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Wu JY, Touponse GC, Theologitis M, Ahmad HS, Zygourakis CC. Demographic and Socioeconomic Trends in Cervical Fusion Utilization from 2004 Through 2021 and the COVID-19 Pandemic. World Neurosurg 2024; 182:e107-e125. [PMID: 38000672 DOI: 10.1016/j.wneu.2023.11.055] [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: 10/31/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Cervical fusion rates increased in the U.S. exponentially 1990-2014, but trends leading up to/during the COVID-19 pandemic have not been fully evaluated by patient socioeconomic status (SES). Here, we provide the most recent, comprehensive characterization of demographic and SES trends in cervical fusions, including during the pandemic. METHODS We collected the following variables on adults undergoing cervical fusions, 1/1/2004-3/31/2021, in Optum's Clinformatics Data Mart: age, Charlson Comorbidity Index, provider's practicing state, gender, race, education, and net worth. We performed multivariate linear and logistic regression to evaluate associations of cervical fusion rates with SES variables. RESULTS Cervical fusion rates increased 2004-2016, then decreased 2016-2020. Proportions of Asian, Black, and Hispanic patients undergoing cervical fusions increased (OR = 1.001,1.001,1.004, P < 0.01), with a corresponding decrease in White patients (OR = 0.996, P < 0.001) over time. There were increases in cervical fusions in higher education groups (OR = 1.006, 1.002, P < 0.001) and lowest net worth group (OR = 1.012, P < 0.001). During the pandemic, proportions of White (OR = 1.015, P < 0.01) and wealthier patients (OR ≥ 1.015, P < 0.01) undergoing cervical fusions increased. CONCLUSIONS We present the first documented decrease in annual cervical surgery rates in the U.S. Our data reveal a bimodal distribution for cervical fusion patients, with racial-minority, lower-net-worth, and highly-educated patients receiving increasing proportions of surgical interventions. White and wealthier patients were more likely to undergo cervical fusions during the COVID-19 pandemic, which has been reported in other areas of medicine but not yet in spine surgery. There is still considerable work needed to improve equitable access to spine care for the entire U.S. POPULATION
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Affiliation(s)
- Janet Y Wu
- School of Medicine, Stanford University, Stanford, California, USA
| | - Gavin C Touponse
- School of Medicine, Stanford University, Stanford, California, USA
| | | | - Hasan S Ahmad
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Corinna C Zygourakis
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA.
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Ghenbot Y, Ahmad HS, Chauhan D, Wathen C, Arena J, Turlip R, Parr R, Gibby W, Yoon JW. Effects of Augmented Reality on Thoracolumbar Pedicle Screw Instrumentation Across Different Levels of Surgical Experience. World Neurosurg 2024; 182:e284-e291. [PMID: 38008167 DOI: 10.1016/j.wneu.2023.11.100] [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: 10/30/2023] [Revised: 11/18/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVE Augmented reality (AR) is an emerging technology that may accelerate skill acquisition and improve accuracy of thoracolumbar pedicle screw placements. We aimed to quantify the relative assistance of AR compared with freehand (FH) pedicle screw accuracy across different surgical experience levels. METHODS A spine fellowship-trained and board-certified attending neurosurgeon, postgraduate year 4 neurosurgery resident, and second-year medical student placed 32 FH and 32 AR-assisted thoracolumbar pedicle screws in 3 cadavers. A cableless, voice-activated AR system was paired with a headset. Accuracy was assessed using χ2 analysis and the Gertzbein-Robbins scale. Angular error, distance error, and time per pedicle screw were collected and compared. RESULTS The attending neurosurgeon had 91.6% (11/12) clinically acceptable (Gertzbein-Robbins scale A or B) insertion in both FH and AR groups; the resident neurosurgeon had 100% (9/9) FH and AR in both cases; the medical student had 72.3% (8/11) FH accuracy and 81.8% (9/11) AR accuracy. The medical student displayed significantly lower ideal (Gertzbein-Robbins scale A) FH accuracy compared with the resident neurosurgeon (P = 0.017) and attending neurosurgeon (P = 0.005), but no difference when using AR. FH screw placement was faster by both the attending neurosurgeon (median 46 seconds vs. 94.5 seconds, P = 0.0047) and the neurosurgery resident neurosurgeon (median 144 seconds vs. 140 seconds, P = 0.05). Total clinically acceptable AR and FH accuracy was 90.6% (29/32) and 87.5% (28/32), respectively (P = 0.69). CONCLUSIONS AR screw placement allowed an inexperienced medical student to double their accuracy in 1 training session. With subsequent iterations, this promising technology could serve as an important tool for surgical training.
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Affiliation(s)
- Yohannes Ghenbot
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hasan S Ahmad
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daksh Chauhan
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Connor Wathen
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Arena
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan Turlip
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan Parr
- Novarad Corporation, Provo, Utah, USA
| | - Wendell Gibby
- Novarad Corporation, Provo, Utah, USA; Department of Radiology, University of California San Diego School of Medicine, San Diego, California, USA
| | - Jang W Yoon
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Ghenbot Y, Arena J, Wathen C, Ahmad HS, Chauhan D, Bryan K, Paik C, Yoon JW. Endoscopic-Assisted Evacuation of Lumbar Epidural Abscess: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01015. [PMID: 38189458 DOI: 10.1227/ons.0000000000001051] [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: 09/26/2023] [Accepted: 10/31/2023] [Indexed: 01/09/2024] Open
Affiliation(s)
- Yohannes Ghenbot
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Chauhan D, Ahmad HS, Hamade A, Yang AI, Wathen C, Ghenbot Y, Mannam S, Subtirelu R, Bashti M, Wang MY, Basil G, Yoon JW. Determining Differences in Perioperative Functional Mobility Patterns in Lumbar Decompression Versus Fusion Patients Using Smartphone Activity Data. Neurosurgery 2024:00006123-990000000-01010. [PMID: 38169310 DOI: 10.1227/neu.0000000000002808] [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: 06/20/2023] [Accepted: 11/08/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Smartphone activity data recorded through high-fidelity accelerometry can provide accurate postoperative assessments of patient mobility. The "big data" available through smartphones allows for advanced analyses, yielding insight into patient well-being. This study compared rate of change in functional activity data between lumbar fusion (LF) and lumbar decompression (LD) patients to determine preoperative and postoperative course differences. METHODS Twenty-three LF and 18 LD patients were retrospectively included. Activity data (steps per day) recorded in Apple Health, encompassing over 70 000 perioperative data points, was classified into 6 temporal epochs representing distinct functional states, including acute preoperative decline, immediate postoperative recovery, and postoperative decline. The daily rate of change of each patient's step counts was calculated for each perioperative epoch. RESULTS Patients undergoing LF demonstrated steeper preoperative declines than LD patients based on the first derivative of step count data (P = .045). In the surgical recovery phase, LF patients had slower recoveries (P = .041), and LF patients experienced steeper postoperative secondary declines than LD patients did (P = .010). The rate of change of steps per day demonstrated varying perioperative trajectories that were not explained by differences in age, comorbidities, or levels operated. CONCLUSION Patients undergoing LF and LD have distinct perioperative activity profiles characterized by the rate of change in the patient daily steps. Daily steps and their rate of change is thus a valuable metric in phenotyping patients and understanding their postsurgical outcomes. Prospective studies are needed to expand upon these data and establish causal links between preoperative patient mobility, patient characteristics, and postoperative functional outcomes.
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Affiliation(s)
- Daksh Chauhan
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hasan S Ahmad
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ali Hamade
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew I Yang
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Connor Wathen
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yohannes Ghenbot
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sai Mannam
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert Subtirelu
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Malek Bashti
- Department of Neurosurgery, Miller School of Medicine at the University of Miami, Miami, Florida, USA
| | - Michael Y Wang
- Department of Neurosurgery, Miller School of Medicine at the University of Miami, Miami, Florida, USA
| | - Gregory Basil
- Department of Neurosurgery, Miller School of Medicine at the University of Miami, Miami, Florida, USA
| | - Jang W Yoon
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Turlip R, Ghenbot Y, Chen C, Ahmad HS, Chauhan D, McCloskey K, Yoon JW. In Reply to the Letter to the Editor Regarding "Virtual and Augmented Reality in Spine Surgery: A Systematic Review". World Neurosurg 2024; 181:206. [PMID: 38229288 DOI: 10.1016/j.wneu.2023.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 10/07/2023] [Indexed: 01/18/2024]
Affiliation(s)
- Ryan Turlip
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yohannes Ghenbot
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Caitlyn Chen
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hasan S Ahmad
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daksh Chauhan
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kyle McCloskey
- Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Jang W Yoon
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Mannam SS, Subtirelu R, Chauhan D, Ahmad HS, Matache IM, Bryan K, Chitta SVK, Bathula SC, Turlip R, Wathen C, Ghenbot Y, Ajmera S, Blue R, Chen HI, Ali ZS, Malhotra N, Srinivasan V, Ozturk AK, Yoon JW. Large Language Model-Based Neurosurgical Evaluation Matrix: A Novel Scoring Criteria to Assess the Efficacy of ChatGPT as an Educational Tool for Neurosurgery Board Preparation. World Neurosurg 2023; 180:e765-e773. [PMID: 37839567 DOI: 10.1016/j.wneu.2023.10.043] [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: 10/03/2023] [Accepted: 10/07/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION Technological advancements are reshaping medical education, with digital tools becoming essential in all levels of training. Amidst this transformation, the study explores the potential of ChatGPT, an artificial intelligence model by OpenAI, in enhancing neurosurgical board education. The focus extends beyond technology adoption to its effective utilization, with ChatGPT's proficiency evaluated against practice questions from the Primary Neurosurgery Written Board Exam. METHODS Using the Congress of Neurologic Surgeons (CNS) Self-Assessment Neurosurgery (SANS) Exam Board Review Prep questions, we conducted 3 rounds of analysis with ChatGPT. We developed a novel ChatGPT Neurosurgical Evaluation Matrix (CNEM) to assess the output quality, accuracy, concordance, and clarity of ChatGPT's answers. RESULTS ChatGPT achieved spot-on accuracy for 66.7% of prompted questions, 59.4% of unprompted questions, and 63.9% of unprompted questions with a leading phrase. Stratified by topic, accuracy ranged from 50.0% (Vascular) to 78.8% (Neuropathology). In comparison to SANS explanations, ChatGPT output was considered better in 19.1% of questions, equal in 51.6%, and worse in 29.3%. Concordance analysis showed that 95.5% of unprompted ChatGPT outputs and 97.4% of unprompted outputs with a leading phrase were aligned. CONCLUSIONS Our study evaluated the performance of ChatGPT in neurosurgical board education by assessing its accuracy, clarity, and concordance. The findings highlight the potential and challenges of integrating AI technologies like ChatGPT into medical and neurosurgical board education. Further research is needed to refine these tools and optimize their performance for enhanced medical education and patient care.
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Affiliation(s)
- Sneha Sai Mannam
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert Subtirelu
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daksh Chauhan
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hasan S Ahmad
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Irina Mihaela Matache
- Department of Physiology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Kevin Bryan
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Siddharth V K Chitta
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shreya C Bathula
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan Turlip
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Connor Wathen
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yohannes Ghenbot
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sonia Ajmera
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rachel Blue
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - H Isaac Chen
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zarina S Ali
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Neil Malhotra
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Visish Srinivasan
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ali K Ozturk
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jang W Yoon
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Chauhan D, Ahmad HS, Subtirelu R, Mannam S, Turlip R, Bryan K, Bathula S, Ghenbot Y, Yang AI, Wang MY, Basil G, Ali ZS, Yoon JW. Defining the minimal clinically important difference in smartphone-based mobility after spine surgery: correlation of survey questionnaire to mobility data. J Neurosurg Spine 2023; 39:427-437. [PMID: 37243547 DOI: 10.3171/2023.5.spine23336] [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: 03/27/2023] [Accepted: 05/01/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Patient-reported outcome measures (PROMs) are the gold standard for assessing postoperative outcomes in spine surgery. However, PROMs are also limited by the inherent subjectivity of self-reported qualitative data. Recent literature has highlighted the utility of patient mobility data streamed from smartphone accelerometers as an objective measure of functional outcomes and complement to traditional PROMs. Still, for activity-based data to supplement existing PROMs, they must be validated against current metrics. In this study, the authors assessed the relationships and concordance between longitudinal smartphone-based mobility data and PROMs. METHODS Patients receiving laminectomy (n = 21) or fusion (n = 10) between 2017 and 2022 were retrospectively included. Activity data (steps-per-day count) recorded in the Apple Health mobile application over a 2-year perioperative window were extracted and subsequently normalized to allow for intersubject comparison. PROMS, including the visual analog scale (VAS), Patient Reported Outcome Measurement Information System Pain Interference (PROMIS-PI), Oswestry Disability Index (ODI), and EQ-5D, collected at the preoperative and 6-week postoperative visits were retrospectively extracted from the electronic medical record. Correlations between PROMs and patient mobility were assessed and compared between patients who did and those who did not achieve the established minimal clinically important difference (MCID) for each measure. RESULTS A total of 31 patients receiving laminectomy (n = 21) or fusion (n = 10) were included. Change between preoperative and 6-week postoperative VAS and PROMIS-PI scores demonstrated moderate (r = -0.46) and strong (r = -0.74) inverse correlations, respectively, with changes in normalized steps-per-day count. In cohorts of patients who achieved PROMIS-PI MCID postoperatively, indicating subjective improvement in pain, there was a 0.784 standard deviation increase in normalized steps per day, representing a 56.5% improvement (p = 0.027). Patients who did achieve the MCID of improvement in either PROMIS-PI or VAS after surgery were more likely to experience an earlier sustained improvement in physical activity commensurate to or greater than their preoperative baseline (p = 2.98 × 10-18) than non-MCID patients. CONCLUSIONS This study demonstrates a strong correlation between changes in mobility data extracted from patient smartphones and changes in PROMs following spine surgery. Further elucidating this relationship will allow for more robust supplementation of existing spine outcome measure tools with analyzed objective activity data.
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Affiliation(s)
- Daksh Chauhan
- 1Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Hasan S Ahmad
- 1Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Robert Subtirelu
- 1Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Sai Mannam
- 1Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Ryan Turlip
- 1Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Kevin Bryan
- 1Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Shreya Bathula
- 1Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Yohannes Ghenbot
- 1Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Andrew I Yang
- 1Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Michael Y Wang
- 2Department of Neurosurgery, Miller School of Medicine at the University of Miami, Florida
| | - Gregory Basil
- 2Department of Neurosurgery, Miller School of Medicine at the University of Miami, Florida
| | - Zarina S Ali
- 1Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Jang W Yoon
- 1Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; and
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McCloskey K, Singh S, Ahmad HS, Turlip R, Ghenbot Y, Yoon JW. Standardizing Lumbar Interbody Fusion Nomenclature. Clin Spine Surg 2023; 36:217-219. [PMID: 36728215 DOI: 10.1097/bsd.0000000000001425] [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: 02/10/2022] [Accepted: 12/13/2022] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN This article is a research methodology study. OBJECTIVE We summarize current ambiguities and inaccuracies regarding lumbar interbody fusion nomenclature and propose a standardized reporting method to improve the clarity of future research and communication among spine surgeons and researchers. SUMMARY OF BACKGROUND DATA Lumbar interbody fusion techniques have seen an impressive degree of refinement over recent years. This innovation has ushered in a plethora of naming conventions for these new surgical approaches. Many of the current trends in naming lumbar fusion techniques are, however, redundant and contradictory, creating unnecessary confusion in the field. METHODS Following an extensive literature review, we developed a 4-part naming convention that highlights the crucial features of lumbar fusion surgical procedures. RESULTS Current literature regarding lumbar fusions is rife with inconsistent usage and privatization of terminology that can inadvertently result in ambiguous operative vocabulary, potentially compromising the accuracy of future research. We propose a 4-part naming system that highlights crucial features of lumbar interbody fusions, including (1) intra-operative repositioning, (2) patient position, (3) surgical technique, and (4) orientation of the surgical corridor to the psoas muscle. CONCLUSIONS This study raises awareness of current inconsistencies in naming conventions and proposes a standardized system for improving the clarity of lumber interbody fusion terminology for the broader spine community. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Kyle McCloskey
- Department of Neurosurgery, Drexel University College of Medicine
| | - Shikha Singh
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Hasan S Ahmad
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Ryan Turlip
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Yohannes Ghenbot
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Jang W Yoon
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Ghenbot Y, Alexis M, McCloskey K, Ahmad HS, Chauhan D, Yoon JW. Endoscopic Transforaminal Diskectomy for Far Lateral Disk Herniation Using a Fluoroscopy-Based Instrument-Tracking Navigation System: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023:01787389-990000000-00707. [PMID: 37133266 DOI: 10.1227/ons.0000000000000706] [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: 11/05/2022] [Accepted: 02/08/2023] [Indexed: 05/04/2023] Open
Affiliation(s)
- Yohannes Ghenbot
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maya Alexis
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kyle McCloskey
- Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Hasan S Ahmad
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daksh Chauhan
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jang W Yoon
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Chauhan D, Ahmad HS, Singh S, Albayar A, Patel A, Welch WC, Yoon JW. A Prospective Cohort Study of Radiation Exposure to a Spine Surgeon's Exposed Body Parts During Utilization of Intraoperative Radiation-based Imaging. Clin Spine Surg 2023; 36:90-95. [PMID: 36959180 DOI: 10.1097/bsd.0000000000001450] [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: 08/29/2022] [Accepted: 01/25/2023] [Indexed: 03/25/2023]
Abstract
STUDY DESIGN Prospective cohort study. SUMMARY OF BACKGROUND DATA C-arm fluoroscopy and O-arm navigation are vital tools in modern spine surgeries, but their repeated usage can endanger spine surgeons. Although a surgeon's chest and abdomen are protected by lead aprons, the eyes and extremities generally receive less protection. OBJECTIVE In this study, we compare differences in intraoperative radiation exposure across the protected and unprotected regions of a surgeon's body. METHODS Sixty-five consecutive spine surgeries were performed by a single spine-focused neurosurgeon over 9 months. Radiation exposure to the primary surgeon was measured through dosimeters worn over the lead apron, under the lead apron, on surgical loupes, and as a ring on the dominant hand. Differences were assessed with rigorous statistical testing and radiation exposure per surgical case was extrapolated. RESULTS During the study, the measured radiation exposure over the apron, 176 mrem, was significantly greater than that under the apron, 8 mrem (P = 0.0020), demonstrating a shielding protective effect. The surgeon's dominant hand was exposed to 329 mrem whereas the eyes were exposed to 152.5 mrem of radiation. Compared with the surgeon's protected abdominal area, the hands (P = 0.0002) and eyes (P = 0.0002) received significantly greater exposure. Calculated exposure per case was 2.8 mrem for the eyes and 5.1 mrem for the hands. It was determined that a spine-focused neurosurgeon operating 400 cases annually will incur a radiation exposure of 60,750 mrem to the hands and 33,900 mrem to the eyes over a 30-year career. CONCLUSIONS Our study found that spine surgeons encounter significantly more radiation exposure to the eyes and the extremities compared with protected body regions. Lifetime exposure exceeds the annual limits set by the International Commission on Radiologic Protection for the extremities (50,000 mrem/y) and the eyes (15,000 mrem/y), calling for increased awareness about the dangerous levels of radiation exposure that a spine surgeon incurs over one's career.
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Affiliation(s)
- Daksh Chauhan
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Blue R, Gujral J, Ahmad HS, Choudhri O. Endoscopic fenestration of an enlarging giant occipital arachnoid cyst. Neurosurgical Focus: Video 2023; 8:V2. [PMID: 37089746 PMCID: PMC10114910 DOI: 10.3171/2023.1.focvid22129] [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] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/17/2023] [Indexed: 04/03/2023]
Abstract
This case demonstrates an endoscopic fenestration of an enlarging giant occipital arachnoid cyst. The patient is a 42-year-old woman presenting with headache, progressive vision loss, and nausea and vomiting. MRI demonstrates a large, nonenhancing cystic lesion in the right occipital lobe measuring up to 8.3 cm, consistent with an arachnoid cyst. This surgical video illustrates the technique for an endoscopic fenestration into the native ventricular system utilizing stereotactic MRI-guided stealth navigation. Postoperatively, the patient had full recovery with improvement of headaches and vision and was discharged on postoperative day 1 without complications.
The video can be found here: https://stream.cadmore.media/r10.3171/2023.1.FOCVID22129
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Affiliation(s)
- Rachel Blue
- Department of Neurosurgery, University of Pennsylvania, Philadelphia; and
| | - Jaskeerat Gujral
- University of Pennsylvania, College of Arts and Sciences, Philadelphia, Pennsylvania
| | - Hasan S. Ahmad
- Department of Neurosurgery, University of Pennsylvania, Philadelphia; and
| | - Omar Choudhri
- Department of Neurosurgery, University of Pennsylvania, Philadelphia; and
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12
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Cheung A, Moin MN, Kwon F, Guan J, Liu C, Jiang L, Raimondo C, Chotai S, Chambless LB, Ahmad HS, Chauhan D, Yoon JW, Hollon TC, Buch V, Kondziolka D, Chen D, Al-Aswad L, Aphinyanaphongs Y, Oermann E. 316 Neurosurgical Federated Learning: A Multi-Center Collaboration to Detect Intracranial Hemorrhage Without Directly Sharing Data. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_316] [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: 03/18/2023] Open
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13
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Turlip R, Ahmad HS, Ghenbot YG, Wathen C, Chauhan D, McCloskey K, Yoon JW. Characterizing and Improving Nomenclature for Reporting Lumbar Interbody Fusion Techniques. World Neurosurg 2023:S1878-8750(23)00361-3. [PMID: 36921714 DOI: 10.1016/j.wneu.2023.03.040] [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: 11/20/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Lumbar interbody fusion (LIF) techniques have seen impressive innovation in recent years, leading to an expansion of the LIF lexicon. OBJECTIVE This study systematically analyzes LIF nomenclature in contemporary literature and proposes a standardized classification system for reporting LIF terminology. METHODS A search query was conducted through the PubMed database using "lumbar fusion OR lumbar interbody fusion". A total of 1,455 articles were identified, and 605 references to LIF were recorded. Following a systematic review of the terminology, we developed a LIF reporting guidelines that capture the existing LIF nomenclature while avoiding redundant or ambiguous terminology. RESULTS The most referenced anatomical approaches were transforaminal (43.0%), followed by posterior (25.0%), lateral (19.7%), and anterior (10.9%). Overall, there were 72 unique ways to describe LIF. Unique prefixes were recorded by approach (posterior: 26; lateral: 13; anterior: 3). 40 unique prefixes/suffixes overlapped in their usage. 'MI' (14.4%), 'MIS' (38.1%), and 'MISS' (0.6%) all referenced a minimally invasive approach. 'O' (12.5%), 'CO' (1.3%), and 'TO' (1.3%) all described open techniques. 'Endo' (0.6%), 'Endoscopic-assisted' (1.3%), and 'PE' (1.9%) all referenced endoscopic-assisted procedures. CONCLUSION The current lumbar interbody fusion nomenclature contains many unique LIF terms that were found to be inconsistently defined, redundant, or ambiguous. We propose the standardization of a 4-part naming system which highlights the crucial parts of lumbar interbody fusion: (1) intra-operative repositioning, (2) patient position, (3) anatomical approach, and (4) orientation of the surgical corridor to the psoas muscles.
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Affiliation(s)
- Ryan Turlip
- Perelman School of Medicine, University of Pennsylvania, Department of Neurosurgery, 800 Spruce Street, Philadelphia, PA, United States
| | - Hasan S Ahmad
- Perelman School of Medicine, University of Pennsylvania, Department of Neurosurgery, 800 Spruce Street, Philadelphia, PA, United States
| | - Yohannes G Ghenbot
- Perelman School of Medicine, University of Pennsylvania, Department of Neurosurgery, 800 Spruce Street, Philadelphia, PA, United States
| | - Connor Wathen
- Perelman School of Medicine, University of Pennsylvania, Department of Neurosurgery, 800 Spruce Street, Philadelphia, PA, United States
| | - Daksh Chauhan
- Perelman School of Medicine, University of Pennsylvania, Department of Neurosurgery, 800 Spruce Street, Philadelphia, PA, United States
| | - Kyle McCloskey
- Drexel University College of Medicine, Department of Neurosurgery, Philadelphia, PA, United States
| | - Jang W Yoon
- Perelman School of Medicine, University of Pennsylvania, Department of Neurosurgery, 800 Spruce Street, Philadelphia, PA, United States.
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14
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Borja AJ, Ahmad HS, Tomlinson SB, Na J, McClintock SD, Welch WC, Marcotte PJ, Ozturk AK, Malhotra NR. "July Effect" in Spinal Fusions: A Coarsened Exact-Matched Analysis. Neurosurgery 2023; 92:623-631. [PMID: 36700756 DOI: 10.1227/neu.0000000000002256] [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] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/21/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Few neurosurgical studies examine the July Effect within elective spinal procedures, and none uses an exact-matched protocol to rigorously account for confounders. OBJECTIVE To evaluate the July Effect in single-level spinal fusions, after coarsened exact matching of the patient cohort on key patient characteristics (including race and comorbid status) known to independently affect neurosurgical outcomes. METHODS Two thousand three hundred thirty-eight adult patients who underwent single-level, posterior-only lumbar fusion at a single, multicenter university hospital system were retrospectively enrolled. Primary outcomes included readmissions, emergency department visits, reoperation, surgical complications, and mortality within 30 days of surgery. Logistic regression was used to analyze month as an ordinal variable. Subsequently, outcomes were compared between patients with surgery at the beginning vs end of the academic year (ie, July vs April-June), before and after coarsened exact matching on key characteristics. After exact matching, 99 exactly matched pairs of patients (total n = 198) were included for analysis. RESULTS Among all patients, operative month was not associated with adverse postoperative events within 30 days of the index operation. Furthermore, patients with surgeries in July had no significant difference in adverse outcomes. Similarly, between exact-matched cohorts, patients in July were observed to have noninferior adverse postoperative events. CONCLUSION There was no evidence suggestive of a July Effect after single-level, posterior approach spinal fusions in our cohort. These findings align with the previous literature to imply that teaching hospitals provide adequate patient care throughout the academic year, regardless of how long individual resident physician assistants have been in their particular role.
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Affiliation(s)
- Austin J Borja
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hasan S Ahmad
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Samuel B Tomlinson
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jianbo Na
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- McKenna EpiLog Fellowship in Population Health, at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Scott D McClintock
- The West Chester Statistical Institute and Department of Mathematics, West Chester University, West Chester, Pennsylvania, USA
| | - William C Welch
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paul J Marcotte
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ali K Ozturk
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Neil R Malhotra
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- McKenna EpiLog Fellowship in Population Health, at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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15
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Ahmad HS, Blue R, Ajmera S, Heman-Ackah S, Spadola M, Lazor JW, Lee JYK. The Influence of Radiologist Practice Setting on Identification of Vascular Compression from Magnetic Resonance Imaging in Trigeminal Neuralgia. World Neurosurg 2023; 171:e398-e403. [PMID: 36513300 DOI: 10.1016/j.wneu.2022.12.026] [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: 08/30/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Preoperative magnetic resonance imaging (MRI) studies are routinely ordered for trigeminal neuralgia (TN), though with contested reliability in contemporary literature. A potential reason for this disagreement is inconsistency in MRI reading methodologies. Here, we compare the rate of reported neurovascular compression on preoperative MRI by radiologists employed in community or private practice settings and academic neuroradiologists. METHODS A retrospective review was conducted on patients who underwent endoscopic microvascular decompression for TN with intraoperatively visualized neurovascular compression and primary read by a non-academic or community radiologist. Patient imaging was then re-read by a board-certified neuroradiologist practicing in an academic setting, who was blinded to the initial read and the side of TN symptoms. RESULTS Non-academic radiologists reported vascular compression in 26.0% (20/77) of all patients, and mention was rarely made of the non-pathological side (sensitivity = 26.0%). On academic neuroradiologist re-reads, vascular compression was noted in 87.0% (67/77) of patients on the pathological side and in 57.1% (44/77) on the non-pathological side (sensitivity = 87.0%, specificity = 42.9%). Isotropic/near isotropic 3-dimensional steady state or heavily T2-weighted sequences were read with 92.3% sensitivity and 36.9% specificity, compared to 58.3% sensitivity and 66.7% specificity using routine T2 weighted sequences. CONCLUSIONS The frequency of vascular compression reported by non-academic radiologists is much lower than what is reported by academic neuroradiologists reading the same MRI scans. These results highlight the effect of practice setting on the predictive power of neuroimaging. Future studies are indicated to further investigate these relationships, as well as to trial newer imaging modalities.
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Affiliation(s)
- Hasan S Ahmad
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Rachel Blue
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sonia Ajmera
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sabrina Heman-Ackah
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael Spadola
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jillian W Lazor
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Y K Lee
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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16
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McCloskey K, Turlip R, Ahmad HS, Ghenbot YG, Chauhan D, Yoon JW. Virtual and Augmented Reality in Spine Surgery: A Systematic Review. World Neurosurg 2023; 173:96-107. [PMID: 36812986 DOI: 10.1016/j.wneu.2023.02.068] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 11/28/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Augmented reality (AR) and virtual reality (VR) implementation in spinal surgery has expanded rapidly over the past decade. This systematic review summarizes the use of AR/VR technology in surgical education, preoperative planning, and intraoperative guidance. METHODS A search query for AR/VR technology in spine surgery was conducted through PubMed, Embase, and Scopus. After exclusions, 48 studies were included. Included studies were then grouped into relevant subsections. Categorization into subsections yielded 12 surgical training studies, 5 preoperative planning, 24 intraoperative usage, and 10 radiation exposure. RESULTS VR-assisted training significantly reduced penetration rates or increased accuracy rates compared to lecture-based groups in 5 studies. Preoperative VR planning significantly influenced surgical recommendations and reduced radiation exposure, operating time, and estimated blood loss. For 3 patient studies, AR-assisted pedicle screw placement accuracy ranged from 95.77% to 100% using the Gertzbein grading scale. Head-mounted display was the most common interface used intraoperatively followed by AR microscope and projector. AR/VR also had applications in tumor resection, vertebroplasty, bone biopsy, and rod bending. Four studies reported significantly reduced radiation exposure in AR group compared to fluoroscopy group. CONCLUSIONS AR/VR technologies have the potential to usher in a paradigm shift in spine surgery. However, the current evidence indicates there is still a need for 1) defined quality and technical requirements for AR/VR devices, 2) more intraoperative studies that explore usage outside of pedicle screw placement, and 3) technological advancements to overcome registration errors via the development of an automatic registration method.
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Affiliation(s)
- Kyle McCloskey
- Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Ryan Turlip
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hasan S Ahmad
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yohannes G Ghenbot
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daksh Chauhan
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jang W Yoon
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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17
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Ghenbot Y, Ahmad HS, Chauhan D, McCloskey K, Turlip R, Yoon JW. Simultaneous Anterior Posterior Approach for Single-Position Lateral Lumbar Interbody Fusion with Robotic Assistance: Technical Guidelines and Early Outcomes. World Neurosurg 2023; 170:e425-e430. [PMID: 36396051 DOI: 10.1016/j.wneu.2022.11.038] [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: 08/17/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Lumbar lateral interbody fusion (LLIF) is traditionally performed in 2 stages: placing the interbody cage in the lateral decubitus position, then placing the percutaneous pedicle screw in the prone position. Performing interbody fusion and posterior fixation simultaneously could improve operative efficiency and clinical outcomes associated with longer operative times. We describe the operative steps and report clinical and radiographic outcomes associated with a simultaneous anterior and posterior approach (SAPA) for LLIF. METHODS Patients who underwent SAPA LLIF performed by a single surgeon over 1 year were retrospectively reviewed. Demographic, clinical, and radiographic data were analyzed, an operative guideline was created, and a learning curve was constructed using operative times. RESULTS SAPA LLIF was performed in 11 patients. Three patients experienced transient postoperative femoral nerve plexopathy with symptoms of ipsilateral hip flexion weakness and/or anterior thigh numbness; there were no other complications in the cohort. Radiographically, patients achieved significant increases in disc height (8.3 mm vs. 13.5 mm, P = 0.002) and foraminal height (20.2 mm vs. 25.3 mm, P = 0.0001). Patients showed significant improvements in Oswestry Disability Index (52 vs. 27.8, P = 0.002) and Patient-Reported Outcome Measurement Information System Physical Function (32.6 vs. 39, P = 0.048) and Pain Interference (64.9 vs. 59.6, P = 0.001) at 3 months. A downward trend in operative time was observed for 1-level SAPA LLIF. CONCLUSIONS SAPA LLIF is a safe approach for LLIF that results in favorable clinical outcomes. This technique can potentially improve operative efficiency further along the course of a surgeon's learning curve.
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Affiliation(s)
- Yohannes Ghenbot
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hasan S Ahmad
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daksh Chauhan
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kyle McCloskey
- Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Ryan Turlip
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jang W Yoon
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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18
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Cheung ATM, Nasir-Moin M, Fred Kwon YJ, Guan J, Liu C, Jiang L, Raimondo C, Chotai S, Chambless L, Ahmad HS, Chauhan D, Yoon JW, Hollon T, Buch V, Kondziolka D, Chen D, Al-Aswad LA, Aphinyanaphongs Y, Oermann EK. Methods and Impact for Using Federated Learning to Collaborate on Clinical Research. Neurosurgery 2023; 92:431-438. [PMID: 36399428 DOI: 10.1227/neu.0000000000002198] [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: 06/05/2022] [Accepted: 08/20/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The development of accurate machine learning algorithms requires sufficient quantities of diverse data. This poses a challenge in health care because of the sensitive and siloed nature of biomedical information. Decentralized algorithms through federated learning (FL) avoid data aggregation by instead distributing algorithms to the data before centrally updating one global model. OBJECTIVE To establish a multicenter collaboration and assess the feasibility of using FL to train machine learning models for intracranial hemorrhage (ICH) detection without sharing data between sites. METHODS Five neurosurgery departments across the United States collaborated to establish a federated network and train a convolutional neural network to detect ICH on computed tomography scans. The global FL model was benchmarked against a standard, centrally trained model using a held-out data set and was compared against locally trained models using site data. RESULTS A federated network of practicing neurosurgeon scientists was successfully initiated to train a model for predicting ICH. The FL model achieved an area under the ROC curve of 0.9487 (95% CI 0.9471-0.9503) when predicting all subtypes of ICH compared with a benchmark (non-FL) area under the ROC curve of 0.9753 (95% CI 0.9742-0.9764), although performance varied by subtype. The FL model consistently achieved top three performance when validated on any site's data, suggesting improved generalizability. A qualitative survey described the experience of participants in the federated network. CONCLUSION This study demonstrates the feasibility of implementing a federated network for multi-institutional collaboration among clinicians and using FL to conduct machine learning research, thereby opening a new paradigm for neurosurgical collaboration.
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Affiliation(s)
| | | | | | | | - Chris Liu
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | - Lavender Jiang
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA.,Center for Data Science, New York University, New York, New York, USA
| | | | - Silky Chotai
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lola Chambless
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Hasan S Ahmad
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daksh Chauhan
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jang W Yoon
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Todd Hollon
- Department of Neurosurgery, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Vivek Buch
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | | | - Dinah Chen
- Department of Ophthalmology, NYU Langone Health, New York, New York, USA
| | - Lama A Al-Aswad
- Department of Ophthalmology, NYU Langone Health, New York, New York, USA
| | | | - Eric Karl Oermann
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA.,Center for Data Science, New York University, New York, New York, USA.,Department of Radiology, NYU Langone Health, New York, New York, USA
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McCloskey K, Alexis M, Ghenbot Y, Ahmad HS, Chauhan D, Yoon JW. Combined L5-S1 Anterior Lumbar Interbody Fusion and Multilevel Lateral Lumbar Interbody Fusion in a Single-Stage Lateral Decubitus Position Using Fluoroscopy-Based Instrument Tracking System. World Neurosurg 2023; 172:9. [PMID: 36657713 DOI: 10.1016/j.wneu.2023.01.031] [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: 11/19/2022] [Accepted: 01/10/2023] [Indexed: 01/19/2023]
Abstract
Anterior lumbar interbody fusion (ALIF), traditionally performed supine, allows for significant restoration of lumbar lordosis, disc height, and foraminal height in degenerative spine diseases; however, an iatrogenic injury to the viscera and the great vessels can have devastating consequences. Although lateral lumbar interbody fusion (LLIF) is an acceptable and minimally invasive alternative at the L5-S1 level, this approach is suboptimal because of a narrow surgical corridor limited by the iliac crest, common iliac artery and vein, and psoas. Furthermore, combining supine L5-S1 ALIF and lateral decubitus (LD) LLIF requires time-consuming patient repositioning.1,2 To maximize the advantages of both procedures in patients with disease spanning the lumbosacral junction, ALIF and LLIF can be performed in a single stage with the patient remaining in an LD position throughout. To improve the efficiency of this single-position procedure, a fluoroscopy-based instrument tracking system (TrackX Technology Inc., Hillsborough, North Carolina, USA) was used to navigate surgical tools during the procedure. We show this technique in a 43-year-old patient with medically intractable back and leg pain secondary to multi-level degenerative lumbar spondylosis. The patient consented to this procedure; all participants consented to publication of their images. This tracking system allowed for accurate and precise virtual projections of surgical instruments, thereby facilitating the identification of midline and proper trajectories to perform discectomy and implant placement, reducing the amount of intraoperative fluoroscopy use, and eliminating intraoperative computed tomography. To our knowledge, this is the first operative video showing a fluoroscopy-based instrument tracking system used in a combined single-position LD-ALIF and LD-LLIF.
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Affiliation(s)
- Kyle McCloskey
- Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Maya Alexis
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yohannes Ghenbot
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hasan S Ahmad
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daksh Chauhan
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jang W Yoon
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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20
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Ahmad HS, Chauhan D, McCloskey K, Sinha S, Yoon JW. Simultaneous Anterior and Posterior Approach for Prone Lateral Lumbar Interbody Fusion With Robotically Assisted Posterior Instrumentation: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 24:e46. [PMID: 36227179 DOI: 10.1227/ons.0000000000000443] [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: 02/22/2022] [Accepted: 07/29/2022] [Indexed: 01/06/2023] Open
Affiliation(s)
- Hasan S Ahmad
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daksh Chauhan
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kyle McCloskey
- Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Saurabh Sinha
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jang W Yoon
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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21
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Blue R, Gutierrez A, Ahmad HS, Alexis M, Kumar R, Spadola M, Wathen C, Weinstein M, Petrov D. Intraoperative Hypotension Is Not Correlated With Acute Kidney Injury During Spinal Fusion Surgery. Int J Spine Surg 2022; 16:1061-1067. [PMID: 36543389 PMCID: PMC9807044 DOI: 10.14444/8367] [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] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Intraoperative hypotension (IOH) has been found to be associated with organ damage, including cardiac injury and acute kidney injury (AKI). However, to our knowledge, this relationship has not been studied in a neurosurgery-specific patient population. In this report, we review our institutional experience to understand the magnitude of association between IOH in spinal fusion operations and incidence of postoperative AKI. METHODS This retrospective cohort study included 910 patients who underwent posterior spinal fusion procedures performed in the prone position. Intraoperative variables collected and analyzed include minute-by-minute mean arterial pressure (MAP) from an arterial catheter, intermittent blood pressure cuff readings, volume of administered intravenous fluids, urine output, and all relevant vitals and administered medications. The electronic medical record was queried for additional patient data. IOH was defined as MAP <65 mm Hg for greater than 10 minutes. The primary endpoints of the study were presence and staging of AKI ( [Kidney Disease: Improving Global Outcomes] consensus classification), postoperative ileus, and postoperative troponin leak. RESULTS Using a partial correlation analysis, no association was found between IOH metrics (IOH occurrence, IOH duration >10 minutes, and total IOH time) and any outcome metrics, including AKI, except for vasopressor usage and estimated blood loss. Patient age at surgery was not associated with any outcome variables. The lack of association between IOH and AKI contrasts with existing literature; this could be due to underlying differences in our patient population or could highlight a more complex relationship between IOH and AKI than previously understood. CONCLUSION Occurrence and duration of IOH were not associated with AKI, postoperative ileus, troponin leak, length of stay, or any other major outcome variables in spinal fusion patients. CLINICAL RELEVANCE These findings depart from previous literature showing a correlation between IOH and AKI and provide level 3 evidence clinically relevant to spinal surgery. Further research is needed to better understand the exact nature of this relationship. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Rachel Blue
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA, Rachel Blue, Department of Neurosurgery, Penn Presbyterian Medical Center, 51 N 39th St, Philadelphia, PA 19104, USA;
| | - Alexis Gutierrez
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Hasan S. Ahmad
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Maya Alexis
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Rachit Kumar
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael Spadola
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Connor Wathen
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mitchell Weinstein
- Department of Anesthesiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dmitriy Petrov
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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22
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Borja AJ, Ahmad HS, Ghenbot Y, Na J, McClintock SD, Mueller KB, Burkhardt JK, Yoon JW, Malhotra NR. Resident Assistant Training Level is not Associated with Patient Spinal Fusion Outcomes. Clin Neurol Neurosurg 2022; 221:107388. [DOI: 10.1016/j.clineuro.2022.107388] [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: 06/13/2022] [Revised: 07/17/2022] [Accepted: 07/23/2022] [Indexed: 11/03/2022]
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Ahmad HS, McCloskey K, Sinha S, Yoon JW. Simultaneous Anterior and Posterior Approach for Anterior-to-Psoas Lateral Lumbar Interbody Fusion With Robotically Assisted Posterior Instrumentation: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2022; 23:e67-e68. [PMID: 35726947 DOI: 10.1227/ons.0000000000000215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/26/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Hasan S Ahmad
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kyle McCloskey
- Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Saurabh Sinha
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jang W Yoon
- Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
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Ahmad HS, Singh S, Jiao K, Basil GW, Yang AI, Wang MY, Welch WC, Yoon JW. Data-driven phenotyping of preoperative functional decline patterns in patients undergoing lumbar decompression and lumbar fusion using smartphone accelerometry. Neurosurg Focus 2022; 52:E4. [DOI: 10.3171/2022.1.focus21732] [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: 11/29/2021] [Accepted: 01/25/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Treatment of degenerative lumbar spine pathologies typically escalates to surgical intervention when symptoms begin to significantly impair patients’ functional status. Currently, surgeons rely on subjective patient assessments through patient-reported outcome measures to estimate the decline in patient wellness and quality of life. In this analysis, the authors sought to use smartphone-based accelerometry data to provide an objective, continuous measurement of physical activity that might aid in effective characterization of preoperative functional decline in different lumbar spine surgical indications.
METHODS
Up to 1 year of preoperative activity data (steps taken per day) from 14 patients who underwent lumbar decompression and 15 patients who underwent endoscopic lumbar fusion were retrospectively extracted from patient smartphones. A data-driven algorithm was constructed based on 10,585 unique activity data points to identify and characterize the functional decline of patients preceding surgical intervention. Algorithmic estimation of functional decline onset was compared with reported symptom onset in clinical documentation across patients who presented acutely (≤ 5 months of symptoms) or chronically (> 5 months of symptoms).
RESULTS
The newly created algorithm identified a statistically significant decrease in physical activity during measured periods of functional decline (p = 0.0020). To account for the distinct clinical presentation phenotypes of patients requiring lumbar decompression (71.4% acute and 28.6% chronic) and those requiring lumbar fusion (6.7% acute and 93.3% chronic), a variable threshold for detecting clinically significant reduced physical activity was implemented. The algorithm characterized functional decline (i.e., acute or chronic presentation) in patients who underwent lumbar decompression with 100% accuracy (sensitivity 100% and specificity 100%), while characterization of patients who underwent lumbar fusion was less effective (accuracy 26.7%, sensitivity 21.4%, and specificity 100%). Adopting a less-permissive detection threshold in patients who underwent lumbar fusion, which rendered the algorithm robust to minor fluctuations above or below the chronically decreased level of preoperative activity in most of those patients, increased functional decline classification accuracy of patients who underwent lumbar fusion to 66.7% (sensitivity 64.3% and specificity 100%).
CONCLUSIONS
In this study, the authors found that smartphone-based accelerometer data successfully characterized functional decline in patients with degenerative lumbar spine pathologies. The accuracy and sensitivity of functional decline detection were much lower when using non–surgery-specific detection thresholds, indicating the effectiveness of smartphone-based mobility analysis in characterizing the unique physical activity fingerprints of different lumbar surgical indications. The results of this study highlight the potential of using activity data to detect symptom onset and functional decline in patients, enabling earlier diagnosis and improved prognostication.
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Affiliation(s)
- Hasan S. Ahmad
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Shikha Singh
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Kenneth Jiao
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Gregory W. Basil
- Department of Neurosurgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Andrew I. Yang
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Michael Y. Wang
- Department of Neurosurgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - William C. Welch
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Jang W. Yoon
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; and
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Ahmad HS, Yoon JW. Intra-operative wearable visualization in spine surgery: past, present, and future. J Spine Surg 2022; 8:132-138. [PMID: 35441103 PMCID: PMC8990397 DOI: 10.21037/jss-21-95] [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] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/27/2022] [Indexed: 04/15/2023]
Abstract
The history of modern surgery has run parallel to the invention and development of intra-operative visualization techniques. The first operating room, built in 1804 at Pennsylvania Hospital, demonstrates this principle: illumination of the surgical field by the Sun through an overhead skylight allowed surgeries to proceed even prior to the invention of anesthesia or sterile technique. Surgeries were restricted to begin around when the Sun was at its zenith; without adequate light from the Sun and skylight, surgeons were unable to achieve adequate visualization. In the years since, new visualization instruments have expanded the scope and success of surgical intervention. Spine surgery in particular has benefited greatly from improved visualization technologies, due to the complex and intricate nervous, vascular and musculoskeletal structures that are closely intertwined which surgeons must manipulate. Over time, new technologies have also advanced to take up smaller footprints, leading to the rise of wearable tools that surgeons don intra-operatively to better visualize the surgical field. As surgical techniques shift to more minimally invasive methods, reliable, fidelitous, and ergonomic wearables are of growing importance. Here, we discuss the past and present of wearable visualization tools, from the first surgical loupes to cutting-edge augmented reality (AR) goggles, and comment on how emerging innovations will continue to revolutionize spine surgery.
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Affiliation(s)
- Hasan S Ahmad
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jang W Yoon
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Ahmad HS, Yang AI, Joshi DS, Cleri N, Basil G, Wang MY, Welch WC, Yoon JW. 318 Classifying Peri-operative Course and Outcomes in Spine Surgery Using Smartphone-Based Accelerometry. Neurosurgery 2022. [DOI: 10.1227/neu.0000000000001880_318] [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: 11/19/2022] Open
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Ahmad HS, Yang AI, Basil GW, Welch WC, Wang MY, Yoon JW. Towards personalized and value-based spine care: objective patient monitoring with smartphone activity data. J Spine Surg 2022; 8:87-92. [PMID: 35441101 PMCID: PMC8990396 DOI: 10.21037/jss-21-67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/27/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Hasan S. Ahmad
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew I. Yang
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory W. Basil
- Department of Neurosurgery, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - William C. Welch
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael Y. Wang
- Department of Neurosurgery, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Jang W. Yoon
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Singh S, McCloskey K, Ahmad HS, Turlip R, Ghenbot Y, Sinha S, Yoon JW. Minimally Invasive Deformity Correction Technique: Initial Case Series of Anterior Lumbar Interbody Fusion at L5–S1 for Multi-Level Lumbar Interbody Fusion in a Lateral Decubitus Position. World Neurosurg 2022; 162:e416-e426. [DOI: 10.1016/j.wneu.2022.03.026] [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: 01/15/2022] [Revised: 03/05/2022] [Accepted: 03/07/2022] [Indexed: 11/17/2022]
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Ahmad HS, Yang AI, Basil GW, Joshi D, Wang MY, Welch WC, Yoon JW. Developing a Prediction Model for Identification of Distinct Perioperative Clinical Stages in Spine Surgery With Smartphone-Based Mobility Data. Neurosurgery 2022; 90:588-596. [PMID: 35199652 DOI: 10.1227/neu.0000000000001885] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/26/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Spine surgery outcomes assessment currently relies on patient-reported outcome measures, which satisfy established reliability and validity criteria, but are limited by the inherently subjective and discrete nature of data collection. Physical activity measured from smartphones offers a new data source to assess postoperative functional outcomes in a more objective and continuous manner. OBJECTIVE To present a methodology to characterize preoperative mobility and gauge the impact of surgical intervention using objective activity data garnered from smartphone-based accelerometers. METHODS Smartphone mobility data from 14 patients who underwent elective lumbar decompressive surgery were obtained. A time series analysis was conducted on the number of steps per day across a 2-year perioperative period. Five distinct clinical stages were identified using a data-driven approach and were validated with clinical documentation. RESULTS Preoperative presentation was correctly classified as either a chronic or acute mobility decline in 92% of patients, with a mean onset of acute decline of 11.8 ± 2.9 weeks before surgery. Postoperative recovery duration demonstrated wide variability, ranging from 5.6 to 29.4 weeks (mean: 20.6 ± 4.9 weeks). Seventy-nine percentage of patients ultimately achieved a full recovery, associated with an 80% ± 33% improvement in daily steps compared with each patient's preoperative baseline (P = .002). Two patients subsequently experienced a secondary decline in mobility, which was consistent with clinical history. CONCLUSION The perioperative clinical course of patients undergoing spine surgery was systematically classified using smartphone-based mobility data. Our findings highlight the potential utility of such data in a novel quantitative and longitudinal surgical outcome measure.
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Affiliation(s)
- Hasan S Ahmad
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew I Yang
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gregory W Basil
- Department of Neurosurgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Disha Joshi
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael Y Wang
- Department of Neurosurgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - William C Welch
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jang W Yoon
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Ahmad HS, Yang AI, Basil GW, Wang MY, Yoon JW. Objective Outcomes in Lateral Osteotomy Through Anterior-to-Psoas for Severe Adult Degenerative Spine Deformity Correction. Cureus 2021; 13:e18277. [PMID: 34722055 PMCID: PMC8545550 DOI: 10.7759/cureus.18277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 01/23/2023] Open
Abstract
Multilevel lateral interbody fusion is an acceptable surgical technique in patients with severe degenerative adult spinal deformity (ASD). The current standard-of-care in spine surgery includes the use of patient reported outcome measures (PROMs) to assess post-operative improvement. Objective activity data during the peri-operative period may provide supplementary information for patients recovering from ASD surgery. In this report, we use smartphone-based activity data as an objective outcome measure for a patient who underwent a two-stage operation for ASD corrective surgery: lateral osteotomy and lumbar interbody fusion with posterior column release. An 82-year-old male presented with intractable back pain secondary to severe thoracolumbar scoliotic deformity (Lenke 5BN). Pre-operative images demonstrated the presence of bridging osteophytes over the left lateral aspect of L2-5 disc spaces and over the apex of the lumbar curvature, with significant neuroforaminal stenosis. Surgical correction was completed in two stages: (1) left-sided lateral osteotomy using anterior-to-psoas approach (ATP) in a right lateral decubitus position, and (2) multilevel Ponte osteotomies and instrumented fusion from T10-pelvis. Post-operative radiography showed correction to scoliotic deformity and sagittal misalignment. The patient had developed seroma and wound dehiscence, which was evacuated on post-operative day 11. At 14-month follow-up, the patient reported significant improvement in pain symptoms, corroborated by patient reported outcome measures. To further quantify and assess patient recovery, smartphone-based patient activity data was collected and analyzed to serve as a proxy for the patient's functional improvement. The patient's walking steps-per-day was compared pre- and post-operatively. The patient's pre-operative baseline was 223 steps/day; the patient's activity during immediate post-operative recovery dropped to 179 steps/day; the patient returned to baseline activity levels approximately 3 months after surgery, reaching an average of 216 steps/day. In conclusion, we found that lateral osteotomy through an ATP approach is a powerful tool to restore normal spine alignment and can be successfully performed using anatomic landmarks. Additionally, smartphone-based mobility data can assess pre-operative activity level and allow for remote patient monitoring beyond routine follow-up schedule.
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Affiliation(s)
- Hasan S Ahmad
- Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Andrew I Yang
- Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Gregory W Basil
- Neurosurgery, University of Miami Miller School of Medicine, Miami, USA
| | - Michael Y Wang
- Neurosurgery, University of Miami Miller School of Medicine, Miami, USA
| | - Jang W Yoon
- Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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Ahmad HS, Ahmed F, Hitchner MK, Li EH, Williams C. Improving Access to Medical Education for Underrepresented and Low-Income Students. Acad Med 2021; 96:1077-1078. [PMID: 36047863 DOI: 10.1097/acm.0000000000004144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Hasan S Ahmad
- First-year medical student, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;
| | - Fahad Ahmed
- First-year medical student, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michaela K Hitchner
- Third-year medical student, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eric H Li
- Third-year medical student, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cheyenne Williams
- Fourth-year medical student, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Yoon JW, Spadola M, Blue R, Saylany A, Sharma N, Ahmad HS, Buch V, Madhavan K, Chen HI, Steinmetz MP, Welch WC, Malhotra NR. Do-It-Yourself Augmented Reality Heads-Up Display (DIY AR-HUD): A Technical Note. Int J Spine Surg 2021; 15:826-833. [PMID: 34266938 DOI: 10.14444/8106] [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] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND We present a "Do-It-Yourself" method to build an affordable augmented reality heads-up display system (AR-HUD) capable of displaying intraoperative images. All components are commercially available products, which the surgeons may use in their own practice for educational and research purposes. METHODS Moverio BT 35-E smart glasses were connected to operating room imaging modalities (ie, fluoroscopy and 3D navigation platforms) via a high-definition multimedia interface (HDMI) converter, allowing for continuous high-definition video transmission. The addition of an HDMI transmitter-receiver makes the AR-HUD system wireless. RESULTS We used our AR-HUD system in 3 patients undergoing instrumented spinal fusion. AR-HUD projected fluoroscopy images onto the surgical field, eliminating shift of surgeon focus and procedure interruption, with only a 40- to 100-ms delay in transmission, which was not clinically impactful. CONCLUSIONS An affordable AR-HUD capable of displaying real-time information into the surgeon's view can be easily designed, built, and tested in surgical practice. As wearable heads-up display technology continues to evolve rapidly, individual components presented here may be substituted to improve its functionality and usability. Surgeons are in a unique position to conduct clinical testing in the operating room environment to optimize the augmented reality system for surgical use.
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Affiliation(s)
- Jang W Yoon
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael Spadola
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rachel Blue
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anissa Saylany
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nikhil Sharma
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hasan S Ahmad
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Vivek Buch
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - H Isaac Chen
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael P Steinmetz
- Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - William C Welch
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Neil R Malhotra
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Scangos KW, Ahmad HS, Shafi A, Sellers KK, Dawes HE, Krystal A, Chang EF. Pilot Study of An Intracranial Electroencephalography Biomarker of Depressive Symptoms in Epilepsy. J Neuropsychiatry Clin Neurosci 2020; 32:185-190. [PMID: 31394989 PMCID: PMC7429560 DOI: 10.1176/appi.neuropsych.19030081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Adult patients with epilepsy have an increased prevalence of major depressive disorder (MDD). Intracranial EEG (iEEG) captured during extended inpatient monitoring of patients with treatment-resistant epilepsy offers a particularly promising method to study MDD networks in epilepsy. METHODS The authors used 24 hours of resting-state iEEG to examine the neural activity patterns within corticolimbic structures that reflected the presence of depressive symptoms in 13 adults with medication-refractory epilepsy. Principal component analysis was performed on the z-scored mean relative power in five standard frequency bands averaged across electrodes within a region. RESULTS Principal component 3 was a statistically significant predictor of the presence of depressive symptoms (R2=0.35, p=0.014). A balanced logistic classifier model using principal component 3 alone correctly classified 78% of patients as belonging to the group with a high burden of depressive symptoms or a control group with minimal depressive symptoms (sensitivity, 75%; specificity, 80%; area under the curve=0.8, leave-one-out cross validation). Classification was dependent on beta power throughout the corticolimbic network and low-frequency cingulate power. CONCLUSIONS These finding suggest, for the first time, that neural features across circuits involved in epilepsy may distinguish patients who have depressive symptoms from those who do not. Larger studies are required to validate these findings and to assess their diagnostic utility in MDD.
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Pramudji H, Demes CM, Dewi K, Tasmini T, Ahmad HS. Association of -174 G>C interleukin-6 gene polymorphism with interleukin-6 and c-reactive protein levels and obesity: A case-control study among people/residents of Western Indonesia. Med J Malaysia 2019; 74:400-404. [PMID: 31649216] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Interleukin-6 (IL-6) and C-Reactive Protein (CRP) are mediators of inflammatory responses and increase in people who are obese . The increase of IL-6 and CRP levels is modified by polymorphism of -174 G>C IL-6 gene. AIM The purpose of this study was to investigate the relationship between -174 G>C IL-6 polymorphism gene on the level of IL-6 and CRP in the population of western Indonesia obese who are obese. METHODS In this study, we examined 178 subjects consisting of 89 who are obese with BMI> 25, and controls with BMI between 18.5 and 23. Fasting blood was taken from each subject for the examination of IL-6 and CRP levels by the ELISA method. Determination of genotype -174 G>C IL-6 gene was examined by Polymerase Chain reaction- Restriction Fragment Length Polymorphism (PCR-RFLP) methods. RESULTS The results of this study showed increased levels of IL-6 and CRP in the obese group compared to the controls. In the obese group, CC genotype had higher CRP and lower IL-6 levels than the GC and GG genotypes. The frequency of CC genotype in the obese group was 47.2% compared with 28.1% in controls and this genotype was considered a risk factor for obesity. Carriers of the C genotype as a dominant or a recessive model had greater risk of obesity. CONCLUSION It was concluded that the polymorphism - 174G>C IL-6 gene is a risk factor for obesity and is associated with increased levels of IL-6 and CRP in an obese group of the Western Indonesian ethnic population.
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Affiliation(s)
- H Pramudji
- Universitas Gadjah Mada, Faculty of Medicine, Public Health and Nursing, Department of Biochemistry, Yogyakarta, Indonesia.
| | - C M Demes
- Universitas Maranatha, Faculty of Medicine, Bandung, Indonesia
| | - K Dewi
- Universitas Muhammadiyah Purwokerto, Faculty of Medicine, Department of Biochemistry, Jawa Tengah, Indonesia
| | - T Tasmini
- Universitas Gadjah Mada, Faculty of Medicine, Public Health and Nursing, Department of Biochemistry, Yogyakarta, Indonesia
| | - H S Ahmad
- Universitas Gadjah Mada, Faculty of Medicine, Public Health and Nursing, Department of Biochemistry, Yogyakarta, Indonesia
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Sahu SK, Singh NK, Singh S, Kumar A, Agarwal A, Bijalwan P, Ahmad HS, Sachan PK. Colobronchial fistula: a rare cause of chronic cough. Natl Med J India 2011; 24:345-346. [PMID: 22680259] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We report a colobronchial fistula in a middle-aged woman. She had been having cough with expectoration of sputum with a faeculent odour since the age of 7 years. Imaging revealed a fistulous connection between the hepatic flexure and the right bronchial tree, which was successfully repaired surgically.
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Affiliation(s)
- S K Sahu
- Department of General Surgery, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Doiwala, Dehradum, Uttarakhand, India.
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Abstract
Rabbits were injected intraperitoneally with purified echinulin, a product of Aspergillus chevalieri. After 2 h, the rabbits were bled and enzyme analyses were carried out on the supernates of liver homogenates and citrated plasma. Elevated levels of total plasma lactate dehydrogenase, cardiac derived isozyme, glutamic-oxaloacetic and glutamic-pyruvic transaminase activities in animals receiving toxin were observed. These levels were statistically significant compared to the vehicle control. A significant increase in liver lactate dehydrogenase of toxin-treated rabbits was also observed. Light-microscopic examination of lung and liver showed a significant degree of damage. The increase in plasma enzyme levels is indicative of damage to these organs.
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Affiliation(s)
- M Ali
- Department of Biochemistry, Faculty of Science, Kuwait University, Safat
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