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Subramanian T, Kaidi A, Shahi P, Asada T, Hirase T, Vaishnav A, Maayan O, Amen TB, Araghi K, Simon CZ, Mai E, Tuma OC, Eun Kim AY, Singh N, Korsun MK, Zhang J, Allen M, Kwas CT, Kim ET, Sheha ED, Dowdell JE, Qureshi SA, Iyer S. Practical Answers to Frequently Asked Questions in Anterior Cervical Spine Surgery for Degenerative Conditions. J Am Acad Orthop Surg 2024:00124635-990000000-00952. [PMID: 38709837 DOI: 10.5435/jaaos-d-23-01037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/15/2024] [Indexed: 05/08/2024] Open
Abstract
INTRODUCTION Surgical counseling enables shared decision making and optimal outcomes by improving patients' understanding about their pathologies, surgical options, and expected outcomes. Here, we aimed to provide practical answers to frequently asked questions (FAQs) from patients undergoing an anterior cervical diskectomy and fusion (ACDF) or cervical disk replacement (CDR) for the treatment of degenerative conditions. METHODS Patients who underwent primary one-level or two-level ACDF or CDR for the treatment of degenerative conditions with a minimum of 1-year follow-up were included. Data were used to answer 10 FAQs that were generated from author's experience of commonly asked questions in clinic before ACDF or CDR. RESULTS A total of 395 patients (181 ACDF, 214 CDR) were included. (1, 2, and 3) Will my neck/arm pain and physical function improve? Patients report notable improvement in all patient-reported outcome measures. (4) Is there a chance I will get worse? 13% (ACDF) and 5% (CDR) reported worsening. (5) Will I receive a significant amount of radiation? Patients on average received a 3.7 (ACDF) and 5.5 mGy (CDR) dose during. (6) How long will I stay in the hospital? Most patients get discharged on postoperative day one. (7) What is the likelihood that I will have a complication? 13% (8% minor and 5% major) experienced in-hospital complications (ACDF) and 5% (all minor) did (CDR). (8) Will I need another surgery? 2.2% (ACDF) and 2.3% (CDR) of patients required a revision surgery. (9 & 10) When will I be able to return to work/driving? Most patients return to working (median of 16 [ACDF] and 14 days [CDR]) and driving (median of 16 [ACDF] and 12 days [CDR]). CONCLUSIONS The answers to the FAQs can assist surgeons in evidence-based patient counseling.
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Affiliation(s)
- Tejas Subramanian
- From the Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY (Subramanian, Kaidi, Shahi, Asada, Hirase, Vaishnav, Maayan, Amen, Araghi, Simon, Mai, Tuma, Eun Kim, Singh, Korsun, Zhang, Allen, Kim, Sheha, Dowdell, Qureshi, and Iyer), and the Weill Cornell Medicine, New York, NY (Subramanian, Mai, Eun Kim, Qureshi, and Iyer)
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Singh N, Zhao E, Johnson M, Singh S, Asada T, Shahi P, Maayan O, Araghi K, Pajak A, Subramanian T, Simon C, Korsun M, Tuma O, Sheha E, Dowdell J, Qureshi S, Iyer S. Psoas Muscle Health is Correlated with Time to Achieve MCID in Patients with Predominant Axial Back Pain Following Decompression Surgery: Early Results. Spine (Phila Pa 1976) 2024:00007632-990000000-00651. [PMID: 38686831 DOI: 10.1097/brs.0000000000005018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 03/31/2024] [Indexed: 05/02/2024]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To determine the impact of psoas muscle health (cross-sectional area, CSA) on achieving minimal clinically important differences (MCID) in patient-reported outcome measures (PROMs) following laminectomy for patients with predominant back pain (PBP) and leg pain (PLP). SUMMARY OF BACKGROUND DATA Psoas muscle health is linked to postoperative outcomes in decompression patients, with MRI-based grading of psoas CSA correlating with these outcomes. However, evidence on its impact on symptomatic recovery, measured by PROMs, is lacking. METHODS 106 patients with PBP (VAS back >VAS leg) and 139 patients with PLP (VAS leg >VAS back) who underwent laminectomy from 2017-2021 were included. Axial T2 MRI images were analyzed for psoas CSA using a validated method. Based on the lowest-quartile normalized total psoas area (NTPA) thresholds, patients were divided into "Good" and "Poor" muscle health groups. The correlation analyses were performed between the psoas CSA and changes in PROMs. Kaplan-Meier survival analysis was conducted to determine the probability of achieving MCID as a function of time. RESULTS Of 106 PBP patients, 83 (78.3%) had good muscle health, 23 (21.6%) had poor muscle health. Of 139 PLP patients, 54 (38.8%) had good muscle health, 85 (61.1%) had poor muscle health. In the PBP group, older age was associated with poor muscle health (69.70±9.26 vs. 59.92±15.01, P=0.0002). For both cohorts, there were no differences in the rate of MCID achievement for any PROMs between the good and poor muscle health groups. In the PBP group, Kaplan-Meier analysis showed patients with good psoas health achieved MCID-VAS back and Oswestry Disability Index (ODI) in median times of 14 and 42 days (P=0.045 and 0.015), respectively. CONCLUSION Good psoas muscle health is linked to faster attainment of MCID, especially in patients with PBP compared to PLP after decompression surgery. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Nishtha Singh
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
| | - Eric Zhao
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
- Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA
| | | | - Sumedha Singh
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
| | - Tomoyuki Asada
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
| | - Pratyush Shahi
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
| | - Omri Maayan
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
- Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA
| | - Kasra Araghi
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
| | - Anthony Pajak
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
| | - Tejas Subramanian
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
- Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA
| | - Chad Simon
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
| | - Max Korsun
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
| | - Olivia Tuma
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
| | - Evan Sheha
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
- Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA
| | - James Dowdell
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
- Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA
| | - Sheeraz Qureshi
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
- Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA
| | - Sravisht Iyer
- Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
- Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA
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Singh S, Shahi P, Song J, Subramanian T, Morse K, Maayan O, Araghi K, Singh N, Tuma O, Asada T, Korsun M, Mai E, Dowdell J, Sheha E, Sandhu H, Albert T, Qureshi S, Iyer S. Clinical and Radiological Predictors of Slower and Non-Improvement Following Surgical Treatment of L4-5 Degenerative Spondylolisthesis: Preliminary Results. Spine (Phila Pa 1976) 2024:00007632-990000000-00649. [PMID: 38679887 DOI: 10.1097/brs.0000000000005019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/13/2024] [Indexed: 05/01/2024]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE To identify the predictors of slower and non-improvement following surgical treatment of L4-5 degenerative lumbar spondylolisthesis (DLS). SUMMARY OF BACKGROUND DATA There is limited evidence regarding clinical and radiological predictors of slower and non-improvement following surgery for L4-5 DLS. METHODS Patients who underwent minimally invasive decompression or fusion for L4-5 DLS and had a minimum of 1-year follow-up were included. Outcome measures were: (1) minimal clinically important difference (MCID), (2) patient acceptable symptom state (PASS), and (3) global rating change (GRC). Clinical variables analyzed for predictors were age, gender, body mass index (BMI), surgery type, comorbidities, anxiety, depression, smoking, osteoporosis, and preoperative patient reported outcome measures (PROMs) (Oswestry Disability Index, ODI; Visual Analog Scale, VAS back and leg; 12-Item Short Form Survey Physical Component Score, SF-12 PCS). Radiological variables analyzed were slip percentage, translational and angular motion, facet diastasis/cyst/orientation, laterolisthesis, disc height, scoliosis, main and fractional curve Cobb angles, and spinopelvic parameters. RESULTS 233 patients (37% decompression, 63% fusion) were included. At <3 months, high pelvic tilt (PT) (OR 0.92, P 0.02) and depression (OR 0.28, P 0.02) were predictors of MCID non-achievement and GRC non-betterment, respectively. Neither retained significance at >6 months and hence, were identified as predictors of slower improvement. At >6 months, low preoperative VAS leg (OR 1.26, P 0.01) and high facet orientation (OR 0.95, P 0.03) were predictors of MCID non-achievement, high L4-5 slip percentage (OR 0.86, P 0.03) and L5-S1 angular motion (OR 0.78, P 0.01) were predictors of GRC non-betterment, and high preoperative ODI (OR 0.96, P 0.04) was a predictor of PASS non-achievement. CONCLUSIONS High PT and depression were predictors of slower improvement and low preoperative leg pain, high disability, high facet orientation, high slip percentage, and L5-S1 angular motion were predictors of non-improvement. However, these are preliminary findings and further studies with homogeneous cohorts are required to establish these findings.
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Affiliation(s)
- Sumedha Singh
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Pratyush Shahi
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Junho Song
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Tejas Subramanian
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
- Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA, Institute where the work was performed: Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Kyle Morse
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Omri Maayan
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
- Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA, Institute where the work was performed: Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Kasra Araghi
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Nishtha Singh
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Olivia Tuma
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Tomoyuki Asada
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Maximilian Korsun
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Eric Mai
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - James Dowdell
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Evan Sheha
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Harvinder Sandhu
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Todd Albert
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Sheeraz Qureshi
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Sravisht Iyer
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
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Maayan O, Shahi P, Merrill RK, Pajak A, Lu AZ, Oquendo Y, Subramanian T, Araghi K, Tuma OC, Korsun MK, Asada T, Singh N, Singh S, Sheha ED, Dowdell JE, Qureshi SA, Iyer S. Ninety Percent of Patients Are Satisfied With Their Decision to Undergo Spine Surgery for Degenerative Conditions. Spine (Phila Pa 1976) 2024; 49:561-568. [PMID: 38533908 DOI: 10.1097/brs.0000000000004714] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/28/2023] [Indexed: 03/28/2024]
Abstract
STUDY DESIGN Cross-sectional survey and retrospective review of prospectively collected data. OBJECTIVE To explore how patients perceive their decision to pursue spine surgery for degenerative conditions and evaluate factors correlated with decisional regret. SUMMARY OF BACKGROUND DATA Prior research shows that one-in-five older adults regret their decision to undergo spinal deformity surgery. However, no studies have investigated decisional regret in patients with degenerative conditions. METHODS Patients who underwent cervical or lumbar spine surgery for degenerative conditions (decompression, fusion, or disk replacement) between April 2017 and December 2020 were included. The Ottawa Decisional Regret Questionnaire was implemented to assess prevalence of decisional regret. Questionnaire scores were used to categorize patients into low (<40) or medium/high (≥40) decisional regret cohorts. Patient-reported outcome measures (PROMs) included the Oswestry Disability Index, Patient-reported Outcomes Measurement Information System, Visual Analog Scale (VAS) Back/Leg/Arm, and Neck Disability Index at preoperative, early postoperative (<6 mo), and late postoperative (≥6 mo) timepoints. Differences in demographics, operative variables, and PROMs between low and medium/high decisional regret groups were evaluated. RESULTS A total of 295 patients were included (mean follow-up: 18.2 mo). Overall, 92% of patients agreed that having surgery was the right decision, and 90% would make the same decision again. In contrast, 6% of patients regretted the decision to undergo surgery, and 7% noted that surgery caused them harm. In-hospital complications (P=0.02) and revision fusion (P=0.026) were significantly associated with higher regret. The medium/high decisional regret group also exhibited significantly worse PROMs at long-term follow-up for all metrics except VAS-Arm, and worse achievement of minimum clinically important difference for Oswestry Disability Index (P=0.007), Patient-Reported Outcomes Measurement Information System (P<0.0001), and VAS-Leg (P<0.0001). CONCLUSIONS Higher decisional regret was encountered in the setting of need for revision fusion, increased in-hospital complications, and worse PROMs. However, 90% of patients overall were satisfied with their decision to undergo spine surgery for degenerative conditions. Current tools for assessing patient improvement postoperatively may not adequately capture the psychosocial values and patient expectations implicated in decisional regret.
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Affiliation(s)
- Omri Maayan
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medical College, New York, NY
| | | | | | | | - Amy Z Lu
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medical College, New York, NY
| | | | - Tejas Subramanian
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medical College, New York, NY
| | | | | | | | | | | | | | | | | | - Sheeraz A Qureshi
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Sravisht Iyer
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medical College, New York, NY
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Oren T, Ercanli N, Maayan O, Tham S, Wright D, Kaur G. Treatments and interventions addressing chronic somatic pain in torture survivors: A systematic review. PLOS Glob Public Health 2024; 4:e0003070. [PMID: 38547161 PMCID: PMC10977680 DOI: 10.1371/journal.pgph.0003070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/11/2024] [Indexed: 05/09/2024]
Abstract
Torture survivors experience chronic, somatic pain that may be exacerbated by environmental, social, and structural factors that extend beyond immediate traumatic events and diagnoses. We conducted a systematic review of research describing the types and efficacy of treatments for chronic somatic pain in a global population of torture survivors. In this systematic review, we searched Ovid MEDLINE, Ovid EMBASE (1974 to present), and PubMed. We used all appropriate controlled vocabulary and keywords for interventions and treatments for chronic somatic pain in torture survivors. The population included survivors of torture of any age and in any country. Outcomes included pain relief, pain intensity, distress level, and quality of life. Four authors participated in screening, full-text review, and quality assessment, with each title and abstract being independently reviewed by two authors. This study is reported according to the PRISMA guidelines and registered in PROSPERO. We included six pre-post intervention studies and four pilot or modified randomized controlled trials (RCTs), for a total of ten studies included in the analysis. Different combinations of interventions targeted pain reduction in refugees, the majority of whom were torture survivors as the primary (n = 1) or secondary (n = 9) outcome. Sample sizes varied from eight to 470 participants. We identified three main types of interventions: multimodal combined, manual therapy, and specific types of talk therapy. Five studies demonstrated positive outcomes on pain and its intensity, three reported no effect, and two had mixed outcomes. Pain in torture survivors is often considered a symptom secondary to mental health illness and not targeted directly. Instead, combined interventions are mainly directed at posttraumatic stress disorder (PTSD), depression, and anxiety. Most studies noted promising preliminary results and plans to conduct RCTs to increase the reproducibility and quality of their pilot data.
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Affiliation(s)
- Tanzilya Oren
- Department of Anesthesiology, Human Rights Impact Lab, Weill Cornell Medical College, New York, New York, United States of America
| | - Nihan Ercanli
- College of Human Ecology, Cornell University, Ithaca, New York, United States of America
| | - Omri Maayan
- Department of Anesthesiology, Human Rights Impact Lab, Weill Cornell Medical College, New York, New York, United States of America
| | - Samantha Tham
- Department of Anesthesiology, Human Rights Impact Lab, Weill Cornell Medical College, New York, New York, United States of America
| | - Drew Wright
- Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medical College, New York, New York, United States of America
| | - Gunisha Kaur
- Department of Anesthesiology, Human Rights Impact Lab, Weill Cornell Medical College, New York, New York, United States of America
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Zhao E, Shinn DJ, Basilious M, Subramanian T, Shahi P, Amen TB, Maayan O, Dalal S, Araghi K, Song J, Sheha ED, E Dowdell J, Iyer S, Qureshi SA. Impact of Metabolic Syndrome on Early Postoperative Outcomes After Cervical Disk Replacement: A Propensity-matched Analysis. Clin Spine Surg 2024:01933606-990000000-00257. [PMID: 38321612 DOI: 10.1097/bsd.0000000000001567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 11/29/2023] [Indexed: 02/08/2024]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To compare the demographics, perioperative variables, and complication rates following cervical disk replacement (CDR) among patients with and without metabolic syndrome (MetS). SUMMARY OF BACKGROUND DATA The prevalence of MetS-involving concurrent obesity, insulin resistance, hypertension, and hyperlipidemia-has increased in the United States over the last 2 decades. Little is known about the impact of MetS on early postoperative outcomes and complications following CDR. METHODS The 2005-2020 National Surgical Quality Improvement Program was queried for patients who underwent primary 1- or 2-level CDR. Patients with and without MetS were divided into 2 cohorts. MetS was defined, according to other National Surgical Quality Improvement Program studies, as concurrent diabetes mellitus, hypertension requiring medication, and body mass index ≥30 kg/m2. Rates of 30-day readmission, reoperation, complications, length of hospital stay, and discharge disposition were compared using χ2 and Fisher exact tests. One to 2 propensity-matching was performed, matching for demographics, comorbidities, and number of operative levels. RESULTS A total of 5395 patients were included for unmatched analysis. Two hundred thirty-six had MetS, and 5159 did not. The MetS cohort had greater rates of 30-day readmission (2.5% vs. 0.9%; P=0.023), morbidity (2.5% vs. 0.9%; P=0.032), nonhome discharges (3% vs. 0.6%; P=0.002), and longer hospital stays (1.35±4.04 vs. 1±1.48 days; P=0.029). After propensity-matching, 699 patients were included. All differences reported above lost significance (P>0.05) except for 30-day morbidity (superficial wound infections), which remained higher for the MetS cohort (2.5% vs. 0.4%, P=0.02). CONCLUSIONS We identified MetS as an independent predictor of 30-day morbidity in the form of superficial wound infections following single-level CDR. Although MetS patients experienced greater rates of 30-day readmission, nonhome discharge, and longer lengths of stay, MetS did not independently predict these outcomes after controlling for baseline differences in patient characteristics. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Eric Zhao
- Hospital for Special Surgery
- Weill Cornell Medicine, New York, NY
| | - Daniel J Shinn
- Hospital for Special Surgery
- Weill Cornell Medicine, New York, NY
| | | | | | | | | | - Omri Maayan
- Hospital for Special Surgery
- Weill Cornell Medicine, New York, NY
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Amen TB, Akosman I, Subramanian T, Johnson MA, Rudisill SS, Song J, Maayan O, Barber LA, Lovecchio FC, Qureshi S. Postoperative racial disparities following spine surgery are less pronounced in the outpatient setting. Spine J 2024:S1529-9430(24)00032-9. [PMID: 38301902 DOI: 10.1016/j.spinee.2024.01.019] [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] [Received: 04/15/2023] [Revised: 01/16/2024] [Accepted: 01/22/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND CONTEXT Racial disparities in spine surgery have been thoroughly documented in the inpatient (IP) setting. However, despite an increasing proportion of procedures being performed as same-day surgeries, whether similar differences have developed in the outpatient (OP) setting remains to be elucidated. PURPOSE This study aimed to investigate racial differences in postoperative outcomes between Black and White patients following OP and IP lumbar and cervical spine surgery. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE Patients who underwent IP or OP microdiscectomy, laminectomy, anterior cervical discectomy and fusion (ACDF), or cervical disc replacement (CDR) between 2017 and 2021. OUTCOME MEASURES Thirty-day rates of serious and minor adverse events, readmission, reoperation, non-home discharge, and mortality. METHODS A retrospective review of patients who underwent IP or OP microdiscectomy, laminectomy, anterior cervical discectomy and fusion (ACDF), or cervical disc replacement (CDR) between 2017 and 2021 was conducted using the National Surgical Quality Improvement Program (NSQIP) database. Disparities between Black and White patients in (1) adverse event rates, (2) readmission rates, (3) reoperation rates, (4) non-home discharge rates, (5) mortality rates, (6) operative times, and (7) hospital LOS between Black and White patients were measured and compared between IP and OP surgical settings. Multivariable logistic regression analyses were used to adjust for potential effects of baseline demographic and clinical differences. RESULTS Of 81,696 total surgeries, 49,351 (60.4%) were performed as IP and 32,345 (39.6%) were performed as OP procedures. White patients accounted for a greater proportion of IP (88.2% vs. 11.8%) and OP (92.7% vs. 7.3%) procedures than Black patients. Following IP surgery, Black patients experienced greater odds of serious (OR 1.214, 95% CI 1.077-1.370, p=.002) and minor adverse events (OR 1.377, 95% CI 1.113-1.705, p=.003), readmission (OR 1.284, 95% CI 1.130-1.459, p<.001), reoperation (OR 1.194, 95% CI 1.013-1.407, p=.035), and non-home discharge (OR 2.304, 95% CI 2.101-2.528, p<.001) after baseline adjustment. Disparities were less prominent in the OP setting, as Black patients exhibited greater odds of readmission (OR 1.341, 95% CI 1.036-1.735, p=0.026) but were no more likely than White patients to experience adverse events, reoperation, individual complications, non-home discharge, or death (p>.050 for all). CONCLUSIONS Racial inequality in postoperative complications following spine surgery is evident, however disparities in complication rates are relatively less following OP compared to IP procedures. Further work may be beneficial in elucidating the causes of these differences to better understand and mitigate overall racial disparities within the inpatient setting. These decreased differences may also provide promising indication that progress towards reducing inequality is possible as spine care transitions to the OP setting.
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Affiliation(s)
- Troy B Amen
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
| | - Izzet Akosman
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Tejas Subramanian
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Mitchell A Johnson
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Samuel S Rudisill
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Junho Song
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Omri Maayan
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Lauren A Barber
- Visiting Fellow at St. George and Sutherland Clinical School, University of New South Wales Medicine, Sydney, NSW 2052, Australia
| | | | - Sheeraz Qureshi
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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Asada T, Singh S, Maayan O, Shahi P, Singh N, Subramanian T, Araghi K, Korsun M, Tuma O, Pajak A, Lu A, Mai E, Kim YE, Dowdell J, Sheha ED, Iyer S, Qureshi SA. Impact of Frailty and Cervical Radiographic Parameters on Postoperative Dysphagia Following Anterior Cervical Spine Surgery. Spine (Phila Pa 1976) 2024; 49:81-89. [PMID: 37661809 DOI: 10.1097/brs.0000000000004815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/19/2023] [Indexed: 09/05/2023]
Abstract
STUDY DESIGN Retrospective review of a prospectively collected registry. OBJECTIVE The purpose of the present study was to investigate the impact of frailty and radiographical parameters on postoperative dysphagia after anterior cervical spine surgery (ACSS). SUMMARY OF BACKGROUND DATA There is a growing body of literature indicating an association between frailty and increased postoperative complications following various surgeries. However, few studies have investigated the relationship between frailty and postoperative dysphagia after anterior cervical spine surgery. MATERIALS AND METHODS Patients who underwent anterior cervical spine surgery for the treatment of degenerative cervical pathology were included. Frailty and dysphagia were assessed by the modified Frailty Index-11 (mFI-11) and Eat Assessment Tool 10 (EAT-10), respectively. We also collected clinical demographics and cervical alignment parameters previously reported as risk factors for postoperative dysphagia. Multivariable logistic regression was performed to identify the odds ratio (OR) of postoperative dysphagia at early (2-6 weeks) and late postoperative time points (1-2 years). RESULTS Ninety-five patients who underwent ACSS were included in the study. Postoperative dysphagia occurred in 31 patients (32.6%) at the early postoperative time point. Multivariable logistic regression identified higher mFI-11 score (OR, 4.03; 95% CI: 1.24-13.16; P =0.021), overcorrection of TS-CL after surgery (TS-CL, T1 slope minus C2-C7 lordosis; OR, 0.86; 95% CI: 0.79-0.95; P =0.003), and surgery at C3/C4 (OR, 12.38; 95% CI: 1.41-108.92; P =0.023) as factors associated with postoperative dysphagia. CONCLUSIONS Frailty, as assessed by the mFI-11, was significantly associated with postoperative dysphagia after ACSS. Additional factors associated with postoperative dysphagia were overcorrection of TS-CL and surgery at C3/C4. These findings emphasize the importance of assessing frailty and cervical alignment in the decision-making process preceding ACSS.
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Affiliation(s)
- Tomoyuki Asada
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki Prefecture, Japan
| | - Sumedha Singh
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Omri Maayan
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Pratyush Shahi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Nishtha Singh
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Tejas Subramanian
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Kasra Araghi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Maximilian Korsun
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Olivia Tuma
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Anthony Pajak
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Amy Lu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Eric Mai
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Yeo Eun Kim
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - James Dowdell
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Evan D Sheha
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Sravisht Iyer
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Sheeraz A Qureshi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
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9
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Nakarai H, Kato S, Hirao Y, Maayan O, Kawamura N, Higashikawa A, Takeshita Y, Ono T, Fukushima M, Hara N, Azuma S, Iwai H, Taniguchi Y, Matsubayashi Y, Takeshita K, Tanaka S, Oshima Y. Coexisting Lower Back Pain in Patients With Cervical Myelopathy. Clin Spine Surg 2024:01933606-990000000-00254. [PMID: 38245809 DOI: 10.1097/bsd.0000000000001572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/29/2023] [Indexed: 01/22/2024]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The aim of the present study is to investigate the coexisting lower back pain (LBP) in patients with cervical myelopathy and to evaluate changes in LBP after cervical spine surgery. SUMMARY OF BACKGROUND DATA Only a few studies with a small number of participants have evaluated the association between cervical myelopathy surgery and postoperative improvement in LBP. METHODS Patients who underwent primary cervical decompression surgery with or without fusion for myelopathy and completed preoperative and 1-year postoperative questionnaires were reviewed using a prospectively collected database involving 9 tertiary referral hospitals. The questionnaires included the patient-reported Japanese Orthopaedic Association (PRO-JOA) score and Numerical Rating Scales (NRS). The minimum clinically important difference (MCID) for NRS-LBP was defined as >30% improvement from baseline. Patient demographics, characteristics, and PRO-JOA score were compared between patients with and without concurrent LBP, and the contributor to achieving the MCID for LBP was analyzed using logistic regression analysis. RESULTS A total of 786 consecutive patients with cervical myelopathy were included, of which 525 (67%) presented with concurrent LBP. LBP was associated with a higher body mass index (P<0.001) and worse preoperative PRO-JOA score (P<0.001). Among the 525 patients with concurrent LBP, the mean postoperative NRS-LBP significantly improved from 4.5±2.4 to 3.4±2.7 (P<0.01) postoperatively, with 248 (47%) patients reaching the MCID cutoff. Patients with a PRO-JOA recovery rate >50% were more likely to achieve MCID compared with those with a recovery rate <0% (adjusted odd ratio 4.02, P<0.001). CONCLUSIONS More than 50% of patients with myelopathy reported improvement in LBP after cervical spine surgery, and 47% achieved the MCID for LBP, which was positively correlated with a better PRO-JOA recovery rate. Treating cervical myelopathy in patients with concomitant LBP may be sufficient to mitigate concomitant LBP. LEVEL OF EVIDENCE Level Ⅲ.
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Affiliation(s)
- Hiroyuki Nakarai
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
- University of Tokyo Spine Group (UTSG)
| | - So Kato
- University of Tokyo Spine Group (UTSG)
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo
| | - Yujiro Hirao
- Department of Orthopaedic Surgery, Takashimadaira Chuo General Hospital, Takashimadaira, Itabashi
| | - Omri Maayan
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Naohiro Kawamura
- University of Tokyo Spine Group (UTSG)
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Shibuya-Ku, Tokyo
| | - Akiro Higashikawa
- University of Tokyo Spine Group (UTSG)
- Department of Orthopedic Surgery, Kanto Rosai Hospital, Nakahara-Ku, Kawasaki
| | - Yujiro Takeshita
- University of Tokyo Spine Group (UTSG)
- Department of Orthopedic Surgery, Yokohama Rosai Hospital, Yokohama City, Kanagawa
| | - Takashi Ono
- University of Tokyo Spine Group (UTSG)
- Department of Spinal Surgery, Japan Community Health-care Organization Tokyo Shinjuku Medical Center, Shinjuku-Ku, Tokyo
| | | | - Nobuhiro Hara
- University of Tokyo Spine Group (UTSG)
- Department of Orthopedic Surgery, Japanese Red Cross Musashino Hospital, Musashino City, Tokyo
| | - Seiichi Azuma
- University of Tokyo Spine Group (UTSG)
- Department of Orthopedic Surgery, Saitama Red Cross Hospital, Saitama City, Saitama
| | - Hiroki Iwai
- University of Tokyo Spine Group (UTSG)
- Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Shinagawa-ku, Tokyo
| | - Yuki Taniguchi
- University of Tokyo Spine Group (UTSG)
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo
| | - Yoshitaka Matsubayashi
- University of Tokyo Spine Group (UTSG)
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo
| | - Katsushi Takeshita
- Department of Orthopaedic, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo
| | - Yasushi Oshima
- University of Tokyo Spine Group (UTSG)
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo
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10
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Kazarian GS, Du J, Gang CH, Shahi P, Asada T, Lu A, Korsun M, Tuma O, Singh N, Araghi K, Maayan O, Singh S, Iyer S. Preoperative and Postoperative Segmental and Overall Range of Motion in Patients Undergoing Lumbar Spinal Fusion Using HA-Infused PEEK and HA-Treated Titanium Alloy Interbody Cages. Global Spine J 2023:21925682231223117. [PMID: 38116633 DOI: 10.1177/21925682231223117] [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: 12/21/2023] Open
Abstract
STUDY DESIGN Retrospective observational radiographic analysis. OBJECTIVE Determine how single level lumbar interbody fusion (LIF) alters segmental range of motion (ROM) at adjacent levels and decreases overall ROM. METHODS This study included 54 patients who underwent single-level anterior (ALIF, 39%), thoraco-LIF (TLIF, 26%), posterior LIF (PLIF, 22%), or lateral LIF (LLIF, 13%) (L2-3/L3-4/L4-5/L5-S1: 4%/13%/35%/48%). Segmental ROM from L1-2 to L5-S1 and the overall lumbar ROM (L1-S1) were assessed from preoperative and postoperative flexion-extension radiographs. K-means cluster analysis was used to identify ROM subgroups. RESULTS The overall L1-S1 ROM decreased 14% (25.5 ± 20.4° to 22.0 ± 17.2°, P = .104) postoperatively. ROM at the fusion level decreased 77% (4.8 ± 5.0° to 1.1 ± 1.1°, P < .001). Caudal adjacent segment ROM decreased 12% (5.2 ± 5.7° to 4.6 ± 4.4°, P = .345) and cranially ROM increased 34% (4.3 ± 5.0° to 5.7 ± 5.7°, P = .05). K-cluster analysis identified 3 distinct clusters (P < .05). Cluster 1 lost more ROM and had less improvement in patient-reported outcomes measures (PROMs) than average. Cluster 2 had less ROM loss than average with worse PROMs improvement. Cluster 3 did not have changes in ROM and better improvement in PROMs than average. Successful fusion was verified in 96% of all instrumented segments with >6 months follow-up (ROM <4°). CONCLUSION Following single-level L IF, patients should expect a loss of 3.3°, or 14% of overall lumbar motion with increases in ROM of the cranial segment. However, specific clusters of patients exist that experience different relative changes in ROM and PROMs.
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Affiliation(s)
- Gregory S Kazarian
- Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Jerry Du
- Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | | | - Pratysuh Shahi
- Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Tomoyuki Asada
- Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Amy Lu
- Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Maximillian Korsun
- Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Olivia Tuma
- Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Nishtha Singh
- Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Kasra Araghi
- Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Omri Maayan
- Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Sumedha Singh
- Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Sravisht Iyer
- Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
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11
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Subramanian T, Shinn DJ, Korsun MK, Shahi P, Asada T, Amen TB, Maayan O, Singh S, Araghi K, Tuma OC, Singh N, Simon CZ, Zhang J, Sheha ED, Dowdell JE, Huang RC, Albert TJ, Qureshi SA, Iyer S. Recovery Kinetics After Cervical Spine Surgery. Spine (Phila Pa 1976) 2023; 48:1709-1716. [PMID: 37728119 DOI: 10.1097/brs.0000000000004830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023]
Abstract
STUDY DESIGN Retrospective review of a prospectively maintained multisurgeon registry. OBJECTIVE To study recovery kinetics and associated factors after cervical spine surgery. SUMMARY OF BACKGROUND DATA Few studies have described return to activities cervical spine surgery. This is a big gap in the literature, as preoperative counseling and expectations before surgery are important. MATERIALS AND METHODS Patients who underwent either anterior cervical discectomy and fusion (ACDF) or cervical disk replacement (CDR) were included. Data collected included preoperative patient-reported outcome measures, return to driving, return to working, and discontinuation of opioids data. A multivariable regression was conducted to identify the factors associated with return to driving by 15 days, return to working by 15 days, and discontinuing opioids by 30 days. RESULTS Seventy ACDF patients and 70 CDR patients were included. Overall, 98.2% of ACDF patients and 98% of CDR patients returned to driving in 16 and 12 days, respectively; 85.7% of ACDF patients and 90.9% of CDR patients returned to work in 16 and 14 days; and 98.3% of ACDF patients and 98.3% of CDR patients discontinued opioids in a median of seven and six days. Though not significant, minimal (odds ratio (OR)=1.65) and moderate (OR=1.79) disability was associated with greater odds of returning to driving by 15 days. Sedentary work (OR=0.8) and preoperative narcotics (OR=0.86) were associated with decreased odds of returning to driving by 15 days. Medium (OR=0.81) and heavy (OR=0.78) intensity occupations were associated with decreased odds of returning to work by 15 days. High school education (OR=0.75), sedentary work (OR=0.79), and retired/not working (OR=0.69) were all associated with decreased odds of discontinuing opioids by 30 days. CONCLUSIONS Recovery kinetics for ACDF and CDR are comparable. Most patients return to all activities after ACDF and CDR within 16 days. These findings serve as an important compass for preoperative counseling.
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Affiliation(s)
- Tejas Subramanian
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
- Weill Cornell Medicine, New York, NY
| | - Daniel J Shinn
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
- Weill Cornell Medicine, New York, NY
| | - Maximilian K Korsun
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Pratyush Shahi
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Tomoyuki Asada
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Troy B Amen
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Omri Maayan
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
- Weill Cornell Medicine, New York, NY
| | - Sumedha Singh
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Kasra Araghi
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Olivia C Tuma
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Nishtha Singh
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Chad Z Simon
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Joshua Zhang
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Evan D Sheha
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
- Weill Cornell Medicine, New York, NY
| | - James E Dowdell
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
- Weill Cornell Medicine, New York, NY
| | - Russel C Huang
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Todd J Albert
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Sheeraz A Qureshi
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
- Weill Cornell Medicine, New York, NY
| | - Sravisht Iyer
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
- Weill Cornell Medicine, New York, NY
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12
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Mai E, Shahi P, Lee R, Shinn DJ, Vaishnav A, Araghi K, Singh N, Maayan O, Tuma OC, Pajak A, Asada T, Korsun MK, Singh S, Kim YE, Louie PK, Huang RC, Albert TJ, Dowdell J, Sheha ED, Iyer S, Qureshi SA. Risk factors for failure to achieve minimal clinically important difference following cervical disc replacement. Spine J 2023; 23:1808-1816. [PMID: 37660897 DOI: 10.1016/j.spinee.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND CONTEXT While cervical disc replacement (CDR) has been emerging as a reliable and efficacious treatment option for degenerative cervical spine pathology, not all patients undergoing CDR will achieve minimal clinically important difference (MCID) in patient-reported outcome measures (PROMs) postoperatively-risk factors for failure to achieve MCID in PROMs following CDR have not been established. PURPOSE To identify risk factors for failure to achieve MCID in Neck Disability Index (NDI, Visual Analog Scale (VAS) neck and arm following primary 1- or 2-level CDRs in the early and late postoperative periods. STUDY DESIGN Retrospective review of prospectively collected data. PATIENT SAMPLE Patients who had undergone primary 1- or 2-level CDR for the treatment of degenerative cervical pathology at a single institution with a minimum follow-up of 6 weeks between 2017 and 2022. OUTCOME MEASURES Patient-reported outcomes: Neck disability index (NDI), Visual analog scale (VAS) neck and arm, MCID. METHODS Minimal clinically important difference achievement rates for NDI, VAS-Neck, and VAS-Arm within early (within 3 months) and late (6 months to 2 years) postoperative periods were assessed based on previously established thresholds. Multivariate logistic regressions were performed for each PROM and evaluation period, with failure to achieve MCID assigned as the outcome variable, to establish models to identify risk factors for failure to achieve MCID and predictors for achievement of MCID. Predictor variables included in the analyses featured demographics, comorbidities, diagnoses/symptoms, and perioperative characteristics. RESULTS A total of 154 patients met the inclusion criteria. The majority of patients achieved MCID for NDI, VAS-Neck, and VAS-Arm for both early and late postoperative periods-79% achieved MCID for at least one of the PROMs in the early postoperative period, while 80% achieved MCID for at least one of the PROMs in the late postoperative period. Predominant neck pain was identified as a risk factor for failure to achieve MCID for NDI in the early (OR: 3.13 [1.10-8.87], p-value: .032) and late (OR: 5.01 [1.31-19.12], p-value: .018) postoperative periods, and VAS-Arm for the late postoperative period (OR: 36.63 [3.78-354.56], p-value: .002). Myelopathy was identified as a risk factor for failure to achieve MCID for VAS-Neck in the early postoperative period (OR: 3.40 [1.08-10.66], p-value: .036). Anxiety was identified as a risk factor for failure to achieve MCID for VAS-Neck in the late postoperative period (OR: 6.51 [1.91-22.18], p-value: .003). CDR at levels C5C7 was identified as a risk factor for failure to achieve MCID in NDI for the late postoperative period (OR: 9.74 [1.43-66.34], p-value: .020). CONCLUSIONS Our study identified several risk factors for failure to achieve MCID in common PROMs following CDR including predominant neck pain, myelopathy, anxiety, and CDR at levels C5-C7. These findings may help inform the approach to counseling patients on outcomes of CDR as the evidence suggests that those with the risk factors above may not improve as reliably after CDR.
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Affiliation(s)
- Eric Mai
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA; Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA
| | - Pratyush Shahi
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Ryan Lee
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Daniel J Shinn
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA; Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA
| | - Avani Vaishnav
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Kasra Araghi
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Nishtha Singh
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Omri Maayan
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA; Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA
| | - Olivia C Tuma
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Anthony Pajak
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Tomoyuki Asada
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Maximilian K Korsun
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Sumedha Singh
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Yeo Eun Kim
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA; Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA
| | - Philip K Louie
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Russel C Huang
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Todd J Albert
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - James Dowdell
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Evan D Sheha
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Sravisht Iyer
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA
| | - Sheeraz A Qureshi
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA.
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Subramanian T, Merrill RK, Shahi P, Pathania S, Araghi K, Maayan O, Zhao E, Shinn D, Kim YE, Kamil R, Song J, Dalal SS, Vaishnav AS, Othman Y, Steinhaus ME, Sheha ED, Dowdell JE, Iyer S, Qureshi SA. Predictors of Subsidence and its Clinical Impact After Expandable Cage Insertion in Minimally Invasive Transforaminal Interbody Fusion. Spine (Phila Pa 1976) 2023; 48:1670-1678. [PMID: 36940252 DOI: 10.1097/brs.0000000000004619] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/27/2023] [Indexed: 03/22/2023]
Abstract
STUDY DESIGN Retrospective review of prospectively collected multisurgeon data. OBJECTIVE Examine the rate, clinical impact, and predictors of subsidence after expandable minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) cage. SUMMARY OF BACKGROUND DATA Expandable cage technology has been adopted in MI-TLIF to reduce the risks and optimize outcomes. Although subsidence is of particular concern when using expandable technology as the force required to expand the cage can weaken the endplates, its rates, predictors, and outcomes lack evidence. MATERIALS AND METHODS Patients who underwent 1 or 2-level MI-TLIF using expandable cages for degenerative lumbar conditions and had a follow-up of >1 year were included. Preoperative and immediate, early, and late postoperative radiographs were reviewed. Subsidence was determined if the average anterior/posterior disc height decreased by >25% compared with the immediate postoperative value. Patient-reported outcomes were collected and analyzed for differences at the early (<6 mo) and late (>6 mo) time points. Fusion was assessed by 1-year postoperative computed tomography. RESULTS One hundred forty-eight patients were included (mean age, 61 yr, 86% 1-level, 14% 2-level). Twenty-two (14.9%) demonstrated subsidence. Although statistically not significant, patients with subsidence were older, had lower bone mineral density, and had higher body mass index and comorbidity burden. Operative time was significantly higher ( P = 0.02) and implant width was lower ( P < 0.01) for subsided patients. Visual analog scale-leg was significantly lower for subsided patients compared with nonsubsided patients at a >6 months time point. Long-term (>6 mo) patient-acceptable symptom state achievement rate was lower for subsided patients (53% vs . 77%), although statistically not significant ( P = 0.065). No differences existed in complication, reoperation, or fusion rates. CONCLUSIONS Of the patients, 14.9% experienced subsidence predicted by narrower implants. Although subsidence did not have a significant impact on most patient-reported outcome measures and complication, reoperation, or fusion rates, patients had lower visual analog scale-leg and patient-acceptable symptom state achievement rates at the >6-month time point. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Tejas Subramanian
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medical College, New York, NY
| | | | | | - Shane Pathania
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medical College, New York, NY
| | | | - Omri Maayan
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Eric Zhao
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Daniel Shinn
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Yeo Eun Kim
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medical College, New York, NY
| | | | - Junho Song
- Hospital for Special Surgery, New York, NY
| | | | | | | | | | | | | | - Sravisht Iyer
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Sheeraz A Qureshi
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medical College, New York, NY
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Amen TB, Song J, Mai E, Rudisill SS, Bovonratwet P, Subramanian T, Kaidi AK, Maayan O, Qureshi SA, Iyer S. Unplanned readmissions following ambulatory spine surgery: assessing common reasons and risk factors. Spine J 2023; 23:1848-1857. [PMID: 37716549 DOI: 10.1016/j.spinee.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/29/2023] [Accepted: 09/06/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND CONTEXT Although outpatient spine surgery is becoming increasingly popular in the United States, unplanned readmission following outpatient surgery remains a significant postoperative concern. PURPOSE This study aimed to (1) describe the incidence and timing of 30-day unplanned readmission after ambulatory lumbar and cervical spine surgery (2) evaluate the common reasons for readmission, and (3) identify factors associated with readmission in this population. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE Patients who underwent ambulatory cervical or lumbar spine surgery between 2015 and 2020 were identified in the National Surgical Quality Improvement Program (NSQIP) database. OUTCOME MEASURES Hospital readmission within 30 postoperative days. METHODS Patients who underwent ambulatory cervical or lumbar spine surgery between 2015 and 2020 were identified using the National Surgical Quality Improvement Program (NSQIP) database. Reasons for and timing of unplanned readmissions were recorded. Multivariable poisson regressions were employed to determine any independent predictors of readmission. RESULTS A total of 33,092 ambulatory cervical and 68,115 ambulatory lumbar spine surgery patients were identified. Incidences of 30-day readmission were 3.37% and 3.07% among cervical and lumbar patients, respectively. The most common surgical site-related reasons for readmission included uncontrolled pain, recurrence of disc herniation or major symptom, and postoperative hematoma/seroma. Common nonsurgical site-related reasons included gastrointestinal, neurological, and cardiovascular complications. Factors associated with readmission among cervical patients included age ≥55, BMI ≥35, functional dependence, diabetes, smoking, COPD, and steroid use, whereas factors associated with readmission following lumbar spine surgery included age ≥65, female sex, BMI ≥35, functional dependence, ASA ≥3, diabetes, smoking, COPD, and hypertension (p<.05 for all). CONCLUSION This study highlights the common reasons and factors associated with unplanned readmission following ambulatory spine surgery. Consideration of these factors may be critical to ensuring appropriate patient selection for ambulatory spine surgery.
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Affiliation(s)
- Troy B Amen
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, USA.
| | - Junho Song
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, USA
| | - Eric Mai
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, USA
| | - Samuel S Rudisill
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Patawut Bovonratwet
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, USA
| | - Tejas Subramanian
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, USA
| | - Austin K Kaidi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, USA
| | - Omri Maayan
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, USA
| | - Sheeraz A Qureshi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, USA
| | - Sravisht Iyer
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, USA
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Shahi P, Subramanian T, Maayan O, Araghi K, Singh N, Singh S, Asada T, Tuma O, Korsun M, Sheha E, Dowdell J, Qureshi SA, Iyer S. Preoperative Disability Influences Effectiveness of MCID and PASS in Predicting Patient Improvement Following Lumbar Spine Surgery. Clin Spine Surg 2023; 36:E506-E511. [PMID: 37651575 DOI: 10.1097/bsd.0000000000001517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/19/2023] [Indexed: 09/02/2023]
Abstract
STUDY DESIGN Retrospective cohort. SUMMARY OF BACKGROUND DATA Although minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) are utilized to interpret Oswestry Disability Index (ODI), it is unclear whether there is a clearly better metric between the two and if not, which metric should be utilized when. OBJECTIVE To compare the characteristics of MCID and PASS when interpreting ODI after lumbar spine surgery. METHODS Patients who underwent primary minimally invasive transforaminal lumbar interbody fusion or decompression were included. The ODI and global rating change data at 1 year were analyzed. The global rating change was collapsed to a dichotomous outcome variable-(a) improved, (b) not improved The sensitivity, specificity, positive predictive value and negative predictive value of MCID and PASS were calculated for the overall cohort and separately for patients with minimal, moderate, and severe preoperative disability. Two groups with patients who achieved PASS but not MCID and patients who achieved MCID but not PASS were analyzed. RESULTS Two hundred twenty patients (mean age 62 y, 57% males) were included. PASS (86% vs. 69%) and MCID (88% vs. 63%) had significantly greater sensitivity in patients with moderate and severe preoperative disability, respectively. Nineteen percent of patients achieved PASS but not MCID and 10% of patients achieved MCID but not PASS, with the preoperative ODI being significantly greater in the latter. Most of these patients still reported improvement with no significant difference between the 2 groups (93% vs. 86%). CONCLUSION Significant postoperative clinical improvement is most effectively assessed by PASS in patients with minimal or moderate preoperative disability and by MCID in patients with severe preoperative disability. Adequate interpretation of ODI using the PASS and MCID metrics warrants individualized application as their utility is highly dependent on the degree of preoperative disability.
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Affiliation(s)
| | - Tejas Subramanian
- Hospital for Special Surgery
- Weill Cornell Medical College, New York, NY
| | - Omri Maayan
- Hospital for Special Surgery
- Weill Cornell Medical College, New York, NY
| | | | | | | | | | | | | | | | | | - Sheeraz A Qureshi
- Hospital for Special Surgery
- Weill Cornell Medical College, New York, NY
| | - Sravisht Iyer
- Hospital for Special Surgery
- Weill Cornell Medical College, New York, NY
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Subramanian T, Araghi K, Akosman I, Tuma O, Hassan A, Lahooti A, Pajak A, Shahi P, Merrill R, Maayan O, Sheha E, Dowdell J, Iyer S, Qureshi S. Quality of Spine Surgery Information on Social Media: A DISCERN Analysis of TikTok Videos. Neurospine 2023; 20:1443-1449. [PMID: 38171310 PMCID: PMC10762400 DOI: 10.14245/ns.2346700.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/04/2023] [Accepted: 08/14/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE The use of social media applications to disseminate information has substantially risen in recent decades. Spine and back pain-related hashtags have garnered several billion views on TikTok. As such, these videos, which share experiences, offer entertainment, and educate users about spinal surgery, have become increasingly influential. Herein, we assess the quality of spine surgery content TikTok from providers and patients. METHODS Fifty hashtags encompassing spine surgery ("#spinalfusion," "#scoliosissurgery," and "#spinaldecompression") were searched using TikTok's algorithm and included. Two independent reviewers rated the quality of each video via the DISCERN questionnaire. Video metadata (likes, shares, comments, views, length) were all collected; type of content creator (musculoskeletal, layperson) and content category (educational, patient experience, entertainment) were determined. RESULTS The overall DISCERN score was, on average, 24.4. #Spinalfusion videos demonstrated greater engagement, higher average likes (p = 0.02), and more comments (p < 0.001) compared to #spinaldecompression and #scoliosissurgery. #Spinaldecompression had the highest DISCERN score (p < 0.001), likely explained by the higher percentage of videos that were educational (p < 0.001) and created by musculoskeletal (MSK) professionals (p < 0.001). Compared to laypersons, MSK professionals had significantly higher quality videos (p < 0.001). Similarly, the educational category demonstrated higher quality videos (p < 0.001). Video interaction trended lower with MSK videos and educational videos had the lowest interaction of the content categories (likes: p = 0.023, comments: p = 0.005). CONCLUSION The quality of spine surgery videos on TikTok is low. As the influence of the new social media landscape governs how the average person consumes information, MSK providers should participate in disseminating high-quality content.
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Affiliation(s)
- Tejas Subramanian
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | | | - Izzet Akosman
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Olivia Tuma
- Hospital for Special Surgery, New York, NY, USA
| | - Amier Hassan
- Weill Cornell Medical College, New York, NY, USA
| | - Ali Lahooti
- Weill Cornell Medical College, New York, NY, USA
| | | | | | | | - Omri Maayan
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Evan Sheha
- Hospital for Special Surgery, New York, NY, USA
| | | | | | - Sheeraz Qureshi
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
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Shahi P, Maayan O, Subramanian T, Singh N, Singh S, Araghi K, Tuma O, Asada T, Korsun M, Sheha E, Dowdell J, Qureshi SA, Iyer S. Preoperative Disability Influences Effectiveness of Minimal Clinically Important Difference and Patient Acceptable Symptom State in Predicting Patient Improvement Following Cervical Spine Surgery. Global Spine J 2023:21925682231215765. [PMID: 37984881 DOI: 10.1177/21925682231215765] [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: 11/22/2023] Open
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE To compare the characteristics of the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) metrics when interpreting Neck Disability Index (NDI) following cervical spine surgery. METHODS Patients who underwent primary cervical fusion, discectomy, or laminectomy were included. NDI and global rating change (GRC) data at 6 months/1 year/2 years were analyzed. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MCID and PASS in predicting improvement on GRC were calculated for the overall cohort and separately for patients with minimal (NDI <30), moderate (NDI 30 - 49), and severe (NDI ≥ 50) preoperative disability. Two groups with patients who achieved PASS but not MCID and patients who achieved MCID but not PASS were analyzed. RESULTS 141 patients (206 responses) were included. PASS had significantly greater sensitivity for the overall cohort (85% vs 73% with MCID, P = .02) and patients with minimal disability (96% vs 53% with MCID, P < .001). MCID had greater sensitivity for patients with severe disability (78% vs 57% with PASS, P = .05). Sensitivity was not significantly different for PASS and MCID in patients with moderate preoperative disability (83% vs 92%, P = .1). 17% of patients achieved PASS but not MCID and 9% of patients achieved MCID but not PASS. Most of these patients still reported improvement with no significant difference between the 2 groups (89% vs 72%, P = .13). CONCLUSION PASS and MCID are better metrics for patients with minimal and severe preoperative disability, respectively. Both metrics are equally effective for patients with moderate preoperative disability.
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Affiliation(s)
- Pratyush Shahi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Omri Maayan
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Tejas Subramanian
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Nishtha Singh
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Sumedha Singh
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Kasra Araghi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Olivia Tuma
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Tomoyuki Asada
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Maximilian Korsun
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Evan Sheha
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - James Dowdell
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Sheeraz A Qureshi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Sravisht Iyer
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, NY, USA
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Clohisy JCF, Maayan O, Asada T, Qureshi SA. Cervical Total Disc Replacement in Athletes: A Systematic Review. Clin Spine Surg 2023; 36:369-374. [PMID: 37735765 DOI: 10.1097/bsd.0000000000001526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 08/10/2023] [Indexed: 09/23/2023]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To perform a systematic review to describe clinical characteristics, outcomes, and return to play after cervical total disc replacement (cTDR) in athletes. SUMMARY OF BACKGROUND DATA The role of cTDR in treating athletes with symptomatic cervical degenerative disc disease is undefined. METHODS A systematic search using MEDLINE through PubMed, EMBASE, and the Cochrane Library was conducted to identify all relevant literature. Data regarding study type, country in which the study was conducted, sample size, mean age, sex, type of sport, level of patient participation in sports, surgical indication, levels operated, type of implant, duration of follow-up, reoperations, surgical complications, extent of postoperative return to sports (RTSs), time to RTSs, and outcome notes were extracted from the included studies and analyzed. RESULTS Seven studies, including 4 case series and 3 case reports, and a total of 57 cTDR cases, were included. There was significant heterogeneity among the cTDR cases in terms of chosen sport and level of participation. Prestige LP was utilized in 51 out of 57 (89.5%) cases and 53 out of 57 (93%) cases were single-level. No reoperations were noted at a mean follow-up of 51.6 months. All patients returned to sports postoperatively. Return to training and competition occurred at a mean of 10.1 weeks and 30.7 weeks postoperatively, respectively. CONCLUSIONS The available evidence regarding cTDR in athletes indicates that these patients RTSs at high rates, with return to training occurring around 10 weeks and return to competition occurring around 30 weeks. Clinical outcomes in these patients are like those reported for the general population. Low-level evidence, small numbers of cases, heterogeneity in chosen sport and participation level, and predominance of a single implant type limit the conclusions that can be drawn from the current literature on this patient population.
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Affiliation(s)
- John C F Clohisy
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
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19
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Maayan O, Pajak A, Shahi P, Asada T, Subramanian T, Araghi K, Singh N, Korsun MK, Singh S, Tuma OC, Sheha ED, Dowdell JE, Qureshi SA, Iyer S. Percutaneous Transforaminal Endoscopic Discectomy Learning Curve: A CuSum Analysis. Spine (Phila Pa 1976) 2023; 48:1508-1516. [PMID: 37235810 DOI: 10.1097/brs.0000000000004730] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023]
Abstract
STUDY DESIGN Retrospective review of prospectively collected data. OBJECTIVE To describe the learning curve for percutaneous transforaminal endoscopic discectomy (PTED) and demonstrate its efficacy in treating lumbar disc herniation. SUMMARY OF BACKGROUND DATA The learning curve for PTED has not yet been standardized in the literature. PATIENTS AND METHODS Consecutive patients who underwent lumbar PTED by a single surgeon between December 2020 and 2022 were included. Cumulative sum analysis was applied to operative and fluoroscopy time to assess the learning curve. Inflection points were used to divide cases into early and late phases. The 2 phases were analyzed for differences in operative and fluoroscopy time, length of stay, complications, and patient-reported outcome measures (PROMs). Patient characteristics and operative levels were also compared. PROMs entailed the Oswestry Disability Index, Patient-Reported Outcomes Measurement Information System, Visual Analog Scale Back/Leg, and 12-item Short Form Survey at preoperative, early postoperative (<6 mo), and late postoperative (≥6 mo) time points. PROMs between PTED cases and a comparable cohort of tubular microdiscectomy cases, performed by the same surgeon, were compared. RESULTS Fifty-five patients were included. Cumulative sum analysis indicated that both operative and fluoroscopy time diminished rapidly after case 31, suggesting a learning curve of 31 cases (early phase: n = 31; late phase: n = 24). Late-phase cases exhibited significantly lower operative times (85.7 vs . 62.2 min, P = 0.001) and fluoroscopy times (131.0 vs . 97.2 s, P = 0.001) compared with the early-phase cases. Both early and late-phase cases showed significant improvement in all PROMs. There were no differences in PROMs between the patients who underwent PTED and tubular microdiscectomy. CONCLUSION The PTED learning curve was found to be 31 cases and did not impact PROMs or complication rates. Although this learning curve reflects the experiences of a single surgeon and may not be broadly applicable, PTED can serve as an effective modality for the treatment of lumbar disc herniation.
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Affiliation(s)
- Omri Maayan
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
- Department of Orthopaedic Surgery, Weill Cornell Medicine, New York, NY
| | - Anthony Pajak
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Pratyush Shahi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Tomoyuki Asada
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Tejas Subramanian
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
- Department of Orthopaedic Surgery, Weill Cornell Medicine, New York, NY
| | - Kasra Araghi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Nishtha Singh
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | | | - Sumedha Singh
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Olivia C Tuma
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Evan D Sheha
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - James E Dowdell
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Sheeraz A Qureshi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
- Department of Orthopaedic Surgery, Weill Cornell Medicine, New York, NY
| | - Sravisht Iyer
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
- Department of Orthopaedic Surgery, Weill Cornell Medicine, New York, NY
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20
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Shahi P, Subramanian T, Maayan O, Korsun M, Singh S, Araghi K, Singh N, Asada T, Tuma O, Vaishnav A, Sheha E, Dowdell J, Qureshi S, Iyer S. Surgeon Experience Influences Robotics Learning Curve for Minimally Invasive Lumbar Fusion: A Cumulative Sum Analysis. Spine (Phila Pa 1976) 2023; 48:1517-1525. [PMID: 37280735 DOI: 10.1097/brs.0000000000004745] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/25/2023] [Indexed: 06/08/2023]
Abstract
STUDY DESIGN Retrospective review of prospectively collected data. OBJECTIVE To analyze the learning curves of three spine surgeons for robotic minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). SUMMARY OF BACKGROUND DATA Although the learning curve for robotic MI-TLIF has been described, the current evidence is of low quality with most studies being single-surgeon series. MATERIALS AND METHODS Patients who underwent single-level MI-TLIF with three spine surgeons (years in practice: surgeon 1: 4, surgeon 2: 16, and surgeon 3: two) using a floor-mounted robot were included. Outcome measures were operative time, fluoroscopy time, intraoperative complications, screw revision, and patient-reported outcome measures. Each surgeon's cases were divided into successive groups of 10 patients and compared for differences. Linear regression and cumulative sum (CuSum) analyses were performed to analyze the trend and learning curve, respectively. RESULTS A total of 187 patients were included (surgeon 1: 45, surgeon 2: 122, and surgeon 3: 20). For surgeon 1, CuSum analysis showed a learning curve of 21 cases with the attainment of mastery at case 31. Linear regression plots showed negative slopes for operative and fluoroscopy time. Both learning phase and postlearning phase groups showed significant improvement in patient-reported outcome measures. For surgeon 2, CuSum analysis demonstrated no discernible learning curve. There was no significant difference between successive patient groups in either operative time or fluoroscopy time. For surgeon 3, CuSum analysis demonstrated no discernible learning curve. Even though the difference between successive patient groups was not significant, cases 11 to 20 had an average operative time of 26 minutes less than cases 1-10), suggesting an ongoing learning curve. CONCLUSIONS Surgeons who are well-experienced can be expected to have no or minimal learning curve for robotic MI-TLIF. Early attendings are likely to have a learning curve of around 21 cases with the attainment of mastery at case 31. Learning curve does not seem to impact clinical outcomes after surgery. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
| | - Tejas Subramanian
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Omri Maayan
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medical College, New York, NY
| | | | | | | | | | | | | | | | - Evan Sheha
- Hospital for Special Surgery, New York, NY
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21
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Korsun MK, Shahi P, Shinn DJ, Pajak A, Araghi K, Maayan O, Singh N, Tuma O, Asada T, Singh S, Kim AYE, Mai E, Lu AZ, Sheha E, Dowdell J, Qureshi S, Iyer S. Improvement in predominant back pain following minimally invasive decompression for spinal stenosis. J Neurosurg Spine 2023; 39:576-582. [PMID: 37486867 DOI: 10.3171/2023.5.spine23278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/19/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVE The objective of this study was to assess the outcomes of patients with predominant back pain (pBP) undergoing minimally invasive decompression surgery compared with patients with nonpredominant back pain (npBP). METHODS This was a retrospective cohort study. Patients were divided into two groups based on the presenting complaint: 1) pBP, defined as visual analog scale (VAS) back pain score > VAS leg pain score; and 2) npBP. Changes in patient-reported outcome measures (PROMs) were compared at the early (< 6 months) and late (≥ 6 months) postoperative time points. Outcomes measures were: 1) PROMs (Oswestry Disability Index [ODI], VAS back and leg pain scores, 12-Item Short-Form Health Survey Physical Component Score [SF-12 PCS], and Patient-Reported Outcomes Measurement Information System Physical Function [PROMIS PF]), and 2) minimal clinically important difference (MCID) achievement rate and time. For the late MCID achievement point, a second analysis was conducted restricting VAS back and leg pain scores only to patients with preoperative scores ≥ 5. RESULTS Three hundred ninety patients were included (126 with pBP and 264 with npBP). There were no differences in patient demographics and operated levels. There were no differences in preoperative ODI, SF-12 PCS, and PROMIS PF scores. The pBP cohort had a significantly greater preoperative VAS back pain score than the npBP cohort, whereas the npBP cohort had a significantly greater preoperative VAS leg pain score than the pBP cohort. There were no differences in the absolute values or changes in ODI, VAS back pain, SF-12 PCS, and PROMIS PF scores at any time point. There was a significant difference in the early VAS leg pain scores (greater in npBP) that disappeared by the late postoperative time point. There was no difference in the MCID achievement rate in the ODI, SF-12 PCS, or PROMIS PF scores. By the late postoperative time point, 51.2% and 55.3% achieved an MCID on the ODI, 58.1% and 62.7% on the SF-12 PCS, 60% and 67.6% on the PROMIS PF, 81.1% and 73.2% on VAS back pain scores for those with preoperative scores ≥ 5, and 72% and 83.6% on VAS leg pain scores for those with preoperative scores ≥ 5 for the pBP and npBP cohorts, respectively. Additionally, there were no differences in time to MCID achievement for any PROMs. CONCLUSIONS The pBP and npBP cohorts showed similar improvement in PROMs and MCID achievement rates. This result shows that minimally invasive laminectomy is equally effective for patients presenting with pBP or npBP.
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Affiliation(s)
- Maximilian K Korsun
- 1Department of Orthopaedics, Hospital for Special Surgery, New York, New York
| | - Pratyush Shahi
- 1Department of Orthopaedics, Hospital for Special Surgery, New York, New York
| | - Daniel J Shinn
- 2Department of Orthopaedics, Weill Cornell Medical College, New York, New York; and
| | - Anthony Pajak
- 1Department of Orthopaedics, Hospital for Special Surgery, New York, New York
| | - Kasra Araghi
- 1Department of Orthopaedics, Hospital for Special Surgery, New York, New York
| | - Omri Maayan
- 1Department of Orthopaedics, Hospital for Special Surgery, New York, New York
- 2Department of Orthopaedics, Weill Cornell Medical College, New York, New York; and
| | - Nishtha Singh
- 1Department of Orthopaedics, Hospital for Special Surgery, New York, New York
| | - Olivia Tuma
- 1Department of Orthopaedics, Hospital for Special Surgery, New York, New York
| | - Tomoyuki Asada
- 1Department of Orthopaedics, Hospital for Special Surgery, New York, New York
- 3Department of Orthopaedics, University of Tsukuba, Ibaraki, Japan
| | - Sumedha Singh
- 1Department of Orthopaedics, Hospital for Special Surgery, New York, New York
| | - Ashley Yeo Eun Kim
- 1Department of Orthopaedics, Hospital for Special Surgery, New York, New York
- 2Department of Orthopaedics, Weill Cornell Medical College, New York, New York; and
| | - Eric Mai
- 1Department of Orthopaedics, Hospital for Special Surgery, New York, New York
- 2Department of Orthopaedics, Weill Cornell Medical College, New York, New York; and
| | - Amy Z Lu
- 1Department of Orthopaedics, Hospital for Special Surgery, New York, New York
- 2Department of Orthopaedics, Weill Cornell Medical College, New York, New York; and
| | - Evan Sheha
- 1Department of Orthopaedics, Hospital for Special Surgery, New York, New York
| | - James Dowdell
- 1Department of Orthopaedics, Hospital for Special Surgery, New York, New York
| | - Sheeraz Qureshi
- 1Department of Orthopaedics, Hospital for Special Surgery, New York, New York
| | - Sravisht Iyer
- 1Department of Orthopaedics, Hospital for Special Surgery, New York, New York
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Shahi P, Subramanian T, Araghi K, Singh S, Asada T, Maayan O, Korsun M, Singh N, Tuma O, Dowdell J, Sheha E, Qureshi S, Iyer S. Comparison of Robotics and Navigation for Clinical Outcomes After Minimally Invasive Lumbar Fusion. Spine (Phila Pa 1976) 2023; 48:1342-1347. [PMID: 37199417 DOI: 10.1097/brs.0000000000004721] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/08/2023] [Indexed: 05/19/2023]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE To compare navigation and robotics in terms of clinical outcomes after minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). SUMMARY OF BACKGROUND DATA Although robotics has been shown to have advantages like reduced radiation exposure, greater screw size, and slightly better accuracy over navigation, none of the studies has compared these two modalities in terms of clinical outcomes. METHODS Patients who underwent single-level MI-TLIF using robotics or navigation and had a minimum of 1-year follow-up were included. The robotics and navigation groups were compared for improvement in patient-reported outcome measures (PROMs), minimal clinically important difference, patient-acceptable symptom state, response on the global rating change scale, and screw-related complication and reoperation rates. RESULTS A total of 278 patients (143 robotics, 135 navigation) were included. There was no significant difference between the robotics and navigation groups in the baseline demographics, operative variables, and preoperative PROMs. Both groups showed significant improvement in PROMs at below six and six months or above, with no significant difference in the magnitude of improvement between the two groups. Most patients achieved minimal clinically important difference and patient-acceptable symptom state and reported feeling better on the global rating change scale, with no significant difference in the proportions between the robotics and navigation groups. The screw-related complication and reoperation rates also showed no significant difference between the two groups. CONCLUSIONS Robotics did not seem to lead to significantly better clinical outcomes compared with navigation following MI-TLIF. Although the clinical outcomes may be similar, robotics offers the advantages of reduced radiation exposure, greater screw size, and slightly better accuracy over navigation. These advantages should be considered when determining the utility and cost-effectiveness of robotics in spine surgery. Larger multicenter prospective studies are required in the future to further investigate this subject.
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Affiliation(s)
| | - Tejas Subramanian
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medical College, New York, NY
| | | | | | | | - Omri Maayan
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medical College, New York, NY
| | | | | | | | | | - Evan Sheha
- Hospital for Special Surgery, New York, NY
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23
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Araghi K, Fourman MS, Merrill RK, Maayan O, Zhao E, Pajak A, Subramanian T, Kim DN, Kamil R, Shahi P, Sheha ED, Dowdell JE, Iyer S, Qureshi SA. Postoperative Radiculitis After L5-S1 Anterior Lumbar Interbody Fusion. Spine (Phila Pa 1976) 2023; 48:1317-1325. [PMID: 37259185 DOI: 10.1097/brs.0000000000004740] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/24/2023] [Indexed: 06/02/2023]
Abstract
STUDY DESIGN Retrospective chart review. OBJECTIVE This study aimed to examine postoperative radiculitis after isolated L5-S1 anterior lumbar interbody fusion (ALIF), determine which factors contribute to its development, and investigate the comparative outcomes of patients with versus without postoperative radiculitis. SUMMARY OF BACKGROUND DATA Both standalone and traditionalALIF are common and safe lumbar spine fusion techniques. Although optimal safety and effectiveness are achieved through appropriate patient selection, postoperative radiculitis after L5-S1 ALIF is a potential complication that seems to be the least predictable in the absence of iatrogenic injury. PATIENTS AND METHODS All adult patients (18-80 yr) with preoperative radiculopathies who underwent L5-S1 ALIF by 9 board-certified spine surgeons at a single academic institution from January 2016 to December 2021 with a minimum of 3 months follow-up were included. Patient records were assessed for data on clinical characteristics and patient-reported outcome scores (patient-reported outcome measures). All patient records were evaluated to determine whether postoperative radiculitis developed. Radiographic measurements using x-rays were completed using all available pre and postoperative imaging. Multivariable logistic regressions were performed utilizing radiculitis as the dependent variable and various independent predictor variables. RESULTS One hundred forty patients were included, 48 (34%) patients developed postoperative radiculitis, with symptom onset and resolution occurring at 14.5 and 83 days, respectively. The two groups had no differences in preoperative or postoperative radiographic parameters. Multivariable regression showed 3 independent predictors of postoperative radiculitis: methylprednisolone use [OR: 6.032; (95% CI: 1.670-25.568)], increased implant height [OR: 1.509; (95% CI: 1.189-1.960)], and no posterior fixation [OR: 2.973; (95% CI: 1.353-0.806)]. CONCLUSIONS Of the 34% of patients who developed postoperative radiculitis after L5-S1 ALIF, it resolved on average within 3 months of surgery. These findings may help reduce the risk of undue short-term morbidity after isolated L5-S1 ALIF by informing preoperative counseling and intraoperative decision-making.
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Affiliation(s)
- Kasra Araghi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Mitchell S Fourman
- Department of Orthopaedic Surgery, Orthopaedic Spine Service, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Robert K Merrill
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Omri Maayan
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Eric Zhao
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Anthony Pajak
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Tejas Subramanian
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - David N Kim
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Robert Kamil
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Pratyush Shahi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Evan D Sheha
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - James E Dowdell
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Sravisht Iyer
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Sheeraz A Qureshi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
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Nakarai H, Kato S, Yamato Y, Kodama H, Ohba Y, Sasaki K, Iizuka T, Tozawa K, Urayama D, Komatsu N, Okazaki R, Oshina M, Ogiso S, Masuda K, Maayan O, Tanaka S, Oshima Y. Quality of Life and Postoperative Satisfaction in Patients with Benign Extramedullary Spinal Tumors: A Multicenter Study. Spine (Phila Pa 1976) 2023; 48:E308-E316. [PMID: 37417695 DOI: 10.1097/brs.0000000000004771] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/29/2023] [Indexed: 07/08/2023]
Abstract
STUDY DESIGN Retrospective cohort study using prospectively collected registry data. OBJECTIVE The purpose of this study is to evaluate health-related quality of life (HRQOL) and postoperative satisfaction in patients with different histotypes of benign extramedullary spinal tumors (ESTs). BACKGROUND Little is known about how different histotypes influence HRQOL and postoperative satisfaction in EST patients. MATERIALS AND METHODS Patients undergoing primary benign EST surgery at 11 tertiary referral hospitals between 2017 and 2021 who completed preoperative and 1-year postoperative questionnaires were included. HRQOL assessment included the Physical Component Summary and Mental Component Summary (MCS) of Short Form-12, EuroQol 5-dimension, Oswestry/Neck Disability Index (ODI/NDI), and Numeric Rating Scales (NRS) for upper/lower extremities (UEP/LEP) and back pain (BP). Patients who answered "very satisfied," "satisfied," or "somewhat satisfied" on a seven-point Likert scale were considered to be satisfied with treatment. Student t -tests or Welch's t -test were used to compare continuous variables between two groups, and one-way analysis of variance was used to compare outcomes between the three groups of EST histotypes (schwannoma, meningioma, atypical). Categorical variables were compared using the χ 2 test or Fisher exact test. RESULTS A total of 140 consecutive EST patients were evaluated; 100 (72%) had schwannomas, 30 (21%) had meningiomas, and 10 (7%) had other ESTs. Baseline Physical Component Summary was significantly worse in patients with meningiomas ( P =0.04), and baseline NRS-LEP was significantly worse in patients with schwannomas ( P =0.03). However, there were no significant differences in overall postoperative HRQOL or patient satisfaction between histology types. Overall, 121 (86%) patients were satisfied with surgery. In a subgroup analysis comparing intradural schwannomas and meningiomas adjusted for patient demographics and tumor location with inverse probability weighting, schwannoma patients had worse baseline MCS ( P =0.03), ODI ( P =0.03), NRS-BP ( P <.001), and NRS-LEP ( P =0.001). Schwannoma patients also had worse postoperative MCS ( P =0.03) and NRS-BP ( P =0.001), with no significant difference in the percentage of satisfied patients ( P =0.30). CONCLUSIONS Patients who underwent primary benign EST resection had a significant improvement in HRQOL postoperatively, and ~90% of these patients reported being satisfied with their treatment outcomes one year after surgery. EST patients may exhibit a relatively lower threshold for postoperative satisfaction compared with patients undergoing surgery for degenerative spine conditions.
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Affiliation(s)
- Hiroyuki Nakarai
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
| | - So Kato
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukimasa Yamato
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyasu Kodama
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yutaro Ohba
- Department of Orthopedic Surgery, Kanto Rosai Hospital, Kanagawa, Japan
| | - Katsuyuki Sasaki
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Department of Orthopedic Surgery, Yokohama Rosai Hospital, Kanagawa, Japan
| | - Tetsusai Iizuka
- Department of Orthopedic Surgery, Yokohama Rosai Hospital, Kanagawa, Japan
| | - Keiichiro Tozawa
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Spine center, Toranomon Hospital, Tokyo, Japan
| | - Daiki Urayama
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Department of Spinal Surgery, Japan Community Health-care Organization Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Naoto Komatsu
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Department of Orthopedic Surgery, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Rentaro Okazaki
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Department of Orthopedic Surgery, Saitama Red Cross Hospital, Saitama, Japan
| | - Masahito Oshina
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Department of Orthopedic Surgery, NTT Medical Center Tokyo, Tokyo, Japan
| | - Sawako Ogiso
- Department of Orthopedic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Kazuhiro Masuda
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Department of Orthopedic Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Omri Maayan
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasushi Oshima
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Subramanian T, Shinn D, Shahi P, Akosman I, Amen T, Maayan O, Zhao E, Araghi K, Song J, Dalal S, Dowdell J, Iyer S, Qureshi S. Severe Obesity Is an Independent Risk Factor of Early Readmission and Nonhome Discharge After Cervical Disc Replacement. Neurospine 2023; 20:890-898. [PMID: 37798984 PMCID: PMC10562223 DOI: 10.14245/ns.2346442.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/23/2023] [Accepted: 06/06/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE Despite growing interest in cervical disc replacement (CDR) for conditions such as cervical radiculopathy, limited data exists describing the impact of obesity on early postoperative outcomes and complications. These data are especially important as nearly half of the adult population in the United States is expected to become obese (body mass index [BMI] ≥ 30 kg/m2) by 2030. The goal of this study was to compare the demographics, perioperative variables, and complication rates following CDR. METHODS The 2005-2020 American College of Surgeons National Surgical Quality Improvement Program datasets were queried for patients who underwent primary 1- or 2-level CDR. Patients were divided into 3 cohorts: Nonobese (BMI: 18.5-29.9 kg/m2), Obese class-I (BMI: 30-34.9 kg/m2), Obese class-II/III (BMI ≥ 35 kg/m2). Morbidity was defined as the presence of any complication within 30 days postoperatively. Rates of 30-day readmission, reoperation, morbidity, individual complications, length of stay, frequency of nonhome discharge disposition were collected. RESULTS A total of 5,397 patients were included for analysis: 3,130 were nonobese, 1,348 were obese class I, and 919 were obese class II/III. There were more 2-level CDRs performed in the class II/III cohort compared to the nonobese group (25.7% vs. 21.5%, respectively; p < 0.05). Class-II/III had more nonhome discharges than class I and nonobese (2.1% vs. 0.5% vs. 0.7%, respectively; p < 0.001). Readmission rates differed as well (nonobese: 0.5%, class I: 1.1%, class II/III: 2.1%; p < 0.001) with pairwise significance between class II/II and nonobese. Class II/III obesity was an independent risk factor for both readmission (odds ratio [OR], 3.32; p = 0.002) and nonhome discharge (OR, 2.51; p = 0.02). Neither 30-day reoperation nor morbidity rates demonstrated significance. No mortalities were reported. CONCLUSION Although obese class-II/III were risk factors for 30-day readmission and nonhome discharge, there was no significant difference in reoperation rates or morbidity. CDR procedures can continue to be safely preformed independent of obesity status.
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Affiliation(s)
- Tejas Subramanian
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medicine, New York, NY, USA
| | - Daniel Shinn
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medicine, New York, NY, USA
| | | | - Izzet Akosman
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medicine, New York, NY, USA
| | - Troy Amen
- Hospital for Special Surgery, New York, NY, USA
| | - Omri Maayan
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medicine, New York, NY, USA
| | - Eric Zhao
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medicine, New York, NY, USA
| | | | - Junho Song
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medicine, New York, NY, USA
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26
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Araghi K, Subramanian T, Haque N, Merrill R, Amen TB, Shahi P, Singh S, Maayan O, Sheha E, Dowdell J, Iyer S, Qureshi SA. Provider Referral Patterns and Surgical Utilization Among New Patients Seen in Spine Clinic. Spine (Phila Pa 1976) 2023; 48:885-891. [PMID: 37026719 DOI: 10.1097/brs.0000000000004656] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/05/2023] [Indexed: 04/08/2023]
Abstract
STUDY DESIGN Retrospective chart review. OBJECTIVE The objective of this study was to elucidate the demographics of patient referrals from different sources and identify factors that affect a patient's likelihood of undergoing surgery. SUMMARY OF BACKGROUND DATA Despite baseline factors for surgical consideration, such as attempting conservative management, surgeons encounter many patients who are not surgically indicated. Overreferrals, that is, a patient referred to a surgeon that does not need surgery, can result in long wait times, delayed care, worse outcomes, and resource waste. MATERIALS AND METHODS All new patients at a single academic institution seen in the clinic by eight spine surgeons between January 1, 2018, and January 1, 2022, were analyzed. Referral types included self-referral, musculoskeletal (MSK), and non-MSK provider referral. Patient demographics included age, body mass index (BMI), zip code as a proxy for socioeconomic status, sex, insurance type, and surgical procedures undergone within 1.5 years postclinic visit. Analysis of variance and a Kruskal-Wallis test was used to compare means among normally and non-normally disturbed referral groups, respectively. Multivariable logistic regressions were run to assess demographic variables associated with undergoing surgery. RESULTS From 9356 patients, 84% (7834) were self-referred, 3% (319) were non-MSK, and 13% (1203) were MSK. A statistically significant association with ultimately undergoing surgery was observed with MSK referral type compared with non-MSK referral [odds ratio (OR)=1.37, CI: 1.04-1.82, P =0.0246]. Additional independent variables observed to be associated with patients undergoing surgery included older age (OR=1.004, CI: 1.002-1.007, P =0.0018), higher BMI (OR=1.02, CI: 1.011-1.029, P <0.0001), high-income quartile (OR=1.343, CI: 1.177-1.533, P <0.0001), and male sex (OR=1.189, CI: 1.085-1.302, P =0.0002). CONCLUSIONS A statistically significant association with undergoing surgery was observed with a referral by an MSK provider, older age, male sex, high BMI, and a high-income quartile home zip code. Understanding these factors and patterns is critical for optimizing practice efficiency and reducing the burdens of inappropriate referrals.
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Affiliation(s)
| | - Tejas Subramanian
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medicine, New York, NY
| | | | | | | | | | | | - Omri Maayan
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medicine, New York, NY
| | - Evan Sheha
- Hospital for Special Surgery, New York, NY
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27
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Shahi P, Maayan O, Shinn D, Dalal S, Song J, Araghi K, Melissaridou D, Vaishnav A, Shafi K, Pompeu Y, Sheha E, Dowdell J, Iyer S, Qureshi SA. Floor-Mounted Robotic Pedicle Screw Placement in Lumbar Spine Surgery: An Analysis of 1,050 Screws. Neurospine 2023; 20:577-586. [PMID: 37401076 PMCID: PMC10323346 DOI: 10.14245/ns.2346070.035] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVE To analyze the usage of floor-mounted robot in minimally invasive lumbar fusion. METHODS Patients who underwent minimally invasive lumbar fusion for degenerative pathology using floor-mounted robot (ExcelsiusGPS) were included. Pedicle screw accuracy, proximal level violation rate, pedicle screw size, screw-related complications, and robot abandonment rate were analyzed. RESULTS Two hundred twenty-nine patients were included. Most surgeries were primary single-level fusion. Sixty-five percent of surgeries had intraoperative computed tomography (CT) workflow, 35% had preoperative CT workflow. Sixty-six percent were transforaminal lumbar interbody fusion, 16% were lateral, 8% were anterior, and 10% were a combined approach. A total of 1,050 screws were placed with robotic assistance (85% in prone position, 15% in lateral position). Postoperative CT scan was available for 80 patients (419 screws). Overall pedicle screw accuracy rate was 96.4% (prone, 96.7%; lateral, 94.2%; primary, 96.7%; revision, 95.3%). Overall poor screw placement rate was 2.8% (prone, 2.7%; lateral, 3.8%; primary, 2.7%; revision, 3.5%). Overall proximal facet and endplate violation rates were 0.4% and 0.9%. Average diameter and length of pedicle screws were 7.1 mm and 47.7 mm. Screw revision had to be done for 1 screw (0.1%). Use of the robot had to be aborted in 2 cases (0.8%). CONCLUSION Usage of floor-mounted robotics for the placement of lumbar pedicle screws leads to excellent accuracy, large screw size, and negligible screw-related complications. It does so for screw placement in prone/lateral position and primary/revision surgery alike with negligible robot abandonment rates.
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Affiliation(s)
| | - Omri Maayan
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | | | | | - Junho Song
- Hospital for Special Surgery, New York, NY, USA
| | | | | | | | - Karim Shafi
- Hospital for Special Surgery, New York, NY, USA
| | - Yuri Pompeu
- Hospital for Special Surgery, New York, NY, USA
| | - Evan Sheha
- Hospital for Special Surgery, New York, NY, USA
| | | | - Sravisht Iyer
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Sheeraz A. Qureshi
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
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28
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Singh S, Shahi P, Asada T, Kaidi A, Subramanian T, Zhao E, Kim AYE, Maayan O, Araghi K, Singh N, Tuma O, Korsun M, Kamil R, Sheha E, Dowdell J, Qureshi S, Iyer S. Poor Muscle Health and Low Preoperative ODI are Independent Predictors for Slower Achievement of MCID After Minimally Invasive Decompression. Spine J 2023:S1529-9430(23)00157-2. [PMID: 37059307 DOI: 10.1016/j.spinee.2023.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/27/2023] [Accepted: 04/07/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND CONTEXT Although some previous studies have analyzed predictors of non-improvement, most of these have focused on demographic and clinical variables and have not accounted for radiological predictors. In addition, while several studies have examined the degree of improvement after decompression, there is less data on the rate of improvement. PURPOSE To identify the risk factors and predictors (both radiological and non-radiological) for slower as well as non-achievement of minimal clinically important difference (MCID) after minimally invasive decompression. DESIGN Retrospective cohort PATIENT SAMPLE: Patients who underwent minimally invasive decompression for degenerative lumbar spine conditions and had a minimum of 1-year follow-up were included. Patients with preoperative Oswestry Disability Index (ODI) <20 were excluded. OUTCOME MEASURE MCID achievement in ODI (cut off 12.8). METHODS Patients were stratified into two groups (achieved MCID, did not achieve MCID) at two timepoints (early ≤3 months, late ≥6 months). Non-radiological (age, gender, BMI, comorbidities, anxiety, depression, number of levels operated, preoperative ODI, preoperative back pain) and radiological (MRI - Schizas grading for stenosis, dural sac cross-sectional area, Pfirrmann grading for disc degeneration, psoas cross-sectional area and Goutallier grading, facet cyst/effusion; X-ray - spondylolisthesis, lumbar lordosis, spinopelvic parameters) variables were assessed with comparative analysis to identify risk factors and with multiple regression models to identify predictors for slower achievement of MCID (MCID not achieved by ≤3 months) and non-achievement of MCID (MCID not achieved at ≥6 months). RESULTS 338 patients were included. At ≤3 months, patients who did not achieve MCID had significantly lower preoperative ODI (40.1 vs. 48.1, p<0.001) and worse psoas Goutallier grading (p=0.048). At ≥6 months, patients who did not achieve MCID had significantly lower preoperative ODI (38 vs. 47.5, p<0.001), higher age (68 vs. 63 years, p=0.007), worse average L1-S1 Pfirrmann grading (3.5 vs. 3.2, p=0.035), and higher rate of pre-existing spondylolisthesis at the operated level (p=0.047). When these and other probable risk factors were put into a regression model, low preoperative ODI (p=0.002) and poor Goutallier grading (p=0.042) at the early timepoint and low preoperative ODI (p<0.001) at the late timepoint came out as independent predictors for MCID non-achievement. CONCLUSION After minimally invasive decompression, low preoperative ODI and poor muscle health are risk factors and predictors for slower achievement of MCID. For non-achievement of MCID, low preoperative ODI, higher age, greater disc degeneration, and spondylolisthesis are risk factors and low preoperative ODI is the only independent predictor.
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Affiliation(s)
- Sumedha Singh
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Pratyush Shahi
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Tomoyuki Asada
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Austin Kaidi
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Tejas Subramanian
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
| | - Eric Zhao
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
| | - Ashley Yeo Eun Kim
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
| | - Omri Maayan
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
| | - Kasra Araghi
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Nishtha Singh
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Olivia Tuma
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Maximilian Korsun
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Robert Kamil
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Evan Sheha
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - James Dowdell
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Sheeraz Qureshi
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
| | - Sravisht Iyer
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
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Maayan O, Tusa Lavieri ME, Babu C, Chua J, Christos PJ, Schwartz TH. Additive risk of surgical site infection from more than one risk factor following craniotomy for tumor. J Neurooncol 2023; 162:337-342. [PMID: 36988747 PMCID: PMC10953908 DOI: 10.1007/s11060-023-04294-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/10/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE This study seeks to expound upon risk factor etiologies for surgical site infection (SSI) and investigate their combinatorial effects on infection rate following craniotomy for neuro-oncologic pathology. METHODS Patients who underwent neuro-oncologic craniotomy between 2006 and 2020 were included. Medical records were reviewed to identify the occurrence of wound infection at ≤ 3 months postoperatively. Potential risk factors for infection included tumor pathology, location, anesthesia type, indication, ventricular entry, foreign body, brachytherapy, lumbar drain, prior operation, prior cranial radiation, prior infection, bevacizumab, and medical comorbidities (hypertension, obesity, diabetes, hyperlipidemia, other cancer, cirrhosis). Logistic regression was implemented to determine risk factors for SSI. Chi-square tests were used to assess whether the number of risk factors (e.g., 0, ≥ 1, ≥2, ≥ 3, ≥4) increases the risk of SSI compared to patients with fewer risk factors. The relative increase with each additional risk factor was also evaluated. RESULTS A total of 1209 patients were included. SSI occurred in 42 patients (3.5%) by 90 days after surgery. Significant risk factors on multivariate logistic regression were bevacizumab (OR 40.84; p < 0.001), cirrhosis (OR 14.20, p = 0.03), foreign body placement (OR 4.06; P < 0.0001), prior radiation (OR 2.20; p = 0.03), and prior operation (OR 1.92; p = 0.04). Infection rates in the combinatorial analysis were as follows: ≥1 risk factor = 5.9% (OR 2.74; p = 0.001), ≥ 2 = 6.7% (OR 2.28; p = 0.01), ≥ 3 = 19.0% (OR 6.5; p < 0.0001), ≥ 4 = 100% (OR 30.2; p < 0.0001). CONCLUSIONS Risk factors in aggregate incrementally increase the risk of postoperative SSI after craniotomy for tumor.
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Affiliation(s)
- Omri Maayan
- Weill Cornell Medical College, New York, NY, USA
| | | | | | - Jason Chua
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Paul J Christos
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Theodore H Schwartz
- Department of Neurological Surgery, Weill Cornell Medicine/New York Presbyterian Hospital, 525 East 68th St, Box #99, New York, NY, 10065, USA.
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Maayan O, Babu C, Tusa Lavieri ME, Chua J, Christos PJ, Schwartz TH. Combined use of vancomycin powder and betadine irrigation lowers the incidence of postcraniotomy wound infection in low-risk cases: a single-center risk-stratified cohort analysis. Acta Neurochir (Wien) 2022; 164:867-874. [PMID: 35028744 DOI: 10.1007/s00701-021-05075-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Postoperative surgical site infections (SSIs) constitute a significant source of morbidity for neurosurgical patients. Protocols that minimize postoperative wound infections are integral to improving outcomes and curtailing expenditures. The present study seeks to identify risk factors for infection and assess the efficacy of prophylactic betadine irrigation and vancomycin powder in addition to standard antibiotic irrigation. METHODS We reviewed craniotomies performed by THS at Weill Cornell/New York Presbyterian Hospital to treat neuro-oncologic pathology. Patients were divided into three groups: group 1 - antibiotic irrigation, group 2 - antibiotic irrigation and betadine irrigation, group 3 - antibiotic irrigation, betadine irrigation, and vancomycin powder. SSI was confirmed with bacterial culture. Risk factor identification and assessment of treatment paradigms was performed using chi-square tests and univariate logistic regression. RESULTS Among 1209 total patients, the 30- and 90-day SSI rates were 1.7% and 3.5%, respectively. Significant predictors of SSI included preoperative use of bevacizumab (OR 40.84; p < 0.0001), foreign body (OR 4.06; p < 0.0001), prior radiation (OR 2.20; p = 0.03), and prior operation/biopsy (OR 1.92; p = 0.04). Risk of infection was 2.1% in low-risk cases and 6.9% in high-risk cases. A significant, incremental decrement in SSIs was identified between the prophylaxis groups, although only among low-risk cases: group 1: 4.53%, group 2: 1.39%, group 3: 0.42% (p = 0.02). Neither vancomycin powder nor betadine significantly reduced the risk of SSI in patients with one or more risk factors. CONCLUSION Vancomycin powder with betadine irrigation decreased SSI rates following neuro-oncologic cranial procedures in patients at low risk of infection (i.e., no preoperative risk factors).
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Affiliation(s)
- Omri Maayan
- Weill Cornell Medical College, New York, NY, USA
| | | | | | - Jason Chua
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Paul J Christos
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Theodore H Schwartz
- Department of Neurological Surgery, Weill Cornell Medicine/New York Presbyterian Hospital, 525 East 68th St, Box #99, New York, NY, 10065, USA.
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Tosi U, Maayan O, An A, Lavieri MET, Guadix SW, DeRosa AP, Christos PJ, Pannullo S, Stieg PE, Brandmaier A, Knisely JPS, Ramakrishna R. Stereotactic radiosurgery for vestibular schwannomas in neurofibromatosis type 2 patients: a systematic review and meta-analysis. J Neurooncol 2022; 156:431-441. [PMID: 35040021 DOI: 10.1007/s11060-021-03910-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/22/2021] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Neurofibromatosis type 2 (NF2) is characterized by often bilateral vestibular schwannomas (VS) that result in progressive hearing loss and compression of nearby brainstem structures causing cranial nerve palsies. Treatment of these tumors remains challenging, as both surgical removal and expectant management can result in symptom progression. Stereotactic radiosurgery (SRS) has been investigated for the management of NF2-associated VS; however, the role, promises, and pitfalls of this treatment modality remain unclear. METHODS Ovid MEDLINE, EMBASE, Web of Science, and Cochrane Reviews were searched for studies assessing SRS outcome in NF2-associated VS only. Primary endpoints included tumor control, serviceable hearing, presence of tinnitus, and cranial nerve V and VII symptoms. RESULTS A total of 16 studies (589 patients harboring 750 tumors) were analyzed. Clinical tumor control was achieved in 88% of cases (95% CI 80-95%); salvage surgery was needed in 8% (95% CI 4-13%) of cases. Treatment resulted in a worsening of pre-treatment serviceable hearing (OR = 0.26, p < 0.01), increased facial nerve (OR = 1.62, p < 0.01) and trigeminal nerve (OR = 1.42, p = 0.07) impairment. The incidence of vestibular symptoms and hydrocephalus were not consistently reported and thus could not be assessed. CONCLUSIONS The treatment of NF2-associated VS continues to pose a challenge, as current SRS regimens result in impaired hearing and worse cranial nerve comorbidities, despite achieving high tumor control. It remains unclear if these findings have to be regarded as treatment complications or, rather, continued disease progression.
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Affiliation(s)
- Umberto Tosi
- Department of Neurological Surgery, Weill Cornell Medicine, 525 E. 68th St.10065, Box 99, New York, NY, USA
| | - Omri Maayan
- Department of Neurological Surgery, Weill Cornell Medicine, 525 E. 68th St.10065, Box 99, New York, NY, USA
| | - Anjile An
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA
| | - Miguel E Tusa Lavieri
- Department of Neurological Surgery, Weill Cornell Medicine, 525 E. 68th St.10065, Box 99, New York, NY, USA
| | - Sergio W Guadix
- Department of Neurological Surgery, Weill Cornell Medicine, 525 E. 68th St.10065, Box 99, New York, NY, USA
| | - Antonio P DeRosa
- Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, NY, USA
| | - Paul J Christos
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA
| | - Susan Pannullo
- Department of Neurological Surgery, Weill Cornell Medicine, 525 E. 68th St.10065, Box 99, New York, NY, USA
| | - Philip E Stieg
- Department of Neurological Surgery, Weill Cornell Medicine, 525 E. 68th St.10065, Box 99, New York, NY, USA
| | - Andrew Brandmaier
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, USA
| | | | - Rohan Ramakrishna
- Department of Neurological Surgery, Weill Cornell Medicine, 525 E. 68th St.10065, Box 99, New York, NY, USA.
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Tosi U, Lavieri MET, An A, Maayan O, Guadix SW, DeRosa AP, Christos PJ, Pannullo S, Stieg PE, Brandmaier A, Knisely JPS, Ramakrishna R. Outcomes of stereotactic radiosurgery for large vestibular schwannomas: a systematic review and meta-analysis. Neurooncol Pract 2021; 8:405-416. [PMID: 34277019 DOI: 10.1093/nop/npab011] [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] [Indexed: 11/12/2022] Open
Abstract
Background Large vestibular schwannomas (VS) pose a treatment challenge for both microsurgery (MS) and stereotactic radiosurgery (SRS). Technical developments have allowed for safer irradiation of large tumors. It remains unclear if SRS can achieve appropriate tumor control and acceptable cranial nerve toxicities. In this study, we assess outcomes of irradiation for large VS. Methods PubMed MEDLINE, EMBASE, Web of Science, and Cochrane were searched for all the studies assessing SRS outcome in large VS. Primary endpoints included clinical and radiographic tumor control, need for salvage surgery, serviceable hearing, cranial nerve V and VII impairment, presence of hydrocephalus requiring shunting, and presence of vertigo/dizziness. Results Twenty-two studies were identified that met selection criteria for analysis from an initial pool of 1272 reports. They were evaluated according to treatment protocol: 1) single-dose SRS (13 studies, 483 patients), 2) combination of MS and SRS (7 studies, 182 patients), and 3) fractionated SRS (3 studies, 82 patients). Tumor control was achieved in 89%, 94%, and 91% of patients, respectively. Odds ratios (ORs) of post- over pretreatment serviceable hearing were 0.42 (P < .01), 0.47 (P = .05), and 0.60 (P = .22); for facial nerve impairment, these ORs were 1.08 (P = .69), 3.45 (P = .28), and 0.87 (P = .71), respectively. Conclusions The management of large VS remains challenging. All treatment modalities resulted in high tumor control rates and worsening of pretreatment hearing. None, however, caused significant facial nerve impairment, suggesting that management strategies incorporating focal irradiation can be successful.
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Affiliation(s)
- Umberto Tosi
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | | | - Anjile An
- Division of Biostatistics and Epidemiology, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Omri Maayan
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Sergio W Guadix
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Antonio P DeRosa
- Samuel J. Wood Library, Weill Cornell Medicine, New York, New York, USA
| | - Paul J Christos
- Division of Biostatistics and Epidemiology, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Susan Pannullo
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Philip E Stieg
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Andrew Brandmaier
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Jonathan P S Knisely
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Rohan Ramakrishna
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
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Tosi U, Maayan O, An A, Lavieri M, Guadix S, DeRosa A, Christos P, Pannullo S, Stieg P, Brandmaier A, Knisely J, Ramakrishna R. NCOG-12. STEREOTACTIC RADIOSURGERY FOR VESTIBULAR SCHWANNOMAS IN NEUROFIBROMATOSIS TYPE 2 PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
One of the hallmarks of neurofibromatosis type 2 (NF2) is the presence of bilateral vestibular schwannomas (VSs) that result in progressive hearing loss and compression of nearby brainstem structures causing cranial nerve palsies. Treatment of these tumors remains challenging, as both surgical removal and expectant management can result in symptom progression. Stereotactic radiosurgery (SRS) has recently been investigated for the management of NF2-associated VSs; however, the role, promises, and pitfalls of this treatment modality remain unclear.
METHODS
Ovid MEDLINE, EMBASE, Web of Science, and Cochrane Reviews were searched for studies assessing SRS outcome in NF2-associated VSs only. Primary endpoints included tumor control, serviceable hearing, presence of tinnitus, and cranial nerve V and VII symptoms.
RESULTS
A total of 16 studies (589 patients harboring 750 tumors) was included in this analysis. Clinical tumor control was achieved in 88% of cases (95% CI: 80%-95%); salvage surgery was needed in 8% (95% CI: 4%-13%) of cases. Treatment resulted in a worsening of pre-treatment serviceable hearing (OR of 0.26, p < 0.01), in an increase of facial nerve impairment (OR of 1.62, p < 0.01), and showed a trend for increase trigeminal nerve impairment as well (OR of 1.42, p = 0.07). The incidence of vestibular symptoms and hydrocephalus requiring shunting could not be assessed since these measures were not reported consistently.
CONCLUSIONS
The treatment of NF2-associated VS continues to pose a challenge, as current SRS regimens result in impaired hearing and worse cranial nerve comorbidities, despite achieving high tumor control. It remains unclear if these findings have to be intended as treatment complications or, rather, continuous disease progression despite tumor control.
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Affiliation(s)
| | | | - Anjile An
- Weill Cornell Medicine, New York, NY, USA
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Schragenheim J, Bellner L, Cao J, Singh SP, Bamshad D, McClung JA, Maayan O, Meissner A, Grant I, Stier CT, Abraham NG. EET enhances renal function in obese mice resulting in restoration of HO-1-Mfn1/2 signaling, and decrease in hypertension through inhibition of sodium chloride co-transporter. Prostaglandins Other Lipid Mediat 2018; 137:30-39. [PMID: 29787809 DOI: 10.1016/j.prostaglandins.2018.05.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 04/12/2018] [Accepted: 05/14/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND We have previously reported that epoxyeicosatrienoic acid (EET) has multiple beneficial effects on renal and adipose tissue function, in addition to its vasodilatory action; it increases insulin sensitivity and inhibits inflammation. In an examination of the signaling mechanisms by which EET reduces renal and peri-renal fat function, we hypothesized that EET ameliorates obesity-induced renal dysfunction by improving sodium excretion, reducing the sodium-chloride cotransporter NCC, lowering blood pressure, and enhancing mitochondrial and thermogenic gene levels in PGC-1α dependent mice. METHODS EET-agonist treatment normalized glucose metabolism, renal ENaC and NCC protein expression, urinary sodium excretion and blood pressure in obese (db/db) mice. A marked improvement in mitochondrial integrity, thermogenic genes, and PGC-1α-HO-1-adiponectin signaling occurred. Knockout of PGC-1α in EET-treated mice resulted in a reversal of these beneficial effects including a decrease in sodium excretion, elevation of blood pressure and an increase in the pro-inflammatory adipokine nephroblastoma overexpressed gene (NOV). In the elucidation of the effects of EET on peri-renal adipose tissue, EET increased adiponectin, mitochondrial integrity, thermogenic genes and decreased NOV, i.e. "Browning' peri-renal adipose phenotype that occurs under high fat diets. Taken together, these data demonstrate a critical role of an EET agonist in the restoration of healthy adipose tissue with reduced release of inflammatory molecules, such as AngII and NOV, thereby preventing their detrimental impact on sodium absorption and NCC levels and the development of obesity-induced renal dysfunction.
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Affiliation(s)
- Joseph Schragenheim
- Department of Pharmacology, New York Medical College, Valhalla, NY, 10595, United States
| | - Lars Bellner
- Department of Pharmacology, New York Medical College, Valhalla, NY, 10595, United States
| | - Jian Cao
- Chinese PLA General Hospital, Beijing, 100853, China
| | - Shailendra P Singh
- Department of Pharmacology, New York Medical College, Valhalla, NY, 10595, United States
| | - David Bamshad
- Department of Medicine, New York Medical College, Valhalla, NY, 10595, United States
| | - John A McClung
- Department of Medicine, New York Medical College, Valhalla, NY, 10595, United States
| | - Omri Maayan
- Department of Pharmacology, New York Medical College, Valhalla, NY, 10595, United States
| | - Aliza Meissner
- Department of Medicine, New York Medical College, Valhalla, NY, 10595, United States
| | - Ilana Grant
- Department of Medicine, New York Medical College, Valhalla, NY, 10595, United States
| | - Charles T Stier
- Department of Pharmacology, New York Medical College, Valhalla, NY, 10595, United States.
| | - Nader G Abraham
- Department of Pharmacology, New York Medical College, Valhalla, NY, 10595, United States; Department of Medicine, New York Medical College, Valhalla, NY, 10595, United States; Department of Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, 25701, United States.
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Weizman L, Miller KL, Eldar YC, Maayan O, Chiew M. PEAR: PEriodic and ApeRiodic signal separation for fast FMRI. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2017:505-508. [PMID: 29059920 DOI: 10.1109/embc.2017.8036872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Undersampling of functional MRI (fMRI) data leads to increased temporal resolution, as it allows shorter acquisition time per frame. High quality reconstruction of fMRI data from undersampled measurements requires proper modeling of the fMRI data. Recent publications suggest that the fMRI signal is a superposition of periodic and aperiodic signals. In this paper we develop an fMRI reconstruction approach based on this modeling. The fMRI data is assumed to be composed of two components: a component that holds a sum of periodic signals which is sparse in the temporal Fourier domain and an component that holds the remaining imaging information (consisting of the background and aperiodic signals) which has low rank. Data reconstruction is done by solving a constrained problem that enforces a fixed, moderate rank on one of the components, and a limited number of temporal frequencies on the other. Our approach is coined PEAR - PEriodic and ApeRiodic signal separation for fast fMRI. Experimental results are based on fMRI reconstruction using realistic timecourses. Evaluation was performed both quantitatively and visually versus ground truth. Results demonstrate PEAR's improvement in estimating the realistic timecourses versus state-of-the-art approaches at acceleration ratio of R=16.6.
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