1
|
Petrone B, Albano J, Stockton R, Atlas AM, Aronica C, Grewal K. Demographic Analysis of Pedicle Diameter, and Estimated Pedicle Screw Length of the Lumbar Spine in a Diverse Population. Int J Spine Surg 2021; 15:259-265. [PMID: 33900983 DOI: 10.14444/8035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Recent literature confirms the importance of understanding the variability in pedicle morphology among races. These studies suggest that more detailed and reliable measurements of pedicles should be undertaken. However, there is limited data on average pedicle diameters (PDs) or estimated pedicle screw lengths (EPSLs) between diverse racial populations. We sought to determine the differences in PD and EPSL in the lumbar spine between various races: "Asian," "Black," "White," and "Hispanic" to aid in perioperative planning during instrumented spinal fusion. METHODS Axial cuts of 404 patients were inspected to obtain their transverse outer cortical PD as measured through the isthmus, and EPSL by measuring the posterior entry point at the longest distance, which perpendicularly transected the measured isthmic diameter, to the anterior vertebral cortex from L1 to L5. We examined the average PD and PD range at each level for each race. To determine the significance, we used a mixed analysis of variance and a post hoc analysis. RESULTS In this retrospective chart review the races were found to be significantly different in PD and EPSL (P < .001). Post hoc analysis using Dunn-Bonferroni correction showed that Asians had significantly smaller PDs than Blacks and Whites (P < .002 and P < .014, respectively). The White and Hispanic population had significantly longer EPSLs when compared to Blacks and Asians from L1 to L5 (P < .01). CONCLUSIONS This study demonstrates that there are significant differences in pedicle morphology among races that must be taken into consideration when inserting pedicle screws during lumbar spinal fusion. Knowledge of these differences is of the utmost importance in order to limit complications while improving fixation. LEVEL OF EVIDENCE 3. CLINICAL RELEVANCE Pedicle morphology is variable between races and understanding these differences is important for the safe placement of pedicle screws.
Collapse
Affiliation(s)
- Brandon Petrone
- Department of Orthopedic Surgery, Northwell Health Plainview Hospital, Plainview, New York
| | - Joseph Albano
- Department of Orthopedic Surgery, Northwell Health Plainview Hospital, Plainview, New York
| | - Robert Stockton
- Department of Orthopedic Surgery, Northwell Health Plainview Hospital, Plainview, New York
| | - Aaron M Atlas
- Department of Orthopedic Surgery, Northwell Health Plainview Hospital, Plainview, New York
| | - Courtney Aronica
- Department of Orthopedic Surgery, Northwell Health Plainview Hospital, Plainview, New York
| | - Kanwarpaul Grewal
- Department of Orthopedic Surgery, Northwell Health Plainview Hospital, Plainview, New York
| |
Collapse
|
2
|
Green E, Frane N, Ganz M, Stockton R, Stapleton E, Mallen J. Additive effect of continuous adductor canal block and liposomal bupivacaine periarticular injection in total knee arthroplasty. Eur J Orthop Surg Traumatol 2019; 29:1525-1532. [DOI: 10.1007/s00590-019-02452-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 05/17/2019] [Indexed: 01/22/2023]
|
3
|
Stockton R, Albano J, Lentz J, Ganz M, Grewal K, Katsigiorgis G. A comparison of lumbar transverse pedicle angles between ethnic groups: a retrospective review. BMC Musculoskelet Disord 2019; 20:114. [PMID: 30885189 PMCID: PMC6421668 DOI: 10.1186/s12891-019-2507-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Spinal surgery requires an intimate understanding of pedicle morphology to provide safe and effective outcomes. Although current research has attempted to identify morphological vertebral pedicle trends, no study has utilized computed tomography (CT) scans to compare the lumbar transverse pedicle angle (TPA) with patient demographics factors in a diverse population throughout multiple hospital centers. METHODS Analysis of randomly selected CT scans from L1-L5 of 97 individuals who underwent imaging over a two-week period for non-back pain related complaints was conducted. Measuring 970 TPAs in total allowed for comparison of each patients' pedicle angle with important patient specific demographics including ethnicity, age, gender, height and weight. Statistical analysis utilized multiple comparisons of demographics at each level with post-hoc Bonferroni correction analysis to compare demographics at each level. RESULTS With relation to gender, age, height or weight, no statistically significant differences were identified for TPAs at any vertebral level. However, when stratified by ethnicity, the differences in transverse pedicle angles averages (TPA -Avg) at L2 and L3 were found to be statistically significant (p < 0.05). CONCLUSION We have identified a previously unknown and significant relationship between ethnicity and TPA at lumbar vertebral levels. These findings provide critical information that may be added to the operating surgeons' knowledge of pedicle morphology. We hope this novel information can assist in preoperative planning of pedicle screw placement and potentially help improve surgical outcomes.
Collapse
Affiliation(s)
- Robert Stockton
- Department of Orthopedic Surgery, Northwell Health Plainview Hospital, 888 Old country road, Plainview, NY, 11803, USA
| | - Joseph Albano
- Department of Orthopedic Surgery, Northwell Health Plainview Hospital, 888 Old country road, Plainview, NY, 11803, USA
| | - Jonathon Lentz
- Department of Orthopedic Surgery, Northwell Health Plainview Hospital, 888 Old country road, Plainview, NY, 11803, USA
| | - Maximillian Ganz
- Department of Orthopedic Surgery, Northwell Health Plainview Hospital, 888 Old country road, Plainview, NY, 11803, USA. .,NYIT College of Osteopathic Medicine, Old Westbury, NY, USA.
| | - Kanwarpaul Grewal
- Department of Orthopedic Surgery, Northwell Health Plainview Hospital, 888 Old country road, Plainview, NY, 11803, USA
| | - Gus Katsigiorgis
- Department of Orthopedic Surgery, Northwell Health Plainview Hospital, 888 Old country road, Plainview, NY, 11803, USA
| |
Collapse
|
4
|
Albano J, Lentz J, Stockton R, DePalma V, Markowitz M, Ganz M, Katsigiorgis G, Grewal K. Demographic Analysis of Lumbar Pedicle Diameters in a Diverse Population. Asian Spine J 2019; 13:410-416. [PMID: 30685957 PMCID: PMC6547397 DOI: 10.31616/asj.2018.0195] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 09/10/2018] [Indexed: 11/23/2022] Open
Abstract
Study Design Retrospective chart review. Purpose We sought to determine the differences in pedicle diameter (PD) in the lumbar spine between various races: ‘Asian,’ ‘Black,’ ‘White,’ and ‘Other.’ These data could aid in perioperative planning during instrumented spinal fusion. Overview of Literature Recent literature underscores the importance of understanding diverse pedicle isthmus morphology to perform successful transpedicular procedures. These studies suggest that more detailed and reliable measurements of pedicles should be undertaken. However, none of the current literature comprehensively compares average PDs between diverse racial populations with a standardized study design. Methods Coronal cuts of 5,060 lumbar spine pedicles were inspected to obtain their transverse outer cortical PD as measured through the isthmus at L1–L5. Data were collected and categorized on the basis of patient-reported race. We examined average PD and PD range at each level for each race. To determine the significance, we used a mixed analysis of variance and a post hoc analysis. Results The Asian cohort consistently had a significantly smaller PD at L1–L5 than Blacks or Whites (p<0.001), as did the ‘Other’ group compared with Blacks (p<0.001) and Whites (p=0.032). At L1–L2, the ‘Other’ group showed the least variability in PD. At L3–L5, the Asian population showed the smallest range, and the Black population had the largest variability in PD except at L5. There was a significant difference in PD between the various races. Conclusions The Asian population consistently has significantly smaller pedicles in the lumbar spine than the Black or White populations. This information could prove useful for surgical planning. We suggest using preoperative computed tomography for pedicle screw templating as a safe method for pedicle screw instrumentation with the highest pullout strength given the wide range of PD in the Black population and the variability of PD between races.
Collapse
Affiliation(s)
- Joseph Albano
- Department of Orthopedic Surgery, Northwell Health Plainview Hospital, Plainview, NY, USA
| | - Jonathon Lentz
- Department of Orthopedic Surgery, Northwell Health Plainview Hospital, Plainview, NY, USA
| | - Robert Stockton
- Department of Orthopedic Surgery, Northwell Health Plainview Hospital, Plainview, NY, USA
| | - Vincent DePalma
- Department of Orthopedic Surgery, Northwell Health Plainview Hospital, Plainview, NY, USA
| | - Michael Markowitz
- Department of Orthopedic Surgery, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Maximillian Ganz
- Department of Orthopedic Surgery, Northwell Health Plainview Hospital, Plainview, NY, USA
| | - Gus Katsigiorgis
- Department of Orthopedic Surgery, Northwell Health Plainview Hospital, Plainview, NY, USA
| | - Kanwarpaul Grewal
- Department of Orthopedic Surgery, Northwell Health Plainview Hospital, Plainview, NY, USA
| |
Collapse
|
5
|
Weinstock-Guttman B, Baier M, Stockton R, Weinstock A, Justinger T, Munschauer F, Brownscheidle C, Williams J, Fisher E, Miller D, Rudick R. Pattern reversal visual evoked potentials as a measure of visual pathway pathology in multiple sclerosis. Mult Scler 2004; 9:529-34. [PMID: 14582782 DOI: 10.1191/1352458503ms935rr] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [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: 11/05/2022]
Abstract
BACKGROUND Pattern reversal visual evoked potentials (PRVEPs) have a well-documented role in diagnosis of multiple sclerosis (MS), but their value as a visual function surrogate remains controversial. METHODS We evaluated PRVEP in 37 patients with MS who were participating in a long-term follow-up study following a phase III trial of interferon beta-1a (Avonex). Patients were examined to determine the Kurtzke Extended Disability Status Score (EDSS), multiple sclerosis functional composite (MSFC), contrast letter acuity (CLA), and had cranial MRI scans to determine whole brain atrophy (BPF). PRVEP was evaluated for P100 latency, amplitude, and waveform morphology. Two summary scores were created: for Score A, abnormal latencies, morphologies, and amplitudes of each individual eye were added; for Score B, abnormal latencies, morphologies, and amplitude ratio between eyes was determined. Sixteen patients in this group also had PRVEP at the time they enrolled in the clinical trial, eight years previously. RESULTS At the follow-up exam, over 75% of patients had abnormal PVEP parameters while visual acuity (VA) was abnormal only in 59%. Increased PRVEP latency over the eight-year period correlated with deterioration assessed by EDSS (P = 0.006), BPF (P = 0.0001), and MSFC (P = 0.0041). Score A was significantly correlated with EDSS, BPF, CLA, cognitive function, and quality of life assessed with the Sickness Impact profile. No correlation was seen with the MSFC. CONCLUSIONS The results indicate that PRVEP measures MS-related pathology, and can provide not only diagnostic but also prognostic information during evaluation of MS patients.
Collapse
|
6
|
Affiliation(s)
- R Stockton
- Department of Ophthalmology, SUNY, Buffalo, USA
| | | | | |
Collapse
|
7
|
Stockton R, Wilhelm J, Armstrong D, Klick R, Cotter J, Reynolds J. Cytochrome oxidase activity in the fetal sheep retina. Adv Exp Med Biol 1994; 366:426-7. [PMID: 7771279 DOI: 10.1007/978-1-4615-1833-4_40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- R Stockton
- Department of Ophthalmology, SUNY, Buffalo, USA
| | | | | | | | | | | |
Collapse
|
8
|
|
9
|
Abstract
The distribution and variation of cardiac rate and rhythm in normal neonates has previously received little attention. This has made clinical assessment of dysrhythmia in newborns difficult. We therefore performed continuous 24-hour electrocardiography in 29 normal newborn subjects (age range, 1 to 6 days; mean, 3.5 days). The ECG tapes were then analysed in detail to define the normal range of cardiac rate, conduction intervals, and rhythm during waking and sleeping periods. Maximum sinus rate (awake) ranged from 150 to 222 beats per minute (mean, 192 +/- 16 [SD]), and minimum rate (awake) from 78 to 140 beats per minute (mean, 107 +/- 15). During sleep, the maximum rate ranged from 125 to 210 (mean, 168 +/- 23) and the minimum from 72 to 120 beats per minute (mean, 92 +/- 11). The maximum variation in rate for any individual during the 24-hour period ranged from 73 to 134 beats per minute (mean, 100 +/- 17). Sinus rhythm predominated with mild irregularity occurring episodically in 24 and moderate irregularity in 4 infants. An isolated atrial premature beat was present in 2 subjects, and an atrioventricular (AV) junctional escape rhythm occurred in one other after a sinus pause of 840 msec. Ventricular premature beats or AV conduction abnormalities were not observed. The corrected QT interval (QTc) ranged from 0.298 to 0.514 sec (mean, 0.390 +/- 0.026). The maximum variation in QTc over 24 hours ranged from 0.052 to 0.160 sec (mean, 0.097 +/- 0.028). We conclude that cardiac rhythm and conduction appear more stable in normal newborns than in older normal subjects and that bradycardia, conduction defects, and ventricular ectopy of the type recently reported in young normal adults seem to be more uncommon in the neonatal period.
Collapse
|