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Tawil ME, Chryssikos T, Dada A, Ambati VS, Macki M, Zammar SG, Tan W, Tan L. Use of minimally invasive ultrasound transducer during tubular microdiscectomy. Neurosurg Focus Video 2024; 10:V6. [PMID: 38616912 PMCID: PMC11013343 DOI: 10.3171/2024.1.focvid23206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/30/2024] [Indexed: 04/16/2024]
Abstract
Minimally invasive ultrasound during tubular microdiscectomy is novel. The authors report the technique during surgery for L5-S1 herniated disc. Ultrasound provided real-time visualization of the pathology and neural elements. After discectomy and tactile assessment, ultrasound showed decompression of the thecal sac and traversing nerve root. The patient tolerated the procedure well, with resolution of preoperative pain and strength improvement. Postoperative MRI revealed a residual asymptomatic disc fragment that was retrospectively identified on ultrasonography. Minimally invasive ultrasound could become a useful supplement to direct visual and tactile assessment during tubular microdiscectomy, but further experience with surgical anatomy on ultrasound is required. The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23206.
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Affiliation(s)
- Michael E. Tawil
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Timothy Chryssikos
- Department of Neurological Surgery, University of California, San Francisco, California
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland; and
| | - Abraham Dada
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Vardhaan S. Ambati
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Mohamed Macki
- Department of Neurological Surgery, University of California, San Francisco, California
- Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Samer G. Zammar
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Wei Tan
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Lee Tan
- Department of Neurological Surgery, University of California, San Francisco, California
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Hamilton T, Lim S, Telemi E, Yun HJ, Macki M, Schultz L, Yeh HH, Springer K, Taliaferro K, Perez-Cruet M, Aleem I, Park P, Easton R, Nerenz DR, Schwalb JM, Abdulhak M, Chang V. Risk factors for not reaching minimal clinically important difference at 90 days and 1 year after elective lumbar spine surgery: a cohort study. J Neurosurg Spine 2024; 40:343-350. [PMID: 38064702 DOI: 10.3171/2023.9.spine23483] [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: 05/03/2023] [Accepted: 09/28/2023] [Indexed: 03/03/2024]
Abstract
OBJECTIVE Patient-perceived functional improvement is a core metric in lumbar surgery for degenerative disease. It is important to identify both modifiable and nonmodifiable risk factors that can be evaluated and possibly optimized prior to elective surgery. This case-control study was designed to study risk factors for not achieving the minimal clinically important difference (MCID) in Patient-Reported Outcomes Measurement Information System Function 4-item Short Form (PROMIS PF) score. METHODS The authors queried the Michigan Spine Surgery Improvement Collaborative database to identify patients who underwent elective lumbar surgical procedures with PROMIS PF scores. Cases were divided into two cohorts based on whether patients achieved MCID at 90 days and 1 year after surgery. Patient characteristics and operative details were analyzed as potential risk factors. RESULTS The authors captured 10,922 patients for 90-day follow-up and 4453 patients (40.8%) did not reach MCID. At the 1-year follow-up period, 7780 patients were identified and 2941 patients (37.8%) did not achieve MCID. The significant demographic characteristic-adjusted relative risks (RRs) for both groups (RR 90 day, RR 1 year) included the following: symptom duration > 1 year (1.34, 1.41); previous spine surgery (1.25, 1.30); African American descent (1.25, 1.20); chronic opiate use (1.23, 1.25); and less than high school education (1.20, 1.34). Independent ambulatory status (0.83, 0.88) and private insurance (0.91, 0.85) were associated with higher likelihood of reaching MCID at 90 days and 1 year, respectively. CONCLUSIONS Several key unique demographic risk factors were identified in this cohort study that precluded optimal postoperative functional outcomes after elective lumbar spine surgery. With this information, appropriate preoperative counseling can be administered to assist in shaping patient expectations.
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Affiliation(s)
| | | | | | - Ho Jun Yun
- 2Wayne State University School of Medicine, Detroit
| | | | | | | | | | | | | | | | - Paul Park
- 8Neurosurgery, University of Michigan, Ann Arbor; and
| | - Richard Easton
- 9Department of Orthopedic Surgery, William Beaumont Hospital-Troy, Michigan
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Chryssikos T, Tawil ME, Ambati VS, Macki M, DiGiorgio AM, Mummaneni PV, Tan L. Real-Time Intraoperative Ultrasound Using a Minimally Invasive Transducer During Anterior Cervical Spine Surgery. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01034. [PMID: 38295396 DOI: 10.1227/ons.0000000000001065] [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] [Received: 09/22/2023] [Accepted: 12/01/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Intraoperative ultrasound (IOUS) during anterior cervical surgery is hindered by large transducer size and small operative corridor. We hypothesized that a linear (minimally invasive) transducer designed for transsphenoidal surgery can visualize the spinal cord, nerve roots, and surrounding structures during anterior cervical approaches, facilitating intraoperative assessment of central and foraminal decompression. METHODS IOUS was used to evaluate 26 levels in 17 patients (15 anterior cervical discectomy and fusion, 1 corpectomy, 1 arthroplasty) with a linear probe (7 × 6-mm end-fire transducer, 150-mm length, 12-15 MHz). After pin-based distraction, discectomy, and posterior longitudinal ligament resection, IOUS assessed adequacy of cord decompression and, following proximal foraminotomy or uncinectomy, nerve root decompression. If indicated, additional decompression was completed. Criteria for adequate central and foraminal decompression were visualization of subarachnoid space around the cord and cerebrospinal fluid pulsatility along the root sleeve/absence of nerve root compression distal to the root sleeve, respectively. RESULTS IOUS successfully visualized the cord, nerve roots, and surrounding structures in all 26 levels and influenced management in 11 levels (42.3%). IOUS indicated persistent cord and nerve root compression in 2 and 7 levels, respectively. Planned uncinectomy was aborted in 2 levels after IOUS demonstrated adequate nerve root decompression with intervertebral distraction/proximal foraminotomy alone. IOUS identified persistent nerve root compression after initial proximal foraminotomy in 4 levels and uncinectomy in 2 levels. An unplanned uncinectomy was performed in 1 level after IOUS showed persistent nerve root compression after multiple iterations of proximal foraminotomy. At follow-up (mean 3.1 months), the mean improvement in Numeric Rating Scale neck and arm pain, Neck Disability Index, and modified Japanese Orthopedic Association was 4.0%, 3.2%, 3.7%, and 0.7%, respectively. CONCLUSION The neural elements and their relationships to surrounding bone/soft tissue can be visualized using a minimally invasive IOUS transducer during anterior cervical surgery without having to remove pin-based distraction. This allows surgeons to intraoperatively verify the extent of central and foraminal decompression.
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Affiliation(s)
- Timothy Chryssikos
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Michael E Tawil
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Vardhaan S Ambati
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Mohamed Macki
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anthony M DiGiorgio
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Lee Tan
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
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Dada A, Macki M, Tawil M, Chryssikos T, Tan LA. Surgical Untethering of S1 Nerve Root Herniation Into L4 Perineural Cyst: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024; 26:103. [PMID: 37707423 DOI: 10.1227/ons.0000000000000898] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 07/06/2023] [Indexed: 09/15/2023] Open
Affiliation(s)
- Abraham Dada
- Department of Neurological Surgery, University of California, San Francisco, School of Medicine, San Francisco , California , USA
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Hersh AM, Pennington Z, Lubelski D, Elsamadicy AA, Dea N, Desai A, Gokaslan ZL, Goodwin CR, Hsu W, Jallo GI, Krishnaney A, Laufer I, Lo SFL, Macki M, Mehta AI, Ozturk A, Shin JH, Soliman H, Sciubba DM. Treatment of intramedullary spinal cord tumors: a modified Delphi technique of the North American Spine Society Section of Spine Oncology. J Neurosurg Spine 2024; 40:1-10. [PMID: 37856379 DOI: 10.3171/2023.8.spine23190] [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: 02/18/2023] [Accepted: 08/08/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE Intramedullary spinal cord tumors (IMSCTs) are rare tumors with heterogeneous presentations and natural histories that complicate their management. Standardized guidelines are lacking on when to surgically intervene and the appropriate aggressiveness of resection, especially given the risk of new neurological deficits following resection of infiltrative tumors. Here, the authors present the results of a modified Delphi method using input from surgeons experienced with IMSCT removal to construct a framework for the operative management of IMSCTs based on the clinical, radiographic, and tumor-specific characteristics. METHODS A modified Delphi technique was conducted using a group of 14 neurosurgeons experienced in IMSCT resection. Three rounds of written correspondence, surveys, and videoconferencing were carried out. Participants were queried about clinical and radiographic criteria used to determine operative candidacy and guide decision-making. Members then completed a final survey indicating their choice of observation or surgery, choice of resection strategy, and decision to perform duraplasty, in response to a set of patient- and tumor-specific characteristics. Consensus was defined as ≥ 80% agreement, while responses with 70%-79% agreement were defined as agreement. RESULTS Thirty-six total characteristics were assessed. There was consensus favoring surgical intervention for patients with new-onset myelopathy (86% agreement), chronic myelopathy (86%), or progression from mild to disabling numbness (86%), but disagreement for patients with mild numbness or chronic paraplegia. Age was not a determinant of operative candidacy except among frail patients, who were deemed more suitable for observation (93%). Well-circumscribed (93%) or posteriorly located tumors reaching the surface (86%) were consensus surgical lesions, and participants agreed that the presence of syringomyelia (71%) and peritumoral T2 signal change (79%) were favorable indications for surgery. There was consensus that complete loss of transcranial motor evoked potentials with a 50% decrease in the D-wave amplitude should halt further resection (93%). Preoperative symptoms seldom influenced choice of resection strategy, while a distinct cleavage plane (100%) or visible tumor-cord margins (100%) strongly favored gross-total resection. CONCLUSIONS The authors present a modified Delphi technique highlighting areas of consensus and agreement regarding surgical management of IMSCTs. Although not intended as a substitute for individual clinical decision-making, the results can help guide care of these patients. Additionally, areas of controversy meriting further investigation are highlighted.
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Affiliation(s)
- Andrew M Hersh
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Zach Pennington
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Daniel Lubelski
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Nicolas Dea
- 4Department of Neurosurgery, Vancouver Spine Surgery Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Atman Desai
- 5Department of Neurosurgery, Stanford Medicine, Palo Alto, California
| | - Ziya L Gokaslan
- 6Department of Neurosurgery, Brown University, Providence, Rhode Island
| | - C Rory Goodwin
- 7Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Wesley Hsu
- 8Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - George I Jallo
- 9Department of Neurosurgery, Johns Hopkins Medicine, Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Ajit Krishnaney
- 10Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
| | - Ilya Laufer
- 11Department of Neurosurgery, New York University Grossman School of Medicine, New York, New York
| | - Sheng-Fu Larry Lo
- 12Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Mohamed Macki
- 13Department of Neurosurgery, University of California San Francisco School of Medicine, San Francisco, California
| | - Ankit I Mehta
- 14Department of Neurosurgery, University of Illinois at Chicago, Illinois
| | - Ali Ozturk
- 15Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - John H Shin
- 16Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hesham Soliman
- 12Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Daniel M Sciubba
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- 12Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, New York
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Macki M, Chryssikos T, Meade SM, Aabedi AA, Letchuman V, Ambati V, Krishnan N, Tawil ME, Tichelaar S, Rivera J, Chan AK, Tan LA, Chou D, Mummaneni P. Multilevel Laminoplasty for CSM: Is C3 Laminectomy Better Than C3 Laminoplasty at the Superior Vertebra? J Clin Med 2023; 12:7594. [PMID: 38137663 PMCID: PMC10743713 DOI: 10.3390/jcm12247594] [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: 10/28/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION In a multilevel cervical laminoplasty operation for patients with cervical spondylotic myelopathy (CSM), a partial or complete C3 laminectomy may be performed at the upper level instead of a C3 plated laminoplasty. It is unknown whether C3 technique above the laminoplasty affects loss of cervical lordosis or range of motion. METHODS Patients undergoing multilevel laminoplasty of the cervical spine (C3-C6/C7) at a single institution were retrospectively reviewed. Patients were divided into two cohorts based on surgical technique at C3: C3-C6/C7 plated laminoplasty ("C3 laminoplasty only", N = 61), C3 partial or complete laminectomy, plus C4-C6/C7 plated laminoplasty (N = 39). All patients had at least 1-year postoperative X-ray treatment. RESULTS Of 100 total patients, C3 laminoplasty and C3 laminectomy were equivalent in all demographic data, except for age (66.4 vs. 59.4 years, p = 0.012). None of the preoperative radiographic parameters differed between the C3 laminoplasty and C3 laminectomy cohorts: cervical lordosis (13.1° vs. 11.1°, p = 0.259), T1 slope (32.9° vs. 29.2°, p = 0.072), T1 slope-cervical lordosis (19.8° vs. 18.6°, p = 0.485), or cervical sagittal vertical axis (3.1 cm vs. 2.7 cm, p = 0.193). None of the postoperative radiographic parameters differed between the C3 laminoplasty and C3 laminectomy cohorts: cervical lordosis (9.4° vs. 11.2°, p = 0.369), T1 slope-cervical lordosis (21.7° vs. 18.1°, p = 0.126), to cervical sagittal vertical axis (3.3 cm vs. 3.6 cm, p = 0.479). In the total cohort, 31% had loss of cervical lordosis >5°. Loss of lordosis reached 5-10° (mild change) in 13% of patients and >10° (moderate change) in 18% of patients. C3 laminoplasty and C3 laminectomy cohorts did not differ with respect to no change (<5°: 65.6% vs. 74.3%, respectively), mild change (5-10°: 14.8% vs. 10.3%), and moderate change (>10°: 19.7% vs. 15.4%) in cervical lordosis, p = 0.644. When controlling for age, ordinal regression showed that surgical technique at C3 did not increase the odds of postoperative loss of cervical lordosis. C3 laminectomy versus C3 laminoplasty did not differ in the postoperative range of motion on cervical flexion-extension X-rays (23.9° vs. 21.7°, p = 0.451, N = 91). CONCLUSION There was no difference in postoperative loss of cervical lordosis or postoperative range of motion in patients who underwent either C3-C6/C7 plated laminoplasty or C3 laminectomy plus C4-C6/C7 plated laminoplasty.
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Affiliation(s)
- Mohamed Macki
- Cleveland Clinic Center for Spine Health, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
- Department of Neurological Surgery, University of California, San Francisco, CA 94143, USA (P.M.)
| | - Timothy Chryssikos
- Department of Neurological Surgery, University of California, San Francisco, CA 94143, USA (P.M.)
| | - Seth M. Meade
- Cleveland Clinic Center for Spine Health, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Alexander A. Aabedi
- Department of Neurological Surgery, University of California, San Francisco, CA 94143, USA (P.M.)
| | - Vijay Letchuman
- Department of Neurological Surgery, University of California, San Francisco, CA 94143, USA (P.M.)
| | - Vardhaan Ambati
- Department of Neurological Surgery, University of California, San Francisco, CA 94143, USA (P.M.)
| | - Nishanth Krishnan
- Department of Neurological Surgery, University of California, San Francisco, CA 94143, USA (P.M.)
- University of California San Francisco Medical School, University of California San Francisco, San Francisco, CA 94143, USA
| | - Michael E. Tawil
- Department of Neurological Surgery, University of California, San Francisco, CA 94143, USA (P.M.)
| | - Seth Tichelaar
- Department of Neurosurgery, Stanford University, Stanford, CA 94305, USA
| | - Joshua Rivera
- Department of Neurological Surgery, University of California, San Francisco, CA 94143, USA (P.M.)
| | - Andrew K. Chan
- Department of Neurological Surgery, University of California, San Francisco, CA 94143, USA (P.M.)
| | - Lee A. Tan
- Department of Neurological Surgery, University of California, San Francisco, CA 94143, USA (P.M.)
| | - Dean Chou
- Department of Neurological Surgery, University of California, San Francisco, CA 94143, USA (P.M.)
| | - Praveen Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, CA 94143, USA (P.M.)
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Macki M, Ambati VS, Park C, Tawil M, Dada A, Jamieson A, Wilkinson S, Chryssikos T, Mummaneni PV. Surgical resection of lumbar intradural metastatic renal cell carcinoma. Neurosurg Focus Video 2023; 9:V22. [PMID: 37859942 PMCID: PMC10583818 DOI: 10.3171/2023.7.focvid2379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/14/2023] [Indexed: 10/21/2023]
Abstract
A 60-year-old male with renal cell carcinoma (RCC) presented with back pain, weakness, and bowel and bladder urgency. MRI demonstrated a cauda equina tumor at L2. Following L1-3 laminectomies, intraoperative ultrasound localized the tumor. After dural opening, a vascular tumor was adherent to the cauda equina. Intraoperative nerve stimulation helped to identify the nerve rootlets. Tumor was removed in a piecemeal fashion. Tumor dissection caused periodic spasms in L1-3 distributions. A neuromonitoring checklist was used to recover motor evoked potential signals with elevated mean arterial pressures. Hemostasis was challenging with the vascular tumor. Intraoperative ultrasound confirmed tumor debulking. Pathology confirmed metastatic RCC.
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Affiliation(s)
- Mohamed Macki
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Vardhaan S Ambati
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Christine Park
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Michael Tawil
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Abraham Dada
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Alysha Jamieson
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Sean Wilkinson
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Timothy Chryssikos
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, California
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Sorour O, Macki M, Tan L. Enhanced Recovery After Surgery Protocols and Spinal Deformity. Neurosurg Clin N Am 2023; 34:677-687. [PMID: 37718114 DOI: 10.1016/j.nec.2023.05.003] [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 authors outline a review of preoperative, intraoperative, and postoperative considerations surrounding adult spinal deformity. Preoperative management topics include imaging, hemoglobin A1c levels before spine surgery, osteoporotic management, and prehabilitation. Topics surrounding intraoperative management include the use of antibiotics, liposomal bupivacaine, and Foley catheters. The authors also discuss postoperative questions surrounding analgesia, nausea and vomiting, thromboembolic prophylaxis, and early mobilization. Throughout their discussion, the authors incorporate enhanced recovery after surgery protocols to hopefully lead to future discussions regarding optimizing complex spinal patients.
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Affiliation(s)
- Omar Sorour
- Department of Neurosurgery, University of California, San Francisco, 505 Parnassus Avenue - Office M779, San Francisco, CA 94143, USA
| | - Mohamed Macki
- Department of Neurosurgery, University of California, San Francisco, 505 Parnassus Avenue - Office M779, San Francisco, CA 94143, USA
| | - Lee Tan
- Department of Neurosurgery, University of California, San Francisco, 505 Parnassus Avenue - Office M779, San Francisco, CA 94143, USA.
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Ambati VS, Macki M, Chan AK, Michalopoulos GD, Le VP, Jamieson AB, Chou D, Shaffrey CI, Gottfried ON, Bisson EF, Asher AL, Coric D, Potts EA, Foley KT, Wang MY, Fu KM, Virk MS, Knightly JJ, Meyer S, Park P, Upadhyaya C, Shaffrey ME, Buchholz AL, Tumialán LM, Turner JD, Sherrod BA, Haid RW, Bydon M, Mummaneni PV. Three-level ACDF versus 3-level laminectomy and fusion: are there differences in outcomes? An analysis of the Quality Outcomes Database cervical spondylotic myelopathy cohort. Neurosurg Focus 2023; 55:E2. [PMID: 37657103 DOI: 10.3171/2023.6.focus23295] [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: 05/01/2023] [Accepted: 06/16/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE The authors sought to compare 3-level anterior with posterior fusion surgical procedures for the treatment of multilevel cervical spondylotic myelopathy (CSM). METHODS The authors analyzed prospective data from the 14 highest enrolling sites of the Quality Outcomes Database CSM module. They compared 3-level anterior cervical discectomy and fusion (ACDF) and posterior cervical laminectomy and fusion (PCF) surgical procedures, excluding surgical procedures crossing the cervicothoracic junction. Rates of reaching the minimal clinically important difference (MCID) in patient-reported outcomes (PROs) were compared at 24 months postoperatively. Multivariable analyses adjusted for potential confounders elucidated in univariable analysis. RESULTS Overall, 199 patients met the inclusion criteria: 123 ACDF (61.8%) and 76 PCF (38.2%) patients. The 24-month follow-up rates were similar (ACDF 90.2% vs PCF 92.1%, p = 0.67). Preoperatively, ACDF patients were younger (60.8 ± 10.2 vs 65.0 ± 10.3 years, p < 0.01), and greater proportions were privately insured (56.1% vs 36.8%, p = 0.02), actively employed (39.8% vs 22.8%, p = 0.04), and independently ambulatory (14.6% vs 31.6%, p < 0.01). Otherwise, the cohorts had equivalent baseline modified Japanese Orthopaedic Association (mJOA), Neck Disability Index (NDI), numeric rating scale (NRS)-arm pain, NRS-neck pain, and EQ-5D scores (p > 0.05). ACDF patients had reduced hospitalization length (1.6 vs 3.9 days, p < 0.01) and a greater proportion had nonroutine discharge (7.3% vs 22.8%, p < 0.01), but they had a higher rate of postoperative dysphagia (13.5% vs 3.5%, p = 0.049). Compared with baseline values, both groups demonstrated improvements in all outcomes at 24 months (p < 0.05). In multivariable analyses, after controlling for age, insurance payor, employment status, ambulation status, and other potential clinically relevant confounders, ACDF was associated with a greater proportion of patients with maximum satisfaction on the North American Spine Society Patient Satisfaction Index (NASS) (NASS score of 1) at 24 months (69.4% vs 53.7%, OR 2.44, 95% CI 1.17-5.09, adjusted p = 0.02). Otherwise, the cohorts shared similar 24-month outcomes in terms of reaching the MCID for mJOA, NDI, NRS-arm pain, NRS-neck pain, and EQ-5D score (adjusted p > 0.05). There were no differences in the 3-month readmission (ACDF 4.1% vs PCF 3.9%, p = 0.97) and 24-month reoperation (ACDF 13.5% vs PCF 18.6%, p = 0.36) rates. CONCLUSIONS In a cohort limited to 3-level fusion surgical procedures, ACDF was associated with reduced blood loss, shorter hospitalization length, and higher routine home discharge rates; however, PCF resulted in lower rates of postoperative dysphagia. The procedures yielded comparably significant improvements in functional status (mJOA score), neck and arm pain, neck pain-related disability, and quality of life at 3, 12, and 24 months. ACDF patients had significantly higher odds of maximum satisfaction (NASS score 1). Given comparable outcomes, patients should be counseled on each approach's complication profile to aid in surgical decision-making.
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Affiliation(s)
- Vardhaan S Ambati
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Mohamed Macki
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Andrew K Chan
- 2Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | | | - Vivian P Le
- 1Department of Neurological Surgery, University of California, San Francisco, California
- 2Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Alysha B Jamieson
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Dean Chou
- 2Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | | | - Oren N Gottfried
- 4Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Erica F Bisson
- 5Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Anthony L Asher
- 6Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Domagoj Coric
- 6Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Eric A Potts
- 7Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Kevin T Foley
- 8Department of Neurosurgery, University of Tennessee, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Michael Y Wang
- 9Department of Neurological Surgery, University of Miami, Florida
| | - Kai-Ming Fu
- 10Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - Michael S Virk
- 10Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - John J Knightly
- 11Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Scott Meyer
- 11Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Paul Park
- 8Department of Neurosurgery, University of Tennessee, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Cheerag Upadhyaya
- 12Marion Bloch Neuroscience Institute, Saint Luke's Health System, Kansas City, Missouri
| | - Mark E Shaffrey
- 13Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Avery L Buchholz
- 13Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | | | - Jay D Turner
- 14Barrow Neurological Institute, Phoenix, Arizona; and
| | - Brandon A Sherrod
- 5Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Regis W Haid
- 15Atlanta Brain and Spine Care, Atlanta, Georgia
| | - Mohamad Bydon
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Praveen V Mummaneni
- 1Department of Neurological Surgery, University of California, San Francisco, California
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10
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Lim S, Schultz L, Zakko P, Macki M, Hamilton T, Pawloski J, Fadel H, Mansour T, Yeh HH, Preston G, Nerenz D, Schwalb JM, Abdulhak M, Park P, Aleem I, Easton R, Khalil J, Perez-Cruet M, Park D, Chang V. The Potential Negative Effects of Smoking on Cervical and Lumbar Surgery Beyond Pseudarthrosis: A Michigan Spine Surgery Improvement Collaborative Study. World Neurosurg 2023; 173:e241-e249. [PMID: 36791883 DOI: 10.1016/j.wneu.2023.02.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVE To review the Michigan Spine Surgery Improvement Collaborative registry to investigate the long-term associations between current smoking status and outcomes after elective cervical and lumbar spine surgery. METHODS Using the Michigan Spine Surgery Improvement Collaborative, we captured all cases from January 1, 2017, to November 21, 2020, with outcomes data available; 19,251 lumbar cases and 7936 cervical cases were included. Multivariate regression analyses were performed to assess the relationship of smoking with the clinical outcomes. RESULTS Current smoking status was associated with lower urinary retention and satisfaction for patients after lumbar surgery and was associated with less likelihood of achieving minimal clinically important difference in primary outcome measures including Patient-Reported Outcomes Measurement Information System, back pain, leg pain, and EuroQol-5D at 90 days and 1 year after surgery. Current smokers were also less likely to return to work at 90 days and 1 year after surgery. Among patients who underwent cervical surgery, current smokers were less likely to have urinary retention and dysphagia postoperatively. They were less likely to be satisfied with the surgery outcome at 1 year. Current smoking was associated with lower likelihood of achieving minimal clinically important difference in Patient-Reported Outcomes Measurement Information System, neck pain, arm pain, and EuroQol-5D at various time points. There was no difference in return-to-work status. CONCLUSIONS Our analysis suggests that smoking is negatively associated with functional improvement, patient satisfaction, and return-to-work after elective spine surgery.
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Affiliation(s)
- Seokchun Lim
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Lonni Schultz
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA; Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan, USA
| | - Philip Zakko
- Department of Orthopedics, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Mohamed Macki
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Travis Hamilton
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Jacob Pawloski
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Hassan Fadel
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Tarek Mansour
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Hsueh-Han Yeh
- Center for Health Services Research, Henry Ford Hospital, Detroit, Michigan, USA
| | - Gordon Preston
- Department of Orthopedics, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - David Nerenz
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA; Center for Health Services Research, Henry Ford Hospital, Detroit, Michigan, USA
| | - Jason M Schwalb
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Muwaffak Abdulhak
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Ilyas Aleem
- Department of Orthopedics, University of Michigan, Ann Arbor, Michigan, USA
| | - Richard Easton
- Department of Orthopedics, William Beaumont Hospital, Troy, Michigan, USA
| | - Jad Khalil
- Department of Orthopedics, William Beaumont Hospital, Royal Oak, Michigan, USA
| | | | - Daniel Park
- Department of Orthopedics, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Victor Chang
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA.
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11
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Lim S, Yeh HH, Macki M, Haider S, Hamilton T, Mansour TR, Telemi E, Schultz L, Nerenz DR, Schwalb JM, Abdulhak M, Park P, Aleem I, Easton R, Khalil JG, Perez-Cruet M, Chang V. Postoperative opioid prescription and patient-reported outcomes after elective spine surgery: a Michigan Spine Surgery Improvement Collaborative study. J Neurosurg Spine 2023; 38:242-248. [PMID: 36208431 DOI: 10.3171/2022.8.spine22571] [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: 05/26/2022] [Accepted: 08/25/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study was designed to assess how postoperative opioid prescription dosage could affect patient-reported outcomes after elective spine surgery. METHODS Patients enrolled in the Michigan Spine Surgery Improvement Collaborative (MSSIC) from January 2020 to September 2021 were included in this study. Opioid prescriptions at discharge were converted to total morphine milligram equivalents (MME). A reference value of 225 MME per week was used as a cutoff. Patients were divided into two cohorts based on prescribed total MME: ≤ 225 MME and > 225 MME. Primary outcomes included patient satisfaction, return to work status after surgery, and whether improvement of the minimal clinically important difference (MCID) of the Patient-Reported Outcomes Measurement Information System 4-question short form for physical function (PROMIS PF) and EQ-5D was met. Generalized estimated equations were used for multivariate analysis. RESULTS Regression analysis revealed that patients who had postoperative opioids prescribed with > 225 MME were less likely to be satisfied with surgery (adjusted OR [aOR] 0.81) and achieve PROMIS PF MCID (aOR 0.88). They were also more likely to be opioid dependent at 90 days after elective spine surgery (aOR 1.56). CONCLUSIONS The opioid epidemic is a serious threat to national public health, and spine surgeons must practice conscientious postoperative opioid prescribing to achieve adequate pain control. The authors' analysis illustrates that a postoperative opioid prescription of 225 MME or less is associated with improved patient satisfaction, greater improvement in physical function, and decreased opioid dependence compared with those who had > 225 MME prescribed.
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Affiliation(s)
| | | | | | | | | | | | | | - Lonni Schultz
- Departments of1Neurological Surgery
- 2Public Health Services, and
| | - David R Nerenz
- Departments of1Neurological Surgery
- 3Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | | | | | | | - Ilyas Aleem
- 5Orthopedics, University of Michigan, Ann Arbor, Michigan
| | - Richard Easton
- 6Department of Orthopedics, William Beaumont Hospital, Troy, Michigan; and
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12
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Fadel HA, Haider S, Pawloski JA, Zakaria HM, Macki M, Bartlett S, Schultz L, Robin AM, Kalkanis SN, Lee IY. Laser Interstitial Thermal Therapy for First-Line Treatment of Surgically Accessible Recurrent Glioblastoma: Outcomes Compared With a Surgical Cohort. Neurosurgery 2022; 91:701-709. [PMID: 35986677 DOI: 10.1227/neu.0000000000002093] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/05/2022] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Laser interstitial thermal therapy (LITT) for glioblastoma (GBM) has been reserved for poor surgical candidates and deep "inoperable" lesions. We present the first reported series of LITT for surgically accessible recurrent GBM (rGBM) that would otherwise be treated with surgical resection. OBJECTIVE To evaluate the use of LITT for unifocal, lobar, first-time rGBM compared with a similar surgical cohort. METHODS A retrospective institutional database was used to identify patients with unifocal, lobar, first-time rGBM who underwent LITT or resection between 2013 and 2020. Clinical and volumetric lesional characteristics were compared between cohorts. Subgroup analysis of patients with lesions ≤20 cm 3 was also completed. Primary outcomes were overall survival and progression-free survival. RESULTS Of the 744 patients with rGBM treated from 2013 to 2020, a LITT cohort of 17 patients were compared with 23 similar surgical patients. There were no differences in baseline characteristics, although lesions were larger in the surgical cohort (7.54 vs 4.37 cm 3 , P = .017). Despite differences in lesion size, both cohorts had similar extents of ablation/resection (90.7% vs 95.1%, P = .739). Overall survival (14.1 vs 13.8 months, P = .578) and progression-free survival (3.7 vs 3.3 months, P = 0. 495) were similar. LITT patients had significantly shorter hospital stays (2.2 vs 3.0 days, P = .004). Subgroup analysis of patients with lesions ≤20 cm 3 showed similar outcomes, with LITT allowing for significantly shorter hospital stays. CONCLUSION We found no difference in survival outcomes or morbidity between LITT and repeat surgery for surgically accessible rGBM while LITT resulted in shorter hospital stays and more efficient postoperative care.
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Affiliation(s)
- Hassan A Fadel
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Sameah Haider
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Jacob A Pawloski
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Hesham M Zakaria
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mohamed Macki
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Seamus Bartlett
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Lonni Schultz
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan, USA
| | - Adam M Robin
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Steven N Kalkanis
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Ian Y Lee
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
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13
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Macki M, Hamilton T, Massie L, Bazydlo M, Schultz L, Seyfried D, Park P, Aleem I, Abdulhak M, Chang VW, Schwalb JM. Characteristics and outcomes of patients undergoing lumbar spine surgery for axial back pain in the Michigan Spine Surgery Improvement Collaborative. Spine J 2022; 22:1651-1659. [PMID: 35803577 DOI: 10.1016/j.spinee.2022.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The indications for surgical intervention of axial back pain without leg pain for degenerative lumbar disorders have been limited in the literature, as most study designs allow some degree of leg symptoms in the inclusion criteria. PURPOSE To determine the outcome of surgery (decompression only vs. fusion) for pure axial back pain without leg pain. STUDY DESIGN/SETTING Prospectively collected data in the Michigan Spine Surgery Improvement Collaborative (MSSIC). PATIENT SAMPLE Patients with pure axial back pain without leg pain underwent lumbar spine surgery for primary diagnoses of lumbar disc herniation, lumbar stenosis, and isthmic or degenerative spondylolisthesis ≤ grade II. OUTCOME MEASURES Minimally clinically important difference (MCID) for back pain, Numeric Rating Scale of back pain, Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), MCID of PROMIS-PF, and patient satisfaction on the North American Spine Surgery Patient Satisfaction Index were collected at 90 days, 1 year, and 2 years after surgery. METHODS Log-Poisson generalized estimating equation models were constructed with patient-reported outcomes as the independent variable, reporting adjusted risk ratios (RRadj). RESULTS Of the 388 patients at 90 days, multi-level versus single level lumbar surgery decreased the likelihood of obtaining a MCID in back pain by 15% (RRadj=0.85, p=.038). For every one-unit increase in preoperative back pain, the likelihood for a favorable outcome increased by 8% (RRadj=1.08, p<.001). Of the 326 patients at 1 year, symptom duration > 1 year decreased the likelihood of a MCID in back pain by 16% (RRadj=0.84, p=.041). The probability of obtaining a MCID in back pain increased by 9% (RRadj=1.09, p<.001) for every 1-unit increase in baseline back pain score and by 14% for fusions versus decompression alone (RRadj=1.14, p=.0362). Of the 283 patients at 2 years, the likelihood of obtaining MCID in back pain decreased by 30% for patients with depression (RRadj=0.70, p<.001) and increased by 8% with every one-unit increase in baseline back pain score (RRadj=1.08, p<.001). CONCLUSIONS Only the severity of preoperative back pain was associated with improvement in MCID in back pain at all time points, suggesting that surgery should be considered for selected patients with severe axial pain without leg pain. Fusion surgery versus decompression alone was associated with improved patient-reported outcomes at 1 year only, but not at the other time points.
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Affiliation(s)
- Mohamed Macki
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202 USA
| | - Travis Hamilton
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202 USA
| | - Lara Massie
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202 USA
| | - Michael Bazydlo
- Department of Public Health Sciences, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202 USA
| | - Lonni Schultz
- Department of Public Health Sciences, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202 USA
| | - Donald Seyfried
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202 USA
| | - Paul Park
- Department of Neurosurgery, University of Michigan, 1500 East Medical Center Drive #5201, Ann Arbor, MI 48109 USA
| | - Ilyas Aleem
- Department of Orthopaedic Surgery, University of Michigan, 1500 East Medical Center Drive, Floor 2 Reception B, Ann Arbor, MI 48109 USA
| | - Muwaffak Abdulhak
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202 USA
| | - Victor W Chang
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202 USA
| | - Jason M Schwalb
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202 USA.
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14
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Lim S, Bazydlo M, Macki M, Haider S, Hamilton T, Hunt R, Chaker A, Kantak P, Schultz L, Nerenz D, Schwalb JM, Abdulhak M, Park P, Aleem I, Easton R, Khalil JG, Perez-Cruet MJ, Chang V. Validation of the Benefits of Ambulation Within 8 Hours of Elective Cervical and Lumbar Surgery: A Michigan Spine Surgery Improvement Collaborative Study. Neurosurgery 2022; 91:505-512. [PMID: 35550477 DOI: 10.1227/neu.0000000000002032] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/10/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Early ambulation is considered a key element to Enhanced Recovery After Surgery protocol after spine surgery. OBJECTIVE To investigate whether ambulation less than 8 hours after elective spine surgery is associated with improved outcome. METHODS The Michigan Spine Surgery Improvement Collaborative database was queried to track all elective cervical and lumbar spine surgery between July 2018 and April 2021. In total, 7647 cervical and 17 616 lumbar cases were divided into 3 cohorts based on time to ambulate after surgery: (1) <8 hours, (2) 8 to 24 hours, and (3) >24 hours. RESULTS For cervical cases, patients who ambulated 8 to 24 hours (adjusted odds ratio [aOR] 1.38; 95% CI 1.11-1.70; P = .003) and >24 hours (aOR 2.20; 95% CI 1.20-4.03; P = .011) after surgery had higher complication rate than those who ambulated within 8 hours of surgery. Similar findings were noted for lumbar cases with patients who ambulated 8 to 24 hours (aOR 1.31; 95% CI 1.12-1.54; P < .001) and >24 hours (aOR 1.96; 95% CI 1.50-2.56; P < .001) after surgery having significantly higher complication rate than those ambulated <8 hours after surgery. Analysis of secondary outcomes for cervical cases demonstrated that <8-hour ambulation was associated with home discharge, shorter hospital stay, lower 90-day readmission, and lower urinary retention rate. For lumbar cases, <8-hour ambulation was associated with shorter hospital stay, satisfaction with surgery, lower 30-day readmission, home discharge, and lower urinary retention rate. CONCLUSION Ambulation within 8 hours after surgery is associated with significant improved outcome after elective cervical and lumbar spine surgery.
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Affiliation(s)
- Seokchun Lim
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Michael Bazydlo
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mohamed Macki
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Sameah Haider
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Travis Hamilton
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Rachel Hunt
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Anisse Chaker
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Pranish Kantak
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Lonni Schultz
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.,Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan, USA
| | - David Nerenz
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.,Center for Health Services Research, Henry Ford Hospital, Detroit, Michigan, USA
| | - Jason M Schwalb
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.,Center for Health Services Research, Henry Ford Hospital, Detroit, Michigan, USA
| | - Muwaffak Abdulhak
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Ilyas Aleem
- Department of Orthopedics, University of Michigan, Ann Arbor, Michigan, USA
| | - Richard Easton
- Department of Orthopedics, William Beaumont Hospital, Troy, Michigan, USA
| | - Jad G Khalil
- Department of Orthopedics, William Beaumont Hospital, Royal Oak, Michigan, USA
| | | | - Victor Chang
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
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15
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Macki M, Pawloski J, Fadel HA, Abdulhak MM. Surgical management of Grisel syndrome in the adult patient: illustrative case. Journal of Neurosurgery: Case Lessons 2022; 3:CASE21692. [PMID: 36130538 PMCID: PMC9379629 DOI: 10.3171/case21692] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/03/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Grisel syndrome describes an infectious soft tissue process that destabilizes the cervical bony elements and ligamentous complexes. This nontraumatic atlantoaxial rotary subluxation occurs in children primarily. This case illustrates a rare case presentation of an adult with Grisel syndrome: infectious destruction of the right atlantoaxial facet joint caused the occiput-C1 vertebra (head) to rotate rightward with lateral horizontal displacement off the C2 vertebra. OBSERVATIONS Because the infection destroyed the C1 bony arch and atlantoaxial facet joints with epidural extension, the rotated head and atlas pulled the brainstem–cervical spinal cord junction against a fixed odontoid process, resulting in a cord contusion. Because of the highly unstable craniocervical junction, the patient presented with torticollis and left upper extremity weakness. LESSONS Treatment entailed closed reduction under general anesthesia followed by occipitocervical fusion with an occipital plate, C1 lateral mass screws, and C2-C5 pedicle screws. This case describes the unique surgical pearls necessary for occipitocervical fusion of an unstable craniocervical junction, including tips with neuronavigation, trajectories of the cervical pedicle screws, aligning the lateral mass and pedicle screws with the occipital plate, and nuances with occipitocervical distraction.
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Affiliation(s)
- Mohamed Macki
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
| | - Jacob Pawloski
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
| | - Hassan A. Fadel
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
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16
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Lim S, Bazydlo M, Macki M, Haider S, Schultz L, Nerenz D, Fadel H, Pawloski J, Yeh HH, Park P, Aleem I, Khalil J, Easton R, Schwalb JM, Abdulhak M, Chang V. A Matched Cohort Analysis of Drain Usage in Elective Anterior Cervical Discectomy and Fusion: A Michigan Spine Surgery Improvement Collaborative (MSSIC) Study. Spine (Phila Pa 1976) 2022; 47:220-226. [PMID: 34516058 DOI: 10.1097/brs.0000000000004169] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This is a retrospective, cohort analysis of multi-institutional database. OBJECTIVE This study was designed to analyze the impact of drain use following elective anterior cervical discectomy and fusion (ACDF) surgeries. SUMMARY OF BACKGROUND DATA After ACDF, a drain is often placed to prevent postoperative hematoma. However, there has been no high quality evidence to support its use with ACDF despite the theoretical benefits and risks of drain placement. METHODS The Michigan Spine Surgery Improvement Collaborative database was queried to identify all patients undergoing elective ACDF between February 2014 and October 2019. Cases were divided into two cohorts based on drain use. Propensity-score matching was utilized to adjust for inherent differences between the two cohorts. Measured outcomes included surgical site hematoma, length of stay, surgical site infection, dysphagia, home discharge, readmission within 30 days, and unplanned reoperation. RESULTS We identified 7943 patients during the study period. Propensity-score matching yielded 3206 pairs. On univariate analysis of matched cohorts, there were no differences in rate of postoperative hematoma requiring either return to OR or readmission. We noted patients with drains had a higher rate of dysphagia (4.6% vs. 6.3%; P = 0.003) and had longer hospital stay (P < 0.001). On multivariate analysis, drain use was associated with significantly increased length of stay (relative risk 1.23, 95% confidence interval [CI] 1.13-1.34; P < 0.001). There were no significant differences in other outcomes measured. CONCLUSION Our analysis demonstrated that drain use is associated with significant longer hospital stay.Level of Evidence: 3.
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Affiliation(s)
- Seokchun Lim
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
| | - Michael Bazydlo
- Department of Public Health Services, Henry Ford Hospital, Detroit, MI
| | - Mohamed Macki
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
| | - Sameah Haider
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
| | - Lonni Schultz
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
- Department of Public Health Services, Henry Ford Hospital, Detroit, MI
| | - David Nerenz
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
- Center for Health Services Research, Henry Ford Hospital, Detroit, MI
| | - Hassan Fadel
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
| | - Jacob Pawloski
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
| | - Hsueh-Han Yeh
- Center for Health Services Research, Henry Ford Hospital, Detroit, MI
| | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI
| | - Ilyas Aleem
- Department of Orthopaedics, University of Michigan, Ann Arbor, MI
| | - Jad Khalil
- Department of Orthopaedics, William Beaumont Hospital, Royal Oak, MI
| | - Richard Easton
- Department of Orthopaedics, William Beaumont Hospital, Royal Oak, MI
| | - Jason M Schwalb
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
| | - Muwaffak Abdulhak
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
| | - Victor Chang
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
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17
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Macki M, Hamilton T, Lim S, Mansour TR, Telemi E, Bazydlo M, Schultz L, Nerenz DR, Park P, Chang V, Schwalb J, Abdulhak MM. The role of postoperative antibiotic duration on surgical site infection after lumbar surgery. J Neurosurg Spine 2022; 36:254-260. [PMID: 34534952 DOI: 10.3171/2021.4.spine201839] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 10/14/2020] [Accepted: 04/01/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Despite a general consensus regarding the administration of preoperative antibiotics, poorly defined comparison groups and underpowered studies prevent clear guidelines for postoperative antibiotics. Utilizing a data set tailored specifically to spine surgery outcomes, in this clinical study the authors aimed to determine whether there is a role for postoperative antibiotics in the prevention of surgical site infection (SSI). METHODS The Michigan Spine Surgery Improvement Collaborative registry was queried for all lumbar operations performed for degenerative spinal pathologies over a 5-year period from 2014 to 2019. Preoperative prophylactic antibiotics were administered for all surgical procedures. The study population was divided into three cohorts: no postoperative antibiotics, postoperative antibiotics ≤ 24 hours, and postoperative antibiotics > 24 hours. This categorization was intended to determine 1) whether postoperative antibiotics are helpful and 2) the appropriate duration of postoperative antibiotics. First, multivariable analysis with generalized estimating equations (GEEs) was used to determine the association between antibiotic duration and all-type SSI with adjusted odds ratios; second, a three-tiered outcome-no SSI, superficial SSI, and deep SSI-was calculated with multivariable multinomial logistical GEE analysis. RESULTS Among 37,161 patients, the postoperative antibiotics > 24 hours cohort had more men with older average age, greater body mass index, and greater comorbidity burden. The postoperative antibiotics > 24 hours cohort had a 3% rate of SSI, which was significantly higher than the 2% rate of SSI of the other two cohorts (p = 0.004). On multivariable GEE analysis, neither postoperative antibiotics > 24 hours nor postoperative antibiotics ≤ 24 hours, as compared with no postoperative antibiotics, was associated with a lower rate of all-type postoperative SSIs. On multivariable multinomial logistical GEE analysis, neither postoperative antibiotics ≤ 24 hours nor postoperative antibiotics > 24 hours was associated with rate of superficial SSI, as compared with no antibiotic use at all. The odds of deep SSI decreased by 45% with postoperative antibiotics ≤ 24 hours (p = 0.002) and by 40% with postoperative antibiotics > 24 hours (p = 0.008). CONCLUSIONS Although the incidence of all-type SSI was highest in the antibiotics > 24 hours cohort, which also had the highest proportions of risk factors, duration of antibiotics failed to predict all-type SSI. On multinomial subanalysis, administration of postoperative antibiotics for both ≤ 24 hours and > 24 hours was associated with decreased risk of only deep SSI but not superficial SSI. Spine surgeons can safely consider antibiotics for 24 hours, which is equally as effective as long-term administration for prophylaxis against deep SSI.
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Affiliation(s)
| | | | | | | | | | | | | | - David R Nerenz
- 3Center for Health Policy and Health Services Research, Henry Ford Hospital, Detroit, Michigan; and
| | - Paul Park
- 4University of Michigan, Ann Arbor, Michigan
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Macki M, La Marca F. Evolution of Complex Spine Surgery in Neurosurgery: From Big to Minimally Invasive Surgery for the Treatment of Spinal Deformity. Adv Tech Stand Neurosurg 2022; 45:339-357. [PMID: 35976456 DOI: 10.1007/978-3-030-99166-1_11] [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: 06/15/2023]
Abstract
Spinal instrumentation for adult spinal deformity dates back to the surgical correction of secondary complications from infectious processes, such as Pott's disease and poliomyelitis [1]. With the population aging at a longer life expectancy today, advanced degenerative spinal diseases and idiopathic scoliosis supersede as the most common causes of adult spinal deformity. Correction of the thoracolumbar malignment, specifically, has rapidly evolved with the burgeoning success of spinal instrumentation. The objective of this chapter is to review the metamorphosis of operative principles for adult thoracolumbar deformity, from aggressive osteotomies in the posterior bony elements to minimally invasive surgery (MIS) at the intervertebral disc space.
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Affiliation(s)
- Mohamed Macki
- Department of Neurosurgery, Henry Ford Allegiance Hospital, Jackson, MI, USA
| | - Frank La Marca
- Department of Neurosurgery, Henry Ford Allegiance Hospital, Jackson, MI, USA.
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Macki M, Anand SK, Hamilton T, Lim S, Mansour T, Bazydlo M, Schultz L, Abdulhak MM, Khalil JG, Park P, Aleem I, Easton R, Schwalb JM, Nerenz D, Chang V. Analysis of Factors Associated with Return-to-Work After Lumbar Surgery up to 2-Years Follow-up: A Michigan Spine Surgery Improvement Collaborative (MSSIC) Study. Spine (Phila Pa 1976) 2022; 47:49-58. [PMID: 34265812 DOI: 10.1097/brs.0000000000004163] [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] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Michigan Spine Surgery Improvement Collaborative (MSSIC) prospectively collects data on all patients undergoing operations for degenerative and/or deformity indications. OBJECTIVE We aimed to identify which factors are significantly associated with return-to-work after lumbar surgery at long-term follow-up. SUMMARY OF BACKGROUND DATA Prior publications have created a clinically relevant predictive model for return-to-work, wherein education, gender, race, comorbidities, and preoperative symptoms increased likelihood of return-to-work at 3 months after lumbar surgery. We sought to determine if these trends 1) persisted at 1 year and 2 years postoperatively; or 2) differed among preoperatively employed versus unemployed patients. METHODS MSSIC was queried for all patients undergoing lumbar operations (2014-2019). All patients intended to return-to-work postoperatively. Patients were followed for up to 2 years postoperatively. Measures of association were calculated with multivariable generalized estimating equations. RESULTS Return-to-work increased from 63% (3542/5591) at 90 days postoperatively to 75% (3143/4147) at 1 year and 74% (2133/2866) at 2 years postoperatively. Following generalized estimating equations, neither clinical nor surgical variables predicted return-to-work at all three time intervals: 90 days, 1 year, and 2 years postoperatively. Only socioeconomic factors reached statistical significance at all follow-up points. Preoperative employment followed by insurance status had the greatest associations with return-to-work. In a subanalysis of patients who were preoperatively employed, insurance was the only factor with significant associations with return-to-work at all three follow-up intervals. The return-to-work rates among unemployed patients at baseline increased from 29% (455/1100) at 90 days, 44% (495/608) at 1 year, and 46% (366/426) at 2 years postoperatively. The only two significant factors associated with return-to-work at all three follow-up intervals were Medicaid, as compared with private insurance, and male gender. CONCLUSION In patients inquiring about long-term return-to-work after lumbar surgery, insurance status represents the important determinant of employment status.Level of Evidence: 2.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jad G Khalil
- Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak
| | | | - Ilyas Aleem
- Department of Orthopaedic Surgery, University of Michigan Hospital, Ann Arbor
| | - Richard Easton
- Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak
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20
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Hamilton T, Macki M, Oh SY, Bazydlo M, Schultz L, Zakaria HM, Khalil JG, Perez-Cruet M, Aleem I, Park P, Easton R, Nerenz DR, Schwalb J, Abdulhak M, Chang V. The association of patient education level with outcomes after elective lumbar surgery: a Michigan Spine Surgery Improvement Collaborative study. J Neurosurg Spine 2021:1-9. [PMID: 34891131 DOI: 10.3171/2021.9.spine21421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/10/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Socioeconomic factors have been shown to impact a host of healthcare-related outcomes. Level of education is a marker of socioeconomic status. This study aimed to investigate the relationship between patient education level and outcomes after elective lumbar surgery and to characterize any education-related disparities. METHODS The Michigan Spine Surgery Improvement Collaborative registry was queried for all lumbar spine operations. Primary outcomes included patient satisfaction determined by the North American Spine Society patient satisfaction index, and reaching the minimum clinically important difference of Patient-Reported Outcomes Measurement Information System Physical Function score and return to work up to 2 years after surgery. Multivariate Poisson generalized estimating equation models reported adjusted risk ratios. RESULTS A total of 26,229 lumbar spine patients had data available for inclusion in this study. On multivariate generalized estimating equation analysis all comparisons were done versus the high school (HS)/general equivalency development (GED)-level cohort. For North American Spine Society satisfaction scores after surgery the authors observed the following: at 90 days the likelihood of satisfaction significantly decreased by 11% (p < 0.001) among < HS, but increased by 1% (p = 0.52) among college-educated and 3% (p = 0.011) among postcollege-educated cohorts compared to the HS/GED cohort; at 1 year there was a decrease of 9% (p = 0.02) among < HS and increases of 3% (p = 0.02) among college-educated and 9% (p < 0.001) among postcollege-educated patients; and at 2 years, there was an increase of 5% (p = 0.001) among postcollege-educated patients compared to the < HS group. The likelihood of reaching a minimum clinically important difference of Patient-Reported Outcomes Measurement Information System Physical Function score at 90 days increased by 5% (p = 0.005) among college-educated and 9% (p < 0.001) among postcollege-educated cohorts; at 1 year, all comparison cohorts demonstrated significance, with a decrease of 12% (p = 0.007) among < HS, but an increase by 6% (p < 0.001) among college-educated patients and 14% (p < 0.001) among postcollege-educated compared to the HS/GED cohort; at 2 years, there was a significant decrease by 19% (p = 0.003) among the < HS cohort, an increase by 8% (p = 0.001) among the college-educated group, and an increase by 16% (p < 0.001) among the postcollege-educated group. For return to work, a significant increase was demonstrated at 90 days and 1 year when comparing the HS or less group with college or postcollege cohorts. CONCLUSIONS This study demonstrated negative associations on all primary outcomes with lower levels of education. This finding suggests a potential disparity linked to education in elective spine surgery.
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Affiliation(s)
| | | | - Seok Yoon Oh
- 2Chicago Medical School, Rosalind Franklin University of Medicine and Science, Chicago, Illinois
| | | | - Lonni Schultz
- Departments of1Neurosurgery and.,3Public Health Sciences, and
| | | | | | | | | | - Paul Park
- 7Neurosurgery, University of Michigan Hospital, Ann Arbor
| | - Richard Easton
- 8Department of Orthopedic Surgery, William Beaumont Hospital-Troy, Michigan; and
| | - David R Nerenz
- 9Center for Health Services Research, Henry Ford Hospital, Detroit
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Zakaria HM, Wilkinson BM, Pennington Z, Saadeh YS, Lau D, Chandra A, Ahmed AK, Macki M, Anand SK, Abouelleil MA, Fateh JA, Rick JW, Morshed RA, Deng H, Chen KY, Robin A, Lee IY, Kalkanis S, Chou D, Park P, Sciubba DM, Chang V. Sarcopenia as a Prognostic Factor for 90-Day and Overall Mortality in Patients Undergoing Spine Surgery for Metastatic Tumors: A Multicenter Retrospective Cohort Study. Neurosurgery 2021. [DOI: 10.1093/neuros/nyaa245_s039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Macki M, Haddad Y, Suryadevara R, Dabaja AL, Chedid M, Chang V. Prophylactic Low-Molecular-Weight Heparin Versus Unfractionated Heparin in Spine Surgery (PLUSS): A Pilot Matched Cohort Study. Neurosurgery 2021; 89:1097-1103. [PMID: 34634115 DOI: 10.1093/neuros/nyab363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/04/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite a proven superior efficacy of prophylactic low-molecular-weight heparin (LMWH) over unfractionated heparin (UFH) in the majority of surgical specialties, chemoprophylactic techniques after spine surgery have not been established because of the fear of epidural hematomas with LMWH. OBJECTIVE To determine the efficacy of LMWH vs UFH in the prevention of venous thromboembolism (VTE) events, balanced against the risk of epidural hematoma. METHODS This is the first matched cohort design that directly compares prophylactic LMWH to UFH after spine surgery for degenerative/deformity pathologies at a tertiary academic center. Prospectively collected patients receiving prophylactic LMWH and a historical cohort of patients receiving prophylactic UFH (prior to 2017) were matched in 1:1 ratio based on age ±5 yr, American Society of Anesthesiologists classification, location in the spinal column, and type of surgery. RESULTS Of 562 patients, VTE events equaled 1.4% (n = 8): 1.4% (n = 4) with LMWH was exactly equal to 1.4% (n = 4) with UFH. Epidural hematomas reached 0.8% (n = 5): 1.4% (n = 4) with UFH vs 0.3% (n = 1) with the LMWH (P = .178). Utilizing adjusted odds ratio (ORadj), the type of chemoprophylaxis after spine surgery failed to predict VTE events. Similarly, the chemoprophylactic technique failed to predict epidural hematoma in the multivariable regression analysis, although UFH trended toward a higher complication rate (ORadj = 3.15 [0.48-20.35], P = .227). CONCLUSION Chemoprophylactic patterns failed to predict VTE. Although no differences in epidural hematoma rates were detected, our analysis does highlight a trend toward a safer profile with LMWH vs UFH. LMWH may be a safe alternative to UFH in spine surgery.
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Affiliation(s)
- Mohamed Macki
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Yazeed Haddad
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | | | - Abed Latif Dabaja
- Department of Internal Medicine, Garden City Hospital, Garden City, Michigan, USA
| | - Mokbel Chedid
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Victor Chang
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
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Khalifeh JM, Massie LW, Dibble CF, Dorward IG, Macki M, Khandpur U, Alshohatee K, Jain D, Chang V, Ray WZ. Decompression of Lumbar Central Spinal Canal Stenosis Following Minimally Invasive Transforaminal Lumbar Interbody Fusion. Clin Spine Surg 2021; 34:E439-E449. [PMID: 33979102 DOI: 10.1097/bsd.0000000000001192] [Citation(s) in RCA: 3] [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: 05/17/2020] [Accepted: 02/24/2021] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN This was a retrospective clinical series. OBJECTIVE The objective of this study was to evaluate radiologic changes in central spinal canal dimensions following minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) with placement of a static or an expandable interbody device. SUMMARY OF BACKGROUND DATA MIS-TLIF is used to treat lumbar degenerative diseases and low-grade spondylolisthesis. MIS-TLIF enables direct and indirect decompression of lumbar spinal stenosis, with patients experiencing relief from radiculopathy and neurogenic claudication. However, the effects of MIS-TLIF on the central spinal canal are not well-characterized. MATERIALS AND METHODS We identified patients who underwent MIS-TLIF for degenerative lumbar spondylolisthesis and concurrent moderate to severe spinal stenosis. We selected patients who had both preoperative and postoperative magnetic resonance imaging (MRI) and upright lateral radiographs of the lumbar spine. Measurements on axial T2-weighted MRI scans include anteroposterior and transverse dimensions of the dural sac and osseous spinal canal. Measurements on radiographs include disk height, neural foraminal height, segmental lordosis, and spondylolisthesis. We made pairwise comparisons between each of the central canal dimensions and lumbar sagittal segmental radiologic outcome measures relative to their corresponding preoperative values. Correlation coefficients were used to quantify the association between changes in lumbar sagittal segmental parameters relative to changes in radiologic outcomes of central canal dimensions. Statistical analysis was performed for "all patients" and further stratified by interbody device subgroups (static and expandable). RESULTS Fifty-one patients (age 60.4 y, 68.6% female) who underwent MIS-TLIF at 55 levels (65.5% at L4-L5) were included in the analysis. Expandable interbody devices were used in 45/55 (81.8%) levels. Mean duration from surgery to postoperative MRI scan was 16.5 months (SD 11.9). MIS-TLIF was associated with significant improvements in dural sac dimensions (anteroposterior +0.31 cm, transverse +0.38 cm) and osseous spinal canal dimensions (anteroposterior +0.16 cm, transverse +0.32 cm). Sagittal lumbar segmental parameters of disk height (+0.56 cm), neural foraminal height (+0.35 cm), segmental lordosis (+4.26 degrees), and spondylolisthesis (-7.5%) were also improved following MIS-TLIF. We did not find meaningful associations between the changes in central canal dimensions relative to the corresponding changes in any of the sagittal lumbar segmental parameters. Stratified analysis by interbody device type (static and expandable) revealed similar within-group changes as in the overall cohort and minimal between-group differences. CONCLUSIONS MIS-TLIF is associated with radiologic decompression of neural foraminal and central spinal canal stenosis. The mechanism for neural foraminal and central canal decompression is likely driven by a combination of direct and indirect corrective techniques.
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Affiliation(s)
- Jawad M Khalifeh
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD
| | - Lara W Massie
- Department of Neurological Surgery, Henry Ford Health System, Detroit, MI
| | - Christopher F Dibble
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO
| | - Ian G Dorward
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO
| | - Mohamed Macki
- Department of Neurological Surgery, Henry Ford Health System, Detroit, MI
| | - Umang Khandpur
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO
| | - Kafa Alshohatee
- Department of Neurological Surgery, Henry Ford Health System, Detroit, MI
| | - Deeptee Jain
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Victor Chang
- Department of Neurological Surgery, Henry Ford Health System, Detroit, MI
| | - Wilson Z Ray
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO
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24
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Lim S, Yeh HH, Macki M, Mansour T, Schultz L, Telemi E, Haider S, Nerenz DR, Schwalb JM, Abdulhak M, Park P, Aleem I, Easton R, Khalil J, Perez-Cruet M, Chang V. Preoperative HbA1c > 8% Is Associated With Poor Outcomes in Lumbar Spine Surgery: A Michigan Spine Surgery Improvement Collaborative Study. Neurosurgery 2021; 89:819-826. [PMID: 34352887 DOI: 10.1093/neuros/nyab294] [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] [Received: 12/08/2020] [Accepted: 06/07/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Preoperative hemoglobin A1c (HbA1c) is a useful screening tool since a significant portion of diabetic patients in the United States are undiagnosed and the prevalence of diabetes continues to increase. However, there is a paucity of literature analyzing comprehensive association between HbA1c and postoperative outcome in lumbar spine surgery. OBJECTIVE To assess the prognostic value of preoperative HbA1c > 8% in patients undergoing elective lumbar spine surgery. METHODS The Michigan Spine Surgery Improvement Collaborative (MSSIC) database was queried to track all elective lumbar spine surgeries between January 2018 and December 2019. Cases were divided into 2 cohorts based on preoperative HbA1c level (≤8% and >8%). Measured outcomes include any complication, surgical site infection (SSI), readmission (RA) within 30 d (30RA) and 90 d (90RA) of index operation, patient satisfaction, and the percentage of patients who achieved minimum clinically important difference (MCID) using Patient-Reported Outcomes Measurement Information System. RESULTS We captured 4778 patients in this study. Our multivariate analysis demonstrated that patients with HbA1c > 8% were more likely to experience postoperative complication (odds ratio [OR] 1.81, 95% CI 1.20-2.73; P = .005) and be readmitted within 90 d of index surgery (OR 1.66, 95% CI 1.08-2.54; P = .021). They also had longer hospital stay (OR 1.12, 95% CI 1.03-1.23; P = .009) and were less likely to achieve functional improvement after surgery (OR 0.64, 95% CI 0.44-0.92; P = .016). CONCLUSION HbA1c > 8% is a reliable predictor of poor outcome in elective lumbar spine surgery. Clinicians should consider specialty consultation to optimize patients' glycemic control prior to surgery.
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Affiliation(s)
- Seokchun Lim
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Hsueh-Han Yeh
- Department of Public Health Services, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mohamed Macki
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Tarek Mansour
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Lonni Schultz
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA.,Department of Public Health Services, Henry Ford Hospital, Detroit, Michigan, USA
| | - Edvin Telemi
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Sameah Haider
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - David R Nerenz
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA.,Center for Health Services Research, Henry Ford Hospital, Detroit, Michigan, USA
| | - Jason M Schwalb
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Muwaffak Abdulhak
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Ilyas Aleem
- Department of Orthopedics, University of Michigan, Ann Arbor, Michigan, USA
| | - Richard Easton
- Department of Orthopedics, William Beaumont Hospital, Troy, Michigan, USA
| | - Jad Khalil
- Department of Orthopedics, William Beaumont Hospital, Royal Oak, Michigan, USA
| | | | - Victor Chang
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
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Macki M, Hamilton T, Haddad YW, Chang V. Expandable Cage Technology-Transforaminal, Anterior, and Lateral Lumbar Interbody Fusion. Oper Neurosurg (Hagerstown) 2021; 21:S69-S80. [PMID: 34128070 DOI: 10.1093/ons/opaa342] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/19/2020] [Indexed: 12/13/2022] Open
Abstract
This review of the literature will focus on the indications, surgical techniques, and outcomes for expandable transforaminal lumbar interbody fusion (TLIF), anterior lumbar interbody fusion (ALIF), and lateral lumbar interbody fusion (LLIF) operations. The expandable TLIF cage has become a workhorse for common degenerative pathology, whereas expandable ALIF cages carry the promise of greater lordotic correction while evading the diseased posterior elements. Expandable LLIF cages call upon minimally invasive techniques for a retroperitoneal, transpsoas approach to the disc space, obviating the need for an access surgeon and decreasing risk of injury to the critical neurovascular structures. Nuances between expandable and static cages for all 3 TLIF, ALIF, and LLIF operations are discussed in this review.
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Affiliation(s)
- Mohamed Macki
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Travis Hamilton
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Yazeed W Haddad
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Victor Chang
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
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Macki M, Chang V. Commentary: Comparison of the Safety of Prophylactic Anticoagulants After Intracranial Surgery. Neurosurgery 2021; 89:E158-E159. [PMID: 34161590 DOI: 10.1093/neuros/nyab230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 05/16/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mohamed Macki
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Victor Chang
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
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Hamilton T, Macki M, Zervos TM, Chang V. Minimally Invasive Techniques for Iliac Bolt Placement: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 20:E292. [PMID: 33556166 DOI: 10.1093/ons/opab001] [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: 01/13/2020] [Accepted: 11/27/2020] [Indexed: 11/14/2022] Open
Abstract
As the popularity of minimally invasive surgery (MIS) continues to grow, novel techniques are needed to meet the demands of multisegment fixation for advanced spinal diseases. In one such example, iliac bolts are often required to anchor large fusion constructs, but MIS technical notes are missing from the literature. A 67-yr-old female presented with a symptomatic coronal deformity: preoperative pelvic incidence = 47°, pelvic tilt = 19°, and lumbar lordosis = 29°, sagittal vertical axis = +5.4 cm with 30° of scoliosis. The operative plan included T10-ilium fusion with transforaminal interbody grafts at L2-3, L3-4, L4-5, and L5-S1. The intraoperative video is of minimally invasive placement of iliac bolts using the O-Arm Surgical Imaging System (Medtronic®). The patient consented to the procedure. A mini-open exposure that remains above the fascial planes allows for multilevel instrumentation with appropriate decompression at the interbody segments. After the placement of the pedicle screws under image-guidance, the direction is turned to the minimally invasive iliac bolts. Following the trajectory described in the standard open approach,1 the posterior superior iliac spine (PSIS) is identified with the navigation probe, which will guide the Bovie cautery through the fascia. This opening assists in the trajectory of the navigated-awl tap toward the anterior superior iliac spine (ASIS). Next, 8.5 mm x 90 mm iliac screws were placed in the cannulated bone under navigation. After intraoperative image confirmation of screw placement, the contoured rods are threaded under the fascia. The setscrews lock the rod in position. MIS approaches obviate cross-linking the rods, rendering pelvic fixation more facile. This technique allows for minimal dissection of the posterior pelvic soft tissue while maintaining adequate fixation.
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Affiliation(s)
- Travis Hamilton
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mohamed Macki
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Thomas M Zervos
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Victor Chang
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
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Macki M, Hamilton T, Lim S, Telemi E, Bazydlo M, Nerenz DR, Zakaria HM, Schultz L, Khalil JG, Perez-Cruet MJ, Aleem IS, Park P, Schwalb JM, Abdulhak MM, Chang V. Disparities in outcomes after spine surgery: a Michigan Spine Surgery Improvement Collaborative study. J Neurosurg Spine 2021; 35:91-99. [PMID: 33962387 DOI: 10.3171/2020.10.spine20914] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/12/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Most studies on racial disparities in spine surgery lack data granularity to control for both comorbidities and self-assessment metrics. Analyses from large, multicenter surgical registries can provide an enhanced platform for understanding different factors that influence outcome. In this study, the authors aimed to determine the effects of race on outcomes after lumbar surgery, using patient-reported outcomes (PROs) in 3 areas: the North American Spine Society patient satisfaction index, the minimal clinically important difference (MCID) on the Oswestry Disability Index (ODI) for low-back pain, and return to work. METHODS The Michigan Spine Surgery Improvement Collaborative was queried for all elective lumbar operations. Patient race/ethnicity was categorized as Caucasian, African American, and "other." Measures of association between race and PROs were calculated with generalized estimating equations (GEEs) to report adjusted risk ratios. RESULTS The African American cohort consisted of a greater proportion of women with the highest comorbidity burden. Among the 7980 and 4222 patients followed up at 1 and 2 years postoperatively, respectively, African American patients experienced the lowest rates of satisfaction, MCID on ODI, and return to work. Following a GEE, African American race decreased the probability of satisfaction at both 1 and 2 years postoperatively. Race did not affect return to work or achieving MCID on the ODI. The variable of greatest association with all 3 PROs at both follow-up times was postoperative depression. CONCLUSIONS While a complex myriad of socioeconomic factors interplay between race and surgical success, the authors identified modifiable risk factors, specifically depression, that may improve PROs among African American patients after elective lumbar spine surgery.
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Affiliation(s)
- Mohamed Macki
- 1Department of Neurosurgery, Henry Ford Hospital, Detroit
| | | | - Seokchun Lim
- 1Department of Neurosurgery, Henry Ford Hospital, Detroit
| | - Edvin Telemi
- 1Department of Neurosurgery, Henry Ford Hospital, Detroit
| | | | - David R Nerenz
- 1Department of Neurosurgery, Henry Ford Hospital, Detroit
| | | | - Lonni Schultz
- 1Department of Neurosurgery, Henry Ford Hospital, Detroit
| | | | | | | | - Paul Park
- 5Neurosurgery, University of Michigan Hospital, Ann Arbor, Michigan
| | | | | | - Victor Chang
- 1Department of Neurosurgery, Henry Ford Hospital, Detroit
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Macki M, Fadel HA, Hamilton T, Lim S, Massie LW, Zakaria HM, Pawloski J, Chang V. The influence of sagittal spinopelvic alignment on patient discharge disposition following minimally invasive lumbar interbody fusion. J Spine Surg 2021; 7:8-18. [PMID: 33834123 DOI: 10.21037/jss-20-596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The aim of this study was to investigate the changes to spinopelvic sagittal alignment following minimally invasive (MIS) lumbar interbody fusion, and the influence of such changes on postoperative discharge disposition. Methods The Michigan Spine Surgery Improvement Collaborative was queried for all patients who underwent transforaminal lumbar interbody fusion (TLIF)or lateral lumbar interbody fusion (LLIF) procedures for degenerative spine disease. Several spinopelvic sagittal alignment parameters were measured, including sagittal vertical axis (SVA), lumbar lordosis, pelvic tilt, pelvic incidence, and pelvic incidence-lumbar lordosis mismatch. Primary outcome measure-discharge to a rehabilitation facility-was expressed as adjusted odds ratio (ORadj) following a multivariable logistical regression. Results Of the 83 patients in the study population, 11 (13.2%) were discharged to a rehabilitation facility. Preoperative SVA was equivalent. Postoperative SVA increased to 8.0 cm in the discharge-to-rehabilitation division versus a decrease to 3.6 cm in the discharge-to-home division (P<0.001). The odds of discharge to a rehabilitation facility increased by 25% for every 1-cm increase in postoperative sagittal balance (ORadj =1.27, P=0.014). The strongest predictor of discharge to rehabilitation was increasing decade of life (ORadj =3.13, P=0.201). Conclusions Correction of sagittal balance is associated with greater odds of discharge to home. These findings, coupled with the recognized implications of admission to a rehabilitation facility, will emphasize the importance of spine surgeons accounting for SVA into their surgical planning of MIS lumbar interbody fusions.
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Affiliation(s)
- Mohamed Macki
- Department of Neurosurgery, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI, USA
| | - Hassan A Fadel
- Department of Neurosurgery, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI, USA
| | - Travis Hamilton
- Department of Neurosurgery, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI, USA
| | - Seokchun Lim
- Department of Neurosurgery, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI, USA
| | - Lara W Massie
- Department of Neurosurgery, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI, USA
| | - Hesham Mostafa Zakaria
- Department of Neurosurgery, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI, USA
| | - Jacob Pawloski
- Department of Neurosurgery, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI, USA
| | - Victor Chang
- Department of Neurosurgery, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI, USA
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Zakaria HM, Wilkinson BM, Pennington Z, Saadeh YS, Lau D, Chandra A, Ahmed AK, Macki M, Anand SK, Abouelleil MA, Fateh JA, Rick JW, Morshed RA, Deng H, Chen KY, Robin A, Lee IY, Kalkanis S, Chou D, Park P, Sciubba DM, Chang V. Sarcopenia as a Prognostic Factor for 90-Day and Overall Mortality in Patients Undergoing Spine Surgery for Metastatic Tumors: A Multicenter Retrospective Cohort Study. Neurosurgery 2021; 87:1025-1036. [PMID: 32592483 DOI: 10.1093/neuros/nyaa245] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [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: 01/03/2019] [Accepted: 04/06/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Novel methods in predicting survival in patients with spinal metastases may help guide clinical decision-making and stratify treatments regarding surgery vs palliative care. OBJECTIVE To evaluate whether the frailty/sarcopenia paradigm is predictive of survival and morbidity in patients undergoing surgery for spinal metastasis. METHODS A total of 271 patients from 4 tertiary care centers who had undergone surgery for spinal metastasis were identified. Frailty/sarcopenia was defined by psoas muscle size. Survival hazard ratios were calculated using multivariate analysis, with variables from demographic, functional, oncological, and surgical factors. Secondary outcomes included improvement of neurological function and postoperative morbidity. RESULTS Patients in the smallest psoas tertile had shorter overall survival compared to the middle and largest tertile. Psoas size (PS) predicted overall mortality more strongly than Tokuhashi score, Tomita score, and Karnofsky Performance Status (KPS). PS predicted 90-d mortality more strongly than Tokuhashi score, Tomita score, and KPS. Patients with a larger PS were more likely to have an improvement in deficit compared to the middle tertile. PS was not predictive of 30-d morbidity. CONCLUSION In patients undergoing surgery for spine metastases, PS as a surrogate for frailty/sarcopenia predicts 90-d and overall mortality, independent of demographic, functional, oncological, and surgical characteristics. The frailty/sarcopenia paradigm is a stronger predictor of survival at these time points than other standards. PS can be used in clinical decision-making to select which patients with metastatic spine tumors are appropriate surgical candidates.
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Affiliation(s)
| | | | | | | | - Darryl Lau
- University of California, San Francisco, San Francisco, California
| | - Ankush Chandra
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan.,University of California, San Francisco, San Francisco, California
| | | | - Mohamed Macki
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
| | | | | | | | - Jonathan W Rick
- University of California, San Francisco, San Francisco, California
| | - Ramin A Morshed
- University of California, San Francisco, San Francisco, California
| | - Hansen Deng
- University of California, San Francisco, San Francisco, California
| | - Kai-Yuan Chen
- University of California, San Francisco, San Francisco, California.,Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Adam Robin
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
| | - Ian Y Lee
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
| | - Steven Kalkanis
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
| | - Dean Chou
- University of California, San Francisco, San Francisco, California
| | - Paul Park
- University of Michigan, Ann Arbor, Michigan
| | | | - Victor Chang
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
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Macki M, Pawloski J, Fadel H, Hamilton T, Haider S, Elmenini J, Fakih M, Johnson JL, Rock J. The Effect of Antithrombotics on Hematoma Expansion in Small- to Moderate-Sized Traumatic Intraparenchymal Hemorrhages. World Neurosurg 2021; 149:e101-e107. [PMID: 33640526 DOI: 10.1016/j.wneu.2021.02.072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Although pre-injury antithrombotic agents, including antiplatelets and anticoagulants, are historically associated with expansion of traumatic intraparenchymal hemorrhage (tIPH), the literature has poorly elucidated the actual risk of hematoma expansion on repeat computed tomography (CT). The objective was to determine the effect of antithrombotic agents on hematoma expansion in tIPH by comparing patients with and without pre-injury antithrombotic medication. METHODS The volume of all tIPHs over a 5-year period at an academic Level 1 trauma center was measured retrospectively. The initial tIPH was divided into 3 equally sized quantiles. The third tercile, representing the largest subset of tIPH, was then removed from the study population because these patients reflect a different pathophysiologic mechanism that may require a more acute and aggressive level of care with reversal agents and/or operative management. Per institutional policy, all patients with small- to moderate-sized hemorrhages received a 24-hour stability CT scan. Patients who received reversal agents were excluded. RESULTS Of the 105 patients with a tIPH on the initial head CT scan, small- to moderate-sized hemorrhages were <5 cm3. The size of tIPH on initial imaging did not statistically significantly differ between the antithrombotic cohort (0.7 ± 0.1 cm3) and the non-antithrombotic cohort (0.5 ± 0.1 cm3) (P = 0.091). Similarly, the volume of tIPH failed to differ on 24-hour repeat imaging (1.0 ± 0.2 cm3 vs. 0.6 ± 0.1 cm3, respectively, P = 0.172). Following a multiple linear regression, only history of stroke, not antithrombotic medications, predicted increased tIPH on 24-hour repeat imaging. CONCLUSIONS In small- to moderate-sized tIPH, withholding antithrombotic agents without reversal may be sufficient.
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Affiliation(s)
- Mohamed Macki
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Jacob Pawloski
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Hassan Fadel
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Travis Hamilton
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Sameah Haider
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Jaafar Elmenini
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mohamed Fakih
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Jeffrey L Johnson
- Department of Acute Care Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Jack Rock
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.
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Chang VW, Bazydlo M, Yeh HH, Schultz L, Nerenz D, Schwalb JM, Abdulhak M, Khalil J, Easton R, Park P, Aleem I, Macki M, Hamilton TM. Associations Between Ambulation Within 8 Hours and Outcome After Spine Surgery. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
The concept of patient navigation was first introduced in 1989 by the American Cancer Society and was first implemented in 1990 by Dr. Harold Freeman in Harlem, NY. The role of a patient navigator (PN) is to coordinate care between the care team, the patient, and their family while also providing social support. In the last 30 years, patient navigation in oncological care has expanded internationally and has been shown to significantly improve patient care experience, especially in the United States cancer care system. Like oncology care, patients who require epilepsy care face socioeconomic and healthcare system barriers and are at significant risk of morbidity and mortality if their care needs are not met. Although shortcomings in epilepsy care are longstanding, the COVID-19 pandemic has exacerbated these issues as both patients and providers have reported significant delays in care secondary to the pandemic. Prior to the pandemic, preliminary studies had shown the potential efficacy of patient navigation in improving epilepsy care. Considering the evidence that such programs are helpful for severely disadvantaged cancer patients and in enhancing epilepsy care, we believe that professional societies should support and encourage PN programs for coordinated and comprehensive care for patients with epilepsy.
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Affiliation(s)
- Sharath Kumar Anand
- Wayne State University School of Medicine, 540 E Canfield St., Detroit, MI, USA.
| | - Mohamed Macki
- Department of Neurosurgery, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, USA
| | - Lauren G Culver
- Wayne State University School of Medicine, 540 E Canfield St., Detroit, MI, USA
| | - Vibhangini S Wasade
- Department of Neurology, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, USA; Department of Neurology, Wayne State University School of Medicine, 540 E Canfield St., Detroit, MI, USA
| | - Samantha Hendren
- Division of Colorectal Surgery, Department of Surgery, University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI, USA
| | - Jason M Schwalb
- Department of Neurosurgery, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, USA; Center for Health Policy and Health Services Research, Henry Ford Health System, 2799 W Grand Blvd, Detroit MI 48202, USA
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Macki M, Hamilton TM, Bazydlo M, Schultz L, Telemi E, Mansour TR, Seyfried DM, Schwalb JM, Chang VW, Abdulhak M. The Role of Post Operative Antibiotic Duration on Surgical Site Infection After Lumbar Surgery. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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35
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Zervos T, Bazydlo M, Tundo K, Macki M, Rock JP. Risk Factors Associated With Symptomatic Deep Vein Thrombosis Following Elective Spine Surgery. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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36
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Chang VW, Yeh HH, Bazydlo M, Nerenz D, Schultz L, Schwalb JM, Abdulhak M, Park P, Aleem I, Easton R, Khalil J, Macki M, Hamilton TM. Analysis of the Effects of Intraoperative Neurophysiological Monitoring on Elective Lumbar Surgery. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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37
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Macki M, Hamilton T, Bazydlo M, Schultz L, Seyfried DM, Park P, Abdulhak M, Chang VW, Schwalb JM. Michigan Spine Surgeons are not Overtreating Axial Back Pain Without Radicular Symptoms. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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38
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Chang VW, Bazydlo M, Yeh HH, Schultz L, Nerenz D, Easton R, Khalil J, Schwalb JM, Abdulhak M, Aleem I, Park P, Macki M, Hamilton TM. Analysis of the Effects of Intraoperative Neurophysiological Monitoring on Anterior Cervical Surgery. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Anand SK, Macki M. What have we learned from C5 palsy - A short communication. J Clin Neurosci 2020; 81:111-112. [PMID: 33222897 DOI: 10.1016/j.jocn.2020.09.044] [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: 03/27/2020] [Revised: 09/04/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Abstract
A study group on C5 palsy retrospectively reviewed 1001 cervical operations at their institutions in order to understand the incidence, prognosticators, pathogenesis, and outcome of C5 palsy after cervical operations. Three studies are summarized. C5 palsy was higher after posterior versus anterior operations. C4-C5 foraminotomy and age were the strongest predictors of C5 palsy after posterior surgeries and anterior cervical decompression-fusion, respectively. Among patients undergoing C4-C5 posterior laminoforaminotomy with instrumented fusion, cord shift on postoperative imaging was thought to be implicated in the pathogenesis of C5 palsy. Among affected patients, 81.4% recovered. Median time to resolution of C5 palsy was between 6 months to 1 year.
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Affiliation(s)
- Sharath Kumar Anand
- Wayne State University School of Medicine, 540 East Canfield, Detroit, MI 48201 USA
| | - Mohamed Macki
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Boulevard, Royal Oak, MI 48202, USA.
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40
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Zervos TM, Bazydlo M, Tundo K, Macki M, Rock J. Risk Factors Associated with Symptomatic Deep Vein Thrombosis Following Elective Spine Surgery: A Case-Control Study. World Neurosurg 2020; 144:e460-e465. [PMID: 32889183 DOI: 10.1016/j.wneu.2020.08.182] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Few studies provide insight into risk factors (RFs) associated with postoperative deep vein thrombosis (DVT) following elective spinal surgery. DVTs are detrimental in this population because of the risk of pulmonary embolization or surgical site hemorrhage with treatment. OBJECTIVE Elective spine surgery patients have a low incidence of DVT, thus a case-control study was selected to investigate RFs associated with postoperative, symptomatic DVT. METHODS Cases were matched to controls in a 1:2 ratio based on surgery type. Risk of having a prior DVT and choice of subcutaneous heparin dosing following surgery was analyzed in a multivariate regression model with other potentially confounding variables. RESULTS A total of 195 patients were included in this study. Independent of patient age, history of DVT was associated with postoperative symptomatic DVT (odds ratio [OR], 4.09; 95% confidence interval [CI], 1.22-13.78). Two versus 3 times daily postoperative heparin dosing (OR, 1.56; 95% CI, 0.32-7.56), surgery length (OR, 1.32; 95% CI, 0.98-1.79), and patient age (OR, 1.04; 95% CI, 1.0-1.08) were not statistically significant, independent RFs. Older age and longer length of surgery trended toward association with DVT without reaching significance. Length of stay was increased from 3-5 days (P < 0.001) in DVT patients compared with controls. CONCLUSIONS These results suggest that patients with a history of DVT undergoing elective spinal surgery are at higher risk of developing symptomatic DVT postoperatively resulting in significantly increased length of stay. Further studies on additional preoperative screening and medical optimization in elective spine surgery patients may help reduce the rate of symptomatic, postoperative DVT.
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Affiliation(s)
- Thomas M Zervos
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.
| | - Michael Bazydlo
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan, USA
| | - Kelly Tundo
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mohamed Macki
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Jack Rock
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
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Macki M, Zakaria HM, Massie LW, Elmenini J, Fakih M, Dakroub B, Chang V. The Effect of Physical Therapy on Time to Discharge After Lumbar Interbody Fusion. Clin Neurol Neurosurg 2020; 197:106157. [PMID: 32861038 DOI: 10.1016/j.clineuro.2020.106157] [Citation(s) in RCA: 2] [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: 05/28/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND With a lesser degree of tissue destruction, patients undergoing minimally-invasive spine surgery are primed to benefit from early mobilization, which can further enhance recovery and hasten rehabilitation. We aimed to determine the role of physical therapy on earlier discharge after minimally-invasive transforaminal lumbar interbody fusion (TLIF). METHODS Michigan Spine Surgery Improvement Collaborative (MSSIC) provided patients undergoing one- and two-level minimally-invasive TLIF for degenerative lumbar disease. The study population was divided into patients with a one-day length of stay (LOS 1), two days (LOS 2), and three or more days (LOS ≥ 3) to maintain three equal-time cohorts. On POD 0, physical therapy (or, in very rare circumstances, a spine-care-specialized nurse in patients arriving to the in-patient floors late after hours) must evaluate capacity to ambulate. RESULTS Of the 101 patients, the median day of first ambulation statistically significantly increased from the LOS 1 to LOS ≥ 3 cohort (P = 0.007). Mean distance ambulated decreased from 156.5 ± 123.1 feet in the LOS 1 group, 108.9 ± 83.9 feet in the LOS 2 group, to 69.2 ± 58.3 feet in the LOS ≥ 3 group (P = 0.002). Patient-reported outcomes did not differ among the three cohorts. Following a multivariable ordinal logistical regression controlling for disposition to rehab over home (ORadj = 5.47, P = 0.045), the odds of longer LOS decreased by 39% for every 50-feet ambulated (P = 0.002). CONCLUSIONS Time to first ambulation independently increases the odds of earlier discharge, regardless of comorbidity burden and surgical determinants.
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Affiliation(s)
- Mohamed Macki
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI 48202 USA
| | - Hesham Mostafa Zakaria
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI 48202 USA
| | - Lara W Massie
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI 48202 USA
| | - Jaafar Elmenini
- Wayne State University School of Medicine, 540 East Canfield Street, Detroit, MI 48201 USA
| | - Mohamed Fakih
- Wayne State University School of Medicine, 540 East Canfield Street, Detroit, MI 48201 USA
| | - Belal Dakroub
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI 48202 USA
| | - Victor Chang
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI 48202 USA.
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Macki M, Mahajan A, Shatz R, Air EL, Novikova M, Fakih M, Elmenini J, Kaur M, Bouchard KR, Funk BA, Schwalb JM. Prevalence of Alternative Diagnoses and Implications for Management in Idiopathic Normal Pressure Hydrocephalus Patients. Neurosurgery 2020; 87:999-1007. [DOI: 10.1093/neuros/nyaa199] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 03/18/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Following Bayes theorem, ventriculomegaly and ataxia confer only a 30% chance of idiopathic Normal Pressure Hydrocephalus (NPH). When coupled with positive responses to best diagnostic testing (extended lumbar drainage), 70% of patients recommended for shunting will not actually have NPH. This is inadequate clinical care.
OBJECTIVE
To determine the proportion of alternative and treatable diagnoses in patients referred to a multidisciplinary NPH clinic.
METHODS
Patients without previously diagnosed NPH were queried from prospectively collected data. At least 1 neurosurgeon, cognitive neurologist, and neuropsychologist jointly formulated best treatment plans.
RESULTS
Of 328 total patients, 45% had an alternative diagnosis; 11% of all patients improved with treatment of an alternative diagnosis. Of 87 patients with treatable conditions, the highest frequency of pathologies included sleep disorders, and cervical stenosis, followed by Parkinson disease. Anti-cholinergic burden was a contributor for multiple patients. Of 142 patients undergoing lumbar puncture, 71% had positive responses and referred to surgery. Compared to NPH patients, mimickers were statistically significantly older with lower Montreal Cognitive Assessment (MoCA) score and worse gait parameters. Overall, 26% of the original patients underwent shunting. Pre-post testing revealed a statistically significant improved MoCA score and gait parameters in those patients who underwent surgery with follow-up.
CONCLUSION
Because the Multidisciplinary NPH Clinic selected only 26% for surgery (corroborating 30% in Bayes theorem), an overwhelming majority of patients with suspected NPH will harbor alternative diagnoses. Identification of contributing/confounding conditions will support the meticulous work-up necessary to appropriately manage patients without NPH while optimizing clinical responses to shunting in correctly diagnosed patients.
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Affiliation(s)
- Mohamed Macki
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
| | - Abhimanyu Mahajan
- Department of Neurology and Rehabilitation Medicine, The University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Rhonna Shatz
- Department of Neurology and Rehabilitation Medicine, The University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ellen L Air
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
| | - Marina Novikova
- Department of Neurology, Henry Ford Hospital, Detroit, Michigan
| | - Mohamed Fakih
- Wayne State University School of Medicine, Detroit, Michigan
| | - Jaafar Elmenini
- Wayne State University School of Medicine, Detroit, Michigan
| | - Manpreet Kaur
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan
| | - Kenneth R Bouchard
- Department of Otolaryngology, Division of Audiology, Henry Ford West Bloomfield Hospital, West Bloomfield, Michigan
| | - Brent A Funk
- Department of Behavioral Health, Division of Neuropsychology, Henry Ford Health System, Detroit, Michigan
| | - Jason M Schwalb
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
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Abstract
Occipitocervical fusions in the adult population are most commonly indicated for neoplastic tumors invading the craniocervical junction (CCJ), rheumatological deformities compromising the foramen magnum, and traumatic dislocations resulting in occiput-C1 instability. Appropriate preoperative imaging will not only assist in identifying the pathology but also determine a treatment regimen for the diseased junction. A treatment algorithm for craniocervical disease is proposed. Lesions must first be identified as irreducible versus reducible: restore extension and/or distraction of the craniovertebral junction without injuring the neural elements. Irreducible lesions require decompression only, while reducible lesions require an added fusion. Techniques in fusion are broadly divided into external immobilization versus internal fixation. The former entails halo rings and tongs for a prolonged duration. Fixation surgeries vary from wiring to screw fixation of the occiput-C1 segment. Details of the operation as well as potential complications are discussed.
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Affiliation(s)
- Mohamed Macki
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI, USA
| | - Travis Hamilton
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI, USA
| | - Jacob Pawloski
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI, USA
| | - Victor Chang
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI, USA
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Macki M, Haider SA, Anand SK, Fakih M, Elmenini J, Suryadevara R, Chang V. A Survey of Chemoprophylaxis Techniques in Spine Surgery Among American Neurosurgery Training Programs. World Neurosurg 2020; 133:e428-e433. [DOI: 10.1016/j.wneu.2019.09.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/06/2019] [Accepted: 09/07/2019] [Indexed: 10/26/2022]
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Macki M, Alvi MA, Kerezoudis P, Xiao S, Schultz L, Bazydlo M, Bydon M, Park P, Chang V. Predictors of patient dissatisfaction at 1 and 2 years after lumbar surgery. J Neurosurg Spine 2019; 32:373-382. [PMID: 31756702 DOI: 10.3171/2019.8.spine19260] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 08/28/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE As compensation transitions from a fee-for-service to pay-for-performance healthcare model, providers must prioritize patient-centered experiences. Here, the authors' primary aim was to identify predictors of patient dissatisfaction at 1 and 2 years after lumbar surgery. METHODS The Michigan Spine Surgery Improvement Collaborative (MSSIC) was queried for all lumbar operations at the 1- and 2-year follow-ups. Predictors of patients' postoperative contentment were identified per the North American Spine Surgery (NASS) Patient Satisfaction Index, wherein satisfied patients were assigned a score of 1 ("the treatment met my expectations") or 2 ("I did not improve as much as I had hoped, but I would undergo the same treatment for the same outcome") and unsatisfied patients were assigned a score of 3 ("I did not improve as much as I had hoped, and I would not undergo the same treatment for the same outcome") or 4 ("I am the same or worse than before treatment"). Multivariable Poisson generalized estimating equation models were used to report adjusted risk ratios (RRadj). RESULTS Among 5390 patients with a 1-year follow-up, 22% reported dissatisfaction postoperatively. Dissatisfaction was predicted by higher body mass index (RRadj =1.07, p < 0.001), African American race compared to white (RRadj = 1.51, p < 0.001), education level less than high school graduation compared to a high school diploma or equivalent (RRadj = 1.25, p = 0.008), smoking (RRadj = 1.34, p < 0.001), daily preoperative opioid use > 6 months (RRadj = 1.22, p < 0.001), depression (RRadj = 1.31, p < 0.001), symptom duration > 1 year (RRadj = 1.32, p < 0.001), previous spine surgery (RRadj = 1.32, p < 0.001), and higher baseline numeric rating scale (NRS)-back pain score (RRadj = 1.04, p = 0.002). Conversely, an education level higher than high school graduation, independent ambulation (RRadj = 0.90, p = 0.039), higher baseline NRS-leg pain score (RRadj = 0.97, p = 0.013), and fusion surgery (RRadj = 0.88, p = 0.014) decreased dissatisfaction.Among 2776 patients with a 2-year follow-up, 22% reported dissatisfaction postoperatively. Dissatisfaction was predicted by a non-white race, current smoking (RRadj = 1.26, p = 0.004), depression (RRadj = 1.34, p < 0.001), symptom duration > 1 year (RRadj = 1.47, p < 0.001), previous spine surgery (RRadj = 1.28, p < 0.001), and higher baseline NRS-back pain score (RRadj = 1.06, p = 0.003). Conversely, at least some college education (RRadj = 0.87, p = 0.035) decreased the risk of dissatisfaction. CONCLUSIONS Both comorbid conditions and socioeconomic circumstances must be considered in counseling patients on postoperative expectations. After race, symptom duration was the strongest predictor of dissatisfaction; thus, patient-centered measures must be prioritized. These findings should serve as a tool for surgeons to identify at-risk populations that may need more attention regarding effective communication and additional preoperative counseling to address potential barriers unique to their situation.
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Affiliation(s)
| | | | | | | | - Lonni Schultz
- 4Public Health Sciences, Henry Ford Hospital, Detroit, Michigan
| | - Michael Bazydlo
- 4Public Health Sciences, Henry Ford Hospital, Detroit, Michigan
| | - Mohamad Bydon
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; and
| | - Paul Park
- 5Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
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Zakaria H, Saadeh Y, Lau D, Pennington Z, Ahmed A, Chandra A, Macki M, Lee I, Chou D, Park P, Sciubba D, Chang V. CMET-15. SARCOPENIA INDEPENDENTLY AND STRONGLY PREDICTS SURVIVAL IN PATIENTS UNDERGOING SPINE SURGERY FOR METASTATIC TUMORS. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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
INTRODUCTION
Predicting survival and surgical morbidity in patients with spinal metastases would help guide clinical decision making and stratify treatments between surgical intervention and palliative care. This multi-center retrospective cohort study evaluates whether the frailty/sarcopenia paradigm, as measured by psoas size, is predictive of survival in patients undergoing surgery for spinal metastasis.
METHODS
271 patients from four institutes who had undergone surgery for spinal metastasis were identified. Morphometric measurements were taken of the psoas muscle at the L4 vertebral level < 200d from surgery. Mortality hazard ratios were calculated using multivariate analysis, with variables included from past medical history, type and extent of tumor spread, type and intensity of surgery, and postoperative chemotherapy or radiation.
RESULTS
Psoas size was predictive of overall mortality; patients in the smallest tertile had shorter overall survival compared to the middle (OR 0.52, p< 0.001) and largest tertile (OR 0.45, p< 0.001). Psoas size predicted overall mortality more strongly than Tokuhashi score (OR 0.91, p= 0.010), Tomita score (OR 1.07, p= 0.04), and KPS (OR 0.99, p= 0.58). Psoas size was also predictive of 90-day survival; patients in the smallest tertile had shorter 90-day survival compared to the middle (OR 0.24, p= 0.003) and largest tertile (OR 0.16, p= 0.001). Psoas size predicted 90-day mortality more strongly than Tokuhashi score (OR 0.73, p= 0.002), Tomita score (OR 1.00, p= 0.92), and KPS (OR 0.98, p= 0.39).
CONCLUSION
In patients undergoing surgery for spine metastases, psoas size as a surrogate for frailty/sarcopenia predicts 90-day and overall mortality, independent of demographical, functional, oncological, and surgical characteristics. The sarcopenia/frailty paradigm is a stronger predictor of survival at these time points than the Tokuhashi score, Tomita score, and KPS. Psoas size can be used in clinical decision-making to select which patients with metastatic spine tumors are appropriate surgical candidates.
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Affiliation(s)
| | | | - Darryl Lau
- University of California, San Francisco, San Francisco, CA, USA
| | | | - Ali Ahmed
- Johns Hopkins University, Baltimore, MD, USA
| | - Ankush Chandra
- University of California, San Francisco, San Francisco, CA, USA
| | | | - Ian Lee
- Henry Ford Health System, Detroit, MI, USA
| | - Dean Chou
- University of California, San Francisco, San Francisco, CA, USA
| | - Paul Park
- University of Michigan, Ann Arbor, MI, USA
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Zakaria H, Chandra A, Macki M, Robin A, Walbert T, Chang V, Kalkanis S, Lee I. INNV-21. IN NEWLY-DIAGNOSED GLIOBLASTOMA, FRAILTY/SARCOPENIA PREDICTS 30D MORBIDITY & 30D, 90D, AND OVERALL MORTALITY AS ACCURATELY AS CURRENT STANDARDS. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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
INTRODUCTION
Identification of novel prognostic biomarkers for glioblastoma (GBM) could stratify patients between aggressive or palliative treatments. Frailty, as measured by sarcopenia (lack of muscle mass), has been proven to predict survival in cancers. We evaluate whether the frailty/sarcopenia phenotype (FSP) predicts morbidity and mortality in GBM, and compare it to other survival markers.
METHODS
In 257 patients undergoing initial diagnostic surgery for GBM, FSP was defined by temporalis muscle thickness from preoperative MRI; patients were grouped into tertiles (thirds) based on size, which corresponded to the severity of FSP. Morbidity and mortality hazard ratios were calculated from surgery using multivariate analysis, accounting for age, gender, past medical history, tumor focality / laterality / eloquence / volume, extent of resection, MGMT / IDH status, and initiation of postoperative chemo/radiation. Morbidity was defined as any of these events within 30d: DVT, PE, SSI, UTI, MI, urinary retention, ileus, readmission.
RESULTS
FSP at diagnostic surgery predicted any morbidity (OR2.98, P= 0.005) at 30d. FSP at diagnostic surgery was the only risk factor associated with 30d mortality (OR10.0, P= 0.030), and was also strongly associated with 90d mortality (OR25.0, P= 0.003). FSP at diagnostic surgery was associated with decreased overall survival (OR0.41, P< 0.001) at a level comparable to other mortality predictors, including temozolomide/EBRT (OR0.27), gross total resection (OR0.54), favorable MGMT (OR0.44) or IDH (OR0.44) mutations. Kaplan-Meier curves display overall survival based on severity of FSP.
CONCLUSION
FSP is a preoperative, simple, accurate, and non-invasive methodology to predict 30d morbidity & 30-day, 90-day, and overall mortality from diagnosis in GBM. FSP is independent of age (not an age surrogate), demographic, oncologic, genetic, surgical, and therapeutic factors. Mortality prediction is comparable to temozolamid/EBRT, total resection, MGMT, and IDH. It is a low cost, intuitive, and potentially universal methodology to guide treatment decision making.
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Affiliation(s)
| | - Ankush Chandra
- University of California, San Francisco, San Francisco, CA, USA
| | | | | | | | | | | | - Ian Lee
- Henry Ford Hospital, Detroit, MI, USA
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Macki M, Fakih M, Anand SK, Suryadevara R, Elmenini J, Chang V. A direct comparison of prophylactic low-molecular-weight heparin versus unfractionated heparin in neurosurgery: A meta-analysis. Surg Neurol Int 2019; 10:202. [PMID: 31768282 PMCID: PMC6826314 DOI: 10.25259/sni_428_2019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 09/23/2019] [Indexed: 11/04/2022] Open
Abstract
Background Several studies have confirmed the role of prophylactic low-molecular-weight heparin (LMWH) for venous thromboembolism (VTE) in neurosurgery; however, a paucity of literature has assessed its safety and efficacy versus prophylactic unfractionated heparin (UFH). The objective is to present a meta-analysis directly comparing prophylactic LMWH to UFH for the prevention of VTE in neurosurgery. Materials and Methods Relevant studies that directly compared LMWH to UFH for prophylaxis of VTE in neurosurgery and/or spine surgery were identified by MEDLINE and EMBASE searches plus a scrutiny of references from the original articles and reviews. Three randomized trials were included in the meta-analysis. Efficacy and safety were ascertained per three primary outcome measures: VTE, minor complications (decline in hemoglobin/hematocrit), and major complications. Forest plot analysis provided odds ratio (OR), 95% confidence intervals (CIs), and P-values. Results Of the 429 patients in the pooled analysis, the postoperative VTE rate of 5.6% (12/213) after LMWH chemoprophylaxis was equivalent to 3.7% (8/216) after UFH chemoprophylaxis (OR = 1.42, 95% CI 0.62-3.75, P = 0.308). Minor complications of 4.7% versus 4.6%, respectively, were nearly equal (OR = 1.01, 95% CI 0.41- 2.50, P = 0.929). All four major complications included intracranial hemorrhages: three after LMWH (1.4%) and one after UFH (0.5%) (OR = 2.32, 95% CI 0.34-16.01, P = 0.831). Tests for heterogeneity were nonsignificant in all three outcome measures. Conclusion Rates of VTE, minor complications, and major complications were equivalent between prophylactic LMWH and UFH in neurosurgery. Further, randomized clinical trials comparing the two heparin products are required to elucidate superior safety and efficacy in neurosurgical patients.
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Affiliation(s)
- Mohamed Macki
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mohamed Fakih
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | | | | | - Jaafar Elmenini
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Victor Chang
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
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Macki M, Fakih M, Elmenini J, Anand SK, Robin AM. Trends in the Abscopal Effect After Radiation to Spinal Metastases: A Systematic Review. Cureus 2019; 11:e5844. [PMID: 31754579 PMCID: PMC6830850 DOI: 10.7759/cureus.5844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 07/17/2019] [Indexed: 11/15/2022] Open
Abstract
While the abscopal effect has been previously described, the phenomenon has been poorly defined in the case of spinal metastases. This article is unique in that we present the first systematic review of the abscopal effect after radiation therapy to metastatic spinal cancer, especially since the spinal column represents one of the most common metastatic locations. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) resources, a systematic review identified relevant studies via a computer-aided search of MEDLINE and Embase. Ten publications that met the inclusion and exclusion criteria from the PRISMA flow diagram described a total of 13 patients, 76.9% of whom demonstrated image findings of the abscopal effect. In summary, important trends in the nine patients who experienced the abscopal effect in this review include higher doses of radiation and treatment with immunomodulators, both of which may help guide treatment paradigms for spinal metastases superimposed on diffuse metastatic disease. These trends, however, still warrant further investigations with experimental and clinical studies for a mechanistic understanding of the abscopal effect.
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Zakaria HM, Mansour TR, Telemi E, Hunt RJ, Asmaro KP, Macki M, Bazydlo M, Schultz L, Nerenz D, Abdulhak M, Schwalb JM, Chang VW. The Association Between PHQ-2 Screening and Patient Satisfaction and Return to Work Up To 2-Years After Lumbar Fusion: Analysis From the Michigan Spine Surgery Improvement Collaborative (MSSIC). Neurosurgery 2019. [DOI: 10.1093/neuros/nyz310_626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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