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1. Early management of adult traumatic spinal cord injury in patients with polytrauma: a consensus and clinical recommendations jointly developed by the World Society of Emergency Surgery (WSES) & the European Association of Neurosurgical Societies (EANS)

Author

Picetti, E, Demetriades, A, Catena, F, Aarabi, B, Abu-Zidan, F, Alves, O, Ansaloni, L, Armonda, R, Badenes, R, Bala, M, Balogh, Z, Barbanera, A, Bertuccio, A, Biffl, W, Bouzat, P, Buki, A, Castano-Leon, A, Cerasti, D, Citerio, G, Coccolini, F, Coimbra, R, Coniglio, C, Costa, F, De Iure, F, Depreitere, B, Fainardi, E, Fehlings, M, Gabrovsky, N, Godoy, D, Gruen, P, Gupta, D, Hawryluk, G, Helbok, R, Hossain, I, Hutchinson, P, Iaccarino, C, Inaba, K, Ivanov, M, Kaprovoy, S, Kirkpatrick, A, Klein, S, Kolias, A, Konovalov, N, Lagares, A, Lippa, L, Loza-Gomez, A, Luoto, T, Maas, A, Maciejczak, A, Maier, R, Marklund, N, Martin, M, Melloni, I, Mendoza-Lattes, S, Meyfroidt, G, Munari, M, Napolitano, L, Okonkwo, D, Otomo, Y, Papadopoulos, M, Petr, O, Peul, W, Pudkrong, A, Qasim, Z, Rasulo, F, Reizinho, C, Ringel, F, Rizoli, S, Rostami, E, Rubiano, A, Russo, E, Sarwal, A, Schwab, J, Servadei, F, Sharma, D, Sharif, S, Shiban, E, Shutter, L, Stahel, P, Taccone, F, Terpolilli, N, Thomé, C, Toth, P, Tsitsopoulos, P, Udy, A, Vaccaro, A, Varon, A, Vavilala, M, Younsi, A, Zackova, M, Zoerle, T, Robba, C, Picetti, Edoardo, Demetriades, Andreas K., Catena, Fausto, Aarabi, Bizhan, Abu-Zidan, Fikri M., Alves, Oscar L., Ansaloni, Luca, Armonda, Rocco A., Badenes, Rafael, Bala, Miklosh, Balogh, Zsolt J., Barbanera, Andrea, Bertuccio, Alessandro, Biffl, Walter L., Bouzat, Pierre, Buki, Andras, Castano-Leon, Ana Maria, Cerasti, Davide, Citerio, Giuseppe, Coccolini, Federico, Coimbra, Raul, Coniglio, Carlo, Costa, Francesco, De Iure, Federico, Depreitere, Bart, Fainardi, Enrico, Fehlings, Michael J., Gabrovsky, Nikolay, Godoy, Daniel Agustin, Gruen, Peter, Gupta, Deepak, Hawryluk, Gregory W. J., Helbok, Raimund, Hossain, Iftakher, Hutchinson, Peter J., Iaccarino, Corrado, Inaba, Kenji, Ivanov, Marcel, Kaprovoy, Stanislav, Kirkpatrick, Andrew W., Klein, Sam, Kolias, Angelos, Konovalov, Nikolay A., Lagares, Alfonso, Lippa, Laura, Loza-Gomez, Angelica, Luoto, Teemu M., Maas, Andrew I. R., Maciejczak, Andrzej, Maier, Ronald V., Marklund, Niklas, Martin, Matthew J., Melloni, Ilaria, Mendoza-Lattes, Sergio, Meyfroidt, Geert, Munari, Marina, Napolitano, Lena M., Okonkwo, David O., Otomo, Yasuhiro, Papadopoulos, Marios C., Petr, Ondra, Peul, Wilco C., Pudkrong, Aichholz K., Qasim, Zaffer, Rasulo, Frank, Reizinho, Carla, Ringel, Florian, Rizoli, Sandro, Rostami, Elham, Rubiano, Andres M., Russo, Emanuele, Sarwal, Aarti, Schwab, Jan M., Servadei, Franco, Sharma, Deepak, Sharif, Salman, Shiban, Ehab, Shutter, Lori, Stahel, Philip F., Taccone, Fabio S., Terpolilli, Nicole A., Thomé, Claudius, Toth, Peter, Tsitsopoulos, Parmenion P., Udy, Andrew, Vaccaro, Alexander R., Varon, Albert J., Vavilala, Monica S., Younsi, Alexander, Zackova, Monika, Zoerle, Tommaso, Robba, Chiara, Picetti, E, Demetriades, A, Catena, F, Aarabi, B, Abu-Zidan, F, Alves, O, Ansaloni, L, Armonda, R, Badenes, R, Bala, M, Balogh, Z, Barbanera, A, Bertuccio, A, Biffl, W, Bouzat, P, Buki, A, Castano-Leon, A, Cerasti, D, Citerio, G, Coccolini, F, Coimbra, R, Coniglio, C, Costa, F, De Iure, F, Depreitere, B, Fainardi, E, Fehlings, M, Gabrovsky, N, Godoy, D, Gruen, P, Gupta, D, Hawryluk, G, Helbok, R, Hossain, I, Hutchinson, P, Iaccarino, C, Inaba, K, Ivanov, M, Kaprovoy, S, Kirkpatrick, A, Klein, S, Kolias, A, Konovalov, N, Lagares, A, Lippa, L, Loza-Gomez, A, Luoto, T, Maas, A, Maciejczak, A, Maier, R, Marklund, N, Martin, M, Melloni, I, Mendoza-Lattes, S, Meyfroidt, G, Munari, M, Napolitano, L, Okonkwo, D, Otomo, Y, Papadopoulos, M, Petr, O, Peul, W, Pudkrong, A, Qasim, Z, Rasulo, F, Reizinho, C, Ringel, F, Rizoli, S, Rostami, E, Rubiano, A, Russo, E, Sarwal, A, Schwab, J, Servadei, F, Sharma, D, Sharif, S, Shiban, E, Shutter, L, Stahel, P, Taccone, F, Terpolilli, N, Thomé, C, Toth, P, Tsitsopoulos, P, Udy, A, Vaccaro, A, Varon, A, Vavilala, M, Younsi, A, Zackova, M, Zoerle, T, Robba, C, Picetti, Edoardo, Demetriades, Andreas K., Catena, Fausto, Aarabi, Bizhan, Abu-Zidan, Fikri M., Alves, Oscar L., Ansaloni, Luca, Armonda, Rocco A., Badenes, Rafael, Bala, Miklosh, Balogh, Zsolt J., Barbanera, Andrea, Bertuccio, Alessandro, Biffl, Walter L., Bouzat, Pierre, Buki, Andras, Castano-Leon, Ana Maria, Cerasti, Davide, Citerio, Giuseppe, Coccolini, Federico, Coimbra, Raul, Coniglio, Carlo, Costa, Francesco, De Iure, Federico, Depreitere, Bart, Fainardi, Enrico, Fehlings, Michael J., Gabrovsky, Nikolay, Godoy, Daniel Agustin, Gruen, Peter, Gupta, Deepak, Hawryluk, Gregory W. J., Helbok, Raimund, Hossain, Iftakher, Hutchinson, Peter J., Iaccarino, Corrado, Inaba, Kenji, Ivanov, Marcel, Kaprovoy, Stanislav, Kirkpatrick, Andrew W., Klein, Sam, Kolias, Angelos, Konovalov, Nikolay A., Lagares, Alfonso, Lippa, Laura, Loza-Gomez, Angelica, Luoto, Teemu M., Maas, Andrew I. R., Maciejczak, Andrzej, Maier, Ronald V., Marklund, Niklas, Martin, Matthew J., Melloni, Ilaria, Mendoza-Lattes, Sergio, Meyfroidt, Geert, Munari, Marina, Napolitano, Lena M., Okonkwo, David O., Otomo, Yasuhiro, Papadopoulos, Marios C., Petr, Ondra, Peul, Wilco C., Pudkrong, Aichholz K., Qasim, Zaffer, Rasulo, Frank, Reizinho, Carla, Ringel, Florian, Rizoli, Sandro, Rostami, Elham, Rubiano, Andres M., Russo, Emanuele, Sarwal, Aarti, Schwab, Jan M., Servadei, Franco, Sharma, Deepak, Sharif, Salman, Shiban, Ehab, Shutter, Lori, Stahel, Philip F., Taccone, Fabio S., Terpolilli, Nicole A., Thomé, Claudius, Toth, Peter, Tsitsopoulos, Parmenion P., Udy, Andrew, Vaccaro, Alexander R., Varon, Albert J., Vavilala, Monica S., Younsi, Alexander, Zackova, Monika, Zoerle, Tommaso, and Robba, Chiara

Abstract

Background: The early management of polytrauma patients with traumatic spinal cord injury (tSCI) is a major challenge. Sparse data is available to provide optimal care in this scenario and worldwide variability in clinical practice has been documented in recent studies. Methods: A multidisciplinary consensus panel of physicians selected for their established clinical and scientific expertise in the acute management of tSCI polytrauma patients with different specializations was established. The World Society of Emergency Surgery (WSES) and the European Association of Neurosurgical Societies (EANS) endorsed the consensus, and a modified Delphi approach was adopted. Results: A total of 17 statements were proposed and discussed. A consensus was reached generating 17 recommendations (16 strong and 1 weak). Conclusions: This consensus provides practical recommendations to support a clinician’s decision making in the management of tSCI polytrauma patients.

Published
2024

2. Early management of adult traumatic spinal cord injury in patients with polytrauma : a consensus and clinical recommendations jointly developed by the World Society of Emergency Surgery (WSES) & the European Association of Neurosurgical Societies (EANS)

Author

Picetti, Edoardo, Demetriades, Andreas K., Catena, Fausto, Aarabi, Bizhan, Abu-Zidan, Fikri M., Alves, Oscar L., Ansaloni, Luca, Armonda, Rocco A., Badenes, Rafael, Bala, Miklosh, Balogh, Zsolt J., Barbanera, Andrea, Bertuccio, Alessandro, Biffl, Walter L., Bouzat, Pierre, Buki, Andras, Castano-Leon, Ana Maria, Cerasti, Davide, Citerio, Giuseppe, Coccolini, Federico, Coimbra, Raul, Coniglio, Carlo, Costa, Francesco, De Iure, Federico, Depreitere, Bart, Fainardi, Enrico, Fehlings, Michael J., Gabrovsky, Nikolay, Godoy, Daniel Agustin, Gruen, Peter, Gupta, Deepak, Hawryluk, Gregory W. J., Helbok, Raimund, Hossain, Iftakher, Hutchinson, Peter J., Iaccarino, Corrado, Inaba, Kenji, Ivanov, Marcel, Kaprovoy, Stanislav, Kirkpatrick, Andrew W., Klein, Sam, Kolias, Angelos, Konovalov, Nikolay A., Lagares, Alfonso, Lippa, Laura, Loza-Gomez, Angelica, Luoto, Teemu M., Maas, Andrew I. R., Maciejczak, Andrzej, Maier, Ronald, V, Marklund, Niklas, Martin, Matthew J., Melloni, Ilaria, Mendoza-Lattes, Sergio, Meyfroidt, Geert, Munari, Marina, Napolitano, Lena M., Okonkwo, David O., Otomo, Yasuhiro, Papadopoulos, Marios C., Petr, Ondra, Peul, Wilco C., Pudkrong, Aichholz K., Qasim, Zaffer, Rasulo, Frank, Reizinho, Carla, Ringel, Florian, Rizoli, Sandro, Rostami, Elham, Rubiano, Andres M., Russo, Emanuele, Sarwal, Aarti, Schwab, Jan M., Servadei, Franco, Sharma, Deepak, Sharif, Salman, Shiban, Ehab, Shutter, Lori, Stahel, Philip F., Taccone, Fabio S., Terpolilli, Nicole A., Thome, Claudius, Toth, Peter, Tsitsopoulos, Parmenion P., Udy, Andrew, Vaccaro, Alexander R., Varon, Albert J., Vavilala, Monica S., Younsi, Alexander, Zackova, Monika, Zoerle, Tommaso, Robba, Chiara, Picetti, Edoardo, Demetriades, Andreas K., Catena, Fausto, Aarabi, Bizhan, Abu-Zidan, Fikri M., Alves, Oscar L., Ansaloni, Luca, Armonda, Rocco A., Badenes, Rafael, Bala, Miklosh, Balogh, Zsolt J., Barbanera, Andrea, Bertuccio, Alessandro, Biffl, Walter L., Bouzat, Pierre, Buki, Andras, Castano-Leon, Ana Maria, Cerasti, Davide, Citerio, Giuseppe, Coccolini, Federico, Coimbra, Raul, Coniglio, Carlo, Costa, Francesco, De Iure, Federico, Depreitere, Bart, Fainardi, Enrico, Fehlings, Michael J., Gabrovsky, Nikolay, Godoy, Daniel Agustin, Gruen, Peter, Gupta, Deepak, Hawryluk, Gregory W. J., Helbok, Raimund, Hossain, Iftakher, Hutchinson, Peter J., Iaccarino, Corrado, Inaba, Kenji, Ivanov, Marcel, Kaprovoy, Stanislav, Kirkpatrick, Andrew W., Klein, Sam, Kolias, Angelos, Konovalov, Nikolay A., Lagares, Alfonso, Lippa, Laura, Loza-Gomez, Angelica, Luoto, Teemu M., Maas, Andrew I. R., Maciejczak, Andrzej, Maier, Ronald, V, Marklund, Niklas, Martin, Matthew J., Melloni, Ilaria, Mendoza-Lattes, Sergio, Meyfroidt, Geert, Munari, Marina, Napolitano, Lena M., Okonkwo, David O., Otomo, Yasuhiro, Papadopoulos, Marios C., Petr, Ondra, Peul, Wilco C., Pudkrong, Aichholz K., Qasim, Zaffer, Rasulo, Frank, Reizinho, Carla, Ringel, Florian, Rizoli, Sandro, Rostami, Elham, Rubiano, Andres M., Russo, Emanuele, Sarwal, Aarti, Schwab, Jan M., Servadei, Franco, Sharma, Deepak, Sharif, Salman, Shiban, Ehab, Shutter, Lori, Stahel, Philip F., Taccone, Fabio S., Terpolilli, Nicole A., Thome, Claudius, Toth, Peter, Tsitsopoulos, Parmenion P., Udy, Andrew, Vaccaro, Alexander R., Varon, Albert J., Vavilala, Monica S., Younsi, Alexander, Zackova, Monika, Zoerle, Tommaso, and Robba, Chiara

Abstract

Background: The early management of polytrauma patients with traumatic spinal cord injury (tSCI) is a major challenge. Sparse data is available to provide optimal care in this scenario and worldwide variability in clinical practice has been documented in recent studies. Methods: A multidisciplinary consensus panel of physicians selected for their established clinical and scientific expertise in the acute management of tSCI polytrauma patients with different specializations was established. The World Society of Emergency Surgery (WSES) and the European Association of Neurosurgical Societies (EANS) endorsed the consensus, and a modified Delphi approach was adopted. Results: A total of 17 statements were proposed and discussed. A consensus was reached generating 17 recommendations (16 strong and 1 weak). Conclusions: This consensus provides practical recommendations to support a clinician's decision making in the management of tSCI polytrauma patients.

Published
2024
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3. An international validation of the AO spine subaxial injury classification system

Author

Karamian, Brian A., Schroeder, Gregory D., Lambrechts, Mark J., Canseco, Jose A., Oner, Cumhur, Vialle, Emiliano, Rajasekaran, Shanmuganathan, Dvorak, Marcel R., Benneker, Lorin M., Kandziora, Frank, Schnake, Klaus, Kepler, Christopher K., Vaccaro, Alexander R., Rutges, Joost, Karamian, Brian A., Schroeder, Gregory D., Lambrechts, Mark J., Canseco, Jose A., Oner, Cumhur, Vialle, Emiliano, Rajasekaran, Shanmuganathan, Dvorak, Marcel R., Benneker, Lorin M., Kandziora, Frank, Schnake, Klaus, Kepler, Christopher K., Vaccaro, Alexander R., and Rutges, Joost

Abstract

Purpose: To validate the AO Spine Subaxial Injury Classification System with participants of various experience levels, subspecialties, and geographic regions. Methods: A live webinar was organized in 2020 for validation of the AO Spine Subaxial Injury Classification System. The validation consisted of 41 unique subaxial cervical spine injuries with associated computed tomography scans and key images. Intraobserver reproducibility and interobserver reliability of the AO Spine Subaxial Injury Classification System were calculated for injury morphology, injury subtype, and facet injury. The reliability and reproducibility of the classification system were categorized as slight (ƙ = 0–0.20), fair (ƙ = 0.21–0.40), moderate (ƙ = 0.41–0.60), substantial (ƙ = 0.61–0.80), or excellent (ƙ = > 0.80) as determined by the Landis and Koch classification. Results: A total of 203 AO Spine members participated in the AO Spine Subaxial Injury Classification System validation. The percent of participants accurately classifying each injury was over 90% for fracture morphology and fracture subtype on both assessments. The interobserver reliability for fracture morphology was excellent (ƙ = 0.87), while fracture subtype (ƙ = 0.80) and facet injury were substantial (ƙ = 0.74). The intraobserver reproducibility for fracture morphology and subtype were excellent (ƙ = 0.85, 0.88, respectively), while reproducibility for facet injuries was substantial (ƙ = 0.76). Conclusion: The AO Spine Subaxial Injury Classification System demonstrated excellent interobserver reliability and intraobserver reproducibility for fracture morphology, substantial reliability and reproducibility for facet injuries, and excellent reproducibility with substantial reliability for injury subtype.

Published
2023

4. An international validation of the AO spine subaxial injury classification system

Author

Karamian, Brian A, Schroeder, Gregory D, Lambrechts, Mark J; https://orcid.org/0000-0002-9106-2228, Canseco, Jose A, Oner, Cumhur, Vialle, Emiliano, Rajasekaran, Shanmuganathan, Dvorak, Marcel R, Benneker, Lorin Michael, Kandziora, Frank, Schnake, Klaus John; https://orcid.org/0000-0003-3118-0924, Kepler, Christopher K, Vaccaro, Alexander R, Karamian, Brian A, Schroeder, Gregory D, Lambrechts, Mark J; https://orcid.org/0000-0002-9106-2228, Canseco, Jose A, Oner, Cumhur, Vialle, Emiliano, Rajasekaran, Shanmuganathan, Dvorak, Marcel R, Benneker, Lorin Michael, Kandziora, Frank, Schnake, Klaus John; https://orcid.org/0000-0003-3118-0924, Kepler, Christopher K, and Vaccaro, Alexander R

Abstract

PURPOSE To validate the AO Spine Subaxial Injury Classification System with participants of various experience levels, subspecialties, and geographic regions. METHODS A live webinar was organized in 2020 for validation of the AO Spine Subaxial Injury Classification System. The validation consisted of 41 unique subaxial cervical spine injuries with associated computed tomography scans and key images. Intraobserver reproducibility and interobserver reliability of the AO Spine Subaxial Injury Classification System were calculated for injury morphology, injury subtype, and facet injury. The reliability and reproducibility of the classification system were categorized as slight (ƙ = 0-0.20), fair (ƙ = 0.21-0.40), moderate (ƙ = 0.41-0.60), substantial (ƙ = 0.61-0.80), or excellent (ƙ = > 0.80) as determined by the Landis and Koch classification. RESULTS A total of 203 AO Spine members participated in the AO Spine Subaxial Injury Classification System validation. The percent of participants accurately classifying each injury was over 90% for fracture morphology and fracture subtype on both assessments. The interobserver reliability for fracture morphology was excellent (ƙ = 0.87), while fracture subtype (ƙ = 0.80) and facet injury were substantial (ƙ = 0.74). The intraobserver reproducibility for fracture morphology and subtype were excellent (ƙ = 0.85, 0.88, respectively), while reproducibility for facet injuries was substantial (ƙ = 0.76). CONCLUSION The AO Spine Subaxial Injury Classification System demonstrated excellent interobserver reliability and intraobserver reproducibility for fracture morphology, substantial reliability and reproducibility for facet injuries, and excellent reproducibility with substantial reliability for injury subtype.

Published
2023

5. Update on Upper Cervical Injury Classifications: The New AO Upper Cervical Spine Classification System

Author

MS Orthopaedie Algemeen, Regenerative Medicine and Stem Cells, Vaccaro, Alexander R., Karamian, Brian A., Levy, Hannah A., Canseco, Jose A., Rajasekaran, Shanmuganathan, Benneker, Lorin M., Oner, F. Cumhur, Kandziora, Frank, Schnake, Klaus J., Kepler, Christopher K., Schroeder, Gregory D., MS Orthopaedie Algemeen, Regenerative Medicine and Stem Cells, Vaccaro, Alexander R., Karamian, Brian A., Levy, Hannah A., Canseco, Jose A., Rajasekaran, Shanmuganathan, Benneker, Lorin M., Oner, F. Cumhur, Kandziora, Frank, Schnake, Klaus J., Kepler, Christopher K., and Schroeder, Gregory D.

Published
2022

6. The Subaxial Cervical AO Spine Injury Score

Author

MS Orthopaedie Algemeen, Regenerative Medicine and Stem Cells, Canseco, Jose A., Schroeder, Gregory D., Paziuk, Taylor M., Karamian, Brian A., Kandziora, Frank, Vialle, Emiliano N., Oner, F. Cumhur, Schnake, Klaus J., Dvorak, Marcel F., Chapman, Jens R., Benneker, Lorin M., Rajasekaran, Shanmuganathan, Kepler, Christopher K., Vaccaro, Alexander R., MS Orthopaedie Algemeen, Regenerative Medicine and Stem Cells, Canseco, Jose A., Schroeder, Gregory D., Paziuk, Taylor M., Karamian, Brian A., Kandziora, Frank, Vialle, Emiliano N., Oner, F. Cumhur, Schnake, Klaus J., Dvorak, Marcel F., Chapman, Jens R., Benneker, Lorin M., Rajasekaran, Shanmuganathan, Kepler, Christopher K., and Vaccaro, Alexander R.

Published
2022

7. The influence of surgeon experience and subspeciality on the reliability of the AO spine sacral classification system

Author

Eurospine (2021 : Wien), Karamian, Brian, Schroeder, Gregory, Canseco, Jose, Benneker, Lorin, Kandziora, Frank, Rajasekaran, Shanmuganathan, Öner, F. Cumhur, Schnake, Klaus J., Kepler, Christopher, Vaccaro, Alexander R., Eurospine (2021 : Wien), Karamian, Brian, Schroeder, Gregory, Canseco, Jose, Benneker, Lorin, Kandziora, Frank, Rajasekaran, Shanmuganathan, Öner, F. Cumhur, Schnake, Klaus J., Kepler, Christopher, and Vaccaro, Alexander R.

Abstract

Study Design: Cross-sectional survey Objective: To determine the influence of surgeons’ level of experience and subspeciality training on the reliability, reproducibility, and accuracy of sacral fracture classification using the AO Spine Sacral Injury Classification System. Summary of Background Data: An ideal classification system is easily comprehensible and reliable amongst the diverse group of surgeons. A surgeons’ level of experience may have a significant effect on the reliability and accuracy of a classification system. Moreover, surgeons of different subspecialities may have various levels of comfort with imaging assessment of sacral injuries required for accurate diagnosis and classification. Methods: High-resolution computerized tomography (CT) images from 26 cases were assessed by 172 investigators from a diverse array of surgical subspecialities (general orthopaedics, neurosurgery, orthopaedic spine, orthopaedic trauma) and experience (<5, 5-10, 11-20, >20 years). Validation assessments were performed via web conference using high-resolution images, as well as axial/sagittal/coronal CT scan sequences. Two assessments were performed by each investigator independently three weeks apart in randomized order. Reliability and reproducibility were calculated with cohen’s kappa coefficient (k) and gold standard classification agreement was determined for each fracture morphology and subtype and stratified by experience and subspeciality. Results: Respondents achieved an overall k = 0.87 for morphology and k = 0.77 for subtype classification, representing excellent and substantial intraobserver reproducibility, respectively. Respondents from all four practice experience groups demonstrated excellent interobserver reliability when classifying overall morphology (k=0.842/0.850, Assessment 1/Assessment 2) and substantial interobserver reliability in overall subtype (k=0.719/0.751) in both assessments. General orthopaedists, neurosurgeons, and orthopaedic spine surge

Published
2021

8. Validation of the AO Spine Sacral Classification System: Reliability Among Surgeons Worldwide

Author

MS Orthopaedie Algemeen, Regenerative Medicine and Stem Cells, Schroeder, Gregory D., Karamian, Brian A., Canseco, Jose A., Vialle, Luiz R., Kandziora, Frank, Benneker, Lorin M., Rajasekaran, Shanmuganathan, Holstein, Jörg H., Schnake, Klaus J., Kurd, Mark F., Dvorak, Marcel F., Vialle, Emiliano N., Joaquim, Andrei F., Kanna, Rishi M., Fehlings, Michael, Wilson, Jefferson R., Chapman, Jens R., Krieg, James C., Kleweno, Conor P., Firoozabadi, Reza, Öner, F. Cumhur, Kepler, Christopher K., Vaccaro, Alexander R., MS Orthopaedie Algemeen, Regenerative Medicine and Stem Cells, Schroeder, Gregory D., Karamian, Brian A., Canseco, Jose A., Vialle, Luiz R., Kandziora, Frank, Benneker, Lorin M., Rajasekaran, Shanmuganathan, Holstein, Jörg H., Schnake, Klaus J., Kurd, Mark F., Dvorak, Marcel F., Vialle, Emiliano N., Joaquim, Andrei F., Kanna, Rishi M., Fehlings, Michael, Wilson, Jefferson R., Chapman, Jens R., Krieg, James C., Kleweno, Conor P., Firoozabadi, Reza, Öner, F. Cumhur, Kepler, Christopher K., and Vaccaro, Alexander R.

Published
2021

9. Surgical management of thoracolumbar burst fractures: Surgical decision-making using the AOSpine thoracolumbar injury classification score and thoracolumbar injury classification and severity score

Author

MS Orthopaedie Algemeen, Regenerative Medicine and Stem Cells, Morrissey, Patrick B., Shafi, Karim A., Wagner, Scott C., Butler, Joseph S., Kaye, Ian D., Sebastian, Arjun S., Schroeder, Gregory D., Kepler, Christopher K., Aarabi, Bizhan, Oner, Fetullah C., Vaccaro, Alexander R., MS Orthopaedie Algemeen, Regenerative Medicine and Stem Cells, Morrissey, Patrick B., Shafi, Karim A., Wagner, Scott C., Butler, Joseph S., Kaye, Ian D., Sebastian, Arjun S., Schroeder, Gregory D., Kepler, Christopher K., Aarabi, Bizhan, Oner, Fetullah C., and Vaccaro, Alexander R.

Published
2021

10. Reliability, validity and responsiveness of the Dutch version of the AOSpine PROST (Patient Reported Outcome Spine Trauma)

Author

MS Orthopaedie Algemeen, Regenerative Medicine and Stem Cells, Sadiqi, Said, Post, Marcel W., Hosman, Allard J., Dvorak, Marcel F., Chapman, Jens R., Benneker, Lorin M., Kandziora, Frank, Rajasekaran, S., Schnake, Klaus J., Vaccaro, Alexander R., Oner, F. Cumhur, MS Orthopaedie Algemeen, Regenerative Medicine and Stem Cells, Sadiqi, Said, Post, Marcel W., Hosman, Allard J., Dvorak, Marcel F., Chapman, Jens R., Benneker, Lorin M., Kandziora, Frank, Rajasekaran, S., Schnake, Klaus J., Vaccaro, Alexander R., and Oner, F. Cumhur

Published
2021

11. The Current Status of Spinal Posttraumatic Deformity: A Systematic Review

Author

Orthopaedie Opleiding, Zorgeenheid Orthopaedie Medisch, MS Orthopaedie Algemeen, Other research (not in main researchprogram), Regenerative Medicine and Stem Cells, De Gendt, Erin E A, Vercoulen, Timon F G, Joaquim, Andrei F, Guo, Wei, Vialle, Emiliano N, Schroeder, Gregory D, Schnake, Klaus S, Vaccaro, Alexander R, Benneker, Lorin Michael, Muijs, Sander P J, Oner, F Cumhur, Orthopaedie Opleiding, Zorgeenheid Orthopaedie Medisch, MS Orthopaedie Algemeen, Other research (not in main researchprogram), Regenerative Medicine and Stem Cells, De Gendt, Erin E A, Vercoulen, Timon F G, Joaquim, Andrei F, Guo, Wei, Vialle, Emiliano N, Schroeder, Gregory D, Schnake, Klaus S, Vaccaro, Alexander R, Benneker, Lorin Michael, Muijs, Sander P J, and Oner, F Cumhur

Published
2021

12. The data set development for the National Spinal Cord Injury Registry of Iran (NSCIR-IR): progress toward improving the quality of care.

Author

Azadmanjir, Zahra, Azadmanjir, Zahra, Jazayeri, Seyed Behzad, Habibi Arejan, Roya, Ghodsi, Zahra, Sharif-Alhoseini, Mahdi, Kheiri, Ghazaleh, Zendehdel, Kazem, Safdarian, Mahdi, Sadeghian, Farideh, Khazaeipour, Zahra, Naghdi, Khatereh, Arab Kheradmand, Jalil, Saadat, Soheil, Pirnejad, Habibollah, Fazel, Mohammad Reza, Fakharian, Esmail, Mohammadzadeh, Mahdi, Sadeghi-Naini, Mohsen, Saberi, Houshang, Derakhshan, Pegah, Sabour, Hadis, Benzel, Edward C, Oreilly, Gerard, Noonan, Vanessa, Vaccaro, Alexander R, Emami-Razavi, Seyed Hassan, Rahimi-Movaghar, Vafa, Azadmanjir, Zahra, Azadmanjir, Zahra, Jazayeri, Seyed Behzad, Habibi Arejan, Roya, Ghodsi, Zahra, Sharif-Alhoseini, Mahdi, Kheiri, Ghazaleh, Zendehdel, Kazem, Safdarian, Mahdi, Sadeghian, Farideh, Khazaeipour, Zahra, Naghdi, Khatereh, Arab Kheradmand, Jalil, Saadat, Soheil, Pirnejad, Habibollah, Fazel, Mohammad Reza, Fakharian, Esmail, Mohammadzadeh, Mahdi, Sadeghi-Naini, Mohsen, Saberi, Houshang, Derakhshan, Pegah, Sabour, Hadis, Benzel, Edward C, Oreilly, Gerard, Noonan, Vanessa, Vaccaro, Alexander R, Emami-Razavi, Seyed Hassan, and Rahimi-Movaghar, Vafa

Abstract

Study designDescriptive study.ObjectivesThe aim of this manuscript is to describe the development process of the data set for the National Spinal Cord Injury Registry of Iran (NSCIR-IR).SettingSCI community in Iran.MethodsThe NSCIR-IR data set was developed in 8 months, from March 2015 to October 2015. An expert panel of 14 members was formed. After a review of data sets of similar registries in developed countries, the selection and modification of the basic framework were performed over 16 meetings, based on the objectives and feasibility of the registry.ResultsThe final version of the data set was composed of 376 data elements including sociodemographic, hospital admission, injury incidence, prehospital procedures, emergency department visit, medical history, vertebral injury, spinal cord injury details, interventions, complications, and discharge data. It also includes 163 components of the International Standards for the Neurologic Classification of Spinal Cord Injury (ISNCSCI) and 65 data elements related to quality of life, pressure ulcers, pain, and spasticity.ConclusionThe NSCIR-IR data set was developed in order to meet the quality improvement objectives of the registry. The process was centered around choosing the data elements assessing care provided to individuals in the acute and chronic phases of SCI in hospital settings. The International Spinal Cord Injury Data Set was selected as a basic framework, helped by comparison with data from other countries. Expert panel modifications facilitated the implementation of the registry process with the current clinical workflow in hospitals.

Published
2020

13. A Randomized Controlled Trial of Early versus Late Surgical Decompression for Thoracic and Thoracolumbar Spinal Cord Injury in 73 Patients.

Author

Haghnegahdar, Ali, Haghnegahdar, Ali, Behjat, Reza, Saadat, Soheil, Badhiwala, Jetan, Farrokhi, Majid Reza, Niakan, Amin, Eghbal, Keyvan, Barzideh, Ehsan, Shahlaee, Abtin, Ghaffarpasand, Fariborz, Ghodsi, Zahra, Vaccaro, Alexander R, Sadeghi-Naini, Mohsen, Fehlings, Michael G, Guest, James David, Derakhshan, Pegah, Rahimi-Movaghar, Vafa, Haghnegahdar, Ali, Haghnegahdar, Ali, Behjat, Reza, Saadat, Soheil, Badhiwala, Jetan, Farrokhi, Majid Reza, Niakan, Amin, Eghbal, Keyvan, Barzideh, Ehsan, Shahlaee, Abtin, Ghaffarpasand, Fariborz, Ghodsi, Zahra, Vaccaro, Alexander R, Sadeghi-Naini, Mohsen, Fehlings, Michael G, Guest, James David, Derakhshan, Pegah, and Rahimi-Movaghar, Vafa

Abstract

Convincing clinical evidence exists to support early surgical decompression in the setting of cervical spinal cord injury (SCI). However, clinical evidence on the effect of early surgery in patients with thoracic and thoracolumbar (from T1 to L1 [T1-L1]) SCI is lacking and a critical knowledge gap remains. This randomized controlled trial (RCT) sought to evaluate the safety and efficacy of early (<24 h) compared with late (24-72 h) decompressive surgery after T1-L1 SCI. From 2010 to 2018, patients (≥16 years of age) with acute T1-L1 SCI presenting to a single trauma center were randomized to receive either early (<24 h) or late (24-72 h) surgical decompression. The primary outcome was an ordinal change in American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade at 12-month follow-up. Secondary outcomes included complications and change in ASIA motor score (AMS) at 12 months. Outcome assessors were blinded to treatment assignment. Of 73 individuals whose treatment followed the study protocol, 37 received early surgery and 36 underwent late surgery. The mean age was 29.74 ± 11.4 years. In the early group 45.9% of patients and in the late group 33.3% of patients had a ≥1-grade improvement in AIS (odds ratio [OR] 1.70, 95% confidence interval [CI]: 0.66-4.39, p = 0.271); significantly more patients in the early (24.3%) than late (5.6%) surgery group had a ≥2-grade improvement in AIS (OR 5.46, 95% CI: 1.09-27.38, p = 0.025). There was no statistically significant difference in the secondary outcome measures. Surgical decompression within 24 h of acute traumatic T1-L1 SCI is safe and is associated with improved neurological outcome, defined as at least a 2-grade improvement in AIS at 12 months.

Published
2020

14. The data set development for the National Spinal Cord Injury Registry of Iran (NSCIR-IR): progress toward improving the quality of care.

Author

Azadmanjir, Zahra, Azadmanjir, Zahra, Jazayeri, Seyed Behzad, Habibi Arejan, Roya, Ghodsi, Zahra, Sharif-Alhoseini, Mahdi, Kheiri, Ghazaleh, Zendehdel, Kazem, Safdarian, Mahdi, Sadeghian, Farideh, Khazaeipour, Zahra, Naghdi, Khatereh, Arab Kheradmand, Jalil, Saadat, Soheil, Pirnejad, Habibollah, Fazel, Mohammad Reza, Fakharian, Esmail, Mohammadzadeh, Mahdi, Sadeghi-Naini, Mohsen, Saberi, Houshang, Derakhshan, Pegah, Sabour, Hadis, Benzel, Edward C, Oreilly, Gerard, Noonan, Vanessa, Vaccaro, Alexander R, Emami-Razavi, Seyed Hassan, Rahimi-Movaghar, Vafa, Azadmanjir, Zahra, Azadmanjir, Zahra, Jazayeri, Seyed Behzad, Habibi Arejan, Roya, Ghodsi, Zahra, Sharif-Alhoseini, Mahdi, Kheiri, Ghazaleh, Zendehdel, Kazem, Safdarian, Mahdi, Sadeghian, Farideh, Khazaeipour, Zahra, Naghdi, Khatereh, Arab Kheradmand, Jalil, Saadat, Soheil, Pirnejad, Habibollah, Fazel, Mohammad Reza, Fakharian, Esmail, Mohammadzadeh, Mahdi, Sadeghi-Naini, Mohsen, Saberi, Houshang, Derakhshan, Pegah, Sabour, Hadis, Benzel, Edward C, Oreilly, Gerard, Noonan, Vanessa, Vaccaro, Alexander R, Emami-Razavi, Seyed Hassan, and Rahimi-Movaghar, Vafa

Abstract

Study designDescriptive study.ObjectivesThe aim of this manuscript is to describe the development process of the data set for the National Spinal Cord Injury Registry of Iran (NSCIR-IR).SettingSCI community in Iran.MethodsThe NSCIR-IR data set was developed in 8 months, from March 2015 to October 2015. An expert panel of 14 members was formed. After a review of data sets of similar registries in developed countries, the selection and modification of the basic framework were performed over 16 meetings, based on the objectives and feasibility of the registry.ResultsThe final version of the data set was composed of 376 data elements including sociodemographic, hospital admission, injury incidence, prehospital procedures, emergency department visit, medical history, vertebral injury, spinal cord injury details, interventions, complications, and discharge data. It also includes 163 components of the International Standards for the Neurologic Classification of Spinal Cord Injury (ISNCSCI) and 65 data elements related to quality of life, pressure ulcers, pain, and spasticity.ConclusionThe NSCIR-IR data set was developed in order to meet the quality improvement objectives of the registry. The process was centered around choosing the data elements assessing care provided to individuals in the acute and chronic phases of SCI in hospital settings. The International Spinal Cord Injury Data Set was selected as a basic framework, helped by comparison with data from other countries. Expert panel modifications facilitated the implementation of the registry process with the current clinical workflow in hospitals.

Published
2020

15. Regional and experiential differences in surgeon preference for the treatment of cervical facet injuries: a case study survey with the AO Spine Cervical Classification Validation Group

Author

Canseco, Jose A, Schroeder, Gregory D, Patel, Parthik D, Grasso, Giovanni, Chang, Michael, Kandziora, Frank, Vialle, Emiliano N, Oner, F Cumhur, Schnake, Klaus J, Dvorak, Marcel F, Chapman, Jens R, Benneker, Lorin M, Rajasekaran, Shanmuganathan, Kepler, Christopher K, Vaccaro, Alexander R, Canseco, Jose A, Schroeder, Gregory D, Patel, Parthik D, Grasso, Giovanni, Chang, Michael, Kandziora, Frank, Vialle, Emiliano N, Oner, F Cumhur, Schnake, Klaus J, Dvorak, Marcel F, Chapman, Jens R, Benneker, Lorin M, Rajasekaran, Shanmuganathan, Kepler, Christopher K, and Vaccaro, Alexander R

Abstract

PURPOSE: The management of cervical facet dislocation injuries remains controversial. The main purpose of this investigation was to identify whether a surgeon's geographic location or years in practice influences their preferred management of traumatic cervical facet dislocation injuries. METHODS: A survey was sent to 272 AO Spine members across all geographic regions and with a variety of practice experience. The survey included clinical case scenarios of cervical facet dislocation injuries and asked responders to select preferences among various diagnostic and management options. RESULTS: A total of 189 complete responses were received. Over 50% of responding surgeons in each region elected to initiate management of cervical facet dislocation injuries with an MRI, with 6 case exceptions. Overall, there was considerable agreement between American and European responders regarding management of these injuries, with only 3 cases exhibiting a significant difference. Additionally, results also exhibited considerable management agreement between those with ≤ 10 and > 10 years of practice experience, with only 2 case exceptions noted. CONCLUSION: More than half of responders, regardless of geographical location or practice experience, identified MRI as a screening imaging modality when managing cervical facet dislocation injuries, regardless of the status of the spinal cord and prior to any additional intervention. Additionally, a majority of surgeons would elect an anterior approach for the surgical management of these injuries. The study found overall agreement in management preferences of cervical facet dislocation injuries around the globe.

Published
2020

16. Implementation of a Spine-Centered Care Pathway at a Regional Academic Spine Center.

Author

Ghobrial, George M, Wilson, Jefferson, Franco, Daniel, Vogl, Kristen, Vaccaro, Alexander R, Harrop, James S, Ghobrial, George M, Wilson, Jefferson, Franco, Daniel, Vogl, Kristen, Vaccaro, Alexander R, and Harrop, James S

Abstract

Study Design: Retrospective case series. Objective: To describe the early implementation of an inpatient spinal surgery unit and measure the impact on cost and length of stay (LOS). Methods: A retrospective case review was performed for frequent spine-related diagnosis-related groups (DRGs) cared for by a dedicated multidisciplinary team: combined anterior/posterior (AP) spinal fusion with major complicating or comorbid condition (MCC), combined (AP) spinal fusion with CC, combined (AP) spinal fusion without complicating or comorbid (CC)/MCC, cervical spinal fusion with MCC, cervical spinal fusion with CC, and cervical spinal fusion without CC/MCC. Four time periods were compared: historical control, initial pathway implementation, full pathway implementation, and spine unit opening. Mean hospital LOS, mean and median total costs (USD), and ratio of costs-to-charges were analyzed. Results: The number of spine cases per interim ranged from 219 to 258. The mean overall hospital LOS and mean cost varied from 3.8 to 4.3 days for all DRGs across the time periods and was not significant. Cost also did not vary significantly throughout. Median variable cost per anterior/posterior spinal fusion procedure with a CC or MCC declined by 16 311, first with the institution of a spine pathway protocol by USD8738 and then USD7423 with the establishment of a spine care unit but did not reach significance. Conclusions: The use of a standardized, inpatient spine care pathway implemented by a multidisciplinary team may reduce the hospital length of stay and decrease overall costs.

Published
2020

17. Reliability and Validity of the English Version of the AOSpine PROST (Patient Reported Outcome Spine Trauma)

Author

RF&S Team 1 Medisch, Brain, MS Orthopaedie Algemeen, Regenerative Medicine and Stem Cells, Sadiqi, Said, Dvorak, Marcel F., Vaccaro, Alexander R., Schroeder, Gregory D., Post, Marcel W., Benneker, Lorin M., Kandziora, Frank, Rajasekaran, S., Schnake, Klaus J., Vialle, Emiliano N., Oner, F. Cumhur, RF&S Team 1 Medisch, Brain, MS Orthopaedie Algemeen, Regenerative Medicine and Stem Cells, Sadiqi, Said, Dvorak, Marcel F., Vaccaro, Alexander R., Schroeder, Gregory D., Post, Marcel W., Benneker, Lorin M., Kandziora, Frank, Rajasekaran, S., Schnake, Klaus J., Vialle, Emiliano N., and Oner, F. Cumhur

Published
2020

18. Description and Reliability of the AOSpine Sacral Classification System

Author

MS Orthopaedie Algemeen, Regenerative Medicine and Stem Cells, Other research (not in main researchprogram), Vaccaro, Alexander R., Schroeder, Gregory D., Divi, Srikanth N., Kepler, Christopher K., Kleweno, Conor P., Krieg, James C., Wilson, Jefferson R., Holstein, Jörg H., Kurd, Mark F., Firoozabadi, Reza, Vialle, Luiz R., Oner, F. Cumhur, Kandziora, Frank, Chapman, Jens R., Schnake, Klaus J., Benneker, Lorin M., Dvorak, Marcel F., Rajasekaran, Shanmuganathan, Vialle, Emiliano N., Joaquim, Andrei F., El-Sharkawi, Mohammad Mostafa, Dhakal, Gaurav R., Popescu, Eugen C., Kanna, Rishi M., Muijs, S. P.J., Tee, Jin W., Bellabarba, Carlo, MS Orthopaedie Algemeen, Regenerative Medicine and Stem Cells, Other research (not in main researchprogram), Vaccaro, Alexander R., Schroeder, Gregory D., Divi, Srikanth N., Kepler, Christopher K., Kleweno, Conor P., Krieg, James C., Wilson, Jefferson R., Holstein, Jörg H., Kurd, Mark F., Firoozabadi, Reza, Vialle, Luiz R., Oner, F. Cumhur, Kandziora, Frank, Chapman, Jens R., Schnake, Klaus J., Benneker, Lorin M., Dvorak, Marcel F., Rajasekaran, Shanmuganathan, Vialle, Emiliano N., Joaquim, Andrei F., El-Sharkawi, Mohammad Mostafa, Dhakal, Gaurav R., Popescu, Eugen C., Kanna, Rishi M., Muijs, S. P.J., Tee, Jin W., and Bellabarba, Carlo

Published
2020

19. Development and reliability of the AOSpine CROST (Clinician Reported Outcome Spine Trauma): a tool to evaluate and predict outcomes from clinician’s perspective

Author

Orthopaedie Opleiding, MS Orthopaedie Algemeen, Other research (not in main researchprogram), Regenerative Medicine and Stem Cells, Sadiqi, Said, Muijs, Sander P.J., Renkens, Jeroen J.M., Post, Marcel W., Benneker, Lorin M., Chapman, Jens R., Kandziora, Frank, Schnake, Klaus J., Vialle, Emiliano N., Vaccaro, Alexander R., Oner, F. Cumhur, Orthopaedie Opleiding, MS Orthopaedie Algemeen, Other research (not in main researchprogram), Regenerative Medicine and Stem Cells, Sadiqi, Said, Muijs, Sander P.J., Renkens, Jeroen J.M., Post, Marcel W., Benneker, Lorin M., Chapman, Jens R., Kandziora, Frank, Schnake, Klaus J., Vialle, Emiliano N., Vaccaro, Alexander R., and Oner, F. Cumhur

Published
2020

20. Does Riluzole Influence Bone Formation? : An In Vitro Study of Human Mesenchymal Stromal Cells and Osteoblast

Author

Schroeder, Gregory D., Kepler, Christopher K., Grad, Sibylle, Alini, Mauro, Fang, Taolin, Markova, Dessislava Z., Koerner, John D., Rajasekaran, Shanmuganathan, Chapman, Jens, Kandziora, Frank, Schnake, Klaus J., Dvorak, Marcel F., Oner, F. Cumhur, Vaccaro, Alexander R., Schroeder, Gregory D., Kepler, Christopher K., Grad, Sibylle, Alini, Mauro, Fang, Taolin, Markova, Dessislava Z., Koerner, John D., Rajasekaran, Shanmuganathan, Chapman, Jens, Kandziora, Frank, Schnake, Klaus J., Dvorak, Marcel F., Oner, F. Cumhur, and Vaccaro, Alexander R.

Published
2019

21. Does Riluzole Influence Bone Formation? : An In Vitro Study of Human Mesenchymal Stromal Cells and Osteoblast

Author

Schroeder, Gregory D., Kepler, Christopher K., Grad, Sibylle, Alini, Mauro, Fang, Taolin, Markova, Dessislava Z., Koerner, John D., Rajasekaran, Shanmuganathan, Chapman, Jens, Kandziora, Frank, Schnake, Klaus J., Dvorak, Marcel F., Oner, F. Cumhur, Vaccaro, Alexander R., Schroeder, Gregory D., Kepler, Christopher K., Grad, Sibylle, Alini, Mauro, Fang, Taolin, Markova, Dessislava Z., Koerner, John D., Rajasekaran, Shanmuganathan, Chapman, Jens, Kandziora, Frank, Schnake, Klaus J., Dvorak, Marcel F., Oner, F. Cumhur, and Vaccaro, Alexander R.

Published
2019

22. Does Riluzole Influence Bone Formation? : An In Vitro Study of Human Mesenchymal Stromal Cells and Osteoblast

Author

Schroeder, Gregory D., Kepler, Christopher K., Grad, Sibylle, Alini, Mauro, Fang, Taolin, Markova, Dessislava Z., Koerner, John D., Rajasekaran, Shanmuganathan, Chapman, Jens, Kandziora, Frank, Schnake, Klaus J., Dvorak, Marcel F., Oner, F. Cumhur, Vaccaro, Alexander R., Schroeder, Gregory D., Kepler, Christopher K., Grad, Sibylle, Alini, Mauro, Fang, Taolin, Markova, Dessislava Z., Koerner, John D., Rajasekaran, Shanmuganathan, Chapman, Jens, Kandziora, Frank, Schnake, Klaus J., Dvorak, Marcel F., Oner, F. Cumhur, and Vaccaro, Alexander R.

Published
2019

23. Does Riluzole Influence Bone Formation?: An In Vitro Study of Human Mesenchymal Stromal Cells and Osteoblast

Author

MS Orthopaedie Algemeen, Regenerative Medicine and Stem Cells, Schroeder, Gregory D., Kepler, Christopher K., Grad, Sibylle, Alini, Mauro, Fang, Taolin, Markova, Dessislava Z., Koerner, John D., Rajasekaran, Shanmuganathan, Chapman, Jens, Kandziora, Frank, Schnake, Klaus J., Dvorak, Marcel F., Oner, F. Cumhur, Vaccaro, Alexander R., MS Orthopaedie Algemeen, Regenerative Medicine and Stem Cells, Schroeder, Gregory D., Kepler, Christopher K., Grad, Sibylle, Alini, Mauro, Fang, Taolin, Markova, Dessislava Z., Koerner, John D., Rajasekaran, Shanmuganathan, Chapman, Jens, Kandziora, Frank, Schnake, Klaus J., Dvorak, Marcel F., Oner, F. Cumhur, and Vaccaro, Alexander R.

Published
2019

24. Rho Inhibitor VX-210 in Acute Traumatic Subaxial Cervical Spinal Cord Injury: Design of the SPinal Cord Injury Rho INhibition InvestiGation (SPRING) Clinical Trial.

Author

Fehlings, Michael G, Fehlings, Michael G, Kim, Kee D, Aarabi, Bizhan, Rizzo, Marco, Bond, Lisa M, McKerracher, Lisa, Vaccaro, Alexander R, Okonkwo, David O, Fehlings, Michael G, Fehlings, Michael G, Kim, Kee D, Aarabi, Bizhan, Rizzo, Marco, Bond, Lisa M, McKerracher, Lisa, Vaccaro, Alexander R, and Okonkwo, David O

Abstract

Traumatic spinal cord injury (SCI) is associated with a lifetime of disability stemming from loss of motor, sensory, and autonomic functions; these losses, along with increased comorbid sequelae, negatively impact health outcomes and quality of life. Early decompression surgery post-SCI can enhance patient outcomes, but does not directly facilitate neural repair and regeneration. Currently, there are no U.S. Food and Drug Administration-approved pharmacological therapies to augment motor function and functional recovery in individuals with traumatic SCI. After an SCI, the enzyme, Rho, is activated by growth-inhibitory factors and regulates events that culminate in collapse of the neuronal growth cone, failure of axonal regeneration, and, ultimately, failure of motor and functional recovery. Inhibition of Rho activation is a potential treatment for injuries such as traumatic SCI. VX-210, an investigational agent, inhibits Rho. When administered extradurally after decompression (corpectomy or laminectomy) and stabilization surgery in a phase 1/2a study, VX-210 was well tolerated. Here, we describe the design of the SPRING trial, a multicenter, phase 2b/3, randomized, double-blind, placebo-controlled clinical trial to evaluate the efficacy and safety of VX-210 (NCT02669849). A subset of patients with acute traumatic cervical SCI is currently being enrolled in the United States and Canada. Medical, neurological, and functional changes are evaluated at 6 weeks and at 3, 6, and 12 months after VX-210 administration. Efficacy will be assessed by the primary outcome measure, change in upper extremity motor score at 6 months post-treatment, and by secondary outcomes that include question-based and task-based evaluations of functional recovery.

Published
2018

25. Quantitative Assessment of the Anatomical Footprint of the C1 Pedicle Relative to the Lateral Mass: A Guide for C1 Lateral Mass Fixation.

Author

Su, Brian W, Su, Brian W, Theologis, Alexander A, Byers, Robert H, Shimer, Adam L, Schroeder, Gregory D, Vaccaro, Alexander R, Tay, Bobby, Su, Brian W, Su, Brian W, Theologis, Alexander A, Byers, Robert H, Shimer, Adam L, Schroeder, Gregory D, Vaccaro, Alexander R, and Tay, Bobby

Abstract

Study designAnatomic study.ObjectivesTo determine the relationship of the anatomical footprint of the C1 pedicle relative to the lateral mass (LM).MethodsAnatomic measurements were made on fresh frozen human cadaveric C1 specimens: pedicle width/height, LM width/height (minimum/maximum), LM depth, distance between LM's medial aspect and pedicle's medial border, distance between LM's lateral aspect to pedicle's lateral border, distance between pedicle's inferior aspect and LM's inferior border, distance between arch's midline and pedicle's medial border. The percentage of LM medial to the pedicle and the distance from the center of the LM to the pedicle's medial wall were calculated.ResultsA total of 42 LM were analyzed. The C1 pedicle's lateral aspect was nearly confluent with the LM's lateral border. Average pedicle width was 9.0 ± 1.1 mm, and average pedicle height was 5.0 ± 1.1 mm. Average LM width and depth were 17.0 ± 1.6 and 17.2 ± 1.6 mm, respectively. There was 6.9 ± 1.5 mm of bone medial to the medial C1 pedicle, which constituted 41% ± 9% of the LM's width. The distance from C1 arch's midline to the medial pedicle was 13.5 ± 2.0 mm. The LM's center was 1.6 ± 1 mm lateral to the medial pedicle wall. There was on average 3.5 ± 0.6 mm of the LM inferior to the pedicle inferior border.ConclusionsThe center of the lateral mass is 1.6 ± 1 mm lateral to the medial wall of the C1 pedicle and approximately 15 mm from the midline. There is 6.9 ± 1.5 mm of bone medial to the medial C1 pedicle. Thus, the medial aspect of C1 pedicle may be used as an anatomic reference for locating the center of the C1 LM for screw fixation.

Published
2018

26. Rho Inhibitor VX-210 in Acute Traumatic Subaxial Cervical Spinal Cord Injury: Design of the SPinal Cord Injury Rho INhibition InvestiGation (SPRING) Clinical Trial.

Author

Fehlings, Michael G, Fehlings, Michael G, Kim, Kee D, Aarabi, Bizhan, Rizzo, Marco, Bond, Lisa M, McKerracher, Lisa, Vaccaro, Alexander R, Okonkwo, David O, Fehlings, Michael G, Fehlings, Michael G, Kim, Kee D, Aarabi, Bizhan, Rizzo, Marco, Bond, Lisa M, McKerracher, Lisa, Vaccaro, Alexander R, and Okonkwo, David O

Abstract

Traumatic spinal cord injury (SCI) is associated with a lifetime of disability stemming from loss of motor, sensory, and autonomic functions; these losses, along with increased comorbid sequelae, negatively impact health outcomes and quality of life. Early decompression surgery post-SCI can enhance patient outcomes, but does not directly facilitate neural repair and regeneration. Currently, there are no U.S. Food and Drug Administration-approved pharmacological therapies to augment motor function and functional recovery in individuals with traumatic SCI. After an SCI, the enzyme, Rho, is activated by growth-inhibitory factors and regulates events that culminate in collapse of the neuronal growth cone, failure of axonal regeneration, and, ultimately, failure of motor and functional recovery. Inhibition of Rho activation is a potential treatment for injuries such as traumatic SCI. VX-210, an investigational agent, inhibits Rho. When administered extradurally after decompression (corpectomy or laminectomy) and stabilization surgery in a phase 1/2a study, VX-210 was well tolerated. Here, we describe the design of the SPRING trial, a multicenter, phase 2b/3, randomized, double-blind, placebo-controlled clinical trial to evaluate the efficacy and safety of VX-210 (NCT02669849). A subset of patients with acute traumatic cervical SCI is currently being enrolled in the United States and Canada. Medical, neurological, and functional changes are evaluated at 6 weeks and at 3, 6, and 12 months after VX-210 administration. Efficacy will be assessed by the primary outcome measure, change in upper extremity motor score at 6 months post-treatment, and by secondary outcomes that include question-based and task-based evaluations of functional recovery.

Published
2018

27. Quantitative Assessment of the Anatomical Footprint of the C1 Pedicle Relative to the Lateral Mass: A Guide for C1 Lateral Mass Fixation.

Author

Su, Brian W, Su, Brian W, Theologis, Alexander A, Byers, Robert H, Shimer, Adam L, Schroeder, Gregory D, Vaccaro, Alexander R, Tay, Bobby, Su, Brian W, Su, Brian W, Theologis, Alexander A, Byers, Robert H, Shimer, Adam L, Schroeder, Gregory D, Vaccaro, Alexander R, and Tay, Bobby

Abstract

Study designAnatomic study.ObjectivesTo determine the relationship of the anatomical footprint of the C1 pedicle relative to the lateral mass (LM).MethodsAnatomic measurements were made on fresh frozen human cadaveric C1 specimens: pedicle width/height, LM width/height (minimum/maximum), LM depth, distance between LM's medial aspect and pedicle's medial border, distance between LM's lateral aspect to pedicle's lateral border, distance between pedicle's inferior aspect and LM's inferior border, distance between arch's midline and pedicle's medial border. The percentage of LM medial to the pedicle and the distance from the center of the LM to the pedicle's medial wall were calculated.ResultsA total of 42 LM were analyzed. The C1 pedicle's lateral aspect was nearly confluent with the LM's lateral border. Average pedicle width was 9.0 ± 1.1 mm, and average pedicle height was 5.0 ± 1.1 mm. Average LM width and depth were 17.0 ± 1.6 and 17.2 ± 1.6 mm, respectively. There was 6.9 ± 1.5 mm of bone medial to the medial C1 pedicle, which constituted 41% ± 9% of the LM's width. The distance from C1 arch's midline to the medial pedicle was 13.5 ± 2.0 mm. The LM's center was 1.6 ± 1 mm lateral to the medial pedicle wall. There was on average 3.5 ± 0.6 mm of the LM inferior to the pedicle inferior border.ConclusionsThe center of the lateral mass is 1.6 ± 1 mm lateral to the medial wall of the C1 pedicle and approximately 15 mm from the midline. There is 6.9 ± 1.5 mm of bone medial to the medial C1 pedicle. Thus, the medial aspect of C1 pedicle may be used as an anatomic reference for locating the center of the C1 LM for screw fixation.

Published
2018

28. Development of the AOSpine Patient Reported Outcome Spine Trauma (AOSpine PROST) : a universal disease-specific outcome instrument for individuals with traumatic spinal column injury

Author

Sadiqi, S, Lehr, A Mechteld, Post, Marcel W, Dvorak, Marcel F, Kandziora, Frank, Rajasekaran, S, Schnake, Klaus J, Vaccaro, Alexander R, Oner, F Cumhur, Sadiqi, S, Lehr, A Mechteld, Post, Marcel W, Dvorak, Marcel F, Kandziora, Frank, Rajasekaran, S, Schnake, Klaus J, Vaccaro, Alexander R, and Oner, F Cumhur

Published
2017

29. Development of the AOSpine Patient Reported Outcome Spine Trauma (AOSpine PROST) : a universal disease-specific outcome instrument for individuals with traumatic spinal column injury

Author

Sadiqi, S, Lehr, A Mechteld, Post, Marcel W, Dvorak, Marcel F, Kandziora, Frank, Rajasekaran, S, Schnake, Klaus J, Vaccaro, Alexander R, Oner, F Cumhur, Sadiqi, S, Lehr, A Mechteld, Post, Marcel W, Dvorak, Marcel F, Kandziora, Frank, Rajasekaran, S, Schnake, Klaus J, Vaccaro, Alexander R, and Oner, F Cumhur

Published
2017

30. Development of the AOSpine Patient Reported Outcome Spine Trauma (AOSpine PROST): a universal disease-specific outcome instrument for individuals with traumatic spinal column injury

Author

Orthopaedie Onderzoek, MS Orthopaedie Algemeen, MS Orthopaedie Spine, Regenerative Medicine and Stem Cells, Sadiqi, S, Lehr, A Mechteld, Post, Marcel W, Dvorak, Marcel F, Kandziora, Frank, Rajasekaran, S, Schnake, Klaus J, Vaccaro, Alexander R, Oner, F Cumhur, Orthopaedie Onderzoek, MS Orthopaedie Algemeen, MS Orthopaedie Spine, Regenerative Medicine and Stem Cells, Sadiqi, S, Lehr, A Mechteld, Post, Marcel W, Dvorak, Marcel F, Kandziora, Frank, Rajasekaran, S, Schnake, Klaus J, Vaccaro, Alexander R, and Oner, F Cumhur

Published
2017

31. A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Role of Baseline Magnetic Resonance Imaging in Clinical Decision Making and Outcome Prediction

Author

Fehlings, Michael G., Martin, Allan R., Tetreault, Lindsay A., Aarabi, Bizhan, Anderson, Paul, Arnold, Paul M., Brodke, Darrel, Burns, Anthony S., Chiba, Kazuhiro, Dettori, Joseph R., Furlan, Julio C., Hawryluk, Gregory, Holly, Langston T., Howley, Susan, Jeji, Tara, Kalsi-Ryan, Sukhvinder, Kotter, Mark, Kurpad, Shekar, Kwon, Brian K., Marino, Ralph J., Massicotte, Eric, Merli, Geno J., Middleton, James W., Nakashima, Hiroaki, Nagoshi, Narihito, Palmieri, Katherine, Singh, Anoushka, Skelly, Andrea C., Tsai, Eve C., Vaccaro, Alexander R., Wilson, Jefferson R., Yee, Albert, Harrop, James, Fehlings, Michael G., Martin, Allan R., Tetreault, Lindsay A., Aarabi, Bizhan, Anderson, Paul, Arnold, Paul M., Brodke, Darrel, Burns, Anthony S., Chiba, Kazuhiro, Dettori, Joseph R., Furlan, Julio C., Hawryluk, Gregory, Holly, Langston T., Howley, Susan, Jeji, Tara, Kalsi-Ryan, Sukhvinder, Kotter, Mark, Kurpad, Shekar, Kwon, Brian K., Marino, Ralph J., Massicotte, Eric, Merli, Geno J., Middleton, James W., Nakashima, Hiroaki, Nagoshi, Narihito, Palmieri, Katherine, Singh, Anoushka, Skelly, Andrea C., Tsai, Eve C., Vaccaro, Alexander R., Wilson, Jefferson R., Yee, Albert, and Harrop, James

Abstract

Introduction: The objective of this guideline is to outline the role of magnetic resonance imaging (MRI) in clinical decision making and outcome prediction in patients with traumatic spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions related to the use of MRI in patients with traumatic SCI. This review focused on longitudinal studies that controlled for baseline neurologic status. A multidisciplinary Guideline Development Group (GDG) used this information, their clinical expertise, and patient input to develop recommendations on the use of MRI for SCI patients. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as “we recommend,” whereas a weaker recommendation is indicated by “we suggest.” Results: Based on the limited available evidence and the clinical expertise of the GDG, our recommendations were: (1) “We suggest that MRI be performed in adult patients with acute SCI prior to surgical intervention, when feasible, to facilitate improved clinical decision-making” (quality of evidence, very low) and (2) “We suggest that MRI should be performed in adult patients in the acute period following SCI, before or after surgical intervention, to improve prediction of neurologic outcome” (quality of evidence, low). Conclusions: These guidelines should be implemented into clinical practice to improve outcomes and prognostication for patients with SCI. © 2017, © The Author(s) 2017.

Published
2017

32. A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Type and Timing of Anticoagulant Thromboprophylaxis

Author

Fehlings, Michael G., Tetreault, Lindsay A., Aarabi, Bizhan, Anderson, Paul, Arnold, Paul M., Brodke, Darrel S., Burns, Anthony S., Chiba, Kazuhiro, Dettori, Joseph R., Furlan, Julio C., Hawryluk, Gregory, Holly, Langston T., Howley, Susan, Jeji, Tara, Kalsi-Ryan, Sukhvinder, Kotter, Mark, Kurpad, Shekar, Kwon, Brian K., Marino, Ralph J., Martin, Allan R., Massicotte, Eric, Merli, Geno J., Middleton, James W., Nakashima, Hiroaki, Nagoshi, Narihito, Palmieri, Katherine, Singh, Anoushka, Skelly, Andrea C., Tsai, Eve C., Vaccaro, Alexander R., Wilson, Jefferson R., Yee, Albert, Harrop, James, Fehlings, Michael G., Tetreault, Lindsay A., Aarabi, Bizhan, Anderson, Paul, Arnold, Paul M., Brodke, Darrel S., Burns, Anthony S., Chiba, Kazuhiro, Dettori, Joseph R., Furlan, Julio C., Hawryluk, Gregory, Holly, Langston T., Howley, Susan, Jeji, Tara, Kalsi-Ryan, Sukhvinder, Kotter, Mark, Kurpad, Shekar, Kwon, Brian K., Marino, Ralph J., Martin, Allan R., Massicotte, Eric, Merli, Geno J., Middleton, James W., Nakashima, Hiroaki, Nagoshi, Narihito, Palmieri, Katherine, Singh, Anoushka, Skelly, Andrea C., Tsai, Eve C., Vaccaro, Alexander R., Wilson, Jefferson R., Yee, Albert, and Harrop, James

Abstract

Introduction: The objective of this study is to develop evidence-based guidelines that recommend effective, safe and cost-effective thromboprophylaxis strategies in patients with spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions relating to thromboprophylaxis in SCI. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as “we recommend,” whereas a weaker recommendation is indicated by “we suggest.” Results: Based on conclusions from the systematic review and expert panel opinion, the following recommendations were developed: (1) “We suggest that anticoagulant thromboprophylaxis be offered routinely to reduce the risk of thromboembolic events in the acute period after SCI;” (2) “We suggest that anticoagulant thromboprophylaxis, consisting of either subcutaneous low-molecular-weight heparin or fixed, low-dose unfractionated heparin (UFH) be offered to reduce the risk of thromboembolic events in the acute period after SCI. Given the potential for increased bleeding events with the use of adjusted-dose UFH, we suggest against this option;” (3) “We suggest commencing anticoagulant thromboprophylaxis within the first 72 hours after injury, if possible, in order to minimize the risk of venous thromboembolic complications during the period of acute hospitalization.” Conclusions: These guidelines should be implemented into clinical practice in patients with SCI to promote standardization of care, decrease heterogeneity of management strategies and encourage clinicians to make evidence-informed decisions. © 2017, © The Author(s) 2017.

Published
2017

33. A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury and Central Cord Syndrome: Recommendations on the Timing (≤24 Hours Versus >24 Hours) of Decompressive Surgery

Author

Fehlings, Michael G., Tetreault, Lindsay A., Wilson, Jefferson R., Aarabi, Bizhan, Anderson, Paul, Arnold, Paul M., Brodke, Darrel S., Burns, Anthony S., Chiba, Kazuhiro, Dettori, Joseph R., Furlan, Julio C., Hawryluk, Gregory, Holly, Langston T., Howley, Susan, Jeji, Tara, Kalsi-Ryan, Sukhvinder, Kotter, Mark, Kurpad, Shekar, Marino, Ralph J., Martin, Allan R., Massicotte, Eric, Merli, Geno J., Middleton, James W., Nakashima, Hiroaki, Nagoshi, Narihito, Palmieri, Katherine, Singh, Anoushka, Skelly, Andrea C., Tsai, Eve C., Vaccaro, Alexander R., Yee, Albert, Harrop, James S., Fehlings, Michael G., Tetreault, Lindsay A., Wilson, Jefferson R., Aarabi, Bizhan, Anderson, Paul, Arnold, Paul M., Brodke, Darrel S., Burns, Anthony S., Chiba, Kazuhiro, Dettori, Joseph R., Furlan, Julio C., Hawryluk, Gregory, Holly, Langston T., Howley, Susan, Jeji, Tara, Kalsi-Ryan, Sukhvinder, Kotter, Mark, Kurpad, Shekar, Marino, Ralph J., Martin, Allan R., Massicotte, Eric, Merli, Geno J., Middleton, James W., Nakashima, Hiroaki, Nagoshi, Narihito, Palmieri, Katherine, Singh, Anoushka, Skelly, Andrea C., Tsai, Eve C., Vaccaro, Alexander R., Yee, Albert, and Harrop, James S.

Abstract

Objective: To develop recommendations on the timing of surgical decompression in patients with traumatic spinal cord injury (SCI) and central cord syndrome. Methods: A systematic review of the literature was conducted to address key relevant questions. A multidisciplinary guideline development group used this information, along with their clinical expertise, to develop recommendations for the timing of surgical decompression in patients with SCI and central cord syndrome. Based on GRADE, a strong recommendation is worded as “we recommend,” whereas a weak recommendation is presented as “we suggest.” Results: Conclusions from the systematic review included (1) isolated studies reported statistically significant and clinically important improvements following early decompression at 6 months and following discharge from inpatient rehabilitation; (2) in one study on acute central cord syndrome without instability, a marginally significant improvement in total motor scores was reported at 6 and 12 months in patients managed with early versus late surgery; and (3) there were no significant differences in length of acute care/rehabilitation stay or in rates of complications between treatment groups. Our recommendations were: “We suggest that early surgery be considered as a treatment option in adult patients with traumatic central cord syndrome” and “We suggest that early surgery be offered as an option for adult acute SCI patients regardless of level.” Quality of evidence for both recommendations was considered low. Conclusions: These guidelines should be implemented into clinical practice to improve outcomes in patients with acute SCI and central cord syndrome by promoting standardization of care, decreasing the heterogeneity of management strategies, and encouraging clinicians to make evidence-informed decisions. © 2017, © The Author(s) 2017.

Published
2017

34. A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Use of Methylprednisolone Sodium Succinate

Author

Fehlings, Michael G., Wilson, Jefferson R., Tetreault, Lindsay A., Aarabi, Bizhan, Anderson, Paul A., Arnold, Paul M., Brodke, Darrel S., Burns, Anthony S., Chiba, Kazuhiro, Dettori, Joseph R., Furlan, Julio C., Hawryluk, Gregory W., Holly, Langston T., Howley, Susan, Jeji, Tara, Kalsi-Ryan, Sukhvinder, Kotter, Mark R., Kurpad, Shekar N., Kwon, Brian, Marino, Ralph J., Martin, Allan R., Massicotte, Eric M., Merli, Geno J., Middleton, James W., Nakashima, Hiroaki, Nagoshi, Narihito, Palmieri, Katherine, Skelly, Andrea C., Singh, Anoushka, Tsai, Eve, Vaccaro, Alexander R., Yee, Albert, Harrop, James S., Fehlings, Michael G., Wilson, Jefferson R., Tetreault, Lindsay A., Aarabi, Bizhan, Anderson, Paul A., Arnold, Paul M., Brodke, Darrel S., Burns, Anthony S., Chiba, Kazuhiro, Dettori, Joseph R., Furlan, Julio C., Hawryluk, Gregory W., Holly, Langston T., Howley, Susan, Jeji, Tara, Kalsi-Ryan, Sukhvinder, Kotter, Mark R., Kurpad, Shekar N., Kwon, Brian, Marino, Ralph J., Martin, Allan R., Massicotte, Eric M., Merli, Geno J., Middleton, James W., Nakashima, Hiroaki, Nagoshi, Narihito, Palmieri, Katherine, Skelly, Andrea C., Singh, Anoushka, Tsai, Eve, Vaccaro, Alexander R., Yee, Albert, and Harrop, James S.

Abstract

Introduction: The objective of this guideline is to outline the appropriate use of methylprednisolone sodium succinate (MPSS) in patients with acute spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions related to the use of MPSS in acute SCI. A multidisciplinary Guideline Development Group used this information, in combination with their clinical expertise, to develop recommendations for the use of MPSS. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as “we recommend,” whereas a weaker recommendation is indicated by “we suggest.” Results: The main conclusions from the systematic review included the following: (1) there were no differences in motor score change at any time point in patients treated with MPSS compared to those not receiving steroids; (2) when MPSS was administered within 8 hours of injury, pooled results at 6- and 12-months indicated modest improvements in mean motor scores in the MPSS group compared with the control group; and (3) there was no statistical difference between treatment groups in the risk of complications. Our recommendations were: (1) “We suggest not offering a 24-hour infusion of high-dose MPSS to adult patients who present after 8 hours with acute SCI”; (2) “We suggest a 24-hour infusion of high-dose MPSS be offered to adult patients within 8 hours of acute SCI as a treatment option”; and (3) “We suggest not offering a 48-hour infusion of high-dose MPSS to adult patients with acute SCI.” Conclusions: These guidelines should be implemented into clinical practice to improve outcomes and reduce morbidity in SCI patients. © 2017, © The Author(s) 2017.

Published
2017

35. A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Type and Timing of Rehabilitation

Author

Fehlings, Michael G., Tetreault, Lindsay A., Aarabi, Bizhan, Anderson, Paul, Arnold, Paul M., Brodke, Darrel S., Chiba, Kazuhiro, Dettori, Joseph R., Furlan, Julio C., Harrop, James, Hawryluk, Gregory, Holly, Langston T., Howley, Susan, Jeji, Tara, Kalsi-Ryan, Sukhvinder, Kotter, Mark, Kurpad, Shekar, Kwon, Brian K., Marino, Ralph J., Martin, Allan R., Massicotte, Eric, Merli, Geno J., Middleton, James W., Nakashima, Hiroaki, Nagoshi, Narihito, Palmieri, Katherine, Singh, Anoushka, Skelly, Andrea C., Tsai, Eve C., Vaccaro, Alexander R., Wilson, Jefferson R., Yee, Albert, Burns, Anthony S., Fehlings, Michael G., Tetreault, Lindsay A., Aarabi, Bizhan, Anderson, Paul, Arnold, Paul M., Brodke, Darrel S., Chiba, Kazuhiro, Dettori, Joseph R., Furlan, Julio C., Harrop, James, Hawryluk, Gregory, Holly, Langston T., Howley, Susan, Jeji, Tara, Kalsi-Ryan, Sukhvinder, Kotter, Mark, Kurpad, Shekar, Kwon, Brian K., Marino, Ralph J., Martin, Allan R., Massicotte, Eric, Merli, Geno J., Middleton, James W., Nakashima, Hiroaki, Nagoshi, Narihito, Palmieri, Katherine, Singh, Anoushka, Skelly, Andrea C., Tsai, Eve C., Vaccaro, Alexander R., Wilson, Jefferson R., Yee, Albert, and Burns, Anthony S.

Abstract

Introduction: The objective of this study is to develop guidelines that outline the appropriate type and timing of rehabilitation in patients with acute spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions related to rehabilitation in patients with acute SCI. A multidisciplinary guideline development group used this information, and their clinical expertise, to develop recommendations for the type and timing of rehabilitation. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as “we recommend,” whereas a weaker recommendation is indicated by “we suggest. Results: Based on the findings from the systematic review, our recommendations were: (1) We suggest rehabilitation be offered to patients with acute spinal cord injury when they are medically stable and can tolerate required rehabilitation intensity (no included studies; expert opinion); (2) We suggest body weight–supported treadmill training as an option for ambulation training in addition to conventional overground walking, dependent on resource availability, context, and local expertise (low evidence); (3) We suggest that individuals with acute and subacute cervical SCI be offered functional electrical stimulation as an option to improve hand and upper extremity function (low evidence); and (4) Based on the absence of any clear benefit, we suggest not offering additional training in unsupported sitting beyond what is currently incorporated in standard rehabilitation (low evidence). Conclusions: These guidelines should be implemented into clinical practice to improve outcomes and reduce morbidity in patients with SCI by promoting standardization of care, decreasing the heterogeneity of management strategies and encouraging clinicians to make evidence-informed decisions. © 2017, © The Author(s) 2017.

Published
2017

36. Toward the development of a universal outcome instrument for spine trauma : A systematic review and content comparison of outcome measures used in spine trauma research using the ICF as reference

Author

Oner, F. Cumhur, Jacobs, Wilco C H, Lehr, A. Mechteld, Sadiqi, Said, Post, Marcel W., Aarabi, Bizhan, Chapman, Jens R., Dvorak, Marcel F., Fehlings, Michael G., Kandziora, Frank, Rajasekaran, S., Vaccaro, Alexander R., Oner, F. Cumhur, Jacobs, Wilco C H, Lehr, A. Mechteld, Sadiqi, Said, Post, Marcel W., Aarabi, Bizhan, Chapman, Jens R., Dvorak, Marcel F., Fehlings, Michael G., Kandziora, Frank, Rajasekaran, S., and Vaccaro, Alexander R.

Published
2016

37. Outcomes and National Trends for the Surgical Treatment of Lumbar Spine Trauma.

Author

Drazin, Doniel, Drazin, Doniel, Nuno, Miriam, Shweikeh, Faris, Vaccaro, Alexander R, Baron, Eli, Kim, Terrence T, Johnson, J Patrick, Drazin, Doniel, Drazin, Doniel, Nuno, Miriam, Shweikeh, Faris, Vaccaro, Alexander R, Baron, Eli, Kim, Terrence T, and Johnson, J Patrick

Abstract

Introduction. Operative treatment of lumbar spine compression fractures includes fusion and/or cement augmentation. Our aim was to evaluate postoperative differences in patients treated surgically with fusion, vertebroplasty, or kyphoplasty. Methods. The Nationwide Inpatient Sample Database search for adult vertebral compression fracture patients treated 2004-2011 identified 102,316 surgical patients: 30.6% underwent spinal fusion, 17.1% underwent kyphoplasty, and 49.9% underwent vertebroplasty. Univariate analysis of patient and hospital characteristics, by treatment, was performed. Multivariable analysis was used to determine factors associated with mortality, nonroutine discharge, complications, and patient safety. Results. Average patient age: fusion (46.2), kyphoplasty (78.5), vertebroplasty (76.7) (p < .0001). Gender, race, household income, hospital-specific characteristics, and insurance differences were found (p ≤ .001). Leading comorbidities were hypertension, osteoporosis, and diabetes. Risks for higher mortality (OR 2.0: CI: 1.6-2.5), nonroutine discharge (OR 1.6, CI: 1.6-1.7), complications (OR 1.1, CI: 1.0-1.1), and safety related events (OR 1.1, CI: 1.0-1.1) rose consistently with increasing age, particularly among fusion patients. Preexisting comorbidities and longer in-hospital length of stay were associated with increased odds of nonroutine discharge, complications, and patient safety. Conclusions. Fusion patients had higher rates of poorer outcomes compared to vertebroplasty and kyphoplasty cohorts. Mortality, nonroutine discharge, complications, and adverse events increased consistently with older age.

Published
2016

38. The selection of core International Classification of Functioning, Disability, and Health (ICF) categories for patient-reported outcome measurement in spine trauma patients-results of an international consensus process

Author

Sadiqi, Said, Lehr, A Mechteld, Post, Marcel W, Jacobs, Wilco C H, Aarabi, Bizhan, Chapman, Jens R, Dunn, Robert N, Dvorak, Marcel F, Fehlings, Michael G, Rajasekaran, S, Vialle, Luiz R, Vaccaro, Alexander R, Oner, F Cumhur, Sadiqi, Said, Lehr, A Mechteld, Post, Marcel W, Jacobs, Wilco C H, Aarabi, Bizhan, Chapman, Jens R, Dunn, Robert N, Dvorak, Marcel F, Fehlings, Michael G, Rajasekaran, S, Vialle, Luiz R, Vaccaro, Alexander R, and Oner, F Cumhur

Published
2016

39. Is there a regional difference in morphology interpretation of A3 and A4 fractures among different cultures?

Author

Schroeder, Gregory D., Kepler, Christopher K., Koerner, John D., Chapman, Jens R., Bellabarba, Carlo, Oner, F. Cumhur, Reinhold, Max, Dvorak, Marcel F., Aarabi, Bizhan, Vialle, Luiz, Fehlings, Michael G., Rajasekaran, Shanmuganathan, Kandziora, Frank, Schnake, Klaus J., Vaccaro, Alexander R., Schroeder, Gregory D., Kepler, Christopher K., Koerner, John D., Chapman, Jens R., Bellabarba, Carlo, Oner, F. Cumhur, Reinhold, Max, Dvorak, Marcel F., Aarabi, Bizhan, Vialle, Luiz, Fehlings, Michael G., Rajasekaran, Shanmuganathan, Kandziora, Frank, Schnake, Klaus J., and Vaccaro, Alexander R.

Published
2016

40. The surgical algorithm for the AOSpine thoracolumbar spine injury classification system

Author

Vaccaro, Alexander R., Schroeder, Gregory D., Kepler, Christopher K., Cumhur Oner, F., Vialle, Luiz R., Kandziora, Frank, Koerner, John D., Kurd, Mark F., Reinhold, Max, Schnake, Klaus J., Chapman, Jens, Aarabi, Bizhan, Fehlings, Michael G., Dvorak, Marcel F., Vaccaro, Alexander R., Schroeder, Gregory D., Kepler, Christopher K., Cumhur Oner, F., Vialle, Luiz R., Kandziora, Frank, Koerner, John D., Kurd, Mark F., Reinhold, Max, Schnake, Klaus J., Chapman, Jens, Aarabi, Bizhan, Fehlings, Michael G., and Dvorak, Marcel F.

Published
2016

41. AOSpine subaxial cervical spine injury classification system

Author

Vaccaro, Alexander R., Koerner, John D., Radcliff, Kris E., Oner, F. Cumhur, Reinhold, Maximilian, Schnake, Klaus J., Kandziora, Frank, Fehlings, Michael G., Dvorak, Marcel F., Aarabi, Bizhan, Rajasekaran, Shanmuganathan, Schroeder, Gregory D., Kepler, Christopher K., Vialle, Luiz R., Vaccaro, Alexander R., Koerner, John D., Radcliff, Kris E., Oner, F. Cumhur, Reinhold, Maximilian, Schnake, Klaus J., Kandziora, Frank, Fehlings, Michael G., Dvorak, Marcel F., Aarabi, Bizhan, Rajasekaran, Shanmuganathan, Schroeder, Gregory D., Kepler, Christopher K., and Vialle, Luiz R.

Published
2016

42. Advanced Concepts in Lumbar Degenerative Disk Disease

Author

Pinheiro-Franco, Jo?o Luiz., Vaccaro, Alexander R., Benzel, Edward C., Mayer, H. Michael., Pinheiro-Franco, Jo?o Luiz., Vaccaro, Alexander R., Benzel, Edward C., and Mayer, H. Michael.

Published
2016

43. The selection of core International Classification of Functioning, Disability, and Health (ICF) categories for patient-reported outcome measurement in spine trauma patients-results of an international consensus process

Author

Sadiqi, Said, Lehr, A Mechteld, Post, Marcel W, Jacobs, Wilco C H, Aarabi, Bizhan, Chapman, Jens R, Dunn, Robert N, Dvorak, Marcel F, Fehlings, Michael G, Rajasekaran, S, Vialle, Luiz R, Vaccaro, Alexander R, Oner, F Cumhur, Sadiqi, Said, Lehr, A Mechteld, Post, Marcel W, Jacobs, Wilco C H, Aarabi, Bizhan, Chapman, Jens R, Dunn, Robert N, Dvorak, Marcel F, Fehlings, Michael G, Rajasekaran, S, Vialle, Luiz R, Vaccaro, Alexander R, and Oner, F Cumhur

Published
2016

44. Toward the development of a universal outcome instrument for spine trauma : A systematic review and content comparison of outcome measures used in spine trauma research using the ICF as reference

Author

Oner, F. Cumhur, Jacobs, Wilco C H, Lehr, A. Mechteld, Sadiqi, Said, Post, Marcel W., Aarabi, Bizhan, Chapman, Jens R., Dvorak, Marcel F., Fehlings, Michael G., Kandziora, Frank, Rajasekaran, S., Vaccaro, Alexander R., Oner, F. Cumhur, Jacobs, Wilco C H, Lehr, A. Mechteld, Sadiqi, Said, Post, Marcel W., Aarabi, Bizhan, Chapman, Jens R., Dvorak, Marcel F., Fehlings, Michael G., Kandziora, Frank, Rajasekaran, S., and Vaccaro, Alexander R.

Published
2016

45. The surgical algorithm for the AOSpine thoracolumbar spine injury classification system

Author

Vaccaro, Alexander R., Schroeder, Gregory D., Kepler, Christopher K., Cumhur Oner, F., Vialle, Luiz R., Kandziora, Frank, Koerner, John D., Kurd, Mark F., Reinhold, Max, Schnake, Klaus J., Chapman, Jens, Aarabi, Bizhan, Fehlings, Michael G., Dvorak, Marcel F., Vaccaro, Alexander R., Schroeder, Gregory D., Kepler, Christopher K., Cumhur Oner, F., Vialle, Luiz R., Kandziora, Frank, Koerner, John D., Kurd, Mark F., Reinhold, Max, Schnake, Klaus J., Chapman, Jens, Aarabi, Bizhan, Fehlings, Michael G., and Dvorak, Marcel F.

Published
2016

46. AOSpine subaxial cervical spine injury classification system

Author

Vaccaro, Alexander R., Koerner, John D., Radcliff, Kris E., Oner, F. Cumhur, Reinhold, Maximilian, Schnake, Klaus J., Kandziora, Frank, Fehlings, Michael G., Dvorak, Marcel F., Aarabi, Bizhan, Rajasekaran, Shanmuganathan, Schroeder, Gregory D., Kepler, Christopher K., Vialle, Luiz R., Vaccaro, Alexander R., Koerner, John D., Radcliff, Kris E., Oner, F. Cumhur, Reinhold, Maximilian, Schnake, Klaus J., Kandziora, Frank, Fehlings, Michael G., Dvorak, Marcel F., Aarabi, Bizhan, Rajasekaran, Shanmuganathan, Schroeder, Gregory D., Kepler, Christopher K., and Vialle, Luiz R.

Published
2016

47. Surgeon Reported Outcome Measure for Spine Trauma an International Expert Survey Identifying Parameters Relevant for The Outcome of Subaxial Cervical Spine Injuries

Author

Sadiqi, Said, Verlaan, Jorrit Jan, Lehr, A. M., Dvorak, Marcel F., Kandziora, Frank, Rajasekaran, S., Schnake, Klaus J., Vaccaro, Alexander R., Oner, F. C., Sadiqi, Said, Verlaan, Jorrit Jan, Lehr, A. M., Dvorak, Marcel F., Kandziora, Frank, Rajasekaran, S., Schnake, Klaus J., Vaccaro, Alexander R., and Oner, F. C.

Published
2016

48. Is there a regional difference in morphology interpretation of A3 and A4 fractures among different cultures?

Author

Schroeder, Gregory D., Kepler, Christopher K., Koerner, John D., Chapman, Jens R., Bellabarba, Carlo, Oner, F. Cumhur, Reinhold, Max, Dvorak, Marcel F., Aarabi, Bizhan, Vialle, Luiz, Fehlings, Michael G., Rajasekaran, Shanmuganathan, Kandziora, Frank, Schnake, Klaus J., Vaccaro, Alexander R., Schroeder, Gregory D., Kepler, Christopher K., Koerner, John D., Chapman, Jens R., Bellabarba, Carlo, Oner, F. Cumhur, Reinhold, Max, Dvorak, Marcel F., Aarabi, Bizhan, Vialle, Luiz, Fehlings, Michael G., Rajasekaran, Shanmuganathan, Kandziora, Frank, Schnake, Klaus J., and Vaccaro, Alexander R.

Published
2016

49. Advanced Concepts in Lumbar Degenerative Disk Disease

Author

Pinheiro-Franco, Jo?o Luiz., Vaccaro, Alexander R., Benzel, Edward C., Mayer, H. Michael., Pinheiro-Franco, Jo?o Luiz., Vaccaro, Alexander R., Benzel, Edward C., and Mayer, H. Michael.

Published
2016

50. Outcomes and National Trends for the Surgical Treatment of Lumbar Spine Trauma.

Author

Drazin, Doniel, Drazin, Doniel, Nuno, Miriam, Shweikeh, Faris, Vaccaro, Alexander R, Baron, Eli, Kim, Terrence T, Johnson, J Patrick, Drazin, Doniel, Drazin, Doniel, Nuno, Miriam, Shweikeh, Faris, Vaccaro, Alexander R, Baron, Eli, Kim, Terrence T, and Johnson, J Patrick

Abstract

Introduction. Operative treatment of lumbar spine compression fractures includes fusion and/or cement augmentation. Our aim was to evaluate postoperative differences in patients treated surgically with fusion, vertebroplasty, or kyphoplasty. Methods. The Nationwide Inpatient Sample Database search for adult vertebral compression fracture patients treated 2004-2011 identified 102,316 surgical patients: 30.6% underwent spinal fusion, 17.1% underwent kyphoplasty, and 49.9% underwent vertebroplasty. Univariate analysis of patient and hospital characteristics, by treatment, was performed. Multivariable analysis was used to determine factors associated with mortality, nonroutine discharge, complications, and patient safety. Results. Average patient age: fusion (46.2), kyphoplasty (78.5), vertebroplasty (76.7) (p < .0001). Gender, race, household income, hospital-specific characteristics, and insurance differences were found (p ≤ .001). Leading comorbidities were hypertension, osteoporosis, and diabetes. Risks for higher mortality (OR 2.0: CI: 1.6-2.5), nonroutine discharge (OR 1.6, CI: 1.6-1.7), complications (OR 1.1, CI: 1.0-1.1), and safety related events (OR 1.1, CI: 1.0-1.1) rose consistently with increasing age, particularly among fusion patients. Preexisting comorbidities and longer in-hospital length of stay were associated with increased odds of nonroutine discharge, complications, and patient safety. Conclusions. Fusion patients had higher rates of poorer outcomes compared to vertebroplasty and kyphoplasty cohorts. Mortality, nonroutine discharge, complications, and adverse events increased consistently with older age.

Published
2016

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