Orthopedics Commons^™

Do Nsaids' Decrease Union Rates Following Joint Arthrodesis? A Meta-Analysis, Emerson Rowe, Julian Takagi-Stewart, Asif Ilyas, Sina Ramtin

Tower Health Research Day

No abstract provided.

Delayed Diagnosis Of Mycobacterium Bovis Bacillus Calmette-Guérin Periprosthetic Joint Infection Following Total Knee Arthroplasty, Christopher E. Pelt, Salika Shakir, Michael J. Cahill, Jakrapun Pupaibool, Barbara C. Cahill

SKMC Student Presentations and Publications

Periprosthetic joint infection (PJI) can present challenges in diagnosis and treatment, particularly in the setting of atypical causative organisms such as fungi and mycobacteria. Herein, we present a case and provide a review of the diagnosis and treatment of an unusual PJI caused by bacillus Calmette-Guérin, administered during the treatment of bladder cancer 3 years prior to total knee arthroplasty and subsequent PJI. Although the patient's history of bladder cancer was known, neither his Bacillus Calmette-Guérin treatment nor its potential for distant site spread that could lead to PJI were appreciated, leading to a prolonged diagnostic evaluation and treatment course.

The Impact Of Robotic Assistance For Lumbar Fusion Surgery On 90-Day Surgical Outcomes And 1-Year Revisions, Jeremy Heard, Yunsoo Lee, Nicholas D D'Antonio, Rajkishen Narayanan, Mark Lambrechts, John Bodnar, Caroline Purtill, Joshua Pezzulo, Dominic Farronato, Pat Fitzgerald, Jose Canseco, Ian Kaye, Alan Hilibrand, Alex Vaccaro, Christopher Kepler, Gregory Schroeder

Department of Orthopaedic Surgery Faculty Papers

Objectives: To evaluate the (1) 90-day surgical outcomes and (2) 1-year revision rate of robotic versus nonrobotic lumbar fusion surgery. Methods: Patients >18 years of age who underwent primary lumbar fusion surgery at our institution were identified and propensity-matched in a 1:1 fashion based on robotic assistance during surgery. Patient demographics, surgical characteristics, and surgical outcomes, including 90-day surgical complications and 1-year revisions, were collected. Multivariable regression analysis was performed. Significance was set to P < 0.05. Results: Four hundred and fifteen patients were identified as having robotic lumbar fusion and were matched to a control group. Bivariant analysis revealed no significant difference in total 90-day surgical complications (P = 0.193) or 1-year revisions (P = 0.178). The operative duration was longer in robotic surgery (287 + 123 vs. 205 + 88.3, P ≤ 0.001). Multivariable analysis revealed that robotic fusion was not a significant predictor of 90-day surgical complications (odds ratio [OR] = 0.76 [0.32-1.67], P = 0.499) or 1-year revisions (OR = 0.58 [0.28-1.18], P = 0.142). Other variables identified as the positive predictors of 1-year revisions included levels fused (OR = 1.26 [1.08-1.48], P = 0.004) and current smokers (OR = 3.51 [1.46-8.15], P = 0.004). Conclusion: Our study suggests that robotic-assisted and nonrobotic-assisted lumbar fusions are associated with a similar risk of 90-day surgical complications and 1-year revision rates; however, robotic surgery does increase time under anesthesia.

Evaluation Of Perioperative Care And Drivers Of Cost In Geriatric Thoracolumbar Trauma, Omar Tarawneh, Rajkishen Narayanan, Michael Mccurdy, Tariq Issa, Yunsoo Lee, Olivia Opara, Nicholas Pohl, Alexa Tomlak, Matthew Sherman, Jose Canseco, Alan Hilibrand, Alex Vaccaro, Gregory Schroeder, Christopher Kepler

Department of Orthopaedic Surgery Faculty Papers

INTRODUCTION: As the population of elderly patients continues to rise, the number of these individuals presenting with thoracolumbar trauma is expected to increase.

RESEARCH QUESTION: To investigate thoracolumbar fusion outcomes for patients with vertebral fractures as stratified by decade. Secondarily, we examined the variability of cost across age groups by identifying drivers of cost of care.

MATERIALS AND METHODS: We queried the United States Nationwide Inpatient Sample(NIS) for adult patients undergoing spinal fusion for thoracolumbar fractures between 2012 and 2017. Patients were stratified by decade 60-69(sexagenarians), 70-79(septuagenarians) and 80-89(octogenarians). Bivariable analysis followed by multivariable regression was performed to assess independent …

Increased Hif-2Α Activity In The Nucleus Pulposus Causes Intervertebral Disc Degeneration In The Aging Mouse Spine, Shira N Johnston, Maria Tsingas, Rahatul Ain, Ruteja A Barve, Makarand Risbud

Department of Orthopaedic Surgery Faculty Papers

Hypoxia-inducible factors (HIFs) are essential to the homeostasis of hypoxic tissues. Although HIF-2α, is expressed in nucleus pulposus (NP) cells, consequences of elevated HIF-2 activity on disc health remains unknown. We expressed HIF-2α with proline to alanine substitutions (P405A; P531A) in the Oxygen-dependent degradation domain (HIF-2αdPA) in the NP tissue using an inducible, nucleus pulposus-specific K19^CreERT allele to study HIF-2α function in the adult intervertebral disc. Expression of HIF-2α in NP impacted disc morphology, as evident from small but significantly higher scores of degeneration in NP of 24-month-old K19^CreERT; HIF-2α^dPA (K19-dPA) mice. Noteworthy, comparisons of grades …

Midterm Outcomes Of Suture Anchor Fixation For Displaced Olecranon Fractures, Michael Gutman, Jacob Kirsch, Jonathan Koa, Mohamad Fares, Joseph Abboud

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Displaced olecranon fractures constitute a challenging problem for elbow surgeons. The purpose of this study is to evaluate the role of suture anchor fixation for treating patients with displaced olecranon fractures.

METHODS: A retrospective review was performed for all consecutive patients with displaced olecranon fractures treated with suture anchor fixation with at least 2 years of clinical follow-up. Surgical repair was performed acutely in all cases with nonmetallic suture anchors in a double-row configuration utilizing suture augmentation via the triceps tendon. Osseous union and perioperative complications were uniformly assessed.

RESULTS: Suture anchor fixation was performed on 17 patients with …

Combination Radiofrequency Ablation And Vertebral Cement Augmentation For Spinal Metastatic Tumors: A Systematic Review And Meta-Analysis Of Safety And Treatment Outcomes, Andrew Chen, Navraj Sagoo, Christopher Vannabouathong, Yashas Reddy, Sathvik Deme, Sahiti Patibandla, Peter Passias, Shaleen Vira

SKMC Student Presentations and Publications

BACKGROUND: The treatment of spine metastases continues to pose a significant clinical challenge, requiring the integration of multiple therapeutic modalities to address the multifactorial aspects of this disease process. Radiofrequency ablation (RFA) and vertebral cement augmentation (VCA) are 2 less invasive modalities compared to open surgery that have emerged as promising strategies, offering the potential for both pain relief and preservation of vertebral stability. The utility of these approaches, however, remains uncertain and subject to ongoing investigation.This systematic review and meta-analysis evaluates the available evidence and synthesize the results of studies that have investigated the combination of RFA and VCA …

In-Hospital Mortality Trends After Surgery For Traumatic Thoracolumbar Injury: A National Inpatient Sample Database Study, Michael Mccurdy, Rajkishen Narayanan, Omar Tarawneh, Yunsoo Lee, Matthew Sherman, Teeto Ezeonu, Michael Carter, Jose A. Canseco, Alan S. Hilibrand, Alex R. Vaccaro, Christopher K. Kepler, Gregory D. Schroeder

Department of Orthopaedic Surgery Faculty Papers

INTRODUCTION: Given the increasing incidence of traumatic thoracolumbar injuries in recent years, studies have sought to investigate potential risk factors for outcomes in these patients.

RESEARCH QUESTION: The aim of this study was to investigate trends and risk factors for in-hospital mortality after fusion for traumatic thoracolumbar injury.

MATERIALS AND METHODS: Patients undergoing thoracolumbar fusion after traumatic injury were queried from the National Inpatient Sample (NIS) from 2012 to 2017. Analysis was performed to identify risk factors for inpatient mortality after surgery.

RESULTS: Patients in 2017 were on average older (51.0 vs. 48.5, P = 0.004), had more admitting diagnoses …

Risk Factors Associated With Poor Outcomes After Quadriceps Tendon Repair, Carlo Coadonato, Neel K. Patel, John Hayden Sonnier, Gregory Connors, Matthew Sabitsky, Emma Johnson, Donald W. Mazur, Shyam Brahmabhatt, Kevin Freedman

Rothman Institute Faculty Papers

Background:

Ruptures of the quadriceps tendon present most frequently in older adults and individuals with underlying medical conditions.

Purpose:

To examine the relationship between patient-specific factors and tear characteristics with outcomes after quadriceps tendon repair.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

A retrospective review was conducted on all patients who underwent quadriceps tendon repair between January 1, 2016, and January 1, 2021, at a single institution. Patients <18 years and those with chronic quadriceps tendon tears (>6 weeks to surgery) were excluded. Information was collected regarding patient characteristics, presenting symptoms, tear characteristics, physical examination findings, and postoperative outcomes. Poor outcome was defined as a need for …

Interobserver Reliability In The Classification Of Thoracolumbar Fractures Using The Ao Spine Tl Injury Classification System Among 22 Clinical Experts In Spine Trauma Care, Jose A. Canseco, Taylor Paziuk, Gregory D. Schroeder, Marcel F. Dvorak, Cumhur F. Öner, Lorin M. Benneker, Emiliano Vialle, Shanmuganathan Rajasekaran, Mohammad El-Sharkawi, Richard J. Bransford, Rishi M. Kanna, Martin Holas, Sander Muijs, Eugen Cezar Popescu, Charlotte Dandurand, Jin W. Tee, Gaston Camino-Willhuber, Mohamed M. Aly, Andrei Fernandes Joaquim, Ory Keynan, Harvinder Singh Chhabra, Sebastian Bigdon, Ulrich J. Spiegl, Klaus Schnake, Alexander R. Vaccaro

Rothman Institute Faculty Papers

STUDY DESIGN: Reliability study utilizing 183 injury CT scans by 22 spine trauma experts with assessment of radiographic features, classification of injuries and treatment recommendations.

OBJECTIVES: To assess the reliability of the AOSpine TL Injury Classification System (TLICS) including the categories within the classification and the M1 modifier.

METHODS: Kappa and Intraclass correlation coefficients were produced. Associations of various imaging characteristics (comminution, PLC status) and treatment recommendations were analyzed through regression analysis. Multivariable logistic regression modeling was used for making predictive algorithms.

RESULTS: Reliability of the AO Spine TLICS at differentiating A3 and A4 injuries (N = 71) (K = …

The Ao Spine Thoracolumbar Injury Classification System And Treatment Algorithm In Decision Making For Thoracolumbar Burst Fractures Without Neurologic Deficit, Barry T.S. Kweh, Jin Wee Tee, Charlotte Dandurand, Alexander R. Vaccaro, Benneker M. Lorin, Klaus Schnake, Emiliano Vialle, Shanmuganathan Rajasekaran, Mohammad El-Skarkawi, Richard J. Bransford, Rishi M. Kanna, Mohamed M. Aly, Martin Holas, Jose A. Canseco, Sander Muijs, Eugen C. Popescu, Gaston Camino-Willhuber, Andrei F. Joaquim, Harvinder S. Chhabra, Sebastian Frederick Bigdon, Ulrich Spiegel, Marcel Dvorak, Cumhur F. Öner, Gregory Schroeder

Rothman Institute Faculty Papers

STUDY DESIGN: Prospective Observational Study.

OBJECTIVE: To determine the alignment of the AO Spine Thoracolumbar Injury Classification system and treatment algorithm with contemporary surgical decision making.

METHODS: 183 cases of thoracolumbar burst fractures were reviewed by 22 AO Spine Knowledge Forum Trauma experts. These experienced clinicians classified the fracture morphology, integrity of the posterior ligamentous complex and degree of comminution. Management recommendations were collected.

RESULTS: There was a statistically significant stepwise increase in rates of operative management with escalating category of injury (P < .001). An excellent correlation existed between recommended expert management and the actual treatment of each injury category: A0/A1/A2 (OR 1.09, 95% CI 0.70-1.69, P = .71), A3/4 (OR 1.62, 95% CI 0.98-2.66, P = .58) and B1/B2/C (1.00, 95% …

Understanding Decision Making As It Influences Treatment In Thoracolumbar Burst Fractures Without Neurological Deficit: Conceptual Framework And Methodology, Charlotte Dandurand, Cumhur F. Öner, Olesja Hazenbiller, Richard J. Bransford, Klaus Schnake, Alexander R. Vaccaro, Lorin M. Benneker, Emiliano Vialle, Gregory D. Schroeder, Shanmuganathan Rajasekaran, Mohammad El-Skarkawi, Rishi M. Kanna, Mohamed Aly, Martin Holas, Jose A. Canseco, Sander Muijs, Eugen Cezar Popescu, Jin Wee Tee, Gaston Camino-Willhuber, Andrei Fernandes Joaquim, Ory Keynan, Harvinder Singh Chhabra, Sebastian Bigdon, Ulrich Spiegel, Marcel F. Dvorak

Rothman Institute Faculty Papers

STUDY DESIGN: This paper presents a description of a conceptual framework and methodology that is applicable to the manuscripts that comprise this focus issue.

OBJECTIVES: Our goal is to present a conceptual framework which is relied upon to better understand the processes through which surgeons make therapeutic decisions around how to treat thoracolumbar burst fractures (TL) fractures.

METHODS: We will describe the methodology used in the AO Spine TL A3/4 Study prospective observational study and how the radiographs collected for this study were utilized to study the relationships between various variables that factor into surgeon decision making.

RESULTS: With 22 …

Expert Opinion, Real-World Classification, And Decision-Making In Thoracolumbar Burst Fractures Without Neurologic Deficits?, Gaston Camino-Willhuber, Sebastian Bigdon, Charlotte Dandurand, Marcel F. Dvorak, Cumhur F. Öner, Klaus Schnake, Sander Muijs, Lorin M. Benneker, Emiliano Vialle, Jin W. Tee, Ory Keynan, Harvinder S. Chhabra, Andrei F. Joaquim, Eugen C. Popescu, Jose A Canseco, Martin Holas, Rishi M. Kanna, Mohamed M. Aly, Nader Fallah, Gregory D. Schroeder, Ulrich Spiegl, Mohammad El-Skarkawi, Richard J. Bransford, Shanmuganathan Rajasekaran, Alexander R. Vaccaro

Rothman Institute Faculty Papers

STUDY DESIGN: Retrospective analysis of prospectively collected data.

OBJECTIVES: To compare decision-making between an expert panel and real-world spine surgeons in thoracolumbar burst fractures (TLBFs) without neurological deficits and analyze which factors influence surgical decision-making.

METHODS: This study is a sub-analysis of a prospective observational study in TL fractures. Twenty two experts were asked to review 183 CT scans and recommend treatment for each fracture. The expert recommendation was based on radiographic review.

RESULTS: Overall agreement between the expert panel and real-world surgeons regarding surgery was 63.2%. In 36.8% of cases, the expert panel recommended surgery that was not performed …

Predictive Algorithm For Surgery Recommendation In Thoracolumbar Burst Fractures Without Neurological Deficits, Charlotte Dandurand, Nader Fallah, Cumhur F. Öner, Richard J. Bransford, Klaus Schnake, Alex R. Vaccaro, Lorin M. Benneker, Emiliano Vialle, Gregory D. Schroeder, Shanmuganathan Rajasekaran, Mohammad El-Skarkawi, Rishi M. Kanna, Mohamed Aly, Martin Holas, Jose A. Canseco, Sander Muijs, Eugen Cezar Popescu, Jin Wee Tee, Gaston Camino-Willhuber, Andrei Fernandes Joaquim, Ory Keynan, Harvinder Singh Chhabra, Sebastian Bigdon, Ulrich Spiegel, Marcel F. Dvorak

Department of Orthopaedic Surgery Faculty Papers

STUDY DESIGN: Predictive algorithm via decision tree.

OBJECTIVES: Artificial intelligence (AI) remain an emerging field and have not previously been used to guide therapeutic decision making in thoracolumbar burst fractures. Building such models may reduce the variability in treatment recommendations. The goal of this study was to build a mathematical prediction rule based upon radiographic variables to guide treatment decisions.

METHODS: Twenty-two surgeons from the AO Knowledge Forum Trauma reviewed 183 cases from the Spine TL A3/A4 prospective study (classification, degree of certainty of posterior ligamentous complex (PLC) injury, use of M1 modifier, degree of comminution, treatment recommendation). Reviewers' regions …

Significance Of Facet Fluid Index In Anterior Cervical Degenerative Spondylolisthesis, Yunsoo Lee, Jeremy Heard, Mark J Lambrechts, Nathaniel Kern, Bright Wiafe, Perry Goodman, John J. Mangan, Jose A. Canseco, Mark F. Kurd, Ian D. Kaye, Alan S. Hilibrand, Alex R. Vaccaro, Christopher K. Kepler, Gregory D. Schroeder, Jeffrey A. Rihn

Department of Orthopaedic Surgery Faculty Papers

STUDY DESIGN: Retrospective cohort study.

PURPOSE: To correlate cervical facet fluid characteristics to radiographic spondylolisthesis, determine if facet fluid is associated with instability in cervical degenerative spondylolisthesis, and examine whether vertebral levels with certain facet fluid characteristics and spondylolisthesis are more likely to be operated on.

OVERVIEW OF LITERATURE: The relationship between facet fluid and lumbar spondylolisthesis is well-documented; however, there is a paucity of literature investigating facet fluid in degenerative cervical spondylolisthesis.

METHODS: Patients diagnosed with cervical degenerative spondylolisthesis were identified from a hospital's medical records. Demographic and surgical characteristics were collected through a structured query language search and …

A New Perspective On Intervertebral Disc Calcification-From Bench To Bedside, Emanuel Novais, Rajkishen Narayanan, Jose Canseco, Koen Van De Wetering, Christopher Kepler, Alan Hilibrand, Alex Vaccaro, Makarand Risbud

Department of Orthopaedic Surgery Faculty Papers

Disc degeneration primarily contributes to chronic low back and neck pain. Consequently, there is an urgent need to understand the spectrum of disc degeneration phenotypes such as fibrosis, ectopic calcification, herniation, or mixed phenotypes. Amongst these phenotypes, disc calcification is the least studied. Ectopic calcification, by definition, is the pathological mineralization of soft tissues, widely studied in the context of conditions that afflict vasculature, skin, and cartilage. Clinically, disc calcification is associated with poor surgical outcomes and back pain refractory to conservative treatment. It is frequently seen as a consequence of disc aging and progressive degeneration but exhibits unique molecular …

Impact Of Opioid-Free Analgesia On Pain Severity And Patient Satisfaction After Discharge From Surgery: Multispecialty, Prospective Cohort Study In 25 Countries, Tabish Chawla, Aliya Aziz, Anoosha Marium, Ayesha Akbar Waheed, Faiqa Binte Aamir, Faiza Qureshi, Hammad Ather, Iqra Fatima Munawar Ali, Izza Tahir, Maha Ghulam Akbar, Ronika Devi Ukrani, Sajjan Raja, Sehar Salim Virani, Shahryar Noordin, Saif Ur Rehman, Shalni Golani, Syed Roohan Aamir, Syed Musa Mufarrih, Usama Waqar, Maliha Taufiq

Section of General Surgery

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.
Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview …

A Novel Multimodal Postoperative Pain Protocol For 1- To 2-Level Open Lumbar Fusions: A Retrospective Cohort Study, Michael Markowitz, Barrett I. Woods, Gregory D. Schroeder, Christopher K Kepler, David Kaye, Mark Kurd, Joshua Armstrong, Alex R. Vaccaro, Kris Radcliff

Rothman Institute Faculty Papers

BACKGROUND: There has been increased interest in exploring methods to reduce postoperative pain without opioid medications. In 2015, a multimodal analgesia protocol was used involving the perioperative use of celecoxib, gabapentin, intravenous acetaminophen, lidocaine, and liposomal bupivacaine. Overall, the goal was to reduce the utilization of scheduled opioids in favor of nonopioid pain management.

METHODS: The results of a consecutive series of 1- to 2-level open primary lumbar fusions were compared to a cohort of patients after the implementation the perioperative multimodal pain management protocol. Primary endpoints included patient-reported pain scores and secondary endpoints included length of stay.

RESULTS: There …

Evaluating The Efficacy Of A Thermoresponsive Hydrogel For Delivering Anti-Collagen Antibodies To Reduce Posttraumatic Scarring In Orthopedic Tissues., Andrzej Steplewski, Jolanta Fertala, Lan Cheng, Mark Wang, Michael Rivlin, Pedro K Beredjiklian, Andrzej Fertala

Department of Orthopaedic Surgery Faculty Papers

Excessive posttraumatic scarring in orthopedic tissues, such as joint capsules, ligaments, tendons, muscles, and peripheral nerves, presents a significant medical problem, resulting in pain, restricted joint mobility, and impaired musculoskeletal function. Current treatments for excessive scarring are often ineffective and require the surgical removal of fibrotic tissue, which can aggravate the problem. The primary component of orthopedic scars is collagen I-rich fibrils. Our research team has developed a monoclonal anti-collagen antibody (ACA) that alleviates posttraumatic scarring by inhibiting collagen fibril formation. We previously established the safety and efficacy of ACA in a rabbit-based arthrofibrosis model. In this study, we evaluate …

Sirtuin 6 Activation Rescues The Age-Related Decline In Dna Damage Repair In Primary Human Chondrocytes, Michaela E. Copp, Jacqueline Shine, Hannon L. Brown, Kirti R. Nimmala, Oliver B. Hansen, Susan Chubinskaya, John A. Collins, Richard F. Loeser, Brian O. Diekman

Department of Orthopaedic Surgery Faculty Papers

While advanced age is widely recognized as the greatest risk factor for osteoarthritis (OA), the biological mechanisms behind this connection remain unclear. Previous work has demonstrated that chondrocytes from older cadaveric donors have elevated levels of DNA damage as compared to chondrocytes from younger donors. The purpose of this study was to determine whether a decline in DNA repair efficiency is one explanation for the accumulation of DNA damage with age, and to quantify the improvement in repair with activation of Sirtuin 6 (SIRT6). After acute damage with irradiation, DNA repair was shown to be more efficient in chondrocytes from …

Correction Of Spinal Sagittal Alignment After Posterior Lumbar Decompression: Does Severity Of Central Canal Stenosis Matter?, Delano Trenchfield, Yunsoo Lee, Mark J. Lambrechts, Nicholas D'Antonio, Jeremy Heard, John Paulik, Sydney Somers, Jeffrey Rihn, Mark Kurd, David Kaye, Jose Canseco, Alan Hilibrand, Alex Vaccaro, Christopher K Kepler, Gregory Schroeder

Rothman Institute Faculty Papers

STUDY DESIGN: This study adopted a retrospective study design.

PURPOSE: Our study aimed to investigate the impact of central canal stenosis severity on surgical outcomes and lumbar sagittal correction after lumbar decompression.

OVERVIEW OF LITERATURE: Studies have evaluated sagittal correction in patients with central canal stenosis after lumbar decompression and the association of stenosis severity with worse preoperative sagittal alignment. However, none have evaluated the impact of spinal stenosis severity on sagittal correction.

METHODS: Patients undergoing posterior lumbar decompression (PLD) of ≤4 levels were divided into severe and non-severe central canal stenosis groups based on the Lee magnetic resonance imaging …

Inhibition Of Neurogenic Inflammatory Pathways Associated With The Reduction In Discogenic Back Pain, Jose A. Canseco, Hannah A. Levy, Brian A. Karamian, Olivia Blaber, Michael Chang, Neil Patel, John G. Curran, Alan S. Hilibrand, Gregory D. Schroeder, Alex R. Vaccaro, Dessislava Z. Markova, David E. Surrey, Christopher K. Kepler

Rothman Institute Faculty Papers

STUDY DESIGN: Retrospective cohort study.

PURPOSE: This study aimed to determine whether the initiation of anti-calcitonin gene-related peptide (CGRP inhibitor) medication therapy for migraines was also associated with improvements in back/neck pain, mobility, and function in a patient population with comorbid degenerative spinal disease and migraine.

OVERVIEW OF LITERATURE: CGRP upregulates pro-inflammatory cytokines such as tumor necrosis factor-α, interleukin-6, brain-derived neurotrophic factor, and nerve growth factor in spinal spondylotic disease, which results in disc degeneration and sensitization of nociceptive neurons. Although CGRP inhibitors can quell neurogenic inflammation in migraines, their off-site efficacy as a therapeutic target for discogenic back/neck pain …

Finite Element Analysis Comparing A Peek Posterior Fixation Device Versus Pedicle Screws For Lumbar Fusion, Robert Eastlack, Pierce Nunley, Kornelis Poelstra, Alex Vaccaro, Marcus Stone, Larry Miller, Pierre Legay, Julien Clin, Aakash Agarwal

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Pedicle screw loosening and breakage are common causes of revision surgery after lumbar fusion. Thus, there remains a continued need for supplemental fixation options that offer immediate stability without the associated failure modes. This finite element analysis compared the biomechanical properties of a novel cortico-pedicular posterior fixation (CPPF) device with those of a conventional pedicle screw system (PSS).

METHODS: The CPPF device is a polyetheretherketone strap providing circumferential cortical fixation for lumbar fusion procedures via an arcuate tunnel. Using a validated finite element model, we compared the stability and load transfer characteristics of CPPF to intact conditions under a …

How Does The Severity Of Neuroforaminal Compression In Cervical Radiculopathy Affect Outcomes Of Anterior Cervical Discectomy And Fusion, Mark J. Lambrechts, Tariq Z. Issa, Yunsoo Lee, Khoa S. Tran, Jeremy Heard, Caroline Purtill, Tristan B. Fried, Samuel Oh, Erin Kim, John J. Mangan, Jose A. Canseco, I. David Kaye, Jeffrey A. Rihn, Alan S. Hilibrand, Alex R. Vaccaro, Christopher K. Kepler, Gregory D. Schroeder

Rothman Institute Faculty Papers

STUDY DESIGN: This study is a retrospective cohort study.

PURPOSE: This study aims to determine whether preoperative neuroforaminal stenosis (FS) severity is associated with motor function patient-reported outcome measures (PROMs) following anterior cervical discectomy and fusion (ACDF).

OVERVIEW OF LITERATURE: Cervical FS can significantly contribute to patient symptoms. While magnetic resonance imaging (MRI) has been used to classify FS, there has been limited research into the impact of FS severity on patient outcomes.

METHODS: Patients undergoing primary, elective 1-3 level ACDF for radiculopathy at a single academic center between 2015 and 2021 were identified retrospectively. Cervical FS was evaluated using …

Resilience Of Patients Undergoing Knee And Shoulder Arthroscopy Procedures, Jillian Mazzocca, Natalie Lowenstein, Connor Crutchfield, Jamie Collins, Elizabeth Matzkin

Student Papers, Posters & Projects

INTRODUCTION: Resilience is a person's capacity to overcome adversity. The purpose was to determine what patient factors correlate with resilience using the Brief Resilience Score. We hypothesize that characteristics of female sex, younger age, Workers' Compensation status, and preoperative opioid use are predictors of a lower preoperative resilience score and that patients with positive psychosocial factors would have higher resilience scores.

METHODS: Eight hundred nine patients undergoing knee or shoulder arthroscopy were preoperatively categorized into low, normal, and high-resilience groups. Preoperative patient-reported outcome measures (PROMs) and demographics were assessed. Statistical analyses evaluated differences in demographics and PROMs between resilience groups. …

Venous Thromboembolism In Orthopedic Surgery: Global Guidelines, Kadir Uzel, İbrahim Azboy, Javad Parvizi

Rothman Institute Faculty Papers

Venous thromboembolism (VTE) is a severe complication that can occur after major orthopedic procedures. As VTE-related morbidity and mortality are a significant concern for both medical professionals and patients, and preventative measures are typically employed. Multiple organizations, including the American College of Chest Physicians (ACCP) and the American Academy of Orthopedic Surgeons (AAOS), have developed guidelines for VTE prophylaxis specifically in patients undergoing joint replacement procedures. However, recently, the International Consensus Meeting (ICM) was convened, which brought together over 600 experts from 68 countries and 135 international societies. These experts, spanning a range of medical disciplines including orthopedic surgery, anesthesia, …

Role Of Preoperative Nerve Conduction Studies For Penetrating Hand Injuries Involving The Median Palmar Cutaneous Nerve, Saral Patel, David Hutchinson, Sebastian D. Arango, Andrew J. Miller, Rowena Mcbeath

Department of Orthopaedic Surgery Faculty Papers

Penetrating lacerations to the hand are a common cause of nerve injury and can lead to debilitating pain and numbness in the distribution of the nerve affected. Owing to an overlap in the cutaneous innervation from different sensory nerves, clinically identifying the injured nerve can be difficult. We present a novel case of isolated injury to the palmar cutaneous nerve from a penetrating knife injury which was detected using 'comparison waveform' nerve conduction studies. Using this technique, we can isolate injuries to the palmar cutaneous branch of the median nerve (PCBmdn) from the median nerve, dorsal radial sensory nerve, and …

The Use Of Iodophor-Impregnated Drapes In Patients With Iodine-Related Allergies: A Case Series And Review Of The Literature, Andrew Fraval, Nicolina Zappley, William J. Hozack

Rothman Institute Faculty Papers

Background

Methods

Multilevel Ossification Of The Posterior Longitudinal Ligament Causing Cervical Myelopathy: An Observational Series Of North American Patients, Jonathan A. Ledesma, Tariq Z. Issa, Mark J. Lambrechts, Cannon Greco Hiranaka, Khoa Tran, Patrick O'Connor, Jose A. Canseco, Alan S. Hilibrand, Christopher K. Kepler, Todd J. Albert, Alex R. Vaccaro, Gregory D. Schroeder, David Greg Anderson

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Few studies regarding ossification of the posterior longitudinal ligament (OPLL) outside of Asia currently exist in the literature. A set of patients with multilevel cervical OPLL causing symptomatic myelopathy or radiculopathy from a North American sample is analyzed.

OBJECTIVE: The objective of this study was to describe the demographics, radiographic findings, and surgical outcomes of a cohort of North American patients with degenerative spondylosis presenting for operative management of multilevel (>3 segments) cervical OPLL.

MATERIALS AND METHODS: Forty-three patients diagnosed with multilevel cervical OPLL and degenerative spondylosis presenting with symptomatic cervical myelopathy or radiculopathy were surgically treated over …

Lateral Approach To The Lumbar Spine: The Utility Of An Access Surgeon, Matthew Meade, Yunsoo Lee, Parker Brush, Mark Lambrechts, Eleanor Jenkins, Cristian Desimone, Michael Mccurdy, John Mangan, Jose Canseco, Mark Kurd, Alan Hilibrand, Alexander Vaccaro, Christopher Kepler, Gregory Schroeder

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Lateral lumbar interbody fusions (LLIFs) utilize a retroperitoneal approach that avoids the intraperitoneal organs and manipulation of the anterior vasculature encountered in anterior approaches to the lumbar spine. The approach was championed by spinal surgeons; however, general/vasculature surgeons may be more comfortable with the approach.

OBJECTIVE: The objective of this study was to compare short-term outcomes following LLIF procedures based on whether a spine surgeon or access surgeon performed the approach.

MATERIALS AND METHODS: We retrospectively identified all one- to two-level LLIFs at a tertiary care center from 2011 to 2021 for degenerative spine disease. Patients were divided into …