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4. Bone Quality as Measured by Hounsfield Units More Accurately Predicts Proximal Junctional Kyphosis than Vertebral Bone Quality Following Long-Segment Thoracolumbar Fusion

Author

Pennington, Zach, Mikula, Anthony L., Lakomkin, Nikita, Martini, Michael, Pinter, Zachariah W., Shafi, Mahnoor, Hamouda, Abdelrahman, Bydon, Mohamad, Clarke, Michelle J., Freedman, Brett A., Krauss, William E., Nassr, Ahmad N., Sebastian, Arjun S., Fogelson, Jeremy L., and Elder, Benjamin D.

Published
2024
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17. The Effect of C2 Muscular Exposure Technique on Radiographic and Clinical Outcomes After C2–T2 Posterior Cervical Fusion.

Author

Levy, Hannah A., Pinter, Zachariah W., Pumford, Andrew, Salmons, Harold I., Townsley, Sarah, Katsos, Konstantinos, Reed, Ryder, Chen, Selby, Abode-Iyamah, Kingsley, Deen, H. Gordon, Clarke, Michelle, Bydon, Mohamad, Fogelson, Jeremy L., Elder, Benjamin D., Currier, Bradford, Freedman, Brett A., Nassr, Ahmad N., Karamian, Brian A., and Sebastian, Arjun S.

Published
2024
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18. Transforaminal lumbar interbody fusion subsidence: computed tomography analysis of incidence, associated risk factors, and impact on outcomes.

Author

Levy, Hannah A., Pinter, Zachariah W., Reed, Ryder, Harmer, Joshua R., Raftery, Kay, Nathani, Karim Rizwan, Katsos, Konstantinos, Bydon, Mohamad, Fogelson, Jeremy L., Elder, Benjamin D., Currier, Bradford L., Newell, Nicolas, Nassr, Ahmad N., Freedman, Brett A., Karamian, Brian A., and Sebastian, Arjun S.

Published
2024
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22. A Prospective Study of Lumbar Facet Arthroplasty in the Treatment of Degenerative Spondylolisthesis and Stenosis: Results from the Total Posterior Spine System (TOPS) IDE Study

Author

Pinter, Zachariah W., Freedman, Brett A., Nassr, Ahmad, Sebastian, Arjun S., Coric, Domagoj, Welch, William C., Steinmetz, Michael P., Robbins, Stephen E., Ament, Jared, Anand, Neel, Arnold, Paul, Baron, Eli, Huang, Jason, Whitmore, Robert, Whiting, Donald, Tahernia, David, Sandhu, Faheem, Chahlavi, Ali, Cheng, Joseph, Chi, John, Pirris, Stephen, Groff, Michael, Fabi, Alain, Meyer, Scott, Kushwaha, Vivek, Kent, Roland, DeLuca, Steven, Smorgick, Yossi, and Anekstein, Yoram

Published
2023
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28. Factors Related to Clinical Performance in Spine Surgery Fellowship: Can We Predict Success.

Author

Levy, Hannah A., Boere, Payton, Randell, Zane, Bodnar, John, Paulik, John, Spina, Nicholas T., Spiker, William R., Lawrence, Brandon D., Brodke, Darrel S., Kurd, Mark F., Rihn, Jeffrey A., Canseco, Jose A., Schroeder, Gregory D., Kepler, Christopher K., Vaccaro, Alexander R., Currier, Bradford, Huddleston, Paul M., Nassr, Ahmad N., Freedman, Brett A., and Sebastian, Arjun S.

Published
2024
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29. Change in spinal bone mineral density as estimated by Hounsfield units following osteoporosis treatment with romosozumab, teriparatide, denosumab, and alendronate: an analysis of 318 patients.

Author

Mikula, Anthony L., Lakomkin, Nikita, Hamouda, Abdelrahman M., Everson, Megan C., Pennington, Zach, Kumar, Rahul, Pinter, Zachariah W., Martini, Michael L., Bydon, Mohamad, Kennel, Kurt A., Baffour, Francis, Nassr, Ahmad, Freedman, Brett, Sebastian, Arjun S., Abode-Iyamah, Kingsley, Anderson, Paul A., Fogelson, Jeremy L., and Elder, Benjamin D.

Published
2024
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33. Cervical Alignment and Proximal and Distal Junctional Failure in Posterior Cervical Fusion: A Multicenter Comparison of 2 Surgical Approaches

Author

Pinter, Zachariah W., Karamian, Brian, Bou Monsef, Jad, Mao, Jennifer, Xiong, Ashley, Bowles, Daniel R., Conaway, William K., Reiter, David M., Honig, Rachel, Currier, Bradford, Nassr, Ahmad, Freedman, Brett A., Bydon, Mohamad, Elder, Benjamin D., Kaye, Ian D., Kepler, Christopher, Schroeder, Gregory, Vaccaro, Alexander, Wagner, Scott, and Sebastian, Arjun S.

Published
2022
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38. Lumbar Facet Arthroplasty Versus Fusion for Grade-I Degenerative Spondylolisthesis with Stenosis: A Prospective Randomized Controlled Trial.

Author

Nassr, Ahmad, Coric, Domagoj, Pinter, Zachariah W., Sebastian, Arjun S., Freedman, Brett A., Whiting, Donald, Chahlavi, Ali, Pirris, Stephen, Phan, Nicolas, Meyer, Scott A., Tahernia, A. David, Sandhu, Faheem, Deutsch, Harel, Potts, Eric A., Cheng, Joseph, Chi, John H., Groff, Michael, Anekstein, Yoram, Steinmetz, Michael P., and Welch, William C.

Subjects
ZYGAPOPHYSEAL joint, RANDOMIZED controlled trials, ARTHROPLASTY, SPINAL stenosis, SPONDYLOLISTHESIS, SURGICAL complications
Abstract

Background: The comparative effectiveness of decompression plus lumbar facet arthroplasty versus decompression plus instrumented lumbar spinal fusion in patients with lumbar spinal stenosis and grade-I degenerative spondylolisthesis is unknown. Methods: In this randomized, controlled, Food and Drug Administration Investigational Device Exemption trial, we assigned patients who had single-level lumbar spinal stenosis and grade-I degenerative spondylolisthesis to undergo decompression plus lumbar facet arthroplasty (arthroplasty group) or decompression plus fusion (fusion group). The primary outcome was a predetermined composite clinical success score. Secondary outcomes included the Oswestry Disability Index (ODI), visual analog scale (VAS) back and leg pain, Zurich Claudication Questionnaire (ZCQ), Short Form (SF)-12, radiographic parameters, surgical variables, and complications. Results: A total of 321 adult patients were randomized in a 2:1 fashion, with 219 patients assigned to undergo facet arthroplasty and 102 patients assigned to undergo fusion. Of these, 113 patients (51.6%) in the arthroplasty group and 47 (46.1%) in the fusion group who had either reached 24 months of postoperative follow-up or were deemed early clinical failures were included in the primary outcome analysis. The arthroplasty group had a higher proportion of patients who achieved composite clinical success than did the fusion group (73.5% versus 25.5%; p < 0.001), equating to a between-group difference of 47.9% (95% confidence interval, 33.0% to 62.8%). The arthroplasty group outperformed the fusion group in most patient-reported outcome measures (including the ODI, VAS back pain, and all ZCQ component scores) at 24 months postoperatively. There were no significant differences between groups in surgical variables or complications, except that the fusion group had a higher rate of developing symptomatic adjacent segment degeneration. Conclusions: Among patients with lumbar spinal stenosis and grade-I degenerative spondylolisthesis, lumbar facet arthroplasty was associated with a higher rate of composite clinical success than fusion was at 24 months postoperatively. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Published
2024
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45. Significant Reduction in Bone Density as Measured by Hounsfield Units in Patients with Ankylosing Spondylitis or Diffuse Idiopathic Skeletal Hyperostosis.

Author

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

Subjects
BONE density, ANKYLOSING spondylitis, EXOSTOSIS
Abstract

Background: Multisegmental pathologic autofusion occurs in patients with ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH). It may lead to reduced vertebral bone density due to stress shielding. Methods: This study aimed to determine the effects of autofusion on bone density by measuring Hounsfield units (HU) in the mobile and immobile spinal segments of patients with AS and DISH treated at a tertiary care center. The mean HU was calculated for five distinct regions—cranial adjacent mobile segment, cranial fused segment, mid-construct fused segment, caudal fused segment, and caudal adjacent mobile segment. Means for each region were compared using paired-sample t-tests. Multivariable regression was used to determine independent predictors of mid-fused segment HUs. Results: One hundred patients were included (mean age 76 ± 11 years, 74% male). The mean HU for the mid-construct fused segment (100, 95% CI [86, 113]) was significantly lower than both cranial and caudal fused segments (174 and 108, respectively; both p < 0.001), and cranial and caudal adjacent mobile segments (195 and 115, respectively; both p < 0.001). Multivariable regression showed the mid-construct HUs were predicted by history of smoking (−30 HU, p = 0.009). Conclusions: HUs were significantly reduced in the middle of long-segment autofusion, which was consistent with stress shielding. Such shielding may contribute to the diminution of vertebral bone integrity in AS/DISH patients and potentially increased fracture risk. [ABSTRACT FROM AUTHOR]

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

Author

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

Subjects
SPINE abnormalities, SURGICAL blood loss, OSTEOTOMY, ORTHOPEDISTS, ADULTS
Abstract

Background: Pedicle subtraction osteotomy (PSO) is a powerful tool for sagittal plane correction in patients with rigid adult spinal deformity (ASD); however, it is associated with high intraoperative blood loss and the increased risk of durotomy. The objective of the present study was to identify intraoperative techniques and baseline patient factors capable of predicting intraoperative durotomy. Methods: A tri-institutional database was retrospectively queried for all patients who underwent PSO for ASD. Data on baseline comorbidities, surgical history, surgeon characteristics and intraoperative maneuvers were gathered. PSO aggressiveness was defined as conventional (Schwab 3 PSO) or an extended PSO (Schwab type 4). The primary outcome of the study was the occurrence of durotomy intraoperatively. Univariable analyses were performed with Mann–Whitney U tests, Chi-squared analyses, and Fisher's exact tests. Statistical significance was defined by p < 0.05. Results: One hundred and sixteen patients were identified (mean age 61.9 ± 12.6 yr; 44.8% male), of whom 51 (44.0%) experienced intraoperative durotomy. There were no significant differences in baseline comorbidities between those who did and did not experience durotomy, with the exception that baseline weight and body mass index were higher in patients who did not suffer durotomy. Prior surgery (OR 2.73; 95% CI [1.13, 6.58]; p = 0.03) and, more specifically, prior decompression at the PSO level (OR 4.23; 95% CI [1.92, 9.34]; p < 0.001) was predictive of durotomy. A comparison of surgeon training showed no statistically significant difference in durotomy rate between fellowship and non-fellowship trained surgeons, or between orthopedic surgeons and neurosurgeons. The PSO level, PSO aggressiveness, the presence of stenosis at the PSO level, nor the surgical instrument used predicted the odds of durotomy occurrence. Those experiencing durotomy had similar hospitalization durations, rates of reoperation and rates of nonroutine discharge. Conclusions: In this large multisite series, a history of prior decompression at the PSO level was associated with a four-fold increase in intraoperative durotomy risk. Notably the use of extended (versus) standard PSO, surgical technique, nor baseline patient characteristics predicted durotomy. Durotomies occurred in 44% of patients and may prolong operative times. Additional prospective investigations are merited. [ABSTRACT FROM AUTHOR]

Published
2024
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49. Comparison of Hounsfield units and vertebral bone quality score for the prediction of time to pathologic fracture in mobile spine metastases treated with radiotherapy.

Author

Pennington, Zach, Mikula, Anthony L., Lakomkin, Nikita, Martini, Michael, Clarke, Michelle J., Sebastian, Arjun S., Freedman, Brett A., Rose, Peter S., Karim, S. Mohammed, Ahmad Nassr, Bydon, Mohamad, Kowalchuk, Roman O., Merrell, Kenneth W., Krauss, William E., Fogelson, Jeremy L., and Elder, Benjamin D.

Published
2024
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