1
|
Hou BQ, Croft AJ, Vaughan WE, Davidson C, Pennings JS, Bowers MF, Vickery JW, Abtahi AM, Gardocki RJ, Lugo-Pico JG, Zuckerman SL, Stephens BF. Racial and Socioeconomic Disparities in Laminoplasty Versus Laminectomy With Fusion in Patients With Cervical Spondylosis. Spine (Phila Pa 1976) 2024; 49:694-700. [PMID: 38655789 DOI: 10.1097/brs.0000000000004793] [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: 05/01/2023] [Accepted: 07/26/2023] [Indexed: 04/26/2024]
Abstract
STUDY DESIGN A retrospective cohort study using prospectively collected data. OBJECTIVE The aim of this study was to investigate preoperative differences in racial and socioeconomic factors in patients undergoing laminoplasty (LP) versus laminectomy and fusion (LF) for degenerative cervical myelopathy (DCM). SUMMARY OF BACKGROUND DATA DCM is prevalent in the United States, requiring surgical intervention to prevent neurological degeneration. While LF is utilized more frequently, LP is an emerging alternative. Previous studies have demonstrated similar neurological outcomes for both procedures. However, treatment selection is primarily at the discretion of the surgeon and may be influenced by social determinants of health that impact surgical outcomes. MATERIALS AND METHODS The Quality Outcome Database (QOD), a national spine registry, was queried for adult patients who underwent either LP or LF for the management of DCM. Covariates associated with socioeconomic status, pain and disability, and demographic and medical history were collected. Multivariate logistic regression was performed to assess patient factors associated with undergoing LP versus LF. RESULTS Of 1673 DCM patients, 157 (9.4%) underwent LP and 1516 (90.6%) underwent LF. A significantly greater proportion of LP patients had private insurance (P<0.001), a greater than high school level education (P<0.001), were employed (P<0.001), and underwent primary surgery (P<0.001). LP patients reported significantly lower baseline neck/arm pain and Neck Disability Index (P<0.001). In the multivariate regression model, lower baseline neck pain [odds ratio (OR)=0.915, P=0.001], identifying as non-Caucasian (OR=2.082, P<0.032), being employed (OR=1.592, P=0.023), and having a greater than high school level education (OR=1.845, P<0.001) were associated with undergoing LP rather than LF. CONCLUSIONS In DCM patients undergoing surgery, factors associated with patients undergoing LP versus LF included lower baseline neck pain, non-Caucasian race, higher education, and employment. While symptomatology may influence the decision to choose LP over LF, there may also be socioeconomic factors at play. The trend of more educated and employed patients undergoing LP warrants further investigation.
Collapse
Affiliation(s)
- Brian Q Hou
- Vanderbilt University School of Medicine, Nashville, TN
- Vanderbilt Spine Outcomes Lab, Vanderbilt University Medical Center, Nashville, TN
| | - Andrew J Croft
- Vanderbilt Spine Outcomes Lab, Vanderbilt University Medical Center, Nashville, TN
| | - Wilson E Vaughan
- Vanderbilt Spine Outcomes Lab, Vanderbilt University Medical Center, Nashville, TN
| | - Claudia Davidson
- Vanderbilt Spine Outcomes Lab, Vanderbilt University Medical Center, Nashville, TN
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN
| | - Jacquelyn S Pennings
- Vanderbilt Spine Outcomes Lab, Vanderbilt University Medical Center, Nashville, TN
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Mitchell F Bowers
- Vanderbilt Spine Outcomes Lab, Vanderbilt University Medical Center, Nashville, TN
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Justin W Vickery
- Vanderbilt Spine Outcomes Lab, Vanderbilt University Medical Center, Nashville, TN
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Amir M Abtahi
- Vanderbilt Spine Outcomes Lab, Vanderbilt University Medical Center, Nashville, TN
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Raymond J Gardocki
- Vanderbilt Spine Outcomes Lab, Vanderbilt University Medical Center, Nashville, TN
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Julian G Lugo-Pico
- Vanderbilt Spine Outcomes Lab, Vanderbilt University Medical Center, Nashville, TN
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Scott L Zuckerman
- Vanderbilt Spine Outcomes Lab, Vanderbilt University Medical Center, Nashville, TN
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Byron F Stephens
- Vanderbilt Spine Outcomes Lab, Vanderbilt University Medical Center, Nashville, TN
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
2
|
Chen JW, Chanbour H, Gupta R, Izah J, Vaughan WE, Abtahi AM, Zuckerman SL, Stephens BF. Adult versus adolescent idiopathic scoliosis surgery: a meta-analysis of clinical and radiographic outcomes. Eur Spine J 2024; 33:1637-1643. [PMID: 38436875 DOI: 10.1007/s00586-024-08177-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] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/31/2023] [Accepted: 01/31/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION While the natural history of adolescent idiopathic scoliosis (AIS) and adult idiopathic scoliosis (AdIS) is well documented in the literature, the impact of age on postoperative outcomes remains an active area of research. We performed a systematic review and meta-analysis to compare patients undergoing surgery for AIS and AdIS with respect to: (1) postoperative Cobb correction, (2) perioperative variables, and (3) postoperative complications. METHODS A systematic literature search was performed in accordance with preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. INCLUSION CRITERIA studies published between 2002 and 2022, retrospective, and comparing AIS vs. AdIS patients undergoing deformity surgery. The primary outcome was postoperative Cobb correction. Secondary outcomes included estimated blood loss (EBL), operative time, total instrumented levels, length of stay (LOS), and postoperative complications. Random-effects models were performed according to the method of DerSimonian and Laird. RESULTS Of 190 identified articles, 14 fit the inclusion criteria. A total of 1788 patients were included, 1275(71.3%) with AIS, and 513(28.7%) with AdIS. There was a significant age difference between AIS and AdIS (15.3 vs. 36.7 years, mean difference (MD) = 21.3 years, 95%CI = 14.3-28.4,p < 0.001). Mean postoperative Cobb percentage correction was reported in 5 articles and was significantly higher in AIS (68.4%) vs. AdIS (61.4%) (MD = -7.2, 95%CI = -11.6,-2.7,p = 0.001). EBL was not significantly different between AIS and AdIS (695.6 mL vs 817.7 mL,p = 0.204). Furthermore, no difference was found in operative time (MD = 37.9 min,95%CI = -10.7;86.6,p = 0.127), total instrumented level (MD = 0.88,95%CI = -0.7,2.4,p = 0.273), and LOS (MD = 0.5, 95%CI = -0.2;1.2, p = 0.188). Four articles reported postoperative complications in AIS vs AdIS, with no difference in neurological deficit, instrumentation-related complications, and medical complications. CONCLUSION AIS patients had better radiographic correction compared to AdIS. Though no difference was found in perioperative outcomes and complications, these findings emphasize the importance of counseling patients regarding the optimal timing of surgical correction.
Collapse
Affiliation(s)
- Jeffrey W Chen
- School of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rishabh Gupta
- School of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Justine Izah
- School of Medicine, Meharry Medical College, Nashville, TN, USA
| | | | - Amir M Abtahi
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave S, South Tower, Suite #4200, Nashville, TN, 37232, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave S, South Tower, Suite #4200, Nashville, TN, 37232, USA
| | - Byron F Stephens
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave S, South Tower, Suite #4200, Nashville, TN, 37232, USA.
| |
Collapse
|
3
|
Pennings JS, Chanbour H, Croft AJ, Vaughan WE, Khan I, Davidson C, Bydon M, Asher AL, Archer KR, Gardocki RJ, Berkman RA, Abtahi AM, Stephens BF, Zuckerman SL. Impact of Unplanned Readmission on Patient-Reported Outcomes After Cervical Spine Surgery: A National Study of 13 355 Patients. Neurosurgery 2024:00006123-990000000-01065. [PMID: 38380924 DOI: 10.1227/neu.0000000000002872] [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: 09/11/2023] [Accepted: 12/19/2023] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Although risk factors for unplanned readmission after cervical spine surgery have been widely reported, less is known about how readmission itself affects patient-reported outcome measures (PROMs). Using the Quality Outcomes Database registry of patients undergoing elective cervical spine surgery, we sought to (1) determine the impact of unplanned readmission on PROMs and (2) compare the effect of specific readmission reasons on PROMs. METHODS An observational study was performed using a multi-institution, retrospective registry for patients undergoing cervical spine surgery. The occurrence of 90-day unplanned readmission classified into medical, surgical, pain only, and no readmissions was the exposure variable. Outcome variables included 12-month PROMs of Neck Disability Index (NDI), Numeric Rating Scale (NRS)-neck/arm pain, EuroQol-5D (EQ-5D), and patient dissatisfaction. Multivariable models predicting each PROM were built using readmission reasons controlling for demographics, clinical characteristics, and preoperative PROMs. RESULTS Data from 13 355 patients undergoing elective cervical spine surgery (82% anterior approach and 18% posterior approach) were analyzed. Unplanned readmission within 90 days of surgery occurred in 3.8% patients, including medical (1.6%), surgical (1.8%), and pain (0.3%). Besides medical reasons, wound infection/dehiscence was the most common reason for unplanned readmission for the total cohort (0.5%), dysphagia in the anterior approach (0.6%), and wound infection/dehiscence in the posterior approach (1.5%). Based on multivariable regression, surgical readmission was significantly associated with worse 12-month NDI, NRS-neck pain, NRS-arm pain, EQ-5D, and higher odds of dissatisfaction. Pain readmissions were associated with worse 12-month NDI and NRS-neck pain scores, and worse dissatisfaction. For specific readmission reasons, pain, surgical site infection/wound dehiscence, hematoma/seroma, revision surgery, deep vein thrombosis, and pulmonary embolism were significantly associated with worsened 12-month PROMs. CONCLUSION In patients undergoing elective cervical spine surgery, 90-day unplanned surgical and pain readmissions were associated with worse 12-month PROMs compared with patients with medical readmissions and no readmissions.
Collapse
Affiliation(s)
- Jacquelyn S Pennings
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andrew J Croft
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Wilson E Vaughan
- Tulane University, School of Medicine, New Orleans, Louisiana, USA
| | - Inamullah Khan
- Department of Neurosurgery, University of Missouri Health Care, Columbia, Missouri, USA
| | - Claudia Davidson
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mohammad Bydon
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Anthony L Asher
- Department of Neurosurgery, Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina, USA
| | - Kristin R Archer
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Physical Medicine & Rehabilitation, Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Raymond J Gardocki
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Richard A Berkman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amir M Abtahi
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Byron F Stephens
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Scott L Zuckerman
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
4
|
Steinle AM, Vaughan WE, Croft AJ, Hymel A, Pennings JS, Chanbour H, Asher A, Gardocki R, Zuckerman SL, Abtahi AM, Stephens BF. Comparing Patient-Reported Outcomes, Complications, Readmissions, and Revisions in Posterior Lumbar Fusion With, Versus Without, an Interbody Device. Spine (Phila Pa 1976) 2024; 49:232-238. [PMID: 37339259 DOI: 10.1097/brs.0000000000004750] [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: 09/30/2022] [Accepted: 05/21/2023] [Indexed: 06/22/2023]
Abstract
STUDY DESIGN Retrospective analysis on prospectively collected data. OBJECTIVES To compare posterior lumbar fusions with versus without an interbody in: (1) Patient-reported outcomes (PROs) at 1 year and (2) postoperative complications, readmission, and reoperations. SUMMARY OF BACKGROUND DATA Elective lumbar fusion is commonly used to treat various lumbar pathologies. Two common approaches for open posterior lumbar fusion include posterolateral fusion (PLF) alone without an interbody and with an interbody through techniques, like transforaminal lumbar interbody fusion. Whether fusion with or without an interbody leads to better outcomes remains an area of active research. PATIENTS AND METHODS The Lumbar Module of the Quality Outcomes Database was queried for adults undergoing elective primary posterior lumbar fusion with or without an interbody. Covariates included demographic variables, comorbidities, primary spine diagnosis, operative variables, and baseline PROs, including Oswestry Disability Index, North American Spine Society satisfaction index, numeric rating scale-back/leg pain, and Euroqol 5-dimension. Outcomes included complications, reoperations, readmissions, return to work/activities, and PROs. Propensity score matching and linear regression modeling were used to estimate the average treatment effect on the treated to assess the impact of interbody use on patient outcomes. RESULTS After propensity matching, there were 1044 patients with interbody and 215 patients undergoing PLF. The average treatment effect on the treated analysis showed that having an interbody or not had no significant impact on any outcome of interest, including 30-day complications and reoperations, 3-month readmissions, 12-month return to work, and 12-month PROs. CONCLUSION There were no discernible differences in outcomes between patients undergoing PLF alone versus with an interbody in elective posterior lumbar fusion. These results add to the growing body of evidence that posterior lumbar fusions with and without an interbody seem to have similar outcomes up to 1 year postoperatively when treating degenerative lumbar spine conditions.
Collapse
Affiliation(s)
- Anthony M Steinle
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Wilson E Vaughan
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Andrew J Croft
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Alicia Hymel
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Jacquelyn S Pennings
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN
| | - Hani Chanbour
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN
| | - Anthony Asher
- Neuroscience Institute, Atrium Health and Department of Neurosurgery, Carolinas Medical Center, Charlotte, North Carolina; Carolina Neurosurgery and Spine Associates, Charlotte, NC
| | - Raymond Gardocki
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Scott L Zuckerman
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN
| | - Amir M Abtahi
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN
| | - Byron F Stephens
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
5
|
Steinle AM, Fogel JD, Chen JW, Chanbour H, Vaughan WE, Karwandyar A, Croft AJ, McDonough J, Chandler PJ, Gardocki R, Zuckerman SL, Abtahi AM, Stephens BF. Determining the Effect of Intraoperative TXA on Postoperative Blood Loss in ACDF. Clin Spine Surg 2024; 37:E18-E23. [PMID: 37559204 DOI: 10.1097/bsd.0000000000001508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 06/21/2023] [Indexed: 08/11/2023]
Abstract
STUDY DESIGN Retrospective cohort study using prospectively collected data. OBJECTIVE To determine the effectiveness of intraoperative tranexamic acid (TXA) in anterior cervical discectomy and fusion (ACDF) on postoperative blood loss. SUMMARY OF BACKGROUND DATA TXA has been proven to be a safe and effective agent in reducing blood loss after cervical surgery; however, its efficacy when used intraoperatively for ACDF surgeries had yet to be researched. Currently, there are few studies examining the effects of intraoperative TXA in cervical spinal fusion, and none specifically examining TXA use in ACDF. METHODS A tertiary medical center's prospectively collected spine registry was queried between 1/1/18 and 12/1/21 for all patients who underwent elective ACDF surgery and received a drain postoperatively. Patients were separated into 2 groups; those who had received intraoperative TXA and those who did not. Baseline demographic and operative variables were collected from the registry. The primary outcome was postoperative blood loss over a 24-hour period. Secondary outcomes included total drain output, intraoperative estimated blood loss, operative duration, drain duration, changes in preoperative to postoperative hemoglobin and hematocrit levels, and rate of transfusions, complications, revisions, and reoperations. Univariate and multivariate regression analyses were performed. RESULTS Two hundred eighty-six patients were included. One hundred ninety patients underwent ACDF and did not receive intraoperative TXA, whereas 96 patients underwent ACDF and did receive TXA. There were no differences in any demographic or baseline variables. Multivariate analysis showed intraoperative TXA was associated with shorter drain duration (β=-5.74, 95% CI: -10.9 to -0.53, P =0.031) and reduction in 24-hour drain output (β=-12.2, 95% CI: -19.4 to -4.89, P =0.001) and total drain output (β=-14.0, 95% CI: -22.9 to -5.05, P =0.002). CONCLUSIONS TXA use during ACDF procedures leads to a decrease in perioperative blood loss and faster drain removal. TXA is an effective and safe agent for reducing perioperative blood loss in ACDF surgery. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Anthony M Steinle
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | - Jessa D Fogel
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | | | - Hani Chanbour
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN
| | | | - Ayub Karwandyar
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | - Andrew J Croft
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | - Judy McDonough
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | - Philip J Chandler
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | - Raymond Gardocki
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | - Scott L Zuckerman
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN
| | - Amir M Abtahi
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN
| | - Byron F Stephens
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
6
|
Chanbour H, Chen JW, Vaughan WE, Abtahi AM, Gardocki RJ, Stephens BF, Zuckerman SL. Which Bone Mineral Density Measure Offers a More Reliable Prediction of Mechanical Complications in Adult Spinal Deformity Surgery: Hounsfield Units or DEXA Scan? World Neurosurg 2023; 178:e657-e665. [PMID: 37543204 DOI: 10.1016/j.wneu.2023.07.140] [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: 07/21/2023] [Accepted: 07/30/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE In patients undergoing adult spinal deformity (ASD) surgery, we sought to: (1) determine the relationship between dual-energy x-ray absorptiometry (DEXA)-measured bone mineral density (BMD), T-scores, and Hounsfield units (HU), and (2) compare the ability of DEXA-measured BMD, T-scores, and HU to predict mechanical complications and reoperations. METHODS A single-institution retrospective cohort study was undertaken for cases from 2013 to 2017. INCLUSION CRITERIA ≥5-level-fusion, sagittal/coronal deformity, and 2-year follow-up. Multivariable regression controlled for age, body mass index, receiving anabolic medications, and postoperative sagittal vertical axis and pelvic-incidence lumbar-lordosis mismatch. A subanalysis was performed for osteopenic patients (-1 < T-score < -2). RESULTS Of 145 patients undergoing ASD surgery, 72 (49.6%) had both preoperative DEXA and computed tomography scans. Mean DEXA-measured BMD was 0.91 ± 0.52 g/cm2, mean T-score was -1.61 ± 1.03, and mean HU was 153.5 ± 52.8. While no correlation was found between DEXA-measured BMD and HU (r = 0.17, P = 0.144), T-score and HU had a weakly positive correlation (r = 0.31, P = 0.007). Mechanical complications occurred in 48 (66.7%) patients, including 27 (37.5%) proximal junctional kyphosis (PJK), 1 (1.4%) distal junctional kyphosis, 5 (6.9%) implant failure, 30 (41.7%) rod fracture/pseudarthrosis, 42 (58.3%) reoperations, and 16 (22.2%) reoperations due to PJK. No association was found between DEXA-measured BMD or T-scores with mechanical complications or reoperations. While univariate regression showed a significant association between lower HU and PJK (OR 0.98, 95%CI 0.97-0.99, P = 0.011), the significance was lost after multivariable analysis. When considering osteopenic patients (n = 37), only DEXA-measured BMD was an independent risk factor for PJK (OR 0.01, 95%CI 0.00-0.09, P = 0.017), with a threshold of 0.82 g/cm2 (AUC 0.70, 95%CI 0.53-0.84, P = 0.019). CONCLUSIONS Poor correlation was found between the 3 BMD modalities. DEXA-measured BMD may be superior to T-scores and HU in predicting PJK among patients with osteopenia with a threshold of BMD <0.82 g/cm2.
Collapse
Affiliation(s)
- Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeffrey W Chen
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Wilson E Vaughan
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amir M Abtahi
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Raymond J Gardocki
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Byron F Stephens
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
| |
Collapse
|
7
|
Gardocki RJ, Chandler PJ, Vaughan WE, Zuckerman SL, Abtahi AM, Stephens BF. Endoscopic transforaminal treatment of a thoracic perineural cyst: a case report. Eur Spine J 2023; 32:2679-2684. [PMID: 36813905 DOI: 10.1007/s00586-023-07582-y] [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: 11/15/2022] [Revised: 01/25/2023] [Accepted: 02/04/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND AND IMPORTANCE To describe the first case of a thoracic perineural cyst successfully treated using a direct thoracic transforaminal endoscopic approach. METHODS Case report. CLINICAL PRESENTATION A 66-year-old male presented with right-sided radicular pain in a T4 distribution. MRI of the thoracic spine revealed a right T4 perineural cyst caudally displacing the root in the T4-5 foramen. He had failed attempts at nonoperative management. The patient underwent an all endoscopic transforaminal perineural cyst decompression and resection as a same-day surgical procedure. Postoperatively, the patient noted near complete resolution of the preoperative radicular pain. A thoracic MRI with and without contrast was performed 3 months after surgery and showed no evidence of the preoperative perineural cyst and no symptom recurrence was noted by the patient. CONCLUSION This case report presents the first safe and successful report of an all endoscopic transforaminal decompression and resection of a perineural cyst in the thoracic spine.
Collapse
Affiliation(s)
- Raymond J Gardocki
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA
| | - Philip J Chandler
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA.
| | - Wilson E Vaughan
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA
| | - Scott L Zuckerman
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amir M Abtahi
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Byron F Stephens
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
8
|
Stephens BF, McKeithan LJ, Waddell WH, Romano J, Steinle AM, Vaughan WE, Pennings JS, Nian H, Khan I, Bydon M, Zuckerman SL, Archer KR, Abtahi AM. A clinical model to predict postoperative improvement in sub-domains of the modified Japanese Orthopedic Association score for degenerative cervical myelopathy. Eur Spine J 2023; 32:1265-1274. [PMID: 36877365 DOI: 10.1007/s00586-023-07607-6] [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: 07/14/2022] [Revised: 01/11/2023] [Accepted: 02/12/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE The modified Japanese Orthopedic Association (mJOA) score consists of six sub-domains and is used to quantify the severity of cervical myelopathy. The current study aimed to assess for predictors of postoperative mJOA sub-domains scores following elective surgical management for patients with cervical myelopathy and develop the first clinical prediction model for 12-month mJOA sub-domain scores.Please confirm if the author names are presented accurately and in the correct sequence (given name, middle name/initial, family name). Author 1 Given name: [Byron F.] Last name [Stephens], Author 2 Given name: [Lydia J.] Last name [McKeithan], Author 3 Given name: [W. Hunter] Last name [Waddell], Author 4 Given name: [Anthony M.] Last name [Steinle], Author 5 Given name: [Wilson E.] Last name [Vaughan], Author 6 Given name: [Jacquelyn S.] Last name [Pennings], Author 7 Given name: [Jacquelyn S.] Last name [Pennings], Author 8 Given name: [Scott L.] Last name [Zuckerman], Author 9 Given name: [Kristin R.] Last name [Archer], Author 10 Given name: [Amir M.] Last name [Abtahi] Also, kindly confirm the details in the metadata are correct.Last Author listed should be Kristin R. Archer METHODS: A multivariable proportional odds ordinal regression model was developed for patients with cervical myelopathy. The model included patient demographic, clinical, and surgery covariates along with baseline sub-domain scores. The model was internally validated using bootstrap resampling to estimate the likely performance on a new sample of patients. RESULTS The model identified mJOA baseline sub-domains to be the strongest predictors of 12-month scores, with numbness in legs and ability to walk predicting five of the six mJOA items. Additional covariates predicting three or more items included age, preoperative anxiety/depression, gender, race, employment status, duration of symptoms, smoking status, and radiographic presence of listhesis. Surgical approach, presence of motor deficits, number of surgical levels involved, history of diabetes mellitus, workers' compensation claim, and patient insurance had no impact on 12-month mJOA scores. CONCLUSION Our study developed and validated a clinical prediction model for improvement in mJOA scores at 12 months following surgery. The results highlight the importance of assessing preoperative numbness, walking ability, modifiable variables of anxiety/depression, and smoking status. This model has the potential to assist surgeons, patients, and families when considering surgery for cervical myelopathy. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Byron F Stephens
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, South Tower, 1215 21st Ave S #3200, Nashville, TN, 37232, USA. .,Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA. .,Department of Neurological Surgery, Vanderbilt University Medical Center, The Village at Vanderbilt, 1500 21st Ave S Suite 1506, Nashville, TN, 37212, USA.
| | - Lydia J McKeithan
- Department of General Surgery, Vanderbilt University Medical Center, 1161 21st Ave S # D5203, Nashville, TN, 37232, USA
| | - W Hunter Waddell
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, South Tower, 1215 21st Ave S #3200, Nashville, TN, 37232, USA
| | - Joseph Romano
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, South Tower, 1215 21st Ave S #3200, Nashville, TN, 37232, USA
| | - Anthony M Steinle
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, South Tower, 1215 21st Ave S #3200, Nashville, TN, 37232, USA
| | - Wilson E Vaughan
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, South Tower, 1215 21st Ave S #3200, Nashville, TN, 37232, USA
| | - Jacquelyn S Pennings
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, South Tower, 1215 21st Ave S #3200, Nashville, TN, 37232, USA.,Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA
| | - Hui Nian
- Department of Biostatistics, Vanderbilt University Medical Center, Vanderbilt University, 2525 West End Ave ste 1100, Nashville, TN, 37203, USA
| | - Inamullah Khan
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, South Tower, 1215 21st Ave S #3200, Nashville, TN, 37232, USA
| | - Mohamad Bydon
- Department of Neurosurgery, Mayo Clinic, Rochester, 200 1st St SW Floor 8, Rochester, MN, 55905, USA
| | - Scott L Zuckerman
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, South Tower, 1215 21st Ave S #3200, Nashville, TN, 37232, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, The Village at Vanderbilt, 1500 21st Ave S Suite 1506, Nashville, TN, 37212, USA
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, South Tower, 1215 21st Ave S #3200, Nashville, TN, 37232, USA.,Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA.,Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Medicine, Vanderbilt University Medical Center, 3401 West End Ave Suite 380, Nashville, TN, 37203, USA
| | - Amir M Abtahi
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, South Tower, 1215 21st Ave S #3200, Nashville, TN, 37232, USA.,Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA
| |
Collapse
|
9
|
Abstract
STUDY DESIGN This was a narrative review. OBJECTIVES Provide a comprehensive review of radiographic alignment parameters and their effect on procedure selection, surgical decision-making, and clinical outcomes for the treatment of cervical spondylotic myelopathy (CSM). SUMMARY OF BACKGROUND DATA The use of radiographic parameters to predict prognosis and surgical outcomes in patients with CSM is an evolving field given the complex presentation of patients with this condition. METHODS A literature search was conducted using PubMed for surgical treatment of CSM, with an emphasis on cervical radiographic parameters and clinical outcomes. RESULTS The principal goals of spine surgery can be broken down into decompression, stabilization, and restoration of alignment. The principle of restoring balance takes careful preoperative planning and attention to radiographic parameters including cervical lordosis, C2-C7 sagittal vertical axis, neck tilt, thoracic inlet angle, T1 slope, K-line, and modified K-line. Surgical interventions for CSM include anterior cervical discectomy and fusion, posterior cervical fusion, or laminoplasty and careful consideration of radiographic measures guide surgical decision-making is essential to ensure optimal outcomes. CONCLUSION Utilization of key radiographic parameters in surgical planning and decision-making allows surgeons to optimize clinical outcomes for CSM. LEVEL OF EVIDENCE Level V.
Collapse
Affiliation(s)
| | | | - Amir M Abtahi
- Department of Orthopaedic Surgery
- Center for Musculoskeletal Research
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
10
|
Steinle AM, Fogel JD, Gupta R, Davidson C, Hymel AM, Vaughan WE, Croft AJ, Pennings JS, Archer KR, Zuckerman SL, Gardocki RJ, Abtahi AM, Stephens BF. Assessing the Insurance Deductible Effect on Outcomes After Elective Spinal Surgery. World Neurosurg 2022; 168:e354-e368. [DOI: 10.1016/j.wneu.2022.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 11/08/2022]
|
11
|
Steinle AM, Chen JW, O'Brien A, Vaughan WE, Croft AJ, Waddell WH, Vickery J, Elrod RW, Chanbour H, Lugo-Pico J, Zuckerman SL, Abtahi AM, Stephens BF. Efficacy and Safety of the Ultrasonic Bone Scalpel in Lumbar Laminectomies. Spine Surg Relat Res 2022. [DOI: 10.22603/ssrr.2022-0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
| | - Jeffrey W. Chen
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | - Alexander O'Brien
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | - Wilson E. Vaughan
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | - Andrew J. Croft
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | - W. Hunter Waddell
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | - Justin Vickery
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | - Robert W. Elrod
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | - Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center
| | - Julian Lugo-Pico
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | | | - Amir M. Abtahi
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | - Byron F. Stephens
- Department of Neurological Surgery, Vanderbilt University Medical Center
| |
Collapse
|
12
|
Abstract
The dipolar correlation function for a system of coupterions diffusing on the surface of a polyelectrolyte cylinder is computed. The influence of screened coulombic repulsions on the dielectric increment is determined. Dissociation and reassociation of the counterions to the cylinder is treated microscopically and the coupled bulk diffusion is solved in the presence of the Poisson-Boltzmann potential. It is found that the correlation function contains a small, fast decaying, molecular weight independent part arising from diffusion around the cylinder and a large, slowly decaying, molecular weight dependent part arising from diffusion along the cylinder axis. The dissociation-reassociation kinetics can play a large, possible dominant, role in determining the relaxation rates.
Collapse
Affiliation(s)
- P I Meyer
- Department of Chemistry, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | | | | |
Collapse
|
13
|
Abstract
The time dependence of the orientation of a cylindrical biopolymer and the configuration of its counterion complement in the presence of an external electric field is found by solving a model forced diffusion equation. The solution is a high temperature expansion in the external field strength and is used to predict the nature of the dielectric relaxation and the dynamic Kerr effect for such systems. Specific application is made to the dynamic Kerr effect of a DNA oligomer for which experimental data appear in the literature. The analysis yields a value for the surface diffusion coefficient of a sodium ion on DNA at 20 degrees C of 3.8 x 10(-10) m2 s-1.
Collapse
Affiliation(s)
- W E Sonnen
- Department of Chemistry, University of Wisconsin, Madison 53706
| | | | | |
Collapse
|
14
|
Altig JA, Wesenberg GE, Vaughan WE. Dielectric behavior of polyelectrolytes. IV. Electric polarizability of rigid biopolymers in electric fields. Biophys Chem 1986; 24:221-34. [PMID: 3768468 DOI: 10.1016/0301-4622(86)85028-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The equilibrium Kerr effect of a system of mobile charges constrained to the surface of biomacromolecules is calculated. Cylindrical and spherical geometries are considered. For the cylinder we determine the anisotropy of electric polarizability as a function of length, temperature, and number of charged species in the low-field regime, and the fraction of the maximum induced dipole in the field direction for higher electric fields. The results are compared to experimental data for DNA oligomers taken from the literature. With spherical geometry we calculate the fractional induced dipole moment as a function of electric field strength and from this deduce the orientation function. The field dependence of the orientation function is compared to experimental data in the literature for bovine disk membrane vesicles.
Collapse
|
15
|
Abstract
The role of the Coulomb forces between the counterions on the surface of polyelectrolytes on the dielectric response is analyzed. An estimate of the maximum dielectric increment (as a function of the number of counterions) is found as a function of the molecular length. The minimum-energy configuration of the counterions on a cylinder is found to be a double helix, suggesting the fundamental importance of electrostatic interactions in determining structure. Solutions of the dynamical equations for a few counterions indicate that a single mode dominates the relaxation which is enhanced by the inter-ion repulsions. A lower bound is found for this mode based on analysis of the system response for short lengths. Sum rules for the rates and amplitudes of the dipolar correlation function are derived and lead to an upper bound for the rate of the dominant mode. These bounds approach one another for the parameters characteristic of restriction fragments of DNA. This permits a prediction of the magnitude and time scale of the dielectric response.
Collapse
Affiliation(s)
- G E Wesenberg
- Department of Chemistry, University of Wisconsin Madison, Madison, WI 53706, USA
| | | |
Collapse
|
16
|
Abstract
The dipolar correlation function for a system of counterions diffusing on the surface of a polyelectrolyte cylinder is computed. Repulsive coulombic interactions between the counterions are taken into account. Lateral dissociation and reassociation to the cylinder is treated microscopically. Numerical calculations needed to obtain quantitative results for the long time behavior are presented. The model dependence on its parameters is interpreted with special emphasis on parameter values typical of DNA.
Collapse
Affiliation(s)
- P I Meyer
- Department of Chemistry, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | | |
Collapse
|
17
|
|