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Morse KW, Sun J, Hu L, Bok S, Debnath S, Cung M, Yallowitz AR, Meyers KN, Iyer S, Greenblatt MB. Development of Murine Anterior Interbody and Posterolateral Spinal Fusion Techniques. J Bone Joint Surg Am 2024; 106:735-745. [PMID: 38194481 DOI: 10.2106/jbjs.23.00690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND Multiple animal models have previously been utilized to investigate anterior fusion techniques, but a mouse model has yet to be developed. The purpose of this study was to develop murine anterior interbody and posterolateral fusion techniques. METHODS Mice underwent either anterior interbody or posterolateral spinal fusion. A protocol was developed for both procedures, including a description of the relevant anatomy. Samples were subjected to micro-computed tomography to assess fusion success and underwent biomechanical testing with use of 4-point bending. Lastly, samples were fixed and embedded for histologic evaluation. RESULTS Surgical techniques for anterior interbody and posterolateral fusion were developed. The fusion rate was 83.3% in the anterior interbody model and 100% in the posterolateral model. Compared with a control, the posterolateral model exhibited a greater elastic modulus. Histologic analysis demonstrated endochondral ossification between bridging segments, further confirming the fusion efficacy in both models. CONCLUSIONS The murine anterior interbody and posterolateral fusion models are efficacious and provide an ideal platform for studying the molecular and cellular mechanisms mediating spinal fusion. CLINICAL RELEVANCE Given the extensive genetic tools available in murine disease models, use of fusion models such as ours can enable determination of the underlying genetic pathways involved in spinal fusion.
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Affiliation(s)
- Kyle W Morse
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Jun Sun
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY
| | - Lingling Hu
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY
- Research Division, Hospital for Special Surgery, New York, NY
| | - Seoyeon Bok
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY
| | - Shawon Debnath
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY
| | - Michelle Cung
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY
| | - Alisha R Yallowitz
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY
| | - Kathleen N Meyers
- Department of Biomechanics, Hospital for Special Surgery, New York, NY
| | - Sravisht Iyer
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Matthew B Greenblatt
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY
- Research Division, Hospital for Special Surgery, New York, NY
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Manzi JE, Dowling B, Krichevsky S, Roberts NL, Sudah SY, Moran J, Chen FR, Quan T, Morse KW, Dines JS. Pitch-classifier model for professional pitchers utilizing 3D motion capture and machine learning algorithms. J Orthop 2024; 49:140-147. [PMID: 38682007 PMCID: PMC11043625 DOI: 10.1016/j.jor.2023.12.007] [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: 09/06/2022] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 05/01/2024] Open
Abstract
Introduction A pitcher's ability to achieve pitch location precision after a complex series of motions is of paramount importance. Kinematics have been used in analyzing performance benefits like ball velocity, as well as injury risk profile; however, prior utilization of such data for pitch location metrics is limited. Objective To develop a pitch classifier model utilizing machine learning algorithms to explore the potential relationships between kinematic variables and a pitcher's ability to throw a strike or ball. Methods This was a descriptive laboratory study involving professional baseball pitchers (n = 318) performing pitching tests under the setting of 3D motion-capture (480 Hz). Main outcome measures included accuracy, sensitivity, specificity, F1 score, positive predictive value (PPV), and negative predictive value (NPV) of the random forest model. Results The optimized random forest model resulted in an accuracy of 70.0 %, sensitivity of 70.3 %, specificity of 48.5 %, F1 equal to 80.6 %, PPV of 94.3 %, and a NPV of 11.6 %. Classification accuracy for predicting strikes and balls achieved an area under the curve of 0.67. Kinematics that derived the highest % increase in mean square error included: trunk flexion excursion(4.06 %), pelvis obliquity at foot contact(4.03 %), and trunk rotation at hand separation(3.94 %). Pitchers who threw strikes had significantly less trunk rotation at hand separation(p = 0.004) and less trunk flexion at ball release(p = 0.003) compared to balls. The positive predictive value for determining a strike was within an acceptable range, while the negative predictive value suggests if a pitch was determined as a ball, the model was not adequate in its prediction. Conclusions Kinematic measures of pelvis and trunk were crucial determinants for the pitch classifier sequence, suggesting pitcher kinematics at the proximal body segments may be useful in determining final pitch location.
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Affiliation(s)
- Joseph E. Manzi
- Department of Orthopaedic Surgery, Northwell Health, New York, NY, USA
| | - Brittany Dowling
- Sports Performance Center, Midwest Orthopaedics at Rush, Chicago, IL, USA
| | - Spencer Krichevsky
- Stony Brook University, Department of Biomedical Informatics, Stony Brook, NY, USA
| | | | - Suleiman Y. Sudah
- Department of Orthopaedic Surgery, Monmouth Medical Center, Monmouth, NJ, USA
| | - Jay Moran
- Yale School of Medicine, New Haven, CT, USA
| | - Frank R. Chen
- Department of Anesthesiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Theodore Quan
- George Washington University School of Medicine, Washington, DC 20037, USA
| | - Kyle W. Morse
- Sports Medicine Institute Hospital for Special Surgery, New York, NY, USA
| | - Joshua S. Dines
- Sports Medicine Institute Hospital for Special Surgery, New York, NY, USA
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3
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Bovonratwet P, Chen AZ, Song J, Morse KW, Shafi KA, Amen TB, Dowdell JE, Sheha ED, Qureshi SA, Iyer S. Telemedicine in Spine Patients: Utilization and Satisfaction Remain High Even After Easing of COVID-19 Lockdown Restrictions. Spine (Phila Pa 1976) 2024; 49:208-213. [PMID: 36856548 DOI: 10.1097/brs.0000000000004615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/06/2022] [Indexed: 03/02/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The objectives of the present study were to (1) define telemedicine utilization rates during and after the initial height of the COVID-19 lockdown period and (2) determine patient satisfaction with telemedicine during and after the initial height of the COVID-19 lockdown period for spine patients at an orthopedic specialty hospital. SUMMARY OF BACKGROUND DATA Previous studies have shown high patient satisfaction with telemedicine during the initial height of the COVID-19 pandemic. However, there exists limited data about spine telemedicine utilization and patient satisfaction after the reopening of in-person office visits and the easing of restrictions on elective surgical care. MATERIALS AND METHODS All patients who had an in-person or telemedicine visit at an urban tertiary specialty hospital from April 1, 2020 to April 15, 2021 were identified. Rates of overall telemedicine utilization over time were delineated. Patient satisfaction with telemedicine, as assessed through a series of questionnaires, was also evaluated over time. RESULTS Overall, 60,368 patients were identified. Of these, 19,568 patients (32.4%) had telemedicine visit. During the peak initial coronavirus lockdown period, the rate of overall telemedicine utilization, on average, was greater than 90%. After the peak period, the rate of overall telemedicine utilization on average was at ~29% of all visits per month. The percentage of patients who would have been definitely comfortable if the telemedicine visit had been in-person increased over the entire study period ( P <0.001). Despite this, patient satisfaction based on survey responses remained statistically similar throughout the study period ( P >0.05). CONCLUSION The rate of telemedicine utilization in spine patients remains high, at ~one-third of all visits, even after the initial peak coronavirus lockdown period. In addition, patient satisfaction with telemedicine remained consistent throughout the study period, regardless of pandemic restrictions on in-person visits. LEVEL OF EVIDENCE 3.
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Asada T, Simon CZ, Lu AZ, Adida S, Dupont M, Parel PM, Zhang J, Bhargava S, Morse KW, Dowdell JE, Iyer S, Qureshi SA. Robot-navigated pedicle screw insertion can reduce intraoperative blood loss and length of hospital stay: analysis of 1,633 patients utilizing propensity score matching. Spine J 2024; 24:118-124. [PMID: 37704046 DOI: 10.1016/j.spinee.2023.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/14/2023] [Accepted: 09/06/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND CONTEXT Navigation and robotic technologies have emerged as an alternative option to conventional freehand techniques for pedicle screw insertion. However, the effectiveness of these technologies in reducing the perioperative complications of spinal fusion surgery remains limited due to the small cohort size in the existing literature. PURPOSE To investigate whether utilization of robotically navigated pedicle screw insertion can reduce the perioperative complications of spinal fusion surgery-including reoperations-with a sizeable cohort. STUDY DESIGN Retrospective study. PATIENT SAMPLE Patients who underwent primary lumbar fusion surgery between 2019 and 2022. OUTCOME MEASURES Perioperative complications including readmission, reoperation, its reasons, estimated blood loss, operative time, and length of hospital stay. METHODS Patients' data were collected including age, sex, race, body mass index, upper-instrumented vertebra, lower-instrumented vertebra, number of screws inserted, and primary procedure name. Patients were classified into the following two groups: freehand group and robot group. The variable-ratio greedy matching was utilized to create the matched cohorts by propensity score and compared the outcomes between the two group. RESULTS A total of 1,633 patients who underwent primary instrumented spinal lumbar fusion surgery were initially identified (freehand 1,286; robot 347). After variable ratio matching was performed with age, sex, body mass index, fused levels, and upper instrumented vertebrae level, 694 patients in the freehand group and 347 patients in robot groups were selected. The robot group showed less estimated blood loss (418.9±398.9 vs 199.2±239.6 ml; p<.001), shorter LOS (4.1±3.1 vs 3.2±3.0 days; p<.001) and similar operative time (212.5 vs 222.0 minutes; p=.151). Otherwise, there was no significant difference in readmission rate (3.6% vs 2.6%; p=.498), reoperation rate (3.2% vs 2.6%; p=.498), and screw malposition requiring reoperation (five cases, 0.7% vs one case, 0.3%; p=1.000). CONCLUSIONS Perioperative complications requiring readmission and reoperation were similar between fluoroscopy guided freehand and robotic surgery. Robot-guided pedicle screw insertion can enhance surgical efficiency by reducing intraoperative blood loss and length of hospital stay without extending operative time.
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Affiliation(s)
- Tomoyuki Asada
- Hospital for Special Surgery, 535 E. 70th St, New York, NY 10021, USA; Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Chad Z Simon
- Hospital for Special Surgery, 535 E. 70th St, New York, NY 10021, USA
| | - Amy Z Lu
- Hospital for Special Surgery, 535 E. 70th St, New York, NY 10021, USA
| | - Samuel Adida
- Hospital for Special Surgery, 535 E. 70th St, New York, NY 10021, USA
| | - Marcel Dupont
- Hospital for Special Surgery, 535 E. 70th St, New York, NY 10021, USA
| | - Philip M Parel
- Hospital for Special Surgery, 535 E. 70th St, New York, NY 10021, USA
| | - Joshua Zhang
- Hospital for Special Surgery, 535 E. 70th St, New York, NY 10021, USA
| | - Satyaj Bhargava
- Hospital for Special Surgery, 535 E. 70th St, New York, NY 10021, USA
| | - Kyle W Morse
- Hospital for Special Surgery, 535 E. 70th St, New York, NY 10021, USA
| | - James E Dowdell
- Hospital for Special Surgery, 535 E. 70th St, New York, NY 10021, USA
| | - Sravisht Iyer
- Hospital for Special Surgery, 535 E. 70th St, New York, NY 10021, USA
| | - Sheeraz A Qureshi
- Hospital for Special Surgery, 535 E. 70th St, New York, NY 10021, USA.
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Damle SR, Krzyzanowska AK, Korsun MK, Morse KW, Gilbert S, Kim HJ, Boachie-Adjei O, Rawlins BA, van der Meulen MCH, Greenblatt MB, Hidaka C, Cunningham ME. Inducing Angiogenesis in the Nucleus Pulposus. Cells 2023; 12:2488. [PMID: 37887332 PMCID: PMC10605635 DOI: 10.3390/cells12202488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/28/2023] Open
Abstract
Bone morphogenetic protein (BMP) gene delivery to Lewis rat lumbar intervertebral discs (IVDs) drives bone formation anterior and external to the IVD, suggesting the IVD is inhospitable to osteogenesis. This study was designed to determine if IVD destruction with a proteoglycanase, and/or generating an IVD blood supply by gene delivery of an angiogenic growth factor, could render the IVD permissive to intra-discal BMP-driven osteogenesis and fusion. Surgical intra-discal delivery of naïve or gene-programmed cells (BMP2/BMP7 co-expressing or VEGF165 expressing) +/- purified chondroitinase-ABC (chABC) in all permutations was performed between lumbar 4/5 and L5/6 vertebrae, and radiographic, histology, and biomechanics endpoints were collected. Follow-up anti-sFlt Western blotting was performed. BMP and VEGF/BMP treatments had the highest stiffness, bone production and fusion. Bone was induced anterior to the IVD, and was not intra-discal from any treatment. chABC impaired BMP-driven osteogenesis, decreased histological staining for IVD proteoglycans, and made the IVD permissive to angiogenesis. A soluble fragment of VEGF Receptor-1 (sFlt) was liberated from the IVD matrix by incubation with chABC, suggesting dysregulation of the sFlt matrix attachment is a possible mechanism for the chABC-mediated IVD angiogenesis we observed. Based on these results, the IVD can be manipulated to foster vascular invasion, and by extension, possibly osteogenesis.
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Affiliation(s)
- Sheela R. Damle
- HSS Research Institute, Hospital for Special Surgery, 515 E 71st Street, New York, NY 10021, USA
| | - Agata K. Krzyzanowska
- HSS Research Institute, Hospital for Special Surgery, 515 E 71st Street, New York, NY 10021, USA
| | - Maximilian K. Korsun
- HSS Research Institute, Hospital for Special Surgery, 515 E 71st Street, New York, NY 10021, USA
| | - Kyle W. Morse
- HSS Research Institute, Hospital for Special Surgery, 515 E 71st Street, New York, NY 10021, USA
| | - Susannah Gilbert
- HSS Research Institute, Hospital for Special Surgery, 515 E 71st Street, New York, NY 10021, USA
| | - Han Jo Kim
- HSS Research Institute, Hospital for Special Surgery, 515 E 71st Street, New York, NY 10021, USA
- Weill Cornell Medical College, Cornell University, New York, NY 10065, USA
| | - Oheneba Boachie-Adjei
- HSS Research Institute, Hospital for Special Surgery, 515 E 71st Street, New York, NY 10021, USA
- Weill Cornell Medical College, Cornell University, New York, NY 10065, USA
| | - Bernard A. Rawlins
- HSS Research Institute, Hospital for Special Surgery, 515 E 71st Street, New York, NY 10021, USA
- Weill Cornell Medical College, Cornell University, New York, NY 10065, USA
| | - Marjolein C. H. van der Meulen
- HSS Research Institute, Hospital for Special Surgery, 515 E 71st Street, New York, NY 10021, USA
- Meinig School of Biomedical Engineering and Sibley School of Mechanical & Aerospace Engineering, Cornell University, Ithaca, NY 14853, USA
| | | | - Chisa Hidaka
- HSS Research Institute, Hospital for Special Surgery, 515 E 71st Street, New York, NY 10021, USA
- Department of Genetic Medicine and Belfer Gene Therapy Core Facility, Weill Medical College of Cornell University, New York, NY 10065, USA
| | - Matthew E. Cunningham
- HSS Research Institute, Hospital for Special Surgery, 515 E 71st Street, New York, NY 10021, USA
- Weill Cornell Medical College, Cornell University, New York, NY 10065, USA
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6
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Amen TB, Chatterjee A, Dekhne M, Rudisill SS, Subramanian T, Song J, Kazarian GS, Morse KW, Iyer S, Qureshi S. Improving Racial and Ethnic Disparities in Outpatient Anterior Cervical Discectomy and Fusion Driven by Increasing Utilization of Ambulatory Surgical Centers in New York State. Spine (Phila Pa 1976) 2023; 48:1282-1288. [PMID: 37249380 DOI: 10.1097/brs.0000000000004736] [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: 02/14/2023] [Accepted: 05/12/2023] [Indexed: 05/31/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The purpose of this study was to assess trends in disparities in utilization of hospital outpatient departments (HOPDs) and ambulatory surgical centers (ASCs) for outpatient ACDF (OP-ACDF) between White, Black, Hispanic, and Asian/Pacific Islander patients from 2015 to 2018 in New York State. SUMMARY OF BACKGROUND DATA Racial and ethnic disparities within the field of spine surgery have been thoroughly documented. To date, it remains unknown how these disparities have evolved in the outpatient setting alongside the rapid emergence of ASCs and whether restrictive patterns of access to these outpatient centers exist by race and ethnicity. MATERIALS AND METHODS We conducted a retrospective review from 2015 to 2018 using the Healthcare Cost and Utilization Project (HCUP) New York State Ambulatory Database. Differences in utilization rates for OP-ACDF were assessed and trended over time by race and ethnicity for both HOPDs and freestanding ASCs. Poisson regression was used to evaluate the association between utilization rates for OP-ACDF and race/ethnicity. RESULTS Between 2015 and 2018, Black, Hispanic, and Asian patients were less likely to undergo OP-ACDF compared with White patients in New York State. However, the magnitude of these disparities lessened over time, as Black, Hispanic, and Asian patients had greater relative increases in utilization of HOPDs and ASCs for ACDF when compared with White patients ( Ptrend <0.001). The magnitude of the increase in freestanding ASC utilization was such that minority patients had higher ACDF utilization rates in freestanding ASCs by 2018 ( P <0.001). CONCLUSIONS We found evidence of improving racial disparities in the relative utilization of outpatient ACDF in New York State. The increase in access to outpatient ACDF appeared to be driven by an increasing number of patients undergoing ACDF in freestanding ASCs in large metropolitan areas. These improving disparities are encouraging and contrast previously documented inequalities in inpatient spine surgery. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Troy B Amen
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
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7
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Bok S, Yallowitz AR, Sun J, McCormick J, Cung M, Hu L, Lalani S, Li Z, Sosa BR, Baumgartner T, Byrne P, Zhang T, Morse KW, Mohamed FF, Ge C, Franceschi RT, Cowling RT, Greenberg BH, Pisapia DJ, Imahiyerobo TA, Lakhani S, Ross ME, Hoffman CE, Debnath S, Greenblatt MB. A multi-stem cell basis for craniosynostosis and calvarial mineralization. Nature 2023; 621:804-812. [PMID: 37730988 PMCID: PMC10799660 DOI: 10.1038/s41586-023-06526-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 08/09/2023] [Indexed: 09/22/2023]
Abstract
Craniosynostosis is a group of disorders of premature calvarial suture fusion. The identity of the calvarial stem cells (CSCs) that produce fusion-driving osteoblasts in craniosynostosis remains poorly understood. Here we show that both physiologic calvarial mineralization and pathologic calvarial fusion in craniosynostosis reflect the interaction of two separate stem cell lineages; a previously identified cathepsin K (CTSK) lineage CSC1 (CTSK+ CSC) and a separate discoidin domain-containing receptor 2 (DDR2) lineage stem cell (DDR2+ CSC) that we identified in this study. Deletion of Twist1, a gene associated with craniosynostosis in humans2,3, solely in CTSK+ CSCs is sufficient to drive craniosynostosis in mice, but the sites that are destined to fuse exhibit an unexpected depletion of CTSK+ CSCs and a corresponding expansion of DDR2+ CSCs, with DDR2+ CSC expansion being a direct maladaptive response to CTSK+ CSC depletion. DDR2+ CSCs display full stemness features, and our results establish the presence of two distinct stem cell lineages in the sutures, with both populations contributing to physiologic calvarial mineralization. DDR2+ CSCs mediate a distinct form of endochondral ossification without the typical haematopoietic marrow formation. Implantation of DDR2+ CSCs into suture sites is sufficient to induce fusion, and this phenotype was prevented by co-transplantation of CTSK+ CSCs. Finally, the human counterparts of DDR2+ CSCs and CTSK+ CSCs display conserved functional properties in xenograft assays. The interaction between these two stem cell populations provides a new biologic interface for the modulation of calvarial mineralization and suture patency.
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Affiliation(s)
- Seoyeon Bok
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Alisha R Yallowitz
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Jun Sun
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Jason McCormick
- Flow Cytometry Core Facility, Weill Cornell Medicine, New York, NY, USA
| | - Michelle Cung
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Lingling Hu
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Sarfaraz Lalani
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Zan Li
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Branden R Sosa
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Tomas Baumgartner
- Flow Cytometry Core Facility, Weill Cornell Medicine, New York, NY, USA
| | - Paul Byrne
- Flow Cytometry Core Facility, Weill Cornell Medicine, New York, NY, USA
| | - Tuo Zhang
- Genomics Resources Core Facility, Weill Cornell Medicine, New York, NY, USA
| | - Kyle W Morse
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Fatma F Mohamed
- Department of Periodontics, Prevention and Geriatrics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Chunxi Ge
- Department of Periodontics, Prevention and Geriatrics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Renny T Franceschi
- Department of Periodontics, Prevention and Geriatrics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Randy T Cowling
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, CA, USA
| | - Barry H Greenberg
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, CA, USA
| | - David J Pisapia
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Thomas A Imahiyerobo
- Division of Plastic Surgery, Department of Surgery, New York-Presbyterian Hospital and Columbia University Medical Center, New York, NY, USA
| | - Shenela Lakhani
- Center for Neurogenetics, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - M Elizabeth Ross
- Center for Neurogenetics, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Caitlin E Hoffman
- Department of Neurological Surgery, Weill Cornell Medicine and New York-Presbyterian Hospital, New York, NY, USA
| | - Shawon Debnath
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA.
| | - Matthew B Greenblatt
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA.
- Research Division, Hospital for Special Surgery, New York, NY, USA.
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8
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Sun J, Hu L, Bok S, Yallowitz AR, Cung M, McCormick J, Zheng LJ, Debnath S, Niu Y, Tan AY, Lalani S, Morse KW, Shinn D, Pajak A, Hammad M, Suhardi VJ, Li Z, Li N, Wang L, Zou W, Mittal V, Bostrom MPG, Xu R, Iyer S, Greenblatt MB. A vertebral skeletal stem cell lineage driving metastasis. Nature 2023; 621:602-609. [PMID: 37704733 PMCID: PMC10829697 DOI: 10.1038/s41586-023-06519-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 08/04/2023] [Indexed: 09/15/2023]
Abstract
Vertebral bone is subject to a distinct set of disease processes from long bones, including a much higher rate of solid tumour metastases1-4. The basis for this distinct biology of vertebral bone has so far remained unknown. Here we identify a vertebral skeletal stem cell (vSSC) that co-expresses ZIC1 and PAX1 together with additional cell surface markers. vSSCs display formal evidence of stemness, including self-renewal, label retention and sitting at the apex of their differentiation hierarchy. vSSCs are physiologic mediators of vertebral bone formation, as genetic blockade of the ability of vSSCs to generate osteoblasts results in defects in the vertebral neural arch and body. Human counterparts of vSSCs can be identified in vertebral endplate specimens and display a conserved differentiation hierarchy and stemness features. Multiple lines of evidence indicate that vSSCs contribute to the high rates of vertebral metastatic tropism observed in breast cancer, owing in part to increased secretion of the novel metastatic trophic factor MFGE8. Together, our results indicate that vSSCs are distinct from other skeletal stem cells and mediate the unique physiology and pathology of vertebrae, including contributing to the high rate of vertebral metastasis.
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Affiliation(s)
- Jun Sun
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Lingling Hu
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Seoyeon Bok
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Alisha R Yallowitz
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Michelle Cung
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Jason McCormick
- Flow Cytometry Core Facility, Weill Cornell Medicine, New York, NY, USA
| | - Ling J Zheng
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Shawon Debnath
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Yuzhe Niu
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Adrian Y Tan
- Genomics Resources Core Facility, Weill Cornell Medicine, New York, NY, USA
| | - Sarfaraz Lalani
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Kyle W Morse
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Daniel Shinn
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Anthony Pajak
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Mohammed Hammad
- Research Division, Hospital for Special Surgery, New York, NY, USA
| | - Vincentius Jeremy Suhardi
- Research Division, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Zan Li
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Na Li
- State Key Laboratory of Cellular Stress Biology, School of Medicine, Xiamen University, Xiamen, China
| | - Lijun Wang
- Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Weiguo Zou
- Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, China
| | - Vivek Mittal
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Mathias P G Bostrom
- Research Division, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopedic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Ren Xu
- State Key Laboratory of Cellular Stress Biology, School of Medicine, Xiamen University, Xiamen, China
| | - Sravisht Iyer
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Matthew B Greenblatt
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA.
- Research Division, Hospital for Special Surgery, New York, NY, USA.
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9
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Thakur A, Groisser B, Hillstrom HJ, Cunningham ME, Hresko MT, Otremski H, Morse KW, Page K, Gmelich C, Kimmel R, Wolf A, Widmann RF, Heyer JH. 3D surface topographic measurements for idiopathic scoliosis are highly correlative to patient self-image questionnaires. Spine Deform 2023; 11:871-880. [PMID: 36881217 DOI: 10.1007/s43390-023-00672-3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/18/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE Adolescent idiopathic scoliosis (AIS) is a deformity of the spine that results in external asymmetry of the torso in the shoulder, waist, and rib hump. Several patient reported outcome measures (PROMS) including the Trunk Appearance Perception Scale (TAPS) and SRS-22r self-image domain are used to measure the patient's self-perception. The purpose of this study is to investigate the relationship between objective surface topographic measurements of the torso to subjective patient self-perception. METHODS 131 AIS subjects and 37 controls participated in this study. All subjects completed TAPS and SRS-22r PROMS followed by whole body 3d surface topographic scanning. An automated analysis pipeline was used to compute 57 measurements. Multivariate linear models were developed to predict TAPS and SRS-22r self-image using each unique combination of 3 parameters and leave one out validation where the best combinations were selected. RESULTS Back surface rotation, waist crease vertical asymmetry and rib prominence volume were most predictive of TAPS. The final predicted TAPS values from leave one out cross validation was correlated to ground truth TAPS scores with an R value of 0.65. Back surface rotation, silhouette centroid deviation, and shoulder normal asymmetry were most predictive of SRS-22r self-image with a correlation of R = 0.48. CONCLUSION Surface topographic measurements of the torso are correlated to TAPS and SRS-22r self-image scores in AIS patients and controls, with TAPS exhibiting a stronger relationship, better reflecting the patient's external asymmetries.
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Affiliation(s)
- Ankush Thakur
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | | | - Howard J Hillstrom
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | | | - M Timothy Hresko
- Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Hila Otremski
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Kyle W Morse
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Kira Page
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Caroline Gmelich
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | | | | | - Roger F Widmann
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Jessica H Heyer
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
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10
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Bovonratwet P, Kulm S, Kolin DA, Song J, Morse KW, Cunningham ME, Albert TJ, Sandhu HS, Kim HJ, Iyer S, Elemento O, Qureshi SA. Identification of Novel Genetic Markers for the Risk of Spinal Pathologies: A Genome-Wide Association Study of 2 Biobanks. J Bone Joint Surg Am 2023:00004623-990000000-00758. [PMID: 36927824 DOI: 10.2106/jbjs.22.00872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
BACKGROUND Identifying genetic risk factors for spinal disorders may lead to knowledge regarding underlying molecular mechanisms and the development of new treatments. METHODS Cases of lumbar spondylolisthesis, spinal stenosis, degenerative disc disease, and pseudarthrosis after spinal fusion were identified from the UK Biobank. Controls were patients without the diagnosis. Whole-genome regressions were used to test for genetic variants potentially implicated in the occurrence of each phenotype. External validation was performed in FinnGen. RESULTS A total of 389,413 participants were identified from the UK Biobank. A locus on chromosome 2 spanning GFPT1, NFU1, AAK1, and LOC124906020 was implicated in lumbar spondylolisthesis. Two loci on chromosomes 2 and 12 spanning genes GFPT1, NFU1, and PDE3A were implicated in spinal stenosis. Three loci on chromosomes 6, 10, and 15 spanning genes CHST3, LOC102723493, and SMAD3 were implicated in degenerative disc disease. Finally, 2 novel loci on chromosomes 5 and 9, with the latter corresponding to the LOC105376270 gene, were implicated in pseudarthrosis. Some of these variants associated with spinal stenosis and degenerative disc disease were also replicated in FinnGen. CONCLUSIONS This study revealed nucleotide variations in select genetic loci that were potentially implicated in 4 different spinal pathologies, providing potential insights into the pathological mechanisms. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Scott Kulm
- Caryl and Israel Englander Institute of Precision Medicine, Weill Cornell Medicine, New York, NY
| | - David A Kolin
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Junho Song
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Kyle W Morse
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | | | - Todd J Albert
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | | | - Han Jo Kim
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Sravisht Iyer
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Olivier Elemento
- Caryl and Israel Englander Institute of Precision Medicine, Weill Cornell Medicine, New York, NY
| | - Sheeraz A Qureshi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
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11
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Sun J, Hu L, Bok S, Yallowitz AR, Cung M, McCormick J, Zheng LJ, Debnath S, Niu Y, Tan AY, Lalani S, Morse KW, Shinn D, Pajak A, Li Z, Li N, Xu R, Iyer S, Greenblatt MB. Discovery of a Vertebral Skeletal Stem Cell Driving Spinal Metastases. Res Sq 2023:rs.3.rs-2106142. [PMID: 36747772 PMCID: PMC9901027 DOI: 10.21203/rs.3.rs-2106142/v1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Vertebral bone is subject to a distinct set of disease processes from those of long bones, notably including a much higher rate of solid tumor metastases that cannot be explained by passive blood flow distribution alone. The basis for this distinct biology of vertebral bone has remained elusive. Here we identify a vertebral skeletal stem cell (vSSC), co-expressing the transcription factors ZIC1 and PAX1 together with additional cell surface markers, whose expression profile and function are markedly distinct from those of long bone skeletal stem cells (lbSSCs). vSSCs display formal evidence of stemness, including self-renewal, label retention and sitting at the apex of their differentiation hierarchy. Lineage tracing of vSSCs confirms that they make a persistent contribution to multiple mature cell lineages in the native vertebrae. vSSCs are physiologic mediators of spine mineralization, as genetic blockade of the ability of vSSCs to generate osteoblasts results in defects in the vertebral neural arch and body. Human counterparts of vSSCs can be identified in vertebral endplate specimens and display a conserved differentiation hierarchy and stemness. Multiple lines of evidence indicate that vSSCs contribute to the high rates of vertebral metastatic tropism observed clinically in breast cancer. Specifically, when an organoid system is used to place both vSSCs and lbSSCs in an identical anatomic context, vSSC-lineage cells are more efficient than lbSSC-lineage cells at recruiting metastases, a phenotype that is due in part to increased secretion of the novel metastatic trophic factor MFGE8. Similarly, genetically targeting loss-of-function to the vSSC lineage results in reduced metastasis rates in the native vertebral environment. Taken together, vSSCs are distinct from other skeletal stem cells and mediate the unique physiology and pathology of vertebrae, including contributing to the high rate of metastatic seeding of the vertebrae.
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Affiliation(s)
- Jun Sun
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Lingling Hu
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Seoyeon Bok
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Alisha R Yallowitz
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Michelle Cung
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Jason McCormick
- Flow Cytometry Core Facility, Weill Cornell Medicine, New York, NY, USA
| | - Ling J Zheng
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Shawon Debnath
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Yuzhe Niu
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Adrian Y Tan
- Genomics Resources Core Facility, Weill Cornell Medicine, New York, NY, USA
| | - Sarfaraz Lalani
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Kyle W Morse
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Daniel Shinn
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
| | - Anthony Pajak
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Zan Li
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Na Li
- State Key Laboratory of Cellular Stress Biology, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Ren Xu
- State Key Laboratory of Cellular Stress Biology, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Sravisht Iyer
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Matthew B Greenblatt
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
- Research Division, Hospital for Special Surgery, New York, NY, USA
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12
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Louie PK, Sheikh Alshabab B, McCarthy MH, Virk S, Dowdell JE, Steinhaus ME, Lovecchio F, Samuel AM, Morse KW, Schwab FJ, Albert TJ, Qureshi SA, Iyer S, Katsuura Y, Huang RC, Cunningham ME, Yao YC, Weissmann K, Lafage R, Lafage V, Kim HJ. Classification system for cervical spine deformity morphology: a validation study. J Neurosurg Spine 2022; 37:865-873. [PMID: 35901688 DOI: 10.3171/2022.5.spine211537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 05/16/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to initially validate a recent morphological classification of cervical spine deformity pathology. METHODS The records of 10 patients for each of the 3 classification subgroups (flat neck, focal deformity, and cervicothoracic), as well as for 8 patients with coronal deformity only, were extracted from a prospective multicenter database of patients with cervical deformity (CD). A panel of 15 physicians of various training and professional levels (i.e., residents, fellows, and surgeons) categorized each patient into one of the 4 groups. The Fleiss kappa coefficient was utilized to evaluate intra- and interrater reliability. Accuracy, defined as properly selecting the main driver of deformity, was reported overall, by morphotype, and by reviewer experience. RESULTS The overall classification demonstrated a moderate to substantial agreement (round 1: interrater Fleiss kappa = 0.563, 95% CI 0.559-0.568; round 2: interrater Fleiss kappa = 0.612, 95% CI 0.606-0.619). Stratification by level of training demonstrated similar mean interrater coefficients (residents 0.547, fellows 0.600, surgeons 0.524). The mean intrarater score was 0.686 (range 0.531-0.823). A substantial agreement between rounds 1 and 2 was demonstrated in 81.8% of the raters, with a kappa score > 0.61. Stratification by level of training demonstrated similar mean intrarater coefficients (residents 0.715, fellows 0.640, surgeons 0.682). Of 570 possible questions, reviewers provided 419 correct answers (73.5%). When considering the true answer as being selected by at least one of the two main drivers of deformity, the overall accuracy increased to 86.0%. CONCLUSIONS This initial validation of a CD morphological classification system reiterates the importance of dynamic plain radiographs for the evaluation of patients with CD. The overall reliability of this CD morphological classification has been demonstrated. The overall accuracy of the classification system was not impacted by rater experience, demonstrating its simplicity.
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Affiliation(s)
- Philip K Louie
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.,2Department of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Franciscan Health, Seattle, Washington
| | - Basel Sheikh Alshabab
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Michael H McCarthy
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.,3Department of Orthopaedic Surgery, Indiana Spine Group, University of Indiana, Carmel, Indiana
| | - Sohrab Virk
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.,4Department of Orthopaedic Surgery, Northwell Health, New Hyde Park, New York
| | - James E Dowdell
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Michael E Steinhaus
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.,5Spine Institute, MountainStar Healthcare, Murray, Utah
| | - Francis Lovecchio
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Andre M Samuel
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Kyle W Morse
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Frank J Schwab
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.,4Department of Orthopaedic Surgery, Northwell Health, New Hyde Park, New York
| | - Todd J Albert
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Sheeraz A Qureshi
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Sravisht Iyer
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Yoshihiro Katsuura
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.,6Department of Orthopedics, Adventist Health, Willits, California
| | - Russel C Huang
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Matthew E Cunningham
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Yu-Cheng Yao
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.,7Department of Orthopedics, Taipei Veterans General Hospital, Taipei, Taiwan; and
| | - Karen Weissmann
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.,8Department of Orthopedics and Traumatology, University of Chile, Santiago, Chile
| | - Renaud Lafage
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.,4Department of Orthopaedic Surgery, Northwell Health, New Hyde Park, New York
| | - Virginie Lafage
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.,4Department of Orthopaedic Surgery, Northwell Health, New Hyde Park, New York
| | - Han Jo Kim
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
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13
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Manzi JE, Dowling B, Wang Z, Quan T, Nolan J, Moran J, Morse KW, Nicholson A, Dines JS. Kinetic and kinematic comparisons in high school pitchers with low and high pitch location consistency. J Shoulder Elbow Surg 2022; 31:2620-2628. [PMID: 35931332 DOI: 10.1016/j.jse.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/29/2022] [Accepted: 06/19/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although ball velocity has often been associated with increased kinetics at the upper extremity and risk of injury in youth and adolescent pitchers, it is unclear if the performance metric pitch location consistency has any positive or negative associations with pitching kinetics. METHODS High school pitchers (n = 59) pitched 8-12 fastballs using 3D motion capture (480 Hz). Pitchers were divided into high-consistency (HiCon) and low-consistency (LoCon) groups based on the absolute center deviation of each pitcher's pitch to the center of the pitcher's mean pitch location. Ninety-five percent confidence ellipses with major and minor radii were constructed, and kinematics and kinetics were compared between groups. RESULTS Compared with LoCon pitchers, HiCon pitchers had decreased lead hip flexion at elbow extension (40° ± 12° vs. 52° ± 13°, respectively, P = .008), and at foot contact, decreased back hip extension (-1° ± 10° vs. -10° ± 13°, respectively, P = .038) and increased back hip internal rotation (9° ± 15° vs. -2° ± 15°, respectively, P = .043). LoCon pitchers achieved maximum lead hip flexion earlier in the pitch (61.3% ± 23.2% vs. 75.8% ± 15.1%, respectively, P = .039). A multiregression model predicted 0.49 of variance in pitch location consistency using kinematic inputs. DISCUSSSION AND CONCLUSION Pitchers who differ in pitch location consistency outcomes do not appear to demonstrate physiologically unsafe kinematics. High school pitchers who strive for improved pitch consistency can consider adjusting parameters of hip kinematics during early portions of the pitch.
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Affiliation(s)
- Joseph E Manzi
- Department of Orthopaedic Surgery, Lenox Hill, New York, NY, USA.
| | - Brittany Dowling
- Sports Performance Center, Midwest Orthopaedics at Rush, Oak Brook, IL, USA
| | - Zhaorui Wang
- Department of Orthopaedic Surgery, Lenox Hill, New York, NY, USA
| | - Theodore Quan
- Department of Orthopedic Surgery, George Washington Hospital, Washington, DC, USA
| | | | - Jay Moran
- Yale University School of Medicine, New Haven, CT, USA
| | - Kyle W Morse
- Sports Medicine Institute Hospital for Special Surgery, New York, NY, USA
| | - Allen Nicholson
- Department of Orthopaedic Surgery, Monmouth Medical Center, Monmouth, NJ, USA
| | - Joshua S Dines
- Sports Medicine Institute Hospital for Special Surgery, New York, NY, USA.
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14
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Morse KW, Moore H, Kumagai H, Hahn W, Koo A, Meyers KN, Bouxsein ML, Brooks DJ, Lanske B, Iyer S, Cunningham M. Abaloparatide Enhances Fusion and Bone Formation in a Rabbit Spinal Arthrodesis Model. Spine (Phila Pa 1976) 2022; 47:1607-1612. [PMID: 35943233 PMCID: PMC10024932 DOI: 10.1097/brs.0000000000004452] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/21/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective randomized placebo controlled animal trial. OBJECTIVE Determine the effect of daily subcutaneous abaloparatide injection on the intervertebral fusion rate in rabbits undergoing posterolateral fusion. STUDY OF BACKGROUND DATA Despite the wide utilization of spine fusion, pseudarthrosis remains prevalent, and results in increased morbidity. Abaloparatide is a novel analog of parathyroid hormone-related peptide (1-34) and has shown efficacy in a rat posterolateral spine fusion model to increase fusion rates. The effect of abaloparatide on the fusion rate in a larger animal model remains unknown. MATERIALS AND METHODS A total of 24 skeletally mature New Zealand White male rabbits underwent bilateral posterolateral spine fusion. Following surgery, the rabbits were randomized to receive either saline as control or abaloparatide subcutaneous injection daily. Specimens underwent manual assessment of fusion, radiographic analysis with both x-ray and high-resolution peripheral quantitative computed tomography, and biomechanical assessment. RESULTS Rabbits that received abaloparatide had a 100% (10/10) fusion rate compared with 45% (5/11) for controls ( P <0.02) as assessed by manual palpation. Radiographic analysis determined an overall mean fusion score of 4.17±1.03 in the abaloparatide group versus 3.39±1.21 for controls ( P <0.001). The abaloparatide group also had a greater volume of bone formed with a bone volume of 1209±543 mm 3 compared with 551±152 mm 3 ( P <0.001) for controls. The abaloparatide group had significantly greater trabecular bone volume fraction and trabecular thickness and lower specific bone surface and connectivity density in the adjacent levels when compared with controls. Abaloparatide treatment did not impact trabecular number or separation. There were no differences in biomechanical testing in flexion, extension, or lateral bending ( P >0.05) between groups. CONCLUSIONS Abaloparatide significantly increased the fusion rate in a rabbit posterolateral fusion model as assessed by manual palpation. In addition, there were marked increases in the radiographic evaluation of fusion.
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Affiliation(s)
- Kyle W. Morse
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Harold Moore
- Weill Cornell Medical College, New York, NY, USA
| | - Hiroshi Kumagai
- Department of Orthopaedic Surgery, Tsukuba Memorial Hospital, Tsukuba, Japan
| | - William Hahn
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | | | - Kathleen N. Meyers
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Mary L. Bouxsein
- Center for Advanced Orthopaedic Studies, Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Daniel J. Brooks
- Center for Advanced Orthopaedic Studies, Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Sravisht Iyer
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Matthew Cunningham
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
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15
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Morse KW, Steinhaus M, Bovonratwet P, Kazarian G, Gang CH, Vaishnav AS, Lafage V, Lafage R, Iyer S, Qureshi S. Current treatment and decision-making factors leading to fusion vs decompression for one-level degenerative spondylolisthesis: survey results from members of the Lumbar Spine Research Society and Society of Minimally Invasive Spine Surgery. Spine J 2022; 22:1778-1787. [PMID: 35878759 DOI: 10.1016/j.spinee.2022.07.095] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 04/29/2022] [Revised: 06/13/2022] [Accepted: 07/18/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Degenerative spondylolisthesis (DS) is one of the most common pathologies spine surgeons treat. While a number of potential factors have been identified, there is no current consensus on which variables most impact the decision to fuse vs. decompress alone in this population. PURPOSE The purpose of this study was to describe current DS treatment practices and identify both the radiographic and clinical factors leading to the decision to fuse segments for one level DS. STUDY DESIGN/SETTING Descriptive cross-sectional survey. PATIENT SAMPLE Surveys were administered to members of Lumbar Spine Research Society and Society of Minimally Invasive Spine Surgery. OUTCOME MEASURES Surgeon demographics and treatment practices were reported. Radiographic and clinical parameters were ranked by each surgeon with regards to their importance. METHODS The primary analysis was limited to completed surveys. Baseline characteristics were summarized. Clinical and radiographic parameters were ranked and compared. Ranking of each clinical and radiographic parameters was reported using best and worst rank, mean rank position, and percentiles. The most important, top 3 most important, and top 5 most important parameters were ordered given each parameter's ranking frequency. RESULTS 381 surveys were returned completed. With regards to fusion vs. decompression, 19.9% fuse all cases, 39.1% fuse > 75%, 17.8% fuse 50%-75%, and 23.2% fuse <25%. The most common decompressive technique was a partial laminotomy (51.4%), followed by full laminectomy (28.9%). 82.2% of respondents instrument all fusion cases. Instability (93.2%), spondylolisthesis grade (59.8%), and laterolisthesis (37.3%) were the most common radiographic factors impacting the decision to fuse. With regards to the clinical factors leading to fusion, mechanical low back pain (83.2%), activity level (58.3%), and neurogenic claudication (42.8%) were the top 3 clinical parameters. CONCLUSIONS There is little consensus on the treatment of DS, with society members showing substantial variation in treatment patterns with the majority utilizing fusion for treatment. The most common radiographic parameters impacting treatment are instability, spondylolisthesis grade, and laterolisthesis while mechanical low back pain, activity level, and neurogenic claudication are the most common clinical parameters.
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Affiliation(s)
- Kyle W Morse
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA.
| | - Michael Steinhaus
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA; Intermountain Spine Institute, Murray, UT, USA
| | - Patawut Bovonratwet
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Gregory Kazarian
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Catherine Himo Gang
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Avani S Vaishnav
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA; Department of Orthopaedic Surgery, Boston University, Boston, MA, USA
| | - Virginie Lafage
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA; Department of Spine Surgery, Lenox Hill Hospital, New York, NY, USA
| | - Renaud Lafage
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Sravisht Iyer
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Sheeraz Qureshi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
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16
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Manzur MK, Samuel AM, Morse KW, Shafi KA, Gatto BJ, Gang CH, Qureshi SA, Iyer S. Indirect Lumbar Decompression Combined With or Without Additional Direct Posterior Decompression: A Systematic Review. Global Spine J 2022; 12:980-989. [PMID: 34011192 PMCID: PMC9344527 DOI: 10.1177/21925682211013011] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVE Indirect decompression via lateral lumbar interbody fusion (LLIF) can ameliorate central and foraminal lumbar stenosis. In severe central stenosis, additional posterior direct decompression is utilized. The aim of this review is to synthesize existing literature on these 2 techniques and identify significant differences in outcomes between isolated indirect decompression via LLIF and combined indirect decompression supplemented with direct posterior decompression. METHODS A database search algorithm was utilized to query MEDLINE, COCHRANE, and EMBASE to identify literature reporting adult decompression study groups that involved an oblique or lateral fusion approach through September 2020. Improvement in outcomes measures and complication rates were pooled and tested for significance. RESULTS A total of 110 publications were assessed with 15 studies meeting inclusion criteria, including 557 patients and 1008 levels. Mean age was 63.1 years with BMI of 27.5 kg/m2. For the combined indirect and direct decompression cohort, lumbar lordosis (LL) increased 133.9%, from 22.8o to 48.7o, while the indirect decompression cohort LL increased 8.9%, from 41.9o to 45.5o. Difference in LL improvement between cohorts was insignificant (P > .05). Oswestry Disability Index (ODI) decreased from 36.5 to 19.4 in the combined indirect and direct decompression cohort, and from 44.4 to 23.1 in the indirect decompression cohort. ODI reduction was insignificant (P = .053). CONCLUSIONS Prior studies of both indirect decompression as well as combined indirect and direct decompression of lumbar spine stenosis are limited by small samples, heterogeneous populations, and lack of direct comparisons. Both procedures result in improved function and pain postoperatively with direct decompression restoring more lordosis in patients with worse preoperative alignment.
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Affiliation(s)
- Mustfa K. Manzur
- Sidney Kimmel Medical College at Thomas
Jefferson University, Philadelphia, PA, USA
| | | | | | | | | | | | | | - Sravisht Iyer
- Hospital for Special Surgery, New York,
NY, USA,Sravisht Iyer, Department of Orthopedic
Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021,
USA.
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17
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Wessel LE, Kim J, Morse KW, Loisel F, Koff MF, Breighner RE, Doty SB, Wolfe SW. The Dorsal Ligament Complex: A Cadaveric, Histology, and Imaging Study. J Hand Surg Am 2022; 47:480.e1-480.e9. [PMID: 34294477 DOI: 10.1016/j.jhsa.2021.06.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 03/30/2021] [Accepted: 06/02/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The distinction between the dorsal intercarpal (DIC) and dorsal scaphotriquetral (DST) ligaments is imprecise and unclear in the literature. The purpose of our cadaveric study was to define the origins, insertions, and anatomic relationships of the dorsal wrist ligaments and relate these anatomic findings to magnetic resonance imaging (MRI) scans and histology. METHODS The study included 17 unmatched fresh-frozen cadaveric specimens (7 male and 10 female), with a mean age of 67.1 years (range, 48-86 years). Wrists with arthritis or carpal malalignment were excluded. Ligaments were dissected and insertion sites were recorded in the radioulnar (width) and proximodistal (length) dimensions, centered at the midpoints of the insertion. Three cadaveric specimens underwent a histologic analysis to demonstrate ligament composition and insertion sites. Three additional cadavers underwent MRI, from which 3-dimensional models were built to model ligament topography. RESULTS The conjoined triquetral insertion of the DIC, DST, and dorsal radiocarpal (DRC) measured 88.5 ± 6.4 mm2. In each specimen, there were 2 distinct deep and superficial components of intercarpal fibers. The deep component inserted on the lunate with an area of 59.0 ± 5.0 mm2. The deep and superficial components diverged as they coursed radially. The superficial component proceeded to the scaphoid ridge, trapezium, and trapezoid, whereas the deep component inserted on the proximal row. The deep fibers blended distally from their lunate insertion with the DST, forming a robust, 2.9 ± 0.8-mm wide extension over the dorsal capitate. The DRC inserted on the lunate, proximal to the DIC and DST insertions, with an area of 23.9 ± 5.4 mm2. CONCLUSIONS The dorsal ligament complex forms a firm link across the proximal carpal row and the DST provides extension of the proximal row over the capitate. CLINICAL RELEVANCE This information can guide surgeons while performing a dorsal approach to the wrist and repairing traumatic ligament disruption.
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Affiliation(s)
- Lauren E Wessel
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY.
| | - Jinseong Kim
- School of Medicine, Mt. Sinai Medical School, New York City, NY
| | - Kyle W Morse
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY
| | - Francois Loisel
- Department of Orthopaedic Surgery, University Hospital Besançon, Besançon, France
| | - Matthew F Koff
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, NY
| | - Ryan E Breighner
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, NY
| | - Stephen B Doty
- HSS Research Institute, Hospital for Special Surgery, New York City, NY
| | - Scott W Wolfe
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY
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18
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Morse KW, Heinz NK, Abolade JM, Wright-Chisem J, Alice Russell L, Zhang M, Mirza S, Pearce-Fisher D, Orange DE, Figgie MP, Sculco PK, Goodman SM. Factors Associated With Increasing Length of Stay for Rheumatoid Arthritis Patients Undergoing Total Hip Arthroplasty and Total Knee Arthroplasty. HSS J 2022; 18:196-204. [PMID: 35645648 PMCID: PMC9096994 DOI: 10.1177/15563316221076603] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Received: 09/01/2021] [Accepted: 11/05/2021] [Indexed: 12/12/2022]
Abstract
Background: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are cost-effective procedures that decrease pain and improve health-related quality of life for patients with advanced symptomatic arthritis, including rheumatoid arthritis (RA). Patients with RA have a longer length of stay (LOS) after THA or TKA than patients with osteoarthritis, yet the factors contributing to LOS have not been investigated. Purpose: We sought to identify the factors contributing to LOS for patients with RA undergoing THA and TKA at a single tertiary care orthopedic specialty hospital. Methods: We retrospectively reviewed data from a prospectively collected cohort of 252 RA patients undergoing either THA or TKA. Demographics, RA characteristics, medications, serologies, and disease activity were collected preoperatively. Linear regression was performed to explore the relationship between LOS (log-transformed) and possible predictors. A multivariate model was constructed through backward selection using significant predictors from a univariate analysis. Results: Of the 252 patients with RA, 83% were women; they had a median disease duration of 14 years and moderate disease activity at the time of arthroplasty. We had LOS data on 240 (95%) of the cases. The mean LOS was 3.4 ± 1.5 days. The multivariate analysis revealed a longer LOS for RA patients who underwent TKA versus THA, were women versus men, required a blood transfusion, and took preoperative opioids. Conclusion: Our retrospective study found that increased postoperative LOS in RA patients undergoing THA or TKA was associated with factors both non-modifiable (type of surgery, sex) and modifiable (postoperative blood transfusion, preoperative opioid use). These findings suggest that preoperative optimization of the patient with RA might focus on improving anemia and reducing opioid use in efforts to shorten LOS. More rigorous study is warranted.
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Affiliation(s)
- Kyle W. Morse
- Department of Medicine, Hospital for
Special Surgery, New York, NY, USA,Kyle W. Morse, MD, Department of Medicine,
Hospital for Special Surgery, 535 E 70th St., New York, NY 10021, USA.
| | - Nicole K. Heinz
- Department of Medicine, Hospital for
Special Surgery, New York, NY, USA
| | - Jeremy M. Abolade
- Department of Medicine, Hospital for
Special Surgery, New York, NY, USA
| | | | - Linda Alice Russell
- Department of Medicine, Hospital for
Special Surgery, New York, NY, USA,Department of Medicine, Weill Cornell
Medicine, New York, NY, USA
| | - Meng Zhang
- Department of Medicine, Feinstein
Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Serene Mirza
- Department of Medicine, Hospital for
Special Surgery, New York, NY, USA
| | | | - Dana E. Orange
- Department of Medicine, Hospital for
Special Surgery, New York, NY, USA,Rockefeller University, New York, NY,
USA
| | - Mark P. Figgie
- Department of Medicine, Hospital for
Special Surgery, New York, NY, USA,Department of Medicine, Weill Cornell
Medicine, New York, NY, USA
| | - Peter K. Sculco
- Department of Medicine, Hospital for
Special Surgery, New York, NY, USA,Department of Medicine, Weill Cornell
Medicine, New York, NY, USA
| | - Susan M. Goodman
- Department of Medicine, Hospital for
Special Surgery, New York, NY, USA,Department of Medicine, Weill Cornell
Medicine, New York, NY, USA
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19
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Samuel AM, Morse KW, Pompeu YA, Vaishnav AS, Gang CH, Kim HJ, Qureshi SA. Preoperative opioids before adult spinal deformity surgery associated with increased reoperations and high rates of chronic postoperative opioid use at 3-year follow-up. Spine Deform 2022; 10:615-623. [PMID: 35066794 PMCID: PMC9063716 DOI: 10.1007/s43390-021-00450-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 11/20/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine the association of preoperative opioid prescriptions with reoperations and postoperative opioid prescriptions after adult spina deformity (ASD) surgery. With the current opioid crisis, patients undergoing surgery for ASD are at particular risk for opioid-related complications due to significant preoperative disability and surgical morbidity. No previous studies consider preoperative opioids in this population. METHODS A retrospective cohort study of patients undergoing posterior spinal fusion (7 or more levels) for ASD was performed. All patients had at least 3 years of postoperative follow-up 3 years postoperatively. Prescriptions for 4 different opioid medications (hydromorphone, oxycodone, hydrocodone, and tramadol) were identified within 3 months preoperatively and up to 3 years postoperatively. Multivariate regression was utilized to determine the association of preoperative use with reoperations and with postoperative opioid use, controlling for both patient and surgery-related confounding factors. RESULTS A total of 743 patients were identified and 59.6% (443) had opioid prescriptions within 3 months preoperatively. Postoperative opioid prescriptions were identified in 66.9% of patients at 12 months postoperatively, and in 54.8% at 36 months postoperatively. The 3-year reoperation rate was 11.0% in patients without preoperative prescriptions, 16.0% in patients with preoperative any opioid prescriptions (P = 0.07), and 34.8% in patients with preoperative hydromorphone prescriptions (P < 0.01). In multivariate analysis, preoperative opioid prescriptions were associated with increased reoperations (odds ratio [OR]: 1.62, P = 0.04), and chronic postoperative opioid use (OR: 4.40, P < 0.01). Preoperative hydromorphone prescriptions had the strongest association with both reoperations (OR: 4.96; P < 0.01) and chronic use (OR: 5.19: P = 0.03). CONCLUSION In the ASD population, preoperative opioids are associated with both reoperations and chronic opioid use, with hydromorphone having the strongest association. Further investigation of the benefits of preoperative weaning programs is warranted.
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Affiliation(s)
- Andre M Samuel
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Kyle W Morse
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Yuri A Pompeu
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Avani S Vaishnav
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Catherine Himo Gang
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Han Jo Kim
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA
| | - Sheeraz A Qureshi
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
- Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA.
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20
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Morse KW, Alluri RK, Vaishnav AS, Urakawa H, Mok JK, Virk SS, Sheha ED, Qureshi SA. Do preoperative clinical and radiographic characteristics impact patient outcomes following one-level minimally invasive transforaminal lumbar interbody fusion based upon presenting symptoms? Spine J 2022; 22:570-577. [PMID: 34699995 PMCID: PMC9178522 DOI: 10.1016/j.spinee.2021.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 07/30/2021] [Revised: 09/13/2021] [Accepted: 10/12/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Patients undergoing minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) frequently present with lower extremity neurologic symptoms with or without associated lower back pain. While symptomatic improvement of leg and back pain has been reported, the resolution of back pain when it is a predominant presenting symptom remains underreported following MI-TLIF. PURPOSE The purpose of this study was to compare clinical outcomes at 1 year of patients undergoing MI-TLIF with lower extremity neurologic symptoms with and without a significant component of back pain. STUDY DESIGN A retrospective review of prospectively collected data from a single surgeon surgical database from 2017 to 2019 was performed. PATIENT SAMPLE Fifty one patients undergoing MI-TLIF. OUTCOME MEASURES Self-reported measures included the Oswestry Disability Index (ODI), Visual analog scale back pain (VAS-back), and VAS leg pain (VAS-leg). METHODS Patients were divided into two groups: Leg Pain Predominant (patients reported greater than 50% leg pain upon presentation) and Back Pain Predominant (patients reported 50% or greater back pain). Multivariate analysis was performed to determine differences between groups based upon any significantly baseline characteristics. RESULTS Preoperative demographic and radiographic outcomes were similar between the two groups. Both groups demonstrated significant improvement in ODI, VAS-Back and VAS-leg at 1-year postoperatively. On multivariate analysis, there were differences in ODI at 1-year, 1-year back pain, and 1-year leg pain between groups with those who initially presented with leg pain having a lower ODI, VAS Back, and VAS leg. Patients who presented with predominantly leg pain were more likely to meet minimal clinically important difference (MCID) criteria for ODI and VAS-back compared to those with predominantly back pain. CONCLUSION Following MI-TLIF, patients with lower extremity neurologic symptoms with and without a significant component of back pain have improvements in back pain, leg pain, and ODI regardless of their primary presenting pain complaint; however, patients who presented with predominantly leg pain were more likely to meet MCID criteria for improvement in their back pain and ODI score.
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Affiliation(s)
- Kyle W. Morse
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Ram K. Alluri
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Avani S. Vaishnav
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Hikari Urakawa
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | | | - Sohrab S. Virk
- Department of Orthopaedic Surgery, North Shore Long Island Jewish Medical Center, New Hyde Park, NY
| | - Evan D. Sheha
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.,Weill Cornell Medical College, New York, NY
| | - Sheeraz A. Qureshi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.,Weill Cornell Medical College, New York, NY.,Corresponding author: Sheeraz A. Qureshi, MD MBA, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA, Phone: 212-606-1585, Fax: 917-260-3185,
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21
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Abstract
Introduction: Pediatric spinal deformity involves a complex 3-dimensional (3D) deformity that increases the risk of pedicle screw placement due to the close proximity of neurovascular structures. To increase screw accuracy, improve patient safety, and minimize surgical complications, the placement of pedicle screws is evolving from freehand techniques to computer-assisted navigation and to the introduction of robotic-assisted placement. Purpose: The aim of this review was to review the current literature on the use of robotic navigation in pediatric spinal deformity surgery to provide both an error analysis of these techniques and to provide recommendations to ensure its safe application. Methods: A narrative review was conducted in April 2021 using the MEDLINE (PubMed) database. Studies were included if they were peer-reviewed retrospective or prospective studies, included pediatric patients, included a primary diagnosis of pediatric spine deformity, utilized robotic-assisted spinal surgery techniques, and reported thoracic or lumbar pedicle screw breach rates or pedicle screw malpositioning. Results: In the few studies published on the use of robotic techniques in pediatric spinal deformity surgery, several found associations between the technology and increased rates of screw placement accuracy, reduced rates of breach, and minimal complications. All were retrospective studies. Conclusions: Current literature is of a low level of evidence; nonetheless, the findings suggest the accuracy and safety of robotic-assisted spinal surgery in pediatric pedicle screw placement. The introduction of robotics may drive further advances in less invasive pediatric spinal deformity surgery. Further study is warranted.
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Affiliation(s)
- Kyle W. Morse
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Hila Otremski
- Pediatric Orthopedic Department, Dana Dwek Children’s Hospital, Tel Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Kira Page
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Roger F. Widmann
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
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22
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Avrumova F, Morse KW, Heath M, Widmann RF, Lebl DR. Evaluation of K-wireless robotic and navigation assisted pedicle screw placement in adult degenerative spinal surgery: learning curve and technical notes. J Spine Surg 2021; 7:141-154. [PMID: 34296026 DOI: 10.21037/jss-20-687] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/12/2021] [Indexed: 11/06/2022]
Abstract
Background K-wireless robotic pedicle screw instrumentation with navigation is a new technology with large potential. Barriers to adoption are added registration time with robotic-navigated system and reliable screw positioning. Understanding the learning curve and limitations is crucial for successful implementation. The purpose of this study was to describe a learning curve of k-wireless robotic assisted pedicle screw placement with navigation and compare to conventional techniques. Methods A retrospective review of prospectively collected data of 65 consecutive adult patients underwent robotic-navigated posterior spinal fusion by a single spine surgeon. Registration, screw placement, and positioning times were recorded. All patients underwent intra-operative 3D fluoroscopy and screw trajectory was compared to pre-operative CT. Results A total of 364 instrumented pedicles were planned robotically, 311 (85.4%) were placed robotically; 17 screws (4.7%) converted to k-wire, 21 (5.8%) converted to freehand, and 15 (4.1%) planned freehand. Of the 311 robotically placed pedicle screws, three dimensional fluoroscopic imaging showed 291 (93.5%) to be GRS Grade A in the axial plane (fully contained within the pedicle) and 281 (90.4%) were GRS Grade A in the sagittal plane. All breached screw deviations from plan were identified on 3D fluoroscopy during surgery and repositioned and confirmed by additional 3d fluoroscopy scan. Reasons for conversion included morphology of starting point (n=18), soft tissue pressure (n=9), hypoplastic pedicles (n=6), obstructive reference pin placement (n=2), and robotic arm issues (n=1). Seventeen (5.5%) critical breaches (≥2-4 mm) were recorded in 11 patients, 9 (2.9%) critical breaches were due to soft tissue pressure causing skive. Two patients experienced 6 (1.9%) critical breaches from hypoplastic pedicles, and 3 (0.9%) unplanned lateral breaches were found in another patient. One patient (0.3%) experienced skive due to morphology and spinal instability from isthmic spondylolisthesis. Imaging showed 143 screws placed medially to plan (1.2±0.9 mm), 170 lateral (1.2±1.1 mm), 193 screws caudal (1.0±0.6 mm) and 117 cranial (0.6±0.5 mm). No adverse clinical sequelae occurred from implantation of any screw. Conclusions The learning curve showed improvement in screw times for the first several cases. Understanding the learning curve and situations where the robotic technique may be suboptimal can help guide the surgeon safe and effectively for adoption, as well as further refine these technologies.
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Affiliation(s)
- Fedan Avrumova
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Kyle W Morse
- Academic Training, Hospital for Special Surgery, New York, NY, USA
| | - Madison Heath
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Roger F Widmann
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Darren R Lebl
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
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23
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Abstract
Background Femoroacetabular impingement and degenerative hip osteoarthritis (OA) affect athletes across a wide variety of sports. Hip resurfacing arthroplasty (HRA) has emerged as a surgical treatment for active individuals with end-stage hip OA to provide pain relief and allow return to high-impact activities. Return to professional sports after HRA has not been well characterized. Purpose/Hypothesis The aim of this study was to report on a series of elite athletes in a variety of sports who underwent HRA. We hypothesized that professional and elite-level athletes would be able to return to sports after HRA for end-stage hip OA. Study Design Case series; Level of evidence, 4. Methods A retrospective case series was conducted on professional athletes who underwent HRA at a single institution between 2007 and 2017. All surgeries were performed by a single surgeon using the posterolateral approach. Athletes' return to play and sport-specific performance statistics were obtained using self-reported and publicly available data sources. Athletes were matched to an age- and performance-based cohort to determine changes in performance-based metrics. Results Eight professional athletes were identified, including 2 baseball pitchers, 1 ice hockey defenseman, 1 foil fencer, 1 men's doubles tennis player, 1 basketball player, 1 ultramarathoner, and 1 Ironman triathlete. All 8 patients returned to sports; 6 of 8 (75%) patients were able to return for at least 1 full season at a professional level after surgery. There were no significant differences between performance statistics for athletes who returned to play and their preoperative performance measures for the years leading up to surgery or the age- and performance-matched cohort. Conclusion HRA remains a surgical alternative for end-stage hip OA in young, high-impact, active patients. While the primary goals of surgery are pain control and quality of life improvement, it is possible to return to elite-level sporting activity after HRA.
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Affiliation(s)
- Kyle W Morse
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Ajay Premkumar
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Andrew Zhu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Rachelle Morgenstern
- Department of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
| | - Edwin P Su
- Department of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
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24
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Morse KW, Heinz NK, Abolade JM, Wright-Chisem JI, Russell LA, Zhang M, Mirza SZ, Orange DE, Figgie MP, Sculco PK, Goodman SM. Response to Letter to the Editor on: Tranexamic Acid Does Not Reduce the Risk of Transfusion in Rheumatoid Arthritis Patients Undergoing Total Joint Arthroplasty. J Arthroplasty 2020; 35:3778-3779. [PMID: 32888753 DOI: 10.1016/j.arth.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 08/04/2020] [Indexed: 02/02/2023] Open
Affiliation(s)
- Kyle W Morse
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Nicole K Heinz
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Jeremy M Abolade
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | | | - Linda A Russell
- Department of Rheumatology, Hospital for Special Surgery, New York, NY
| | - Meng Zhang
- Feinstein Institute, Northwell Health, Manhasset, NY
| | | | - Dana E Orange
- Department of Rheumatology, Hospital for Special Surgery, New York, NY; Laboratory of Molecular Neurooncology, Rockefeller University, New York, NY
| | - Mark P Figgie
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Peter K Sculco
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Susan M Goodman
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY; Department of Rheumatology, Hospital for Special Surgery, New York, NY
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25
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Morse KW, Wessel LE, Premkumar A, James EW, Nwachukwu BU, Fufa DT. At the US Epicenter of the COVID-19 Pandemic, an Orthopedic Residency Program Reorganizes. HSS J 2020; 16:127-134. [PMID: 32837408 PMCID: PMC7325474 DOI: 10.1007/s11420-020-09765-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/19/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Kyle W. Morse
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Lauren E. Wessel
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Ajay Premkumar
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Evan W. James
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Benedict U. Nwachukwu
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Duretti T. Fufa
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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26
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Morse KW, Heinz NK, Abolade JM, Wright-Chisem JI, Russell LA, Zhang M, Mirza SZ, Orange DE, Figgie MP, Sculco PK, Goodman SM. Tranexamic Acid Does Not Reduce the Risk of Transfusion in Rheumatoid Arthritis Patients Undergoing Total Joint Arthroplasty. J Arthroplasty 2020; 35:2367-2374. [PMID: 32423756 DOI: 10.1016/j.arth.2020.04.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 02/18/2020] [Revised: 04/06/2020] [Accepted: 04/13/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Patients with rheumatoid arthritis (RA) receive transfusions more often than patients with osteoarthritis following lower extremity total joint arthroplasty (TJA), but mitigating factors are not described. Tranexamic acid (TXA) is widely used to reduce blood loss in patients undergoing TJA, but its effect on transfusion rates in patients with RA has not been studied. METHODS We retrospectively reviewed data from a prospectively collected cohort of patients with RA undergoing TJA. Disease activity measured by Clinical Disease Activity Index, patient-reported outcome measures, and serologies was obtained. Baseline characteristics were summarized and compared. Transfusion requirements and TXA usage were obtained from chart review. Logistic regression was used to determine factors associated with transfusion in RA patients undergoing TJA. RESULTS The cohort included 252 patients, mostly women with longstanding RA and end-stage arthritis requiring TJA. In multivariate analysis, 1 g/dL decrease in baseline hemoglobin (odds ratio [OR] = 0.394, 95% confidence interval [CI] [0.232, 0.669], P = .001), 1-minute increase in surgical duration (OR = 1.022, 95% CI [1.008, 1.037], P = .003), and 1-point increase in Clinical Disease Activity Index (OR = 1.079, 95% CI [1.001, 1.162]) were associated with increased risk of transfusion. TXA use was not associated with decreased risk of postoperative transfusion. CONCLUSIONS Preoperative health optimization should include assessment and treatment of anemia in RA patients before TJA, as preoperative hemoglobin level is the main risk factor for postoperative transfusion. Increased disease activity and increased surgical time were independent risk factors for postoperative transfusion but are less modifiable. While TXA did not decrease transfusion risk in this population, a prospective trial is needed to confirm this. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Kyle W Morse
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Nicole K Heinz
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Jeremy M Abolade
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | | | - Linda A Russell
- Department of Rheumatology, Hospital for Special Surgery, New York, NY
| | - Meng Zhang
- Feinstein Institute, Northwell Health, Manhasset, NY
| | - Serene Z Mirza
- Department of Rheumatology, Hospital for Special Surgery, New York, NY
| | - Dana E Orange
- Department of Rheumatology, Hospital for Special Surgery, New York, NY; Laboratory of Molecular Neurooncology, Rockefeller University, New York, NY
| | - Mark P Figgie
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Peter K Sculco
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Susan M Goodman
- Department of Rheumatology, Hospital for Special Surgery, New York, NY
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Abstract
Most minimally displaced scaphoid fractures and all displaced scaphoid fractures in elite athletes are treated with early fixation to maximally expedite the return to full function. Computed tomographic (CT) scans are recommended in all scaphoid fractures to facilitate a complete understanding of fracture anatomy and to allow for optimal screw placement. Screw placement is important to maximize healing capacity of the fracture and allow for return to sport. Postoperative CT scans can be helpful to evaluate the extent of healing and may allow patients to return to play sooner.
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Affiliation(s)
- Edward W Jernigan
- Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, 523 East 72nd Street, FL 4, New York, NY 10021, USA
| | - Kyle W Morse
- Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, 523 East 72nd Street, FL 4, New York, NY 10021, USA.
| | - Michelle G Carlson
- Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, 523 East 72nd Street, FL 4, New York, NY 10021, USA
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Abstract
PURPOSE OF REVIEW To summarize the current anatomy, biomechanics, presentation, treatment, and outcomes of injuries to the biceps and superior labral complex in overhead athletes. RECENT FINDINGS The biceps and superior labral complex is composed of anatomically distinct zones. The inability to accurately diagnose biceps lesions contributes to continued morbidity especially as arthroscopy and advanced imaging fail to fully evaluate the entire course of the biceps tendon. Superior labrum anterior and posterior (SLAP) repair, long head of biceps tenodesis, and tenotomy are the most common operative techniques for surgical treatment of biceps-labral complex (BLC) pathology. Labral repair in overhead athletes has resulted in mixed outcomes for athletes and is best indicated for patients under age 40 years old. Injuries to the BLC are potentially challenging injuries to diagnose and treat, particularly in the overhead athlete. SLAP repair remains the treatment of choice for high-level overhead athletes and patients younger than 40 years of age, while biceps tenodesis and tenotomy are preferred for older patients.
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Affiliation(s)
- Kyle W Morse
- Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, NY, USA.
| | - Jonathan-James Eno
- Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, NY, USA
| | - David W Altchek
- Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Joshua S Dines
- Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, NY, USA
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Swanstrom MM, Morse KW, Lipman JD, Hearns KA, Carlson MG. Variable Bone Density of Scaphoid: Importance of Subchondral Screw Placement. J Wrist Surg 2018; 7:66-70. [PMID: 29383278 PMCID: PMC5788749 DOI: 10.1055/s-0037-1605381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 11/14/2016] [Accepted: 07/10/2017] [Indexed: 10/19/2022]
Abstract
Background Ideal internal fixation of the scaphoid relies on adequate bone stock for screw purchase; so, knowledge of regional bone density of the scaphoid is crucial. Questions/Purpose The purpose of this study was to evaluate regional variations in scaphoid bone density. Materials and Methods Three-dimensional CT models of fractured scaphoids were created and sectioned into proximal/distal segments and then into quadrants (volar/dorsal/radial/ulnar). Concentric shells in the proximal and distal pole were constructed in 2-mm increments moving from exterior to interior. Bone density was measured in Hounsfield units (HU). Results Bone density of the distal scaphoid (453.2 ± 70.8 HU) was less than the proximal scaphoid (619.8 ± 124.2 HU). There was no difference in bone density between the four quadrants in either pole. In both the poles, the first subchondral shell was the densest. In both the proximal and distal poles, bone density decreased significantly in all three deeper shells. Conclusion The proximal scaphoid had a greater density than the distal scaphoid. Within the poles, there was no difference in bone density between the quadrants. The subchondral 2-mm shell had the greatest density. Bone density dropped off significantly between the first and second shell in both the proximal and distal scaphoids. Clinical Relevance In scaphoid fracture ORIF, optimal screw placement engages the subchondral 2-mm shell, especially in the distal pole, which has an overall lower bone density, and the second shell has only two-third the density of the first shell.
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Affiliation(s)
- Morgan M. Swanstrom
- Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York
| | - Kyle W. Morse
- Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York
| | - Joseph D. Lipman
- Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York
| | - Krystle A. Hearns
- Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York
| | - Michelle G. Carlson
- Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York
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Swanstrom MM, Morse KW, Lipman JD, Hearns KA, Carlson MG. Effect of Screw Perpendicularity on Compression in Scaphoid Waist Fractures. J Wrist Surg 2017; 6:178-182. [PMID: 28725497 PMCID: PMC5515612 DOI: 10.1055/s-0036-1596059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 08/08/2016] [Accepted: 10/25/2016] [Indexed: 10/20/2022]
Abstract
Background Central and perpendicular (PERP) screw orientations have each been described for scaphoid fracture fixation. It is unclear, however, which orientation produces greater compression. Questions/Purposes This study compares compression in scaphoid waist fractures with screw fixation in both PERP and pole-to-pole (PTP) configurations. PERP orientation was hypothesized to produce greater compression than PTP orientation. Methods Ten preoperative computed tomography scans of scaphoid waist fractures were classified by fracture type and orientation in the coronal and sagittal planes. Three-dimensional models of each scaphoid and fracture plane were created. Simulated Acutrak 2 (Acumed, Hillsboro, OR) screws were placed into the models in both PERP and PTP orientations. Engagement length and screw angle relative to the fracture were measured. Compression strength was calculated from the shear area, average density, and angle acuity. Results The PTP angle between screw and fracture ranged from 36 to 84 degrees. By definition, the PERP screw-to-fracture angle was 90 degrees. Perpendicularity of the PTP screw to the fracture was positively correlated to compression strength. PERP screws had greater compression than PTP screws when the PTP screw-to-fracture angle was < 80 degrees (106 vs. 80 N), but there was no difference in compression when the PTP screw-to-fracture angle was > 80 degrees, approximating the PERP screw. Conclusion Increasing screw perpendicularity resulted in higher compression when the screw-to-fracture angle of the PTP screw was < 80 degrees. Maximum compression was obtained with a screw PERP to the fracture. The increased compression gained from PERP screw placement offsets the decreased engagement length. Clinical Relevance These results provide guidelines for optimal screw placement in scaphoid waist fractures.
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Affiliation(s)
- Morgan M. Swanstrom
- Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York
| | - Kyle W. Morse
- Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York
| | - Joseph D. Lipman
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Krystle A. Hearns
- Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York
| | - Michelle G. Carlson
- Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York
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Morse KW, Astbury NM, Walczyszyn A, Hashim SA, Geliebter A. Changes in zinc-α2-glycoprotein (ZAG) plasma concentrations pre and post Roux-En-Y gastric bypass surgery (RYGB) or a very low calorie (VLCD) diet in clinically severe obese patients: Preliminary Study. ACTA ACUST UNITED AC 2017; 3. [PMID: 29367881 PMCID: PMC5777576 DOI: 10.15761/iod.1000170] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The purpose of this preliminary study was to investigate changes in plasma concentrations of zinc-α2-glycoprotein (ZAG), a lipid mobilizing hormone, in obese subjects following Roux-En-Y Gastric Bypass (RYGB) surgery or a very low calorie diet (VLCD). Fasting blood concentrations and anthropometric measurements were measured pre and 12 weeks post intervention. 14 healthy, obese individuals underwent either RYGB (N=6) surgery or a VLCD (N=8). Body composition and fasting plasma ZAG concentrations were measured at baseline (pre) and 12 weeks post intervention (post). At pre-intervention baseline, there was no difference in plasma ZAG between the two intervention groups. Post-intervention, there was a significant overall reduction (F(1,11) = 32.8, p<0.001) in plasma ZAG, which was significant only within the RYGB group from pre to post intervention (33.2 ± 5.7 μg/ml to 26.7 ± 4.8 μg/ml (p<0.015)) and significantly greater than the change within the VLCD group. The change in ZAG was inversely correlated across groups with BMI reduction (r= −0.60, p<0.05), % body fat reduction (r= −0.68, p<0.015), reduction in weight (r= −0.58, p<0.05), and % weight loss (r= −0.70, p<0.05). Overall, subjects who underwent RYGB or VLCD had a significant reduction in plasma ZAG. This reduction was significant within the RYGB group alone, who lost a larger amount of weight than the VLCD group, which suggests that ZAG may have a protective effect during marked weight loss.
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Affiliation(s)
- Kyle W Morse
- Weill Cornell Medical College, New York, NY, USA
| | | | | | | | - Allan Geliebter
- Weill Cornell Medical College, New York, NY, USA.,Department of Psychiatry, Mt Sinai St. Luke's Hospital, New York, NY, USA
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32
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Abstract
Background: Hand injuries can result in significant time away from competition for professional basketball players. Time to return to play after hand injuries in elite athletes has not been well described. Purpose: To report the return to play from metacarpal fractures, phalangeal fractures, and thumb ligament tears in National Basketball Association (NBA) players over a 5-year period. Study Design: Descriptive epidemiology study. Methods: The NBA transaction report was analyzed from January 2009 to May 2014. Players were identified if they were added to the inactive list (IL), missed games due to their injury, or underwent surgery as a result of hand injury. Number of games missed due to injury, days spent on the IL, and age at injury were calculated by injury type and location. Results: One hundred thirty-seven injuries were identified: 39 injuries to the hand and 98 injuries to the finger. Three major injury patterns were identified and analyzed: metacarpal fractures (n = 26), phalangeal fractures (n = 33), and thumb ligament tears (n = 9). The type of injury sustained affected return to play (P < .05). All thumb ligament tears required surgery and had the longest return to play of 67.5 ± 17.7 days (P < .05). The return to play for surgically treated metacarpal fractures (56.7 ± 26.3 days) was significantly greater than nonsurgically treated metacarpal fractures (26.3 ± 12.1 days; P < .01). Return to play for surgically repaired phalangeal fractures (46.2 ± 10.8 days) trended greater but was not significantly different than phalangeal fractures treated nonsurgically (33.3 ± 28.5 days; P = .21). Conclusion: Hand injuries in professional basketball players can lead to prolonged periods of time away from competition, especially after surgery. This study provides guidelines on expected return to play in the NBA after these common hand injuries.
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Affiliation(s)
- Kyle W. Morse
- Hospital for Special Surgery, New York, New York, USA
| | | | - Michelle Gerwin Carlson
- Hospital for Special Surgery, New York, New York, USA
- Michelle Gerwin Carlson, MD, Hospital for Special Surgery, 523 East 72nd Street, 4th Floor, New York, NY 10021, USA ()
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Ghatan AC, Puri SG, Morse KW, Hearns KA, von Althann C, Carlson MG. Relative Contribution of the Subsheath to Extensor Carpi Ulnaris Tendon Stability: Implications for Surgical Reconstruction and Rehabilitation. J Hand Surg Am 2016; 41:225-32. [PMID: 26691954 DOI: 10.1016/j.jhsa.2015.10.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 10/21/2015] [Accepted: 10/21/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify the varying contributions of the proximal and distal portions of the subsheath of the extensor carpi ulnaris (ECU) to its stability, evaluate the correlation of ulnar groove depth and ECU subluxation, and observe the effect of forearm and wrist positions on ECU stability. METHODS Extensor carpi ulnaris tendon position relative to the ulnar groove was measured in 10 human cadaveric specimens with the subsheath intact, partially sectioned (randomized to distal or proximal half), and fully sectioned. Measurements were obtained in 9 positions: forearm supinated, neutral, and pronated and wrist extended, neutral, and flexed. Ulnar groove depth was measured on all specimens. RESULTS In 7 of 10 specimens with an intact subsheath, the ECU tendon subluxated out of the groove in at least 1 forearm-wrist position. We noted the subluxation of the ECU tendon in all wrist-forearm positions with the exception of pronation-extension in at least 1 specimen. For partial subsheath sectioning, tendon displacement markedly increased after distal subsheath sectioning but not after proximal sectioning. For full subsheath sectioning, wrist flexion produced subluxation in all forearm positions, and forearm supination produced subluxation in all wrist positions. Maximum displacement occurred in supination-flexion. There was no correlation between ulnar groove depth and ECU subluxation. CONCLUSIONS Mild tendon subluxation occurred in the intact specimens in most tested positions. Two positions were remarkable for their consistency in maintaining the tendon within the groove: pronation-neutral and pronation-extension. In fully sectioned specimens, the greatest subluxation occurred in supination-flexion, with supination and flexion independently producing subluxation. Partial sectioning demonstrated that the distal portion of the subsheath played a more important role than the proximal portion in stabilizing the ECU. CLINICAL RELEVANCE Subsheath repair or reconstruction should target the distal portion of the subsheath. During postinjury rehabilitation or following surgical reconstruction, combined forearm supination and wrist flexion should be avoided.
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Das MK, Maiti PK, Roy S, Mittakanti M, Morse KW, Hall IH. Relationship of hypolipidemic and antineoplastic activities of tricyclohexyl- and triphenylphosphine boranes, carboxyboranes, cyanoboranes, and related derivatives. Arch Pharm (Weinheim) 1992; 325:267-72. [PMID: 1524468 DOI: 10.1002/ardp.19923250504] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A series of tricyclohexyl- and triphenylphosphine boranes, carboxyboranes and cyanoboranes were synthesized. These compounds have potent hypolipidemic effects, antineoplastic and antiinflammatory activities in rodents. Furthermore, they demonstrated potent cyctotoxicity against standard human tissue culture lines. The compounds which afforded the best hypolipidemic activity, i.e. greater than 40% reduction of serum cholesterol and triglyceride levels, were diphenyl-(4-methylphenyl)-phosphine borane and triphenylphosphine carboxyborane. Other derivatives demonstrated more potent antineoplastic activity against the Ehrlich ascites carcinoma growth including triphenylphosphine cyanoborane, 2-amino-4-methyl-pyridine cyanoborane and 2-amino-pyridine cyanoborane. Most of the derivatives showed good activity against murine L1210 lymphoid leukemia, Tmolt3 human leukemia, uterine HeLaS cells, and human glioma cell growth. Select compounds were active against colon adenocarcinoma, KB nasopharynx, lung bronchogenic and osteosarcoma cell growth. Tricyclohexyl- and triphenylphosphine boranes and the carboxy derivatives of the latter borane demonstrated good antiinflammatory activity.
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Affiliation(s)
- M K Das
- Department of Chemistry, Jadavpur University, Calcutta, India
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Hall IH, Wong OT, Sood A, Sood CK, Spielvogel BF, Shrewsbury RP, Morse KW. Hypolipidaemic activity in rodents of boron analogs of phosphonoacetates and cyanoborane adducts of dialkyl aminomethylphosphonates. Pharmacol Res 1992; 25:259-70. [PMID: 1518770 DOI: 10.1016/s1043-6618(05)80075-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Boron analogues of phosphonoacetates proved to be potent hypolipidaemic agents in rodents, lowering both serum cholesterol and triglyceride levels. (C2H5O)3PBH2COOCH3 proved to be the most effective agent in mice, lowering serum cholesterol 46% and serum triglycerides 54% after 16 days. (C2H5O)3PBH2COOH and Na+H+(C2H5O)2(-O)PBH2COO- caused greater than a 40% reduction in lipids. The cyanoborane adducts of aminomethylphosphonates were generally less effective; (C6H5O)2P(O)CH2NH2BH2CN was the most effective, lowering serum cholesterol 32% and serum triglycerides 43% after 16 days. The phosphonoacetates appeared to lower lipid concentrations by several mechanisms. First, they lowered the de novo synthesis of cholesterol and triglycerides in the liver. Second, they accelerated the excretion of lipids into the bile and faeces. Thirdly, they modulated LDL and HDL-cholesterol contents in a manner which suggests they reduced the deposition of lipids in peripheral tissues, and accelerated the movement of cholesterol from tissues (e.g. plaques) to the liver for excretion into the bile.
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Affiliation(s)
- I H Hall
- Division of Medicinal Chemistry and Natural Products, School of Pharmacy, University of North Carolina, Chapel Hill 27599
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Spielvogel BF, Sood A, Morse KW, Wong OT, Hall IH. The cytotoxicity of amine-cyanoboranes, amine-cyanoalkylboranes and aminomethyl-phosphonate cyanoborane adducts against the growth of murine and human tissue culture cells. Pharmazie 1991; 46:592-4. [PMID: 1798714] [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] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The amine-cyanoboranes, the amine-cyanoalkylboranes and the aminomethyl-phosphonate-N-cyanoborane adducts proved to be active antineoplastic agents. These compounds were more effective against single cell cultured cell growth rather than solid tumors. The following amine-cyanoboranes, (CH3)2(C18H37)NBH2CN (5), (CH3)2NHBH[CH(CH3)2]CN (7) and (CH3)3NB(CN)2.CH3 (10), were the most active in vivo and in vitro. A related phosphine-cyanoborane was also very active in both in vivo and in vitro model screens. Of the amino-methyl-phosphonate-N-cyanoborane adducts, (CH3O)2.P(O)CH2N(C2H5)2BH2CN (13) proved to be the most active. The amine-cyanoalkylboranes had the poorest in vivo activity; the in vitro cytotoxicity, however, was similar to that of other cyanoboranes.
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Affiliation(s)
- B F Spielvogel
- Gross Chemical Laboratory, Duke University, Durham, North Carolina
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Hall IH, Morse KW, Spielvogel BF, Sood A. DNA interaction with metal complexes and salts of substituted boranes and hydroborates in murine and human tumor cell lines. Anticancer Drugs 1991; 2:389-99. [PMID: 1797196 DOI: 10.1097/00001813-199108000-00009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A series of metal complexes and sodium salts of substituted boranes and hydroborates was shown to have cytotoxicity in murine and human tumor screens. Most of these agents were active against the growth of L-1210, Tmolt3 and Hela-S3. Selected agents demonstrated activity against the growth of monolayer human cell lines derived from solid tumors. Interestingly, many of the compounds demonstrated even lower ED50 values in the solid tumor than the L-1210 leukemic screen. Four compounds, Cu2(m-CH3)3NBH2CO2)4.2(CH3)NBH2COOH (I), [Fe3O((CH3)3NBH2CO2)6(CH3OH)3]NO3.CH3CN (II), cis-[Co(en)2((CH3)3N.BH2CO2)2]Cl.2.5 H2O.0.5 CH3OH (V), and Na(CH3)3NBH2CO2.0.25 CH3OH (IX) were shown preferentially to inhibit DNA synthesis of L-1210 cells with only moderate inhibition of RNA and protein synthesis. In preliminary studies these agents effectively inhibited the activities of regulatory enzymes involved in the purine pathway and nucleoside kinases resulting in the suppression of d(NTP) pool levels. The boron derivatives also caused L-1210 DNA strand scission. These drugs may act together to inhibit DNA synthesis and induce cytotoxicity.
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Affiliation(s)
- I H Hall
- Division of Medicinal Chemistry and Natural Products, School of Pharmacy, University of North Carolina, Chapel Hill 27599-7360
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Hall IH, Gilbert CJ, McPhail AT, Morse KW, Hassett K, Spielvogel BF. Antineoplastic activity of a series of boron analogues of alpha-amino acids. J Pharm Sci 1985; 74:755-8. [PMID: 4032249 DOI: 10.1002/jps.2600740712] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A series of amine cyanoboranes, amine carboxyboranes, and boron analogues of alpha-amino acids have been investigated for antineoplastic activity against the growth of Ehrlich ascites cells. Additional studies demonstrated that the boron analogues inhibited DNA and RNA synthesis at 300 microM. The suppression of DNA synthesis of Ehrlich ascites cells correlated with the reduction of DNA polymerase, 5-phosphoribosyl-1-pyrophosphate amidotransferase, and dihydrofolate reductase activities afforded by the boron compounds. These derivatives did not suppress protein synthesis, thymidylate synthetase, or thymidine monophosphate kinase activities as previously reported for some boron antineoplastic agents.
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