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Katiyar P, Reyes J, Coury J, Lombardi J, Sardar Z. Preoperative Optimization for Adult Spinal Deformity Surgery: A Systematic Review. Spine (Phila Pa 1976) 2024; 49:304-312. [PMID: 37678375 DOI: 10.1097/brs.0000000000004823] [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: 04/27/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE The purpose of this review is to identify modifiable risk factors in patients undergoing adult spinal deformity surgery and compile literature recommendations for the preoperative optimization of these risk factors. SUMMARY OF BACKGROUND DATA Optimization of modifiable risk factors not only benefits the patient but also lessens resource and cost burdens on the health care system, allowing for better quality and value-based care. There is limited but applicable literature discussing preoperative optimization in adult spinal deformity surgery patients specifically. METHODS We searched PubMed for studies that looked at one of the variables of interest (eg, osteoporosis, prehabilitation and functional status, multidisciplinary preoperative screening, infection, obesity, nutrition, smoking, diabetes, blood loss, chronic opioid use, and psychosocial factors) in adult patients with spinal deformity according to Preferred Reporting Items for Systematic Reviews and Meta-Analyse guidelines. RESULTS Seventy studies were included in the final review and synthesis of information. Guidelines and recommendations from these studies were compared and compiled into evidence-based action items for preoperative optimization of modifiable risk factors before adult spinal deformity surgery. CONCLUSIONS While the approach of preoperative optimization of modifiable risk factors may incur additional planning efforts and patient care time, it has the potential to significantly reduce perioperative complications and reduce morbidity and mortality during surgery, thus allowing for improved outcomes, increased quality of life, and satisfaction from this patient population. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Prerana Katiyar
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Justin Reyes
- Och Spine Hospital at Columbia New York Presbyterian Hospital, New York, NY
| | - Josephine Coury
- Och Spine Hospital at Columbia New York Presbyterian Hospital, New York, NY
| | - Joseph Lombardi
- Och Spine Hospital at Columbia New York Presbyterian Hospital, New York, NY
| | - Zeeshan Sardar
- Och Spine Hospital at Columbia New York Presbyterian Hospital, New York, NY
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Lin JD, Schupper AJ, Matthew J, Lee N, Osorio JA, Marciano G, Lombardi JM, Sardar Z, Lehman RA, Lenke LG. A New Objective Radiographic Criteria for Diagnosis of Adult Idiopathic Scoliosis: Apical Pedicle Diameter Asymmetry. World Neurosurg 2023; 178:e141-e146. [PMID: 37437804 DOI: 10.1016/j.wneu.2023.07.010] [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: 03/31/2023] [Revised: 07/02/2023] [Accepted: 07/03/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE We sought to test the hypothesis that a difference of ≥1 mm in pedicle diameter between the convex and concave pedicles at the apex of a lumbar curve is a sensitive and/or specific criteria for adult idiopathic scoliosis (AdIS). METHODS Thirty-nine operative patients with adult deformity and lumbar major curves were identified. A chart review was performed. Radiographic measurements included lumbar Cobb, curve apex, and Cobb levels involved. Apical pedicle diameter at the concavity and convexity of the curve apex were measured. RESULTS Among these 39 patients, the average Cobb angle was 48.3 degrees. Curve apex averaged at L1/2 (range L1-L3). The curves spanned 4.7 levels (range 3-7). Twenty-five curves had the apex to the left, while 14 had the apex to the right. The average pedicle diameter at the apex was 6.1 mm. Fourteen patients had apical pedicle diameter asymmetry (APDA) >1 mm. Most (7 of 8, or 87.5%) of the patients with a history of adult idiopathic scoliosis had APDA >1 mm. A minority (7 of 31, 22.5%) of patients without known history of adult idiopathic scoliosis had APDA >1 mm (P < 0.01). CONCLUSIONS Apical pedicle diameter asymmetry is among the sensitive diagnostic criteria for AdIS and may be useful for differentiating lumbar major AdIS from degenerative lumbar scoliosis. The sensitivity of APDA >1 mm is 87.5%, with specificity of 77.4%. We propose a new, sensitive radiographic criterion for adult idiopathic scoliosis. A difference of ≥1 mm in pedicle diameter between the convex and concave pedicles at that apex of a lumbar curve has a sensitivity of 87.5% and specificity of 77.4% for patient-reported history of adolescent scoliosis. It can be a useful tool as exclusion criteria for studies on AdIS.
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Affiliation(s)
- James D Lin
- Department of Orthopedic Surgery, Mount Sinai Hospital, New York, New York, USA
| | | | - Justin Matthew
- The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Nathan Lee
- The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Joseph A Osorio
- Department of Neurosurgery, University of California, San Diego, School of Medicine, San Diego, California, USA
| | - Gerard Marciano
- The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Joseph M Lombardi
- The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Zeeshan Sardar
- The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Ronald A Lehman
- The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Lawrence G Lenke
- The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, New York, New York, USA
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Arciero E, Desai S, Coury J, Gupta P, Trofa DP, Sardar Z, Lombardi J. Comparison of Psychometric Properties of Patient-Reported Outcomes Measurement Information System With Traditional Outcome Metrics in Spine Surgery. JBJS Rev 2023; 11:01874474-202303000-00006. [PMID: 36947636 DOI: 10.2106/jbjs.rvw.22.00193] [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] [Indexed: 03/24/2023]
Abstract
OBJECTIVE Patient-Reported Outcomes Measurement Information System (PROMIS) was developed to address certain shortcomings of traditional, or legacy patient-reported outcome measures (PROMs). Because the use of PROMIS across orthopedic populations continues to increase, the purpose of this study was to provide a comprehensive overview of the use and validation of PROMIS in spine surgery. METHODS PubMed and Google Scholar were searched for relevant articles reporting on the use and validation of PROMIS in spine surgery. The PROMIS formats and individual domains used by investigators were noted. Additionally, psychometric properties reported in validation studies were evaluated. RESULTS Both individual studies and systematic reviews have demonstrated the convergent validity of PROMIS domains, reporting moderate-to-strong correlations with legacy measures in a variety of spine patient populations. Across spine surgery patient populations, PROMIS instruments are consistently efficient, demonstrating decreased question burden compared with legacy PROMs. PROMIS domains overall exhibit responsiveness comparable with legacy measures, and the normalization of PROMIS scores to a general population allows for broad coverage, resulting in acceptable floor and ceiling effects. Despite the many strengths of PROMIS, there remain some populations where PROMIS is not suited to be used in isolation. CONCLUSIONS PROMIS is widely used as an outcome measure in spine surgery and has been validated in a range of patient populations. Although PROMIS domains cannot fully replace legacy measures in spine patients, they can be used in certain settings to provide an efficient and psychometrically sound PROM.
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Affiliation(s)
- Emily Arciero
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
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Luzzi A, Sardar Z, Cerpa M, Ferrer X, Coury J, Crockatt W, Ha A, Roye B, Vitale M, Lenke L. Risk of distal junctional kyphosis in scheuermann's kyphosis is decreased by selecting the LIV as two vertebrae distal to the first lordotic disc. Spine Deform 2022; 10:1437-1442. [PMID: 35840788 DOI: 10.1007/s43390-022-00542-4] [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: 01/20/2022] [Accepted: 06/04/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE To determine whether (1) distal junctional kyphosis (DJK) is decreased by selecting the stable sagittal vertebra (SSV), versus the vertebra below the 1st lordotic disc (1stLD), as the lowest instrumented level (LIV); (2) DJK is decreased if the LIV is two versus one vertebrae distal to the 1stLD. METHODS A multi-institution prospective database was queried for SK patients who underwent posterior-only instrumentation and fusion with > 2 year follow-up. DJK was defined as > 10° change in the distal junctional angle postoperative from the preoperative junctional angle. Statistical analysis was performed using t test, chi-square test and logistic regression. RESULTS Of 94 patients included, 38 (40%) developed radiographic DJK. 31 (39%) patients in whom the LIV was at or distal to the SSV developed DJK, whereas 7 (47%) in whom the LIV was proximal to the SSV developed DJK. 20 (59%) patients in whom the LIV was one vertebra below and 10 (22%) in whom the LIV was two vertebrae below the 1stLD developed DJK. Logistic regression demonstrated a significant increase in DJK development if the LIV was one vertebra below the 1stLD (OR = 3.2 (1.28-8.18)). There was not a significant relationship between DJK development and LIV position relative to the SSV. CONCLUSION In SK surgery, LIV selection/fusion to two vertebrae below the 1stLD decreased the development of DJK. A significant relationship was not found between DJK development and location of distal fusion level in regards to the SSV, possibly due to the small number of patients who had LIV proximal to SSV.
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Affiliation(s)
- Andrew Luzzi
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 622 W168th Street, PH-11, New York, 10032, NY, United States.
| | - Zeeshan Sardar
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 622 W168th Street, PH-11, New York, 10032, NY, United States
| | - Meghan Cerpa
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 622 W168th Street, PH-11, New York, 10032, NY, United States
| | - Xavier Ferrer
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 622 W168th Street, PH-11, New York, 10032, NY, United States
| | - Josephine Coury
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 622 W168th Street, PH-11, New York, 10032, NY, United States
| | - William Crockatt
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 622 W168th Street, PH-11, New York, 10032, NY, United States
| | - Alex Ha
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 622 W168th Street, PH-11, New York, 10032, NY, United States
| | - Benjamin Roye
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 622 W168th Street, PH-11, New York, 10032, NY, United States
| | - Michael Vitale
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 622 W168th Street, PH-11, New York, 10032, NY, United States
| | - Lawrence Lenke
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 622 W168th Street, PH-11, New York, 10032, NY, United States
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Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE Determine the rate and risk factors for S2AI screw-related pain after adult spinal deformity surgery with a minimum 2-year follow-up. METHODS A consecutive 83 spinal deformity patients undergoing surgical treatment between August 2015 and December 2017 with minimum 2-year follow-up for S2AI screw complication and screw-related pain were included. Linear regression was performed on various risk factors and postoperative S2AI screw-related pain. Subset analysis of 53 patients was performed on preoperative and postoperative SRS and ODI scores, operative data, and radiographic data. RESULTS The overall proportion of S2AI screw-related pain was 9.6%. An S2AI screw complication was identified radiographically in 10.8% of patients; among these, 22.2% experienced S2AI screw-related pain. 3.4% of all patients underwent S2A1 screw removal. The SRS, ODI, sagittal vertical axis (SVA), and coronal alignment scores/measurements improved following treatment in all patients. However, the mean difference for the pre and postoperative SRS function score (1.2 ± 0.5 vs 0.9 ± 0.8) and SVA (4.0 ± 4.9 cm vs 2.1 ± 4.8 cm) were higher for the pain group. CONCLUSIONS A minimum 2-year analysis of S2AI screw fixation in adult spinal deformity patients showed that 9.6% of patients experienced S2AI screw-related pain and 3.4% of patients had S2A1 screws removed. The size and the number of S2AI screws did not predict postoperative pain, nor were radiographic findings correlated with clinical outcomes. The patient outcome scores, coronal alignment, and SVA improved for all patients, but within the pain group there was an overall larger change in the SVA and SRS function score.
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Affiliation(s)
- Alex S. Ha
- Department of Orthopaedics, Columbia
University Medical Center, The Spine Hospital at New York-Presbyterian, New York,
NY, USA
| | - Daniel Y. Hong
- Department of Orthopaedics, Columbia
University Medical Center, The Spine Hospital at New York-Presbyterian, New York,
NY, USA
| | - Andrew J. Luzzi
- Department of Orthopaedics, Columbia
University Medical Center, The Spine Hospital at New York-Presbyterian, New York,
NY, USA
| | - Josephine R. Coury
- Department of Orthopaedics, Columbia
University Medical Center, The Spine Hospital at New York-Presbyterian, New York,
NY, USA
| | - Meghan Cerpa
- Department of Orthopaedics, Columbia
University Medical Center, The Spine Hospital at New York-Presbyterian, New York,
NY, USA,Meghan Cerpa, Columbia University Medical
Center, 5141 Broadway, New York, NY 10034, USA.
| | - Zeeshan Sardar
- Department of Orthopaedics, Columbia
University Medical Center, The Spine Hospital at New York-Presbyterian, New York,
NY, USA
| | - Lawrence G. Lenke
- Department of Orthopaedics, Columbia
University Medical Center, The Spine Hospital at New York-Presbyterian, New York,
NY, USA
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Beschloss AM, DiCindio CM, Lombardi JS, Shillingford JN, Laratta JL, Holderread B, Louie P, Pugely AJ, Sardar Z, Khalsa AS, Arlet VM, Saifi C. The Rise and Fall of Bone Morphogenetic Protein 2 Throughout the United States. Clin Spine Surg 2022; 35:264-269. [PMID: 35180720 DOI: 10.1097/bsd.0000000000001301] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 01/17/2022] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Retrospective Database Study. OBJECTIVE Investigate utilization of bone morphogenetic protein (BMP-2) between 2004 and 2014. SUMMARY OF BACKGROUND DATA The utilization, particularly off-label utilization, of BMP-2 has been controversial and debated in the literature. Given the concerns regarding cancer and potential complications, the risk benefit profile of BMP must be weighed with each surgical case. The debate regarding the costs and potential side effects of BMP-2 compared with autologous iliac crest bone harvest has continued. METHODS The National Inpatient Sample (NIS) database was queried for the use of BMP-2 (ICD-9-CM 84.52) between 2004 and 2014 across 44 states. The NIS database represents a 20% sample of discharges, weighted to provide national estimates. BMP-2 utilization rates in spine surgery fusion procedures were calculated as a fraction of the total number of thoracic, lumbar, and sacral spinal fusion surgeries performed each year. RESULTS Between 2004 and 2014, BMP-2 was utilized in 927,275 spinal fusion surgeries. In 2004, BMP-2 was utilized in 28.3% of all cases (N=48,613). The relative use of BMP-2 in spine fusion surgeries peaked in 2008 at 47.0% (N=112,180). Since then, it has continued to steadily decline with an endpoint of 23.6% of cases in 2014 (N=60,863). CONCLUSIONS Throughout the United States, the utilization of BMP-2 in thoracolumbar fusion surgeries increased from 28.3% to 47.0% between 2004 and 2008. However, from 2008 to 2014, the utilization of BMP-2 in thoracolumbar spine fusion surgeries decreased significantly from 47.0% to 23.4%. While this study provides information on the utilization of BMP-2 for the entire United States over an 11-year period, further research is needed to the determine the factors affecting these trends.
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Affiliation(s)
- Alexander M Beschloss
- Department of Orthopaedic Surgery, Perelman School of Medicine The Spine Center at Pennsylvania Hospital, Philadelphia, PA
| | - Christina M DiCindio
- Department of Orthopaedic Surgery, Perelman School of Medicine The Spine Center at Pennsylvania Hospital, Philadelphia, PA
| | - Joseph S Lombardi
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York-Presbyterian, New York, NY
| | - Jamal N Shillingford
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York-Presbyterian, New York, NY
| | | | - Brendan Holderread
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX
| | - Phillip Louie
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Andrew J Pugely
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, IA
| | - Zeeshan Sardar
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York-Presbyterian, New York, NY
| | - Amrit S Khalsa
- Department of Orthopaedic Surgery, Perelman School of Medicine The Spine Center at Pennsylvania Hospital, Philadelphia, PA
| | - Vincent M Arlet
- Department of Orthopaedic Surgery, Perelman School of Medicine The Spine Center at Pennsylvania Hospital, Philadelphia, PA
| | - Comron Saifi
- Department of Orthopaedic Surgery, Perelman School of Medicine The Spine Center at Pennsylvania Hospital, Philadelphia, PA
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Ha AS, Hong DY, Coury JR, Cerpa M, Baum G, Sardar Z, Lenke LG. Partial Intraoperative Global Alignment and Proportion Scores Do Not Reliably Predict Postoperative Mechanical Failure in Adult Spinal Deformity Surgery. Global Spine J 2021; 11:1046-1053. [PMID: 32677530 PMCID: PMC8351057 DOI: 10.1177/2192568220935438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
STUDY DESIGN Retrospective radiographic review. OBJECTIVES The Global Alignment and Proportion (GAP) score allows sagittal plane analysis for deformity patients and may be predictive of mechanical complications. This study aims to assess the effectiveness of predicting mechanical failure based on partial intraoperative GAP (iGAP) scores. METHODS A retrospective radiographic review was performed on 48 deformity patients between July 2015 to January 2017 with a 2-year follow-up. Using the same methodology as the original GAP study, the partial iGAP score was calculated with the sum of the scores for age, relative lumbar lordosis (RLL), and lordosis distribution index (LDI). Therefore, the iGAP score (0-7) was grouped into proportional (0-2), mildly disproportionate (3-5), and severely disproportionate (6-7). Logistic regression was performed to assess the ability of the partial iGAP score to predict postoperative mechanical failure. RESULTS The mean iGAP for patients with a mechanical failure was 3.54, whereas the iGAP for those without a mechanical failure was 3.46 (P = .90). The overall mechanical failure rate was 27.1%. The mechanical failures included 8 proximal junctional kyphosis, 7 rod fractures, and 1 rod slippage from the distal end of the construct. Logistic regression analysis revealed that the partial iGAP score was not able to predict postoperative mechanical failure (χ2 = 1.4; P = .49). CONCLUSION The iGAP scores for RLL or LDI did not show any significant correlation to postoperative mechanical failure. Ultimately, the proposed partial iGAP score did not predict postoperative mechanical failure and thus, cannot be used as an intraoperative alignment assessment to avoid postoperative mechanical complications.
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Affiliation(s)
- Alex S. Ha
- The Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Daniel Y. Hong
- The Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Josephine R. Coury
- The Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Meghan Cerpa
- The Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Griffin Baum
- The Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Zeeshan Sardar
- The Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Lawrence G. Lenke
- The Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
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Baum GR, Ha AS, Cerpa M, Zuckerman SL, Lin JD, Menger RP, Osorio JA, Morr S, Leung E, Lehman RA, Sardar Z, Lenke LG. Does the Global Alignment and Proportion score overestimate mechanical complications after adult spinal deformity correction? J Neurosurg Spine 2020:1-7. [PMID: 33007745 DOI: 10.3171/2020.6.spine20538] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/01/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The goal of this study was to validate the Global Alignment and Proportion (GAP) score in a cohort of patients undergoing adult spinal deformity (ASD) surgery. The GAP score is a novel measure that uses sagittal parameters relative to each patient's lumbosacral anatomy to predict mechanical complications after ASD surgery. External validation is required. METHODS Adult ASD patients undergoing > 4 levels of posterior fusion with a minimum 2-year follow-up were included. Six-week postoperative standing radiographs were used to calculate the GAP score, classified into a spinopelvic state as proportioned (P), moderately disproportioned (MD), or severely disproportioned (SD). A chi-square analysis, receiver operating characteristic curve, and Cochran-Armitage analysis were performed to assess the relationship between the GAP score and mechanical complications. RESULTS Sixty-seven patients with a mean age of 52.5 years (range 18-75 years) and a mean follow-up of 2.04 years were included. Patients with < 2 years of follow-up were included only if they had an early mechanical complication. Twenty of 67 patients (29.8%) had a mechanical complication. The spinopelvic state breakdown was as follows: P group, 21/67 (31.3%); MD group, 23/67 (34.3%); and SD group, 23/67 (34.3%). Mechanical complication rates were not significantly different among all groups: P group, 19.0%; MD group, 30.3%; and SD group, 39.1% (χ2 = 1.70, p = 0.19). The rates of mechanical complications between the MD and SD groups (30.4% and 39.1%) were less than those observed in the original GAP study (MD group 36.4%-57.1% and SD group 72.7%-100%). Within the P group, the rates in this study were higher than in the original study (19.0% vs 4.0%, respectively). CONCLUSIONS The authors found no statistically significant difference in the rate of mechanical complications between the P, MD, and SD groups. The current validation study revealed poor generalizability toward the authors' patient population.
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Affiliation(s)
- Griffin R Baum
- 1Department of Neurosurgery, Lenox Hill Hospital, Hofstra/Northwell School of Medicine, Manhasset
| | - Alex S Ha
- 2Department of Orthopedic Surgery Spine, Columbia University, New York
| | - Meghan Cerpa
- 2Department of Orthopedic Surgery Spine, Columbia University, New York
| | - Scott L Zuckerman
- 2Department of Orthopedic Surgery Spine, Columbia University, New York
| | - James D Lin
- 3Department of Orthopaedic Surgery, Mount Sinai, New York, New York
| | - Richard P Menger
- 4Department of Neurosurgery, University of South Alabama, Mobile, Alabama
| | - Joseph A Osorio
- 5Department of Neurosurgery, University of California, San Diego, California; and
| | - Simon Morr
- 6Department of Neurosurgery, Columbia University, New York, New York
| | - Eric Leung
- 2Department of Orthopedic Surgery Spine, Columbia University, New York
| | - Ronald A Lehman
- 2Department of Orthopedic Surgery Spine, Columbia University, New York
| | - Zeeshan Sardar
- 2Department of Orthopedic Surgery Spine, Columbia University, New York
| | - Lawrence G Lenke
- 2Department of Orthopedic Surgery Spine, Columbia University, New York
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Cerpa M, Sardar Z, Lenke L. Revision surgery in proximal junctional kyphosis. Eur Spine J 2020; 29:78-85. [PMID: 32016539 DOI: 10.1007/s00586-020-06320-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 01/22/2020] [Accepted: 01/24/2020] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Proximal junctional kyphosis (PJK) is a relatively common complication following spinal deformity surgery that may require reoperation. Although isolating the incidence is highly variable, in part due to the inconsistency in how PJK is defined, previous studies have reported the incidence to be as high as 39% with revision surgery performed in up to 47% of those with PJK. Despite the discordance in reported incidence, PJK remains a constant challenge that can result in undesirable outcomes following adult spine deformity surgery. METHODS A comprehensive literature review using Medline and PubMed was performed. Keywords included "proximal junctional kyphosis," "postoperative complications," "spine deformity surgery," "instrumentation failure," and "proximal junctional failure" used separately or in conjunction. RESULTS While the characterization of PJK is variable, a postoperative proximal junction sagittal Cobb angle at least 10°, 15°, or 20° greater than the measurement preoperatively, it is a consistent radiographic phenomenon that is well defined in the literature. While particular studies in the current literature may ascertain certain variables as significantly associated with the development of proximal junctional kyphosis where other studies do not, it is imperative to note that they are not all one in the same. Different patient populations, outcome variables assessed, statistical methodology, surgeon/surgical characteristics, etc. often make these analyses not completely comparable nor generalizable. CONCLUSIONS The goal of adult spine deformity surgery is to optimize patient outcomes and mitigate postoperative complications whenever possible. Due to the multifactorial nature of this complication, further research is required to enhance our understanding and eradicate the pathology. Patient optimization is the principal guideline in not only PJK prevention, but overall postoperative complication prevention. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Meghan Cerpa
- The Och Spine Hospital at New York-Presbyterian/Columbia University Medical Center, 5141 Broadway, New York, NY, 10034, USA.
| | - Zeeshan Sardar
- The Och Spine Hospital at New York-Presbyterian/Columbia University Medical Center, 5141 Broadway, New York, NY, 10034, USA
| | - Lawrence Lenke
- The Och Spine Hospital at New York-Presbyterian/Columbia University Medical Center, 5141 Broadway, New York, NY, 10034, USA
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Harper KD, Phillips D, Lopez JM, Sardar Z. Acute traumatic thoracolumbar paraspinal compartment syndrome: case report. J Neurosurg Spine 2019; 30:140-145. [PMID: 30485208 DOI: 10.3171/2018.6.spine18186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/06/2018] [Indexed: 11/06/2022]
Abstract
Although compartment syndrome can occur in any compartment in the body, it rarely occurs in the paraspinal musculature and has therefore only been reported in a few case reports. Despite its rare occurrence, acute paraspinal compartment syndrome has been shown to occur secondary to reperfusion injury and traumatic and atraumatic causes. Diagnosis can be based on clinical examination findings, MRI or CT studies, or through direct measurement of intramuscular pressures. Conservative management should only be used in the setting of chronic presentation. Operative decompression via fasciotomy in cases of acute presentation may improve the patient's symptoms and outcomes. When treating acute paraspinal compartment syndrome via surgical decompression, an important aspect is the anatomical consideration. Although grouped under one name, each paraspinal muscle is enclosed within its own fascial compartment, all of which must be addressed to achieve an adequate decompression. The authors present the case of a 43-year-old female patient who presented to the emergency department with increasing low-back and flank pain after a fall. Associated sensory deficits in a cutaneous distribution combined with imaging and clinical findings contributed to the diagnosis of acute traumatic paraspinal compartment syndrome. The authors discuss this case and describe their surgical technique for managing acute paraspinal compartment syndrome.
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Affiliation(s)
| | - Dayna Phillips
- Departments of1Orthopaedic Surgery and Sports Medicine and
| | - Joseph M Lopez
- 2Trauma and Surgical Critical Care, Temple University Hospital, Philadelphia, Pennsylvania
| | - Zeeshan Sardar
- Departments of1Orthopaedic Surgery and Sports Medicine and
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Abstract
The readability of scientific papers has decreased dramati cally in the past 100 years, but now appears to have bottomed out at the ' very difficult' level. Volume and price inflationary pressures on publishers have probably been responsible for other changes in journal characteristics between 1900 and 1970 such as increased printing density and number of words and characters per journal per year.
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Affiliation(s)
- R.T. Bottle
- Department of Information Science, The City University, London ECIV OHB, United Kingdom
| | - J.S. Rennie
- Department of Information Science, The City University, London ECIV OHB, United Kingdom
| | - S. Russ
- Department of Information Science, The City University, London ECIV OHB, United Kingdom
| | - Z. Sardar
- Department of Information Science, The City University, London ECIV OHB, United Kingdom
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Bailey C, Stratton A, Manson N, Layne E, McKeon M, Harris S, McIntosh G, DellaMora L, McIntosh G, Miyanji F, Joukhadar N, Miyanji F, Miyanji F, Miyanji F, Miyanji F, Larouche J, Aoude A, Hardy-St-Pierre G, Roffey D, Evaniew N, Fazli G, Lin C, Dea N, Flood M, Glennie RA, Millstone DB, Nater A, Witiw C, Maggio D, Harris S, Collings D, Yee A, Tetreault L, Street J, Phillips J, Cochran M, Bigney E, Bouchard J, Jack A, Shamji M, Shamji M, Nakashima H, Chaudhary BR, Johnson M, Manson N, Tetreault L, Glennie RA, Evaniew N, Morris S, Spurway A, Bateman A, Abduljabbar F, Shamji M, McLachlin S, Manson N, Palkovsky R, Ailon T, Tetreault L, Johnson M, Street J, Street J, Bourassa-Moreau E, Nouri A, McIntosh G, Contreras A, Phan P, Hardy-St-Pierre G, Jarzem P, Wu H, Parsons D, Chukwunyerenwa C, Nadeau M, Bailey S, Rosas-Arellano P, Dehens S, Sequeira K, Miller T, Watson J, Siddiqi F, Gurr K, Urquhart J, Thomas K, McIntosh G, Hirsch L, Abraham E, Green A, McIntosh G, Roffey D, Wilson C, Kingwell S, Wai E, Manson N, Abraham E, Taylor E, Murray J, Albert W, Rampersaud R, Hall H, Carter T, Gregg C, Perruccio AV, Badley EM, Rampersaud YR, Steenstra I, Hall H, Carter T, Bastrom T, Samdani A, Yaszay B, Clements D, Shah S, Marks M, Betz R, Shufflebarger H, Newton P, Skaggs D, Heflin J, Yasin M, El-Hawary R, Bastrom T, Samdani A, Yaszay B, Asghar J, Shah S, Betz R, Shufflebarger H, Newton P, Reilly C, Choi J, Mok J, Nitikman M, Desai S, Reilly C, Desai S, Doddabasappa S, Reilly C, Nitikman M, Desai S, Paquette S, Fisher C, Domisse I, Wadey V, Hall H, Finkelstein J, Bouchard J, Hurlbert J, Broad R, Fox R, Hedden D, Nataraj A, Carey T, Bailey C, Chapman M, Moroz P, Chow D, Wai E, Tsai E, Christie S, Lundine K, Paquet J, Splawinski J, Wheelock B, Goytan M, Ahn H, Massicotte E, Fehlings M, Yee A, Alhamzah H, Fortin M, Jarzem P, Ouellet J, Weber M, Jack A, Thomas KC, Nataraj A, Coyle M, Kingwell S, Wai E, van der Watt L, Bhandari M, Ghert M, Aleem I, Drew B, Guyatt G, Jeyaratnam J, Nandlall N, Coyte P, Rampersaud R, Witiw C, Sundararajan K, Rampersaud YR, Fisher C, Batke J, Street J, Abraham E, Green A, Manson N, Ailon T, Batke J, Dea N, Street J, Perruccio AV, Badley EM, Rampersaud YR, Fehlings M, Tetreault L, Kopjar B, Fisher C, Vaccaro A, Arnold P, Schuster J, Finkelstein J, Rhines L, Dekutoski M, Gokaslan Z, France J, Rose P, Lin C, Sundararajan K, Rampersaud YR, Ailon T, Smith J, Shaffrey C, Lafage V, Schwab F, Haid R, Protopsaltis T, Klineberg E, Scheer J, Bess S, Arnold P, Chapman J, Fehlings M, Ames C, Rampersaud R, Nutt L, Urquhart J, Kuska L, Siddiqi F, Gurr K, Bailey C, Burch S, Sahgal A, Chow E, Niu C, Fisher C, Whyne C, Akens M, Bisland S, Wilson B, Nouri A, Cote P, Fehlings M, Mendelsohn D, Strelzow J, Batke J, Dvorak M, Fisher C, Urquhart J, Tallon C, Gurr K, Siddiqi F, Bailey S, Bailey C, Abraham E, Green A, Manson N, Manson NA, Green AJ, Abraham EP, Hurlbert J, Mogadham K, Swamy G, Tsahtsarlis A, Siddiqui M, Pierre GHS, Nataraj A, Mohanty C, Massicotte E, Fehlings M, Shcharinsky A, Tetreault L, Nagoshi N, Aria N, Fehlings M, Amritanand R, Rampersaud YR, Passmore S, McIntosh G, Abraham E, Green A, McIntosh G, Kopjar B, Cote P, Fehlings M, Arnold P, Batke J, Dea N, Dvorak M, Noonan V, Street J, Khan M, Drew B, Kwok D, Bhandari M, Ghert M, Howard J, Rasmusson D, El-Hawary R, Kishta W, Chukwunyerenwa C, El-Hawary R, Balkovec C, Akens M, Harrison R, McGill S, Yee A, Al-Jurayyan A, Alqahtani S, Sardar Z, Saluja RS, Ouellet J, Weber M, Steffen T, Beckman L, Jarzem P, Tu Y, Salter M, Polley B, Beig M, Larouche J, Whyne C, Green A, McIntosh G, Abraham E, Nicholls F, Burch S, Wagner P, Zhou H, Egge N, Harrigan M, Lapinsky A, Connoly P, Street J, DiPaola C, Kopjar B, Tan G, Cote P, Fehlings M, Passmore S, Street J, Fisher C, McIntosh G, Perlus IR, Kennedy J, Lenehan B, Strelzow J, Mendelsohn D, Dea N, Dvorak M, Fisher C, Mac-Thiong JM, Parent S, Li A, Thompson C, Tetreault L, Zamorano J, Dalzell K, Davis A, Mikulis D, Yee A, Fehlings M, Hall H, Carter T, Gregg C, Batke J, Dea N, Dvorak MF, Fisher CG, Street J, Le V(B, Roffey D, Kingwell S, MacPherson P, Desjardins M, Wai E, Siddiqui M, Henderson RL, Nataraj A, Simoes L, Assaker R, Ritter-Lang K, Vardon D, Litrico S, Fuentes S, Putzier M, Frank J, Guigui P, Nakach G, Le Huec JC, Pennington A, Batke J, Yang K, Fisher CG, Dvorak MF, Street J, Da Cunha R, Al Sayegh S, LaMothe J, Letal M, Johal H, Ferri-de-Barros F, El-Hawary R, Gauthier L, Spurway A, Johnston C, McClung A, Batke J, Lauscher HN, Fischer C, Street J. Canadian spine society 15th annual scientific conference. Can J Surg 2015; 58:S43-70. [PMID: 26011856 DOI: 10.1503/cjs.005515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Sardar Z, Alexander D, Oxner W, du Plessis S, Yee A, Wai EK, Anderson DG, Jarzem P. Twelve-month results of a multicenter, blinded, pilot study of a novel peptide (B2A) in promoting lumbar spine fusion. J Neurosurg Spine 2015; 22:358-66. [PMID: 25615629 DOI: 10.3171/2013.11.spine121106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Failure of fusion after a transforaminal lumbar interbody fusion (TLIF) procedure is a challenging problem that can lead to ongoing low-back pain, dependence on pain medication, and inability to return to work. B2A is a synthetic peptide that has proven efficacy in achieving fusion in animal models and may have a better safety profile than bone morphogenetic protein. The authors undertook this study to evaluate the safety and efficacy of B2A peptide-enhanced ceramic granules (Prefix) in comparison with autogenous iliac crest bone graft (ICBG, control) in patients undergoing single-level TLIF. METHODS Twenty-four patients with single-level degenerative disorders of the lumbar spine at L2-S1 requiring TLIF were enrolled between 2009 and 2010. They were randomly assigned to 3 groups: a control group (treated with ICBG, n = 9), a Prefix 150 group (treated with Prefix 150 μg/cm(3) granules, n = 8), and a Prefix 750 group (treated with Prefix 750 μg/cm(3) granules, n = 7). Outcome measures included the Oswestry Disability Index (ODI), visual analog pain scale, and radiographic fusion as assessed by CT and dynamic flexion/extension lumbar plain radiographs. RESULTS At 12 months after surgery, the radiographic fusion rate was 100% in the Prefix 750 group, 78% in the control group, and 50% in the Prefix 150 group, although the difference was not statistically significant (p = 0.08). At 6 weeks the mean ODI score was 41.0 for the control group, 27.7 for the Prefix 750 group, and 32.2 for the Prefix 150 group, whereas at 12 months the mean ODI was 24.4 for control, 31.1 for Prefix 750, and 29.7 for Prefix 150 groups. Complications were evenly distributed among the groups. CONCLUSIONS Prefix appears to provide a safe alternative to autogenous ICBG. Prefix 750 appears to show superior radiographic fusion when compared with autograft at 12 months after TLIF, although no statistically significant difference was demonstrated in this small study. Prefix and control groups both appeared to demonstrate comparable improvements to ODI at 12 months.
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Affiliation(s)
- Zeeshan Sardar
- McGill University Health Centre, McGill University, Montreal, Quebec
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van West H, Hodgson B, Parent E, Samuel S, Hodgson B, Ferland C, Soroceanu A, Soroceanu A, Protopsaltis T, Protopsaltis T, Radovanovic I, Amritanand R, Shamji M, Haugo K, Malham G, Jarzem P, Rampersaud Y, Tomkins-Lane C, Manson N, Malham G, Rampersaud Y, Malham G, Malham G, King V, Goldstein C, Fisher C, Fehlings M, Fisher C, Wong E, Sardar Z, Christie S, Patel A, Pinkoski C, Ahn H, Drew B, Dvorak M, Pezeshki P, Altaf F, Wilde P, Rampersaud Y, Sparrey C, Tetreault L, Fehlings M, Tetreault L, Rampersaud R, Jack A, Johnstone R, Fernandes A, Urquhart J, Morokoff A, Manson N, Tomkins-Lane C, Phan P, Evaniew N, Shamji M, Manson J, Rampersaud Y, Nault ML, St-Pierre GH, Larouche J, Lewis S, Wilgenbusch C, Lewis S, Rampersaud Y, Johnson R, Cushnie D, Sridharan S, Street J, Gregg C, Missiuna P, Abraham E, Abraham E, Manson N, Huang E, Passmore S, Mac-Thiong JM, Labelle H, Moulin D, Turgeon I, Roy-Beaudry M, Bourassa N, Petit Y, Parent. S, Chabot S, Westover L, Hill D, Moreau M, Hedden D, Lou E, Adeeb. S, Smith M, Bridge C, Hsu B, Gray. R, Group PORSCHES, Saran N, Mac-Thiong JM, Stone L, Ouellet. J, Protopsaltis T, Terran J, Bronsard N, Smith J, Klineberg E, Mundis G, Hostin R, Hart R, Shaffrey C, Bess S, Ames C, Schwab F, Lafage. V, Schwab F, Lafage V, Protopsaltis T, Ames C, Bess S, Smith J, Errico. T, Schwab F, Soroceanu A, Bronsard N, Smith J, Klineberg E, Mundis G, Hostin R, Hart R, Burton D, Ames C, Shaffrey C, Bess S, Errico T, Lafage. V, Terran J, Soroceanu A, Bronsard N, Smith J, Klineberg E, Mundis G, Kim HJ, Hostin R, Hart R, Shaffrey C, Bess S, Ames C, Schwab F, Lafage. V, Urquhart J, Gananapathy V, Siddiqi F, Gurr K, Bailey C, Ravi B, David K, Rampersaud. R, Tu Y, Salter. M, Nichol H, Fourney D, Kelly. M, Parker R, Ellis N, Blecher C, Chow F, Claydon. M, Sardar Z, Alexander D, Oxner W, Plessis SD, Yee A, Wai. E, Lewis S, Davey J, Gandhi R, Mahomed. N, Hu R, Thomas K, Hepler C, Choi K, Rowed K, Haig. A, Lam. K, Parker R, Blecher C, Seex. K, Perruccio A, Gandhi R, Program. UHNA, Ellis N, Parker R, Goss B, Blecher C, Ballok. Z, Parker R, Ellis N, Chan P, Varma. D, Swart A, Winder M, Varga PP, Gokaslan Z, Boriani S, Luzzati A, Rhines L, Fisher C, Chou D, Williams R, Dekutoski M, Quraishi N, Bettegowda C, Kawahara N, Fehlings. M, Versteeg A, Boriani S, Varga PP, Dekutoski M, Luzzati A, Gokaslan Z, Williams R, Reynolds J, Fehlings M, Bettegowda C, Rhines. L, Zamorano J, Nater A, Tetrault L, Varga P, Gokaslan Z, Boriani S, Fisher C, Rhines L, Bettegowda C, Kawahara N, Chou. D, Fehlings M, Kopjar B, Vaccaro A, Arnold P, Schuster J, Finkelstein J, Rhines L, Dekutoski M, Gokaslan Z, France. J, Whyne C, Singh D, Ford. M, Aldebeyan W, Ouellet J, Steffen T, Beckman L, Weber M, Jarzem. P, Kwon B, Ahn H, Bailey C, Fehlings M, Fourney D, Gagnon D, Tsai E, Tsui D, Parent S, Chen J, Dvorak M, Noonan V, Rivers C, Network RHSCIR, Batke J, Lenehan B, Fisher C, Dvorak M, Street. J, Fox R, Nataraj A, Bailey C, Christie S, Duggal N, Fehlings M, Finkelstein J, Fourney D, Hurlbert R, Kwon B, Townson A, Tsai E, Attabib N, Chen J, Dvorak M, Noonan V, Rivers C, Network. RHSCIR, Fehlings M, Paquet J, Ahn H, Attabib N, Bailey C, Christie S, Duggal N, Finkelstein J, Fourney D, Hurlbert R, Johnson M, Kwon B, Parent S, Tsai E, Dvorak M, Noonan V, Rivers C, Shen T, Network. RHSCIR, Fisher C, Kwon B, Drew B, Fehlings M, Paquet J, Ahn H, Attabib N, Bailey C, Christie S, Duggal N, Finkelstein J, Fourney D, Hurlbert R, Johnson M, Mac-Thiong JM, Parent S, Tsai E, Fallah N, Noonan V, Rivers C, Network RHSCIR, Davidson S, McCann C, Akens M, Murphy K, Whyne C, Sherar M, Yee. A, Belanger L, Ronco J, Dea N, Paquette S, Boyd M, Street J, Fisher C, Dvorak M, Kwon B, Gonzalvo A, Fitt G, Liew S, de la Harpe D, Turner P, Rogers M, Bidos A, Fanti C, Young B, Drew B, Puskas. D, Tam H, Manansala S, Nosov V, Delva M, Alshafai N, Kopjar B, Tan G, Arnold P, Fehlings. M, Kopjar B, Arnold P, Ibrahim A, Tetrault. L, Kopjar B, Arnold P, Fehlings. M, Sundararajan K, Eng. S, St-Pierre G, Nataraj A, Urquhart J, Rosas-Arellano P, Tallon C, Gurr K, Siddiqi F, Bailey S, Bailey C, Sundararajan K, Rampersaud. R, Rosa-Arellano P, Tallon C, Bailey S, Gurr K, Bailey. C, Parker R, Milili L, Goss B, Malham. G, Green A, McKeon M, Abraham. E, Lafave L, Parnell J, Rempel J, Moriartey S, Andreas Y, Wilson P, Hepler C, Ray H, Hu. R, Ploumis A, Hess K, Wood. K, Yarascavitch B, Madden K, Ghert M, Drew B, Bhandari M, Kwok D, Tu YS, Salter. M, Hadlow. A, Tso P, Walker K, Lewis S, Davey J, Mahomed N, Coyte. P, Mac-Thiong JM, Roy-Beaudry M, Turgeon I, Labelle H, deGuise J, Parent. S, Jack A, Fox R, Nataraj A, Paquette S, Leroux T, Yee A, Ahn H, Broad R, Fisher C, Hall H, Nataraj A, Hedden D, Christie S, Carey T, Mehta V, Fehlings M, Wadey. V, Dear T, Hashem. M, Fourney D, Goldstein S, Bodrogi A, Lipkus M, Dear T, Keshen S, Veillette C, Gandhi R, Adams D, Briggs N, Davey J, Fehlings M, Lau J, Lewis S, Magtoto R, Marshall K, Massicotte E, Ogilvie-Harris D, Sarro A, Syed K, Mohamed. N, Perera S, Taha A, Urquhart J, Gurr K, Siddiqi F, Bailey C, Thomas K, Cho R, Swamy G, Power C, Henari S, Lenehan. B, McIntosh G, Hall H, Hoffman. C, Karachi A, Pazionis T, AlShaya O, Green A, McKeon M, Manson. N, Green A, McKeon M, Manson. N, Green A, McKeon M, Murray J, Abraham. E, Thomas K, Suttor S, Goyal T, Littlewood J, Bains I, Bouchard J, Hu R, Jacobs B, Cho R, Swamy G, Johnson M, Pelleck V, Amad Y, Ramos E, Glazebrook C. Combined Spine Conference of the Canadian Spine Society New Zealand Orthopaedic Spine Society, Spine Society of Australia: Fairmont Château Lake Louise, Lake, Louise, Alberta, Tuesday, Feb. 25 to Saturday, Mar. 1, 20141.1.01 The use of suspension radiographs to predict LIV tilt.1.1.02 Surgical correction of adolescent idiopathic scoliosis without fusion: an animal model.1.1.03 Are full torso surface topography postural measurements more sensitive to change than back only parameters in adolescents with idiopathic scoliosis and a main thoracic curve?1.2.04 Restoration of thoracic kyphosis in adolescent idiopathic kyphosis: comparative radiographic analysis of round versus rail rods.1.2.05 Scoliosis surgery in spastic quadriplegic cerebral palsy: Is fusion to the pelvis always necessary? A 4–18-year follow-up study.1.2.06 Identification and validation of pain-related biomarkers surrounding spinal surgery in adolescents.1.3.07 Cervical sagittal deformity develops after PJK in adult throacolumbar deformity correction: radiographic analysis using a novel global sagittal angular parameter, the CTPA.1.3.08 Impact of obesity on complications and patient-reported outcomes in adult spinal deformity surgery.1.3.09 The T1 pelvic angle, a novel radiographic measure of sagittal deformity, accounts for both pelvic retroversion and truncal inclination and correlates strongly with HRQOL.1.4.10 Determining cervical sagittal deformity when it is concurrent with thoracolumbar deformity.1.4.11 The influence of sagittal balance and pelvic parameters on the outcome of surgically treated patients with degenerative spondylolisthesis.1.4.12 Predictors of degenerative spondylolisthesis and loading translation in surgical lumbar spinal stenosis patients.2.1.13 Mechanical allodynia following disc herniation requires intraneural macrophage infiltration and can be blocked by systemic selenium delivery or attenuation of BDNF activity.2.1.14 The effect of alanyl-glutamine on epidural fibrosis in a rat laminectomy model.2.1.15 Anterior lumbar interbody fusion using recombinant human bone morphogenetic protein-2: a prospective study of complications.2.2.16 2-year results of a Canadian, multicentre, blinded, pilot study of a novel peptide in promoting lumbar spine fusion.2.2.17 Comparative outcomes and cost-utility following surgical treatment of focal lumbar spinal stenosis compared with osteoarthritis of the hip or knee: long-term change in health-related quality of life.2.2.18 Changes in objectively measured walking performance, function, and pain following surgery for spondylolisthesis and lumbar spinal stenosis.2.3.19 A prospective multicentre observational data-monitored study of minimally invasive fusion to treat degenerative lumbar disorders: complications and outcomes at 1-year follow-up.2.3.20 Assessment and classification of subsidence in lateral interbody fusion using serial computed tomography.2.3.21 Predictors of willingness to undergo spinal and orthopaedic surgery after surgical consultation.2.4.22 Indirect foraminal decompression is independent of facet arthropathy in extreme lateral interbody fusion.2.4.23 Cervical artificial disc replacement with ProDisc-C: clinical and radiographic outcomes with long-term follow-up.2.4.24 Tantalum trabecular metal implants in anterior cervical corpectomy and fusion.3.1.25 Hemangiomas of the spine: results of surgical management and prognostic variables for local recurrence and mortality in a multicentre study.3.1.26 Chondrosarcomas of the spine: prognostic variables for local recurrence and mortality in a multicentre study.3.1.27 Risk factors for recurrence of surgically treated spine schwannomas: analysis of 169 patients from a multicentre international database.3.2.28 Survival pattern and the effect of surgery on health related quality of life and functional outcome in patients with metastatic epidural spinal cord compression from lung cancer — the AOSpine North America prospective multicentre study.3.2.29 A biomechanical assessment of kyphoplasty as a stand-alone treatment in a human cadaveric burst fracture model.3.2.30 What is safer in incompetent vertebrae with posterior wall defects, kyphoplasty or vertebroplasty: a study in vertebral analogs.3.3.31 Feasibility of recruiting subjects for acute spinal cord injury (SCI) clinical trials in Canada.3.3.32 Prospective analysis of adverse events in elderly patients with traumatic spinal cord injury.3.3.33 Does traction before surgery influence time to neural decompression in patients with spinal cord injury?3.4.34 Current treatment of individuals with traumatic spinal cord injury: Do we need age-specific guidelines?3.4.35 Current surgical practice for traumatic spinal cord injury in Canada.3.4.36 The importance of “time to surgery” for traumatic spinal cord injured patients: results from an ambispective Canadian cohort of 949 patients.3.5.37 Assessment of a novel coil-shaped radiofrequency probe in the porcine spine.3.5.38 The effect of norepinephrine and dopamine on cerebrospinal fluid pressure after acute spinal cord injury.3.5.39 The learning curve of pedicle screw placement: How many screws are enough?4.1.40 Preliminary report from the Ontario Inter-professional Spine Assessment and Education Clinics (ISAEC).4.1.41 A surrogate model of the spinal cord complex for simulating bony impingement.4.1.42 Clinical and surgical predictors of specific complications following surgery for the treatment of degenerative cervical myelopathy: results from the multicentre, prospective AOSpine international study on 479 patients.4.2.43 Outcomes of surgical management of cervical spondylotic myelopathy: results of the prospective, multicentre, AOSpine international study in 479 patients.4.2.44 A clinical prediction rule for clinical outcomes in patients undergoing surgery for degenerative cervical myelopathy: analysis of an international AOSpine prospective multicentre data set of 757 subjects.4.2.45 The prevalence and impact of low back and leg pain among aging Canadians: a cross-sectional survey.4.3.46 Adjacent segment pathology: Progressive disease course or a product of iatrogenic fusion?4.3.47 Natural history of degenerative lumbar spondylolisthesis in patients with spinal stenosis.4.3.48 Changes in self-reported clinical status and health care utilization during wait time for surgical spine consultation: a prospective observational study.4.3.49 The Canadian surgical wait list for lumbar degenerative spinal stenosis has a detrimental effect on patient outcomes.4.3.50 Segmental lordosis is independent of interbody cage position in XLIF.4.3.51 Elevated patient BMI does not negatively affect self-reported outcomes of thoracolumbar surgery.1.5.52 The Spinal Stenosis Pedometer and Nutrition Lifestyle Intervention (SSPANLI): development and pilot.1.5.53 Study evaluating the variability of surgical strategy planning for patients with adult spinal deformity.1.5.54 Atlantoaxial instability in acute odontoid fractures is associated with nonunion and mortality.1.5.55 Peripheral hypersensitivity to subthreshold stimuli persists after resolution of acute experimental disc-herniation neuropathy.1.5.56 Radiation induced lumbar spinal osteonecrosis: case report and literature review.1.5.57 Comparative outcomes and cost-utility following surgical treatment of focal lumbar spinal stenosis compared with osteoarthritis of the hip or knee: Part 2 — estimated lifetime incremental cost-utility ratios.1.5.58 A predictive model of progression for adolescent idiopathic scoliosis based on 3D spine parameters at first visit.1.5.59 Development of a clinical prediction model for surgical decision making in patients with degenerative lumbar spine disease.2.5.60 Canadian spine surgery fellowship education: evaluating opportunity in developing a nationally based training curriculum.2.5.61 Pedicle subtraction osteotomy for severe proximal thoracic junctional kyphosis.2.5.62 A comparison of spine surgery referrals triaged through a multidisciplinary care pathway versus conventional referrals.2.5.63 Results and complications of posterior-based 3 column osteotomies in patients with previously fused spinal deformities.2.5.64 Orthopaedic Surgical AdVerse Event Severity (Ortho-SAVES) system: identifying opportunities for improved patient safety and resource utilization.2.5.65 Spontaneous spinal extra-axial haematomas — surgical experience in Otago and Southland 2011–2013.2.5.66 Obesity and spinal epidural lipomatosis in cauda equina syndrome.2.5.67 Factors affecting restoration of lumbar lordosis in adult degenerative scoliosis patients treated with lateral trans-psoas interbody fusion.3.6.68 Systematic review of complications in spinal surgery: a comparison of retrospective and prospective study design.3.6.69 Postsurgical rehabilitation patients have similar fear avoidance behaviour levels as those in nonoperative care.3.6.70 Outcomes of surgical treatment of adolescent spondyloptosis: a case series.3.6.71 Surgical success in primary versus revision thoracolumbar spine surgery.3.6.72 The effect of smoking on subjective patient outcomes in thoracolumbar surgery.3.6.73 Modelling patient recovery to predict outcomes following elective thoracolumbar surgery for degenerative pathologies.3.6.74 Outcomes from trans-psoas versus open approaches in the treatment of adult degenerative scoliosis.3.6.75 Lumbar spinal stenosis and presurgical assessment: the impact of walking induced strain on a performance-based outcome measure. Can J Surg 2014. [DOI: 10.1503/cjs.005614] [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] [Indexed: 11/01/2022] Open
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Sardar Z, Jarzem P. Failure of a carbon fiber-reinforced polymer implant used for transforaminal lumbar interbody fusion. Global Spine J 2013; 3:253-6. [PMID: 24436878 PMCID: PMC3854590 DOI: 10.1055/s-0033-1343075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 01/15/2013] [Indexed: 11/08/2022] Open
Abstract
Lumbar interbody fusion is a common procedure owing to the high prevalence of degenerative spinal disorders. During such procedures, carbon fiber-reinforced polymer (CFRP) cages are frequently utilized to fill the void created between adjacent vertebral bodies, to provide mechanical stability, and to carry graft material. Failure of such implants can lead to significant morbidity. We discuss the possible causes leading to the failure of a CFRP cage in a patient with rheumatoid arthritis. Review of a 49-year-old woman who underwent revision anterior lumbar interbody fusion 2 years after posterior instrumentation and transforaminal lumbar interbody fusion at L4-L5 and L5-S1. The patient developed pseudarthrosis at the two previously fused levels with failure of the posterior instrumentation. Revision surgery reveled failure with fragmentation of the CFRP cage at the L5-S1 level. CFRP implants can break if mechanical instability or nonunion occurs in the spinal segments, thus emphasizing the need for optimizing medical management and meticulous surgical technique in achieving stability.
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Affiliation(s)
- Zeeshan Sardar
- McGill University Health Centre, Montreal, Quebec, Canada,Address for correspondence Zeeshan Sardar, MDCM, MSc Orthopaedic Residency Training Program, Shriners Hospital for Children1529 Cedar Avenue, Montreal, QuebecCanada H3G 1A6
| | - Peter Jarzem
- McGill University Health Centre, Montreal, Quebec, Canada
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Han Y, Sardar Z, McGrail S, Steffen T, Martineau PA. Peri-anterior cruciate ligament reconstruction femur fracture: a biomechanical analysis of the femoral tunnel as a stress riser. Knee Surg Sports Traumatol Arthrosc 2011; 19 Suppl 1:S77-85. [PMID: 21562843 DOI: 10.1007/s00167-011-1527-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 04/19/2011] [Indexed: 11/24/2022]
Abstract
PURPOSE Sixteen case reports of distal femur fractures as post-operative complications after anterior cruciate ligament (ACL) reconstruction have been described in the literature. The femoral tunnel has been suggested as a potential stress riser for fracture formation. Additionally, double bundle ACL reconstructions may compound this risk. This is the first biomechanical study to examine the significance of a stress riser effect of the femoral tunnel(s) after ACL reconstruction. The hypotheses tested in this study are that the femoral tunnel acts as a stress riser for fracture and that this effect increases with the size of the tunnel (8 mm vs. 10 mm) and with the number of tunnels (1 vs. 2). METHODS Femoral tunnels simulating single bundle (SB) hamstring graft (8 mm), bone-patellar tendon-bone graft (10 mm), and double bundle (DB) ACL reconstruction (7, 6 mm) were drilled in fourth-generation saw bones. These three experimental groups and a control group consisting of native saw bones without tunnels were loaded to failure. RESULTS All fractures occurred through the tunnels in the DB group, whereas fractures did not consistently occur through the tunnels in the SB groups. The mean fracture load was 6,145N ± 471N in the native group, 5,691N ± 198N in the 8 mm SB group, 5,702N ± 282N in the 10 mm SB group, and 4,744N ± 418N in the DB group. The mean fracture load for the DB group was significantly lower when compared to the native, 8 mm SB, and 10 mm SB groups independently (P value = 0.0016, 0.0060, and 0.0038, respectively). The mean fracture loads for neither SB groups were not significantly different from the native group. CONCLUSIONS An anatomically placed femoral tunnel in single bundle ACL reconstruction in our experimental model was not a significant stress riser to fracture, whereas the two femoral tunnels in double bundle ACL reconstruction significantly decreased load to failure. The results support the sparsity of reported peri-ACL reconstruction femur fractures in single femoral tunnel techniques. However, the increased fracture risk in double bundle ACL reconstruction may be a cause for concern and impact patient selection.
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Affiliation(s)
- Yung Han
- Department of Orthopaedic Surgery, McGill University, Montreal, QC, Canada.
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Shoker A, Sardar Z, Yang H, Hussain M. Production of human alloreactive antibodies by uremic sensitized lymphocytes engrafted in severe combined immunodeficient mice. Transplantation 1999; 68:1188-94. [PMID: 10551649 DOI: 10.1097/00007890-199910270-00020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Numerous studies have documented antibody responses to nominal antigens in human peripheral blood lymphocyte (hu-PBL)-severe combined immunodeficient (SCID) mice engrafted with PBL. We suggest, therefore, that engraftment of SCID mice by allosensitized cells produces alloreactive antibodies (allo-Ab). As such, SCID mice can be used as a model to examine the cellular basis of the sustenance of humoral alloresponses. METHODS C.B-17 SCID mice were engrafted intraperitoneally with PBL from sensitized uremic patients for 5 weeks and classified into the following: group 1, 8 mice engrafted with unactivated cells (n = 5; n = sensitized patients); group 2, 6 mice engrafted with unactivated PBL (n = 3) followed 2 days later by in vivo activation with interleukin-2 (IL-2) and lipopolysaccharide (LPS); group 3, 11 mice engrafted with cells preactivated in vitro with IL-2 and LPS (n = 6); group 4, 9 mice engrafted with cells preactivated with irradiated allogeneic transformed B cells, IL-2, and LPS (n = 5); group 5, 10 mice engrafted with cells preactivated with IL-2, LPS, and HLA class II allopeptides and adjuvant (n = 6); group 6, 8 control mice engrafted with control cells preactivated with IL-2 and LPS. Two weeks later, each group was rechallenged by the same stimuli. Allo-Ab production was measured by the panel-reactive antibody PRA-STAT ELISA method. Results. Allo-Ab was produced in 54.5% of group 3, 43% of group 4; 80% of group 5, and 0% of groups 1, 2, and 6. The ratio of alloreactive positive wells in the allo-Ab-producing PBL-hu-SCID mice to that present in the respective patient's sera was 82%, 52%, and 87% in groups 3, 4, and 5, respectively. Conclusions. The study demonstrates the feasibility of using the hu-PBL-SCID model to study alloreactive memory B-cell function in humans. Discrete HLA-class allopeptides (group 5) appeared more potent allo-Ab producers than allogeneic cells (group 4).
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Affiliation(s)
- A Shoker
- Department of Medicine, Royal University Hospital, Saskatoon, Saskatchewan, Canada.
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