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von Glinski A, Pierre C, Elia C, Ishak B, Godolias P, Blecher R, Detorri JR, Norvell D, Jouppi L, Gerstmeyer J, Deem SA, Golden JB, Schildhauer TA, Oskouian RJ, Chapman JR. The PAC (Post-operative Airway Compromise) score - First steps to Develop a Post-Surgery Tool for the Assessment of Upper Airway-related Complications following Anterior Cervical Spine Surgery. World Neurosurg 2024:S1878-8750(24)00730-7. [PMID: 38692566 DOI: 10.1016/j.wneu.2024.04.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Acute upper airway compromise is a rare but catastrophic complication after anterior cervical discectomy and fusion (ACDF). This study aims to develop a score to identify patients at risk for acute postoperative airway compromise (PAC). METHODS Potential risk factors for acute PAC were selected by a modified Delphi process. Ten patients with acute PAC were identified out of 1,466 patients who underwent elective ACDF between July 2014 - May 2019. A comparison group was created by a randomized selection process (non-PAC group). Associated factors with PAC and a p-value <.10 were entered into a logistic regression model and coefficients contributed each risk factor's overall score. Calibration of the model was evaluated by Hosmer-Lemeshow (H-L) goodness-of-fit test. Quantitative discrimination was calculated and the final model was internally validated with bootstrap sampling. RESULTS We identified 18 potential risk factors from our Delphi process, of which 6 factors demonstrated a significant association with airway compromise: age >65 years, current smoking status, ASA >2, history of a bleeding disorder, surgery of upper subaxial cervical spine (>C4), and duration of surgery >179 min. The final prediction model included five predictors with very strong performance characteristics. These five factors formed the PAC-Score (PACS) which had a range from 0 to 100. A score of 20 yielded the greatest balance of sensitivity (80%) and specificity (88%). CONCLUSIONS The acute Postoperative Airway Compromise Score (PACS) demonstrates strong performance characteristics. The PAC score may help identify patients at risk for upper airway compromise caused by surgical site abnormalities.
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Affiliation(s)
- Alexander von Glinski
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, United States; Seattle Science Foundation, Seattle, Washington, United States; Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany; Hansjörg Wyss Hip and Pelvic Center, Swedish Hospital, Seattle, Washington, United States; Katholisches Klinikum St. Josef, Orthopedic university hospital Bochum, Bochum, Germany
| | - Clifford Pierre
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, United States; Seattle Science Foundation, Seattle, Washington, United States.
| | - Christopher Elia
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, United States; Seattle Science Foundation, Seattle, Washington, United States; Department of Neurosurgery, Riverside University Health Systems, Moreno Valley, California, United States
| | - Basem Ishak
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, United States; Seattle Science Foundation, Seattle, Washington, United States
| | - Periklis Godolias
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, United States; Seattle Science Foundation, Seattle, Washington, United States; Department of Orthopedics and Trauma Surgery, St. Josef Hospital Essen-Werden, Propsteistrasse 2, 45239 Essen, Germany
| | - Ronen Blecher
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, United States; Seattle Science Foundation, Seattle, Washington, United States
| | - Joseph R Detorri
- Department of Neurosurgery, Riverside University Health Systems, Moreno Valley, California, United States
| | - Daniel Norvell
- Department of Neurosurgery, Riverside University Health Systems, Moreno Valley, California, United States
| | - Luke Jouppi
- Seattle Science Foundation, Seattle, Washington, United States
| | - Julius Gerstmeyer
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, United States; Seattle Science Foundation, Seattle, Washington, United States; Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | | | - J Blake Golden
- Neurocritical Care, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, United States
| | - Thomas A Schildhauer
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Rod J Oskouian
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, United States; Seattle Science Foundation, Seattle, Washington, United States
| | - Jens R Chapman
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, United States; Seattle Science Foundation, Seattle, Washington, United States
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Lewik G, Lewik G, Müller LS, von Glinski A, Schulte TL, Lange T. Postoperative Epidural Fibrosis: Challenges and Opportunities - A Review. Spine Surg Relat Res 2024; 8:133-142. [PMID: 38618214 PMCID: PMC11007250 DOI: 10.22603/ssrr.2023-0106] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 07/30/2023] [Indexed: 04/16/2024] Open
Abstract
Postoperative epidural fibrosis (EF) is still a major limitation to the success of spine surgery. Fibrotic adhesions in the epidural space, initiated via local trauma and inflammation, can induce difficult-to-treat pain and constitute the main cause of failed back surgery syndrome, which not uncommonly requires operative revision. Manifold agents and methods have been tested for EF relief in order to mitigate this longstanding health burden and its socioeconomic consequences. Although several promising strategies could be identified, few have thus far overcome the high translational hurdle, and there has been little change in standard clinical practice. Nonetheless, notable research progress in the field has put new exciting avenues on the horizon. In this review, we outline the etiology and pathogenesis of EF, portray its clinical and surgical presentation, and critically appraise current efforts and novel approaches toward enhanced prevention and treatment.
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Affiliation(s)
- Guido Lewik
- Department of Orthopedics and Trauma Surgery, Katholisches Klinikum Bochum - St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Gerrit Lewik
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Lena S Müller
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Alexander von Glinski
- Department of Orthopedics and Trauma Surgery, Katholisches Klinikum Bochum - St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Tobias L Schulte
- Department of Orthopedics and Trauma Surgery, Katholisches Klinikum Bochum - St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Tobias Lange
- Department of Orthopedics and Trauma Surgery, Katholisches Klinikum Bochum - St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
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Ishak B, Pulido JN, von Glinski A, Ansari D, Oskouian RJ, Chapman JR. Vasoplegia Following Complex Spine Surgery: Incidence and Risk. Global Spine J 2024; 14:400-406. [PMID: 35634908 PMCID: PMC10802555 DOI: 10.1177/21925682221105823] [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] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES Vasoplegia is a life-threatening form of distributive or vasodilatory shock that is characterized by reduced systemic vascular resistance with resultant hypotension and normal to elevated cardiac output affecting morbidity and mortality. Vasoplegia in the context of Spine Surgery has not been described previously. The purpose of this case series is to determine incidence, risk factors, complications and postoperative outcome in patients with vasoplegia after complex multi-level thoraco-lumbar spine surgery. METHODS A retrospective review of the electronic medical records at our institution was conducted between January 2014 and June 2018. All patients undergoing multi-level spine surgery (>6 levels) were screened for intraoperative hypotension. Patient demographics, surgical characteristics, neurological status, blood loss, risk factors, medical treatment, complications, hospital course and mortality were collected. All patients included in this study had a minimum follow-up period of 3 months. RESULTS Out of 8521 surgically treated patients, 994 patients with multi-level thoraco-lumbar spine surgery were identified. A total of 41 patients had intraoperative hypotensive events. Of those, 5 patients with vasoplegia could be identified after elimination of all other potential contributing factors. Vasoplegia did not influence the neurological outcome. One major and three minor complications occurred. All patients showed full recovery. The risk factors identified for vasoplegia include prolonged surgery with osteotomies. CONCLUSIONS Vasoplegia is a rare condition with an incidence of .6%. Patients experiencing vasoplegia did not appear to experience worse surgical outcomes. The use of special intraoperative hemodynamic monitoring should be considered in selected cases.
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Affiliation(s)
- Basem Ishak
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
| | - Juan N Pulido
- Swedish Medical Center, Cardiothoracic Anesthesiology and Critical Care Medicine, Seattle, WA, USA
| | - Alexander von Glinski
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
- BG University Hospital Bergmannsheil, Ruhr University, Bochum, Germany
| | - Darius Ansari
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
| | - Rod J Oskouian
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
| | - Jens R Chapman
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
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Pluemer J, Freyvert Y, Pratt N, Robinson JE, Cooke JA, Tataryn ZL, Pierre CA, Godolias P, Frieler S, von Glinski A, Yilmaz E, Daher ZA, Al-Awadi HA, Young MH, Oskouian RJ, Chapman JR. A novel scoring system concept for de novo spinal infection treatment, the Spinal Infection Treatment Evaluation Score (SITE Score): a proof-of-concept study. J Neurosurg Spine 2023; 38:396-404. [PMID: 36681973 DOI: 10.3171/2022.11.spine22719] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 11/02/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE De novo infections of the spine are an increasing healthcare problem. The decision for nonsurgical or surgical treatment is often made case by case on the basis of physician experience, specialty, or practice affiliation rather than evidence-based medicine. To create a more systematic foundation for surgical assessments of de novo spinal infections, the authors applied a formal validation process toward developing a spinal infection scoring system using principles gained from other spine severity scoring systems like the Spine Instability Neoplastic Score, Thoracolumbar Injury Classification and Severity Score, and AO Spine classification of thoracolumbar injuries. They utilized an expert panel and literature reviews to develop a severity scale called the "Spinal Infection Treatment Evaluation Score" (SITE Score). METHODS The authors conducted an evidence-based process of combining literature reviews, extracting key elements from previous scoring systems, and obtaining iterative expert panel input while following a formal Delphi process. The resulting basic SITE scoring system was tested on selected de novo spinal infection cases and serially refined by an international multidisciplinary expert panel. Intra- and interobserver reliabilities were calculated using the intraclass correlation coefficient (ICC) and Fleiss' and Cohen's kappa, respectively. A receiver operating characteristic analysis was performed for cutoff value analysis. The predictive validity was assessed through cross-tabulation analysis. RESULTS The conceptual SITE scoring system combines the key variables of neurological symptoms, infection location, radiological variables for instability and impingement of neural elements, pain, and patient comorbidities. Ten patients formed the first cohort of de novo spinal infections, which was used to validate the conceptual scoring system. A second cohort of 30 patients with de novo spinal infections, including the 10 patients from the first cohort, was utilized to validate the SITE Score. Mean scores of 6.73 ± 1.5 and 6.90 ± 3.61 were found in the first and second cohorts, respectively. The ICCs for the total score were 0.989 (95% CI 0.975-0.997, p < 0.01) in the first round of scoring system validation, 0.992 (95% CI 0.981-0.998, p < 0.01) in the second round, and 0.961 (95% CI 0.929-0.980, p < 0.01) in the third round. The mean intraobserver reliability was 0.851 ± 0.089 in the third validation round. The SITE Score yielded a sensitivity of 97.77% ± 3.87% and a specificity of 95.53% ± 3.87% in the last validation round for the panel treatment decision. CONCLUSIONS The SITE scoring concept showed statistically meaningful reliability parameters. Hopefully, this effort will provide a foundation for a future evidence-based decision aid for treating de novo spinal infections. The SITE Score showed promising inter- and intraobserver reliability. It could serve as a helpful tool to guide physicians' therapeutic decisions in managing de novo spinal infections and help in comparison studies to better understand disease severity and outcomes.
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Affiliation(s)
- Jonathan Pluemer
- 1Swedish Neuroscience Institute, Swedish Medical Center, Seattle
- 2Seattle Science Foundation, Seattle, Washington; and
- 3Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Germany
| | - Yevgeniy Freyvert
- 1Swedish Neuroscience Institute, Swedish Medical Center, Seattle
- 2Seattle Science Foundation, Seattle, Washington; and
| | - Nathan Pratt
- 1Swedish Neuroscience Institute, Swedish Medical Center, Seattle
- 2Seattle Science Foundation, Seattle, Washington; and
| | - Jerry E Robinson
- 1Swedish Neuroscience Institute, Swedish Medical Center, Seattle
- 2Seattle Science Foundation, Seattle, Washington; and
| | - Jared A Cooke
- 1Swedish Neuroscience Institute, Swedish Medical Center, Seattle
- 2Seattle Science Foundation, Seattle, Washington; and
| | - Zachary L Tataryn
- 1Swedish Neuroscience Institute, Swedish Medical Center, Seattle
- 2Seattle Science Foundation, Seattle, Washington; and
| | - Clifford A Pierre
- 1Swedish Neuroscience Institute, Swedish Medical Center, Seattle
- 2Seattle Science Foundation, Seattle, Washington; and
| | - Periklis Godolias
- 1Swedish Neuroscience Institute, Swedish Medical Center, Seattle
- 2Seattle Science Foundation, Seattle, Washington; and
| | - Sven Frieler
- 1Swedish Neuroscience Institute, Swedish Medical Center, Seattle
- 2Seattle Science Foundation, Seattle, Washington; and
- 3Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Germany
| | - Alexander von Glinski
- 1Swedish Neuroscience Institute, Swedish Medical Center, Seattle
- 2Seattle Science Foundation, Seattle, Washington; and
- 3Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Germany
| | - Emre Yilmaz
- 1Swedish Neuroscience Institute, Swedish Medical Center, Seattle
- 2Seattle Science Foundation, Seattle, Washington; and
- 3Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Germany
| | - Zeyad A Daher
- 2Seattle Science Foundation, Seattle, Washington; and
| | | | | | - Rod J Oskouian
- 1Swedish Neuroscience Institute, Swedish Medical Center, Seattle
- 2Seattle Science Foundation, Seattle, Washington; and
| | - Jens R Chapman
- 1Swedish Neuroscience Institute, Swedish Medical Center, Seattle
- 2Seattle Science Foundation, Seattle, Washington; and
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Ishak B, Abdul-Jabbar A, von Glinski A, Yilmaz E, Unterberg AW, Hopkins S, Roh J, Oskouian R, Hart R, Chapman JR. Comparing Combined Anterior and Posterior to Posterior-Only Decompression and Fusion Crossing the Cervico-Thoracic Junction in Octogenarians. Global Spine J 2023; 13:164-171. [PMID: 33715487 PMCID: PMC9837525 DOI: 10.1177/2192568221994793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The purpose of the study was to compare early complication, morbidity and mortality risks associated with fusion surgery crossing the cervico-thoracic junction in patients aged over 80 years undergoing combined anterior and posterior approach versus a posterior-only approach. METHODS We retrospectively identified octogenarian patients with myelopathy who underwent fusion crossing the cervico-thoracic junction. Patient demographics, Nurick score, surgical characteristics, complications, hospital course, early outcome and 90-day mortality were collected. Comorbidities were classified using the age-adjusted Charlson Comorbidity Index (AACCI). Radiographic measurements for deformity correction included the C2-C7 sagittal Cobb angle, C2-7 sagittal vertical axis and T1 slope pre- and postoperatively. RESULTS Out of 8,521 surgically treated patients, 12 octogenarian patients had a combined anterior and posterior approach (AP group) and 14 were treated from posterior-only (P group). Mean age was 81.4 ± 1.2 and 82.5 ± 2.7 years, respectively. There was no significant difference in Nurick scores between the groups (P > 0.05). The major complication risk in the AP group was significantly higher, requiring PEG tube placement due to severe dysphagia in 4 patients (33%) compared to none in the P group. A greater improvement in cervical lordosis could be achieved through a combined approach. The 90-day mortality risk was 8% for the AP group and 0% for the P group. CONCLUSIONS A combined anterior and posterior approach is associated with a significantly higher major complication rate and can result in severe dysphagia requiring PEG tube placement in one-third of patients over 80 years of age.
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Affiliation(s)
- Basem Ishak
- Swedish Neuroscience Institute, Seattle,
WA, USA,Department of Neurosurgery, Heidelberg
University Hospital, Heidelberg, Germany,Basem Ishak, University of Heidelberg,
Department of Neurosurgery, Im Neuenheimer Feld 400, 69120 Heidelberg. Germany.
| | | | - Alexander von Glinski
- Swedish Neuroscience Institute, Seattle,
WA, USA,Department of Trauma Surgery, BG
University Hospital Bochum, Bochum, Germany
| | - Emre Yilmaz
- Swedish Neuroscience Institute, Seattle,
WA, USA,Department of Trauma Surgery, BG
University Hospital Bochum, Bochum, Germany
| | | | | | - Jeffrey Roh
- Swedish Neuroscience Institute, Seattle,
WA, USA
| | - Rod Oskouian
- Swedish Neuroscience Institute, Seattle,
WA, USA
| | - Robert Hart
- Swedish Neuroscience Institute, Seattle,
WA, USA
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Mrotzek SJ, Ahmadi S, von Glinski A, Brinkemper A, Aach M, Schildhauer TA, Cibura C. Rehabilitation during early postoperative period following total knee arthroplasty using single-joint hybrid assistive limb as new therapy device: a randomized, controlled clinical pilot study. Arch Orthop Trauma Surg 2022; 142:3941-3947. [PMID: 34783882 PMCID: PMC9596552 DOI: 10.1007/s00402-021-04245-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 10/31/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The first weeks after total knee arthroplasty (TKA) are crucial for the functional outcome. To improve knee mobility, a continuous passive motion (CPM) motor rail is commonly used during in-hospital rehabilitation. The single-joint hybrid assistive limb (HAL-SJ) is a new therapy device. The aim of the study was to improve patients' range of motion (ROM), mobility, and satisfaction using the active-assistive support of the HAL-SJ. MATERIALS AND METHODS Between 09/2017 and 10/2020, 34 patients, who underwent TKA and matched the inclusion criteria, were randomized into study (HAL-SJ) and control (CPM) group. Treatment began after drain removal and was carried out until discharge. Primary outcome parameters were raised pre- and postoperatively and included the Oxford knee score (OKS), visual analog scale (VAS), and acquired range of motion. Furthermore complications caused by the device were recorded. RESULTS OKS increased in both groups postoperatively, but only significantly in the HAL-SJ group. Postoperative pain improved in both groups without significant differences. Flexion improvement was significant in both groups between days 3/7 and 8 weeks postoperatively. We did not encounter any complications related to HAL-SJ. CONCLUSIONS In conclusion, use of the HAL-SJ during rehabilitation in the early postoperative period after TKA was safe without disadvantages compared to the control group and seems to have advantages in terms of daily life impairment.
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Affiliation(s)
- Silvia J Mrotzek
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil Bochum, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
| | - Shahir Ahmadi
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil Bochum, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Alexander von Glinski
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil Bochum, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Alexis Brinkemper
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil Bochum, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Mirko Aach
- Department of Spinal Cord Injuries, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Thomas A Schildhauer
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil Bochum, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Charlotte Cibura
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil Bochum, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
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Rövekamp M, von Glinski A, Volkenstein S, Dazert S, Sengstock C, Schildhauer TA, Breisch M. Olfactory Stem Cells for the Treatment of Spinal Cord Injury - a new pathway to the cure? World Neurosurg 2022; 161:e408-e416. [PMID: 35149247 DOI: 10.1016/j.wneu.2022.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/03/2022] [Accepted: 02/03/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Since full functional recovery after spinal cord injuries (SCI) remains a major challenge, stem cell therapies represent promising strategies to improve neurological functions after SCI. The olfactory mucosa (OM) displays an attractive source of multipotent cells for regenerative approaches and is easily accessible by biopsies due to its exposed location. The regenerative capacity of the resident olfactory stem cells (OSC) has been demonstrated in animal as well as clinical studies. This study aims to demonstrate the feasibility of isolation, purification and cultivation of OSC. METHODS OM specimens were taken dorso-posterior from nasal middle turbinate. OSC were isolated and purified using the neurosphere assay. Differentiation capacity of the OSC in neural lineage and their behavior in a plasma clot matrix were investigated. RESULTS Our study demonstrated that OSC differentiated into neural lineage and were positive for GFAP as well as β-III tubulin. Furthermore, OSC were viable and proliferated in a plasma clot matrix. CONCLUSION Since there are no standard methods for purification, characterization, and delivery of OSC to the injury site, which is a prerequisite for the clinical approval, this study focuses on the establishment of appropriate methods and underlies the high potential of the OM for autologous cell therapeutical approaches.
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Affiliation(s)
- Markus Rövekamp
- Surgical Research, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp Platz 1, 44789 Bochum, Germany.
| | - Alexander von Glinski
- Deparment of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp Platz 1, 44789 Bochum, Germany
| | - Stefan Volkenstein
- Department of Otorhinolaryngology, Head- and Neck Surgery/ St. Elisabeth-Hospital, Ruhr University Bochum, Bleichstraße 15, 44787 Bochum, Germany
| | - Stefan Dazert
- Department of Otorhinolaryngology, Head- and Neck Surgery/ St. Elisabeth-Hospital, Ruhr University Bochum, Bleichstraße 15, 44787 Bochum, Germany
| | - Christina Sengstock
- Leibniz-Institut für Analytische Wissenschaften -ISAS- e.V., Bunsen-Kirchhoff-Straße 11, 44139 Dortmund, Germany
| | - Thomas Armin Schildhauer
- Deparment of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp Platz 1, 44789 Bochum, Germany
| | - Marina Breisch
- Surgical Research, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp Platz 1, 44789 Bochum, Germany
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8
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von Glinski A, Elia CJ, Wiginton JG, Ansari D, Pierre C, Ishak B, Yilmaz E, Blecher R, Dettori JR, Hayman E, Schildhauer TA, Oskouian RJ, Chapman JR. Iliac Screw Fixation Revisited: Improved Clinical and Radiologic Outcomes Using a Modified Iliac Screw Fixation Technique. Clin Spine Surg 2022; 35:E127-E131. [PMID: 33901033 DOI: 10.1097/bsd.0000000000001182] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 02/24/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE To describe the modified iliac screw (mILS) technique and compare it to other spinopelvic fixation techniques in terms of wound healing complications, hardware prominence, and failure. SUMMARY OF BACKGROUND DATA The traditional entry point of an iliac screw often causes postoperative gluteal pain from the prominent screw head. The use of an offset connector also adds a point of weakness to the construct. By choosing a different screw entry point offset connectors can be avoided, and the screw head itself is less prominent, thereby reducing postoperative discomfort. MATERIALS AND METHODS A retrospective analysis was performed of adult patients undergoing lumbopelvic fixation (LPF) between January 2014 and June 2019. Patients were grouped into 1 of 3 groups based on the technique of pelvic fixation: S2 alar-iliac (S2AI) screw, traditional iliac screw (tILS), and mILS. The primary outcome parameter was the minimal distance from screw head to skin. Secondary outcome parameters were instrumentation loosening/failure, adjacent level fractures, pseudoarthrosis, and medial or lateral iliac screw perforation. RESULTS A total of 190 patients undergoing LPF were included in the following 3 groups: mILS group (n=113), tILS group (n=40), and S2AI group (n=37). The mean minimal distance from screw head to skin in the mILS group was 31.3 mm compared with 23.7 mm in the tILS group (P<0.00199). No statistically significant differences were found when comparing the 3 groups with respect to complications. The mILS group did not show any cases of prominent instrumentation and had the lowest rate of instrumentation failure. CONCLUSIONS The mILS technique is an acceptable alternative for LPF, offering the benefits of iliac screw fixation while avoiding offset connectors and screw prominence complications associated with tILS. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Alexander von Glinski
- Swedish Neuroscience Institute, Swedish Medical Center
- Seattle Science Foundation, Seattle, WA
- Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
- Hansjörg Wyss Hip and Pelvic Center, Swedish Hospital, Seattle, WA
| | - Christopher J Elia
- Swedish Neuroscience Institute, Swedish Medical Center
- Seattle Science Foundation, Seattle, WA
- Riverside University Health System Medical Center, Moreno Valley, CA
| | - James G Wiginton
- Riverside University Health System Medical Center, Moreno Valley, CA
| | - Darius Ansari
- Swedish Neuroscience Institute, Swedish Medical Center
- Seattle Science Foundation, Seattle, WA
| | - Clifford Pierre
- Swedish Neuroscience Institute, Swedish Medical Center
- Seattle Science Foundation, Seattle, WA
| | - Basem Ishak
- Swedish Neuroscience Institute, Swedish Medical Center
- Seattle Science Foundation, Seattle, WA
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Emre Yilmaz
- Swedish Neuroscience Institute, Swedish Medical Center
- Seattle Science Foundation, Seattle, WA
| | - Ronen Blecher
- Swedish Neuroscience Institute, Swedish Medical Center
- Seattle Science Foundation, Seattle, WA
| | | | - Erik Hayman
- Swedish Neuroscience Institute, Swedish Medical Center
- Seattle Science Foundation, Seattle, WA
| | - Thomas A Schildhauer
- Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Rod J Oskouian
- Swedish Neuroscience Institute, Swedish Medical Center
- Seattle Science Foundation, Seattle, WA
| | - Jens R Chapman
- Swedish Neuroscience Institute, Swedish Medical Center
- Seattle Science Foundation, Seattle, WA
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9
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Ishak B, Pierre CA, Ansari D, Lachkar S, von Glinski A, Unterberg AW, Oskouian RJ, Chapman JR. A novel anatomo-physiologic high-grade spondylolisthesis model to evaluate L5 nerve stretch injury after spondylolisthesis reduction. Neurosurg Rev 2021; 45:1741-1746. [PMID: 34964070 PMCID: PMC8976797 DOI: 10.1007/s10143-021-01721-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/15/2021] [Accepted: 12/15/2021] [Indexed: 11/29/2022]
Abstract
L5 nerve palsy is a well-known complication following reduction of high-grade spondylolisthesis. While several mechanisms for its occurrence have been proposed, the hypothesis of L5 nerve root strain or displacement secondary to mechanical reduction remains poorly studied. The aim of this cadaveric study is to determine changes in morphologic parameters of the L5 nerve root during simulated intraoperative reduction of high-grade spondylolisthesis. A standard posterior approach to the lumbosacral junction was performed in eight fresh-frozen cadavers with lumbosacral or lumbopelvic screw fixation. Wide decompressions of the spinal canal and L5 nerve roots with complete facetectomies were accomplished with full exposure of the L5 nerve roots. A 100% translational slip was provoked by release of the iliolumbar ligaments and cutting the disc with the attached anterior longitudinal ligament. To evaluate the path of the L5 nerves during reduction maneuvers, metal bars were inserted bilaterally at the inferomedial aspects of the L5 pedicle at a distance of 10 mm from the midpoint of the L5 pedicle screws. There was no measurable change in length of the L5 nerve roots after 50% and 100% reduction of spondylolisthesis. Mechanical strain or displacement during reduction is an unlikely cause of L5 nerve root injury. Further anatomical or physiological studies are necessary to explore alternative mechanisms of L5 nerve palsy in the setting of high-grade spondylolisthesis correction, and surgeons should favor extensive surgical decompression of the L5 nerve roots when feasible.
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Affiliation(s)
- Basem Ishak
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. .,Seattle Science Foundation, Seattle, WA, USA. .,Swedish Neuroscience Institute, Seattle, USA.
| | | | | | | | - Alexander von Glinski
- Seattle Science Foundation, Seattle, WA, USA.,Swedish Neuroscience Institute, Seattle, USA.,Department of Trauma Surgery, BG University Hospital Bochum, Bochum, Germany
| | - Andreas W Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Rod J Oskouian
- Seattle Science Foundation, Seattle, WA, USA.,Swedish Neuroscience Institute, Seattle, USA
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10
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Brinkemper A, von Glinski A, Schildhauer TA. Influence of an on-body lifting aid (HAL® for Care Support) on kinematics during repetitive lifting in healthy men. J Clin Neurosci 2021; 93:23-30. [PMID: 34656253 DOI: 10.1016/j.jocn.2021.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 07/15/2021] [Accepted: 08/18/2021] [Indexed: 10/20/2022]
Abstract
Work-related lower back pain (LBP) leads to socio-economic burden and demands solutions. The hybrid assistive limb (HAL) for Care Support (Cyberdyne Inc., Ibaraki, Japan) is an active on-body lifting aid to assist joint motion according to the wearer's voluntary motor drive to reduce the lumbar load. A few studies investigated HAL and stated efficacy in terms of enhanced performance and reduced fatigue, yet the question remained if the use of HAL may result in a different execution of movement, for example by influencing the kinematics of the lower extremities. The aim of this study was to determine the influence of HAL on kinematics of the lower limbs and the spinal column during repetitive freestyle symmetrical lifting. Kinematic data was recorded by an inertial measurement unit sensor system in 11 healthy men lifting and lowering a 19.5 kg barbell under three conditions (no HAL, HAL Level 3/5, HAL Level 5/5). Outcome parameters were maximum and minimum angles as well as range of motion (ROM) of thoracic spine, lumbar spine, hip- and knee joint in sagittal plane. We found a significantly decreased ROM of the lumbar spine as well as a significantly reduced maximum and minimum thorax extension when starting lifting and in upright position after lifting, respectively, while using HAL. Influence of HAL on the kinematics of the lower limbs was not significant. Differences between both evaluated HAL conditions were not significant. This study proved limited lumbar spine ROM and reduced thorax extension without alterations of lower limbs kinematics when using HAL. This might potentially decrease the risk of work-related LBP.
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Affiliation(s)
- Alexis Brinkemper
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany.
| | - Alexander von Glinski
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Thomas Armin Schildhauer
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
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11
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Ishak B, Frieler S, Rustagi T, von Glinski A, Blecher R, Norvell DC, Unterberg A, Strot S, Roh J, Hart RA, Oskouian R, Chapman JR. Rates of early complications and mortality in patients older than 80 years of age after surgical treatment of acute traumatic spinal fractures: ankylosing spondylitis versus osteoporosis. Neurosurg Focus 2021; 51:E4. [PMID: 34598129 DOI: 10.3171/2021.7.focus21150] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/13/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this retrospective cohort study was to analyze the early complications and mortality associated with multilevel spine surgery for unstable fractures in patients older than 80 years of age with ankylosing spondylitis and to compare the results with an age- and sex-matched cohort of patients with unstable osteoporotic fractures. METHODS A retrospective review of the electronic medical records at a single institution was conducted between January 2014 and December 2019. Patient demographics, surgical characteristics, complications, hospital course, and 90-day mortality were collected. Comorbidities were stratified using the age-adjusted Charlson Comorbidity Index (CCI). RESULTS Among 11,361 surgically treated patients, 22 patients with ankylosing spondylitis (AS group) and 24 patients with osteoporosis (OS group) were identified. The mean ages were 83.1 ± 3.1 years and 83.2 ± 2.6 years, respectively. A significant difference in the mean CCI score was found (7.6 vs 5.6; p < 0.001). Multilevel posterior fusion procedures were conducted in all patients, with 6.7 ± 1.4 fused levels in the AS group and 7.1 ± 1.1 levels fused in the OS group (p > 0.05). Major complications developed in 10 patients (45%) in the AS group compared with 4 patients (17%) in the OS group (p < 0.05). The 90-day mortality was 36% in the AS group compared with 0% in the OS group (p < 0.001). CONCLUSIONS Patients older than 80 years of age with AS bear a high risk of adverse events after multilevel spinal fusion procedures. The high morbidity and 90-day mortality should be clearly discussed and carefully weighed against surgical treatment.
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Affiliation(s)
- Basem Ishak
- 1Swedish Neuroscience Institute, Seattle; and.,2Department of Neurosurgery, Heidelberg University Hospital, Heidelberg; and
| | - Sven Frieler
- 1Swedish Neuroscience Institute, Seattle; and.,4Department of Trauma Surgery, BG University Hospital Bochum, Germany
| | - Tarush Rustagi
- 3Indian Spinal Injuries Centre, Vasant Kunj New Delhi, Delhi, India; and
| | - Alexander von Glinski
- 1Swedish Neuroscience Institute, Seattle; and.,4Department of Trauma Surgery, BG University Hospital Bochum, Germany
| | - Ronen Blecher
- 1Swedish Neuroscience Institute, Seattle; and.,5Assuta University Hospital Ashdod, Ben Gurion University of the Negev, Israel
| | | | - Andreas Unterberg
- 2Department of Neurosurgery, Heidelberg University Hospital, Heidelberg; and
| | - Sarah Strot
- 1Swedish Neuroscience Institute, Seattle; and
| | - Jeffrey Roh
- 1Swedish Neuroscience Institute, Seattle; and
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12
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Ishak B, von Glinski A, Dupont G, Lachkar S, Yilmaz E, Iwanaga J, Unterberg A, Oskouian R, Tubbs RS, Chapman JR. Update on the Biomechanics of the Craniocervical Junction, Part II: Alar Ligament. Global Spine J 2021; 11:1064-1069. [PMID: 32691628 PMCID: PMC8351059 DOI: 10.1177/2192568220941452] [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: 11/15/2022] Open
Abstract
STUDY DESIGN In vitro biomechanical study. OBJECTIVE The strength of the alar ligament has been described inconsistently, possibly because of the nonphysiological biomechanical testing models, and the inability to test the ligament with both attachments simultaneously. The purpose of this biomechanical model was to reevaluate the alar ligament's tensile strength with both bony attachments, while also keeping the transverse ligament intact, all in a more physiological biomechanical model that mimics the mechanism of traumatic injury closely. METHODS Eleven fresh-frozen occipito-atlanto-axial (C0-C1-C2) specimens were harvested from individuals whose mean age at death was 77.4 years (range 46-97 years). Only the alar and transverse ligaments were preserved, and the bony C0-C1-C2 complex was left intact. Axial tension was exerted on the dens to displace it posteriorly, while the occipito-axial complex was fixed anteriorly. A device that applies controlled increasing force was used to test the tensile strength (M2-200, Mark-10 Corporation). RESULTS The mean force required for the alar ligament to fail was 394 ± 52 N (range 317-503 N). However, both the right and left alar ligaments ruptured simultaneously in 10 specimens. The ligament failed most often at the dens (n = 10), followed by occipital condyle rupture (n = 1). The transverse ligament remained intact in all specimens. CONCLUSIONS When both the right and left alar ligament were included, the total alar ligament failure occurred at an average force of 394 N. The alar ligament failed before the transverse ligament.
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Affiliation(s)
- Basem Ishak
- Seattle Science Foundation, Seattle, WA, USA,Swedish Neuroscience Institute, Seattle, WA, USA,Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany,Basem Ishak, Department of Neurosurgery, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Alexander von Glinski
- Seattle Science Foundation, Seattle, WA, USA,Swedish Neuroscience Institute, Seattle, WA, USA,BG University Hospital Bochum, Bochum, Germany
| | | | | | - Emre Yilmaz
- Seattle Science Foundation, Seattle, WA, USA,Swedish Neuroscience Institute, Seattle, WA, USA,BG University Hospital Bochum, Bochum, Germany
| | - Joe Iwanaga
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Andreas Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Rod Oskouian
- Seattle Science Foundation, Seattle, WA, USA,Swedish Neuroscience Institute, Seattle, WA, USA
| | - R. Shane Tubbs
- Tulane University School of Medicine, New Orleans, LA, USA,St. George’s University, Grenada, West Indies
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13
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von Glinski A, Elia C, Yilmaz E, Frieler S, Ishak B, Anand MK, Iwanaga J, Abdul-Jabbar A, Oskouian RJ, Tubbs RS, Chapman JR. Space-Occupying Lesions of the Retropharyngeal Space: An Anatomical Study With Application to Postoperative Retropharyngeal Hematomas. Global Spine J 2021; 11:704-708. [PMID: 32875906 PMCID: PMC8165929 DOI: 10.1177/2192568220922192] [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: 11/27/2022] Open
Abstract
STUDY DESIGN Cadaver study. OBJECTIVE The retropharyngeal space's (RPS's) clinical relevance is apparent in anterior cervical spine surgery with respect to postoperative hematoma, which can cause life-threatening airway obstruction. This cadaver study aims to establish guidance toward a better understanding of the tolerance of the RPS to accommodate fluid accumulation. METHODS Five fresh-frozen cadavers were dissected in the supine position. A digital manometer and a 20 Fr Foley catheter were inserted into the RPS via an anterolateral approach. While inflating the Foley catheter, the position of the esophagus/trachea was documented using fluoroscopy, and the retropharyngeal pressure was measured. We quantified the volume required to deviate the esophagus/trachea >1 cm from its original position using fluoroscopy. We also recorded the volume required to cause a visible change to the normal neck contour. RESULTS A mean volume of 12.5 mL (mean pressure 1.50 mm Hg) was needed to cause >1 cm of esophageal deviation. Tracheal deviation was encountered at a mean volume of 20.0 mL (mean pressure of 2.39 mm Hg). External visible clinical neck contour changes were apparent at a mean volume of 39 mL. CONCLUSION A relatively small volume of fluid in the RPS can cause the esophagus/trachea to radiographically deviate. The esophagus is the structure in the RPS to be most influenced by mass effect. The mean volume of fluid required to cause clinically identifiable changes to the normal neck contour was nearly double the volume required to cause 1 cm of esophageal/tracheal deviation in a cadaver model.
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Affiliation(s)
- Alexander von Glinski
- Swedish Medical Center, Seattle, Washington, DC, USA,Seattle Science Foundation, Seattle, Washington, DC, USA,Ruhr University Bochum, Bochum, Germany,Swedish Hospital, Seattle, Washington, DC, USA,Alexander von Glinski, Seattle Science Foundation, 550 17th Avenue, Suite 600, Seattle, WA 98122, USA.
| | - Christopher Elia
- Swedish Medical Center, Seattle, Washington, DC, USA,Seattle Science Foundation, Seattle, Washington, DC, USA
| | | | - Sven Frieler
- Swedish Medical Center, Seattle, Washington, DC, USA
| | - Basem Ishak
- Swedish Medical Center, Seattle, Washington, DC, USA,Seattle Science Foundation, Seattle, Washington, DC, USA
| | | | - Joe Iwanaga
- Seattle Science Foundation, Seattle, Washington, DC, USA,Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine
| | - Amir Abdul-Jabbar
- Swedish Medical Center, Seattle, Washington, DC, USA,Seattle Science Foundation, Seattle, Washington, DC, USA
| | - Rod J. Oskouian
- Swedish Medical Center, Seattle, Washington, DC, USA,Seattle Science Foundation, Seattle, Washington, DC, USA
| | - R. Shane Tubbs
- Swedish Medical Center, Seattle, Washington, DC, USA,St George’s University, Grenada, West Indies,Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine
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14
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von Glinski A, Takayanagi A, Elia C, Ishak B, Listmann M, Pierre CA, Blecher R, Hayman E, Chapman JR, Oskouian RJ. Surgical Treatment of Ossifications of the Cervical Anterior Longitudinal Ligament: A Retrospective Cohort Study. Global Spine J 2021; 11:709-715. [PMID: 32875898 PMCID: PMC8165911 DOI: 10.1177/2192568220922195] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES The study aims to evaluate anterior cervical discectomy and fusion (ACDF) in the treatment of patients with ossification of the anterior longitudinal ligament (OALL). METHODS We retrospectively reviewed cases performed at our institution between January 2015 and December 2018; adult (age ≥18 years) patients who underwent anterior cervical decompression and fusion in the presence of dysphagia and OALL. Ten patients (9 male, 1 female, mean age 64.4 years) with OALL who underwent ACDF were included. Charts were reviewed for demographics and comorbidities. Primary outcomes assessed were intra- and postoperative complications. Secondary outcomes were fusion rates, instrumentation failure, postsurgical instability/deformity, and readmission rates. RESULTS The average duration of symptoms prior to surgery was 12.3 months. All patients presented with dysphagia (mean Bazaz score 2.0). The average number of levels with OALL was 4.7 (±1.67). All patients underwent ACDF and 3 patients underwent additional posterior cervical fusion for kyphotic deformity correction or when extensive laminectomy was required. We did not encounter any intraoperative complications. Eight patients (72%) had solid fusion demonstrated on the lateral x-rays and no evidence of progressive kyphotic deformity. We did not encounter any instrumentation failure or loosening. Two patients developed recurrence of dysphagia (Bazaz scores 2 and 3 respectively). CONCLUSION ACDF for OALL with dysphagia and concomitant myelopathy in our small series of 10 patients demonstrate good fusion and clinical outcomes. Larger studies will be necessary to determine the optimal treatment for patients with dysphagia due to OALL.
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Affiliation(s)
- Alexander von Glinski
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
,Seattle Science Foundation, Seattle, WA, USA,BG University Hospital Bergmannsheil, Ruhr University, Bochum, Germany,Swedish Hospital, Seattle, WA, USA,Alexander von Glinski, Seattle Science Foundation, 550 17th Avenue, Suite 600, Seattle, WA 98 122, USA.
| | | | - Christopher Elia
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
,Seattle Science Foundation, Seattle, WA, USA,Riverside University Health Systems, Moreno Valley, CA, USA
| | - Basem Ishak
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
,Seattle Science Foundation, Seattle, WA, USA
| | | | - Clifford A. Pierre
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
,Seattle Science Foundation, Seattle, WA, USA
| | - Ronen Blecher
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
,Seattle Science Foundation, Seattle, WA, USA,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Erik Hayman
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
,Seattle Science Foundation, Seattle, WA, USA
| | - Jens R. Chapman
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
,Seattle Science Foundation, Seattle, WA, USA
| | - Rod J. Oskouian
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
,Seattle Science Foundation, Seattle, WA, USA
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15
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Elia C, Takayanagi A, Arvind V, Goodmanson R, von Glinski A, Pierre C, Sung J, Qutteineh B, Jung E, Chapman J, Oskouian R. Risk Factors Associated with 90-Day Readmissions Following Occipitocervical Fusion-A Nationwide Readmissions Database Study. World Neurosurg 2020; 147:e247-e254. [PMID: 33321249 DOI: 10.1016/j.wneu.2020.12.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 12/04/2020] [Accepted: 12/05/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Occipitocervical fusion (OCF) procedures are increasing due to an aging population and the prevalence of trauma, rheumatoid arthritis, and tumors. Reoperation rates and readmission risk factors for cervical fusions have been established, but in relation to OCF they have not been explored. This study investigates the patterns of readmissions and complications following OCF using a national database. METHODS The 2016 U.S. Nationwide Readmissions Database was used for sample collection. Adults (>18 years) who underwent OCF were identified using the 2016 ICD-10 coding system, and we examined the readmission rates (30-day and 90-day) and reoperation rates. RESULTS Between January and September 2016, a total of 477 patients underwent OCF; the 30-day and 90-day readmission rates were 10.4% and 22.4%, respectively. The 90-day reoperation rate related to the index surgery was 5.7%. Mean age (68.58 years) was significantly greater in the readmitted group versus nonreadmitted group (61.76 years) (P < 0.001). The readmitted group had a significantly higher Charlson Comorbidity Index and Elixhauser Comorbidity Index (5.00 and 2.41, respectively) than the nonreadmitted group (3.25 and 1.15, respectively; P < 0.001). Nonelective OCF showed a higher readmission rate (29.18%) versus elective OCF (12.23%) (P < 0.001). Medicare and Medicaid patients showed the highest rates of readmission (27.27% and 20.41%, respectively). Readmitted patients had higher total health care costs. CONCLUSIONS Nonelective OCF was found to have a readmission rate of almost 2½× that of elective OCF. Understanding risk factors associated with OCF will help with operative planning and patient optimization.
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Affiliation(s)
- Christopher Elia
- Division of Neurosurgery, Riverside University Health Systems, Moreno Valley, California, USA; Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA
| | - Ariel Takayanagi
- Division of Neurosurgery, Riverside University Health Systems, Moreno Valley, California, USA
| | - Varun Arvind
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ryan Goodmanson
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA
| | - Alexander von Glinski
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Hansjörg Wyss Hip and Pelvic Center, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA; Department of Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Clifford Pierre
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA.
| | - Jeanju Sung
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Bilal Qutteineh
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA
| | - Edward Jung
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA
| | - Jens Chapman
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Rod Oskouian
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA
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16
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Pierre CA, von Glinski A, Elia C, Ansari D, Ishak B, Blecher R, Frieler S, Qutteineh B, Hopkins S, Oskouian RJ, Chapman J. Surgical Management of Charcot Spinal Arthropathy Using a Quadruple-Rod Construct. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_743] [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: 11/13/2022] Open
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17
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Steinhilber B, Luger T, Schwenkreis P, Middeldorf S, Bork H, Mann B, von Glinski A, Schildhauer TA, Weiler S, Schmauder M, Heinrich K, Winter G, Schnalke G, Frener P, Schick R, Wischniewski S, Jäger M. The use of exoskeletons in the occupational context for primary, secondary, and tertiary prevention of work-related musculoskeletal complaints. IISE Trans Occup Ergon Hum Factors 2020; 8:132-144. [PMID: 33140996 DOI: 10.1080/24725838.2020.1844344] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Indexed: 12/26/2022]
Abstract
OCCUPATIONAL APPLICATIONS This guideline includes 20 recommendations and four key statements that achieved consensus or strong consensus regarding the application of exoskeletons in the workplace for the prevention of musculoskeletal complaints and diseases, the general use and implementation of exoskeletons, and recommendations for risk assessment. The guideline is intended for company physicians, occupational physicians, ergonomists, occupational safety specialists, and employers, and serves as information for all other actors in practical occupational safety. Due to the lack of evidence from the scientific literature, the recommendations and key statements are the result of expert discussions that were conducted at a consensus conference in accordance with the Regulations of the Association of the Scientific Medical Societies in Germany, moderated by an external consultant.
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Affiliation(s)
- Benjamin Steinhilber
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Tübingen, Germany
| | - Tessy Luger
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Tübingen, Germany
| | - Peter Schwenkreis
- Neurological University Hospital, BG University Hospital Bergmannsheil GmbH, Bochum, Germany
| | - Stefan Middeldorf
- Centre for Orthopaedics, Schön Clinic Bad Staffelstein, Bad Staffelstein, Germany
| | - Hartmut Bork
- St. Josef-Stift Sendenhorst Hospital for Orthopaedic Surgery and Rheumatology, Sendenhorst, Germany
| | - Bernhard Mann
- Institute for Sociology, University of Koblenz-Landau, Koblenz-Metternich, Germany
| | - Alexander von Glinski
- Surgical University Hospital and Polyclinic, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Thomas A Schildhauer
- Surgical University Hospital and Polyclinic, BG University Hospital Bergmannsheil, Bochum, Germany
| | | | - Martin Schmauder
- Institute of Material Handling and Industrial Engineering, Technical University Dresden, Dresden, Germany
| | - Kai Heinrich
- Institute for Occupational Safety and Health of the German Social Accident Insurance, Sankt Augustin, Germany
| | - Gabriele Winter
- (BG) German Social Accident Insurance Institution for Commercial Transport, Postal Logistics and Telecommunication, Darmstadt, Germany
| | - Gerhard Schnalke
- Outpatient Rehabilitation Center Braunschweig, Braunschweig, Germany
| | - Peter Frener
- (BG) German Social Accident Insurance Institution for the Woodworking and Metalworking Industries, Düsseldorf, Germany
| | - Ralf Schick
- (BG) German Social Accident Insurance Institution for the Trade and Logistics Industry, Mannheim, Germany
| | | | - Matthias Jäger
- Leibniz Research Centre for Working Environment and Human Factors, Dortmund University of Technology, Dortmund, Germany
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18
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von Glinski A, Frieler S, Yilmaz E, Ishak B, Goodmanson R, Iwanaga J, Schildhauer TA, Chapman JR, Oskouian RJ, Mayo K, Tubbs RS. Osteology of the ilium revised: illuminating the clinical relevance. Eur J Trauma Emerg Surg 2020; 47:1671-1677. [PMID: 32886140 DOI: 10.1007/s00068-020-01482-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/24/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Several studies on anterior and posterior pelvic ring fixation have identified a fragile monocortical area located at the iliac wing. However, there are no current studies regarding this structure's dimensions and relation to known anatomic structures. METHODS Eleven human ilia were dissected from 6 specimens. After debulking soft tissue, photoluminescence was used to indicate the fragile area. The size and thickness of the iliac wing were determined and mapped in relation to the anterior superior iliac spine (ASIS) and the posterior superior iliac spine (PSIS). RESULTS This photoluminescent unicortical area measured 15.57 cm2 with a mean minimal thickness of 1.37 mm at its thinnest part. Its average diameter was 41.15 mm horizontally and 37.45 mm vertically. In all cases, it was located at the middle third of the ilium with a mean distance of 64.58 mm to the AIIS and 62.73 mm to the PSIS. Trajectory angulation above 4.5° from the PSIS lead to violation of this area. CONCLUSION This study provides useful anatomical information regarding a thin unicortical area at the iliac wing that is relevant to anterior and posterior pelvic ring fixation and the potential complications that can arise from iatrogenic perforation of this area.
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Affiliation(s)
- Alexander von Glinski
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
- Seattle Science Foundation, Seattle, WA, USA
- Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
- Hansjörg Wyss Hip and Pelvic Center, Swedish Hospital, Seattle, WA, USA
| | - Sven Frieler
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA.
- Seattle Science Foundation, Seattle, WA, USA.
- Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
- Hansjörg Wyss Hip and Pelvic Center, Swedish Hospital, Seattle, WA, USA.
| | - Emre Yilmaz
- Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Basem Ishak
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
- Seattle Science Foundation, Seattle, WA, USA
| | - Ryan Goodmanson
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
- Seattle Science Foundation, Seattle, WA, USA
| | - Joe Iwanaga
- Seattle Science Foundation, Seattle, WA, USA
| | - Thomas A Schildhauer
- Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Jens R Chapman
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
| | - Rod J Oskouian
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
- Seattle Science Foundation, Seattle, WA, USA
| | - Keith Mayo
- Hansjörg Wyss Hip and Pelvic Center, Swedish Hospital, Seattle, WA, USA
| | - R Shane Tubbs
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
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von Glinski A, Frieler S, Blecher R, Mayo K, Lee CB, Yilmaz E, Chapman JR, Oskouian RJ, Tubbs S, Schildhauer TA. The iliac pillar - Definition of an osseous fixation pathway for internal and external fixation. Orthop Traumatol Surg Res 2020; 106:869-875. [PMID: 32571741 DOI: 10.1016/j.otsr.2020.04.009] [Citation(s) in RCA: 4] [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: 11/01/2019] [Revised: 03/01/2020] [Accepted: 04/07/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Increasing numbers of unstable pelvic ring fractures, due to the ongoing demographic change and improvements in the rescue of high-energy traumatic events, are challenging trauma and orthopedic surgeons. While initial installation of an external fixation device is often necessary, placement of iliac crest pins can be difficult due to the complex osteology of the ilium. HYPOTHESIS We aim to analyze (1) the length, localization and angulation of the iliac pillar and (2) to define the dimensions of the surgical corridor for a better understanding of pin entry point and trajectory, thus preventing shortcomings in anterior external fixation of pelvic ring injuries. METHODS Twenty hemipelvises from 10 fresh-frozen cadaveric torsos (3 female, 7 males; mean age 80.2 years) were harvested. The following measurements were taken with digital calipers: Location of the iliac pillar in relation to the anterior superior iliac spine and to the acetabulum roof, mean length and diameter of the iliac pillar, maximum diameter of the iliac pillar. In addition we measured the width of the different bone layers. RESULTS The mean length of the hourglass shaped iliac pillar was 107.04mm with a mean width of 17.0mm (min. 15.1; max. 19.2). The mean distance to the anterior superior iliac spine was 69.00mm (min. 64.8; max. 73.4). The mean maximum width of the iliac pillar was 12.16mm (min. 9.4; max. 13.8). Caudally the line describing the iliac pillar intercepts the cranial acetabular rim at 12 o'clock. The smallest mean diameter of the cancellous bone was 7.5mm±2.0. CONCLUSION The iliac pillar is part of the complex osteology of the human pelvis. A cohesive description of its location and dimensions has been lacking. Successful treatment of pelvic fracture depends on an optimal preoperative planning, accurate overall reduction, and stable fixation. We described the origin and angulation to provide a good bone stock for external fixation pin and the width of the different bone layers. This study therefore contributes by facilitating a thorough understanding of pelvic osteology and describing the location and dimensions of an optimal osseous pathway. LEVEL OF EVIDENCE Anatomical descriptive study.
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Affiliation(s)
- Alexander von Glinski
- Swedish Medical Center, Swedish Neuroscience Institute, Seattle, WA, United States; Seattle Science Foundation, Seattle, WA, United States; Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany; Hansjörg Wyss Hip and Pelvic Center, Swedish Hospital, Seattle, WA, United States.
| | - Sven Frieler
- Swedish Medical Center, Swedish Neuroscience Institute, Seattle, WA, United States; Seattle Science Foundation, Seattle, WA, United States; Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Ronen Blecher
- Swedish Medical Center, Swedish Neuroscience Institute, Seattle, WA, United States; Seattle Science Foundation, Seattle, WA, United States
| | - Kajsa Mayo
- Hansjörg Wyss Hip and Pelvic Center, Swedish Hospital, Seattle, WA, United States
| | - Cara Beth Lee
- Hansjörg Wyss Hip and Pelvic Center, Swedish Hospital, Seattle, WA, United States
| | - Emre Yilmaz
- Swedish Medical Center, Swedish Neuroscience Institute, Seattle, WA, United States; Seattle Science Foundation, Seattle, WA, United States; Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Jens R Chapman
- Swedish Medical Center, Swedish Neuroscience Institute, Seattle, WA, United States; Seattle Science Foundation, Seattle, WA, United States
| | - Rod J Oskouian
- Swedish Medical Center, Swedish Neuroscience Institute, Seattle, WA, United States; Seattle Science Foundation, Seattle, WA, United States
| | - Shane Tubbs
- Hansjörg Wyss Hip and Pelvic Center, Swedish Hospital, Seattle, WA, United States; Department of Anatomical Sciences, Saint-George's University, Saint-George's, Grenada
| | - Thomas A Schildhauer
- Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
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20
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Ishak B, Abdul-Jabbar A, Moss GB, Yilmaz E, von Glinski A, Frieler S, Unterberg AW, Blecher R, Altafulla J, Roh J, Hart RA, Oskouian RJ, Chapman JR. De novo methicillin-resistant Staphylococcus aureus vs. methicillin-sensitive Staphylococcus aureus infections of the spine, similar clinical outcome, despite more severe presentation in surgical patients. Neurosurg Rev 2020; 44:2111-2118. [PMID: 32851541 DOI: 10.1007/s10143-020-01376-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/18/2020] [Accepted: 08/20/2020] [Indexed: 11/28/2022]
Abstract
Vertebral osteomyelitis (VO) is a severe infection of the vertebral body and the adjacent disc space, where Staphylococcus aureus is most commonly isolated. The objective of this retrospective study was to determine risk factors for and compare outcome differences between de novo methicillin-resistant Staphylococcus aureus (MRSA) VO and methicillin-sensitive Staphylococcus aureus (MSSA) VO. A retrospective cohort study was performed by review of the electronic medical records of 4541 consecutive spine surgery patients. Among these 37 underwent surgical treatment of de novo MRSA and MSSA spinal infections. Patient demographics, pre- and postoperative neurological status (ASIA impairment score), surgical treatment, inflammatory laboratory values, nutritional status, comorbidities, antibiotics, hospital stay, ICU stay, reoperation, readmission, and complications were collected. A minimum follow-up (FU) of 12 months was required. Among the 37 patients with de novo VO, 19 were MRSA and 18 were MSSA. Mean age was 52.4 and 52.9 years in the MRSA and MSSA groups, respectively. Neurological deficits were found in 53% of patients with MRSA infection and in 17% of the patients with MSSA infection, which was statistically significant (p < 0.05). Chronic renal insufficiency and malnutrition were found to be significant risk factors for MRSA VO. Preoperative albumin was significantly lower in the MRSA group (p < 0.05). Patients suffering from spinal infection with chronic renal insufficiency and malnutrition should be watched more carefully for MRSA. The MRSA group did not show a significant difference with regard to final clinical outcome despite more severe presentation.
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Affiliation(s)
- Basem Ishak
- Swedish Neuroscience Institute, Seattle, WA, USA. .,Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
| | | | - Gregory B Moss
- Department of Infectious Disease, Swedish Medical Center, Seattle, WA, USA
| | - Emre Yilmaz
- Swedish Neuroscience Institute, Seattle, WA, USA.,Department of Trauma Surgery, BG University Hospital Bochum, Bochum, Germany
| | - Alexander von Glinski
- Swedish Neuroscience Institute, Seattle, WA, USA.,Department of Trauma Surgery, BG University Hospital Bochum, Bochum, Germany
| | - Sven Frieler
- Swedish Neuroscience Institute, Seattle, WA, USA.,Department of Trauma Surgery, BG University Hospital Bochum, Bochum, Germany
| | - Andreas W Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | | | | | - Jeffrey Roh
- Swedish Neuroscience Institute, Seattle, WA, USA
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21
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von Glinski A, Ishak B, Elia CJ, Goodmanson R, Pierre C, Norvell DC, Ansari D, Brune P, Oskouian RJ, Chapman JR. Emerging Insight in the Use of an Active Post Discharge Surveillance Program in Spine Surgery: A Retrospective Pilot Study. World Neurosurg 2020; 139:e237-e244. [DOI: 10.1016/j.wneu.2020.03.185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 12/27/2022]
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Ramey WL, von Glinski A, Jack A, Blecher R, Oskouian RJ, Chapman JR. Antibiotic-impregnated polymethylmethacrylate strut graft as a treatment of spinal osteomyelitis: case series and description of novel technique. J Neurosurg Spine 2020; 33:415-420. [PMID: 32384277 DOI: 10.3171/2020.3.spine191313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/14/2019] [Accepted: 03/06/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The surgical treatment of osteomyelitis and discitis of the spine often represents a challenging clinical entity for a multitude of reasons, including progression of infection despite debridement, development of spinal deformity and instability, bony destruction, and seeding of hardware. Despite advancement in spinal hardware and implantation techniques, these aforementioned challenges not uncommonly result in treatment failure, especially in instances of heavy disease burden with enough bony endplate destruction as to not allow support of a modern titanium cage implant. While antibiotic-infused polymethylmethacrylate (aPMMA) has been used in orthopedic surgery in joints of the extremities, its use has not been extensively described in the spine literature. Herein, the authors describe for the first time a series of patients treated with a novel surgical technique for the treatment of spinal osteomyelitis and discitis using aPMMA strut grafts with posterior segmental fusion. METHODS Over the course of 3 years, all patients with spinal osteomyelitis and discitis at a single institution were identified and included in the retrospective cohort if they were surgically treated with spinal fusion and implantation of an aPMMA strut graft at the nidus of infection. Basic demographics, surgical techniques, levels treated, complications, and return to the operating room for removal of the aPMMA strut graft and placement of a traditional cage were examined. The surgical technique consisted of performing a discectomy and/or corpectomy at the level of osteomyelitis and discitis followed by placement of aPMMA impregnated with vancomycin and/or tobramycin into the cavity. Depending on the patient's condition during follow-up and other deciding clinical and radiographic factors, the patient may return to the operating room nonurgently for removal of the PMMA spacer and implantation of a permanent cage with allograft to ultimately promote fusion. RESULTS Fifteen patients were identified who were treated with an aPMMA strut graft for spinal osteomyelitis and discitis. Of these, 9 patients returned to the operating room for aPMMA strut graft removal and insertion of a cage with allograft at an average of 19 weeks following the index procedure. The most common infections were methicillin-sensitive Staphylococcus aureus (n = 6) and methicillin-resistant S. aureus (n = 5). There were 13 lumbosacral infections and 1 each of cervical and thoracic infection. Eleven patients were cured of their infection, while 2 had recurrence of their infection; 2 patients were lost to follow-up. Three patients required unplanned return trips to the operating room, two of which were for wound complications, with the third being for recurrent infection. CONCLUSIONS In cases of severe infection with considerable bony destruction, insertion of an aPMMA strut graft is a novel technique that should be considered in order to provide strong anterior-column support while directly delivering antibiotics to the infection bed. While the active infection is being treated medically, this structural aPMMA support bridges the time it takes for the patient to be converted from a catabolic to an anabolic state, when it is ultimately safe to perform a definitive, curative fusion surgery.
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Affiliation(s)
- Wyatt L Ramey
- 1Swedish Neuroscience Institute, Swedish Medical Center, Seattle
| | - Alexander von Glinski
- 1Swedish Neuroscience Institute, Swedish Medical Center, Seattle
- 2Seattle Science Foundation, Seattle, Washington
- 3Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Germany; and
- 4Hansjoerg Wyss Hip and Pelvic Center, Swedish Hospital, Seattle, Washington
| | - Andrew Jack
- 1Swedish Neuroscience Institute, Swedish Medical Center, Seattle
| | - Ronen Blecher
- 1Swedish Neuroscience Institute, Swedish Medical Center, Seattle
| | - Rod J Oskouian
- 1Swedish Neuroscience Institute, Swedish Medical Center, Seattle
- 2Seattle Science Foundation, Seattle, Washington
| | - Jens R Chapman
- 1Swedish Neuroscience Institute, Swedish Medical Center, Seattle
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von Glinski A, Yilmaz E, Ishak B, Hayman E, Ramey W, Jack A, Iwanaga J, Oskouian RJ, Tubbs RS, Chapman JR. The Modified Iliac Screw: An Anatomic Comparison and Technical Guide. World Neurosurg 2020; 136:e608-e613. [DOI: 10.1016/j.wneu.2020.01.091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/11/2020] [Accepted: 01/13/2020] [Indexed: 11/25/2022]
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Ansari D, Burley HEK, von Glinski A, Elia C, Chapman JR, Oskouian RJ. The new onset of dysphagia four years after anterior cervical discectomy and fusion: Case report and literature review. Surg Neurol Int 2020; 11:32. [PMID: 32257558 PMCID: PMC7110425 DOI: 10.25259/sni_46_2020] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 02/13/2020] [Indexed: 11/18/2022] Open
Abstract
Background: Dysphagia is a common complication immediately following anterior cervical spine surgery. However, its onset more than 1-year postoperatively is rare. Case Description: A 45-year-old male initially underwent a C3-4 and C5-6 anterior cervical discectomy and fusion (ACDF). At age 49, 4 years later, he presented with worsening dysphagia accompanied by neck and right upper extremity pain. Radiographs demonstrated an extruded left C3 screw, which had migrated into the prevertebral soft tissues at the C4-C5 level; there was also loosening of the right C3 screw. The subsequent barium swallow study revealed that the screw was embedded in the pharyngeal wall. The patient required a two-stage operation; first, to remove the anterior instrumentation, and second, to perform a posterior instrumented C2-T2 fusion. Conclusion: A barium swallow study and other dynamic imaging are a valuable component of the diagnostic workup and therapeutic intervention to evaluate the delayed onset dysphagia following an ACDF.
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Affiliation(s)
- Darius Ansari
- Seattle Science Foundation, Seattle, Washington.,Department of Medicine, University of Illinois College of Medicine, Chicago, Illinois
| | - Halle E K Burley
- Seattle Science Foundation, Seattle, Washington.,Department of Medicine, Western University of Health Sciences College of Osteopathic Medicine of the Pacific-Northwest, Lebanon, Oregon
| | - Alexander von Glinski
- Seattle Science Foundation, Seattle, Washington.,Swedish Medical Center, Swedish Neuroscience Institute, Washington.,Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany.,Hansjörg Wyss Hip and Pelvic Center, Swedish Hospital, Seattle, Washington
| | - Christopher Elia
- Swedish Medical Center, Swedish Neuroscience Institute, Washington.,Riverside University Health System Medical Center, Moreno Valley, California, United States
| | - Jens R Chapman
- Swedish Medical Center, Swedish Neuroscience Institute, Washington
| | - Rod J Oskouian
- Seattle Science Foundation, Seattle, Washington.,Swedish Medical Center, Swedish Neuroscience Institute, Washington
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25
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von Glinski A, Yilmaz E, Goodmanson R, Pierre C, Frieler S, Shaffer A, Ishak B, Lee CB, Mayo K. The impact of the 30 most cited articles on hip arthroscopy: what is the subject matter? J Hip Preserv Surg 2020; 7:14-21. [PMID: 32382424 PMCID: PMC7195922 DOI: 10.1093/jhps/hnz067] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 12/19/2019] [Accepted: 12/24/2019] [Indexed: 11/13/2022] Open
Abstract
The purpose of this study was to identify the 30 most cited articles on hip arthroscopy and discuss their influence on recent surgical treatment. Due to advancements in hip arthroscopy, there is a widening spectrum of diagnostic and treatment indications. The purpose of this study was to identify the 30 most cited articles on hip arthroscopy and discuss their influence on contemporary surgical treatment. The Thomson Reuters Web of Science was used to identify the 30 most cited studies on hip arthroscopy between 1900 and 2018. These 30 articles generated 6152 citations with an average of 205.07 citations per item. Number of citations ranged from 146 to 461. Twenty-five out of the 30 papers were clinical cohort studies with a level of evidence between III and IV, encompassing 4348 patients. Four studies were reviewed (one including a technical note) and one a case report. We were able to identify the 30 most cited articles in the field of hip arthroscopy. Most articles were reported in high-impact journals, but reported small sample sizes in a retrospective setting. Prospective multi-arm cohort trials or randomized clinical trials represent opportunities for future studies.
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Affiliation(s)
- Alexander von Glinski
- Hansjörg Wyss Hip and Pelvic Center, Swedish Hospital, 600 Broadway #340, Seattle, WA 98122, USA.,Swedish Neuroscience Institute, Swedish Medical Center, 550 17th Ave #540, Seattle, WA 98122, USA.,Seattle Science Foundation, 550 17th Ave Suite 600, Seattle, WA 98122, USA.,Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, Bochum 44789, Germany
| | - Emre Yilmaz
- Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, Bochum 44789, Germany
| | - Ryan Goodmanson
- Swedish Neuroscience Institute, Swedish Medical Center, 550 17th Ave #540, Seattle, WA 98122, USA.,Seattle Science Foundation, 550 17th Ave Suite 600, Seattle, WA 98122, USA
| | - Clifford Pierre
- Swedish Neuroscience Institute, Swedish Medical Center, 550 17th Ave #540, Seattle, WA 98122, USA.,Seattle Science Foundation, 550 17th Ave Suite 600, Seattle, WA 98122, USA
| | - Sven Frieler
- Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, Bochum 44789, Germany
| | - Andre Shaffer
- Hansjörg Wyss Hip and Pelvic Center, Swedish Hospital, 600 Broadway #340, Seattle, WA 98122, USA
| | - Basem Ishak
- Swedish Neuroscience Institute, Swedish Medical Center, 550 17th Ave #540, Seattle, WA 98122, USA.,Seattle Science Foundation, 550 17th Ave Suite 600, Seattle, WA 98122, USA
| | - Cara Beth Lee
- Hansjörg Wyss Hip and Pelvic Center, Swedish Hospital, 600 Broadway #340, Seattle, WA 98122, USA
| | - Keith Mayo
- Hansjörg Wyss Hip and Pelvic Center, Swedish Hospital, 600 Broadway #340, Seattle, WA 98122, USA
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von Glinski A, Elia C, Ansari D, Yilmaz E, Takayanagi A, Norvell DC, Pierre CA, Abdul-Jabbar A, Chapman JR, Oskouian RJ. Complications and Mortality in Octogenarians Undergoing Lumbopelvic Fixation. World Neurosurg 2020; 134:e272-e276. [DOI: 10.1016/j.wneu.2019.10.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/07/2019] [Accepted: 10/08/2019] [Indexed: 01/27/2023]
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Rausch V, von Glinski A, Rosteius T, Königshausen M, Schildhauer TA, Seybold D, Gessmann J. Secondary purulent infections of the elbow joint: a retrospective, single-center study. BMC Musculoskelet Disord 2020; 21:38. [PMID: 31954400 PMCID: PMC6969974 DOI: 10.1186/s12891-020-3046-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/06/2020] [Indexed: 12/04/2022] Open
Abstract
Background Septic arthritis of the elbow joint is a rare condition. Limited data is available on infections of the elbow joint following trauma or prior surgery on this joint. The aim of this study was to describe the etiology, comorbidities, bacterial spectrum and therapy of secondary purulent elbow infections. Methods Patients treated in our hospital were selected through retrospective chart review between 2006 and 2015. We included all patients with an empyema of the elbow after a trauma or surgical intervention on this joint. 30 patients between 26 and 82 years (mean: 52.47) were included. Results Seven patients (23.3%) were female, 23 (76.7%) male. 22 patients (73.3%) had a history of trauma, eight (26.7%) had prior elective surgeries on their elbow. Between one and 25 surgeries (mean: 5.77) were necessary for treatment. In nine patients, debridement and synovectomy were sufficient, eight patients (26.7%) received resection of the elbow joint. One patient was treated with a chronic fistula. In 18 patients (60%), cultures of aspiration/intraoperative swabs were positive for Staphylococcus aureus, four of these were methicillin-resistant. Four patients (13.3%) had positive cultures for Staphylococcus epidermidis, in five patients (16.7%) no bacteria could be cultured. Conclusions Secondary infections of the elbow joint are a rare disease with potentially severe courses, requiring aggressive surgical treatment and possibly severely impacting elbow function. Staphylococcus aureus was the most common bacteria in secondary infections and should be addressed by empiric antibiotic treatment when no suspicion for other participating organisms is present.
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Affiliation(s)
- Valentin Rausch
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
| | - Alexander von Glinski
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Thomas Rosteius
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Matthias Königshausen
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Thomas A Schildhauer
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Dominik Seybold
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Jan Gessmann
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
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Yilmaz E, von Glinski A, Ishak B, Abdul-Jabbar A, Blecher R, O'Lynnger T, Alonso F, Benca E, Chapman JR, Oskouian RJ. Outcome After Extreme Lateral Transpsoas Approach: Corpectomies Versus Interbody Fusion. World Neurosurg 2019; 131:e170-e175. [PMID: 31330334 DOI: 10.1016/j.wneu.2019.07.102] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The lateral transpsoas approach (LTPA) has gained popularity in thoracolumbar spine surgery procedures; however, there is an insufficient amount of data pertaining to motor and sensory complications that arise when a corpectomy is performed through the LTPA approach. METHODS Patients who underwent a corpectomy through a LTPA at a single institution between 2006 and 2016 were analyzed. Demographics, neurological outcomes, and complications were recorded. The minimum follow-up was 6 months. Univariate analysis was performed to compare demographics, surgical characteristics, complications, and outcome scores. To compare categorical variables, the χ2 test was used. For continuous outcomes, simple linear regression was used. Statistical significance was set at P < 0.05. RESULTS A total of 166 patients were included. The patients were divided into 2 groups; LTPA without corpectomy (n = 112) versus LTPA with corpectomy (n = 54). Patients without corpectomy showed a significantly lower rate of postoperative infections compared with patients with corpectomy (3.6% vs. 22.2%; P < 0.000). A higher percentage of postoperative complications was found in patients with corpectomy (31.5% vs. 13.4%; P = 0.006). The rate of neurologic complications at the 6-month follow-up and the reoperation rate (22.7% vs. 32.4%; P = 0.256) were higher in the corpectomy group (8.9% vs. 7.4%; P = 0.741), no significant difference was found between the groups. CONCLUSION Patients who underwent an LTPA corpectomy have a higher risk to suffer from postoperative complications. The results at the 6-month follow-up did not significantly differ between the groups.
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Affiliation(s)
- Emre Yilmaz
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA; Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, Bochum, Germany
| | - Alexander von Glinski
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA; Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, Bochum, Germany; Hansjörg Wyss Hip and Pelvic Center, Swedish Hospital, Seattle, Washington, USA.
| | - Basem Ishak
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA; Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Amir Abdul-Jabbar
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA
| | - Ronan Blecher
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA
| | - Thomas O'Lynnger
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA
| | - Fernando Alonso
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA
| | - Eric Benca
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA
| | - Jens R Chapman
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Rod J Oskouian
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
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von Glinski A, Yilmaz E, Mrotzek S, Marek E, Jettkant B, Brinkemper A, Fisahn C, Schildhauer TA, Geßmann J. Effectiveness of an on-body lifting aid (HAL® for care support) to reduce lower back muscle activity during repetitive lifting tasks. J Clin Neurosci 2019; 63:249-255. [DOI: 10.1016/j.jocn.2019.01.038] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 01/28/2019] [Indexed: 10/27/2022]
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von Glinski A, Yilmaz E, Rausch V, Königshausen M, Schildhauer TA, Seybold D, Geßmann J. Semitendinosus autograft augmentation after bilateral patellar tendon re-rupture: a case report and technique note. Eur J Orthop Surg Traumatol 2019; 29:1347-1353. [PMID: 30900018 DOI: 10.1007/s00590-019-02420-8] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/18/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Acute bilateral patellar tendon rupture is a rare occurrence, especially in young patients in the absence of comorbidities. We describe a case of bilateral patellar tendon re-rupture in a young patient without predisposing factors. Further, we explain a technique for autograft augmented patellar tendon repair with bidirectional fixation using an ipsilateral semitendinosus graft in transosseous patellar and tibia bone tunnels. CASE PRESENTATION We present the case of a 40-year-old healthy worker with bilateral acute on chronic patellar tendon rupture maintained following initial trauma and Krackow repair 2 years ago. He underwent bilateral reconstruction using semitendinosus autograft. At 1 year postoperatively, he has maintained the full range of motion and strength without re-rupture. CONCLUSION This is the first case describing a new fixation technique after bilateral patellar tendon re-rupture. The use of semitendinosus autograft for reconstruction of the patellar tendon after re-rupture is a viable and effective option.
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Affiliation(s)
- Alexander von Glinski
- Department of General and Trauma Surgery, BG University Hospital, Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany. .,Swedish Neuroscience Institute, Swedish Medical Center, 550 17th Avenue, Suite 500 James Tower, 5th Floor, Seattle, WA, 98122, USA. .,Hansjörg Wyss Hip and Pelvis Center, Swedish Hospital, Seattle, WA, USA.
| | - Emre Yilmaz
- Department of General and Trauma Surgery, BG University Hospital, Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany.,Swedish Neuroscience Institute, Swedish Medical Center, 550 17th Avenue, Suite 500 James Tower, 5th Floor, Seattle, WA, 98122, USA
| | - Valentin Rausch
- Department of General and Trauma Surgery, BG University Hospital, Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Matthias Königshausen
- Department of General and Trauma Surgery, BG University Hospital, Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Thomas Armin Schildhauer
- Department of General and Trauma Surgery, BG University Hospital, Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Dominik Seybold
- Department of General and Trauma Surgery, BG University Hospital, Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Jan Geßmann
- Department of General and Trauma Surgery, BG University Hospital, Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
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von Glinski A, Yilmaz E, Rausch V, Koenigshausen M, Schildhauer TA, Seybold D, Geßmann J. Surgical management of sternoclavicular joint septic arthritis. J Clin Orthop Trauma 2019; 10:406-413. [PMID: 30828216 PMCID: PMC6383133 DOI: 10.1016/j.jcot.2018.05.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 04/10/2018] [Accepted: 05/07/2018] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Infections of the sternoclavicular joint (SCJ) account for less than 1% of all joint infections. There are no standardized diagnostic and therapeutic algorithms defined in literature. This study intended to report the risk factors, the bacterial spectrum, the extent and localization and the clinical outcome of SCJ infections. PATIENTS AND METHODS We retrospectively reviewed the medical charts of 13 patients (8 men, five women, mean age 37.6 years) with SCJ infections between Januray 1st 2008 and October 30th 2015 for clinical parameters and radiological studies. All patients were interviewed during their follow-up along with clinical examination and assessing the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). RESULTS Nine patients presented with local chest pain and swelling; in 4 patients, the prevalent symptom was pain without local signs of inflammation. Full blood count revealed a mean leukocytosis of 15 × 109 L and a mean CRP of 21.0 mg/dl. Approximately 61.5% reported known diabetes mellitus. 10 patients presented an involvement of surrounding structures. All patients received a preoperativ CT scan. Each patient was treated via SCJ resection without intraoperative complications. Primary wound closure was possible in all cases. The mean follow-up was 95 days. Wound culture revealed Staphylococcus aureus in all patients. Pathological examination affirmed acute osteomyelitis in 7 patients. Four patients required the intensive care of which 2 patients died from septic shock. Recurrent infection was encountered in 3 patients who underwent revision surgery. Mean DASH Score was 18.7. CONCLUSION CT should be routinely obtained to recognize the possible extends to the surrounding structures. SCJ resection can result in satisfactory clinical results and should be considered in cases of extended infections including the surrounding structures. Empiric antibiotic coverage should contain cephalosporin or extended-spectrum penicillin. Inappropriate or less-invasive surgical procedures may cause recurrencent infections, especially in cases of osteomyelitis.
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Affiliation(s)
- Alexander von Glinski
- Department of General and Trauma Surgery, BG University Hospital, Bochum, Germany,Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany,Corresponding author at: Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany.
| | - Emre Yilmaz
- Department of General and Trauma Surgery, BG University Hospital, Bochum, Germany,Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany,Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, United States
| | - Valentin Rausch
- Department of General and Trauma Surgery, BG University Hospital, Bochum, Germany,Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Matthias Koenigshausen
- Department of General and Trauma Surgery, BG University Hospital, Bochum, Germany,Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Thomas Armin Schildhauer
- Department of General and Trauma Surgery, BG University Hospital, Bochum, Germany,Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Dominik Seybold
- Department of General and Trauma Surgery, BG University Hospital, Bochum, Germany,Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Jan Geßmann
- Department of General and Trauma Surgery, BG University Hospital, Bochum, Germany,Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany,Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, United States
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Königshausen M, Rausch V, Mempel E, von Glinski A, Ull C, Bernstorff M, Schildhauer T, Seybold D, Gessmann J. Bilateral Proximal Humerus Fracture - a Rare Combination with a High Complication Rate after Surgery. Z Orthop Unfall 2018; 156:646-652. [PMID: 29972854 DOI: 10.1055/a-0619-6400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Bilateral acute proximal humerus fractures are rare. There are no data available about these bilateral injuries. The aim of the study was to analyse bilateral proximal humerus fractures retrospectively in terms of incidence, complications and revisions. METHODS All bilateral proximal humerus fractures were evaluated retrospectively using the institution's database, with the focus on cause of the injury, fracture severity and the clinical course compared to published information on monolateral proximal humerus fractures. Bilateral posterior dislocation fractures were excluded, because these fractures are a separate entity. RESULTS Between 2005 and 2016, n = 17 patients were primarily treated within our hospital for an acute proximal humerus fracture on both sides (n = 12 female, n = 5 male, average age: 68 years; overall 34 proximal humerus fractures). The general trauma mechanism was a fall on both arms (82% [18% polytrauma]). There were 65% displaced 3-/4-part proximal humerus fractures. Angle-stable plate osteosynthesis was performed predominantly (64%), followed by fracture prosthesis (18%; tension wiring: 3%; non-operatively: 15%). Overall, n = 10 patients (59%) or n = 18 (53%) proximal humerus fractures developed a complication, primarily with loss of reduction or implant loosening (44%). In n = 14 (78%) of the complications further operations were necessary. Alcohol abuse was increasingly found in 29% of the cases within the bilateral patient cohort compared to patients with monolateral fractures. CONCLUSION Bilateral proximal humerus fractures are mainly associated with comminuted displaced fractures and a higher complication rate in comparison to monolateral fractures after surgical treatment.
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Affiliation(s)
- Matthias Königshausen
- Chirurgische Universitäts- und Poliklinik, BG Klinik Bergmannsheil Bochum, Ruhr-Universität Bochum
| | - Valentin Rausch
- Chirurgische Universitäts- und Poliklinik, BG Klinik Bergmannsheil Bochum, Ruhr-Universität Bochum
| | - Eileen Mempel
- Chirurgische Universitäts- und Poliklinik, BG Klinik Bergmannsheil Bochum, Ruhr-Universität Bochum
| | - Alexander von Glinski
- Chirurgische Universitäts- und Poliklinik, BG Klinik Bergmannsheil Bochum, Ruhr-Universität Bochum
| | - Christopher Ull
- Chirurgische Universitäts- und Poliklinik, BG Klinik Bergmannsheil Bochum, Ruhr-Universität Bochum
| | - Maria Bernstorff
- Chirurgische Universitäts- und Poliklinik, BG Klinik Bergmannsheil Bochum, Ruhr-Universität Bochum
| | - Thomas Schildhauer
- Chirurgische Universitäts- und Poliklinik, BG Klinik Bergmannsheil Bochum, Ruhr-Universität Bochum
| | - Dominik Seybold
- Chirurgische Universitäts- und Poliklinik, BG Klinik Bergmannsheil Bochum, Ruhr-Universität Bochum
| | - Jan Gessmann
- Chirurgische Universitäts- und Poliklinik, BG Klinik Bergmannsheil Bochum, Ruhr-Universität Bochum
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