1
|
Han N, Pratt N, Usmani MF, Hayman E, Jones S, Johnsen P, Thomson AE, Ye I, Chryssikos T, Sharma A, Olexa J, Cavanaugh DL, Koh EY, Buraimoh K, Ludwig S, Sansur C. Anterior longitudinal ligament release from a posterior approach: an alternative to three-column osteotomy. Eur Spine J 2022; 31:2196-2203. [PMID: 34978600 DOI: 10.1007/s00586-021-07100-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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 12/19/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Expansion of the anterior column and compression of the posterior column restores lordosis and sagittal imbalance. Anterior longitudinal ligament (ALL) release has been described from lateral and anterior approaches as a technique to improve lumbar lordosis; however, posterior approach to release the ALL has not been adequately assessed. METHODS We demonstrate a case series of ALL release using a posterior approach performed in conjunction with posterior column osteotomy (PCO), with or without transforaminal lumbar interbody fusion (TLIF) for spinal deformity. Eleven cases were identified from billing records between 2010 and 2019. Retrospective review was conducted for perioperative complications and revision surgery. Overall and segmental lumbar lordosis (LL) correction was measured from pre- and postoperative imaging. RESULTS Eleven patients underwent ALL release with a PCO. Kyphosis, scoliosis, and flat back syndrome were the most common spinal deformities. On average, patients had 9 ± 3 levels fused and a single level ALL release. ALL release was most commonly performed at L1-L2 and L2-L3 levels. An overall LL correction of 28.6° ± 19.8o was achieved; ALL release introduced 16.7° ± 11.9° of lordotic correction and accounted for 49.2 ± 30.4% of the overall lordotic correction. Average blood loss was 1030 ± 573 mL. CONCLUSIONS ALL release as an adjunct to PCO and TLIF is a viable technique for providing increased deformity correction without subjecting the patient to a more invasive three-column osteotomy. While this approach may not be appropriate for all patients, it represents a useful option in spinal deformity correction while limiting blood loss and additional anterior surgery. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Nathan Han
- Department of Neurosurgery, University of Maryland Medical Center, 22 S. Greene St, Baltimore, MD, 21201, USA.
| | - Nathan Pratt
- Department of Neurosurgery, University of Maryland Medical Center, 22 S. Greene St, Baltimore, MD, 21201, USA
| | - M Farooq Usmani
- Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Erik Hayman
- Department of Neurosurgery, University of Maryland Medical Center, 22 S. Greene St, Baltimore, MD, 21201, USA
| | - Salazar Jones
- Department of Neurosurgery, University of Maryland Medical Center, 22 S. Greene St, Baltimore, MD, 21201, USA
| | - Parker Johnsen
- Department of Orthopaedics, Cooper University Hospital, Camden, NJ, USA
| | - Alexandra E Thomson
- Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Ivan Ye
- Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Timothy Chryssikos
- Department of Neurosurgery, University of Maryland Medical Center, 22 S. Greene St, Baltimore, MD, 21201, USA
| | - Ashish Sharma
- Department of Neurosurgery, University of Maryland Medical Center, 22 S. Greene St, Baltimore, MD, 21201, USA
| | - Joshua Olexa
- Department of Neurosurgery, University of Maryland Medical Center, 22 S. Greene St, Baltimore, MD, 21201, USA
| | - Daniel L Cavanaugh
- Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Eugene Y Koh
- Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Kendall Buraimoh
- Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Steven Ludwig
- Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Charles Sansur
- Department of Neurosurgery, University of Maryland Medical Center, 22 S. Greene St, Baltimore, MD, 21201, USA
| |
Collapse
|
2
|
Weir TB, Usmani MF, Camacho J, Sokolow M, Bruckner J, Jazini E, Jauregui JJ, Gopinath R, Sansur C, Davis R, Koh EY, Banagan KE, Gelb DE, Buraimoh K, Ludwig SC. Effect of Surgical Setting on Cost and Hospital Reported Outcomes for Single-Level Anterior Cervical Discectomy and Fusion. Int J Spine Surg 2021; 15:701-709. [PMID: 34266936 DOI: 10.14444/8092] [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: 11/20/2022] Open
Abstract
BACKGROUND Hospitals seek to reduce costs and improve patient outcomes by decreasing length of stay (LOS), 30-day all-cause readmissions, and preventable complications. We evaluated hospital-reported outcome measures for elective single-level anterior cervical discectomy and fusions (ACDFs) between tertiary (TH) and community hospitals (CH) to determine location-based differences in complications, LOS, and overall costs. METHODS Patients undergoing elective single-level ACDF in a 1-year period were retrospectively reviewed from a physician-driven database from a single medical system consisting of 1 TH and 4 CHs. Adult patients who underwent elective single-level ACDF were included. Patients with trauma, tumor, prior cervical surgery, and infection were excluded. Outcomes measures included all-cause 30-day readmissions, preventable complications, LOS, and hospital costs. RESULTS A total of 301 patients (60 TH, 241 CH) were included. CHs had longer LOS (1.25 ± 0.50 versus 1.08 ± 0.28 days, P = .01). There were no differences in complication and readmission rates between hospital settings. CH, orthopaedic subspecialty, female sex, and myelopathy were predictors for longer LOS. Overall, costs at the TH were significantly higher than at CHs ($17 171 versus $11 737; Δ$ = 5434 ± 3996; P < .0001). For CHs, the total costs of drugs, rooms, supplies, and therapy were significantly higher than at the TH. TH status, orthopaedic subspecialty, and myelopathy were associated with higher costs. CONCLUSION Patients undergoing single-level ACDFs at CHs had longer LOS, but similar complications and readmission rates as those at the TH. However, cost of ACDF was 1.5 times greater in the TH. To improve patient outcomes, optimize value, and reduce hospital costs, modifiable factors for elective ACDFs should be evaluated. LEVEL OF EVIDENCE 3.
Collapse
Affiliation(s)
- Tristan B Weir
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - M Farooq Usmani
- Department of General Surgery, Eastern Virginia Medical School, Norfolk, Virginia
| | - Jael Camacho
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Michael Sokolow
- Quality Management Division, University of Maryland Medical System, Baltimore, Maryland
| | - Jacob Bruckner
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Julio J Jauregui
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Rohan Gopinath
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Charles Sansur
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Randy Davis
- Department of Orthopaedics, University of Maryland Baltimore Washington Medical Center, Baltimore, Maryland
| | - Eugene Y Koh
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kelley E Banagan
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Daniel E Gelb
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kendall Buraimoh
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Steven C Ludwig
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| |
Collapse
|
3
|
Strickland AR, Usmani MF, Camacho JE, Sahai A, Bruckner JJ, Buraimoh K, Koh EY, Gelb DE, Ludwig SC. Evaluation of Risk Factors for Postoperative Urinary Retention in Elective Thoracolumbar Spinal Fusion Patients. Global Spine J 2021; 11:338-344. [PMID: 32875879 PMCID: PMC8013941 DOI: 10.1177/2192568220904681] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
STUDY DESIGN Retrospective case series. OBJECTIVES Postoperative urinary retention (POUR) represents a common postoperative complication of all elective surgeries. The aim of this study was to identify demographic, comorbid, and surgical factors risk factors for POUR in patients who underwent elective thoracolumbar spine fusion. METHODS Following institutional review board approval, patients who underwent elective primary or revision thoracic and lumbar instrumented spinal fusion in a 2-year period in tertiary and academic institution were reviewed. Sex, age, BMI, preoperative diagnosis, comorbid conditions, benign prostatic hyperplasia, diabetes, primary or revision surgery status, narcotic use, and operative factors were collected and analyzed between patients with and without POUR. RESULTS Of the 217 patients reviewed, 54 (24.9%) developed POUR. The average age for a patient with POUR was 67 ± 9, as opposed to 59 ± 10 for those without (P < .0001). Single-level fusions were associated with a 0% incidence of POUR, compared with 54.5% in 6 or more levels. The average hospital stay was increased by 1 day for those who had POUR (5.8 ± 3.3 vs 4.9 ± 3.9 days). There was no significant association with other demographic variables, comorbid conditions, or surgical factors. CONCLUSIONS POUR was a common complication in our patient cohort, with an incidence of 24.9%. Our findings demonstrate that patients who developed POUR are significantly older and have larger constructs. Patients who developed POUR also had longer in-hospital stays. Although our study supports other findings in the spine literature, more prospective data is needed to define diagnostic criteria of POUR as well as its management.
Collapse
Affiliation(s)
| | | | - Jael E. Camacho
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Amil Sahai
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | - Eugene Y. Koh
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Daniel E. Gelb
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Steven C. Ludwig
- University of Maryland School of Medicine, Baltimore, MD, USA
- Steven C. Ludwig, University of Maryland, Department of Orthopaedics, 110 South Paca Street, 6th Floor, Suite 300, Baltimore, MD 21201, USA.
| |
Collapse
|
4
|
Weir TB, Sardesai N, Jauregui JJ, Jazini E, Sokolow MJ, Usmani MF, Camacho JE, Banagan KE, Koh EY, Kurtom KH, Davis RF, Gelb DE, Ludwig SC. Effect of Surgical Setting on Hospital-Reported Outcomes for Elective Lumbar Spinal Procedures: Tertiary Versus Community Hospitals. Global Spine J 2020; 10:375-383. [PMID: 32435555 PMCID: PMC7222676 DOI: 10.1177/2192568219848666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE As hospital compensation becomes increasingly dependent on pay-for-performance and bundled payment compensation models, hospitals seek to reduce costs and increase quality. To our knowledge, no reported data compare these measures between hospital settings for elective lumbar procedures. The study compares hospital-reported outcomes and costs for elective lumbar procedures performed at a tertiary hospital (TH) versus community hospitals (CH) within a single health care system. METHODS Retrospective review of a physician-maintained, prospectively collected database consisting of 1 TH and 4 CH for 3 common lumbar surgeries from 2015 to 2016. Patients undergoing primary elective microdiscectomy for disc herniation, laminectomy for spinal stenosis, and laminectomy with fusion for degenerative spondylolisthesis were included. Patients were excluded for traumatic, infectious, or malignant pathology. Comparing hospital settings, outcomes included length of stay (LOS), rates of 30-day readmissions, potentially preventable complications (PPC), and discharge to rehabilitation facility, and hospital costs. RESULTS A total of 892 patients (n = 217 microdiscectomies, n = 302 laminectomies, and n = 373 laminectomy fusions) were included. The TH served a younger patient population with fewer comorbid conditions and a higher proportion of African Americans. The TH performed more decompressions (P < .001) per level fused; the CH performed more interbody fusions (P = .007). Cost of performing microdiscectomy (P < .001) and laminectomy (P = .014) was significantly higher at the TH, but there was no significant difference for laminectomy with fusion. In a multivariable stepwise linear regression analysis, the TH was significantly more expensive for single-level microdiscectomy (P < .001) and laminectomy with single-level fusion (P < .001), but trended toward significance for laminectomy without fusion (P = .052). No difference existed for PPC or readmissions rate. Patients undergoing laminectomy without fusion were discharged to a facility more often at the TH (P = .019). CONCLUSIONS We provide hospital-reported outcomes between a TH and CH. Significant differences in patient characteristics and surgical practices exist between surgical settings. Despite minimal differences in hospital-reported outcomes, the TH was significantly more expensive.
Collapse
Affiliation(s)
- Tristan B. Weir
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Neil Sardesai
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Ehsan Jazini
- MedStar Georgetown University Hospital, Washington, DC, USA
| | | | | | - Jael E. Camacho
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Eugene Y. Koh
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Randy F. Davis
- University of Maryland Baltimore Washington Medical Center, Glen Burnie, MD, USA
| | - Daniel E. Gelb
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Steven C. Ludwig
- University of Maryland School of Medicine, Baltimore, MD, USA,Steven C. Ludwig, Department of Orthopaedics, University of Maryland, 110 South Paca Street, 6th Floor, Suite 300, Baltimore, MD 21201, USA.
| |
Collapse
|
5
|
Cavanaugh D, Usmani MF, Weir TB, Camacho J, Yousaf I, Khatri V, Bivona L, Shasti M, Koh EY, Banagan KE, Ludwig SC, Gelb DE. Radiographic Evaluation of Minimally Invasive Instrumentation and Fusion for Treating Unstable Spinal Column Injuries. Global Spine J 2020; 10:169-176. [PMID: 32206516 PMCID: PMC7076603 DOI: 10.1177/2192568219856872] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE Facet fusion in minimally invasive spine surgery (MISS) may reduce morbidity and promote long-term construct stability. The study compares the maintenance of correction of thoracolumbar (TL) trauma patients who underwent MISS with facet fusion (FF) and without facet fusion (WOFF) and evaluates instrumentation loosening and failure. METHODS TL trauma patients who underwent MISS between 2006 and 2013 were identified and stratified into FF and WOFF groups. To evaluate progressive kyphosis and loss of correction, Cobb angles were measured at immediate postoperative, short-term, and long-term follow-up. Evidence of >2 mm of radiolucency on radiographs indicated screw loosening. If instrumentation was removed, postremoval kyphosis angle was obtained. RESULTS Of the 80 patients, 24 were in FF and 56 were in WOFF group. Between immediate postoperative and short-term follow-up, kyphosis angle changed by 4.0° (standard error [SE] 1.3°) in the FF and by 3.0° (SE 0.4°) in the WOFF group. The change between immediate postoperative and long-term follow-up kyphosis angles was 3.4° (S.E 1.1°) and 5.2° (S.E 1.6°) degrees in the FF and WOFF groups, respectively. Facet fusion had no impact on the change in kyphosis at short term (P = .49) or long term (P = .39). The screw loosening rate was 20.5% for the 80 patients with short-term follow-up and 68.8% for the 16 patients with long-term follow-up. There was no difference in screw loosening rate. Fifteen patients underwent instrumentation removal-all from the FF group. CONCLUSION FF in MISS does not impact the correction achieved and maintenance of correction in patients with traumatic spine injuries.
Collapse
Affiliation(s)
- Daniel Cavanaugh
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Tristan B. Weir
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jael Camacho
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Imran Yousaf
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Vishal Khatri
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Louis Bivona
- Cooper University Health Care, Baltimore, MD, USA
| | - Mark Shasti
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Eugene Y. Koh
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | - Daniel E. Gelb
- University of Maryland School of Medicine, Baltimore, MD, USA,Daniel E. Gelb, Department of Orthopaedics, University of Maryland, 110 South Paca Street, 6th Floor, Suite 300, Baltimore, MD 21201, USA.
| |
Collapse
|
6
|
Afolabi A, Weir TB, Usmani MF, Camacho JE, Bruckner JJ, Gopinath R, Banagan KE, Koh EY, Gelb DE, Ludwig SC. Comparison of percutaneous minimally invasive versus open posterior spine surgery for fixation of thoracolumbar fractures: A retrospective matched cohort analysis. J Orthop 2019; 18:185-190. [PMID: 32042224 DOI: 10.1016/j.jor.2019.11.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 11/24/2019] [Indexed: 12/15/2022] Open
Abstract
Introduction Percutaneous minimally invasive spine surgery (MISS) is a treatment option for thoracolumbar fractures and we aim to evaluate its outcomes. Methods A retrospective matched cohort study of all patients with thoracolumbar fractures treated with MISS or open posterior approach. Results We included 100 MISS and 155 open patients. After controlling for patient characteristics, our results statistically favor MISS in mean operative time, mean intraoperative blood loss, and number of patients requiring postoperative blood transfusions within 48 h. Conclusions Advantages of using MISS for treatment of thoracolumbar fractures are decreased operative time, decreased blood loss, and fewer patients requiring transfusions.
Collapse
Affiliation(s)
- Abimbola Afolabi
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tristan B Weir
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - M Farooq Usmani
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jael E Camacho
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jacob J Bruckner
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Rohan Gopinath
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kelley E Banagan
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Eugene Y Koh
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Daniel E Gelb
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Steven C Ludwig
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
7
|
Camacho JE, Usmani MF, Strickland AR, Banagan KE, Ludwig SC. The use of minimally invasive surgery in spine trauma: a review of concepts. J Spine Surg 2019; 5:S91-S100. [PMID: 31380497 DOI: 10.21037/jss.2019.04.13] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Traumatic injuries to the spine can be common in the setting of blunt trauma and delayed diagnosis can have a deleterious effect on patients' health. The goals of treatment in managing spine trauma are prevention of neurological injury, providing stability to the spine, and correcting post-traumatic deformity. Minimally invasive spine surgery (MISS) techniques are an alternative to open spine surgery for treatment of spine fractures. MISS is also a viable treatment in the setting of damage control orthopedics, when patients with multiple traumatic injuries may be unable to tolerate a traditional open approach. MISS techniques have been used in the treatment of unstable fractures with or without spinal cord injury, flexion and extension-distraction injuries, and unstable sacral fractures. Traditional open surgeries have been associated with increased blood loss, longer operative times, and a higher risk for surgical site infection (SSI). MISS techniques have the potential to reduce open approach-associated morbidity, and improve postoperative care and rehabilitation. MISS techniques for spine trauma are an indispensable option in the treatment armamentarium of spine surgeons.
Collapse
Affiliation(s)
- Jael E Camacho
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - M Farooq Usmani
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ashely R Strickland
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kelley E Banagan
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Steven C Ludwig
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
8
|
Camacho JE, Usmani MF, Ho CY, Sansur CA, Ludwig SC. Perineal and Radicular Pain Caused by Contralateral Sacral Nerve Root Schwannoma: Case Report and Review of Literature. World Neurosurg 2019; 129:210-215. [PMID: 31203077 DOI: 10.1016/j.wneu.2019.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 06/04/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Sacral schwannomas are very rare nerve sheath tumors. Patients usually present with a variety of nonspecific symptoms, which often lead to a delay in diagnosis. Although most schwannomas are benign, they present surgical challenges owing to their proximity to neurologic and other anatomic structures. CASE DESCRIPTION This 58-year-old female presented with a 2-month old history of left-sided perineal and radicular pain secondary to a right S2 sacral nerve root schwannoma. The sacral mass demonstrated homogenous enhancement with cystic changes in a T2-weighted magnetic resonance imaging sequence. The patient underwent S1-S3 laminectomy and tumor excision through a posterior surgical approach. Intraoperative monitoring was used to distinguish nonfunctional tissue during tumor resection. The patient had an unremarkable postoperative course. CONCLUSIONS Sacral schwannomas can present with a variety of nonspecific symptoms. They pose unique challenges given their location, size, and involvement of surrounding structures. Complete surgical resection is the main goal of sacral schwannoma treatment. A combined anterior-posterior surgical approach and a multidisciplinary surgical team are associated with improved outcomes.
Collapse
Affiliation(s)
- Jael E Camacho
- Department of Orthopedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - M Farooq Usmani
- Department of Orthopedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Cheng-Ying Ho
- Department of Pathology and Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Charles A Sansur
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Steven C Ludwig
- Department of Orthopedics, University of Maryland School of Medicine, Baltimore, Maryland, USA.
| |
Collapse
|
9
|
Prevosto C, Usmani MF, McDonald S, Gumienny AM, Key T, Goodman RS, Gaston JSH, Deery MJ, Busch R. Allele-Independent Turnover of Human Leukocyte Antigen (HLA) Class Ia Molecules. PLoS One 2016; 11:e0161011. [PMID: 27529174 PMCID: PMC4987023 DOI: 10.1371/journal.pone.0161011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 07/28/2016] [Indexed: 11/29/2022] Open
Abstract
Major histocompatibility complex class I (MHCI) glycoproteins present cytosolic peptides to CD8+ T cells and regulate NK cell activity. Their heavy chains (HC) are expressed from up to three MHC gene loci (human leukocyte antigen [HLA]-A, -B, and -C in humans), whose extensive polymorphism maps predominantly to the antigen-binding groove, diversifying the bound peptide repertoire. Codominant expression of MHCI alleles is thus functionally critical, but how it is regulated is not fully understood. Here, we have examined the effect of polymorphism on the turnover rates of MHCI molecules in cell lines with functional MHCI peptide loading pathways and in monocyte-derived dendritic cells (MoDCs). Proteins were labeled biosynthetically with heavy water (2H2O), folded MHCI molecules immunoprecipitated, and tryptic digests analysed by mass spectrometry. MHCI-derived peptides were assigned to specific alleles and isotypes, and turnover rates quantified by 2H incorporation, after correcting for cell growth. MHCI turnover half-lives ranged from undetectable to a few hours, depending on cell type, activation state, donor, and MHCI isotype. However, in all settings, the turnover half-lives of alleles of the same isotype were similar. Thus, MHCI protein turnover rates appear to be allele-independent in normal human cells. We propose that this is an important feature enabling the normal function and codominant expression of MHCI alleles.
Collapse
Affiliation(s)
- Claudia Prevosto
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - M. Farooq Usmani
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Sarah McDonald
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | | | - Tim Key
- Tissue Typing Laboratory, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Reyna S. Goodman
- Tissue Typing Laboratory, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - J. S. Hill Gaston
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Michael J. Deery
- Cambridge Centre for Proteomics, University of Cambridge, Cambridge, United Kingdom
| | - Robert Busch
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
- Department of Life Sciences, University of Roehampton, London, United Kingdom
| |
Collapse
|