Surgery Commons^™

Traction Table Positioning For Cephalomedullary Nailing Of Proximal Femur Fractures In Patients With Ipsilateral Below-Knee Amputation, Brogan Hill, Andres D. Toledo, Christopher Morford, Riley Hamel, Nate Tomilonus, Andrew Boltuch

West Florida Division GME Research Day 2026

No abstract provided.

Thoracolumbar Fractures: Historical Systems And Advancements With The Ao Spine Classification, Barry Ting Sheen Kweh, Alex R. Vaccaro, Gregory D. Schroeder, Jose A. Canseco, Maximilian Reinhold, Mohamed M. Aly, Sebastian Bigdon, Mohammad El-Skarkawi, Richard J. Bransford, Andrei Fernandes Joaquim, Harvinder Singh Chhabra, Emiliano Vialle, Rishi M. Kanna, Charlotte Dandurand, Cumhur Öner, Jin Wee Tee

Rothman Institute Papers

Study Design: Systematic Review. Objective: To describe the historical classifications of thoracolumbar injuries and their evolution into the AO Spine Thoracolumbar Injury Classification System. Methods: A systematic review of MEDLINE, EMBASE and Cochrane Databases was performed in keeping with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Results: 445 articles were crystallized to 14 included studies. Simple categorization systems offered by Bohler or Watson-Jones merely identify fracture morphology. Holdsworth and Denis conveyed a sense of the stability of injuries by noting columns of stability, but still failed to take into consideration important factors such as neurological status or …

Accuracy Of The Nestlé Mini Nutritional Assessment® (Mna®) Screen In Identifying Prealbumin–Defined Malnutrition Amongst Spine Surgery Patients, Stylianos Mysirlidis, Luke Fischbach, Matthew Giammanco, Alex Zhang, Phillip Alexeev, Ryan Snowden

SPARK Symposium Presentations

Abstract:

Background:

Malnutrition is a significant risk factor for patients undergoing surgery, including those receiving spine surgery. These patients are at greater risk of adverse postoperative outcomes, impaired wound healing, and spinal fusion failure. Therefore, it is essential to identify at-risk, malnourished patients prior to intervention to mitigate any complications such as surgical site infections, unplanned readmissions, and reoperations. The primary focus of this study was to assess the accuracy of the Nestlé Mini Nutritional Assessment® (MNA®) on identifying true malnutrition amongst those patients undergoing spine surgery.

Methods:

We conducted a retrospective cohort study of 674 consecutive …

Outcomes After Orif Of Closed Bimalleolar And Trimalleolar Ankle Fractures In Patients With Autoimmune Disease, Mckenna Box, Troy B. Puga, Lachlan Anderson, Alyssa Kozlowski, John T. Riehl

North Texas GME Research Forum 2026

Background: Autoimmune disease is associated with chronic systemic inflammation, immunosuppressive therapy, and increased medical comorbidity, which may influence postoperative outcomes following fracture fixation. Data evaluating outcomes after ankle fracture surgery in this population remain limited. We hypothesized that autoimmune disease would be associated with higher postoperative complication rates following open reduction and internal fixation (ORIF) of closed ankle fractures.

Methods: We performed a retrospective cohort study using a multi-hospital dataset (2017-2025) to identify adult patients undergoing ORIF for closed bimalleolar or trimalleolar ankle fractures. Patients with autoimmune disease were propensity score matched 1:2 to patients without autoimmune disease based on …

A Comparative Analysis Of The Sport Mental Health Assessment Tool (Smhat-1) Between Paediatric And Adult Olympic And Paralympic Athletes, Ashley N Triplett, Travis Anderson, Eric G Post, Jessica Bartley, Jeffrey S Shilt, Eric L Dugan, Amber Donaldson, Jonathan Finnoff, William M Adams

Faculty, Staff and Students Publications

Objective: To determine if paediatric athletes exhibit differences in positive screenings on the Sport Mental Health Assessment Tool (SMHAT-1) compared with adults.

Methods: Team USA Olympic and Paralympic paediatric athletes ≤21 years (n=589; 58.8% female; age=19.5±1.7 years) completed the SMHAT-1 between January 2021 and September 2024. A comparative sample of Team USA adult athletes (n=493, 54.2% female; age=27.3±4.9 years) matched for sex and sport was randomly sampled, and the percentage of athletes with a positive screening on each questionnaire was calculated. χ2 analysis compared the proportion of positive screenings between paediatric and adult samples. Piecewise linear regression assessed the association …

Histopathological Effects Of The Intrathecal Chondroitinase Abc Administration In Spinal Cord Injured Rats: A Systematic Review, Mohammad Amin Habibi, Ali Anjomshoa, Mohsen Sadeghi-Naini, Zahra Ghodsi, Samuel Berchi Kankam, Erfan Razavi, Armin Aryannejad, Seyed Mohammad Piri, Akam Ramezani, Rasha Atlasi, Kawthar Mohamed, Sina Shoo, Meysam Kaveh, Akbar Fotouhi, Arman Zeinaddini, James S. Harrop, Alex R. Vaccaro, Michael G. Fehlings, Vafa Rahimi-Movaghar

Department of Orthopaedic Surgery Faculty Papers

Introduction: Chondroitinase ABC (ChABC) has been considered a potential treatment for spinal cord injury (SCI). We aim to identify and evaluate the histopathological effects of intrathecal ChABC administration in SCI rat models.

Methods: We searched PubMed/MEDLINE, Scopus, Web of Science, Embase, and Cochrane Library for studies published from the inception of each database until November 22, 2022.

Results: Of 3857 screened citations, 17 studies met eligibility criteria and were entered into the qualitative analysis. Sixteen studies were of high quality, and one study was of medium quality. The four main rat strains used in studies were Sprague-Dawley, Wistar, Lister hooded, …

A Comprehensive Review Of Bone Remodeling After Trauma And Operative Treatment In Orthopedic Surgery, Sarah E. Rabin, Ian P. Marshall, Benjamin A. Nelson, Justine N. Li, Madison M. Baldauf, Ashley B. Bozzay, Benjamin W. Hoyt

Department of Medicine Faculty Publications

Bone remodeling is a dynamic process involving bone resorption and formation that is regulated on a cellular level and impacted by mechanical stress. A variety of Orthopedic surgery treatment strategies can affect bone remodeling, which can in turn may have long-term impacts on skeletal stress tolerance and function. This review provides a comprehensive overview of bone remodeling involved in Orthopedic surgery. Materials related to bone remodeling principles across Orthopedic surgery domains were selected and compiled using databases including PubMed, MEDLINE, AccessMedicine, and CINAHL; case studies were not included. Relevant literature was summarized for a general review of bone remodeling and …

3d Geometric Modelling And Clinical Validation Of Lower Limb And Preliminary 2-Year Post-Operative Clinical Outcomes Of Neutral Boundary Alignment In Total Knee Arthroplasty, Bruno Violante, Lorenzo Deveza, Francesco Pollara, Giovanni Rusconi, Gianroberto Ferreri, Alessandro Annibaldi, Ilwhan Park

Faculty, Staff and Students Publications

Purpose: To introduce a novel three-dimensional (3D) modelling concept for lower limb alignment in total knee arthroplasty (TKA), termed neutral boundary alignment (NBA) and to present preliminary clinical data supporting this physics-based custom alignment strategy.

Methods: NBA is defined as the alignment at which the knee joint line is parallel to the ground during the mid-stance phase of gait, achieving static equilibrium with the NBA axis aligned to gravity. A theoretical geometric model of the lower limb was developed, integrating principles of physics to describe this condition. Preliminary clinical validation was performed using radiographic data from an initial cohort of …

Failure Rates And Patient-Reported Outcomes Are Similar Across 5 Arthroscopic, Suprapectoral Biceps Tenodesis Fixation Techniques, Senah E. Stephens, Samantha M. Strohm, Rachael M. Shaughnessy, Katherine S. Worcester, Kevin F. Bonner

Department Surgery Faculty Publications

Purpose

To compare failure rates and patient-reported outcome measures (PROMs) across 5 arthroscopic, suprapectoral biceps tenodesis fixation techniques: tenodesis screw, tenodesis anchor, expanding tenodesis anchor, onlay with single all-suture anchor, and soft tissue tenodesis in the bicipital groove with suture.

Methods

This was a retrospective cohort study approved by the Institutional Review Board, including patients age 18 years or older who underwent arthroscopic, suprapectoral biceps tenodesis between 2014 and 2024 with a minimum of 6 months of clinical follow-up. Exclusion criteria included cervical pathology, chronic pain syndromes, revisions, and workers' compensation cases. Patients completed PROMs including pain Visual Analog Scale …

Research Productivity Variation In Applicants Who Matched Into Home Orthopaedic Surgery Programs, Frances Akwuole, Cole Christenson, Freddy Jacome, James Macleod, Omar Shaikh, Michael W. Pullen, Avani Chopra, Owen Lema, Justin Lee, Sia Cho, Annemarie K. Leonard, Alfonso Mejia

Graduate Medical Education Research Journal

Background. Research output among orthopaedic surgery applicants remains an important factor in the orthopaedic surgery residency selection process. However, there is limited literature comparing objective measures such as research productivity across different types of orthopaedic surgery applicants. We aim to determine if students who match at their home programs have significantly different research productivity and, secondarily, Alpha Omega Alpha (AOA) membership rates, compared to those who match at external programs.

Methods. This study was conducted in April 2024. A list of orthopaedic surgery residents was acquired from publicly available websites using a Python script. Programs were stratified into four geographic …

Synergizing Digital And Print: Leveraging Spine Surgeons' Social Media To Transform Publishing And Society Interaction, Benedikt W. Burkhardt, Kai-Uwe Lewandrowski, Choll W. Kim, Morgan P Lorio, Oscar L. Alves, Rossano Kepler Alvim Fiorelli, Sergio Luis Schmidt, Hansen A. Yuan, Alex R. Vaccaro

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Social media has fundamentally altered how information is created, disseminated, and consumed, with growing impact on spine surgeons and professional societies. Traditional academic publishing remains the standard for research validation, but digital platforms now shape much of the real-time dialogue in spine care.

OBJECTIVE: To explore strategies for integrating spine surgeons' social media presence with traditional publishing channels to enhance knowledge dissemination, support clinical innovation, and improve member engagement within spine societies.

METHODS: This perspective reviews current patterns of social media use among spine surgeons, focusing on platforms such as X (formerly Twitter), Instagram, and LinkedIn. It analyzes benefits …

Regenerative And Wellness Medicine: A Boon Or Barrier To Surgical Innovation In Degenerative Spine Care?, Álvaro Dowling, Kai-Uwe Lewandrowski, Morgan P. Lorio, Óscar L. Alves, Rossano Kepler Alvim Fiorelli, Sergio Luis Schmidt, Hansen A. Yuan, Alexander R. Vaccaro

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Regenerative and wellness medicine is rapidly reshaping health care, particularly in the management of degenerative spine conditions. Noninvasive or minimally invasive options such as stem cell therapy, platelet-rich plasma (PRP) injections, and holistic wellness programs are increasingly selected by patients who wish to avoid the risks, costs, and prolonged recovery associated with elective spine surgery.

PURPOSE: This perspective article examines whether regenerative and wellness approaches function primarily as a boon or a barrier to innovation in spine surgery and explores their impact on traditional, insurance-based surgical care models.

METHODS: Using a narrative, opinion-based framework, this article synthesizes current trends …

Osteoprogenitor Cells From Non-Regenerative Bone Show Greater Resistance To Cellular Stress Than Those From Regenerative Bone, Joshua Broussard, Sylvia Culpepper, Tyrel Long, Alexander J. Trostle, Robert J. Tower, Mimi C. Sammarco, Jennifer Simkin

School of Medicine Faculty Publications

INTRODUCTION: Bone regeneration following injury depends on osteoprogenitor cells derived predominantly from the periosteum. Incomplete regeneration has been attributed to both cell-extrinsic factors (e.g., environment, inflammation, mechanical instability) and cell-intrinsic factors (e.g., impaired proliferation or differentiation of stem cells). In the digit amputation mouse model, amputation through the third phalanx (P3) supports complete regeneration, while amputation through the second phalanx (P2) results in callus formation and scarring. Periosteal cells are known to be the major contributing cell source for repair and regeneration. Yet the healing outcomes of P2 and P3 amputations are significantly different. This study tests whether P2 and …

Surgical Revision In The Presence Of An S. Aureus Infection Increases Virulence Factor Expression And Activates A Multi-Tissue Inflammatory Response, Carly J. Smith, Arianna J. Moniodes, Amanda R. Watkins, Autumn G. Melvage, Thomas P. Thompson, Eirene Choi, Abigail A. Lucas, Brendan F. Gilmore, Thomas P. Schaer, Noreen J. Hickok, Theresa A. Freeman

Department of Orthopaedic Surgery Faculty Papers

Replacing implanted medical hardware due to infection often requires one or more revision surgeries. Each surgery triggers a tissue injury response and disrupts the established bacterial biofilm. However, the complex tissue response to reinjury and biofilm disturbance is not well understood. Our results show that with an existing infection, immunological niches such as the bone marrow, lymph nodes, and circulating blood further upregulate pro-inflammatory programs in response to revision. Rather than reducing bacterial burden, this heightened inflammation provokes virulence factor expression and tissue damage, including bone osteolysis and muscle fibrosis. While muscle fibrosis appears transient and begins resolving by 14 …

Transient Neuromonitoring Changes And Delayed Vertebrobasilar Infarction Following Anterior Cervical Discectomy And Fusion: Illustrative Case, Jacob M. Chaisson, Jack A. Leoni, Ellery A. Hayden, Gabriel C. Tender, Amit K. Bhandutia

School of Medicine Faculty Publications

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) is a common spinal procedure with a well-established safety profile. While direct vertebral artery injury is rare and typically recognized intraoperatively, delayed posterior circulation stroke is an even less common but major complication. In patients with risk factors for vascular disease, vascular stress from surgical manipulation may predispose them to thromboembolic events that are not immediately apparent. Transient intraoperative neuromonitoring (IONM) changes may represent early, underrecognized indicators of such vascular compromise. OBSERVATIONS: The authors present the case of a 61-year-old male who underwent elective three-level ACDF for degenerative cervical myelopathy. During cage placement, …

Incomplete (A3) Versus Complete (A4) Thoracolumbar Burst Fractures: Results From A Prospective International Multicenter Cohort Study, Jin W. Tee, Barry T. S. Kweh, Alex R. Vaccaro, Klaus J. Schnake, Mohammad El-Sharkawi, Eugen C. Popescu, Shanmuganathan Rajasekaran, Lorin M. Benneker, Sebastian F. Bigdon, John France, Jerome Paquet, R. Todd Allen, William F. Lavelle, Miguel Hirschfeld, Spyridon Pneumaticos, Richard J. Bransford, Andrei F. Joaquim, Harvinder S. Chhabra, Ulrich Spiegl, Hauri Dimitri, F. Cumhur Oner, Marcel Dvorak, Gregory D. Schroeder, Charlotte Dandurand

Department of Orthopaedic Surgery Faculty Papers

OBJECTIVE: The objective was to compare incomplete (A3) versus complete (A4) thoracolumbar burst fractures managed nonoperatively or operatively with respect to reaching minimal clinically important difference (MCID) in Oswestry Disability Index (ODI) score.

METHODS: A prospective observational international multicenter cohort study was conducted. After stratification using the AO Spine Thoracolumbar Injury Classification System, A3 and A4 outcomes were analyzed separately within nonoperative and operative management groups. Outcomes included absolute and relative improvement in ODI scores between discharge and 12-month follow-up. Kaplan-Meier curves were generated and compared with the log-rank test. Multivariable Cox regression models were constructed. The Cox regression models …

Patient Preferences When Selecting Their Total Joint Arthroplasty Surgeon: A Multicenter Survey Study, Jake Laverdiere, Danielle Lonati, Swaroopa Vaidya, Gregory Panza, Antonia Chen, Mary Morcos, Yale Fillingham, Jessica Leipman, Molly Hartzler, Jenna Bernstein

Rothman Institute Papers

BACKGROUND: Surgeon selection can influence patient satisfaction, outcomes, and access in total joint arthroplasty (TJA). Awareness of patient preferences enables practices to enhance trust, optimize communication, and improve adherence. While referrals and word-of-mouth recommendations often outweigh online marketing, prospective multicenter research exploring how patients choose their TJA surgeon is limited. The aim of this study was to identify key decision-making factors and how they vary by demographics.

METHODS: This prospective, multicenter cross-sectional survey study included patients undergoing elective total joint arthroplasty at 4 high-volume institutions from January 2024 to 2025. Participants completed a survey on surgeon selection, including how they …

Outcomes After Ulnar Collateral Ligament Reconstruction And Repair In Nonthrowing Athletes, William L. Johns, Neel K. Patel, Benjamin Miltenberg, Ryan W. Paul, Adeeb J. Hanna, Michael C. Ciccotti, Steven B. Cohen, Michael G. Ciccotti, Christopher C. Dodson

Rothman Institute Papers

BACKGROUND: Surgical management of ulnar collateral ligament (UCL) tears in nonthrowing athletes is less commonly performed, and the outcomes of that management have not been thoroughly described.

PURPOSE: To describe the clinical outcomes of surgical management of UCL injury in nonthrowing athletes.

STUDY DESIGN: Case series; Level of evidence, 4.

METHODS: A retrospective review was conducted on all patients who underwent UCL reconstruction or repair across a 10-year period (2010-2020), with nonthrowing athletes who had >2-year follow-up being specifically identified. Demographic variables such as age, sport participation, concomitant procedures, and graft type, as well as postoperative outcomes such as complications, …

Radiation-Induced Brachial Plexopathy: Current Understanding, Diagnosis, And Treatment Options, Alex G. Lambi, Tomas Holly, Ryan E. Tomlinson, Mary F. Barbe

Department of Orthopaedic Surgery Faculty Papers

Radiation-induced brachial plexopathy (RIBP) is a gruesome complication of cancers treated with radiation therapy around the lung and chest wall, head and neck, and breast and axilla. It can occur in an early-onset (transient) or a late-onset (chronic) fashion. The diagnosis involves exclusion of a compressive neoplastic process, either new or recurrent, and relies largely on patient symptomatology without well-validated, objective scoring systems. Treatment options remain limited as no major advances have been made to prevent or halt disease progression. This article reviews the background incidence, pathophysiology, and diagnosis of RIBP. In addition to surgical treatment options, nonsurgical modalities, often …

Does Preoperative Arthritis Affect The Outcomes Of Superior Capsular Reconstruction? A Systematic Review, Tae-Hoon Park, Hyungsuk Kim, Sukil Kim, Jongin Lee, Gerald R. Williams, Hyun Seok Song

Rothman Institute Papers

BACKGROUND: The optimal indications for superior capsular reconstruction (SCR) in cases of massive irreparable rotator cuff tears (RCTs) accompanied by degenerative arthritis remain controversial.

METHODS: A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching PubMed, Embase (Elsevier), and Google Scholar. Studies were included if they documented Hamada grade and reported clinical and radiographic outcomes after SCR for irreparable RCTs. American Shoulder and Elbow Surgeons (ASES) score, visual analog scale for pain (pVAS), active range of motion, and acromiohumeral distance (AHD) were analyzed.

RESULTS: In all 7 studies, there was no consistent …

A Computer Vision And Machine Learning Approach To Classify Views In Distal Radius Radiographs, Rohan Vemu, Dion Birhiray, Bassem Darwish, Raven Hollis, Sai Unnam, Srikhar Chilukuri, Lorenzo Deveza

Faculty, Staff and Students Publications

Advances in computer vision and machine learning have augmented the ability to analyze orthopedic radiographs. A critical but underexplored component of this process is the accurate classification of radiographic views and localization of relevant anatomical regions, both of which can impact the performance of downstream diagnostic models. This study presents a deep learning object detection model and mobile application designed to classify distal radius radiographs into standard views-anterior-posterior (AP), lateral (LAT), and oblique (OB)- while localizing the anatomical region most relevant to distal radius fractures. A total of 1593 deidentified radiographs were collected from a single institution between 2021 and …

A Supplement, Not A Substitute: Accuracy And Completeness Of Chatgpt Responses For Common Elbow Pathology, Benjamin Fiedler, Umar Ghilzai, Abdullah Ghali, Phillip Goldman, Pablo Coello, Michael B Gottschalk, Eric R Wagner, Adil Shahzad Ahmed

Faculty, Staff and Students Publications

Hypothesis: Large language models (LLMs) like ChatGPT have increasingly been used as online resources for patients with orthopedic conditions. Yet there is a paucity of information assessing the ability of LLMs to accurately and completely answer patient questions. The present study comparatively assessed both ChatGPT 3.5 and GPT-4 responses to frequently asked questions on common elbow pathologies, scoring for accuracy and completeness. It was hypothesized that ChatGPT 3.5 and GPT-4 would demonstrate high levels of accuracy for the specific query asked, but some responses would lack completeness, and GPT-4 would yield more accurate and complete responses than ChatGPT 3.5.

Methods: …

Epidemiology Of Lower Extremity Amputations In The United States: An Analysis Of The Global Burden Of Disease Database From 1990 To 2019., Peter B Spencer, Cameron J Sabet, Gabrielle Dykhouse, Taylor J Manes, Phillip C Mckegg, Ambrose Loc T Ngo, Ayah Ibrahim, Jack Weick

Surgery Articles

BACKGROUND: Lower extremity amputations (LEAs) are medically, psychologically, and functionally devastating. The objective of our study was to evaluate region- and sex-specific differences of unilateral and bilateral LEAs across the United States (US) from 1990 to 2019.

METHODS: The Global Burden of Disease database was used to analyze years lived with disability (YLDs), prevalence, and incidence rates per 100,000 people for LEAs in the US from 1990 to 2019. Data were stratified into four US Census Bureau-defined regions: Northeast, Midwest, South, and West. Differences between regions and sexes were assessed, with statistical significance defined as p < 0.05.

RESULTS: From 1990 to …

Ketorolac Use Following Operative Clavicle Fracture Fixation Is Not Associated With Increased Nonunion Or Surgical Complications: A Propensity-Matched Analysis, Tuckerman Jones, Tej Joshi, Akhil Katakam, Daniella Ogilvie, Sefy Paulose, Balazs Galdi

Wills Eye Hospital Papers

OBJECTIVES: Nonsteroidal anti-inflammatory drugs (NSAIDs), including ketorolac, are commonly used for postoperative pain management. Concerns about their potential impact on bone healing have been raised. This study investigated the relationship between ketorolac use and postoperative complications following clavicle surgery, including nonunion rates.

METHODS: This retrospective cohort study used the TriNetX Research Database to identify patients who underwent surgical fixation of clavicle fractures between 2002 and 2022. Two propensity-matched cohorts were created: patients who received postoperative ketorolac and those who did not. Primary outcomes included nonunion diagnosis and revision surgery; secondary outcomes included opioid use, wound disruption, surgical site infection, and …

Perspectives On Communicating Information And Shared Decision-Making In Patients Undergoing Transtibial Amputation, Lina Walther Sjödin, Lasse J. Lapidus, Eva Torbjörnsson

Journal of Patient-Centered Research and Reviews

Purpose: Patients undergoing lower extremity amputation often desire to take an active part in decision-making. The primary aim of this study was to explore patients’ experiences of the care trajectory and information provided after a new care program was introduced. The secondary aim was to explore patients' perspectives of their involvement and participation in shared decision-making throughout the care process. The care program features new educational material, recommendations for the sagittal surgical technique, and information about a rigid removable dressing, early liner treatment, and a multidisciplinary team follow up three weeks after amputation.

Methods: Fifteen participants who underwent transtibial amputation …

The Impact Of Cage Position, Radiographic Parameters, And Hounsfield Units On Subsidence Rate After One To Three Level Anterior Cervical Discectomy And Fusion, Jarod Olson, Jonathan Dalton, Omar H. Tarawneh, Rajkishen Narayanan, Alec Giakas, Rachel Huang, Joydeep Baidya, Robert J. Oris, Joshua Mathew, William A. Green, Nicholas B. Pohl, Anthony Labarbiera, Benjamin Crain, Nathaniel Pineda, Joseph Rajasekaran, Gordon Hua, Mark F. Kurd, Jeffrey A. Rihn, Jose A. Canseco, Alan S. Hilibrand, Alex R. Vaccaro, Christopher K Kepler, Gregory D. Schroeder

Department of Orthopaedic Surgery Faculty Papers

STUDY DESIGN: The study design was a retrospective cohort.

OBJECTIVE: The objective of the study was to validate the relationship between Hounsfield units (HU) and subsidence, including multilevel anterior cervical discectomy and fusion (ACDF). Cage/graft subsidence commonly occurs after ACDF. Prior work on 1-level ACDF found increased subsidence rates in patients with lower HUs.

MATERIALS AND METHODS: Adults who underwent 1-3 level ACDF at a tertiary center and had preoperative computed tomography scans were included (2018-2022). HUs were assessed ~5 mm caudal to the superior endplate. Six-month postoperative radiographs were evaluated for cage/graft positioning, screw loosening, and subsidence. Receiver operating …

The Impact Of Foraminotomy On Patient-Reported Outcomes Following 3+ Level Posterior Cervical Decompression And Fusion For Myeloradiculopathy, Robert J. Oris, Jonathan Dalton, Joydeep Baidya, Tariq Z. Issa, Tyler D. Alexander, Jarod Olson, Rachel Huang, Chloe Herczeg, Omar Tarawneh, Rajkishen Narayanan, Michael Carter, Jonah Hammerstedt, Sebastian Quiana, Mark Kurd, Barrett I. Woods, I David Kaye, Thomas Cha, Jose A Canseco, Alan S. Hilibrand, Alex R. Vaccaro, Christopher K. Kepler, Gregory D. Schroeder

Department of Orthopaedic Surgery Faculty Papers

OBJECTIVE: To evaluate whether patients with myeloradiculopathy experience better improvement in patient-reported outcome measures (PROMs) from the addition of foraminotomy in the setting of posterior cervical decompression and fusion (PCDF).

METHODS: Adult patients who underwent ≥≥ 3-level PCDF (2017-2022) at a single tertiary center were retrospectively identified. Patients were included if their indication was myeloradiculopathy - patients were excluded if they had a combined anterior/posterior approach, an indication of infection/tumor/trauma, or incomplete 1-year PROMs. Operative notes were evaluated to identify the patients who had a foraminotomy specifically for neuro-decompression. Patients with or without foraminotomy were evaluated for demographic/surgical variables, surgical …

Modeling Musculoskeletal Combat Casualty Care: Nato Trauma System Performance In Large Scale Combat Operations, Mark P. Cote, Kaitlyn E. Holly, Roman J. Schoenfeld, Matthew R. Bryan, Malina O. Hatton, Mitchel B. Harris, Tracey P. Koehlmoos, Andrew J. Schoenfeld

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: It is unclear whether the current North Atlantic Treaty Organization (NATO) trauma system will be effective in the setting of Large-Scale Combat Operations (LSCO). We sought to model the efficacy of the NATO trauma system in the setting of LSCO. We also intended to model novel scenarios that could better adapt the current system to LSCO.

METHODS: We developed a discrete-event simulation model for patients with combat musculoskeletal injuries treated within the standard NATO system. The primary outcome of the model was survival. The model's health states were characterized as stable, hypovolemia, sepsis, shock, or death. The model simulated …

Determining Risk Factors And Rate Of Surgery After Collagenase Injections For Dupuytren Contracture, Ryan C. Cha, Juliet S. Chung, Sina Ramtin, Asif M. Ilyas

Department of Orthopaedic Surgery Faculty Papers

Purpose: Collagenase injections are a nonsurgical treatment for Dupuytren contracture, but their long-term effectiveness in preventing surgery remains unclear. This study aimed to evaluate the rate of surgical intervention following collagenase treatment and identify whether specific risk factors increase the likelihood of future surgical correction. Methods: This retrospective cohort study utilized the TriNetX US Collaborative network to identify patients diagnosed with Dupuytren contracture between January 2007 and September 2024. Patients initially treated with collagenase injections were identified using relevant current procedural terminology codes. Procedure-specific current procedural terminology codes were then used to determine which patients underwent a subsequent fasciectomy or …

Lumbar Microdiscectomy: A Rare Case Of A Duplicate L5 Exiting Nerve Root., Sahil Garg, Sean M Muir, Arianna K Gill, Komi E Afetse, Sanjitpal S Gill

Surgery Articles

The microdiscectomy procedure has been regarded as the preferred method for the treatment of lumbar disc herniation (LDH). Intraoperatively, the procedure may be further complicated due to underlying anatomical variations in the lumbar spine or nerve root variations. Nerve root anomalies (NRAs), in particular, are relatively underdiscussed within the literature. Despite the rarity of these variations to the exiting nerve root, the increased surgical risk that an NRA may add warrants the need for increased awareness and associated complication mitigation. This case describes a rare instance of a symptomatic duplicate L5 nerve root discovered preoperatively and highlights the steps taken …