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1. Construct length analysis of type B and C cervical and thoracolumbar fractures

Author

Jeremy C. Heard, Mark J. Lambrechts, Yunsoo Lee, Teeto Ezeonu, Delano R. Trenchfield, Nicholas D. D’Antonio, Azra N. Dees, Bright M. Wiafe, John J. Mangan, Jose A. Canseco, Barrett I. Woods, Ian David Kaye, Alan S. Hilibrand, Alexander R. Vaccaro, Christopher K. Kepler, and Gregory D. Schroeder

Subjects
burst fracture, cervical, fusion, thoracolumbar, trauma, vertebral body fracture, Diseases of the musculoskeletal system, RC925-935
Abstract

Objectives: The purpose of this study is to identify if construct length affects the rate of surgical complications and instrumentation revision following surgical fixation of subaxial and thoracolumbar Type B and C fractures. This study evaluates the effect of ankylosing spondylitis/diffuse idiopathic skeletal hyperostosis (AS/DISH) within this population on outcomes. Methods: Retrospective review of 91 cervical and 89 thoracolumbar Type B and C fractures. Groups were divided by construct length for analysis: short-segment (constructs spanning two or less segments adjacent to the fracture) and long-segment (constructs spanning more than two segments adjacent to the vertebral fracture). Results: For cervical fractures, construct length did not impact surgical complications (P = 0.641), surgical hardware revision (P = 0.167), or kyphotic change (P = 0.994). For thoracolumbar fractures, construct length did not impact surgical complications (P = 0.508), surgical hardware revision (P = 0.224), and kyphotic change (P = 0.278). Cervical Type B fractures were nonsignificantly more likely to have worsened kyphosis (P = 0.058) than Type C fractures. Assessing all regions of the spine, a diagnosis of AS/DISH was associated with an increase in kyphosis (P = 0.030) and a diagnosis of osteoporosis was associated with surgical hardware failure (P = 0.006). Conclusion: Patients with short-segment instrumentation have similar surgical outcomes and changes in kyphosis compared to those with long-segment instrumentation. A diagnosis of AS/DISH or osteoporosis was associated with worse surgical outcomes.

Published
2024
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2. Risk of noise-induced hearing loss in the spine surgeon

Author

Matthew H. Meade, DO, Stephanie A. Kwan, DO, Mark E. Michael, DO, Nicholas J. Minissale, DO, Levi Buchan, DO, Jeffrey R. Gleimer, DO, Barrett I. Woods, MD, and Christopher Kepler, MD

Subjects
Noise, Noise-induced hearing loss, Occupational hazard, Spine, Decibel, Hearing loss, Orthopedic surgery, RD701-811, Neurology. Diseases of the nervous system, RC346-429
Abstract

ABSTRACT: Background: Occupation-related noise-induced hearing loss (NIHL) has both negative economic and quality of life implications. The risk spine surgeons undertake in regards to NIHL during operative intervention is unknown. Governing bodies, including the National Institute for Occupational Safety and Health, have recommended exposure limits not to exceed 85 decibels (dB) over 8 hours. The purpose of this study is to characterize noise exposure to spine surgeons in the operating room (OR). Methods: Prospective collection of intraoperative recordings of spinal surgeries (cervical and thoracic/lumbar) was undertaken. Data gathered included procedure, operative duration, presence of background music, and noise information. Noise information included maximum decibel level (MDL), Peak level (LCPeak), Equivalent continuous sound pressure level, time weighted average (TWA), dose, and projected dose. Noise measurements were compared with baseline controls with and without music (empty ORs). Results: Two hundred seven noise recordings were analyzed. One hundred eighteen of those being spinal surgeries, 49 baseline recordings without music, and 40 with music. Maximum decibel level reached a maximum value of 111.5 dBA, with an average amongst surgical recordings of 103 dBA. Maximum decibel level exceeded 85 dBA in 100% of cases and was greater than 100 dBA in 78%. The maximum LCPeak recorded was 132.9 dBC with an average of 120 dBC. Furthermore, the average dose was 7.8% with an average projected dose of 26.5%. The highest dose occurred during a laminectomy at 72.9% of daily allowable noise. Maximum projected dose yielded 156% during a 3-level anterior cervical discectomy and fusion. Conclusions: Spine surgeons are routinely exposed to damaging noise levels (>85 dBA) during operative intervention. With spine surgeons often performing multiple surgeries a day, the cumulative risk of noise exposure cannot be ignored. The synergistic effects of continuous and impact noise places spine surgeons at risk for the development of occupation-related NIHL.

Published
2024
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3. Utility of Seated Lateral Radiographs in the Diagnosis and Classification of Lumbar Degenerative Spondylolisthesis

Author

Tariq Z. Issa, Yunsoo Lee, Emily Berthiaume, Mark J. Lambrechts, Caroline Zaworski, Qudratallah S. Qadiri, Henley Spracklen, Richard Padovano, Jackson Weber, John J. Mangan, Jose A. Canseco, Barrett I. Woods, I. David Kaye, Alan S. Hilibrand, Christopher K. Kepler, Alexander R. Vaccaro, Gregory D. Schroeder, and Joseph K. Lee

Subjects
lumbar spine, spondylolisthesis, radiography, seated lateral, flexion-extension, Medicine
Abstract

Study Design Retrospective cohort study. Purpose Our goal was to determine which radiographic images are most essential for degenerative spondylolisthesis (DS) classification and instability detection. Overview of Literature The heterogeneity in DS requires multiple imaging views to evaluate vertebral translation, disc space, slip angle, and instability. However, there are several restrictions on frequently used imaging perspectives such as flexion-extension and upright radiography. Methods We assessed baseline neutral upright, standing flexion, seated lateral radiographs, and magnetic resonance imaging (MRI) for patients identified with spondylolisthesis from January 2021 to May 2022 by a single spine surgeon. DS was classified by Meyerding and Clinical and Radiographic Degenerative Spondylolisthesis classifications. A difference of >10° or >8% between views, respectively, was used to characterize angular and translational instability. Analysis of variance and paired chi-square tests were utilized to compare modalities. Results A total of 136 patients were included. Seated lateral and standing flexion radiographs showed the greatest slip percentage (16.0% and 16.7%), while MRI revealed the lowest (12.2%, p0.05). Translational instability was shown to be more prevalent when associated with seated lateral or standing flexion than when combined with neutral upright (31.5% vs. 20.2%, p=0.041; and 28.1% vs. 14.6%, p=0.014, respectively). There were no differences between seated lateral or standing flexion in the detection of instability (all p>0.20). Conclusions Seated lateral radiographs are appropriate alternatives for standing flexion radiographs. Films taken when standing up straight do not offer any more information for DS detection. Rather than standing flexion-extension radiographs, instability can be detected using an MRI, which is often performed preoperatively, paired with a single seated lateral radiograph.

Published
2023
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4. Reasons for transfer and subsequent outcomes among patients undergoing elective spine surgery at an orthopedic specialty hospital

Author

Tristan Blase Fried, Yunsoo Lee, Jeremy C Heard, Nicholas S Siegel, Tariq Z Issa, Mark J Lambrechts, Caroline Zaworski, Jasmine Wang, Taylor D'Amore, Amit Syal, Charles Lawall, John J Mangan, Jose A Canseco, Barrett I Woods, Ian David Kaye, Alan S Hilibrand, Alexander R Vaccaro, Christopher K Kepler, and Gregory D Schroeder

Subjects
specialty hospital, spine surgery, transfer, Diseases of the musculoskeletal system, RC925-935
Abstract

Objective: To evaluate the reasons for transfer as well as the 90-day outcomes of patients who were transferred from a high-volume orthopedic specialty hospital (OSH) following elective spine surgery. Materials and Methods: All patients admitted to a single OSH for elective spine surgery from 2014 to 2021 were retrospectively identified. Ninety-day complications, readmissions, revisions, and mortality events were collected and a 3:1 propensity match was conducted. Results: Thirty-five (1.5%) of 2351 spine patients were transferred, most commonly for arrhythmia (n = 7; 20%). Thirty-three transferred patients were matched to 99 who were not transferred, and groups had similar rates of complications (18.2% vs. 10.1%; P = 0.228), readmissions (3.0% vs. 4.0%; P = 1.000), and mortality (6.1% vs. 0%; P = 0.061). Conclusion: Overall, this study demonstrates a low transfer rate following spine surgery. Risk factors should continue to be optimized in order to decrease patient risks in the postoperative period at an OSH.

Published
2023
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5. Sagittal alignment differences on the operating room table compared to preoperative and postoperative imaging in anterior cervical discectomy and fusion

Author

Mark J Lambrechts, Gregory R Toci, Brian A Karamian, Zachary Kozick, John Prodoehl, David Reiter, Rahul Muchintala, Eric Tecce, Alexander Vaccaro Jr, Patrick O'Connor, Amit Syal, Dominic Lambo, Jose A Canseco, I David Kaye, Barrett I Woods, Alan S Hilibrand, Christopher K Kepler, Alexander R Vaccaro, and Gregory D Schroeder

Subjects
alignment, anterior cervical discectomy and fusion, intraoperative positioning, lordosis, Diseases of the musculoskeletal system, RC925-935
Abstract

Study Design: The study design used was a retrospective cohort. Objective: The objective of this study is to determine if intraoperative improvements in sagittal alignment on the operating table persisted on postoperative standing radiographs. Summary of Background Data: Cervical sagittal alignment may be correlated to postoperative outcomes. Since anterior cervical discectomy and fusions (ACDFs) can restore some cervical lordosis through intervertebral grafts/cages, it is important to understand if intraoperative radiographic measurements correlate with persistent postoperative radiographic changes. Materials and Methods: Patients undergoing elective primary ACDF were screened for the presence of lateral cervical radiographs preoperatively, intraoperatively, and postoperatively. Patients were excluded if their first postoperative radiograph was more than 3 months following the procedure or if cervical lordosis was not able to be measured at each time point. Paired t-tests were utilized to compare differences in measurements between time points. Statistical significance was set at P < 0.05. Results: Of 46 included patients, 26 (56.5%) were female, and the mean age was 55.2 ± 11.6 years. C0-C2 lordosis significantly increased from the preoperative to intraoperative time point (delta [Δ] = 4.49, P = 0.029) and significantly decreased from the intraoperative to postoperative time period (Δ = −6.57, P < 0.001), but this resulted in no significant preoperative to postoperative change (Δ = −2.08, P = 0.096). C2 slope decreased from the preoperative to the intraoperative time point (Δ = −3.84, P = 0.043) and significantly increased from the intraoperative to the postoperative time point (Δ = 3.68, P = 0.047), which also resulted in no net change in alignment between the preoperative and postoperative periods (Δ = −0.16, P = 0.848). There was no significant difference in the C2-C7 SVA from the preoperative to intraoperative (Δ = 0.85, P = 0.724) or intraoperative to postoperative periods (Δ = 2.04, P = 0.401); however, the C2-C7 SVA significantly increased from the preoperative to postoperative period (Δ = 2.88, P = 0.006). Conclusions: Intraoperative positioning predominantly affects the mobile upper cervical spine, particularly C0-C2 lordosis and C2 slope, but these changes do not persist postoperatively.

Published
2022
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6. How does spinopelvic alignment influence short-term clinical outcomes after lumbar fusion in patients with single-level degenerative spondylolisthesis?

Author

Stephen DiMaria, Brian A Karamian, Mark J Lambrechts, Arun P Kanhere, John J Mangan, Winston W Yen, Arlene Maheu, Mahir A Qureshi, Jose A Canseco, David I Kaye, Barrett I Woods, Mark F Kurd, Kris E Radcliff, Alan S Hilibrand, Christopher K Kepler, Alexander R Vaccaro, and Gregory D Schroeder

Subjects
degenerative spondylolisthesis, lumbar lordosis, patient-reported outcome measures, pelvic tilt, sacral slope, spinopelvic alignment, Diseases of the musculoskeletal system, RC925-935
Abstract

Context: Studies on adult spinal deformity have shown spinopelvic malalignment results in worse outcomes. However, it is unclear if this relationship exists in patients with single-level degenerative spondylolisthesis (DS) receiving short-segment fusions. Aims: To determine if spinopelvic alignment affects patient-reported outcome measures (PROMs) after posterior lumbar decompression and fusion (PLDF) with or without a transforaminal lumbar interbody fusion in patients with L4-5 DS. Settings and Design: A retrospective cohort analysis was conducted on patients who underwent PLDF for L4-5 DS at a single tertiary referral academic medical center. Materials and Methods: Patients were divided into groups based on preoperative cutoff values of 20° for pelvic tilt (PT) and 11° for pelvic incidence-lumbar lordosis mismatch (PI-LL) with subsequent reclassification based on correction to 20° was associated with significantly greater reduction in PI-LL (−2.41° vs. 1.21°, P = 0.004) and increase in sacral slope (SS) (1.06° vs. −1.86°, P = 0.005) compared to patients with preoperative PT 20° is associated with improved PI-LL reduction and an increase in SS. However, no differences in clinical outcomes were found 1 year postoperatively for patients with preoperative PT >20° and PI-LL ≥11° compared to patients below this threshold.

Published
2022
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7. The impact of preoperative neurological symptom severity on postoperative outcomes in cervical spondylotic myelopathy

Author

Gregory R Toci, Jose A Canseco, Brian A Karamian, Michael Chang, Giovanni Grasso, Kristen Nicholson, Emily M Pflug, Glenn S Russo, Daniel Tarazona, I David Kaye, Mark F Kurd, Alan S Hilibrand, Barrett I Woods, Jeffrey A Rihn, D Greg Anderson, Kris E Radcliff, Christopher K Kepler, Alexander R Vaccaro, and Gregory D Schroeder

Subjects
cervical spondylosis, modified japanese orthopaedic association, myelopathy, patient-reported outcomes, Diseases of the musculoskeletal system, RC925-935
Abstract

Study Design: The study design is a retrospective cohort study. Objective: To compare patient-reported outcomes between patients with mild versus moderate-to-severe myelopathy following surgery for cervical spondylotic myelopathy (CSM). Summary of Background Data: Recent studies have demonstrated that decompression for CSM leads to improved quality of life when measured by patient-reported outcomes. However, it is unknown if preoperative myelopathy classification is predictive of superior postoperative improvements. Materials and Methods: A retrospective review of patients treated surgically for CSM at a single institution from 2014 to 2015 was performed. Preoperative myelopathy severity was classified according to the modified Japanese Orthopaedic Association (mJOA) scale as either mild (≥15) or moderate-to-severe (

Published
2022
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9. Reimbursement of Lumbar Fusion at an Orthopaedic Specialty Hospital Versus Tertiary Referral Center

Author

Karamian, Brian A., Canseco, Jose A., Kanhere, Arun P., Minetos, Paul D., Lambrechts, Mark J., Lee, Yunsoo, Trenchfield, Delano, Pohl, Nicholas, Kothari, Parth, Conaway, William, Jeyamohan, Hareindra, Endersby, Kevin, Kaye, David, Woods, Barrett I., Rihn, Jeffrey A., Kurd, Mark F., Hilibrand, Alan S., Kepler, Christopher K., Vaccaro, Alexander R., and Schroeder, Gregory D.

Published
2024
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14. The Implication of Preoperative Central Stenosis on Patient-Reported Outcomes After Lumbar Decompression Surgery

Author

Yeung, Caleb M., Heard, Jeremy C., Lee, Yunsoo, Lambrechts, Mark J., Somers, Sydney, Singh, Akash, Bloom, Evan, D'Antonio, Nicholas D., Trenchfield, Delano, Labarbiera, Anthony, Mangan, John J., Canseco, Jose A., Woods, Barrett I., Kurd, Mark F., Kaye, Ian D., Lee, Joseph K., Hilibrand, Alan S., Vaccaro, Alexander R., Kepler, Christopher K., and Schroeder, Gregory D.

Published
2023
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20. Preoperative Opioid Prescribers and Lumbar Fusion: Their Effect on Clinical Outcomes and Postoperative Opioid Usage

Author

Lambrechts, Mark J., Toci, Gregory R., Fried, Tristan B., Issa, Tariq Z., Karamian, Brian A., Carter, Michael V., Breyer, Garrett M., Curran, John G., Hassan, Waqas, Jeyamohan, Hareindra, Minetos, Paul D., Stolzenberg, David, Mehnert, Michael, Canseco, Jose A., Woods, Barrett I., Kaye, Ian David, Hilibrand, Alan S., Kepler, Christopher K., Vaccaro, Alexander R., and Schroeder, Gregory D.

Published
2023
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22. Modified Frailty Index Does Not Provide Additional Value in Predicting Outcomes in Patients Undergoing Elective Transforaminal Lumbar Interbody Fusion

Author

Tran, Khoa S., Lambrechts, Mark J., Issa, Tariq Z., Tecce, Eric, Corr, Andrew, Toci, Gregory R., Wong, Ashley, DiMaria, Stephen, Kirkpatrick, Quinn, Chu, Justin, Gilmore, Griffin, Kurd, Mark F., Rihn, Jeffery A., Woods, Barrett I., Kaye, Ian David, Canseco, Jose A., Hilibrand, Alan S., Kepler, Christopher K., Vaccaro, Alexander R., and Schroeder, Gregory D.

Published
2023
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30. Construct length analysis of type B and C cervical and thoracolumbar fractures

Author

Heard, Jeremy C., primary, Lambrechts, Mark J., additional, Lee, Yunsoo, additional, Ezeonu, Teeto, additional, Trenchfield, Delano R., additional, D’Antonio, Nicholas D., additional, Dees, Azra N., additional, Wiafe, Bright M., additional, Mangan, John J., additional, Canseco, Jose A., additional, Woods, Barrett I., additional, Kaye, Ian David, additional, Hilibrand, Alan S., additional, Vaccaro, Alexander R., additional, Kepler, Christopher K., additional, and Schroeder, Gregory D., additional

Published
2024
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31. Patients From Socioeconomically Distressed Communities Experience Similar Clinical Improvements Following Anterior Cervical Discectomy and Fusion

Author

Lambrechts, Mark J., Toci, Gregory R., Issa, Tariq Z., Siegel, Nicholas S., O’Connor, Patrick, Siniakowicz, Claudia, Syal, Amit, Weber, Jackson, Lawall, Charles, Brush, Parker, Canseco, Jose A., Kaye, Ian D., Woods, Barrett I., Schroeder, Gregory D., Hilibrand, Alan S., Vaccaro, Alexander R., and Kepler, Christopher K.

Published
2022
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32. Static Versus Expandable Polyether Ether Ketone (PEEK) Interbody Cages: A Comparison of One-Year Clinical and Radiographic Outcomes for One-Level Transforaminal Lumbar Interbody Fusion

Author

Canseco, Jose A., Karamian, Brian A., DiMaria, Stephen L., Patel, Parthik D., Divi, Srikanth N., Chang, Michael, Timmons, Tyler, Grewal, Lovy, Hallman, Haydn, Lee, Joseph K., Kaye, I. David, Woods, Barrett I., Kurd, Mark F., Anderson, D. Greg, Rihn, Jeffrey A., Hilibrand, Alan S., Kepler, Christopher K., Vaccaro, Alexander R., and Schroeder, Gregory D.

Published
2021
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34. How do C2 tilt and C2 slope correlate with patient reported outcomes in patients after anterior cervical discectomy and fusion?

Author

Divi, Srikanth N., Bronson, Wesley H., Canseco, Jose A., Chang, Michael, Goyal, Dhruv K.C., Nicholson, Kristen J., Mujica, Victor E., Kaye, Ian David, Kurd, Mark F., Woods, Barrett I., Radcliff, Kristen E., Rihn, Jeffrey A., Anderson, David Greg, Hilibrand, Alan S., Kepler, Christopher K., Vaccaro, Alexander R., and Schroeder, Gregory D.

Published
2021
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36. Risk Factors for 30-day and 90-day Readmission After Lumbar Decompression

Author

Canseco, Jose A., Karamian, Brian A., Minetos, Paul D., Paziuk, Taylor M., Gabay, Alyssa, Reyes, Ariana A., Bechay, Joseph, Xiao, Kevin B., Nourie, Blake O., Kaye, I. David, Woods, Barrett I., Rihn, Jeffrey A., Kurd, Mark F., Anderson, D. Greg, Hilibrand, Alan S., Kepler, Christopher K., Schroeder, Gregory D., and Vaccaro, Alexander R.

Published
2022
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38. The Effect of L5-S1 Degenerative Disc Disease on Outcomes of L4-L5 Fusion

Author

Conaway, William, Karamian, Brian A., Mao, Jennifer Z., Kothari, Parth, Canseco, Jose A., Bowles, Daniel R., DiMaria, Stephen L., Semenza, Nicholas C., Massood, Alec J., Gebeyehu, Teleale F., Kheir, Nadim, Yen, Winston W., Woods, Barrett I., Lee, Joseph K., Rihn, Jeffrey A., Kaye, I. David, Kepler, Christopher K., Hilibrand, Alan S., Vaccaro, Alexander R., and Schroeder, Gregory D.

Published
2022
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39. Effect of a Mandatory Prescription Drug Monitoring Program on Patient-initiated Phone Calls After Spine Surgery

Author

Karamian, Brian A., Jeyamohan, Hareindra, Minetos, Paul D., Kothari, Parth, Canseco, Jose A., Bowles, Daniel R., Pekuri, Anu, Conaway, William, DiMaria, Stephen L., Mao, Jennifer Z., Woods, Barrett I., Kaye, I. David, Lee, Joseph K., Rihn, Jeffrey A., Hilibrand, Alan S., Kepler, Christopher K., Vaccaro, Alexander R., and Schroeder, Gregory D.

Published
2022
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40. Patients With Preoperative Cervical Deformity Experience Similar Clinical Outcomes to Those Without Deformity Following 1–3 Level Anterior Cervical Decompression and Fusion

Author

Karamian, Brian A., Mao, Jennifer Z., Viola, Anthony, III, Ju, Derek G., Canseco, Jose A., Toci, Gregory R., Bowles, Daniel R., Reiter, David M., Semenza, Nicholas C., Woods, Barrett I., Lee, Joseph K., Hilibrand, Alan S., Kaye, I. David, Kepler, Christopher K., Vaccaro, Alexander R., and Schroeder, Gregory D.

Published
2022
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42. Processing and Handling Cost of Single-use Versus Traditional Instrumentation for 1 Level Lumbar Fusions

Author

Galetta, Matthew S., Divi, Srikanth N., Shapses, Mark A., Hartman, Joseph B., Nicholson, Kristen J., Goyal, Dhruv K.C., Fang, Taolin, Mangan, John J., Kaye, Ian David, Kurd, Mark F., Woods, Barrett I., Radcliff, Kris E., Rihn, Jeffrey A., Anderson, David Greg, Hilibrand, Alan S., Kepler, Christopher K., Vaccaro, Alexander R., and Schroeder, Gregory D.

Published
2020
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44. Modified Frailty Index Does Not Provide Additional Value in Predicting Outcomes in Patients Undergoing Elective Transforaminal Lumbar Interbody Fusion

Author

Khoa S. Tran, Mark J. Lambrechts, Tariq Z. Issa, Eric Tecce, Andrew Corr, Gregory R. Toci, Ashley Wong, Stephen DiMaria, Quinn Kirkpatrick, Justin Chu, Griffin Gilmore, Mark F. Kurd, Jeffery A. Rihn, Barrett I. Woods, Ian David Kaye, Jose A. Canseco, Alan S. Hilibrand, Christopher K. Kepler, Alexander R. Vaccaro, and Gregory D. Schroeder

Subjects
Surgery, Neurology (clinical)
Abstract

To determine the predictive value of the modified Frailty Index (mFI) in evaluating sarcopenia and clinical outcomes in patients undergoing 1-level or 2-level transforaminal lumbar interbody fusion (TLIF).Patients who underwent a 1-level or 2-level TLIF between 2012 and 2020 were retrospectively identified. Frailty was compared among groups using mFI, and sarcopenia was classified by the psoas muscle cross-sectional area. Bivariate statistics compared demographics, comorbidities, and clinical outcomes. A linear regression model was developed using the Charlson Comorbidity Index (CCI) or mFI as independent variables to determine potential predictors for improvement in 1-year patient-reported outcomes.Of 488 included patients, 60 were severely frail and 60 patients had sarcopenia, but sarcopenia was not associated with patient frailty (P = 0.469). Severely frail patients had worse baseline Oswestry Disability Index (ODI) (P0.001), Mental Component Score-12 (P = 0.001), and Physical Component Score-12 (P0.001), and worse improvement in ODI (P = 0.037), Physical Component Score-12 (P0.001), and visual analog scale (VAS) back (P = 0.007). mFI was an independent predictor of poorer improvement in VAS back and ODI, whereas age + CCI in addition predicted poorer improvement in VAS leg. Patients with higher mFI experienced longer length of stay, less frequent home discharge, and higher rates of complications, but similar readmission and reoperation rates.Frailer patients experience poorer improvement in back pain, physical functioning, and disability after TLIF. mFI and the combination of age and CCI comparably predict patient-reported outcomes but do not correlate to baseline sarcopenia. Frailty increased the risk of complications, length of hospital stay, and risk of nonhome discharge.

Published
2023
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45. Impact of Prolonged Operative Duration on Postoperative Symptomatic Venous Thromboembolic Events After Thoracolumbar Spine Surgery

Author

Khoa S. Tran, Tariq Ziad Issa, Yunsoo Lee, Mark J. Lambrechts, Skylar Nahi, Cannon Hiranaka, Andrew Tokarski, Dominic Lambo, Blaire Adler, Ian David Kaye, Jeffrey A. Rihn, Barrett I. Woods, Jose A. Canseco, Alan S. Hilibrand, Alexander R. Vaccaro, Christopher K. Kepler, and Gregory D. Schroeder

Subjects
Venous Thrombosis, Logistic Models, Postoperative Complications, Risk Factors, Humans, Surgery, Venous Thromboembolism, Neurology (clinical), Pulmonary Embolism
Abstract

To determine the effect of operative duration on the rate of postoperative symptomatic venous thromboembolic (VTE) events in patients undergoing thoracolumbar spine fusion.We identified all thoracolumbar spine fusion patients between 2012 and 2021. Operative duration was defined as time from skin incision to skin closure. A 1:1 propensity match was conducted incorporating patient and surgical characteristics. Logistic regression was performed to assess predictors of postoperative symptomatic VTE events. A receiver operating characteristic curve was created to determine a cutoff time for increased likelihood of VTE.We identified 101 patients with VTE and 1108 patients without VTE. Seventy-five patients with VTE were matched to 75 patients without VTE. Operative duration (339 vs. 262 minutes, P = 0.010) and length of stay (5.00 vs. 3.54 days, P = 0.008) were significantly longer in patients with a VTE event. Operative duration was an independent predictor of VTE on multivariate regression (odds ratio: 1.003, 95% confidence interval: 1.001-1.01, P = 0.021). For each additional hour of operative duration, the risk of VTE increased by 18%. A cutoff time of 218 minutes was identified (area under the curve [95% confidence interval] = 0.622 [0.533-0.712]) as an optimal predictor of increased risk for a VTE event.Operative duration significantly predicted symptomatic VTE, especially after surgical time cutoff of 218 minutes. Each additional hour of operative duration was found to increase VTE risk by 18%. We also identify the impact of VTE on 90-day readmission rates, suggesting significantly higher costs and opportunity for hospital acquired conditions, in line with prior literature.

Published
2023
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46. Does displacement of cervical and thoracolumbar dislocation-translation injuries predict spinal cord injury or recovery?

Author

Mark J, Lambrechts, Nicholas D, D'Antonio, Brian A, Karamian, Arun P, Kanhere, Azra, Dees, Bright M, Wiafe, Jose A, Canseco, Barrett I, Woods, I David, Kaye, Jeffrey, Rihn, Mark, Kurd, Alan S, Hilibrand, Christopher K, Kepler, Alexander R, Vaccaro, and Gregory D, Schroeder

Subjects
Spinal Injuries, Joint Dislocations, Cervical Vertebrae, Humans, Spinal Fractures, General Medicine, Decompression, Surgical, Magnetic Resonance Imaging, Spinal Cord Injuries, Retrospective Studies
Abstract

OBJECTIVE For patients with cervical and thoracolumbar AO Spine type C injuries, the authors sought to 1) identify whether preoperative vertebral column translation is predictive of a complete spinal cord injury (SCI) and 2) identify whether preoperative or postoperative vertebral column translation is predictive of neurological improvement after surgical decompression. METHODS All patients who underwent operative treatment for cervical and thoracolumbar AO Spine type C injuries at the authors’ institution between 2006 and 2021 were identified. CT and MRI were utilized to measure vertebral column translation in millimeters prior to and after surgery. A receiver operating characteristic (ROC) curve was generated to predict the probability of sustaining a complete SCI on the basis of the amount of preoperative vertebral column translation. ROC curves were then used to predict the probability of neurological recovery on the basis of preoperative and postoperative vertebral column translation. RESULTS ROC analysis of 67 patients identified 6.10 mm (area under the curve [AUC] 0.77, 95% CI 0.650–0.892) of preoperative vertebral column translation as predictive of complete SCI. Additionally, ROC curve analysis found that 10.4 mm (AUC 0.654, 95% CI 0.421–0.887) of preoperative vertebral column translation was strongly predictive of no postoperative neurological improvement. Residual postoperative vertebral column translation after fracture reduction and instrumentation had no predictive value on neurological recovery (AUC 0.408, 95% CI 0.195–0.622). CONCLUSIONS For patients with cervical and thoracolumbar AO Spine type C injuries, the amount of preoperative vertebral column translation is highly predictive of complete SCI and the likelihood of postoperative neurological recovery.

Published
2022
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48. Utility of Seated Lateral Radiographs in the Diagnosis and Classification of Lumbar Degenerative Spondylolisthesis

Author

Issa, Tariq Z., primary, Lee, Yunsoo, additional, Berthiaume, Emily, additional, Lambrechts, Mark J., additional, Zaworski, Caroline, additional, Qadiri, Qudratallah S., additional, Spracklen, Henley, additional, Padovano, Richard, additional, Weber, Jackson, additional, Mangan, John J., additional, Canseco, Jose A., additional, Woods, Barrett I., additional, Kaye, I. David, additional, Hilibrand, Alan S., additional, Kepler, Christopher K., additional, Vaccaro, Alexander R., additional, Schroeder, Gregory D., additional, and Lee, Joseph K., additional

Published
2023
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49. BMI Does Not Affect Complications or Patient Reported Outcomes After Lumbar Decompression Surgery

Author

Divi, Srikanth N., Goyal, Dhruv K.C., Stull, Justin D., Kothari, Parth, Padua, Fortunato G., Patel, Parthik D., Bowles, Daniel R., Reyes, Ariana A., Galetta, Matthew S., Kaye, Ian D., Kurd, Mark F., Woods, Barrett I., Radcliff, Kris E., Rihn, Jeffrey A., Anderson, David G., Hilibrand, Alan S., Kepler, Christopher K., Vaccaro, Alexander R., and Schroeder, Gregory D.

Published
2020
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50. The Impact of Multiple Comorbid Mental Health Disorders on Health-related Quality of Life Following ACDF

Author

Mangan, John J., III, Tadley, Madeline, Divi, Srikanth N., Stull, Justin D., Goyal, Dhruv K.C., McKenzie, James C., Casper, David S., Galetta, Matthew S., Kaye, Ian D., Kurd, Mark F., Woods, Barrett I., Radcliff, Kris E., Rihn, Jeffery A., Anderson, David G., Hilibrand, Alan S., Kepler, Christopher K., Vaccaro, Alexander R., and Schroeder, Gregory D.

Published
2020
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