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Aboushaala K, Chee AV, Toro SJ, Vucicevic R, Yuh C, Dourdourekas J, Patel IK, Espinoza-Orias A, Oh C, Al-Harthi L, Karppinen J, Goldberg EJ, Phillips FM, Colman M, Williams FMK, Borgia JA, Green S, Forsyth C, An HS, Samartzis D. Discovery of circulating blood biomarkers in patients with and without Modic changes of the lumbar spine: a preliminary analysis. Eur Spine J 2024; 33:1398-1406. [PMID: 38451373 DOI: 10.1007/s00586-024-08192-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/30/2024] [Accepted: 02/11/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE The following study aimed to determine the existence of blood biomarkers in symptomatic patients with or without lumbar Modic changes (MC). METHODS A cross-sectional sub-analyses of a prospective cohort was performed. Fasting blood samples were collected from patients with and without lumbar MC who had undergone spinal fusion or microdiscectomy. An 80-plex panel and CCL5/RANTES were used to assess preoperative plasma cytokine concentrations. Patient demographics and imaging phenotypes were also assessed. RESULTS Thirty-one subjects were analysed (n = 18 no MC; n = 13 MC). No significant differences were found in age, sex, body mass index, smoking and alcohol history, and surgical procedure (i.e. fusion, decompression) between the two groups (p > 0.05). Several statistically significant blood biomarkers in MC patients were identified, including elevated levels of C-C Motif Chemokine Ligand 5 (CCL5, p = 0.0006), while Macrophage Migration Inhibitory Factor (MIF) was significantly lower (p = 0.009). Additionally, C-X-C Motif Chemokine Ligand 5 (CXCL5, p = 0.052), Pentraxin 3 (PTX3, p = 0.06) and Galectin-3 (Gal-3, p = 0.07) showed potential relevance. Moreover, MC patients exhibited significantly higher levels of disc degeneration (p = 0.0001) and displacement severity (p = 0.020). Based on multivariate analyses and controlling for disc degeneration/displacement, CCL5 (OR 1.02; 95% CI 1.002-1.033; p = 0.028) and MIF (OR 0.60; 95% CI 0.382-0.951; p = 0.030) were independently associated with MC patients. CONCLUSION This "proof-of-concept" study is the first to identify specific and significantly circulating blood biomarkers associated with symptomatic patients with lumbar MC, independent of disc alterations of degeneration and/or bulges/herniations. Specifically, differences in CCL5 and MIF protein levels were significantly noted in MC patients compared to those without MC.
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Affiliation(s)
- Khaled Aboushaala
- Department of Orthopedic Surgery, Rush Medical College, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - Ana V Chee
- Department of Orthopedic Surgery, Rush Medical College, 1611 W. Harrison St, Chicago, IL, 60612, USA.
| | - Sheila J Toro
- Department of Orthopedic Surgery, Rush Medical College, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - Rajko Vucicevic
- Department of Orthopedic Surgery, Rush Medical College, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - Catherine Yuh
- Department of Orthopedic Surgery, Rush Medical College, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - Jake Dourdourekas
- Department of Orthopedic Surgery, Rush Medical College, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - Ishani K Patel
- Department of Orthopedic Surgery, Rush Medical College, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - Alejandro Espinoza-Orias
- Department of Orthopedic Surgery, Rush Medical College, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - Chundo Oh
- Department of Orthopedic Surgery, Rush Medical College, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - Lena Al-Harthi
- Department of Microbial Pathogens and Immunity, Rush Medical College, Chicago, IL, USA
| | - Jaro Karppinen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Edward J Goldberg
- Department of Orthopedic Surgery, Rush Medical College, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - Frank M Phillips
- Department of Orthopedic Surgery, Rush Medical College, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - Matthew Colman
- Department of Orthopedic Surgery, Rush Medical College, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - Frances M K Williams
- Department of Orthopedic Surgery, Rush Medical College, 1611 W. Harrison St, Chicago, IL, 60612, USA
- Department of Twins Research and Genetic Epidemiology, King's College, London, UK
| | - Jeffrey A Borgia
- Departments of Anatomy & Cell Biology and Pathology, Rush Medical College, Chicago, IL, USA
| | - Stefan Green
- Department of Internal Medicine, Rush Medical College, Chicago, IL, USA
| | | | - Howard S An
- Department of Orthopedic Surgery, Rush Medical College, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - Dino Samartzis
- Department of Orthopedic Surgery, Rush Medical College, 1611 W. Harrison St, Chicago, IL, 60612, USA.
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Wong AYL, Mallow GM, Pinto SM, Hornung AL, Rudisill SS, Aboushaala K, Udby PM, An HS, Samartzis D. The efficacy and safety of oral antibiotic treatment in patients with chronic low back pain and Modic changes: A systematic review and meta-analysis. JOR Spine 2024; 7:e1281. [PMID: 38222804 PMCID: PMC10782054 DOI: 10.1002/jsp2.1281] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 01/16/2024] Open
Abstract
Background This systematic review and meta-analysis aimed to summarize evidence regarding the effectiveness and safety of oral antibiotic intervention for chronic low back pain (CLBP) patients with/without type-1 Modic changes (MC1). Methods AMED, CINAHL, Cochrane Library, Embase, and Medline were searched from inception to March 3, 2023. Randomized controlled trials (RCTs) or non-RCTs that investigated the effectiveness or safety of oral antibiotics in treating CLBP patients were eligible for inclusion. Two independent reviewers screened abstracts, full-text articles, and extracted data. The methodological quality of each included article were evaluated by RoB2 and NIH quality assessment tools. The quality of evidence was appraised by GRADE. Meta-analyses were performed, where applicable. A subgroup analysis was conducted to evaluate the RCTs and case series separately, and to evaluate the effect of removing a low-quality RCT. Results Three RCTs and four case series were included. All Amoxicillin-clavulanate/Amoxicillin treatments lasted for approximately 3 months. Moderate- and low-quality evidence suggested that antibiotic was significantly better than placebo in improving disability and quality of life in CLBP patients with MC1 at 12-month follow-up, respectively. Low-quality evidence from meta-analyses of RCTs showed that oral antibiotic was significantly better than placebo in improving pain and disability in CLBP patients with MC1 immediately post-treatment. Very low-quality evidence from the case series suggested that oral Amoxicillin-clavulanate significantly improved LBP/leg pain, and LBP-related disability. Conversely, low-quality evidence found that oral Amoxicillin alone was not significantly better than placebo in improving global perceived health in patients with CLBP at the 12-month follow-up. Additionally, oral antibiotic users had significantly more adverse effects than placebo users. Conclusions Although oral antibiotics were statistically superior to placebo in reducing LBP-related disability in patients with CLBP and concomitant MC1, its clinical significance remains uncertain. Future large-scale high-quality RCTs are warranted to validate the effectiveness of antibiotics in individuals with CLBP.
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Affiliation(s)
- Arnold Y. L. Wong
- Department of Rehabilitation SciencesThe Hong Kong Polytechnic UniversityHung Hom, Hong KongSARChina
| | - G. Michael Mallow
- Department of Orthopedic SurgeryRush University Medical CenterChicagoIllinoisUSA
| | - Sabina M. Pinto
- Department of Rehabilitation SciencesThe Hong Kong Polytechnic UniversityHung Hom, Hong KongSARChina
| | - Alexander L. Hornung
- Department of Orthopedic SurgeryRush University Medical CenterChicagoIllinoisUSA
| | - Samuel S. Rudisill
- Department of Orthopedic SurgeryRush University Medical CenterChicagoIllinoisUSA
| | - Khaled Aboushaala
- Department of Orthopedic SurgeryRush University Medical CenterChicagoIllinoisUSA
| | - Peter M. Udby
- Spine UnitRigshospitalet, University of CopenhagenCopenhagenDenmark
| | - Howard S. An
- Department of Orthopedic SurgeryRush University Medical CenterChicagoIllinoisUSA
| | - Dino Samartzis
- Department of Orthopedic SurgeryRush University Medical CenterChicagoIllinoisUSA
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Aboushaala K, Wong AYL, Barajas JN, Lim P, Al-Harthi L, Chee A, Forsyth CB, Oh CD, Toro SJ, Williams FMK, An HS, Samartzis D. The Human Microbiome and Its Role in Musculoskeletal Disorders. Genes (Basel) 2023; 14:1937. [PMID: 37895286 PMCID: PMC10606932 DOI: 10.3390/genes14101937] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
Musculoskeletal diseases (MSDs) are characterized as injuries and illnesses that affect the musculoskeletal system. MSDs affect every population worldwide and are associated with substantial global burden. Variations in the makeup of the gut microbiota may be related to chronic MSDs. There is growing interest in exploring potential connections between chronic MSDs and variations in the composition of gut microbiota. The human microbiota is a complex community consisting of viruses, archaea, bacteria, and eukaryotes, both inside and outside of the human body. These microorganisms play crucial roles in influencing human physiology, impacting metabolic and immunological systems in health and disease. Different body areas host specific types of microorganisms, with facultative anaerobes dominating the gastrointestinal tract (able to thrive with or without oxygen), while strict aerobes prevail in the nasal cavity, respiratory tract, and skin surfaces (requiring oxygen for development). Together with the immune system, these bacteria have coevolved throughout time, forming complex biological relationships. Changes in the microbial ecology of the gut may have a big impact on health and can help illnesses develop. These changes are frequently impacted by lifestyle choices and underlying medical disorders. The potential for safety, expenses, and efficacy of microbiota-based medicines, even with occasional delivery, has attracted interest. They are, therefore, a desirable candidate for treating MSDs that are chronic and that may have variable progression patterns. As such, the following is a narrative review to address the role of the human microbiome as it relates to MSDs.
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Affiliation(s)
- Khaled Aboushaala
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA; (K.A.); (J.N.B.); (P.L.); (A.C.); (C.-d.O.); (S.J.T.); (H.S.A.)
- International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL 60612, USA
| | - Arnold Y. L. Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China;
| | - Juan Nicolas Barajas
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA; (K.A.); (J.N.B.); (P.L.); (A.C.); (C.-d.O.); (S.J.T.); (H.S.A.)
- International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL 60612, USA
| | - Perry Lim
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA; (K.A.); (J.N.B.); (P.L.); (A.C.); (C.-d.O.); (S.J.T.); (H.S.A.)
- International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL 60612, USA
| | - Lena Al-Harthi
- Department of Microbial Pathogens and Immunity, Rush University Medical Center, Chicago, IL 60612, USA;
| | - Ana Chee
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA; (K.A.); (J.N.B.); (P.L.); (A.C.); (C.-d.O.); (S.J.T.); (H.S.A.)
- International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL 60612, USA
| | - Christopher B. Forsyth
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL 60612, USA;
| | - Chun-do Oh
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA; (K.A.); (J.N.B.); (P.L.); (A.C.); (C.-d.O.); (S.J.T.); (H.S.A.)
- International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL 60612, USA
| | - Sheila J. Toro
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA; (K.A.); (J.N.B.); (P.L.); (A.C.); (C.-d.O.); (S.J.T.); (H.S.A.)
- International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL 60612, USA
| | | | - Howard S. An
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA; (K.A.); (J.N.B.); (P.L.); (A.C.); (C.-d.O.); (S.J.T.); (H.S.A.)
- International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL 60612, USA
| | - Dino Samartzis
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA; (K.A.); (J.N.B.); (P.L.); (A.C.); (C.-d.O.); (S.J.T.); (H.S.A.)
- International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL 60612, USA
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Rudisill SS, Hornung AL, Kia C, Mallow GM, Aboushaala K, Lim P, Martin J, Wong AYL, Toro S, Kozaki T, Barajas JN, Colman M, Phillips FM, An HS, Samartzis D. Obesity in children with low back pain: implications with imaging phenotypes and opioid use. Spine J 2023; 23:945-953. [PMID: 36963445 DOI: 10.1016/j.spinee.2023.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 02/07/2023] [Accepted: 03/15/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND CONTEXT Low back pain (LBP) is common in children and adolescents, carrying substantial risk for recurrence and continuation into adulthood. Studies have linked obesity to the development of pediatric LBP; however, its association with lumbar spine degeneration, alignment parameters, and opioid use remains debated. PURPOSE Considering the increasing prevalence of pediatric obesity and LBP and the inherent issues with opioid use, this study aimed to assess the association of obesity with lumbar spine degeneration, spinopelvic alignment, and opioid therapy among pediatric patients. STUDY DESIGN/SETTING A retrospective study of pediatric patients presenting to a single institute with LBP and no history of spine deformity, tumor, or infection was performed. PATIENT SAMPLE A totasl of 194 patients (mean age: 16.7±2.3 years, 45.3% male) were included, of which 30 (15.5%) were obese. OUTCOME MEASURES Prevalence of imaging phenotypes and opioid use among obese to nonobese pediatric LBP patients. Magnetic resonance and plain radiographic imaging were evaluated for degenerative phenotypes (disc bulging, disc herniation, disc degeneration [DD], high-intensity zones [HIZ], disc narrowing, Schmorl's nodes, endplate phenotypes, Modic changes, spondylolisthesis, and osteophytes). Lumbopelvic parameters including lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence and pelvic incidence-lumbar lordosis (PI-LL) mismatch were also examined. METHODS Demographic and clinical information was recorded, including use of opioids. The associations between obesity and lumbar phenotypes or opiod use were assessed by multiple regression models. RESULTS Based on multivariate analysis, obesity was significantly associated with the presence of HIZ (adjusted OR: 5.36, 95% CI: 1.30 to 22.09). Further analysis demonstrated obesity (adjusted OR: 3.92, 95% CI: 1.49 to 10.34) and disc herniation (OR: 4.10, 95% CI: 1.50 to 11.26) were associated with opioid use, independent of duration of symptoms, other potential demographic determinants, and spinopelvic alignment. CONCLUSIONS In pediatric patients, obesity was found to be significantly associated with HIZs of the lumbar spine, while disc herniation and obesity were associated with opioid use. Spinopelvic alignment parameters did not mitigate any outcome. This study underscores that pediatric obesity increases the risk of developing specific degenerative spine changes and pain severity that may necessitate opioid use, emphasizing the importance of maintaining healthy body weight in promoting lumbar spine health in the young.
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Affiliation(s)
- Samuel S Rudisill
- Department of Orthopaedic Surgery, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA; The International Spine Research and Innovation Initiative, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - Alexander L Hornung
- Department of Orthopaedic Surgery, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA; The International Spine Research and Innovation Initiative, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - Cameron Kia
- Department of Orthopaedic Surgery, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA; The International Spine Research and Innovation Initiative, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - Gary Michael Mallow
- Department of Orthopaedic Surgery, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA; The International Spine Research and Innovation Initiative, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - Khaled Aboushaala
- Department of Orthopaedic Surgery, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA; The International Spine Research and Innovation Initiative, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - Perry Lim
- Department of Orthopaedic Surgery, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA; The International Spine Research and Innovation Initiative, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - John Martin
- The International Spine Research and Innovation Initiative, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - Arnold Y L Wong
- The International Spine Research and Innovation Initiative, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA; Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Sheila Toro
- Department of Orthopaedic Surgery, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA; The International Spine Research and Innovation Initiative, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - Takuhei Kozaki
- Department of Orthopaedic Surgery, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA; The International Spine Research and Innovation Initiative, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - Juan Nicolas Barajas
- Department of Orthopaedic Surgery, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA; The International Spine Research and Innovation Initiative, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - Matthew Colman
- Department of Orthopaedic Surgery, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA; The International Spine Research and Innovation Initiative, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - Frank M Phillips
- Department of Orthopaedic Surgery, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA; The International Spine Research and Innovation Initiative, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - Howard S An
- Department of Orthopaedic Surgery, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA; The International Spine Research and Innovation Initiative, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA
| | - Dino Samartzis
- Department of Orthopaedic Surgery, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA; The International Spine Research and Innovation Initiative, Orthopaedic Building, Rush University Medical Center, Suite 204, 1611 W. Harrison St, Chicago, IL, 60612, USA.
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Samartzis D, Aboushaala K, Albert TJ, Cha T, Chee A, Diwan AD, Espinoza-Orias A, Hu SS, Inoue N, Jacobs JJ, Lenke LG, Louie PK, Martin JT, Nassr A, Oh C, Phillips FM, Riew KD, Shen FH, Tannoury C, Vaccaro AR, Wong AYL, Yoon ST. Howard S. An: 2023 International Society for the Study of the Lumbar Spine Wiltse Lifetime Achievement Award. Spine (Phila Pa 1976) 2023; 48:810-813. [PMID: 38404045 DOI: 10.1097/brs.0000000000004627] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 03/22/2023]
Affiliation(s)
- Dino Samartzis
- Department of Orthopedic Surgery, RUSH University Medical Center, Chicago, IL
| | - Khaled Aboushaala
- Department of Orthopedic Surgery, RUSH University Medical Center, Chicago, IL
| | - Todd J Albert
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York City, NY
| | - Thomas Cha
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA
| | - Ana Chee
- Department of Orthopedic Surgery, RUSH University Medical Center, Chicago, IL
| | - Ashish D Diwan
- Department of Orthopedic Surgery, St. George Hospital Campus, The University of New South Wales, Kogarah, Australia
| | | | - Serena S Hu
- Department of Orthopedic Surgery, Stanford University, Redwood City, CA
| | - Nozomu Inoue
- Department of Orthopedic Surgery, RUSH University Medical Center, Chicago, IL
| | - Joshua J Jacobs
- Department of Orthopedic Surgery, RUSH University Medical Center, Chicago, IL
| | - Lawrence G Lenke
- Department of Orthopedic Surgery, Columbia University, New York City, NY
| | - Philip K Louie
- Department of Neurosurgery, Virginia Mason Franciscan Health, Seattle, WA
| | - John T Martin
- Department of Orthopedic Surgery, RUSH University Medical Center, Chicago, IL
| | - Ahmad Nassr
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Chundo Oh
- Department of Orthopedic Surgery, RUSH University Medical Center, Chicago, IL
| | - Frank M Phillips
- Department of Orthopedic Surgery, RUSH University Medical Center, Chicago, IL
| | | | - Francis H Shen
- Department of Orthopedic Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Chadi Tannoury
- Department of Orthopedic Surgery, Boston University Medical Center Boston, MA
| | - Alexander R Vaccaro
- Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Arnold Y L Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
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Hornung AL, Barajas JN, Rudisill SS, Aboushaala K, Butler A, Park G, Harada G, Leonard S, Roberts A, An HS, Epifanov A, Albert HB, Tkachev A, Samartzis D. Prediction of lumbar disc herniation resorption in symptomatic patients: a prospective, multi-imaging and clinical phenotype study. Spine J 2023; 23:247-260. [PMID: 36243388 DOI: 10.1016/j.spinee.2022.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 09/22/2022] [Accepted: 10/04/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND CONTEXT Symptomatic lumbar disc herniations (LDH) are very common. LDH resorption may occur by a "self-healing" process, however this phenomenon remains poorly understood. By most guidelines, if LDH remains symptomatic after 3 months and conservative management fails, surgical intervention may be an option. PURPOSE The following prospective study aimed to identify determinants that may predict early versus late LDH resorption. STUDY DESIGN/SETTING Prospective study with patients recruited at a single center. PATIENT SAMPLE Ninety-three consecutive patients diagnosed with acute symptomatic LDH were included in this study (n=23 early resorption and n=67 late resorption groups) with a mean age of 48.7±11.9 years. OUTCOMES MEASURE Baseline assessment of patient demographics (eg, smoking status, height, weight, etc.), herniation characteristics (eg, the initial level of herniation, the direction of herniation, prevalence of multiple herniations, etc.) and MRI phenotypes (eg, Modic changes, end plate abnormalities, disc degeneration, vertebral body dimensions, etc.) were collected for further analysis. Lumbar MRIs were performed approximately every 3 months for 1 year from time of enrollment to assess disc integrity. METHODS All patients were managed similarly. LDH resorption was classified as early (<3 months) or late (>3 months). A prediction model of pretreatment factors was constructed. RESULTS No significant differences were noted between groups at any time-point (p>.05). Patients in the early resorption group experienced greater percent reduction of disc herniation between MRI-0-MRI-1 (p=.043), reduction of herniation size for total study duration (p=.007), and percent resorption per day compared to the late resorption group (p<.001). Based on multivariate modeling, greater L4 posterior vertebral height (coeff:14.58), greater sacral slope (coeff:0.12), and greater herniated volume (coeff:0.013) at baseline were found to be most predictive of early resorption (p<.05). CONCLUSIONS This is the first comprehensive imaging and clinical phenotypic prospective study, to our knowledge, that has identified distinct determinants for early LDH resorption. Early resorption can occur in 24.7% of LDH patients. We developed a prediction model for early resorption which demonstrated great overall performance according to pretreatment measures of herniation size, L4 posterior body height, and sacral slope. A risk profile is proposed which may aid clinical decision-making and managing patient expectations.
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Affiliation(s)
- Alexander L Hornung
- Department of Orthopaedic Surgery, Rush University Medical Center, Orthopaedic Building, 2(nd) Floor, 1611 W. Harrison St, Chicago, IL 60612, USA; The International Spine Research and Innovation Initiative, Rush University Medical Center, Orthopaedic Building, 2nd floor, 1611 W. Harrison St, Chicago, IL 60612, USA
| | - J Nicolas Barajas
- Department of Orthopaedic Surgery, Rush University Medical Center, Orthopaedic Building, 2(nd) Floor, 1611 W. Harrison St, Chicago, IL 60612, USA; The International Spine Research and Innovation Initiative, Rush University Medical Center, Orthopaedic Building, 2nd floor, 1611 W. Harrison St, Chicago, IL 60612, USA
| | - Samuel S Rudisill
- Department of Orthopaedic Surgery, Rush University Medical Center, Orthopaedic Building, 2(nd) Floor, 1611 W. Harrison St, Chicago, IL 60612, USA; The International Spine Research and Innovation Initiative, Rush University Medical Center, Orthopaedic Building, 2nd floor, 1611 W. Harrison St, Chicago, IL 60612, USA
| | - Khaled Aboushaala
- Department of Orthopaedic Surgery, Rush University Medical Center, Orthopaedic Building, 2(nd) Floor, 1611 W. Harrison St, Chicago, IL 60612, USA; The International Spine Research and Innovation Initiative, Rush University Medical Center, Orthopaedic Building, 2nd floor, 1611 W. Harrison St, Chicago, IL 60612, USA
| | - Alexander Butler
- Department of Orthopaedic Surgery, Rush University Medical Center, Orthopaedic Building, 2(nd) Floor, 1611 W. Harrison St, Chicago, IL 60612, USA; The International Spine Research and Innovation Initiative, Rush University Medical Center, Orthopaedic Building, 2nd floor, 1611 W. Harrison St, Chicago, IL 60612, USA
| | - Grant Park
- Department of Orthopaedic Surgery, Rush University Medical Center, Orthopaedic Building, 2(nd) Floor, 1611 W. Harrison St, Chicago, IL 60612, USA; The International Spine Research and Innovation Initiative, Rush University Medical Center, Orthopaedic Building, 2nd floor, 1611 W. Harrison St, Chicago, IL 60612, USA
| | - Garrett Harada
- Department of Orthopaedic Surgery, Rush University Medical Center, Orthopaedic Building, 2(nd) Floor, 1611 W. Harrison St, Chicago, IL 60612, USA; The International Spine Research and Innovation Initiative, Rush University Medical Center, Orthopaedic Building, 2nd floor, 1611 W. Harrison St, Chicago, IL 60612, USA
| | - Skylar Leonard
- Department of Orthopaedic Surgery, Rush University Medical Center, Orthopaedic Building, 2(nd) Floor, 1611 W. Harrison St, Chicago, IL 60612, USA; The International Spine Research and Innovation Initiative, Rush University Medical Center, Orthopaedic Building, 2nd floor, 1611 W. Harrison St, Chicago, IL 60612, USA
| | - Ashley Roberts
- Department of Orthopaedic Surgery, Rush University Medical Center, Orthopaedic Building, 2(nd) Floor, 1611 W. Harrison St, Chicago, IL 60612, USA; The International Spine Research and Innovation Initiative, Rush University Medical Center, Orthopaedic Building, 2nd floor, 1611 W. Harrison St, Chicago, IL 60612, USA
| | - Howard S An
- Department of Orthopaedic Surgery, Rush University Medical Center, Orthopaedic Building, 2(nd) Floor, 1611 W. Harrison St, Chicago, IL 60612, USA; The International Spine Research and Innovation Initiative, Rush University Medical Center, Orthopaedic Building, 2nd floor, 1611 W. Harrison St, Chicago, IL 60612, USA
| | - Anton Epifanov
- Tkachev and Epifanov Clinic, Novouzenskaya str, 6-B, Volograd, 400120, Russia
| | - Hanne B Albert
- The Modic ClinicJernbanegade 43. sal th 5000 Odense, Denmark
| | - Alexander Tkachev
- Tkachev and Epifanov Clinic, Novouzenskaya str, 6-B, Volograd, 400120, Russia.
| | - Dino Samartzis
- Department of Orthopaedic Surgery, Rush University Medical Center, Orthopaedic Building, 2(nd) Floor, 1611 W. Harrison St, Chicago, IL 60612, USA; The International Spine Research and Innovation Initiative, Rush University Medical Center, Orthopaedic Building, 2nd floor, 1611 W. Harrison St, Chicago, IL 60612, USA.
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Sansom S, Lin MY, Schoeny M, Fukuda C, Bassis C, Shimasaki T, Dangana TE, Moore NM, Yelin R, Liu S, Young VB, Rhee Y, Tabith L, Sheng J, Cisneros EC, Murray J, Chang K, Lolans K, Ariston M, Rotunno W, Ramos H, Li H, Aboushaala K, Iwai N, Hayden MK. 919. Understanding Intermittent Detection of Multidrug-Resistant Organisms (MDROs) in Rectally Colonized Patients. Open Forum Infect Dis 2020. [PMCID: PMC7777592 DOI: 10.1093/ofid/ofaa439.1107] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background MDRO detection in colonized patients may be intermittent for reasons that are incompletely understood. We examined temporal patterns of gut MDRO colonization after initial MDRO detection by rectal swab screening, and determined the relationship of culture positivity to the relative abundance of corresponding MDRO operational taxonomic units (OTUs) identified by 16S rRNA gene sequence analysis. Methods Rectal or fecal swabs were collected daily from MICU patients 1/11/2017-1/11/2018. First MICU admissions with ≥2 swabs and MICU stays ≥3 days were studied. Samples were cultured for vancomycin-resistant enterococci (VRE), carbapenem-resistant Enterobacteriaceae (CRE) and P. aeruginosa (CRPA), and extended-spectrum β-lactamase-producing (ESBL) Enterobacteriaceae by selective media. Resistance mechanisms were confirmed by phenotypic methods and/or PCR. Limit of detection was similar for different MDROs (24-52 CFU/sample). OTU categories corresponding to MDRO species were identified by taxonomy and BLAST. Multilevel regression models estimated the association between MDRO detection and relative abundance of the corresponding OTU. Results 796 unique patients with 3519 swabs were studied. Median (IQR) age was 64 (51-74) years, MICU length of stay was 5 (3-8) days, and number of samples-per-patient was 3 (2-5). Following initial MDRO detection, the probability of subsequent detection varied by MDRO type, and was highest for VRE and lowest for CRPA [Figure 1]. Within each sample, we found a significant association between MDRO detection and relative abundance of the corresponding OTU [Table 1]. In contrast, relative OTU abundance in the first sample with MDRO detection was not predictive of odds of future MDRO detection (p >0.05 for all comparisons). Carriage of >1 MDRO did not affect the odds of MDRO detection in later samples. Figure 1. Probability of Subsequent MDRO Detection after First Positive Varies by MDRO Type ![]()
Table 1. Higher Mean Corresponding OTU Relative Abundance Within Each Sample is Associated with MDRO Detection ![]()
Conclusion MDRO culture positivity in rectally colonized patients was correlated with relative abundance of the corresponding OTU in the same sample. Serial detection of different MDRO types was variable, possibly due to distinct microbial community dynamics of different MDRO types. Intermittent failure to detect MDROs could result in misattribution of MDRO acquisition, resulting in inappropriate investigation or intervention. Disclosures All Authors: No reported disclosures
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Sophia Liu
- University of Michigan-Ann Arbor, Ann Arbor, Michigan
| | | | - Yoona Rhee
- Rush University Medical Center, Berwyn, IL
| | | | | | | | | | - Kyle Chang
- Rush University Medical Center, Berwyn, IL
| | | | | | | | | | - Haiying Li
- Rush University Medical Center, Berwyn, IL
| | | | - Naomi Iwai
- Rush University Medical Center, Berwyn, IL
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Tabaraee E, Ahn J, Aboushaala K, Singh K. A Comparison of Surgical Outcomes Between Minimally Invasive and Open Thoracolumbar Corpectomy. Int J Spine Surg 2020; 14:736-744. [PMID: 33097587 DOI: 10.14444/7106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Minimally invasive (MIS) techniques have gained considerable attention for the management of degenerative spinal pathologies. However, few studies have compared the outcomes between MIS and open thoracolumbar corpectomies. The purpose of this study was to compare perioperative variables between MIS and open thoracolumbar corpectomy. METHODS Retrospective review of 33 patients who underwent either an MIS or open thoracolumbar corpectomy by a single surgeon between 2005 and 2012 was performed. Patients were separated into anterior-posterior MIS (MIS AP), anterior-posterior open (AP), and posterior open (P) cohorts. Postoperative narcotic use was converted to oral morphine equivalents (OMEs). Demographics, comorbidity, perioperative variables, complications, and computed tomographic analyses were assessed. Fisher exact test was performed for categorical variables and Student t test for continuous variables. A P value of ≤ .05 denoted statistical significance. RESULTS Thirty-three patients underwent an MIS AP, AP, or P thoracolumbar corpectomy (39.4% vs 15.2% vs 45.5%, respectively). MIS AP patients were younger with a lower comorbidity burden than either open cohorts. In addition, MIS AP patients demonstrated a decreased procedural time, lower blood loss, and shorter hospitalization than either open cohorts. MIS AP patients required less units of transfusion than P and AP patients while demonstrating lower postoperative narcotics consumption and reoperations rates than open AP patients. Surgical site infection rates, body mass index, intraoperative fluid requirements, and complication rates were similar between cohorts. All patients demonstrated successful arthrodesis at 1 year based upon computed tomography. CONCLUSIONS MIS AP thoracolumbar corpectomy patients incurred decreased procedural times, shorter hospitalization, and lower blood loss compared with open patients. MIS AP patients demonstrated decreased postoperative narcotics consumption and reoperation rates compared with traditional AP patients. All patients demonstrated successful arthrodesis. CLINICAL RELEVANCE The MIS approach to thoracolumbar corpectomies appears to be a safe and efficacious alternative when compared with traditional methods.
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Affiliation(s)
- Ehsan Tabaraee
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Junyoung Ahn
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Khaled Aboushaala
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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Bassis C, Seekatz A, Dangana TE, Shimasaki T, Yelin RD, Schoeny M, Rhee Y, Ariston M, Lolans K, Cornejo Cisneros E, Aboushaala K, Thabit L, Murray J, Sheng J, Ollison S, Bell PB, Fogg L, Weinstein RA, Lin MY, Young VB, Hayden MK. 2849. Gut Microbiota Differences at the Time of Medical Intensive Care Unit (MICU) Admission Are Associated with Acquisition of Multi-drug-Resistant Organisms (MDROs) Among Patients Not Already Colonized with an MDRO. Open Forum Infect Dis 2019. [PMCID: PMC6808848 DOI: 10.1093/ofid/ofz359.154] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Among hospitalized patients, underlying variation in gut microbiota may confer differential risk for gut MDRO acquisition. Methods Rectal swab samples were collected from patients ≤2 days of MICU admission and then daily in the 27-bed MICU of an acute care hospital in Chicago, IL over 1 year. Patients were screened for MDRO colonization by selective culture (see Figure 1 for MDRO types); those with ≥2 swabs and MICU stays ≥3 days were studied. Bacterial 16S rRNA gene amplicon sequences were used for microbiota analysis. Medical records were reviewed. Results In preliminary analysis, 2,480 samples were collected from 627 patients who acquired 170 MDROs (Figure 1). Debilitation, co-morbidities, and certain medical devices were associated with MDRO acquisition, though admission MDRO status was not (table). While no interactions were detected between admission MDRO status and clinical predictors of MDRO acquisition, there were significant differences in gut microbiota composition at the time of MICU admission between patients colonized with an MDRO on admission and those not colonized (P < 0.001, using analysis of molecular variance (AMOVA) on distances). Therefore, we stratified our analysis by admission MDRO colonization status. For patients MDRO-colonized at admission, there were no significant differences in microbiota of patients who later did or did not acquire a new MDRO (AMOVA P-value = 0.32). For patients not MDRO-colonized on admission, there was a significant difference in microbiota of patients who later acquired an MDRO and those who did not (AMOVA P-value: 0.026). Differentially abundant operational taxonomic units (OTUs, based on 3% sequence difference) included OTUs classified as Anaerococcus and as other Clostridiales (higher in patients who remained uncolonized) and as Enterococcus (higher in patients who acquired an MDRO) (Figure 2). Diversity was also higher in patients who remained uncolonized (Wilcoxon test P-value: 0.035) (Figure 3). Conclusion Among patients not already colonized with an MDRO on admission, we identified gut microbiota differences associated with MDRO acquisition that could help explain patient-level variation in MDRO colonization resistance. ![]()
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Disclosures All Authors: No reported Disclosures.
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Affiliation(s)
| | | | | | | | | | | | - Yoona Rhee
- Rush University Medical Center, Chicago, Illinois
| | | | - Karen Lolans
- Rush University Medical Center, Chicago, Illinois
| | | | | | | | - John Murray
- Rush University Medical Center, Chicago, Illinois
| | | | | | | | - Louis Fogg
- Rush University Medical Center, Chicago, Illinois
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Ahn J, Bohl DD, Tabaraee E, Aboushaala K, Elboghdady IM, Singh K. Preoperative narcotic utilization: accuracy of patient self-reporting and its association with postoperative narcotic consumption. J Neurosurg Spine 2016; 24:206-14. [DOI: 10.3171/2015.3.spine141300] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Little is known about the accuracy of reporting of preoperative narcotic utilization in spinal surgery. As such, the purpose of this study is to compare postoperative narcotic consumption between preoperative narcotic utilizers who do and do not accurately self-report preoperative utilization.
METHODS
Patients who underwent anterior cervical discectomy and fusion, minimally invasive lumbar discectomy, or minimally invasive transforaminal lumbar interbody fusion procedures between 2013 and 2014 were prospectively identified. The accuracy of self-reporting preoperative narcotic consumption was determined utilizing the Illinois Prescription Monitoring Program. Total inpatient narcotic consumption during postoperative Days 0 and 1 was compared according to the demographics and preoperative narcotic reporting accuracy. Similarly, the proportion of patients who continued to be dependent on narcotic medications at each postoperative visit was compared according to the demographics and preoperative narcotic reporting accuracy.
RESULTS
A total of 195 patients met the inclusion criteria. Of these, 25% did not use narcotics preoperatively, while 47% and 28% did do so with accurate and inaccurate reporting, respectively. Patients who used narcotics preoperatively were more likely to demonstrate elevated inpatient narcotic consumption (adjusted RR 5.3; 95% CI 1.4–20.1; p = 0.013). However, such patients were no more or less likely to be dependent on narcotic medications at the first (p = 0.618) or second (p = 0.798) postoperative visit. Among patients who used narcotics preoperatively, no differences were demonstrated in terms of inpatient narcotic consumption (p = 0.182) or narcotic dependence following the first (p = 0.982) or second (p = 0.866) postoperative visit according to the self-reported accuracy of preoperative narcotic utilization. The only preoperative factors that were independently associated with elevated inpatient narcotic consumption were workers’ compensation status and procedure type. The only preoperative factors that were independently associated with narcotic dependence at the first postoperative visit were female sex, workers’ compensation status, and procedure type. The only preoperative factor that was independently associated with narcotic dependence at the second postoperative visit was procedure type.
CONCLUSIONS
The findings suggest that determining the actual preoperative narcotic utilization in patients who undergo spine surgery may help optimize postoperative pain management. Approximately 75% of patients used narcotics preoperatively. Patients who used narcotics preoperatively demonstrated significantly higher inpatient narcotic consumption, but this difference did not persist following discharge. Finally, postoperative narcotic consumption (inpatient and following discharge) was independent of the self-reported accuracy of preoperative narcotic utilization. Taken together, these findings suggest that corroboration between the patient’s self-reported preoperative narcotic utilization and other sources of information (e.g., family members and narcotic registries) may be clinically valuable with respect to minimizing narcotic requirements, thereby potentially improving the management of postoperative pain.
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Affiliation(s)
- Junyoung Ahn
- 1Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois; and
| | - Daniel D. Bohl
- 2Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Ehsan Tabaraee
- 1Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois; and
| | - Khaled Aboushaala
- 1Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois; and
| | - Islam M. Elboghdady
- 1Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois; and
| | - Kern Singh
- 1Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois; and
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