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3. Laminectomy versus laminectomy and fixation for multilevel degenerative cervical myelopathy: factors influencing surgical decision making amongst surgeons in the UK (Preprint)

Author

Stefan Yordanov, Xiaoyu Yang, Oliver Mowforth, Andreas Demetriades, Marcel Ivanov, Pierluigi Vergara, Adrian Gardner, Erlickh Pereira, Anthony Bateman, Alexander Alamri, Jibin Francis, Rikin Trivedi, Mark Kotter, Benjamin Davies, and Alexandru Budu

Abstract

BACKGROUND Degenerative cervical myelopathy (DCM) is estimated to affect 2% of the adult population. DCM is caused when degenerative processes stress and injure the spinal cord. Surgery to remove stress on the spinal cord is the mainstay of treatment. A range of techniques are in use. Whilst various factors are described to inform their selection, there is no consensus and limited comparative evidence. OBJECTIVE Here, we report on a study of the principal investigators of the NIHR POLYFIX-DCM clinical trial, exploring decision-making with a focus on laminectomy versus laminectomy and fusion. METHODS A series of 7 cases were shared with 24 principal investigators using SurveyMonkey (California USA). Each case consisted of a mid-sagittal T2-weighted MRI and lateral cervical x-rays in flexion and extension. Surgeons were asked if their preferred approach was anterior or posterior. If posterior, they were asked whether they preferred to instrument and whether they had equipoise to randomise in NIHR POLYFIX DCM. Variance in decision making was then explored using factors reported to inform decision making, such as alignment, location of compression, number of levels operated, presence of mobile spondylolisthesis and patient age. RESULTS The majority of PIs (53%) completed the survey. Overall PIs favoured a posterior approach (75%) with instrumentation (66%) and would randomise most (62%) cases. Factors reported to inform decision making poorly explained variance in responses in both univariate testing and with a multivariate model (R2= 0.1). Only surgeon experience >5 years and orthopaedic specialty training background were significant predictors, both associated with an anterior approach [OR – 1.255, p = 0.019 and OR - 1.344, p=0.007 respectively] and fusion for posterior procedures [OR – 0.628, p5 years’ experience less likely to randomise (OR -0.68, p CONCLUSIONS In this representative sample of spine surgeons in the UK.In the UK, there is no consensus on surgical strategy, including the role of instrumented fusion following posterior decompression. Overall, there is clinical equipoise, and conceptually a randomised controlled trial appears feasible. This sets the premise for NIHR POLYFIX DCM.

Published
2023
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4. Effect of surgical experience and spine subspecialty on the reliability of the AO Spine Upper Cervical Injury Classification System

Author

Mark J. Lambrechts, Gregory D. Schroeder, Brian A. Karamian, Jose A. Canseco, F. Cumhur Oner, Lorin M. Benneker, Richard J. Bransford, Frank Kandziora, Shanmuganathan Rajasekaran, Mohammad El-Sharkawi, Rishi Kanna, Andrei Fernandes Joaquim, Klaus Schnake, Christopher K. Kepler, Alexander R. Vaccaro, Dewan Asif, Sachin Borkar, Joseph Bakar, Slavisa Zagorac, Welege Wimalachandra, Oleksandr Garashchuk, Francisco Verdu-Lopez, Giorgio Lofrese, Pragnesh Bhatt, Oke Obadaseraye, Axel Partenheimer, Marion Riehle, Eugen Cesar Popescu, Christian Konrads, Nur Aida Faruk Senan, Adetunji Toluse, Nuno Neves, Takahiro Sunami, Bart Kuipers, Jayakumar Subbiah, Anas Dyab, Peter Loughenbury, Derek Cawley, René Schmidt, Loya Kumar, Farhan Karim, Zacharia Silk, Michele Parolin, Hisco Robijn, Al Kalbani, Ricky Rasschaert, Christian Müller, Marc Nieuwenhuijse, Selim Ayhan, Shay Menachem, Sarvdeep Dhatt, Nasser Khan, Subramaniam Haribabu, Moses Kimani, Olger Alarcon, Nnaemeka Alor, Dinesh Iyer, Michal Ziga, Konstantinos Gousias, Gisela Murray, Michel Triffaux, Sebastian Hartmann, Sung-Joo Yuh, Siegmund Lang, Kyaw Linn, Charanjit Singh Dhillon, Waeel Hamouda, Stefano Carnesecchi, Vishal Kumar, Lady Lozano Cari, Gyanendra Shah, Furuya Takeo, Federico Sartor, Fernando Gonzalez, Hitesh Dabasia, Wongthawat Liawrungrueang, Lincoln Liu, Younes El Moudni, Ratko Yurak, Héctor Aceituno, Madhivanan Karthigeyan, Andreas Demetriades, Sathish Muthu, Matti Scholz, Wael Alsammak, Komal Chandrachari, Khoh Phaik Shan, Sokol Trungu, Joost Dejaegher, Omar Marroquin, Moisa Horatiu Alexandru, Máximo-Alberto Diez-Ulloa, Paulo Pereira, Claudio Bernucci, Christian Hohaus, Miltiadis Georgiopoulos, Annika Heuer, Ahmed Arieff Atan, Mark Murerwa, Richard Lindtner, Manjul Tripathi, Huynh Hieu Kim, Ahmed Hassan, Norah Foster, Amanda O’Halloran, Koroush Kabir, Mario Ganau, Daniel Cruz, Amin Henine, Jeronimo Milano, Abeid Mbarak, Arnaldo Sousa, Satyashiva Munjal, Mahmoud Alkharsawi, Muhammad Mirza, Parmenion Tsitsopoulos, Fon-Yih Tsuang, Oliver Risenbeck, Arun-Kumar Viswanadha, Samer Samy, David Orosco, Gerardo Zambito-Brondo, Nauman Chaudhry, Luis Marquez, Jacob Lepard, Juan Muñoz, Stipe Corluka, Soh Reuben, Ariel Kaen, Nishanth Ampar, Sebastien Bigdon, Damián Caba, Francisco De Miranda, Loren Lay, Ivan Marintschev, Mohammed Imran, Sandeep Mohindra, Naga Raju Reddycherla, Pedro Bazán, Abduljabbar Alhammoud, Iain Feeley, Konstantinos Margetis, Alexander Durst, Ashok Kumar Jani, Rian Souza Vieira, Felipe Santos, Joshua Karlin, Nicola Montemurro, Sergey Mlyavykh, Brian Sonkwe, Darko Perovic, Juan Lourido, Alessandro Ramieri, Eduardo Laos, Uri Hadesberg, Andrei-Stefan Iencean, Pedro Neves, Eduardo Bertolini, Naresh Kumar, Philippe Bancel, Bishnu Sharma, John Koerner, Eloy Rusafa Neto, Nima Ostadrahimi, Olga Morillo, Kumar Rakesh, Andreas Morakis, Amauri Godinho, P. Keerthivasan, Richard Menger, Louis Carius, Rajesh Bahadur Lakhey, Ehab Shiban, Vishal Borse, Elizabeth Boudreau, Gabriel Lacerda, Paterakis Konstantinos, Mubder Mohammed Saeed, Toivo Hasheela, Susana Núñez Pereira, Jay Reidler, Nimrod Rahamimov, Mikolaj Zimny, Devi Prakash Tokala, Hossein Elgafy, Ketan Badani, Bing Wui Ng, Cesar Sosa Juarez, Thomas Repantis, Ignacio Fernández-Bances, John Kleimeyer, Nicolas Lauper, Luis María Romero-Muñoz, Ayodeji Yusuf, Zdenek Klez, John Afolayan, Joost Rutges, Alon Grundshtein, Rafal Zaluski, Stavros I. Stavridis, Takeshi Aoyama, Petr Vachata, Wiktor Urbanski, Martin Tejeda, Luis Muñiz, Susan Karanja, Antonio Martín-Benlloch, Heiller Torres, Chee-Huan Pan, Luis Duchén, Yuki Fujioka, Meric Enercan, Mauro Pluderi, Catalin Majer, and Vijay Kamath

Subjects
orthopedic spine surgeon, AO Spine, upper cervical spine, reproducibility, neurosurgeon, reliability, trauma, 610 Medicine & health, General Medicine, 610 Medizin und Gesundheit
Abstract

OBJECTIVE The objective of this paper was to determine the interobserver reliability and intraobserver reproducibility of the AO Spine Upper Cervical Injury Classification System based on surgeon experience (< 5 years, 5–10 years, 10–20 years, and > 20 years) and surgical subspecialty (orthopedic spine surgery, neurosurgery, and "other" surgery). METHODS A total of 11,601 assessments of upper cervical spine injuries were evaluated based on the AO Spine Upper Cervical Injury Classification System. Reliability and reproducibility scores were obtained twice, with a 3-week time interval. Descriptive statistics were utilized to examine the percentage of accurately classified injuries, and Pearson’s chi-square or Fisher’s exact test was used to screen for potentially relevant differences between study participants. Kappa coefficients (κ) determined the interobserver reliability and intraobserver reproducibility. RESULTS The intraobserver reproducibility was substantial for surgeon experience level (< 5 years: 0.74 vs 5–10 years: 0.69 vs 10–20 years: 0.69 vs > 20 years: 0.70) and surgical subspecialty (orthopedic spine: 0.71 vs neurosurgery: 0.69 vs other: 0.68). Furthermore, the interobserver reliability was substantial for all surgical experience groups on assessment 1 (< 5 years: 0.67 vs 5–10 years: 0.62 vs 10–20 years: 0.61 vs > 20 years: 0.62), and only surgeons with > 20 years of experience did not have substantial reliability on assessment 2 (< 5 years: 0.62 vs 5–10 years: 0.61 vs 10–20 years: 0.61 vs > 20 years: 0.59). Orthopedic spine surgeons and neurosurgeons had substantial intraobserver reproducibility on both assessment 1 (0.64 vs 0.63) and assessment 2 (0.62 vs 0.63), while other surgeons had moderate reliability on assessment 1 (0.43) and fair reliability on assessment 2 (0.36). CONCLUSIONS The international reliability and reproducibility scores for the AO Spine Upper Cervical Injury Classification System demonstrated substantial intraobserver reproducibility and interobserver reliability regardless of surgical experience and spine subspecialty. These results support the global application of this classification system.

Published
2023
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5. Is perioperative COVID-19 really associated with worse surgical outcomes? A nationwide COVIDSurg propensity-matched analysis

Author

Argandykov, Dias, Dorken-Gallastegi, Ander, El Moheb, Mohamad, Gebran, Anthony, Proaño-Zamudio, Jefferson A, Bokenkamp, Mary, Renne, Angela M, Nepogodiev, Dmitri, Bhangu, Aneel, Kaafarani, Haytham M A, Kwabena, Siaw-Acheampong, Leah, Argus, Daoud, Chaudhry, Brett, E Dawson, James, C Glasbey, Rohan, R Gujjuri, Conor, S Jones, Sivesh, K Kamarajah, Chetan, Khatri, James, M Keatley, Samuel, Lawday, Elizabeth, Li, Harvinder, Mann, Ella, J Marson, Kenneth, A Mclean, Maria, Picciochi, Elliott, H Taylor, Abhinav, Tiwari, Joana F, F Simoes, Isobel, M Trout, Mary, L Venn, Richard J, W Wilkin, Aneel, Bhangu, Dmitri, Nepogodiev, Irida, Dajti, Arben, Gjata, Luis, Boccalatte, Mariamarta, Modolo, Daniel, Cox, Peter, Pockney, Philip, Townend, Felix, Aigner, Irmgard, Kronberger, Kamral, Hossain, Gabrielle, Vanramshorst, Ismail, Lawani, Gustavo, Ataide, Glauco, Baiocchi, Igor, Buarque, Muhammad, Gohar, Mihail, Slavchev, Arnav, Agarwal, Amanpreet, Brar, Janet, Martin, Maria Marta Modolo, Maricarmen, Olivos, Jose, Calvache, Carlos Jose Perez Rivera, Ana Danic Hadzibegovic, Tomislav, Kopjar, Jakov, Mihanovic, Jaroslav, Klat, René, Novysedlak, Peter, Christensen, Alaa, El-Hussuna, Sylvia, Batista, Eddy, Lincango, Sameh, H Emile, Mengistu Gebreyohanes Mengesha, Samuel, Hailu, Hailu, Tamiru, Joonas, Kauppila, Johanna, Laukkarinen, Alexis, Arnaud, Markus, Albertsmeiers, Hans, Lederhuber, Markus, Loffler, Stephen, Tabiri, Symeon, Metallidis, Georgios, Tsoulfas, Maria Aguilera Lorena, Gustavo, Grecinos, Tamas, Mersich, Daniel, Wettstein, Dhruv, Ghosh, Gabriele, Kembuan, Peiman, Brouk, Mohammad, Khosravi, Masoud, Mozafari, Ahmed, Adil, Helen, M Mohan, Oded, Zmora, Marco, Fiore, Gallo, Gaetano, Francesco, Pata, Gianluca, Pellino, Sohei, Satoi, Faris, Ayasra, Mohammad, Chaar, Ildar, R Fakhradiyev, Mohammad, Jamal, Muhammed, Elhadi, Aiste, Gulla, April, Roslani, Laura, Martinez, Antonio Ramos De La Medina, Oumaima, Outani, Pascal, Jonker, Schelto, Kruijff, Milou, Noltes, Pieter, Steinkamp, Willemijn van der Plas, Adesoji, Ademuyiwa, Babatunde, Osinaike, Justina, Seyi-Olajide, Emmanuel, Williams, Sofija, Pejkova, Knut Magne Augestad, Zainab Al Balushi, Ahmad, Qureshi, Raza, Sayyed, Mustafa Abu Mohsen Daraghmeh, Sadi, Abukhalaf, Moises, Cukier, Hugo, Gomez, Sebastian, Shu, Ximena, Vasquez, Marie Dione Parreno-Sacdalan, Piotr, Major, José, Azevedo, Miguel, Cunha, Irene, Santos, Ahmad, Zarour, Eduard-Alexandru, Bonci, Ionut, Negoi, Sergey, Efetov, Andrey, Litvin, Faustin, Ntirenganya, Ehab, Alameer, Dejan, Radenkovic, Frederick Koh Hong Xiang, Chew Min Hoe, James Ngu Chi Yong, Rachel, Moore, Ncamsile, Nhlabathi, Ruth Blanco Colino, Ana Minaya Bravo, Ana, Minaya-Bravo, Umesh, Jayarajah, Dakshitha, Wickramasinghe, Mohammed, Elmujtaba, William, Jebril, Martin, Rutegård, Malin, Sund, Arda, Isik, Sezai, Leventoğlu, Tom E, F Abbott, Ruth, Benson, Caruna, Ed, Sohini, Chakrabortee, Andreas, Demetriades, Anant, Desai, Thomas, D Drake, John, G Edwards, Jonathan, P Evans, Samuel, Ford, Christina, Fotopoulou, Ewen, Griffiths, Peter, Hutchinson, Michael, D Jenkinson, Tabassum, Khan, Stephen, Knight, Angelos, Kolias, Elaine, Leung, Siobhan, Mckay, Lisa, Norman, Riinu, Ots, Vidya, Raghavan, Keith, Roberts, Andrew, Schache, Richard, Shaw, Katie, Shaw, Neil, Smart, Grant, Stewart, Sudha, Sundar, Dale, Vimalchandran, Naomi, Wright, Sattar, Alshryda, Osaid, Alser, Kerry, Breen, Ian, Ganly, Haytham, Kaafarani, Brittany, Kendall, Hassan, Mashbari, Hamza Al Naggar, Dennis, Mazingi, J J, Wong, Napolitano, L, Hemmila, M, Amin, D, Abramowicz, S, S M, Roser, K A, Olson, Riley, C, Heron, C, Cardenas, T, Leede, E, Thornhill, M, A B, Haynes, Mcelhinney, K, Roward, S, M D, Trust, C E, Hill, P G, Teixeira, Etchill, E, Stevens, K, M R, Ladd, Long, C, Rose, J, Kent, A, Yesantharao, P, Vervoort, D, Jenny, H, Gabre-Kidan, A, Margalit, A, Tsai, L, Malapati, H, Yesantharao, L, Abdou, H, Diaz, J, Richmond, M, Clark, J, O'Meara, L, Hanna, N, Ying, Y, Fleming, J, Ovaitt, A, Gigliotti, J, Fuson, A, Cooper, Z, Salim, A, A Hirji, S, Brown, A, Chung, C, Hansen, L, U Okafor, B, Roxo, V, P Raut, C, S Jolissaint, J, A Mahvi, D, Kaafarani, H, Breen, K, Bankhead-Kendall, B, Alser, O, Mashbari, H, Velmahos, G, L R, Maurer, El Moheb, M, Gaitanidis, A, Naar, L, M A, Christensen, Kapoen, C, Langeveld, K, El Hechi, M, Mokhtari, A, H Haqqani, M, T Drake, F, Goldenberg-Sandau, A, Galbreath, B, Reinke, C, Ross, S, Thompson, K, Manning, D, Perkins, R, Eriksson, E, Evans, H, Masrur, M, Giulianotti, P, Benedetti, E, Chang, G, Ourieff, J, Dehart, D, Dorafshar, A, Price, T, R Bhama, A, Torquati, A, Cherullo, E, Kennedy, R, Myers, J, Rubin, K, S Ban, V, G Aoun, S, H Batjer, H, Caruso, J, Carmichael, H, G Velopulos, C, L Wright, F, Urban, S, C McIntyre Jr, R, J Schroeppel, T, A Hennessy, E, Dunn, J, Zier, L, Burlew, C, Coleman, J, P Colling, K, Hall, B, E Rice, H, S Hwang, E, A Olson, S, Moris, D, Verma, R, Hassan, R, Volpe, A, Merola, S, A O'Banion, L, Lilienstein, J, Dirks, R, Marwan, H, Almasri, M, Kulkarni, G, Mehdi, M, Abouassi, A, Abdallah, M, M San Andrés, Eid, J, Aigbivbalu, E, Sundaresan, J, George, B, Ssentongo, A, Ssentongo, P, S Oh, J, Hazelton, J, Maines, J, Gusani, N, Garner, M, Horvath, S, Zheng, F, Ujiki, M, Kinnaman, G, Meagher, A, Sharma, I, Holler, E, Mckenzie, K, Chan, J, Fretwell, K, W Nugent 3rd, Khalil, A, Chen, D, Post, N, Rostkowski, T, Brahmbhatt, D, Huynh, K, L Hibbard, M, Schellenberg, M, Martin, Rcg, Bhutiani, N, Giorgakis, E, Laryea, J, Bhavaraju, A, Sexton, K, Roberts, M, Kost, M, Kimbrough, M, Burdine, L, Kalkwarf, K, Robertson, R, Gosain, A, Camp, L, Lewit, R, P Kronenfeld, J, Urrechaga, E, Goel, N, Rattan, R, Hart, V, Allen, M, Gilna, G, Cioci, A, Ruiz, G, Rakoczy, K, Pavlis, W, Saberi, R, Morris, R, S Karam, B, Brathwaite, Cem, Liu, H, Petrone, P, Hakmi, H, H Sohail, A, Baltazar, G, Heckburn, R, M Nygaard, R, T Colonna, E, W Endorf, F, J Hill, M, Maiga, A, Dennis, B, H Levin, J, Lallemand, M, Choron, R, Peck, G, Soliman, F, Rehman, S, Glass, N, Juthani, B, Deisher, D, M Ruzgar, N, J Ullrich, S, Sion, M, Paranjape, C, M El Moheb, R Kar, A, Gillezeau, C, Rapp, J, Taioli, E, A Miles, B, Alpert, N, Podolsky, D, L Coleman, N, P Callahan, M, Ganly, I, Brown, L, Monson, Jrt, Dehal, A, Abbas, A, Soliman, A, Kim, B, Jones, C, Dauer, E, Renza-Stingone, E, Hernandez, E, Gokcen, E, Kropf, E, Sufrin, H, Hirsch, H, Ross, H, Engel, J, Sewards, J, Poggio, J, Sanserino, K, Rae, L, Philp, M, Metro, M, Mcnelis, P, Petrov, R, Pazionis, T, Till, B, Lamm, R, J Rios-Diaz, A, Palazzo, F, Rosengart, M, Nicholson, K, M Carrick, M, Rodkey, K, Suri, A, Callcut, R, Nicholson, S, Talathoti, N, Klaristenfeld, D, Biffl, W, Marsh, C, Schaffer, K, E Berndtson, A, Averbach, S, Curry, T, Kwan-Feinberg, R, Consorti, E, Gonzalez, R, Grolman, R, Liu, T, Merzlikin, O, K Abel, M, Ozgediz, D, Boeck, M, Z Kornblith, L, Nunez-Garcia, B, Robinson, B, Park, P, F Utria, A, E Rice-Townsend, S, Javid, P, Hauptman, J, Kieran, K, Nehra, D, Walters, A, Cuschieri, J, H Davidson, G, Nunez, J, Cosker, R, Eckhouse, S, Choudhry, A, Marx, W, Jamil, T, Seegert, S, Al-Embideen, S, Quintana, M, Jackson, H, D Wexner, S, Kent, I, and N Martins, P

Subjects
COVID-19, COVIDSurg, mortality, postoperative complications, Surgery, Critical Care and Intensive Care Medicine
Published
2023

7. Peripheral nerve surgery in Serbia: 'Think global, act local' and the privilege of service

Author

Lukas Rasulić, Mariano Socolovsky, Christian Heinen, Andreas Demetriades, Milan Lepić, Nathan A. Shlobin, Andrija Savić, Jovan Grujić, Stefan Mandić-Rajčević, Sanja Lepić, and Miroslav Samardžic

Abstract

The phrase "think globally, act locally", which has often been used to refer to conservation of the environment, highlights the importance of maintaining a holistic perspective and stipulates that each individual has a role to play in their community and larger world. Although peripheral nerve surgery has been largely unemphasized in global neurosurgical efforts, a wide disparity in peripheral nerve surgery is presumed to exist between high-income and low- and middle-income countries. Serbia is an upper middle-income country with a long history of peripheral nerve surgery.How can understanding the development of peripheral nerve surgery in Serbia advance global education and improve peripheral nerve surgery worldwide?An anecdotal and narrative review of recent advances in peripheral nerve surgery in Serbia was conducted. The World Federation of Neurosurgical Society (WFNS) Peripheral Nerve Surgery Committee discussions on improving peripheral nerve surgery education were summarized.In this manuscript, we describe the application of "think globally, act locally" to peripheral nerve surgery by providing an account of the development of peripheral nerve surgery in Serbia. Then, we report measures taken by the WFNS Peripheral Nerve Surgery Committee to improve education on peripheral nerve surgery in LMICs.Viewing the development of peripheral nerve surgery in Serbia through the lens of "think globally, act locally" may guide the development of peripheral nerve surgery in LMICs.

Published
2022

8. The clinical features and prognosis of scan negative uro-neurological disorders

Author

Ingrid Hoeritzauer, Alan Carson, Patrick Statham, Jalesh Panicker, Voula Granitsiotis, Maria Eugenicos, David Summers, Andreas Demetriades, and Jon Stone

Subjects
Psychiatry and Mental health, Surgery, Neurology (clinical)
Abstract

BackgroundMore than 50% of patients presenting with cauda equina syndrome (CES) have normal imaging. These patients require phenotyping to ascertain symptom aetiology and mechanism.Prospective Study Results198 patients presented with suspected CES over 28 months. 47 were diagnosed with ‘scan-positive’ CES (mean age 48yrs, 43% female). 76 patients had evidence of nerve root compres- sion or displacement and were placed into a ‘mixed’ category (mean age 46yrs, 71% female) and 61 patients had normal scans ‘scan-negative’ CES (mean age 40yrs, 77% female). Fourteen patients had a neurological diagnosis explaining their clinical CES symptoms during admission.Patients with ‘scan-positive’ CES were more likely to have reduced or lost bilateral ankle jerks (78% vs. 30% and 12%, p≤0.0001). Patients with ‘scan-negative’ CES were found to have positive signs of a functional neurological disorder on examination (11% v. 34% and 68%, p≤0.0001) as well as high rates of panic, medication usage and psychopathology. Four patients out of 151 (4%, mixed group n=3, ‘scan-negative’ group n=1) had a neurological diagnosis after discharged which potentially explained their clinical CES presentation.ConclusionsThis is the first well phenotyped, prospective study of patients with ‘scan-negative’ CES dem- onstrating a pain, medication and functional mechanism of symptom production.ingrid.hoeritzauer@ed.ac.uk

Published
2022
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