1
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Agarwal N, Johnson SE, Bydon M, Bisson EF, Chan AK, Shabani S, Letchuman V, Michalopoulos GD, Lu DC, Wang MY, Lavadi RS, Haid RW, Knightly JJ, Sherrod BA, Gottfried ON, Shaffrey CI, Goldberg JL, Virk MS, Hussain I, Glassman SD, Shaffrey ME, Park P, Foley KT, Pennicooke B, Coric D, Slotkin JR, Upadhyaya C, Potts EA, Tumialán LM, Chou D, Fu KMG, Asher AL, Mummaneni PV. Cervical spondylotic myelopathy and driving abilities: defining the prevalence and long-term postoperative outcomes using the Quality Outcomes Database. J Neurosurg Spine 2024; 40:630-641. [PMID: 38364219 DOI: 10.3171/2023.11.spine23738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/28/2023] [Indexed: 02/18/2024]
Abstract
OBJECTIVE Cervical spondylotic myelopathy (CSM) can cause significant difficulty with driving and a subsequent reduction in an individual's quality of life due to neurological deterioration. The positive impact of surgery on postoperative patient-reported driving capabilities has been seldom explored. METHODS The CSM module of the Quality Outcomes Database was utilized. Patient-reported driving ability was assessed via the driving section of the Neck Disability Index (NDI) questionnaire. This is an ordinal scale in which 0 represents the absence of symptoms while driving and 5 represents a complete inability to drive due to symptoms. Patients were considered to have an impairment in their driving ability if they reported an NDI driving score of 3 or higher (signifying impairment in driving duration due to symptoms). Multivariable logistic regression models were fitted to evaluate mediators of baseline impairment and improvement at 24 months after surgery, which was defined as an NDI driving score < 3. RESULTS A total of 1128 patients who underwent surgical intervention for CSM were included, of whom 354 (31.4%) had baseline driving impairment due to CSM. Moderate (OR 2.3) and severe (OR 6.3) neck pain, severe arm pain (OR 1.6), mild-moderate (OR 2.1) and severe (OR 2.5) impairment in hand/arm dexterity, severe impairment in leg use/walking (OR 1.9), and severe impairment of urinary function (OR 1.8) were associated with impaired driving ability at baseline. Of the 291 patients with baseline impairment and available 24-month follow-up data, 209 (71.8%) reported postoperative improvement in their driving ability. This improvement seemed to be mediated particularly through the achievement of the minimal clinically important difference (MCID) in neck pain and improvement in leg function/walking. Patients with improved driving at 24 months noted higher postoperative satisfaction (88.5% vs 62.2%, p < 0.01) and were more likely to achieve a clinically significant improvement in their quality of life (50.7% vs 37.8%, p < 0.01). CONCLUSIONS Nearly one-third of patients with CSM report impaired driving ability at presentation. Seventy-two percent of these patients reported improvements in their driving ability within 24 months of surgery. Surgical management of CSM can significantly improve patients' driving abilities at 24 months and hence patients' quality of life.
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Affiliation(s)
- Nitin Agarwal
- 1Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- 2Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- 3Neurological Surgery, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Sarah E Johnson
- 4Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mohamad Bydon
- 4Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Erica F Bisson
- 5Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Andrew K Chan
- 6Department of Neurosurgery, Columbia University Irving Medical Center, New York, New York
| | - Saman Shabani
- 7Department of Neurological Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Vijay Letchuman
- 8Department of Neurosurgery, University of California, San Francisco, San Francisco, California
| | | | - Daniel C Lu
- 9Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California
| | - Michael Y Wang
- 10Department of Neurological Surgery, University of Miami, Miami, Florida
| | - Raj Swaroop Lavadi
- 1Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Regis W Haid
- 11Atlanta Brain and Spine Care, Atlanta, Georgia
| | - John J Knightly
- 12Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Brandon A Sherrod
- 5Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Oren N Gottfried
- 13Department of Neurosurgery, Duke University, Durham, North Carolina
| | | | - Jacob L Goldberg
- 14Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | - Michael S Virk
- 14Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | - Ibrahim Hussain
- 14Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | | | - Mark E Shaffrey
- 16Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Paul Park
- 17Department of Neurosurgery, Semmes Murphey Clinic, University of Tennessee, Memphis, Tennessee
| | - Kevin T Foley
- 17Department of Neurosurgery, Semmes Murphey Clinic, University of Tennessee, Memphis, Tennessee
| | - Brenton Pennicooke
- 18Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Domagoj Coric
- 19Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina
| | | | - Cheerag Upadhyaya
- 21Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina
| | - Eric A Potts
- 22Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indianapolis, Indiana; and
| | - Luis M Tumialán
- 23Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Dean Chou
- 6Department of Neurosurgery, Columbia University Irving Medical Center, New York, New York
| | - Kai-Ming G Fu
- 14Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | - Anthony L Asher
- 19Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina
| | - Praveen V Mummaneni
- 8Department of Neurosurgery, University of California, San Francisco, San Francisco, California
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2
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Agarwal N, Letchuman V, Lavadi RS, Le VP, Aabedi AA, Shabani S, Chan AK, Park P, Uribe JS, Turner JD, Eastlack RK, Fessler RG, Fu KM, Wang MY, Kanter AS, Okonkwo DO, Nunley PD, Anand N, Mundis GM, Passias PG, Bess S, Shaffrey CI, Chou D, Mummaneni PV. What is the effect of preoperative depression on outcomes after minimally invasive surgery for adult spinal deformity? A prospective cohort analysis. J Neurosurg Spine 2024; 40:602-610. [PMID: 38364229 DOI: 10.3171/2023.12.spine221330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 12/08/2023] [Indexed: 02/18/2024]
Abstract
OBJECTIVE Depression has been implicated with worse immediate postoperative outcomes in adult spinal deformity (ASD) correction, yet the specific impact of depression on those patients undergoing minimally invasive surgery (MIS) requires further clarity. This study aimed to evaluate the role of depression in the recovery of patients with ASD after undergoing MIS. METHODS Patients who underwent MIS for ASD with a minimum postoperative follow-up of 1 year were included from a prospectively collected, multicenter registry. Two cohorts of patients were identified that consisted of either those affirming or denying depression on preoperative assessment. The patient-reported outcome measures (PROMs) compared included scores on the Oswestry Disability Index (ODI), numeric rating scale (NRS) for back and leg pain, Scoliosis Research Society Outcomes Questionnaire (SRS-22), SF-36 physical component summary, SF-36 mental component summary (MCS), EQ-5D, and EQ-5D visual analog scale. RESULTS Twenty-seven of 147 (18.4%) patients screened positive for preoperative depression. The nondepressed cohort had an average of 4.83 levels fused, and the depressed cohort had 5.56 levels fused per patient (p = 0.267). At 1-year follow-up, 10 patients still reported depression, representing a 63% decrease. Postoperatively, both cohorts demonstrated improvement in their PROMs; however, at 1-year follow-up, those without depression had statistically better outcomes based on the EQ-5D, MCS, and SRS-22 scores (p < 0.05). Patients with depression continued to experience higher NRS leg scores at 1-year follow-up (3.63 vs 2.22, p = 0.018). After controlling for covariates, the authors found that depression significantly impacted only 1-year follow-up MCS scores (β = 8.490, p < 0.05). CONCLUSIONS Depressed and nondepressed patients reported similar improvements after MIS surgery, except MCS scores were more likely to improve in nondepressed patients.
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Affiliation(s)
- Nitin Agarwal
- 1Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- 2Division of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- 3Neurological Surgery, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Vijay Letchuman
- 4Department of Neurological Surgery, University of California, San Francisco, California
| | - Raj Swaroop Lavadi
- 1Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Vivian P Le
- 5Department of Neurosurgery, Columbia University Irving Medical Center, New York, New York
| | - Alexander A Aabedi
- 4Department of Neurological Surgery, University of California, San Francisco, California
| | - Saman Shabani
- 6Department of Neurological Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Andrew K Chan
- 5Department of Neurosurgery, Columbia University Irving Medical Center, New York, New York
| | - Paul Park
- 7Department of Neurosurgery, Semmes Murphey Clinic, Memphis, Tennessee
| | - Juan S Uribe
- 8Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Jay D Turner
- 8Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Robert K Eastlack
- 9Department of Orthopedic Surgery, Scripps Clinic, La Jolla, California
| | - Richard G Fessler
- 10Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois
| | - Kai-Ming Fu
- 11Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - Michael Y Wang
- 12Department of Neurosurgery, University of Miami, Florida
| | - Adam S Kanter
- 13Division of Neurosurgery, Hoag Neurosciences Institute, Newport Beach, California
| | - David O Okonkwo
- 2Division of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Neel Anand
- 15Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, California
| | - Gregory M Mundis
- 9Department of Orthopedic Surgery, Scripps Clinic, La Jolla, California
| | - Peter G Passias
- 16Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, New York
| | - Shay Bess
- 17Denver International Spine Center, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, Colorado; and
| | | | - Dean Chou
- 5Department of Neurosurgery, Columbia University Irving Medical Center, New York, New York
| | - Praveen V Mummaneni
- 4Department of Neurological Surgery, University of California, San Francisco, California
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Bin-Alamer O, Qedair J, Abou-Al-Shaar H, Mallela AN, Balasubramanian K, Alnefaie N, Abou Al-Shaar AR, Plute T, Lu VM, McCarthy DJ, Fields DP, Agarwal N, Gerszten PC, Hamilton DK. Surgical intervention ≤ 24 hours versus > 24 hours after injury for the management of acute traumatic central cord syndrome: a systematic review and meta-analysis. J Neurosurg Spine 2024; 40:653-661. [PMID: 38335527 DOI: 10.3171/2023.11.spine23789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 11/16/2023] [Indexed: 02/12/2024]
Abstract
OBJECTIVE The objective was to evaluate the efficacy, outcomes, and complications of surgical intervention performed within 24 hours (≤ 24 hours) versus after 24 hours (> 24 hours) in managing acute traumatic central cord syndrome (ATCCS). METHODS Articles pertinent to the study were retrieved from PubMed, Scopus, Web of Science, and Cochrane. The authors performed a systematic review and meta-analysis of treatment procedures and outcomes according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRIMSA) guidelines. RESULTS Seven articles comprising 488 patients were included, with 188 (38.5%) patients in the ≤ 24-hour group and 300 (61.5%) in the > 24-hour group. Significant differences were not found between groups in terms of demographic characteristics, injury mechanism, spinal cord compression level, neuroimaging features, and the American Spinal Injury Association (ASIA) motor score at admission. Both groups had a similar approach to surgery and steroid administration. The surgical complication rate was significantly higher in the > 24-hour group (4.5%) compared to the ≤ 24-hour group (1.2%) (p = 0.05). Clinical follow-up duration was similar at 12 months (interquartile range 3-36) for both groups (p > 0.99). The ≤ 24-hour group demonstrated a not statistically significant greater improvement in ASIA motor score, with a mean difference of 12 (95% CI -20.7 to 44.6) compared to the > 24-hour group. CONCLUSIONS The present study indicates potential advantages of early (≤ 24 hours) surgery in ATCCS patients, specifically in terms of lower complication rates. However, further research is needed to confirm these findings and their clinical implications.
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Affiliation(s)
- Othman Bin-Alamer
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jumanah Qedair
- 2College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Hussam Abou-Al-Shaar
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Arka N Mallela
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Nada Alnefaie
- 4Department of Adult Neurosurgery, National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Tritan Plute
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Victor M Lu
- 6Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida
| | - David J McCarthy
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Daryl P Fields
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Nitin Agarwal
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Peter C Gerszten
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - D Kojo Hamilton
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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4
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Monek AC, Mitha R, Andrews E, Sarkaria IS, Agarwal N, Hamilton DK. Multidisciplinary Surgical Approach Using Augmented Reality Preplanning for Resection of Giant Thoracic Schwannoma With Robotic-Assisted Thoracoscopic Mobilization. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01147. [PMID: 38687027 DOI: 10.1227/ons.0000000000001174] [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] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/24/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND AND IMPORTANCE In adults, primary spinal cord tumors account for 5% of all primary tumors of the central nervous system, with schwannomas making up about 74% of all nerve sheath tumors. Thoracic schwannomas can pose a threat to neurovasculature, presenting a significant challenge to safe and complete surgical resection. For patients presenting with complex pathologies including tumors, a dual surgeon approach may be used to optimize patient care and improve outcomes. CLINICAL PRESENTATION A 73-year-old female previously diagnosed with a nerve sheath tumor of the fourth thoracic vertebra presented with significant thoracic pain and a history of falls. Imaging showed that the tumor had doubled in size ranging from T3 to T5. Augmented reality volumetric rendering was used to clarify anatomic relationships of the mass for perioperative evaluation and decision-making. A dual surgeon approach was used for complete resection. First, a ventrolateral left video-assisted thoracoscopic surgery was performed with robotic assistance followed by a posterior tumor resection and thoracic restabilization. The patient did well postoperatively. CONCLUSION Although surgical treatment of large thoracic dumbbell tumors presents a myriad of risks, perioperative evaluation with augmented reality, new robotic surgical techniques, and a dual surgeon approach can be implemented to mitigate these risks.
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Affiliation(s)
- Adam C Monek
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rida Mitha
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Edward Andrews
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Inderpal S Sarkaria
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - D Kojo Hamilton
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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5
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Mummaneni PV, Bisson EF, Michalopoulos G, Mualem WJ, El Sammak S, Wang MY, Chan AK, Haid RW, Knightly JJ, Chou D, Sherrod BA, Gottfried ON, Shaffrey CI, Goldberg JL, Virk MS, Hussain I, Agarwal N, Glassman SD, Shaffrey ME, Park P, Foley KT, Pennicooke B, Coric D, Slotkin JR, Potts EA, Fu KMG, Asher AL, Bydon M. Comparing posterior cervical foraminotomy with anterior cervical discectomy and fusion in radiculopathic patients: an analysis from the Quality Outcomes Database. J Neurosurg Spine 2024:1-13. [PMID: 38626479 DOI: 10.3171/2024.2.spine221280] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/05/2024] [Indexed: 04/18/2024]
Abstract
OBJECTIVE The objective of this study was to compare clinical and patient-reported outcomes (PROs) between posterior foraminotomy and anterior cervical discectomy and fusion (ACDF) in patients presenting with cervical radiculopathy. METHODS The Quality Outcomes Database was queried for patients who had undergone ACDF or posterior foraminotomy for radiculopathy. To create two highly homogeneous groups, optimal individual matching was performed at a 5:1 ratio between the two groups on 29 baseline variables (including demographic characteristics, comorbidities, symptoms, patient-reported scores, underlying pathologies, and levels treated). Outcomes of interest were length of stay, reoperations, patient-reported satisfaction, increase in EQ-5D score, and decrease in Neck Disability Index (NDI) scores for arm and neck pain as long as 1 year after surgery. Noninferiority analysis of achieving patient satisfaction and minimal clinically important difference (MCID) in PROs was performed with an accepted risk difference of 5%. RESULTS A total of 7805 eligible patients were identified: 216 of these underwent posterior foraminotomy and were matched to 1080 patients who underwent ACDF. The patients who underwent ACDF had more underlying pathologies, lower EQ-5D scores, and higher NDI and neck pain scores at baseline. Posterior foraminotomy was associated with shorter hospitalization (0.5 vs 0.9 days, p < 0.001). Reoperations within 12 months were significantly more common among the posterior foraminotomy group (4.2% vs 1.9%, p = 0.04). The two groups performed similarly in PROs, with posterior foraminotomy being noninferior to ACDF in achieving MCID in EQ-5D and neck pain scores but also having lower rates of maximal satisfaction at 12 months (North American Spine Society score of 1 achieved by 65.2% posterior foraminotomy patients vs 74.6% of ACDF patients, p = 0.02). CONCLUSIONS The two procedures were found to be offered to different populations, with ACDF being selected for patients with more complicated pathologies and symptoms. After individual matching, posterior foraminotomy was associated with a higher reoperation risk within 1 year after surgery compared to ACDF (4.2% vs 1.9%). In terms of 12-month PROs, posterior foraminotomy was noninferior to ACDF in improving quality of life and neck pain. The two procedures also performed similarly in improving NDI scores and arm pain, but ACDF patients had higher maximal satisfaction rates.
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Affiliation(s)
- Praveen V Mummaneni
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Erica F Bisson
- 2Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Giorgos Michalopoulos
- 3Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 4Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - William J Mualem
- 3Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 4Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Sally El Sammak
- 3Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 4Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Michael Y Wang
- 5Department of Neurosurgery, University of Miami, Florida
| | - Andrew K Chan
- 6Department of Neurological Surgery, Columbia University, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | | | | | - Dean Chou
- 6Department of Neurological Surgery, Columbia University, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Brandon A Sherrod
- 2Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Oren N Gottfried
- 9Department of Neurological Surgery, Duke University Medical Center, Durham, North Carolina
| | - Christopher I Shaffrey
- 9Department of Neurological Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jacob L Goldberg
- 10Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | - Michael S Virk
- 10Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | - Ibrahim Hussain
- 10Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | - Nitin Agarwal
- 11Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | | | - Mark E Shaffrey
- 13Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Paul Park
- 14Department of Neurosurgery, University of Tennessee, Memphis, Tennessee
| | - Kevin T Foley
- 14Department of Neurosurgery, University of Tennessee, Memphis, Tennessee
| | - Brenton Pennicooke
- 11Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Domagoj Coric
- 15Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina
| | - Jonathan R Slotkin
- 16Department of Neurosurgery, Geisinger Health, Danville, Pennsylvania; and
| | - Eric A Potts
- 17Department of Neurological Surgery, Indiana University, Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Kai-Ming G Fu
- 10Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | - Anthony L Asher
- 15Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina
| | - Mohamad Bydon
- 3Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 4Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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6
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Chan AK, Park C, Shaffrey CI, Gottfried ON, Than KD, Bisson EF, Bydon M, Asher AL, Coric D, Potts EA, Foley KT, Wang MY, Fu KM, Virk MS, Knightly JJ, Meyer S, Park P, Upadhyaya CD, Shaffrey ME, Buchholz AL, Tumialán LM, Turner JD, Michalopoulos G, Sherrod BA, Agarwal N, Chou D, Haid RW, Mummaneni PV. What predicts the best 24-month outcomes following surgery for cervical spondylotic myelopathy? A QOD prospective registry study. J Neurosurg Spine 2024; 40:453-464. [PMID: 38181405 DOI: 10.3171/2023.11.spine23222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 11/09/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE The aim of this study was to identify predictors of the best 24-month improvements in patients undergoing surgery for cervical spondylotic myelopathy (CSM). For this purpose, the authors leveraged a large prospective cohort of surgically treated patients with CSM to identify factors predicting the best outcomes for disability, quality of life, and functional status following surgery. METHODS This was a retrospective analysis of prospectively collected data. The Quality Outcomes Database (QOD) CSM dataset (1141 patients) at 14 top enrolling sites was used. Baseline and surgical characteristics were compared for those reporting the top and bottom 20th percentile 24-month Neck Disability Index (NDI), EuroQol-5D (EQ-5D), and modified Japanese Orthopaedic Association (mJOA) change scores. A multivariable logistic model was constructed and included candidate variables reaching p ≤ 0.20 on univariate analyses. Least important variables were removed in a stepwise manner to determine the significant predictors of the best outcomes (top 20th percentile) for 24-month NDI, EQ-5D, and mJOA change. RESULTS A total of 948 (83.1%) patients with 24-month follow-up were included in this study. For NDI, 204 (17.9%) had the best NDI outcome and 200 (17.5%) had the worst NDI outcome. Factors predicting the best NDI outcomes included symptom duration less than 12 months (OR 1.5, 95% CI 1.1-1.9; p = 0.01); procedure other than posterior fusion (OR 1.5, 95% CI 1.03-2.1; p = 0.03); higher preoperative visual analog scale neck pain score (OR 1.2, 95% CI 1.1-1.3; p < 0.001); and higher baseline NDI (OR 1.06, 95% CI 1.05-1.07; p < 0.001). For EQ-5D, 163 (14.3%) had the best EQ-5D outcome and 169 (14.8%) had the worst EQ-5D outcome. Factors predicting the best EQ-5D outcomes included arm pain-only complaints (compared to neck pain) (OR 1.9, 95% CI 1.3-2.9; p = 0.002) and lower baseline EQ-5D (OR 167.7 per unit lower, 95% CI 85.0-339.4; p < 0.001). For mJOA, 222 (19.5%) had the best mJOA outcome and 238 (20.9%) had the worst mJOA outcome. Factors predicting the best mJOA outcomes included lower BMI (OR 1.03 per unit lower, 95% CI 1.004-1.05; p = 0.02; cutoff value of ≤ 29.5 kg/m2); arm pain-only complaints (compared to neck pain) (OR 1.7, 95% CI 1.1-2.5; p = 0.02); and lower baseline mJOA (OR 1.6 per unit lower, 95% CI 1.5-1.7; p < 0.001). CONCLUSIONS Compared to the worst outcomes for EQ-5D, the best outcomes were associated with patients with arm pain-only complaints. For mJOA, lower BMI and arm pain-only complaints portended the best outcomes. For NDI, those with the best outcomes had shorter symptom durations, higher preoperative neck pain scores, and less often underwent posterior spinal fusions. Given the positive impact of shorter symptom duration on outcomes, these data suggest that early surgery may be beneficial for patients with CSM.
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Affiliation(s)
- Andrew K Chan
- 1Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York; The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Christine Park
- 2Department of Neurosurgery, Duke University, Durham, North Carolina
| | | | - Oren N Gottfried
- 2Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Khoi D Than
- 2Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Erica F Bisson
- 3Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Mohamad Bydon
- 4Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Anthony L Asher
- 5Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Domagoj Coric
- 5Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Eric A Potts
- 6Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Kevin T Foley
- 7Department of Neurosurgery, University of Tennessee; Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Michael Y Wang
- 8Department of Neurological Surgery, University of Miami, Florida
| | - Kai-Ming Fu
- 9Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - Michael S Virk
- 9Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - John J Knightly
- 10Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Scott Meyer
- 10Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Paul Park
- 11Department of Neurological Surgery, University of Michigan, Ann Arbor, Michigan
| | - Cheerag D Upadhyaya
- 12Marion Bloch Neuroscience Institute, Saint Luke's Health System, Kansas City, Missouri
| | - Mark E Shaffrey
- 13Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Avery L Buchholz
- 13Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | | | - Jay D Turner
- 14Barrow Neurological Institute, Phoenix, Arizona
| | | | - Brandon A Sherrod
- 3Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Nitin Agarwal
- 15Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Dean Chou
- 1Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York; The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Regis W Haid
- 16Atlanta Brain and Spine Care, Atlanta, Georgia
| | - Praveen V Mummaneni
- 15Department of Neurological Surgery, University of California, San Francisco, California; and
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7
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Agarwal N, DiGiorgio A, Michalopoulos GD, Letchuman V, Chan AK, Shabani S, Lavadi RS, Lu DC, Wang MY, Haid RW, Knightly JJ, Sherrod BA, Gottfried ON, Shaffrey CI, Goldberg JL, Virk MS, Hussain I, Glassman SD, Shaffrey ME, Park P, Foley KT, Pennicooke B, Coric D, Upadhyaya C, Potts EA, Tumialán LM, Fu KMG, Asher AL, Bisson EF, Chou D, Bydon M, Mummaneni PV. Impact of Educational Background on Preoperative Disease Severity and Postoperative Outcomes Among Patients With Cervical Spondylotic Myelopathy. Clin Spine Surg 2024; 37:E137-E146. [PMID: 38102749 DOI: 10.1097/bsd.0000000000001557] [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: 10/31/2022] [Accepted: 10/03/2023] [Indexed: 12/17/2023]
Abstract
STUDY DESIGN Retrospective review of a prospectively maintained database. OBJECTIVE Assess differences in preoperative status and postoperative outcomes among patients of different educational backgrounds undergoing surgical management of cervical spondylotic myelopathy (CSM). SUMMARY OF BACKGROUND DATA Patient education level (EL) has been suggested to correlate with health literacy, disease perception, socioeconomic status (SES), and access to health care. METHODS The CSM data set of the Quality Outcomes Database (QOD) was queried for patients undergoing surgical management of CSM. EL was grouped as high school or below, graduate-level, and postgraduate level. The association of EL with baseline disease severity (per patient-reported outcome measures), symptoms >3 or ≤3 months, and 24-month patient-reported outcome measures were evaluated. RESULTS Among 1141 patients with CSM, 509 (44.6%) had an EL of high school or below, 471 (41.3%) had a graduate degree, and 161 (14.1%) had obtained postgraduate education. Lower EL was statistically significantly associated with symptom duration of >3 months (odds ratio=1.68), higher arm pain numeric rating scale (NRS) (coefficient=0.5), and higher neck pain NRS (coefficient=0.79). Patients with postgraduate education had statistically significantly lower Neck Disability Index (NDI) scores (coefficient=-7.17), lower arm pain scores (coefficient=-1), and higher quality-adjusted life-years (QALY) scores (coefficient=0.06). Twenty-four months after surgery, patients of lower EL had higher NDI scores, higher pain NRS scores, and lower QALY scores ( P <0.05 in all analyses). CONCLUSIONS Among patients undergoing surgical management for CSM, those reporting a lower educational level tended to present with longer symptom duration, more disease-inflicted disability and pain, and lower QALY scores. As such, patients of a lower EL are a potentially vulnerable subpopulation, and their health literacy and access to care should be prioritized.
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Affiliation(s)
- Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh School of Medicine
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Anthony DiGiorgio
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA
| | | | - Vijay Letchuman
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA
| | - Andrew K Chan
- Department of Neurosurgery, Columbia University Irving Medical Center, New York City, NY
| | - Saman Shabani
- Department of Neurological Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Raj Swaroop Lavadi
- Department of Neurological Surgery, University of Pittsburgh School of Medicine
| | - Daniel C Lu
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA
| | - Michael Y Wang
- Department of Neurological Surgery, University of Miami, Miami, FL
| | | | | | | | | | | | - Jacob L Goldberg
- Department of Neurological Surgery, Weill Cornell Medical Center, New York, NY
| | - Michael S Virk
- Department of Neurological Surgery, Weill Cornell Medical Center, New York, NY
| | - Ibrahim Hussain
- Department of Neurological Surgery, Weill Cornell Medical Center, New York, NY
| | | | - Mark E Shaffrey
- Department of Neurosurgery, University of Virginia, Charlottesville, VA
| | - Paul Park
- Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, University of Tennessee, Memphis, TN
| | - Kevin T Foley
- Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, University of Tennessee, Memphis, TN
| | - Brenton Pennicooke
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Domagoj Coric
- Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte
| | - Cheerag Upadhyaya
- Department of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Eric A Potts
- Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indianapolis, IN
| | - Luis M Tumialán
- Department of Neurosurgery, Barrow Neurologic Institute, Phoenix, AZ
| | - Kai-Ming G Fu
- Department of Neurological Surgery, Weill Cornell Medical Center, New York, NY
| | - Anthony L Asher
- Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte
| | - Erica F Bisson
- Department of Neurosurgery, University of Utah, Salt Lake City, UT
| | - Dean Chou
- Department of Neurosurgery, Columbia University Irving Medical Center, New York City, NY
| | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| | - Praveen V Mummaneni
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA
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8
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Kumar RP, Elsayed GA, Hafez DM, Agarwal N. Advances in Anterolateral Approaches to the Lumbar Spine: A Focus on Technological Developments. Neurosurg Clin N Am 2024; 35:199-205. [PMID: 38423735 DOI: 10.1016/j.nec.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
A historical overview of the evolution of anterolateral approaches to the lumber spine and associated patient outcomes is presented. In addition, the modern incorporation of new technologies is discussed, including interbody cages, intraoperative image guidance, robotics, augmented reality, and machine learning, which have significantly improved the spine surgery safety and efficacy profile. Current challenges and future directions are also covered, emphasizing the need for further research and development, particularly in robotic assistance and machine learning algorithms.
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Affiliation(s)
- Rohit Prem Kumar
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, UPMC Presbyterian, Suite B-400, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Galal A Elsayed
- Och Spine, Weill Cornell Medicine/NewYork-Presbyterian, 525 East 68th Street, New York, NY 10068, USA
| | - Daniel M Hafez
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, 660 South Euclid Avenue, Campus Box 8057, St. Louis, Missouri 63110, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, UPMC Presbyterian, Suite B-400, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
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9
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Alan N, Zenkin S, Lavadi RS, Legarreta AD, Hudson JS, Fields DP, Agarwal N, Mamindla P, Ak M, Peddagangireddy V, Puccio L, Buell TJ, Hamilton DK, Kanter AS, Okonkwo DO, Zinn PO, Colen RR. Associating T1-Weighted and T2-Weighted Magnetic Resonance Imaging Radiomic Signatures With Preoperative Symptom Severity in Patients With Cervical Spondylotic Myelopathy. World Neurosurg 2024; 184:e137-e143. [PMID: 38253177 DOI: 10.1016/j.wneu.2024.01.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 01/14/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Preoperative symptom severity in cervical spondylotic myelopathy (CSM) can be variable. Radiomic signatures could provide an imaging biomarker for symptom severity in CSM. This study utilizes radiomic signatures of T1-weighted and T2-weighted magnetic resonance imaging images to correlate with preoperative symptom severity based on modified Japanese Orthopaedic Association (mJOA) scores for patients with CSM. METHODS Sixty-two patients with CSM were identified. Preoperative T1-weighted and T2-weighted magnetic resonance imaging images for each patient were segmented from C2-C7. A total of 205 texture features were extracted from each volume of interest. After feature normalization, each second-order feature was further subdivided to yield a total of 400 features from each volume of interest for analysis. Supervised machine learning was used to build radiomic models. RESULTS The patient cohort had a median mJOA preoperative score of 13; of which, 30 patients had a score of >13 (low severity) and 32 patients had a score of ≤13 (high severity). Radiomic analysis of T2-weighted imaging resulted in 4 radiomic signatures that correlated with preoperative mJOA with a sensitivity, specificity, and accuracy of 78%, 89%, and 83%, respectively (P < 0.004). The area under the curve value for the ROC curves were 0.69, 0.70, and 0.77 for models generated by independent T1 texture features, T1 and T2 texture features in combination, and independent T2 texture features, respectively. CONCLUSIONS Radiomic models correlate with preoperative mJOA scores using T2 texture features in patients with CSM. This may serve as a surrogate, objective imaging biomarker to measure the preoperative functional status of patients.
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Affiliation(s)
- Nima Alan
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.
| | - Serafettin Zenkin
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Raj Swaroop Lavadi
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Andrew D Legarreta
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Joseph S Hudson
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Daryl P Fields
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Priyadarshini Mamindla
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Murat Ak
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Vishal Peddagangireddy
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Lauren Puccio
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Thomas J Buell
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - D Kojo Hamilton
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Adam S Kanter
- Department of Neurosurgery, Hoag Neurosciences Institute, Newport Beach, California
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Pascal O Zinn
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Rivka R Colen
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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10
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Park C, Shaffrey CI, Than KD, Bisson EF, Sherrod BA, Asher AL, Coric D, Potts EA, Foley KT, Wang MY, Fu KM, Virk MS, Knightly JJ, Meyer S, Park P, Upadhyaya C, Shaffrey ME, Buchholz AL, Tumialán LM, Turner JD, Agarwal N, Chan AK, Chou D, Chaudhry NS, Haid RW, Mummaneni PV, Michalopoulos GD, Bydon M, Gottfried ON. Does the number of social factors affect long-term patient-reported outcomes and satisfaction in those with cervical myelopathy? A QOD study. J Neurosurg Spine 2024; 40:428-438. [PMID: 38241683 DOI: 10.3171/2023.11.spine23127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 11/16/2023] [Indexed: 01/21/2024]
Abstract
OBJECTIVE It is not clear whether there is an additive effect of social factors in keeping patients with cervical spondylotic myelopathy (CSM) from achieving both a minimum clinically important difference (MCID) in outcomes and satisfaction after surgery. The aim of this study was to explore the effect of multiple social factors on postoperative outcomes and satisfaction. METHODS This was a multiinstitutional, retrospective study of the prospective Quality Outcomes Database (QOD) CSM cohort, which included patients aged 18 years or older who were diagnosed with primary CSM and underwent operative management. Social factors included race (White vs non-White), education (high school or below vs above), employment (employed vs not), and insurance (private vs nonprivate). Patients were considered to have improved from surgery if the following criteria were met: 1) they reported a score of 1 or 2 on the North American Spine Society index, and 2) they met the MCID in patient-reported outcomes (i.e., visual analog scale [VAS] neck and arm pain, Neck Disability Index [NDI], and EuroQol-5D [EQ-5D]). RESULTS Of the 1141 patients included in the study, 205 (18.0%) had 0, 347 (30.4%) had 1, 334 (29.3%) had 2, and 255 (22.3%) had 3 social factors. The 24-month follow-up rate was > 80% for all patient-reported outcomes. After adjusting for all relevant covariates (p < 0.02), patients with 1 or more social factors were less likely to improve from surgery in all measured outcomes including VAS neck pain (OR 0.90, 95% CI 0.83-0.99) and arm pain (OR 0.88, 95% CI 0.80-0.96); NDI (OR 0.90, 95% CI 0.83-0.98); and EQ-5D (OR 0.90, 95% CI 0.83-0.97) (all p < 0.05) compared to those without any social factors. Patients with 2 social factors (outcomes: neck pain OR 0.86, arm pain OR 0.81, NDI OR 0.84, EQ-5D OR 0.81; all p < 0.05) or 3 social factors (outcomes: neck pain OR 0.84, arm pain OR 0.84, NDI OR 0.84, EQ-5D OR 0.84; all p < 0.05) were more likely to fare worse in all outcomes compared to those with only 1 social factor. CONCLUSIONS Compared to those without any social factors, patients who had at least 1 social factor were less likely to achieve MCID and feel satisfied after surgery. The effect of social factors is additive in that patients with a higher number of factors are less likely to improve compared to those with only 1 social factor.
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Affiliation(s)
- Christine Park
- 1Department of Neurosurgery, Duke University, Durham, North Carolina
| | | | - Khoi D Than
- 1Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Erica F Bisson
- 2Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Brandon A Sherrod
- 2Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Anthony L Asher
- 3Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Domagoj Coric
- 3Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Eric A Potts
- 4Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Kevin T Foley
- 5Department of Neurosurgery, Semmes Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Michael Y Wang
- 6Department of Neurosurgery, University of Miami, Florida
| | - Kai-Ming Fu
- 7Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - Michael S Virk
- 7Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | | | - Scott Meyer
- 8Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Paul Park
- 9Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Cheerag Upadhyaya
- 10Marion Bloch Neuroscience Institute, Saint Luke's Health System, Kansas City, Missouri
| | - Mark E Shaffrey
- 11Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Avery L Buchholz
- 11Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | | | - Jay D Turner
- 12Barrow Neurological Institute, Phoenix, Arizona
| | - Nitin Agarwal
- 13Department of Neurosurgery, Washington University in St. Louis, Missouri
| | - Andrew K Chan
- 14Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Dean Chou
- 14Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Nauman S Chaudhry
- 15Department of Neurosurgery, University of South Florida, Tampa, Florida
| | - Regis W Haid
- 16Atlanta Brain and Spine Care, Atlanta, Georgia
| | - Praveen V Mummaneni
- 17Department of Neurosurgery, University of California, San Francisco, California; and
| | | | - Mohamad Bydon
- 18Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Oren N Gottfried
- 1Department of Neurosurgery, Duke University, Durham, North Carolina
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11
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Kumar RP, Adida S, Lavadi RS, Mitha R, Legarreta AD, Hudson JS, Shah M, Diebo B, Fields DP, Buell TJ, Hamilton DK, Daniels AH, Agarwal N. A guide to selecting upper thoracic versus lower thoracic uppermost instrumented vertebra in adult spinal deformity correction. Eur Spine J 2024:10.1007/s00586-024-08206-9. [PMID: 38522054 DOI: 10.1007/s00586-024-08206-9] [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] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/26/2024] [Accepted: 02/24/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE Operative treatment of adult spinal deformity (ASD) has been shown to improve patient health-related quality of life (HRQOL). Selection of the uppermost instrumented vertebra (UIV) in either the upper thoracic (UT) or lower thoracic (LT) spine is a pivotal decision with effects on operative and postoperative outcomes. This review overviews the multifaceted decision-making process for UIV selection in ASD correction. METHODS PubMed was queried for articles using the keywords "uppermost instrumented vertebra", "upper thoracic", "lower thoracic", and "adult spinal deformity". RESULTS Optimization of UIV selection may lead to superior deformity correction, better patient-reported outcomes, and lower risk of proximal junctional kyphosis (PJK) and failure (PJF). Patient alignment characteristics, including preoperative thoracic kyphosis, coronal deformity, and the magnitude of sagittal correction influence surgical decision-making when selecting a UIV, while comorbidities such as poor body mass index, osteoporosis, and neuromuscular pathology should also be taken in to account. Additionally, surgeon experience and resources available to the hospital may also play a role in this decision. Currently, it is incompletely understood whether postoperative HRQOLs, functional and radiographic outcomes, and complications after surgery differ between selection of the UIV in either the UT or LT spine. CONCLUSION The correct selection of the UIV in surgical planning is a challenging task, which requires attention to preoperative alignment, patient comorbidities, clinical characteristics, available resources, and surgeon-specific factors such as experience.
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Affiliation(s)
- Rohit Prem Kumar
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Samuel Adida
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Raj Swaroop Lavadi
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Rida Mitha
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andrew D Legarreta
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Joseph S Hudson
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Manan Shah
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Bassel Diebo
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Daryl P Fields
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Thomas J Buell
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - D Kojo Hamilton
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
- Neurological Surgery, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.
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12
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Espinoza J, Agarwal N, Johnson A, Hernandez-Andrade E, Backley S, Papanna R, Bergh EP. Risk stratification for donor twin fetal death by evaluating middle cerebral artery in twin-to-twin transfusion syndrome in absence of twin anemia polycythemia sequence. Ultrasound Obstet Gynecol 2024. [PMID: 38437460 DOI: 10.1002/uog.27629] [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] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/29/2024] [Accepted: 02/18/2024] [Indexed: 03/06/2024]
Abstract
OBJECTIVE To determine the association of high middle cerebral artery peak systolic velocity (MCA-PSV) with fetal demise in donor twins among pregnancies complicated by twin-to-twin transfusion syndrome (TTTS) in the absence of twin anemia polycythemia sequence (TAPS). METHODS This prospective cohort study included TTTS cases that underwent laser surgery between 2011 and 2022 at a single center. TAPS cases were excluded from the study. The primary objective was to explore the association of high MCA-PSV (>1.5 multiples of the median) with fetal demise of the donor twin among pregnancies complicated by TTTS. Secondary objectives were: 1) to evaluate if donor or recipient MCA-PSV is associated with an increased risk for their corresponding fetal death using receiving operator characteristic curve analysis; and 2) to compare the proportion of fetuses with low MCA pulsatility index among donor twins with high MCA-PSV and in those with normal MCA-PSV to evaluate the contribution of blood flow redistribution to high MCA-PSV. Multivariable and Poisson regression analysis were performed to explore the association of isolated high donor MCA-PSV and fetal demise, adjusted for TTTS stage, selective fetal growth restriction (sFGR), and other confounders. p<0.05 was considered significant. RESULTS Out of 660 TTTS cases, donor MCA-PSV was unavailable in 48 (7.3%) cases. Of the remaining 612 patients, 9 (1.5%) were lost to follow-up, and 96 TAPS cases were excluded. High donor MCA-PSV was seen in 6.5% (33/507) of the study population. High donor MCA-PSV was an independent risk factor for donor fetal demise (adjusted relative risk (aRR) of 4.52; 95% CI: 2.72-7.50), adjusted for confounders. Regression analysis restricted to each Quintero TTTS stage demonstrated that high donor MCA-PSV was an independent risk factor for donor fetal demise in Quintero stage II (aRR of 14.21; 95% CI: 1.09-186.2) and Quintero stage III (aRR of 3.41; 95% CI: 1.82-6.41). Donor MCA-PSV was associated with donor fetal demise (AUC: 0.69; p<0.001), but recipient MCA-PSV was not associated with its corresponding fetal demise (AUC: 0.54; p=0.44). A higher proportion of donor twins in the group with high MCA-PSV had a low MCA pulsatility index than in those with normal MCA-PSV (33.3% vs. 15.5%; p=0.016). CONCLUSIONS Elevated donor MCA-PSV without TAPS prior to laser surgery is associated with a 4-fold increased risk for donor fetal demise, adjusted for sFGR, TTTS stage, and other confounders. Doppler evaluation of donor MCA-PSV prior to laser surgery can further stratify TTTS staging to evaluate the risk for donor fetal demise. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- J Espinoza
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - N Agarwal
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - A Johnson
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - E Hernandez-Andrade
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - S Backley
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - R Papanna
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - E P Bergh
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
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13
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Mooney J, Nathani KR, Zeitouni D, Michalopoulos GD, Wang MY, Coric D, Chan AK, Lu DC, Sherrod BA, Gottfried ON, Shaffrey CI, Than KD, Goldberg JL, Hussain I, Virk MS, Agarwal N, Glassman SD, Shaffrey ME, Park P, Foley KT, Chou D, Slotkin JR, Tumialán LM, Upadhyaya CD, Potts EA, Fu KMG, Haid RW, Knightly JJ, Mummaneni PV, Bisson EF, Asher AL, Bydon M. Does diabetes affect outcome or reoperation rate after lumbar decompression or arthrodesis? A matched analysis of the Quality Outcomes Database data set. J Neurosurg Spine 2024; 40:331-342. [PMID: 38039534 DOI: 10.3171/2023.9.spine23522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 09/25/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE Diabetes mellitus (DM) is a known risk factor for postsurgical and systemic complications after lumbar spinal surgery. Smaller studies have also demonstrated diminished improvements in patient-reported outcomes (PROs), with increased reoperation and readmission rates after lumbar surgery in patients with DM. The authors aimed to examine longer-term PROs in patients with DM undergoing lumbar decompression and/or arthrodesis for degenerative pathology. METHODS The Quality Outcomes Database was queried for patients undergoing elective lumbar decompression and/or arthrodesis for degenerative pathology. Patients were grouped into DM and non-DM groups and optimally matched in a 1:1 ratio on 31 baseline variables, including the number of operated levels. Outcomes of interest were readmissions and reoperations at 30 and 90 days after surgery in addition to improvements in Oswestry Disability Index, back pain, and leg pain scores and quality-adjusted life-years at 90 days after surgery. RESULTS The matched decompression cohort comprised 7836 patients (3236 [41.3] females) with a mean age of 63.5 ± 12.6 years, and the matched arthrodesis cohort comprised 7336 patients (3907 [53.3%] females) with a mean age of 64.8 ± 10.3 years. In patients undergoing lumbar decompression, no significant differences in nonroutine discharge, length of stay (LOS), readmissions, reoperations, and PROs were observed. In patients undergoing lumbar arthrodesis, nonroutine discharge (15.7% vs 13.4%, p < 0.01), LOS (3.2 ± 2.0 vs 3.0 ± 3.5 days, p < 0.01), 30-day (6.5% vs 4.4%, p < 0.01) and 90-day (9.1% vs 7.0%, p < 0.01) readmission rates, and the 90-day reoperation rate (4.3% vs 3.2%, p = 0.01) were all significantly higher in the DM group. For DM patients undergoing lumbar arthrodesis, subgroup analyses demonstrated a significantly higher risk of poor surgical outcomes with the open approach. CONCLUSIONS Patients with and without DM undergoing lumbar spinal decompression alone have comparable readmission and reoperation rates, while those undergoing arthrodesis procedures have a higher risk of poor surgical outcomes up to 90 days after surgery. Surgeons should target optimal DM control preoperatively, particularly for patients undergoing elective lumbar arthrodesis.
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Affiliation(s)
- James Mooney
- 1Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Karim Rizwan Nathani
- 2Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Daniel Zeitouni
- 4Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
- 5Department of Neurosurgery, Atrium Health, Charlotte, North Carolina
| | - Giorgos D Michalopoulos
- 2Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Michael Y Wang
- 6Department of Neurosurgery, University of Miami, Florida
| | - Domagoj Coric
- 7Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina
| | - Andrew K Chan
- 8Department of Neurological Surgery, Columbia University, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Daniel C Lu
- 9Department of Neurosurgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Brandon A Sherrod
- 10Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Oren N Gottfried
- 11Department of Neurological Surgery, Duke University Medical Center, Durham, North Carolina
| | - Christopher I Shaffrey
- 11Department of Neurological Surgery, Duke University Medical Center, Durham, North Carolina
| | - Khoi D Than
- 11Department of Neurological Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jacob L Goldberg
- 12Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | - Ibrahim Hussain
- 12Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | - Michael S Virk
- 12Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | - Nitin Agarwal
- 24Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Mark E Shaffrey
- 14Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Paul Park
- 15Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Kevin T Foley
- 16Department of Neurosurgery, University of Tennessee, Memphis, Tennessee
| | - Dean Chou
- 8Department of Neurological Surgery, Columbia University, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | | | - Luis M Tumialán
- 18Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Cheerag D Upadhyaya
- 19Department of Neurosurgery, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Eric A Potts
- 20Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Kai-Ming G Fu
- 12Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | - Regis W Haid
- 22Atlanta Brain and Spine Care, Atlanta, Georgia
| | - John J Knightly
- 23Atlantic Neurosurgical Specialists, Morristown, New Jersey; and
| | - Praveen V Mummaneni
- 21Department of Neurological Surgery, University of California, San Francisco, California
| | - Erica F Bisson
- 10Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Anthony L Asher
- 4Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
| | - Mohamad Bydon
- 2Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
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14
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Dietz N, Alkin V, Agarwal N, Sharma M, Oxford BG, Wang D, Ugiliweneza B, Mettille J, Boakye M, Drazin D. Cannabis Use Disorder Trends and Health Care Utilization After Cervical and Lumbar Spine Fusions. Spine (Phila Pa 1976) 2024; 49:E28-E45. [PMID: 37962203 DOI: 10.1097/brs.0000000000004874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/22/2023] [Indexed: 11/15/2023]
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE To identify differences in complication rates after cervical and lumbar fusion over the first postoperative year between those with and without cannabis use disorder (CUD) and to assess how CUD affects opioid prescription patterns. SUMMARY OF BACKGROUND DATA Cannabis is legal for medical purposes in 36 states and for recreational use in 18 states. Cannabis has multisystem effects and may contribute to transient vasoconstrictive, prothrombotic, and inflammatory effects. METHODS The IBM MarketScan Database (2009-2019) was used to identify patients who underwent cervical or lumbar fusions, with or without CUD. Exact match hospitalization and postdischarge outcomes were analyzed at index, six, and 12 months. RESULTS Of 72,024 cervical fusion (2.0% with CUD) and 105,612 lumbar fusion patients (1.5% with CUD), individuals with CUD were more likely to be young males with higher Elixhauser index. The cervical CUD group had increased neurological complications (3% vs. 2%) and sepsis (1% vs. 0%) during the index hospitalization and neurological (7% vs. 5%) and wound complications (5% vs. 3%) at 12 months. The lumbar CUD group had increased wound (8% vs. 5%) and myocardial infarction (MI) (2% vs. 1%) complications at six months and at 12 months. For those with cervical myelopathy, increased risk of pulmonary complications was observed with CUD at index hospitalization and 12-month follow-up. For those with lumbar stenosis, cardiac complications and MI were associated with CUD at index hospitalization and 12 months. CUD was associated with opiate use disorder, decreasing postoperatively. CONCLUSIONS No differences in reoperation rates were observed for CUD groups undergoing cervical or lumbar fusion. CUD was associated with an increased risk of stroke for the cervical fusion cohort and cardiac (including MI) and pulmonary complications for lumbar fusion at index hospitalization and six and 12 months postoperatively. Opiate use disorder and decreased opiate dependence after surgery also correlated with CUD.
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Affiliation(s)
- Nicholas Dietz
- Department of Neurosurgery, University of Louisville, Louisville, KY
| | | | - Nitin Agarwal
- Washington University, Barnes Jewish Hospital Plaza, St. Louis, MO
| | - Mayur Sharma
- Department of Neurosurgery, University of Louisville, Louisville, KY
| | | | - Dengzhi Wang
- Department of Neurosurgery, University of Louisville, Louisville, KY
| | - Beatrice Ugiliweneza
- Department of Neurosurgery, University of Louisville, Louisville, KY
- Department of Health Management and Systems Science, School of Public Health and Information Science, University of Louisville, Louisville, KY
| | | | - Maxwell Boakye
- Department of Neurosurgery, University of Louisville, Louisville, KY
| | - Doniel Drazin
- Providence Regional Medical Center Everett, Everett, WA
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15
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Park C, Shaffrey CI, Than KD, Michalopoulos GD, El Sammak S, Chan AK, Bisson EF, Sherrod BA, Asher AL, Coric D, Potts EA, Foley KT, Wang MY, Fu KM, Virk MS, Knightly JJ, Meyer S, Park P, Upadhyaya C, Shaffrey ME, Buchholz AL, Tumialán LM, Turner J, Agarwal N, Chou D, Chaudhry NS, Haid RW, Mummaneni PV, Bydon M, Gottfried ON. What factors influence surgical decision-making in anterior versus posterior surgery for cervical myelopathy? A QOD analysis. J Neurosurg Spine 2024; 40:206-215. [PMID: 37948703 DOI: 10.3171/2023.8.spine23194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/29/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE The aim of this study was to explore the preoperative patient characteristics that affect surgical decision-making when selecting an anterior or posterior operative approach in patients diagnosed with cervical spondylotic myelopathy (CSM). METHODS This was a multi-institutional, retrospective study of the prospective Quality Outcomes Database (QOD) Cervical Spondylotic Myelopathy module. Patients aged 18 years or older diagnosed with primary CSM who underwent multilevel (≥ 2-level) elective surgery were included. Demographics and baseline clinical characteristics were collected. RESULTS Of the 841 patients with CSM in the database, 492 (58.5%) underwent multilevel anterior surgery and 349 (41.5%) underwent multilevel posterior surgery. Surgeons more often performed a posterior surgical approach in older patients (mean 64.8 ± 10.6 vs 58.5 ± 11.1 years, p < 0.001) and those with a higher American Society of Anesthesiologists class (class III or IV: 52.4% vs 46.3%, p = 0.003), a higher rate of motor deficit (67.0% vs 58.7%, p = 0.014), worse myelopathy (mean modified Japanese Orthopaedic Association score 11.4 ± 3.1 vs 12.4 ± 2.6, p < 0.001), and more levels treated (4.3 ± 1.3 vs 2.4 ± 0.6, p < 0.001). On the other hand, surgeons more frequently performed an anterior surgical approach when patients were employed (47.2% vs 23.2%, p < 0.001) and had intervertebral disc herniation as an underlying pathology (30.7% vs 9.2%, p < 0.001). CONCLUSIONS The selection of approach for patients with CSM depends on patient demographics and symptomology. Posterior surgery was performed in patients who were older and had worse systemic disease, increased myelopathy, and greater levels of stenosis. Anterior surgery was more often performed in patients who were employed and had intervertebral disc herniation.
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Affiliation(s)
- Christine Park
- 1Department of Neurosurgery, Duke University, Durham, North Carolina
| | | | - Khoi D Than
- 1Department of Neurosurgery, Duke University, Durham, North Carolina
| | | | - Sally El Sammak
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Andrew K Chan
- 3Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Erica F Bisson
- 4Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Brandon A Sherrod
- 4Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Anthony L Asher
- 5Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Domagoj Coric
- 5Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Eric A Potts
- 6Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Kevin T Foley
- 7Department of Neurosurgery, University of Tennessee, Semmes Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Michael Y Wang
- 8Department of Neurosurgery, University of Miami, Florida
| | - Kai-Ming Fu
- 9Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - Michael S Virk
- 9Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - John J Knightly
- 10Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Scott Meyer
- 10Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Paul Park
- 11Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Cheerag Upadhyaya
- 12Marion Bloch Neuroscience Institute, Saint Luke's Health System, Kansas City, Missouri
| | - Mark E Shaffrey
- 13Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Avery L Buchholz
- 13Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | | | - Jay Turner
- 14Barrow Neurological Institute, Phoenix, Arizona
| | - Nitin Agarwal
- 15Department of Neurosurgery, Washington University in St. Louis, Missouri
| | - Dean Chou
- 3Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Nauman S Chaudhry
- 1Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Regis W Haid
- 16Atlanta Brain and Spine Care, Atlanta, Georgia; and
| | - Praveen V Mummaneni
- 17Department of Neurosurgery, University of California, San Francisco, California
| | - Mohamad Bydon
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Oren N Gottfried
- 1Department of Neurosurgery, Duke University, Durham, North Carolina
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16
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Algattas H, Mitha R, Agarwal N, Lang MJ. Bow Hunter Syndrome: An Illustrative Case and Operative Management. World Neurosurg 2024; 182:135. [PMID: 37797682 DOI: 10.1016/j.wneu.2023.09.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/26/2023] [Indexed: 10/07/2023]
Abstract
The differential for vertebrobasilar insufficiency is wide and can be caused by posterior circulation infarcts, steal-type phenomena, or other systemic causes. In the absence of imaging findings explaining symptomology, the utility of appropriate history gathering and dynamic angiography cannot be understated in identifying Bow Hunter's syndrome, a rare cause of dynamic vertebrobasilar insufficiency. We present a case of a 69-year-old man who complained of presyncope and severe dizziness when turning his head towards the right. On examination he had no radiculopathy but did have objective evidence of myelopathy. Computed tomography imaging and dynamic angiography demonstrated C3-C4 right uncovertebral joint hypertrophy and near complete stenosis of the right vertebral artery with dynamic head position towards the right. Given vertebrobasilar insufficiency and myelopathy, he was taken to the operating room for C3-C4 anterior cervical discectomy and fusion with vertebral artery decompression (Video 1). The patient provided consent for the procedure. Standard anterior cervical neck dissection was undertaken with additional platysmal undermining to facilitate exposure of the right uncovertebral joint and transverse processes. The vertebral artery was first decompressed above and below the area of most significant stenosis at the respective transverse foramina before the hypertrophied uncovertebral joint was removed. Next, discectomy and posterior osteophyte removal were completed in typical fashion followed by graft, plate, and screw placement. Postoperatively the patient had immediate resolution of symptoms and continued so at eight month follow-up. Imaging demonstrated return to normal caliber of the right vertebral artery and successful decompression.
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Affiliation(s)
- Hanna Algattas
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Rida Mitha
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Michael J Lang
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
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17
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Mitha R, Colan JA, Hernandez-Rovira MA, Jawad-Makki MAH, Patel RP, Elsayed GA, Shaw JD, Okonkwo DO, Buell TJ, Hamilton DK, Agarwal N. Topical tranexamic acid (TXA) is non-inferior to intravenous TXA in adult spine surgery: a meta-analysis. Neurosurg Rev 2024; 47:48. [PMID: 38224410 DOI: 10.1007/s10143-023-02254-3] [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] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 01/16/2024]
Abstract
Tranexamic acid (TXA) has long been utilized in spine surgery and can be administered through intravenous (IV) and topical routes. Although, topical and IV administration of TXA are both effective in decreasing blood loss during spine surgery, complications like deep vein thrombosis (DVT) and pulmonary embolism have been reported with the use of intravenous TXA (ivTXA). These potential complications may be mitigated through the use of topical TXA (tTXA). To assess optimal dosing protocols and efficacy of topical TXA in spine surgery, Embase, Ovid-MEDLINE, Scopus, Cochrane, and clinicaltrials.gov were queried for original research on the use of tTXA in adult patients undergoing spine surgery. Data parameters analyzed included blood loss, transfusion rate, thromboembolic, and other complications. Data was synthesized and confidence evaluated according to the Grades of Recommendation, Assessment, Development, and Evaluation approach. Nineteen studies were included in the final analysis with 2197 patients. Of the 18 published studies, 9 (50%) displayed high levels of evidence. Topical TXA showed a trend towards a lower risk of transfusion and complications. Protocols that used 1g tTXA showed a significantly reduced risk for transfusion when compared to controls (risk ratio -1.05, 95% CI (-1.62, -0.48); P = 0.94, I2 = 0%). Complications associated with tTXA included DVTs and wound infections. Topical TXA was non-inferior to intravenous TXA with similar efficacy and complication profiles for bleeding control in spine surgery; however, more studies are needed to discern benefits and risks.
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Affiliation(s)
- Rida Mitha
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Jhair Alejandro Colan
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | | | - Mohamed-Ali H Jawad-Makki
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Rujvee P Patel
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Galal A Elsayed
- Och Spine, Weill Cornell Medicine, New-York Presbyterian Hospital, New York, NY, 10065, USA
| | - Jeremy D Shaw
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA
| | - Thomas J Buell
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA
| | - D Kojo Hamilton
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA.
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA.
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18
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Adida S, Legarreta AD, Hudson JS, McCarthy D, Andrews E, Shanahan R, Taori S, Lavadi RS, Buell TJ, Hamilton DK, Agarwal N, Gerszten PC. Machine Learning in Spine Surgery: A Narrative Review. Neurosurgery 2024; 94:53-64. [PMID: 37930259 DOI: 10.1227/neu.0000000000002660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/06/2023] [Indexed: 11/07/2023] Open
Abstract
Artificial intelligence and machine learning (ML) can offer revolutionary advances in their application to the field of spine surgery. Within the past 5 years, novel applications of ML have assisted in surgical decision-making, intraoperative imaging and navigation, and optimization of clinical outcomes. ML has the capacity to address many different clinical needs and improve diagnostic and surgical techniques. This review will discuss current applications of ML in the context of spine surgery by breaking down its implementation preoperatively, intraoperatively, and postoperatively. Ethical considerations to ML and challenges in ML implementation must be addressed to maximally benefit patients, spine surgeons, and the healthcare system. Areas for future research in augmented reality and mixed reality, along with limitations in generalizability and bias, will also be highlighted.
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Affiliation(s)
- Samuel Adida
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Andrew D Legarreta
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Joseph S Hudson
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - David McCarthy
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Edward Andrews
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Regan Shanahan
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Suchet Taori
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Raj Swaroop Lavadi
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Thomas J Buell
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - D Kojo Hamilton
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Nitin Agarwal
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
| | - Peter C Gerszten
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
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19
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Luy DD, Agarwal N, McDowell MM, Tonetti DA, Goldschmidt E, Friedlander RM. Acquired Chiari Type I Malformation Associated with Type IV Dural Arteriovenous Fistula: Case Report. J Neurol Surg A Cent Eur Neurosurg 2024; 85:94-99. [PMID: 35263802 DOI: 10.1055/a-1792-5000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Chiari malformations, usually congenital, can rarely be associated with arteriovenous (AV) fistulas. We present the first case involving a type IV dural AV fistula with a Chiari type I malformation. METHODS Retrospective chart review was performed to obtain pertinent details regarding history and examination, pathologic findings, and treatment course. RESULTS A 63-year-old woman with a 2-year history of migraines presented with 5 months of occipital, right-sided headaches and neck pain exacerbated by Valsalva maneuvers. Computed tomography (CT) and magnetic resonance imaging (MRI) of the head showed a possible right occipital AV malformation, bilateral cerebellar subdural hygromas, and tonsillar crowding at the foramen magnum indicating an acquired Chiari type I malformation. Angiography demonstrated a Cognardtype IV right posterior occipital dural AV fistula supplied by bilateral middle meningeal and posterior meningeal arteries. CONCLUSION After treatment of the dural AV fistula, hygroma evacuation, and decompression of the acquired Chiari malformation, the patient's Valsalva-induced headaches abated.
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Affiliation(s)
- Diego D Luy
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Michael M McDowell
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Daniel A Tonetti
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Ezequiel Goldschmidt
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Robert M Friedlander
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
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20
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Gajjar AA, Patel SV, Lavadi RS, Mitha R, Kumar RP, Taylor T, Elsayed GA, Hamilton DK, Agarwal N. Art and Neurosurgery: The Importance of Medical Illustration. World Neurosurg 2024; 181:82-89. [PMID: 37838159 DOI: 10.1016/j.wneu.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/16/2023]
Abstract
Art in neurosurgery has been a critical part of the discipline for centuries. Numerous cultures, such as ancient India, China, and Egypt, and more contemporary scientists, such as Leonardo da Vinci, Max Brödel, and Norman Dott, have significantly contributed to medical illustration. Today, advancements in three-dimensional technology have allowed for the creation of detailed neuroanatomy models for surgical planning and education. Medical illustrations are also used for research and outcome documentation as they help visualize anatomy and surgical procedures. Its use in education, surgical planning, and navigation remains integral to the advancement of neurosurgery. This review demonstrates the invaluable contribution of art in neurosurgery and how it has enabled continuous progress in the field.
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Affiliation(s)
- Avi A Gajjar
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Shrey V Patel
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Raj Swaroop Lavadi
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rida Mitha
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rohit Prem Kumar
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Tavis Taylor
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Galal A Elsayed
- Och Spine, Weill Cornell Medicine / NewYork-Presbyterian Hospital, New York, New York, USA
| | - D Kojo Hamilton
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
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Goyal T, Dokania MK, Rana ASK, Agarwal N, Jain A, Sharma L. Resectable Distal Duodenal Gastrointestinal Stromal Tumour Presenting with Features of Anaemia. J West Afr Coll Surg 2024; 14:113-117. [PMID: 38486652 PMCID: PMC10936884 DOI: 10.4103/jwas.jwas_95_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/29/2023] [Indexed: 03/17/2024]
Abstract
Although gastrointestinal stromal tumours (GISTs) are encountered all along the gastrointestinal tract, duodenal GISTs are uncommon and account for <5% of the cases. A 45-year-old woman presented chiefly with anaemia and associated symptoms, whom on further evaluation was found to have a non-metastatic GIST in the distal duodenum sparing the pancreas and major vasculature. Patient was undertaken for segmental duodenectomy with the help of advanced bipolar energy device (tumour occupying D3-D4 with 1 cm proximal margin and 15 cm jejunum) preserving the pancreas and ampulla with end-to-end duodenojejunostomy with an uneventful postoperative course and clear margins on histopathology. Thus, the patient underwent a less morbid procedure with satisfactory oncological outcome and early resumption of activity. This highlights the need to conduct more trials to gather high level evidence in favour of conservative resection and its oncological adequacy and impact on overall survival and recurrence.
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Affiliation(s)
- Tushar Goyal
- Department of Surgery, ABVIMS and DR RML Hospital, New Delhi, Delhi, India
| | | | | | - Nitin Agarwal
- Department of Surgery, ABVIMS and DR RML Hospital, New Delhi, Delhi, India
| | - Atul Jain
- Department of Surgery, ABVIMS and DR RML Hospital, New Delhi, Delhi, India
| | - Lalit Sharma
- Department of Surgery, ABVIMS and DR RML Hospital, New Delhi, Delhi, India
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22
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Dokania MK, Ankur A, Agarwal N, Jain A, Anshu A, Singh RAK. Comparison of Perioperative Complication Rates of Total Extraperitoneal and Transabdominal Preperitoneal Repairs in Primary Inguinal Hernia. J West Afr Coll Surg 2024; 14:69-75. [PMID: 38486649 PMCID: PMC10936899 DOI: 10.4103/jwas.jwas_76_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 07/21/2023] [Indexed: 03/17/2024]
Abstract
Background Hernia may be defined as a protrusion of viscus through layers anatomically designed to contain that viscus. Most abdominal hernias occur at well-described sites of potential weakness. Repair of inguinal hernia is one of the most common operations in general surgery. Objectives: To compare the perioperative complication rates of total extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) repairs of primary inguinal hernias. Materials and Methods It is a randomised comparative study, conducted at the department of general surgery. A total of 50 patients were included and divided into two groups with 25 in each. Group A represents the laparoscopic TEP repair and group B represents the laparoscopic TAPP repair. Patients above 18 years with primary unilateral inguinal hernia were included. Patients having complicated inguinal hernia and history of previous abdominal surgery were excluded. Results We observed that hernia occurrence is more common in the 31-50 years of age group and right-sided hernia is more common. Scrotal oedema and conversion to open surgery chances are similar in both TEP and TAPP groups. The duration of surgery in TEP is significantly higher as compared to TAPP. Patients who underwent TEP experienced less pain as compared to TAPP as per visual analogue scale. Postoperative hospital stay and time taken to resume the routine activity were significantly less in case of TEP. Conclusion TEP is preferred over TAPP for laparoscopic hernia repair because it preserves the peritoneal integrity and has lesser postoperative pain. The early recovery and return to the routine work were seen with the patient treated with the TEP and also showed better visual analogue score than the TAPP repair group.
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Affiliation(s)
| | - Ankur Ankur
- Department of Surgery, ABVIMS & Dr RML Hospital, New Delhi, India
| | - Nitin Agarwal
- Department of Surgery, ABVIMS & Dr RML Hospital, New Delhi, India
| | - Atul Jain
- Department of Surgery, ABVIMS & Dr RML Hospital, New Delhi, India
| | - Anshu Anshu
- Department of Surgery, ABVIMS & Dr RML Hospital, New Delhi, India
| | - Rana A K Singh
- Department of Surgery, ABVIMS & Dr RML Hospital, New Delhi, India
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23
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Agarwal N, Papanna R, Bergh EP, Hernandez-Andrade E, Backley S, Salazar A, Johnson A, Espinoza J. Management of large placental chorioangioma: two-port laser approach for fetal intervention. Ultrasound Obstet Gynecol 2023; 62:882-890. [PMID: 37448172 DOI: 10.1002/uog.26307] [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] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/09/2023] [Accepted: 05/12/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES There is a paucity of literature providing evidence-based guidelines for the management of large placental chorioangioma (≥ 4 cm in diameter). The objectives of this study were to compare outcomes between patients managed expectantly and those undergoing in-utero intervention and to describe the different in-utero techniques used for cessation of blood flow to the tumor and the associated outcome. METHODS This was a retrospective cohort study of 34 patients referred for the management of large placental chorioangioma in a single center between January 2011 and December 2022, who were managed expectantly or underwent in-utero intervention. In-utero intervention was performed when the fetus developed any signs of impending compromise, including high combined cardiac output (CCO), worsening polyhydramnios or abnormal fetal Doppler velocimetry findings. Interventions included radiofrequency ablation (RFA), interstitial laser ablation (ILA) and single-port or two-port fetoscopic laser photocoagulation (FLP). Treatment selection was dependent on the proximity of the tumor to the umbilical cord insertion (UCI) and placental location. The two-port technique was performed in patients with a chorioangioma with large feeding vessels (≥ 3 mm) located in the posterior placenta, in which one port was used for occlusion using bipolar forceps and the other port was used for laser photocoagulation of the feeding vessels downstream. The single-port technique was used for chorioangioma with small feeding vessels (< 3 mm) located in the posterior placenta. ILA or RFA was performed in cases with an anterior placenta. Supportive treatments, including amnioreduction and intrauterine transfusion (IUT), were performed for worsening polyhydramnios and suspected fetal anemia based on middle cerebral artery Doppler flow studies, respectively. Comparative statistical analysis between cases undergoing expectant management vs in-utero intervention was performed. Descriptive details were provided for patients who underwent in-utero intervention. RESULTS Thirty-four cases of large chorioangioma were evaluated, of which 25 (73.5%) were managed expectantly and nine (26.5%) underwent intervention. The frequency of polyhydramnios was significantly higher in the intervention group compared with the expectant-management group (66.7% vs 8.0%, P < 0.001). The live-birth rate among expectantly managed cases with large chorioangioma was significantly higher compared with that in cases that underwent in-utero intervention (96.0% vs 62.5%, P = 0.01). In the intervention group, preoperative CCO was elevated in all cases with available information and preoperative hydrops was present in 33.3% (3/9) of cases. One patient experienced fetal demise following IUT prior to planned FLP. Among the remaining eight patients, four underwent two-port FLP, two underwent single-port FLP, one underwent ILA and one underwent both ILA and RFA. All three cases in which hydrops was present at the time of intervention resulted in fetal demise. CONCLUSIONS In-utero interventions aimed at cessation of blood flow in the feeding vessels are a therapeutic option for the management of cases with large chorioangioma. The two-port percutaneous technique appears to improve the efficiency of FLP when a large chorioangioma with large feeding vessels is located in the posterior placenta. We propose that in-utero interventions for large chorioangioma should be initiated prior to the development of fetal hydrops. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- N Agarwal
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - R Papanna
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - E P Bergh
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - E Hernandez-Andrade
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - S Backley
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - A Salazar
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - A Johnson
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - J Espinoza
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
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24
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Fields DP, Lavadi RS, Hudson JS, McCarthy DJ, Hect J, Wawrose R, Capuk O, Agarwal N, McDowell MM, Simon D, Abel TJ, Greene S. Patterns in Follow-Up Imaging Usage for Pediatric Patients with Whiplash-Associated Disorder. World Neurosurg 2023; 180:e786-e790. [PMID: 37852474 DOI: 10.1016/j.wneu.2023.10.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/06/2023] [Accepted: 10/07/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND A clinical concern exists that pediatric patients with whiplash-associated disorder (WAD) might have missed structural injuries or, alternatively, subsequently develop structural injuries over time, despite initially negative imaging findings. The primary objective of this study is to assess follow-up imaging usage for pediatric patients presenting with WAD. METHODS A retrospective review of 444 pediatric patients presenting to a level 1 pediatric trauma hospital from January 1, 2010 to December 31, 2019 was performed. Imaging was reviewed at the initial encounter and the 3- and 6-month follow-up appointments. RESULTS At the initial evaluation, children aged <6 years were more likely to receive radiographs (P = 0.007) and magnetic resonance imaging (P = 0.048) than were children aged 6-11 and 12-18 years. At the 3- and 6-month follow-up appointments, persistent neck pain was rare, representing <15% of patients at either time. Regardless of pain persistence, 80.2% of patients seen at the 3-month follow-up and 100% of patients at the 6-month follow-up underwent additional imaging studies. At the 3-month follow-up, children with persistent neck pain were more likely to undergo magnetic resonance imaging than were patients without persistent pain (P < 0.001). Also, patients with persistent neck pain were also more likely to not undergo any imaging evaluation (P = 0.002). Follow-up imaging studies did not reveal new structural injuries at either time point. CONCLUSIONS Follow-up imaging for pediatric patients with low-grade WAD did not identify new structural pathology-in patients with or without persistent neck pain.
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Affiliation(s)
- Daryl P Fields
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
| | - Raj Swaroop Lavadi
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Joseph S Hudson
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - David J McCarthy
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jasmine Hect
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Richard Wawrose
- Department of Orthopedics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Okan Capuk
- Department of Neurology, University of Pittsburgh Institute for Neurodegenerative Diseases, Pittsburgh, Pennsylvania, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michael M McDowell
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Department of Neurological Surgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Dennis Simon
- Department of Neurological Surgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Taylor J Abel
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Department of Neurological Surgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Stephanie Greene
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Department of Neurological Surgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Adida S, Legarreta A, Hudson JS, Kumar RP, Kass NM, Agarwal N, Gerszten PC, Andrews EG. Application of Machine Learning for Automatic Segmentation of Paraspinal Musculature. World Neurosurg 2023; 180:228-230. [PMID: 37940447 DOI: 10.1016/j.wneu.2023.10.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Affiliation(s)
- Samuel Adida
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Andrew Legarreta
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Joseph S Hudson
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Rohit P Kumar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nicolás M Kass
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nitin Agarwal
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Peter C Gerszten
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Edward G Andrews
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Agarwal N, Ashutosh, Sharma A, Gupta A. A prospective study on skin and soft tissue infections: a fact-finding mission from a tertiary centre in north India. J Wound Care 2023; 32:S4-S13. [PMID: 37907364 DOI: 10.12968/jowc.2023.32.sup11.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
OBJECTIVE Despite the high prevalence and poor outcome of skin and soft tissue infections (SSTIs), very few studies from India have dealt with the subject. We planned a prospective study of inpatients with SSTIs to study the aetiology, clinical presentation (severity) and outcome of patients with SSTIs in our facility. METHOD Patients with SSTIs involving >5% body surface area (BSA) and/or systemic signs were admitted to the surgery department of a teaching tertiary level hospital in Delhi, India, and were clinically classified into cellulitis, necrotising soft tissue infections (NSTIs), pyomyositis, and abscess. Demographic and clinical variables such as: age; sex; occupation; history of trauma/insect or animal bites; duration of illness; presenting symptoms and signs; comorbid conditions; predisposing factors such as lymphoedema or venous disease; hospital course; treatment instituted; complications; hospital outcome; presence of crepitus, bullae, gangrene, muscle necrosis and compartment syndrome were recorded. The chief outcome parameters were death and length of hospital stay; others, such as abscess drainage, the need for plastic surgical procedures and amputations were also noted. RESULTS Out of 250 patients enrolled in the study, 145 (58%) had NSTIs, 64 (26%) had abscesses, 15 (6%) had cellulitis and 26 (10%) had pyomyositis. Mortality was observed with NSTIs (27/145, 19%) and with pyomyositis (3/26, 11.5%). Factors affecting mortality by univariate analysis in the NSTI group were: abnormal pulse; hypotension; tachypnea; bullae; increased blood urea and serum creatinine; inotrope or ventilator support (all with p<0.001); local tenderness, gangrene, dialysis support and BSA (9.33±6.44 versus 5.12±3.62; p<0.05 for the last four). No factor was found to be significant on multivariate analysis. Variables associated with hospital stay >12 days were immunocompromise, pus discharge, ulceration or gangrene, and after interventions such as blood transfusion, drainage or skin grafting. CONCLUSION High prevalence of NSTI and pyomyositis with high mortality was observed in our SSTI patients, often in immunocompetent young individuals. Epidemiological studies focused on virulent strains of Staphylococcus aureus may be required to identify the cause, since Staphylococcal toxins have been implicated in other infections.
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Affiliation(s)
- Nitin Agarwal
- Formerly at Department of Surgery, University College of Medical Sciences (UCMS) and Guru Tegh Bahadur Hospital (GTBH), Delhi, India
- Department of Surgery and Transplant, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital (RMLH), Delhi, India
| | - Ashutosh
- Formerly at Department of Surgery, University College of Medical Sciences (UCMS) and Guru Tegh Bahadur Hospital (GTBH), Delhi, India
| | - Ashish Sharma
- Formerly at Department of Surgery, University College of Medical Sciences (UCMS) and Guru Tegh Bahadur Hospital (GTBH), Delhi, India
| | - Arun Gupta
- Formerly at Department of Surgery, University College of Medical Sciences (UCMS) and Guru Tegh Bahadur Hospital (GTBH), Delhi, India
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27
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Agarwal N, Roy S, Lavadi RS, Alan N, Ozpinar A, Buell TJ, Hamilton DK, Kanter AS, Okonkwo DO. Durability of stand-alone anterolateral interbody fusion in staged minimally invasive circumferential scoliosis surgery with delayed posterior instrumentation due to medical necessity. Spine Deform 2023; 11:1495-1501. [PMID: 37525061 DOI: 10.1007/s43390-023-00725-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 06/17/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE Circumferential minimally invasive scoliosis surgeries are often staged, wherein anterior and/or lateral lumbar interbody fusion is followed by percutaneous posterior fixation days later. This study examines the impact on outcomes when posterior augmentation was delayed due to unexpected medical issues following the first stage, anterolateral procedure. METHODS A retrospective review was conducted of all patients undergoing minimally invasive circumferential deformity corrections from 2006 to 2019. Patients in whom planned posterior fixation was postponed due to medical necessity or safety concerns were identified. Perioperative surgical metrics and radiographic parameters were collected. RESULTS Three of the six patients initially scheduled for circumferential fusion never underwent posterior augmentation due to symptomatic improvement (2.3, 5, and 10.7 years of follow-up). The other three underwent posterior fixation once medically optimized after an average interval of 4.7 months (range 3.2-7.8 months) due to persistent symptoms. It was also observed that the average coronal malalignment in the postoperative period was 5.1 cm in the group requiring further fixation and only 1.6 cm in the group which did not. CONCLUSION In select cases, the indirect decompression and stability conferred by minimally invasive anterolateral arthrodesis alone may afford adequate pain relief to delay or even avoid posterior fixation in patients with adult spinal deformity.
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Affiliation(s)
- Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B-400, Pittsburgh, PA, 15213, USA.
| | - Souvik Roy
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Raj Swaroop Lavadi
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Nima Alan
- Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | | | - Thomas J Buell
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - D Kojo Hamilton
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Adam S Kanter
- Department of Neurosurgery, Hoag Neurosciences Institute, Newport Beach, CA, USA
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Yang E, Mummaneni PV, Chou D, Bydon M, Bisson EF, Shaffrey CI, Gottfried ON, Asher AL, Coric D, Potts EA, Foley KT, Wang MY, Fu KM, Virk MS, Knightly JJ, Meyer S, Park P, Upadhyaya CD, Shaffrey ME, Buchholz AL, Tumialán LM, Turner JD, Michalopoulos GD, Sherrod BA, Agarwal N, Haid RW, Chan AK. Cervical laminoplasty versus laminectomy and posterior cervical fusion for cervical myelopathy: propensity-matched analysis of 24-month outcomes from the Quality Outcomes Database. J Neurosurg Spine 2023; 39:671-681. [PMID: 37728378 DOI: 10.3171/2023.6.spine23345] [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: 04/25/2023] [Accepted: 06/08/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE Compared with laminectomy with posterior cervical fusion (PCF), cervical laminoplasty (CL) may result in different outcomes for those operated on for cervical spondylotic myelopathy (CSM). The aim of this study was to compare 24-month patient-reported outcomes (PROs) for laminoplasty versus PCF by using the Quality Outcomes Database (QOD) CSM data set. METHODS This was a retrospective study using an augmented data set from the prospectively collected QOD Registry Cervical Module. Patients undergoing laminoplasty or PCF for CSM were included. Using the nearest-neighbor method, the authors performed 1:1 propensity matching based on age, operated levels, and baseline modified Japanese Orthopaedic Association (mJOA) and visual analog scale (VAS) neck pain scores. The 24-month PROs, i.e., mJOA, Neck Disability Index (NDI), VAS neck pain, VAS arm pain, EQ-5D, EQ-VAS, and North American Spine Society (NASS) satisfaction scores, were compared. Only cases in the subaxial cervical region were included; those that crossed the cervicothoracic junction were excluded. RESULTS From the 1141 patients included in the QOD CSM data set who underwent anterior or posterior surgery for cervical myelopathy, 946 (82.9%) had 24 months of follow-up. Of these, 43 patients who underwent laminoplasty and 191 who underwent PCF met the inclusion criteria. After matching, the groups were similar for baseline characteristics, including operative levels (CL group: 4.0 ± 0.9 vs PCF group: 4.2 ± 1.1, p = 0.337) and baseline PROs (p > 0.05), except for a higher percentage involved in activities outside the home in the CL group (95.3% vs 81.4%, p = 0.044). The 24-month follow-up for the matched cohorts was similar (CL group: 88.4% vs PCF group: 83.7%, p = 0.534). Patients undergoing laminoplasty had significantly lower estimated blood loss (99.3 ± 91.7 mL vs 186.7 ± 142.7 mL, p = 0.003), decreased length of stay (3.0 ± 1.6 days vs 4.5 ± 3.3 days, p = 0.012), and a higher rate of routine discharge (88.4% vs 62.8%, p = 0.006). The CL cohort also demonstrated a higher rate of return to activities (47.2% vs 21.2%, p = 0.023) after 3 months. Laminoplasty was associated with a larger improvement in 24-month NDI score (-19.6 ± 18.9 vs -9.1 ± 21.9, p = 0.031). Otherwise, there were no 3- or 24-month differences in mJOA, mean NDI, VAS neck pain, VAS arm pain, EQ-5D, EQ-VAS, and distribution of NASS satisfaction scores (p > 0.05) between the cohorts. CONCLUSIONS Compared with PCF, laminoplasty was associated with decreased blood loss, decreased length of hospitalization, and higher rates of home discharge. At 3 months, laminoplasty was associated with a higher rate of return to baseline activities. At 24 months, laminoplasty was associated with greater improvements in neck disability. Otherwise, laminoplasty and PCF shared similar outcomes for functional status, pain, quality of life, and satisfaction. Laminoplasty and PCF achieved similar neck pain scores, suggesting that moderate preoperative neck pain may not necessarily be a contraindication for laminoplasty.
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Affiliation(s)
- Eunice Yang
- 1Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Praveen V Mummaneni
- 2Department of Neurosurgery, University of California, San Francisco, California
| | - Dean Chou
- 1Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Mohamad Bydon
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Erica F Bisson
- 4Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | | | - Oren N Gottfried
- 5Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Anthony L Asher
- 6Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Domagoj Coric
- 6Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Eric A Potts
- 7Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Kevin T Foley
- 8Department of Neurosurgery, University of Tennessee, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Michael Y Wang
- 9Department of Neurosurgery, University of Miami, Florida
| | - Kai-Ming Fu
- 10Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - Michael S Virk
- 10Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - John J Knightly
- 11Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Scott Meyer
- 11Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Paul Park
- 12Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Cheerag D Upadhyaya
- 13Marion Bloch Neuroscience Institute, Saint Luke's Health System, Kansas City, Missouri
| | - Mark E Shaffrey
- 14Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Avery L Buchholz
- 14Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | | | - Jay D Turner
- 15Barrow Neurological Institute, Phoenix, Arizona
| | | | - Brandon A Sherrod
- 4Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Nitin Agarwal
- 16Department of Neurosurgery, University of Pittsburgh, Pennsylvania; and
| | - Regis W Haid
- 17Atlanta Brain and Spine Care, Atlanta, Georgia
| | - Andrew K Chan
- 1Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
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Campbell LJ, Mummaneni PV, Letchuman V, Langnas E, Agarwal N, Guan LS, Croci R, Vargas E, Reisner L, Bickler P, Chou D, Chang E, Guan Z. Mismatched opioid prescription in patients discharged after neurological surgeries: a retrospective cohort study. Pain 2023; 164:2615-2621. [PMID: 37326642 DOI: 10.1097/j.pain.0000000000002966] [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] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/22/2023] [Indexed: 06/17/2023]
Abstract
ABSTRACT Although postsurgical overprescription has been well-studied, postsurgical opioid underprescription remains largely overlooked. This retrospective cohort study was to investigate the extent of discharge opioid overprescription and underprescription in patients after neurological surgeries. Six thousand nine hundred forty-nine adult opioid-naive patients who underwent inpatient neurosurgical procedures at the University of California San Francisco were included. The primary outcome was the discrepancy between individual patient's prescribed daily oral morphine milligram equivalent (MME) at discharge and patient's own inpatient daily MME consumed within 24 hours of discharge. Analyses include Wilcoxon, Mann-Whitney, Kruskal-Wallis, and χ 2 tests, and linear or multivariable logistic regression. 64.3% and 19.5% of patients were opioid overprescribed and underprescribed, respectively, with median prescribed daily MME 360% and 55.2% of median inpatient daily MME in opioid overprescribed and underprescribed patients, respectively. 54.6% of patients with no inpatient opioid the day before discharge were opioid overprescribed. Opioid underprescription dose-dependently increased the rate of opioid refill 1 to 30 days after discharge. From 2016 to 2019, the percentage of patients with opioid overprescription decreased by 24.8%, but the percentage of patients with opioid underprescription increased by 51.2%. Thus, the mismatched discharge opioid prescription in patients after neurological surgeries presented as both opioid overprescription and underprescription, with a dose-dependent increased rate of opioid refill 1 to 30 days after discharge in opioid underprescription. Although we are fighting against opioid overprescription to postsurgical patients, we should not ignore postsurgical opioid underprescription.
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Affiliation(s)
- Liam J Campbell
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, United States
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, United States
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Vijay Letchuman
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Erica Langnas
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, United States
| | - Nitin Agarwal
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St Louis, MO, United States
| | - Lucy S Guan
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, United States
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, United States
| | - Rhiannon Croci
- UCSF Health Informatics, University of California San Francisco, San Francisco, CA, United States
| | - Enrique Vargas
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Lori Reisner
- Department of Clinical Pharmacology, University of California San Francisco, San Francisco, CA, United States
| | - Phil Bickler
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, United States
| | - Dean Chou
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurosurgery, Columbia University, New York, NY, United States
| | - Edward Chang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Zhonghui Guan
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, United States
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Pai J, Joshi RK, Bhaskar S, Patil S, Bv S, R S, Iyengar AR, Agarwal N, Shorie M. Revisiting the cortisol reference ranges in humans: the role of demographics. Endocrine 2023; 82:414-418. [PMID: 37501014 DOI: 10.1007/s12020-023-03456-x] [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: 04/20/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023]
Abstract
The current study explores the effect of demographics on serum cortisol expression in a study group of 52 individuals to improve the current serum reference ranges to produce personalized expression profiles consequently increasing clinical confidence in the diagnosis. The serum cortisol concentration was inspected against demographical data like age, sex, and body mass index and showed an association with age and sex. The serum cortisol values also indicated a positive association with chronic illnesses however this finding requires a more focused study for establishment. Additionally, saliva samples are also collected from the same study group at the same time through drool and an absorbent sponge and correlated with serum values to draw an alternative route of serological testing. Salivary cortisol from drool showed a linear correlation with Pearson's correlation coefficients of 0.71 and 0.72 with serum cortisol and with saliva samples collected using a porous sponge respectively. Overall, the study shows the role of demographics in shaping the reference ranges for cortisol, suggesting a path for developing personalized diagnostics. The study also highlights the efficacy of saliva as an alternative to serum cortisol to facilitate cortisol measurement for efficient stress management.
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Affiliation(s)
- Jayeeta Pai
- Cortiqa Health Private Limited, Bangalore, India.
| | | | | | - Seema Patil
- DA Pandu Memorial RV Dental College, Bangalore, India
| | - Subhash Bv
- DA Pandu Memorial RV Dental College, Bangalore, India
| | - Shriyanka R
- DA Pandu Memorial RV Dental College, Bangalore, India
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Mandel N, Büttner M, Poschet G, Kuner R, Agarwal N. SUMOylation Modulates Reactive Oxygen Species (ROS) Levels and Acts as a Protective Mechanism in the Type 2 Model of Diabetic Peripheral Neuropathy. Cells 2023; 12:2511. [PMID: 37947589 PMCID: PMC10648122 DOI: 10.3390/cells12212511] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/06/2023] [Accepted: 10/17/2023] [Indexed: 11/12/2023] Open
Abstract
Diabetic peripheral neuropathy (DPN) is the prevalent type of peripheral neuropathy; it primarily impacts extremity nerves. Its multifaceted nature makes the molecular mechanisms of diabetic neuropathy intricate and incompletely elucidated. Several types of post-translational modifications (PTMs) have been implicated in the development and progression of DPN, including phosphorylation, glycation, acetylation and SUMOylation. SUMOylation involves the covalent attachment of small ubiquitin-like modifier (SUMO) proteins to target proteins, and it plays a role in various cellular processes, including protein localization, stability, and function. While the specific relationship between high blood glucose and SUMOylation is not extensively studied, recent evidence implies its involvement in the development of DPN in type 1 diabetes. In this study, we investigated the impact of SUMOylation on the onset and progression of DPN in a type 2 diabetes model using genetically modified mutant mice lacking SUMOylation, specifically in peripheral sensory neurons (SNS-Ubc9-/-). Behavioural measurement for evoked pain, morphological analyses of nerve fibre loss in the epidermis, measurement of reactive oxygen species (ROS) levels, and antioxidant molecules were analysed over several months in SUMOylation-deficient and control mice. Our longitudinal analysis at 30 weeks post-high-fat diet revealed that SNS-Ubc9-/- mice exhibited earlier and more pronounced thermal and mechanical sensation loss and accelerated intraepidermal nerve fibre loss compared to control mice. Mechanistically, these changes are associated with increased levels of ROS both in sensory neuronal soma and in peripheral axonal nerve endings in SNS-Ubc9-/- mice. In addition, we observed compromised detoxifying potential, impaired respiratory chain complexes, and reduced levels of protective lipids in sensory neurons upon deletion of SUMOylation in diabetic mice. Importantly, we also identified mitochondrial malate dehydrogenase (MDH2) as a SUMOylation target, the activity of which is negatively regulated by SUMOylation. Our results indicate that SUMOylation is an essential neuroprotective mechanism in sensory neurons in type 2 diabetes, the deletion of which causes oxidative stress and an impaired respiratory chain, resulting in energy depletion and subsequent damage to sensory neurons.
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Affiliation(s)
- Nicolas Mandel
- Institute of Pharmacology, Medical Faculty Heidelberg, Heidelberg University, Im Neuenheimer Feld 366, 69120 Heidelberg, Germany (R.K.)
| | - Michael Büttner
- Centre for Organismal Studies (COS), University of Heidelberg, Im Neuenheimer Feld 360, 69120 Heidelberg, Germany
| | - Gernot Poschet
- Centre for Organismal Studies (COS), University of Heidelberg, Im Neuenheimer Feld 360, 69120 Heidelberg, Germany
| | - Rohini Kuner
- Institute of Pharmacology, Medical Faculty Heidelberg, Heidelberg University, Im Neuenheimer Feld 366, 69120 Heidelberg, Germany (R.K.)
| | - Nitin Agarwal
- Institute of Pharmacology, Medical Faculty Heidelberg, Heidelberg University, Im Neuenheimer Feld 366, 69120 Heidelberg, Germany (R.K.)
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Park C, Agarwal N, Mummaneni PV, Berven SH. Spinopelvic Alignment: Importance in Spinal Pathologies and Realignment Strategies. Neurosurg Clin N Am 2023; 34:519-526. [PMID: 37718098 DOI: 10.1016/j.nec.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Sagittal spinal malalignment can lead to pain, decreased function, dynamic imbalance, and compromise of patient-reported health status. The goal of reconstructive spine surgery is to restore spinal alignment parameters, and an understanding of appropriate patient-specific alignment is important for surgical planning and approaches. Radiographic spinopelvic parameters are strongly correlated with pain and function. The relationship between spinopelvic parameters and disability in adult spinal deformity patients is well-established, and optimal correction of sagittal alignment results in improved outcomes regarding patient health status and mechanical complications of surgery.
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Affiliation(s)
- Christine Park
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA.
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Sigurd H Berven
- Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA
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Pugazenthi S, Hernandez-Rovira MA, Fabiano AS, Rogers JL, Gajjar AA, Lavadi RS, Elsayed GA, Greenberg JK, Hafez DM, Janjua MB, Ogunlade J, Pennicooke BH, Agarwal N. Mapping the geographic migration of United States neurosurgeons across training and current practice regions: associations with academic productivity. J Neurosurg 2023; 139:1109-1119. [PMID: 36933250 DOI: 10.3171/2023.1.jns222269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/17/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVE Characterizing changes in the geographic distribution of neurosurgeons in the United States (US) may inform efforts to provide a more equitable distribution of neurosurgical care. Herein, the authors performed a comprehensive analysis of the geographic movement and distribution of the neurosurgical workforce. METHODS A list containing all board-certified neurosurgeons practicing in the US in 2019 was obtained from the American Association of Neurological Surgeons membership database. Chi-square analysis and a post hoc comparison with Bonferroni correction were performed to assess differences in demographics and geographic movement throughout neurosurgeon careers. Three multinomial logistic regression models were performed to further evaluate relationships among training location, current practice location, neurosurgeon characteristics, and academic productivity. RESULTS The study cohort included 4075 (3830 male, 245 female) neurosurgeons practicing in the US. Seven hundred eighty-one neurosurgeons practice in the Northeast, 810 in the Midwest, 1562 in the South, 906 in the West, and 16 in a US territory. States with the lowest density of neurosurgeons included Vermont and Rhode Island in the Northeast; Arkansas, Hawaii, and Wyoming in the West; North Dakota in the Midwest; and Delaware in the South. Overall, the effect size, as measured by Cramér's V statistic, between training stage and training region is relatively modest at 0.27 (1.0 is complete dependence); this finding was reflected in the similarly modest pseudo R2 values of the multinomial logit models, which ranged from 0.197 to 0.246. Multinomial logistic regression with L1 regularization revealed significant associations between current practice region and residency region, medical school region, age, academic status, sex, or race (p < 0.05). On subanalysis of the academic neurosurgeons, the region of residency training correlated with an advanced degree type in the overall neurosurgeon cohort, with more neurosurgeons than expected holding Doctor of Medicine and Doctor of Philosophy degrees in the West (p = 0.021). CONCLUSIONS Female neurosurgeons were less likely to practice in the South, and neurosurgeons in the South and West had reduced odds of holding academic rather than private positions. The Northeast was the most likely region to contain neurosurgeons who had completed their training in the same locality, particularly among academic neurosurgeons who did their residency in the Northeast.
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Affiliation(s)
- Sangami Pugazenthi
- 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | | | - Alexander S Fabiano
- 2Department of Neurosurgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - James L Rogers
- 3Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Avi A Gajjar
- 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Raj Swaroop Lavadi
- 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Galal A Elsayed
- 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Jacob K Greenberg
- 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Daniel M Hafez
- 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - M Burhan Janjua
- 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - John Ogunlade
- 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Brenton H Pennicooke
- 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Nitin Agarwal
- 4Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh; and
- 5Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Park C, Shabani S, Agarwal N, Tan L, Mummaneni PV. Robotic-Assisted Surgery and Navigation in Deformity Surgery. Neurosurg Clin N Am 2023; 34:659-664. [PMID: 37718112 DOI: 10.1016/j.nec.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Deformity surgery is advancing quickly with the use of three-dimensional navigation and robotics. In spinal fusion, the use of robotics improves screw placement accuracy and reduces radiation, complications, blood loss, and recovery time. Currently, there is limited evidence showing that robotics is better than traditional freehand techniques. Most studies favoring robotics are small and retrospective due to the novelty of the technology in deformity surgery. Using these systems can also be expensive and time-consuming. Surgeons should use these advancements as tools, but not rely on them to replace surgical experience, anatomy knowledge, and good judgment.
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Affiliation(s)
- Christine Park
- Department of Neurological Surgery, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA.
| | - Saman Shabani
- Department of Neurological Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Lee Tan
- Department of Neurological Surgery, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA
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35
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Pugazenthi S, Hernandez-Rovira MA, Mitha R, Rogers JL, Lavadi RS, Kann MR, Cardozo MR, Hardi A, Elsayed GA, Joseph J, Housley SN, Agarwal N. Evaluating the state of non-invasive imaging biomarkers for traumatic brain injury. Neurosurg Rev 2023; 46:232. [PMID: 37682375 DOI: 10.1007/s10143-023-02085-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/03/2023] [Accepted: 07/07/2023] [Indexed: 09/09/2023]
Abstract
Non-invasive imaging biomarkers are useful for prognostication in patients with traumatic brain injury (TBI) at high risk for morbidity with invasive procedures. The authors present findings from a scoping review discussing the pertinent biomarkers. Embase, Ovid-MEDLINE, and Scopus were queried for original research on imaging biomarkers for prognostication of TBI in adult patients. Two reviewers independently screened articles, extracted data, and evaluated risk of bias. Data was synthesized and confidence evaluated with the linked evidence according to the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. Our search yielded 3104 unique citations, 44 of which were included in this review. Study populations varied in TBI severity, as defined by Glasgow Coma Scale (GCS), including: mild (n=9), mild and moderate (n=3), moderate and severe (n=7), severe (n=6), and all GCS scores (n=17). Diverse imaging modalities were used for prognostication, predominantly computed tomography (CT) only (n=11), magnetic resonance imaging (MRI) only (n=9), and diffusion tensor imaging (DTI) (N=9). The biomarkers included diffusion coefficient mapping, metabolic characteristics, optic nerve sheath diameter, T1-weighted signal changes, cortical cerebral blood flow, axial versus extra-axial lesions, T2-weighted gradient versus spin echo, translocator protein levels, and trauma imaging of brainstem areas. The majority (93%) of studies identified that the imaging biomarker of interest had a statistically significant prognostic value; however, these are based on a very low to low level of quality of evidence. No study directly compared the effects on specific TBI treatments on the temporal course of imaging biomarkers. The current literature is insufficient to make a strong recommendation about a preferred imaging biomarker for TBI, especially considering GRADE criteria revealing low quality of evidence. Rigorous prospective research of imaging biomarkers of TBI is warranted to improve the understanding of TBI severity.
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Affiliation(s)
- Sangami Pugazenthi
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | | | - Rida Mitha
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - James L Rogers
- Vanderbilt University School of Medicine, Nashville, TN, 37235, USA
| | - Raj Swaroop Lavadi
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Michael R Kann
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Miguel Ruiz Cardozo
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Angela Hardi
- Becker Medical Library, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Galal A Elsayed
- Och Spine, Weill Cornell Medicine, New-York Presbyterian Hospital, New York City, NY, USA
| | - Jacob Joseph
- Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - Stephen N Housley
- School of Applied Physiology, Georgia Institute of Technology, Atlanta, GA, 30332, USA
- Integrated Cancer Research Center, Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA.
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
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36
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Shakrawal J, Bhatnagar KR, Agarwal N. Axenfeld-Rieger anomaly with slit pupils. J Fr Ophtalmol 2023; 46:829-830. [PMID: 37225607 DOI: 10.1016/j.jfo.2022.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/06/2022] [Indexed: 05/26/2023]
Affiliation(s)
- J Shakrawal
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India.
| | - K R Bhatnagar
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - N Agarwal
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
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Hussain O, Kaushal M, Agarwal N, Kurpad S, Shabani S. The Role of Magnetic Resonance Imaging and Computed Tomography in Spinal Cord Injury. Life (Basel) 2023; 13:1680. [PMID: 37629537 PMCID: PMC10455833 DOI: 10.3390/life13081680] [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: 06/08/2023] [Revised: 07/26/2023] [Accepted: 08/02/2023] [Indexed: 08/27/2023] Open
Abstract
Traumatic injuries of the spine are associated with long-term morbidity and mortality. Timely diagnosis and appropriate management of mechanical instability and spinal cord injury are important to prevent further neurologic deterioration. Spine surgeons require an understanding of the essential imaging techniques concerning the diagnosis, management, and prognosis of spinal cord injury. We present a review in the role of computed tomography (CT) including advancements in multidetector CT (MDCT), dual energy CT (DECT), and photon counting CT, and how it relates to spinal trauma. We also review magnetic resonance imaging (MRI) and some of the developed MRI based classifications for prognosticating the severity and outcome of spinal cord injury, such as diffusion weighted imaging (DWI), diffusion tractography (DTI), functional MRI (fMRI), and perfusion MRI.
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Affiliation(s)
- Omar Hussain
- Department of Neurological Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (O.H.); (M.K.); (S.K.)
| | - Mayank Kaushal
- Department of Neurological Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (O.H.); (M.K.); (S.K.)
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA;
| | - Shekar Kurpad
- Department of Neurological Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (O.H.); (M.K.); (S.K.)
| | - Saman Shabani
- Department of Neurological Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (O.H.); (M.K.); (S.K.)
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Magistri M, Happ LE, Ramdial J, Lu X, Stathias V, Kunkalla K, Agarwal N, Jiang X, Schürer SC, Dubovy SR, Chapman JR, Vega F, Dave S, Lossos IS. Correction: The Genetic Landscape of Ocular Adnexa MALT Lymphoma Reveals Frequent Aberrations in NFAT and MEF2B Signaling Pathways. Cancer Res Commun 2023; 3:1688. [PMID: 37649813 PMCID: PMC10464847 DOI: 10.1158/2767-9764.crc-23-0371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 08/25/2023] [Indexed: 09/01/2023]
Abstract
[This corrects the article DOI: 10.1158/2767-9764.CRC-21-0022.][This corrects the article DOI: 10.1158/2767-9764.CRC-21-0022.].
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Habib A, Muthiah N, Alattar A, Hoppe M, Agarwal N, Alan N, Hamilton DK, Ozpinar A. Direct Iliac Screw vs Sacral-2-Alar-Iliac Screws Technique for Sacropelvic Fixation: Technical Nuances and a Review of the Literature. Int J Spine Surg 2023; 17:511-519. [PMID: 37055178 PMCID: PMC10478702 DOI: 10.14444/8449] [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] [Indexed: 04/15/2023] Open
Abstract
Sacropelvic (SP) fixation is the immobilization of the sacroiliac joint to attain lumbosacral fusion and prevent distal spinal junctional failure. SP fixation is indicated in numerous spinal conditions (eg, scoliosis, multilevel spondylolisthesis, spinal/sacral trauma, tumors, or infections). Many SP fixation techniques have been described in the literature. Currently, the most used surgical techniques for SP fixation are direct iliac screws and sacral-2-alar-iliac screws. There is currently no consensus in the literature on which technique carries more favorable clinical outcomes. In this review, we aim to assess the available data on each technique and discuss their respective advantages and disadvantages. We will also present our experience with a modification of direct iliac screws using a subcrestal approach and outline the future prospects of SP fixation.
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Affiliation(s)
- Ahmed Habib
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, USA
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Nallammai Muthiah
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Ali Alattar
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Meagan Hoppe
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Nitin Agarwal
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Nima Alan
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - David Kojo Hamilton
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Alp Ozpinar
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, USA
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40
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Muzyka L, Pugazenthi S, Lavadi RS, Shah D, Patel A, Rangwalla T, Javeed S, Elsayed G, Greenberg JK, Pennicooke B, Agarwal N. Geographic Distribution in Training and Practice of Academic Neurological and Orthopedic Spine Surgeons in the United States. World Neurosurg 2023; 176:e281-e288. [PMID: 37209918 DOI: 10.1016/j.wneu.2023.05.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/22/2023]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE This study aimed to stratify the geographic distribution of academic spine surgeons in the United States, analyzing how this distribution highlights differences in academic, demographic, professional metrics, and gaps in access to spine care. METHODS Spine surgeons were identified using American Association of Neurological Surgeons and American Academy of Orthopedic Surgeons databases, categorizing into geographic regions of training and practice. Departmental websites, National Institutes of Health (NIH) RePort Expenditures and Results, Google Patent, and NIH icite databases were queried for demographic and professional metrics. RESULTS Academic spine surgeons (347 neurological; 314 orthopedic) are predominantly male (95%) and few have patents (23%) or NIH funding (4%). Regionally, the Northeast has the highest proportion per capita (3.28 surgeons per million), but California is the state with the highest proportion (13%). The Northeast has the greatest regional retention post-residency at 74%, followed by the Midwest (59%). The West and South are more associated with additional degrees. Neurosurgery-trained surgeons hold more additional degrees (17%) than orthopedic surgeons (8%), whereas more orthopedic surgeons hold leadership positions (34%) than neurosurgeons (20%). CONCLUSIONS Academic spine surgeons are found at the highest proportion in the Northeast and California; the Northeast has the greatest regional retention. Spine neurosurgeons have more additional degrees, whereas spine orthopedic surgeons have more leadership positions. These results are relevant to training programs looking to correct geographic disparities, surgeons in search of training programs, or students in pursuit of spine surgery.
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Affiliation(s)
- Logan Muzyka
- Department of Neurosurgery, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - Sangami Pugazenthi
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Raj Swaroop Lavadi
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Darsh Shah
- Department of Neurosurgery, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - Arpan Patel
- Department of Neurosurgery, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - Taiyeb Rangwalla
- Department of Neurosurgery, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - Saad Javeed
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Galal Elsayed
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jacob K Greenberg
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Brenton Pennicooke
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Nitin Agarwal
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
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Gajjar AA, Le AHD, Jacobs R, Mooney JH, Lavadi RS, Kumar RP, White MD, Elsayed GA, Agarwal N. Patient perception of spinal cord injury through social media: An analysis of 703 Instagram and 117 Twitter posts. J Craniovertebr Junction Spine 2023; 14:288-291. [PMID: 37860020 PMCID: PMC10583803 DOI: 10.4103/jcvjs.jcvjs_87_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/13/2023] [Indexed: 10/21/2023] Open
Abstract
Introduction Social media has developed exponentially over the last decade as a means for individuals and patients to connect to others and has provided a unique opportunity for physicians to provide broader information to the general public to attempt to positively modify health behavior. The purpose of this study was to assess the patient's perception of spinal cord injury (SCI) on social media. Methods Instagram and Twitter social media platforms were analyzed to determine posts written by patients with SCI. The initial search for Instagram posts tagged with "#spinalcordinjury" yielded over 270,000 posts in April 2021. Posts pertaining to the patient's experience were retrospectively collected from January 2020 to April 2021. Twitter posts that included "#spinalcordinjury," "@spinalcordinjury," and "spinal cord injury" were retrospectively collected in April 2021. One hundred seventeen tweets were found that were directly from a patient with SCI. Themes associated with patients' experiences living with SCI were coded. Results The most common theme on Instagram was spreading positivity and on Twitter was the appearance of the wheelchair (75.8% and 37.3%, respectively). Other common themes on Instagram were the appearance of a wheelchair (71.8%), recovery or rehabilitation (29.9%), and life satisfaction (29.0%). Prevalent themes on Twitter included spreading positivity (23.2%) and recovery or rehabilitation (21.3%). Conclusion The prevalence of themes of positivity and awareness may indicate the utilization of social media as a support mechanism for patients living with SCI. Identification of prevalent themes is important for the holistic treatment of SCI survivors.
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Affiliation(s)
- Avi A. Gajjar
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Kansas City, Missouri, USA
| | - Anthony Huy Dinh Le
- Department of Neurosurgery, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Rachel Jacobs
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Kansas City, Missouri, USA
| | - James H. Mooney
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Raj Swaroop Lavadi
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Kansas City, Missouri, USA
| | - Rohit Prem Kumar
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Kansas City, Missouri, USA
| | - Michael D. White
- Department of Neurological Surgery, Barrow Neurologic Institute, Phoenix, Arizona, USA
| | - Galal A. Elsayed
- Department of Neurosurgery, Weill Cornell Medical College, New York, NY, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Kansas City, Missouri, USA
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Lavadi RS, Elsayed GA, Buell TJ, Hamilton DK, Agarwal N. Strategies for spine surgeons to enhance a clinical practice and research program: stepping stones for practice management. J Neurosurg Spine 2023; 39:132-135. [PMID: 36964726 DOI: 10.3171/2023.2.spine22924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 02/15/2023] [Indexed: 03/26/2023]
Abstract
In this review, the value of patient-reported outcome measures, immersive technology, and patient review systems is discussed, and these strategies are presented as ways to enhance both the research and clinical aspects of a practice. The value of a research team and open access research databases is also discussed. Establishing a research program does not need elaborate resources to sustain efforts. The aforementioned simple yet effective strategies can enhance the clinical and research experience for surgeons in both academic and private practice settings.
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Affiliation(s)
- Raj Swaroop Lavadi
- 1Department of Neurological Surgery, University of Pittsburgh School of Medicine; and
| | - Galal A Elsayed
- 1Department of Neurological Surgery, University of Pittsburgh School of Medicine; and
| | - Thomas J Buell
- 1Department of Neurological Surgery, University of Pittsburgh School of Medicine; and
| | - D Kojo Hamilton
- 1Department of Neurological Surgery, University of Pittsburgh School of Medicine; and
| | - Nitin Agarwal
- 1Department of Neurological Surgery, University of Pittsburgh School of Medicine; and
- 2Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Chan AK, Shaffrey CI, Park C, Gottfried ON, Than KD, Bisson EF, Bydon M, Asher AL, Coric D, Potts EA, Foley KT, Wang MY, Fu KM, Virk MS, Knightly JJ, Meyer S, Park P, Upadhyaya CD, Shaffrey ME, Buchholz AL, Tumialán LM, Turner JD, Michalopoulos GD, Sherrod BA, Agarwal N, Chou D, Haid RW, Mummaneni PV. Do comorbid self-reported depression and anxiety influence outcomes following surgery for cervical spondylotic myelopathy? J Neurosurg Spine 2023; 39:11-27. [PMID: 37021762 DOI: 10.3171/2023.2.spine22685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 02/20/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE Depression and anxiety are associated with inferior outcomes following spine surgery. In this study, the authors examined whether patients with cervical spondylotic myelopathy (CSM) who have both self-reported depression (SRD) and self-reported anxiety (SRA) have worse postoperative patient-reported outcomes (PROs) compared with patients who have only one or none of these comorbidities. METHODS This study is a retrospective analysis of prospectively collected data from the Quality Outcomes Database CSM cohort. Comparisons were made among patients who reported the following: 1) either SRD or SRA, 2) both SRD and SRA, or 3) neither comorbidity at baseline. PROs at 3, 12, and 24 months (scores for the visual analog scale [VAS] for neck pain and arm pain, Neck Disability Index [NDI], modified Japanese Orthopaedic Association [mJOA] scale, EQ-5D, EuroQol VAS [EQ-VAS], and North American Spine Society [NASS] patient satisfaction index) and achievement of respective PRO minimal clinically important differences (MCIDs) were compared. RESULTS Of the 1141 included patients, 199 (17.4%) had either SRD or SRA alone, 132 (11.6%) had both SRD and SRA, and 810 (71.0%) had neither. Preoperatively, patients with either SRD or SRA alone had worse scores for VAS neck pain (5.6 ± 3.1 vs 5.1 ± 3.3, p = 0.03), NDI (41.0 ± 19.3 vs 36.8 ± 20.8, p = 0.007), EQ-VAS (57.0 ± 21.0 vs 60.7 ± 21.7, p = 0.03), and EQ-5D (0.53 ± 0.23 vs 0.58 ± 0.21, p = 0.008) than patients without such disorders. Postoperatively, in multivariable adjusted analyses, baseline SRD or SRA alone was associated with inferior improvement in the VAS neck pain score and a lower rate of achieving the MCID for VAS neck pain score at 3 and 12 months, but not at 24 months. At 24 months, patients with SRD or SRA alone experienced less change in EQ-5D scores and were less likely to meet the MCID for EQ-5D than patients without SRD or SRA. Furthermore, patient self-reporting of both psychological comorbidities did not impact PROs at all measured time points compared with self-reporting of only one psychological comorbidity alone. Each cohort (SRD or SRA alone, both SRD and SRA, and neither SRD nor SRA) experienced significant improvements in mean PROs at all measured time points compared with baseline (p < 0.05). CONCLUSIONS Approximately 12% of patients who underwent surgery for CSM presented with both SRD and SRA, and 29% presented with at least one symptom. The presence of either SRD or SRA was independently associated with inferior scores for 3- and 12-month neck pain following surgery, but this difference was not significant at 24 months. However, at long-term follow-up, patients with SRD or SRA experienced lower quality of life than patients without SRD or SRA. The comorbid presence of both depression and anxiety was not associated with worse patient outcomes than either diagnosis alone.
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Affiliation(s)
- Andrew K Chan
- 1Department of Neurological Surgery, Columbia University, The Och Spine Hospital at NewYork/Presbyterian, New York, New York
| | | | - Christine Park
- 2Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Oren N Gottfried
- 2Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Khoi D Than
- 2Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Erica F Bisson
- 3Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Mohamad Bydon
- 4Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Anthony L Asher
- 5Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Domagoj Coric
- 5Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Eric A Potts
- 6Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Kevin T Foley
- 7Department of Neurosurgery, University of Tennessee, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Michael Y Wang
- 8Department of Neurological Surgery, University of Miami, Florida
| | - Kai-Ming Fu
- 9Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - Michael S Virk
- 9Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - John J Knightly
- 10Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Scott Meyer
- 10Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Paul Park
- 7Department of Neurosurgery, University of Tennessee, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
- 11Department of Neurological Surgery, University of Michigan, Ann Arbor, Michigan
| | - Cheerag D Upadhyaya
- 12Marion Bloch Neuroscience Institute, Saint Luke's Health System, Kansas City, Missouri
| | - Mark E Shaffrey
- 13Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Avery L Buchholz
- 13Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | | | - Jay D Turner
- 14Barrow Neurological Institute, Phoenix, Arizona
| | | | - Brandon A Sherrod
- 3Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Nitin Agarwal
- 15Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Dean Chou
- 1Department of Neurological Surgery, Columbia University, The Och Spine Hospital at NewYork/Presbyterian, New York, New York
| | - Regis W Haid
- 16Atlanta Brain and Spine Care, Atlanta, Georgia
| | - Praveen V Mummaneni
- 15Department of Neurological Surgery, University of California, San Francisco, California; and
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Agarwal N, White MD, Roy S, Ozpinar A, Alan N, Lavadi RS, Okonkwo DO, Hamilton DK, Kanter AS. Long-Term Durability of Stand-Alone Lateral Lumbar Interbody Fusion. Neurosurgery 2023; 93:60-65. [PMID: 36757328 DOI: 10.1227/neu.0000000000002371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 11/21/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND The long-term durability of stand-alone lateral lumbar interbody fusion (LLIF) remains unknown. OBJECTIVE To evaluate whether early patient-reported outcome measures after stand-alone LLIF are sustained on long-term follow-up. METHODS One hundred and twenty-six patients who underwent stand-alone LLIF between 2009 and 2017 were included in this study. Patient-reported outcome measures included the Oswestry Disability Index (ODI), EuroQOL-5D (EQ-5D), and visual analog score (VAS) scores. Durable outcomes were defined as scores showing a significant improvement between preoperative and 6-week scores without demonstrating any significant decline at future time points. A repeated measures analysis was conducted using generalized estimating equations (model) to assess the outcome across different postoperative time points, including 6 weeks, 1 year, 2 years, and 5 years. RESULTS ODI scores showed durable improvement at 5-year follow-up, with scores improving from 46.9 to 38.5 ( P = .001). Improvements in EQ-5D showed similar durability up to 5 years, improving from 0.48 to 0.65 ( P = .03). VAS scores also demonstrated significant improvements postoperatively that were durable at 2-year follow-up, improving from 7.0 to 4.6 ( P < .0001). CONCLUSION Patients undergoing stand-alone LLIF were found to have significant improvements in ODI and EQ-5D at 6-week follow-up that remained durable up to 5 years postoperatively. VAS scores were found to be significantly improved at 6 weeks and up to 2 years postoperatively but failed to reach significance at 5 years. These findings demonstrate that patients undergoing stand-alone LLIF show significant improvement in overall disability after surgery that remains durable at long-term follow-up.
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Affiliation(s)
- Nitin Agarwal
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Michael D White
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Souvik Roy
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Alp Ozpinar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nima Alan
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Raj Swaroop Lavadi
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - D Kojo Hamilton
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Adam S Kanter
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Hoag Specialty Clinic, Hoag Neurosciences Institute, Newport Beach, California, USA
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Singh AK, Saxena A, Agarwal N. Performance analysis of a serrated absorber plate solar air heater with paraffin wax storage. Environ Sci Pollut Res Int 2023:10.1007/s11356-023-27961-8. [PMID: 37291348 DOI: 10.1007/s11356-023-27961-8] [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] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/24/2023] [Indexed: 06/10/2023]
Abstract
The study aims to examine the thermal performance of solar air heaters employing two different absorber plates under two different configurations. The experiments have been conducted in the summer climatic conditions of Moradabad City, India. A total of about 04 models of solar air heaters have been developed. The experimental investigation has been done using a flat-plate absorber and a serrated geometric absorber (with and without using the tested phase change material) to estimate the thermal performance. Notably, 03 different mass flow rates (i.e., 0.01 kg/s, 0.02 kg/s, and 0.03 kg/s) have been used to investigate the heat transfer coefficient, instantaneous efficiency, and daily efficiencies. Results of the study showed that Model-4 is the best among all the tested models that provide an average exhaust temperature of about 46 °C after sunset. The optimum daily average efficiency has been obtained at about 63% at 0.03 kg/s. The efficiency of a serrated plate-type SAH without using phase change material is about 23% higher than that of a conventional system, while it is about 19% higher than that of a conventional SAH using phase change material. Overall, the modified system is suitable for moderate-temperature applications, like agricultural drying and space heating.
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Affiliation(s)
- Arvind Kumar Singh
- Mechanical Engineering Department, Moradabad Institute of Technology, Moradabad, India.
| | - Abhishek Saxena
- Mechanical Engineering Department, School of Engineering, Dev Bhoomi Uttarakhand University, Dehradun, India
| | - Nitin Agarwal
- Mechanical Engineering Department Shri Venkateshwara, University, Gajraula, India
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Shahrestani S, Chan AK, Bisson EF, Bydon M, Glassman SD, Foley KT, Shaffrey CI, Potts EA, Shaffrey ME, Coric D, Knightly JJ, Park P, Wang MY, Fu KM, Slotkin JR, Asher AL, Virk MS, Michalopoulos GD, Guan J, Haid RW, Agarwal N, Chou D, Mummaneni PV. Developing nonlinear k-nearest neighbors classification algorithms to identify patients at high risk of increased length of hospital stay following spine surgery. Neurosurg Focus 2023; 54:E7. [PMID: 37283368 DOI: 10.3171/2023.3.focus22651] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 08/29/2022] [Accepted: 03/22/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Spondylolisthesis is a common operative disease in the United States, but robust predictive models for patient outcomes remain limited. The development of models that accurately predict postoperative outcomes would be useful to help identify patients at risk of complicated postoperative courses and determine appropriate healthcare and resource utilization for patients. As such, the purpose of this study was to develop k-nearest neighbors (KNN) classification algorithms to identify patients at increased risk for extended hospital length of stay (LOS) following neurosurgical intervention for spondylolisthesis. METHODS The Quality Outcomes Database (QOD) spondylolisthesis data set was queried for patients receiving either decompression alone or decompression plus fusion for degenerative spondylolisthesis. Preoperative and perioperative variables were queried, and Mann-Whitney U-tests were performed to identify which variables would be included in the machine learning models. Two KNN models were implemented (k = 25) with a standard training set of 60%, validation set of 20%, and testing set of 20%, one with arthrodesis status (model 1) and the other without (model 2). Feature scaling was implemented during the preprocessing stage to standardize the independent features. RESULTS Of 608 enrolled patients, 544 met prespecified inclusion criteria. The mean age of all patients was 61.9 ± 12.1 years (± SD), and 309 (56.8%) patients were female. The model 1 KNN had an overall accuracy of 98.1%, sensitivity of 100%, specificity of 84.6%, positive predictive value (PPV) of 97.9%, and negative predictive value (NPV) of 100%. Additionally, a receiver operating characteristic (ROC) curve was plotted for model 1, showing an overall area under the curve (AUC) of 0.998. Model 2 had an overall accuracy of 99.1%, sensitivity of 100%, specificity of 92.3%, PPV of 99.0%, and NPV of 100%, with the same ROC AUC of 0.998. CONCLUSIONS Overall, these findings demonstrate that nonlinear KNN machine learning models have incredibly high predictive value for LOS. Important predictor variables include diabetes, osteoporosis, socioeconomic quartile, duration of surgery, estimated blood loss during surgery, patient educational status, American Society of Anesthesiologists grade, BMI, insurance status, smoking status, sex, and age. These models may be considered for external validation by spine surgeons to aid in patient selection and management, resource utilization, and preoperative surgical planning.
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Affiliation(s)
- Shane Shahrestani
- 1Keck School of Medicine, University of Southern California, Los Angeles, California
- 2Department of Medical Engineering, California Institute of Technology, Pasadena, California
| | - Andrew K Chan
- 3Department of Neurological Surgery, Columbia University, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Erica F Bisson
- 4Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Mohamad Bydon
- 5Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Kevin T Foley
- 7Department of Neurological Surgery, University of Tennessee
| | - Christopher I Shaffrey
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
- Departments of8Neurosurgery andOrthopedic Surgery, Duke University, Durham, North Carolina
| | - Eric A Potts
- 10Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Mark E Shaffrey
- 11Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Domagoj Coric
- 12Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - John J Knightly
- 13Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Paul Park
- 7Department of Neurological Surgery, University of Tennessee
| | - Michael Y Wang
- 14Department of Neurological Surgery, University of Miami, Florida
| | - Kai-Ming Fu
- 15Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | | | - Anthony L Asher
- 12Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Michael S Virk
- 15Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | | | - Jian Guan
- 4Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Regis W Haid
- 17Atlanta Brain and Spine Care, Atlanta, Georgia; and
| | - Nitin Agarwal
- 18Department of Neurological Surgery, University of California, San Francisco, California
| | - Dean Chou
- 3Department of Neurological Surgery, Columbia University, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Praveen V Mummaneni
- 18Department of Neurological Surgery, University of California, San Francisco, California
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Park C, Mummaneni PV, Gottfried ON, Shaffrey CI, Tang AJ, Bisson EF, Asher AL, Coric D, Potts EA, Foley KT, Wang MY, Fu KM, Virk MS, Knightly JJ, Meyer S, Park P, Upadhyaya C, Shaffrey ME, Buchholz AL, Tumialán LM, Turner JD, Sherrod BA, Agarwal N, Chou D, Haid RW, Bydon M, Chan AK. Which supervised machine learning algorithm can best predict achievement of minimum clinically important difference in neck pain after surgery in patients with cervical myelopathy? A QOD study. Neurosurg Focus 2023; 54:E5. [PMID: 37283449 DOI: 10.3171/2023.3.focus2372] [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: 01/31/2023] [Accepted: 03/22/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the performance of different supervised machine learning algorithms to predict achievement of minimum clinically important difference (MCID) in neck pain after surgery in patients with cervical spondylotic myelopathy (CSM). METHODS This was a retrospective analysis of the prospective Quality Outcomes Database CSM cohort. The data set was divided into an 80% training and a 20% test set. Various supervised learning algorithms (including logistic regression, support vector machine, decision tree, random forest, extra trees, gaussian naïve Bayes, k-nearest neighbors, multilayer perceptron, and extreme gradient boosted trees) were evaluated on their performance to predict achievement of MCID in neck pain at 3 and 24 months after surgery, given a set of predicting baseline features. Model performance was assessed with accuracy, F1 score, area under the receiver operating characteristic curve, precision, recall/sensitivity, and specificity. RESULTS In total, 535 patients (46.9%) achieved MCID for neck pain at 3 months and 569 patients (49.9%) achieved it at 24 months. In each follow-up cohort, 501 patients (93.6%) were satisfied at 3 months after surgery and 569 patients (100%) were satisfied at 24 months after surgery. Of the supervised machine learning algorithms tested, logistic regression demonstrated the best accuracy (3 months: 0.76 ± 0.031, 24 months: 0.773 ± 0.044), followed by F1 score (3 months: 0.759 ± 0.019, 24 months: 0.777 ± 0.039) and area under the receiver operating characteristic curve (3 months: 0.762 ± 0.027, 24 months: 0.773 ± 0.043) at predicting achievement of MCID for neck pain at both follow-up time points, with fair performance. The best precision was also demonstrated by logistic regression at 3 (0.724 ± 0.058) and 24 (0.780 ± 0.097) months. The best recall/sensitivity was demonstrated by multilayer perceptron at 3 months (0.841 ± 0.094) and by extra trees at 24 months (0.817 ± 0.115). Highest specificity was shown by support vector machine at 3 months (0.952 ± 0.013) and by logistic regression at 24 months (0.747 ± 0.18). CONCLUSIONS Appropriate selection of models for studies should be based on the strengths of each model and the aims of the studies. For maximally predicting true achievement of MCID in neck pain, of all the predictions in this balanced data set the appropriate metric for the authors' study was precision. For both short- and long-term follow-ups, logistic regression demonstrated the highest precision of all models tested. Logistic regression performed consistently the best of all models tested and remains a powerful model for clinical classification tasks.
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Affiliation(s)
- Christine Park
- 1Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Praveen V Mummaneni
- 2Department of Neurosurgery, University of California, San Francisco, California
| | - Oren N Gottfried
- 1Department of Neurosurgery, Duke University, Durham, North Carolina
| | | | - Anthony J Tang
- 3Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Erica F Bisson
- 4Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Anthony L Asher
- 5Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Domagoj Coric
- 5Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Eric A Potts
- 6Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Kevin T Foley
- 7Department of Neurosurgery, University of Tennessee, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Michael Y Wang
- 8Department of Neurosurgery, University of Miami, Florida
| | - Kai-Ming Fu
- 9Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - Michael S Virk
- 9Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - John J Knightly
- 10Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Scott Meyer
- 10Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Paul Park
- 11Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Cheerag Upadhyaya
- 12Marion Bloch Neuroscience Institute, Saint Luke's Health System, Kansas City, Missouri
| | - Mark E Shaffrey
- 13Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Avery L Buchholz
- 13Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | | | - Jay D Turner
- 14Barrow Neurological Institute, Phoenix, Arizona
| | - Brandon A Sherrod
- 4Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Nitin Agarwal
- 15Department of Neurosurgery, Washington University in St. Louis, Missouri
| | - Dean Chou
- 3Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Regis W Haid
- 16Atlanta Brain and Spine Care, Atlanta, Georgia; and
| | - Mohamad Bydon
- 17Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Andrew K Chan
- 3Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
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Shabani S, Agarwal N, Ben-Natan AR, Huang J, Le VP, Chou D, Mummaneni PV. Technical Note: Hinged Table for Single-Position Navigated Lateral Surgery: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 24:e441. [PMID: 36827189 DOI: 10.1227/ons.0000000000000648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/06/2022] [Indexed: 02/25/2023] Open
Affiliation(s)
- Saman Shabani
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
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49
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Papanna R, Agarwal N, Bergh EP, Brock C, Espinoza J, Johnson A. Fetoscopic laser ablation in pregnancies with Type-II vasa previa. Ultrasound Obstet Gynecol 2023; 61:779-781. [PMID: 36609872 DOI: 10.1002/uog.26153] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/30/2022] [Accepted: 12/16/2022] [Indexed: 06/03/2023]
Affiliation(s)
- R Papanna
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UT Health Houston, Houston, TX, USA
| | - N Agarwal
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UT Health Houston, Houston, TX, USA
| | - E P Bergh
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UT Health Houston, Houston, TX, USA
| | - C Brock
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UT Health Houston, Houston, TX, USA
| | - J Espinoza
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UT Health Houston, Houston, TX, USA
| | - A Johnson
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UT Health Houston, Houston, TX, USA
- Midwest Fetal Center, Minneapolis, MN, USA
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50
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Alan N, Deng H, Muthiah N, Vodovotz L, Dembinski R, Guha D, Agarwal N, Ozpinar A, Hamilton DK, Kanter AS, Okonkwo DO. Graft subsidence and reoperation after lateral lumbar interbody fusion: a propensity score-matched and cost analysis of polyetheretherketone versus 3D-printed porous titanium interbodies. J Neurosurg Spine 2023:1-9. [PMID: 37178027 DOI: 10.3171/2023.4.spine22492] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 04/03/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Lumbar interbody cage subsidence has a multifactorial etiology. Cage material, although well studied after transforaminal lumbar interbody fusion, has not been investigated as a contributing factor to subsidence after lateral lumbar interbody fusion (LLIF). In this study the authors compared rates of subsidence and reoperation after LLIF between polyetheretherketone (PEEK) and 3D-printed porous titanium (pTi) in an institutional propensity score-matched and cost analysis. METHODS This is a retrospective observational cohort analysis of adult patients who underwent LLIF with pTi versus PEEK between 2016 and 2020. Demographic, clinical, and radiographic characteristics were collected. Propensity scores were calculated and 1:1 matching without replacement of surgically treated levels was performed. The primary outcome of interest was subsidence. The Marchi subsidence grade was determined at the time of last follow-up. Chi-square or Fisher's exact tests were used to compare subsidence and reoperation rates between lumbar levels treated with PEEK versus pTi. Modeling and cost analysis were performed using TreeAge Pro Healthcare. RESULTS The authors identified a total of 192 patients; 137 underwent LLIF with PEEK (212 levels) and 55 had LLIF with pTi (97 levels). After propensity score matching, a total of 97 lumbar levels remained in each treatment group. After matching, there were no statistically significant differences between groups in baseline characteristics. Levels treated with pTi were significantly less likely to exhibit subsidence (any grade) compared to those treated with PEEK (8% vs 27%, p = 0.001). Five (5.2%) levels treated with PEEK required reoperation for subsidence, but only 1 (1.0%) level treated with pTi required reoperation for subsidence (p = 0.12). Given subsidence and revision rates experienced in the cohorts in this study, the pTi interbody device is economically superior to PEEK in a single-level LLIF as long as its cost is at least $1185.94 lower than that of PEEK. CONCLUSIONS The pTi interbody device was associated with less subsidence, but statistically similar revision rates after LLIF. pTi is potentially a superior economic choice at this study's reported revision rate.
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Affiliation(s)
- Nima Alan
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh
| | - Hansen Deng
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh
| | - Nallammai Muthiah
- 2University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Lena Vodovotz
- 2University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Robert Dembinski
- 2University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Daipayan Guha
- 3Department of Neurological Surgery, University of Toronto, Ontario, Canada; and
| | - Nitin Agarwal
- 4Department of Neurological Surgery, University of California, San Francisco, California
| | - Alp Ozpinar
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh
| | - D Kojo Hamilton
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh
| | - Adam S Kanter
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh
| | - David O Okonkwo
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh
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