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2. Tethered spinal cord tension assessed via ultrasound elastography in computational and intraoperative human studies

Author

Kerensky, Max J., Paul, Abhijit, Routkevitch, Denis, Hersh, Andrew M., Kempski Leadingham, Kelley M., Davidar, A. Daniel, Judy, Brendan F., Punnoose, Joshua, Williams, Autumn, Kumar, Avisha, Lehner, Kurt, Smith, Beth, Son, Jennifer K., Azadi, Javad R., Shekhar, Himanshu, Mercado-Shekhar, Karla P., Thakor, Nitish V., Theodore, Nicholas, and Manbachi, Amir

Published
2024
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3. Acute Implantation of a Bioresorbable Polymer Scaffold in Patients With Complete Thoracic Spinal Cord Injury: 24-Month Follow-up From the INSPIRE Study

Author

Kim, Kee D, Lee, K Stuart, Coric, Domagoj, Harrop, James S, Theodore, Nicholas, and Toselli, Richard M

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Rehabilitation, Neurosciences, Patient Safety, Physical Injury - Accidents and Adverse Effects, Neurodegenerative, Traumatic Head and Spine Injury, Spinal Cord Injury, Neurological, Absorbable Implants, Follow-Up Studies, Humans, Polymers, Prospective Studies, Recovery of Function, Spinal Cord Injuries, Absorbable implants, Biopolymers, Clinical trial, Spinal cord contusion, Spinal cord injuries, Spinal cord regeneration, Tissue scaffolding, Neurology & Neurosurgery, Clinical sciences, Biological psychology
Abstract

BackgroundBased on 6-month data from the InVivo Study of Probable Benefit of the Neuro-Spinal Scaffold for Safety and Neurological Recovery in Patients with Complete Thoracic Spinal Cord Injury (INSPIRE) study (NCT02138110), acute implantation of an investigational bioresorbable polymer device (Neuro-Spinal Scaffold [NSS]) appeared to be safe in patients with complete thoracic spinal cord injury (SCI) and was associated with an ASIA Impairment Scale (AIS) conversion rate that exceeded historical controls.ObjectiveTo evaluate outcomes through 24 months postimplantation.MethodsINSPIRE was a prospective, open-label, multicenter, single-arm study. Eligible patients had traumatic nonpenetrating SCI with a visible contusion on MRI, AIS A classification, neurological level of injury at T2-T12, and requirement for open spine surgery ≤96 hours postinjury.ResultsNineteen patients underwent NSS implantation. Three patients had early death determined by investigators to be unrelated to the NSS or its implantation procedure. Seven of 16 evaluable patients (44%) had improvement of ≥1 AIS grade at 6 months (primary end point) to AIS B (n = 5) or AIS C (n = 2). Three patients with AIS B at 6 months had further neurological improvement to AIS C by 12 (n = 2) and 24 (n = 1) months, respectively; none have deteriorated per latest available follow-up. No unanticipated or serious adverse device effects were reported.ConclusionIn this small group of patients with complete thoracic SCI, acute NSS implantation within the spinal cord appeared to be safe with no long-term neurological issues identified during the 24-month follow-up. Patients remain stable, with additional AIS conversions observed in some patients at 12 months and beyond. These data further support the safety and probable benefit of NSS implantation in this patient population.

Published
2022

5. C-Arm Non-Circular Orbits: Geometric Calibration, Image Quality, and Avoidance of Metal Artifacts

Author

Wu, Pengwei, Sheth, Niral, Sisniega, Alejandro, Wang, Tongyu, Uneri, Ali, Han, Runze, Vijayan, Rohan, Vagdargi, Prasad, Kreher, Bjoern, Kunze, Holger, Kleinszig, Gerhard, Vogt, Sebastian, Lo, Sheng-Fu Larry, Theodore, Nicholas, and Siewerdsen, Jeffrey

Subjects
Physics - Medical Physics, Electrical Engineering and Systems Science - Image and Video Processing
Abstract

Metal artifacts present a frequent challenge to cone-beam CT (CBCT) in image-guided surgery, obscuring visualization of metal instruments and adjacent anatomy. Recent advances in mobile C-arm systems have enabled 3D imaging capacity with non-circular orbits. We extend a previously proposed metal artifacts avoidance (MAA) method to reduce the influence of metal artifacts by prospectively defining a non-circular orbit that avoids metal-induced biases in projection domain. Accurate geometric calibration is an important challenge to accurate 3D image reconstruction for such orbits. We investigate the performance of interpolation-based calibration from a library of circular orbits for any non-circular orbit. We apply the method to non-circular scans acquired for MAA, which involves: (i) coarse 3D localization of metal objects via only two scout views using an end-to-end trained neural network; (ii) calculation of the metal-induced x-ray spectral shift for all possible views; and (iii) identification of the non-circular orbit that minimizes the variations in spectral shift. Non-circular orbits with interpolation-based geometric calibration yielded reasonably accurate 3D image reconstruction. The end-to-end neural network accurately localized metal implants with just two scout views even in complex anatomical scenes, improving Dice coefficient by ~42% compared to a more conventional cascade of separately trained U-nets. In a spine phantom with pedicle screw instrumentation, non-circular orbits identified by the MAA method reduced the magnitude of metal "blomming" artifacts (apparent width of the screw shaft) in CBCT reconstructions by ~70%. The proposed imaging and calibration methods present a practical means to improve image quality in mobile C-arm CBCT by identifying non-circular scan protocols that improve sampling and reduce metal-induced biases in the projection data., Comment: This work was presented at the 6th International Conference on Image Formation in X-Ray Computed Tomography, August, 2020, Regensburg, Germany

Published
2020

7. Scoring System to Triage Patients for Spine Surgery in the Setting of Limited Resources: Application to the Coronavirus Disease 2019 (COVID-19) Pandemic and Beyond

Author

Sciubba, Daniel M, Ehresman, Jeff, Pennington, Zach, Lubelski, Daniel, Feghali, James, Bydon, Ali, Chou, Dean, Elder, Benjamin D, Elsamadicy, Aladine A, Goodwin, C Rory, Goodwin, Matthew L, Harrop, James, Klineberg, Eric O, Laufer, Ilya, Lo, Sheng-Fu L, Neuman, Brian J, Passias, Peter G, Protopsaltis, Themistocles, Shin, John H, Theodore, Nicholas, Witham, Timothy F, and Benzel, Edward C

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Good Health and Well Being, Betacoronavirus, COVID-19, Coronavirus Infections, Decision Making, Elective Surgical Procedures, Health Care Rationing, Humans, Pandemics, Patient Selection, Pneumonia, Viral, SARS-CoV-2, Triage, Medical ethics, Pandemic, Rationing, Resource allocation, Spine surgery, Neurosciences, Clinical sciences
Abstract

BackgroundAs of May 4, 2020, the coronavirus disease 2019 (COVID-19) pandemic has affected >3.5 million people and touched every inhabited continent. Accordingly, it has stressed health systems worldwide, leading to the cancellation of elective surgical cases and discussions regarding health care resource rationing. It is expected that rationing of surgical resources will continue even after the pandemic peak and may recur with future pandemics, creating a need for a means of triaging patients for emergent and elective spine surgery.MethodsUsing a modified Delphi technique, a cohort of 16 fellowship-trained spine surgeons from 10 academic medical centers constructed a scoring system for the triage and prioritization of emergent and elective spine surgeries. Three separate rounds of videoconferencing and written correspondence were used to reach a final scoring system. Sixteen test cases were used to optimize the scoring system so that it could categorize cases as requiring emergent, urgent, high-priority elective, or low-priority elective scheduling.ResultsThe devised scoring system included 8 independent components: neurologic status, underlying spine stability, presentation of a high-risk postoperative complication, patient medical comorbidities, expected hospital course, expected discharge disposition, facility resource limitations, and local disease burden. The resultant calculator was deployed as a freely available Web-based calculator (https://jhuspine3.shinyapps.io/SpineUrgencyCalculator/).ConclusionsWe present the first quantitative urgency scoring system for the triage and prioritizing of spine surgery cases in resource-limited settings. We believe that our scoring system, although not all encompassing, has potential value as a guide for triaging spine surgical cases during the COVID pandemic and post-COVID period.

Published
2020

11. Antiresorptive Medications Prior to Stereotactic Body Radiotherapy for Spinal Metastasis are Associated with Reduced Incidence of Vertebral Body Compression Fracture.

Author

Patel, Palak P., Esposito, Edward P., Zhu, Jiafeng, Chen, Xuguang, Khan, Majid, Kleinberg, Lawrence, Lubelski, Daniel, Theodore, Nicholas, Lo, Sheng-fu Larry, Hun Lee, Sang, Kebaish, Khaled, Bydon, Ali, and Redmond, Kristin J.

Subjects
VERTEBRAL fractures, STEREOTACTIC radiotherapy, VERTEBRAE injuries, BONE metastasis, DRUGS, METASTASIS
Abstract

Study Design: Retrospective Cohort Objective: Antiresorptive drugs are often given to minimize fracture risk for bone metastases, but data regarding optimal time or ability to reduce stereotactic body radiotherapy (SBRT)-induced fracture risk is limited. This study examines the association between antiresorptive use surrounding spinal SBRT and vertebral compression fracture (VCF) incidence to provide information regarding effectiveness and optimal timing of use. Methods: Patients treated with SBRT for spinal metastases at a single institution between 2009-2020 were included. Kaplan-Meier analysis was used to compare cumulative incidence of VCF for those taking antiresorptive drugs pre-SBRT, post-SBRT only, and none at all. Cox proportional hazards and Fine-Gray competing risk models were used to identify additional factors associated with VCF. Results: Of the 234 patients (410 vertebrae) analyzed, 49 (20.9%) were taking bisphosphonates alone, 42 (17.9%) were taking denosumab alone, and 25 (10.7%) were taking both. Kaplan-Meier analysis revealed a statistically significant lower VCF incidence for patients initiating antiresorptive drugs before SBRT compared to those taking none at all (4% vs 12% at 1 year post-SBRT, P =.045; and 4% vs 23% at 2 years, P =.008). On multivariate analysis, denosumab duration (HR:.87, P =.378) or dose (HR: 1.00, P =.644) as well as bisphosphonate duration (HR:.98, P =.739) or dose (HR:.99, P =.741) did not have statistical significance on VCF incidence. Conclusion: Initiating antiresorptive agents before SBRT may reduce the risk of treatment-induced VCF. Antiresorptive drugs are underutilized in patients with spine metastases and may represent a useful intervention to minimize toxicity and improve long-term outcomes. [ABSTRACT FROM AUTHOR]

Published
2024
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15. Robot-assisted screw fixation in a cadaver utilizing magnetic resonance imaging–based synthetic computed tomography: toward radiation-free spine surgery. Illustrative case

Author

Davidar, A. Daniel, primary, Judy, Brendan F., additional, Hersh, Andrew M., additional, Weber-Levine, Carly, additional, Alomari, Safwan, additional, Menta, Arjun K., additional, Jiang, Kelly, additional, Bhimreddy, Meghana, additional, Hussain, Mir, additional, Crawford, Neil R., additional, Khan, Majid, additional, Gong, Gary, additional, and Theodore, Nicholas, additional

Published
2023
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16. Oncologic and Functional Outcomes After Stereotactic Body Radiation Therapy for High-Grade Malignant Spinal Cord Compression

Author

Patel, Palak P., primary, Cao, Yilin, additional, Chen, Xuguang, additional, LeCompte, Michael C., additional, Kleinberg, Lawrence, additional, Khan, Majid, additional, McNutt, Todd, additional, Bydon, Ali, additional, Kebaish, Khaled, additional, Theodore, Nicholas, additional, Larry Lo, Sheng-fu, additional, Lee, Sang H., additional, Lubelski, Daniel, additional, and Redmond, Kristin J., additional

Published
2023
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17. Low-Intensity Pulsed Ultrasound Neuromodulation of a Rodent's Spinal Cord Suppresses Motor Evoked Potentials

Author

Tsehay, Yohannes, primary, Zeng, Yinuo, additional, Weber-Levine, Carly, additional, Awosika, Tolulope, additional, Kerensky, Max, additional, Hersh, Andrew M., additional, Ou, Ze, additional, Jiang, Kelly, additional, Bhimreddy, Meghana, additional, Bauer, Stuart J., additional, Theodore, John N., additional, Quiroz, Victor M., additional, Suk, Ian, additional, Alomari, Safwan, additional, Sun, Junfeng, additional, Tong, Shanbao, additional, Thakor, Nitish, additional, Doloff, Joshua C., additional, Theodore, Nicholas, additional, and Manbachi, Amir, additional

Published
2023
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21. Response to Letter to the Editor Regarding “Antiresorptive Medications Prior to Stereotactic Body Radiotherapy for Spinal Metastasis are Associated With Reduced Incidence of Vertebral Body Compression Fracture”

Author

Patel, Palak P., primary, Esposito, Edward P., additional, Zhu, Jiafeng, additional, Chen, Xuguang, additional, Khan, Majid, additional, Kleinberg, Lawrence, additional, Lubelski, Daniel, additional, Theodore, Nicholas, additional, Larry Lo, Sheng-fu, additional, Lee, Sang H., additional, Kebaish, Khaled, additional, Bydon, Ali, additional, and Redmond, Kristin J., additional

Published
2023
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22. Towards standardization of the parameters for opening the blood–brain barrier with focused ultrasound to treat glioblastoma multiforme: A systematic review of the devices, animal models, and therapeutic compounds used in rodent tumor models

Author

Thombre, Rasika, primary, Mess, Griffin, additional, Kempski Leadingham, Kelley M., additional, Kapoor, Shivani, additional, Hersh, Andrew, additional, Acord, Molly, additional, Kaovasia, Tarana, additional, Theodore, Nicholas, additional, Tyler, Betty, additional, and Manbachi, Amir, additional

Published
2023
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23. Antiresorptive Medications Prior to Stereotactic Body Radiotherapy for Spinal Metastasis are Associated with Reduced Incidence of Vertebral Body Compression Fracture

Author

Patel, Palak P., primary, Esposito, Edward P., additional, Zhu, Jiafeng, additional, Chen, Xuguang, additional, Khan, Majid, additional, Kleinberg, Lawrence, additional, Lubelski, Daniel, additional, Theodore, Nicholas, additional, Lo, Sheng-fu Larry, additional, Hun Lee, Sang, additional, Kebaish, Khaled, additional, Bydon, Ali, additional, and Redmond, Kristin J., additional

Published
2023
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24. Automatic detection of foreign body objects in neurosurgery using a deep learning approach on intraoperative ultrasound images: From animal models to first in-human testing

Author

Abramson, Haley G., primary, Curry, Eli J., additional, Mess, Griffin, additional, Thombre, Rasika, additional, Kempski-Leadingham, Kelley M., additional, Mistry, Shivang, additional, Somanathan, Subhiksha, additional, Roy, Laura, additional, Abu-Bonsrah, Nancy, additional, Coles, George, additional, Doloff, Joshua C., additional, Brem, Henry, additional, Theodore, Nicholas, additional, Huang, Judy, additional, and Manbachi, Amir, additional

Published
2022
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28. Porcine Model of Spinal Cord Injury: A Systematic Review

Author

Weber-Levine, Carly, primary, Hersh, Andrew M., additional, Jiang, Kelly, additional, Routkevitch, Denis, additional, Tsehay, Yohannes, additional, Perdomo-Pantoja, Alexander, additional, Judy, Brendan F., additional, Kerensky, Max, additional, Liu, Ann, additional, Adams, Melanie, additional, Izzi, Jessica, additional, Doloff, Joshua C., additional, Manbachi, Amir, additional, and Theodore, Nicholas, additional

Published
2022
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33. Automated prediction of the Thoracolumbar Injury Classification and Severity Score from CT using a novel deep learning algorithm

Author

Doerr, Sophia A., primary, Weber-Levine, Carly, additional, Hersh, Andrew M., additional, Awosika, Tolulope, additional, Judy, Brendan, additional, Jin, Yike, additional, Raj, Divyaansh, additional, Liu, Ann, additional, Lubelski, Daniel, additional, Jones, Craig K., additional, Sair, Haris I., additional, and Theodore, Nicholas, additional

Published
2022
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35. Trends in Intraoperative Assessment of Spinal Alignment: A Survey of Spine Surgeons in the United States

Author

Gullotti, David M., primary, Soltanianzadeh, Amir H., additional, Fujita, Saki, additional, Inserni, Miguel, additional, Ruppel, Edward, additional, Franconi, Nicholas G., additional, Zygourakis, Corinna, additional, Protopsaltis, Themistocles, additional, Lo, Sheng-Fu Larry, additional, Sciubba, Daniel M., additional, and Theodore, Nicholas, additional

Published
2022
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41. Response to Letter to the Editor Regarding "Antiresorptive Medications Prior to Stereotactic Body Radiotherapy for Spinal Metastasis are Associated With Reduced Incidence of Vertebral Body Compression Fracture".

Author

Patel, Palak P., Esposito, Edward P., Zhu, Jiafeng, Chen, Xuguang, Khan, Majid, Kleinberg, Lawrence, Lubelski, Daniel, Theodore, Nicholas, Larry Lo, Sheng-fu, Lee, Sang H., Kebaish, Khaled, Bydon, Ali, and Redmond, Kristin J.

Subjects
VERTEBRAL fractures, STEREOTACTIC radiotherapy, DRUGS, METASTASIS
Abstract

This document is a response to a letter discussing a study on the use of antiresorptive medications prior to stereotactic body radiotherapy (SBRT) for spinal metastasis. The authors address questions raised in the letter, including the higher risk of vertebral compression fracture (VCF) in patients receiving antiresorptive therapy after SBRT. While the difference in VCF incidence was not found to be statistically significant, the authors speculate that patients who develop fractures may be more likely to receive antiresorptive agents. The document also clarifies components of the statistical analysis and emphasizes the need for larger datasets and prospective studies to confirm the findings. [Extracted from the article]

Published
2024
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46. Augmented Reality in Spine Surgery: A Narrative Review

Author

Hersh, Andrew, primary, Mahapatra, Smruti, additional, Weber-Levine, Carly, additional, Awosika, Tolulope, additional, Theodore, John N., additional, Zakaria, Hesham M., additional, Liu, Ann, additional, Witham, Timothy F., additional, and Theodore, Nicholas, additional

Published
2021
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47. We the people: a needed reform of state initiative and referendum procedures.

Author

Theodore, Nicholas R.

Subjects
Referendum -- Evaluation, Brown v. Carnahan (370 S.W.3d 637 (Mo. 2012)), Missouri. Secretary of State -- Powers and duties -- Evaluation
Abstract

I. INTRODUCTION The landscape of the United States' political elections has been marked by many dramatic changes in the past century. While many are quick to point to several changes [...]

Published
2013

49. Dataset of the first report of pharmacogenomics profiling in an outpatient spine setting

Author

Cottrill, Ethan, primary, Pennington, Zach, additional, Lai, Chun Wan Jeffrey, additional, Ehresman, Jeff, additional, Jiang, Bowen, additional, Ahmed, A. Karim, additional, Zhu, Alex, additional, Perdomo-Pantoja, Alexander, additional, Sciubba, Daniel M., additional, Witham, Timothy, additional, Lee, Chun Hin, additional, MacDonald, Kevin, additional, and Theodore, Nicholas, additional

Published
2021
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50. Scoring System to Triage Patients for Spine Surgery in the Setting of Limited Resources

Author

Sciubba, Daniel M, Ehresman, Jeffrey S, Pennington, Zach, Lubelski, Daniel, Feghali, James, Bydon, Ali, Chou, Dean, Elder, Benjamin D, Elsamadicy, Aladine A, Goodwin, Matthew, Goodwin, C. Rory, Harrop, James S, Huq, Sakibul, Klineberg, Eric, Laufer, Ilya, Lo, Sheng-fu L, Neumaan, Brian J, Passias, Peter G, Protopsaltis, Themistocles, Shin, John H, Theodore, Nicholas, Witham, Timothy F, and Benzel, Edward C

Subjects
CNS ACCEPTED ABSTRACTS, AcademicSubjects/MED00930, Surgery, Neurology (clinical), CNS Best Clinical Research Award
Abstract

INTRODUCTION As of May 04, 2020, the COVID-19 pandemic has affected over 3.5 million people and touched every inhabited continent. Accordingly, it has stressed health systems the world over leading to the cancellation of elective surgical cases and discussions regarding healthcare resource rationing. It is expected that rationing of surgical resources will continue even after the pandemic peak, and may recur with future pandemics, creating a need for a means of triaging emergent and elective spine surgery patients. METHODS Using a modified Delphi technique, a cohort of 16 fellowship-trained spine surgeons from 10 academic medical centers constructed a scoring system for the triage and prioritization of emergent and elective spine surgeries. Three separate rounds of videoconferencing and written correspondence were used to reach a final scoring system. Sixteen test cases were used to optimize the scoring system so that it could categorize cases as requiring emergent, urgent, high-priority elective, or low-priority elective scheduling. RESULTS The devised scoring system included 8 independent components: neurological status, underlying spine stability, presentation of a highrisk post-operative complication, patient medical comorbidities, expected hospital course, expected discharge disposition, facility resource limitations, and local disease burden. The resultant calculator was deployed as a freely-available web-based calculator: https://jhuspine3.shinyapps.io/SpineUrgencyCalculator/ CONCLUSION Here we present the first quantitative urgency scoring system for the triage and prioritizing of spine surgery cases in resource-limited settings. We believe that our scoring system, while not all-encompassing, has potential value as a guide for triaging spine surgical cases during the COVID pandemic and post-COVID period.

Published
2020

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