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Pugazenthi S, Hernandez-Rovira MA, Fabiano AS, Rogers JL, Gajjar AA, Lavadi RS, Elsayed GA, Greenberg JK, Hafez DM, Janjua MB, Ogunlade J, Pennicooke BH, Agarwal N. Mapping the geographic migration of United States neurosurgeons across training and current practice regions: associations with academic productivity. J Neurosurg 2023; 139:1109-1119. [PMID: 36933250 DOI: 10.3171/2023.1.jns222269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/17/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVE Characterizing changes in the geographic distribution of neurosurgeons in the United States (US) may inform efforts to provide a more equitable distribution of neurosurgical care. Herein, the authors performed a comprehensive analysis of the geographic movement and distribution of the neurosurgical workforce. METHODS A list containing all board-certified neurosurgeons practicing in the US in 2019 was obtained from the American Association of Neurological Surgeons membership database. Chi-square analysis and a post hoc comparison with Bonferroni correction were performed to assess differences in demographics and geographic movement throughout neurosurgeon careers. Three multinomial logistic regression models were performed to further evaluate relationships among training location, current practice location, neurosurgeon characteristics, and academic productivity. RESULTS The study cohort included 4075 (3830 male, 245 female) neurosurgeons practicing in the US. Seven hundred eighty-one neurosurgeons practice in the Northeast, 810 in the Midwest, 1562 in the South, 906 in the West, and 16 in a US territory. States with the lowest density of neurosurgeons included Vermont and Rhode Island in the Northeast; Arkansas, Hawaii, and Wyoming in the West; North Dakota in the Midwest; and Delaware in the South. Overall, the effect size, as measured by Cramér's V statistic, between training stage and training region is relatively modest at 0.27 (1.0 is complete dependence); this finding was reflected in the similarly modest pseudo R2 values of the multinomial logit models, which ranged from 0.197 to 0.246. Multinomial logistic regression with L1 regularization revealed significant associations between current practice region and residency region, medical school region, age, academic status, sex, or race (p < 0.05). On subanalysis of the academic neurosurgeons, the region of residency training correlated with an advanced degree type in the overall neurosurgeon cohort, with more neurosurgeons than expected holding Doctor of Medicine and Doctor of Philosophy degrees in the West (p = 0.021). CONCLUSIONS Female neurosurgeons were less likely to practice in the South, and neurosurgeons in the South and West had reduced odds of holding academic rather than private positions. The Northeast was the most likely region to contain neurosurgeons who had completed their training in the same locality, particularly among academic neurosurgeons who did their residency in the Northeast.
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Affiliation(s)
- Sangami Pugazenthi
- 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | | | - Alexander S Fabiano
- 2Department of Neurosurgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - James L Rogers
- 3Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Avi A Gajjar
- 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Raj Swaroop Lavadi
- 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Galal A Elsayed
- 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Jacob K Greenberg
- 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Daniel M Hafez
- 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - M Burhan Janjua
- 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - John Ogunlade
- 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Brenton H Pennicooke
- 1Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Nitin Agarwal
- 4Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh; and
- 5Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Tretiakov PS, Budis E, Dave P, Mir J, Galetta M, Lorentz N, Janjua MB, Jankowski PP, Passias PG. Does the presence of cervical deformity in patients with baseline mild myelopathy increase operative urgency in adult cervical spinal surgery? A retrospective analysis. Neurosurg Focus 2023; 55:E9. [PMID: 37657110 DOI: 10.3171/2023.6.focus23304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/19/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE The objective of this study was to assess whether delaying surgical management of cervical deformity (CD) in patients with concomitant mild myelopathy increases the risk of suboptimal outcomes. METHODS Patients aged ≥ 18 years who had a baseline diagnosis of mild myelopathy with baseline and up to 2 years of postoperative data were assessed. Patients were categorized as having CD (CD+) or not (CD-) at baseline. Patients with symptoms of myelopathy for more than 1 year after the initial visit prior to surgery were considered delayed. Clinical and radiographic data were assessed using means comparison analyses. Multivariate regression analysis assessed correlations between increasing time to surgery and peri- and postoperative outcomes adjusted for baseline age and frailty score. Backstep logistic regression analysis assessed the risk of complications or reoperation, while controlling for baseline T1 slope minus cervical lordosis (TS-CL). RESULTS One hundred six patients were included (mean age 58.11 ± 11.97 years, 48% female, mean BMI 29.13 ± 6.89). Of the patients with baseline mild myelopathy, 22 (20.8%) were CD- while 84 (79.2%) were CD+. Overall, 9.5% of patients were considered to have delayed surgery. Linear regression revealed that both CD- and CD+ patients were more likely to require reoperation when there was more time between the initial visit and surgical admission (p < 0.001). Additionally, an adjusted logistic regression indicated that CD+ patients who had a greater length of time to surgery had a higher likelihood for major complications (p < 0.001). Conversely, CD+ patients who were operated on within 30 days of the initial visit had a significantly lower risk for a major complication (OR 0.901, 95% CI 0.889-1.105, p = 0.043), and a lower risk for reoperation (OR 0.954, 95% CI 0.877-1.090, p = 0.043), while controlling for the severity of deformity based on baseline TS-CL. CONCLUSIONS The findings of this study demonstrate that a delay in surgery after the initial visit significantly increases the risk for major complications and reoperation in patients with CD with associated mild baseline myelopathy. Early operative treatment in this patient population may lower the risk of postoperative complications.
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Affiliation(s)
- Peter S Tretiakov
- 1Departments of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, New York
| | - Emmanuel Budis
- 2Departments of Orthopedics and Physical Rehabilitation, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Pooja Dave
- 1Departments of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, New York
| | - Jamshaid Mir
- 1Departments of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, New York
| | - Matthew Galetta
- 1Departments of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, New York
| | - Nathan Lorentz
- 1Departments of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, New York
| | - M Burhan Janjua
- 3Department of Neurological Surgery, Washington University, St. Louis, Missouri; and
| | - Pawel P Jankowski
- 4Department of Neurological Surgery, Hoag Hospital Memorial Presbyterian, Newport Beach, California
| | - Peter G Passias
- 1Departments of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, New York
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Passias PG, Joujon-Roche R, Mir JM, Williamson TK, Tretiakov PS, Imbo B, Krol O, Passfall L, Ahmad S, Lebovic J, Owusu-Sarpong S, Lanre-Amos T, Protopsaltis T, Lafage R, Lafage V, Park P, Chou D, Mummaneni PV, Fu KMG, Than KD, Smith JS, Janjua MB, Schoenfeld AJ, Diebo BG, Vira S. Natural history of adult spinal deformity: how do patients with suboptimal surgical outcomes fare relative to nonoperative counterparts? J Neurosurg Spine 2023; 39:92-100. [PMID: 37060316 DOI: 10.3171/2023.2.spine22559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 02/20/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVE Management of adult spinal deformity (ASD) has increasingly favored operative intervention; however, the incidence of complications and reoperations is high, and patients may fail to achieve idealized postsurgical results. This study compared health-related quality of life (HRQOL) metrics between patients with suboptimal surgical outcomes and those who underwent nonoperative management as a proxy for the natural history (NH) of ASD. METHODS ASD patients with 2-year data were included. Patients who were offered surgery but declined were considered nonoperative (i.e., NH) patients. Operative patients with suboptimal outcome (SOp)-defined as any reoperation, major complication, or ≥ 2 severe Scoliosis Research Society (SRS)-Schwab modifiers at follow-up-were selected for comparison. Propensity score matching (PSM) on the basis of baseline age, deformity, SRS-22 Total, and Charlson Comorbidity Index score was used to match the groups. ANCOVA and stepwise logistic regression analysis were used to assess outcomes between groups at 2 years. RESULTS In total, 441 patients were included (267 SOp and 174 NH patients). After PSM, 142 patients remained (71 SOp 71 and 71 NH patients). At baseline, the SOp and NH groups had similar demographic characteristics, HRQOL, and deformity (all p > 0.05). At 2 years, ANCOVA determined that NH patients had worse deformity as measured with sagittal vertical axis (36.7 mm vs 21.3 mm, p = 0.025), mismatch between pelvic incidence and lumbar lordosis (11.9° vs 2.9°, p < 0.001), and pelvic tilt (PT) (23.1° vs 20.7°, p = 0.019). The adjusted regression analysis found that SOp patients had higher odds of reaching the minimal clinically important differences in Oswestry Disability Index score (OR [95% CI] 4.5 [1.7-11.5], p = 0.002), SRS-22 Activity (OR [95% CI] 3.2 [1.5-6.8], p = 0.002), SRS-22 Pain (OR [95% CI] 2.8 [1.4-5.9], p = 0.005), and SRS-22 Total (OR [95% CI] 11.0 [3.5-34.4], p < 0.001). CONCLUSIONS Operative patients with SOp still experience greater improvements in deformity and HRQOL relative to the progressive radiographic and functional deterioration associated with the NH of ASD. The NH of nonoperative management should be accounted for when weighing the risks and benefits of operative intervention for ASD.
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Affiliation(s)
- Peter G Passias
- 1Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York
| | - Rachel Joujon-Roche
- 1Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York
| | - Jamshaid M Mir
- 1Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York
| | - Tyler K Williamson
- 1Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York
| | - Peter S Tretiakov
- 1Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York
| | - Bailey Imbo
- 1Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York
| | - Oscar Krol
- 1Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York
| | - Lara Passfall
- 1Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York
| | - Salman Ahmad
- 1Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York
| | - Jordan Lebovic
- 1Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York
| | - Stephane Owusu-Sarpong
- 1Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York
| | - Tomi Lanre-Amos
- 1Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York
| | - Themistocles Protopsaltis
- 1Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York
| | | | - Virginie Lafage
- 3Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, New York
| | - Paul Park
- 4University of Michigan, Ann Arbor, Michigan
| | - Dean Chou
- 5Department of Neurological Surgery, UCSF Medical Center, San Francisco, California
| | - Praveen V Mummaneni
- 5Department of Neurological Surgery, UCSF Medical Center, San Francisco, California
| | - Kai-Ming G Fu
- 6Department of Neurosurgery, Cornell University School of Medicine, New York, New York
| | - Khoi D Than
- 7Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Justin S Smith
- 8Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - M Burhan Janjua
- 9Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri
| | - Andrew J Schoenfeld
- 10Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Bassel G Diebo
- 11Deparment of Orthopedic Surgery, SUNY Downstate, New York, New York; and
| | - Shaleen Vira
- 12Department of Orthopedic Surgery, UT Southwestern, Dallas, Texas
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Imbo B, Williamson T, Joujon-Roche R, Krol O, Tretiakov P, Ahmad S, Bennett-Caso C, Schoenfeld AJ, Dinizo M, De La Garza-Ramos R, Janjua MB, Vira S, Ihejirika-Lomedico R, Raman T, O'Connell B, Maglaras C, Paulino C, Diebo B, Lafage R, Lafage V, Passias PG. Long-term Morbidity in Patients Following Surgical Correction of Adult Spinal Deformity: Results from a Cohort with Minimum 5 Year Follow-up. Spine (Phila Pa 1976) 2023:00007632-990000000-00313. [PMID: 37040468 DOI: 10.1097/brs.0000000000004681] [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: 06/27/2022] [Accepted: 12/13/2022] [Indexed: 04/13/2023]
Abstract
STUDY DESIGN Retrospective. OBJECTIVE To describe the rate of post-operative morbidity before and after 2-year follow-up for patients undergoing surgical correction of adult spinal deformity. SUMMARY OF BACKGROUND DATA Advances in modern surgical techniques for deformity surgery have shown promising short-term clinical results. However, the permanence of radiographic correction, mechanical complications, and revision surgery in adult spinal deformity (ASD) surgery remains a clinical challenge. Little information exists on the incidence of long-term morbidity beyond the acute post-operative window. METHODS ASD patients with complete baseline (BL) and 5-year (5Y) health related quality of life (HRQL) and radiographic data were included. Rates of adverse events, including proximal junctional kyphosis (PJK), proximal junctional failure (PJF), and reoperations up to 5Y were documented. Primary and revision surgeries were compared. We used logistic regression analysis to adjust for demographic and surgical confounders. RESULTS Of 118 patients eligible for 5Y follow up, 99(83.9%) had complete follow-up data. The majority were female (83%), mean age 54.1 yrs and 10.4 levels fused and 14 undergoing 3-CO. 33 patients had a prior fusion and 66 were primary cases. By 5Y postop the cohort had a adverse event rate of 70.7% with 25(25.3%) sustaining a major complication and 26(26.3%) receiving reoperation. 38 (38.4%) developed PJK by 5Y and 3 (4.0%) developed PJF. The cohort had a significantly higher rate of complications (63.6% vs. 19.2%), PJK (34.3% vs. 4.0%), and reoperations (21.2% vs. 5.1%) before 2Y, all P<0.01. The most common complications beyond 2Y were mechanical complications. CONCLUSIONS While incidence of adverse events was high before two years, there was a substantial reduction in longer follow-up indicating complications after two years are less common. Complications beyond two years consisted mostly of mechanical issues.
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Affiliation(s)
- Bailey Imbo
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, USA
| | - Tyler Williamson
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, USA
| | - Rachel Joujon-Roche
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, USA
| | - Oscar Krol
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, USA
| | - Peter Tretiakov
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, USA
| | - Salman Ahmad
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, USA
| | - Claudia Bennett-Caso
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, USA
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael Dinizo
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, USA
| | | | - M Burhan Janjua
- Department of Neurosurgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Shaleen Vira
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Rivka Ihejirika-Lomedico
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, USA
| | - Tina Raman
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, USA
| | - Brooke O'Connell
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, USA
| | - Constance Maglaras
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, USA
| | - Carl Paulino
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, New York, NY, USA
| | - Bassel Diebo
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, New York, NY, USA
| | - Renaud Lafage
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Virginie Lafage
- Department of Orthopedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Peter G Passias
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, USA
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Janjua MB, Passias PG, Ray WZ. Critical appraisal of bibliometric study on most influential publications of upper cervical spine instability. J Spine Surg 2022; 8:190-192. [PMID: 35875620 PMCID: PMC9263730 DOI: 10.21037/jss-22-25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Affiliation(s)
- M. Burhan Janjua
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Peter G. Passias
- Department of Orthopedic Surgery, New York University Langone Medical Center, New York, NY, USA
| | - Wilson Z. Ray
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Passias PG, Pierce KE, Kummer N, Krol O, Passfall L, Janjua MB, Sciubba D, Ahmad W, Naessig S, Diebo B. Impact of Myelopathy Severity and Degree of Deformity on Postoperative Outcomes in Cervical Spinal Deformity Patients. Neurospine 2021; 18:628-634. [PMID: 34610694 PMCID: PMC8497248 DOI: 10.14245/ns.2040456.228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 04/27/2021] [Indexed: 12/01/2022] Open
Abstract
Objective Malalignment of the cervical spine can result in cord compression, leading to a myelopathy diagnosis. Whether deformity or myelopathy severity is stronger predictors of surgical outcomes is understudied.
Methods Surgical cervical deformity (CD) patients with baseline (BL) and up to 1-year data were included. Modified Japanese Orthopaedic Association (mJOA) score categorized BL myelopathy (mJOA = 18 excluded), with moderate myelopathy mJOA being 12 to 17 and severe myelopathy being less than 12. BL deformity severity was categorized using the mismatch between T1 slope and cervical lordosis (TS-CL), with CL being the angle between the lower endplates of C2 and C7. Moderate deformity was TS-CL less than or equal to 25° and severe deformity was greater than 25°. Categorizations were combined into 4 groups: group 1 (G1), severe myelopathy and severe deformity; group 2 (G2), severe myelopathy and moderate deformity; group 3 (G3), moderate myelopathy and moderate deformity; group 4 (G4), moderate myelopathy and severe deformity. Univariate analyses determined whether myelopathy or deformity had greater impact on outcomes.
Results One hundred twenty-eight CD patients were included (mean age, 56.5 years; 46% female; body mass index, 30.4 kg/m2) with a BL mJOA score of 12.8±2.7 and mean TS-CL of 25.9°±16.1°. G1 consisted of 11.1% of our CD population, with 21% in G2, 34.6% in G3, and 33.3% in G4. At BL, Neck Disability Index (NDI) was greatest in G2 (p=0.011). G4 had the lowest EuroQol-5D (EQ-5D) (p<0.001). Neurologic exam factors were greater in severe myelopathy (p<0.050). At 1-year, severe deformity met minimum clinically important differences (MCIDs) for NDI more than moderate deformity (p=0.002). G2 had significantly worse outcomes compared to G4 by 1-year NDI (p=0.004), EQ-5D (p=0.028), Numerical Rating Scale neck (p=0.046), and MCID for NDI (p=0.001).
Conclusion Addressing severe deformity had increased clinical weight in improving patient-reported outcomes compared to addressing severe myelopathy.
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Affiliation(s)
- Peter G Passias
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY, USA
| | - Katherine E Pierce
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY, USA
| | - Nicholas Kummer
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY, USA
| | - Oscar Krol
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY, USA
| | - Lara Passfall
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY, USA
| | | | - Daniel Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Waleed Ahmad
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY, USA
| | - Sara Naessig
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY, USA
| | - Bassel Diebo
- Department of Orthopedics, SUNY Downstate, Brooklyn, NY, USA
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Cazzulino A, Gandhi R, Woodard T, Ackshota N, Janjua MB, Arlet V, Saifi C. Soft Landing technique as a possible prevention strategy for proximal junctional failure following adult spinal deformity surgery. J Spine Surg 2021; 7:26-36. [PMID: 33834125 DOI: 10.21037/jss-20-622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This cross sectional study describes a "Soft Landing" strategy utilizing hooks for minimizing proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). The technique creates a gradual transition from a rigid segmental construct to unilateral hooks at the upper instrumented level and preservation of the soft tissue attachments on the contralateral side of the hooks. Authors devise a novel classification system for better grading of PJK severity. Methods Thirty-nine consecutive adult spinal deformity (ASD) patients at a single institution received the "Soft Landing" technique. The proximal junctional angle was measured preoperatively and at last follow-up using standing 36-inch spinal radiographs. Changes in proximal junctional angle and rates of PJK and PJF were measured and used to create a novel classification system for evaluating and categorizing ASD patients postoperatively. Results The mean age of the cohort was 61.4 years, and 90% of patients were women. Average follow up was 2.2 years. The mean change in proximal junctional angle was 8° (SD 7.4°) with the majority of patients (53%) experiencing less than 10° and only 1 patients with proximal junctional angle over 20°. Four patients (10%) needed additional surgery for proximal extension of the uppermost instrumented vertebra (UIV) secondary to PJF. Conclusions Soft Landing technique is a possibly effective treatment strategy to prevent PJK and PJF following ASD that requires further evaluation. The described classification system provides management framework for better grading of PJK. The "Soft Landing" technique warrants further comparison to other techniques currently used to prevent both PJK and failure.
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Affiliation(s)
- Alejandro Cazzulino
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Rikesh Gandhi
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Thaddeus Woodard
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Nissim Ackshota
- Department of Orthopedic Surgery, The Chaim Sheba Medical Center at Tel-Hashomer, Tel-Aviv, Israel
| | | | - Vincent Arlet
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Comron Saifi
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
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Caruso JP, Janjua MB, Dolce A, Price AV. Retrospective analysis of open surgical versus laser interstitial thermal therapy callosotomy in pediatric patients with refractory epilepsy. J Neurosurg Pediatr 2021; 27:420-428. [PMID: 33482643 DOI: 10.3171/2020.7.peds20167] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 07/28/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Corpus callosotomy remains an established surgical treatment for certain types of medically refractory epilepsy in pediatric patients. While the traditional surgical approach is often well tolerated, the advent of MR-guided laser interstitial thermal therapy (LITT) provides a new opportunity to ablate the callosal body in a minimally invasive fashion and minimize the risks associated with an open interhemispheric approach. However, the literature is sparse regarding the comparative efficacy and safety profiles of open corpus callosotomy (OCC) and LITT callosotomy. To this end, the authors present a novel retrospective analysis comparing the efficacy and safety of these methods. METHODS Patients who underwent OCC and LITT callosotomy during the period from 2005 to 2018 were included in a single-center retrospective analysis. Patient demographic and procedural variables were collected, including length of stay, procedural blood loss, corticosteroid requirements, postsurgical complications, and postoperative disposition. Pre- and postoperative seizure frequency (according to seizure type) were recorded. RESULTS In total, 19 patients, who underwent 24 interventions (16 OCC and 8 LITT), were included in the analysis. The mean follow-up durations for the OCC and LITT cohorts were 83.5 months and 12.3 months, respectively. Both groups experienced reduced frequencies of seizure and drop attack frequency postoperatively. Additionally, LITT callosotomy was associated with a significant decrease in estimated blood loss and decreased length of pediatric ICU stay, with a trend of shorter length of hospitalization. CONCLUSIONS Longer-term follow-up and a larger population are required to further delineate the comparative efficacies of LITT callosotomy and OCC for the treatment of pediatric medically refractory epilepsy. However, the authors' data demonstrate that LITT shows promise as a safe and effective alternative to OCC.
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Affiliation(s)
| | | | - Alison Dolce
- 2Neurology, Children's Medical Center, University of Texas Southwestern, Dallas, Texas
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Passias PG, Naessig S, Para A, Ahmad W, Pierce K, Janjua MB, Vira S, Sciubba D, Diebo B. Complication rates following Chiari malformation surgical management for Arnold-Chiari type I based on surgical variables: A national perspective. J Craniovertebr Junction Spine 2020; 11:169-172. [PMID: 33100765 PMCID: PMC7546047 DOI: 10.4103/jcvjs.jcvjs_69_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/26/2020] [Indexed: 12/04/2022] Open
Abstract
Introduction: This study aimed to identify complication trends of Chiari Malformation Type 1 patients (CM-1) for certain procedures and concomitant diagnoses on a national level. Materials The Kids’ Inpatient Database was queried for diagnoses of operative CM-1 by International Classification of Disease-9 codes (348.4). Differences in preoperative demographics and perioperative complication rates between patient cohorts were assessed using Pearson's Chi-squared test and t-test when necessary. Binary logistic regression was utilized to find significant factors associated with complication rate. Certain surgical procedures were analyzed for their relationship with postoperative outcomes. Results: Thirteen thousand eight hundred and twelve CM-1 patients were identified with 8.2% suffering from a complication. From 2003 to 2012, the rate of complications for CM-1 pts decreased significantly (9.6%–5.1%) along with surgical rate (33.3%–28.6%), despite the increase in CM-1 diagnosis (36.3%–42.3%; all P < 0.05). CM-1 pts who had a complication were younger and had a lower invasiveness score; however, they had a larger Charlson Comorbidity Index than those who did not have a complication (all P < 0.05). CM-1 pts who experienced complications had a concurrent diagnosis of syringomyelia (7.1%), and also scoliosis (3.2%; all P < 0.05). CM-1 pts who did not have a complication had a greater rate of operation than those that had a complication (76.4% vs. 23.6% P < 0.05). The most common complications were nervous system related (2.8%), anemia (2.4%), and acute respiratory distress (2.1%). CM-1 pts that underwent an instrumented fusion (3.4% vs. 2.1%) had a greater complication rate as well as compared to those who underwent a craniotomy (23.2% vs. 19.1%; all P < 0.05). However, CM-1 pts that underwent a decompression had lower postoperative complications (21.3% vs. 28.9%; all P < 0.05). Conclusions: Chiari patients undergoing craniectomies as well as instrumented fusions are at a higher risk of postoperative complications especially when the instrumented fusions were performed on >4 levels.
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Affiliation(s)
- Peter G Passias
- Departments of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
| | - Sara Naessig
- Departments of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
| | - Ashok Para
- Departments of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
| | - Waleed Ahmad
- Departments of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
| | - Katherine Pierce
- Departments of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
| | - M Burhan Janjua
- Departments of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
| | - Shaleen Vira
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Daniel Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bassel Diebo
- Department of Orthopaedic Surgery, Suny Downstate, New York, NY, USA
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Janjua MB, Haynie AE, Bansal V, Bhattacharia S, Grant T, McQuillan D, Passias PG, Ozturk AK, Hwang SW. Determinants of Chiari I progression in pregnancy. J Clin Neurosci 2020; 77:1-7. [PMID: 32414621 DOI: 10.1016/j.jocn.2020.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/03/2020] [Indexed: 10/24/2022]
Abstract
Chiari Malformation type 1 (CM-I) is congenital or an acquired anomaly of the hind brain; develops when the cerebellar tonsils recede downwards below the foramen magnum. Recurrent post tussive suboccipital headache is the common presentation in a pregnant woman and the diagnosis is usually missed or delayed due to lack of formal understanding of this neurological pathology. Much has been written regarding presentation, morphology and the treatment of CM-I; however, little is known when the etiology is acquired or an iatrogenic in its evolution. Similarly, unknown is the progression of CM-I (diagnosed or undiagnosed) in pregnancy. The objective of this study is to elucidate the causes of progression of CM-I in pregnancy, and how this can be avoided. A detailed literature review has been conducted to find the case reports or case studies on association of CM-I in pregnancy; therefore, the risk factors regarding the progression have been sought. There is a lack of literature on timing, mode of anesthesia, and the management of CM-I. Moreover, authors have sought a questionnaire to screen these patients at pre-conception, intrapartum visits if, the initial diagnosis is delayed. Crucial points of concern including but not limited to the diagnosis, pre-conception counseling, timing of intervention during pregnancy, and mode of anesthesia, have been discussed in detail. In summary, a formal management algorithm has been proposed to avoid the rapid progression of this complex neurological pathology especially, in women of child bearing age and/or during pregnancy.
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Affiliation(s)
- M Burhan Janjua
- Department of Neurological Surgery, Mercy Health Hospital, Rockford, IL, USA.
| | - Alexus E Haynie
- Department of Neurology, Mercy Health Hospital, Rockford, IL, USA
| | - Vibhav Bansal
- Department of Neurology, Mercy Health Hospital, Rockford, IL, USA.
| | | | - Tamila Grant
- Department of Anesthesiology, Mercy Health Hospital, Rockford, IL, USA
| | - Daniel McQuillan
- Department of Anesthesiology, Mercy Health Hospital, Rockford, IL, USA
| | - Peter G Passias
- Department of Orthopedic Surgery, NYU Langone Medical Center, New York, NY, USA
| | - Ali K Ozturk
- Department of Neurosurgery, University of Pennsylvania Hospital, PA, USA
| | - Steven W Hwang
- Department of Pediatric Neurosurgery, Shriners Hospital for Children Philadelphia, PA, USA
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Janjua MB, Ozturk AK, Ackshota N, McShane BJ, Saifi C, Welch WC, Arlet V. Surgical Treatment of Flat Back Syndrome With Anterior Hyperlordotic Cages. Oper Neurosurg (Hagerstown) 2020; 18:261-270. [PMID: 31231770 DOI: 10.1093/ons/opz141] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 02/20/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Traditional correction for flat back syndrome is performed with a posterior-based surgery or combined approaches in revision cases. OBJECTIVE To evaluate outcome from anterior surgery with the use of hyperlordotic cages (HLCs) in patients with flat back syndrome. METHODS All patients operated with or without prior posterior lumbar surgery were studied. Pre- to postoperative sagittal alignment was analyzed. Radiographic parameters were analyzed including T1 pelvic angle (T1PA), sagittal vertical axis (SVA), pelvic tilt (PT), pelvic incidence (PI), lumbar lordosis (LL), sacral slope (SS), pelvic incidence and lumbar lordosis (PI-LL), and T4-12TK. RESULTS All 50 patients (mean age of 58 yr, 72% female with mean body mass index of 28) demonstrated significant radiographic alignment difference in their spinopelvic and global parameters from pre- to postoperative standing: LL (-37.04° vs -59.55°, P < .001), SS (35.12 vs 41.13, P < .001), PI-LL (23.55 vs 6.46), T4-12 TK (30.59 vs 41.67), PT (28.22 vs 22.13), SVA in mm (80.94 vs 37.39), and T1PA (28.70° vs 18.43°, P < .001). Using linear regression analysis, predicted pre- to postoperative change in standing LL corresponded to a pre- to postoperative changes in standing PI-LL mismatch, T1PA, TK, SS, PT, and SVA (R2 = 0.59, 0.38, 0.25, 0.16, 0.12, and 0.17, respectively). Five degrees of pre- to postoperative change in T1PA translates to -4.15° change in LL. CONCLUSION Anterior surgery with HLCs followed by posterior instrumentation is an effective technique to treat flat back syndrome. HLCs are effective to maximize LL up to 30°, which is equivalent in magnitude to a pedicle subtraction osteotomy, but associated with less blood loss, quicker recovery, lower complications, and good surgical outcome.
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Affiliation(s)
- M Burhan Janjua
- Department of Neurosurgery, University of Pennsylvania Hospital, Philadelphia, Pennsylvania.,Department of Orthopedic Surgery, University of Pennsylvania Hospital, Philadelphia, Pennsylvania
| | - Ali K Ozturk
- Department of Neurosurgery, University of Pennsylvania Hospital, Philadelphia, Pennsylvania
| | - Nissim Ackshota
- Department of Orthopedic Surgery, University of Pennsylvania Hospital, Philadelphia, Pennsylvania
| | - Brendan J McShane
- Department of Neurosurgery, University of Pennsylvania Hospital, Philadelphia, Pennsylvania
| | - Comron Saifi
- Department of Orthopedic Surgery, University of Pennsylvania Hospital, Philadelphia, Pennsylvania
| | - William C Welch
- Department of Neurosurgery, University of Pennsylvania Hospital, Philadelphia, Pennsylvania
| | - Vincent Arlet
- Department of Neurosurgery, University of Pennsylvania Hospital, Philadelphia, Pennsylvania.,Department of Orthopedic Surgery, University of Pennsylvania Hospital, Philadelphia, Pennsylvania
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Sullivan PZ, Albayar A, Ramayya AG, McShane B, Marcotte P, Malhotra NR, Ali ZS, Chen HI, Janjua MB, Saifi C, Schuster J, Grady MS, Jones J, Ozturk AK. Association of spinal instability due to metastatic disease with increased mortality and a proposed clinical pathway for treatment. J Neurosurg Spine 2020; 32:950-957. [PMID: 32059185 DOI: 10.3171/2019.11.spine19775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 11/20/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Multidisciplinary treatment including medical oncology, radiation oncology, and surgical consultation is necessary to provide comprehensive therapy for patients with spinal metastases. The goal of this study was to review the use of radiation therapy and/or surgical intervention and their impact on patient outcomes. METHODS In this retrospective series, the authors identified at their institution those patients with spinal metastases who had received radiation therapy alone or had undergone surgery with or without radiation therapy within a 6-year period. Data on patient age, chemotherapy, surgical procedure, radiation therapy, Karnofsky Performance Status (KPS), primary tumor pathology, Spinal Instability Neoplastic Score (SINS), and survival after treatment were collected from the patient electronic medical records. N - 1 chi-square testing was used for comparisons of proportions. The Student t-test was used for comparisons of means. A p value < 0.05 was considered statistically significant. A survival analysis was completed using a multivariate Cox proportional hazards model. RESULTS Two hundred thirty patients with spinal metastases were identified, 109 of whom had undergone surgery with or without radiation therapy. Among the 104 patients for whom the surgical details were reviewed, 34 (33%) had a history of preoperative radiation to the surgical site but ultimately required surgical intervention. In this surgical group, a significantly increased frequency of death within 30 days was noted for the SINS unstable patients (23.5%) as compared to that for the SINS stable patients (2.3%; p < 0.001). The SINS was a significant predictor of time to death among surgical patients (HR 1.11, p = 0.037). Preoperative KPS was not independently associated with decreased survival (p > 0.5) on univariate analysis. One hundred twenty-six patients met the criteria for inclusion in the radiation-only analysis. Ninety-eight of these patients (78%) met the criteria for potential instability (PI) at the time of treatment, according to the SINS system. Five patients (5%) with PI in the radiation therapy group had a documented neurosurgical or orthopedic surgery consultation prior to radiation therapy. CONCLUSIONS At the authors' institution, patients with gross mechanical instability per the SINS system had an increased rate of 30-day postoperative mortality, which remained significant when controlling for other factors. Surgical consultation for metastatic spine patients receiving radiation oncology consultation with PI is low. The authors describe an institutional pathway to encourage multidisciplinary treatment from the initial encounter in the emergency department to expedite surgical evaluation and collaboration.
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Affiliation(s)
| | | | | | | | | | | | | | | | - M Burhan Janjua
- 3Orthopedic Surgery, Pennsylvania Hospital, Philadelphia, Pennsylvania; and
| | - Comron Saifi
- 4Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas
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13
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Janjua MB, Reddy S, Welch WC, Samdani AF, Ozturk AK, Hwang SW, Price AV, Weprin BE, Swift DM. Thirty-day readmission risk after intracranial tumor resection surgeries in children. J Neurosurg Pediatr 2020; 25:97-105. [PMID: 31675691 DOI: 10.3171/2019.7.peds19272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/29/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The risk of readmission after brain tumor resection among pediatric patients has not been defined. The authors' objective was to evaluate the readmission rates and predictors of readmission after pediatric brain tumor resection. METHODS Nationwide Readmissions Database (NRD) data sets from 2010 to 2014 were searched for unplanned readmissions within 30 days of the discharge date after pediatric brain tumor resection. Patient demographic variables included sex, age, expected payment source (Medicaid or private insurance), and median annual household income. Readmission events for chemotherapy, radiation therapy, or further tumor resection were not included. RESULTS Of 282 patients (12.7%) readmitted within 30 days of the index event, the median time to readmission was 10 days (IQR 5-19 days). The most common reason for readmission was hydrocephalus, which accounted for 19% of readmission events. Other CNS-related complications (24%), surgical site infections or septicemia (14%), seizures (7%), and hematological disorders (7%) accounted for other major readmission events. The median charge for readmission events was $35,431, and the median length of readmission stay was 4 days. In multivariate regression, factors associated with a significant increase in readmission risk included Medicaid as the primary payor, discharge from the index event with home health services, and fluid and electrolyte disorders during the index event. CONCLUSIONS More than 10% of pediatric brain tumor patients have unplanned readmission events within 30 days of discharge after tumor resection. Medicaid patients and those with preoperative or early postoperative fluid and electrolyte disturbances may benefit from early or frequent outpatient visits after tumor resection.
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Affiliation(s)
- M Burhan Janjua
- 1Division of Pediatric Neurosurgery, Department of Neurosurgery, UT Southwestern Medical Center, Dallas, Texas
- 2Department of Neurosurgery, University of Pennsylvania Hospital System, Philadelphia; and
| | - Sumanth Reddy
- 1Division of Pediatric Neurosurgery, Department of Neurosurgery, UT Southwestern Medical Center, Dallas, Texas
| | - William C Welch
- 2Department of Neurosurgery, University of Pennsylvania Hospital System, Philadelphia; and
| | - Amer F Samdani
- 3Department of Neurosurgery, Shriners Hospital for Children, Philadelphia, Pennsylvania
| | - Ali K Ozturk
- 2Department of Neurosurgery, University of Pennsylvania Hospital System, Philadelphia; and
| | - Steven W Hwang
- 3Department of Neurosurgery, Shriners Hospital for Children, Philadelphia, Pennsylvania
| | - Angela V Price
- 1Division of Pediatric Neurosurgery, Department of Neurosurgery, UT Southwestern Medical Center, Dallas, Texas
| | - Bradley E Weprin
- 1Division of Pediatric Neurosurgery, Department of Neurosurgery, UT Southwestern Medical Center, Dallas, Texas
| | - Dale M Swift
- 1Division of Pediatric Neurosurgery, Department of Neurosurgery, UT Southwestern Medical Center, Dallas, Texas
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Janjua MB, Reddy S, Welch WC, Passias PG. Is minimally invasive sacroiliac joint arthrodesis the treatment of choice for sacroiliac joint dysfunction? J Spine Surg 2019; 5:378-380. [PMID: 31663050 DOI: 10.21037/jss.2019.06.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- M Burhan Janjua
- Department of Pediatric Neurosurgery, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Neurosurgery, University of Pennsylvania Hospital, Pennsylvania, PA, USA
| | - Sumanth Reddy
- Department of Pediatric Neurosurgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - William C Welch
- Department of Neurosurgery, University of Pennsylvania Hospital, Pennsylvania, PA, USA
| | - Peter G Passias
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
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15
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Janjua MB, Reddy S, El Ahmadieh TY, Ban VS, Ozturk AK, Hwang SW, Samdani AF, Passias PG, Welch WC, Arlet V. Occipital neuralgia: A neurosurgical perspective. J Clin Neurosci 2019; 71:263-270. [PMID: 31606286 DOI: 10.1016/j.jocn.2019.08.102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 08/25/2019] [Indexed: 01/03/2023]
Abstract
Occipital neuralgia typically arises in the setting of nerve compression by fibrosis, surrounding anatomic structures, or osseous pathology, such as bone spurs or hypertrophic atlanto-epistropic ligament. It generally presents as paroxysmal bouts of sharp pain in the sensory distribution of the first three occipital nerves. Due to the long course of the greater occipital nerve (GON), and its peculiar anatomy, and location in a mobile region of the neck, it is unsurprising that the GON is at high risk for compression. Little is known how to diagnose or treat this neuropathic pain syndrome. The objective of this paper is to isolate the etiology involved, and treat this condition promptly. After all nonoperative efforts are exhausted, surgical transection of the nerve is the treatment of choice in these cases. An isolated C2 neurectomy or ganglionectomy is performed for an optimal pain relief. C1-2 instrumented fusion can be considered if, extensive facet arthropathy with instability is identified. Authors review the spectrum of treatment options for this debilitating condition, and discuss the case example of a patient who required conversion to a C1-C2 instrumented fusion following C2 ganglionectomy due to an underlying extensive degenerative disease and intraoperative findings suggestive of atlantoaxial instability.
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Affiliation(s)
- M Burhan Janjua
- Department of Neurosurgery, UT Southwestern Medical Center, Dallas, TX, United States; Department of Neurosurgery, University of Pennsylvania Hospital System, Philadelphia, PA, United States; Department of Orthopedic Surgery, University of Pennsylvania Hospital System, Philadelphia, PA, United States.
| | - Sumanth Reddy
- Department of Neurosurgery, UT Southwestern Medical Center, Dallas, TX, United States
| | - Tarek Y El Ahmadieh
- Department of Neurosurgery, UT Southwestern Medical Center, Dallas, TX, United States
| | - Vin Shen Ban
- Department of Neurosurgery, UT Southwestern Medical Center, Dallas, TX, United States
| | - Ali K Ozturk
- Department of Orthopedic Surgery, University of Pennsylvania Hospital System, Philadelphia, PA, United States
| | - Steven W Hwang
- Department of Neurosurgery, Shriners Hospital for Children, Philadelphia, PA, United States
| | - Amer F Samdani
- Department of Neurosurgery, Shriners Hospital for Children, Philadelphia, PA, United States
| | - Peter G Passias
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, United States
| | - William C Welch
- Department of Neurosurgery, University of Pennsylvania Hospital System, Philadelphia, PA, United States
| | - Vincent Arlet
- Department of Orthopedic Surgery, University of Pennsylvania Hospital System, Philadelphia, PA, United States
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Janjua MB, Ackshota N, Arlet V. Technical Consideration for TLIF Cage Retrieval and Deformity Correction With Anterior Interbody Fusion in Lumbar Revision Surgeries. Spine Deform 2019; 7:633-640. [PMID: 31202382 DOI: 10.1016/j.jspd.2018.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 08/30/2018] [Accepted: 10/13/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Symptomatic pseudoarthrosis after transforaminal lumbar interbody fusion (TLIF) could result in sagittal malalignment. Revision posterior surgery with TLIF cage removal poses a challenge intraoperatively. The authors have proposed salvage anterior approach for cage removal and have discussed unique experience with the correction in their deformity patients. METHODS All patients with symptoms of clinical deformity or symptomatic pseudoarthrosis operated from January of 2012 to February of 2018 were included in the study. TLIF cage removal followed by anterior lumbar interbody fusion (ALIF) surgery was performed in all patients. Radiographic sagittal parameters including thoracic kyphosis (TK; T4-T12), sagittal vertical axis (SVA), T1 pelvic angle (TPA), lumbar lordosis (LL), the mismatch between pelvic incidence (PI) and LL (PI-LL), sacral slope (SS), pelvic tilt (PT), and PI were analyzed. RESULTS 6 patients (mean age of 57 years, 83% female) underwent TLIF retrieval through anterior approach and ALIF with hyperlordotic cages (HLCs), followed by posterior spinal fusion surgery. Described technique entails use of tailored instruments with sequential gentle distraction of end plates with TLIF spreader could facilitate in the cage removal. Mean number of interbody levels fused pre as well as post were 1.5. The radiographic sagittal parameters from preoperative versus postoperative standing were as follows: T4-T12 TK, 16° vs. 37.6°; LL, -25° vs. -47.6°; PT, 36° vs. 26°; PI-LL, 35° vs. 12.4°; SVA, 12° vs. 5.6°; and TPA, 44° vs. 25°, with p<.001. Mean number of instrumented level fused were 8.1. Using linear regression analysis, change from pre-to postoperative standing in LL predicted pre-to postoperative change in SVA and TPA for global correction (R= -0.30 and -0.80, respectively). CONCLUSIONS Anterior approach is a suitable technique for TLIF cage removal while preserving the end plates for subsequent optimal interbody fusion at the index level in symptomatic pseudoarthrosis patients or those with clinical deformity. ALIF with HLCs with or without Ponte osteotomy can restore segmental and overall sagittal alignment.
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Affiliation(s)
- M Burhan Janjua
- Department of Orthopedic Surgery, University of Pennsylvania Hospital, 235 S 8th St., Washington West Bldg, 800 Spruce Street, Philadelphia, PA 19107, USA; Department of Neurosurgery, University of Pennsylvania Hospital, 235 S 8th St., Washington West Bldg, 800 Spruce Street, Philadelphia, PA 19107, USA
| | - Nissim Ackshota
- Department of Orthopedic Surgery, University of Pennsylvania Hospital, 235 S 8th St., Washington West Bldg, 800 Spruce Street, Philadelphia, PA 19107, USA
| | - Vincent Arlet
- Department of Orthopedic Surgery, University of Pennsylvania Hospital, 235 S 8th St., Washington West Bldg, 800 Spruce Street, Philadelphia, PA 19107, USA.
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Janjua MB, Reddy S, Welch WC, Ozturk AK, Price AV, Weprin B, Swift DM, Krisht AF. Concomitant ruptured anterior circulation and unruptured posterior circulation aneurysms: Treatment strategy and review of literature. J Clin Neurosci 2019; 66:252-258. [PMID: 31113699 DOI: 10.1016/j.jocn.2019.04.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 03/22/2019] [Accepted: 04/28/2019] [Indexed: 10/26/2022]
Abstract
Basilar artery apex or bifurcation is the most common location for aneurysms arising from posterior cerebral circulation. Reports of unruptured aneurysms of the basilar bifurcation associated with ruptured anterior circulation aneurysms are rare. The presence of multiple intracranial aneurysms poses a significantly high risk to management than a single aneurysm due several factors involved. Surgical management is considered the best treatment modality for most aneurysmal types and location with quite a few limitations when applicable. Authors have conducted a literature review of anterior and posterior circulation concomitant aneurysms and report their own experience with a case of anterior communicating artery blister type aneurysmal rupture presented with the symptoms and signs of subarachnoid hemorrhage concomitant with an unruptured basilar artery bifurcation aneurysm. Moreover, the anomalous origin of thalamoperforators at the basilar apex instead of the posterior cerebral artery makes it reasonably challenging for the microsurgical clipping. Discussed is the clinical presentation, radiological studies obtained, surgical approach utilized with an adequate exposure of the entire circle of Willis as well as the critical decision making when managing these challenging cases.
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Affiliation(s)
- M Burhan Janjua
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, United States; Department of Neurological Surgery, CHI St. Vincent Arkansas Neuroscience Institute, Little Rock, AR, United States.
| | - Sumanth Reddy
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, United States
| | - William C Welch
- Department of Neurological Surgery, University of Pennsylvania Hospital, United States
| | - Ali K Ozturk
- Department of Neurological Surgery, University of Pennsylvania Hospital, United States
| | - Angela V Price
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, United States
| | - Bradley Weprin
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, United States
| | - Dale M Swift
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, United States
| | - Ali F Krisht
- Department of Neurological Surgery, CHI St. Vincent Arkansas Neuroscience Institute, Little Rock, AR, United States
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Janjua MB, Reddy S, Samdani AF, Welch WC, Ozturk AK, Price AV, Weprin BE, Swift DM. Predictors of 90-Day Readmission in Children Undergoing Spinal Cord Tumor Surgery: A Nationwide Readmissions Database Analysis. World Neurosurg 2019; 127:e697-e706. [PMID: 30947001 DOI: 10.1016/j.wneu.2019.03.245] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 03/22/2019] [Accepted: 03/23/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE A fair number of hospital admissions occur after 30 days; thus, the true readmission rate could have been underestimated. Therefore, we hypothesized that the 90-day readmission rate might better characterize the factors contributing to readmission for pediatric patients undergoing spinal tumor resection. METHODS The Nationwide Readmissions Database was used to study the patient demographic data, comorbidities, admissions, hospital course, spinal tumor behavior (malignant vs. benign), complications, revisions, and 30- and 90-day readmissions. RESULTS Of the 397 patients included in the 30-day cohort, 43 (10.8%) had been readmitted. In comparison, the 90-day readmission rate was significantly greater; 52 of 325 patients were readmitted (16.0%; P < 0.04). Patients aged 16-20 constituted the largest subgroup. However, the highest readmission rate was observed for patients aged <5 years (30-day, 21.7%; 90-day, 26.4%). Medicaid patients were more likely to be readmitted than were private insurance patients (30-day odds ratio [OR], 3.3 [P < 0.001]; 90-day OR, 2.29 [P < 0.02]). In both cohorts, patients with malignant tumors required readmission more often than did those with benign tumors (30-day OR, 2.78 [P < 0.02]; 90-day OR, 1.92 [P = 0.08]). In the 90-day cohort, the patients had been readmitted 26.4 days after discharge versus 10.6 days in the 30-day cohort. Within the 90-day cohort, 18.6% of the readmissions were for spinal reoperation, 28.3% for chemotherapy or hematologic complications, and 25.6% for other central nervous system disorders. The median charges for each readmission were ∼$50,000 and ∼$40,000 for the 30- and 90-day cohorts, respectively. Medicaid insurance, malignant tumors, and younger age were significant predictors of readmission in the 90-day cohort. CONCLUSIONS The prevalence and charges associated with unplanned hospital readmissions after spinal tumor resection were remarkably high. Younger age, Medicaid insurance, malignant tumors, and complications during the initial admission were significant predictors of 90-day readmission.
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Affiliation(s)
- M Burhan Janjua
- Department of Pediatric Neurosurgery, UT Southwestern Medical Center, Dallas, Texas, USA; Department of Neurosurgery, University of Pennsylvania Hospital, Philadelphia, Pennsylvania, USA.
| | - Sumanth Reddy
- Department of Pediatric Neurosurgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Amer F Samdani
- Division of Pediatric Spine, Department of Neurosurgery, Shriners Hospital for Children - Philadelphia, Philadelphia, Pennsylvania, USA
| | - William C Welch
- Department of Neurosurgery, University of Pennsylvania Hospital, Philadelphia, Pennsylvania, USA
| | - Ali K Ozturk
- Department of Neurosurgery, University of Pennsylvania Hospital, Philadelphia, Pennsylvania, USA
| | - Angela V Price
- Department of Pediatric Neurosurgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Bradley E Weprin
- Department of Pediatric Neurosurgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Dale M Swift
- Department of Pediatric Neurosurgery, UT Southwestern Medical Center, Dallas, Texas, USA
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Janjua MB, Hwang SW, Samdani AF, Pahys JM, Baaj AA, Härtl R, Greenfield JP. Instrumented arthrodesis for non-traumatic craniocervical instability in very young children. Childs Nerv Syst 2019; 35:97-106. [PMID: 29959504 DOI: 10.1007/s00381-018-3876-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 06/21/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Occipitocervical instrumentation is infrequently required for stabilization of the axial and subaxial cervical spine in very young children. However, when it is necessary, unique surgical considerations arise in children when compared with similar procedures in adults. METHODS The authors reviewed literature describing fusion of the occipitocervical junction (OCJ) in toddlers and share their experience with eight cases of young children (age less than or equal to 4 years) receiving occiput to axial or subaxial spine instrumentation and fixation. Diagnoses and indications included severe or secondary Chiari malformation, skeletal dysplastic syndromes, Klippel-Feil syndrome, Pierre Robin syndrome, Gordon syndrome, hemivertebra and atlantal occipitalization, basilar impression, and iatrogenic causes. RESULTS All patients underwent occipital bone to cervical spine instrumentation and fixation at different levels. Constructs extended from the occiput to C2 and T1 utilizing various permutations of titanium rods, autologous rib autografts, Mersilene sutures, and combinations of autografts with bone matrix materials. All patients were placed in rigid cervical bracing or halo fixation postoperatively. No postoperative neurological deficits or intraoperative vascular injuries occurred. CONCLUSION Instrumented arthrodesis can be a treatment option in very young children to address the non-traumatic craniocervical instability while reducing the need for prolonged external halo vest immobilization. Factors affecting fusion are addressed with respect to preoperative, intraoperative, and postoperative decision-making that may be unique to the toddler population.
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Affiliation(s)
- M Burhan Janjua
- Department of Neurological Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA. .,Shriners Hospitals for Children-Philadelphia, 3551 N Broad St, Philadelphia, PA, 19140, USA. .,Department of Orthopaedic and Neurological Surgery, University of Pennsylvania Hospital, Philadelphia, PA, USA.
| | - Steven W Hwang
- Shriners Hospitals for Children-Philadelphia, 3551 N Broad St, Philadelphia, PA, 19140, USA
| | - Amer F Samdani
- Shriners Hospitals for Children-Philadelphia, 3551 N Broad St, Philadelphia, PA, 19140, USA
| | - Joshua M Pahys
- Shriners Hospitals for Children-Philadelphia, 3551 N Broad St, Philadelphia, PA, 19140, USA
| | - Ali A Baaj
- Department of Neurological Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Roger Härtl
- Department of Neurological Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Jeffrey P Greenfield
- Department of Neurological Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
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Janjua MB, Toll B, Ghandi S, Sebert ME, Swift DM, Pahys JM, Samdani AF, Hwang SW. Risk Factors for Wound Infections after Deformity Correction Surgery in Neuromuscular Scoliosis. Pediatr Neurosurg 2019; 54:108-115. [PMID: 30783030 DOI: 10.1159/000496693] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 07/10/2018] [Accepted: 01/04/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This study aims to elucidate surgical risk factors in neuromuscular scoliosis (NMS) with respect to wound site infection after spinal fusion. METHODS A retrospective review was performed of all patients treated surgically for NMS between January 2008 and December 2016 (minimum 6 months' follow-up). A sub-cohort of 60 patients with minimum 2 years of follow-up data was also analyzed. RESULTS In 102 patients (53 boys and 49 girls), the mean age at surgery was 14.0 years (SD ±2.7). Mean follow-up was 2.53 years (±1.66), and mean time to presentation of infection was 2.14 months (±4.95). The overall perioperative complication rate was 26.5%, with 14.7% of patients developing deep wound infection. Gram-negative bacteria were responsible for 60% of infections; 20% were Gram positive, and 20% involved both types. Pulmonary comorbidities (p = 0.007), pre- to postoperative increase in weight (p = 0.010), exaggerated lumbar lordosis at follow-up (p = 0.008), history of seizures (p = 0.046), previous myelomeningocele repair (p = 0.046), and previous operations (p = 0.013) were significant risk factors for infection. CONCLUSION Our data suggest that in the pediatric population treated surgically for NMS, wound infection is strongly associated with postoperative increase in body weight, residual lumbar lordosis, pulmonary comorbidity, history of myelomeningocele repair, seizures, and previous operations.
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Affiliation(s)
- M Burhan Janjua
- Departments of Orthopaedic Surgery and Neurosurgery, Shriners Hospitals for Children-Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Orthopedic and Neurosurgery, University of Pennsylvania Hospital, Philadelphia, Pennsylvania, USA.,Department of Pediatric Neurosurgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Brandon Toll
- Departments of Orthopaedic Surgery and Neurosurgery, Shriners Hospitals for Children-Philadelphia, Philadelphia, Pennsylvania, USA
| | - Shashank Ghandi
- Departments of Orthopaedic Surgery and Neurosurgery, Shriners Hospitals for Children-Philadelphia, Philadelphia, Pennsylvania, USA
| | - Michael E Sebert
- Department of Infectious Disease, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Dale M Swift
- Department of Pediatric Neurosurgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Joshua M Pahys
- Departments of Orthopaedic Surgery and Neurosurgery, Shriners Hospitals for Children-Philadelphia, Philadelphia, Pennsylvania, USA
| | - Amer F Samdani
- Departments of Orthopaedic Surgery and Neurosurgery, Shriners Hospitals for Children-Philadelphia, Philadelphia, Pennsylvania, USA
| | - Steven W Hwang
- Departments of Orthopaedic Surgery and Neurosurgery, Shriners Hospitals for Children-Philadelphia, Philadelphia, Pennsylvania, USA,
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Hitti FL, McShane BJ, Yang AI, Rinehart C, Albayar A, Branche M, Malhotra NR, Janjua MB, Ali ZS, Schuster JM, Ozturk AK. Predictors of Failure of Nonoperative Management Following Subaxial Spine Trauma and Creation of Modified Subaxial Injury Classification System. World Neurosurg 2018; 122:e1359-e1364. [PMID: 30448573 DOI: 10.1016/j.wneu.2018.11.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/04/2018] [Accepted: 11/07/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Subaxial cervical spine injuries may be treated with either nonoperative stabilization or surgical fixation. The subaxial injury classification (SLIC) provides 1 method for suggesting the degree of necessity for surgery. In the current study, we examined if the SLIC score, or other preoperative metrics, can predict failure of nonoperative management. METHODS We performed a retrospective chart review to identify patients who presented with acute, nonpenetrating, subaxial cervical spine injury within our health system between 2007 and 2016. Patient demographics, medical comorbidities, injuries, and treatments were collected. Logistic regression analysis was used to determine potential predictors of failure of nonoperative management. RESULTS During the study period, 40 patients met the inclusion criteria. A small subset of patients failed nonoperative management (n = 5, 12.5%). The mean SLIC score was 3.9 ± 1.9; however, 14 (35%) patients had scores >4. Neither total SLIC score (P = 0.68) nor SLIC subscores (morphology [P = 0.96], discoligamentous complex [P = 0.83], neurologic status [P = 0.60]) predicted failure of nonoperative treatment. Time to evaluation/treatment did predict failure of nonoperative management. Evaluation within 8 hours of injury was a negative predictor of failure (odds ratio = 0.03, P = 0.001) and evaluation 24 hours or more after injury was a positive predictor of failure (odds ratio = 66.00, P < 0.001). We created a modified SLIC score on the basis of these findings, which significantly predicted failure of nonoperative management (P = 0.044). CONCLUSIONS Management of subaxial spine injuries is complex. In our cohort, SLIC scoring did not adequately predict odds of failure of nonoperative management. Time to evaluation, however, did. We created a modified SLIC score that significantly predicted failure of nonoperative management.
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Affiliation(s)
- Frederick L Hitti
- Department of Neurosurgery, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Brendan J McShane
- Department of Neurosurgery, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew I Yang
- Department of Neurosurgery, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cole Rinehart
- Department of Neurosurgery, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ahmed Albayar
- Department of Neurosurgery, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marc Branche
- Department of Neurosurgery, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Neil R Malhotra
- Department of Neurosurgery, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - M Burhan Janjua
- Department of Neurosurgery, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Orthopaedic Surgery, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zarina S Ali
- Department of Neurosurgery, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James M Schuster
- Department of Neurosurgery, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ali K Ozturk
- Department of Neurosurgery, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Janjua MB, Ozturk A, Piazza M, Passias P, Arlet V, Welch WC. Technical nuances of percutaneous sacroiliac joint fixation: A cadaveric study. J Clin Neurosci 2018; 61:315-321. [PMID: 30424968 DOI: 10.1016/j.jocn.2018.10.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 10/27/2018] [Indexed: 10/27/2022]
Abstract
Sacroiliac (SI) joint can produce debilitating lower back pain with radiation to groin, buttocks, and lower extremities. SI joint dysfunction poses a clinical challenge to the spine surgeons. Studies entailing surgical arthrodesis utilizing Titanium implants have been reported with reputedly high level of patient satisfaction. Authors have described technical aspects of surgical technique with use of titanium screw implants. The transarticular technique is used to places SI joint screw implants across the articular portion of SI joint. Cadaveric SI joint instrumentation is performed under fluoroscopic guidance. Moreover, Medline literature search is conducted to study surgical outcome, and patient satisfaction. 4 cadavers are prepped prone for the percutaneous approach. Bilaterally 6 screws are placed using transarticular placement technique under fluoroscopic guidance. The posterior technique utilizes alignment guide to place the screws inline on the inlet view, parallel in the outlet view, and parallel to the dorsal aspect of the sacral body in the lateral view. One C-arm is used in the entire technique. The technical aspects of surgical technique have been described in a stepwise fashion for easy reproducibility in the operating room. Each screw track is checked with tactile feel of a blunt K-wire before final deployment. All bilateral screws were checked on a set of fluoroscopic views. A detail clinical examination, diagnostic joint injection, with the radiological imaging must be considered before surgical consideration. SI Joint fusion utilizing 3 transarticular sacral screws is equally effective and safe procedure to treat chronic lower back pain ensuing from SI joint dysfunction.
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Affiliation(s)
- M Burhan Janjua
- Department of Orthopedic Surgery, University of Pennsylvania Hospital, Philadelphia, PA, United States; Department of Neurosurgery, University of Pennsylvania Hospital, Philadelphia, PA, United States.
| | - Ali Ozturk
- Department of Neurosurgery, University of Pennsylvania Hospital, Philadelphia, PA, United States
| | - Matthew Piazza
- Department of Neurosurgery, University of Pennsylvania Hospital, Philadelphia, PA, United States
| | - Peter Passias
- Department of Orthopedic Surgery, NYU Langone Medical Center, and Hospital for Joint Diseases, New York, NY, United States
| | - Vincent Arlet
- Department of Orthopedic Surgery, University of Pennsylvania Hospital, Philadelphia, PA, United States
| | - William C Welch
- Department of Neurosurgery, University of Pennsylvania Hospital, Philadelphia, PA, United States
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Toll BJ, Samdani AF, Janjua MB, Gandhi S, Pahys JM, Hwang SW. Perioperative complications and risk factors in neuromuscular scoliosis surgery. J Neurosurg Pediatr 2018; 22:207-213. [PMID: 29749884 DOI: 10.3171/2018.2.peds17724] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE High rates of perioperative complications are associated with deformity correction in neuromuscular scoliosis. The current study aimed to evaluate complications associated with surgical correction of neuromuscular scoliosis and to characterize potential risk factors. METHODS Data were retrospectively collected from a single-center cohort of 102 consecutive patients who underwent spinal fusions for neuromuscular scoliosis between January 2008 and December 2016 and who had a minimum of 6 months of follow-up. A subgroup analysis was performed on data from patients who had at least 2 years of follow-up. Univariate and multivariate regression analyses, as well as binary correlational models and Student t-tests, were employed for further statistical analysis. RESULTS The present cohort had 53 boys and 49 girls with a mean age at surgery of 14.0 years (± 2.7 SD, range 7.5-19.5 years). The most prevalent diagnoses were cerebral palsy (26.5%), spinal cord injury (24.5%), and neurofibromatosis (10.8%). Analysis reflected an overall perioperative complication rate of 27% (37 complications in 27 patients), 81.1% of which constituted major complications (n = 30) compared to a rate of 18.9% for minor complications (n = 7). Complications were predicted by nonambulatory status (p = 0.037), increased intraoperative blood loss (p = 0.012), increased intraoperative time (p = 0.046), greater pelvic obliquity at follow-up (p = 0.028), and greater magnitude of sagittal profile at follow-up (p = 0.048). Pulmonary comorbidity (p = 0.001), previous operations (p = 0.013), history of seizures (p = 0.046), diagnosis of myelomeningocele (p = 0.046), increase in weight postoperatively (p < 0.005), and increased lumbar lordosis at follow-up (p = 0.015) were identified as risk factors for perioperative infection. CONCLUSIONS These results suggest that in neuromuscular scoliosis, patients with preexisting pulmonary compromise and greater intraoperative blood loss have the greatest risk of experiencing a major perioperative complication following surgical deformity correction.
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Janjua MB, Tishelman JC, Vasquez-Montes D, Vaynrub M, Errico TJ, Buckland AJ, Protopsaltis T. The value of sitting radiographs: analysis of spine flexibility and its utility in preoperative planning for adult spinal deformity surgery. J Neurosurg Spine 2018; 29:414-421. [PMID: 29979136 DOI: 10.3171/2018.2.spine17749] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Sitting radiographs are a valuable tool to consider the thoracic compensatory mechanism in patients who are candidates for thoracolumbar correction surgery.
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Affiliation(s)
- M Burhan Janjua
- Departments of1Orthopedic Surgery and.,2Neurosurgery, NYU Langone Medical Center and Hospital for Joint Diseases, New York, New York
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Janjua MB, Hoffman CE, Souweidane MM. Contemporary management and surveillance strategy after shunt or endoscopic third ventriculostomy procedures for hydrocephalus. J Clin Neurosci 2017; 45:18-23. [PMID: 28765060 DOI: 10.1016/j.jocn.2017.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 06/04/2017] [Accepted: 07/11/2017] [Indexed: 11/18/2022]
Abstract
The management of hydrocephalus can be challenging even in expert hands. Due to acute presentation, recurrence, accompanying complications, the need for urgent diagnosis; a robust management plan is an absolute necessity. We devised a novel time efficient surveillance strategy during emergency, and clinic follow up settings which has never been described in the literature. We searched all articles embracing management/surveillance protocol on pediatric hydrocephalus utilizing the terms "hydrocephalus follow up" or "surveillance protocol after hydrocephalus treatment". The authors present their own strategy based on vast experience in the hydrocephalus management at a single institution. The need for the diagnostic laboratory testing, age and presentation based radiological imaging, significance of neuro-opthalmological exam, and when to consider the emergent exploration have been discussed in detail. Moreover, a definitive triaging strategy has been described with the help of flow chart diagrams for clinicians, and the neurosurgeons in practice. The triage starts from detail history, physical exam, necessary labs, radiological imaging depending on the presentation, and the age of the child. A quick head CT scan helps after shunt surgery while, a FAST sequence MRI scan (fsMRI) is important in post ETV patients. The need for neuro-opthalmological exam, and the shunt series stays vital in asymptomatic patients during regular follow up.
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Affiliation(s)
- M Burhan Janjua
- Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, 525 East, 68th Street, New York, NY 10065, United States.
| | - Caitlin E Hoffman
- Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, 525 East, 68th Street, New York, NY 10065, United States
| | - Mark M Souweidane
- Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, 525 East, 68th Street, New York, NY 10065, United States
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Janjua MB, Caruso JP, Greenfield JP, Souweidane MM, Schwartz TH. The combined transpetrosal approach: Anatomic study and literature review. J Clin Neurosci 2017; 41:36-40. [DOI: 10.1016/j.jocn.2017.03.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 03/06/2017] [Indexed: 10/19/2022]
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Abstract
Spinal cord compression due to synovial facet cyst in thoracolumbar spine is rare. Several etiologies of juxtafacet cysts (JFCs) in this location have been discussed, particularly overload of the arthritic facet joints. Due to the narrow caliber of the thoracic spine, JFC in this location can present with radicular pain or progressive myelopathy. We report an interesting case of a 67 year-old woman who presented with the signs and symptoms of thoracic myelopathy. A left-sided T11/12 JFC was identified on MRI and CT scans correlating with her myelopathy. She experienced a substantial improvement in her myelopathic symptoms after surgical excision of the JFC. The presentation, etiology, and therapeutic aspects of JFC are discussed in detail.
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Affiliation(s)
- M Burhan Janjua
- 1Department of Orthopedic Surgery, 2Department of Neurological Surgery, New York University Langone Medical Center Hospital for Joint Diseases, New York, NY, USA
| | - Michael L Smith
- 1Department of Orthopedic Surgery, 2Department of Neurological Surgery, New York University Langone Medical Center Hospital for Joint Diseases, New York, NY, USA
| | - Kartik Shenoy
- 1Department of Orthopedic Surgery, 2Department of Neurological Surgery, New York University Langone Medical Center Hospital for Joint Diseases, New York, NY, USA
| | - Yong H Kim
- 1Department of Orthopedic Surgery, 2Department of Neurological Surgery, New York University Langone Medical Center Hospital for Joint Diseases, New York, NY, USA
| | - Afshin E Razi
- 1Department of Orthopedic Surgery, 2Department of Neurological Surgery, New York University Langone Medical Center Hospital for Joint Diseases, New York, NY, USA
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Abstract
Introduction Posterior C1-C2 fusion is a highly successful treatment for atlantoaxial instability and other pathologies of the cervical spine, with fusion rates approaching 95%-100%. However, poor visualization of the lateral masses of C1 secondary to the course of the C2 nerve root along with blood loss from the venous plexus and compression of the C2 nerve from lateral mass screws are technical obstacles that can arise during surgery. Thus, sacrifice of the C2 nerve root has long since been debated in fusions involving the C1 and C2 vertebral bodies. Methods Cadaveric dissections on four adult specimens were performed. Both intradural and extradural courses of C2 were studied in detail. The tentative site of C2 nerve root compression during placement of C1 lateral mass screws was studied in detail. Both the indication as well as the ease of C2 neurectomy were studied in relation to postoperative compression and entrapment. Results Four-six dorsal rootlets of C2 nerve were observed while studying the intradural course. The extradural course was studied with respect to the lateral mass of C1. The greater occipital nerve (GON) course was fairly consistent in all specimens. Transection of C2 around its ganglion would allow for proper C1 lateral mass screw placement as the course of C2 nerve interferes with proper placement of instrumentation. Conclusion C2 nerve root transection is associated with occipital numbness but this often has no effect on health-related quality of life (HRQOL). The C2 nerve root preservation is often associated with entrapment neuropathy or occipital neuralgia, which greatly affects HRQOL. The C2 nerve root transection helps in better visualization, aids in optimal placement of C1 lateral mass screws, minimizes estimated blood loss and improves surgical outcome with successful fusion.
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Affiliation(s)
- M Burhan Janjua
- Neurosurgery/Spine Surgery, New York University Langone Medical Center
| | - Peter L Zhou
- Hospital for Joint Diseases, New York University Langone Medical Center
| | | | - Ali A Baaj
- Neurological Surgery, New York-Presbyterian/Weill Cornell Medical College
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Henn MC, Janjua MB, Zhang H, Kanter EM, Makepeace CM, Schuessler RB, Nichols CG, Lawton JS. Increased tolerance to stress in cardiac expressed gain-of-function of adenosine triphosphate-sensitive potassium channel subunit Kir6.1. J Surg Res 2016; 206:460-465. [PMID: 27884343 DOI: 10.1016/j.jss.2016.08.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 06/22/2016] [Accepted: 08/05/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND The adenosine triphosphate-sensitive potassium (KATP) channel opener diazoxide (DZX) prevents myocyte volume derangement and reduced contractility secondary to stress. KATP channels are composed of pore-forming (Kir6.1 or Kir6.2) and regulatory (sulfonylurea receptor, SUR1 or SUR2) subunits. Gain of function (GOF) of Kir6.1 subunits has been implicated in cardiac pathology in Cantu syndrome in humans (cardiomegaly, lymphedema, and pericardial effusions). We hypothesized that GOF of Kir6.1 subunits would result in altered myocyte response to stress. MATERIALS AND METHODS Isolated cardiac myocytes from wild type (WT) and transgenic Kir6.1GOF mice were exposed to Tyrode's physiologic solution for 20 min, test solution (Tyrode's or stress [hyperkalemic cardioplegia {CPG, known myocyte stress}] +/- KATP channel opener DZX), followed by Tyrode's for 20 min. Myocyte volume and contractility were measured and compared. RESULTS WT myocytes demonstrated significant swelling in response to stress, but significantly less swelling was seen in Kir6.1GOF myocytes. DZX prevented swelling secondary to CPG in WT but resulted in a nonsignificant reduction in swelling in Kir6.1GOF myocytes. Both WT and Kir6.1GOF myocytes demonstrated a reduction in contractility during stress, although this was only significant in Kir6.1GOF myocytes. DZX was not associated with an improvement in contractility in Kir6.1GOF myocytes following stress. CONCLUSIONS Similar to previous results in Kir6.1(-/-) myocytes, Kir6.1GOF myocytes demonstrate resistance (less volume derangement) to stress of cardioplegia. Understanding the role of Kir6.1 in myocyte response to stress may aid in the treatment of patients with Cantu syndrome and warrants further investigation.
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Affiliation(s)
- Matthew C Henn
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - M Burhan Janjua
- Department of Neurological Surgery, Weill Cornell Medical College, New York, New York
| | - Haixia Zhang
- Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, Missouri
| | - Evelyn M Kanter
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Carol M Makepeace
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Richard B Schuessler
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Colin G Nichols
- Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, Missouri
| | - Jennifer S Lawton
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
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Henn MC, Janjua MB, Kanter EM, Makepeace CM, Schuessler RB, Nichols CG, Lawton JS. Adenosine Triphosphate-Sensitive Potassium Channel Kir Subunits Implicated in Cardioprotection by Diazoxide. J Am Heart Assoc 2015; 4:e002016. [PMID: 26304939 PMCID: PMC4599460 DOI: 10.1161/jaha.115.002016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background ATP-sensitive potassium (KATP) channel openers provide cardioprotection in multiple models. Ion flux at an unidentified mitochondrial KATP channel has been proposed as the mechanism. The renal outer medullary kidney potassium channel subunit, potassium inward rectifying (Kir)1.1, has been implicated as a mitochondrial channel pore-forming subunit. We hypothesized that subunit Kir1.1 is involved in cardioprotection (maintenance of volume homeostasis and contractility) of the KATP channel opener diazoxide (DZX) during stress (exposure to hyperkalemic cardioplegia [CPG]) at the myocyte and mitochondrial levels. Methods and Results Kir subunit inhibitor Tertiapin Q (TPN-Q) was utilized to evaluate response to stress. Mouse ventricular mitochondrial volume was measured in the following groups: isolation buffer; 200 μmol/L of ATP; 100 μmol/L of DZX+200 μmol/L of ATP; or 100 μmol/L of DZX+200 μmol/L of ATP+TPN-Q (500 or 100 nmol/L). Myocytes were exposed to Tyrode’s solution (5 minutes), test solution (Tyrode’s, cardioplegia [CPG], CPG+DZX, CPG+DZX+TPN-Q, Tyrode’s+TPN-Q, or CPG+TPN-Q), N=12 for all (10 minutes); followed by Tyrode’s (5 minutes). Volumes were compared. TPN-Q, with or without DZX, did not alter mitochondrial or myocyte volume. Stress (CPG) resulted in myocyte swelling and reduced contractility that was prevented by DZX. TPN-Q prevented the cardioprotection afforded by DZX (volume homeostasis and maintenance of contractility). Conclusions TPN-Q inhibited myocyte cardioprotection provided by DZX during stress; however, it did not alter mitochondrial volume. Because TPN-Q inhibits Kir1.1, Kir3.1, and Kir3.4, these data support that any of these Kir subunits could be involved in the cardioprotection afforded by diazoxide. However, these data suggest that mitochondrial swelling by diazoxide does not involve Kir1.1, 3.1, or 3.4.
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Affiliation(s)
- Matthew C Henn
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO (M.C.H., B.J., E.M.K., C.M.M., R.B.S., J.S.L.)
| | - M Burhan Janjua
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO (M.C.H., B.J., E.M.K., C.M.M., R.B.S., J.S.L.)
| | - Evelyn M Kanter
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO (M.C.H., B.J., E.M.K., C.M.M., R.B.S., J.S.L.)
| | - Carol M Makepeace
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO (M.C.H., B.J., E.M.K., C.M.M., R.B.S., J.S.L.)
| | - Richard B Schuessler
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO (M.C.H., B.J., E.M.K., C.M.M., R.B.S., J.S.L.)
| | - Colin G Nichols
- Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO (C.G.N.)
| | - Jennifer S Lawton
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO (M.C.H., B.J., E.M.K., C.M.M., R.B.S., J.S.L.)
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Affiliation(s)
- Orwa Aboud
- Department of Neurology, University of Arkansas at Medical Sciences (UAMS), Little Rock, Arkansas
| | - Talal Aboud
- Atlantic University Medical School, New York, New York
| | | | - Ali I. Raja
- Arkansas Neuroscience Institute, CHI St Vincent Infirmary, Five St Vincent Circle, Ste 503, Little Rock, AR 72205
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Henn MC, Janjua MB, Zhang H, Kanter EM, Makepeace CM, Schuessler RB, Nichols CG, Lawton JS. Diazoxide Cardioprotection Is Independent of Adenosine Triphosphate-Sensitive Potassium Channel Kir6.1 Subunit in Response to Stress. J Am Coll Surg 2015; 221:319-25. [PMID: 25872691 DOI: 10.1016/j.jamcollsurg.2015.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 02/10/2015] [Accepted: 02/10/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND The sarcolemmal adenosine triphosphate-sensitive potassium channel (sK(ATP)), composed primarily of potassium inward rectifier (Kir) 6.2 and sulfonylurea receptor 2A subunits, has been implicated in cardiac myocyte volume regulation during stress; however, it is not involved in cardioprotection by the adenosine triphosphate-sensitive potassium channel (K(ATP)) channel opener diazoxide (7-chloro-3-methyl-1,2,4-benzothiadiazine-1,1-dioxide [DZX]). Paradoxically, the sK(ATP) channel subunit Kir6.2 is necessary for detrimental myocyte swelling secondary to stress. The Kir6.1 subunit can also contribute to K(ATP) channels in the heart, and we hypothesized that this subunit might play a role in myocyte volume regulation in response to stress. STUDY DESIGN Isolated cardiac myocytes from either wild-type mice or mice lacking the Kir6.1 subunit (Kir6.1[-/-]) were exposed to control Tyrode's solution (TYR) for 20 minutes, test solution (TYR, hypothermic hyperkalemic cardioplegia [CPG], or CPG + K(ATP) channel opener DZX [CPG + DZX]) for 20 minutes, followed by TYR for 20 minutes. Myocyte volume and contractility were measured and analyzed. RESULTS Both wild-type and Kir6.1(-/-) myocytes demonstrated substantial swelling during exposure to stress (CPG), which was prevented by DZX. Wild-type myocytes also demonstrated reduced contractility during stress of CPG that was prevented by DZX. However, Kir6.1(-/-) myocytes did not show reduced contractility during stress. CONCLUSIONS These data indicate that K(ATP) channel subunit Kir6.1 is not necessary for DZX's maintenance of cell volume during the stress of CPG. The absence of Kir6.1 does not affect the contractile properties of myocytes during stress, suggesting the absence of Kir6.1 improves myocyte tolerance to stress via an unknown mechanism.
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Affiliation(s)
- Matthew C Henn
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO
| | | | - Haixia Zhang
- Department of Cell Biology and Physiology, Washington University School of Medicine, St Louis, MO
| | - Evelyn M Kanter
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Carol M Makepeace
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Richard B Schuessler
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Colin G Nichols
- Department of Cell Biology and Physiology, Washington University School of Medicine, St Louis, MO
| | - Jennifer S Lawton
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO.
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Janjua MB, Makepeace CM, Anastacio MM, Schuessler RB, Nichols CG, Lawton JS. Cardioprotective benefits of adenosine triphosphate-sensitive potassium channel opener diazoxide are lost with administration after the onset of stress in mouse and human myocytes. J Am Coll Surg 2014; 219:803-13. [PMID: 25158912 DOI: 10.1016/j.jamcollsurg.2014.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 04/28/2014] [Accepted: 05/06/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Adenosine triphosphate-sensitive (KATP) potassium channel opener diazoxide (DZX) maintains myocyte volume and contractility during stress via an unknown mechanism when administered at the onset of stress. This study was performed to investigate the cardioprotective potential of DZX when added after the onset of the stresses of hyperkalemic cardioplegia, metabolic inhibition, and hypo-osmotic stress. STUDY DESIGN Isolated mouse ventricular and human atrial myocytes were exposed to control Tyrode's solution (TYR) for 10 to 20 minutes, test solution for 30 minutes (hypothermic hyperkalemic cardioplegia [CPG], CPG + 100uM diazoxide [CPG+DZX], metabolic inhibition [MI], MI+DZX, mild hypo-osmotic stress [0.9T], or 0.9T + DZX), with DZX added after 10 or 20 minutes of stress, followed by 20 minutes of re-exposure to TYR (±DZX). Myocyte volume (human + mouse) and contractility (mouse) were compared. RESULTS Mouse and human myocytes demonstrated significant swelling during exposure to CPG, MI, and hypo-osmotic stress that was not prevented by DZX when administered either at 10 or 20 minutes after the onset of stress. Contractility after the stress of CPG in mouse myocytes significantly declined when DZX was administered 20 minutes after the onset of stress (p < 0.05 vs TYR). Contractility after hypo-osmotic stress in mouse myocytes was not altered by the addition of DZX. CONCLUSIONS To maintain myocyte volume homeostasis and contractility during stress (hyperkalemic cardioplegia, metabolic inhibition, and hypo-osmotic stress), KATP channel opener diazoxide requires administration at the onset of stress in this isolated myocyte model. These data have potential implications for any future clinical application of diazoxide.
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Affiliation(s)
- M Burhan Janjua
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Carol M Makepeace
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Melissa M Anastacio
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Richard B Schuessler
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Colin G Nichols
- Department of Cell Biology and Physiology, Washington University School of Medicine, St Louis, MO
| | - Jennifer S Lawton
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO.
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