Medicine and Health Sciences Commons^™

Tulip-Screw Head Disjunction From Posterior C2 Fracture Fixation Instrumentation., Halle E K Burley, Darius S Ansari, Alexander Von Glinski, Ryan Goodmanson, Benjamin A Schell, Jens R Chapman, Rod J Oskouian

Articles, Abstracts, and Reports

This report presents an unusual case of instrumentation failure after posterior fixation of a C2 fracture and reviews currently available treatment alternatives. The patient, a 53-year-old female, initially presented to the emergency department at an outside facility with acute alcohol intoxication and acute neck pain following a fall from a ladder. CT demonstrated bilateral C2 pars fractures and unstable posteroinferior displacement of the posterior elements. She underwent an emergent C2 open-reduction internal fixation (ORIF) at the outside facility with 3.5 mm polyaxial synapse pedicle screws (DePuy Synthes, Switzerland). There were no known complications and the patient was discharged. Two years …

Primary Cns Lymphoma Commonly Expresses Immune Response Biomarkers., Alexander Ou, Ashley Sumrall, Surasak Phuphanich, David Spetzler, Zoran Gatalica, Joanne Xiu, Sharon Michelhaugh, Andrew Brenner, Manjari Pandey, Santosh Kesari, W Michael Korn, Sandeep Mittal, Jason Westin, Amy B Heimberger

Articles, Abstracts, and Reports

Background: Primary central nervous system lymphoma (PCNSL) is rare and there is limited genomic and immunological information available. Incidental clinical and radiographic responses have been reported in PCNSL patients treated with immune checkpoint inhibitors.

Materials and Methods: To genetically characterize and ascertain if the majority of PCNSL patients may potentially benefit from immune checkpoint inhibitors, we profiled 48 subjects with PCNSL from 2013 to 2018 with (1) next-generation sequencing to detect mutations, gene amplifications, and microsatellite instability (MSI); (2) RNA sequencing to detect gene fusions; and (3) immunohistochemistry to ascertain PD-1 and PD-L1 expression. Tumor mutational burden (TMB) was calculated …

Resting-State Static And Dynamic Functional Abnormalities In Active Professional Fighters With Repetitive Head Trauma And With Neuropsychological Impairments., Xiaowei Zhuang, Virendra Mishra, Rajesh Nandy, Zhengshi Yang, Karthik Sreenivasan, Lauren Bennett, Charles Bernick, Dietmar Cordes

Articles, Abstracts, and Reports

Previous neuroimaging studies have identified structural brain abnormalities in active professional fighters with repetitive head trauma and correlated these changes with fighters' neuropsychological impairments. However, functional brain changes in these fighters derived using neuroimaging techniques remain unclear. In this study, both static and dynamic functional connectivity alterations were investigated (1) between healthy normal control subjects (NC) and fighters and (2) between non-impaired and impaired fighters. Resting-state fMRI data were collected on 35 NC and 133 active professional fighters, including 68 impaired fighters and 65 non-impaired fighters, from the Professional Fighters Brain Health Study at our center. Impaired fighters performed worse …

Sex Moderates The Relationship That Number Of Professional Fights Has With Cognition And Brain Volumes., Lauren L Bennett, Steve J Stephen, Charles Bernick, Guogen Shan, Sarah J Banks

Articles, Abstracts, and Reports

Objective: Incidence of concussions and report of symptoms are greater among women across sports. While structural brain changes and cognitive declines are associated with repetitive head impact (RHI), the role of sex is not well-understood. This study aimed to determine if there is a moderating effect of sex on the relationship the number of professional fights has with cognitive functioning and regional brain volumes in a cohort of boxers, mixed martial artists, and martial artists. Methods: A total of 55 women were matched with 55 men based on age, years of education, ethnicity, and fighting style. Cognition was assessed via …

Investigating The Effects Of Brainstem Neuronal Adaptation On Cardiovascular Homeostasis., James H Park, Jonathan Gorky, Babatunde Ogunnaike, Rajanikanth Vadigepalli, James S Schwaber

Articles, Abstracts, and Reports

Central coordination of cardiovascular function is accomplished, in part, by the baroreceptor reflex, a multi-input multi-output physiological control system that regulates the activity of the parasympathetic and sympathetic nervous systems via interactions among multiple brainstem nuclei. Recent single-cell analyses within the brain revealed that individual neurons within and across brain nuclei exhibit distinct transcriptional states contributing to neuronal function. Such transcriptional heterogeneity complicates the task of understanding how neurons within and across brain nuclei organize and function to process multiple inputs and coordinate cardiovascular functions within the larger context of the baroreceptor reflex. However, prior analysis of brainstem neurons revealed …

Quality And Clinical Care Development In Spine Surgery-Connecting The Dots: An Expanded Clinical Narrative., Sarah Hopkins, Polly Brune, Jens R Chapman, Marc Horton, Rod J Oskouian, Akshal Patel, Marc D Moisi

Articles, Abstracts, and Reports

Our health care system is an evidenced-based quality-centric environment. Pursuit of quality is a process that encompasses knowledge development and care advancements through collaboration and expertise. Depicted here is the foundational knowledge, process, and contributions that hallmark successful clinical quality programs. Beginning with methodology, followed by process and form, we create the foundational knowledge and exemplars demonstrating framework and continuum of process in pursuit and attainment of successful clinical quality and care development for patients. Although our protocol has been devised for complex spine care, this could be implemented across all health care specialties to provide individualized and high-quality care …

Current Advancements In The Management Of Spinal Cord Injury: A Comprehensive Review Of Literature., Manan Shah, Catherine Peterson, Emre Yilmaz, Dia Radi Halalmeh, Marc Moisi

Articles, Abstracts, and Reports

Background: Spinal cord injury (SCI) carries debilitating lifelong consequences and, therefore, requires careful review of different treatment strategies.

Methods: An extensive review of the English literature (PubMed 1990 and 2019) was performed regarding recent advances in the treatment of SCI; this included 46 articles written over 28 years.

Results: Results of this search were divided into five major modalities; neuroprotective and neuroregenerative pharmaceuticals, neuromodulation, stem cell-based therapies, and various external prosthetic devices. Lately, therapeutic strategies were mainly focused on two major areas: neuroregeneration and neuroprotection.

Conclusion: Despite recent advancements, more clinical trials on a larger scale and further research are …

Cerebellar-Cortical Function And Connectivity During Sensorimotor Behavior In Aging Fmr1 Gene Premutation Carriers., Walker S Mckinney, James Bartolotti, Pravin Khemani, Jun Yi Wang, Randi J Hagerman, Matthew W Mosconi

Articles, Abstracts, and Reports

INTRODUCTION: Premutation carriers of the FMR1 gene are at risk of developing fragile X-associated tremor/ataxia syndrome (FXTAS), a neurodegenerative disease characterized by motor, cognitive, and psychiatric decline as well as cerebellar and cerebral white matter pathology. Several studies have documented preclinical sensorimotor issues in aging premutation carriers, but the extent to which sensorimotor brain systems are affected and may represent early indicators of atypical neurodegeneration has not been determined.

MATERIALS AND METHODS: Eighteen healthy controls and 16 FMR1 premutation carriers (including five with possible, probable, or definite FXTAS) group-matched on age, sex, and handedness completed a visually guided precision gripping …

The New Onset Of Dysphagia Four Years After Anterior Cervical Discectomy And Fusion: Case Report And Literature Review., Darius Ansari, Halle E K Burley, Alexander Von Glinski, Christopher Elia, Jens R Chapman, Rod J Oskouian

Articles, Abstracts, and Reports

Background: Dysphagia is a common complication immediately following anterior cervical spine surgery. However, its onset more than 1-year postoperatively is rare.

Case Description: A 45-year-old male initially underwent a C3-4 and C5-6 anterior cervical discectomy and fusion (ACDF). At age 49, 4 years later, he presented with worsening dysphagia accompanied by neck and right upper extremity pain. Radiographs demonstrated an extruded left C3 screw, which had migrated into the prevertebral soft tissues at the C4-C5 level; there was also loosening of the right C3 screw. The subsequent barium swallow study revealed that the screw was embedded in the pharyngeal wall. …

Reattachment Of The Multifidus Tendon In Lumbar Surgery To Decrease Postoperative Back Pain: A Technical Note., Neil Klinger, Emre Yilmaz, Dia R Halalmeh, R Shane Tubbs, Marc D Moisi

Articles, Abstracts, and Reports

The posterior midline approach to the lumbar spine requires significant manipulation of the paraspinal muscles. Muscle detachment and retraction results in iatrogenic damage such as crush injury, devascularization, and denervation, all of which have been associated with postoperative pain. The muscle most directly affected by the posterior approach is the lumbar multifidus (LM), the largest and most medial of the deep lumbar paraspinal muscles. The effects of the posterior approach on the integrity of the LM is concerning, as multiple studies have demonstrated that intraoperative injuries sustained by the LM lead to postoperative muscle atrophy and potentially worsening low back …

Big Spine Data Put To Good Use: The Nhs Sets An Example., Jens R Chapman, Jeffrey C Wang, Karsten Wiechert

Articles, Abstracts, and Reports

No abstract provided.

Utilization, Safety, And Tolerability Of Ocrelizumab: Year 2 Data From The Providence Ocrelizumab Registry, Kyle E Smoot

Articles, Abstracts, and Reports

Background: Ocrelizumab (OCR), a humanized anti-CD20 monoclonal antibody, was approved in the US in 2017 for the treatment of relapsing MS (RMS) and primary progressive MS (PPMS). The Providence OCR Registry was established to monitor long-term treatment and safety outcomes.

Objective: To evaluate OCR treatment outcomes using real-world data from a diverse, community-based MS population.

Methods: Adult MS patients who have been prescribed OCR were eligible. Chart reviews at OCR start date and then every 6 months were done by a trained RN. Expanded Disability Status Scale (EDSS) scores were determined by the treating provider on the start date and …

Henle's Ligament: A Comprehensive Review Of Its Anatomy And Terminology Over Almost One And A Half Centuries., Raja Gnanadev, Joe Iwanaga, Rod J Oskouian, Marios Loukas, R Shane Tubbs

Articles, Abstracts, and Reports

Henle's ligament was first described by German physician and anatomist, Friedrich Henle, in 1871. This review article will cover Henle's original description of the ligament, historical changes in terminology, embryological studies of the ligament, and the clinical significance of Henle's ligament. This article has a particular focus on the variation in the terminology of this structure and the implications of this.

Alzheimer’S Disease And Other Dementias Workgroup: Alzheimer’S Disease And Other Dementias Report And Recommendations, V Weir (Ed), K Rhoads (Chair), Nancy B. Isenberg, See All Group Members In Comments

Articles, Abstracts, and Reports

Rates of Alzheimer’s disease and other dementias are expected to increase greatly over the next decades. Many practices lack guidelines on how to increase quality of diagnosing, treating, and supporting people with dementia and their family members and other caregivers. This workgroup met from January to November 2017, aligned with and built off the Alzheimer’s State Plan, and organized recommendations with the following focus areas:

• Early detection and appropriate diagnosis
• Ongoing care and support or management including for family members and caregivers
• Advance care planning and palliative care
• Assessment and planning for need for increased support and/or higher levels …

Brief Cognitive Screening Tools For Primary Care Practice, K Rhoads, Nancy B. Isenberg, L Korte

Articles, Abstracts, and Reports

Early detection and diagnosis of Alzheimer’s disease and other cognitive impairment presents as a critical issue facing primary and specialty care providers in Washington State. In order to address the gaps and challenges faced by providers, the Dementia Action Collaborative offers the current paper to provide information and guidance around early detection and diagnosis of memory loss and dementia, including Alzheimer’s disease. At the conclusion of this paper, providers should be able to identify indications and opportunities for detection, appropriate tools, and care pathways for individuals and families affected by cognitive impairment and dementia.