116 results on '"Ahilan, A."'
Search Results
2. Why are patients dissatisfied after spine surgery when improvements in disability and pain are clinically meaningful?
- Author
-
Sivaganesan, Ahilan, Khan, Inamullah, Pennings, Jacquelyn S., Roth, Steven G., Nolan, Elizabeth R., Oleisky, Emily R., Asher, Anthony L., Bydon, Mohamad, Devin, Clinton J., and Archer, Kristin R.
- Published
- 2020
- Full Text
- View/download PDF
3. Opioid-free spine surgery: a prospective study of 244 consecutive cases by a single surgeon
- Author
-
Berkman, Richard A., Wright, Amanda H., and Sivaganesan, Ahilan
- Published
- 2020
- Full Text
- View/download PDF
4. Measuring clinically relevant improvement after lumbar spine surgery: is it time for something new?
- Author
-
Asher, Anthony M., Oleisky, Emily R., Pennings, Jacquelyn S., Khan, Inamullah, Sivaganesan, Ahilan, Devin, Cinton J., Bydon, Mohamad, Asher, Anthony L., and Archer, Kristin R.
- Published
- 2020
- Full Text
- View/download PDF
5. Impact of occupational characteristics on return to work for employed patients after elective lumbar spine surgery
- Author
-
Khan, Inamullah, Bydon, Mohamad, Archer, Kristin R., Sivaganesan, Ahilan, Asher, Anthony M., Alvi, Muhammad Ali, Kerezoudis, Panagiotis, Knightly, John J., Foley, Kevin T., Bisson, Erica F., Shaffrey, Christopher, Asher, Anthony L., Spengler, Dan M., and Devin, Clinton J.
- Published
- 2019
- Full Text
- View/download PDF
6. Effect of pre-injection opioid use on post-injection patient-reported outcomes following epidural steroid injections for radicular pain
- Author
-
Wei, Johnny J., Chotai, Silky, Sivaganesan, Ahilan, Archer, Kristin R., Schneider, Byron J., Yang, Aaron J., and Devin, Clinton J.
- Published
- 2018
- Full Text
- View/download PDF
7. Effect of obesity on cost per quality-adjusted life years gained following anterior cervical discectomy and fusion in elective degenerative pathology
- Author
-
Chotai, Silky, Sielatycki, J. Alex, Parker, Scott L., Sivaganesan, Ahilan, Kay, Harrison L., Stonko, David P., Wick, Joseph B., McGirt, Matthew J., and Devin, Clinton J.
- Published
- 2016
- Full Text
- View/download PDF
8. Predictors of the efficacy of epidural steroid injections for structural lumbar degenerative pathology
- Author
-
Sivaganesan, Ahilan, Chotai, Silky, Parker, Scott L., Asher, Anthony L., McGirt, Matthew J., and Devin, Clinton J.
- Published
- 2016
- Full Text
- View/download PDF
9. Matched-pair cohort study of 1-year patient-reported outcomes following pelvic fixation
- Author
-
Kelly, Patrick D., Sivaganesan, Ahilan, Chotai, Silky, Parker, Scott L., McGirt, Matthew J., and Devin, Clinton J.
- Published
- 2016
- Full Text
- View/download PDF
10. Traumatic atlantooccipital dislocation: comprehensive assessment of mortality, neurologic improvement, and patient-reported outcomes at a Level 1 trauma center over 15 years
- Author
-
Mendenhall, Stephen K., Sivaganesan, Ahilan, Mistry, Akshitkumar, Sivasubramaniam, Priya, McGirt, Matthew J., and Devin, Clinton J.
- Published
- 2015
- Full Text
- View/download PDF
11. Why are patients dissatisfied after spine surgery when improvements in disability and pain are clinically meaningful?
- Author
-
Inamullah Khan, Anthony L. Asher, Emily R. Oleisky, Steven G. Roth, Kristin R. Archer, Jacquelyn S. Pennings, Ahilan Sivaganesan, Mohamad Bydon, Clinton J. Devin, and Elizabeth R. Nolan
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Context (language use) ,Odds ,03 medical and health sciences ,0302 clinical medicine ,Patient satisfaction ,Lumbar ,Rating scale ,medicine ,Humans ,Orthopedics and Sports Medicine ,Prospective Studies ,Elective surgery ,Retrospective Studies ,030222 orthopedics ,Lumbar Vertebrae ,Rehabilitation ,business.industry ,Minimal clinically important difference ,Treatment Outcome ,Patient Satisfaction ,Physical therapy ,Surgery ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
Background Context Studies have found that most patients are satisfied after spine surgery, with rates ranging from 53% to 90%. Patient satisfaction appears to be closely related to achieving clinical improvement in pain and disability after surgery. While the majority of the literature has focused on patients who report both satisfaction and clinical improvement in disability and pain, there remains an important sub-population of patients who have clinically relevant improvement but report being dissatisfied with surgery. Purpose To examine why patients who achieve clinical improvement in disability or pain also report dissatisfaction at 1-year after spinal surgery. Study Design Retrospective analysis of prospective data from a national spine registry, the Quality Outcomes Database (QOD). Patient Sample There were 32,076 participants undergoing elective surgery for degenerative spine pathology who had clinical improvement in disability or pain. Outcome Measures Satisfaction with surgery was assessed with 1-item from the North American Spine Society (NASS) lumbar spine outcome assessment. Participants with answer choices other than “treatment met my expectations” were classified as dissatisfied. Methods Patients completed a baseline and 12-month postoperative assessment to evaluate disability, pain, and satisfaction. Clinical improvement was defined as patients who achieved a 30% or greater improvement in spine related disability (Oswestry/Neck Disability Index) or extremity pain (11-point Numerical Rating Scale) from baseline to 12-months after surgery. A generalized linear mixed model (GLMM) was used to predict the odds of the patient being dissatisfied 1-year after surgery from demographic, clinical and surgical characteristics, postoperative complications and revision, and return to work and previous physical activity. Random effects were included to model the effect of both site and surgeon on dissatisfaction. Sensitivity analyses were conducted on samples who achieved 1) 30% or greater improvement in disability only, 2) 30% or greater improvement in axial (back/neck) pain only, and 3) 30% or greater improvement in both disability and axial pain. Results showed the same pattern of findings across all samples. Results Twenty-eight percent of patients were classified as dissatisfied with their spine surgery and 72% classified as satisfied. For patients with clinical improvement in disability or extremity pain at 1-year, significant predictors of higher odds of dissatisfaction included baseline psychological distress, current smoking status, worker's compensation claim, lower education, higher ASA grade, lumbar vs. cervical procedure, and increased axial pain, major complication within 90 days, and revision surgery within 12-months. The most important contributors to dissatisfaction were return to work and return to previous physical activity, with the odds of dissatisfaction being over 2 times and 4 times higher for these variables. Site and surgeon explained 3.8% of the variance in dissatisfaction, with more of the variance attributed to site than to surgeon. Conclusions Several modifiable factors, including psychological distress, current smoking status, and failure to return to work and physical activity, helped explain why patients report being dissatisfied with surgery despite clinical improvement in disability or pain. The findings of this study have the potential to help providers identify at-risk patients, set realistic expectations during preoperative counseling, and implement postoperative management strategies. A multidisciplinary approach to rehabilitation that includes functional goal setting or restoration may help to improve patients psychological distress as well as return to work and previous physical activity after spine surgery.
- Published
- 2020
12. Impact of occupational characteristics on return to work for employed patients after elective lumbar spine surgery
- Author
-
Kristin R. Archer, Panagiotis Kerezoudis, Mohamad Bydon, Inamullah Khan, Clinton J. Devin, Anthony M. Asher, Anthony L. Asher, Kevin T Foley, Muhammad Ali Alvi, Christopher I. Shaffrey, Dan M. Spengler, Ahilan Sivaganesan, John J Knightly, and Erica F Bisson
- Subjects
Adult ,Male ,medicine.medical_specialty ,Population ,Subgroup analysis ,Context (language use) ,Intervertebral Disc Degeneration ,Neurosurgical Procedures ,03 medical and health sciences ,Postoperative Complications ,Return to Work ,0302 clinical medicine ,Lumbar ,medicine ,Back pain ,Humans ,Orthopedics and Sports Medicine ,education ,Aged ,030222 orthopedics ,education.field_of_study ,Lumbar Vertebrae ,business.industry ,Middle Aged ,medicine.disease ,Low back pain ,Spondylolisthesis ,Oswestry Disability Index ,Elective Surgical Procedures ,Unemployment ,Physical therapy ,Female ,Surgery ,Neurology (clinical) ,medicine.symptom ,business ,Intervertebral Disc Displacement ,030217 neurology & neurosurgery - Abstract
BACKGROUND CONTEXT Low back pain has an immense impact on the US economy. A significant number of patients undergo surgical management in order to regain meaningful functionality in daily life and in the workplace. Return to work (RTW) is a key metric in surgical outcomes, as it has profound implications for both individual patients and the economy at large. PURPOSE In this study, we investigated the factors associated with RTW in patients who achieved otherwise favorable outcomes after lumbar spine surgery. STUDY DESIGN/SETTING This study retrospectively analyzes prospectively collected data from the lumbar module of national spine registry, the Quality Outcomes Database (QOD). PATIENT SAMPLE The lumbar module of QOD includes patients undergoing lumbar surgery for primary stenosis, disc herniation, spondylolisthesis (Grade I) and symptomatic mechanical disc collapse or revision surgery for recurrent same-level disc herniation, pseudarthrosis, and adjacent segment disease. Exclusion criteria included age under 18 years and diagnoses of infection, tumor, or trauma as the cause of lumbar-related pain. OUTCOME MEASURES The outcome of interest for this study was the return to work 12-month after surgery. METHODS The lumbar module of QOD was queried for patients who were employed at the time of surgery. Good outcomes were defined as patients who had no adverse events (readmissions/complications), had achieved 30% improvement in Oswestry disability index (ODI) and were satisfied (NASS satisfaction) at 3-month post-surgery. Distinct multivariable logistic regression models were fitted with 12-month RTW as outcome for a. overall population and b. the patients with good outcomes. The variables included in the models were age, gender, race, insurance type, education level, occupation type, currently working/on-leave status, workers’ compensation, ambulatory status, smoking status, anxiety, depression, symptom duration, number of spinal levels, diabetes, motor deficit, and preoperative back-pain, leg-pain and ODI score. RESULTS Of the total 12,435 patients, 10,604 (85.3%) had successful RTW at 1-year postsurgery. Among patients who achieved good surgical outcomes, 605 (7%) failed to RTW. For both the overall and subgroup analysis, older patients had lower odds of RTW. Females had lower odds of RTW compared with males and patients with higher back pain and baseline ODI had lower odds of RTW. Patients with longer duration of symptoms, more physically demanding occupations, worker's compensation claim and those who had short-term disability leave at the time of surgery had lower odds of RTW independent of their good surgical outcomes. CONCLUSIONS This study identifies certain risk factors for failure to RTW independent of surgical outcomes. Most of these risk factors are occupational; hence, involving the patient's employer in treatment process and setting realistic expectations may help improve the patients' work-related functionality.
- Published
- 2019
13. P142. Rating spine surgeons: Physician rating websites versus a patient reported outcomes derived ranking
- Author
-
Wanner, JP, primary, Pennings, Jacquelyn S., additional, Nian, Hui, additional, Khan, Inamullah, additional, Sivaganesan, Ahilan, additional, Bydon, Mohamad, additional, Knightly, John J., additional, Glassman, Steven D., additional, Abtahi, Amir M., additional, Zuckerman, Scott L., additional, Devin, Clinton J., additional, Archer, Kristin R., additional, and Stephens, Byearon F., additional
- Published
- 2021
- Full Text
- View/download PDF
14. P112. Cervical disc replacement for radiculopathy versus myeloradiculopathy: An MCID analysis
- Author
-
Alluri, Ram K., primary, Vaishnav, Avani S., additional, Sivaganesan, Ahilan, additional, Melissaridou, Dimitra, additional, Lee, Ryan, additional, Urakawa, Hikari, additional, Sato, Kosuke, additional, Chaudhary, Chirag, additional, Mok, Jung, additional, Colaizzo, Derek, additional, Chandra, Akhil, additional, Dupont, Marcel, additional, Sheha, Evan, additional, Huang, Russel C., additional, Albert, Todd J., additional, Gang, Catherine Himo, additional, and Qureshi, Sheeraz A., additional
- Published
- 2021
- Full Text
- View/download PDF
15. P141. Do age adjusted parameters influence patient reported outcomes after lumbar decompression?
- Author
-
Clark, Nicholas, primary, Kim, Jeong Hoon, additional, Kohn, Max, additional, Sivaganesan, Ahilan, additional, Alluri, Ram K., additional, Steinhaus, Michael E., additional, and Iyer, Sravisht, additional
- Published
- 2021
- Full Text
- View/download PDF
16. 160. Anterior cervical discectomy and fusion vs cervical disc replacement for cervical spondylotic myelopathy: An MCID comparison
- Author
-
Alluri, Ram K., primary, Vaishnav, Avani S., additional, Sivaganesan, Ahilan, additional, Lee, Ryan, additional, Urakawa, Hikari, additional, Sato, Kosuke, additional, Mok, Jung, additional, Chaudhary, Chirag, additional, Dupont, Marcel, additional, Colaizzo, Derek, additional, Chandra, Akhil, additional, Sheha, Evan, additional, Huang, Russel C., additional, Albert, Todd J., additional, Gang, Catherine Himo, additional, and Qureshi, Sheeraz A., additional
- Published
- 2021
- Full Text
- View/download PDF
17. Comparing different chronic preoperative opioid use definitions on outcomes after spine surgery
- Author
-
Ahilan Sivaganesan, Inamullah Khan, Jacquelyn S. Pennings, Kristin R. Archer, Emily R. Oleisky, Jeffrey M. Hills, Richard Call, and Clinton J. Devin
- Subjects
Adult ,Male ,medicine.medical_specialty ,Context (language use) ,03 medical and health sciences ,0302 clinical medicine ,Spine surgery ,Internal medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,Patient Reported Outcome Measures ,Registries ,Medical prescription ,Pain, Postoperative ,030222 orthopedics ,business.industry ,Chronic pain ,Retrospective cohort study ,Guideline ,Middle Aged ,Opioid-Related Disorders ,medicine.disease ,Drug Utilization ,Spine ,Analgesics, Opioid ,Opioid ,Elective Surgical Procedures ,Preoperative Period ,Cohort ,Female ,Surgery ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
Background Context No consensus exists for defining chronic preoperative opioid use. Most spine studies rely solely on opioid duration to stratify patients into preoperative risk categories. Purpose The purpose of this study is to compare established opioid definitions that contain both duration and dosage to opioid models that rely solely on duration, including the CDC Guideline for Prescribing Opioids for Chronic Pain, in patients undergoing spine surgery. Study Design This was a retrospective cohort study that used opioid data from the Tennessee Controlled Substance Monitoring Database and prospective clinical data from a single-center academic spine registry. Patient Sample The study cohort consisted of 2,373 patients who underwent elective spine surgery for degenerative conditions between January 2011 and February 2017 and who completed a follow-up assessment at 12 months after surgery. Outcome Measures Postoperative opioid use and patient-reported satisfaction (NASS Satisfaction Scale), disability (Oswestry/Neck Disability Index), and pain (Numeric Rating Scale) at 12 month follow-up. Methods Six different chronic preoperative opioid use variables were created based on the number of times a prescription was filled and/or daily morphine milligram equivalent for the one year before surgery. These variables defined chronic opioid use as 1) most days for > 3 months (CDC), 2) continuous use for ≥ 6 months (Schoenfeld), 3) >4,500 mg for at least 9 months (Svendsen wide), 4) >9,000 mg for 12 months (Svendsen intermediary), 5) >18,000 mg for 12 months (Svendsen strict), 6) low-dose chronic (1-36 mg for >91 days), medium-dose chronic (36-120 mg for >91 days), and high-dose chronic (>120 mg for >91 days) (Edlund). Multivariable regression models yielding C-index and R2 values were used to compare chronic preoperative opioid use definitions by postoperative outcomes, adjusting for type of surgery. Results Chronic preoperative opioid use was reported in 470 to 725 (19.8% to 30.6%) patients, depending on definition. The Edlund definition, accounting for duration and dosage, had the highest predictive ability for postoperative opioid use (77.5%), followed by Schoenfeld (75.7%), CDC (72.6%), and Svendsen (59.9% to 72.5%) definitions. A combined Edlund and Schoenfeld duration and dosage definition in post-hoc analysis, that included 3 and 6 month duration cut-offs, performed the best overall with a C-index of 78.4%. Both Edlund and Schoenfeld definitions explained similar amounts of variance in satisfaction, disability, and pain (4.2% to 8.5%). Svendsen and CDC definitions demonstrated poorer performance for patient-reported outcomes (1.4% to 7.2%). Conclusions The Edlund definition is recommended for identifying patients at highest risk for postoperative opioid use. When opioid dosage is unavailable, the Schoenfeld definition is a reasonable choice with similar predictive ability. For patient-reported outcomes, either the Edlund or Schoenfeld definition is recommended. Future work should consider combing dosage and duration, with 3 and 6 month cutoffs, into chronic opioid use definitions.
- Published
- 2019
18. P142. Rating spine surgeons: Physician rating websites versus a patient reported outcomes derived ranking
- Author
-
Inamullah Khan, Kristin R. Archer, Clinton J. Devin, Byearon F. Stephens, Hui Nian, Mohamad Bydon, Ahilan Sivaganesan, Amir M. Abtahi, John J Knightly, Steven D. Glassman, JP Wanner, Scott L. Zuckerman, and Jacquelyn S. Pennings
- Subjects
medicine.medical_specialty ,business.industry ,Physical therapy ,Medicine ,Surgery ,Orthopedics and Sports Medicine ,Neurology (clinical) ,business ,Ranking (information retrieval) - Published
- 2021
19. Effect of pre-injection opioid use on post-injection patient-reported outcomes following epidural steroid injections for radicular pain
- Author
-
Silky Chotai, Clinton J. Devin, Byron J Schneider, Ahilan Sivaganesan, Aaron J. Yang, Johnny J. Wei, and Kristin R. Archer
- Subjects
Adult ,Male ,medicine.medical_treatment ,Injections, Epidural ,03 medical and health sciences ,0302 clinical medicine ,Back pain ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Patient Reported Outcome Measures ,030212 general & internal medicine ,Aged ,Neck pain ,business.industry ,Epidural steroid injection ,Minimal clinically important difference ,Odds ratio ,Middle Aged ,medicine.disease ,humanities ,Oswestry Disability Index ,Analgesics, Opioid ,Opioid ,Back Pain ,Radicular pain ,Anesthesia ,Female ,Steroids ,Surgery ,Neurology (clinical) ,medicine.symptom ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
Background Context Chronic opioid therapy is associated with worse patient-reported outcomes (PROs) following spine surgery. However, little literature exists on the relationship between opioid use and PROs following epidural steroid injections for radicular pain. Purpose We evaluated the association between pre-injection opioid use and PROs following spine epidural steroid injection. Study Design This study is a retrospective analysis of a prospective longitudinal registry database. Patient Sample A total of 392 patients within our database who were undergoing epidural steroid injections (ESIs) at our institution for degenerative structural spine diagnoses and met our inclusion criteria were included in this study. Outcome Measures Patient-reported outcomes for disability (Oswestry Disability Index/Neck Disability Index [ODI/NDI)]), quality of life (EuroQol-5D [EQ-5D]), and pain (Numerical Rating Scale scores for back pain, neck pain, leg pain, and arm pain [NRS-BP/NP/LP/AP]) were assessed at baseline and at 3 and 12 months post-injection. Methods Multivariable proportional odds logistic regression models were created to examine the relationship between pre-injection opioid use and post-injection PROs. A logistic regression with Bayesian Markov chain Monte Carlo parameter estimation was used to investigate a possible cutoff value of pre-injection opioid use above which the effectiveness of ESI (as measured by minimum clinically important difference [MCID] for ODI/NDI) decreases. Results A total of 276 patients with complete 12-month follow-up following ESI were analyzed. The mean pre-injection daily morphine equivalent amount (MEA) was 14.7 mg (95% confidence interval [CI] 12.4 mg–19.1 mg) for the cohort. Pre-injection opioid use was associated with slightly higher odds of worse disability (odds ratio [OR] 1.03, p=.03) and leg/arm pain (OR 1.01, p=.04) scores at 3 months post-injection only. No significant association between pre-injection opioid use and MCID for ODI/NDI was found, although a cutoff of 55.5 mg/day might serve as a significant threshold. Conclusion Increased pre-injection opioid use does not impact long-term outcomes after ESIs for degenerative spine diseases. A pre-injection MEA around 50 mg/day may represent a threshold above which the 3-month effectiveness of ESI for back- and neck-related disability decreases. Epidural steroid injection is an effective treatment modality for pain in patients using opioids, and can be part of a multimodal strategy for opioid independence.
- Published
- 2018
20. 160. Anterior cervical discectomy and fusion vs cervical disc replacement for cervical spondylotic myelopathy: An MCID comparison
- Author
-
Marcel Dupont, Kosuke Sato, Avani S. Vaishnav, Chirag Chaudhary, Ryan Lee, Ahilan Sivaganesan, Todd J. Albert, Sheeraz A. Qureshi, Evan D. Sheha, Derek Colaizzo, Hikari Urakawa, Ram K. Alluri, Catherine Himo Gang, Jung Mok, Akhil Chandra, and Russel C. Huang
- Subjects
Cervical disc replacement ,Facet (geometry) ,medicine.medical_specialty ,business.industry ,Minimal clinically important difference ,Gold standard ,Context (language use) ,Anterior cervical discectomy and fusion ,medicine.disease ,Facet joint ,Surgery ,medicine.anatomical_structure ,Cervical spondylosis ,Medicine ,Orthopedics and Sports Medicine ,Neurology (clinical) ,business - Abstract
BACKGROUND CONTEXT Comparative studies of patients with cervical spondylosis treated with either cervical disc replacement (CDR) or anterior cervical discectomy and fusion (ACDF) are sparse in number. Previous studies have demonstrated good outcomes in patients undergoing CDR with moderate cervical spondylosis involving the disc, uncovertebral or facet joints. PURPOSE To compare clinical outcomes in patients with moderate cervical spondylosis undergoing CDR vs, the gold standard, ACDF. STUDY DESIGN/SETTING Retrospective review of prospectively collected data. PATIENT SAMPLE Patients who underwent one or 2-level CDR or ACDF with moderate cervical spondylosis, quantified using a validated grading scale, were identified, and prospectively collected data was retrospectively reviewed. OUTCOME MEASURES Neck Disability Index (NDI), VAS-Neck, VAS-Arm and PROMIS Physical Function (PROMIS-PF) computer adaptive test score. Methods Patients who underwent one or two-level CDR or ACDF with moderate cervical spondylosis, quantified using a validated grading scale, were identified, and prospectively collected data was retrospectively reviewed. Cervical spondylosis was graded by assessing disc height, facet arthrosis, and uncovertebral joint degeneration. Each of these characteristics was given a score of 0, 1 or 2 with increasing scores correlating with more severe disease. Demographic, operative, and cervical spondylosis grades and achievement of MCID for each PRO was analyzed and compared between the two groups. Results A total of 66 patients were included in the present study, of which 35 (53%) were treated with CDR and 31 (47%) with ACDF. Average follow up was 15.5 months. Patients treated with ACDF were significantly older (58.7 vs 43.0 years-old, P Conclusions The results of the present study demonstrate that patients with moderate cervical spondylosis treated with CDR reported similar postoperative patient reported outcomes to those treated with ACDF. The use of CDR in patients with spondylosis of the uncovertebral joint, facet joint, or disc space height loss may result in similar outcomes compared to ACDF treated patients, while preserving motion and avoiding the biologic demand of obtaining a fusion across the involved cervical levels. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.
- Published
- 2021
21. P112. Cervical disc replacement for radiculopathy versus myeloradiculopathy: An MCID analysis
- Author
-
Akhil Chandra, Ryan Lee, Catherine Himo Gang, Evan D. Sheha, Jung Mok, Russel C. Huang, Todd J. Albert, Sheeraz A. Qureshi, Avani S. Vaishnav, Chirag Chaudhary, Kosuke Sato, Dimitra Melissaridou, Marcel Dupont, Ram K. Alluri, Derek Colaizzo, Hikari Urakawa, and Ahilan Sivaganesan
- Subjects
Cervical disc replacement ,medicine.medical_specialty ,business.industry ,Minimal clinically important difference ,Context (language use) ,medicine.disease ,humanities ,law.invention ,Myelopathy ,Postoperative visit ,Randomized controlled trial ,law ,Internal medicine ,Medicine ,Surgery ,Orthopedics and Sports Medicine ,In patient ,Neurology (clinical) ,business ,Neck Disability Index - Abstract
BACKGROUND CONTEXT Several previous randomized controlled trials have documented the success of cervical disc replacement (CDR) in treating radiculopathy and/or myelopathy, but many did not systematically compare outcomes of patients with radiculopathy versus those with myelopathy. Currently, there is still controversy about whether CDR utilization in patients with components of myelopathy can result in equivalent outcomes when compared to its use in patients with only radiculopathy. PURPOSE The purpose of the present study was to compare the minimally clinically important difference (MCID) across multiple patient-reported outcomes (PROs) in patients undergoing CDR for cervical spondylotic radiculopathy versus myeloradiculopathy. STUDY DESIGN/SETTING Retrospective review of prospectively collected data. PATIENT SAMPLE Patients who underwent one or two-level CDR with radiculopathy versus myeloradiculopathy. OUTCOME MEASURES Neck Disability Index (NDI), VAS-Neck, VAS-Arm, Short Form-12 Health Survey (SF-12) Physical Component Score (PCS), SF-12 Mental Component Score (MCS), PROMIS Physical Function (PF). METHODS Demographic variables and operative characteristics were analyzed for differences between patients with radiculopathy versus myeloradiculopathy. PROs were assessed for differences between the two diagnosis groups as well as improvements within each group following surgery. An MCID analysis of PROs for each diagnosis group was performed and the percentage of patients achieving the MCID was compared between the two diagnosis groups. RESULTS A total of 85 patients were included in the present study, of which 48 (56%) had radiculopathy and 37 (44%) had myeloradiculopathy. Average follow-up was 13.4 months. There were no significant differences in preoperative demographic variables, or the number and distribution of cervical levels treated between the two diagnosis groups. There were no significant differences in preoperative NDI, Neck-VAS, Arm-VAS, SF-12 PCS, SF-12 MCS, and PROMIS PF scores between the two groups. At the final postoperative visit, there was no significant difference in each PRO assessed between the radiculopathy and myeloradiculopathy groups and both groups demonstrated statistically significant improvement in each PRO compared to preoperative values (P CONCLUSIONS This is the first study to compare the MCID across various PROs in patients with radiculopathy versus myelopathy undergoing CDR. The percentage of patients achieving the MCID was not significantly different at each postoperative period assessed in the radiculopathy and myeloradiculopathy groups. In addition, the percentage of patients achieving the MCID continued to increase from 6-weeks to final follow-up in both groups for almost all PROs assessed. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.
- Published
- 2021
22. P141. Do age adjusted parameters influence patient reported outcomes after lumbar decompression?
- Author
-
Max Kohn, Sravisht Iyer, Ram K. Alluri, Ahilan Sivaganesan, Nicholas J. Clark, Michael E. Steinhaus, and Jeong Hoon Kim
- Subjects
Pelvic tilt ,medicine.medical_specialty ,business.industry ,Visual analogue scale ,Decompression ,Minimal clinically important difference ,Context (language use) ,Sagittal plane ,Oswestry Disability Index ,Surgery ,Lumbar ,medicine.anatomical_structure ,Medicine ,Orthopedics and Sports Medicine ,Neurology (clinical) ,business - Abstract
BACKGROUND CONTEXT The impact of sagittal malalignment after lumbar fusion has been well described. However, few studies have examined the impact of sagittal alignment on outcomes after lumbar decompression. The existing literature has focused exclusively on normative measures of alignment (e.g., pelvic incidence lumbar lordosis mismatch [PI-LL] > 10) but has not considered age-adjusted alignment. PURPOSE To determine if age-adjusted sagittal malalignment (PI-LL or pelvic tilt [PT]), influences postoperative patient reported outcomes (PROs) after lumbar decompression surgery. STUDY DESIGN/SETTING Retrospective review of 62 patients who underwent lumbar decompression. PATIENT SAMPLE A total of 62 patients. OUTCOME MEASURES Oswestry disability index (ODI), Visual analog scale (VAS) Back, VAS leg METHODS Patients with >3 months follow-up who underwent one to four level lumbar decompression at a single institution were included. Patients were stratified into three groups based on achievement of age-adjusted thresholds in PI-LL and PT postoperatively. The first group included patients within the age-adjusted threshold ±10 years (MATCHED), and the other groups included those who were outside of the age-adjusted threshold ±10 years as over corrected (OVER), and under corrected (UNDER). The equations used to determine their age-adjusted sagittal parameters included: PT = [(Age-55)/3] + 20, and PI-LL = [(Age-55)/2] +3. Oswestry Disability Index (ODI), Visual Analog Scale (VAS) Back, and VAS Leg were evaluated. The percent of patients achieving MCID at final follow-up was calculated. RESULTS A total of 62 patients (mean 66 years, 50% female) were included with a mean follow-up of 368 days (range, 40 to 1,401). Groups for postoperative age-adjusted PI-LL included 12 MATCHED patients, 30 OVER patients and 20 UNDER patients. Groups for postoperative age-adjusted PT included 16 MATCHED patients, 27 OVER patients and 19 UNDER patients. For the entire cohort, there was a significant decrease in PI-LL (preop 8.7° vs postop 5.5°, p=0.001). There was no significant change in PT for the entire group (preop 22.5° vs postop 23.1°, p=0.39). There was no significant preoperative to postoperative PI-LL difference in the MATCHED (10.5° vs 7.9°, p=0.08) or UNDER patients (22.2° vs 19.3°, p=0.08), but PI-LL significantly decreased in the OVER group (preop -0.9°vs postop -4.7°, p=0.02). There were no significant differences in the preoperative to postoperative PT in the MATCHED (22.0° vs 22.8°, p=0.22), UNDER (28.4° vs 31.3°, p=0.11) or OVER groups (18.7° vs 17.5°, p=0.12). All groups exhibited significant improvements postoperatively for VAS Back, VAS Leg, and ODI scores (p CONCLUSIONS Patients with postoperative age-adjusted spinopelvic abnormalities after lumbar decompression surgery had similar PROs when compared to patients without age-adjusted spinopelvic abnormalities. Therefore, isolated decompression is a viable treatment strategy in patients with sagittal malalignment. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.
- Published
- 2021
23. Effect of obesity on cost per quality-adjusted life years gained following anterior cervical discectomy and fusion in elective degenerative pathology
- Author
-
J. Alex Sielatycki, Harrison L. Kay, Ahilan Sivaganesan, Scott L. Parker, David P. Stonko, Joseph B. Wick, Clinton J. Devin, Silky Chotai, and Matthew J. McGirt
- Subjects
Adult ,Male ,medicine.medical_specialty ,Cost effectiveness ,Cost-Benefit Analysis ,Subgroup analysis ,Anterior cervical discectomy and fusion ,Intervertebral Disc Degeneration ,03 medical and health sciences ,Indirect costs ,0302 clinical medicine ,Quality of life ,medicine ,Humans ,Orthopedics and Sports Medicine ,health care economics and organizations ,Aged ,030222 orthopedics ,Neck pain ,Lumbar Vertebrae ,business.industry ,Middle Aged ,Obesity, Morbid ,Quality-adjusted life year ,Spinal Fusion ,Cervical Vertebrae ,Quality of Life ,Physical therapy ,Female ,Surgery ,Quality-Adjusted Life Years ,Neurology (clinical) ,medicine.symptom ,business ,Body mass index ,030217 neurology & neurosurgery ,Diskectomy - Abstract
Obese patients have greater comorbidities along with higher risk of complications and greater costs after spine surgery, which may result in increased cost and lower quality of life compared with their non-obese counterparts.The aim of the present study was to determine cost-utility following anterior cervical discectomy and fusion (ACDF) in obese patients.This study analyzed prospectively collected data.Patients undergoing elective ACDF for degenerative cervical pathology at a single academic institution were included in the study.Cost and quality-adjusted life years (QALYs) were the outcome measures.One- and two-year medical resource utilization, missed work, and health state values (QALYs) were assessed. Two-year resource use was multiplied by unit costs based on Medicare national payment amounts (direct cost). Patient and caregiver workday losses were multiplied by the self-reported gross-of-tax wage rate (indirect cost). Total cost (direct+indirect) was used to compute cost per QALY gained. Patients were defined as obese for body mass index (BMI) ≥35 based on the WHO definition of class II obesity. A subgroup analysis was conducted in morbidly obese patients (BMI≥40).There were significant improvements in pain (neck pain or arm pain), disability (Neck Disability Index), and quality of life (EuroQol-5D and Short Form-12) at 2 years after surgery (p.001). There was no significant difference in post-discharge health-care resource utilization, direct cost, indirect cost, and total cost between obese and non-obese patients at postoperative 1-year and 2-year follow-up. Mean 2-year direct cost for obese patients was $19,225±$8,065 and $17,635±$6,413 for non-obese patients (p=.14). There was no significant difference in the mean total 2-year cost between obese ($23,144±$9,216) and non-obese ($22,183±$10,564) patients (p=.48). Obese patients had a lower mean cumulative gain in QALYs versus non-obese patients at 2-years (0.34 vs. 0.42, p=.32). Two-year cost-utility in obese ($68,070/QALY) versus non-obese patients ($52,816/QALY) was not significantly different (p=.11). Morbidly obese patients had lower QALYs gained (0.17) and higher cost per QALYs gained ($138,094/QALY) at 2 years.Anterior cervical discectomy and fusion provided a significant gain in health state utility in obese patients, with a mean 2-year cost-utility of $68,070 per QALYs gained, which can be considered moderately cost-effective. Morbidly obese patients had lower cost-effectiveness; however, surgery does provide a significant improvement in outcomes. Obesity, and specifically morbid obesity, should to be taken into consideration as physician and hospital reimbursements move toward a bundled model.
- Published
- 2016
24. Predictors of the efficacy of epidural steroid injections for structural lumbar degenerative pathology
- Author
-
Matthew J. McGirt, Ahilan Sivaganesan, Anthony L. Asher, Silky Chotai, Scott L. Parker, and Clinton J. Devin
- Subjects
Adult ,Male ,Pathology ,medicine.medical_specialty ,medicine.medical_treatment ,Injections, Epidural ,03 medical and health sciences ,0302 clinical medicine ,Lumbar ,030202 anesthesiology ,Back pain ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Prospective Studies ,Prospective cohort study ,Aged ,business.industry ,Epidural steroid injection ,Minimal clinically important difference ,Area under the curve ,Middle Aged ,medicine.disease ,humanities ,Oswestry Disability Index ,Stenosis ,Treatment Outcome ,Back Pain ,Physical therapy ,Female ,Steroids ,Surgery ,Neurology (clinical) ,medicine.symptom ,business ,Intervertebral Disc Displacement ,030217 neurology & neurosurgery - Abstract
Background Lumbar epidural steroid injection (LESI) is a valuable therapeutic option when administered to the appropriate patient, for the appropriate disease process, at the appropriate time. There is considerable variability in patient-reported outcomes (PROs) after LESI, creating uncertainty as to who will benefit from the therapy and who will not. Purpose We set out to identify patient attributes, which are important predictors for the achievement of a minimum clinically important difference (MCID) in the Oswestry Disability Index (ODI) after LESI. Study Design A prospective cohort study was carried out. Patient Sample A total of 239 consecutive patients undergoing LESI for back-related disability, back pain (BP), and leg pain (LP) associated with degenerative pathology comprised the patient sample. Outcome Measures Baseline and 3-month patient self-reported ODI, numeric rating scale-BP and LP, Euro-Qol-5D, and Short Form (SF)-12 scores were recorded. Methods A total of 239 consecutive patients undergoing LESI for degenerative pathology over a period of 2 years who were enrolled into a prospective web-based registry were included in the study. Using the previously reported anchor-based approach, an MCID threshold of 7.1% was established for ODI after LESI. Each enrolled patient was then dichotomized as a "responder" (achieving MCID) or a "non-responder." Multiple logistic regression analysis was then performed, with the achievement of MCID serving as the outcome of interest. Candidate variables included in the regression analyses were age, gender, employment, insurance type, smoking status, preoperative ambulation, preinjection narcotic use, comorbidities, predominant LP or BP symptoms, symptom duration, diagnosis, number of levels, prior surgery, baseline PROs, type of stenosis (central, lateral recesses, or foraminal), injection route (transforaminal, interlaminar, or caudal), and number of injections. Subsequently, we also randomly selected 80% of the patients to serve as the training data for a multiple logistic regression model. Once this predictive model was built, it was validated using the remaining 20% of patients. Results There were 124 (62%) patients who achieved MCID for ODI. The existence of central stenosis (p=.006), TF or IL injection route (p=.02) compared with caudal epidural steroid injection, higher baseline ODI (p=.00001), and a diagnosis of disc herniation (p=.02) increase the odds of achieving MCID for ODI at 3 months. Symptom duration for over a year (p=.006), prior surgery (p=.08), and preinjection anxiety (p=.001) decrease the odds of achieving MCID. The area under the curve (AUC) for our predictive model's receiver-operator characteristic was 0.81 when using the 80% training data set, and the AUC was 0.72 when using the 20% validation data. Conclusion We have identified patient attributes that are important predictors for the achievement of MCID in ODI 3 months after LESI. The use of these attributes, in the form of a predictive model for LESI efficacy, has the potential to improve decision making around LESI. Spine care providers can use the information to gain insight into the likelihood that a particular patient will experience a meaningful benefit from LESI.
- Published
- 2016
25. Traumatic atlantooccipital dislocation: comprehensive assessment of mortality, neurologic improvement, and patient-reported outcomes at a Level 1 trauma center over 15 years
- Author
-
Priya Sivasubramaniam, Akshitkumar M. Mistry, Stephen K. Mendenhall, Ahilan Sivaganesan, Matthew J. McGirt, and Clinton J. Devin
- Subjects
Adult ,Male ,medicine.medical_specialty ,Pediatrics ,Adolescent ,Joint Dislocations ,Context (language use) ,Trauma Centers ,Quality of life ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Joint dislocation ,Aged ,business.industry ,Incidence (epidemiology) ,Trauma center ,Glasgow Coma Scale ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Surgery ,Atlanto-Occipital Joint ,Spinal Fusion ,Spinal Injuries ,Injury Severity Score ,Female ,Neurology (clinical) ,business - Abstract
Background context Only Level 3 evidence exists for the diagnosis and treatment of atlantooccipital dislocation (AOD) with few studies examining mortality, neurologic improvement, and patient-reported outcomes (PROs). Purpose First, the aim was to determine: the incidence of AOD, 90-day surgical morbidity and mortality after AOD, patient factors that may be associated with delayed or missed diagnosis, and factors that were associated with mortality and neurologic improvement after AOD. Secondly, the aim was to quantify the pain, disability, and quality of life experienced by patients surviving AOD. Study design/setting This was a retrospective cohort study. Patient sample A total of 5,337 consecutive spine computed tomography traumagrams from 1997 to 2012 were included. Outcome measures Mortality, neurologic improvement, complications, EuroQol five dimensions (EQ-5D), Neck Disability Index (NDI), Numeric Rating Scale (NRS)-neck, NRS-arm, and return-to-work were the outcome measures. Methods Patients were considered to have AOD if they met one of the following radiographic criteria: basion-dens interval greater than 10 mm; basion-axial interval: anterior displacement greater than 12 mm or posterior displacement greater than 4 mm between the basion and posterior C2 line; and condyle to C1 interval greater than 1.4 mm. Linear regression analysis was performed to identify factors associated with 90-day mortality, neurologic improvement, and missed diagnosis. Patient-reported outcomes were assessed via phone interview. Results Thirty-one patients met radiographic criteria for AOD; an incidence of 0.6% over 15 years. Twenty-one (68%) patients were treated with occipital cervical fusion. At 90 days postoperatively, there were no new neurologic deficits or reoperations. Eight (26%) patients died within 90 days. All patients who died had no documented AOD diagnosis and were not treated surgically. Missed AOD diagnosis was the strongest predictor of mortality. Younger age, lower Glasgow Coma Score, lower Injury Severity Score (ISS) score, and worse initial American Spinal Injury Association (ASIA) score were significantly associated with greater neurologic improvement. Higher ISS score and better ASIA score were significantly associated with missed AOD diagnosis. The average PROs metrics at time of telephone follow-up were as follows: EQ-5D=0.73±0.19, NDI=30.89±18.57, NRS-neck=2.33±2.21, NRS-arm=2.00±2.54. Of the patients with follow-up data, four were employed full-time, and five were receiving disability. Conclusions Our work suggests that failure to diagnose AOD is a powerful predictor of mortality. Higher ISS scores and better neurologic presentation were significantly associated with missed diagnosis. Craniocervical arthrodesis preserved neurologic function with low complication rate and unexpectedly high PROs and return-to-work. These results must be carefully interpreted because it is unclear whether missed AOD diagnosis accompanies another death-causing injury (eg, traumatic brain injury) or if failure to treat AOD contributes to mortality in a multifactorial manner.
- Published
- 2015
26. 233. Does postoperative physical therapy improve patient-reported outcomes at one-year following cervical spine surgery?
- Author
-
Jacquelyn S. Pennings, Emily R. Oleisky, Daniel R. Verhotz, Rogelio A. Coronado, Kristin R. Archer, Inamullah Khan, JP Wanner, Ahilan Sivaganesan, and Clinton J. Devin
- Subjects
medicine.medical_specialty ,Rehabilitation ,business.industry ,medicine.medical_treatment ,Minimal clinically important difference ,Laminectomy ,Anterior cervical discectomy and fusion ,Context (language use) ,Quality of life ,medicine ,Physical therapy ,Surgery ,Orthopedics and Sports Medicine ,Neurology (clinical) ,business ,Body mass index ,Depression (differential diagnoses) - Abstract
BACKGROUND CONTEXT Pain and disability can persist after spinal surgery for which physical therapy (PT) is commonly prescribed. Currently, there is limited evidence to support the effectiveness of postoperative PT following cervical spine surgery. PURPOSE The purpose of this study was to examine the association between attending outpatient PT during the postoperative period and patient-reported outcomes at 1 year following cervical spine surgery. STUDY DESIGN/SETTING Retrospective evaluation of prospectively collected data from a single-center, spine registry. PATIENT SAMPLE A total of 767 participants undergoing anterior cervical discectomy and fusion (ACDF) or posterior laminectomy with or without fusion for a degenerative condition. OUTCOME MEASURES The primary outcomes for this study were disability (Neck Disability Index: NDI), quality of life (EQ-5D), and neck and arm pain (11-point Numeric Rating Scale: NRS). METHODS Participants were enrolled into a spine registry prior to surgery and completed a preoperative assessment. Follow-up assessments occurred at 3 months and 1 year after surgery. A categorical variable to describe PT over the 1-year period was created (No PT [reference], PT 0-3 months only, PT 0-3 and 3-12 months, PT 3-12 months only). Linear mixed-effects models were used to examine the effect of PT group on outcomes over time (3 months and 1 year). All analyses controlled for preoperative outcome scores, time, age, gender, race, smoking status, insurance type, body mass index, ambulation status, comorbidities, duration of symptoms, surgery type, revision, discharge status, number of levels, ASA grade and preoperative depression/anxiety and narcotic use. Significance was set at p RESULTS Over the 1-year period, 351 patients had no PT (46%), 193 had PT from 0-3 months only (25%), 138 had PT from 0-3 and 3-12 months (18%), and 85 had PT from 3-12 months only (11%). The mixed-effects models found no significant relationship between PT 0-3 months only and all patient-reported outcomes at 1-year compared to the No PT group (p > .05). Patients who had PT between 3-12 months only had NDI scores 5.8-points higher, EQ-5D scores 0.03-points lower, and neck and arm pain scores 0.98-points and 0.68-points higher than the No PT group (p CONCLUSIONS Results from a retrospective multivariable analysis suggest that there is no difference in 1-year patient-reported outcomes between patients who utilize PT during the first 3 months only and patients who have No PT after cervical spine surgery. However, attending postoperative PT later in recovery, between 3 and 12 months, appears to result in increased disability and pain at 1-year after surgery, after accounting for patient and clinical characteristics. While the differences between groups are statistically significant, they do not appear to be clinically significant based on established MCID values. Overall, results suggest that attending PT after surgery may not lead to improved patient-reported outcomes compared to No PT. Additional research is needed to determine subgroups of patients who might benefit from traditional PT or alternative rehabilitation approaches that are informed by a biopsychosocial model. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.
- Published
- 2019
27. 45. Trajectory of change in mJOA score within one year following surgery for degenerative cervical myelopathy
- Author
-
Jacquelyn S. Pennings, Mohamad Bydon, JP Wanner, Inamullah Khan, Ahilan Sivaganesan, Clinton J. Devin, and Kristin R. Archer
- Subjects
medicine.medical_specialty ,business.industry ,Context (language use) ,Cervical cord compression ,medicine.disease ,Surgery ,Natural history ,Myelopathy ,Orthopedic surgery ,medicine ,Orthopedics and Sports Medicine ,In patient ,Neurology (clinical) ,Elective surgery ,business ,Progressive disease - Abstract
BACKGROUND CONTEXT Degenerative cervical myelopathy (DCM) is a progressive disease resulting from cervical cord compression. The natural progression of DCM is variable; some patients experience periods of stability, while others rapidly deteriorate following disease onset. The majority of these patients require surgical decompression to halt disease progression and improve functionality. The modified Japanese Orthopedic Association (mJOA) is a patient-reported questionnaire commonly used to grade symptoms and is a validated tool for assessment of postoperative improvement in the surgical management of cervical myelopathy. However, literature describing the natural history of recovery following surgical decompression is limited, especially in the postsurgical period of 3 to 12 months. PURPOSE The aim of the study is to assess the trajectory of mJOA improvement in the postsurgical period of 3 to 12 months in patients who underwent surgery for cervical myelopathy. STUDY DESIGN/SETTING This study is a retrospective analysis of prospectively collected data from the cervical module of a national spine registry, the Quality Outcomes Database (QOD). PATIENT SAMPLE A total of 2,156 patients who underwent elective surgery for DCM and had complete 3- and 12-month follow-up data in the QOD registry were included in the study. OUTCOME MEASURES The mJOA score was used to define severity of myelopathic symptoms in patients who underwent surgery for cervical myelopathy. METHODS Patients were divided into mild (≥14), moderate (9-13), or severe ( RESULTS Patients improved significantly from baseline to 3 months on their mJOA scores, regardless of their baseline mJOA severity. Four hundred five (18.8%) showed improvement during the time period of 3- to 12-month postsurgical follow-up. After adjusting for the relevant baseline patient and surgery specific characteristics, the baseline mJOA categories had significant impact on whether a patient improves by 2 points in mJOA score from 3- to 12-month postsurgery (75.49% of the total Wald X2, p CONCLUSIONS In the surgical management of cervical myelopathy, most patients achieve improvement on a shorter follow-up; however, patients with severe symptoms keep improving until after a longer follow-up. Preoperative identification of such patients helps the clinician with setting realistic expectations for each follow-up time point. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.
- Published
- 2019
28. 11. Predicting disability and pain outcomes one year after elective surgery for degenerative cervical diseases: analysis from quality outcomes database
- Author
-
Khan, Inamullah, primary, Devin, Clinton J., additional, Nian, Hui, additional, Harrell, Frank E., additional, Pennings, Jacquelyn S., additional, Bydon, Mohamad, additional, Sivaganesan, Ahilan, additional, and Archer, Kristin R., additional
- Published
- 2019
- Full Text
- View/download PDF
29. P139. Clinically relevant percent reduction (CRPR): a new definition of clinically significant change for lumbar spine surgery
- Author
-
Archer, Kristin R., primary, Asher, Anthony M., additional, Pennings, Jacquelyn S., additional, Khan, Inamullah, additional, Sivaganesan, Ahilan, additional, Bydon, Mohamad, additional, Devin, Clinton J., additional, and Asher, Anthony L., additional
- Published
- 2019
- Full Text
- View/download PDF
30. 233. Does postoperative physical therapy improve patient-reported outcomes at one-year following cervical spine surgery?
- Author
-
Archer, Kristin R., primary, Pennings, Jacquelyn S., additional, Khan, Inamullah, additional, Sivaganesan, Ahilan, additional, Wanner, JP, additional, Verhotz, Daniel R., additional, Coronado, Rogelio A., additional, Devin, Clinton J., additional, and Oleisky, Emily R., additional
- Published
- 2019
- Full Text
- View/download PDF
31. 45. Trajectory of change in mJOA score within one year following surgery for degenerative cervical myelopathy
- Author
-
Khan, Inamullah, primary, Archer, Kristin R., additional, Wanner, JP, additional, Bydon, Mohamad, additional, Pennings, Jacquelyn S., additional, Sivaganesan, Ahilan, additional, and Devin, Clinton J., additional
- Published
- 2019
- Full Text
- View/download PDF
32. Comparing different chronic preoperative opioid use definitions on outcomes after spine surgery
- Author
-
Oleisky, Emily R., primary, Pennings, Jacquelyn S., additional, Hills, Jeffrey, additional, Sivaganesan, Ahilan, additional, Khan, Inamullah, additional, Call, Richard, additional, Devin, Clinton J., additional, and Archer, Kristin R., additional
- Published
- 2019
- Full Text
- View/download PDF
33. P139. Clinically relevant percent reduction (CRPR): a new definition of clinically significant change for lumbar spine surgery
- Author
-
Clinton J. Devin, Anthony L. Asher, Ahilan Sivaganesan, Jacquelyn S. Pennings, Anthony M. Asher, Kristin R. Archer, Inamullah Khan, and Mohamad Bydon
- Subjects
medicine.medical_specialty ,business.industry ,Minimal clinically important difference ,Context (language use) ,medicine.disease ,humanities ,Spondylolisthesis ,Pseudarthrosis ,Stenosis ,Lumbar ,medicine ,Physical therapy ,Surgery ,Orthopedics and Sports Medicine ,Clinical significance ,Neurology (clinical) ,Elective surgery ,business - Abstract
BACKGROUND CONTEXT Minimal clinically important difference (MCID) represents the smallest, clinically relevant change in a patient-reported outcome (PRO) score. However, the literature suggests that an absolute change from baseline may not be a reliable marker of response to treatment for patients with a low or high baseline PRO score. An alternative to MCID is a threshold of clinical relevance defined by percent reduction from baseline PRO score. PURPOSE The purpose of this study was to determine whether a clinically relevant percent reduction (CRPR) of 30% in disability and pain scores is a valid method for determining clinical improvement at 12 months after lumbar spine surgery. STUDY DESIGN/SETTING Retrospective evaluation of prospectively collected data from a national surgical spine registry, the Quality Outcomes Database (QOD). PATIENT SAMPLE A total of 23,280 participants undergoing elective surgery for a lumbar degenerative condition (primary stenosis, disc herniation, spondylolisthesis (Grade I) and symptomatic mechanical disc collapse or revision surgery for recurrent same-level disc herniation, pseudarthrosis and adjacent segment disease). OUTCOME MEASURES Outcomes were disability (ODI), back and leg pain (NRS-BP/LP), and satisfaction (NASS scale). METHODS Participants completed a preoperative assessment and follow-up assessment at 1-year. The change in ODI and NRS-BP/LP scores were categorized as met CRPR (percent change ≥30%) or not met CRPR (percent change RESULTS Results from the satisfaction prediction models found that the OR for 30% ODI CRPR was 11.1 (10.2 to 12.1) and for ODI MCID was 7.8 (7.2 to 8.4), while 30% NRS-BP and NRS-LP CRPR was 7.9 (7.3 to 8.5) and 6.7 (6.2 to 7.2) compared to MCID ORs of 5.5 (5.1 to 5.9) and 5.6 (5.2 to 6.0) (p CONCLUSIONS CRPR may be a more clinically relevant method for identifying response to treatment since it can be applied to broad spinal surgery populations and takes into account the baseline PRO score. Furthermore, a 30% CRPR appears to outperform established MCID thresholds for patients with either low or high preoperative disability and pain scores. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.
- Published
- 2019
34. 11. Predicting disability and pain outcomes one year after elective surgery for degenerative cervical diseases: analysis from quality outcomes database
- Author
-
Mohamad Bydon, Frank E. Harrell, Jacquelyn S. Pennings, Ahilan Sivaganesan, Clinton J. Devin, Inamullah Khan, Kristin R. Archer, and Hui Nian
- Subjects
medicine.medical_specialty ,Neck pain ,Database ,business.industry ,Arthrodesis ,medicine.medical_treatment ,Context (language use) ,computer.software_genre ,medicine.disease ,Myelopathy ,Cohort ,Orthopedic surgery ,medicine ,Surgery ,Orthopedics and Sports Medicine ,Neurology (clinical) ,Elective surgery ,medicine.symptom ,business ,computer ,Depression (differential diagnoses) - Abstract
BACKGROUND CONTEXT In the current era of value-based health care reform, engaging patients in shared decision-making for treatment planning is imperative. Predictive models capable of providing individualized predictions of patient-reported outcomes (PROs) following cervical spine surgery have the potential to be valuable tools for a shared decision-making process. PURPOSE The aim of the study is to develop and validate predictive models for 12-month postoperative disability, pain, and myelopathy outcomes in patients undergoing elective spine surgery for degenerative cervical diseases (radiculopathy and myelopathy). STUDY DESIGN/SETTING This study is a retrospective analysis of prospectively collected data from the cervical module of a national spine registry, the Quality Outcomes Database (QOD). PATIENT SAMPLE Patients undergoing cervical spine surgery for the diagnosis of radiculopathy or myelopathy with degenerative etiologies are eligible for inclusion in the QOD registry. OUTCOME MEASURES The outcomes of interest in this study were neck related disability (NDI), pain [NRS- neck pain (NP) and arm pain (AP)] and modified Japanese Orthopedic Association score for myelopathy (mJOA). METHODS Two distinct sets of multivariable proportional odds ordinal regression models were developed with the outcomes of interest of disability (NDI), pain (NRS-NP and NRS-AP) and myelopathy (mJOA) score in the myelopathy cohort and disability (NDI) and pain (NRS-NP and NRS-AP) in the radiculopathy cohort. Patient characteristics of age, gender, BMI, race, education level, smoking status, history of diabetes, anxiety and depression, symptom duration, motor deficit or numbness at presentation, preoperative imaging finding of listhesis, employment status, workers’ compensation, insurance status, and ambulatory ability, baseline PROs as well as surgery-specific variables of number of levels, arthrodesis, and surgical approach were included in the models. The models were internally validated using bootstrap resampling. RESULTS A total of 5,076 patients who underwent surgery for cervical radiculopathy and 2717 patients who underwent surgery for cervical myelopathy were included in fitting the models for the distinct set of outcomes. There was a significant improvement in all PROs at 12 months after surgery (P CONCLUSIONS These predictive models can provide individualized risk-adjusted estimates of 12-month disability, pain, and myelopathy outcomes for patients undergoing spine surgery for degenerative cervical diseases. Novel predictive models constructed with these data hold the potential to guide individualized patient discussions on postsurgical outcomes and expectations. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.
- Published
- 2019
35. Surgeon-Level Variability in Cost and Outcomes for Elective Lumbar Decompression-Fusion
- Author
-
Matthew J. McGirt, Kristin R. Archer, Clinton J. Devin, John A. Sielatycki, Silky Chotai, and Ahilan Sivaganesan
- Subjects
medicine.medical_specialty ,Decompression ,business.industry ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Lumbar ,030220 oncology & carcinogenesis ,medicine ,Orthopedics and Sports Medicine ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Published
- 2017
36. Pre-Injection Opioid Use as a Predictor of Adverse Postinjection Patient-Reported Outcomes following Epidural Steroid Injections for Degenerative Spine Disease
- Author
-
Ahilan Sivaganesan, Kristin R. Archer, Silky Chotai, Clinton J. Devin, and Johnny J. Wei
- Subjects
Spine (zoology) ,medicine.medical_specialty ,Epidural steroid ,business.industry ,Anesthesia ,Opioid use ,Medicine ,Surgery ,Orthopedics and Sports Medicine ,Neurology (clinical) ,Disease ,business - Published
- 2017
37. Comparative Effectiveness of Single-Level Anterior Cervical Discectomy and Fusion vs Posterior Cervical Foraminotomy for Patients with Cervical Radiculopathy: Analysis from Quality Outcome Database
- Author
-
Matthew J. McGirt, Mohamad Bydon, Christopher I. Shaffrey, Kristin R. Archer, Hui Nian, Frank E. Harrell, Silky Chotai, Clinton J. Devin, Kevin T. Foley, Anthony L. Asher, Steven D. Glassman, and Ahilan Sivaganesan
- Subjects
Cervical radiculopathy ,medicine.medical_specialty ,business.industry ,Foraminotomy ,medicine.medical_treatment ,Medicine ,Surgery ,Orthopedics and Sports Medicine ,Anterior cervical discectomy and fusion ,Neurology (clinical) ,Single level ,business - Published
- 2017
38. Drivers of Cost in Adult Spinal Deformity Surgery
- Author
-
Silky Chotai, Clinton J. Devin, Byron F. Stephens, and Ahilan Sivaganesan
- Subjects
medicine.medical_specialty ,business.industry ,Anesthesia ,Spinal deformity ,Medicine ,Surgery ,Orthopedics and Sports Medicine ,Neurology (clinical) ,business - Published
- 2017
39. Predicting the Odds of Returning to Work for Patients Undergoing Elective Cervical Spine Surgery
- Author
-
Elliott Kim, David P. Stonko, Clinton J. Devin, Ahilan Sivaganesan, Silky Chotai, and Joseph B. Wick
- Subjects
Cervical spine surgery ,medicine.medical_specialty ,Work (electrical) ,business.industry ,medicine ,Surgery ,Orthopedics and Sports Medicine ,Neurology (clinical) ,business ,Odds - Published
- 2017
40. Wednesday, September 26, 2018 2:00 PM – 3:00 PM Improving Quality of Life for Patients with Tumors
- Author
-
Choi, Bryan, primary, Shankar, Ganesh M., additional, Sivaganesan, Ahilan, additional, Yanamadala, Vijay, additional, and Shin, John H., additional
- Published
- 2018
- Full Text
- View/download PDF
41. Surgeon-Level Variability in Cost and Outcomes for Elective Lumbar Decompression-Fusion
- Author
-
Chotai, Silky, primary, Sivaganesan, Ahilan, additional, Sielatycki, John A., additional, Archer, Kristin R., additional, McGirt, Matthew J., additional, and Devin, Clinton J., additional
- Published
- 2017
- Full Text
- View/download PDF
42. Effect of Neck-Related Disability Scores on Satisfaction with Outcomes 12-Months after Elective Surgery for Cervical Spine Degenerative Disease
- Author
-
Sivaganesan, Ahilan, primary, Chotai, Silky, additional, Bydon, Mohamad, additional, Devin, Clinton J., additional, and Asher, Anthony L., additional
- Published
- 2017
- Full Text
- View/download PDF
43. Predicting the Odds of Returning to Work for Patients Undergoing Elective Cervical Spine Surgery
- Author
-
Kim, Elliott, primary, Chotai, Silky, additional, Wick, Joseph B., additional, Stonko, David, additional, Sivaganesan, Ahilan, additional, and Devin, Clinton J., additional
- Published
- 2017
- Full Text
- View/download PDF
44. A Perioperative Protocol for Elective Spine Surgery is Associated with Reduced Length of Stay and Complications
- Author
-
Sivaganesan, Ahilan, primary, Chotai, Silky, additional, Cherkesky, Christy M., additional, McGirt, Matthew J., additional, Stephens, Byron F., additional, and Devin, Clinton J., additional
- Published
- 2017
- Full Text
- View/download PDF
45. Pre-Injection Opioid Use as a Predictor of Adverse Postinjection Patient-Reported Outcomes following Epidural Steroid Injections for Degenerative Spine Disease
- Author
-
Chotai, Silky, primary, Wei, Johnny, additional, Sivaganesan, Ahilan, additional, Archer, Kristin R., additional, and Devin, Clinton J., additional
- Published
- 2017
- Full Text
- View/download PDF
46. Comparative Effectiveness of Single-Level Anterior Cervical Discectomy and Fusion vs Posterior Cervical Foraminotomy for Patients with Cervical Radiculopathy: Analysis from Quality Outcome Database
- Author
-
Asher, Anthony L., primary, Devin, Clinton J., additional, Chotai, Silky, additional, Bydon, Mohamad, additional, Sivaganesan, Ahilan, additional, McGirt, Matthew J., additional, Nian, Hui, additional, Archer, Kristin R., additional, Harrell, Frank E., additional, Foley, Kevin T., additional, Glassman, Steven D., additional, and Shaffrey, Christopher I., additional
- Published
- 2017
- Full Text
- View/download PDF
47. What, If Any, Preoperative Morphine Equianalgesic Dose Predicts Ability to Achieve a Clinically Meaningful Improvement following Spine Surgery?
- Author
-
Wick, Joseph B., primary, Sivaganesan, Ahilan, additional, Chotai, Silky, additional, Archer, Kristin R., additional, Posey, Samuel, additional, Evans, Parker, additional, and Devin, Clinton J., additional
- Published
- 2017
- Full Text
- View/download PDF
48. Drivers of Cost in Adult Spinal Deformity Surgery
- Author
-
Stephens, Byron F., primary, Chotai, Silky, additional, Sivaganesan, Ahilan, additional, and Devin, Clinton J., additional
- Published
- 2017
- Full Text
- View/download PDF
49. Effect of Depression on Patient Reported Outcomes following Cervical Epidural Steroid Injection for Degenerative Spine Disease
- Author
-
Ahilan Sivaganesan, Clint J. Devin, Silky Chotai, Matthew J. McGirt, Elliott Kim, and Byron J Schneider
- Subjects
030222 orthopedics ,Neck pain ,business.industry ,Depression scale ,Disease ,medicine.disease ,Tertiary care ,Cervical epidural steroid injection ,03 medical and health sciences ,0302 clinical medicine ,Radicular pain ,Anesthesia ,Cervical spondylosis ,Medicine ,Surgery ,Orthopedics and Sports Medicine ,Neurology (clinical) ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Depression (differential diagnoses) - Abstract
Objective To assess the effect depression has on outcomes after cervical epidural steroid injections (CESIs). Design Retrospective review of a prospectively collected database. Setting Single institution tertiary care center. Subjects Fifty-seven patients with cervical spondylosis and cervical radicular pain who were deemed appropriate surgical candidates but elected to undergo CESI first were included. Methods Twenty-one of 57 (37%) patients with depression (defined as Zung Depression Scale >33) were included. Patient-reported outcomes including Neck Disability Index (NDI), numeric rating scale (NRS) for arm pain (AP), NRS for neck pain (NP), and EuroQol-5D (EQ-5D) were collected at baseline and three-month follow-up. Minimal clinically important differences were then calculated to provide dichotomous outcome measures of success. Results Overall, 24 and 28 patients achieved at least 50% improvement in AP and NP, respectively. In terms of disability, 25/57 (43.9%) patients achieved >13.2-point improvement on the NDI overall. In patients with depression, 4/21 (19.0%) and 5/21 (23.8%) achieved at least 50% improvement on the NRS for AP and NP, respectively, compared with 20/36 (55.5%) and 23/36 (63.8%) in patients without depression. This difference was statistically significant for both pain measures (P
- Published
- 2016
50. Effect of Complications within 90 Days on Cost-Utility following Lumbar Decompression with and without Fusion for Degenerative Spine Disease
- Author
-
Clinton J. Devin, Matthew J. McGirt, John A. Sielatycki, Ahilan Sivaganesan, Joseph B. Wick, David P. Stonko, Silky Chotai, and Scott L. Parker
- Subjects
Spine (zoology) ,medicine.medical_specialty ,Lumbar ,business.industry ,Decompression ,Cost utility ,Medicine ,Surgery ,Orthopedics and Sports Medicine ,Neurology (clinical) ,Disease ,business - Published
- 2016
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.