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Cornwall GB, Davis A, Walsh WR, Mobbs RJ, Vaccaro A. Innovation and New Technologies in Spine Surgery, Circa 2020: A Fifty-Year Review. Front Surg 2020; 7:575318. [PMID: 33330605 PMCID: PMC7732641 DOI: 10.3389/fsurg.2020.575318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/27/2020] [Indexed: 12/18/2022] Open
Abstract
Spine surgery (lumbar, cervical, deformity, and entire spine) has increased in volume and improved in outcomes over the past 50 years because of innovations in surgical techniques and introduction of new technologies to improve patient care. Innovation is described as a process to add value or create change in an enterprise's economic or social potential. This mini review will assess two of three assessments of innovation in spine surgery: scientific publications and patents issued. The review of both scientific publications and issued patents is a unique assessment. The third assessment of innovation: regulatory clearances of medical devices and equipment for spine surgery and their evolution over time, will also be discussed.
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Affiliation(s)
- G. Bryan Cornwall
- Shiley-Marcos School of Engineering, University of San Diego, San Diego, CA, United States
- Surgical Orthopaedic Research Laboratory, Prince of Wales Hospital, University of New South Wales, Sydney, NSW, Australia
| | | | - William R. Walsh
- Surgical Orthopaedic Research Laboratory, Prince of Wales Hospital, University of New South Wales, Sydney, NSW, Australia
| | - Ralph J. Mobbs
- Surgical Orthopaedic Research Laboratory, Prince of Wales Hospital, University of New South Wales, Sydney, NSW, Australia
| | - Alexander Vaccaro
- Rothman's Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, United States
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Belykh E, Krutko AV, Baykov ES, Giers MB, Preul MC, Byvaltsev VA. Preoperative estimation of disc herniation recurrence after microdiscectomy: predictive value of a multivariate model based on radiographic parameters. Spine J 2017; 17:390-400. [PMID: 27765709 DOI: 10.1016/j.spinee.2016.10.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/27/2016] [Accepted: 10/12/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Recurrence of lumbar disc herniation (rLDH) is one of the unfavorable outcomes after microdiscectomy. Prediction of the patient population with increased risk of rLDH is important because patients may benefit from preventive measures or other surgical options. PURPOSE The study assessed preoperative factors associated with rLDH after microdiscectomy and created a mathematical model for estimation of chances for rLDH. STUDY DESIGN/SETTING This is a retrospective case-control study. PATIENT SAMPLE The study includes patients who underwent microdiscectomy for LDH. OUTCOME MEASURES Lumbar disc herniation recurrence was determined using magnetic resonance imaging. METHODS The study included 350 patients with LDH and a minimum of 3 years of follow-up. Patients underwent microdiscectomy for LDH at the L4-L5 and L5-S1 levels from 2008 to 2012. Patients were divided into two groups to identify predictors of recurrence: those who developed rLDH (n=50) within 3 years and those who did not develop rLDH (n=300) within the same follow-up period. Multivariate analysis was performed using patient baseline clinical and radiography data. Non-linear, multivariate, logistic regression analysis was used to build a predictive model. RESULTS Recurrence of LDH occurred within 1 to 48 months after microdiscectomy. Preoperatively, patients who developed rLDH were smokers (70% vs. 27%, p<.01; odds ratio [OR]=6.31, 95% confidence interval [CI]: 3.27-12.16) and had higher body mass index (29.0±6.1 vs. 27.0±4.3, p=.03; OR=1.09 per 0.01 unit change). Radiological parameters that were associated with rLDH were higher disc height index (0.35±0.007 vs. 0.26±0.002, p<.001), higher segmental range of motion (9.8±0.28° vs. 7.6±0.11°, p<.001; OR=0.53 per 0.01 unit change), and lower central angle of lumbar lordosis (33.4±0.81° vs. 47.1±0.47°, p<.001; OR=0.53 per 0.01 unit change). Additionally, Pfirrmann grade 3 (OR=16.62, 95% CI: 8.10-34.11), protrusion type of LDH (OR=5.90, 95% CI: 3.06-11.36), and Grogan sclerosis grades 3 and 4 (OR=4.81, 95% CI: 2.50-9.22) were also associated with rLDH. Multivariate non-linear modeling allowed for more accurate prediction of rLDH (90% correct prediction of rLDH; 99% correct prediction of no rLDH) than other univariate logit models. CONCLUSIONS Preoperative radiographic parameters in patients with LDH can be used to assess the risk of recurrence after microdiscectomy. The multifactorial non-linear model provided more accurate rLDH probability estimation than the univariate analyses. The software developed from this model may be implemented during patient counseling or decision making when choosing the type of primary surgery for LDH.
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Affiliation(s)
- Evgenii Belykh
- Irkutsk Scientific Center of Surgery and Traumatology, Bortsov Revolyutsii str., 1, Irkutsk, 664003, Russia; Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd, Phoenix, AZ 85013, USA; Department of Neurosurgery, Irkutsk State Medical University, Krasnogo vosstaniya str., 1, Irkutsk, 664003, Russia
| | - Alexander V Krutko
- Neurosurgery Department No. 2, Novosibirsk Scientific Research Institute of Traumatology and Orthopedics, Frunze str., 17, Novosibirsk, 630091, Russia
| | - Evgenii S Baykov
- Neurosurgery Department No. 2, Novosibirsk Scientific Research Institute of Traumatology and Orthopedics, Frunze str., 17, Novosibirsk, 630091, Russia
| | - Morgan B Giers
- Irkutsk Scientific Center of Surgery and Traumatology, Bortsov Revolyutsii str., 1, Irkutsk, 664003, Russia; Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd, Phoenix, AZ 85013, USA
| | - Mark C Preul
- Irkutsk Scientific Center of Surgery and Traumatology, Bortsov Revolyutsii str., 1, Irkutsk, 664003, Russia; Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd, Phoenix, AZ 85013, USA
| | - Vadim A Byvaltsev
- Irkutsk Scientific Center of Surgery and Traumatology, Bortsov Revolyutsii str., 1, Irkutsk, 664003, Russia; Department of Neurosurgery, Irkutsk State Medical University, Krasnogo vosstaniya str., 1, Irkutsk, 664003, Russia; Neurosurgery Department, Irkutsk Railway Clinical Hospital, Botkina str, 10, Irkutsk, 664005, Russia.
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Ji Y, Meng B, Yuan C, Yang H, Zou J. Monitoring somatosensory evoked potentials in spinal cord ischemia-reperfusion injury. Neural Regen Res 2013; 8:3087-94. [PMID: 25206629 PMCID: PMC4158706 DOI: 10.3969/j.issn.1673-5374.2013.33.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 09/27/2013] [Indexed: 11/26/2022] Open
Abstract
It remains unclear whether spinal cord ischemia-reperfusion injury caused by ischemia and other non-mechanical factors can be monitored by somatosensory evoked potentials. Therefore, we monitored spinal cord ischemia-reperfusion injury in rabbits using somatosensory evoked potential detection technology. The results showed that the somatosensory evoked potential latency was significantly prolonged and the amplitude significantly reduced until it disappeared during the period of spinal cord ischemia. After reperfusion for 30–180 minutes, the amplitude and latency began to gradually recover; at 360 minutes of reperfusion, the latency showed no significant difference compared with the pre-ischemic value, while the somatosensory evoked potential amplitude in-creased, and severe hindlimb motor dysfunctions were detected. Experimental findings suggest that changes in somatosensory evoked potential latency can reflect the degree of spinal cord ischemic injury, while the amplitude variations are indicators of the late spinal cord reperfusion injury, which provide evidence for the assessment of limb motor function and avoid iatrogenic spinal cord injury.
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Affiliation(s)
- Yiming Ji
- Department of Orthopedic Surgery, the First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Bin Meng
- Department of Orthopedic Surgery, the First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Chenxi Yuan
- Department of Orthopedic Surgery, the First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Huilin Yang
- Department of Orthopedic Surgery, the First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Jun Zou
- Department of Orthopedic Surgery, the First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
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