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Ibrahim S, Michalopoulos GD, Flanigan P, Johnson SE, Katsos K, Sebastian AS, Freedman BA, Bydon M. Bone morphogenetic protein in subaxial cervical arthrodesis: a meta-analysis of 5828 patients. J Neurosurg Spine 2024:1-14. [PMID: 38701518 DOI: 10.3171/2024.2.spine23941] [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: 08/22/2023] [Accepted: 02/13/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVE Use of bone morphogenetic protein (BMP)-an osteoinductive agent commonly used in lumbar arthrodesis-is off-label for cervical arthrodesis. This study aimed to identify the effect of BMP use on clinical and radiological outcomes in instrumented cervical arthrodesis. METHODS A comprehensive systematic review of the literature was performed to identify studies directly comparing outcomes between cervical arthrodeses with and without using BMP. Outcomes were analyzed separately for cases of anterior cervical discectomy and fusion (ACDF) and posterior cervical fusion (PCF). RESULTS A total of 20 studies with 5828 patients (1948 with BMP and 3880 without BMP) were included. In the ACDF cases, BMP use was associated with higher fusion rates (98.9% vs 93.6%, risk difference [RD] 8%; risk ratio [RR] 1.12, p = 0.02), lower reoperation rates (2.2% vs 3.1%, RD 3%; RR 0.48, p = 0.04), and higher risk of dysphagia (24.7% vs 8.1%, RD 11%; RR 1.93, p = 0.02). No significant differences in the Neck Disability Index, neck pain, or arm pain scores were associated with the use of BMP. On subgroup meta-analysis of ACDF cases, older age (≥ 50 years) and higher BMP dose (≥ 0.9 mg/level) were associated with significantly higher fusion rates and relatively lower risk for dysphagia, whereas arthrodesis of fewer segments (< 2 levels) showed significantly higher dysphagia rates without a significant increase in fusion rates. In the PCF cases, the use of BMP was not associated with significant differences in fusion (p = 0.38) or reoperation (p = 0.61) rates but was associated with significantly higher blood loss during surgery (mean difference 146.7 ml, p ≤ 0.01). CONCLUSIONS Use of BMP in ACDF offers higher rates of augmented fusion and lower rates of all-cause reoperation but with an increased risk of dysphagia. The benefit of fusion outweighs the risk of dysphagia with a higher BMP dose in older patients being operated on for < 2 levels. The use of BMP in PCF seems to have a less important effect on clinical and radiological outcomes.
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Affiliation(s)
- Sufyan Ibrahim
- 1Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester; and
- Departments of2Neurologic Surgery and
| | - Giorgos D Michalopoulos
- 1Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester; and
- Departments of2Neurologic Surgery and
| | | | - Sarah E Johnson
- 1Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester; and
- Departments of2Neurologic Surgery and
| | - Konstantinos Katsos
- 1Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester; and
- Departments of2Neurologic Surgery and
| | | | | | - Mohamad Bydon
- 1Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester; and
- Departments of2Neurologic Surgery and
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2
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Agarwal N, Johnson SE, Bydon M, Bisson EF, Chan AK, Shabani S, Letchuman V, Michalopoulos GD, Lu DC, Wang MY, Lavadi RS, Haid RW, Knightly JJ, Sherrod BA, Gottfried ON, Shaffrey CI, Goldberg JL, Virk MS, Hussain I, Glassman SD, Shaffrey ME, Park P, Foley KT, Pennicooke B, Coric D, Slotkin JR, Upadhyaya C, Potts EA, Tumialán LM, Chou D, Fu KMG, Asher AL, Mummaneni PV. Cervical spondylotic myelopathy and driving abilities: defining the prevalence and long-term postoperative outcomes using the Quality Outcomes Database. J Neurosurg Spine 2024; 40:630-641. [PMID: 38364219 DOI: 10.3171/2023.11.spine23738] [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: 07/18/2023] [Accepted: 11/28/2023] [Indexed: 02/18/2024]
Abstract
OBJECTIVE Cervical spondylotic myelopathy (CSM) can cause significant difficulty with driving and a subsequent reduction in an individual's quality of life due to neurological deterioration. The positive impact of surgery on postoperative patient-reported driving capabilities has been seldom explored. METHODS The CSM module of the Quality Outcomes Database was utilized. Patient-reported driving ability was assessed via the driving section of the Neck Disability Index (NDI) questionnaire. This is an ordinal scale in which 0 represents the absence of symptoms while driving and 5 represents a complete inability to drive due to symptoms. Patients were considered to have an impairment in their driving ability if they reported an NDI driving score of 3 or higher (signifying impairment in driving duration due to symptoms). Multivariable logistic regression models were fitted to evaluate mediators of baseline impairment and improvement at 24 months after surgery, which was defined as an NDI driving score < 3. RESULTS A total of 1128 patients who underwent surgical intervention for CSM were included, of whom 354 (31.4%) had baseline driving impairment due to CSM. Moderate (OR 2.3) and severe (OR 6.3) neck pain, severe arm pain (OR 1.6), mild-moderate (OR 2.1) and severe (OR 2.5) impairment in hand/arm dexterity, severe impairment in leg use/walking (OR 1.9), and severe impairment of urinary function (OR 1.8) were associated with impaired driving ability at baseline. Of the 291 patients with baseline impairment and available 24-month follow-up data, 209 (71.8%) reported postoperative improvement in their driving ability. This improvement seemed to be mediated particularly through the achievement of the minimal clinically important difference (MCID) in neck pain and improvement in leg function/walking. Patients with improved driving at 24 months noted higher postoperative satisfaction (88.5% vs 62.2%, p < 0.01) and were more likely to achieve a clinically significant improvement in their quality of life (50.7% vs 37.8%, p < 0.01). CONCLUSIONS Nearly one-third of patients with CSM report impaired driving ability at presentation. Seventy-two percent of these patients reported improvements in their driving ability within 24 months of surgery. Surgical management of CSM can significantly improve patients' driving abilities at 24 months and hence patients' quality of life.
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Affiliation(s)
- Nitin Agarwal
- 1Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- 2Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- 3Neurological Surgery, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Sarah E Johnson
- 4Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mohamad Bydon
- 4Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Erica F Bisson
- 5Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Andrew K Chan
- 6Department of Neurosurgery, Columbia University Irving Medical Center, New York, New York
| | - Saman Shabani
- 7Department of Neurological Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Vijay Letchuman
- 8Department of Neurosurgery, University of California, San Francisco, San Francisco, California
| | | | - Daniel C Lu
- 9Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California
| | - Michael Y Wang
- 10Department of Neurological Surgery, University of Miami, Miami, Florida
| | - Raj Swaroop Lavadi
- 1Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Regis W Haid
- 11Atlanta Brain and Spine Care, Atlanta, Georgia
| | - John J Knightly
- 12Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Brandon A Sherrod
- 5Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Oren N Gottfried
- 13Department of Neurosurgery, Duke University, Durham, North Carolina
| | | | - Jacob L Goldberg
- 14Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | - Michael S Virk
- 14Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | - Ibrahim Hussain
- 14Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | | | - Mark E Shaffrey
- 16Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Paul Park
- 17Department of Neurosurgery, Semmes Murphey Clinic, University of Tennessee, Memphis, Tennessee
| | - Kevin T Foley
- 17Department of Neurosurgery, Semmes Murphey Clinic, University of Tennessee, Memphis, Tennessee
| | - Brenton Pennicooke
- 18Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Domagoj Coric
- 19Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina
| | | | - Cheerag Upadhyaya
- 21Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina
| | - Eric A Potts
- 22Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indianapolis, Indiana; and
| | - Luis M Tumialán
- 23Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Dean Chou
- 6Department of Neurosurgery, Columbia University Irving Medical Center, New York, New York
| | - Kai-Ming G Fu
- 14Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | - Anthony L Asher
- 19Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina
| | - Praveen V Mummaneni
- 8Department of Neurosurgery, University of California, San Francisco, San Francisco, California
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Michalopoulos GD, Katsos K, Grills IS, Warnick RE, McInerney J, Attia A, Timmerman R, Chang E, Andrews DW, D'Ambrosio AL, Cobb WS, Pouratian N, Spalding AC, Walter K, Jensen RL, Bydon M, Asher AL, Sheehan JP. Stereotactic radiosurgery in the management of non-small cell lung cancer brain metastases: a prospective study using the NeuroPoint Alliance Stereotactic Radiosurgery Registry. J Neurosurg 2024; 140:1223-1232. [PMID: 37948684 DOI: 10.3171/2023.8.jns23308] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 08/31/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE The literature on non-small cell lung cancer (NSCLC) brain metastases (BMs) managed using stereotactic radiosurgery (SRS) relies mainly on single-institution studies or randomized controlled trials (RCTs). There is a literature gap on clinical and radiological outcomes of SRS for NSCLC metastases in real-world practice. The objective of this study was to benchmark mortality and progression outcomes in patients undergoing SRS for NSCLC BMs and identify risk factors for these outcomes using a national quality registry. METHODS The SRS Registry of the NeuroPoint Alliance was used for this study. This registry included patients from 16 enrolling sites who underwent SRS from 2017 to 2022. Data are prospectively collected without a prespecified research purpose. The main outcomes of this analysis were overall survival (OS), out-of-field recurrence, local progression, and intracranial progression. All time-to-event investigations included Kaplan-Meier analyses and multivariable Cox regressions. RESULTS Two hundred sixty-four patients were identified, with a mean age of 66.7 years and a female proportion of 48.5%. Most patients (84.5%) had a Karnofsky Performance Status (KPS) score of 80-100, and the mean baseline EQ-5D score was 0.539 quality-adjusted life years. A single lesion was present in 53.4% of the patients, and 29.1% of patients had 3 or more lesions. The median OS was 28.1 months, and independent predictors of mortality included no control of primary tumor (hazard ratio [HR] 2.1), KPS of 80 (HR 2.4) or lower (HR 2.4), coronary artery disease (HR 2.8), and 5 or more lesions present at the time of SRS treatment (HR 2.3). The median out-of-field progression-free survival (PFS) was 24.8 months, and the median local PFS was unreached. Intralesional hemorrhage was an independent risk factor of local progression, with an HR of 6.0. The median intracranial PFS was 14.0 months and was predicted by the number of lesions at the time of SRS (3-4 lesions, HR 2.2; 5-14 lesions, HR 2.5). CONCLUSIONS In this real-world prospective study, the authors used a national quality registry and found favorable OS in patients with NSCLC BMs undergoing SRS compared with results from previously published RCTs. The intracranial PFS was mainly driven by the emergence of new lesions rather than local progression. A greater number of lesions at baseline was associated with out-of-field progression, while intralesional hemorrhage at baseline was associated with local progression.
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Affiliation(s)
- Giorgos D Michalopoulos
- 1Neuro-Informatics Laboratory, and
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Konstantinos Katsos
- 1Neuro-Informatics Laboratory, and
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Inga S Grills
- 3Department of Neurological Surgery, Beaumont Health System, Royal Oak, Michigan
| | - Ronald E Warnick
- 4Department of Neurosurgery, The Jewish Hospital, Cincinnati, Ohio
| | - James McInerney
- 5Department of Neurosurgery, Penn State Health, Hershey, Pennsylvania
| | - Albert Attia
- 6Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert Timmerman
- 7Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Eric Chang
- 8Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - David W Andrews
- 9Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | | | | | - Nader Pouratian
- 7Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Aaron C Spalding
- 11Norton Cancer Institute, Norton Healthcare, Louisville, Kentucky
| | - Kevin Walter
- 12Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York
| | - Randy L Jensen
- 13Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Mohamad Bydon
- 1Neuro-Informatics Laboratory, and
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Anthony L Asher
- 14Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina; and
| | - Jason P Sheehan
- 15Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
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4
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Bernatz JT, Pumford A, Goh BC, Pinter ZW, Mikula AL, Michalopoulos GD, Bydon M, Huddleston P, Nassr AN, Freedman BA, Sebastian AS. MRI Vertebral Bone Quality Correlates With Interbody Cage Subsidence After Anterior Cervical Discectomy and Fusion. Clin Spine Surg 2024; 37:149-154. [PMID: 38706112 DOI: 10.1097/bsd.0000000000001623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 03/07/2024] [Indexed: 05/07/2024]
Abstract
STUDY DESIGN Retrospective observational study of consecutive patients. OBJECTIVE The purpose of the study was to evaluate VBQ as a predictor of interbody subsidence and to determine threshold values that portend increased risk of subsidence. SUMMARY OF BACKGROUND DATA Many risk factors have been reported for the subsidence of interbody cages in anterior cervical discectomy and fusion (ACDF). MRI Vertebral Bone Quality (VQB) is a relatively new radiographic parameter that can be easily obtained from preoperative MRI and has been shown to correlate with measurements of bone density such as DXA and CT Hounsfield Units. METHODS All patients who underwent 1- to 3-level ACDF using titanium interbodies with anterior plating between the years 2018 and 2020 at our tertiary referral center were included. Subsidence measurements were performed by 2 independent reviewers on CT scans obtained 6 months postoperatively. VBQ was measured on pre-operative sagittal T1 MRI by 2 independent reviewers, and values were averaged. RESULTS Eight-five fusion levels in 44 patients were included in the study. There were 32 levels (38%) with moderate subsidence and 12 levels with severe subsidence (14%). The average VBQ score in those patients with severe subsidence was significantly higher than those without subsidence (3.80 vs. 2.40, P<0.01). A threshold value of 3.2 was determined to be optimal for predicting subsidence (AUC=0.99) and had a sensitivity of 100% and a specificity of 94.1% in predicting subsidence. CONCLUSIONS VBQ strongly correlates with the subsidence of interbody grafts after ACDF. A threshold VBQ score value of 3.2 has excellent sensitivity and specificity for predicting subsidence. Spine surgeons can use VBQ as a readily available screening tool to identify patients at higher risk for subsidence. LEVEL OF EVIDENCE Level-IV.
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Affiliation(s)
| | | | | | | | | | | | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
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5
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Agarwal N, DiGiorgio A, Michalopoulos GD, Letchuman V, Chan AK, Shabani S, Lavadi RS, Lu DC, Wang MY, Haid RW, Knightly JJ, Sherrod BA, Gottfried ON, Shaffrey CI, Goldberg JL, Virk MS, Hussain I, Glassman SD, Shaffrey ME, Park P, Foley KT, Pennicooke B, Coric D, Upadhyaya C, Potts EA, Tumialán LM, Fu KMG, Asher AL, Bisson EF, Chou D, Bydon M, Mummaneni PV. Impact of Educational Background on Preoperative Disease Severity and Postoperative Outcomes Among Patients With Cervical Spondylotic Myelopathy. Clin Spine Surg 2024; 37:E137-E146. [PMID: 38102749 DOI: 10.1097/bsd.0000000000001557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 10/03/2023] [Indexed: 12/17/2023]
Abstract
STUDY DESIGN Retrospective review of a prospectively maintained database. OBJECTIVE Assess differences in preoperative status and postoperative outcomes among patients of different educational backgrounds undergoing surgical management of cervical spondylotic myelopathy (CSM). SUMMARY OF BACKGROUND DATA Patient education level (EL) has been suggested to correlate with health literacy, disease perception, socioeconomic status (SES), and access to health care. METHODS The CSM data set of the Quality Outcomes Database (QOD) was queried for patients undergoing surgical management of CSM. EL was grouped as high school or below, graduate-level, and postgraduate level. The association of EL with baseline disease severity (per patient-reported outcome measures), symptoms >3 or ≤3 months, and 24-month patient-reported outcome measures were evaluated. RESULTS Among 1141 patients with CSM, 509 (44.6%) had an EL of high school or below, 471 (41.3%) had a graduate degree, and 161 (14.1%) had obtained postgraduate education. Lower EL was statistically significantly associated with symptom duration of >3 months (odds ratio=1.68), higher arm pain numeric rating scale (NRS) (coefficient=0.5), and higher neck pain NRS (coefficient=0.79). Patients with postgraduate education had statistically significantly lower Neck Disability Index (NDI) scores (coefficient=-7.17), lower arm pain scores (coefficient=-1), and higher quality-adjusted life-years (QALY) scores (coefficient=0.06). Twenty-four months after surgery, patients of lower EL had higher NDI scores, higher pain NRS scores, and lower QALY scores ( P <0.05 in all analyses). CONCLUSIONS Among patients undergoing surgical management for CSM, those reporting a lower educational level tended to present with longer symptom duration, more disease-inflicted disability and pain, and lower QALY scores. As such, patients of a lower EL are a potentially vulnerable subpopulation, and their health literacy and access to care should be prioritized.
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Affiliation(s)
- Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh School of Medicine
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Anthony DiGiorgio
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA
| | | | - Vijay Letchuman
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA
| | - Andrew K Chan
- Department of Neurosurgery, Columbia University Irving Medical Center, New York City, NY
| | - Saman Shabani
- Department of Neurological Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Raj Swaroop Lavadi
- Department of Neurological Surgery, University of Pittsburgh School of Medicine
| | - Daniel C Lu
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA
| | - Michael Y Wang
- Department of Neurological Surgery, University of Miami, Miami, FL
| | | | | | | | | | | | - Jacob L Goldberg
- Department of Neurological Surgery, Weill Cornell Medical Center, New York, NY
| | - Michael S Virk
- Department of Neurological Surgery, Weill Cornell Medical Center, New York, NY
| | - Ibrahim Hussain
- Department of Neurological Surgery, Weill Cornell Medical Center, New York, NY
| | | | - Mark E Shaffrey
- Department of Neurosurgery, University of Virginia, Charlottesville, VA
| | - Paul Park
- Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, University of Tennessee, Memphis, TN
| | - Kevin T Foley
- Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, University of Tennessee, Memphis, TN
| | - Brenton Pennicooke
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Domagoj Coric
- Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte
| | - Cheerag Upadhyaya
- Department of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Eric A Potts
- Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indianapolis, IN
| | - Luis M Tumialán
- Department of Neurosurgery, Barrow Neurologic Institute, Phoenix, AZ
| | - Kai-Ming G Fu
- Department of Neurological Surgery, Weill Cornell Medical Center, New York, NY
| | - Anthony L Asher
- Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte
| | - Erica F Bisson
- Department of Neurosurgery, University of Utah, Salt Lake City, UT
| | - Dean Chou
- Department of Neurosurgery, Columbia University Irving Medical Center, New York City, NY
| | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| | - Praveen V Mummaneni
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA
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Bydon M, Qu W, Moinuddin FM, Hunt CL, Garlanger KL, Reeves RK, Windebank AJ, Zhao KD, Jarrah R, Trammell BC, El Sammak S, Michalopoulos GD, Katsos K, Graepel SP, Seidel-Miller KL, Beck LA, Laughlin RS, Dietz AB. Intrathecal delivery of adipose-derived mesenchymal stem cells in traumatic spinal cord injury: Phase I trial. Nat Commun 2024; 15:2201. [PMID: 38561341 PMCID: PMC10984970 DOI: 10.1038/s41467-024-46259-y] [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: 05/11/2023] [Accepted: 02/21/2024] [Indexed: 04/04/2024] Open
Abstract
Intrathecal delivery of autologous culture-expanded adipose tissue-derived mesenchymal stem cells (AD-MSC) could be utilized to treat traumatic spinal cord injury (SCI). This Phase I trial (ClinicalTrials.gov: NCT03308565) included 10 patients with American Spinal Injury Association Impairment Scale (AIS) grade A or B at the time of injury. The study's primary outcome was the safety profile, as captured by the nature and frequency of adverse events. Secondary outcomes included changes in sensory and motor scores, imaging, cerebrospinal fluid markers, and somatosensory evoked potentials. The manufacturing and delivery of the regimen were successful for all patients. The most commonly reported adverse events were headache and musculoskeletal pain, observed in 8 patients. No serious AEs were observed. At final follow-up, seven patients demonstrated improvement in AIS grade from the time of injection. In conclusion, the study met the primary endpoint, demonstrating that AD-MSC harvesting and administration were well-tolerated in patients with traumatic SCI.
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Affiliation(s)
- Mohamad Bydon
- Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA.
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Wenchun Qu
- Physical Medicine and Rehabilitation, Mayo Clinic, Jacksonville, FL, USA
| | - F M Moinuddin
- Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Ronald K Reeves
- Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | | | - Kristin D Zhao
- Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Ryan Jarrah
- Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Brandon C Trammell
- Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Sally El Sammak
- Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Giorgos D Michalopoulos
- Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Konstantinos Katsos
- Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Lisa A Beck
- Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | | | - Allan B Dietz
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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7
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Mooney J, Nathani KR, Zeitouni D, Michalopoulos GD, Wang MY, Coric D, Chan AK, Lu DC, Sherrod BA, Gottfried ON, Shaffrey CI, Than KD, Goldberg JL, Hussain I, Virk MS, Agarwal N, Glassman SD, Shaffrey ME, Park P, Foley KT, Chou D, Slotkin JR, Tumialán LM, Upadhyaya CD, Potts EA, Fu KMG, Haid RW, Knightly JJ, Mummaneni PV, Bisson EF, Asher AL, Bydon M. Does diabetes affect outcome or reoperation rate after lumbar decompression or arthrodesis? A matched analysis of the Quality Outcomes Database data set. J Neurosurg Spine 2024; 40:331-342. [PMID: 38039534 DOI: 10.3171/2023.9.spine23522] [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: 05/13/2023] [Accepted: 09/25/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE Diabetes mellitus (DM) is a known risk factor for postsurgical and systemic complications after lumbar spinal surgery. Smaller studies have also demonstrated diminished improvements in patient-reported outcomes (PROs), with increased reoperation and readmission rates after lumbar surgery in patients with DM. The authors aimed to examine longer-term PROs in patients with DM undergoing lumbar decompression and/or arthrodesis for degenerative pathology. METHODS The Quality Outcomes Database was queried for patients undergoing elective lumbar decompression and/or arthrodesis for degenerative pathology. Patients were grouped into DM and non-DM groups and optimally matched in a 1:1 ratio on 31 baseline variables, including the number of operated levels. Outcomes of interest were readmissions and reoperations at 30 and 90 days after surgery in addition to improvements in Oswestry Disability Index, back pain, and leg pain scores and quality-adjusted life-years at 90 days after surgery. RESULTS The matched decompression cohort comprised 7836 patients (3236 [41.3] females) with a mean age of 63.5 ± 12.6 years, and the matched arthrodesis cohort comprised 7336 patients (3907 [53.3%] females) with a mean age of 64.8 ± 10.3 years. In patients undergoing lumbar decompression, no significant differences in nonroutine discharge, length of stay (LOS), readmissions, reoperations, and PROs were observed. In patients undergoing lumbar arthrodesis, nonroutine discharge (15.7% vs 13.4%, p < 0.01), LOS (3.2 ± 2.0 vs 3.0 ± 3.5 days, p < 0.01), 30-day (6.5% vs 4.4%, p < 0.01) and 90-day (9.1% vs 7.0%, p < 0.01) readmission rates, and the 90-day reoperation rate (4.3% vs 3.2%, p = 0.01) were all significantly higher in the DM group. For DM patients undergoing lumbar arthrodesis, subgroup analyses demonstrated a significantly higher risk of poor surgical outcomes with the open approach. CONCLUSIONS Patients with and without DM undergoing lumbar spinal decompression alone have comparable readmission and reoperation rates, while those undergoing arthrodesis procedures have a higher risk of poor surgical outcomes up to 90 days after surgery. Surgeons should target optimal DM control preoperatively, particularly for patients undergoing elective lumbar arthrodesis.
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Affiliation(s)
- James Mooney
- 1Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Karim Rizwan Nathani
- 2Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Daniel Zeitouni
- 4Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
- 5Department of Neurosurgery, Atrium Health, Charlotte, North Carolina
| | - Giorgos D Michalopoulos
- 2Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Michael Y Wang
- 6Department of Neurosurgery, University of Miami, Florida
| | - Domagoj Coric
- 7Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina
| | - Andrew K Chan
- 8Department of Neurological Surgery, Columbia University, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Daniel C Lu
- 9Department of Neurosurgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Brandon A Sherrod
- 10Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Oren N Gottfried
- 11Department of Neurological Surgery, Duke University Medical Center, Durham, North Carolina
| | - Christopher I Shaffrey
- 11Department of Neurological Surgery, Duke University Medical Center, Durham, North Carolina
| | - Khoi D Than
- 11Department of Neurological Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jacob L Goldberg
- 12Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | - Ibrahim Hussain
- 12Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | - Michael S Virk
- 12Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | - Nitin Agarwal
- 24Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Mark E Shaffrey
- 14Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Paul Park
- 15Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Kevin T Foley
- 16Department of Neurosurgery, University of Tennessee, Memphis, Tennessee
| | - Dean Chou
- 8Department of Neurological Surgery, Columbia University, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | | | - Luis M Tumialán
- 18Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Cheerag D Upadhyaya
- 19Department of Neurosurgery, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Eric A Potts
- 20Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Kai-Ming G Fu
- 12Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | - Regis W Haid
- 22Atlanta Brain and Spine Care, Atlanta, Georgia
| | - John J Knightly
- 23Atlantic Neurosurgical Specialists, Morristown, New Jersey; and
| | - Praveen V Mummaneni
- 21Department of Neurological Surgery, University of California, San Francisco, California
| | - Erica F Bisson
- 10Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Anthony L Asher
- 4Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
| | - Mohamad Bydon
- 2Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
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8
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Michalopoulos GD, Pennington Z, Bambakidis P, Alexander AY, Lakomkin N, Charalampous C, Sammak SE, Hassett LC, Graepel S, Meyer FB, Bydon M. Traumatic vertebral artery injury: Denver grade, bilaterality, and stroke risk. A systematic review and meta-analysis. J Neurosurg 2024; 140:522-536. [PMID: 37548568 DOI: 10.3171/2023.5.jns222818] [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: 12/13/2022] [Accepted: 05/23/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE Vertebral artery injury (VAI), a complication of blunt trauma, may cause posterior circulation stroke. An association of disease severity, classified in Denver grades, with stroke risk has not been shown. Using a literature-based analysis, the authors estimated the incidence of VAI following blunt trauma with the aim to investigate the impact of Denver grade and bilateral VAI on stroke occurrence. METHODS A systematic review of the literature on VAI following blunt trauma was conducted, and data on its incidence, the severity per Denver grade, and stroke occurrence were collected. The incidence of VAI and stroke occurrence were analyzed cumulatively and between Denver grades. A meta-analysis with random-effects models was performed. RESULTS Fifty-six studies including 2563 patients were identified. The overall incidence of VAI was 0.49% among blunt trauma cases and 14.5% among patients screened via any type of angiography. The incidence rates of bilateral VAI and concurrent carotid injury among all VAIs were 12.3% and 19.2%, respectively. VAI severity by Denver grade was as follows: grade I, 23.4%; grade II, 28.2%; grade III, 5.8%; grade IV, 42.1%; and grade V, 0.5%. The overall stroke risk was 5.32%, differing significantly among lesions of different Denver grades (p = 0.02). Grade III and IV lesions had the highest stroke prevalence (9.8% and 10.9% respectively), while strokes occurred significantly less frequently in patients with grade I and II lesions (1.9% and 3.0%, respectively). Denver grade V cases were too rare for meaningful analysis. Bilateral VAI was associated with a 33.2% stroke prevalence. The association between Denver grade and stroke occurrence persisted in a sensitivity subanalysis including only unilateral cases (p = 0.03). CONCLUSIONS VAI complicates a small yet nontrivial fraction of blunt trauma cases, with Denver grade IV lesions being the most common. This is the first study to document a significantly higher stroke prevalence among grade III and IV VAIs compared with grade I and II VAIs independently from bilaterality. Bilateral VAIs carry a significantly higher stroke rate.
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Affiliation(s)
- Giorgos D Michalopoulos
- 1Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Zach Pennington
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Peter Bambakidis
- 1Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
| | - A Yohan Alexander
- 1Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- 3University of Minnesota Medical School, Minneapolis, Minnesota
| | - Nikita Lakomkin
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | | | - Sally El Sammak
- 1Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- 4Department of Neurology, Emory University, Atlanta, Georgia; and
| | | | - Stephen Graepel
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Fredric B Meyer
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Mohamad Bydon
- 1Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
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9
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Park C, Shaffrey CI, Than KD, Michalopoulos GD, El Sammak S, Chan AK, Bisson EF, Sherrod BA, Asher AL, Coric D, Potts EA, Foley KT, Wang MY, Fu KM, Virk MS, Knightly JJ, Meyer S, Park P, Upadhyaya C, Shaffrey ME, Buchholz AL, Tumialán LM, Turner J, Agarwal N, Chou D, Chaudhry NS, Haid RW, Mummaneni PV, Bydon M, Gottfried ON. What factors influence surgical decision-making in anterior versus posterior surgery for cervical myelopathy? A QOD analysis. J Neurosurg Spine 2024; 40:206-215. [PMID: 37948703 DOI: 10.3171/2023.8.spine23194] [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: 02/16/2023] [Accepted: 08/29/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE The aim of this study was to explore the preoperative patient characteristics that affect surgical decision-making when selecting an anterior or posterior operative approach in patients diagnosed with cervical spondylotic myelopathy (CSM). METHODS This was a multi-institutional, retrospective study of the prospective Quality Outcomes Database (QOD) Cervical Spondylotic Myelopathy module. Patients aged 18 years or older diagnosed with primary CSM who underwent multilevel (≥ 2-level) elective surgery were included. Demographics and baseline clinical characteristics were collected. RESULTS Of the 841 patients with CSM in the database, 492 (58.5%) underwent multilevel anterior surgery and 349 (41.5%) underwent multilevel posterior surgery. Surgeons more often performed a posterior surgical approach in older patients (mean 64.8 ± 10.6 vs 58.5 ± 11.1 years, p < 0.001) and those with a higher American Society of Anesthesiologists class (class III or IV: 52.4% vs 46.3%, p = 0.003), a higher rate of motor deficit (67.0% vs 58.7%, p = 0.014), worse myelopathy (mean modified Japanese Orthopaedic Association score 11.4 ± 3.1 vs 12.4 ± 2.6, p < 0.001), and more levels treated (4.3 ± 1.3 vs 2.4 ± 0.6, p < 0.001). On the other hand, surgeons more frequently performed an anterior surgical approach when patients were employed (47.2% vs 23.2%, p < 0.001) and had intervertebral disc herniation as an underlying pathology (30.7% vs 9.2%, p < 0.001). CONCLUSIONS The selection of approach for patients with CSM depends on patient demographics and symptomology. Posterior surgery was performed in patients who were older and had worse systemic disease, increased myelopathy, and greater levels of stenosis. Anterior surgery was more often performed in patients who were employed and had intervertebral disc herniation.
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Affiliation(s)
- Christine Park
- 1Department of Neurosurgery, Duke University, Durham, North Carolina
| | | | - Khoi D Than
- 1Department of Neurosurgery, Duke University, Durham, North Carolina
| | | | - Sally El Sammak
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Andrew K Chan
- 3Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Erica F Bisson
- 4Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Brandon A Sherrod
- 4Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Anthony L Asher
- 5Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Domagoj Coric
- 5Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Eric A Potts
- 6Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Kevin T Foley
- 7Department of Neurosurgery, University of Tennessee, Semmes Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Michael Y Wang
- 8Department of Neurosurgery, University of Miami, Florida
| | - Kai-Ming Fu
- 9Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - Michael S Virk
- 9Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - John J Knightly
- 10Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Scott Meyer
- 10Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Paul Park
- 11Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Cheerag Upadhyaya
- 12Marion Bloch Neuroscience Institute, Saint Luke's Health System, Kansas City, Missouri
| | - Mark E Shaffrey
- 13Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Avery L Buchholz
- 13Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | | | - Jay Turner
- 14Barrow Neurological Institute, Phoenix, Arizona
| | - Nitin Agarwal
- 15Department of Neurosurgery, Washington University in St. Louis, Missouri
| | - Dean Chou
- 3Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Nauman S Chaudhry
- 1Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Regis W Haid
- 16Atlanta Brain and Spine Care, Atlanta, Georgia; and
| | - Praveen V Mummaneni
- 17Department of Neurosurgery, University of California, San Francisco, California
| | - Mohamad Bydon
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Oren N Gottfried
- 1Department of Neurosurgery, Duke University, Durham, North Carolina
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Sheehan JP, Michalopoulos GD, Katsos K, Bydon M, Asher AL. The NeuroPoint alliance SRS & tumor QOD registries. J Neurooncol 2024; 166:257-264. [PMID: 38236549 DOI: 10.1007/s11060-023-04553-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/22/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVE Along with the increasing interest in real-world evidence in neuro-oncology, the deficiencies of prior population-based and quality registries became evident. The neuro-oncological quality registries of the NeuroPoint Alliance (NPA) focus on neuro-oncological surgery and stereotactic radiosurgery (SRS) and aim to fill the gaps of neuro-oncological practice in quality surveillance and real-world research. METHODS Herein, we discuss the historical background, design process, and features of the NPA SRS and Tumor QOD registries. The registries'current status and future directions are outlined. RESULTS The NPA SRS and Tumor QOD registries were designed based on the principles of prospective multi-institutional data collection, central auditing for data quality, and focus on patient-reported outcomes (PROs). Currently, the registries include over 4,500 and 2,500 patients each, with caseloads comprising predominantly of brain metastases and primary extra-axial tumors, respectively. The registries serve both as a quality surveillance and improvement tool - providing participating sites with adjusted quality reports - and as platforms for real-world research of observational and, potentially, interventional nature. Future directions of the NPA neuro-oncological registries include the functional communications of the two registries and the incorporation of imaging analyses in the workflow of quality assessment and research efforts. CONCLUSIONS The NPA SRS and Tumor QOD registries are quality registries of unique granularity in terms of surgical variables and postoperative outcomes. They constitute increasingly valuable data sources for real-time quality surveillance of participating sites and real-world research.
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Affiliation(s)
- Jason P Sheehan
- University of Virginia Health System, Charlottesville, VA, USA
| | | | | | | | - Anthony L Asher
- Carolina Neurosurgery and Spine Associates, Charlotte, NC, USA
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11
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Asher AL, Haid RW, Stroink AR, Michalopoulos GD, Alexander AY, Zeitouni D, Chan AK, Virk MS, Glassman SD, Foley KT, Slotkin JR, Potts EA, Shaffrey ME, Shaffrey CI, Park P, Upadhyaya C, Coric D, Tumialán LM, Chou D, Fu KMG, Knightly JJ, Orrico KO, Wang MY, Bisson EF, Mummaneni PV, Bydon M. Research using the Quality Outcomes Database: accomplishments and future steps toward higher-quality real-world evidence. J Neurosurg 2023; 139:1757-1775. [PMID: 37209070 DOI: 10.3171/2023.3.jns222601] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/21/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVE The Quality Outcomes Database (QOD) was established in 2012 by the NeuroPoint Alliance, a nonprofit organization supported by the American Association of Neurological Surgeons. Currently, the QOD has launched six different modules to cover a broad spectrum of neurosurgical practice-namely lumbar spine surgery, cervical spine surgery, brain tumor, stereotactic radiosurgery (SRS), functional neurosurgery for Parkinson's disease, and cerebrovascular surgery. This investigation aims to summarize research efforts and evidence yielded through QOD research endeavors. METHODS The authors identified all publications from January 1, 2012, to February 18, 2023, that were produced by using data collected prospectively in a QOD module without a prespecified research purpose in the context of quality surveillance and improvement. Citations were compiled and presented along with comprehensive documentation of the main study objective and take-home message. RESULTS A total of 94 studies have been produced through QOD efforts during the past decade. QOD-derived literature has been predominantly dedicated to spinal surgical outcomes, with 59 and 22 studies focusing on lumbar and cervical spine surgery, respectively, and 6 studies focusing on both. More specifically, the QOD Study Group-a research collaborative between 16 high-enrolling sites-has yielded 24 studies on lumbar grade 1 spondylolisthesis and 13 studies on cervical spondylotic myelopathy, using two focused data sets with high data accuracy and long-term follow-up. The more recent neuro-oncological QOD efforts, i.e., the Tumor QOD and the SRS Quality Registry, have contributed 5 studies, providing insights into the real-world neuro-oncological practice and the role of patient-reported outcomes. CONCLUSIONS Prospective quality registries are an important resource for observational research, yielding clinical evidence to guide decision-making across neurosurgical subspecialties. Future directions of the QOD efforts include the development of research efforts within the neuro-oncological registries and the American Spine Registry-which has now replaced the inactive spinal modules of the QOD-and the focused research on high-grade lumbar spondylolisthesis and cervical radiculopathy.
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Affiliation(s)
- Anthony L Asher
- 1Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina
| | | | - Ann R Stroink
- 3Central Illinois Neuro Health Science, Bloomington, Illinois
| | - Giorgos D Michalopoulos
- 4Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 5Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - A Yohan Alexander
- 4Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 5Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Daniel Zeitouni
- 1Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina
| | - Andrew K Chan
- 6Department of Neurological Surgery, Columbia University, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Michael S Virk
- 7Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | | | - Kevin T Foley
- 9Department of Neurosurgery, University of Tennessee, Memphis, Tennessee
| | | | - Eric A Potts
- 11Department of Neurological Surgery, Indiana University, Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Mark E Shaffrey
- 12Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Christopher I Shaffrey
- 13Department of Neurological Surgery, Duke University Medical Center, Durham, North Carolina
| | - Paul Park
- 9Department of Neurosurgery, University of Tennessee, Memphis, Tennessee
| | - Cheerag Upadhyaya
- 14Department of Neurosurgery, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Domagoj Coric
- 1Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina
| | - Luis M Tumialán
- 15Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Dean Chou
- 6Department of Neurological Surgery, Columbia University, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Kai-Ming G Fu
- 7Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | - John J Knightly
- 16Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Katie O Orrico
- 17Washington Office, American Association of Neurological Surgeons/Congress of Neurological Surgeons, Washington, DC
| | - Michael Y Wang
- 18Department of Neurosurgery, University of Miami, Florida
| | - Erica F Bisson
- 19Department of Neurological Surgery, University of Utah, Salt Lake City, Utah; and
| | - Praveen V Mummaneni
- 20Department of Neurological Surgery, University of California, San Francisco, California
| | - Mohamad Bydon
- 4Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 5Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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12
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El Sammak S, Michalopoulos GD, Arya N, Bhandarkar AR, Moinuddin FM, Jarrah R, Yolcu YU, Shoushtari A, Bydon M. Prediction Model for Neurogenic Bladder Recovery One Year After Traumatic Spinal Cord Injury. World Neurosurg 2023; 179:e222-e231. [PMID: 37611802 DOI: 10.1016/j.wneu.2023.08.054] [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: 05/21/2023] [Revised: 07/06/2023] [Accepted: 08/11/2023] [Indexed: 08/25/2023]
Abstract
INTRODUCTION Neurogenic bladder is a common complication after spinal cord injury (SCI) that carries substantial burdens on the inflicted individual. The objective of this study is to build a prediction model for neurogenic bladder recovery 1 year after traumatic SCI. METHODS We queried the National Spinal Cord Injury Model Systems database for patients with traumatic SCI who had neurogenic bladder at the time of injury. The primary outcome of interest was the complete recovery of bladder function at 1 year. Multiple imputations were performed to generate replacement values for missing data, and the final imputed data were used for our analysis. A multivariable odds logistic regression model was developed for complete bladder recovery at 1 year. RESULTS We identified a total of 2515 patients with abnormal bladder function at baseline who had an annual follow-up. A total of 417 patients (16.6%) recovered bladder function in 1 year. Predictors of complete bladder recovery included the following baseline parameters: sacral sensation, American Spinal Injury Association (ASIA) impairment score, bowel function at baseline, voluntary sphincter contraction, anal sensation, S1 motor scores, and the number of days in the rehabilitation facility. The model performed with a discriminative capacity of 90.5%. CONCLUSIONS We developed a prediction model for the probability of complete bladder recovery 1 year after SCI. The model performed with a high discriminative capacity. This prediction model demonstrates potential utility in the counseling, research allocation, and management of individuals with SCI.
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Affiliation(s)
- Sally El Sammak
- Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Giorgos D Michalopoulos
- Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Namrata Arya
- Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Alix School of Medicine, Scottsdale, Phoenix, Arizona, USA
| | - Archis R Bhandarkar
- Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
| | - F M Moinuddin
- Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan Jarrah
- Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Yagiz U Yolcu
- Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ali Shoushtari
- Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
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13
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Yang E, Mummaneni PV, Chou D, Bydon M, Bisson EF, Shaffrey CI, Gottfried ON, Asher AL, Coric D, Potts EA, Foley KT, Wang MY, Fu KM, Virk MS, Knightly JJ, Meyer S, Park P, Upadhyaya CD, Shaffrey ME, Buchholz AL, Tumialán LM, Turner JD, Michalopoulos GD, Sherrod BA, Agarwal N, Haid RW, Chan AK. Cervical laminoplasty versus laminectomy and posterior cervical fusion for cervical myelopathy: propensity-matched analysis of 24-month outcomes from the Quality Outcomes Database. J Neurosurg Spine 2023; 39:671-681. [PMID: 37728378 DOI: 10.3171/2023.6.spine23345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/08/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE Compared with laminectomy with posterior cervical fusion (PCF), cervical laminoplasty (CL) may result in different outcomes for those operated on for cervical spondylotic myelopathy (CSM). The aim of this study was to compare 24-month patient-reported outcomes (PROs) for laminoplasty versus PCF by using the Quality Outcomes Database (QOD) CSM data set. METHODS This was a retrospective study using an augmented data set from the prospectively collected QOD Registry Cervical Module. Patients undergoing laminoplasty or PCF for CSM were included. Using the nearest-neighbor method, the authors performed 1:1 propensity matching based on age, operated levels, and baseline modified Japanese Orthopaedic Association (mJOA) and visual analog scale (VAS) neck pain scores. The 24-month PROs, i.e., mJOA, Neck Disability Index (NDI), VAS neck pain, VAS arm pain, EQ-5D, EQ-VAS, and North American Spine Society (NASS) satisfaction scores, were compared. Only cases in the subaxial cervical region were included; those that crossed the cervicothoracic junction were excluded. RESULTS From the 1141 patients included in the QOD CSM data set who underwent anterior or posterior surgery for cervical myelopathy, 946 (82.9%) had 24 months of follow-up. Of these, 43 patients who underwent laminoplasty and 191 who underwent PCF met the inclusion criteria. After matching, the groups were similar for baseline characteristics, including operative levels (CL group: 4.0 ± 0.9 vs PCF group: 4.2 ± 1.1, p = 0.337) and baseline PROs (p > 0.05), except for a higher percentage involved in activities outside the home in the CL group (95.3% vs 81.4%, p = 0.044). The 24-month follow-up for the matched cohorts was similar (CL group: 88.4% vs PCF group: 83.7%, p = 0.534). Patients undergoing laminoplasty had significantly lower estimated blood loss (99.3 ± 91.7 mL vs 186.7 ± 142.7 mL, p = 0.003), decreased length of stay (3.0 ± 1.6 days vs 4.5 ± 3.3 days, p = 0.012), and a higher rate of routine discharge (88.4% vs 62.8%, p = 0.006). The CL cohort also demonstrated a higher rate of return to activities (47.2% vs 21.2%, p = 0.023) after 3 months. Laminoplasty was associated with a larger improvement in 24-month NDI score (-19.6 ± 18.9 vs -9.1 ± 21.9, p = 0.031). Otherwise, there were no 3- or 24-month differences in mJOA, mean NDI, VAS neck pain, VAS arm pain, EQ-5D, EQ-VAS, and distribution of NASS satisfaction scores (p > 0.05) between the cohorts. CONCLUSIONS Compared with PCF, laminoplasty was associated with decreased blood loss, decreased length of hospitalization, and higher rates of home discharge. At 3 months, laminoplasty was associated with a higher rate of return to baseline activities. At 24 months, laminoplasty was associated with greater improvements in neck disability. Otherwise, laminoplasty and PCF shared similar outcomes for functional status, pain, quality of life, and satisfaction. Laminoplasty and PCF achieved similar neck pain scores, suggesting that moderate preoperative neck pain may not necessarily be a contraindication for laminoplasty.
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Affiliation(s)
- Eunice Yang
- 1Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Praveen V Mummaneni
- 2Department of Neurosurgery, University of California, San Francisco, California
| | - Dean Chou
- 1Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Mohamad Bydon
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Erica F Bisson
- 4Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | | | - Oren N Gottfried
- 5Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Anthony L Asher
- 6Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Domagoj Coric
- 6Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Eric A Potts
- 7Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Kevin T Foley
- 8Department of Neurosurgery, University of Tennessee, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Michael Y Wang
- 9Department of Neurosurgery, University of Miami, Florida
| | - Kai-Ming Fu
- 10Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - Michael S Virk
- 10Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - John J Knightly
- 11Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Scott Meyer
- 11Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Paul Park
- 12Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Cheerag D Upadhyaya
- 13Marion Bloch Neuroscience Institute, Saint Luke's Health System, Kansas City, Missouri
| | - Mark E Shaffrey
- 14Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Avery L Buchholz
- 14Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | | | - Jay D Turner
- 15Barrow Neurological Institute, Phoenix, Arizona
| | | | - Brandon A Sherrod
- 4Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Nitin Agarwal
- 16Department of Neurosurgery, University of Pittsburgh, Pennsylvania; and
| | - Regis W Haid
- 17Atlanta Brain and Spine Care, Atlanta, Georgia
| | - Andrew K Chan
- 1Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
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14
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Flanigan P, Nathani KR, Martini M, Michalopoulos GD, Chen S, Kalani M, Bydon M. Impact of preoperative spinal injections within 30 days of lumbar decompression on surgical outcomes: a matched institutional study. J Neurosurg Spine 2023; 39:682-689. [PMID: 37728375 DOI: 10.3171/2023.6.spine23356] [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: 04/24/2023] [Accepted: 06/09/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE The authors sought to determine how the temporal proximity of lumbar epidural spinal injection prior to surgery impacts clinical outcomes (e.g., 30-day readmission, postoperative complications, CSF leak) in patients undergoing lumbar decompression without fusion. METHODS The authors queried their institutional registry to identify patients who underwent elective lumbar decompression for spondylotic pathology between January 2019 and March 2022 at multiple centers within the same hospital network. Patients were divided into groups based on the time between their surgical date and the most recent preoperative spinal injection: group 1, patients with duration < 1 month; group 2, 1-3 months; and group 3, no spinal injection within 3 months. Primary outcomes of interest were the length of hospital stay, postoperative complications, rate of intraoperative CSF leak, and rates of reoperation and hospital readmission. For patients in groups 1 and 2, the authors also recorded the number of injections within 12 months prior to surgery to better understand the effect of multiple recent injections. The independent Student t-test and Pearson's chi-square test were mainly performed for univariate analyses of the continuous and categorical variables, respectively. RESULTS A total of 121 and 283 patients received a spinal injection at < 1 month and 1-3 months prior to surgery, respectively, and were separately matched in a 3:1 ratio with 2562 patients with no history of preoperative spinal injection within 3 months before surgery. Among the matched cohorts, patients who received spinal injections < 1 month before lumbar decompression had significantly higher risks of 30-day complication (7.4% vs 0.8%, OR 9.6, p < 0.001), 30-day readmission (5.8% vs 2.2%, OR 3.5, p = 0.049), and 90-day readmission (9.1% vs 2.8%, OR 3.5, p = 0.003) than patients with no history of spinal injection. However, compared with patients with no history of spinal injection, the patients who received spinal injections 1-3 months before surgery were not at higher risk for postoperative complications or readmission. The CSF leak rates were significantly different between the three patient cohorts (10.7% vs 6.7% vs 4.9% for the < 1 month, 1-3 months, and no injection cohorts, respectively; p = 0.02). CONCLUSIONS Lumbar decompression within 1 month of preoperative spinal injection was associated with higher risks of readmission and postoperative complications, including CSF leak. However, with the exception of CSF leak, these risks were no longer observed when spinal injection occurred 1-3 months prior to lumbar decompression.
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Affiliation(s)
- Patrick Flanigan
- 1Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 2Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Karim R Nathani
- 1Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 2Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Michael Martini
- 1Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Giorgos D Michalopoulos
- 1Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 2Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Selby Chen
- 3Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida; and
| | - Maziyar Kalani
- 4Department of Neurologic Surgery, Mayo Clinic, Scottsdale, Arizona
| | - Mohamad Bydon
- 1Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 2Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
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15
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Ambati VS, Macki M, Chan AK, Michalopoulos GD, Le VP, Jamieson AB, Chou D, Shaffrey CI, Gottfried ON, Bisson EF, Asher AL, Coric D, Potts EA, Foley KT, Wang MY, Fu KM, Virk MS, Knightly JJ, Meyer S, Park P, Upadhyaya C, Shaffrey ME, Buchholz AL, Tumialán LM, Turner JD, Sherrod BA, Haid RW, Bydon M, Mummaneni PV. Three-level ACDF versus 3-level laminectomy and fusion: are there differences in outcomes? An analysis of the Quality Outcomes Database cervical spondylotic myelopathy cohort. Neurosurg Focus 2023; 55:E2. [PMID: 37657103 DOI: 10.3171/2023.6.focus23295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/16/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE The authors sought to compare 3-level anterior with posterior fusion surgical procedures for the treatment of multilevel cervical spondylotic myelopathy (CSM). METHODS The authors analyzed prospective data from the 14 highest enrolling sites of the Quality Outcomes Database CSM module. They compared 3-level anterior cervical discectomy and fusion (ACDF) and posterior cervical laminectomy and fusion (PCF) surgical procedures, excluding surgical procedures crossing the cervicothoracic junction. Rates of reaching the minimal clinically important difference (MCID) in patient-reported outcomes (PROs) were compared at 24 months postoperatively. Multivariable analyses adjusted for potential confounders elucidated in univariable analysis. RESULTS Overall, 199 patients met the inclusion criteria: 123 ACDF (61.8%) and 76 PCF (38.2%) patients. The 24-month follow-up rates were similar (ACDF 90.2% vs PCF 92.1%, p = 0.67). Preoperatively, ACDF patients were younger (60.8 ± 10.2 vs 65.0 ± 10.3 years, p < 0.01), and greater proportions were privately insured (56.1% vs 36.8%, p = 0.02), actively employed (39.8% vs 22.8%, p = 0.04), and independently ambulatory (14.6% vs 31.6%, p < 0.01). Otherwise, the cohorts had equivalent baseline modified Japanese Orthopaedic Association (mJOA), Neck Disability Index (NDI), numeric rating scale (NRS)-arm pain, NRS-neck pain, and EQ-5D scores (p > 0.05). ACDF patients had reduced hospitalization length (1.6 vs 3.9 days, p < 0.01) and a greater proportion had nonroutine discharge (7.3% vs 22.8%, p < 0.01), but they had a higher rate of postoperative dysphagia (13.5% vs 3.5%, p = 0.049). Compared with baseline values, both groups demonstrated improvements in all outcomes at 24 months (p < 0.05). In multivariable analyses, after controlling for age, insurance payor, employment status, ambulation status, and other potential clinically relevant confounders, ACDF was associated with a greater proportion of patients with maximum satisfaction on the North American Spine Society Patient Satisfaction Index (NASS) (NASS score of 1) at 24 months (69.4% vs 53.7%, OR 2.44, 95% CI 1.17-5.09, adjusted p = 0.02). Otherwise, the cohorts shared similar 24-month outcomes in terms of reaching the MCID for mJOA, NDI, NRS-arm pain, NRS-neck pain, and EQ-5D score (adjusted p > 0.05). There were no differences in the 3-month readmission (ACDF 4.1% vs PCF 3.9%, p = 0.97) and 24-month reoperation (ACDF 13.5% vs PCF 18.6%, p = 0.36) rates. CONCLUSIONS In a cohort limited to 3-level fusion surgical procedures, ACDF was associated with reduced blood loss, shorter hospitalization length, and higher routine home discharge rates; however, PCF resulted in lower rates of postoperative dysphagia. The procedures yielded comparably significant improvements in functional status (mJOA score), neck and arm pain, neck pain-related disability, and quality of life at 3, 12, and 24 months. ACDF patients had significantly higher odds of maximum satisfaction (NASS score 1). Given comparable outcomes, patients should be counseled on each approach's complication profile to aid in surgical decision-making.
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Affiliation(s)
- Vardhaan S Ambati
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Mohamed Macki
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Andrew K Chan
- 2Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | | | - Vivian P Le
- 1Department of Neurological Surgery, University of California, San Francisco, California
- 2Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Alysha B Jamieson
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Dean Chou
- 2Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | | | - Oren N Gottfried
- 4Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Erica F Bisson
- 5Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Anthony L Asher
- 6Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Domagoj Coric
- 6Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Eric A Potts
- 7Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Kevin T Foley
- 8Department of Neurosurgery, University of Tennessee, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Michael Y Wang
- 9Department of Neurological Surgery, University of Miami, Florida
| | - Kai-Ming Fu
- 10Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - Michael S Virk
- 10Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - John J Knightly
- 11Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Scott Meyer
- 11Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Paul Park
- 8Department of Neurosurgery, University of Tennessee, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Cheerag Upadhyaya
- 12Marion Bloch Neuroscience Institute, Saint Luke's Health System, Kansas City, Missouri
| | - Mark E Shaffrey
- 13Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Avery L Buchholz
- 13Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | | | - Jay D Turner
- 14Barrow Neurological Institute, Phoenix, Arizona; and
| | - Brandon A Sherrod
- 5Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Regis W Haid
- 15Atlanta Brain and Spine Care, Atlanta, Georgia
| | - Mohamad Bydon
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Praveen V Mummaneni
- 1Department of Neurological Surgery, University of California, San Francisco, California
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16
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Pinter ZW, Reed R, Townsley SE, Mikula AL, Dittman L, Xiong A, Skjaerlund J, Michalopoulos GD, Currier B, Nassr A, Fogelson JL, Freedman BA, Bydon M, Kepler CK, Wagner SC, Elder BD, Sebastian AS. Titanium Cervical Cage Subsidence: Postoperative Computed Tomography Analysis Defining Incidence and Associated Risk Factors. Global Spine J 2023; 13:1703-1715. [PMID: 34558320 PMCID: PMC10556899 DOI: 10.1177/21925682211046897] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE Substantial variability in both the measurement and classification of subsidence limits the strength of conclusions that can be drawn from previous studies. The purpose of this study was to precisely characterize patterns of cervical cage subsidence utilizing computed tomography (CT) scans, determine risk factors for cervical cage subsidence, and investigate the impact of subsidence on pseudarthrosis rates. METHODS We performed a retrospective review of patients who underwent one- to three-levels of anterior cervical discectomy and fusion (ACDF) utilizing titanium interbodies with anterior plating between the years 2018 and 2020. Subsidence measurements were performed by two independent reviewers on CT scans obtained 6 months postoperatively. Subsidence was then classified as mild if subsidence into the inferior and superior endplate were both ≤2 mm, moderate if the worst subsidence into the inferior or superior endplate was between 2 to 4 mm, or severe if the worst subsidence into the inferior or superior endplate was ≥4 mm. RESULTS A total of 51 patients (100 levels) were included in this study. A total of 48 levels demonstrated mild subsidence (≤2 mm), 38 demonstrated moderate subsidence (2-4 mm), and 14 demonstrated severe subsidence (≥4 mm). Risk factors for severe subsidence included male gender, multilevel constructs, greater mean vertebral height loss, increased cage height, lower Taillard index, and lower screw tip to vertebral body height ratio. Severe subsidence was not associated with an increased rate of pseudarthrosis. CONCLUSION Following ACDF with titanium cervical cages, subsidence is an anticipated postoperative occurrence and is not associated with an increased risk of pseudarthrosis.
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Affiliation(s)
| | - Ryder Reed
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Anthony L Mikula
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Lauren Dittman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Ashley Xiong
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Bradford Currier
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Ahmad Nassr
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Christopher K. Kepler
- Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Scott C Wagner
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
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17
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Chen JW, McCandless MG, Bhandarkar AR, Flanigan PM, Lakomkin N, Mikula AL, Michalopoulos GD, Bydon M. The association between bone mineral density and proximal junctional kyphosis in adult spinal deformity: a systematic review and meta-analysis. J Neurosurg Spine 2023; 39:82-91. [PMID: 37029673 DOI: 10.3171/2023.2.spine221101] [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: 10/02/2022] [Accepted: 02/28/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVE Proximal junctional kyphosis (PJK) is a complication of surgical management for adult spinal deformity (ASD) with a multifactorial etiology. Many risk factors are controversial, and their relative importance is not fully understood. The authors aimed to elucidate the association between bone mineral density (BMD) and PJK. METHODS A systematic literature search was performed using PubMed and Web of Science keywords of "Proximal Junctional Kyphosis [MeSH] OR Proximal Junctional Failure [MeSH]" AND "Bone Mineral Density [MeSH] OR Hounsfield Units [MeSH] OR DEXA [MeSH]" set to the date range of January 2002 to July 2022. Studies required a minimum of 10 patients and 12 months of follow-up. Articles were included if they were in the English language and presented a primary retrospective cohort that included a comparison of patients with and without PJK, as well as a radiographic biomarker for BMD, such as Hounsfield units (HU) or T-score. RESULTS A total of 18 unique studies with 2185 patients who underwent ASD surgery were identified. Of these, 537 patients (24.6%) developed PJK. Eight studies provided T-scores that were amenable to comparison, which found that patients who developed PJK were found to have lower BMD T-scores by a mean of -0.69 (95% CI -0.88 to -0.50; I2 = 63.9%, p < 0.001). The HU at the UIV among patients with the PJK group (n = 101) compared with the non-PJK group (n = 156) was found to be significantly lower (mean difference -32.35, 95% CI -46.05 to -18.65; I2 = 28.7%, p < 0.001). CONCLUSIONS This meta-analysis suggests that low preoperative BMD as measured by T-score and a diagnosis of osteoporosis were associated with higher postoperative PJK. Additionally, lower HU on CT at the UIV were found to be significant risk factors for postoperative PJK as well. These findings suggest that more attention to preoperative BMD is a risk factor for PJK among ASD patients is warranted.
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Affiliation(s)
- Jeffrey W Chen
- 1Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Martin G McCandless
- 2University of Mississippi Medical Center School of Medicine, Jackson, Mississippi
| | | | | | - Nikita Lakomkin
- 4Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | - Anthony L Mikula
- 4Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Mohamad Bydon
- 4Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
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18
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Chan AK, Shaffrey CI, Park C, Gottfried ON, Than KD, Bisson EF, Bydon M, Asher AL, Coric D, Potts EA, Foley KT, Wang MY, Fu KM, Virk MS, Knightly JJ, Meyer S, Park P, Upadhyaya CD, Shaffrey ME, Buchholz AL, Tumialán LM, Turner JD, Michalopoulos GD, Sherrod BA, Agarwal N, Chou D, Haid RW, Mummaneni PV. Do comorbid self-reported depression and anxiety influence outcomes following surgery for cervical spondylotic myelopathy? J Neurosurg Spine 2023; 39:11-27. [PMID: 37021762 DOI: 10.3171/2023.2.spine22685] [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: 06/17/2022] [Accepted: 02/20/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE Depression and anxiety are associated with inferior outcomes following spine surgery. In this study, the authors examined whether patients with cervical spondylotic myelopathy (CSM) who have both self-reported depression (SRD) and self-reported anxiety (SRA) have worse postoperative patient-reported outcomes (PROs) compared with patients who have only one or none of these comorbidities. METHODS This study is a retrospective analysis of prospectively collected data from the Quality Outcomes Database CSM cohort. Comparisons were made among patients who reported the following: 1) either SRD or SRA, 2) both SRD and SRA, or 3) neither comorbidity at baseline. PROs at 3, 12, and 24 months (scores for the visual analog scale [VAS] for neck pain and arm pain, Neck Disability Index [NDI], modified Japanese Orthopaedic Association [mJOA] scale, EQ-5D, EuroQol VAS [EQ-VAS], and North American Spine Society [NASS] patient satisfaction index) and achievement of respective PRO minimal clinically important differences (MCIDs) were compared. RESULTS Of the 1141 included patients, 199 (17.4%) had either SRD or SRA alone, 132 (11.6%) had both SRD and SRA, and 810 (71.0%) had neither. Preoperatively, patients with either SRD or SRA alone had worse scores for VAS neck pain (5.6 ± 3.1 vs 5.1 ± 3.3, p = 0.03), NDI (41.0 ± 19.3 vs 36.8 ± 20.8, p = 0.007), EQ-VAS (57.0 ± 21.0 vs 60.7 ± 21.7, p = 0.03), and EQ-5D (0.53 ± 0.23 vs 0.58 ± 0.21, p = 0.008) than patients without such disorders. Postoperatively, in multivariable adjusted analyses, baseline SRD or SRA alone was associated with inferior improvement in the VAS neck pain score and a lower rate of achieving the MCID for VAS neck pain score at 3 and 12 months, but not at 24 months. At 24 months, patients with SRD or SRA alone experienced less change in EQ-5D scores and were less likely to meet the MCID for EQ-5D than patients without SRD or SRA. Furthermore, patient self-reporting of both psychological comorbidities did not impact PROs at all measured time points compared with self-reporting of only one psychological comorbidity alone. Each cohort (SRD or SRA alone, both SRD and SRA, and neither SRD nor SRA) experienced significant improvements in mean PROs at all measured time points compared with baseline (p < 0.05). CONCLUSIONS Approximately 12% of patients who underwent surgery for CSM presented with both SRD and SRA, and 29% presented with at least one symptom. The presence of either SRD or SRA was independently associated with inferior scores for 3- and 12-month neck pain following surgery, but this difference was not significant at 24 months. However, at long-term follow-up, patients with SRD or SRA experienced lower quality of life than patients without SRD or SRA. The comorbid presence of both depression and anxiety was not associated with worse patient outcomes than either diagnosis alone.
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Affiliation(s)
- Andrew K Chan
- 1Department of Neurological Surgery, Columbia University, The Och Spine Hospital at NewYork/Presbyterian, New York, New York
| | | | - Christine Park
- 2Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Oren N Gottfried
- 2Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Khoi D Than
- 2Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Erica F Bisson
- 3Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Mohamad Bydon
- 4Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Anthony L Asher
- 5Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Domagoj Coric
- 5Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Eric A Potts
- 6Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Kevin T Foley
- 7Department of Neurosurgery, University of Tennessee, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Michael Y Wang
- 8Department of Neurological Surgery, University of Miami, Florida
| | - Kai-Ming Fu
- 9Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - Michael S Virk
- 9Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - John J Knightly
- 10Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Scott Meyer
- 10Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Paul Park
- 7Department of Neurosurgery, University of Tennessee, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
- 11Department of Neurological Surgery, University of Michigan, Ann Arbor, Michigan
| | - Cheerag D Upadhyaya
- 12Marion Bloch Neuroscience Institute, Saint Luke's Health System, Kansas City, Missouri
| | - Mark E Shaffrey
- 13Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Avery L Buchholz
- 13Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | | | - Jay D Turner
- 14Barrow Neurological Institute, Phoenix, Arizona
| | | | - Brandon A Sherrod
- 3Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Nitin Agarwal
- 15Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Dean Chou
- 1Department of Neurological Surgery, Columbia University, The Och Spine Hospital at NewYork/Presbyterian, New York, New York
| | - Regis W Haid
- 16Atlanta Brain and Spine Care, Atlanta, Georgia
| | - Praveen V Mummaneni
- 15Department of Neurological Surgery, University of California, San Francisco, California; and
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19
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Shahrestani S, Chan AK, Bisson EF, Bydon M, Glassman SD, Foley KT, Shaffrey CI, Potts EA, Shaffrey ME, Coric D, Knightly JJ, Park P, Wang MY, Fu KM, Slotkin JR, Asher AL, Virk MS, Michalopoulos GD, Guan J, Haid RW, Agarwal N, Chou D, Mummaneni PV. Developing nonlinear k-nearest neighbors classification algorithms to identify patients at high risk of increased length of hospital stay following spine surgery. Neurosurg Focus 2023; 54:E7. [PMID: 37283368 DOI: 10.3171/2023.3.focus22651] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 03/22/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Spondylolisthesis is a common operative disease in the United States, but robust predictive models for patient outcomes remain limited. The development of models that accurately predict postoperative outcomes would be useful to help identify patients at risk of complicated postoperative courses and determine appropriate healthcare and resource utilization for patients. As such, the purpose of this study was to develop k-nearest neighbors (KNN) classification algorithms to identify patients at increased risk for extended hospital length of stay (LOS) following neurosurgical intervention for spondylolisthesis. METHODS The Quality Outcomes Database (QOD) spondylolisthesis data set was queried for patients receiving either decompression alone or decompression plus fusion for degenerative spondylolisthesis. Preoperative and perioperative variables were queried, and Mann-Whitney U-tests were performed to identify which variables would be included in the machine learning models. Two KNN models were implemented (k = 25) with a standard training set of 60%, validation set of 20%, and testing set of 20%, one with arthrodesis status (model 1) and the other without (model 2). Feature scaling was implemented during the preprocessing stage to standardize the independent features. RESULTS Of 608 enrolled patients, 544 met prespecified inclusion criteria. The mean age of all patients was 61.9 ± 12.1 years (± SD), and 309 (56.8%) patients were female. The model 1 KNN had an overall accuracy of 98.1%, sensitivity of 100%, specificity of 84.6%, positive predictive value (PPV) of 97.9%, and negative predictive value (NPV) of 100%. Additionally, a receiver operating characteristic (ROC) curve was plotted for model 1, showing an overall area under the curve (AUC) of 0.998. Model 2 had an overall accuracy of 99.1%, sensitivity of 100%, specificity of 92.3%, PPV of 99.0%, and NPV of 100%, with the same ROC AUC of 0.998. CONCLUSIONS Overall, these findings demonstrate that nonlinear KNN machine learning models have incredibly high predictive value for LOS. Important predictor variables include diabetes, osteoporosis, socioeconomic quartile, duration of surgery, estimated blood loss during surgery, patient educational status, American Society of Anesthesiologists grade, BMI, insurance status, smoking status, sex, and age. These models may be considered for external validation by spine surgeons to aid in patient selection and management, resource utilization, and preoperative surgical planning.
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Affiliation(s)
- Shane Shahrestani
- 1Keck School of Medicine, University of Southern California, Los Angeles, California
- 2Department of Medical Engineering, California Institute of Technology, Pasadena, California
| | - Andrew K Chan
- 3Department of Neurological Surgery, Columbia University, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Erica F Bisson
- 4Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Mohamad Bydon
- 5Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Kevin T Foley
- 7Department of Neurological Surgery, University of Tennessee
| | - Christopher I Shaffrey
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
- Departments of8Neurosurgery andOrthopedic Surgery, Duke University, Durham, North Carolina
| | - Eric A Potts
- 10Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Mark E Shaffrey
- 11Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Domagoj Coric
- 12Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - John J Knightly
- 13Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Paul Park
- 7Department of Neurological Surgery, University of Tennessee
| | - Michael Y Wang
- 14Department of Neurological Surgery, University of Miami, Florida
| | - Kai-Ming Fu
- 15Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | | | - Anthony L Asher
- 12Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Michael S Virk
- 15Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | | | - Jian Guan
- 4Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Regis W Haid
- 17Atlanta Brain and Spine Care, Atlanta, Georgia; and
| | - Nitin Agarwal
- 18Department of Neurological Surgery, University of California, San Francisco, California
| | - Dean Chou
- 3Department of Neurological Surgery, Columbia University, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Praveen V Mummaneni
- 18Department of Neurological Surgery, University of California, San Francisco, California
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20
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Pinter ZW, Reed R, Townsley SE, Mikula AL, Lakomkin N, Kazarian E, Michalopoulos GD, Freedman BA, Currier BL, Elder BD, Bydon M, Fogelson J, Sebastian AS, Nassr AN. Paraspinal Sarcopenia is Associated With Worse Patient-Reported Outcomes Following Laminoplasty for Degenerative Cervical Myelopathy. Spine (Phila Pa 1976) 2023; 48:772-781. [PMID: 36972148 DOI: 10.1097/brs.0000000000004650] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/16/2023] [Indexed: 05/10/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The present study is the first to assess the impact of paraspinal sarcopenia on patient-reported outcome measures (PROMs) following cervical laminoplasty. BACKGROUND While the impact of sarcopenia on PROMs following lumbar spine surgery is well-established, the impact of sarcopenia on PROMs following laminoplasty has not been investigated. METHODS We performed a retrospective review of patients undergoing laminoplasty from C4-6 at a single institution between 2010 and 2021. Two independent reviewers utilized axial cuts of T2-weighted magnetic resonance imaging sequences to assess fatty infiltration of the bilateral transversospinales muscle group at the C5-6 level and classify patients according to the Fuchs Modification of the Goutalier grading system. PROMs were then compared between subgroups. RESULTS We identified 114 patients for inclusion in this study, including 35 patients with mild sarcopenia, 49 patients with moderate sarcopenia, and 30 patients with severe sarcopenia. There were no differences in preoperative PROMs between subgroups. Mean postoperative neck disability index scores were lower in the mild and moderate sarcopenia subgroups (6.2 and 9.1, respectively) than in the severe sarcopenia subgroup (12.9, P =0.01). Patients with mild sarcopenia were nearly twice as likely to achieve minimal clinically important difference (88.6 vs. 53.5%; P <0.001) and six times as likely to achieve SCB (82.9 vs. 13.3%; P =0.006) compared with patients with severe sarcopenia. A higher percentage of patients with severe sarcopenia reported postoperative worsening of their neck disability index (13 patients, 43.3%; P =0.002) and Visual Analog Scale Arm scores (10 patients, 33.3%; P =0.03). CONCLUSION Patients with severe paraspinal sarcopenia demonstrate less improvement in neck disability and pain postoperatively and are more likely to report worsening PROMs following laminoplasty. LEVEL OF EVIDENCE 3.
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Affiliation(s)
| | - Ryder Reed
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Sarah E Townsley
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Anthony L Mikula
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Nikita Lakomkin
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Erick Kazarian
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Brett A Freedman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Benjamin D Elder
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jeremy Fogelson
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Ahmad N Nassr
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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21
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Bydon M, Sardar ZM, Michalopoulos GD, El Sammak S, Chan AK, Carreon LY, Norheim E, Park P, Ratliff JK, Tumialán L, Pugely AJ, Steinmetz MP, Hsu W, Knightly JJ, Ziegenhorn DM, Donnelly PC, Mullen KJ, Rykowsky S, De A, Potts EA, Coric D, Wang MY, Qureshi S, Sethi RK, Fu KM, Patel AA, Yoon ST, Brodke D, Stroink AR, Bisson EF, Haid RW, Asher AL, Burton D, Mummaneni PV, Glassman SD. Representativeness of the American Spine Registry: a comparison of patient characteristics with the National Inpatient Sample. J Neurosurg Spine 2023:1-10. [PMID: 37148235 DOI: 10.3171/2023.3.spine221264] [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: 11/17/2022] [Accepted: 03/20/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE The American Spine Registry (ASR) is a collaborative effort between the American Academy of Orthopaedic Surgeons and the American Association of Neurological Surgeons. The goal of this study was to evaluate how representative the ASR is of the national practice with spinal procedures, as recorded in the National Inpatient Sample (NIS). METHODS The authors queried the NIS and the ASR for cervical and lumbar arthrodesis cases performed during 2017-2019. International Classification of Diseases, 10th Revision and Current Procedural Terminology codes were used to identify patients undergoing cervical and lumbar procedures. The two groups were compared for the overall proportion of cervical and lumbar procedures, age distribution, sex, surgical approach features, race, and hospital volume. Outcomes available in the ASR, such as patient-reported outcomes and reoperations, were not analyzed due to nonavailability in the NIS. The representativeness of the ASR compared to the NIS was assessed via Cohen's d effect sizes, and absolute standardized mean differences (SMDs) of < 0.2 were considered trivial, whereas > 0.5 were considered moderately large. RESULTS A total of 24,800 arthrodesis procedures were identified in the ASR for the period between January 1, 2017, and December 31, 2019. During the same time period, 1,305,360 cases were recorded in the NIS. Cervical fusions comprised 35.9% of the ASR cohort (8911 cases) and 36.0% of the NIS cohort (469,287 cases). The two databases presented trivial differences in terms of patient age and sex for all years of interest across both cervical and lumbar arthrodeses (SMD < 0.2). Trivial differences were also noted in the distribution of open versus percutaneous procedures of the cervical and lumbar spine (SMD < 0.2). Among lumbar cases, anterior approaches were more common in the ASR than in the NIS (32.1% vs 22.3%, SMD = 0.22), but the discrepancy among cervical cases in the two databases was trivial (SMD = 0.03). Small differences were illustrated in terms of race, with SMDs < 0.5, and a more significant discrepancy was identified in the geographic distribution of participating sites (SMDs of 0.7 and 0.74 for cervical and lumbar cases, respectively). For both of these measures, SMDs in 2019 were smaller than those in 2018 and 2017. CONCLUSIONS The ASR and NIS databases presented a very high similarity in proportions of cervical and lumbar spine surgeries, as well as similar distributions of age and sex, and distribution of open versus endoscopic approach. Slight discrepancies in anterior versus posterior approach among lumbar cases and patient race, and more significant discrepancies in geographic representation were also identified, yet decreasing trends in differences suggested the improving representativeness of the ASR over the course of time and its progressive growth. These conclusions are important to underline the external validity of quality investigations and research conclusions to be drawn from analyses in which the ASR is used.
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Affiliation(s)
- Mohamad Bydon
- 1Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Giorgos D Michalopoulos
- 1Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Sally El Sammak
- 1Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Andrew K Chan
- 4Neurological Surgery, Columbia University, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | | | | | - Paul Park
- 7Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - John K Ratliff
- 8Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Luis Tumialán
- 9Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Andrew J Pugely
- 10Department of Orthopedic Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Michael P Steinmetz
- 11Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Wellington Hsu
- 12Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - John J Knightly
- 13Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | | | | | - Kyle J Mullen
- 14American Academy of Orthopaedic Surgeons, Rosemont, Illinois
| | | | - Ayushmita De
- 14American Academy of Orthopaedic Surgeons, Rosemont, Illinois
| | - Eric A Potts
- 16Goodman Campbell Brain and Spine, St. Vincent Health, Indianapolis, Indiana
| | - Domagoj Coric
- 17Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina
| | - Michael Y Wang
- 18Department of Neurosurgery, University of Miami, Florida
| | - Sheeraz Qureshi
- 19Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Rajiv K Sethi
- 20Neuroscience Institute, Virginia Mason Hospital, Seattle, Washington
| | - Kai-Ming Fu
- 21Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | - Alpesh A Patel
- 22Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - S Tim Yoon
- 23Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia
| | - Darrel Brodke
- 22Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Ann R Stroink
- 24Central Illinois Neuro Health Science, Bloomington, Illinois
| | - Erica F Bisson
- 25Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Regis W Haid
- 26Atlanta Brain and Spine Care, Atlanta, Georgia
| | - Anthony L Asher
- 17Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina
| | - Doug Burton
- 27Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas; and
| | - Praveen V Mummaneni
- 28Department of Neurological Surgery, University of California, San Francisco, California
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22
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Bisson EF, Mummaneni PV, Michalopoulos GD, El Sammak S, Chan AK, Agarwal N, Wang MY, Knightly JJ, Sherrod BA, Gottfried ON, Than KD, Shaffrey CI, Goldberg JL, Virk MS, Hussain I, Shabani S, Glassman SD, Tumialan LM, Turner JD, Uribe JS, Meyer SA, Lu DC, Buchholz AL, Upadhyaya C, Shaffrey ME, Park P, Foley KT, Coric D, Slotkin JR, Potts EA, Stroink AR, Chou D, Fu KMG, Haid RW, Asher AL, Bydon M. Sleep Disturbances in Cervical Spondylotic Myelopathy: Prevalence and Postoperative Outcomes-an Analysis From the Quality Outcomes Database. Clin Spine Surg 2023; 36:112-119. [PMID: 36920372 DOI: 10.1097/bsd.0000000000001454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 01/25/2023] [Indexed: 03/16/2023]
Abstract
STUDY DESIGN Prospective observational study, level of evidence 1 for prognostic investigations. OBJECTIVES To evaluate the prevalence of sleep impairment and predictors of improved sleep quality 24 months postoperatively in cervical spondylotic myelopathy (CSM) using the quality outcomes database. SUMMARY OF BACKGROUND DATA Sleep disturbances are a common yet understudied symptom in CSM. MATERIALS AND METHODS The quality outcomes database was queried for patients with CSM, and sleep quality was assessed through the neck disability index sleep component at baseline and 24 months postoperatively. Multivariable logistic regressions were performed to identify risk factors of failure to improve sleep impairment and symptoms causing lingering sleep dysfunction 24 months after surgery. RESULTS Among 1135 patients with CSM, 904 (79.5%) had some degree of sleep dysfunction at baseline. At 24 months postoperatively, 72.8% of the patients with baseline sleep symptoms experienced improvement, with 42.5% reporting complete resolution. Patients who did not improve were more like to be smokers [adjusted odds ratio (aOR): 1.85], have osteoarthritis (aOR: 1.72), report baseline radicular paresthesia (aOR: 1.51), and have neck pain of ≥4/10 on a numeric rating scale. Patients with improved sleep noted higher satisfaction with surgery (88.8% vs 72.9%, aOR: 1.66) independent of improvement in other functional areas. In a multivariable analysis including pain scores and several myelopathy-related symptoms, lingering sleep dysfunction at 24 months was associated with neck pain (aOR: 1.47) and upper (aOR: 1.45) and lower (aOR: 1.52) extremity paresthesias. CONCLUSION The majority of patients presenting with CSM have associated sleep disturbances. Most patients experience sustained improvement after surgery, with almost half reporting complete resolution. Smoking, osteoarthritis, radicular paresthesia, and neck pain ≥4/10 numeric rating scale score are baseline risk factors of failure to improve sleep dysfunction. Improvement in sleep symptoms is a major driver of patient-reported satisfaction. Incomplete resolution of sleep impairment is likely due to neck pain and extremity paresthesia.
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Affiliation(s)
- Erica F Bisson
- Department of Neurological Surgery, University of Utah, Salt Lake City, UT
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA
| | - Giorgos D Michalopoulos
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN
| | - Sally El Sammak
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN
| | - Andrew K Chan
- Department of Neurological Surgery, Columbia University, The Och Spine Hospital at NewYork-Presbyterian, New York, NY
| | - Nitin Agarwal
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO
| | - Michael Y Wang
- Department of Neurosurgery, University of Miami, Miami, FL
| | | | - Brandon A Sherrod
- Department of Neurological Surgery, University of Utah, Salt Lake City, UT
| | - Oren N Gottfried
- Department of Neurological Surgery, Duke University Medical Center, Durham, NC
| | - Khoi D Than
- Department of Neurological Surgery, Duke University Medical Center, Durham, NC
| | | | - Jacob L Goldberg
- Department of Neurological Surgery, Weill Cornell Medical Center, New York
| | - Michael S Virk
- Department of Neurological Surgery, Weill Cornell Medical Center, New York
| | - Ibrahim Hussain
- Department of Neurological Surgery, Weill Cornell Medical Center, New York
| | - Saman Shabani
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI
| | | | - Louis M Tumialan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Jay D Turner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Juan S Uribe
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | | | - Daniel C Lu
- Department of Neurosurgery, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Avery L Buchholz
- Department of Neurosurgery, University of Virginia, Charlottesville, VA
| | - Cheerag Upadhyaya
- Department of Neurosurgery, School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Mark E Shaffrey
- Department of Neurosurgery, University of Virginia, Charlottesville, VA
| | - Paul Park
- Department of Neurosurgery, University of Tennessee, Memphis, TN
| | - Kevin T Foley
- Department of Neurosurgery, University of Tennessee, Memphis, TN
| | - Domagoj Coric
- Neuroscience Institute, Carolina Neurosurgery and Spine Associates, Carolinas Healthcare System, Charlotte, NC
| | | | - Eric A Potts
- Department of Neurological Surgery, Indiana University, Goodman Campbell Brain and Spine, Indianapolis, IN
| | - Ann R Stroink
- Central Illinois Neuro Health Science, Bloomington, IL
| | - Dean Chou
- Department of Neurological Surgery, Columbia University, The Och Spine Hospital at NewYork-Presbyterian, New York, NY
| | - Kai-Ming G Fu
- Department of Neurological Surgery, Weill Cornell Medical Center, New York
| | | | - Anthony L Asher
- Neuroscience Institute, Carolina Neurosurgery and Spine Associates, Carolinas Healthcare System, Charlotte, NC
| | - Mohamad Bydon
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN
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23
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Pinter ZW, Mikula AL, Reed R, Lakomkin N, Townsley SE, Wright B, Kazarian E, Michalopoulos GD, Currier B, Freedman BA, Bydon M, Elder BD, Fogelson J, Sebastian AS, Nassr A. Is Severe Neck Pain a Contraindication to Performing Laminoplasty in Patients With Cervical Spondylotic Myelopathy? Clin Spine Surg 2023; 36:127-133. [PMID: 36920406 DOI: 10.1097/bsd.0000000000001444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
STUDY DESIGN Retrospective review. OBJECTIVE The purpose of this study was to investigate the surgical outcomes in a cohort of patients with severe preoperative axial neck pain undergoing laminoplasty for cervical spondylotic myelopathy (CSM). SUMMARY OF BACKGROUND DATA No study has investigated whether patients with severe axial symptoms may achieve satisfactory neck pain and disability outcomes after laminoplasty. METHODS We performed a retrospective review of 91 patients undergoing C4-6 laminoplasty for CSM at a single academic institution between 2010 and 2021. Patient-reported outcome measures (PROMs), including Neck Disability Index (NDI), visual analog scale (VAS) Neck, and VAS Arm, were recorded preoperatively and at 6 months and 1 year postoperatively. Patients were stratified as having mild pain if VAS neck was 0-3, moderate pain if 4-6, and severe pain if 7-10. PROMs were then compared between subgroups at all the perioperative time points. RESULTS Both the moderate and severe neck pain subgroups demonstrated a substantial improvement in VAS neck from preoperative to 6 months postoperatively (-3.1±2.2 vs. -5.6±2.8, respectively; P <0.001), and these improvements were maintained at 1 year postoperatively. There was no difference in VAS neck between subgroups at either the 6-month or 1-year postoperative time points. Despite the substantially higher mean NDI in the moderate and severe neck pain subgroups preoperatively, there was no difference in NDI at 6 months or 1 year postoperatively ( P =0.99). There were no differences between subgroups in the degree of cord compression, severity of multifidus sarcopenia, sagittal alignment, or complications. CONCLUSIONS Patients with moderate and severe preoperative neck pain undergoing laminoplasty achieved equivalent PROMs at 6 months and 1 year as patients with mild preoperative neck pain. The results of this study highlight the multifactorial nature of neck pain in these patients and indicate that severe axial symptoms are not an absolute contraindication to performing laminoplasty in well-aligned patients with CSM.
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24
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Sherrod BA, Michalopoulos GD, Mulvaney G, Agarwal N, Chan AK, Asher AL, Coric D, Virk MS, Fu KM, Foley KT, Park P, Upadhyaya CD, Knightly JJ, Shaffrey ME, Potts EA, Shaffrey CI, Gottfried ON, Than KD, Wang MY, Tumialán LM, Chou D, Mummaneni PV, Bydon M, Bisson EF. Development of new postoperative neck pain at 12 and 24 months after surgery for cervical spondylotic myelopathy: a Quality Outcomes Database study. J Neurosurg Spine 2023; 38:357-365. [PMID: 36308471 DOI: 10.3171/2022.9.spine22611] [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: 05/31/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Patients who undergo surgery for cervical spondylotic myelopathy (CSM) will occasionally develop postoperative neck pain that was not present preoperatively, yet the incidence of this phenomenon is unclear. The authors aimed to elucidate patient and surgical factors associated with new-onset sustained pain after CSM surgery. METHODS The authors reviewed data from the Quality Outcomes Database (QOD) CSM module. The presence of neck pain was defined using the neck pain numeric rating scale (NRS). Patients with no neck pain at baseline (neck NRS score ≤ 1) were then stratified based on the presence of new postoperative pain development (neck NRS score ≥ 2) at 12 and 24 months postoperatively. RESULTS Of 1141 patients in the CSM QOD, 224 (19.6%) reported no neck pain at baseline. Among 170 patients with no baseline neck pain and available 12-month follow-up, 46 (27.1%) reported new postoperative pain. Among 184 patients with no baseline neck pain and available 24-month follow-up, 53 (28.8%) reported new postoperative pain. The mean differences in neck NRS scores were 4.3 for those with new postoperative pain compared with those without at 12 months (4.4 ± 2.2 vs 0.1 ± 0.3, p < 0.001) and 3.9 at 24 months (4.1 ± 2.4 vs 0.2 ± 0.4, p < 0.001). The majority of patients reporting new-onset neck pain reported being satisfied with surgery, but their satisfaction was significantly lower compared with patients without pain at the 12-month (66.7% vs 94.3%, p < 0.001) and 24-month (65.4% vs 90.8%, p < 0.001) follow-ups. The baseline Neck Disability Index (NDI) was an independent predictor of new postoperative neck pain at both the 12-month and 24-month time points (adjusted OR [aOR] 1.04, 95% CI 1.01-1.06; p = 0.002; and aOR 1.03, 95% CI 1.01-1.05; p = 0.026, respectively). The total number of levels treated was associated with new-onset neck pain at 12 months (aOR 1.34, 95% CI 1.09-1.64; p = 0.005), and duration of symptoms more than 3 months was a predictor of 24-month neck pain (aOR 3.22, 95% CI 1.01-10.22; p = 0.048). CONCLUSIONS Increased NDI at baseline, number of levels treated surgically, and duration of symptoms longer than 3 months preoperatively correlate positively with the risk of new-onset neck pain following CSM surgery. The majority of patients with new-onset neck pain still report satisfaction from surgery, suggesting that the risk of new-onset neck pain should not hinder indicated operations from being performed.
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Affiliation(s)
- Brandon A Sherrod
- 1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | | | - Graham Mulvaney
- 3Department of Neurosurgery, Carolina Neurosurgery and Spine Associates and Neuroscience Institute, Carolinas Health Care System, Charlotte, North Carolina
| | - Nitin Agarwal
- 4Department of Neurosurgery, University of California, San Francisco, California
| | - Andrew K Chan
- 5Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Anthony L Asher
- 3Department of Neurosurgery, Carolina Neurosurgery and Spine Associates and Neuroscience Institute, Carolinas Health Care System, Charlotte, North Carolina
| | - Domagoj Coric
- 3Department of Neurosurgery, Carolina Neurosurgery and Spine Associates and Neuroscience Institute, Carolinas Health Care System, Charlotte, North Carolina
| | - Michael S Virk
- 6Department of Neurosurgery, Weill Cornell Medical College, New York, New York
| | - Kai-Ming Fu
- 6Department of Neurosurgery, Weill Cornell Medical College, New York, New York
| | - Kevin T Foley
- 7Department of Neurosurgery, University of Tennessee and Semmes Murphey Clinic, Memphis, Tennessee
| | - Paul Park
- 8Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Cheerag D Upadhyaya
- 9Saint Luke's Neurological and Spine Surgery, Kansas City, Missouri
- 10Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina
| | - John J Knightly
- 11Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Mark E Shaffrey
- 12Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
| | - Eric A Potts
- 13Department of Neurosurgery, Indiana University; Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | | | - Oren N Gottfried
- 5Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Khoi D Than
- 5Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Michael Y Wang
- 14Department of Neurosurgery, University of Miami, Florida; and
| | | | - Dean Chou
- 4Department of Neurosurgery, University of California, San Francisco, California
| | - Praveen V Mummaneni
- 4Department of Neurosurgery, University of California, San Francisco, California
| | - Mohamad Bydon
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Erica F Bisson
- 1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
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25
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Zaki MM, Joshi RS, Ibrahim S, Michalopoulos GD, Linzey JR, Saadeh YS, Upadhyaya C, Coric D, Potts EA, Bisson EF, Turner JD, Knightly JJ, Fu KM, Foley KT, Tumialan L, Shaffrey ME, Bydon M, Mummaneni PV, Chou D, Chan AK, Meyer S, Asher AL, Shaffrey CI, Gottfried ON, Than KD, Wang M, Haid R, Slotkin JR, Glassman SD, Park P. How closely are outcome questionnaires correlated to patient satisfaction after cervical spine surgery for myelopathy? J Neurosurg Spine 2023; 38:521-529. [PMID: 36805998 DOI: 10.3171/2023.1.spine22888] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/09/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVE Patient-reported outcomes (PROs) have become the standard means to measure surgical outcomes. Insurers and policy makers are also increasingly utilizing PROs to assess the value of care and measure different aspects of a patient's condition. For cervical myelopathy, it is currently unclear which outcome measure best reflects patient satisfaction. In this investigation, the authors evaluated patients treated for cervical myelopathy to determine which outcome questionnaires best correlate with patient satisfaction. METHODS The Quality Outcomes Database (QOD), a prospectively collected multi-institutional database, was used to retrospectively analyze patients undergoing surgery for cervical myelopathy. The North American Spine Society (NASS) satisfaction index, Neck Disability Index (NDI), numeric rating scales for neck pain (NP-NRS) and arm pain (AP-NRS), EQ-5D, and modified Japanese Orthopaedic Association (mJOA) scale were evaluated. RESULTS The analysis included 1141 patients diagnosed with myelopathy, of whom 1099 had an NASS satisfaction index recorded at any of the follow-up time points. Concomitant radiculopathy was an indication for surgery in 368 (33.5%) patients, and severe neck pain (NP-NRS ≥ 7) was present in 471 (42.8%) patients. At the 3-month follow-up, NASS patient satisfaction index scores were positively correlated with scores for the NP-NRS (r = 0.30), AP-NRS (r = 0.32), and NDI (r = 0.36) and negatively correlated with EQ-5D (r = -0.38) and mJOA (r = -0.29) scores (all p < 0.001). At the 12-month follow-up, scores for the NASS index were positively correlated with scores for the NP-NRS (r = 0.44), AP-NRS (r = 0.38), and NDI (r = 0.46) and negatively correlated with scores for the EQ-5D (r = -0.40) and mJOA (r = -0.36) (all p < 0.001). At the 24-month follow-up, NASS index scores were positively correlated with NP-NRS (r = 0.49), AP-NRS (r = 0.36), and NDI (r = 0.49) scores and negatively correlated with EQ-5D (r = -0.44) and mJOA (r = -0.38) scores (all p < 0.001). CONCLUSIONS Neck pain was highly prevalent in patients with myelopathy. Notably, improvement in neck pain-associated disability rather than improvement in myelopathy was the most prominent PRO factor for patients. This finding may reflect greater patient concern for active pain symptoms than for neurological symptoms caused by myelopathy. As commercial payers begin to examine novel remuneration strategies for surgical interventions, thoughtful analysis of PRO measurements will have increasing relevance.
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Affiliation(s)
- Mark M Zaki
- 1Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Rushikesh S Joshi
- 1Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Sufyan Ibrahim
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | | | - Joseph R Linzey
- 1Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Yamaan S Saadeh
- 1Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | | | - Domagoj Coric
- 4Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
| | - Eric A Potts
- 5Goodman Campbell Brain and Spine, Carmel, Indiana
| | - Erica F Bisson
- 6Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Jay D Turner
- 7Barrow Neurological Institute, Phoenix, Arizona
| | | | - Kai-Ming Fu
- 9Department of Neurological Surgery, Weill Cornell Medicine, New York, New York
| | - Kevin T Foley
- 10Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, University of Tennessee, Memphis, Tennessee
| | | | - Mark E Shaffrey
- 11Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Mohamad Bydon
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Praveen V Mummaneni
- 12Department of Neurological Surgery, University of California, San Francisco, California
| | - Dean Chou
- 12Department of Neurological Surgery, University of California, San Francisco, California
| | - Andrew K Chan
- 12Department of Neurological Surgery, University of California, San Francisco, California
| | - Scott Meyer
- 8Altair Health Spine and Wellness, Morristown, New Jersey
| | - Anthony L Asher
- 4Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
| | | | - Oren N Gottfried
- 13Department of Neurological Surgery, Duke University, Durham, North Carolina
| | - Khoi D Than
- 13Department of Neurological Surgery, Duke University, Durham, North Carolina
| | - Michael Wang
- 14Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Regis Haid
- 15Atlanta Brain and Spine, Atlanta, Georgia
| | | | | | - Paul Park
- 1Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan.,10Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, University of Tennessee, Memphis, Tennessee
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Bergin SM, Michalopoulos GD, Shaffrey CI, Gottfried ON, Johnson E, Bisson EF, Wang MY, Knightly JJ, Virk MS, Tumialán LM, Turner JD, Upadhyaya CD, Shaffrey ME, Park P, Foley KT, Coric D, Slotkin JR, Potts EA, Chou D, Fu KMG, Haid RW, Asher AL, Bydon M, Mummaneni PV, Than KD. Characteristics of patients who return to work after undergoing surgery for cervical spondylotic myelopathy: a Quality Outcomes Database study. J Neurosurg Spine 2023; 38:530-539. [PMID: 36805526 DOI: 10.3171/2023.1.spine221078] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/17/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVE Return to work (RTW) is an important surgical outcome for patients who are employed, yet a significant number of patients with cervical spondylotic myelopathy (CSM) who are employed undergo cervical spine surgery and fail to RTW. In this study, the authors investigated factors associated with failure to RTW in the CSM population who underwent cervical spine surgery and who were considered to have a good surgical outcome yet failed to RTW. METHODS This study retrospectively analyzed prospectively collected data from the cervical myelopathy module of a national spine registry, the Quality Outcomes Database. The CSM data set of the Quality Outcomes Database was queried for patients who were employed at the time of surgery and planned to RTW postoperatively. Distinct multivariable logistic regression models were fitted with 3-month RTW as an outcome for the overall population to identify risk factors for failure to RTW. Good outcomes were defined as patients who had no adverse events (readmissions or complications), who had achieved 30% improvement in Neck Disability Index score, and who were satisfied (North American Spine Society satisfaction score of 1 or 2) at 3 months postsurgery. RESULTS Of the 409 patients who underwent surgery, 80% (n = 327) did RTW at 3 months after surgery. At 3 months, 56.9% of patients met the criteria for a good surgical outcome, and patients with a good outcome were more likely to RTW (88.1% vs 69.2%, p < 0.01). Of patients with a good outcome, 11.9% failed to RTW at 3 months. Risk factors for failing to RTW despite a good outcome included preoperative short-term disability or leave status (OR 3.03 [95% CI 1.66-7.90], p = 0.02); a higher baseline Neck Disability Index score (OR 1.41 [95% CI 1.09-1.84], p < 0.01); and higher neck pain score at 3 months postoperatively (OR 0.81 [95% CI 0.66-0.99], p = 0.04). CONCLUSIONS Most patients with CSM who undergo spine surgery reenter the workforce within 3 months from surgery, with RTW rates being higher among patients who experience good outcomes. Among patients with good outcomes who were employed, failure to RTW was associated with being on preoperative short-term disability or leave status prior to surgery as well as higher neck pain scores at baseline and at 3 months postoperatively.
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Affiliation(s)
- Stephen M Bergin
- 1Department of Neurosurgery, Division of Spine, Duke University, Durham, North Carolina
| | | | | | - Oren N Gottfried
- 1Department of Neurosurgery, Division of Spine, Duke University, Durham, North Carolina
| | - Eli Johnson
- 1Department of Neurosurgery, Division of Spine, Duke University, Durham, North Carolina
| | - Erica F Bisson
- 3Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Michael Y Wang
- 5Department of Neurological Surgery, University of Miami, Florida
| | | | - Michael S Virk
- 7Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | | | - Jay D Turner
- 8Barrow Neurological Institute, Phoenix, Arizona
| | - Cheerag D Upadhyaya
- 9Marion Bloch Neuroscience Institute, Saint Luke's Health System, Kansas City, Missouri
| | - Mark E Shaffrey
- 10Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Paul Park
- 11Semmes-Murphey Clinic, University of Tennessee College of Medicine, Memphis, Tennessee
| | - Kevin T Foley
- 11Semmes-Murphey Clinic, University of Tennessee College of Medicine, Memphis, Tennessee
| | - Domagoj Coric
- 12Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | | | - Eric A Potts
- 14Goodman Campbell Brain and Spine, Indianapolis, Indiana; and
| | - Dean Chou
- 4Department of Neurological Surgery, University of California, San Francisco, California
| | - Kai-Ming G Fu
- 7Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - Regis W Haid
- 15Atlanta Brain and Spine Care, Atlanta, Georgia
| | - Anthony L Asher
- 12Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Mohamad Bydon
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Praveen V Mummaneni
- 4Department of Neurological Surgery, University of California, San Francisco, California
| | - Khoi D Than
- 1Department of Neurosurgery, Division of Spine, Duke University, Durham, North Carolina
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27
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Bydon M, Nathani KR, Michalopoulos GD. Commentary: Methods and Impact for Using Federated Learning to Collaborate on Clinical Research. Neurosurgery 2023; 92:e19-e20. [PMID: 36637278 DOI: 10.1227/neu.0000000000002243] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 01/14/2023] Open
Affiliation(s)
- Mohamad Bydon
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Karim Rizwan Nathani
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Giorgos D Michalopoulos
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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28
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Pennington Z, Michalopoulos GD, Wahood W, El Sammak S, Lakomkin N, Bydon M. Trends in Reimbursement and Approach Selection for Lumbar Arthrodesis. Neurosurgery 2023; 92:308-316. [PMID: 36637267 DOI: 10.1227/neu.0000000000002194] [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] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 08/20/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Changes in reimbursement policies have been demonstrated to correlate with clinical practice. OBJECTIVE To investigate trends in physician reimbursement for anterior, posterior, and combined anterior/posterior (AP) lumbar arthrodesis and relative utilization of AP. METHODS We queried the American College of Surgeons National Surgical Quality Improvement Project registry for anterior, posterior, and AP lumbar arthrodeses during 2010 and 2020. Work relative value units per operative hour (wRVUs/h) were calculated for each procedure. Trends in reimbursement and utilization of the AP approach were assessed with linear regression. Subgroup analyses of age and underlying pathology of AP arthrodesis were also performed. RESULTS During 2010 and 2020, AP arthrodesis was associated with significantly higher average wRVUs/h compared with anterior and posterior arthrodesis (AP = 17.4, anterior = 12.4, posterior = 14.5). The AP approach had a significant yearly increase in wRVUs/h (coefficient = 0.48, P = .042), contrary to anterior (coefficient = -0.01, P = .308) and posterior (coefficient = -0.13, P = .006) approaches. Utilization of AP approaches over all arthrodeses increased from 7.5% in 2010 to 15.3% in 2020 (yearly average increase 0.79%, P < .001). AP fusions increased significantly among both degenerative and deformity cases (coefficients 0.88 and 1.43, respectively). The mean age of patients undergoing AP arthrodesis increased by almost 10 years from 2010 to 2020. Rates of major 30-day complications were 2.7%, 3.1%, and 3.5% for AP, anterior, and posterior arthrodesis, respectively. CONCLUSION AP lumbar arthrodesis was associated with higher and increasing reimbursement (wRVUs/h) during the period 2010 to 2020. Reimbursement for anterior arthrodesis was relatively stable, while reimbursement for posterior arthrodesis decreased. The utilization of the combined AP approach relative to the other approaches increased significantly during the period of interest.
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Affiliation(s)
- Zach Pennington
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Giorgos D Michalopoulos
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.,Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Waseem Wahood
- Dr. Karin C Patel College of Allopathic Medicine, Nova Southeastern University, Davie, Florida, USA
| | - Sally El Sammak
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.,Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Nikita Lakomkin
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Bydon
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.,Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
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29
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Mualem W, Nathani KR, Durrani S, Zamanian C, Ghaith AK, Michalopoulos GD, Rotter J, Daniels D, Bydon M. Utilizing pre- and postoperative radiological parameters to predict surgical outcomes following untethering for tethered cord syndrome in a pediatric population. J Neurosurg Pediatr 2023; 31:159-168. [PMID: 36461831 DOI: 10.3171/2022.10.peds22459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/24/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Tethered cord syndrome (TCS) can lead to significant downstream neurological deficits including gait deterioration, incontinence, and often unexplained chronic low-back pain. Surgical intervention may relieve symptoms, but there are no defined radiological parameters associated with surgical outcomes and functional status. The authors aimed to define pre- and postoperative radiological parameters for assessing surgical outcomes in TCS. METHODS The authors performed a single-center retrospective review of all pediatric patients treated for TCS between 2016 and 2021. Patient baseline characteristics and operative metrics included age, sex, level of conus, level of procedure, tethering pathology, symptoms at presentation, complications, improvement of symptoms, and reoperation rate. MRI measurements included pre- and postoperative anterior canal distance (ACD) and bending angle (BA). RESULTS Thirty-three pediatric patients were identified who underwent untethering of the spinal cord and had pre- and postoperative MRI between 2016 and 2021. The mean patient age was 5.64 ± 5.33 years. Twenty patients (60.60%) were female. Regarding the site of untethering, 31 procedures (93.93%) were performed at the lumbosacral region and 2 (6.06%) were performed at the thoracolumbar region. The conus medullaris was found above L3 in 21.21% of patients. Postoperatively, 18.18% of patients experienced complications, 48.48% showed improvement in their symptoms, and 48.48% were equivocal or had persistent symptoms. The mean preoperative ACD0 (measured from the posterior vertebral body margin [middle] to the anterior margin of the conus medullaris) was 6.15 ± 3.18 mm, the postoperative ACD0 was 2.25 ± 2.72 mm, and the average change in ACD0 was -0.90 ± 1.31 mm. The mean preoperative BA was 26.00° ± 11.56°, the mean postoperative BA was 15.92° ± 9.81°, and the average change in BA was -10.08° ± 8.80°. An optimal cutoff value for preoperative BA to predict reoperation in pediatric patients with complex TCS undergoing surgery was ≥ 31.70° (area under the curve = 0.83). CONCLUSIONS In surgically treated patients with TCS, certain preoperative radiological parameters may be important in predicting postoperative surgical outcomes; these parameters can be evaluated and reported to indicate patients at high risk for complications. Further prospective multicenter research is warranted to offer robust evidence of association of patient outcomes with preoperative radiological parameters in TCS.
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Affiliation(s)
- William Mualem
- 1Mayo Clinic Neuro-Informatics Laboratory and
- 2Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | - Karim Rizwan Nathani
- 1Mayo Clinic Neuro-Informatics Laboratory and
- 2Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | - Sulaman Durrani
- 1Mayo Clinic Neuro-Informatics Laboratory and
- 2Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | - Cameron Zamanian
- 1Mayo Clinic Neuro-Informatics Laboratory and
- 2Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | - Abdul Karim Ghaith
- 1Mayo Clinic Neuro-Informatics Laboratory and
- 2Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | - Giorgos D Michalopoulos
- 1Mayo Clinic Neuro-Informatics Laboratory and
- 2Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | - Juliana Rotter
- 2Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | - David Daniels
- 2Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mohamad Bydon
- 1Mayo Clinic Neuro-Informatics Laboratory and
- 2Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
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30
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Pinter ZW, Skjaerlund J, Michalopoulos GD, Nathani KR, Bydon M, Nassr A, Sebastian AS, Freedman BA. Dynamic Radiographs Are Unreliable to Assess Arthrodesis Following Cervical Fusion: A Modeled Radiostereometric Analysis of Cervical Motion. Spine (Phila Pa 1976) 2023; 48:127-136. [PMID: 36083848 DOI: 10.1097/brs.0000000000004470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/12/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN In vitro study. OBJECTIVE The purpose of the present study was to utilize an idealized cervical spine model to determine whether the parallax effect or changes in the position of the spine relative to the x-ray generator influence intervertebral motion parameters on dynamic cervical spine radiographs. SUMMARY OF BACKGROUND DATA The utility of flexion-extension radiographs in clinical practice remains in question due to poor reliability of the parameters utilized to measure motion. MATERIALS AND METHODS A cervical spine model with tantalum beads inserted into the tip of each spinous process was utilized to measure interspinous process distance (IPD) on plain radiographs. The model was then manipulated to alter the generator angle and generator distance, and the IPD was measured. The impact of individual and combined changes in these parameters on IPD was assessed. Multivariate analysis was performed to identify independent drivers of variability in IPD measurements. RESULTS Isolated changes in the generator distance and generator angle and combined changes in these parameters led to significant changes in the measured IPD at each intervertebral level in neutral, flexion, and extension, which, in many instances, exceeded an absolute change of >1 mm or >2 mm. Multivariate analysis revealed that generator distance and generator angle are both independent factors impacting IPD measurements that have an additive effect. CONCLUSIONS In an idealized cervical spine model, small clinically feasible changes in spine position relative to the x-ray generator produced substantial variability in IPD measurements, with absolute changes that often exceeded established cutoffs for determining the presence of pathologic motion across a fused segment. This study further reinforces that motion assessment on dynamic radiographs is not a reliable method for determining the presence of an arthrodesis unless these sources of variability can be consistently eliminated. LEVEL OF EVIDENCE 3.
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Affiliation(s)
| | | | | | - Karim R Nathani
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| | - Ahmad Nassr
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
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31
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Pennington Z, Lakomkin N, Michalopoulos GD, Mikula AL, Ahn ES, Bydon M, Clarke MJ, Elder BD, Fogelson JL. Surgical Management of Hirayama Disease (Monomelic Amyotrophy): Systematic Review and Meta-Analysis of Patient-Level Data. World Neurosurg 2023; 172:e278-e290. [PMID: 36623725 DOI: 10.1016/j.wneu.2023.01.009] [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: 10/12/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Abstract
BACKGROUND Hirayama disease or juvenile-onset monomelic amyotrophy is a clinical syndrome that disproportionately affects young males. Standard of care revolves around conservative management, but some patients experience disease progression that may benefit from surgical intervention. METHODS Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of previous reports of surgical treatment for Hirayama disease was performed. Studies were included if they provided individual patient-level data, described the clinical presentation and surgical intervention, and reported neurological improvement at last follow-up. Comparison between those who improved and those with stable symptoms at last follow-up was performed. Decision-tree analysis was used to identify the best predictors of neurological improvement by last follow-up. RESULTS Of 624 unique articles, 30 were included in the qualitative review and 23 in the meta-analysis. Among the 70 patients in the meta-analysis, mean age was 21.2 ± 6.3 years, 91% were male, and mean symptom duration at presentation was 43.3 ± 61.8 months. Fifty-nine patients (84.3%) had improvement in their neurological symptoms by last follow-up. Univariable analysis showed the only significant predictor of improvement in neurological symptoms by last follow-up was the use of stabilization-alone versus decompression with or without stabilization. Baseline clinical symptoms nor radiographic features predicted outcome. Decision-tree analysis showed surgical strategy (stabilization-alone vs. decompression ± stabilization), age (<20 vs. ≥20), and surgical approach (anterior-only vs. posterior-only or anterior-posterior) predicted a higher likelihood of neurological improvement by last follow-up. CONCLUSIONS Nearly 85% of patients experienced improvement in neurological symptoms. Improvement was best for those who underwent stabilization-alone, and decision-tree analysis suggested that the likelihood of improvement was also superior for patients under 20 years of age and those treated with an anterior versus posterior or staged approach.
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Affiliation(s)
- Zach Pennington
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
| | - Nikita Lakomkin
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Anthony L Mikula
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Edward S Ahn
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Bydon
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Benjamin D Elder
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
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32
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Chan AK, Shaffrey CI, Gottfried ON, Park C, Than KD, Bisson EF, Bydon M, Asher AL, Coric D, Potts EA, Foley KT, Wang MY, Fu KM, Virk MS, Knightly JJ, Meyer S, Park P, Upadhyaya C, Shaffrey ME, Buchholz AL, Tumialán LM, Turner JD, Michalopoulos GD, Sherrod BA, Agarwal N, Chou D, Haid RW, Mummaneni PV. Cervical spondylotic myelopathy with severe axial neck pain: is anterior or posterior approach better? J Neurosurg Spine 2023; 38:42-55. [PMID: 36029264 DOI: 10.3171/2022.6.spine22110] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 01/24/2022] [Accepted: 06/23/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The aim of this study was to determine whether multilevel anterior cervical discectomy and fusion (ACDF) or posterior cervical laminectomy and fusion (PCLF) is superior for patients with cervical spondylotic myelopathy (CSM) and high preoperative neck pain. METHODS This was a retrospective study of prospectively collected data using the Quality Outcomes Database (QOD) CSM module. Patients who received a subaxial fusion of 3 or 4 segments and had a visual analog scale (VAS) neck pain score of 7 or greater at baseline were included. The 3-, 12-, and 24-month outcomes were compared for patients undergoing ACDF with those undergoing PCLF. RESULTS Overall, 1141 patients with CSM were included in the database. Of these, 495 (43.4%) presented with severe neck pain (VAS score > 6). After applying inclusion and exclusion criteria, we compared 65 patients (54.6%) undergoing 3- and 4-level ACDF and 54 patients (45.4%) undergoing 3- and 4-level PCLF. Patients undergoing ACDF had worse Neck Disability Index scores at baseline (52.5 ± 15.9 vs 45.9 ± 16.8, p = 0.03) but similar neck pain (p > 0.05). Otherwise, the groups were well matched for the remaining baseline patient-reported outcomes. The rates of 24-month follow-up for ACDF and PCLF were similar (86.2% and 83.3%, respectively). At the 24-month follow-up, both groups demonstrated mean improvements in all outcomes, including neck pain (p < 0.05). In multivariable analyses, there was no significant difference in the degree of neck pain change, rate of neck pain improvement, rate of pain-free achievement, and rate of reaching minimal clinically important difference (MCID) in neck pain between the two groups (adjusted p > 0.05). However, ACDF was associated with a higher 24-month modified Japanese Orthopaedic Association scale (mJOA) score (β = 1.5 [95% CI 0.5-2.6], adjusted p = 0.01), higher EQ-5D score (β = 0.1 [95% CI 0.01-0.2], adjusted p = 0.04), and higher likelihood for return to baseline activities (OR 1.2 [95% CI 1.1-1.4], adjusted p = 0.002). CONCLUSIONS Severe neck pain is prevalent among patients undergoing surgery for CSM, affecting more than 40% of patients. Both ACDF and PCLF achieved comparable postoperative neck pain improvement 3, 12, and 24 months following 3- or 4-segment surgery for patients with CSM and severe neck pain. However, multilevel ACDF was associated with superior functional status, quality of life, and return to baseline activities at 24 months in multivariable adjusted analyses.
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Affiliation(s)
- Andrew K Chan
- 1Department of Neurosurgery, Duke University, Durham, North Carolina
| | | | - Oren N Gottfried
- 1Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Christine Park
- 1Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Khoi D Than
- 1Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Erica F Bisson
- 2Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Mohamad Bydon
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Anthony L Asher
- 4Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Domagoj Coric
- 4Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Eric A Potts
- 5Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Kevin T Foley
- 6Department of Neurosurgery, University of Tennessee, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Michael Y Wang
- 7Department of Neurological Surgery, University of Miami, Florida
| | - Kai-Ming Fu
- 8Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - Michael S Virk
- 8Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | | | - Scott Meyer
- 9Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Paul Park
- 10Department of Neurological Surgery, University of Michigan, Ann Arbor, Michigan
| | - Cheerag Upadhyaya
- 11Marion Bloch Neuroscience Institute, Saint Luke's Health System, Kansas City, Missouri
| | - Mark E Shaffrey
- 12Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Avery L Buchholz
- 12Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | | | - Jay D Turner
- 13Barrow Neurological Institute, Phoenix, Arizona
| | | | - Brandon A Sherrod
- 2Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Nitin Agarwal
- 14Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Dean Chou
- 14Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Regis W Haid
- 15Atlanta Brain and Spine Care, Atlanta, Georgia
| | - Praveen V Mummaneni
- 14Department of Neurological Surgery, University of California, San Francisco, California; and
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33
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Chan AK, Bydon M, Bisson EF, Glassman SD, Foley KT, Shaffrey CI, Potts EA, Shaffrey ME, Coric D, Knightly JJ, Park P, Wang MY, Fu KM, Slotkin JR, Asher AL, Virk MS, Michalopoulos GD, Guan J, Haid RW, Agarwal N, Park C, Chou D, Mummaneni PV. Minimally invasive versus open transforaminal lumbar interbody fusion for grade I lumbar spondylolisthesis: 5-year follow-up from the prospective multicenter Quality Outcomes Database registry. Neurosurg Focus 2023; 54:E2. [PMID: 36587409 DOI: 10.3171/2022.10.focus22602] [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: 09/01/2022] [Accepted: 10/25/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) has been used to treat degenerative lumbar spondylolisthesis and is associated with expedited recovery, reduced operative blood loss, and shorter hospitalizations compared to those with traditional open TLIF. However, the impact of MI-TLIF on long-term patient-reported outcomes (PROs) is less clear. Here, the authors compare the outcomes of MI-TLIF to those of traditional open TLIF for grade I degenerative lumbar spondylolisthesis at 60 months postoperatively. METHODS The authors utilized the prospective Quality Outcomes Database registry and queried for patients with grade I degenerative lumbar spondylolisthesis who had undergone single-segment surgery via an MI or open TLIF method. PROs were compared 60 months postoperatively. The primary outcome was the Oswestry Disability Index (ODI). The secondary outcomes included the numeric rating scale (NRS) for back pain (NRS-BP), NRS for leg pain (NRS-LP), EQ-5D, North American Spine Society (NASS) satisfaction, and cumulative reoperation rate. Multivariable models were constructed to assess the impact of MI-TLIF on PROs, adjusting for variables reaching p < 0.20 on univariable analyses and respective baseline PRO values. RESULTS The study included 297 patients, 72 (24.2%) of whom had undergone MI-TLIF and 225 (75.8%) of whom had undergone open TLIF. The 60-month follow-up rates were similar for the two cohorts (86.1% vs 75.6%, respectively; p = 0.06). Patients did not differ significantly at baseline for ODI, NRS-BP, NRS-LP, or EQ-5D (p > 0.05 for all). Perioperatively, MI-TLIF was associated with less blood loss (108.8 ± 85.6 vs 299.6 ± 242.2 ml, p < 0.001) and longer operations (228.2 ± 111.5 vs 189.6 ± 66.5 minutes, p < 0.001) but had similar lengths of hospitalizations (MI-TLIF 2.9 ± 1.8 vs open TLIF 3.3 ± 1.6 days, p = 0.08). Discharge disposition to home or home health was similar (MI-TLIF 93.1% vs open TLIF 91.1%, p = 0.60). Both cohorts improved significantly from baseline for the 60-month ODI, NRS-BP, NRS-LP, and EQ-5D (p < 0.001 for all comparisons). In adjusted analyses, MI-TLIF, compared to open TLIF, was associated with similar 60-month ODI, ODI change, odds of reaching ODI minimum clinically important difference, NRS-BP, NRS-BP change, NRS-LP, NRS-LP change, EQ-5D, EQ-5D change, and NASS satisfaction (adjusted p > 0.05 for all). The 60-month reoperation rates did not differ significantly (MI-TLIF 5.6% vs open TLIF 11.6%, p = 0.14). CONCLUSIONS For symptomatic, single-level grade I degenerative lumbar spondylolisthesis, MI-TLIF was associated with decreased blood loss perioperatively, but there was no difference in 60-month outcomes for disability, back pain, leg pain, quality of life, or satisfaction between MI and open TLIF. There was no difference in cumulative reoperation rates between the two procedures. These results suggest that in appropriately selected patients, either procedure may be employed depending on patient and surgeon preferences.
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Affiliation(s)
- Andrew K Chan
- 1Department of Neurological Surgery, Columbia University, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Mohamad Bydon
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Erica F Bisson
- 3Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Steven D Glassman
- 4Orthopedic Surgery, Norton Leatherman Spine Center, Louisville, Kentucky
| | - Kevin T Foley
- 5Department of Neurological Surgery, University of Tennessee, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Christopher I Shaffrey
- 6Departments of Neurosurgery and Orthopedic Surgery, Duke University, Durham, North Carolina
| | - Eric A Potts
- 7Neurosurgery, Goodman Campbell Brain and Spine, Indianapolis, Indianapolis
| | - Mark E Shaffrey
- 8Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Domagoj Coric
- 9Neurosurgery, Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - John J Knightly
- 10Neurosurgery, Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Paul Park
- 5Department of Neurological Surgery, University of Tennessee, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Michael Y Wang
- 11Department of Neurological Surgery, University of Miami, Florida
| | - Kai-Ming Fu
- 12Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | - Jonathan R Slotkin
- 13Neurosurgery, Geisinger Neuroscience Institute, Danville, Pennsylvania
| | - Anthony L Asher
- 9Neurosurgery, Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Michael S Virk
- 12Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | | | - Jian Guan
- 3Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Regis W Haid
- 14Neurosurgery, Atlanta Brain and Spine Care, Atlanta, Georgia
| | - Nitin Agarwal
- 15Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Christine Park
- 16Duke University School of Medicine, Durham, North Carolina
| | - Dean Chou
- 1Department of Neurological Surgery, Columbia University, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Praveen V Mummaneni
- 15Department of Neurological Surgery, University of California, San Francisco, California; and
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Durrani S, Onyedimma C, Jarrah R, Bhatti A, Nathani KR, Bhandarkar AR, Mualem W, Ghaith AK, Zamanian C, Michalopoulos GD, Alexander AY, Jean W, Bydon M. The Virtual Vision of Neurosurgery: How Augmented Reality and Virtual Reality are Transforming the Neurosurgical Operating Room. World Neurosurg 2022; 168:190-201. [DOI: 10.1016/j.wneu.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 11/22/2022]
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Kim G, Sammak SE, Michalopoulos GD, Mualem W, Pinter ZW, Freedman BA, Bydon M. Comparison of surgical interventions for the treatment of early-onset scoliosis: a systematic review and meta-analysis. J Neurosurg Pediatr 2022; 31:342-357. [PMID: 36152334 DOI: 10.3171/2022.8.peds22156] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/03/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Several growth-preserving surgical techniques are employed in the management of early-onset scoliosis (EOS). The authors' objective was to compare the use of traditional growing rods (TGRs), magnetically controlled growing rods (MCGRs), Shilla growth guidance techniques, and vertically expanding prosthetic titanium ribs (VEPTRs) for the management of EOS. METHODS A systematic review of electronic databases, including Ovid MEDLINE and Cochrane, was performed. Outcomes of interest included correction of Cobb angle, T1-S1 distance, and complication rate, including alignment, hardware failure and infection, and planned and unplanned reoperation rates. The percent changes and 95% CIs were pooled across studies using random-effects meta-analysis. RESULTS A total of 67 studies were identified, which included 2021 patients. Of these, 1169 (57.8%) patients underwent operations with TGR, 178 (8.8%) Shilla growth guidance system, 448 (22.2%) MCGR, and 226 (11.1%) VEPTR system. The mean ± SD age of the cohort was 6.9 ± 1.2 years. The authors found that the Shilla technique provided the most significant improvement in coronal Cobb angle immediately after surgery (mean [95% CI] 64.3% [61.4%-67.2%]), whereas VEPTR (27.6% [22.7%-33.6%]) performed significantly worse. VEPTR also performed significantly worse than the other techniques at final follow-up. The techniques also provided comparable gains in T1-S1 height immediately postoperatively (mean [95% CI] 10.7% [8.4%-13.0%]); however, TGR performed better at final follow-up (21.4% [18.7%-24.1%]). Complications were not significantly different among the patients who underwent the Shilla, TGR, MCGR, and VEPTR techniques, except for the rate of infections. The TGR technique had the lowest rate of unplanned reoperations (mean [95% CI] 15% [10%-23%] vs 24% [19%-29%]) but the highest number of planned reoperations per patient (5.31 [4.83-5.82]). The overall certainty was also low, with a high risk of bias across studies. CONCLUSIONS This analysis suggested that the Shilla technique was associated with a greater early coronal Cobb angle correction, whereas use of VEPTR was associated with a lower correction rate at any time point. TGR offered the most significant height gain at final follow-up. The complication rates were comparable across all surgical techniques. The optimal surgical approach should be tailored to individual patients, taking into consideration the strengths and limitations of each option.
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Affiliation(s)
- Gloria Kim
- 1Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Sally El Sammak
- 2Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota; and.,Departments of3Neurologic Surgery and
| | - Giorgos D Michalopoulos
- 2Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota; and.,Departments of3Neurologic Surgery and
| | - William Mualem
- 2Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota; and.,Departments of3Neurologic Surgery and
| | | | | | - Mohamad Bydon
- 2Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota; and.,Departments of3Neurologic Surgery and
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Mualem W, Alexander AY, Bambakidis P, Michalopoulos GD, Kerezoudis P, Link MJ, Peris-Celda M, Mardini S, Bydon M. Predictors of favorable outcome following hypoglossal-to-facial nerve anastomosis for facial nerve palsy: a systematic review and patient-level analysis of a literature-based cohort. J Neurosurg 2022; 138:1034-1042. [PMID: 35962964 DOI: 10.3171/2022.6.jns22240] [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: 03/01/2022] [Accepted: 06/15/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Facial nerve palsy is a debilitating condition that can arise from iatrogenic, traumatic, or congenital causes. One treatment to improve function of the facial muscles after facial nerve injury is hypoglossal-to-facial nerve anastomosis (HFA). HFA's efficacy and predictors of its success vary in the literature. Here, the authors present a patient-level analysis of a literature-based cohort to assess outcomes and investigate predictors of success for HFA. METHODS Seven electronic databases were queried for studies providing baseline characteristics and outcomes of patients who underwent HFA. Postoperative outcomes were measured using the House-Brackmann (HB) grading scale. A change in HB grade of 3 points or more was classified as favorable. A cutoff value for time to anastomosis associated with a favorable outcome was determined using the Youden Index. RESULTS Nineteen articles with 157 patients met the inclusion criteria. The mean follow-up length was 27.4 months, and the mean time to anastomosis after initial injury was 16 months. The end-to-side and end-to-end anastomosis techniques were performed on 84 and 48 patients, respectively. Of the 130 patients who had available preoperative and postoperative HB data, 60 (46.2%) had a favorable outcome. Time from initial injury to anastomosis was significantly different between patients with favorable and unfavorable outcomes (7.3 months vs 29.2 months, respectively; p < 0.001). The optimal cutoff for time to anastomosis to achieve a favorable outcome was 6.5 months (area under the curve 0.75). Patients who underwent anastomosis within 6.5 months of injury were more likely to achieve a favorable outcome (73% vs 31%, p < 0.001). CONCLUSIONS HFA is an effective method for restoring facial nerve function. Favorable outcomes for facial nerve palsy may be more likely to occur when time to anastomosis is within a 6.5-month window.
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Affiliation(s)
- William Mualem
- 1Neuro-Informatics Laboratory, Mayo Clinic, Rochester.,2Department of Neurologic Surgery, Mayo Clinic, Rochester
| | - A Yohan Alexander
- 1Neuro-Informatics Laboratory, Mayo Clinic, Rochester.,2Department of Neurologic Surgery, Mayo Clinic, Rochester
| | | | - Giorgos D Michalopoulos
- 1Neuro-Informatics Laboratory, Mayo Clinic, Rochester.,2Department of Neurologic Surgery, Mayo Clinic, Rochester
| | | | - Michael J Link
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester
| | | | - Samir Mardini
- 4Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mohamad Bydon
- 1Neuro-Informatics Laboratory, Mayo Clinic, Rochester.,2Department of Neurologic Surgery, Mayo Clinic, Rochester
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Sammak SE, Mualem W, Michalopoulos GD, Romero JM, Ha CT, Hunt CL, Bydon M. Rescue therapy with novel waveform spinal cord stimulation for patients with failed back surgery syndrome refractory to conventional stimulation: a systematic review and meta-analysis. J Neurosurg Spine 2022; 37:1-10. [PMID: 36303477 DOI: 10.3171/2022.4.spine22331] [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: 03/22/2022] [Accepted: 04/20/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Conventional spinal cord stimulators (SCSs) have demonstrated efficacy in individuals with failed back surgery syndrome (FBSS). However, a subgroup of patients may become refractory to the effects of conventional waveforms over time. The objective of this study was to systematically review and evaluate the current literature on the use of novel waveform spinal cord stimulation for the management of FBSS refractory to conventional SCSs. METHODS A comprehensive electronic search of the literature published in electronic databases, including Ovid MEDLINE and Epub Ahead of Print, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus, was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The outcomes of interest were reduction in back pain and/or leg pain after conversion from conventional to novel SCSs. Risk of bias was assessed with the Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) tool. The strength of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria. RESULTS A total of 6 studies with 137 patients with FBSS were identified. Studies were published between 2013 and 2021. The mean ± SD age of the pooled patient sample was 55 ± 10.5 years. All patients who underwent treatment with conventional SCSs were identified. Two studies evaluated the efficacy of high-density spinal cord stimulation, 3 studies evaluated burst spinal cord stimulation, and 1 study assessed multimodal waveforms. The mean difference in back pain scores after conversion from a standard SCS to a novel waveform SCS was 2.55 (95% CI 1.59-4.08), demonstrating a significant reduction in back pain after conversion to novel stimulation. The authors also performed a subgroup analysis to compare burst stimulation to tonic waveforms. In this analysis, the authors found no significant difference in the average reductions in back pain between the 2 groups (p = 0.534).The authors found an I2 statistic equivalent to 98.47% in the meta-regression model used to assess the effect of follow-up duration on study outcome; this value implied that the variability in the data can be attributed to the remaining between-study heterogeneity. The overall certainty was moderate, with a high risk of bias across studies. CONCLUSIONS Rescue therapy with novel waveform spinal cord stimulation is a potential option for pain reduction in patients who become refractory to conventional SCSs. Conversion to novel waveform SCSs may potentially mitigate expenses and complications.
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Affiliation(s)
| | - William Mualem
- 1Department of Neurologic Surgery, Mayo Clinic, Rochester
| | | | - Joshua M Romero
- 2Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota; and
| | - Christopher T Ha
- 2Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota; and
| | - Christine L Hunt
- 3Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Jacksonville, Florida
| | - Mohamad Bydon
- 1Department of Neurologic Surgery, Mayo Clinic, Rochester
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38
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Pennington Z, Michalopoulos GD, Biedermann AJ, Ziegler JR, Durst SL, Spinner RJ, Meyer FB, Daniels DJ, Bydon M. Positive impact of the pandemic: the effect of post-COVID-19 virtual visit implementation on departmental efficiency and patient satisfaction in a quaternary care center. Neurosurg Focus 2022; 52:E10. [PMID: 35921181 DOI: 10.3171/2022.3.focus2243] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/07/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic has significantly changed clinical practice across US healthcare. Increased adoption of telemedicine has emerged as an alternative to in-person contact for patient-physician interactions. The aim of this study was to analyze the impact of telemedicine on workflow and care delivery from January 2019 to December 2021 in a neurosurgical department at a quaternary care center. METHODS Prospectively captured data on clinic appointment utilization, duration, and outcomes were queried. Visits were divided into in-person visits and telemedicine appointments, categorized as follow-up visits of previously surgically treated patients, internal consultations, new patient visits, and early postoperative returns after surgery. Appointment volume was compared pre- and postpandemic using March 2020 as the pandemic onset. Clinical efficiency was measured by time to appointment, rate of on-time appointments, proportion of appointments resulting in surgical intervention (surgical yield), and patient-reported satisfaction, the latter measured as the proportion of patients indicating "high likelihood to recommend practice." RESULTS A total of 54,562 visits occurred, most commonly for follow-up for previously operated patients (51.8%), internal new patient referrals (24.5%), and external new patient referrals (19.8%). Total visit volume was stable pre- to postpandemic (1521.3 vs 1512, p = 0.917). However, in-person visits significantly decreased (1517/month vs 1220/month, p < 0.001), with a nadir in April 2020, while telemedicine appointment utilization increased significantly (0.3% vs 19.1% of all visits). Telemedicine utilization remained stable throughout the 1st calendar year following the pandemic. Telemedicine appointments were associated with shorter time to appointment than in-person visits both before and after the pandemic onset (0-5 days from appointment request: 60% vs 33% vs 29.8%, p < 0.001). Patients had on-time appointments in 87% of telemedicine encounters. Notably, telemedicine appointments resulted in surgery in 31.8% of internal consultations or new patient visits, a significantly lower rate than that for in-person visits (51.8%). After the widespread integration of telemedicine, patient satisfaction for all visits was higher than before the pandemic onset (85.9% vs 88.5%, p = 0.027). CONCLUSIONS Telemedicine use significantly increased following the pandemic onset, compensating for observed decreases in face-to-face visits. Utilization rates have remained stable, suggesting effective integration, and delays between referrals and appointments were lower than for in-person visits. Importantly, telemedicine integration was not associated with a decrease in overall patient satisfaction, although telemedicine appointments had a lower surgical yield. These data suggest that telemedicine smoothened the impact of the pandemic on clinical workflow and helped to maintain continuity and quality of outpatient care.
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Affiliation(s)
- Zach Pennington
- 1Department of Neurologic Surgery and.,2Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Giorgos D Michalopoulos
- 1Department of Neurologic Surgery and.,2Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
| | | | | | | | | | | | | | - Mohamad Bydon
- 1Department of Neurologic Surgery and.,2Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
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Mooney J, Michalopoulos GD, Zeitouni D, Sammak SE, Alvi MA, Wang MY, Coric D, Chan AK, Mummaneni PV, Bisson EF, Sherrod B, Haid RW, Knightly JJ, Devin CJ, Pennicooke BH, Asher AL, Bydon M. Outpatient versus inpatient lumbar decompression surgery: a matched noninferiority study investigating clinical and patient-reported outcomes. J Neurosurg Spine 2022; 37:1-13. [PMID: 35523251 DOI: 10.3171/2022.3.spine211558] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/24/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Spine surgery represents an ideal target for healthcare cost reduction efforts, with outpatient surgery resulting in significant cost savings. With an increased focus on value-based healthcare delivery, lumbar decompression surgery has been increasingly performed in the outpatient setting when appropriate. The aim of this study was to compare clinical and patient-reported outcomes following outpatient and inpatient lumbar decompression surgery. METHODS The Quality Outcomes Database (QOD) was queried for patients undergoing elective one- or two-level lumbar decompression (laminectomy or laminotomy with or without discectomy) for degenerative spine disease. Patients were grouped as outpatient if they had a length of stay (LOS) < 24 hours and as inpatient if they stayed in the hospital ≥ 24 hours. Patients with ≥ 72-hour stay were excluded from the comparative analysis to increase baseline comparability between the two groups. To create two highly homogeneous groups, optimal matching was performed at a 1:1 ratio between the two groups on 38 baseline variables, including demographics, comorbidities, symptoms, patient-reported scores, indications, and operative details. Outcomes of interest were readmissions and reoperations at 30 days and 3 months after surgery, overall satisfaction, and decrease in Oswestry Disability Index (ODI), back pain, and leg pain at 3 months after surgery. Satisfaction was defined as a score of 1 or 2 in the North American Spine Society patient satisfaction index. Noninferiority of outpatient compared with inpatient surgery was defined as risk difference of < 1.5% at a one-sided 97.5% confidence interval. RESULTS A total of 18,689 eligible one- and two-level decompression surgeries were identified. The matched study cohorts consisted of 5016 patients in each group. Nonroutine discharge was slightly less common in the outpatient group (0.6% vs 0.3%, p = 0.01). The 30-day readmission rates were 4.4% and 4.3% for the outpatient and inpatient groups, respectively, while the 30-day reoperation rates were 1.4% and 1.5%. The 3-month readmission rates were 6.3% for both groups, and the 3-month reoperation rates were 3.1% for the outpatient cases and 2.9% for the inpatient cases. Overall satisfaction at 3 months was 88.8% for the outpatient group and 88.4% for the inpatient group. Noninferiority of outpatient surgery was documented for readmissions, reoperations, and patient-reported satisfaction from surgery. CONCLUSIONS Outpatient lumbar decompression surgery demonstrated slightly lower nonroutine discharge rates in comparison with inpatient surgery. Noninferiority in clinical outcomes at 30 days and 3 months after surgery was documented for outpatient compared with inpatient decompression surgery. Additionally, outpatient decompression surgery performed noninferiorly to inpatient surgery in achieving patient satisfaction from surgery.
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Affiliation(s)
- James Mooney
- 1Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Giorgos D Michalopoulos
- 2Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Daniel Zeitouni
- 4School of Medicine, University of North Carolina at Chapel Hill, North Carolina
| | - Sally El Sammak
- 2Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mohammed Ali Alvi
- 2Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Michael Y Wang
- 5Department of Neurological Surgery, University of Miami, Florida
| | - Domagoj Coric
- 6Neuroscience Institute, Carolinas Healthcare System, and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Andrew K Chan
- 7Department of Neurological Surgery, University of California, San Francisco, California
| | - Praveen V Mummaneni
- 7Department of Neurological Surgery, University of California, San Francisco, California
| | - Erica F Bisson
- 8Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Brandon Sherrod
- 8Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | | | - John J Knightly
- 10Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Clinton J Devin
- 11Steamboat Orthopaedic and Spine Institute, Steamboat Springs, Colorado; and
| | - Brenton H Pennicooke
- 12Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Anthony L Asher
- 6Neuroscience Institute, Carolinas Healthcare System, and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Mohamad Bydon
- 2Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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Pinter ZW, Salmons HI, Townsley SE, Xiong A, Michalopoulos GD, El Sammak S, Currier B, Nassr A, Freedman BA, Bydon M, Elder BD, Wagner S, Sebastian AS. Improved Sagittal Alignment Is Associated with Early Postoperative Neck Disability and Pain-Related Patient-Reported Outcomes Following Posterior Cervical Decompression and Fusion for Myelopathy. World Neurosurg 2022; 161:e654-e663. [PMID: 35218962 DOI: 10.1016/j.wneu.2022.02.075] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare patient-reported outcomes measures (PROMs) following posterior cervical decompression and fusion (PCDF) based on changes in perioperative cervical sagittal alignment. METHODS We reviewed patients who underwent PCDF from C2 to T2 between the years 2015 and 2020. C2 sagittal vertical axis (SVA) and C2-C7 lordosis were assessed preoperatively and 1-year postoperatively. Neck Disability Index (NDI) and visual analog scale (VAS) Neck scores were collected preoperatively, 3 months' postoperatively, and 1-year postoperatively. PROMs were compared based on perioperative radiographic parameters. RESULTS Eighty-five patients were included in this study. Patients with preoperative C2 SVA <40 mm had a larger improvement in VAS Neck pain scores at 3 months' postoperatively (-4.9 vs. -3.0, P = 0.03) and a larger decrease in NDI scores at 1-year postoperatively (7.2 vs. 3.1, P = 0.04) than patients with C2 SVA ≥40 mm. Patients with postoperative C2 SVA <40 mm demonstrated lower VAS Neck pain scores at 3 months' postoperatively (2.0 vs. 3.4, P = 0.049). The cohort of patients with a decrease of C2 SVA by ≥5 mm demonstrated lower NDI at 3 months' postoperatively but not at 1-year postoperatively in comparison with patients whose C2 SVA increased or remained unchanged (11.7 vs. 23.8 vs. 18.2; P < 0.001). Patients in whom both C2 SVA and C2-C7 lordosis improved demonstrated superior NDI (P < 0.001) and VAS Neck (P = 0.007) at 3 months' but not at 1-year postoperatively. CONCLUSIONS In a uniform cohort of patients undergoing PCDF from C2 to T2, improvements in C2 SVA and C2-C7 lordosis were associated with improved early postoperative PROMs.
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Affiliation(s)
- Zachariah W Pinter
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
| | - Harold I Salmons
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Sarah E Townsley
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ashley Xiong
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Sally El Sammak
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Bradford Currier
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ahmad Nassr
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Brett A Freedman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Benjamin D Elder
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Scott Wagner
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Arjun S Sebastian
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Michalopoulos GD, Nathani KR, Bydon M. Letter to the Editor. Randomized controlled trials on surgical decision-making. J Neurosurg Spine 2022; 37:1-2. [PMID: 35334454 DOI: 10.3171/2022.1.spine211566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Bydon M, Michalopoulos GD. Commentary: The Legal and Socioeconomic Considerations in Spine Telemedicine. Neurosurgery 2022; 90:e125-e126. [PMID: 35238811 DOI: 10.1227/neu.0000000000001918] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/19/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Giorgos D Michalopoulos
- Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Ghaith AK, Onyedimma C, Jarrah R, Bhandarkar AR, Graepel SP, Yolcu YU, El-Sammak S, Michalopoulos GD, Elder BD, Bydon M. Rate of C8 Radiculopathy in Patients Undergoing Cervicothoracic Osteotomy: A Systematic Appraisal of the Literature. World Neurosurg 2022; 161:e553-e563. [DOI: 10.1016/j.wneu.2022.02.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/13/2022] [Accepted: 02/14/2022] [Indexed: 10/19/2022]
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Alvi MA, Asher AL, Michalopoulos GD, Grills IS, Warnick RE, McInerney J, Chiang VL, Attia A, Timmerman R, Chang E, Kavanagh BD, Andrews DW, Walter K, Bydon M, Sheehan JP. Factors associated with progression and mortality among patients undergoing stereotactic radiosurgery for intracranial metastasis: results from a national real-world registry. J Neurosurg 2022; 137:1-14. [PMID: 35171833 DOI: 10.3171/2021.10.jns211410] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 10/14/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Stereotactic radiosurgery (SRS) has been increasingly employed in recent years to treat intracranial metastatic lesions. However, there is still a need for optimization of treatment paradigms to provide better local control and prevent progressive intracranial disease. In the current study, the authors utilized a national collaborative registry to investigate the outcomes of patients with intracranial metastatic disease who underwent SRS and to determine factors associated with lesion treatment response, overall progression, and mortality. METHODS The NeuroPoint Alliance SRS registry was queried for all patients with intracranial metastatic lesions undergoing single- or multifraction SRS at participating institutions between 2016 and 2020. The main outcomes of interest included lesion response (lesion-level analysis), progression using Response Assessment for Neuro-Oncology criteria, and mortality (patient-level analysis). Kaplan-Meier analysis was used to report time to progression and overall survival, and multivariable Cox proportional hazards analysis was used to investigate factors associated with lesion response, progression, and mortality. RESULTS A total of 501 patients (1447 intracranial metastatic lesions) who underwent SRS and had available follow-up were included in the current analyses. The most common primary tumor was lung cancer (49.5%, n = 248), followed by breast (15.4%, n = 77) and melanoma (12.2%, n = 61). Most patients had a single lesion (44.9%, n = 225), 29.3% (n = 147) had 2 or 3 lesions, and 25.7% (n = 129) had > 3 lesions. The mean sum of baseline measurements of the lesions according to Response Evaluation Criteria in Solid Tumors (RECIST) was 35.54 mm (SD 25.94). At follow-up, 671 lesions (46.4%) had a complete response, 631 (43.6%) had a partial response (≥ 30% decrease in longest diameter) or were stable (< 30% decrease but < 20% increase), and 145 (10%) showed progression (> 20% increase in longest diameter). On multivariable Cox proportional hazards analysis, melanoma-associated lesions (HR 0.48, 95% CI 0.34-0.67; p < 0.001) and larger lesion size (HR 0.94, 95% CI 0.93-0.96; p < 0.001) showed lower odds of lesion regression, while a higher biologically effective dose was associated with higher odds (HR 1.001, 95% CI 1.0001-1.00023; p < 0.001). A total of 237 patients (47.3%) had overall progression (local failure or intracranial progressive disease), with a median time to progression of 10.03 months after the index SRS. Factors found to be associated with increased hazards of progression included male sex (HR 1.48, 95% CI 1.108-1.99; p = 0.008), while administration of immunotherapy (before or after SRS) was found to be associated with lower hazards of overall progression (HR 0.62, 95% CI 0.460-0.85; p = 0.003). A total of 121 patients (23.95%) died during the follow-up period, with a median survival of 19.4 months from the time of initial SRS. A higher recursive partitioning analysis score (HR 21.3485, 95% CI 1.53202-3.6285; p < 0.001) was found to be associated with higher hazards of mortality, while single-fraction treatment compared with hypofractionated treatment (HR 0.082, 95% CI 0.011-0.61; p = 0.015), administration of immunotherapy (HR 0.385, 95% CI 0.233-0.64; p < 0.001), and presence of single compared with > 3 lesions (HR 0.427, 95% CI 0.187-0.98; p = 0.044) were found to be associated with lower risk of mortality. CONCLUSIONS The comparability of results between this study and those of previously published clinical trials affirms the value of multicenter databases with real-world data collected without predetermined research purpose.
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Affiliation(s)
- Mohammed Ali Alvi
- 1Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Anthony L Asher
- 3Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Giorgos D Michalopoulos
- 1Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Inga S Grills
- 4Department of Neurological Surgery, Beaumont Health System, Royal Oak, Michigan
| | - Ronald E Warnick
- 5Department of Neurosurgery, The Jewish Hospital, Cincinnati, Ohio
| | - James McInerney
- 6Department of Neurosurgery, Penn State Health, Hershey, Pennsylvania
| | - Veronica L Chiang
- 7Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Albert Attia
- 8Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert Timmerman
- 9Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Eric Chang
- 10Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Brian D Kavanagh
- 11Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - David W Andrews
- 12Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Kevin Walter
- 13Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York; and
| | - Mohamad Bydon
- 1Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jason P Sheehan
- 14Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
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Bydon M, El Sammak S, Michalopoulos GD, Spinner RJ. Commentary: Predicting Clinically Relevant Patient-Reported Symptom Improvement After Carpal Tunnel Release: A Machine Learning Approach. Neurosurgery 2022; 90:e5-e6. [PMID: 34982884 DOI: 10.1227/neu.0000000000001750] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 08/31/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Mohamad Bydon
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.,Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Sally El Sammak
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.,Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Giorgos D Michalopoulos
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.,Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert J Spinner
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
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Asher AL, Sammak SE, Michalopoulos GD, Yolcu YU, Alexander AY, Knightly JJ, Foley KT, Shaffrey CI, Harbaugh RE, Rose GA, Coric D, Bisson EF, Glassman SD, Mummaneni PV, Bydon M. Time trend analysis of database and registry use in the neurosurgical literature: evidence for the advance of registry science. J Neurosurg 2021:1-6. [PMID: 34920432 DOI: 10.3171/2021.9.jns212153] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Anthony L Asher
- 1Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina
| | - Sally El Sammak
- 2Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.,3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Giorgos D Michalopoulos
- 2Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.,3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Yagiz U Yolcu
- 2Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.,3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - A Yohan Alexander
- 2Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.,3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Kevin T Foley
- 5Department of Neurosurgery, University of Tennessee, Memphis, Tennessee
| | - Christopher I Shaffrey
- 6Duke Neurosurgery and Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Robert E Harbaugh
- 7Department of Neurosurgery, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Geoffrey A Rose
- 8Sanger Heart & Vascular Institute, Atrium Health, Charlotte, North Carolina
| | - Domagoj Coric
- 1Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina
| | - Erica F Bisson
- 9Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | | | - Praveen V Mummaneni
- 11Department of Neurological Surgery, University of California, San Francisco, California
| | - Mohamad Bydon
- 2Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.,3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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Mooney J, Michalopoulos GD, Alvi MA, Zeitouni D, Chan AK, Mummaneni PV, Bisson EF, Sherrod BA, Haid RW, Knightly JJ, Devin CJ, Pennicooke B, Asher AL, Bydon M. Minimally invasive versus open lumbar spinal fusion: a matched study investigating patient-reported and surgical outcomes. J Neurosurg Spine 2021:1-14. [PMID: 34905727 DOI: 10.3171/2021.10.spine211128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/06/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE With the expanding indications for and increasing popularity of minimally invasive surgery (MIS) for lumbar spinal fusion, large-scale outcomes analysis to compare MIS approaches with open procedures is warranted. METHODS The authors queried the Quality Outcomes Database for patients who underwent elective lumbar fusion for degenerative spine disease. They performed optimal matching, at a 1:2 ratio between patients who underwent MIS and those who underwent open lumbar fusion, to create two highly homogeneous groups in terms of 33 baseline variables (including demographic characteristics, comorbidities, symptoms, patient-reported scores, indications, and operative details). The outcomes of interest were overall satisfaction, decrease in Oswestry Disability Index (ODI), and back and leg pain, as well as hospital length of stay (LOS), operative time, reoperations, and incidental durotomy rate. Satisfaction was defined as a score of 1 or 2 on the North American Spine Society scale. Minimal clinically important difference (MCID) in ODI was defined as ≥ 30% decrease from baseline. Outcomes were assessed at the 3- and 12-month follow-up evaluations. RESULTS After the groups were matched, the MIS and open groups consisted of 1483 and 2966 patients, respectively. Patients who underwent MIS fusion had higher odds of satisfaction at 3 months (OR 1.4, p = 0.004); no difference was demonstrated at 12 months (OR 1.04, p = 0.67). Lumbar stenosis, single-level fusion, higher American Society of Anesthesiologists Physical Status Classification System grade, and absence of spondylolisthesis were most prominently associated with higher odds of satisfaction with MIS compared with open surgery. Patients in the MIS group had slightly lower ODI scores at 3 months (mean difference 1.61, p = 0.006; MCID OR 1.14, p = 0.0495) and 12 months (mean difference 2.35, p < 0.001; MCID OR 1.29, p < 0.001). MIS was also associated with a greater decrease in leg and back pain at both follow-up time points. The two groups did not differ in operative time and incidental durotomy rate; however, LOS was shorter for the MIS group. Revision surgery at 12 months was less likely for patients who underwent MIS (4.1% vs 5.6%, p = 0.032). CONCLUSIONS In patients who underwent lumbar fusion for degenerative spinal disease, MIS was associated with higher odds of satisfaction at 3 months postoperatively. No difference was demonstrated at the 12-month follow-up. MIS maintained a small, yet consistent, superiority in decreasing ODI and back and leg pain, and MIS was associated with a lower reoperation rate.
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Affiliation(s)
- James Mooney
- 1Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Giorgos D Michalopoulos
- 2Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.,3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mohammed Ali Alvi
- 2Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.,3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Daniel Zeitouni
- 4School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Andrew K Chan
- 5Department of Neurological Surgery, University of California, San Francisco, California
| | - Praveen V Mummaneni
- 5Department of Neurological Surgery, University of California, San Francisco, California
| | - Erica F Bisson
- 6Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Brandon A Sherrod
- 6Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | | | | | - Clinton J Devin
- 9Steamboat Orthopaedic and Spine Institute, Steamboat Springs, Colorado
| | - Brenton Pennicooke
- 10Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri; and
| | - Anthony L Asher
- 11Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina
| | - Mohamad Bydon
- 2Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.,3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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Michalopoulos GD, Bhandarkar AR, Jarrah R, Yolcu YU, Alvi MA, Ghaith AK, Sebastian AS, Freedman BA, Bydon M. Hybrid surgery: a comparison of early postoperative outcomes between anterior cervical discectomy and fusion and cervical disc arthroplasty. J Neurosurg Spine 2021; 36:575-584. [PMID: 34715670 DOI: 10.3171/2021.7.spine21478] [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: 04/01/2021] [Accepted: 07/01/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Hybrid surgery (HS) is the combination of anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) at different levels in the same operation. The aim of this study was to investigate perioperative variables, 30-day postoperative outcomes, and complications of HS in comparison with those of CDA and ACDF. METHODS The authors queried the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) registry for patients who underwent multilevel primary HS, CDA, and ACDF for degenerative disc disease from 2015 to 2019. The authors compared these three operations in terms of 30-day postoperative outcomes, specifically readmission and reoperation rates, discharge destination, and complications. RESULTS This analysis included 439 patients who underwent HS, 976 patients who underwent CDA, and 27,460 patients who underwent ACDF. Patients in the HS and CDA groups were younger, had fewer comorbidities, and myelopathy was less often the indication for surgery compared with patients who underwent ACDF. For the HS group, the unplanned readmission rate was 0.7%, index surgery-related reoperation rate was 0.3%, and nonroutine discharge rate was 2.1%. Major and minor complications were also rare, with rates of 0.2% for each. The mean length of stay in the HS group was 1.5 days. The association of HS with better outcomes in univariate analysis was not evident after adjustment for confounding factors. CONCLUSIONS The authors found that HS was noninferior to ACDF and CDA in terms of early postoperative outcomes among patients treated for degenerative disc disease.
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Affiliation(s)
- Giorgos D Michalopoulos
- 1Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.,2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Archis R Bhandarkar
- 1Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.,3Mayo Clinic Alix School of Medicine, Rochester, Minnesota; and
| | - Ryan Jarrah
- 1Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Yagiz Ugur Yolcu
- 1Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.,2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mohammed Ali Alvi
- 1Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.,2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Abdul Karim Ghaith
- 1Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.,2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Arjun S Sebastian
- 4Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Brett A Freedman
- 4Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mohamad Bydon
- 1Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.,2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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Michalopoulos GD, Yolcu YU, Ghaith AK, Alvi MA, Carr CM, Bydon M. Diagnostic yield, accuracy, and complication rate of CT-guided biopsy for spinal lesions: a systematic review and meta-analysis. J Neurointerv Surg 2021; 13:841-847. [PMID: 33883210 DOI: 10.1136/neurintsurg-2021-017419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND CT-guided biopsy is a commonly used diagnostic procedure for spinal lesions. This meta-analysis aims to investigate its diagnostic performance and complications, as well as factors influencing outcomes. METHODS A systematic review of the literature was performed to identify studies reporting outcomes of CT-guided biopsies for spinal lesions. Diagnostic yield (ie, the rate of procedures resulting in a specific pathological diagnosis) and diagnostic accuracy (ie, the rate of procedures resulting in the correct diagnosis) were the primary outcomes of interest. Complications following biopsy procedures were also included. RESULTS Thirty-nine studies with 3917 patients undergoing 4181 procedures were included. Diagnostic yield per procedure was 91% (95% CI 88% to 94%) among 3598 procedures. The most common reason for non-diagnostic biopsies was inadequacy of sample. No difference in diagnostic yield between different locations and between lytic, sclerotic, and mixed lesions was found. Diagnostic yield did not differ between procedures using ≤13G and ≥14G needles. Diagnostic accuracy per procedure was 86% (95% CI 82% to 89%) among 3054 procedures. Diagnostic accuracy among 2426 procedures that yielded a diagnosis was 94% (95% CI 92% to 96%). Complication rate was 1% (95% CI 0.4% to 1.9%) among 3357 procedures. Transient pain and minor hematoma were the most common complications encountered. CONCLUSION In our meta-analysis of 39 studies reporting diagnostic performance and complications of CT-guided biopsy, we found a diagnostic yield of 91% and diagnostic accuracy of 86% with a complication rate of 1%. Diagnostic yield did not differ between different locations, between lytic, sclerotic and mixed lesions, and between wide- and thin-bore needles.
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Affiliation(s)
- Giorgos D Michalopoulos
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Yagiz Ugur Yolcu
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Abdul Karim Ghaith
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohammed Ali Alvi
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA .,Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
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