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4. Impact of post-procedure stenosis on outcomes of patients with severe intracranial stenosis treated with intracranial stent placement

Author

Nunna, Ravi S, primary, Ma, Xiaoyu, additional, Genovese, Sabrina, additional, Lodhi, Abdullah, additional, Bains, Navpreet K, additional, Cohen, David, additional, Smith, Caitlyn, additional, Ortiz, Michael J, additional, Siddiq, Farhan, additional, Gomez, Camilo R, additional, and Qureshi, Adnan I, additional

Published
2024
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5. Lumbar Microdiscectomy

Author

Nunna, Ravi S., Wewel, Joshua T., O’Toole, John E., O'Brien, Joseph R., editor, Kalantar, S. Bobby, editor, Drazin, Doniel, editor, and Sandhu, Faheem A., editor

Published
2020
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18. Single-level cervical disc replacement (CDR) versus anterior cervical discectomy and fusion (ACDF): A Nationwide matched analysis of complications, 30- and 90-day readmission rates, and cost

Author

Nunna, Ravi S., primary, Ryoo, James S., additional, Ostrov, Philip B., additional, Patel, Saavan, additional, Godolias, Periklis, additional, Daher, Zeyad, additional, Price, Richard, additional, Chapman, Jens R., additional, and Oskouian, Rod J., additional

Published
2023
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23. Current Trends and Socioeconomic Disparities in the Utilization of Spine Augmentation for Patients With Osteoporotic Vertebral Compression Fracture: A Nationwide Inpatient Sample Analysis From 2012 to 2016

Author

Patel, Saavan, Chiu, Ryan G., Chaker, Anisse N., Rosinski, Clayton L., Nunna, Ravi S., Behbahani, Mandana, and Mehta, Ankit I.

Subjects
Orthopedics and Sports Medicine, Surgery, Minimally Invasive Surgery
Abstract

INTRODUCTION: Osteoporotic vertebral compression fracture (OVCF) is a growing health care problem in today’s aging population. Since the advent of kyphoplasty and vertebroplasty, these interventions have been commonly utilized in the treatment of symptomatic OVCF. However, the use of these interventions varies because there is not a standard of care for the management of OVCF. There remain disparities in the use of these procedures as treatment for OVCFs in the United States. METHODS: The 2012 to 2016 Nationwide Inpatient Sample was queried for all patients admitted for OVCF. These patients were then grouped based on whether they received conservative vs surgical (kyphoplasty/vertebroplasty) management and compared with respect to various socioeconomic factors including race, insurance coverage, income quartile, hospital control, and geography. Propensity score matching was utilized to control for potential baseline confounders as well as the influence of other endpoints. RESULTS: The search criteria identified 35,199 patients admitted with OVCF, of whom 7900 (22.4%) received spine augmentation. Blacks/African Americans (risk ratios [RR] = 0.79, P < 0.001), Hispanics/Latinos (RR = 0.82, P < 0.001), Asians/Pacific Islanders (RR = 0.81, P = 0.048), and unknown/other races (RR = 0.88, P = 0.037) were less likely to receive surgical management than whites/Caucasians. When compared with Medicare patients, those with Medicaid (RR = 0.76, P < 0.001) were less likely to receive surgery while privately insured patients were more likely (RR = 1.06, P = 0.42). Patients in the West (RR = 0.90, P < 0.001) were less likely to receive surgery for OVCF than those in the Northeast. CONCLUSIONS: A wide variety of socioeconomic disparities exists in the use of spinal augmentation for the management of OVCF in the United States, limiting patient access to a potentially beneficial procedure. CLINICAL RELEVANCE: Retrospective Analysis. LEVEL OF EVIDENCE: 3.

Published
2022

25. The Impact of Asymptomatic Human Immunodeficiency Virus-Positive Disease Status on Inpatient Complications Following Spine Surgery: A Propensity Score-Matched Analysis

Author

Shah, Neil V., primary, Lettieri, Matthew J., additional, Gedailovich, Samuel, additional, Kim, David, additional, Oad, Madhu, additional, Veenema, Ryne J., additional, Wolfert, Adam J., additional, Beyer, George A., additional, Wang, Hanbin, additional, Nunna, Ravi S., additional, Hollern, Douglas A., additional, Lafage, Renaud, additional, Challier, Vincent, additional, Merola, Andrew A., additional, Passias, Peter G., additional, Schwab, Frank J., additional, Lafage, Virginie, additional, Paulino, Carl B., additional, and Diebo, Bassel G., additional

Published
2023
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26. 30-Day Outcomes of Resolute Onyx Stent for Symptomatic Intracranial Stenosis: A Multicenter Propensity Score–Matched Comparison With Stenting Versus Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis Trial

Author

Siddiq, Farhan, primary, Nunna, Ravi S., additional, Beall, Jonathan M., additional, Khan, Inamullah, additional, Khan, Musharaf, additional, Tekle, Wondwossen G., additional, Ezzeldin, Mohamad, additional, Tanweer, Omar, additional, Burkhardt, Jan-Karl, additional, Jabbour, Pascal M., additional, Tjoumakaris, Stavropoula I., additional, Herial, Nabeel A., additional, Siddiqui, Adnan H., additional, Grandhi, Ramesh, additional, Martin, Renee L., additional, Qureshi, Adnan I., additional, and Hassan, Ameer E., additional

Published
2023
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27. Anterior vs Posterior Approach in Multilevel Cervical Spondylotic Myelopathy: A Nationwide Propensity-Matched Analysis of Complications, Outcomes, and Narcotic Use

Author

Nunna, Ravi S., Khalid, Syed, Chiu, Ryan G., Parola, Rown, Fessler, Richard G., Adogwa, Owoicho, and Mehta, Ankit I.

Subjects
Cervical Spine, Orthopedics and Sports Medicine, Surgery
Abstract

BACKGROUND: There is unclear evidence regarding the optimal surgical approach for multilevel cervical spondylotic myelopathy (CSM). The objective of this study was to compare complications, outcomes, and narcotic use in anterior discectomy and fusion (ACDF) vs posterior decompression and fusion (PCDF) in CSM patients. STUDY DESIGN: Registry-based retrospective cohort analysis. METHODS: Patients undergoing 3-level ACDF or PCDF for CSM between 2007 and 2017 were identified from the Humana Claims Database using relevant procedure codes. Propensity score-matched groups were compared in regards to complications, outcomes, and narcotic use. RESULTS: Propensity score matching generated equal cohorts of 6124 patients. The posterior fusion group had a higher rate of urinary tract infection (OR 2.47, P < 0.0001), deep vein thrombosis (OR 1.90, P < 0.0001), and pulmonary embolism (OR 1.75, P < 0.0001). In regards to 30-day outcomes, the posterior approach demonstrated higher rates of stroke (OR 1.68, P < 0.0001), wound dehiscence (OR 5.59, P < 0.0001), Surgical site infection (SSI) (OR 4.76, P < 0.0001), wound revision surgery (OR 3.02, P < 0.0001), and all-cause readmission (OR 2.01, P < 0.0001). One-year outcomes revealed higher rates of pseudarthrosis (4.7% vs 2.0%, OR 2.43, P < 0.0001) and revision or extension surgery (OR 2.33, P < 0.0001) in the posterior fusion cohort. These patients also demonstrated significantly higher mean morphine milligram equivalent used at 30 days (OR 1.19, P < 0.0001), as well as 60 (OR 1.20, P < 0.0001), 90 (OR 1.21, P < 0.0001), and 120 (OR 1.21, P < 0.0001) days. CONCLUSIONS: This nationwide propensity-matched analysis of multilevel CSM patients found the posterior approach to be associated with increased rates of inpatient complications, wound complications, 30-day readmission, 1-year pseudarthrosis, and 1-year revision or extension surgery. These patients also demonstrated higher levels of narcotic use up to 120 days after surgery. CLINICAL RELEVANCE: The posterior approach for treatment of CSM may be associated with increased rates of short- and long-term complications in addition to increased narcotic consumption in comparison to the anterior approach. LEVEL OF EVIDENCE: 3.

Published
2022

29. Thirty-Day Outcomes of Resolute Onyx Stent for Symptomatic Intracranial Stenosis: A Multicenter Propensity Score–Matched Comparison With Stenting Versus Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis Trial.

Author

Siddiq, Farhan, Nunna, Ravi S., Beall, Jonathan M., Khan, Inamullah, Khan, Musharaf, Tekle, Wondwossen G., Ezzeldin, Mohamad, Tanweer, Omar, Burkhardt, Jan-Karl, Jabbour, Pascal M., Tjoumakaris, Stavropoula I., Herial, Nabeel A., Siddiqui, Adnan H., Grandhi, Ramesh, Martin, Renee L., Qureshi, Adnan I., and Hassan, Ameer E.

Published
2023
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32. Incidence, Management, and Outcomes of Adult Spinal Chordoma Patients in the United States.

Author

Patel, Saavan, Nunna, Ravi S., Nie, James, Ansari, Darius, Chaudhry, Nauman S., and Mehta, Ankit I.

Subjects
CHORDOMA, SURGICAL excision, RADIATION, OVERALL survival, RADIOTHERAPY
Abstract

Study Design: Retrospective cohort study. Objective: Spinal chordomas are rare primary malignant neoplasms of the primitive notochord. They are slow growing but locally aggressive lesions that have high rates of recurrence and metastasis after treatment. Gold standard treatment remains en-bloc surgical resection with questionable efficacy of adjuvant therapies such as radiation and chemotherapy. Here we provide a comprehensive analysis of prognostic factors, treatment modalities, and survival outcomes in patients with spinal chordoma. Methods: Patients with diagnosis codes specific for chordoma of spine, sacrum, and coccyx were queried from the National Cancer Database (NCDB) during the years 2004-2016. Outcomes were investigated using Cox univariate and multivariate regression analyses, and survival curves were generated for comparative visualization. Results: 1,548 individuals were identified with a diagnosis of chordoma, 60.9% of which were at the sacrum or coccyx and 39.1% at the spine. The mean overall survival of patients in our cohort was 8.2 years. Increased age, larger tumor size, and presence of metastases were associated with worsened overall survival. 71.2% of patients received surgical intervention and both partial and radical resection were associated with significantly improved overall survival (P < 0.001). Neither radiotherapy nor chemotherapy administration improved overall survival; however, amongst patients who received radiation, those who received proton-based radiation had significantly improved overall survival compared to traditional radiation. Conclusion: Surgical resection significantly improves overall survival in patients with spinal chordoma. In those patients receiving radiation, those who receive proton-based modalities have improved overall survival. Further studies into proton radiotherapy doses are required. [ABSTRACT FROM AUTHOR]

Published
2023
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35. Supplemental Material - The Risk of Adverse Events in Smokers Undergoing Spinal Fusion: A Systematic Review and Meta-Analysis

Author

Nunna, Ravi S., Ansari, Darius, Ostrov, Philip B., Dettori, Joseph R., Godolias, Periklis, Ortiz-Torres, Michael, Elias, Elias, Gruber, Max, Oskouian, Rod J., and Chapman, Jens R.

Subjects
FOS: Clinical medicine, 110323 Surgery, 110604 Sports Medicine, FOS: Health sciences, 110904 Neurology and Neuromuscular Diseases, 110314 Orthopaedics
Abstract

Supplementary Material for The Risk of Adverse Events in Smokers Undergoing Spinal Fusion: A Systematic Review and Meta-Analysis by Ravi S. Nunna, Darius Ansari, Philip B. Ostrov, Joseph R. Dettori, Periklis Godolias, Elias Elias, Max Gruber, Rod J. Oskouian, and Jens R. Chapman in Global Spine Journal.

Published
2022
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37. The Risk of Adverse Events in Smokers Undergoing Spinal Fusion: A Systematic Review and Meta-Analysis.

Author

Nunna, Ravi S., Ansari, Darius, Ostrov, Philip B., Dettori, Joseph R., Godolias, Periklis, Ortiz-Torres, Michael, Elias, Elias, Gruber, Max, Oskouian, Rod J., and Chapman, Jens R.

Subjects
DRUG side effects, SPINAL fusion, TOBACCO, NICOTINE, OPERATIVE surgery
Abstract

Study Design: Systematic review and meta-analysis. Objectives: Determine if tobacco use is associated with increased risk of postoperative adverse events within 90 days in patients undergoing spinal fusion surgery. Methods: Databases were queried to identify cohort studies that directly compared smokers with non-smokers and provided the absolute number of adverse events and the population at risk. Data quality was evaluated using the Quality in Prognosis Studies tool. Risk ratios (RR) and 95% confidence intervals were calculated and compared between studies. The grading of recommendation, assessment, development and evaluation (GRADE) criteria were used to assess the strength of the evidence. Results: Seventeen studies assessing 37 897 participants met the inclusion criteria. Of these, 10 031 (26.5%) were smokers and 27 866 (73.5%) were nonsmokers. The mean age for the study population was 58 years, and 45% were males. Smoking was not associated with increased risk of one or more major adverse events within 90 days following spine surgery (seven studies, pooled RR 1.13, 95% CI [.75-1.71], I2 = 41%). However, smoking was significantly associated with one or more major adverse events in ≤2 level fusion (three studies, pooled RR 2.46, 95% CI [1.18-5.12], I2 = 0%), but not in fusions of ≥3 levels (four studies, pooled RR.87, 95% CI [.70-1.08], I2 = 0%). Additionally, there was no statistically significant association between smoking and any adverse event, nor increased reoperation risk due to adverse events. Conclusions: In this meta-analysis, tobacco use was not associated with a statistically significant increased risk of adverse events within 90 days in patients undergoing spinal fusion surgery. Our results are limited by the variable reporting methodology for both complication rates as well as smoking incidence between the included individual studies. [ABSTRACT FROM AUTHOR]

Published
2023
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38. Laparoscopic-Assisted Versus Mini-Open Laparotomy for Ventriculoperitoneal Shunt Placement in the Medicare Population

Author

Khalid, Syed I, primary, Nunna, Ravi S, additional, Maasarani, Samantha, additional, Shanker, Rachyl M, additional, Behbahani, Mandana, additional, Edmondson, Corbin P, additional, Mehta, Ankit I, additional, Gupta, Samir K, additional, Chan, Edie Y, additional, Torquati, Alfonso, additional, Byrne, Richard W, additional, and Adogwa, Owoicho, additional

Published
2021
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39. The Risk of Nonunion in Smokers Revisited: A Systematic Review and Meta-Analysis

Author

Nunna, Ravi S., primary, Ostrov, Philip B., additional, Ansari, Darius, additional, Dettori, Joseph R., additional, Godolias, Periklis, additional, Elias, Elias, additional, Tran, Angela, additional, Oskouian, Rod J., additional, Hart, Robert, additional, Abdul-Jabbar, Amir, additional, Jackson, Keith L., additional, Devine, John G., additional, Mehta, Ankit I., additional, Adogwa, Owoicho, additional, and Chapman, Jens R., additional

Published
2021
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40. sj-pdf-1-gsj-10.1177_21925682211046899 – Supplemental Material for The Risk of Nonunion in Smokers Revisited: A Systematic Review and Meta-Analysis

Author

Nunna, Ravi S., Ostrov, Philip B., Ansari, Darius, Dettori, Joseph R., Godolias, Periklis, Elias, Elias, Tran, Angela, Oskouian, Rod J., Hart, Robert, Abdul-Jabbar, Amir, Jackson, Keith L., Devine, John G., Mehta, Ankit I., Adogwa, Owoicho, and Chapman, Jens R.

Subjects
FOS: Clinical medicine, 110323 Surgery, 110604 Sports Medicine, FOS: Health sciences, 110904 Neurology and Neuromuscular Diseases, 110314 Orthopaedics
Abstract

Supplemental Material, sj-pdf-1-gsj-10.1177_21925682211046899 for The Risk of Nonunion in Smokers Revisited: A Systematic Review and Meta-Analysis by Ravi S. Nunna, Philip B. Ostrov, Darius Ansari, Joseph R. Dettori, Periklis Godolias, Elias Elias, Angela Tran, Rod J. Oskouian, Robert Hart, Amir Abdul-Jabbar, Keith L. Jackson, John G.Devine, Ankit I. Mehta, Owoicho Adogwa and Jens R. Chapman in Global Spine Journal

Published
2021
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