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A Murine Model For Developmental Dysplasia Of The Hip: Ablation Of Cx3cr1 Affects Acetabular Morphology And Gait., George J. Feldman, Arlene Offemaria, Hind Sawan, Javad Parvizi, Theresa A. Freeman

Rothman Institute Faculty Papers

BACKGROUND: Developmental dysplasia of the hip (DDH) is a debilitating condition whose distinguishing signs include incomplete formation of the acetabulum leading to dislocation of the femur, accelerated wear of the articular cartilage and joint laxity resulting in osteoarthritis. It is a complex disorder having environmental and genetic causes. Existing techniques fail to detect milder forms of DDH in newborns leading to hip osteoarthritis in young adults. A sensitive, specific and cost effective test would allow identification of newborns that could be non-invasively corrected by the use of a Pavlik harness. Previously, we identified a 2.5 MB candidate region on human …

Sacral Fractures And Associated Injuries., Ricardo Rodrigues-Pinto, Mark F. Kurd, Gregory D. Schroeder, Christopher K. Kepler, James C. Krieg, Jörg H. Holstein, Carlo Bellabarba, Reza Firoozabadi, F Cumhur Oner, Frank Kandziora, Marcel F. Dvorak, Conor P. Kleweno, Luiz R. Vialle, S. Rajasekaran, Klause J. Schnake, Alexander R. Vaccaro

Rothman Institute Faculty Papers

STUDY DESIGN: Literature review.

OBJECTIVE: The aim of this review is to describe the injuries associated with sacral fractures and to analyze their impact on patient outcome.

METHODS: A comprehensive narrative review of the literature was performed to identify the injuries associated with sacral fractures.

RESULTS: Sacral fractures are uncommon injuries that result from high-energy trauma, and that, due to their rarity, are frequently underdiagnosed and mistreated. Only 5% of sacral fractures occur in isolation. Injuries most often associated with sacral fractures include neurologic injuries (present in up to 50% of sacral fractures), pelvic ring disruptions, hip and lumbar spine …

Serum D-Dimer Test Is Promising For The Diagnosis Of Periprosthetic Joint Infection And Timing Of Reimplantation., Alisina Shahi, Michael M. Kheir, Majd Tarabichi, Hamid R.S. Hosseinzadeh, Timothy L. Tan, Javad Parvizi

Rothman Institute Faculty Papers

BACKGROUND: Despite the availability of a battery of tests, the diagnosis of periprosthetic joint infection (PJI) continues to be challenging. Serum D-dimer assessment is a widely available test that detects fibrinolytic activities that occur during infection. We hypothesized that patients with PJI may have a high level of circulating D-dimer and that the presence of a high level of serum D-dimer may be a sign of persistent infection in patients awaiting reimplantation.

METHODS: This prospective study was initiated to enroll patients undergoing primary and revision arthroplasty. Our cohort consisted of 245 patients undergoing primary arthroplasty (n = 23), revision for …

A Prospective Randomized Study Analyzing Preoperative Opioid Counseling In Pain Management After Carpal Tunnel Release Surgery., Todd H. Alter, Asif M Ilyas

Rothman Institute Faculty Papers

PURPOSE: Prescription opioid misuse has become increasingly prevalent in the United States. Preoperative opioid counseling has been proposed to decrease opioid consumption after surgery. This study aimed to evaluate the effect of preoperative opioid counseling on patients' pain experience and opioid consumption after carpal tunnel release (CTR) surgery.

METHODS: A prospective comparison of consecutive patients scheduled to undergo CTR surgery was conducted. Patients were randomized to receive either formal preoperative opioid counseling or no counseling. All operations were performed with the same miniopen CTR surgical technique, and the same number of opioids were prescribed after surgery. Daily opioid pill consumption, …

Corrosion And Tribology Of Materials Used In A Novel Reverse Hip Replacement, Linda Braddon, Zafer Termanini, Steven Macdonald, Jay Parvizi, Jay Lieberman, Victor Frankel, Joseph Zuckerman

Rothman Institute Faculty Papers

Total hip arthroplasty has been utilized for the past 50 years as an effective treatment for degenerative, inflammatory and traumatic disorders of the hip. The design of these implants has generally followed the anatomy of the hip as a ball and socket joint with the femoral head representing the ball and the acetabulum representing the socket. We describe a novel hip arthroplasty design in which the "ball" is located on the acetabular side and the "socket" is located on the femoral side. The results of extensive biomechanical testing are described and document wear and corrosion characteristics that are at least …

Clinical Application Of Ceramics In Anterior Cervical Discectomy And Fusion: A Review And Update, Shayan A. Zadegan, Aidin Abedi, Seyed B. Jazayeri, Hirbod Bonaki, Alex R. Vaccaro, Vafa Rahimi-Movaghar

Rothman Institute Faculty Papers

Study Design: Narrative review. Objectives: Anterior cervical discectomy and fusion (ACDF) is a reliable procedure, commonly used for cervical degenerative disc disease. For interbody fusions, autograft was the gold standard for decades; however, limited availability and donor site morbidities have led to a constant search for new materials. Clinically, it has been shown that calcium phosphate ceramics, including hydroxyapatite (HA) and tricalcium phosphate (TCP), are effective as osteoconductive materials and bone grafts. In this review, we present the current findings regarding the use of ceramics in ACDF. Methods: A review of the relevant literature examining the clinical use of ceramics …

Does The Spine Surgeon’S Experience Affect Fracture Classification, Assessment Of Stability, And Treatment Plan In Thoracolumbar Injuries?, Shanmuganathan Rajasekaran, Rishimugesh Kanna, Gregory D. Schroeder, Frank C. Oner, Luiz Vialle, Jens R. Chapman, Marcel Dvorak, Michael Fehlings, Ajoy P. Shetty, Klaus J. Schnake, Frank M. Kandziora, Alex R. Vaccaro

Rothman Institute Faculty Papers

Study Design: Prospective survey-based study. Objectives: The AO Spine thoracolumbar injury classification has been shown to have good reproducibility among clinicians. However, the influence of spine surgeons’ clinical experience on fracture classification, stability assessment, and decision on management based on this classification has not been studied. Furthermore, the usefulness of varying imaging modalities including radiographs, computed tomography (CT) and magnetic resonance imaging (MRI) in the decision process was also studied. Methods: Forty-one spine surgeons from different regions, acquainted with the AOSpine classification system, were provided with 30 thoracolumbar fractures in a 3-step assessment: first radiographs, followed by CT and MRI. …

Iatrogenic Spinal Cord Injury Resulting From Cervical Spine Surgery., Alan H. Daniels, Robert A. Hart, Alan S. Hilibrand, David E. Fish, Jeffrey C. Wang, Elizabeth L. Lord, Zorica Buser, P. Justin Tortolani, D. Alex Stroh, Ahmad Nassr, Bradford L. Currier, Arjun S. Sebastian, Paul M. Arnold, Michael G. Fehlings, Thomas E. Mroz, K. Daniel Riew

Rothman Institute Faculty Papers

STUDY DESIGN: Retrospective cohort study of prospectively collected data.

OBJECTIVE: To examine the incidence of iatrogenic spinal cord injury following elective cervical spine surgery.

METHODS: A retrospective multicenter case series study involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network was conducted. Medical records for 17 625 patients who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, were reviewed to identify occurrence of iatrogenic spinal cord injury.

RESULTS: In total, 3 cases of iatrogenic spinal cord injury following cervical spine surgery were identified. Institutional incidence rates ranged …

Misplaced Cervical Screws Requiring Reoperation., Jeremy C. Peterson, Paul M. Arnold, Zachary A. Smith, Wellington K. Hsu, Michael G. Fehlings, Robert A. Hart, Alan S. Hilibrand, Ahmad Nassr, Ra'kerry K. Rahman, Chadi A. Tannoury, Tony Tannoury, Thomas E. Mroz, Bradford L. Currier, Anthony F. De Giacomo, Jeremy L. Fogelson, Bruce C. Jobse, Eric M. Massicotte, K. Daniel Riew

Rothman Institute Faculty Papers

STUDY DESIGN: A multicenter, retrospective case series.

OBJECTIVE: In the past several years, screw fixation of the cervical spine has become commonplace. For the most part, this is a safe, low-risk procedure. While rare, screw backout or misplaced screws can lead to morbidity and increased costs. We report our experiences with this uncommon complication.

METHODS: A multicenter, retrospective case series was undertaken at 23 institutions in the United States. Patients were included who underwent cervical spine surgery from January 1, 2005, to December 31, 2011, and had misplacement of screws requiring reoperation. Institutional review board approval was obtained at all …

Epidural Hematoma Following Cervical Spine Surgery., Gregory D. Schroeder, Alan S. Hilibrand, Paul M. Arnold, David E. Fish, Jeffrey C. Wang, Jeffrey L. Gum, Zachary A. Smith, Wellington K. Hsu, Ziya L. Gokaslan, Robert E. Isaacs, Adam S. Kanter, Thomas E. Mroz, Ahmad Nassr, Rick C. Sasso, Michael G. Fehlings, Zorica Buser, Mohamad Bydon, Peter I. Cha, Dhananjay Chatterjee, Erica L. Gee, Elizabeth L. Lord, Erik N. Mayer, Owen J. Mcbride, Emily C. Nguyen, Allison K. Roe, P. Justin Tortolani, D. Alex Stroh, Marisa Y. Yanez, K. Daniel Riew

Rothman Institute Faculty Papers

STUDY DESIGN: A multicentered retrospective case series.

OBJECTIVE: To determine the incidence and circumstances surrounding the development of a symptomatic postoperative epidural hematoma in the cervical spine.

METHODS: Patients who underwent cervical spine surgery between January 1, 2005, and December 31, 2011, at 23 institutions were reviewed, and all patients who developed an epidural hematoma were identified.

RESULTS: A total of 16 582 cervical spine surgeries were identified, and 15 patients developed a postoperative epidural hematoma, for a total incidence of 0.090%. Substantial variation between institutions was noted, with 11 sites reporting no epidural hematomas, and 1 site reporting an …

C5 Palsy After Cervical Spine Surgery: A Multicenter Retrospective Review Of 59 Cases., Sara E. Thompson, Zachary A. Smith, Wellington K. Hsu, Ahmad Nassr, Thomas E. Mroz, David E. Fish, Jeffrey C. Wang, Michael G. Fehlings, Chadi A. Tannoury, Tony Tannoury, P. Justin Tortolani, Vincent C. Traynelis, Ziya Gokaslan, Alan S. Hilibrand, Robert E. Isaacs, Praveen V. Mummaneni, Dean Chou, Sheeraz A. Qureshi, Samuel K. Cho, Evan O. Baird, Rick C. Sasso, Paul M. Arnold, Zorica Buser, Mohamad Bydon, Michelle J Clarke, Anthony F. De Giacomo, Adeeb Derakhshan, Bruce Jobse, Elizabeth L. Lord, Daniel Lubelski, Eric M. Massicotte, Michael P. Steinmetz, Gabriel A. Smith, Jonathan Pace, Mark Corriveau, Sungho Lee, Peter I. Cha, Dhananjay Chatterjee, Erica L. Gee, Erik N. Mayer, Owen J. Mcbride, Allison K. Roe, Marisa Y. Yanez, D. Alex Stroh, Khoi D. Than, K. Daniel Riew

Rothman Institute Faculty Papers

STUDY DESIGN: A multicenter, retrospective review of C5 palsy after cervical spine surgery.

OBJECTIVE: Postoperative C5 palsy is a known complication of cervical decompressive spinal surgery. The goal of this study was to review the incidence, patient characteristics, and outcome of C5 palsy in patients undergoing cervical spine surgery.

METHODS: We conducted a multicenter, retrospective review of 13 946 patients across 21 centers who received cervical spine surgery (levels C2 to C7) between January 1, 2005, and December 31, 2011, inclusive. P values were calculated using 2-sample t test for continuous variables and χ(2) tests or Fisher exact tests for …

Rare Complications Of Cervical Spine Surgery: Pseudomeningocoele., Tamir Ailon, Justin S. Smith, Ahmad Nassr, Zachary A. Smith, Wellington K. Hsu, Michael G. Fehlings, David E. Fish, Jeffrey C. Wang, Alan S. Hilibrand, Praveen V. Mummaneni, Dean Chou, Rick C. Sasso, Vincent C. Traynelis, Paul M. Arnold, Thomas E. Mroz, Zorica Buser, Elizabeth L L. Lord, Eric M. Massicotte, Arjun S. Sebastian, Khoi D. Than, Michael P. Steinmetz, Gabriel A. Smith, Jonathan Pace, Mark Corriveau, Sungho Lee, K. Daniel Riew, Christopher Shaffrey

Rothman Institute Faculty Papers

STUDY DESIGN: This study was a retrospective, multicenter cohort study.

OBJECTIVES: Rare complications of cervical spine surgery are inherently difficult to investigate. Pseudomeningocoele (PMC), an abnormal collection of cerebrospinal fluid that communicates with the subarachnoid space, is one such complication. In order to evaluate and better understand the incidence, presentation, treatment, and outcome of PMC following cervical spine surgery, we conducted a multicenter study to pool our collective experience.

METHODS: This study was a retrospective, multicenter cohort study of patients who underwent cervical spine surgery at any level(s) from C2 to C7, inclusive; were over 18 years of age; and …

Epidemiology And Outcomes Of Vertebral Artery Injury In 16 582 Cervical Spine Surgery Patients: An Aospine North America Multicenter Study., Wellington K. Hsu, Abhishek Kannan, Harry T. Mai, Michael G. Fehlings, Zachary A. Smith, Vincent C. Traynelis, Ziya L. Gokaslan, Alan S. Hilibrand, Ahmad Nassr, Paul M. Arnold, Thomas E. Mroz, Mohamad Bydon, Eric M. Massicotte, Wilson Z. Ray, Michael P. Steinmetz, Gabriel A. Smith, Jonathan Pace, Mark Corriveau, Sungho Lee, Robert E Isaacs, Jeffrey C. Wang, Elizabeth L. Lord, Zorica Buser, K. Daniel Riew

Rothman Institute Faculty Papers

STUDY DESIGN: A multicenter retrospective case series was compiled involving 21 medical institutions. Inclusion criteria included patients who underwent cervical spine surgery between 2005 and 2011 and who sustained a vertebral artery injury (VAI).

OBJECTIVE: To report the frequency, risk factors, outcomes, and management goals of VAI in patients who have undergone cervical spine surgery.

METHODS: Patients were evaluated on the basis of condition-specific functional status using the Neck Disability Index (NDI), modified Japanese Orthopaedic Association (mJOA) score, the Nurick scale, and the 36-Item Short-Form Health Survey (SF-36).

RESULTS: VAIs were identified in a total of 14 of 16 582 …

Incidence And Outcomes Of Acute Implant Extrusion Following Anterior Cervical Spine Surgery., Gabriel A. Smith, Jonathan Pace, Mark Corriveau, Sungho Lee, Thomas E. Mroz, Ahmad Nassr, Michael G. Fehlings, Robert A. Hart, Alan S. Hilibrand, Paul M. Arnold, David B. Bumpass, Ziya Gokaslan, Mohamad Bydon, Jeremy L. Fogelson, Eric M. Massicotte, K. Daniel Riew, Michael P. Steinmetz

Rothman Institute Faculty Papers

STUDY DESIGN: Multi-institutional retrospective case series of 8887 patients who underwent anterior cervical spine surgery.

OBJECTIVE: Anterior decompression from discectomy or corpectomy is not without risk. Surgical morbidity ranges from 9% to 20% and is likely underreported. Little is known of the incidence and effects of rare complications on functional outcomes following anterior spinal surgery. In this retrospective review, we examined implant extrusions (IEs) following anterior cervical fusion.

METHODS: A retrospective multicenter case series study involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network. Medical records for 17 625 patients who received cervical spine surgery (levels …

Surgical Site Infection And Transfusion Rates Are Higher In Underweight Total Knee Arthroplasty Patients., Jorge Manrique, Antonia F. Chen, Md, Mba, Miguel M. Gomez, Mitchell Maltenfort, Phd, William J. Hozack Md

Rothman Institute Faculty Papers

BACKGROUND: Underweight (UW) patients undergoing total hip arthroplasty have exhibited higher complication rates, including infection and transfusion. No study to our knowledge has evaluated UW total knee arthroplasty (TKA) patients. We, therefore, conducted a study to investigate if these patients are at increased risk for complications, including infection and transfusion.

METHODS: A case-control study was conducted using a prospectively collected institutional database. Twenty-seven TKA patients were identified as UW (body mass index [BMI] < 18.5 kg/m

RESULTS: The average BMI was 17.1 kg/m

CONCLUSIONS: Our study demonstrates that UW TKA patients have a higher likelihood of developing SSI and requiring blood transfusions. The …

Epidemiology And Impact Of Abdominal Oblique Injuries In Major And Minor League Baseball., Christopher L Camp, Stan Conte, Steven B. Cohen, Matthew Thompson, John D' Angelo, Joseph T Nguyen, Joshua S Dines

Rothman Institute Faculty Papers

BACKGROUND: Oblique injuries are known to be a common cause of time out of play for professional baseball players, and prior work has suggested that injury rates may be on the rise in Major League Baseball (MLB).

PURPOSE: To better understand the current incidence of oblique injuries, determine their impact based on time out of play, and to identify common injury patterns that may guide future injury prevention programs.

STUDY DESIGN: Descriptive epidemiological study.

METHODS: Using the MLB Health and Injury Tracking System, all oblique injuries that resulted in time out of play in MLB and Minor League Baseball (MiLB) …