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Duvvuri P, Lafage R, Bannwarth M, Passias P, Bess S, Smith JS, Klineberg E, Kim HJ, Shaffrey C, Burton D, Gupta M, Protopsaltis T, Ames C, Schwab F, Lafage V. The Shape of the Fused Spine is Associated With Acute Proximal Junctional Kyphosis in Adult Spinal Deformity: An Assessment Based on Vertebral Pelvic Angles. Global Spine J 2023:21925682221150770. [PMID: 36625677 DOI: 10.1177/21925682221150770] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
STUDY DESIGN Retrospective review of prospective database. OBJECTIVES Vertebral pelvic angles (VPAs) account for complexity in spine shape by assessing the relative position of each vertebra with regard to the pelvis. This study uses VPAs to investigate the shape of the fused spine after T10-pelvis fusion, in patients with adult spinal deformity (ASD), and then explores its association with proximal junctional kyphosis (PJK). METHODS Included patients had radiographic evidence of ASD and underwent T10-pelvis realignment. VPAs were used to construct a virtual shape of the post-operative spine. VPA-predicted and actual shapes were then compared between patients with and without PJK. Logistic regression was used to identify components of the VPA-based model that were independent predictors of PJK occurrence and post-operative shape. RESULTS 287 patients were included. VPA-predicted shape was representative of the true post-operative contour, with a mean point-to-point error of 1.6-2.9% of the T10-S1 spine length. At 6-weeks follow-up, 102 patients (35.5%) developed PJK. Comparison of the true post-operative shapes demonstrated that PJK patients had more posteriorly translated vertebrae from L3 to T7 (P < .001). Logistic regression demonstrated that L3PA (P = .047) and T11PA (P < .001) were the best independent predictors of PJK and were, in conjunction with pelvic incidence, sufficient to reproduce the actual spinal contour (error <3%). CONCLUSIONS VPAs are reliable in reproducing the true, post-operative spine shape in patients undergoing T10-pelvis fusion for ASD. Because VPAs are independent of patient position, L3PA, T11PA, and PI measurements can be used for both pre- and intra-operative planning to ensure optimal alignment.
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Affiliation(s)
- Priya Duvvuri
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | | | - Peter Passias
- Departments of Orthopaedic Surgery, NYU Langone, New York, NY, USA
| | - Shay Bess
- Denver International Spine Center, Presbyterian St Luke's/Rocky Mountain Hospital for Children, Denver, CO, USA
| | - Justin S Smith
- Department of Neurosurgery, University of VirginiaMedical Center, Charlottesville, VA, USA
| | - Eric Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA, USA
| | - Han Jo Kim
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | | | - Douglas Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Munish Gupta
- Department of Orthopaedic Surgery, Washington University, St Louis, MO, USA
| | | | - Christopher Ames
- Department of Neurosurgery, University of California School of Medicine, San Francisco, CA, USA
| | - Frank Schwab
- Department of Orthopaedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA
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Elysee JC, Lovecchio F, Lafage R, Ang B, Huang A, Bannwarth M, Kim HJ, Schwab F, Lafage V. Supine Imaging Is a Superior Predictor of Long-Term Alignment Following Adult Spinal Deformity Surgery. Global Spine J 2022; 12:631-637. [PMID: 32975440 PMCID: PMC9109569 DOI: 10.1177/2192568220960753] [Citation(s) in RCA: 3] [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: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To investigate correlations between preoperative supine imaging and postoperative alignment. METHODS A retrospective review was conducted of a single-institution database of patients with adult spinal deformity (ASD). Patients were stratified by fusion location in the lumbar or thoracic spine. Outcomes of interest were postoperative lumbar lordosis (LL) and thoracic kyphosis (TK). Sagittal alignment parameters were compared and correlation analyses were performed. Multilinear stepwise regression was conducted to identify independent predictors of postoperative LL or TK. Regression analyses were repeated within the lumbar and thoracic fusion cohorts. RESULTS A total of 99 patients were included (mean age 63.2 years, 83.1% female, mean body mass index 27.3 kg/m2). Scoliosis Research Society classification demonstrated moderate to severe sagittal and/or coronal deformity (pelvic tile modifier, 18.2% ++; sagittal vertical axis, 27.3% ++, pelvic incidence minus lumbar lordosis mismatch, 29.3% ++, SRS type, 29.3% N type curve and 68.7% L or D type curve). A total of 73 patients (73.7%) underwent lumbar fusion and 50 (50.5%) underwent thoracic fusion. Correlation analyses demonstrated a significant association between pre- and postoperative LL and TK. Multilinear regression demonstrated that LL supine and pelvic incidence were significant predictors of postoperative LL (r2 = 0.568, P < .001). LL supine, TK supine, and age were significant predictors of postoperative TK (r2 = 0.490, P < .001). CONCLUSION Preoperative supine films are superior to standing in predicting postoperative alignment at 1-year follow-up. Anticipation of undesired alignment changes through supine imaging may be useful in mitigating the risk of iatrogenic malalignment.
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Affiliation(s)
| | | | | | - Bryan Ang
- Hospital for Special Surgery, New York, NY, USA,Bryan Ang, Hospital for Special Surgery, 525
East 71st Street, New York, NY 10021, USA.
| | - Alex Huang
- Hospital for Special Surgery, New York, NY, USA
| | | | - Han Jo Kim
- Hospital for Special Surgery, New York, NY, USA
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Lovecchio F, Elysee JC, Lafage R, Varghese J, Bannwarth M, Schwab F, Lafage V, Kim HJ. The impact of preoperative supine radiographs on surgical strategy in adult spinal deformity. J Neurosurg Spine 2021; 36:71-77. [PMID: 34507286 DOI: 10.3171/2021.3.spine201739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/04/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Preoperative planning for adult spinal deformity (ASD) surgery is essential to prepare the surgical team and consistently obtain postoperative alignment goals. Positional imaging may allow the surgeon to evaluate spinal flexibility and anticipate the need for more invasive techniques. The purpose of this study was to determine whether spine flexibility, defined by the change in alignment between supine and standing imaging, is associated with the need for an osteotomy in ASD surgery. METHODS A single-center, dual-surgeon retrospective analysis was performed of adult patients with ASD who underwent correction of a thoracolumbar deformity between 2014 and 2018 (pelvis to upper instrumented vertebra between L1 and T9). Patients were stratified into osteotomy (Ost) and no-osteotomy (NOst) cohorts according to whether an osteotomy was performed (Schwab grade 2 or higher). Demographic, surgical, and radiographic parameters were compared. The sagittal correction from intraoperative prone positioning alone (sagittal flexibility percentage [Sflex%]) was assessed by comparing the change in lumbar lordosis (LL) between preoperative supine to standing radiographs and preoperative to postoperative alignment. RESULTS Demographics and preoperative and postoperative sagittal alignment were similar between the Ost (n = 60, 65.9%) and NOst (n = 31, 34.1%) cohorts (p > 0.05). Of all Ost patients, 71.7% had a grade 2 osteotomy (mean 3 per patient), 21.7% had a grade 3 osteotomy, and 12.5% underwent both grade 3 and grade 2 osteotomies. Postoperatively, the NOst and Ost cohorts had similar pelvic incidence minus lumbar lordosis (PI-LL) mismatch (mean PI-LL 5.2° vs 1.2°; p = 0.205). Correction obtained through positioning (Sflex%) was significantly lower for in the osteotomy cohort (38.0% vs 76.3%, p = 0.004). A threshold of Sflex% < 70% predicted the need for osteotomy at a sensitivity of 78%, specificity of 56%, and positive predictive value of 77%. CONCLUSIONS The flexibility of the spine is quantitatively related to the use of an osteotomy. Prospective studies are needed to determine thresholds that may be used to standardize surgical decision-making in ASD surgery.
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Bannwarth M, Smith JS, Bess S, Klineberg EO, Ames CP, Mundis GM, Kim HJ, Lafage R, Gupta MC, Burton DC, Shaffrey CI, Schwab FJ, Lafage V. Use of rhBMP-2 for adult spinal deformity surgery: patterns of usage and changes over the past decade. Neurosurg Focus 2021; 50:E4. [PMID: 34062501 DOI: 10.3171/2021.3.focus2164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/17/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Recombinant human bone morphogenetic protein-2 (rhBMP-2) has been shown to increase fusion rates; however, cost, limited FDA approval, and possible complications impact its use. Decisions regarding rhBMP-2 use and changes over time have not been well defined. In this study, the authors aimed to assess changes in rhBMP-2 use for adult spinal deformity (ASD) surgery over the past decade. METHODS A retrospective review of the International Spine Study Group prospective multicenter database was performed to identify ASD patients treated surgically from 2008 to 2018. For assessment of rhBMP-2 use over time, 3 periods were created: 2008-2011, 2012-2015, and 2016-2018. RESULTS Of the patients identified, 1180 met inclusion criteria, with a mean age 60 years and 30% of patients requiring revision surgery; rhBMP-2 was used in 73.9% of patients overall. The mean rhBMP-2 dose per patient was 23.6 mg. Patients receiving rhBMP-2 were older (61 vs 58 years, p < 0.001) and had more comorbidities (Charlson Comorbidity Index 1.9 vs 1.4, p < 0.001), a higher rate of the Scoliosis Research Society-Schwab pelvic tilt modifier (> 0; 68% vs 62%, p = 0.026), a greater deformity correction (change in pelvic incidence minus lumbar lordosis 15° vs 12°, p = 0.01), and more levels fused (8.9 vs 7.9, p = 0.003). Over the 3 time periods, the overall rate of rhBMP-2 use increased and then stabilized (62.5% vs 79% vs 77%). Stratified analysis showed that after an overall increase in rhBMP-2 use, only patients who were younger than 50 years, those who were smokers, those who received a three-column osteotomy (3CO), and patients who underwent revision sustained an increased rate of rhBMP-2 use between the later two periods. No similar increases were noted for older patients, nonsmokers, primary surgery patients, and patients without a 3CO. The total rhBMP-2 dose decreased over time (26.6 mg vs 24.8 mg vs 20.7 mg, p < 0.001). After matching patients by preoperative alignment, 215 patients were included, and a significantly lower rate of complications leading to revision surgery was observed within the 2012-2015 period compared with the 2008-2011 (21.4% vs 13.0%, p = 0.029) period, while rhBMP-2 was increasingly used (80.5% vs 66.0%, p = 0.001). There was a trend toward a lower rate of pseudarthrosis for patients in the 2012-2015 period, but this difference did not reach statistical significance (7% vs 4.2%, p = 0.283). CONCLUSIONS The authors found that rhBMP-2 was used in the majority of ASD patients and was more commonly used in those with greater deformity correction. Additionally, over the last 10 years, rhBMP-2 was increasingly used for ASD patients, but the dose has decreased.
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Affiliation(s)
| | - Justin S Smith
- 2Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
| | - Shay Bess
- 3Rocky Mountain Scoliosis and Spine, Denver, Colorado
| | - Eric O Klineberg
- 4Department of Orthopaedic Surgery, University of California, Davis
| | - Christopher P Ames
- 5Department of Neurological Surgery, University of California, San Francisco
| | | | - Han Jo Kim
- 7Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Renaud Lafage
- 7Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | | | - Douglas C Burton
- 9Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas; and
| | - Christopher I Shaffrey
- 10Departments of Neurosurgery and Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Frank J Schwab
- 7Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Virginie Lafage
- 7Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
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Kim HJ, Yao YC, Bannwarth M, Smith JS, Klineberg EO, Mundis GM, Protopsaltis TS, Charles-Elysee J, Bess S, Shaffrey CI, Passias PG, Schwab FJ, Ames CP, Lafage V. Cervicothoracic Versus Proximal Thoracic Lower Instrumented Vertebra Have Comparable Radiographic and Clinical Outcomes in Adult Cervical Deformity. Global Spine J 2021; 13:1056-1063. [PMID: 34013765 DOI: 10.1177/21925682211017478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Comparative cohort study. OBJECTIVE Factors that influence the lower instrumented vertebra (LIV) selection in adult cervical deformity (ACD) are less reported, and outcomes in the cervicothoracic junction (CTJ) and proximal thoracic (PT) spine are unclear. METHODS A prospective ACD database was analyzed using the following inclusion criteria: LIV between C7 and T5, upper instrumented vertebra at C2, and at least a 1-year follow-up. Patients were divided into CTJ (LIV C7-T2) and PT groups (LIV T3-T5) based on LIV levels. Demographics, operative details, radiographic parameters, and the health-related quality of life (HRQOL) scores were compared. RESULTS Forty-six patients were included (mean age, 62 years), with 22 and 24 patients in the CTJ and PT groups, respectively. Demographics and surgical parameters were comparable between the groups. The PT group had a significantly higher preoperative C2-C7 sagittal vertical axis (cSVA) (46.9 mm vs 32.6 mm, P = 0.002) and T1 slope minus cervical lordosis (45.9° vs 36.0°, P = 0.042) than the CTJ group and was more likely treated with pedicle-subtraction osteotomy (33.3% vs 0%, P = 0.004). The PT group had a larger correction of cSVA (-7.7 vs 0.7 mm, P = 0.037) and reciprocal change of increased T4-T12 kyphosis (8.6° vs 0.0°, P = 0.001). Complications and reoperations were comparable. The HRQOL scores were not different preoperatively and at 1-year follow-up. CONCLUSIONS The selection of PT LIV in cervical deformities was more common in patients with larger baseline deformities, who were more likely to undergo pedicle-subtraction osteotomy. Despite this, the complications and HRQOL outcomes were comparable at 1-year follow-up.
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Affiliation(s)
- Han Jo Kim
- Spine Service, Hospital for Special Surgery, New York, NY, USA
| | - Yu-Cheng Yao
- Spine Service, Hospital for Special Surgery, New York, NY, USA.,Department of Orthopaedic, 46615Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mathieu Bannwarth
- Spine Service, Hospital for Special Surgery, New York, NY, USA.,Neurosurgery, University Hospital Reims, Reims, France
| | - Justin S Smith
- Department of Neurosurgery, 2358University of Virginia Health Sciences Center, Charlottesville, VA, USA
| | - Eric O Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA, USA
| | | | | | | | - Shay Bess
- Department of Orthopaedic Surgery, Denver International Spine Center, Denver, CO, USA
| | | | - Peter G Passias
- Division of Spine Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY, USA
| | - Frank J Schwab
- Spine Service, Hospital for Special Surgery, New York, NY, USA
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Virginie Lafage
- Spine Service, Hospital for Special Surgery, New York, NY, USA
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Lovecchio F, Lafage R, Elysee JC, Huang A, Ang B, Bannwarth M, Kim HJ, Schwab F, Lafage V. The utility of supine radiographs in the assessment of thoracic flexibility and risk of proximal junctional kyphosis. J Neurosurg Spine 2021:1-7. [PMID: 33962389 DOI: 10.3171/2020.11.spine201565] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/02/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Supine radiographs have successfully been used for preoperative planning of lumbar deformity corrections. However, they have not been used to assess thoracic flexibility, which has recently garnered attention as a potential contributor to proximal junctional kyphosis (PJK). The purpose of this study was to compare supine to standing radiographs to assess thoracic flexibility and to determine whether thoracic flexibility is associated with PJK. METHODS A retrospective study was conducted of a single-institution database of patients with adult spinal deformity (ASD). Sagittal alignment parameters were compared between standing and supine and between pre- and postoperative radiographs. Thoracic flexibility was determined as the change between preoperative standing thoracic kyphosis (TK) and preoperative supine TK, and these changes were measured over the overall thoracic spine and the fused portion of the thoracic spine (i.e., TK fused). A case-control analysis was performed to compare thoracic flexibility between patients with PJK and those without (no PJK). The cohort was also stratified into three groups based on thoracic flexibility: kyphotic change (increased TK), lordotic change (decreased TK), and no change. The PJK rate was compared between the cohorts. RESULTS A total of 101 patients (mean 63 years old, 82.2% female, mean BMI 27.4 kg/m2) were included. Preoperative Scoliosis Research Society-Schwab ASD classification showed moderate preoperative deformity (pelvic tilt 27.7% [score ++]; pelvic incidence-lumbar lordosis mismatch 44.6% [score ++]; sagittal vertical axis 42.6% [score ++]). Postoperatively, the average offset from age-adjusted alignment goals demonstrated slight overcorrection in the study sample (-8.5° ± 15.6° pelvic incidence-lumbar lordosis mismatch, -29.2 ± 53.1 mm sagittal vertical axis, -5.4 ± 10.8 pelvic tilt, and -7.6 ± 11.7 T1 pelvic angle). TK decreased between standing and supine radiographs and increased postoperatively (TK fused: -25.3° vs -19.6° vs -29.9°; all p < 0.001). The overall rate of radiographic PJK was 23.8%. Comparisons between PJK and no PJK demonstrated that offsets from age-adjusted alignment goals were similar (p > 0.05 for all). There was a significant difference in the PJK rate when stratified by thoracic flexibility cohorts (kyphotic: 0.0% vs no change: 18.4% vs lordotic: 35.0%; p = 0.049). Logistic regression revealed thoracic flexibility (p = 0.045) as the only independent correlate of PJK. CONCLUSIONS Half of patients with ASD experienced significant changes in TK during supine positioning, a quality that may influence surgical strategy. Increased thoracic flexibility is associated with PJK, possibly secondary to fusing the patient's spine in a flattened position intraoperatively.
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Ang B, Lafage R, Elysée JC, Pannu TS, Bannwarth M, Carlson BB, Schwab FJ, Kim HJ, Lafage V. In the Relationship Between Change in Kyphosis and Change in Lordosis: Which Drives Which? Global Spine J 2021; 11:541-548. [PMID: 32875889 PMCID: PMC8119914 DOI: 10.1177/2192568220914882] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective single-center study. OBJECTIVE Investigate the effect of posterior instrumentation on the relationship between lordosis and kyphosis. METHODS Surgically treated patients with a minimum of 6 months of follow-up were analyzed. Asymptomatic volunteers served to show the normal anatomical relationship between thoracic and lumbar curves. Patients were stratified based on postoperative instrumentation: "Thoracic Fusion" = complete fusion of thoracic spine; "Lumbar Fusion" = complete fusion of lumbar spine; and "Complete Fusion" = fusion from sacrum to at least T5. Bivariate correlations and regression analysis were used to evaluate the relationship between change in thoracic kyphosis (ΔTK) and change in spinopelvic mismatch (ΔPI-LL; pelvic incidence-lumbar lordosis) before and after fusion. Analyses were repeated in "Lumbar Fusion" patients with flexible preoperative thoracic spines. RESULTS For asymptomatic volunteers, the natural anatomical relationship between TK and LL was found to be TK = 41% of LL (r = 0.425, P < .001). A total of 153 of 167 adult spinal deformity patients were included (62 years old, 26.7 kg/m2, 78% female). Mean follow-up was 11.5 ± 6.8 months. "Thoracic Fusion" group showed no alteration in the natural relationship between TK and LL (ΔTK = 39% ΔPI-LL), whereas "Lumbar Fusion" group had a reduction in reciprocal change (ΔTK = 34% ΔPI-LL) although a subanalysis of patients in the "Lumbar Fusion" group with flexible thoracic spines showed a marked compensation in reciprocal change with (ΔTK = 58% ΔPI-LL). CONCLUSION The relationship between ΔTK and ΔPI-LL is dependent on level instrumented. "Thoracic Fusion" drives change in LL while this relationship is affected by TK's natural stiffness in "Lumbar Fusion" patients.
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Affiliation(s)
- Bryan Ang
- Hospital for Special
Surgery, New York, NY, USA,Weill Cornell Medicine Medical School, New York, NY, USA
| | - Renaud Lafage
- Hospital for Special
Surgery, New York, NY, USA,Renaud Lafage, 525 E 71st St, Belaire 4E,
New York, NY 10021, USA.
| | | | | | - Mathieu Bannwarth
- Hospital for Special
Surgery, New York, NY, USA,CHU de Reims, Reims, France
| | - Brandon B. Carlson
- Hospital for Special
Surgery, New York, NY, USA,University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Han Jo Kim
- Hospital for Special
Surgery, New York, NY, USA
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Yao YC, Kim HJ, Bannwarth M, Smith J, Bess S, Klineberg E, Ames CP, Shaffrey CI, Burton D, Gupta M, Mundis GM, Hostin R, Schwab F, Lafage V. Lowest Instrumented Vertebra Selection to S1 or Ilium Versus L4 or L5 in Adult Spinal Deformity: Factors for Consideration in 349 Patients With a Mean 46-Month Follow-Up. Global Spine J 2021; 13:932-939. [PMID: 33906457 DOI: 10.1177/21925682211009178] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To compare the outcomes of patients with adult spinal deformity (ASD) following spinal fusion with the lowest instrumented vertebra (LIV) at L4/L5 versus S1/ilium. METHODS A multicenter ASD database was evaluated. Patients were categorized into 2 groups based on LIV levels-groups L (fusion to L4/L5) and S (fusion to S1/ilium). Both groups were propensity matched by age and preoperative radiographic alignments. Patient demographics, operative details, radiographic parameters, revision rates, and health-related quality of life (HRQOL) scores were compared. RESULTS Overall, 349 patients had complete data, with a mean follow-up of 46 months. Patients in group S (n = 311) were older and had larger sagittal and coronal plane deformities than those in group L (n = 38). After matching, 28 patients were allocated to each group with similar demographic, radiographic, and clinical parameters. Sagittal alignment restoration at postoperative week 6 was significantly better in group S than in group L, but it was similar in both groups at the 2-year follow-up. Fusion to S1/ilium involved a longer operating time, higher PJK rates, and greater PJK angles than that to L4/L5. There were no significant differences in the complication and revision rates between the groups. Both groups showed significant improvements in HRQOL scores. CONCLUSIONS Fusion to S1/ilium had better sagittal alignment restoration at postoperative week 6 and involved higher PJK rates and greater PJK angles than that to L4/L5. The clinical outcomes and rates of revision surgery and complications were similar between the groups.
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Affiliation(s)
- Yu-Cheng Yao
- Department of Orthopedics and Traumatology, 46615Taipei Veterans General Hospital, Taipei, Taiwan.,Spine Service, Hospital for Special Surgery, New York, NY, USA
| | - Han Jo Kim
- Spine Service, Hospital for Special Surgery, New York, NY, USA
| | | | - Justin Smith
- Department of Neurosurgery, University of Virginia Health Sciences Center, Charlottesville, VA, USA
| | - Shay Bess
- Department of Orthopaedic Surgery, Denver International Spine Center, Denver, CO, USA
| | - Eric Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA, USA
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Christopher I Shaffrey
- Department of Neurosurgery, University of Virginia Health Sciences Center, Charlottesville, VA, USA
| | - Douglas Burton
- Department of Orthopedic Surgery, 21638University of Kansas Medical Center, Kansas City, KS, USA
| | - Munish Gupta
- Department of Orthopaedic Surgery, Washington University in St. Louis, MO, USA
| | | | - Richard Hostin
- Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, TX, USA
| | - Frank Schwab
- Spine Service, Hospital for Special Surgery, New York, NY, USA
| | - Virginie Lafage
- Spine Service, Hospital for Special Surgery, New York, NY, USA
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Elysee JC, Lovecchio F, Lafage R, Ang B, Huang A, Bannwarth M, Kim HJ, Schwab F, Lafage V. The relationship of global sagittal malalignment to fatty infiltration in the aging spine. Eur Spine J 2021; 30:2480-2485. [PMID: 33609190 DOI: 10.1007/s00586-021-06759-7] [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] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/01/2021] [Accepted: 01/30/2021] [Indexed: 01/17/2023]
Abstract
PURPOSE To investigate associations between muscle size, fat infiltration (FI), and global sagittal alignment in patients with adult spinal deformity (ASD). METHODS Retrospective cohort study was conducted on a single-institution database of ASD patients with preoperative radiographs and CTs. Following multiplanar reconstructions of CTs, images in the plane of each vertebra were generated. The posterior vertebral musculature (PVM) was contoured on axial images at three vertebral levels (T2, T10, L3). FI was calculated by comparing Hounsfield units within muscles to the normative values of fat. Correlation analyses were conducted between demographics, alignment, and muscle characteristics. RESULTS 107 patients underwent preoperative spine CT (58yo, 79%F, BMI 27 kg/m2). Muscle data were available for 49 pts at T2, 39 pts at T10, and 81 pts at L3. Mean FI was T2 = 33% ± 18, T10 = 28% ± 19, L3_Erector = 39% ± 19, and L3_Psoas = 19% ± 9. FI correlated across levels (T2 vs. T10 r = 0.698; T10 vs L3_Erector r = 0.506; L3_Erector vs Psoas r = 0.419) and with demographics; older pts had greater fat percentages (r = 0.31-0.45) and BMIs (r = 0.24-0.51). Increased FI at T2, T10, and L3 was associated with increased pelvic retroversion (PT: r = 0.25-0.43), global deformity (TPA: r = 0.27-0.45), and anterior malalignment (SVA: r = 0.23-0.41). The degree of FI in the PVM increased with the severity of SRS-Schwab PT and SVA modifiers. CONCLUSION In ASD patients, global sagittal malalignment is related to FI of the PVM throughout the lumbar and thoracic spine, as identified through CT. Future research should investigate how FI relates to ASD pathogenesis.
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Affiliation(s)
| | - Francis Lovecchio
- Hospital for Special Surgery, 535 East 70th St., New York, NY, 10021, USA
| | - Renaud Lafage
- Hospital for Special Surgery, 535 East 70th St., New York, NY, 10021, USA
| | - Bryan Ang
- Hospital for Special Surgery, 535 East 70th St., New York, NY, 10021, USA.
| | - Alex Huang
- Hospital for Special Surgery, 535 East 70th St., New York, NY, 10021, USA
| | - Mathieu Bannwarth
- Hospital for Special Surgery, 535 East 70th St., New York, NY, 10021, USA
| | - Han Jo Kim
- Hospital for Special Surgery, 535 East 70th St., New York, NY, 10021, USA
| | - Frank Schwab
- Hospital for Special Surgery, 535 East 70th St., New York, NY, 10021, USA
| | - Virginie Lafage
- Hospital for Special Surgery, 535 East 70th St., New York, NY, 10021, USA
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Todeschi J, Ferracci FX, Metayer T, Gouges B, Leroy HA, Hamdam N, Bougaci N, De Barros A, Timofeev A, Pretat PH, Bannwarth M, Roblot P, Peltier C, Lleu M, Pommier B, Chibbaro S, Proust F, Cebula H. Impact of discontinuation of antithrombotic therapy after surgery for chronic subdural hematoma. Neurochirurgie 2020; 66:195-202. [DOI: 10.1016/j.neuchi.2020.04.136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/26/2020] [Accepted: 04/05/2020] [Indexed: 02/08/2023]
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11
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Kleiber JC, Marlier B, Bannwarth M, Mehault M, Litre F. Utilisation de l’impression 3D dans un service de neurochirurgie. Neurochirurgie 2017. [DOI: 10.1016/j.neuchi.2016.11.049] [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: 10/19/2022]
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12
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Kleiber JC, Marlier B, Bannwarth M, Theret E, Peruzzi P, Litre F. Is spinal cord stimulation safe? A review of 13 years of implantations and complications. Rev Neurol (Paris) 2016; 172:689-695. [PMID: 27776893 DOI: 10.1016/j.neurol.2016.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 06/29/2016] [Accepted: 09/19/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this review was to evaluate the complications of spinal cord stimulation (SCS) for chronic pain. METHODS This was a retrospective case series of 212 patients treated with SCS for chronic lower-limb neuropathic pain between March 2002 and February 2015 in a Reims academic hospital. All patients received a surgically implanted paddle-type electrode. Complications with this technique are here described and analyzed, and other treatment and preventative methods proposed. RESULTS The major indication was 'failed back surgery syndrome', and 74 (35%) patients experienced complications, of which 57% were benign, while 42% required invasive treatment. Most frequent complications (n=22, 10%) were hardware malfunctions. There were two cases (0.9%) of postoperative neurological deficit and nine (4.2%) with postoperative infections. All patients received the appropriate treatment for their complication. CONCLUSION Despite the presence of complications, SCS is still a safe technique, although careful patient selection and proper surgical technique can help to avoid major complications.
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Affiliation(s)
- J-C Kleiber
- Service de Neurochirurgie, Hôpital Maison-Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France.
| | - B Marlier
- Service de Neurochirurgie, Hôpital Maison-Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - M Bannwarth
- Service de Neurochirurgie, Hôpital Maison-Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - E Theret
- Service de Neurochirurgie, Hôpital Maison-Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - P Peruzzi
- Service de Neurochirurgie, Hôpital Maison-Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - F Litre
- Service de Neurochirurgie, Hôpital Maison-Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
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13
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Bannwarth M, Kleiber JC, Marlier B, Eap C, Duntze J, Litre CF. Ectopic bone formation with joint impingement after posterior lumbar fusion with rhBMP-2. Orthop Traumatol Surg Res 2016; 102:255-6. [PMID: 26947733 DOI: 10.1016/j.otsr.2015.11.013] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 11/09/2015] [Accepted: 11/16/2015] [Indexed: 02/02/2023]
Abstract
Recombinant human bone morphogenetic protein-2 (rhBMP-2) was recently licensed for local administration during posterior lumbar fusion. In this indication, considerable uncertainty remains about the nature and mechanisms of the many adverse effects of rhBMP-2, such as ectopic bone formation. We report a case of ectopic bone formation with impingement on a facet joint and incapacitating low back pain after minimally invasive transforaminal L5-S1 interbody fusion with local application of rhBMP-2 (InductOs(®)). Revision surgery was eventually performed to alleviate the symptoms by removing the ectopic bone. Caution is in order regarding the use of rhBMP-2 during posterior lumbar fusion. Every effort should be made to minimise the risk of complications.
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Affiliation(s)
- M Bannwarth
- Neurosurgery department, Reims University Hospital, Reims, France.
| | - J C Kleiber
- Neurosurgery department, Reims University Hospital, Reims, France
| | - B Marlier
- Neurosurgery department, Reims University Hospital, Reims, France
| | - C Eap
- Neurosurgery department, Reims University Hospital, Reims, France
| | - J Duntze
- Neurosurgery department, Reims University Hospital, Reims, France
| | - C F Litre
- Neurosurgery department, Reims University Hospital, Reims, France
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Eap C, Bannwarth M, Jazeron JF, Kleber JC, Theret É, Duntze J, Litre CF. Spontaneous epidural hematoma due to cervico-thoracic angiolipoma. Neurochirurgie 2015; 61:398-400. [DOI: 10.1016/j.neuchi.2015.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Revised: 08/28/2015] [Accepted: 09/23/2015] [Indexed: 10/22/2022]
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Vernikouskaya I, Fekete N, Bannwarth M, Erle A, Rojewski M, Landfester K, Schmidtke-Schrezenmeier G, Schrezenmeier H, Rasche V. Iron-loaded PLLA nanoparticles as highly efficient intracellular markers for visualization of mesenchymal stromal cells by MRI. Contrast Media Mol Imaging 2014; 9:109-21. [PMID: 24523056 DOI: 10.1002/cmmi.1544] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 03/22/2013] [Accepted: 04/22/2013] [Indexed: 12/14/2022]
Abstract
Monitoring of the fate of cells after injection appears paramount for the further development of cell therapies. In this context magnetic resonance imaging (MRI) is increasing in relevance owing to its unique tissue visualization properties. For assessment of cell trafficking and homing, the cells have to be labeled to become MR visible. The rather low sensitivity of MRI demands dedicated intracellular markers with high payloads of MR contrast agents for ensuring sensitive detection of local cell aggregations. In the presented work the application of custom-designed nanometer-sized iron oxide loaded poly-(l-lactide) (iPLLA) nanoparticles was investigated. The particles were synthesized by the mini-emulsion process and evaluated for labeling of mesenchymal stromal cells (MSCs). The efficient cellular uptake and long intracellular retention times of the particles as well as their nontoxicity are demonstrated. The average cellular iron content was 55 pg iron per cell. Further incorporation of, for example, fluorescent dye enables the generation of multireporter particles, providing the great potential for multimodal imaging. The efficiency of these nanoparticles as MRI contrast agent was evaluated in vitro using relaxation rate mapping, yielding relaxivities r2 = 273.3, r2 (*) = 545.1 mm(-1) s(-1) at 3 T and r2 = 415.7, r2 (*) = 872.3 mm(-1) s(-1) at 11.7 T. The high r2 (*) relaxivity of the iPLLA nanoparticles enabled visualization of a single labeled cell in vitro at 50-µm spatial resolution. In vivo evaluation in a rat injury model revealed the potential of the iPLLA particles to efficiently label MSCs for MRI monitoring of ~20 000-40 000 injected cells at 11.7 T. In conclusion the presented work demonstrates the applicability of iPLLA particles as efficient intracellular marker for MSC labeling for monitoring the fate of the cells by MRI.
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Affiliation(s)
- I Vernikouskaya
- Internal Medicine II, University Hospital of Ulm, Ulm, Germany; Small Animal MRI, University of Ulm, Ulm, Germany
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Sangchan W, Bannwarth M, Ingwersen J, Hugenschmidt C, Schwadorf K, Thavornyutikarn P, Pansombat K, Streck T. Monitoring and risk assessment of pesticides in a tropical river of an agricultural watershed in northern Thailand. Environ Monit Assess 2014; 186:1083-1099. [PMID: 24078052 DOI: 10.1007/s10661-013-3440-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 09/14/2013] [Indexed: 06/02/2023]
Abstract
The increasing application of pesticides in the uplands of northern Thailand has increased the transfer of pesticides to surface water. To assess the risk of pesticide use for stream water quality, we monitored the concentrations of seven pesticides (atrazine, dichlorvos, chlorpyrifos, dimethoate, chlorothalonil, (α-, β-) endosulfan, cypermethrin) frequently used in the Mae Sa watershed (77 km(2)) in water and sediment samples over a period of one and a half years (2007-2008). All investigated pesticides were recorded in the river. Chlorpyrifos was detected most often in water samples (75% at the headwater station), while cypermethrin was most often found in riverbed (86%) and in all suspended sediment samples. The highest concentrations of the pesticides were detected during the rainy season. About 0.002 to 4.1% by mass of the applied pesticides was lost to surface water. The risk assessment was based on the risk characterization ratio (RCR). The RCRs of dichlorvos in water, (α-, β-) endosulfan, and cypermethrin in water and sediments were higher than unity indicating that they are likely to pose a threat to aquatic ecosystem. Finally, we discuss the role of sampling design on ecotoxicological risk assessment. Our study shows that pesticide contamination of surface waters is an environmental issue in the Mae Sa watershed and that measures need to be undertaken to reduce the loss of pesticides from soil to surface waters.
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