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8. Variations in management of A3 and A4 cervical spine fractures as designated by the AO Spine Subaxial Injury Classification System

Author

Kweh, B. T. S., Tee, J. W., Muijs, S., Oner, F. C., Schnake, K. J., Benneker, L. M., Vialle, E. N., Kanziora, F., Rajasekaran, S., Schroeder, G., Vaccaro, A. R., Grin, A., Abdelgawaad, A. S., Zubairi, A. J., Castillo, A., Lezica, A. V., Ramieri, A., Guiroy, A., Grundshtein, A., Godinho, A., Henine, A., Pershin, A. A., Athanasiou, A., Zarate-Kalfopulos, B., Benzarti, S., Bernucci, C., Rebholz, B. J., Direito-Santos, B., Costa, B. L., Saciloto, B., Majer, C., Tannoury, C., Cheng, C., Cheung, J. P. Y., Konrads, C., Jetjumnong, C., Chung, C. K., Popescu, E. C., Kilinçer, C., Harrism, C. B., Steiner, C. D., Igualada, C., Perovic, D., Picazo, D. R., Falcone, L. D. O., Gopalakrishnan, D., Russo, S., Rutges, J., Smith, S. R., Amin, M. Z. H. M., Kweh, B. T. S., Tee, J. W., Muijs, S., Oner, F. C., Schnake, K. J., Benneker, L. M., Vialle, E. N., Kanziora, F., Rajasekaran, S., Schroeder, G., Vaccaro, A. R., Grin, A., Abdelgawaad, A. S., Zubairi, A. J., Castillo, A., Lezica, A. V., Ramieri, A., Guiroy, A., Grundshtein, A., Godinho, A., Henine, A., Pershin, A. A., Athanasiou, A., Zarate-Kalfopulos, B., Benzarti, S., Bernucci, C., Rebholz, B. J., Direito-Santos, B., Costa, B. L., Saciloto, B., Majer, C., Tannoury, C., Cheng, C., Cheung, J. P. Y., Konrads, C., Jetjumnong, C., Chung, C. K., Popescu, E. C., Kilinçer, C., Harrism, C. B., Steiner, C. D., Igualada, C., Perovic, D., Picazo, D. R., Falcone, L. D. O., Gopalakrishnan, D., Russo, S., Rutges, J., Smith, S. R., and Amin, M. Z. H. M.

Abstract

OBJECTIVE Optimal management of A3 and A4 cervical spine fractures, as defined by the AO Spine Subaxial Injury Classification System, remains controversial. The objectives of this study were to determine whether significant management variations exist with respect to 1) fracture location across the upper, middle, and lower subaxial cervical spine and 2) geographic region, experience, or specialty. METHODS A survey was internationally distributed to 272 AO Spine members across six geographic regions (North America, South America, Europe, Africa, Asia, and the Middle East). Participants’ management of A3 and A4 subaxial cervical fractures across cervical regions was assessed in four clinical scenarios. Key characteristics considered in the vignettes included degree of neurological deficit, pain severity, cervical spine stability, presence of comorbidities, and fitness for surgery. Respondents were also directly asked about their preferences for operative management and misalignment acceptance across the subaxial cervical spine. RESULTS In total, 155 (57.0%) participants completed the survey. Pooled analysis demonstrated that surgeons were more likely to offer operative intervention for both A3 (p < 0.001) and A4 (p < 0.001) fractures located at the cervicothoracic junction compared with fractures at the upper or middle subaxial cervical regions. There were no significant variations in management for junctional incomplete (p = 0.116) or complete (p = 0.342) burst fractures between geographic regions. Surgeons with more than 10 years of experience were more likely to operatively manage A3 (p < 0.001) and A4 (p < 0.001) fractures than their younger counterparts. Neurosurgeons were more likely to offer surgical stabilization of A3 (p < 0.001) and A4 (p < 0.001) fractures than their orthopedic colleagues. Clinicians from both specialties agreed regarding their preference for fixation of lower junctional A3 (p = 0.866) and A4 (p = 0.368) fractures. Over

Published
2022

9. Machine learning prediction models in orthopedic surgery: A systematic review in transparent reporting

Author

Zorgeenheid Orthopaedie Medisch, Orthopaedie Opleiding, MS Orthopaedie Algemeen, Regenerative Medicine and Stem Cells, Groot, Olivier Q, Ogink, Paul T, Lans, Amanda, Twining, Peter K, Kapoor, Neal D, DiGiovanni, William, Bindels, Bas J J, Bongers, Michiel E R, Oosterhoff, Jacobien H F, Karhade, Aditya V, Oner, F C, Verlaan, Jorrit-Jan, Schwab, Joseph H, Zorgeenheid Orthopaedie Medisch, Orthopaedie Opleiding, MS Orthopaedie Algemeen, Regenerative Medicine and Stem Cells, Groot, Olivier Q, Ogink, Paul T, Lans, Amanda, Twining, Peter K, Kapoor, Neal D, DiGiovanni, William, Bindels, Bas J J, Bongers, Michiel E R, Oosterhoff, Jacobien H F, Karhade, Aditya V, Oner, F C, Verlaan, Jorrit-Jan, and Schwab, Joseph H

Published
2022

12. Establishing the Injury Severity of Subaxial Cervical Spine Trauma: Validating the Hierarchical Nature of the AO Spine Subaxial Cervical Spine Injury Classification System

Author

Schroeder, G. D., Canseco, J. A., Patel, P. D., Divi, S. N., Karamian, B. A., Kandziora, F., Vialle, E. N., Oner, F. C., Schnake, K. J., Dvorak, M. F., Chapman, J. R., Benneker, L. M., Rajasekaran, S., Kepler, C. K., Vaccaro, A. R., Abdelgawaad, A. S., Abdul, W., Abdulsalam, A., Abeid, M., Ackshota, N., Acosta, O., Akman, Y., Aldahamsheh, O., Alhammoud, A., Aleixo, H., Alexander, H., Alkharsawi, M., Alsammak, W., Amadou, H., Amin, M., Arbatin, J., Atan, A., Athanasiou, A., Bas, P., Bazan, P., Benzakour, T., Benzarti, S., Bernucci, C., Bosco, A., Butler, J., Castillo, A., Cawley, D., Chek, W., Chen, J., Cheng, C., Cheung, J., Chong, C., Corluka, S., Corredor, J., Costa, B., Curri, C., Dawoud, A., Delgado-Fernandez, J., Demiroz, S., Desai, A., Diez-Ulloa, M., Dimas, N., Diniz, S., Direito-Santos, B., Duerinck, J., El-Hewala, T., El-Shamly, M., El-Sharkawi, M., Espinosa, G., Estefan, M., Fang, T., Fernandes, M., Fernandez, N., Ferreira, M., Figueiredo, A., Fiorenza, V., Francis, J., Franz, S., Freedman, B., Fu, L., Fuego, S., Gahlot, N., Ganau, M., Garcia-Pallero, M., Garg, B., Gidvani, S., Giera, B., Godinho, A., Goni, M., Gonzalez, M., Gonzalez, R., Gopalakrishnan, D., Grin, A., Grozman, S., Gruenberg, M., Grundshtein, A., Guasque, J., Guerra, O., Guiroy, A., Hackla, S., Harris, C., Harrop, J., Hassan, W., Henine, A., Hickman, Z., Igualada, C., James, A., Jetjumnong, C., Kaen, A., Karmacharya, B., Kilincer, C., Klezl, Z., Koerner, J., Konrads, C., Krappel, F., Kruyt, M., Krywinski, F., Kundangar, R., Landriel, F., Lindtner, R., Linhares, D., Llombart-Blanco, R., Lopez, W., Lotan, R., Lourido, J., Luna, L., Magashi, T., Majer, C., Mandizvidza, V., Manilha, R., Mannara, F., Margetis, K., Medina, F., Milano, J., Miyakoshi, N., Moisa, H., Montemurro, N., Montoya, J., Morais, J., Morande, S., Msuya, S., Mubarak, M., Mulbah, R., Murugan, Y., Nacer, M., Neves, N., Nicassio, N., Niemeier, T., Olorunsogo, M., Orosco, D., Ozdener, K., Paez, R., Panchal, R., Paterakis, K., Pemovska, E., Pereira, P., Perovic, D., Perozo, J., Pershin, A., Phedy, P., Picazo, D., Pitti, F., Platz, U., Pluderi, M., Ponnusamy, G., Popescu, E., Ramakrishnan, S., Ramieri, A., Rebholz, B., Ricciardi, G., Ricciardi, D., Robinson, Y., Rodriguez, L., Rodrigues-Pinto, R., Romero, I., Rosas, R., Russo, S., Rutges, J., Sartor, F., Shariati, B., Sharma, J., Shoaib, M., Smith, S., Sorimachi, Y., Sribastav, S., Steiner, C., Subbiah, J., Subramanian, P., Suri, T., Tannoury, C., Tokala, D., Toluse, A., Ungurean, V., Vahl, J., Valacco, M., Valdez, C., Vernengo-Lezica, A., Veroni, A., Vieira, R., Viswanadha, A., Wagner, S., Wamae, D., Weening, A., Weidert, S., W. -T., Wu, M. -H., Wu, Yuan, H., Yuh, S. -J., Yurac, R., Zarate-Kalfopulos, B., Ziabrov, A., Zubairi, A., Surgical clinical sciences, Neuroprotection & Neuromodulation, and Neurosurgery

Subjects
Adult, Male, Facet (geometry), medicine.medical_specialty, Cross-sectional study, Clinical Neurology, 610 Medicine & health, Cervical spine injury, cervical spine, Severity of Illness Index, 03 medical and health sciences, 0302 clinical medicine, Injury Severity Score, Surveys and Questionnaires, Severity of illness, Validation, medicine, Humans, Orthopedics and Sports Medicine, Spinal cord injury, Spinal Cord Injuries, 030222 orthopedics, business.industry, Reproducibility of Results, AO spine subaxial cervical spine injury, Cervical spine, Classification system, Injury severity score, Trauma, Cervical Vertebrae, Cross-Sectional Studies, Female, medicine.disease, medicine.anatomical_structure, trauma, Neurology (clinical), Radiology, business, 030217 neurology & neurosurgery, Cervical vertebrae
Abstract

STUDY DESIGN Global cross-sectional survey. OBJECTIVE To validate the AO Spine Subaxial Cervical Spine Injury Classification by examining the perceived injury severity by surgeon across AO geographical regions and practice experience. SUMMARY OF BACKGROUND DATA Previous subaxial cervical spine injury classifications have been limited by subpar interobserver reliability and clinical applicability. In an attempt to create a universally validated scheme with prognostic value, AO Spine established a subaxial cervical spine injury classification involving four elements: (1) injury morphology, (2) facet injury involvement, (3) neurologic status, and (4) case-specific modifiers. METHODS A survey was sent to 272 AO Spine members across all geographic regions and with a variety of practice experience. Respondents graded the severity of each variable of the classification system on a scale from zero (low severity) to 100 (high severity). Primary outcome was to assess differences in perceived injury severity for each injury type over geographic regions and level of practice experience. RESULTS A total of 189 responses were received. Overall, the classification system exhibited a hierarchical progression in subtype injury severity scores. Only three subtypes showed a significant difference in injury severity score among geographic regions: F3 (floating lateral mass fracture, p:0.04), N3 (incomplete spinal cord injury, p:0.03), and M2 (critical disk herniation, p:0.04). When stratified by surgeon experience, pairwise comparison showed only 2 morphological subtypes, B1 (bony posterior tension band injury, p:0.02) and F2 (unstable facet fracture, p:0.03), and one neurologic subtype (N3, p:0.02) exhibited a significant difference in injury severity score. CONCLUSIONS The AO Spine Subaxial Cervical Spine Injury Classification System has shown to be reliable and suitable for proper patient management. The study shows this classification is substantially generalizable by geographic region and surgeon experience; and provides a consistent method of communication among physicians while covering the majority of subaxial cervical spine traumatic injuries.Level of Evidence: 4.

Published
2021

14. Variations in management of A3 and A4 cervical spine fractures as designated by the AO Spine Subaxial Injury Classification System

Author

Kweh, B. T. S., Tee, J. W., Muijs, S., Oner, F. C., Schnake, K. J., Benneker, L. M., Vialle, E. N., Kanziora, F., Rajasekaran, S., Schroeder, G., Vaccaro, A. R., Grin, A., Abdelgawaad, A. S., Zubairi, A. J., Castillo, A., Lezica, A. V., Ramieri, A., Guiroy, A., Grundshtein, A., Godinho, A., Henine, A., Pershin, A. A., Athanasiou, A., Zarate-Kalfopulos, B., Benzarti, S., Bernucci, C., Rebholz, B. J., Direito-Santos, B., Costa, B. L., Saciloto, B., Majer, C., Tannoury, C., Cheng, C., Cheung, J. P. Y., Konrads, C., Jetjumnong, C., Chung, C. K., Popescu, E. C., Kilinçer, C., Harrism, C. B., Steiner, C. D., Igualada, C., Perovic, D., Picazo, D. R., Falcone, L. D. O., Gopalakrishnan, D., Russo, S., Rutges, J., Smith, S. R., Amin, M. Z. H. M., and Orthopedics and Sports Medicine

Subjects
medicine.medical_specialty, Orthotic Devices, Trauma Severity Indices, business.industry, Patient Selection, Specialty, Injury classification, General Medicine, burst, fracture, junctional, subaxial cervical spine, trauma, variation, Cervical regions, Cervical spine, Surgery, Pooled analysis, Fracture Fixation, Surveys and Questionnaires, Orthopedic surgery, Cervicothoracic junction, medicine, Cervical Vertebrae, Humans, Spinal Fractures, Practice Patterns, Physicians', business, Fixation (histology)
Abstract

OBJECTIVE Optimal management of A3 and A4 cervical spine fractures, as defined by the AO Spine Subaxial Injury Classification System, remains controversial. The objectives of this study were to determine whether significant management variations exist with respect to 1) fracture location across the upper, middle, and lower subaxial cervical spine and 2) geographic region, experience, or specialty. METHODS A survey was internationally distributed to 272 AO Spine members across six geographic regions (North America, South America, Europe, Africa, Asia, and the Middle East). Participants’ management of A3 and A4 subaxial cervical fractures across cervical regions was assessed in four clinical scenarios. Key characteristics considered in the vignettes included degree of neurological deficit, pain severity, cervical spine stability, presence of comorbidities, and fitness for surgery. Respondents were also directly asked about their preferences for operative management and misalignment acceptance across the subaxial cervical spine. RESULTS In total, 155 (57.0%) participants completed the survey. Pooled analysis demonstrated that surgeons were more likely to offer operative intervention for both A3 (p < 0.001) and A4 (p < 0.001) fractures located at the cervicothoracic junction compared with fractures at the upper or middle subaxial cervical regions. There were no significant variations in management for junctional incomplete (p = 0.116) or complete (p = 0.342) burst fractures between geographic regions. Surgeons with more than 10 years of experience were more likely to operatively manage A3 (p < 0.001) and A4 (p < 0.001) fractures than their younger counterparts. Neurosurgeons were more likely to offer surgical stabilization of A3 (p < 0.001) and A4 (p < 0.001) fractures than their orthopedic colleagues. Clinicians from both specialties agreed regarding their preference for fixation of lower junctional A3 (p = 0.866) and A4 (p = 0.368) fractures. Overall, surgical fixation was recommended more often for A4 than A3 fractures in all four scenarios (p < 0.001). CONCLUSIONS The subaxial cervical spine should not be considered a single unified entity. Both A3 and A4 fracture subtypes were more likely to be surgically managed at the cervicothoracic junction than the upper or middle subaxial cervical regions. The authors also determined that treatment strategies for A3 and A4 subaxial cervical spine fractures varied significantly, with the latter demonstrating a greater likelihood of operative management. These findings should be reflected in future subaxial cervical spine trauma algorithms.

Published
2020

19. Machine learning prediction models in orthopedic surgery: A systematic review in transparent reporting

Author

Groot, Olivier Q., primary, Ogink, Paul T., additional, Lans, Amanda, additional, Twining, Peter K., additional, Kapoor, Neal D., additional, DiGiovanni, William, additional, Bindels, Bas J. J., additional, Bongers, Michiel E. R., additional, Oosterhoff, Jacobien H. F., additional, Karhade, Aditya V., additional, Oner, F. C., additional, Verlaan, Jorrit‐Jan, additional, and Schwab, Joseph H., additional

Published
2021
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21. 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, Abdelgawaad, Ahmed, Abdul, Waheed, Abdulsalam, Asmatullah, Abeid, Mbarak, Ackshota, Nissim, Acosta, Olga, Akman, Yunus, Aldahamsheh, Osama, Alhammoud, Abduljabbar, Aleixo, Hugo, Alexander, Hamish, Alkharsawi, Mahmoud, Alsammak, Wael, Amadou, Hassame, Amin, Mohamad, Arbatin, Jose, Atan, Ahmad, Athanasiou, Alkinoos, Bas, Paloma, Bazan, Pedro, Benzakour, Thami, Benzarti, Sofien, Bernucci, Claudiio, Bosco, Aju, Butler, Joseph, Castillo, Alejandro, Cawley, Derek, Chek, Wong, Chen, John, Cheng, Christina, Cheung, Jason, Chong, Chun, Corluka, Stipe, Corredor, Jose, Costa, Bruno, Curri, Cloe, Dawoud, Ahmed, Delgado- Fernandez, Juan, Demiroz, Serdar, Desai, Ankit, Diez-Ulloa, Maximo, Dimas, Noe, Diniz, Sara, Direito-Santos, Bruno, Duerinck, Johnny, El- Hewala, Tarek, El-Shamly, Mahmoud, El-Sharkawi, Mohammed, Espinosa, Guillermo, Estefan, Martin, Fang, Taolin, Fernandes, Mauro, Fernandez, Norbert, Ferreira, Marcus, Figueiredo, Alfredo, Fiorenza, Vito, Francis, Jibin, Franz, Seibert, Freedman, Brett, Fu, Lingjie, Fuego, Segundo, Gahlot, Nitesh, Ganau, Mario, Garcia-Pallero, Maria, Garg, Bhavuk, Gidvani, Sandeep, Giera, Bjoern, Godinho, Amauri, Goni, Morshed, Gonzalez, Maria, Gopalakrishnan, Dilip, Grin, Andrey, Grozman, Samuel, Gruenberg, Marcel, Grundshtein, Alon, Guasque, Joana, Guerra, Oscar, Guiroy, Alfredo, Hackla, Shafiq, Harris, Colin, Harrop, James, Hassan, Waqar, Henine, Amin, Hickman, Zachary, Igualada, Cristina, James, Andrew, Jetjumnong, Chumpon, Kaen, Ariel, Karmacharya, Balgopal, Kilincer, Cumur, Klezl, Zdenek, Koerner, John, Konrads, Christian, Krappel, Ferdinand, Kruyt, Moyo, Krywinski, Fernando, Kundangar, Raghuraj, Landriel, Federico, Lindtner, Richard, Linhares, Daniela, Llombart-Blanco, Rafael, Lopez, William, Lotan, Raphael, Lourido, Juan, Luna, Luis, Magashi, Tijjani, Majer, Catalin, Mandizvidza, Valentine, Manilha, Rui, Mannara, Francisco, Margetis, Konstantinos, Medina, Fabrico, Milano, Jeronimo, Miyakoshi, Naohisa, Moisa, Horatiu, Montemurro, Nicola, Montoya, Juan, Morais, Joao, Morande, Sebastian, Msuya, Salim, Mubarak, Mohamed, Mulbah, Robert, Murugan, Yuvaraja, Nacer, Mansouri, Neves, Nuno, Nicassio, Nicola, Niemeier, Thomas, Olorunsogo, Mejabi, Oner, F. C., Orosco, David, Ozdener, Kubilay, Paez, Rodolfo, Panchal, Ripul, Paterakis, Konstantinos, Pemovska, Emilija, Pereira, Paulo, Perovic, Darko, Perozo, Jose, Pershin, Andrey, Phedy, Phedy, Picazo, David, Pitti, Fernando, Platz, Uwe, Pluderi, Mauro, Ponnusamy, Gunasaeelan, Popescu, Eugen, Ramakrishnan, Selvaraj, Ramieri, Alessandro, Rebholz, Brandon, Ricciadri, Guillermo, Ricciardi, Daniel, Robinson, Yohan, Rodriguez, Luis, Rogrigues-Pinto, Ricardo, Romero, Itati, Rosas, Ronald, Russo, Salvatore, Rutges, Joost, Sartor, Federico, Schroeder, Gregory, Shariati, Babak, Sharma, Jeevan, Shoaib, Mahmoud, Smith, Sean, Sorimachi, Yasunori, Sribastav, Shilanant, Steiner, Craig, Subbiah, Jayakumar, Suramanian, Panchu, Suri, Tarun, Tannoury, Chadi, Tokala, Devi, Toluse, Adetunji, Ungurean, Victor, Vaccaro, Alexander, Vahl, Joachim, Valacco, Marcelo, Valdez, Cristian, Vernengo-Lezica, Alejo, Veroni, Andrea, Vieira, Rian, Viswanadha, Arun, Wagner, Scott, Wamae, David, Weening, Alexander, Weidert, Simon, Wu, Wen-Tien, Wu, Meng-Huang, Yuan, Haifeng, Yuh, Sung-Joo, Yurac, Ratko, Zarate- Kalfopulos, Baron, Ziabrov, Alesksei, Zubairi, Akbar, AO Spine Cervical Classification Validation Group, 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 J.A., Schroeder G.D., Patel P.D., Grasso G., Chang M., Kandziora F., Vialle E.N., Oner F.C., Schnake K.J., Dvorak M.F., Chapman J.R., Benneker L.M., Rajasekaran S., Kepler C.K., Vaccaro A.R., Abdelgawaad A., Abdul W., Abdulsalam A., Abeid M., Ackshota N., Acosta O., Akman Y., Aldahamsheh O., Alhammoud A., Aleixo H., Alexander H., Alkharsawi M., Alsammak W., Amadou H., Amin M., Arbatin J., Atan A., Athanasiou A., Bas P., Bazan P., Benzakour T., Benzarti S., Bernucci C., Bosco A., Butler J., Castillo A., Cawley D., Chek W., Chen J., Cheng C., Cheung J., Chong C., Corluka S., Corredor J., Costa B., Curri C., Dawoud A., Delgado-Fernandez J., Demiroz S., Desai A., Diez-Ulloa M., Dimas N., Diniz S., Direito-Santos B., Duerinck J., El-Hewala T., El-Shamly M., El-Sharkawi M., Espinosa G., Estefan M., Fang T., Fernandes M., Fernandez N., Ferreira M., Figueiredo A., Fiorenza V., Francis J., Franz S., Freedman B., Fu L., Fuego S., Gahlot N., Ganau M., Garcia-Pallero M., Garg B., Gidvani S., Giera B., Godinho A., Goni M., Gonzalez M., Gopalakrishnan D., Grin A., Grozman S., Gruenberg M., Grundshtein A., Guasque J., Guerra O., Guiroy A., Hackla S., Harris C., Harrop J., Hassan W., Henine A., Hickman Z., Igualada C., James A., Jetjumnong C., Kaen A., Karmacharya B., Kilincer C., Klezl Z., Koerner J., Konrads C., Krappel F., Kruyt M., Krywinski F., Kundangar R., Landriel F., Lindtner R., Linhares D., Llombart-Blanco R., Lopez W., Lotan R., Lourido J., Luna L., Magashi T., Majer C., Mandizvidza V., Manilha R., Mannara F., Margetis K., Medina F., Milano J., Miyakoshi N., Moisa H., Montemurro N., Montoya J., Morais J., Morande S., Msuya S., Mubarak M., Mulbah R., Murugan Y., Nacer M., Neves N., Nicassio N., Niemeier T., Olorunsogo M., Orosco D., Ozdener K., Paez R., Panchal R., Paterakis K., Pemovska E., Pereira P., Perovic D., Perozo J., Pershin A., Phedy P., Picazo D., Pitti F., Platz U., Pluderi M., Ponnusamy G., Popescu E., Ramakrishnan S., Ramieri A., Rebholz B., Ricciadri G., Ricciardi D., Robinson Y., Rodriguez L., Rogrigues-Pinto R., Romero I., Rosas R., Russo S., Rutges J., Sartor F., Schroeder G., Shariati B., Sharma J., Shoaib M., Smith S., Sorimachi Y., Sribastav S., Steiner C., Subbiah J., Suramanian P., Suri T., Tannoury C., Tokala D., Toluse A., Ungurean V., Vaccaro A., Vahl J., Valacco M., Valdez C., Vernengo-Lezica A., Veroni A., Vieira R., Viswanadha A., Wagner S., Wamae D., Weening A., Weidert S., Wu W.-T., Wu M.-H., Yuan H., Yuh S.-J., Yurac R., Zarate-Kalfopulos B., Ziabrov A., Zubairi A., Surgical clinical sciences, Neuroprotection & Neuromodulation, and Neurosurgery

Subjects
Cervical spine, Joint dislocations, Neck injuries, Spinal diseases, Spinal injuries, Trauma, medicine.medical_specialty, Facet (geometry), Neck injurie, Neuroscience(all), 610 Medicine & health, Experiential learning, Joint dislocation, 03 medical and health sciences, 0302 clinical medicine, Spinal disease, medicine, Humans, Orthopedics and Sports Medicine, 030212 general & internal medicine, Surgeons, Validation group, Spinal injurie, business.industry, Spine.cervical, medicine.disease, Preference, Spinal Fusion, Cervical Vertebrae, Physical therapy, Surgery, Neurosurgery, Anterior approach, business, 030217 neurology & neurosurgery
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

23. Surgical Restoration of Sagittal Alignment of the Spine: Correlation with Improved Patient-Reported Outcomes: A Systematic Review and Meta-Analysis

Author

MS Orthopaedie Algemeen, Regenerative Medicine and Stem Cells, Ochtman, A. E. A., Kruyt, M. C., Jacobs, W. C. H., Kersten, R. F. M. R., le Huec, J. C., Oner, F. C., van Gaalen, S. M., MS Orthopaedie Algemeen, Regenerative Medicine and Stem Cells, Ochtman, A. E. A., Kruyt, M. C., Jacobs, W. C. H., Kersten, R. F. M. R., le Huec, J. C., Oner, F. C., and van Gaalen, S. M.

Published
2020

27. Machine learning prediction models in orthopedic surgery: A systematic review in transparent reporting.

Author

Groot, Olivier Q., Ogink, Paul T., Lans, Amanda, Twining, Peter K., Kapoor, Neal D., DiGiovanni, William, Bindels, Bas J. J., Bongers, Michiel E. R., Oosterhoff, Jacobien H. F., Karhade, Aditya V., Oner, F. C., Verlaan, Jorrit‐Jan, and Schwab, Joseph H.

Subjects
PREDICTION models, ORTHOPEDIC surgery, MACHINE learning, MISSING data (Statistics)
Abstract

Machine learning (ML) studies are becoming increasingly popular in orthopedics but lack a critically appraisal of their adherence to peer‐reviewed guidelines. The objective of this review was to (1) evaluate quality and transparent reporting of ML prediction models in orthopedic surgery based on the transparent reporting of multivariable prediction models for individual prognosis or diagnosis (TRIPOD), and (2) assess risk of bias with the Prediction model Risk Of Bias ASsessment Tool. A systematic review was performed to identify all ML prediction studies published in orthopedic surgery through June 18th, 2020. After screening 7138 studies, 59 studies met the study criteria and were included. Two reviewers independently extracted data and discrepancies were resolved by discussion with at least two additional reviewers present. Across all studies, the overall median completeness for the TRIPOD checklist was 53% (interquartile range 47%–60%). The overall risk of bias was low in 44% (n = 26), high in 41% (n = 24), and unclear in 15% (n = 9). High overall risk of bias was driven by incomplete reporting of performance measures, inadequate handling of missing data, and use of small datasets with inadequate outcome numbers. Although the number of ML studies in orthopedic surgery is increasing rapidly, over 40% of the existing models are at high risk of bias. Furthermore, over half incompletely reported their methods and/or performance measures. Until these issues are adequately addressed to give patients and providers trust in ML models, a considerable gap remains between the development of ML prediction models and their implementation in orthopedic practice. [ABSTRACT FROM AUTHOR]

Published
2022
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33. Sparing the surgical area with stereotactic body radiotherapy for combined treatment of spinal metastases: a treatment planning study

Author

Trialbureau Beeld, Other research (not in main researchprogram), Arts-assistenten Radiotherapie, MS Radiotherapie, Cancer, Epi Kanker Team A, Circulatory Health, JC onderzoeksprogramma Kanker, Divisie Beeld & Oncologie, MS Orthopaedie Spine, Regenerative Medicine and Stem Cells, Klinische Fysica RT, Orthopaedie Opleiding, Versteeg, A L, Hes, J, van der Velden, J M, Eppinga, W, Kasperts, N, Verkooijen, H M, van Vulpen, M, Oner, F C, Seravalli, E, Verlaan, J J, Trialbureau Beeld, Other research (not in main researchprogram), Arts-assistenten Radiotherapie, MS Radiotherapie, Cancer, Epi Kanker Team A, Circulatory Health, JC onderzoeksprogramma Kanker, Divisie Beeld & Oncologie, MS Orthopaedie Spine, Regenerative Medicine and Stem Cells, Klinische Fysica RT, Orthopaedie Opleiding, Versteeg, A L, Hes, J, van der Velden, J M, Eppinga, W, Kasperts, N, Verkooijen, H M, van Vulpen, M, Oner, F C, Seravalli, E, and Verlaan, J J

Published
2019

36. Long-term (> 10 years) clinical outcomes of instrumented posterolateral fusion for spondylolisthesis.

Author

Lehr, A. M., Delawi, D., van Susante, J. L. C., Verschoor, N., Wolterbeek, N., Oner, F. C., and Kruyt, M. C.

Subjects
SPONDYLOLISTHESIS, SPINAL fusion, TREATMENT effectiveness, VISUAL analog scale, PATIENT satisfaction, LEG pain, DIAGNOSIS, RESEARCH, CROSS-sectional method, RESEARCH methodology, MEDICAL cooperation, EVALUATION research, COMPARATIVE studies, RANDOMIZED controlled trials, QUESTIONNAIRES, LUMBAR vertebrae
Abstract

Purpose: Despite the rapid increase in instrumented spinal fusions for a variety of indications, most studies focus on short-term fusion rates. Long-term clinical outcomes are still scarce and inconclusive. This study investigated clinical outcomes > 10 years after single-level instrumented posterolateral spinal fusion for lumbar degenerative or isthmic spondylolisthesis with neurological symptoms.Methods: Cross-sectional long-term follow-up among the Dutch participants of an international multicenter randomized controlled trial comparing osteogenic protein-1 with autograft. Clinical outcomes were assessed using the Oswestry Disability Index (ODI), EQ-5D-3L and visual analogue scale (VAS) for leg and back pain, as well as questions on satisfaction with treatment and additional surgery.Results: The follow-up rate was 73% (41 patients). At mean 11.8 (range 10.1-13.7) years after surgery, a non-significant deterioration of clinical outcomes compared to 1-year follow-up was observed. The mean ODI was 20 ± 19, mean EQ-5D-3L index score 0.784 ± 0.251 and mean VAS for leg and back pain, respectively, 34 ± 33 and 31 ± 28. Multiple regression showed that diagnosis (degenerative vs. isthmic spondylolisthesis), graft type (OP-1 vs. autograft) and 1-year fusion status (fusion vs. no fusion) were not predictive for the ODI at long-term follow-up (p = 0.389). Satisfaction with treatment was excellent and over 70% of the patients reported lasting improvement in back and/or leg pain. No revision surgeries for non-union were reported.Conclusion: This study showed favourable clinical outcomes > 10 years after instrumented posterolateral spinal fusion and supports spondylolisthesis with neurological symptoms as indication for fusion surgery. [ABSTRACT FROM AUTHOR]

Published
2021
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37. Anterior longitudinal ligament in diffuse idiopathic skeletal hyperostosis: Ossified or displaced?

Author

Kuperus, J.S., Smit, E.J.M., Pouran, B., van Hamersvelt, R.W., van Stralen, Marijn, Seevinck, P.R., Buckens, C.F., Bleys, Ronald L.A.W., Weinans, H.H., Oner, F. C., de Jong, P.A., and Verlaan, J-J

Subjects
anterior longitudinal ligament, pathogenesis, computed tomography, bone/bone biology, diffuse idiopathic skeletal hyperostosis, spine, cryomacrotome
Abstract

Diffuse idiopathic skeletal hyperostosis (DISH) is often theorized to be an ossification of the anterior longitudinal ligament (ALL). Using computed tomography (CT) imaging and cryomacrotome sectioning, we investigated the spatial relationship between the ALL and newly formed bone in DISH to test this hypothesis. In the current study, four human cadaveric spines diagnosed with DISH using CT imaging were frozen and sectioned using a cryomacrotome. Photographs were obtained of the specimen at 125 µm intervals. Manual segmentations of the ALL on cryomacrotome photographs were projected onto the three-dimensional reconstructed CT scans. The presence and location of newly formed bone were assessed in relationship to the location of the ALL. The ALL could be identified and segmented on the photographs at all levels. The ALL was located at the midline at levels where no new bone had formed. At the locations where new bone had abundantly formed, the ALL was displaced towards to the contralateral side and not replaced by bony tissue. The displacement of the—morphologically normal appearing—ALL away from the newly formed bone implies that newly formed bone in DISH may not originate from the ALL.

Published
2018

40. CLINICAL RESULTS WITH OSTEOACTIVE BONE SUBSTITUTE

Author

Bakker, D., Draijer, W. F., Schattenkerk, M. P. Eeftinck, van der Eijken, J. W., de Gruijter, A. J., van der Hart, C. P., Klos, B., Nicolai, J.-P. A., Oner, F. C., Pot, J. H., Verbout, A. J., Verburg, A. D., and Bulstra, S. K.

Published
1998

41. Stereotactic Radiotherapy Followed by Surgical Stabilization Within 24 h for Unstable Spinal Metastases; A Stage I/IIa Study According to the IDEAL Framework

Author

Versteeg, Anne L, van der Velden, Joanne M, Hes, Jochem, Eppinga, Wietse, Kasperts, Nicolien, Verkooijen, Helena M, Oner, F C, Seravalli, Enrica, Verlaan, Jorrit-Jan, Versteeg, Anne L, van der Velden, Joanne M, Hes, Jochem, Eppinga, Wietse, Kasperts, Nicolien, Verkooijen, Helena M, Oner, F C, Seravalli, Enrica, and Verlaan, Jorrit-Jan

Published
2018

42. Anterior longitudinal ligament in diffuse idiopathic skeletal hyperostosis: Ossified or displaced?

Author

Kuperus, J.S. (author), Smit, E.J.M. (author), Pouran, B. (author), van Hamersvelt, R.W. (author), van Stralen, Marijn (author), Seevinck, P.R. (author), Buckens, C.F. (author), Bleys, Ronald L.A.W. (author), Weinans, H.H. (author), Oner, F. C. (author), de Jong, P.A. (author), Verlaan, J-J (author), Kuperus, J.S. (author), Smit, E.J.M. (author), Pouran, B. (author), van Hamersvelt, R.W. (author), van Stralen, Marijn (author), Seevinck, P.R. (author), Buckens, C.F. (author), Bleys, Ronald L.A.W. (author), Weinans, H.H. (author), Oner, F. C. (author), de Jong, P.A. (author), and Verlaan, J-J (author)

Abstract

Diffuse idiopathic skeletal hyperostosis (DISH) is often theorized to be an ossification of the anterior longitudinal ligament (ALL). Using computed tomography (CT) imaging and cryomacrotome sectioning, we investigated the spatial relationship between the ALL and newly formed bone in DISH to test this hypothesis. In the current study, four human cadaveric spines diagnosed with DISH using CT imaging were frozen and sectioned using a cryomacrotome. Photographs were obtained of the specimen at 125 µm intervals. Manual segmentations of the ALL on cryomacrotome photographs were projected onto the three-dimensional reconstructed CT scans. The presence and location of newly formed bone were assessed in relationship to the location of the ALL. The ALL could be identified and segmented on the photographs at all levels. The ALL was located at the midline at levels where no new bone had formed. At the locations where new bone had abundantly formed, the ALL was displaced towards to the contralateral side and not replaced by bony tissue. The displacement of the—morphologically normal appearing—ALL away from the newly formed bone implies that newly formed bone in DISH may not originate from the ALL., Biomaterials & Tissue Biomechanics

Published
2018
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43. Stereotactic Radiotherapy Followed by Surgical Stabilization Within 24 h for Unstable Spinal Metastases; A Stage I/IIa Study According to the IDEAL Framework

Author

Trialbureau Beeld, Other research (not in main researchprogram), MS Orthopaedie Spine, Arts-assistenten Radiotherapie, MS Radiotherapie, Cancer, Epi Kanker Team A, Circulatory Health, JC onderzoeksprogramma Kanker, Regenerative Medicine and Stem Cells, Klinische Fysica RT, Orthopaedie Opleiding, Versteeg, Anne L, van der Velden, Joanne M, Hes, Jochem, Eppinga, Wietse, Kasperts, Nicolien, Verkooijen, Helena M, Oner, F C, Seravalli, Enrica, Verlaan, Jorrit-Jan, Trialbureau Beeld, Other research (not in main researchprogram), MS Orthopaedie Spine, Arts-assistenten Radiotherapie, MS Radiotherapie, Cancer, Epi Kanker Team A, Circulatory Health, JC onderzoeksprogramma Kanker, Regenerative Medicine and Stem Cells, Klinische Fysica RT, Orthopaedie Opleiding, Versteeg, Anne L, van der Velden, Joanne M, Hes, Jochem, Eppinga, Wietse, Kasperts, Nicolien, Verkooijen, Helena M, Oner, F C, Seravalli, Enrica, and Verlaan, Jorrit-Jan

Published
2018

45. Diagnosis of diffuse idiopathic skeletal hyperostosis with chest computed tomography: inter-observer agreement

Author

Cancer, MS Radiologie, Researchgr. Systems Radiology, Circulatory Health, Arts-assistenten Radiologie, Brain, MS Orthopaedie Spine, Regenerative Medicine and Stem Cells, Oudkerk, S F, de Jong, Pim A, Attrach, M, Luijkx, T, Buckens, C F, Mali, W P Th M, Oner, F C, Resnick, D L, Vliegenthart, R, Verlaan, J J, Cancer, MS Radiologie, Researchgr. Systems Radiology, Circulatory Health, Arts-assistenten Radiologie, Brain, MS Orthopaedie Spine, Regenerative Medicine and Stem Cells, Oudkerk, S F, de Jong, Pim A, Attrach, M, Luijkx, T, Buckens, C F, Mali, W P Th M, Oner, F C, Resnick, D L, Vliegenthart, R, and Verlaan, J J

Published
2017

46. Sparing the surgical area with stereotactic body radiotherapy for combined treatment of spinal metastases: a treatment planning study.

Author

Versteeg, A. L., Hes, J., van der Velden, J. M., Eppinga, W., Kasperts, N., Verkooijen, H. M., van Vulpen, M., Oner, F. C., Seravalli, E., and Verlaan, J. J.

Subjects
METASTASIS, RADIATION doses, RADIOSURGERY, SPINAL tumors
Abstract

Introduction: Decreasing the radiation dose in the surgical area is important to lower the risk of wound complications when surgery and radiotherapy are combined for the treatment of spinal metastases. The purpose of this study was to compare the radiation dose in the surgical area for spinal metastases between single fraction external beam radiotherapy (EBRT), single fraction stereotactic body radiotherapy (SBRT) and single fraction SBRT with active sparing (SBRT-AS) of the posterior surgical area. Methods: Radiotherapy treatment plans for EBRT, SBRT and SBRT-AS of the posterior surgical area were created for 13 patients with spinal metastases. A single fraction of 8Gy was prescribed to the spinal metastasis in the EBRT plan. For the SBRT treatment plans, a single fraction of 18Gy was prescribed to the metastasis and 8Gy to the rest of the vertebral body. For the SBRT plan with active sparing the dose in the designated surgical area was minimized without compromising the dose to the organs at risk. Results: The median dose in the surgical area was 2.6Gy (1.6-5.3Gy) in the SBRT plan with active sparing of the surgical area compared to a median dose of 3.7Gy (1.6-6.3Gy) in the SBRT plan without sparing and 6.5Gy (3.5-9.1Gy) in the EBRT plans (p < .001). The radiation doses to the spinal metastases and organs at risk were not significantly different between the SBRT plan with and without sparing the surgical area. Conclusions: The radiation dose to the surgical area is significantly decreased with the use of SBRT compared to EBRT. Active sparing of the surgical area further decreased the mean radiation dose in the surgical area without compromising the dose to the spinal metastasis and the organs at risk. [ABSTRACT FROM AUTHOR]

Published
2019
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47. Historical Perspectives on the Evolution of Spino-Pelvic Fixation and its Implications on Clinical Care A Narrative Review

Author

von Glinski, Alexander, Yilmaz, Emre, Godolias, Periklis, Benneker, Lorin, Oner, F. C., Kandziora, Frank, Schroeder, Gregory, Schnake, Klaus, Dvorak, Marcel, Rajasekaran, Shanmuganathan, El-Sharkawi, Mohammad, Vaccaro, Alexander, Bransford, Richard, Schildhauer, Thomas A., and Chapman, Jens R.

Abstract

Study Design Broad narrative review.Objectives To review and summarize the evolution of spinopelvic fixation (SPF) and its implications on clinical care.Methods A thorough review of peer-reviewed literature was performed on the historical evolution of sacropelvic fixation techniques and their respective advantages and disadvantages.Results The sacropelvic junction has been a long-standing challenge due to a combination of anatomic idiosyncrasies and very high biomechanical forces. While first approaches of fusion were determinated by many material and surgical technique-related limitations, the modern idea of stabilization of the lumbosacral junction was largely initiated by the inclusion of the ilium into lumbosacral fusion. While there is a wide spectrum of indications for SPF the chosen technique remains is defined by the individual pathology and surgeons’ preference.Conclusion By a constant evolution of both instrumentation hardware and surgical technique better fusion rates paired with improved clinical results could be achieved.

Published
2024
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50. 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

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