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1. Significant Reduction in Bone Density as Measured by Hounsfield Units in Patients with Ankylosing Spondylitis or Diffuse Idiopathic Skeletal Hyperostosis

Author

Swart, Alexander, primary, Hamouda, Abdelrahman, additional, Pennington, Zach, additional, Lakomkin, Nikita, additional, Mikula, Anthony L., additional, Martini, Michael L., additional, Shafi, Mahnoor, additional, Subramaniam, Thirusivapragasam, additional, Sebastian, Arjun S., additional, Freedman, Brett A., additional, Nassr, Ahmad N., additional, Fogelson, Jeremy L., additional, and Elder, Benjamin D., additional

Published
2024
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2. The Predictors of Incidental Durotomy in Patients Undergoing Pedicle Subtraction Osteotomy for the Correction of Adult Spinal Deformity

Author

Hamouda, Abdelrahman M., primary, Pennington, Zach, additional, Astudillo Potes, Maria, additional, Mikula, Anthony L., additional, Lakomkin, Nikita, additional, Martini, Michael L., additional, Abode-Iyamah, Kingsley O., additional, Freedman, Brett A., additional, McClendon, Jamal, additional, Nassr, Ahmad N., additional, Sebastian, Arjun S., additional, Fogelson, Jeremy L., additional, and Elder, Benjamin D., additional

Published
2024
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6. Titanium Cervical Cage Subsidence: Postoperative Computed Tomography Analysis Defining Incidence and Associated Risk Factors.

Author

Pinter, Zachariah W., Reed, Ryder, Townsley, Sarah E., Mikula, Anthony L, Dittman, Lauren, Xiong, Ashley, Skjaerlund, Jonathan, Michalopoulos, Giorgos D., Currier, Bradford, Nassr, Ahmad, Fogelson, Jeremy L., Freedman, Brett A., Bydon, Mohamad, Kepler, Christopher K., Wagner, Scott C, Elder, Benjamin D., and Sebastian, Arjun S.

Subjects
COMPUTED tomography, LAND subsidence, TITANIUM, STATURE, VERTEBROPLASTY, PSEUDARTHROSIS
Abstract

Study Design: Retrospective cohort study Objective: Substantial variability in both the measurement and classification of subsidence limits the strength of conclusions that can be drawn from previous studies. The purpose of this study was to precisely characterize patterns of cervical cage subsidence utilizing computed tomography (CT) scans, determine risk factors for cervical cage subsidence, and investigate the impact of subsidence on pseudarthrosis rates. Methods: We performed a retrospective review of patients who underwent one- to three-levels of anterior cervical discectomy and fusion (ACDF) utilizing titanium interbodies with anterior plating between the years 2018 and 2020. Subsidence measurements were performed by two independent reviewers on CT scans obtained 6 months postoperatively. Subsidence was then classified as mild if subsidence into the inferior and superior endplate were both ≤2 mm, moderate if the worst subsidence into the inferior or superior endplate was between 2 to 4 mm, or severe if the worst subsidence into the inferior or superior endplate was ≥4 mm. Results: A total of 51 patients (100 levels) were included in this study. A total of 48 levels demonstrated mild subsidence (≤2 mm), 38 demonstrated moderate subsidence (2-4 mm), and 14 demonstrated severe subsidence (≥4 mm). Risk factors for severe subsidence included male gender, multilevel constructs, greater mean vertebral height loss, increased cage height, lower Taillard index, and lower screw tip to vertebral body height ratio. Severe subsidence was not associated with an increased rate of pseudarthrosis. Conclusion: Following ACDF with titanium cervical cages, subsidence is an anticipated postoperative occurrence and is not associated with an increased risk of pseudarthrosis. [ABSTRACT FROM AUTHOR]

Published
2023
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7. No Difference in Neck Pain or Health-Related Quality Measures Between Patients With or Without Degenerative Cervical Spondylolisthesis.

Author

Kaye, Ian David, Sebastian, Arjun S., Wagner, Scott C., Semenza, Nicholas, Bowles, Daniel, Schroeder, Gregory D., Kepler, Chris K., Woods, Barret I., Radcliff, Kris E., Kurd, Mark F., Rihn, Jeff, Anderson, David Greg, Hilibrand, Alan S., and Vaccaro, Alexander R.

Subjects
NECK pain, SPONDYLOLISTHESIS, MULTIPLE regression analysis, VISUAL analog scale, SPINAL surgery, DEMOGRAPHIC characteristics
Abstract

Study Design: This study is a retrospective case control. Objectives: This study aims to determine whether cervical degenerative spondylolisthesis (DS) is associated with increased baseline neck/arm pain and inferior health quality states compared to a similar population without DS. Methods: Patient demographics, pre-operative radiographs, and baseline PROMs were reviewed for 315 patients undergoing anterior cervical decompression and fusion (ACDF) with at least 1 year of follow-up. Patients were categorized based on the presence (S) or absence of a spondylolisthesis (NS). Statistically significant variables were further explored using multiple linear regression analysis. Results: 49/242 (20%) patients were diagnosed with DS, most commonly at the C4–5 level (27/49). The S group was significantly older than the NS group (58.0 ± 10.7 vs 51.9 ± 9.81, P =.001), but otherwise, no demographic differences were identified. Although a higher degree of C2 slope was found among the S cohort (22.5 ± 8.63 vs 19.8 ± 7.78, P =.044), no differences were identified in terms of preoperative visual analogue scale (VAS) neck pain or NDI. In the univariate analysis, the NS group had significantly increased VAS arm pain relative to the S group (4.93 ± 3.16 vs 3.86 ± 3.30, P =.045), which was no longer significant in the multivariate analysis. Conclusions: Although previous reports have suggested an association between cervical DS and neck pain, we could not associate the presence of DS with increased baseline neck or arm pain. Instead, DS appears to be a relatively frequent (20% in this series) age-related condition reflecting radiographic, rather than necessarily clinical, disease. [ABSTRACT FROM AUTHOR]

Published
2023
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12. Allograft Subsidence Decreases Postoperative Segmental Lordosis With Minimal Effect on Global Alignment Following ACDF.

Author

Pinter, Zachariah W., Mikula, Anthony, Shirley, Matthew, Xiong, Ashley, Wagner, Scott, Elder, Benjamin D., Freedman, Brett A., Nassr, Ahmad, Bydon, Mohamad, Currier, Bradford, Kaye, I. David, Kepler, Christopher, and Sebastian, Arjun S.

Subjects
LORDOSIS, HOMOGRAFTS, SURGICAL complications, FOLLOW-up studies (Medicine), COMPUTED tomography
Abstract

Study Design: Retrospective cohort study. Objective: Studies investigating the impact of interbody subsidence in ACDF suggest a correlation between subsidence and worse radiographic and patient-reported outcomes. The purpose of this study was to assess whether allograft subsidence assessed on CT is associated with worse cervical alignment. Methods: We performed a retrospective review of a prospective cohort of patients undergoing 1 to 3 level ACDF. Cervical alignment was assessed on standing radiographs performed preoperatively, less than 2 months postoperatively, and greater than 6 months postoperatively. Allograft subsidence was assessed on CT scan performed at least 6 months postoperatively. Patients with at least 1 level demonstrating greater than 4mm of cage subsidence were classified as severe subsidence. Student's t-test was used to compare all means between groups. Results: We identified 66 patients for inclusion, including 56 patients with non-severe subsidence and 10 patients with severe subsidence. For the entire cohort, there was a significant increase in C2-7 Lordosis (p = 0.005) and Segmental Lordosis (p < 0.00 001) from preoperative to early postoperative. On comparison of severely and non-severely subsided levels, severely subsided levels demonstrated a significantly greater loss of segmental lordosis from early to mid-term follow-up than non-severely subsided levels (-4.89 versus -2.59 degrees, p < 0.0001), manifesting as a significantly lower segmental lordosis at >6 months postoperative (0.54 versus 3.82 degrees, p < 0.00 001). There were no significant differences in global cervical alignment parameters between patients with severe and non-severe subsidence. Conclusions: Severe subsidence is associated with a significant increase in loss of segmental lordosis, but has minimal effect on global cervical alignment parameters. [ABSTRACT FROM AUTHOR]

Published
2022
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13. No Difference in Neck Pain or Health-Related Quality Measures Between Patients With or Without Degenerative Cervical Spondylolisthesis

Author

Kaye, Ian David, primary, Sebastian, Arjun S., additional, Wagner, Scott C., additional, Semenza, Nicholas, additional, Bowles, Daniel, additional, Schroeder, Gregory D., additional, Kepler, Chris K., additional, Woods, Barret I., additional, Radcliff, Kris E., additional, Kurd, Mark F., additional, Rihn, Jeff, additional, Anderson, David Greg, additional, Hilibrand, Alan S., additional, and Vaccaro, Alexander R., additional

Published
2021
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14. Titanium Cervical Cage Subsidence: Postoperative Computed Tomography Analysis Defining Incidence and Associated Risk Factors

Author

Pinter, Zachariah W., primary, Reed, Ryder, additional, Townsley, Sarah E., additional, Mikula, Anthony L, additional, Dittman, Lauren, additional, Xiong, Ashley, additional, Skjaerlund, Jonathan, additional, Michalopoulos, Giorgos D., additional, Currier, Bradford, additional, Nassr, Ahmad, additional, Fogelson, Jeremy L., additional, Freedman, Brett A., additional, Bydon, Mohamad, additional, Kepler, Christopher K., additional, Wagner, Scott C, additional, Elder, Benjamin D., additional, and Sebastian, Arjun S., additional

Published
2021
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15. 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

17. Radiographic Measures of Spinal Alignment Are Not Predictive of the Development of C5 Palsy Following Anterior Cervical Discectomy and Fusion Surgery

Author

Sinensky, Andrew M., primary, Kaye, Ian D., additional, Li, William T., additional, Wagner, Scott C., additional, Butler, Joseph S., additional, Sebastian, Arjun S., additional, Morrissey, Patrick B., additional, Schroeder, Gregory D., additional, Kepler, Christopher, additional, Vaccaro, Alexander R., additional, and Hilibrand, Alan S., additional

Published
2021
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18. Allograft Subsidence Decreases Postoperative Segmental Lordosis With Minimal Effect on Global Alignment Following ACDF

Author

Pinter, Zachariah W., primary, Mikula, Anthony, additional, Shirley, Matthew, additional, Xiong, Ashley, additional, Wagner, Scott, additional, Elder, Benjamin D., additional, Freedman, Brett A., additional, Nassr, Ahmad, additional, Bydon, Mohamad, additional, Currier, Bradford, additional, Kaye, I. David, additional, Kepler, Christopher, additional, and Sebastian, Arjun S., additional

Published
2021
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19. Cervical Paraspinal Muscle Fatty Degeneration Is Not Associated with Muscle Cross-sectional Area: Qualitative Assessment Is Preferable for Cervical Sarcopenia

Author

Pinter, Zachariah W., primary, Wagner, Scott, additional, Fredericks, Donald, additional, Xiong, Ashley, additional, Helgeson, Melvin, additional, Currier, Bradford, additional, Freedman, Brett A., additional, Kepler, Christopher, additional, Elder, Benjamin D., additional, Bydon, Mohamad, additional, Nassr, Ahmad, additional, and Sebastian, Arjun S., additional

Published
2021
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25. Osteoporosis in spine surgery patients: what is the best way to diagnose osteoporosis in this population?

Author

St. Jeor, Jeffery D., primary, Jackson, Taylor J., additional, Xiong, Ashley E., additional, Kadri, Aamir, additional, Freedman, Brett A., additional, Sebastian, Arjun S., additional, Currier, Bradford L., additional, Nassr, Ahmad, additional, Fogelson, Jeremy L., additional, Kennel, Kurt A., additional, Anderson, Paul A., additional, and Elder, Benjamin D., additional

Published
2020
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26. Regional improvements in lumbosacropelvic Hounsfield units following teriparatide treatment

Author

Flanigan, Patrick M., primary, Mikula, Anthony L., additional, Peters, Pierce A., additional, Oushy, Soliman, additional, Fogelson, Jeremy L., additional, Bydon, Mohamad, additional, Freedman, Brett A., additional, Sebastian, Arjun S., additional, Currier, Bradford L., additional, Nassr, Ahmad, additional, Kennel, Kurt A., additional, Anderson, Paul A., additional, Polly, David W., additional, and Elder, Benjamin D., additional

Published
2020
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28. Anterior Cervical Osteophyte Resection for Treatment of Dysphagia

Author

Kolz, Joshua M., primary, Alvi, Mohammed A., additional, Bhatti, Atiq R., additional, Tomov, Marko N., additional, Bydon, Mohamad, additional, Sebastian, Arjun S., additional, Elder, Benjamin D., additional, Nassr, Ahmad N., additional, Fogelson, Jeremy L., additional, Currier, Bradford L., additional, and Freedman, Brett A., additional

Published
2020
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35. Rare Complications of Cervical Spine Surgery: Pseudomeningocoele

Author

Ailon, Tamir, primary, Smith, Justin S., additional, Nassr, Ahmad, additional, Smith, Zachary A., additional, Hsu, Wellington K., additional, Fehlings, Michael G., additional, Fish, David E., additional, Wang, Jeffrey C., additional, Hilibrand, Alan S., additional, Mummaneni, Praveen V., additional, Chou, Dean, additional, Sasso, Rick C., additional, Traynelis, Vincent C., additional, Arnold, Paul M., additional, Mroz, Thomas E., additional, Buser, Zorica, additional, Lord, Elizabeth L., additional, Massicotte, Eric M., additional, Sebastian, Arjun S., additional, Than, Khoi D., additional, Steinmetz, Michael P., additional, Smith, Gabriel A., additional, Pace, Jonathan, additional, Corriveau, Mark, additional, Lee, Sungho, additional, Riew, K. Daniel, additional, and Shaffrey, Christopher, additional

Published
2017
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36. Perioperative Vision Loss in Cervical Spinal Surgery

Author

Gabel, Brandon C., primary, Lam, Arthur, additional, Chapman, Jens R., additional, Oskouian, Rod J., additional, Nassr, Ahmad, additional, Currier, Bradford L., additional, Sebastian, Arjun S., additional, Arnold, Paul M., additional, Hamilton, Steven R., additional, Fehlings, Michael G., additional, Mroz, Thomas E., additional, and Riew, K. Daniel, additional

Published
2017
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38. Iatrogenic Spinal Cord Injury Resulting From Cervical Spine Surgery

Author

Daniels, Alan H., primary, Hart, Robert A., additional, Hilibrand, Alan S., additional, Fish, David E., additional, Wang, Jeffrey C., additional, Lord, Elizabeth L., additional, Buser, Zorica, additional, Tortolani, P. Justin, additional, Stroh, D. Alex, additional, Nassr, Ahmad, additional, Currier, Bradford L., additional, Sebastian, Arjun S., additional, Arnold, Paul M., additional, Fehlings, Michael G., additional, Mroz, Thomas E., additional, and Riew, K. Daniel, additional

Published
2017
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39. Paraspinal Sarcopenia and Lower Hounsfield Units are Independent Predictors of Increased Risk for Proximal Junctional Complications Following Thoracolumbar Fusions Terminating in the Upper Thoracic Spine

Author

Pinter, Zachariah W., Bernatz, James, Mikula, Anthony L., Lakomkin, Nikita, Pennington, Zachary A., Michalopoulos, Giorgos D., Nassr, Ahmad, Freedman, Brett A., Bydon, Mohamad, Fogelson, Jeremy, Sebastian, Arjun S., and Elder, Benjamin D.

Abstract

Study Design Retrospective cohort study.Objective The impact of paraspinal sarcopenia following fusions that extend to the upper thoracic spine remain unknown. The purpose of the present study was to assess the impact of sarcopenia on the development of PJK and PJF following spine fusion surgery from the upper thoracic spine to the pelvis.Methods We performed a retrospective review of patients who underwent spine fusion surgery that extended caudally to the pelvis and terminated cranially between T1-6. The cohort was divided into 2 groups: (1) patients without PJK or PJF and (2) patients with PJK and/or PJF. Univariate and multivariate analyses were performed to determine risk factors for the development of proximal junctional complications.Results We identified 81 patients for inclusion in this study. Mean HU at the UIV was 186.1 ± 47.5 in the cohort of patients without PJK or PJF, which was substantially higher than values recorded in the PJK/PJF subgroup (142.4 ± 40.2) (P< 0.001). Severe multifidus sarcopenia was identified at a higher rate in the subgroup of patients who developed proximal junction pathology (66.7%) than in the subgroup of patients who developed neither PJK nor PJF (7.4%; P< 0.001). Multivariate analysis demonstrated both low HU at the UIV and moderate-severe multifidus sarcopenia to be risk factors for the development of PJK and PJF.Conclusions Severe paraspinal sarcopenia and diminished bone density at the UIV impart an increased risk of developing PJK and PJF in following thoracolumbar fusions from the upper thoracic spine to the pelvis.

Published
2024
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43. Thromboembolic Disease after Cervical Spine Surgery: A Review of 5,405 Surgical Procedures and Matched Cohort Analysis

Author

Sebastian, Arjun S., Currier, Bradford L., Clarke, Michelle J., Larson, Dirk, Huddleston, Paul M., and Nassr, Ahmad

Abstract

Study Design Retrospective matched cohort analysis.Objective The majority of the literature on venous thromboembolism (VTE) after spine surgery is limited to studies of thoracolumbar surgery. Less is known regarding the incidence of VTE and associated risk factors following cervical spine surgery.Methods A total of 5,405 patients at our institution underwent cervical diskectomy, laminectomy, corpectomy, laminoplasty, or fusion between 1995 and 2012; 85 of the 5,405 patients (1.57%) suffered either a DVT (55) or pulmonary embolus (51) within 30 days postoperatively. The cases were matched 1:2 to controls based on age, sex, and date of surgery. Data regarding multiple perioperative factors, demographics, and comorbidities was collected.Results Several risk factors were identified for VTE. Significant medical comorbidities included chronic venous insufficiency (odds ratio [OR]?=?3.40), atrial fibrillation (OR?=?2.69), obesity (OR?=?2.67), and ischemic heart disease (OR?=?2.18). Staged surgery (OR?=?28.0), paralysis (OR?=?19.0), combined approach (OR?=?7.46), surgery for infection (OR?=?18.5), surgery for trauma (OR?=?11.1), comorbid traumatic injuries (OR?>?10), oncologic procedures (OR?=?5.2), use of iliac crest autograft (OR?=?4.16), two or more surgical levels (OR?=?3.48), blood loss?>?300 mL (OR?=?1.66), and length of stay 5 days or greater (OR?=?3.47) were all found to be risk factors for VTE (p?

Published
2016
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