Medicine and Health Sciences Commons^™

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 …

Factors Associated With C5 Palsy Following Cervical Spine Surgery: A Systematic Review., Andrew Jack, Wyatt L Ramey, Joseph R Dettori, Zane Tymchak, Rod J Oskouian, Robert A Hart, Jens R Chapman, Dan Riew

Articles, Abstracts, and Reports

Study Design: Systematic review.

Objectives: C5 palsy (C5P) is a not uncommon and disabling postoperative complication with a reported incidence varying between 0% and 30%. Among others, one explanation for its occurrence includes foraminal nerve root tethering. Although different risk factors have been reported, controversy about its causation and prevention persists. Inconsistent study findings contribute to the persistent ambiguity leading to an assumption of a multifactorial nature of the underlying C5P pathophysiology. Here, we report the results of a systematic review on C5P with narrow inclusion criteria in the hope of elucidating risk factors for C5P due to a common …

Comparison Of Lumbar Laminectomy Alone, Lumbar Laminectomy And Fusion, Stand-Alone Anterior Lumbar Interbody Fusion, And Stand-Alone Lateral Lumbar Interbody Fusion For Treatment Of Lumbar Spinal Stenosis: A Review Of The Literature., Manan Shah, Bradley Kolb, Emre Yilmaz, Dia R Halalmeh, Marc D Moisi

Articles, Abstracts, and Reports

Lumbar spinal stenosis is defined as narrowing of the lumbar spinal canal, which causes compression of the spinal cord and nerves. Spinal stenosis can cause leg pain and potentially back pain that can affect the quality of life. Ultimately, surgical decompression is required to alleviate the symptoms. In this review, we first utilize several important studies to compare lumbar laminectomy alone versus lumbar laminectomy and fusion. We also compare the effectiveness of more novel surgical approaches, stand-alone anterior lumbar interbody fusion (ALIF), and stand-alone lateral lumbar interbody fusion (LLIF). These techniques have their own advantages and disadvantages in which many …

The Art Of Surgery: The Strange World Of The Placebo Response., Joseph R Dettori, Daniel C Norvell, Jens R Chapman

Articles, Abstracts, and Reports

No abstract provided.

Consumer Prices For Surgical Management Of Ankle Arthritis: Limited Availability And Wide Variability., Niall A Smyth, Brody J Dawkins, Joshua P Goldstein, Jonathan R Kaplan, Lew C Schon, Amiethab A Aiyer

Articles, Abstracts, and Reports

Background: Healthcare costs for the surgical management of ankle arthritis continue to rise. Patients are generally unaware of the prices of the services they use. Understanding the costs associated with surgical management of ankle arthritis is an important facet of patient care. The purposes of this study were to (1) determine the access to the surgical cost of total ankle arthroplasty (TAAs) and ankle arthrodesis and (2) the variability of the price between the two procedures.

Methods: Fifty foot and ankle centers (25 academic, 25 private) that perform TAAs and ankle arthrodeses were contacted using a standardized patient script. The …

Global Spinal Deformity From The Upper Cervical Perspective. What Is "Abnormal" In The Upper Cervical Spine?, Peter G Passias, Haddy Alas, Renaud Lafage, Bassel G Diebo, Irene Chern, Christopher P Ames, Paul Park, Khoi D Than, Alan H Daniels, D Kojo Hamilton, Douglas C Burton, Robert A Hart, Shay Bess, Breton G Line, Eric O Klineberg, Christopher I Shaffrey, Justin S Smith, Frank J Schwab, Virginie Lafage

Articles, Abstracts, and Reports

Hypothesis: Reciprocal changes in the upper cervical spine correlate with adult TL deformity modifiers.

Design: This was a retrospective review.

Introduction: The upper cervical spine has remarkable adaptability to wide ranges of thoracolumbar (TL) deformity.

Methods: Patients >18 years with adult spinal deformity (ASD) and complete radiographic data at baseline (BL) and 1 year were identified. Patients were grouped into component types of the Roussouly classification system (Type 1: Pelvic incidence [PI]

Results: A total of 343 ASD patients were analyzed. When grouped by BL Schwab and Roussouly, Group

Conclusions: Our study suggests that upper cervical alignment remains relatively stable …

The Impact Of Osteotomy Grade And Location On Regional And Global Alignment Following Cervical Deformity Surgery., Peter G Passias, Samantha R Horn, Tina Raman, Avery E Brown, Virginie Lafage, Renaud Lafage, Justin S Smith, Cole A Bortz, Frank A Segreto, Katherine E Pierce, Haddy Alas, Breton G Line, Bassel G Diebo, Alan H Daniels, Han Jo Kim, Alex Soroceanu, Gregory M Mundis, Themistocles S Protopsaltis, Eric O Klineberg, Douglas C Burton, Robert A Hart, Frank J Schwab, Shay Bess, Christopher I Shaffrey, Christopher P Ames

Articles, Abstracts, and Reports

Introduction: Correction of cervical deformity (CD) often involves different types of osteotomies to address sagittal malalignment. This study assessed the relationship between osteotomy grade and vertebral level on alignment and clinical outcomes.

Methods: Retrospective review of a multi-center prospectively collected CD database. CD was defined as at least one of the following: C2-C7 Cobb >10°, cervical lordosis (CL) >10°, C2-C7 sagittal vertical axis (cSVA) >4 cm, and chin-brow vertical angle > 25°. Patients were evaluated for level and type of cervical osteotomy.

Results: 86 CD patients were included (61.4 ± 10.6 years, 66.3% female, body mass index 29.1 kg/m

Conclusions: CD …

Early Experience With Cap-Assisted Endoscopic Pancreatic Necrosectomy: A Technique To Enhance Safe Tissue Extraction And Decrease Interventions., Nishant Puri, Alexander Hallac, Wichit Srikureja

Articles, Abstracts, and Reports

No abstract provided.

Innovative Use Of Mesh Bolster For Adult Morgagni Hernia Repair., Nabiel Azar, Robert Azar, Katie Robertson, Priya Gupta

Articles, Abstracts, and Reports

Morgagni hernia is a rare type of congenital diaphragmatic hernia caused by lack of fusion of the pleuroperitoneal membrane anteriorly leading to a defect in the foramen of Morgagni. These are rare hernias and typically present early in life. Those that do not get repaired during infancy or adolescence often present later in life with variable symptoms including obstruction, incarceration, strangulation, pulmonary symptoms, chest pain, etc. Herein we present an adult case that was found incidentally after a screening computerized tomography (CT) chest scan was done for history of smoking. There are two unique aspects to this case: first, given …

Limited Morbidity And Possible Radiographic Benefit Of C2, Peter G Passias, Cole A Bortz, Frank Segreto, Samantha Horn, Katherine E Pierce, Haddy Alas, Avery E Brown, Renaud Lafage, Virginie Lafage, Justin S Smith, Breton Line, Robert Eastlack, Daniel M Sciubba, Eric O Klineberg, Alexandra Soroceanu, Douglas C Burton, Frank J Schwab, Shay Bess, Christopher I Shaffrey, Christopher P Ames

Articles, Abstracts, and Reports

Background: The study aims to evaluate differences in alignment and clinical outcomes between surgical cervical deformity (CD) patients with a subaxial upper-most instrumented vertebra (UIV) and patients with a UIV at C2. Use of CD-corrective instrumentation in the subaxial cervical spine is considered risky due to narrow subaxial pedicles and vertebral artery anatomy. While C2 fixation provides increased stability, the literature lacks guidelines indicating extension of CD-corrective fusion from the subaxial spine to C2.

Methods: Included: operative CD patients with baseline (BL) and 1-year postop (1Y) radiographic data, cervical UIV ≥ C2. Patients were grouped by UIV: C2 or subaxial …

Cardiothoracic Surgery Residency Training In Surgical Ablation For Atrial Fibrillation., Zachary M Deboard, Thomas K Varghese, John R Doty, Craig H Selzman

Articles, Abstracts, and Reports

Background: As no standardized curriculum exists for training cardiothoracic surgery residents in surgical ablation for atrial fibrillation there is potential for variation in operative technique, patient selection, and overall application. Thus we sought to assess the exposure of current residents in order to identify areas for improvement in their education.

Methods: A survey was emailed to residents inquiring about their training experience in surgical ablation for atrial fibrillation. Residents were asked about case volume, procedural variety, and guideline-based clinical scenarios where they felt ablation would be appropriate. Residents were also queried about their abilities to perform various lesion sets and …

How Should We Deal With "Black Swan" Surgeons In Spine Surgery?, Jens R Chapman, Jeffrey C Wang, Karsten Wiechert

Articles, Abstracts, and Reports

No abstract provided.

Comparison Of Best Versus Worst Clinical Outcomes For Adult Cervical Deformity Surgery., Justin S Smith, Christopher I Shaffrey, Han Jo Kim, Peter Passias, Themistocles Protopsaltis, Renaud Lafage, Gregory M Mundis, Eric Klineberg, Virginie Lafage, Frank J Schwab, Justin K Scheer, Michael Kelly, D Kojo Hamilton, Munish Gupta, Vedat Deviren, Richard Hostin, Todd Albert, K Daniel Riew, Robert A Hart, Doug Burton, Shay Bess, Christopher P Ames

Articles, Abstracts, and Reports

Study Design: Retrospective cohort study.

Objective: Factors that predict outcomes for adult cervical spine deformity (ACSD) have not been well defined. To compare ACSD patients with best versus worst outcomes.

Methods: This study was based on a prospective, multicenter observational ACSD cohort. Best versus worst outcomes were compared based on Neck Disability Index (NDI), Neck Pain Numeric Rating Scale (NP-NRS), and modified Japanese Orthopaedic Association (mJOA) scores.

Results: Of 111 patients, 80 (72%) had minimum 1-year follow-up. For NDI, compared with best outcome patients (n = 28), worst outcome patients (n = 32) were more likely to have had a …

Aortic Valve Opening And Closure: The Clover Dynamics., Emmanuel Lansac, Hou-Sen Lim, Yu Shomura, Khee Hiang Lim, Nolan T Rice, Isabelle Di Centa, Pouya Youssefi, Wolfgang Goetz, Carlos M G Duran

Articles, Abstracts, and Reports

Background: Systolic aortic root expansion is reported to facilitate valve opening, but the precise dynamics remain unknown. A sonometric study with a high data sampling rate (200 to 800 Hz) was conducted in an acute ovine model to better understand the timing, mechanisms, and shape of aortic valve opening and closure.

Methods: Eighteen piezoelectric crystals were implanted in 8 sheep at each annular base, commissures, sinus of Valsalva, sinotubular junction, nodulus of Arantius, and ascending aorta (AA). Geometric changes were time related to pressures and flows.

Results: The aortic root was hemodynamically divided into left ventricular (LV) and aortic compartments …

Experience With Acute Diaphragmatic Trauma And Multiple Rib Fractures Using Routine Thoracoscopy., Ledford Powell, Jacob Chai, Aaliyah Shaikh, Almaas Shaikh

Articles, Abstracts, and Reports

Background: Diaphragmatic injury is mostly caused by blunt or penetrating traumas. It is an uncommon diagnosis and therefore carries the risk of being misdiagnosed or delayed in diagnosis. In our institution, we perform routine thoracoscopy for the management of patients with traumatic rib fractures. We have noted several cases of occult diaphragmatic injuries and hypothesize that these injuries may be more of a penetrating injury from rib fractures as opposed to the high velocity blunt trauma typically associated with diaphragmatic injuries.

Methods: A retrospective review of medical records was performed on all patients admitted to our facility with rib fractures …

Postoperative Intracranial Migration Of A C2 Odontoid Screw: A Case Report And Literature Review., Ankush Chandra, Seong-Jin Moon, Blake Walker, Emre Yilmaz, Marc Moisi, Robert Johnson

Articles, Abstracts, and Reports

Background: Intracranial migration of odontoid screws is a rare but serious complication of anterior odontoid screw fixation not often reported in literature by neurosurgeons. Here, we describe the second case in literature of intracranial migration of an odontoid screw.

Case Description: A 64-year-old neurologically intact patient with a type II odontoid fracture secondary to trauma underwent anterior odontoid screw fixation without any intraoperative complications. He tolerated the procedure well, and postoperative imaging demonstrated near anatomic correction of the fracture with satisfactory placement of the lag screw. Unfortunately, the patient was subsequently lost to follow up and he presented 7 months …

Down Syndrome Associated Moyamoya May Worsen Epilepsy Control And Can Benefit From Surgical Revascularization., Sarah R Garson, Stephen J Monteith, Sheila D Smith, Bart P Keogh, Ryder P Gwinn, Michael J Doherty

Articles, Abstracts, and Reports

Objectives: To examine outcome of bilateral extracranial to intracranial (EC-IC) bypass surgeries for a Down syndrome patient with hard-to-treat epilepsy and moyamoya.

Materials and methods: Superficial temporal arteries were anastamosed using an indirect bypass technique to middle cerebral arteries bilaterally to help limit perfusion deficits and seizure controls.

Results: Two superficial temporal to middle cerebral artery indirect bypass surgeries were performed within 3 months. Post-revascularization improvements included seizure control, gait, perfusion, wakefulness, language and quality of life.

Conclusion: In patients with Down syndrome and moyamoya, improvements in seizure control and quality of life may occur with EC-IC bypass procedures.