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3. Does an improvement in cord-level intraoperative neuromonitoring data lead to a reduced risk for postoperative neurologic deficit in spine deformity surgery?

Author

Lee, Nathan J., Lenke, Lawrence G., Yeary, Mitchell, Dionne, Alexandra, Nnake, Chidebelum, Fields, Michael, Simhon, Matthew, Shi, Ted, Arvind, Varun, Ferraro, Anastasia, Cooney, Matthew, Lewerenz, Erik, Reyes, Justin L., Roth, Steven, Hung, Chun Wai, Scheer, Justin K., Zervos, Thomas, Thuet, Earl D., Lombardi, Joseph M., Sardar, Zeeshan M., Lehman, Ronald A., and Hassan, Fthimnir M.

Published
2025
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7. A Novel Preoperative Scoring System to Accurately Predict Cord-Level Intraoperative Neuromonitoring Data Loss During Spinal Deformity Surgery: A Machine-Learning Approach

Author

Lee, Nathan J., Lenke, Lawrence G., Arvind, Varun, Shi, Ted, Dionne, Alexandra C., Nnake, Chidebelum, Yeary, Mitchell, Fields, Michael, Simhon, Matt, Ferraro, Anastasia, Cooney, Matthew, Lewerenz, Erik, Reyes, Justin L., Roth, Steven G., Hung, Chun Wai, Scheer, Justin K., Zervos, Thomas, Thuet, Earl D., Lombardi, Joseph M., Sardar, Zeeshan M., Lehman, Ronald A., Roye, Benjamin D., Vitale, Michael G., and Hassan, Fthimnir M.

Published
2024
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13. Best Practice Guidelines for Assessment and Management of Osteoporosis in Adult Patients Undergoing Elective Spinal Reconstruction

Author

Sardar, Zeeshan M, Coury, Josephine R, Cerpa, Meghan, DeWald, Christopher J, Ames, Christopher P, Shuhart, Christopher, Watkins, Colleen, Polly, David W, Dirschl, Douglas R, Klineberg, Eric O, Dimar, John R, Krohn, Kelly D, Kebaish, Khaled M, Tosi, Laura L, Kelly, Michael, Lane, Nancy E, Binkley, Neil C, Berven, Sigurd H, Lee, Nathan J, Anderson, Paul, Angevine, Peter D, Lehman, Ronald A, and Lenke, Lawrence G

Subjects
Osteoporosis, Aging, Physical Injury - Accidents and Adverse Effects, Clinical Research, Patient Safety, 7.3 Management and decision making, Management of diseases and conditions, Musculoskeletal, Absorptiometry, Photon, Adult, Aged, Bone Density, Bone Density Conservation Agents, Fractures, Bone, Humans, Spine, abaloparatide, best practice, consensus guidelines, CT Hounsfield units, osteoporosis, reconstructive spine surgery, teriparatide, Biomedical Engineering, Clinical Sciences, Orthopedics
Abstract

Study designExpert consensus study.ObjectiveThis expert panel was created to establish best practice guidelines to identify and treat patients with poor bone health prior to elective spinal reconstruction.Summary of background dataCurrently, no guidelines exist for the management of osteoporosis and osteopenia in patients undergoing spinal reconstructive surgery. Untreated osteoporosis in spine reconstruction surgery is associated with higher complications and worse outcomes.MethodsA multidisciplinary panel with 18 experts was assembled including orthopedic and neurological surgeons, endocrinologists, and rheumatologists. Surveys and discussions regarding the current literature were held according to Delphi method until a final set of guidelines was created with over 70% consensus.ResultsPanelists agreed that bone health should be considered in every patient prior to elective spinal reconstruction. All patients above 65 and those under 65 with particular risk factors (chronic glucocorticoid use, high fracture risk or previous fracture, limited mobility, and eight other key factors) should have a formal bone health evaluation prior to undergoing surgery. DXA scans of the hip are preferable due to their wide availability. Opportunistic CT Hounsfield Units of the vertebrae can be useful in identifying poor bone health. In the absence of contraindications, anabolic agents are considered first line therapy due to their bone building properties as compared with antiresorptive medications. Medications should be administered preoperatively for at least 2 months and postoperatively for minimum 8 months.ConclusionBased on the consensus of a multidisciplinary panel of experts, we propose best practice guidelines for assessment and treatment of poor bone health prior to elective spinal reconstructive surgery. Patients above age 65 and those with particular risk factors under 65 should undergo formal bone health evaluation. We also established guidelines on perioperative optimization, utility of various diagnostic modalities, and the optimal medical management of bone health in this population.Level of Evidence: 5.

Published
2022

16. Simultaneous Robotic Single Position Oblique Lumbar Interbody Fusion With Bilateral Sacropelvic Fixation in Lateral Decubitus

Author

Pham, Martin H, Diaz-Aguilar, Luis Daniel, Shah, Vrajesh, Brandel, Michael, Loya, Joshua, and Lehman, Ronald A

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Bioengineering, Pain Research, Minimally invasive surgical procedures, Robotics, Mazor, Sacropelvic fixation, S2-alar-iliac
Abstract

Single position lateral fusion reduces the need for a secondary surgery and robotic guidance allows for potentially higher accuracy of screw placement. We expand the role of robotics with a simultaneous workflow where 2 surgeons can work in single position surgery and discuss the technical feasibility of placement of S2-alar-iliac (S2AI) screws in the lateral position. A 70-year-old male presented with chronic back pain and bilateral leg pain with the left side worse than the right. He subsequently underwent an L3-S1 oblique lumbar interbody fusion (OLIF) with a minimally invasive L3-ilium robotic posterior spinal fixation simultaneously in single lateral position with S2AI screws. The software planning requisite of robotics allowed for a preoperative plan where lumbar cortical screws were used to line up with bilateral S2AI screws. Intraoperatively, the OLIF was performed anterior to the patient which allowed for a second surgeon to perform the posterior stage of screw placement simultaneously in overlapping fashion during OLIF exposure. Once all screws were placed, the OLIF discectomy and cage placement were completed. As the OLIF incision is closed, rodding proceeds posteriorly with subsequent closure simultaneously as well. Operative time from skin incision to skin closure was 3 hours and 47 minutes. We present here a novel technical report on the recommended workflow of simultaneous robotic single position surgery OLIF and demonstrate the feasibility of placement of sacroiliac fixation in the lateral decubitus position. We believe this technique to be minimally invasive, effective, with the benefit of shortening valuable operating room case time.

Published
2021

33. Is there a difference between navigated and non-navigated robot cohorts in robot-assisted spine surgery? A multicenter, propensity-matched analysis of 2,800 screws and 372 patients

Author

Lee, Nathan J., Zuckerman, Scott L., Buchanan, Ian A., Boddapati, Venkat, Mathew, Justin, Leung, Eric, Park, Paul J., Pham, Martin H., Buchholz, Avery L., Khan, Asham, Pollina, John, Mullin, Jeffrey P., Jazini, Ehsan, Haines, Colin, Schuler, Thomas C., Good, Christopher R., Lombardi, Joseph M., and Lehman, Ronald A.

Published
2021
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37. List of Contributors

Author

Ahmed, A. Karim, primary, Al-Saiegh, Fadi, additional, Albert, Todd J., additional, Aleem, Ilyas, additional, Alvarado, Anthony M., additional, Ames, Christopher P., additional, Anderson, Paul A., additional, Arnold, Paul M., additional, Benzel, Edward, additional, Bisson, Erica F., additional, Boaro, Alessandro, additional, Boody, Barrett S., additional, Brodke, Darrel S., additional, Brooks, Nathaniel P., additional, Buell, Thomas J., additional, Burke, Rebecca M., additional, Canseco, Jose A., additional, Cheng, Joseph S., additional, Chou, Dean, additional, Ehresman, Jeff, additional, Gandhi, Sapan D., additional, Goldstein, Zachary H., additional, Groff, Michael W., additional, Gupta, Raghav, additional, Harland, Tessa, additional, Harrop, James S., additional, Heary, Robert F., additional, Hoang, Stanley, additional, Holton, Kenneth J., additional, Hundal, Rajbir S., additional, Joseph, Jacob R., additional, Kalfas, Iain H., additional, Kanter, Adam S., additional, Katsuura, Yoshihiro, additional, Kim, Han Jo, additional, Kim, Jun S., additional, Kolluri, Kamal, additional, Leas, Daniel P., additional, Lehman, Ronald A., additional, Lenke, Lawrence G., additional, Liounakos, Jason I., additional, Mayer, Rory, additional, Mummaneni, Praveen V., additional, Nasser, Rani, additional, Nassr, Ahmad, additional, Owen, Robert J., additional, Padua, Fortunato G., additional, Park, Paul, additional, Park, Paul J., additional, Patel, Arati B., additional, Patel, Rakesh, additional, Pennicooke, Brenton, additional, Pennington, Zach, additional, Phillips, Frank M., additional, Pilitsis, Julie G., additional, Polly, David W., additional, Potts, Eric A., additional, Rao, Raj D., additional, Resnick, Daniel K., additional, Rivera, Joshua, additional, Saleh, Mohamed, additional, San Miguel, Jose E., additional, Sasso, Rick C., additional, Schmoller, Shelly K., additional, Sciubba, Daniel M., additional, Shaffrey, Christopher I., additional, Sheldon, Breanna L., additional, Sherrod, Brandon A., additional, Shorten, Peter, additional, Smith, Justin S., additional, Swong, Kevin, additional, Tan, Lee A., additional, Thomas, Daniel J., additional, Truong, Huy Q., additional, Vaccaro, Alexander R., additional, Wang, Michael Y., additional, Yee, Timothy J., additional, Yen, Chun-Po, additional, and Yener, Ulas, additional

Published
2022
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41. The Lumbosacral Fractional Curve vs Maximum Coronal Cobb Angle in Adult Spinal Deformity Patients with Coronal Malalignment: Which Matters More?

Author

Zuckerman, Scott L, Chanbour, Hani, Hassan, Fthimnir M, Lai, Christopher S, Shen, Yong, Kerolus, Mena G, Ha, Alex, Buchanan, Ian, Lee, Nathan J, Leung, Eric, Cerpa, Meghan, Lehman, Ronald A, and Lenke, Lawrence G

Subjects
LUMBAR vertebrae, PATIENT reported outcome measures, SPINE abnormalities, SURGICAL complications, SACRUM
Abstract

Study Design: Retrospective cohort study. Objectives: In patients undergoing adult spinal deformity (ASD) surgery we sought to: 1) report preoperative and postoperative lumbosacral fractional (LSF) curve and maximum coronal Cobb angles and 2) determine their impact on radiographic, clinical, and patient-reported outcomes (PROs). Methods: A single-institution cohort study was undertaken. The LSF curve was the cobb angle between the sacrum and most tilted lower lumbar vertebra. Coronal/sagittal vertical axis (CVA/SVA) were collected. Patients were compared between 4 groups: 1) Neutral Alignment (NA); 2) coronal malalignment only (CM); 3) Sagittal malalignment only (SM); and 4) Combined-Coronal-Sagittal-Malalignment (CCSM). Outcomes including postoperative CM, postoperative coronal vertical axis, complications, readmissions, reoperation, and PROs. Results: A total of 243 patients underwent ASD surgery with mean total instrumented levels of 13.5. Mean LSF curve was 12.1±9.9°(0.2-62.3) and mean max Cobb angle was 43.0±26.5° (0.0-134.3). The largest mean LSF curves were seen in patients with CM (14.6°) and CCSM (13.1°) compared to NA (12.1°) and SM (9.5°) (p=0.100). A higher LSF curve was seen in patients with fusion to the sacrum and instrumentation to the pelvis (p=0.009), and a higher LSF curve was associated with more TLIFs (p=0.031). Postoperatively, more TLIFs were associated with greater amount of LSF curve correction (p<0.001). Comparing the LSF and the max Cob angle among Qiu types, the highest mean max Cobb angle was in Qiu Type B patients (p=0.025), whereas the highest mean LSF curve was in Qiu Type C patients (p=0.037). Moreover, 82.7% of patients had a LSF curve opposite the max Cobb angle. The LSF curve was larger than the max Cobb angle in 22/243 (9.1%) patients, and most of these 22 patients were Qiu Type A (59.1%). Regarding correction, the max Cobb angle achieved more correction than the LSF curve, judged by the percent improved from preop (54.5% Cobb vs. 46.5% LSF, p=0.025) in patients with max cobb>20° and LSF curve >5°. The LSF curve underwent greater correction in Qiu Type C patients (9.2°) compared to Type A (5.7°) and Type B (5.1°) (p=0.023); however, the max Cobb angle was similarly corrected among Qiu Types: Type A 21.8°, Type B 24.6°, and Type C 25.4° (p=0.602). Minimal differences were seen comparing the preop/postop/change in LSF curve and max Cobb angle regarding postop CM, postop CVA, complications, readmissions, reoperation, and PROs. Conclusions: The LSF curve was highest in patients with CM, CCSM, and Qiu Type C curves. Most patients had a LSF curve opposite the max Cobb angle. The max Cobb angle was more often corrected than the LSF curve. The LSF curve underwent greater correction among Qiu Type C patients, whereas the max Cobb angle was similarly corrected among all Qiu Types. No clear trend was seen regarding postoperative complications and PROs between the LSF curve and max Cobb angle. [ABSTRACT FROM AUTHOR]

Published
2024
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