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Bae J, Sathe A, Lee SM, Theologis AA, Deviren V, Lee SH. Correlation of Paraspinal Muscle Mass With Decompensation of Sagittal Adult Spinal Deformity After Setting of Fatigue Post 10-Minute Walk. Neurospine 2021; 18:495-503. [PMID: 34610681 PMCID: PMC8497245 DOI: 10.14245/ns.2142510.255] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/21/2021] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the changes in spinopelvic parameters before and after the setting of muscle fatigue along with its correlation with pre-existing paraspinal and psoas muscle mass. METHODS Single-center retrospective review of prospectively collected data was conducted on 145-adults with symptomatic loss of lumbar lordosis (LL). Radiographs were taken before and after walking for 10 minutes. Magnetic resonance imaging was used to calculate paraspinal muscle (PSM) cross-sectional area (CSA), mean signal intensity, fatty infiltration (FI), and lean muscle mass at thoracolumbar junction (T12) and lower lumbar level (L4). Psoas CSA was calculated at L3. Patients were divided into 2 groups namely compensated sagittal deformity (CSD) (SVA ≤ 4 cm, PT > 20°) and decompensated sagittal deformity (DSD) (SVA > 4 cm, PT > 20°) based on prewalk measurements. RESULTS Initial mean SVA was 1.8 cm and 11 cm for CSD and DSD respectively (p < 0.01). After walking, significant deteriorations in SVA, PT-LL (p < 0.01) were observed in CSD without significant change in thoracic kyphosis (TK). All sagittal parameters in DSD deteriorated significantly. DSD group had significantly poorer PSM quality at T12 and L4 compared to CSD group. In CSD group, sagittal decompensation correlated with muscle quality, i.e. , decreases in LL (ΔLL) correlated with CSA of PSM/vertebral body (VB) at L4 (r = -0.412, p = 0.046) while increases in TK (ΔTK) correlated with CSA of PSM/VB at T12 (r = 0.477, p = 0.018). ΔSVA and ΔPT correlated with FI at L4 (r = 0.577, p = 0.003 and r = -0.407, p = 0.048, respectively). DSD group, had weak correlations (-0.3 < r < -0.1) between changes in sagittal and PSM parameters. CONCLUSION PSM quality in adults with spinal deformity correlates with patients' ability to maintain an upright posture and sagittal decompensation after walking for 10 minutes.
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Affiliation(s)
- Junseok Bae
- Department of Neurological Surgery, Wooridul Spine Hospital, Seoul, Korea
| | - Ashwin Sathe
- Department of Neurological Surgery, Wooridul Spine Hospital, Seoul, Korea
| | - Shih-Min Lee
- Department of Neurological Surgery, Wooridul Spine Hospital, Seoul, Korea
| | - Alexander A Theologis
- Department of Orthopaedic Surgery, University of California - San Francisco (UCSF), San Francisco, CA, USA
| | - Vedat Deviren
- Department of Orthopaedic Surgery, University of California - San Francisco (UCSF), San Francisco, CA, USA
| | - Sang-Ho Lee
- Department of Neurological Surgery, Wooridul Spine Hospital, Seoul, Korea
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Theologis AA, Crawford M, Diab M. Ethnic Variation in Satisfaction and Appearance Concerns in Adolescents With Idiopathic Scoliosis Undergoing Posterior Spinal Fusion With Instrumentation. Spine Deform 2018; 6:148-155. [PMID: 29413737 DOI: 10.1016/j.jspd.2017.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 07/23/2017] [Accepted: 07/28/2017] [Indexed: 11/16/2022]
Abstract
STUDY DESIGN Cohort analysis. OBJECTIVE Document satisfaction with management and appearance concerns in children of different ethnicity who underwent spinal fusion/instrumentation for adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA Scoliosis Research Society Questionnaire (SRS-30) outcomes in AIS indicate a link between appearance and satisfaction as well as ethnic variation in appearance domain. Exploration of these findings in the Scoliosis Appearance Questionnaire (SAQ) will allow better understanding of ethnic variation in appearance concerns. METHODS Children with AIS who underwent posterior-only operations and completed the SAQ's question 31 were identified. Univariate logistic regression of SAQ questions 12-30 was used to assess relationships with ethnicity. RESULTS 1,977 children [boys: 281, girls: 1,290, unspecified: 406; average age 15.1 ± 2.0 years preoperatively and 817 children (boys: 113, girls: 569, unspecified: 135; average age 15.1 ± 2.0 years) at 2 years' follow-up met inclusion criteria. The majority were Caucasian (57.3%). Few were Hispanic (3.4%). Preoperatively, the largest percentage of patients in each ethnic group answered "very true" to "wanting to be more even." Preoperatively, Asians were least likely to be concerned about evenness of shoulders, hips, waist, ribs, and chest in back (p < .05); however, they expressed greatest concern about height (p < .05). African Americans and Hispanics were more likely to be concerned about breast evenness and anterior chest and looking better in clothes (p < .05). African Americans were most concerned about overall evenness and evenness of shoulders, hips, waist, ribs, posterior chest, leg length, and looking more attractive (p < .05). Surgical scar was most important postoperatively for all ethnicities. African Americans and Hispanics were more self-conscious about scar (p < .05). African Americans were most likely to want to be more even and have more even shoulders, hips, waist, leg lengths, ribs, breasts, and chest postoperatively. CONCLUSIONS Ethnicity influenced appearance concerns in pre- and postoperative SAQ evaluation. Ethnic variation in appearance concerns should be taken into account and differentiated when counseling patients about AIS and surgical correction. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Alexander A Theologis
- Department of Orthopaedic Surgery, University of California-San Francisco (UCSF), San Francisco, CA, USA
| | - Matthew Crawford
- Department of Orthopaedic Surgery, University of California-San Francisco (UCSF), San Francisco, CA, USA
| | - Mohammad Diab
- Department of Orthopaedic Surgery, University of California-San Francisco (UCSF), San Francisco, CA, USA.
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- Department of Orthopaedic Surgery, University of California-San Francisco (UCSF), San Francisco, CA, USA
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Su BW, Theologis AA, Byers RH, Shimer AL, Schroeder GD, Vaccaro AR, Tay B. Quantitative Assessment of the Anatomical Footprint of the C1 Pedicle Relative to the Lateral Mass: A Guide for C1 Lateral Mass Fixation. Global Spine J 2018; 8:507-511. [PMID: 30258757 PMCID: PMC6149043 DOI: 10.1177/2192568217744530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/24/2022] Open
Abstract
STUDY DESIGN Anatomic study. OBJECTIVES To determine the relationship of the anatomical footprint of the C1 pedicle relative to the lateral mass (LM). METHODS Anatomic measurements were made on fresh frozen human cadaveric C1 specimens: pedicle width/height, LM width/height (minimum/maximum), LM depth, distance between LM's medial aspect and pedicle's medial border, distance between LM's lateral aspect to pedicle's lateral border, distance between pedicle's inferior aspect and LM's inferior border, distance between arch's midline and pedicle's medial border. The percentage of LM medial to the pedicle and the distance from the center of the LM to the pedicle's medial wall were calculated. RESULTS A total of 42 LM were analyzed. The C1 pedicle's lateral aspect was nearly confluent with the LM's lateral border. Average pedicle width was 9.0 ± 1.1 mm, and average pedicle height was 5.0 ± 1.1 mm. Average LM width and depth were 17.0 ± 1.6 and 17.2 ± 1.6 mm, respectively. There was 6.9 ± 1.5 mm of bone medial to the medial C1 pedicle, which constituted 41% ± 9% of the LM's width. The distance from C1 arch's midline to the medial pedicle was 13.5 ± 2.0 mm. The LM's center was 1.6 ± 1 mm lateral to the medial pedicle wall. There was on average 3.5 ± 0.6 mm of the LM inferior to the pedicle inferior border. CONCLUSIONS The center of the lateral mass is 1.6 ± 1 mm lateral to the medial wall of the C1 pedicle and approximately 15 mm from the midline. There is 6.9 ± 1.5 mm of bone medial to the medial C1 pedicle. Thus, the medial aspect of C1 pedicle may be used as an anatomic reference for locating the center of the C1 LM for screw fixation.
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Affiliation(s)
- Brian W. Su
- Mt Tam Orthopedics and Spine Center, Larkspur, CA, USA,Brian W. Su, MD, Mt Tam Orthopedics and Spine
Center, Marin General Hospital, Marin Spine & Brain Institute, 2 Bon Air Road, Suite
120, Larkspur, CA 94939, USA.
| | | | | | | | | | | | - Bobby Tay
- University of California at San Francisco, San Francisco, CA, USA
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Gussous Y, Theologis AA, Demb JB, Tangtiphaiboontana J, Berven S. Correlation Between Lumbopelvic and Sagittal Parameters and Health-Related Quality of Life in Adults With Lumbosacral Spondylolisthesis. Global Spine J 2018; 8:17-24. [PMID: 29456911 PMCID: PMC5810889 DOI: 10.1177/2192568217696692] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
STUDY DESIGN Secondary analysis of prospective, multicenter data. OBJECTIVE To evaluate impact of sagittal parameters on health-related quality of life (HRQoL) in adults with lumbosacral spondylolisthesis. METHODS Adults with unoperated lumbosacral spondylolisthesis were identified in the Spinal Deformity Study Group database. Pearson's correlations were calculated between SF-12 (Short Form-12)/Scoliosis Research Society-30 (SRS-30) scores and radiographic parameters (C7 sagittal vertical axis [SVA] deviation, T1 pelvic angle, pelvic tilt [PT], pelvic incidence, sacral slope, slip angle, Meyerding slip grade, Labelle classification). Main effects linear regression models measured association between individual health status measures and individual radiographic predictor variables. RESULTS Forty-five patients were analyzed (male, 15; female, 30; average age 40.5 ± 18.7 years; 14 low-grade, 31 high-grade). For low-grade slips, SVA had strong negative correlations with SF-12 mental component score (MCS), SRS-30 appearance, mental, and satisfaction domains (r = -0.57, r = -0.60, r = -0.58, r = -0.53, respectively; P < .05). For high-grade slips, slip angle had a moderate negative correlation with SF-12 MCS (r = -0.36; P = .05) and SVA had strong negative correlations with SF-12 physical component score (PCS), SRS-30 appearance and activity domains (r = -0.48, r = -0.48, r = -0.45; P < .05) and a moderate negative correlation with SRS-30 total (r = -0.37; P < .05). T1 pelvic angle had a moderate negative correlation with SF-12 PCS and SRS-30 appearance (r = -0.37, r = -0.36; P ≤ .05). For every 1° increase in PT, there was a 0.04-point decrease in SRS appearance, 0.05-point decrease in SRS activity, 0.06-point decrease in SRS satisfaction, and 0.04-point decrease in SRS total score (P < .05). CONCLUSION Lumbosacral spondylolisthesis in adults negatively affects HRQoL. Multiple radiographic sagittal parameters negatively affect HRQoLs for patients with low- and high-grade slips. Improvement of sagittal parameters is an important goal of surgery for adults with lumbosacral spondylolisthesis.
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Affiliation(s)
- Yazeed Gussous
- University of California–San Francisco, San Francisco, CA, USA,Yazeed Gussous, 543 Taylor Avenue, Suite 1074, Columbus, OH 43203, USA.
| | | | - Joshua B. Demb
- University of California–San Francisco, San Francisco, CA, USA
| | | | - Sigurd Berven
- University of California–San Francisco, San Francisco, CA, USA
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Bae J, Theologis AA, Strom R, Tay B, Burch S, Berven S, Mummaneni PV, Chou D, Ames CP, Deviren V. Comparative analysis of 3 surgical strategies for adult spinal deformity with mild to moderate sagittal imbalance. J Neurosurg Spine 2017; 28:40-49. [PMID: 29087808 DOI: 10.3171/2017.5.spine161370] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [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
OBJECTIVE Surgical treatment of adult spinal deformity (ASD) is an effective endeavor that can be accomplished using a variety of surgical strategies. Here, the authors assess and compare radiographic data, complications, and health-related quality-of-life (HRQoL) outcome scores among patients with ASD who underwent a posterior spinal fixation (PSF)-only approach, a posterior approach combined with lateral lumbar interbody fusion (LLIF+PSF), or a posterior approach combined with anterior lumbar interbody fusion (ALIF+PSF). METHODS The medical records of consecutive adults who underwent thoracolumbar fusion for ASD between 2003 and 2013 at a single institution were reviewed. Included were patients who underwent instrumentation from the pelvis to L-1 or above, had a sagittal vertical axis (SVA) of < 10 cm, and underwent a minimum of 2 years' follow-up. Those who underwent a 3-column osteotomy were excluded. Three groups of patients were compared on the basis of the procedure performed, LLIF+PSF, ALIF+PSF, and PSF only. Perioperative spinal deformity parameters, complications, and HRQoL outcome scores (Oswestry Disability Index [ODI], Scoliosis Research Society 22-question Questionnaire [SRS-22], 36-Item Short Form Health Survey [SF-36], visual analog scale [VAS] for back/leg pain) from each group were assessed and compared with each other using ANOVA. The minimal clinically important differences used were -1.2 (VAS back pain), -1.6 (VAS leg pain), -15 (ODI), 0.587/0.375/0.8/0.42 (SRS-22 pain/function/self-image/mental health), and 5.2 (SF-36, physical component summary). RESULTS A total of 221 patients (58 LLIF, 91 ALIF, 72 PSF only) met the inclusion criteria. Average deformities consisted of a SVA of < 10 cm, a pelvic incidence-lumbar lordosis (LL) mismatch of > 10°, a pelvic tilt of > 20°, a lumbar Cobb angle of > 20°, and a thoracic Cobb angle of > 15°. Preoperative SVA, LL, pelvic incidence-LL mismatch, and lumbar and thoracic Cobb angles were similar among the groups. Patients in the PSF-only group had more comorbidities, those in the ALIF+PSF group were, on average, younger and had a lower body mass index than those in the LLIF+PSF group, and patients in the LLIF+PSF group had a significantly higher mean number of interbody fusion levels than those in the ALIF+PSF and PSF-only groups. At final follow-up, all radiographic parameters and the mean numbers of complications were similar among the groups. Patients in the LLIF+PSF group had proximal junctional kyphosis that required revision surgery significantly less often and fewer proximal junctional fractures and vertebral slips. All preoperative HRQoL scores were similar among the groups. After surgery, the LLIF+PSF group had a significantly lower ODI score, higher SRS-22 self-image/total scores, and greater achievement of the minimal clinically important difference for the SRS-22 pain score. CONCLUSIONS Satisfactory radiographic outcomes can be achieved similarly and adequately with these 3 surgical approaches for patients with ASD with mild to moderate sagittal deformity. Compared with patients treated with an ALIF+PSF or PSF-only surgical strategy, patients who underwent LLIF+PSF had lower rates of proximal junctional kyphosis and mechanical failure at the upper instrumented vertebra and less back pain, less disability, and better SRS-22 scores.
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Affiliation(s)
- Junseok Bae
- 1Department of Neurological Surgery, Wooridul Spine Hospital, Seoul, South Korea; and
| | | | | | - Bobby Tay
- Departments of2Orthopaedic Surgery and
| | | | | | | | - Dean Chou
- 3Neurological Surgery, University of California, San Francisco, California
| | - Christopher P Ames
- 3Neurological Surgery, University of California, San Francisco, California
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Theologis AA, Jain D, Ames CP, Pekmezci M. Circumferential fusion for degenerative lumbar spondylolisthesis complicated by distal junctional grade 4 spondylolisthesis in the sub-acute post-operative setting. Eur Spine J 2017; 26:3075-3081. [PMID: 28204925 DOI: 10.1007/s00586-017-4976-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/09/2016] [Revised: 12/13/2016] [Accepted: 01/23/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Surgical management for lumbar stenosis is generally safe and provides significant improvements in pain, disability, and function. Successful lumbar decompression hinges on removing an appropriate amount of lamina and other compressive pathology in the lateral recess. Too little bony decompression can result in persistent pain and disability, while over resection of the pars and/or facets may jeopardize spinal stability. CASE REPORT In this unique report, we present for the first time an acute iatrogenic grade 4 L5-S1 spondylolisthesis distal to a L3-5 laminectomy and circumferential instrumented fusion due to bilateral iatrogenic L5 pars fractures and its management and clinical outcomes after revision operation. The patient presented with worsening pain, neurologic compromise, and severe sagittal imbalance. The iatrogenic, high-grade spondylolisthesis was urgently addressed with a L5-S1 anterior lumbar interbody fusion and extension of posterior instrumentation to the pelvis, which resulted in considerable pain relief, resolution of neurologic deficits, and reconstitution of acceptable sagittal imbalance. CONCLUSION All attempts during a lumbar decompression should be made to prevent iatrogenic pars fractures, as they may result in severe sagittal imbalance, neurologic compromise, and persistent disability. Iatrogenic, high-grade L5-S1 spondylolisthesis can be successfully treated with reduction using circumferential fusion of the lumbosacral junction.
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Affiliation(s)
- Alexander A Theologis
- Department of Orthopaedic Surgery, University of California-San Francisco (UCSF), 500 Parnassus Avenue, MU West 3rd Floor, San Francisco, CA, 94143, USA.
| | - Deeptee Jain
- Department of Orthopaedic Surgery, University of California-San Francisco (UCSF), 500 Parnassus Avenue, MU West 3rd Floor, San Francisco, CA, 94143, USA
| | | | - Murat Pekmezci
- Department of Orthopaedic Surgery, University of California-San Francisco (UCSF), 500 Parnassus Avenue, MU West 3rd Floor, San Francisco, CA, 94143, USA
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Theologis AA, Burch S, Pekmezci M. Placement of iliosacral screws using 3D image-guided (O-Arm) technology and Stealth Navigation: comparison with traditional fluoroscopy. Bone Joint J 2017; 98-B:696-702. [PMID: 27143744 DOI: 10.1302/0301-620x.98b5.36287] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 11/12/2015] [Indexed: 11/05/2022]
Abstract
AIMS We compared the accuracy, operating time and radiation exposure of the introduction of iliosacral screws using O-arm/Stealth Navigation and standard fluoroscopy. MATERIALS AND METHODS Iliosacral screws were introduced percutaneously into the first sacral body (S1) of ten human cadavers, four men and six women. The mean age was 77 years (58 to 85). Screws were introduced using a standard technique into the left side of S1 using C-Arm fluoroscopy and then into the right side using O-Arm/Stealth Navigation. The radiation was measured on the surgeon by dosimeters placed under a lead thyroid shield and apron, on a finger, a hat and on the cadavers. RESULTS There were no neuroforaminal breaches in either group. The set-up time for the O-Arm was significantly longer than for the C-Arm, while total time for placement of the screws was significantly shorter for the O-Arm than for the C-Arm (p = 0.001). The mean absorbed radiation dose during fluoroscopy was 1063 mRad (432.5 mRad to 4150 mRad). No radiation was detected on the surgeon during fluoroscopy, or when he left the room during the use of the O-Arm. The mean radiation detected on the cadavers was significantly higher in the O-Arm group (2710 mRem standard deviation (sd) 1922) than during fluoroscopy (11.9 mRem sd 14.8) (p < 0.01). CONCLUSION O-Arm/Stealth Navigation allows for faster percutaneous placement of iliosacral screws in a radiation-free environment for surgeons, albeit with the same accuracy and significantly more radiation exposure to cadavers, when compared with standard fluoroscopy. TAKE HOME MESSAGE Placement of iliosacral screws with O-Arm/Stealth Navigation can be performed safely and effectively. Cite this article: Bone Joint J 2016;98-B:696-702.
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Affiliation(s)
- A A Theologis
- University of California, San Francisco, 500 Parnassus MU West 3rd Floor, San Francisco, CA, 94143, USA
| | - S Burch
- University of California, San Francisco, 500 Parnassus MU West 3rd Floor, San Francisco, CA, 94143, USA
| | - M Pekmezci
- University of California, San Francisco, 500 Parnassus MU West 3rd Floor, San Francisco, CA, 94143, USA
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Keefe MK, Zygourakis CC, Theologis AA, Canepa E, Shaw JD, Goldman LH, Burch S, Berven S, Chou D, Tay B, Mummaneni P, Deviren V, Ames CP. Sexual function after cervical spine surgery: Independent predictors of functional impairment. J Clin Neurosci 2016; 36:94-101. [PMID: 27825608 DOI: 10.1016/j.jocn.2016.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 10/15/2016] [Indexed: 11/17/2022]
Abstract
Sexual function (SF) is an important component of patient-focused health related quality of life (HRQoL), but it has not been well studied in spine surgery. This study aims to assess SF after cervical spine surgery and identify predictors of SF. This single-center retrospective study evaluates SF of adults who underwent cervical spine surgery 2007-2012. Predictor variables included demographics, medical/surgical history, operative information, HRQoL measures (Neck Disability Index, SF-12), validated SF surveys [Female Sexual Function Index (FSFI) and Brief Sexual Function Inventory (BSFI) for males], and a study-specific SF questionnaire. 59 patients (31M, 28F; mean age=56±8.4) had significantly lower SF scores compared to age-matched peers: average BSFI = 2.26±1.22 (vs. 06±0.74), average FSFI=13.05±11.42 (<26.55 indicating sexual dysfunction). In men, lower mental SF-12 and higher NDI, back pain, and number of operated levels were associated with lower BSFI scores (all p<0.05). In women, higher total number of medications and pain medications were associated with lower FSFI scores (both p<0.05). 46% of patients reported difficulty performing a sexual position after surgery that they had previously enjoyed. 39% of men had difficulty on top during intercourse, and 32% of participants reported difficulty performing oral sex. 39% of patients reported worse SF, while only 5% reported an improvement in postoperative SF. Men and women who underwent cervical spine surgery had lower SF scores than age-matched peers, likely attributable to general mental health, regional neck disability, back pain, and medications. A large portion of patients reported subjectively worsened SF after surgery.
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Affiliation(s)
- Malla K Keefe
- Department of Orthopedic Surgery, University of California, 500 Parnassus Avenue, MU-320W, San Francisco, CA 94143, USA; Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, Rm 779M, CA 94143, USA.
| | - Corinna C Zygourakis
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, Rm 779M, CA 94143, USA.
| | - Alexander A Theologis
- Department of Orthopedic Surgery, University of California, 500 Parnassus Avenue, MU-320W, San Francisco, CA 94143, USA.
| | - Emma Canepa
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, Rm 779M, CA 94143, USA.
| | - Jeremy D Shaw
- Department of Orthopedic Surgery, University of California, 500 Parnassus Avenue, MU-320W, San Francisco, CA 94143, USA.
| | - Lauren H Goldman
- Department of Orthopedic Surgery, University of California, 500 Parnassus Avenue, MU-320W, San Francisco, CA 94143, USA; Department of Radiology, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA.
| | - Shane Burch
- Department of Orthopedic Surgery, University of California, 500 Parnassus Avenue, MU-320W, San Francisco, CA 94143, USA.
| | - Sigurd Berven
- Department of Orthopedic Surgery, University of California, 500 Parnassus Avenue, MU-320W, San Francisco, CA 94143, USA.
| | - Dean Chou
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, Rm 779M, CA 94143, USA.
| | - Bobby Tay
- Department of Orthopedic Surgery, University of California, 500 Parnassus Avenue, MU-320W, San Francisco, CA 94143, USA.
| | - Praveen Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, Rm 779M, CA 94143, USA.
| | - Vedat Deviren
- Department of Orthopedic Surgery, University of California, 500 Parnassus Avenue, MU-320W, San Francisco, CA 94143, USA.
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, Rm 779M, CA 94143, USA.
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Theologis AA, Mundis GM, Nguyen S, Okonkwo DO, Mummaneni PV, Smith JS, Shaffrey CI, Fessler R, Bess S, Schwab F, Diebo BG, Burton D, Hart R, Deviren V, Ames C. Utility of multilevel lateral interbody fusion of the thoracolumbar coronal curve apex in adult deformity surgery in combination with open posterior instrumentation and L5-S1 interbody fusion: a case-matched evaluation of 32 patients. J Neurosurg Spine 2016; 26:208-219. [PMID: 27767682 DOI: 10.3171/2016.8.spine151543] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the utility of supplementing long thoracolumbar posterior instrumented fusion (posterior spinal fusion, PSF) with lateral interbody fusion (LIF) of the lumbar/thoracolumbar coronal curve apex in adult spinal deformity (ASD). METHODS Two multicenter databases were evaluated. Adults who had undergone multilevel LIF of the coronal curve apex in addition to PSF with L5-S1 interbody fusion (LS+Apex group) were matched by number of posterior levels fused with patients who had undergone PSF with L5-S1 interbody fusion without LIF (LS-Only group). All patients had at least 2 years of follow-up. Percutaneous PSF and 3-column osteotomy (3CO) were excluded. Demographics, perioperative details, radiographic spinal deformity measurements, and HRQoL data were analyzed. RESULTS Thirty-two patients were matched (LS+Apex: 16; LS: 16) (6 men, 26 women; mean age 63 ± 10 years). Overall, the average values for measures of deformity were as follows: Cobb angle > 40°, sagittal vertical axis (SVA) > 6 cm, pelvic tilt (PT) > 25°, and mismatch between pelvic incidence (PI) and lumbar lordosis (LL) > 15°. There were no significant intergroup differences in preoperative radiographic parameters, although patients in the LS+Apex group had greater Cobb angles and less LL. Patients in the LS+Apex group had significantly more anterior levels fused (4.6 vs 1), longer operative times (859 vs 379 minutes), and longer length of stay (12 vs 7.5 days) (all p < 0.01). For patients in the LS+Apex group, Cobb angle, pelvic tilt (PT), lumbar lordosis (LL), PI-LL (lumbopelvic mismatch), Oswestry Disability Index (ODI) scores, and visual analog scale (VAS) scores for back and leg pain improved significantly (p < 0.05). For patients in the LS-Only group, there were significant improvements in Cobb angle, ODI score, and VAS scores for back and leg pain. The LS+Apex group had better correction of Cobb angles (56% vs 33%, p = 0.02), SVA (43% vs 5%, p = 0.46), LL (62% vs 13%, p = 0.35), and PI-LL (68% vs 33%, p = 0.32). Despite more LS+Apex patients having major complications (56% vs 13%; p = 0.02) and postoperative leg weakness (31% vs 6%, p = 0.07), there were no intergroup differences in 2-year outcomes. CONCLUSIONS Long open posterior instrumented fusion with or without multilevel LIF is used to treat a variety of coronal and sagittal adult thoracolumbar deformities. The addition of multilevel LIF to open PSF with L5-S1 interbody support in this small cohort was often used in more severe coronal and/or lumbopelvic sagittal deformities and offered better correction of major Cobb angles, lumbopelvic parameters, and SVA than posterior-only operations. As these advantages came at the expense of more major complications, more leg weakness, greater blood loss, and longer operative times and hospital stays without an improvement in 2-year outcomes, future investigations should aim to more clearly define deformities that warrant the addition of multilevel LIF to open PSF and L5-S1 interbody fusion.
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Affiliation(s)
| | - Gregory M Mundis
- Department of Orthopaedic Surgery, San Diego Center for Spinal Disorders, La Jolla, California
| | - Stacie Nguyen
- Department of Orthopaedic Surgery, San Diego Center for Spinal Disorders, La Jolla, California
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
| | - Praveen V Mummaneni
- Department of Neurologic Surgery, University of California, San Francisco, California
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Christopher I Shaffrey
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Richard Fessler
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Shay Bess
- Department of Orthopaedic Surgery, Rocky Mountain Hospital for Children, Denver, Colorado
| | - Frank Schwab
- Department of Orthopedic Surgery, NYU Hospital for Joint Diseases
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, New York
| | - Douglas Burton
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas; and
| | - Robert Hart
- Department of Orthopedic Surgery, Oregon Health & Science University, Portland, Oregon
| | - Vedat Deviren
- Department of Orthopaedic Surgery, University of California, San Francisco
| | - Christopher Ames
- Department of Neurologic Surgery, University of California, San Francisco, California
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Theologis AA, Ailon T, Scheer JK, Smith JS, Shaffrey CI, Bess S, Gupta M, Klineberg EO, Kebaish K, Schwab F, Lafage V, Burton D, Hart R, Ames CP, _ _. Impact of preoperative depression on 2-year clinical outcomes following adult spinal deformity surgery: the importance of risk stratification based on type of psychological distress. J Neurosurg Spine 2016; 25:477-485. [DOI: 10.3171/2016.2.spine15980] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE
The objective of this study was to isolate whether the effect of a baseline clinical history of depression on outcome is independent of associated physical disability and to evaluate which mental health screening tool has the most utility in determining 2-year clinical outcomes after adult spinal deformity (ASD) surgery.
METHODS
Consecutively enrolled patients with ASD in a prospective, multicenter ASD database who underwent surgical intervention with a minimum 2-year follow-up were retrospectively reviewed. A subset of patients who completed the Distress and Risk Assessment Method (DRAM) was also analyzed. The effects of categorical baseline depression and DRAM classification on the Oswestry Disability Index (ODI), SF-36, and Scoliosis Research Society questionnaire (SRS-22r) were assessed using univariate and multivariate linear regression analyses. The probability of achieving ≥ 1 minimal clinically important difference (MCID) on the ODI based on the DRAM’s Modified Somatic Perceptions Questionnaire (MSPQ) score was estimated.
RESULTS
Of 267 patients, 66 (24.7%) had self-reported preoperative depression. Patients with baseline depression had significantly more preoperative back pain, greater BMI and Charlson Comorbidity Indices, higher ODIs, and lower SRS-22r and SF-36 Physical/Mental Component Summary (PCS/MCS) scores compared with those without self-reported baseline depression. They also had more severe regional and global sagittal malalignment. After adjusting for these differences, preoperative depression did not impact 2-year ODI, PCS/MCS, or SRS-22r totals (p > 0.05). Compared with those in the “normal” DRAM category, “distressed somatics” (n = 11) had higher ODI (+23.5 points), lower PCS (−10.9), SRS-22r activity (−0.9), and SRS-22r total (−0.8) scores (p ≤ 0.01), while “distressed depressives” (n = 25) had lower PCS (−8.4) and SRS-22r total (−0.5) scores (p < 0.05). After adjusting for important covariates, each additional point on the baseline MSPQ was associated with a 0.8-point increase in 2-year ODI (p = 0.03). The probability of improving by at least 1 MCID in 2-year ODI ranged from 77% to 21% for MSPQ scores 0–20, respectively.
CONCLUSIONS
A baseline clinical history of depression does not correlate with worse 2-year outcomes after ASD surgery after adjusting for baseline differences in comorbidities, health-related quality of life, and spinal deformity severity. Conversely, DRAM improved risk stratification of patient subgroups predisposed to achieving suboptimal surgical outcomes. The DRAM’s MSPQ was more predictive than MCS and SRS mental domain for 2-year outcomes and may be a valuable tool for surgical screening.
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Affiliation(s)
| | - Tamir Ailon
- 2Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Justin K. Scheer
- 3School of Medicine, University of California, San Diego School of Medicine, San Diego, California
| | - Justin S. Smith
- 2Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Christopher I. Shaffrey
- 2Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Shay Bess
- 4Department of Orthopaedic Surgery, Rocky Mountain Hospital for Children, Denver, Colorado
| | - Munish Gupta
- 5Department of Orthopedic Surgery, California, Davis, Sacramento, California
| | - Eric O. Klineberg
- 5Department of Orthopedic Surgery, California, Davis, Sacramento, California
| | - Khaled Kebaish
- 6Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Frank Schwab
- 7Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, New York
| | - Virginie Lafage
- 7Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, New York
| | - Douglas Burton
- 8Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas; and
| | - Robert Hart
- 9Department of Orthopedic Surgery, Oregon Health Sciences University, Portland, Oregon
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Harris BY, Roth MF, Diebo BG, Bess S, Theologis AA, Scheer JK, Schwab FJ, Lafage V, Ames CP, Hodes R, Ayamga J, Boachie-Adjei O. Investigating the Universality of Preoperative Health-Related Quality of Life (HRQoL) for Surgically Treated Spinal Deformity in Young Adults: A Propensity Score-Matched Comparison Between African and US Populations. Spine Deform 2016; 4:351-357. [PMID: 27927492 DOI: 10.1016/j.jspd.2016.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 02/11/2016] [Accepted: 03/21/2016] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN Retrospective analysis of propensity score-matched (PSM) observational cohorts. OBJECTIVES To evaluate and compare preoperative health-related quality of life (HRQoL) scores and radiographic measurements of young African and US adults with spinal deformity (ASD). SUMMARY OF BACKGROUND DATA Young ASD patients in the United States are motivated more to correct coronal and sagittal plane deformities than to alleviate pain. Motivations for surgical correction in young ASD patients in Africa have not been previously investigated. METHODS Retrospective review of two large databases of African and US patients with ASD. African patients who underwent ASD surgery were PSM by age, gender, and pelvic tilt with US patients. Preoperative radiographic parameters and HRQoL scores (ODI, SRS-22r, back/leg pain) were compared between cohorts. Pearson correlations used to evaluate relationships between radiographic parameters and HRQoL scores. RESULTS Fifty-four US patients (average age 22.9 ± 4.9 years; 0% African American) and 54 African patients (24.6 ± 7.2 years) met inclusion criteria. Compared to the United States, African patients had significantly lower body mass index (21.1 ± 3.3 vs. 24.6 ± 7.2) and more severe scoliosis, coronal malalignment, and sagittal malalignment (p < .05). Africans also had significantly better Oswestry Disability Index (12.8 vs. 17.7), worse Scoliosis Research Society questionnaire (SRS-22r)-Appearance (2.5 vs. 3.2), SRS-Function (3.3 vs. 3.9), and SRS-Total (3.2 vs. 3.5) scores than US patients (p < .05). SRS-Appearance scores correlated with Cobb angles of the upper thoracic (r = -0.321), thoracic (r = -0.277), and thoracolumbar (r = -0.300) curves for US patients. For African patients, global sagittal alignment and C7 inclination correlated with SRS-Appearance (r = -0.347, -0.346, respectively). CONCLUSIONS Young African ASD patients have significantly more severe deformity, less disability, and worse SRS-22r scores preoperatively than a matched cohort of US patients. Spinal deformity and associated poor self-image appear to be the major drivers of surgical intervention in this cohort. Global malalignment in African patients is most closely correlated with appearance scores and should be surgically addressed accordingly. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Bradley Y Harris
- Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, NY, USA
| | - Matthew F Roth
- School of Medicine, Wayne State University, 540 E Canfield St, Detroit, MI 48201, USA
| | - Bassel G Diebo
- Spine Service, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA
| | - Shay Bess
- Orthopaedic Surgery, Rocky Mountain Scoliosis and Spine, 2055 High St, Denver, CO 80205, USA
| | | | - Justin K Scheer
- Neurosurgery, University of California San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - Frank J Schwab
- Spine Service, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA
| | - Virginie Lafage
- Spine Service, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA.
| | - Christopher P Ames
- Neurosurgery, University of California San Francisco, San Francisco, CA, USA
| | - Richard Hodes
- American Jewish Joint Distribution Committee, New York, NY, USA
| | - Jennifer Ayamga
- Research, FOCOS Orthopedic Hospital, Teshie St, Pantang, Accra, Ghana
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- International Spine Study Group Foundation, 15480 Iola St, Brighton, CO 80602, USA
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Lau D, Chan AK, Theologis AA, Chou D, Mummaneni PV, Burch S, Berven S, Deviren V, Ames C. Costs and readmission rates for the resection of primary and metastatic spinal tumors: a comparative analysis of 181 patients. J Neurosurg Spine 2016; 25:366-78. [DOI: 10.3171/2016.2.spine15954] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE
Because the surgical strategies for primary and metastatic spinal tumors are different, the respective associated costs and morbidities associated with those treatments likely vary. This study compares the direct costs and 90-day readmission rates between the resection of extradural metastatic and primary spinal tumors. The factors associated with cost and readmission are identified.
METHODS
Adults (age 18 years or older) who underwent the resection of spinal tumors between 2008 and 2013 were included in the study. Patients with intradural tumors were excluded. The direct costs of index hospitalization and 90-day readmission hospitalization were evaluated. The direct costs were compared between patients who were treated surgically for primary and metastatic spinal tumors. The independent factors associated with costs and readmissions were identified using multivariate analysis.
RESULTS
A total of 181 patients with spinal tumors were included (63 primary and 118 metastatic tumors). Overall, the mean index hospital admission cost for the surgical management of spinal tumors was $52,083. There was no significant difference in the cost of hospitalization between primary ($55,801) and metastatic ($50,098) tumors (p = 0.426). The independent factors associated with higher cost were male sex (p = 0.032), preoperative inability to ambulate (p = 0.002), having more than 3 comorbidities (p = 0.037), undergoing corpectomy (p = 0.021), instrumentation greater than 7 levels (p < 0.001), combined anterior-posterior approach (p < 0.001), presence of a perioperative complication (p < 0.001), and longer hospital stay (p < 0.001). The perioperative complication rate was 21.0%. Of this cohort, 11.6% of patients were readmitted within 90 days, and the mean hospitalization cost of that readmission was $20,078. Readmission rates after surgical treatment for primary and metastatic tumors were similar (11.1% vs 11.9%, respectively) (p = 0.880). Prior hospital stay greater than 15 days (OR 6.62, p = 0.016) and diagnosis of lung metastasis (OR 52.99, p = 0.007) were independent predictors of readmission.
CONCLUSIONS
Primary and metastatic spinal tumors are comparable with regard to the direct costs of the index surgical hospitalization and readmission rate within 90 days. The factors independently associated with costs are related to preoperative health status, type and complexity of surgery, and postoperative course.
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Affiliation(s)
- Darryl Lau
- Departments of 1Neurological Surgery and
| | | | | | - Dean Chou
- Departments of 1Neurological Surgery and
| | | | - Shane Burch
- 2Orthopaedic Surgery, University of California, San Francisco, California
| | - Sigurd Berven
- 2Orthopaedic Surgery, University of California, San Francisco, California
| | - Vedat Deviren
- 2Orthopaedic Surgery, University of California, San Francisco, California
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Sing DC, Barry JJ, Aguilar TU, Theologis AA, Patterson JT, Tay BK, Vail TP, Hansen EN. Prior Lumbar Spinal Arthrodesis Increases Risk of Prosthetic-Related Complication in Total Hip Arthroplasty. J Arthroplasty 2016; 31:227-232.e1. [PMID: 27444852 DOI: 10.1016/j.arth.2016.02.069] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 01/28/2016] [Accepted: 02/09/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Degenerative hip disorders often coexist with degenerative changes of the lumbar spine. Limited data on this patient population suggest inferior functional improvement and pain relief after surgical management. The purpose of this study is to compare the rates of prosthetic-related complication after primary total hip arthroplasty (THA) in patients with and without prior lumbar spine arthrodesis (SA). METHODS Medicare patients (n = 811,601) undergoing primary THA were identified and grouped by length of prior SA (no fusion, 1-2 levels fused [S-SAHA], and ≥3 levels fused [L-SAHA]). RESULTS Compared with controls, patients with prior SA had significantly higher rates of complications including dislocation (control: 2.36%; S-SAHA: 4.26%; and L-SAHA: 7.51%), revision (control: 3.43%, S-SAHA: 5.55%, and L-SAHA: 7.77%), loosening (control: 1.33%, S-SAHA: 2.10%, and L-SAHA: 3.04%), and any prosthetic-related complication (control: 7.33%, S-SAHA: 11.15% [relative risk: 1.52], and L-SAHA: 14.16% [relative risk: 1.93]) within 24 months (P < .001). CONCLUSION The interplay of coexisting degenerative hip and spine disease deserves further attention of both arthroplasty and spine surgeons.
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Affiliation(s)
- David C Sing
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Jeffrey J Barry
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Thomas U Aguilar
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Alexander A Theologis
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Joseph T Patterson
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Bobby K Tay
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Thomas P Vail
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Erik N Hansen
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
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Theologis AA, Tabaraee E, Toogood P, Kennedy A, Birk H, McClellan RT, Pekmezci M. Anterior corpectomy via the mini-open, extreme lateral, transpsoas approach combined with short-segment posterior fixation for single-level traumatic lumbar burst fractures: analysis of health-related quality of life outcomes and patient satisfaction. J Neurosurg Spine 2015; 24:60-8. [PMID: 26431072 DOI: 10.3171/2015.4.spine14944] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [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
OBJECTIVE The authors present clinical outcome data and satisfaction of patients who underwent minimally invasive vertebral body corpectomy and cage placement via a mini-open, extreme lateral, transpsoas approach and posterior short-segment instrumentation for lumbar burst fractures. METHODS Patients with unstable lumbar burst fractures who underwent corpectomy and anterior column reconstruction via a mini-open, extreme lateral, transpsoas approach with short-segment posterior fixation were reviewed retrospectively. Demographic information, operative parameters, perioperative radiographic measurements, and complications were analyzed. Patient-reported outcome instruments (Oswestry Disability Index [ODI], 12-Item Short Form Health Survey [SF-12]) and an anterior scar-specific patient satisfaction questionnaire were recorded at the latest follow-up. RESULTS Twelve patients (7 men, 5 women, average age 42 years, range 22-68 years) met the inclusion criteria. Lumbar corpectomies with anterior column support were performed (L-1, n = 8; L-2, n = 2; L-3, n = 2) and supplemented with short-segment posterior instrumentation (4 open, 8 percutaneous). Four patients had preoperative neurological deficits, all of which improved after surgery. No new neurological complications were noted. The anterior incision on average was 6.4 cm (range 5-8 cm) in length, caused mild pain and disability, and was aesthetically acceptable to the large majority of patients. Three patients required chest tube placement for pleural violation, and 1 patient required reoperation for cage subsidence/hardware failure. Average clinical follow-up was 38 months (range 16-68 months), and average radiographic follow-up was 37 months (range 6-68 months). Preoperative lumbar lordosis and focal lordosis were significantly improved/maintained after surgery. Patients were satisfied with their outcomes, had minimal/moderate disability (average ODI score 20, range 0-52), and had good physical (SF-12 physical component score 41.7% ± 10.4%) and mental health outcomes (SF-12 mental component score 50.2% ± 11.6%) after surgery. CONCLUSIONS Anterior corpectomy and cage placement via a mini-open, extreme lateral, transpsoas approach supplemented by short-segment posterior instrumentation is a safe, effective alternative to conventional approaches in the treatment of single-level unstable burst fractures and is associated with excellent functional outcomes and patient satisfaction.
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Affiliation(s)
- Alexander A Theologis
- Department of Orthopaedic Surgery, University of California, San Francisco General Hospital, San Francisco, California
| | - Ehsan Tabaraee
- Department of Orthopaedic Surgery, University of California, San Francisco General Hospital, San Francisco, California
| | - Paul Toogood
- Department of Orthopaedic Surgery, University of California, San Francisco General Hospital, San Francisco, California
| | - Abbey Kennedy
- Department of Orthopaedic Surgery, University of California, San Francisco General Hospital, San Francisco, California
| | - Harjus Birk
- Department of Orthopaedic Surgery, University of California, San Francisco General Hospital, San Francisco, California
| | - R Trigg McClellan
- Department of Orthopaedic Surgery, University of California, San Francisco General Hospital, San Francisco, California
| | - Murat Pekmezci
- Department of Orthopaedic Surgery, University of California, San Francisco General Hospital, San Francisco, California
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Theologis AA, Tabaraee E, Lin T, Lubicky J, Diab M. Type of bone graft or substitute does not affect outcome of spine fusion with instrumentation for adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2015; 40:1345-51. [PMID: 26010036 DOI: 10.1097/brs.0000000000001002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [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] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort analysis. OBJECTIVE To compare clinical outcomes after spine instrumentation and fusion using 3 different bone grafts in children with adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA Autogenous iliac crest bone graft (AIC) is the "gold standard" to promote fusion in posterior AIS operations, although the morbidity of harvest is a concern. There is limited data comparing outcomes after AIS surgery based on types of bone grafts. METHODS Children (10-18 yr) with AIS who underwent deformity correction via a posterior approach were identified in the Spinal Deformity Study Group database. All had a minimum of 2-year follow-up. Patients were subdivided into 3 groups based on bone graft used: AIC, allograft, and bone substitute (BS). Clinical data included patient demographics, operative details, postoperative analgesic use, and perioperative complications. Lenke curve type and curve magnitude changes were radiographically analyzed. The Scoliosis Research Society-30 questionnaire was used to assess clinical outcomes. RESULTS 461 patients met inclusion criteria (girls: 381, boys: 80; average age 14.7 ± 1.7) and consisted of 152 AIC patients (124 girls, 28 boys), 199 allograft patients (167 girls, 32 boys), and 110 BS patients (90 girls, 20 boys). There was no difference in age (P = 0.41) or gender (P = 0.82). The BS group had significantly smaller preoperative curves and shorter operative times. Postoperatively, patients who received BS had significantly longer hospital stays, used higher quantities of patient-controlled intravenous analgesia and used epidurals longer. The AIC group used patient-controlled intravenous analgesia significantly longer. There were no differences between the groups in regards to curve type, number of levels fused, postoperative infections, pseudarthrosis, reoperations for any indication, and Scoliosis Research Society-30 scores at the latest follow-up. CONCLUSION Outcomes after primary posterior spinal fusion with instrumentation are not influenced by type of bone graft or substitute. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Alexander A Theologis
- *Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA; and †Department of Orthopaedic Surgery, West Virginia University, WV
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Theologis AA, Cahill P, Auriemma M, Betz R, Diab M. Vertebral body stapling in children with idiopathic scoliosis < 10 years old with curve magnitude 30-39 degrees. J Am Coll Surg 2013. [DOI: 10.1016/j.jamcollsurg.2013.07.159] [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: 10/26/2022]
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Theologis AA, Kwan M, Morshed S. Torn Flexor Digitorum Longus Tendon and Lacerated Posterior Tibial Artery Associated with an Open Hawkins Type-III Talar Neck Fracture: A Case Report. JBJS Case Connect 2012; 2:e76. [PMID: 29252372 DOI: 10.2106/jbjs.cc.l.00153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Alexander A Theologis
- Department of Orthopaedic Surgery, University of California-San Francisco (UCSF), UCSF/San Francisco General Hospital Orthopaedic Trauma Institute, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA 94110.
| | - Matthew Kwan
- Department of Plastic Surgery, University of California-San Francisco, 505 Parnassus Avenue, Moffitt M593, San Francisco, CA 94143
| | - Saam Morshed
- Department of Orthopaedic Surgery, University of California-San Francisco (UCSF), UCSF/San Francisco General Hospital Orthopaedic Trauma Institute, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA 94110.
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Theologis AA, Schairer WW, Carballido-Gamio J, Majumdar S, Li X, Ma CB. Longitudinal analysis of T1ρ and T2 quantitative MRI of knee cartilage laminar organization following microfracture surgery. Knee 2012; 19:652-7. [PMID: 22018879 PMCID: PMC3652011 DOI: 10.1016/j.knee.2011.09.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 08/18/2011] [Accepted: 09/12/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To quantitate longitudinally the radiographic properties of different layers of repaired tissue following microfracture (MFx) surgery using T(1ρ) and T(2) magnetic resonance imaging (MRI). DESIGN 10 patients underwent MFx surgery to treat symptomatic focal cartilage defects (FCD). Sagittal three-dimensional (3D) water excitation high-spatial resolution (HR) spoiled gradient recalled (SPGR) for quantitative T(1ρ) and T(2) mapping were acquired for each patient 3-6 months and 1 year after surgery. Cartilage compartments were segmented on HR-SPGR images, and T(1ρ) and T(2) maps were registered to the HR-SPGR images. T(1ρ) and T(2) values for the full thickness of deep and superficial layers of repaired tissue (RT) and normal cartilage (NC) were calculated, and compared within and between respective time points. A p-value <0.05 is considered statistically significant. RESULTS The majority of FCD were found in the MFC. The average surface area of the lesions did not differ significantly overtime. At 3-6 months, RT had significantly higher full thickness T(1ρ) and T(2) values relative to NC. At 1 year, this significant difference was only observed for T(1ρ) values. At 3-6 months follow-up, the RT's superficial layer had significantly higher T(1ρ) and T(2) values than the deep layer of the RT and the superficial layer of NC. At 12 months, the superficial layer of the RT had significantly higher T(1ρ) values than the RT's deep layer and the NC's superficial layer. CONCLUSION T(1ρ) and T(2) MRI are feasible methods for quantitatively and noninvasively monitoring the maturation of repaired tissue following microfracture surgery over time.
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Affiliation(s)
- Alexander A. Theologis
- School of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA,Musculoskeletal Quantitative Imaging Research, Department of Radiology, UCSF, San Francisco, CA, USA,Department of Orthopaedic Surgery, UCSF, San Francisco, CA, USA
| | - William W. Schairer
- School of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA,Musculoskeletal Quantitative Imaging Research, Department of Radiology, UCSF, San Francisco, CA, USA
| | - Julio Carballido-Gamio
- Musculoskeletal Quantitative Imaging Research, Department of Radiology, UCSF, San Francisco, CA, USA
| | - Sharmila Majumdar
- Musculoskeletal Quantitative Imaging Research, Department of Radiology, UCSF, San Francisco, CA, USA
| | - Xiaojuan Li
- Musculoskeletal Quantitative Imaging Research, Department of Radiology, UCSF, San Francisco, CA, USA
| | - C. Benjamin Ma
- Department of Orthopaedic Surgery, UCSF, San Francisco, CA, USA,Corresponding author at: University of California, San Francisco School of Medicine, Department of Orthopaedic Surgery, Mission Bay Ortho Institute, 1500 Owens Street, San Francisco, CA 94158. Tel.: +1 415 353 2808; fax: +1 415 885 9643. (C.B. Ma)
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Holtzman DJ, Theologis AA, Carballido-Gamio J, Majumdar S, Li X, Benjamin C. T(1ρ) and T(2) quantitative magnetic resonance imaging analysis of cartilage regeneration following microfracture and mosaicplasty cartilage resurfacing procedures. J Magn Reson Imaging 2011; 32:914-23. [PMID: 20882622 DOI: 10.1002/jmri.22300] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To examine T(1ρ) (T1rho) and T(2) quantitative magnetic resonance imaging (MRI) in evaluating cartilage regeneration following microfracture (MFx) and mosaicplasty (MOS) cartilage resurfacing procedures. MATERIALS AND METHODS Eighteen patients underwent MFx and eight patients underwent MOS to treat symptomatic focal cartilage defects. Quantitative T(1ρ) and T(2) maps were acquired at 3-6 months and 1 year after surgery. The area of resurfacing was identified, and T(1ρ) and T(2) values for the regenerated tissue (RT) and normal cartilage (NC) were acquired. RT/NC ratios were calculated to standardize absolute T(1ρ) and T(2) values. Data were prospective, cross-sectional, and nonrandomized. RESULTS T(1ρ) and T(2) showed good reanalysis reproducibility for RT and NC. Significant differences between RT and NC were present following MFx at 3-6 months for T(1ρ) and T(2) values as well as following MOS at 3-6 months and 1 year for T(1ρ) values. Following MFx, the T(2) RT/NC ratio was significantly different between 3-6 months and 1 year (P = 0.02), while the T(1ρ) RT/NC ratio approached significance (P = 0.07). Following MOS, the T(1ρ) and T(2) RT/NC ratios were not significantly different between the two timepoints. CONCLUSION T(1ρ) and T(2) MRI are complementary and reproducible methods for quantitatively and noninvasively monitoring regeneration of RT following MFx and MOS.
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Affiliation(s)
- Daniel J Holtzman
- School of Medicine, University of California, San Francisco (UCSF), San Francisco, California 94158, USA
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Theologis AA, Kuo D, Cheng J, Bolbos RI, Carballido-Gamio J, Ma CB, Li X. Evaluation of bone bruises and associated cartilage in anterior cruciate ligament-injured and -reconstructed knees using quantitative t(1ρ) magnetic resonance imaging: 1-year cohort study. Arthroscopy 2011; 27:65-76. [PMID: 21035995 PMCID: PMC3011041 DOI: 10.1016/j.arthro.2010.06.026] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2009] [Revised: 04/19/2010] [Accepted: 06/28/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE To quantitate bone marrow edema-like lesions (BMELs) and the radiologic properties of cartilage in knees with acute anterior cruciate ligament (ACL) injuries using T(1ρ) magnetic resonance imaging over a 1-year period. METHODS Nine patients with ACL injuries were studied. Magnetic resonance imaging scans were acquired within 8 weeks of the injury, after which ACL reconstruction surgery was performed. Images were then acquired 0.5, 6, and 12 months after reconstructions. The volume and signal intensity of BMELs were quantified at baseline and follow-up examinations. T(1ρ) values were quantified in cartilage overlying the BMEL (OC) and compared with surrounding cartilage at all time points. RESULTS BMELs were most commonly found in the lateral tibia and lateral femoral condyle. Nearly 50% of BMELs resolved over a 1-year period. The T(1ρ) values of the OC in the lateral tibia, medial tibia, and medial femoral condyle were elevated compared with respective regions in surrounding cartilage at all time points; the difference was significant only in the lateral tibia (P < .05). The opposite results were found in the lateral femoral condyle. For the medial tibia and medial femoral condyle, none of the time periods was significantly different. The percent increase in T(1ρ) values of OC in the lateral tibia was significantly correlated with BMEL volume (r = 0.74, P < .05). At 1 year, the OC in the lateral tibia, medial tibia, and medial femoral condyle showed increased T(1ρ) values despite improvement of BMEL. CONCLUSIONS In patients after ACL tear and reconstruction, (1) the cartilage overlying BMEL in the lateral tibia experiences persistent T(1ρ) signal changes immediately after acute injuries and at 1-year follow-up despite BMEL improvement, (2) the superficial layers of the overlying cartilage show greater matrix damage than the deep layers, and (3) the volume of the BMEL may predict the severity of the overlying matrix's damage in the lateral tibia. T(1ρ) is capable of quantitatively and noninvasively monitoring this damage and detecting early cartilage changes in the lateral tibia over time. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Alexander A. Theologis
- School of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA,Musculoskeletal Quantitative Imaging Research, Department of Radiology, UCSF, San Francisco, CA, USA
| | - Daniel Kuo
- Musculoskeletal Quantitative Imaging Research, Department of Radiology, UCSF, San Francisco, CA, USA
| | - Jonathan Cheng
- Musculoskeletal Quantitative Imaging Research, Department of Radiology, UCSF, San Francisco, CA, USA
| | - Radu I. Bolbos
- Musculoskeletal Quantitative Imaging Research, Department of Radiology, UCSF, San Francisco, CA, USA
| | - Julio Carballido-Gamio
- Musculoskeletal Quantitative Imaging Research, Department of Radiology, UCSF, San Francisco, CA, USA
| | - C. Benjamin Ma
- Department of Orthopaedic Surgery, UCSF, San Francisco, CA, USA
| | - Xiaojuan Li
- Musculoskeletal Quantitative Imaging Research, Department of Radiology, UCSF, San Francisco, CA, USA,Corresponding Author Contact Information: Xiaojuan Li, Ph.D University of California, San Francisco School of Medicine Department of Radiology China Basin Landing, 185 Berry Street, Suite 350 San Francisco, CA 94107 Phone: (415) 353-4909 Fax: (415) 353-3438
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