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Moser M, Adl Amini D, Albertini Sanchez L, Oezel L, Zhu J, Nevzati E, Carrino JA, Shue J, Sama AA, Cammisa FP, Girardi FP, Hughes AP. The Reciprocal Relationship Between Lumbar Intervertebral Disc Degeneration and the MRI-Based Vertebral Bone Quality Score. Spine (Phila Pa 1976) 2024:00007632-990000000-00568. [PMID: 38270377 DOI: 10.1097/brs.0000000000004937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/18/2024] [Indexed: 01/26/2024]
Abstract
STUDY DESIGN Retrospective longitudinal study. OBJECTIVE To investigate the association between lumbar intervertebral disc degeneration (DD) and the vertebral bone quality (VBQ) score. SUMMARY OF BACKGROUND DATA The VBQ score that is based on magnetic resonance imaging (MRI) has been proposed as a measure of lumbar spine bone quality and is a significant predictor of healthy versus osteoporotic bone. However, the role of segmental contributing factors on VBQ is unknown. METHODS Non-surgical patients who underwent repeated lumbar MRI scans, at least three years apart primarily for low back pain were retrospectively included. VBQ was assessed as previously described. DD was assessed using the Pfirrmann grading (PFG) scale. PFG grades were summarized as PFGL1-4 for the upper three lumbar disc levels, as PFGL4-S1 for the lower two lumbar disc levels, and as PFGL1-S1 for all lumbar disc levels. Multivariable linear mixed models were used with adjustments for age, sex, race, body mass index (BMI), and the clustering of repeated measurements. RESULTS 350 patients (54.6% female, 85.4% Caucasian) were included in the final analysis, with a median age at baseline of 60.1 years and a BMI of 25.8 kg/m2. VBQ significantly increased from 2.28 at baseline to 2.36 at follow-up (P = 0.001). In the unadjusted analysis, a significant positive correlation was found between PFGL1-4, PFGL1-S1, and VBQ at baseline (P < 0.05) that increased over time (P < 0.005). In the adjusted multivariable analysis, PFGL1-4 (β = -0.0195; P = 0.021), PFGL4-S1 (β = -0.0310; P = 0.007), and PFGL1-S1 (β = -0.0160; P = 0.012) were independently and negatively associated with VBQ. CONCLUSION More advanced and long-lasting DD is associated with lower VBQ indicating less bone marrow fat content and potentially stronger bone. VBQ score as a marker of bone quality seems affected by DD.
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Affiliation(s)
- Manuel Moser
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY 10021, USA
- Department of Neurosurgery, Cantonal Hospital Graubünden, Loëstrasse 170, 7000 Chur, Switzerland
| | - Dominik Adl Amini
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY 10021, USA
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Leonardo Albertini Sanchez
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY 10021, USA
- Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
| | - Lisa Oezel
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY 10021, USA
- Department of Orthopedic Surgery and Traumatology, University Hospital Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY 10021, USA
| | - Edin Nevzati
- Department of Neurosurgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000 Lucerne, Switzerland
- Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland
| | - John A Carrino
- Department of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY 10021, USA
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY 10021, USA
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY 10021, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY 10021, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY 10021, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY 10021, USA
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Ebrahimi HDN, Wu CH, Karczewski D, Amini DA, Dahne M, Bäcker HC. Total hip arthroplasty in acute acetabulum fractures: a systematic review. Arch Orthop Trauma Surg 2023; 143:6665-6673. [PMID: 37543998 DOI: 10.1007/s00402-023-05007-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 07/21/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION The incidence of acetabular fractures has increased significantly in recent years due to demographic change. It can be divided into high-energy acetabular fractures primarily seen in adult patients versus geriatric patients mostly suffering from low-energy trauma. Historically, acetabular fractures have been treated either non-operatively or surgically following open reduction and internal fixation (ORIF), whereas nowadays total hip arthroplasty (THA) provides a true alternative. Aim of this study was to perform a systematic review on the outcome following THA in acute acetabulum fractures. METHODS PubMed/MEDLINE, Cochrane and Google databases were systematically searched on December 9, 2021. The key terms were [acetabular fracture] AND [[arthroplasty] OR [fixation]]. All retrospective and prospective original studies in English and German were analyzed the outcome following THA in acute acetabulum fractures were included. RESULTS A total of 2459 studies were screened, which includes 15 studies that met the inclusion criteria with a total of 590 patients at a mean age of 61.3 years (SD 11.48). Most studies described good to excellent results. Especially, THA allows elderly patients quicker mobilization and rehabilitation as well as symptomatic relief, as compared to ORIF or non-operative treatment. Patients who underwent non-operative treatment showed better results compared to those who underwent ORIF initially. CONCLUSION In acetabulum fractures, THA provides a good alternative with very good results when patients are carefully selected. Good to excellent outcomes are reported for both acute and delayed use of THA in elderly patients. LEVEL OF EVIDENCE Level 2, systematic review.
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Affiliation(s)
- Hadis Darvishi Nakhl Ebrahimi
- Center for Muskuloskeletal Surgery, Charité Berlin, UniversityHospital Berlin, Chariteplatz 1, 10117, Berlin, Germany
| | - Chia H Wu
- Department of Orthopaedics and Sports Medicine, Baylor College of Medicine Medical Centre, Houston, TX, USA
| | - Daniel Karczewski
- Center for Muskuloskeletal Surgery, Charité Berlin, UniversityHospital Berlin, Chariteplatz 1, 10117, Berlin, Germany
| | - Dominik Adl Amini
- Center for Muskuloskeletal Surgery, Charité Berlin, UniversityHospital Berlin, Chariteplatz 1, 10117, Berlin, Germany
| | - Michael Dahne
- Center for Muskuloskeletal Surgery, Charité Berlin, UniversityHospital Berlin, Chariteplatz 1, 10117, Berlin, Germany
| | - Henrik C Bäcker
- Center for Muskuloskeletal Surgery, Charité Berlin, UniversityHospital Berlin, Chariteplatz 1, 10117, Berlin, Germany.
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, 300 Grattan, Parkville, VIC, 3052, Australia.
- Department of Orthopaedic Surgery, Auckland City Hospital, 1023, Auckland, New Zealand.
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Moser M, Albertini Sanchez L, Adl Amini D, Oezel L, Salzmann SN, Muellner M, Haffer H, Tan ET, Shue J, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Correlation between MRI-based spinal muscle parameters and the vertebral bone quality score in lumbar fusion patients. Brain Spine 2023; 3:102684. [PMID: 38021001 PMCID: PMC10668100 DOI: 10.1016/j.bas.2023.102684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/29/2023] [Indexed: 12/01/2023]
Abstract
Introduction The vertebral bone quality (VBQ) score that is based on non-contrast enhanced T1-weighted MRI was recently introduced as a novel measure of bone quality in the lumbar spine and shown to be a significant predictor of healthy versus osteopenic/osteoporotic bone. Research question This study aimed to assess possible correlations between the VBQ score and the functional cross-sectional area (FCSA) of psoas and lumbar spine extensor muscles. Material and methods Patients who underwent fusion surgery between 2014 and 2017 and had lumbar MRI and CT scans within 6 months prior to surgery were included. The FCSA was assessed at L3-L5 using a pixel intensity threshold method. The VBQ score was calculated by dividing the signal intensity (SI) of the vertebrae L1-L4 through the SI of the cerebrospinal fluid at L3. Volumetric bone mineral density (vBMD) was assessed by quantitative CT. Results 80 patients (58.8% female, median age 68.8 years) were included. Overall prevalence of osteopenia/osteoporosis was 66.3%, with no significant differences between men and women. The mean (SD) VBQ score was significantly smaller in men, at 2.26 (0.45) versus women at 2.59 (0.39) (p = 0.001). After adjusting for age and BMI, a significant negative correlation was seen between the VBQ score and psoas FCSA at L3 (β = -0.373; p = 0.022), but only in men. Conclusion Our results highlight sex differences in the VBQ score that were not demonstrated by vBMD and suggest a potential role of this novel measure to assess not only bone quality, but also spinal muscle quantity.
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Affiliation(s)
- Manuel Moser
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Department of Neurosurgery, Cantonal Hospital Graubuenden, Loestrasse 170, 7000, Chur, Switzerland
| | - Leonardo Albertini Sanchez
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA
| | - Dominik Adl Amini
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedic Surgery and Traumatology, Charité University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Lisa Oezel
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedic Surgery and Traumatology, University Hospital Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Stephan N. Salzmann
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedic Surgery and Traumatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Maximilian Muellner
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedic Surgery and Traumatology, Charité University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Henryk Haffer
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedic Surgery and Traumatology, Charité University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Ek T. Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Andrew A. Sama
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Frank P. Cammisa
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Federico P. Girardi
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Alexander P. Hughes
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
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Moser M, Adl Amini D, Albertini Sanchez L, Oezel L, Haffer H, Muellner M, Zhu J, Carrino JA, Shue J, Sama AA, Cammisa FP, Girardi FP, Hughes AP. The association between vertebral endplate defects, subchondral bone marrow changes, and lumbar intervertebral disc degeneration: a retrospective, 3-year longitudinal study. Eur Spine J 2023; 32:2350-2357. [PMID: 36773077 DOI: 10.1007/s00586-023-07544-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 10/22/2022] [Accepted: 01/13/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE To investigate the influence of vertebral endplate defects and subchondral bone marrow changes on the development of lumbar intervertebral disc degeneration (DD). METHODS Patients > 18 y/o without any history of lumbar fusion who had repeat lumbar magnetic resonance imaging scans primarily for low back pain (LBP) performed at a minimum of 3 years apart at a single institution, and no spinal surgery in between scans were included. Total endplate score (TEPS), Modic changes (MC), and Pfirrmann grading (PFG) per lumbar disc level were assessed. DD was defined as PFG ≥ 4. RESULTS Three hundred and fifty-three patients (54.4% female) were included in the final analysis, comprising 1765 lumbar intervertebral discs. The patient population was 85.6% Caucasian with a median age of 60.1 years and a body mass index (BMI) of 25.8 kg/m2. A cutoff score of 5 was identified for the TEPS above which both the prevalence of DD and the odds of developing DD increased. The probability of developing DD did not differ significantly between lumbar disc levels (P = 0.419). In the multivariable analysis with adjustments for age, sex, race, body mass index (BMI), MC, TEPS cutoff > 5, and spinal level, only age (OR = 1.020; P = 0.002) was found to be an independent risk factor for developing intervertebral DD. CONCLUSION Our results suggest that TEPS does not unequivocally predict intervertebral DD in patients with LBP, since higher degrees of endplate defects might also develop secondarily to DD, and MC tend to occur late in the cascade of degeneration.
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Affiliation(s)
- Manuel Moser
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Department of Spine Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Dominik Adl Amini
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Leonardo Albertini Sanchez
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA
| | - Lisa Oezel
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedic Surgery and Traumatology, University Hospital Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Henryk Haffer
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Maximilian Muellner
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Jiaqi Zhu
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - John A Carrino
- Department of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA.
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Amini DA, Thiele K, Hanlon J, Karczewski D, Wu C, Stöckle U, Bäcker HC, Dahne M. Percutaneous elevation of radial head fractures without fixation - a promising technique. Acta Orthop Belg 2023; 89:213-216. [PMID: 37924537 DOI: 10.52628/89.2.9106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023]
Abstract
The aim of the study is to describe the surgical technique and to report the outcomes of triceps reflecting anconeus pedicle (TRAP) approach for intercondylar fractures of the humerus. Twenty two patients with intercondylar fractures of the humerus were operated on by open reduction via the TRAP approach and internal fixation with dual precontoured locking plates. Data were collected on union time, postoperative complications, range of motion (ROM), triceps power, and objective clinical measurement. All fractures were united with a mean union time of 16.5 weeks (range 12-22). All patients had good-to-excellent Mayo Elbow Performance (MEP) score results with a mean ROM of 118.2 degrees (range 90-135). Triceps power was grade 5 in 16 patients and grade 4 in 6. There were 3 transient ulnar nerve palsy and 1 heterotopic ossification. TRAP approach is safe and effective in terms of utility for articular reduction, restoration of elbow motion, and triceps function for intercondylar fractures of the humerus.
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Oezel L, Okano I, Jones C, Salzmann SN, Shue J, Adl Amini D, Moser M, Chiapparelli E, Sama AA, Carrino JA, Cammisa FP, Girardi FP, Hughes AP. MRI-based vertebral bone quality score compared to quantitative computed tomography bone mineral density in patients undergoing cervical spinal surgery. Eur Spine J 2023; 32:1636-1643. [PMID: 36882579 DOI: 10.1007/s00586-023-07570-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/18/2023] [Accepted: 01/30/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE The vertebral bone quality (VBQ) score based on magnetic resonance imaging (MRI) was introduced as a bone quality marker in the lumbar spine. Prior studies showed that it could be utilized as a predictor of osteoporotic fracture or complications after instrumented spine surgery. The objective of this study was to evaluate the correlation between VBQ scores and bone mineral density (BMD) measured by quantitative computer tomography (QCT) in the cervical spine. METHODS Preoperative cervical CT and sagittal T1-weighted MRIs from patients undergoing ACDF were retrospectively reviewed and included. The VBQ score in each cervical level was calculated by dividing the signal intensity of the vertebral body by the signal intensity of the cerebrospinal fluid on midsagittal T1-weighted MRI images and correlated with QCT measurements of the C2-T1 vertebral bodies. A total of 102 patients (37.3% female) were included. RESULTS VBQ values of C2-T1 vertebrae strongly correlated with each other. C2 showed the highest VBQ value [Median (range) 2.33 (1.33, 4.23)] and T1 showed the lowest VBQ value [Median (range) 1.64 (0.81, 3.88)]. There was significant weak to moderate negative correlations between and VBQ Scores for all levels [C2: p < 0.001; C3: p < 0.001; C4: p < 0.001; C5: p < 0.004; C6: p < 0.001; C7: p < 0.025; T1: p < 0.001]. CONCLUSION Our results indicate that cervical VBQ scores may be insufficient in the estimation of BMDs, which might limit their clinical application. Additional studies are recommended to determine the utility of VBQ and QCT BMD to evaluate their potential use as bone status markers.
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Affiliation(s)
- Lisa Oezel
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedic Surgery and Traumatology, University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Ichiro Okano
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Conor Jones
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Stephan N Salzmann
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Dominik Adl Amini
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedic Surgery and Traumatology, Charité University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Manuel Moser
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Department of Spine Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Erika Chiapparelli
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - John A Carrino
- Department of Radiology and Imaging, 535 East 70th Street, New York, NY, 10021, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
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Moser M, Adl Amini D, Echeverri C, Oezel L, Haffer H, Muellner M, Tan ET, Shue J, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Changes in psoas and posterior paraspinal muscle morphology after standalone lateral lumbar interbody fusion: a quantitative MRI-based analysis. Eur Spine J 2023; 32:1704-1713. [PMID: 36884111 DOI: 10.1007/s00586-023-07579-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 01/04/2023] [Accepted: 02/04/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE Standalone lateral lumbar interbody fusion (SA-LLIF) without posterior instrumentation can be an alternative to 360° fusion in selected cases. This study aimed to investigate quantitative changes in psoas and paraspinal muscle morphology that occur on index levels after SA-LLIF. METHODS Patients undergoing single- or multi-level SA-LLIF at L2/3 to L4/5 who had preoperative and postoperative lumbar MRI scans, the latter performed between 3 and 18 months after surgery for any reason, were retrospectively included. Muscle measurements were performed of the psoas and posterior paraspinal muscles (PPM; erector spinae and multifidus) on index levels using manual segmentation and an automated pixel intensity threshold method to differentiate muscle from fat signal. Changes in the total cross-sectional area (TCSA), the functional cross-sectional area (FCSA), and the percentage of fat infiltration (FI) of these muscles were assessed. RESULTS A total of 67 patients (55.2% female, age 64.3 ± 10.6 years, BMI 26.9 ± 5.0 kg/m2) with 125 operated levels were included. Follow-up MRI scans were performed after an average of 8.7 ± 4.6 months, primarily for low back pain. Psoas muscle parameters did not change significantly, irrespective of the approach side. Among PPM parameters, the mean TCSA at L4/5 (+ 4.8 ± 12.4%; p = 0.013), and mean FI at L3/4 (+ 3.1 ± 6.5%; p = 0.002) and L4/5 (+ 3.0 ± 7.0%; p = 0.002) significantly increased. CONCLUSION Our study demonstrated that SA-LLIF did not alter psoas muscle morphology, underlining its minimally invasive nature. However, FI of PPM significantly increased over time despite the lack of direct tissue damage to posterior structures, suggesting a pain-mediated response and/or the result of segmental immobilization.
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Affiliation(s)
- Manuel Moser
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Department of Spine Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Dominik Adl Amini
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Cristian Echeverri
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Lisa Oezel
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedic Surgery and Traumatology, University Hospital Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Henryk Haffer
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Maximilian Muellner
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA.
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Haffer H, Chiapparelli E, Muellner M, Moser M, Dodo Y, Reisener MJ, Adl Amini D, Salzmann SN, Zhu J, Han YX, Donnelly E, Shue J, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Bone collagen quality in lumbar fusion patients: the association between volumetric bone mineral density and advanced glycation endproducts. Eur Spine J 2023; 32:1678-1687. [PMID: 36922425 PMCID: PMC10623215 DOI: 10.1007/s00586-023-07589-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/06/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE The sole determination of volumetric bone mineral density (vBMD) is insufficient to evaluate overall bone integrity. The accumulation of advanced glycation endproducts (AGEs) stiffens and embrittles collagen fibers. Despite the important role of AGEs in bone aging, the relationship between AGEs and vBMD is poorly understood. We hypothesized that an accumulation of AGEs, a marker of impaired bone quality, is related to decreased vBMD. METHODS Prospectively collected data of 127 patients undergoing lumbar fusion were analyzed. Quantitative computed tomography (QCT) measurements were performed at the lumbar spine. Intraoperative bone biopsies were obtained and analyzed with confocal fluorescence microscopy for fluorescent AGEs, both trabecular and cortical. Spearman's correlation coefficients were calculated to examine relationships between vBMD and fAGEs, stratified by sex. Multivariable linear regression analysis with adjustments for age, sex, body mass index (BMI), race, diabetes mellitus and HbA1c was used to investigate associations between vBMD and fAGEs. RESULTS One-hundred and twenty-seven patients (51.2% female, 61.2 years, BMI of 28.7 kg/m2) with 107 bone biopsies were included in the final analysis, excluding patients on anti-osteoporotic drug therapy. In the univariate analysis, cortical fAGEs increased with decreasing vBMD at (r = -0.301; p = 0.030), but only in men. In the multivariable analysis, trabecular fAGEs increased with decreasing vBMD after adjusting for age, sex, BMI, race, diabetes mellitus and HbA1c (β = 0.99;95%CI=(0.994,1.000); p = 0.04). CONCLUSION QCT-derived vBMD measurements were found to be inversely associated with trabecular fAGEs. Our results enhance the understanding of bone integrity by suggesting that spine surgery patients with decreased bone quantity may also have poorer bone quality.
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Affiliation(s)
- Henryk Haffer
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Erika Chiapparelli
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Maximilian Muellner
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Manuel Moser
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
- Department of Spine Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Yusuke Dodo
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Marie-Jacqueline Reisener
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Dominik Adl Amini
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stephan N Salzmann
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Jiaqi Zhu
- Department of Epidemiology and Biostatistics, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Yi Xin Han
- Department of Materials Science and Engineering, Cornell University, Ithaca, NY, USA
| | - Eve Donnelly
- Department of Materials Science and Engineering, Cornell University, Ithaca, NY, USA
- Musculoskeletal Integrity Program, Research Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Jennifer Shue
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Andrew A Sama
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Frank P Cammisa
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Federico P Girardi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Alexander P Hughes
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA.
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9
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Becker L, Adl Amini D, Ziegeler K, Muellner M, Diekhoff T, Hughes AP, Pumberger M. Approach-related anatomical differences in patients with lumbo-sacral transitional vertebrae undergoing lumbar fusion surgery at level L4/5. Arch Orthop Trauma Surg 2023; 143:1753-1759. [PMID: 34999995 PMCID: PMC10030414 DOI: 10.1007/s00402-021-04303-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 06/10/2021] [Accepted: 12/08/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Lumbo-sacral transitional vertebrae (LSTV) are accompanied by changes in soft tissue anatomy. The aim of our retrospective study was to evaluate the effects of LSTV as well as the number of free lumbar vertebrae on surgical approaches of ALIF, OLIF and LLIF at level L4/5. MATERIAL AND METHODS We assessed the CTs of 819 patients. Of these, 53 had LSTV from which 11 had six (6LV) and 9 four free lumbar vertebrae (4LV). We matched them for sex and age to a control group. RESULTS Patients with LSTV had a higher iliac crest and vena cava bifurcation, a greater distance between the common iliac veins and an anterior translation of the psoas muscle at level L4/5. In contrast, patients with 6LV had a lower iliac crest and aortic bifurcation, no differences in vena cava bifurcation and distance between the iliac veins compared to the control group. CONCLUSIONS For patients with LSTV and five or four free lumbar vertebrae, the LLIF approach at L4/5 may be hindered due to a high riding iliac crest as well as anterior shift of the psoas muscle. Whereas less mobilization and retraction of the iliac veins may reduce the risk of vascular injury at this segment by ALIF and OLIF. For patients with 6LV, a lower relative height of the iliac crest facilitates lateral approach during LLIF. For ALIF and OLIF, a stronger vessel retraction due to the deeper-seated vascular bifurcation is necessary during ALIF and is therefore potentially at higher risk for vascular injury.
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Affiliation(s)
- Luis Becker
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Dominik Adl Amini
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Maximilian Muellner
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th S, New York, NY, 10021, USA
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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10
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Adl Amini D, Wu CH, Perka C, Bäcker HC. Cure rate of infections is not an argument for spacer in two-stage revision arthroplasty of the hip. Arch Orthop Trauma Surg 2023; 143:2199-2207. [PMID: 35534712 PMCID: PMC10030410 DOI: 10.1007/s00402-022-04463-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 04/25/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION A devastating complication after total hip arthroplasty (THA) is chronic periprosthetic joint infection (PJI). Most frequently spacers (Sp) with or without antibiotics are implanted in a two-stage procedure even though not always indicated due to unknown pathogen, femoral and acetabular defects or muscular insufficiency. MATERIALS AND METHODS A retrospective analysis of a prospectively collected database was conducted, analyzing the treatment of 44 consecutive cases with chronic PJI undergoing two-stage revision using a Girdlestone situation (GS) in the interim period between 01/2015 and 12/2018. Diagnostics included intraoperative microbiological cultures, histological analysis, sonication of the initial implant, analysis of hip aspiration, as well as laboratory diagnostics and blood cultures. We analyzed the general and age-group-specific success rate of treatment using GS. Furthermore, we compared our data with the current literature on spacer implantation regarding common complications. RESULTS In total, 21 female and 23 male patients at a mean age of 59.3 ± 9.6 years were included. Age groups were divided into young, mid-age, and elderly. In most patients, microbiology revealed Staphylococcus epidermidis in 39.1% of cases, following Staphylococcus lugdunensis and Staphylococcus aureus in 10.9% after THA explantation. For histology, Krenn and Morawietz type 2 (infectious type) was diagnosed in 40.9%, type 3 (infectious and abrade-induced type) in 25.0%. With GS, the total cure rate was 84.1% compared to 90.1% (range 61-100%) using Sp as described in the literature. Among age-groups, cure rate varied between 77.8 and 100%. Other complications, which only occurred in the mid-age and elderly group, included the necessity of transfusion in 31.1%, and in total, one periprosthetic fracture was identified (2.3%). CONCLUSION GS shows an acceptable cure rate at a minimum of 2 years when compared to the cure rate reported in the literature for Sp without major complications. For patients with increased risks for treatment failure using spacer, GS seems to be an alternative for chronic PJI when looking at the success rate of treatment. LEVEL OF EVIDENCE III, Retrospective trial.
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Affiliation(s)
- Dominik Adl Amini
- Department of Orthopedic Surgery and Traumatology, Charité, University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Chia H Wu
- Department of Orthopedics & Sports Medicine, Baylor College of Medicine Medical Center, Houston, TX, USA
| | - Carsten Perka
- Department of Orthopedic Surgery and Traumatology, Charité, University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Henrik C Bäcker
- Department of Orthopedic Surgery and Traumatology, Charité, University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany
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11
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Muellner M, Chiapparelli E, Haffer H, Dodo Y, Salzmann SN, Adl Amini D, Moser M, Zhu J, Carrino JA, Tan ET, Shue J, Sama AA, Cammisa FP, Girardi FP, Hughes AP. The association between paraspinal muscle parameters and vertebral pedicle microstructure in patients undergoing lumbar fusion surgery. Int Orthop 2023; 47:1051-1060. [PMID: 36562815 PMCID: PMC10661537 DOI: 10.1007/s00264-022-05659-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/19/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Lumbar fusion surgery has become a standard procedure in spine surgery and commonly includes the posterior placement of pedicle screws. Bone quality is a crucial factor that affects pedicle screw purchase. However, the relationship between paraspinal muscles and the bone quality of the pedicle is unknown. The aim of the study was to determine the relationship between paraspinal muscles and the ex vivo bony microstructure of the lumbar pedicle. METHODS Prospectively, collected data of patients undergoing posterior lumbar fusion for degenerative spinal conditions was analyzed. Pre-operative lumbar magnetic resonance imaging (MRI) scans were evaluated for a quantitative assessment of the cross-sectional area (CSA), functional cross-sectional area (fCSA), and the proportion of intramuscular fat (FI) for the psoas muscle and the posterior paraspinal muscles (PPM) at L4. Intra-operative bone biopsies of the lumbar pedicle were obtained and analyzed with microcomputed tomography (µCT) scans. The following cortical (Cort) and trabecular (Trab) bone parameters were assessed: bone volume fraction (BV/TV), trabecular number (Tb.N), trabecular thickness (Tb.Th), connectivity density (CD), bone-specific surface (BS/BV), apparent density (AD), and tissue mineral density (TMD). RESULTS A total of 26 patients with a mean age of 59.1 years and a mean BMI of 29.8 kg/m2 were analyzed. fCSAPPM showed significant positive correlations with BV/TVTrab (ρ = 0.610; p < 0.001), CDTrab (ρ = 0.679; p < 0.001), Tb.NTrab (ρ = 0.522; p = 0.006), Tb.ThTrab (ρ = 0.415; p = 0.035), and ADTrab (ρ = 0.514; p = 0.007). Cortical bone parameters also demonstrated a significant positive correlation with fCSAPPM (BV/TVCort: ρ = 0.584; p = 0.002; ADCort: ρ = 0.519; p = 0.007). FIPsoas was negatively correlated with TMDCort (ρ = - 0.622; p < 0.001). CONCLUSION This study highlights the close interactions between the bone microstructure of the lumbar pedicle and the paraspinal muscle morphology. These findings give us further insights into the interaction between the lumbar pedicle microstructure and paraspinal muscles.
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Affiliation(s)
- Maximilian Muellner
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Erika Chiapparelli
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Henryk Haffer
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Yusuke Dodo
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Stephan N Salzmann
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
- Division of Orthopaedics, Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, 1090, Vienna, Austria
| | - Dominik Adl Amini
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Manuel Moser
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
- Department of Spine Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Jiaqi Zhu
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - John A Carrino
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, NY, USA
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, NY, USA
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA.
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12
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Oezel L, Memtsoudis SG, Moser M, Zhong H, Adl Amini D, Liu J, Poeran J, Shue J, Sama AA. Trends in use, outcomes, and revision procedures of anterior cervical disc replacement in the United States: a premiere database analysis from 2006-2019. Eur Spine J 2023; 32:667-681. [PMID: 36542166 DOI: 10.1007/s00586-022-07465-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/13/2022] [Accepted: 11/11/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE We sought to characterize trends in demographics, comorbidities, and postoperative complications among patients undergoing primary and revision cervical disc replacement (pCDR/rCDR) procedures. METHODS In this retrospective database study, the Premier Healthcare database was queried from 2006 to 2019. Annual proportions or medians were calculated for patient and hospital characteristics, comorbidities, and postoperative complications associated with CDR surgery. Trends were assessed using linear regression analyses with year of service as the sole predictor. RESULTS A total of 16,178 pCDR and 758 rCDR cases were identified, with a median (IQR) age of 46 (39; 53) and 51 (43; 60) years among patients, respectively. The annual number of both procedures increased between 2006 and 2019, from 135 to 2220 for pCDR (p < 0.001), and from 17 to 49 for rCDR procedures (p < 0.001), with radiculopathy being the main indication for surgery in both groups. Mechanical failure was identified as a major indication for rCDR procedures with an increase over time (p = 0.002). Baseline patient comorbidity burden (p = 0.045) and complication rates (p < 0.001) showed an increase. For both procedures, an increase in outpatient surgeries and procedures performed in rural hospitals was seen (pCDR: p = 0.045; p = 0.006; rCDR: p = 0.028; p = 0.034). CONCLUSION PCDR and rCDR procedures significantly increased from 2006 to 2019. At the same time, comorbidity burden and complication rates increased, while procedures were more often performed in an outpatient and rural setting. The identification of these trends can help guide future practice and lead to further areas of research.
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Affiliation(s)
- Lisa Oezel
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedic Surgery and Traumatology, University Hospital Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Stavros G Memtsoudis
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Manuel Moser
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Department of Spine Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Haoyan Zhong
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Dominik Adl Amini
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedic Surgery and Traumatology, Charité University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Jiabin Liu
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Jashvant Poeran
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Institute for Healthcare Delivery Science, Department of Population Health Science & Policy/ Department of Orthopedics/ Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L.Levy Pl, New York, NY, 10029, USA
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
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13
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Haffer H, Chiapparelli E, Moser M, Muellner M, Dodo Y, Adl Amini D, Zhu J, Miller TT, Han YX, Donnelly E, Shue J, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Dermal ultrasound measurements for bone quality assessment : An investigation of advanced glycation endproducts derived from confocal fluorescence microscopy. J Orthop Res 2023; 41:345-354. [PMID: 35470915 PMCID: PMC9596615 DOI: 10.1002/jor.25350] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 02/04/2023]
Abstract
Bone quality is increasingly being recognized in the assessment of fracture risk. Nonenzymatic collagen cross-linking with the accumulation of advanced glycation end products stiffens and embrittles collagen fibers thus increasing bone fragility. Echogenicity is an ultrasound (US) parameter that provides information regarding the skin collagen structure. We hypothesized that both skin and bone collagen degrade in parallel fashion. Prospectively collected data of 110 patients undergoing posterior lumbar fusion was analyzed. Preoperative skin US measurements were performed in the lumbar region to assess dermal thickness and echogenicity. Intraoperative bone biopsies from the posterior superior iliac spine were obtained and analyzed with confocal fluorescence microscopy for fluorescent advanced glycation endproducts (fAGEs). Pearson's correlation was calculated to examine relationships between (1) US and fAGEs, and (2) age and fAGEs stratified by sex. Multivariable linear regression analysis with adjustments for age, sex, body mass index (BMI), diabetes mellitus, and hemoglobin A1c (HbA1c) was used to investigate associations between US and fAGEs. One hundred and ten patients (51.9% female, 61.6 years, BMI 29.8 kg/m2 ) were included in the analysis. In the univariate analysis cortical and trabecular fAGEs decreased with age, but only in women (cortical: r = -0.32, p = 0.031; trabecular: r = -0.32; p = 0.031). After adjusting for age, sex, BMI, diabetes mellitus, and HbA1c, lower dermal (β = 1.01; p = 0.012) and subcutaneous (β = 1.01; p = 0.021) echogenicity increased with increasing cortical fAGEs and lower dermal echogenicity increased with increasing trabecular fAGEs (β = 1.01; p = 0.021). This is the first study demonstrating significant associations between skin US measurements and in vivo bone quality parameters in lumbar fusion patients. As a noninvasive assessment tool, skin US measurements might be incorporated into future practice to investigate bone quality in spine surgery patients.
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Affiliation(s)
- Henryk Haffer
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Erika Chiapparelli
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Manuel Moser
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
- Department of Spine Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Maximilian Muellner
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Yusuke Dodo
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Dominik Adl Amini
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jiaqi Zhu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Theodore T. Miller
- Department of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Yi Xin Han
- Department of Materials Science and Engineering, Cornell University, Ithaca, NY, USA
| | - Eve Donnelly
- Department of Materials Science and Engineering, Cornell University, Ithaca, NY, USA
- Musculoskeletal Integrity Program, Research Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Jennifer Shue
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Andrew A. Sama
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Frank P. Cammisa
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Federico P. Girardi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Alexander P. Hughes
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
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14
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Moser M, Adl Amini D, Jones C, Zhu J, Okano I, Oezel L, Chiapparelli E, Tan ET, Shue J, Sama AA, Cammisa FP, Girardi FP, Hughes AP. The predictive value of psoas and paraspinal muscle parameters measured on MRI for severe cage subsidence after standalone lateral lumbar interbody fusion. Spine J 2023; 23:42-53. [PMID: 35351664 DOI: 10.1016/j.spinee.2022.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 01/24/2022] [Revised: 03/03/2022] [Accepted: 03/22/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND CONTEXT The effect of psoas and paraspinal muscle parameters on cage subsidence after minimally invasive techniques, such as standalone lateral lumbar interbody fusion (SA-LLIF), is unknown. PURPOSE This study aimed to determine whether the functional cross-sectional area (FCSA) of psoas and lumbar spine extensor muscles (multifidus and erector spinae), and psoas FCSA normalized to the vertebral body area (FCSA/VBA) differ among levels with severe cage subsidence after SA-LLIF when compared to levels without severe cage subsidence. STUDY DESIGN Retrospective single center cohort study. PATIENT SAMPLE Patients who underwent SA-LLIF between 2008 and 2020 for degenerative conditions using exclusively polyetheretherketone (PEEK) cages, had a lumbar magnetic resonance imaging (MRI) scan within 12 months, a lumbar computed tomography (CT) scan within 6 months prior to surgery, and a postoperative clinical and radiographic follow-up at a minimum of 6 months were included. OUTCOME MEASURES Severe cage subsidence. METHODS MRI measurements included psoas and combined multifidus and erector spinae (paraspinal) FCSA and FCSA/VBA at the L3-L5 pedicles. Following manual segmentation of muscles on axial T2-weighted images using ITK-SNAP (version 3.8.0), the FCSA was calculated using a custom written program on Matlab (version R2019a, The MathWorks, Inc.) that used an automated pixel intensity threshold method to differentiate between fat and muscle. Mean volumetric bone mineral density (vBMD) at L1/2 was measured by quantitative CT. The primary endpoint was severe cage subsidence per level according to the classification by Marchi et al. Multivariable logistic regression analysis was performed using generalized linear mixed models. All analyses were stratified by biological sex. RESULTS 95 patients (45.3% female) with a total of 188 operated levels were included in the analysis. The patient population was 92.6% Caucasian with a median age at surgery of 65 years. Overall subsidence (Grades 0-III) was 49.5% (53/107 levels) in men versus 58.0% (47/81 levels) in women (p=.302), and severe subsidence (Grades II-III) was 22.4% (24/107 levels) in men versus 25.9% (21/81 levels) in women (p=.608). In men, median psoas FCSA and psoas FCSA/VBA at L3 and L4 were significantly greater in the severe subsidence group when compared to the non-severe subsidence group. No such difference was observed in women. Paraspinal muscle parameters did not differ significantly between non-severe and severe subsidence groups for both sexes. In the multivariable logistic regression analysis with adjustments for vBMD and cage length, psoas FCSA at L3 (OR 1.002; p=.020) and psoas FCSA/VBA at L3 (OR 8.655; p=.029) and L4 (OR 4.273; p=.043) were found to be independent risk factors for severe cage subsidence in men. CONCLUSIONS Our study demonstrated that greater psoas FCSA at L3 and psoas FCSA/VBA at L3 and L4 were independent risk factors for severe cage subsidence in men after SA-LLIF with PEEK cages. The higher compressive forces the psoas exerts on lumbar segments as a potential stabilizer might explain these findings. Additional pedicle screw fixation might be warranted in these patients to avoid severe cage subsidence.
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Affiliation(s)
- Manuel Moser
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th St, New York, NY 10021, USA; Department of Spine Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000 Lucerne, Switzerland
| | - Dominik Adl Amini
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th St, New York, NY 10021, USA; Department of Orthopedic Surgery and Traumatology, Charité University Hospital Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Conor Jones
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th St, New York, NY 10021, USA; Department of Orthopedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Chicago, IL 60612, USA
| | - Jiaqi Zhu
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th St, New York, NY 10021, USA
| | - Ichiro Okano
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th St, New York, NY 10021, USA; Department of Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
| | - Lisa Oezel
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th St, New York, NY 10021, USA; Department of Orthopedic Surgery and Traumatology, University Hospital Duesseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany
| | - Erika Chiapparelli
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th St, New York, NY 10021, USA
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th St, New York, NY 10021, USA
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th St, New York, NY 10021, USA
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th St, New York, NY 10021, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th St, New York, NY 10021, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th St, New York, NY 10021, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th St, New York, NY 10021, USA.
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Moser M, Okano I, Albertini Sanchez L, Salzmann SN, Carlson BB, Adl Amini D, Oezel L, Chiapparelli E, Tan ET, Shue J, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Preoperative Association Between Quantitative Lumbar Muscle Parameters and Spinal Sagittal Alignment in Lumbar Fusion Patients. Spine (Phila Pa 1976) 2022; 47:1675-1686. [PMID: 36255371 DOI: 10.1097/brs.0000000000004410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/04/2022] [Indexed: 11/05/2022]
Abstract
STUDY DESIGN A retrospective cross-sectional study. OBJECTIVE To assess the association between spinal muscle morphology and spinopelvic parameters in lumbar fusion patients, with a special emphasis on lumbar lordosis (LL). SUMMARY OF BACKGROUND DATA Maintenance of sagittal alignment relies on muscle forces, but the basic association between spinal muscles and spinopelvic parameters is poorly understood. MATERIALS AND METHODS Patients operated between 2014 and 2017 who had both lumbar magnetic resonance imaging scan and standing whole-spine radiographs within six months before surgery were included. Muscle measurements were conducted on axial T2-weighted magnetic resonance images at the superior endplate L3-L5 for the psoas and L3-S1 for combined multifidus and erector spinae (paraspinal) muscles. A pixel intensity threshold method was used to calculate the total cross-sectional area (TCSA) and the functional cross-sectional area (FCSA). Spinopelvic parameters were measured on lateral standing whole-spine radiographs and included LL, pelvic incidence (PI), PI-LL mismatch, pelvic tilt, sacral slope, thoracic kyphosis, and sagittal vertical axis. Analyses were stratified by biological sex. Multivariable linear regression analyses with adjustments for age and body mass index (BMI) were performed. RESULTS A total of 104 patients (62.5% female) were included in the analysis. The patient population was 90.4% White with a median age at surgery of 69 years and a median BMI of 27.8 kg/m 2 . All muscle measurements were significantly smaller in women. PI, pelvic tilt, and thoracic kyphosis were significantly greater in women. PI-LL mismatch was 6.1° (10.6°) in men and 10.2° (13.5°) in women ( P =0.106), and sagittal vertical axis was 45.3 (40.8) mm in men and 35.7 (40.8) mm in women ( P =0.251). After adjusting for age and BMI, paraspinal TCSA at L3-L5, and paraspinal FCSA at L4 showed significant positive associations with LL in women. In men, psoas TCSA at L5 and psoas FCSA at L5 showed significant negative associations with LL, but none of the paraspinal muscle measurements. CONCLUSION Our findings indicate that psoas and lumbar spine extensor muscles interact differently on LL among men and women, creating a unique mechanical environment. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Manuel Moser
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY
- Department of Spine Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Ichiro Okano
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Leonardo Albertini Sanchez
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Stephan N Salzmann
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY
- Department of Orthopedic Surgery and Traumatology, Medical University of Vienna, Vienna, Austria
| | - Brandon B Carlson
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY
- Marc A. Asher, MD, Comprehensive Spine Center, University of Kansas Medical Center, Kansas City, KS
| | - Dominik Adl Amini
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lisa Oezel
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY
- Department of Orthopedic Surgery and Traumatology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Erika Chiapparelli
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY
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Adl Amini D, Thiele K, Hanlon J, Wu CH, Stöckle U, Bäcker HC, Dahne M. Percutaneous elevation of radial head fractures without fixation – a promising technique. JSES Reviews, Reports, and Techniques 2022. [DOI: 10.1016/j.xrrt.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Muellner M, Haffer H, Moser M, Chiapparelli E, Dodo Y, Adl Amini D, Carrino JA, Tan ET, Shue J, Zhu J, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Paraspinal musculature impairment is associated with spinopelvic and spinal malalignment in patients undergoing lumbar fusion surgery. Spine J 2022; 22:2006-2016. [PMID: 35944826 PMCID: PMC10623672 DOI: 10.1016/j.spinee.2022.07.103] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/05/2022] [Accepted: 07/30/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The concept of sagittal spinal malalignment is well established in spinal surgery. However, the effect of musculature on its development has not been fully considered and the position of the pelvis is mostly seen as compensatory and not necessarily a possible cause of sagittal imbalance. PURPOSE This study aimed to investigate the influence of the posterior paraspinal muscles (PPM, erector spinae, and multifidus) and the psoas muscle on spinopelvic and spinal alignment. STUDY DESIGN/SETTING Retrospective cross-sectional study. PATIENT SAMPLE Patients undergoing posterior lumbar fusion between 2014 and 2021 for degenerative conditions at a tertiary care center, with preoperative lumbar magnetic resonance imaging (MRI) within 12 months prior the surgery and a preoperative whole spine radiograph were included. OUTCOME MEASURES PPM and psoas muscle measurements including the cross-sectional area (CSA), the functional cross-sectional area (fCSA), the amount of intramuscular fat (FAT), and the percentage of fat infiltration (FI). Spinopelvic measurements including lumbar lordosis (LL), pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI), and sagittal vertical axis (SVA). METHODS A T2-weighted MRI-based quantitative assessment of the CSA, the fCSA and the amount FAT was conducted, and FI was further calculated. The regions of interest included the psoas muscle and the PPM on both sides at the L4 level that were summarized and normalized by the patient's height (cm2/m2). LL, PT, SS, PI, and SVA were determined on standing lateral radiographs. Spearman correlation was used to calculate the crude relationship between spinopelvic and muscle parameters. Multiple linear regression models with age, sex, LL, PT, SS, and SVA set as independent variables were established to determine the association with spinal muscle outcome measures. RESULTS A total of 150 patients (53.3% female) were included in the final analysis with a median age of 65.6 years and a median BMI of 28.2 kg/m2. Significant positive correlations were observed between PT (ρ=0.327), SVA (ρ=0.256) and PI (ρ=0.202) and the FIPPM. Significant negative correlations were detected for the PT and the fCSAPPM (ρ=-0.202) and PT and the fCSAPsoas (ρ=-0.191). Furthermore, a negative correlation was seen for PI and SVA and FIPsoas. PT (β=0.187; p=.006), SVA (β=0.155; p=.035), age (β=0.468; p<.001) and sex (β=0.235; p<.001) significantly predict FIPPM (corrected R2=0.393) as independent variables. CONCLUSIONS This study demonstrated the potential role of posterior paraspinal muscles and psoas muscle on pelvic retroversion and elucidated the relation to sagittal spinal malalignment. Although we cannot establish causality, we propose that increasing FIPPM, representing loss of muscular strength, may lead to increased pelvic retroversion and thus might be the initiating point for the development of the sagittal imbalance. These findings might challenge the well-known theory of increased pelvic retroversion being a compensatory mechanism for sagittal spinal balance. Thus, muscular weakness might be a factor involved in the development of sagittal spinal malalignment.
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Affiliation(s)
- Maximilian Muellner
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th St, New York City, NY 10021, USA; Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Henryk Haffer
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th St, New York City, NY 10021, USA; Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Manuel Moser
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th St, New York City, NY 10021, USA; Department of Spine Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Erika Chiapparelli
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th St, New York City, NY 10021, USA
| | - Yusuke Dodo
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th St, New York City, NY 10021, USA
| | - Dominik Adl Amini
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th St, New York City, NY 10021, USA; Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - John A Carrino
- Department of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th St, New York City, NY 10021, USA
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, New York City, NY, USA
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th St, New York City, NY 10021, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th St, New York City, NY 10021, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th St, New York City, NY 10021, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th St, New York City, NY 10021, USA.
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Jones C, Okano I, Arzani A, Dodo Y, Moser M, Reisener MJ, Chiapparelli E, Adl Amini D, Shue J, Sama AA, Cammisa FP, Girardi FP, Hughes AP. The predictive value of a novel site-specific MRI-based bone quality assessment, endplate bone quality (EBQ), for severe cage subsidence among patients undergoing standalone lateral lumbar interbody fusion. Spine J 2022; 22:1875-1883. [PMID: 35843534 DOI: 10.1016/j.spinee.2022.07.085] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/18/2022] [Accepted: 07/11/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Studies have shown that site-specific bone density measurements had more predictive value for complications than standard whole-region measurements. Recently, MRI-based assessments of vertebral bone quality (VBQ) were introduced. However, there have been few studies that investigate the association between site-specific MRI bone assessment and osteoporosis-related complications in patients undergoing lumbar interbody fusion. In this work, we created a novel site-specific MRI-based assessment of the endplate bone quality (EBQ) and assessed its predictive value for severe cage subsidence following standalone lateral lumbar interbody fusion (SA-LLIF). PURPOSE To investigate the predictive value of a novel MRI-based bone assessment for severe cage subsidence after SA-LLIF. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE Patients who underwent SA-LLIF from 2008 to 2019 at a single, academic institution with available preoperative lumbar CT and T1-weighted MRIs. OUTCOME MEASURES Association between EBQ and severe subsidence after SA-LLIF. METHODS We retrospectively reviewed the records of SA-LLIF patients treated between 2008 and 2019. EBQ was measured using preoperative non-contrast T1-weighted MRIs of the lumbar spine. EBQ was defined as the average value of signal intensity of both endplates divided by that of the cerebrospinal fluid space at the level of L3. Bivariate and multivariable analyses with generalized linear mixed models were performed and set binary severe subsidence as the outcome. RESULTS Two hundred five levels in 89 patients were included. Fifty levels (24.4%) demonstrated severe subsidence. Bone mineral density measured by quantitative computed tomography was significantly lower in the subsidence group. Both VBQ and EBQ were significantly higher in the subsidence group. The EBQ plus Modic change (MC) model demonstrated that the effect of EBQ was independent of MC. In multivariate analyses adjusted with QCT-vBMD, EBQ showed a significant association with cage subsidence whereas VBQ only showed a marginal trend. The EBQ-based prediction model for severe subsidence showed better goodness of fit compared to the VBQ-based model. CONCLUSIONS High EBQ was an independent factor for severe cage subsidence after SA-LLIF and the EBQ-based model showed better goodness of fit compared to VBQ- or MC-based models. EBQ assessment before SA-LLIF may provide insight into a patient's risk for severe subsidence.
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Affiliation(s)
- Conor Jones
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Ichiro Okano
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA; Department of Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666 Japan
| | - Artine Arzani
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Yusuke Dodo
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA; Department of Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666 Japan
| | - Manuel Moser
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | | | - Erika Chiapparelli
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Dominik Adl Amini
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
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Adl Amini D, Herbolzheimer M, Lutz PM, Lacheta L, Oezel L, Haffer H, Schömig F, Schreiner A, Limmer J, Muellner M. Effects of the SARS-CoV‑2 pandemic on residency training in orthopedics and traumatology in Germany : A nationwide survey. Orthopadie (Heidelb) 2022; 51:844-852. [PMID: 36006432 PMCID: PMC9406266 DOI: 10.1007/s00132-022-04295-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The spread of the coronavirus disease has impacted healthcare systems worldwide; however, restrictions due to the SARS-CoV‑2 (severe acute respiratory syndrome coronavirus 2) pandemic are particularly drastic for physicians in residency training. Imposed restrictions interrupt the standard educational curricula, and consequently limited residents to meet mandatory requirements. AIM The aim of this study was to evaluate the effects of the SARS-CoV‑2 pandemic on residency training in orthopedics and trauma surgery in Germany. METHODOLOGY An online-based, voluntary, and anonymous survey of physicians in residency training for orthopedics and trauma surgery was conducted. Through email lists of junior physician organizations the survey was sent to 789 physicians. Participation was possible between October and November 2021. RESULTS A total of 95 participants (female 41.1%) with a mean age of 31.3 ± 2.8 years were analyzed. In the everyday clinical practice and care 80% of participants thought that they were set back in time of their general training due to the pandemic. There was an average reduction of 25.0% in time spent in the OR and 88.4% agreed that their surgical training was delayed due to the pandemic. Of the respondents 33.6% were able to attend external continuing education courses. Only 4.2% were able to invest more time in research and 55.8% of participants agreed that their residency training will be extended due to the pandemic. CONCLUSION The COVID pandemic has had a significant impact on the residency training in orthopedics and trauma surgery in Germany. In almost all areas of training, residents had to accept restrictions due to the imposed restrictions, which potentially negatively affected their training.
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Affiliation(s)
- Dominik Adl Amini
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
| | | | - Patricia Maria Lutz
- Department for Trauma Surgery, Feldkirch Academic Hospital, Feldkirch, Austria
| | - Lucca Lacheta
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Lisa Oezel
- Department of Orthopedic Surgery and Traumatology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Henryk Haffer
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Friederike Schömig
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Anna Schreiner
- Department for Trauma and Reconstructive Surgery, BG Unfallklinik Tübingen, University of Tübingen, Tübingen, Germany
| | - Jonas Limmer
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Maximilian Muellner
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
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Muellner M, Chiapparelli E, Moser M, Haffer H, Dodo Y, Adl Amini D, Carrino JA, Tan ET, Shue J, Zhu J, Sama AA, Cammisa FP, Girardi FP, Hughes AP. The effect of age on psoas and paraspinal muscle morphology in patients undergoing posterior lumbar fusion surgery. Eur Spine J 2022; 31:2619-2628. [PMID: 35984509 PMCID: PMC10583000 DOI: 10.1007/s00586-022-07346-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/16/2022] [Accepted: 07/28/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE The aim of this study was to determine the effect of age on the psoas and posterior paraspinal muscles (PPM; multifidus muscle and erector spinae) and to evaluate potential sex-related differences. METHODS MRI-based quantitative assessments of the cross-sectional area (CSA), the functional cross-sectional area (fCSA), the fat area (FAT) and the proportion of intramuscular fat (FI) were conducted on patients undergoing lumbar fusion surgery between 2014 and 2021. The regions of interest were the psoas muscle and the PPM at the superior endplate of L4. The left and right sides of the muscle groups were summarized and normalized by the patient's height (cm2/m2). The relationships between age and muscular parameters were analyzed stratified by sex. RESULTS A total of 195 patients (57.9%female) with a median age of 64.2 years and a body mass index of 28.3 kg/m2 were analyzed. The CSAPsoas was 7.7 cm2/m2 and differed significantly between females and males (p < 0.001); likewise, the fCSAPsoas differed significantly between the sexes. The CSAPPM was 18.8 cm2/m2 with no sex-specific differences. Significant differences were found in the FIPPM (males: 41.1% vs. females: 47.9%; p < 0.001), but not in the FIPsoas (males: 3.7% vs. females: 4.5%; p = 0.276). Considering the effect of age on FI, a significant positive correlation was observed for the PPMs for both sexes. Only in women, there was a negative correlation between age and CSAPsoas (ρ = - 0.248; p = 0.008), FATPsoas (ρ = - 0.421; p < 0.001) and FIPsoas (ρ = - 0.371; p < 0.001). CONCLUSION This study demonstrated sex-specific differences in spinal muscle morphology in relation to patient age. With increasing age there was a decrease in FIPsoas in women only, unlike in the PPMs in which there was increased FI that was significantly higher in women compared to men.
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Affiliation(s)
- Maximilian Muellner
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Erika Chiapparelli
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Manuel Moser
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Department of Spine Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Henryk Haffer
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Yusuke Dodo
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Dominik Adl Amini
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany
| | - John A Carrino
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, NY, USA
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, NY, USA
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, New York City, NY, USA
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA.
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Adl Amini D, Moser M, Oezel L, Shue J, Pumberger M, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Fusion assessment in standalone lateral lumbar interbody fusion: 3D-printed titanium versus polyetheretherketone (PEEK) cages. J Spine Surg 2022; 8:323-332. [PMID: 36285103 PMCID: PMC9547697 DOI: 10.21037/jss-22-17] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 07/07/2022] [Indexed: 11/15/2022]
Abstract
Background Compare fusion at two independent timepoints (early and late) between 3D-printed titanium (Ti) and polyetheretherketone (PEEK) cages in patients undergoing standalone lateral lumbar interbody fusion (SA-LLIF). We hypothesized that 3D-printed Ti cages show higher fusion rates at an early timepoint compared to PEEK. Methods A retrospective study of patients undergoing SA-LLIF with 3D-printed Ti cages and PEEK cages between 11/2016 and 01/2020 at a single academic institution was done. Fusion was assessed for each treated level using multiplanar reconstructed computed tomography (CT) scans. Presence of fully bridged interbody trabecular bone or continuous bone centered in the cage was considered as fusion. Results In total, 91 patients (136 levels) were included in the final analysis, 49 patients (72 levels) in the early group and 42 patients (64 levels) in the late group. CT scans were performed on average 8.2±1.8 months postoperatively for the early group and 18.9±7.7 months for the late group. In the early group, fusion was significantly higher for 3D-printed Ti cages compared to PEEK cages (95.8% versus 62.5%; P=0.002), whereas in the late group no significant difference was seen (94.7% versus 80.0%; P=0.258). Conclusions In SA-LLIF, porous 3D-printed Ti cages showed significantly higher fusion rates at an early timepoint compared to PEEK. However, the difference in fusion rates between 3D-printed Ti cages and PEEK cages was found not to be significantly different at a later timepoint in another patient group. This might support the assumption that 3D-printed Ti cages with a porous architecture are more osteoconductive compared to PEEK and tend to fuse earlier.
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Affiliation(s)
- Dominik Adl Amini
- Spine Care Institute, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopedic Surgery and Traumatology, Charité University Hospital Berlin, Berlin, Germany
| | - Manuel Moser
- Spine Care Institute, Hospital for Special Surgery, New York, NY, USA
- Department of Spine Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Lisa Oezel
- Spine Care Institute, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopedic Surgery and Traumatology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, New York, NY, USA
| | - Matthias Pumberger
- Department of Orthopedic Surgery and Traumatology, Charité University Hospital Berlin, Berlin, Germany
| | - Andrew A. Sama
- Spine Care Institute, Hospital for Special Surgery, New York, NY, USA
| | - Frank P. Cammisa
- Spine Care Institute, Hospital for Special Surgery, New York, NY, USA
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22
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Moser M, Adl Amini D, Okano I, Oezel L, Shue J, Carrino JA, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Trabecular volumetric bone mineral density of the occipital bone at preferred screw placement sites measured by quantitative computed tomography. J Orthop Res 2022; 40:1909-1917. [PMID: 34862648 DOI: 10.1002/jor.25224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/13/2021] [Accepted: 11/20/2021] [Indexed: 02/04/2023]
Abstract
This study aimed at quantifying trabecular volumetric bone mineral density (vBMD) at the external occipital protuberance (EOP) and the upper cervical spine. A retrospective review of patients who underwent non-contrast enhanced computed tomography of the cervical spine that included the occipital bone up to the EOP between 2007 and 2020 was conducted. Measurements of trabecular vBMD were performed in the occipital midline area, with the region of interest extending 4.5 mm above and below the center of the EOP, as well as the C1 lateral masses and the C2 vertebral body using asynchronous quantitative computed tomography. Eighty-six patients (female, 37.2%) were included for analysis. The patient population was 81.4% Caucasian with a mean ± SD age of 62.3 ± 13.1 years. Total bone thickness at the EOP was 16.7 ± 3.4 mm, with a ratio of trabecular to total bone thickness of 0.44. Trabecular vBMD (mean ± SD) was significantly higher at the EOP than at C1 and C2 (EOP = 612.3 ± 145.8 mg/cm3 , C1 average = 290.3 ± 66.5 mg/cm3 , C2 = 305.8 ± 78.8 mg/cm3 ; p < 0.001). A significant strong correlation between trabecular vBMD of C1 and C2 was observed (r = 0.744; p < 0.001), but only low correlations between the EOP and C1 (r = 0.295; p = 0.008) and C2 (r = 0.413; p < 0.001). In individuals > 65 years of age, cervical vBMD was significantly lower, but remained high at the EOP. Clinical significance: Trabecular vBMD at the EOP is significantly higher than at the upper cervical vertebrae and remains high in older populations. Together with morphological information about the occipital bone, these results might be helpful for occipitocervical fixation when deciding about uni- or bicortical screw placement at the EOP.
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Affiliation(s)
- Manuel Moser
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Dominik Adl Amini
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA.,Department of Orthopaedic Surgery and Traumatology, Charité University Hospital Berlin, Berlin, Germany
| | - Ichiro Okano
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA.,Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Lisa Oezel
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA.,Department of Orthopaedic Surgery and Traumatology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Jennifer Shue
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - John A Carrino
- Department of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Andrew A Sama
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Frank P Cammisa
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Federico P Girardi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Alexander P Hughes
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
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23
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Oezel L, Hughes AP, Arzani A, Okano I, Amini DA, Moser M, Sama AA, Cammisa FP, Soffin EM. Surgeon-Placed Erector Spinae Plane Catheters for Multilevel Lumbar Spine Fusion: Technique and Outcomes Compared With Single-Shot Blocks. Int J Spine Surg 2022; 16:8300. [PMID: 35835575 PMCID: PMC9421284 DOI: 10.14444/8300] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Postoperative pain management of multilevel lumbar fusion remains challenging. There are few reports of opioid-sparing regional analgesia for spine surgery. We present a novel method for surgeon-placed erector spinae plane (ESP) catheters for multilevel lumbar spine fusion and compare pain- and opioid-related outcomes in a matched cohort who received anesthesiologist-placed ESP blocks. METHODS A retrospective matched pilot study of 18 patients: 6 received intraoperative, bilateral ESP catheters. Tunneled catheters were placed under the intact ESP at the proximal end of the incision. Continuous infusions of ropivacaine (0.2%) were started in the postanesthesia care unit (PACU) after emergence from anesthesia and maintained for 48 hours. Catheter patients were matched 1:2 with 12 patients who received preincision single-shot ESP blocks administered by an anesthesiologist, according to age, gender, American Society of Anesthesiologists class, body mass index, and number of spinal levels fused. All patients were provided opioid intravenous patient-controlled analgesia (IV-PCA). Numeric rating scale pain scores (NRS, 0-10), length of stay (LOS), opioid consumption (oral morphine equivalents, mg), opioid side effects, and complications (motor weakness, local anesthetic toxicity, infection, technical issues, and failure), were compared in the PACU and on the nursing floor. RESULTS Only 1/6 patients with ESP catheter used opioid IV-PCA, compared with 11/12 who received ESP blocks. There were no differences in total opioid consumption (catheters: 135 ± 141 mg; blocks: 183 ± 112 mg; P = 0.448) or median (interquartile range) LOS (catheters: 73 [50,107] hours; blocks: 90 [72,116] hours, P = 0.708). NRS pain was significantly higher in the PACU after ESP catheters (5.9 ± 1.7) vs ESP blocks (3.3 ± 2.4; P = 0.036), but no differences were found at later timepoints (5.0 ± 1.6 vs 4.3 ± 1.1, respectively; P = 0.383). No catheter-related complications were found. CONCLUSION Surgeon-placed ESP catheters represent a simple technique to provide regional analgesia, particularly in centers lacking regional anesthesiology services. Risks, benefits, and efficacy compared to other techniques require prospective study. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Lisa Oezel
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopaedic and Trauma Surgery, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Alexander P Hughes
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, NY, USA
| | - Artine Arzani
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, NY, USA
| | - Ichiro Okano
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, NY, USA
| | - Dominik Adl Amini
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopaedic Surgery and Traumatology, Charité University Hospital, Berlin, Germany
| | - Manuel Moser
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, NY, USA
| | - Andrew A Sama
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, NY, USA
| | - Frank P Cammisa
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, NY, USA
| | - Ellen M Soffin
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA
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24
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Salzmann SN, Okano I, Miller CO, Chiapparelli E, Reisener MJ, Amini DA, Winter F, Shue J, Carrino JA, Sama AA, Cammisa FP, Girardi FP, Hughes AP. The cervical spine demonstrates less postoperative bone loss than the lumbar spine. J Orthop Res 2022; 40:654-660. [PMID: 33914982 DOI: 10.1002/jor.25069] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 02/04/2023]
Abstract
The objective of this study is to determine the bone mineral density (BMD) changes in adjacent vertebra following anterior cervical discectomy and fusion (ACDF). Consecutive patients undergoing ACDF with available preoperative and postoperative computed tomography (CT) imaging were included. Quantitative CT measurements of screw-free cervical and first thoracic vertebra were performed. Comparisons between pre- and postoperative BMD in the vertebrae one or two levels above the upper instrumented vertebra (UIV + 1, UIV + 2) and one level below the lowest instrumented vertebra (LIV + 1) were assessed. Seventy-two patients (men, 66.7%) met the inclusion criteria. The patient population was 91.7% Caucasian with a mean age of 55.0 years. The mean interval (±SD) between surgery and secondary CT was 157 ± 23 days. Preoperative BMD (±SD) in UIV + 1 was 300.6 ± 66.2 mg/cm3 . There was a significant BMD loss of 1.5% at UIV + 1 after surgery, resulting in a postoperative BMD of 296.2 ± 64.8 mg/cm3 (p = .029). At UIV + 2 and LIV + 1, no significant differences between pre- and postoperative BMD (304.7 ± 75.7 mg/cm3 vs. 299.8 ± 74.3 mg/cm3 , 197.3 ± 50.4 mg/cm3 vs. 200.8 ± 48.7 mg/cm3 , p = .113 and p = .078, respectively) were observed. Clinical significance Our results demonstrate a small BMD decrease of 1.5% at UIV + 1. This suggests that the effect of ACDF surgery on the adjacent levels might be smaller compared to the previously described lumbar BMD loss of 10%-20% following posterior lumbar fusion procedures.
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Affiliation(s)
- Stephan N Salzmann
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Ichiro Okano
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Courtney Ortiz Miller
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Erika Chiapparelli
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Marie-Jacqueline Reisener
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Dominik Adl Amini
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA.,Department of Orthopaedic Surgery and Traumatology, Charité University Hospital Berlin Chariteplatz 1, Berlin, Germany
| | - Fabian Winter
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Jennifer Shue
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - John A Carrino
- Department of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Andrew A Sama
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Frank P Cammisa
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Federico P Girardi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Alexander P Hughes
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
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Adl Amini D, Moser M, Oezel L, Zhu J, Okano I, Shue J, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Early Outcomes of 3D-printed Porous Titanium versus Polyetheretherketone (PEEK) Cage Implantation for Standalone Lateral Lumbar Interbody Fusion in the Treatment of Symptomatic Adjacent Segment Degeneration. World Neurosurg 2021; 162:e14-e20. [PMID: 34863938 DOI: 10.1016/j.wneu.2021.11.122] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/26/2021] [Accepted: 11/27/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study compared outcomes of 3D-printed porous titanium (Ti) versus polyetheretherketone (PEEK) cage implantation for standalone lateral lumbar interbody fusion (SA-LLIF) in the treatment of symptomatic adjacent segment degeneration (ASD). METHODS 44 patients (59 levels) underwent SA-LLIF with Ti or PEEK cages between 10/2016 and 07/2020. The primary outcome was cage subsidence according to Marchi et al. Secondary outcomes included revision/recommendations for revision surgery, back/leg pain severity, changes in disc/foraminal height and global/segmental lumbar lordosis. RESULTS 44 patients (21 female) were included with a mean age at surgery of 61.8±11.5 years, average radiological follow-up of 12.5±8.2 and clinical follow-up of 11.0±7.1 months. The overall subsidence rate was significantly less in the Ti versus PEEK group (20% vs. 58.8%; p=0.004). Revision was recommended to none of the patients in the Ti and 3 in the PEEK group (p=0.239). Furthermore, patients in the Ti group showed significantly better improvement in back pain NRS score (p=0.001). Disc height (p<0.001) and foraminal height restoration (p=0.011) were statistically significant in the Ti group, whereas only disc height restoration was significant in the PEEK group (p=0.003). CONCLUSION In patients undergoing SA-LLIF for ASD treatment, 3D-printed Ti cages had significantly lower overall subsidence rate compared to PEEK cages. Furthermore, Ti cages resulted in fewer recommendations for revision surgery. Whether greater pain reduction in the Ti group is associated with earlier or higher fusion rates needs to be further elucidated.
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Affiliation(s)
- Dominik Adl Amini
- Spine Care Institute, Hospital for Special Surgery, 535 East 70(th) Street, New York, NY, 10021, USA; Department of Orthopedic Surgery and Traumatology, Charité University Hospital Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Manuel Moser
- Spine Care Institute, Hospital for Special Surgery, 535 East 70(th) Street, New York, NY, 10021, USA
| | - Lisa Oezel
- Spine Care Institute, Hospital for Special Surgery, 535 East 70(th) Street, New York, NY, 10021, USA; Department of Orthopedic Surgery and Traumatology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - Jiaqi Zhu
- Spine Care Institute, Hospital for Special Surgery, 535 East 70(th) Street, New York, NY, 10021, USA
| | - Ichiro Okano
- Spine Care Institute, Hospital for Special Surgery, 535 East 70(th) Street, New York, NY, 10021, USA
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, 535 East 70(th) Street, New York, NY, 10021, USA
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, 535 East 70(th) Street, New York, NY, 10021, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, 535 East 70(th) Street, New York, NY, 10021, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, 535 East 70(th) Street, New York, NY, 10021, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, 535 East 70(th) Street, New York, NY, 10021, USA.
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26
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Adl Amini D, Moser M, Oezel L, Zhu J, Shue J, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Development of a decision-making pathway for utilizing standalone lateral lumbar interbody fusion. Eur Spine J 2021; 31:1611-1620. [PMID: 34713353 DOI: 10.1007/s00586-021-07027-4] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/17/2021] [Accepted: 10/11/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE To develop a decision-making pathway for primary SA-LLIF. Furthermore, we analyzed the agreement of this pathway and compared outcomes of patients undergoing either SA-LLIF or 360-LLIF. METHOD A decision-making pathway for SA-LLIF was created based on the results of interviews/surveys of senior spine surgeons with over 10 years of experience. Internal validity was retrospectively evaluated using consecutive patients undergoing either SA-LLIF or 360-LLIF between 01/2018 and 07/2020 with 3D-printed Titanium cages. An outcome assessment looking primarily at revision surgery and secondary at cage subsidence, changes in disk and foraminal height, global and segmental lumbar lordosis, duration of surgery, estimated blood loss, and length of stay was carried out. RESULTS 78 patients with 124 treated levels (37 SA-LLIF, 41 360-LLIF) were retrospectively analyzed. The pathway showed a direct agreement (SA-LLIF) of 100.0% and an indirect agreement (360-LLIF) of 95.1%. Clinical follow-up averaged 13.5 ± 6.5 months including 4 revision surgeries in the 360-LLIF group and none in the SA-LLIF group (p = 0.117). Radiographic follow-up averaged 9.5 ± 4.3 months, with no statistically significant difference in cage subsidence rate between the groups (p = 0.440). Compared to preoperative images, patients in both groups showed statistically significant changes in disk height (p < 0.001), foraminal height (p < 0.001), as well as restoration of segmental lordosis (p < 0.001 and p = 0.018). The SA-LLIF group showed shorter duration of surgery, less estimated blood loss and shorter LOS (p < 0.001). CONCLUSION The proposed decision-making pathway provides a guide to adequately select patients for SA-LLIF. Further studies are needed to assess the external applicability and validity. LEVEL OF EVIDENCE III Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
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Affiliation(s)
- Dominik Adl Amini
- Hospital for Special Surgery, Spine Care Institute, 535 East 70th Street, New York, NY, 10021, USA.,Department of Orthopedic Surgery and Traumatology, Charité University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Manuel Moser
- Hospital for Special Surgery, Spine Care Institute, 535 East 70th Street, New York, NY, 10021, USA
| | - Lisa Oezel
- Hospital for Special Surgery, Spine Care Institute, 535 East 70th Street, New York, NY, 10021, USA.,Department of Orthopedic Surgery and Traumatology, University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Jiaqi Zhu
- Hospital for Special Surgery, Spine Care Institute, 535 East 70th Street, New York, NY, 10021, USA
| | - Jennifer Shue
- Hospital for Special Surgery, Spine Care Institute, 535 East 70th Street, New York, NY, 10021, USA
| | - Andrew A Sama
- Hospital for Special Surgery, Spine Care Institute, 535 East 70th Street, New York, NY, 10021, USA
| | - Frank P Cammisa
- Hospital for Special Surgery, Spine Care Institute, 535 East 70th Street, New York, NY, 10021, USA
| | - Federico P Girardi
- Hospital for Special Surgery, Spine Care Institute, 535 East 70th Street, New York, NY, 10021, USA
| | - Alexander P Hughes
- Hospital for Special Surgery, Spine Care Institute, 535 East 70th Street, New York, NY, 10021, USA.
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