Orthopedics Commons^™

Cross-Sectional Area Of The Longus Colli And Cervical Degenerative Spondylolisthesis: A Retrospective Review Evaluating This Anatomic Consideration, Khoa Tran, Aditya Mazmudar, Taylor Paziuk, Mark J. Lambrechts, Eric Tecce, Olivia Blaber, Kamil Okroj, Brian A Karamian, Jose A Canseco, Jeffrey A Rihn, Alan Hilibrand, Christopher Kepler, Alexander R. Vaccaro, Gregory D. Schroeder

Department of Orthopaedic Surgery Faculty Papers

Background: Limited literature is available to define the impact of the longus colli muscle, a deep flexor of the spine, on cervical spine stability despite its close proximity to the vertebrae. Aims and Objectives: The purpose of this study was to determine if longus colli cross-sectional area (CSA) is associated with the severity preoperative cervical degenerative spondylolisthesis. Materials and Methods: Patients undergoing elective anterior cervical discectomy and fusion (ACDF) for cervical spondylolisthesis between 2010-2021 were retrospectively identified. Longus colli cross-sectional areas (CSA) were measured from preoperative MRI images at the C5 level. Preoperative spondylolisthesis measurements were recorded with cervical radiographs. …

Low-Dose Aspirin For Venous Thromboembolism Prophylaxis Is Associated With Lower Rates Of Periprosthetic Joint Infection After Total Joint Arthroplasty, Farideh Najafi, Joseph K. Kendal, Nicholas V. Peterson, Kerri-Anne Ciesielka, Camilo Restrepo, Javad Parvizi, Nicholas M. Bernthal

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Aspirin as a venous thromboembolism (VTE) prophylactic agent has been shown to have antistaphylococcal and antibiofilm roles. Optimal acetylsalicylic acid (ASA) dosage would facilitate antimicrobial effects while avoiding over-aggressive inhibition of platelet antimicrobial function. Our purpose was to determine the periprosthetic joint infection (PJI) rate after total joint arthroplasty in patients receiving low-dose ASA (81 mg twice a day), in comparison to high-dose ASA (325 mg twice a day).

METHODS: We conducted a retrospective cohort study between 2008 and 2020. Eligible patients were older than 18 years, underwent primary total joint arthroplasty, both total knee arthroplasty and total hip …

Injury To The Posterior Horn Of The Lateral Meniscus From A Misplaced Tibial Tunnel For Anterior Cruciate Ligament Reconstruction: A Case Report, Amar S Vadhera, Jonathan S Lee, Harsh Singh, Safa Gursoy, Kyle N Kunze, Nikhil N Verma, Jorge Chahla

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND Posterior meniscal root avulsions can cause meniscal extrusion, joint space narrowing, and progressive knee arthritis. Iatrogenic posterior meniscal root avulsions after malpositioning of the transtibial tunnels during anterior cruciate ligament (ACL) reconstruction can account for poor long-term outcomes seen in some patients following ACL reconstruction. Therefore, correct transtibial tunnel placement during ACL reconstruction is essential to avoid iatrogenic meniscal damage. CASE REPORT A 32-year-old man presented with 1 year of right knee pain and instability following a non-contact twisting injury sustained while playing soccer. An ACL tear with no meniscal involvement was diagnosed at an outside institution. A double-bundle …

Routine Use Of Closed Suction Drains Following Revision Arthroplasty May Not Be Necessary, Farideh Najafi, Jonah M. Stein, Nicholas V. Peterson, Michael Meghpara, Matthew B. Sherman, Camilo Restrepo, Javad Parvizi

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: There are numerous studies demonstrating that closed suction drainage (CSD) usage after primary total joint arthroplasty (TJA) has little to no benefit. There are little data on the role of CSDs after revision TJA. The purpose of our study was to evaluate whether there is any clinical advantage to CSD usage after revision TJA.

METHODS: This retrospective study evaluated the clinical records of 2,030 patients undergoing revision TJA between 2007 and 2021. CSD was used in 472 patients and not used in 1,558 patients. Primary outcome was blood transfusion rate and secondary outcomes included total blood loss (TBL), as …

Sterile Setup Table In The Operating Room Is Not So Sterile, Farideh Najafi, Diana Fernández-Rodríguez, Javad Parvizi

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: One of the important factors for surgical site infection prevention is the implementation of an ultraclean operating room. This study was designed to evaluate back-table sterility during total joint arthroplasty.

METHODS: This prospective study includes 52 patients undergoing primary total joint arthroplasty between November 2021 and January 2022. A total of 4 swabs (2 air swabs and 2 table swabs) were obtained for each case, at the conclusion of surgery and prior to the takedown of drapes. One swab from each set was sent for culture, and the other was sent for next-generation sequencing (NGS) analysis.

RESULTS: Among 104 …

Household Transmission Of Group A Streptococcus Necrotizing Fasciitis., Michael Markowitz, Stephanie Kwan, Jonas Matzon

Department of Orthopaedic Surgery Faculty Papers

A healthy 40-year-old woman was diagnosed with necrotizing fasciitis 2 days after her husband's death from the same infectious process. Prompt identification and immediate surgical intervention prevented a similar result in this patient. Additional investigation into both patients' medical records found the inciting organism to be group A streptococcus. Although the exact mechanism of inoculation is unknown, the spread of this infection within a household prompts the question of whether antibiotic prophylaxis should be given among close contacts in future cases of necrotizing fasciitis.

An Evaluation Of Patients With Abdominal Pain After Lateral Lumbar Interbody Fusion, Tristan B Fried, Khoa Tran, Mark J. Lambrechts, Nicholas D D'Antonio, Brian A Karamian, Justin Chu, Jose A Canseco, Alan S. Hilibrand, Christopher K Kepler, Alexander R Vaccaro, Gregory D. Schroeder

Department of Orthopaedic Surgery Faculty Papers

Context: Abdominal pain after surgery can occur for numerous reasons. Postoperative radiographs may be indicated to evaluate for ileus or other reasons for the pain. Whether outcomes are significantly different based on whether patients get radiographs following lateral lumbar interbody fusion (LLIF) are unclear.

Aims: To investigate the postoperative outcomes of patients experiencing abdominal pain after LLIF.

Settings and design: This retrospective cohort study included patients at a tertiary academic medical center and surrounding affiliated hospitals.

Materials and methods: Patients >18 years of age who underwent elective LLIF at a single institution were retrospectively identified. Patients were stratified into two …

The Cgas-Sting Pathway Affects Vertebral Bone But Does Not Promote Intervertebral Disc Cell Senescence Or Degeneration, Olivia K. Ottone, C. James Kim, John A. Collins, Makarand V. Risbud

Department of Orthopaedic Surgery Faculty Papers

The DNA-sensing cGAS-STING pathway promotes the senescence-associated secretory phenotype (SASP) and mediates type-I interferon inflammatory responses to foreign viral and bacterial DNA as well as self-DNA. Studies of the intervertebral disc in humans and mice demonstrate associations between aging, increased cell senescence, and disc degeneration. Herein we assessed the role of STING in SASP promotion in STING gain- (N153S) and loss-of-function mouse models. N153S mice evidenced elevated circulating levels of proinflammatory markers including IL-1β, IL-6, and TNF-α, showed elevated monocyte and macrophage abundance in the vertebral marrow, and exhibited a mild trabecular and cortical bone phenotype in caudal vertebrae. Interestingly, …

Optimizing The Performance And Treatment Of The Female Athlete, Sommer Hammoud, Robin V. West

Department of Orthopaedic Surgery Faculty Papers

No abstract provided.

Enzymatic Depletion Of Mitochondrial Inorganic Polyphosphate (Polyp) Increases The Generation Of Reactive Oxygen Species (Ros) And The Activity Of The Pentose Phosphate Pathway (Ppp) In Mammalian Cells, Vedangi Hambardikar, Mariona Guitart-Mampel, Ernest Scoma, Pedro Urquiza, Gowda Nagana, Daniel Raftery, John Collins, Maria Solesio

Department of Orthopaedic Surgery Faculty Papers

Inorganic polyphosphate (polyP) is an ancient biopolymer that is well preserved throughout evolution and present in all studied organisms. In mammals, it shows a high co-localization with mitochondria, and it has been demonstrated to be involved in the homeostasis of key processes within the organelle, including mitochondrial bioenergetics. However, the exact extent of the effects of polyP on the regulation of cellular bioenergetics, as well as the mechanisms explaining these effects, still remain poorly understood. Here, using HEK293 mammalian cells under Wild-type (Wt) and MitoPPX (cells enzymatically depleted of mitochondrial polyP) conditions, we show that depletion of polyP within mitochondria …

Survivorship, Complications, And Outcomes Following Distal Femoral Arthroplasty For Non-Neoplastic Indications., Keenan Rhys Sobol, Brianna R Fram, John T Strony, Scot A Brown

Department of Orthopaedic Surgery Faculty Papers

AIMS: Endoprosthetic reconstruction with a distal femoral arthroplasty (DFA) can be used to treat distal femoral bone loss from oncological and non-oncological causes. This study reports the short-term implant survivorship, complications, and risk factors for patients who underwent DFA for non-neoplastic indications.

METHODS: We performed a retrospective review of 75 patients from a single institution who underwent DFA for non-neoplastic indications, including aseptic loosening or mechanical failure of a previous prosthesis (n = 25), periprosthetic joint infection (PJI) (n = 23), and native or periprosthetic distal femur fracture or nonunion (n = 27). Patients with less than 24 months' follow-up …

Abcc6 Null Mice-A Model For Mineralization Disorder Pxe Shows Vertebral Osteopenia Without Enhanced Intervertebral Disc Calcification With Aging, Paige K Boneski, Vedavathi Madhu, Ryan Tomlinson, Irving Shapiro, Koen Van De Wetering, Makarand V Risbud

Department of Orthopaedic Surgery Faculty Papers

Chronic low back pain is a highly prevalent health condition intricately linked to intervertebral disc degeneration. One of the prominent features of disc degeneration that is commonly observed with aging is dystrophic calcification. ATP-binding cassette sub-family C member 6 (ABCC6), a presumed ATP efflux transporter, is a key regulator of systemic levels of the mineralization inhibitor pyrophosphate (PPi). Mutations in ABCC6 result in pseudoxanthoma elasticum (PXE), a progressive human metabolic disorder characterized by mineralization of the skin and elastic tissues. The implications of ABCC6 loss-of-function on pathological mineralization of structures in the spine, however, are unknown. Using the Abcc6 -/- …

Improving Awareness Could Transform Outcomes In Degenerative Cervical Myelopathy [Ao Spine Recode-Dcm Research Priority Number 1], Benjamin M Davies, Oliver Mowforth, Helen Wood, Zahabiya Karimi, Iwan Sadler, Lindsay Tetreault, Jamie Milligan, Jamie R F Wilson, Sukhvinder Kalsi-Ryan, Julio C Furlan, Yoshiharu Kawaguchi, Manabu Ito, Carl Moritz Zipser, Timothy F Boerger, Alex R. Vaccaro, Rory K J Murphy, Mike Hutton, Ricardo Rodrigues-Pinto, Paul A Koljonen, James Harrop, Bizhan Aarabi, Vafa Rahimi-Movaghar, Shekar N Kurpad, James D Guest, Jefferson R Wilson, Brian K Kwon, Mark R N Kotter, Michael G Fehlings

Department of Orthopaedic Surgery Faculty Papers

Study design: Literature Review (Narrative).

Objective: To introduce the number one research priority for Degenerative Cervical Myelopathy (DCM): Raising Awareness.

Methods: Raising awareness has been recognized by AO Spine RECODE-DCM as the number one research priority. This article reviews the evidence that awareness is low, the potential drivers, and why this must be addressed. Case studies of success from other diseases are also reviewed, drawing potential parallels and opportunities for DCM.

Results: DCM may affect as many as 1 in 50 adults, yet few will receive a diagnosis and those that do will wait many years for it. This leads …

Establishing The Socio-Economic Impact Of Degenerative Cervical Myelopathy Is Fundamental To Improving Outcomes [Ao Spine Recode-Dcm Research Priority Number 8], Benjamin M Davies, Richard Phillips, David Clarke, Julio C Furlan, Andreas K Demetriades, Jamie Milligan, Christopher D Witiw, James Harrop, Bizhan Aarabi, Shekar N Kurpad, James D Guest, Jefferson R Wilson, Brian K Kwon, Alex R. Vaccaro, Michael G Fehlings, Vafa Rahimi-Movaghar, Mark R N Kotter

Department of Orthopaedic Surgery Faculty Papers

Study design: Literature Review (Narrative).

Objective: To contextualize AO Spine RECODE-DCM research priority number 5: What is the socio-economic impact of DCM? (The financial impact of living with DCM to the individual, their supporters, and society as a whole).

Methods: In this review, we introduce the methodology of health-economic investigation, including potential techniques and approaches. We summarize the current health-economic evidence within DCM, so far focused on surgical treatment. We also cover the first national estimate, in partnership with Myelopathy.org from the United Kingdom, of the cost of DCM to society. We then demonstrate the significance of this question to …

Enhancing Precision In Bioprinting Utilizing Fuzzy Systems, Ashkan Sedigh, Dayna Dipiero, Kristy M. Shine, Ryan E. Tomlinson

Department of Orthopaedic Surgery Faculty Papers

Bioprinting facilitates the generation of complex, three-dimensional (3D), cell-based constructs for a variety of applications. Although multiple bioprinting technologies have been developed, extrusion-based systems have become the dominant technology due to the diversity of substrate materials (i.e. bioinks) that can be accommodated, either individually or in combination. Each bioink has unique material properties and extrusion characteristics that limit bioprinting precision, particularly when generating identically shaped constructs from different bioinks. Here, we aimed to achieve high precision (i.e. repeatability) across samples by generating bioink-specific printing parameters using a systematic approach. We hypothesized that a Fuzzy system could be used as a …

Severity Assessment Of Impairment In Spinal Cord Injury; A Systematic Review On Challenging Points About International Standards For Neurological Classification Of Spinal Cord Injury, Mahmoud Yousefifard, Mostafa Hosseini, Alireza Oraii, Alex R. Vaccaro, Vafa Rahimi-Movaghar

Department of Orthopaedic Surgery Faculty Papers

Objective: Assessment of spinal cord injuries (SCI) severity is usually done according to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). However, a limitation of ISNCSCI has not been thoroughly evaluate; therefore, a systematic review was performed to gather current evidence on the limitations of the ISNCSCI for assessing SCI. Methods: An extensive literature search was performed using Medline, Embase, Web of Science, Cochrane library, and Scopus for all articles up until the end of 2017 and then was updated to the end of 2020. Data was summarized by two independent reviewers and limitations of the ISNCSCI …

The Impact Of Preoperative Neurological Symptom Severity On Postoperative Outcomes In Cervical Spondylotic Myelopathy, 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 Kurd, Alan S. Hilibrand, Barrett I. Woods, Jeffrey A Rihn, D Greg Anderson, Kris E Radcliff, Christopher K Kepler, Alex R. Vaccaro, Gregory D. Schroeder

Department of Orthopaedic Surgery Faculty Papers

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 …