups using univariate and multivariate analysis. RESULTS There were no significant differences in preoperative, postoperative, or delta scores for PCS-12 or ODI scores between groups. In patients undergoing decompression surgery, those with back pain-dominant or mixed symptoms (B, N, or NLPD groups) did not improve with respect to MCS-12 scores after surgery (P > .05), and those with leg pain-dominant symptoms (LPD group) had greater delta MCS-12 scores (P = .046) and greater recovery rates (P = .035). Multiple linear regression did not find LPD to be an independent predictor of PCS-12 or ODI scores. CONCLUSION Patients undergoing lumbar decompression surgery and leg pain-dominant symptoms noted a greater improvement in MCS-12 scores; however, there were no differences in PCS-12 or ODI scores. LEVEL OF EVIDENCE 3. CLINICAL RELEVANCE Patients undergoing lumbar decompression surgery demonstrate no major clinically significant differences when split up by pain-dominance groups.
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Affiliation(s)
- Srikanth N Divi
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Barrett I Woods
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Dhruv K C Goyal
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matthew S Galetta
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kristen J Nicholson
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Andrew L Dimatteo
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Meghan E Lam
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mahir A Qureshi
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - D Greg Anderson
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mark F Kurd
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jeffrey A Rihn
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ian D Kaye
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kristen E Radcliff
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
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14
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Sinensky AM, Kaye ID, Li WT, Wagner SC, Butler JS, Sebastian AS, Morrissey PB, Schroeder GD, Kepler C, Vaccaro AR, Hilibrand AS. Radiographic Measures of Spinal Alignment Are Not Predictive of the Development of C5 Palsy Following Anterior Cervical Discectomy and Fusion Surgery. Int J Spine Surg 2021; 15:213-218. [PMID: 33900977 DOI: 10.14444/8029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/20/2022] Open
Abstract
BACKGROUND Postoperative C5 palsy is a common complication following cervical decompression, occurring more frequently after posterior-based procedures. It has been theorized that this is the result of C5 nerve stretch resulting from spinal cord drift with these procedures. As such, it is thought to be less common after anterior cervical decompression and fusion (ACDF). However, no consensus has been reached on its true etiology. The purpose of this study is to assess the rate of C5 palsy following ACDF and to determine whether any radiographic or demographic parameters were predictive of its development. METHODS Two hundred and twenty-six patients who received ACDF between September 2015 and September 2016 were reviewed, and 122 were included in the final analysis. Patient demographic, surgical, and radiographic data were analyzed, including preoperative and postoperative radiographic and motor examination results. The Mann-Whitney U test was used to compare continuous variables between independent groups, and Fisher's exact test was used to compare categorical variables between groups. RESULTS Seven patients developed a C5 palsy in the postoperative period, an incidence rate of 5.7%. Among the radiographic parameters evaluated, there were no statistically significant differences between the C5 palsy and nonpalsy groups. Additionally, there were no statistically significant differences in age, patient sex, or numbers of vertebral levels fused between groups. CONCLUSIONS Ultimately, we did not identify any statistically significant demographic or radiographic predictive factors for the development of C5 palsy following ACDF surgery. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Andrew M Sinensky
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ian D Kaye
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
| | - William T Li
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Scott C Wagner
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Joseph S Butler
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
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15
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Goyal DK, Tarazona DA, Segar A, Sutton R, Motto MA, Divi SN, Galtta MS, Hilibrand AS, Kaye ID, Kurd MF, Radcliff KE, Rihn JA, Anderson DG, Kepler CK, Hsu V, Woods B, Vaccaro AR, Schroeder GD. Lumbar Pedicle Morphology and Vertebral Dimensions in Isthmic and Degenerative Spondylolisthesis-A Comparative Study. Int J Spine Surg 2021; 15:243-250. [PMID: 33900981 PMCID: PMC8059380 DOI: 10.14444/8009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/20/2022] Open
Abstract
BACKGROUND The pedicle screw is the most common device used to achieve fixation in fusion of spondylolistheses. Safe and accurate placement with this technique relies on a thorough understanding of the bony anatomy. There is a paucity of literature comparing the surgically relevant osseous anatomy in patients with a degenerative spondylolisthesis (DS) and an isthmic spondylolisthesis (IS). The goal of this study was to determine the differences in the osseous anatomy in patients with a DS and those with an IS. METHODS A retrospective comparative cohort study was conducted on patients with a single-level, symptomatic L4-L5 DS or a single-level, symptomatic L5-S1 IS. Magnetic resonance imaging for these patients was reviewed. Morphometries of the pedicle and vertebral body were analyzed by 2 independent observers for the levels from L3 to S1, and radiographic parameters were compared between groups. RESULTS A total of 572 levels in 143 patients were studied, including 103 patients with a DS and 40 with an IS. After accounting for confounders, IS and DS had an independent effect on transverse vertebral body width, pedicle height and width, and sagittal pedicle angle. Patients with an IS had a smaller pedicle height (P < .001) and pedicle width (P = .001) than patients with DS. In addition, the angulation of the pedicles varied on the basis of the diagnosis. CONCLUSIONS The osseous anatomy is significantly different in patients with a DS than with an IS. Patients with an IS have smaller pedicles in the lumbar spine. Also, the L4 and L5 pedicles are more caudally angulated and the S1 pedicle is less medialized. LEVEL OF EVIDENCE 3. CLINICAL RELEVANCE Understanding the differences in pedicle anatomy is important for the safe placement of pedicle screws.
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Affiliation(s)
- Dhruv K.C. Goyal
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Daniel A. Tarazona
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Anand Segar
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ryan Sutton
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael A. Motto
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Srikanth N. Divi
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matthew S. Galtta
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alan S. Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ian D. Kaye
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mark F. Kurd
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kris E. Radcliff
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jeffrey A. Rihn
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - D. Greg Anderson
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Christopher K. Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Victor Hsu
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Barrett Woods
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alexander R. Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Gregory D. Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
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Divi SN, Kepler CK, Hilibrand AS, Goyal DKC, Mujica VE, Radcliff KE, Anderson DG, Kurd MF, Rihn JA, Kaye ID, Woods BR, Vaccaro AR, Schroeder GD. Patient Outcomes Following Short-segment Lumbar Fusion Are Not Affected by PI-LL Mismatch. Clin Spine Surg 2021; 34:73-77. [PMID: 33633060 DOI: 10.1097/bsd.0000000000001051] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 02/04/2020] [Accepted: 05/22/2020] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This is a retrospective cohort study. OBJECTIVE The objective of this study was to further elucidate the relationship between pelvic incidence-lumbar lordosis (PI-LL) mismatch and surgical outcomes in patients undergoing short segment lumbar fusions for degenerative lumbar disease. SUMMARY OF BACKGROUND DATA There are few studies examining the relationship between spinopelvic parameters and patient reported outcome measurements (PROMs) in short segment lumbar degenerative disease. MATERIALS AND METHODS A retrospective review was conducted at single academic institution. Patients undergoing 1- or 2-level lumbar fusion were retrospectively identified and separated into 2 groups based on postoperative PI-LL mismatch ≤10 degrees (NM) or PI-LL mismatch >10 degrees (M). Outcomes including the Physical Component Score (PCS)-12, Mental Component Score (MCS)-12, Oswestry Disability Index (ODI), Visual Analog Scale (VAS) back and leg scores were analyzed. Absolute PROM scores, the recovery ratio and the percentage of patients achieving minimum clinically important difference between groups were compared and a multiple linear regression analysis was performed. RESULTS A total of 306 patients were included, with 59 patients in the NM group and 247 patients in the M group. Patients in the M group started with a higher degree of PI-LL mismatch compared with the NM group (22.2 vs. 7.6 degrees, P<0.001) and this difference increased postoperatively (24.7 vs. 2.5 degrees, P<0.001). There were no differences between the 2 groups in terms of baseline, postoperative, or Δ outcome scores (P>0.05). In addition, having a PI-LL mismatch was not found to be an independent predictor of any PROM on multivariate analysis (P>0.05). CONCLUSION The findings in this study show that even though patients in the M group had a higher degree of mismatch preoperatively and postoperatively, there was no difference in PROMs. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Srikanth N Divi
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
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Divi SN, Schroeder GD, Goyal DKC, Radcliff KE, Galetta MS, Hilibrand AS, Anderson DG, Kurd MF, Rihn JA, Kaye ID, Woods BR, Vaccaro AR, Kepler CK. Fusion technique does not affect short-term patient-reported outcomes for lumbar degenerative disease. Spine J 2019; 19:1960-1968. [PMID: 31356987 DOI: 10.1016/j.spinee.2019.07.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 04/25/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND/CONTEXT Degenerative lumbar disease can be addressed via an anterior or posterior approach, and with or without the use of an interbody cage. Although several studies have compared the type of approach and technique, there is a lack of literature assessing patient-reported outcome measures (PROMs) and radiographic parameters between different fusion techniques. PURPOSE To determine whether the surgical approach and fusion technique for lumbar degenerative disease had an effect on short-term PROMs and radiographic parameters. STUDY DESIGN/SETTING Retrospective Cohort Study. PATIENT SAMPLE Three hundred and ninety-one patients who underwent a 1-3 level lumbar spine fusion procedure at a high-volume academic center were retrospectively identified. Patients were divided into three groups based on the type of fusion they underwent: posterolateral fusion (PLF), anterior lumbar interbody fusion (ALIF), or transforaminal lumbar interbody fusion (TLIF). OUTCOME MEASURES PROMs: Short Form-12 (SF-12) Physical Component Score (PCS) and Mental Component Score (MCS), Oswestry Disability Index (ODI), Visual Analog Score (VAS) Back, VAS Leg. Spinopelvic measurements: Pelvic Tilt (PT), Sacral Slope (SS), Pelvic Incidence (PI), Lumbar Lordosis (LL), Segmental Lordosis (SL), PI-LL mismatch. METHODS Patients with less than 1-year follow-up were excluded from the cohort. Pre- and postoperative spinopelvic measurements were obtained for all patients. Univariate analysis (Chi-squared/Fisher's exact test or ANOVA test with post-hoc Bonferroni test) was used to compare among the three groups in the PROMs and radiographic spinopelvic parameters. Multiple linear regression was used to determine if fusion technique was an independent predictor of change in each patient outcome. RESULTS Two hundred and sixteen patients were included in the PLF group, 33 patients in the ALIF group, and 142 patients in the TLIF group. The PLF group was significantly older at baseline (p<.001) and had lower preoperative diagnosis rates of degenerative scoliosis and disc herniations (p<.001), whereas the ALIF group underwent a higher proportion of three-level fusions (p<.001). There was no significant difference in spinopelvic parameters preoperatively, however the ALIF group showed significantly more improvement in SL postoperatively (p=.004) than the PLF and TLIF groups. Within each group, SL improved for the PLF and ALIF groups (p=.002 for both), but not for the TLIF group (p=.238). Comparing patient outcomes, the ALIF group reported lower preoperative VAS Leg scores (p=.031), however, this difference resolved postoperatively. Stratifying for preoperative diagnosis, there were no significant differences in outcomes, except for a greater improvement in VAS Leg scores for degenerative scoliosis patients undergoing ALIF. Using multivariate analysis, fusion technique was not found to be a significant predictor of change in any patient outcome or in odds of revision. CONCLUSIONS Lumbar degenerative disease can be treated with several different fusion techniques, however, the relationship between type of fusion and PROMs is not established. Based on the findings in this study, the ALIF group showed greater improvement in SL compared with the PLF and TLIF groups, however, there was no difference noted in overall LL, PI-LL mismatch or other spinopelvic parameters. Despite these radiographic findings, patient outcome measures remained similar between all three fusion types.
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Affiliation(s)
- Srikanth N Divi
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA 19107, USA.
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Dhruv K C Goyal
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Kristen E Radcliff
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Matthew S Galetta
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - D Greg Anderson
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Mark F Kurd
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Jeffrey A Rihn
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Ian D Kaye
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Barrett R Woods
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA 19107, USA
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Wagner SC, Sebastian AS, McKenzie JC, Butler JS, Kaye ID, Morrissey PB, Vaccaro AR, Kepler CK. Severe Lumbar Disability Is Associated With Decreased Psoas Cross-Sectional Area in Degenerative Spondylolisthesis. Global Spine J 2018; 8:716-721. [PMID: 30443482 PMCID: PMC6232713 DOI: 10.1177/2192568218765399] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVES Alterations in lumbar paraspinal muscle cross-sectional area (CSA) may correlate with lumbar pathology. The purpose of this study was to compare paraspinal CSA in patients with degenerative spondylolisthesis and severe lumbar disability to those with mild or moderate lumbar disability, as determined by the Oswestry Disability Index (ODI). METHODS We retrospectively reviewed the medical records of 101 patients undergoing lumbar fusion for degenerative spondylolisthesis. Patients were divided into ODI score ≤40 (mild/moderate disability, MMD) and ODI score >40 (severe disability, SD) groups. The total CSA of the psoas and paraspinal muscles were measured on preoperative magnetic resonance imaging (MRI). RESULTS There were 37 patients in the SD group and 64 in the MMD group. Average age and body mass index were similar between groups. For the paraspinal muscles, we were unable to demonstrate any significant differences in total CSA between the groups. Psoas muscle CSA was significantly decreased in the SD group compared with the MMD group (1010.08 vs 1178.6 mm2, P = .041). Multivariate analysis found that psoas CSA in the upper quartile was significantly protective against severe disability (P = .013). CONCLUSIONS We found that patients with severe lumbar disability had no significant differences in posterior lumbar paraspinal CSA when compared with those with mild/moderate disability. However, severely disabled patients had significantly decreased psoas CSA, and larger psoas CSA was strongly protective against severe disability, suggestive of a potential association with psoas atrophy and worsening severity of lumbar pathology.
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Affiliation(s)
- Scott C. Wagner
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA,
USA,Scott C. Wagner, Department of Orthopaedic
Surgery, Rothman Institute, Thomas Jefferson University Hospitals, Philadelphia,
PA 19107, USA.
| | | | - James C. McKenzie
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA,
USA
| | - Joseph S. Butler
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA,
USA
| | - Ian D. Kaye
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA,
USA
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Wagner SC, Morrissey PB, Kaye ID, Sebastian A, Butler JS, Kepler CK. Intraoperative pedicle screw navigation does not significantly affect complication rates after spine surgery. J Clin Neurosci 2017; 47:198-201. [PMID: 29050896 DOI: 10.1016/j.jocn.2017.09.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 09/30/2017] [Indexed: 11/19/2022]
Abstract
Various forms of intraoperative computer-assisted navigation technologies exist, and have consistently been shown to improve pedicle screw accuracy. However, the overall clinical effects of inaccurate pedicle screw placement have been debated. We examined the clinical effects of improved pedicle screw accuracy with computer navigation technology in reducing complication rates in patients undergoing multi-level spinal fusion. We retrospectively reviewed the ACS-NSQIP registry utilizing Current Procedural Terminology (CPT) codes 22843 + 22844 to identify patients undergoing spinal instrumentation of greater than 7 levels, as well as the CPT code 61783 to denote the use of intraoperative computer-assisted navigation. The data were then subdivided to into cohorts consisting of instrumentation cases with and without navigation. Demographic information, as well as intraoperative and postoperative complications, were compared between groups. A total of 3168 patients met our inclusion criteria. There were no statistically significant differences in preoperative population data. Surgical time was significantly longer in the navigation group (391.41 versus 350.3 min), but there were no significant improvements in complication rates with the use of navigation. We found that the mean operative time was significantly increased for patients undergoing spinal instrumentation with computer navigation. This increase in operative time was not associated with any increase in surgical or medical complications. However, in this large series, we were unable to show any clinical benefit to intraoperative navigation, and no reductions in short term complications or rates of return to surgery were observed.
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Affiliation(s)
- Scott C Wagner
- Department of Orthopaedic Surgery, Rothman Instititute at Thomas Jefferson University, United States.
| | - Patrick B Morrissey
- Department of Orthopaedic Surgery, Rothman Instititute at Thomas Jefferson University, United States
| | - Ian D Kaye
- Department of Orthopaedic Surgery, Rothman Instititute at Thomas Jefferson University, United States
| | - Arjun Sebastian
- Department of Orthopaedic Surgery, Rothman Instititute at Thomas Jefferson University, United States
| | - Joseph S Butler
- Department of Orthopaedic Surgery, Rothman Instititute at Thomas Jefferson University, United States
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Instititute at Thomas Jefferson University, United States
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Bookman JS, Kaye ID, Chen KK, Jaffe FF, Schwarzkopf R. 10-Year Follow-Up Wear Analysis of Marathon Highly Cross-Linked Polyethylene in Primary Total Hip Arthroplasty. J Arthroplasty 2017; 32:2587-2589. [PMID: 28438454 DOI: 10.1016/j.arth.2017.03.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 02/20/2017] [Accepted: 03/07/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Short-term and intermediate-term wear rates for highly cross-linked polyethylene (HCLPE) liners in total hip arthroplasty (THA) are significantly lower than published rates for traditional polyethylene liners. The aim of this study was to report the longest-to-date follow-up of a specific HCLPE liner. METHODS A series of 35 THAs using a specific HCLPE liner were reviewed. Anteroposterior radiographs were reviewed for femoral head penetration, the presence of femoral and/or acetabular osteolysis, long-term survival, total wear, and wear rates in all patients. RESULTS The average patient age at time of surgery was 70 years with an average follow-up of 10 years (118 months; range, 7.2-13.4 years). The mean wear rate in our cohort was 0.07 mm/y. Total wear was 0.71 mm over the study period. No hips showed evidence of osteolysis in any zones. Survivorship at latest follow-up was 100% with all-cause revision as an end point. CONCLUSION The wear rate of HCLPE liners continues to be lower than published wear rates for traditional polyethylene and continues to reaffirm the acceptably low wear rates using HCLPE acetabular liner in primary THA.
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Affiliation(s)
- Jared S Bookman
- Department of Orthopaedic Surgery, NYU Langone Medical Center's Hospital for Joint Diseases, New York, New York
| | - Ian D Kaye
- Department of Orthopaedic Surgery, NYU Langone Medical Center's Hospital for Joint Diseases, New York, New York
| | - Kevin K Chen
- Department of Orthopaedic Surgery, NYU Langone Medical Center's Hospital for Joint Diseases, New York, New York
| | - Fredrick F Jaffe
- Department of Orthopaedic Surgery, NYU Langone Medical Center's Hospital for Joint Diseases, New York, New York
| | - Ran Schwarzkopf
- Department of Orthopaedic Surgery, NYU Langone Medical Center's Hospital for Joint Diseases, New York, New York
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Snir N, Kaye ID, Klifto CS, Hamula MJ, Wolfson TS, Schwarzkopf R, Jaffe FF. 10-year follow-up wear analysis of first-generation highly crosslinked polyethylene in primary total hip arthroplasty. J Arthroplasty 2014; 29:630-3. [PMID: 23993350 DOI: 10.1016/j.arth.2013.07.034] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [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: 04/08/2013] [Revised: 07/05/2013] [Accepted: 07/24/2013] [Indexed: 02/01/2023] Open
Abstract
Our goal was to report a 10-year follow up of linear penetration rates for HCLPE, and to determine whether a difference exists between penetrations measured on pelvis or hip anterior-posterior radiographs. We reviewed 48 total hip arthroplasties where a first-generation HCLPE liner was used. Femoral head penetration was measured on both AP pelvis and hip radiographs. Total wear and wear rate at 10 years were 1.26 mm and 0.122 mm/y, respectively. The rate decreased significantly after the first 2-3 years, plateauing at a wear rate of 0.05 mm/y for the last 5 years. The AP hip total wear and wear rate were 1.38 mm and 0.133 mm/y respectively, while rates were 1.13 mm and 0.109 mm/y respectively for the pelvis radiographs (P<.05). We found a significant difference in measurements of linear penetration when comparing AP pelvis vs. hip radiographs with lower rates recorded using an AP pelvis.
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Affiliation(s)
- Nimrod Snir
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York
| | - Ian D Kaye
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York
| | - Christopher S Klifto
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York
| | - Mathew J Hamula
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York
| | - Theodore S Wolfson
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York
| | - Ran Schwarzkopf
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, California
| | - Fredrick F Jaffe
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York
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