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Haselhuhn JJ, Soriano PBO, Grover P, Dreischarf M, Odland K, Hendrickson NR, Jones KE, Martin CT, Sembrano JN, Polly DW. Spine surgeon versus AI algorithm full-length radiographic measurements: a validation study of complex adult spinal deformity patients. Spine Deform 2024; 12:755-761. [PMID: 38336942 DOI: 10.1007/s43390-024-00825-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/06/2024] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Spinal measurements play an integral role in surgical planning for a variety of spine procedures. Full-length imaging eliminates distortions that can occur with stitched images. However, these images take radiologists significantly longer to read than conventional radiographs. Artificial intelligence (AI) image analysis software that can make such measurements quickly and reliably would be advantageous to surgeons, radiologists, and the entire health system. MATERIALS AND METHODS Institutional Review Board approval was obtained for this study. Preoperative full-length standing anterior-posterior and lateral radiographs of patients that were previously measured by fellowship-trained spine surgeons at our institution were obtained. The measurements included lumbar lordosis (LL), greatest coronal Cobb angle (GCC), pelvic incidence (PI), coronal balance (CB), and T1-pelvic angle (T1PA). Inter-rater intra-class correlation (ICC) values were calculated based on an overlapping sample of 10 patients measured by surgeons. Full-length standing radiographs of an additional 100 patients were provided for AI software training. The AI algorithm then measured the radiographs and ICC values were calculated. RESULTS ICC values for inter-rater reliability between surgeons were excellent and calculated to 0.97 for LL (95% CI 0.88-0.99), 0.78 (0.33-0.94) for GCC, 0.86 (0.55-0.96) for PI, 0.99 for CB (0.93-0.99), and 0.95 for T1PA (0.82-0.99). The algorithm computed the five selected parameters with ICC values between 0.70 and 0.94, indicating excellent reliability. Exemplary for the comparison of AI and surgeons, the ICC for LL was 0.88 (95% CI 0.83-0.92) and 0.93 for CB (0.90-0.95). GCC, PI, and T1PA could be determined with ICC values of 0.81 (0.69-0.87), 0.70 (0.60-0.78), and 0.94 (0.91-0.96) respectively. CONCLUSIONS The AI algorithm presented here demonstrates excellent reliability for most of the parameters and good reliability for PI, with ICC values corresponding to measurements conducted by experienced surgeons. In future, it may facilitate the analysis of large data sets and aid physicians in diagnostics, pre-operative planning, and post-operative quality control.
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Affiliation(s)
- Jason J Haselhuhn
- Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA
| | - Paul Brian O Soriano
- Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA
| | | | | | - Kari Odland
- Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA
| | - Nathan R Hendrickson
- Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA
| | - Kristen E Jones
- Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - Christopher T Martin
- Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA
| | - Jonathan N Sembrano
- Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA
| | - David W Polly
- Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA.
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA.
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Haselhuhn JJ, Odland K, Soriano PBO, Jones KE, Polly DW. A Novel Surgical Indication for Scheuermann's Kyphosis. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202403000-00006. [PMID: 38441155 PMCID: PMC10914238 DOI: 10.5435/jaaosglobal-d-23-00187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/01/2024] [Indexed: 03/07/2024]
Abstract
Scheuermann kyphosis can be treated surgically to restore proper sagittal alignment. Thoracic curves >70° are typically indicated for surgical intervention. However, patients who have reached their natural limit of compensatory lumbar hyperlordosis are at risk of accelerated degeneration. This can be determined by comparing lumbar lordosis on standing neutral radiographs and supine extension radiographs. Minimal additional lordosis in extension compared with neutral, abutment of the spinous processes, or greater lumbar lordosis standing than with attempted extension suggest the patient is maximally compensated. We present a case of an adolescent boy with Scheuermann kyphosis who had reached the limit of his hyperlordosis compensation reserve. He subsequently underwent a T4 to L2 posterior spinal fusion with T7 to T11 Ponte Smith-Petersen grade two osteotomies. He tolerated the procedure well with no intraoperative complications or neuromonitoring changes. The patient has continued to do well and progressed to normal activity at 5-month follow-up.
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Affiliation(s)
- Jason J. Haselhuhn
- From the The Department of Orthopedic Surgery (Dr. Haselhuhn, Dr. Odland, Dr. Soriano, Dr. Jones, and Dr. Polly), and the The Department of Neurosurgery (Dr. Jones and Dr. Polly), University of Minnesota, Minneapolis, MN
| | - Kari Odland
- From the The Department of Orthopedic Surgery (Dr. Haselhuhn, Dr. Odland, Dr. Soriano, Dr. Jones, and Dr. Polly), and the The Department of Neurosurgery (Dr. Jones and Dr. Polly), University of Minnesota, Minneapolis, MN
| | - Paul Brian O. Soriano
- From the The Department of Orthopedic Surgery (Dr. Haselhuhn, Dr. Odland, Dr. Soriano, Dr. Jones, and Dr. Polly), and the The Department of Neurosurgery (Dr. Jones and Dr. Polly), University of Minnesota, Minneapolis, MN
| | - Kristen E. Jones
- From the The Department of Orthopedic Surgery (Dr. Haselhuhn, Dr. Odland, Dr. Soriano, Dr. Jones, and Dr. Polly), and the The Department of Neurosurgery (Dr. Jones and Dr. Polly), University of Minnesota, Minneapolis, MN
| | - David W. Polly
- From the The Department of Orthopedic Surgery (Dr. Haselhuhn, Dr. Odland, Dr. Soriano, Dr. Jones, and Dr. Polly), and the The Department of Neurosurgery (Dr. Jones and Dr. Polly), University of Minnesota, Minneapolis, MN
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Soriano PBO, Haselhuhn JJ, Resch JC, Fischer GA, Swanson DB, Holton KJ, Polly DW. Postoperative use and early discontinuation of intravenous lidocaine in spine patients. Spine Deform 2024; 12:141-148. [PMID: 37610553 DOI: 10.1007/s43390-023-00753-3] [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: 05/18/2023] [Accepted: 08/05/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE Our institution employs a multimodal approach to manage postoperative pain after spine surgery. It involves continuous intravenous (IV) lidocaine until the morning of postoperative day two. This study aimed to determine the rate and reasons for early discontinuation of IV lidocaine in our spine patients. METHODS We conducted a retrospective chart review and included pediatric patients who underwent ≥ 3-level spine surgery and received postoperative IV lidocaine from November 2019 to September 2022. For each case, we recorded the side effects of IV lidocaine, adverse events, time to discontinuation, and discontinuation rate. Subsequently, we used the same methodology to generate an adult cohort for comparison. RESULTS We included 52 pediatric (18M:34F) and 50 (21M:29F) adult patients. The pediatric cohort's mean age was 14 years (8-18), and BMI 23.9 kg/m2 (13.0-42.8). The adult cohort's mean age was 61 years (29-82), and BMI 28.8 kg/m2 (17.2-44.1). IV lidocaine was discontinued prematurely in 21/52 (40.4%) of the pediatric cases and 26/50 (52.0%) of the adult cases (RR = 0.78, p = 0.2428). The side effects noted in the pediatric cases vary, including numbness, visual disturbance, and obtundation, but no seizures. The most common adverse events were fever and motor dysfunction. CONCLUSION The early discontinuation rate of IV lidocaine use after spine surgery for children in our institution does not differ significantly from that of adults. The nature of the side effects and the reasons for discontinuation between the groups were similar. Thus, the safety profile of IV lidocaine for pediatric spine patients is comparable to adults.
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Affiliation(s)
- Paul Brian O Soriano
- Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA
| | - Jason J Haselhuhn
- Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA.
| | - Joseph C Resch
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Gwenyth A Fischer
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Dana B Swanson
- Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA
| | - Kenneth J Holton
- Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA
| | - David W Polly
- Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA.
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA.
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Polly DW, Holton KJ, Haselhuhn JJ, Soriano PBO, Jones KE, Sembrano JN, Martin CT. Does A Hinged Operating Table Facilitate Sagittal Correction in Transforaminal Lumbar Interbody Fusion With Smith-Peterson Osteotomy? A Radiographic Analysis. Clin Orthop Relat Res 2023:00003086-990000000-01409. [PMID: 38038970 DOI: 10.1097/corr.0000000000002910] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 10/05/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Osteotomies allow the restoration of appropriate sagittal alignment; however, closure of osteotomies can be challenging. Typical closure involves compressing pedicle screw heads across the rods, potentially causing screw loosening and failure. Motorized hinged operating tables are often used to assist with controlled closure of osteotomies without manual compression, but there is no published research quantifying the amount of correction provided solely by changes in the table angle. QUESTION/PURPOSE What is the incremental amount of correction achieved by change in the table angle versus instrumented manipulation during osteotomy closure in transforaminal lumbar interbody fusion (TLIF) with Smith-Petersen osteotomy? METHODS Sixty-one patients undergoing Smith-Peterson osteotomy and bilateral TLIF using a motorized hinged table from October 2019 to March 2022 were prospectively enrolled. Two patients did not undergo surgery, two did not have table extension, and seven did not have data collected intraoperatively because of disruptions in research protocols owing to the coronavirus-19 pandemic. Fifty patients (24 male, 26 female) who underwent a total of 73 osteotomies were included in the final analysis. The mean ± standard deviation age was 61 ±11 years, and the mean BMI was 31 ± 6 kg/m2. Patients were positioned prone on the table and flexed to 10° for decompression, Smith-Petersen osteotomy, and TLIF. The table was then extended in 5° increments, and radiographs were taken until 10° of extension was achieved or the osteotomy was fully closed. Changes in segmental lordosis across the operative site for each 5° increment were measured to the nearest degree by two reviewers. Intraclass correlation coefficients for segmental lordosis measurements at each table angle change were calculated as 0.97 to 0.98, with all p values < 0.001, indicating excellent agreement. RESULTS Table change from 10° to 5° yielded a mean segmental lordosis change of 1.9° ± 1.5° (73 osteotomies), 5° to 0° yielded a change of 1.3° ± 0.9° (73 osteotomies), 0° to -5° yielded a change of 1.3° ± 1.0° (69 osteotomies), and -5° to -10° yielded a change of 1.1° ± 1.3° (61 osteotomies). Rod placement and compression yielded a mean 1.8° ± 2.0° of additional segmental lordosis. CONCLUSION Using a motorized hinged table facilitated an average of 5.6° of total segmental lordosis correction during controlled Smith-Peterson osteotomy closure without the need for cantilevering forces across spinal instrumentation. Surgeons can use this technique to reduce the compression forces needed to close osteotomies, which could eliminate a potential source of complications.Level of Evidence Level II, therapeutic study.
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Affiliation(s)
- David W Polly
- The Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
- The Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - Kenneth J Holton
- The Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Jason J Haselhuhn
- The Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Paul Brian O Soriano
- The Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Kristen E Jones
- The Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
- The Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - Jonathan N Sembrano
- The Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Christopher T Martin
- The Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
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Polly DW, Haselhuhn JJ, Soriano PBO, Odland K, Jones KE. Management of High-Grade Dysplastic Spondylolisthesis. Neurosurg Clin N Am 2023; 34:567-572. [PMID: 37718103 DOI: 10.1016/j.nec.2023.06.003] [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] [Indexed: 09/19/2023]
Abstract
The Meyerding classification grades the degree of slippage in the sagittal plane on lateral standing neutral imaging: 0% to 25% Grade I, 25% to 50% Grade II, 50% to 75% Grade III, 75% to 100% Grade IV, and greater than 100% Grade V (Spondyloptosis). Grades I and II are considered low-grade and Grades III-V are considered high-grade. There are several etiologies of spondylolisthesis. A classification system of the most common causes: Type I - Dysplastic, Type II - Isthmic (including subtypes: A - Lytic, B - Elongation, and C - Acute fracture), Type III - Degenerative, Type IV - Traumatic, Type V - Pathologic, and Type VI - Iatrogenic. Dysplastic spondylolisthesis is a type of spondylolisthesis that occurs at L5-S1 when dysplastic lumbosacral anatomy is present, and is associated with high-grade slip and spina bifida occulta.
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Affiliation(s)
- David W Polly
- Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN 55454, USA; Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA.
| | - Jason J Haselhuhn
- Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN 55455, USA.
| | | | - Kari Odland
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Kristen E Jones
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
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Comadoll SM, Holton KJ, Polly DW, Schmitz MW, Haselhuhn JJ, Soriano PBO, Martin CT, Jones KE, Sembrano JN. Chance Fracture Pattern Presenting in Proximal Junctional Failure. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202308000-00003. [PMID: 37540797 PMCID: PMC10405993 DOI: 10.5435/jaaosglobal-d-23-00039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/17/2023] [Accepted: 05/14/2023] [Indexed: 08/06/2023]
Abstract
INTRODUCTION We present a case series of proximal junctional failure due to a Chance-type fracture. METHODS This is a retrospective review of patients who developed proximal junctional kyphosis because of Chance-type proximal junctional failure after spinal fusion for adult spinal deformity. RESULTS Fifteen patients were identified (4M:11F). The average age was 61.4 years (range, 39 to 77). The mean time to fracture identification was 25.4 days (range, 3 to 65). The average number of levels instrumented was 6.7 (range, 2 to 17). No patients had antecedent trauma before fracture onset. In 67% of cases with a lumbar upper instrumented vertebra (UIV), there was overcorrection of lumbar lordosis (LL) and/or lower LL. The five cases with a lower thoracic UIV had undergone notable correction of preoperative thoracolumbar junction kyphosis. 14 of 15 patients were treated with extension of fusion. Pedicle screws at the fracture level were salvaged by changing to an anatomic trajectory. CONCLUSION Continued pain at 6 to 12 weeks with radiographs showing an increased proximal junctional angle and cephalocaudal pedicle widening at the UIV should raise suspicion for this unique fracture pattern. A CT scan is recommended. Low bone density, LL and/or lower LL overcorrection, and selection of lower thoracic UIV in the setting of notable thoracolumbar junction correction may contribute to fracture risk.
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Haselhuhn JJ, Mercado A, Soriano PBO, Polly DW. Halo Formation and Resolution at 7-Year Follow-Up After Sacroiliac Joint Fusion Revision: A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00054. [PMID: 37590559 DOI: 10.2106/jbjs.cc.23.00199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
CASE A 49-year-old woman presented with low back pain after a work-related injury. She failed 5 months of conservative management and subsequently underwent minimally invasive (MI) left sacroiliac joint (SIJ) fusion with 3 triangular titanium implants. Four months postoperatively, she developed recurrence of symptoms and radiographic halo phenomenon about the implants. The cephalad and caudal implants were replaced with threaded self-tapping implants, and the middle implant was unable to be removed. At 7-year follow-up, the halo phenomenon had resolved. CONCLUSION This is an unusual case of radiographic halo phenomenon formation after MI SIJ fusion and halo resolution after subsequent revision.
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Affiliation(s)
- Jason J Haselhuhn
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Arthur Mercado
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Paul Brian O Soriano
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - David W Polly
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota
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