Browsing by Author "Abd-El-Barr, Muhammad M"

Now showing 1 - 20 of 39
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    ItemOpen Access
    A Novel Approach to Percutaneous Lumbar Surgeries via Kambin's Triangle - A Radiographic and Surgical Planning Analysis with Nerve Segmentation Technology.
    (World neurosurgery, 2023-06) Tabarestani, Troy Q; Sykes, David AW; Kouam, Romaric W; Salven, David S; Wang, Timothy Y; Mehta, Vikram A; Shaffrey, Christopher I; Wiggins, Walter F; Chi, John H; Abd-El-Barr, Muhammad M

    Objective

    While Kambin's triangle has become an ever more important anatomic window given its proximity to the exiting nerve root, there have been limited studies examining the effect of disease on the corridor. Our goal was to better understand how pathology can affect Kambin's triangle thereby altering laterality of approach for percutaneous lumbar interbody fusion (percLIF).

    Methods

    The authors performed a single-center retrospective review of patients evaluated for percLIF. The areas of Kambin's triangle were measured without and with nerve segmentation. For the latter, the lumbosacral nerve roots on 3D T2 MRI were manually segmented. Next, the borders of Kambin's triangle were delineated ensuring no overlap between the area and the nerve above.

    Results

    15 patients (67.5 ± 9.7 years, 46.7% female) were retrospectively reviewed. 150 Kambin's triangles were measured. The mean areas from L1-S1 were 50.0 ± 12.3 mm2, 73.8 ± 12.5 mm2, 83.8 ± 12.2 mm2, 88.5 ± 19.0 mm2, and 116 ± 29.3 mm2, respectively. When pathology was present, the areas significantly decreased at L4-L5 (p = 0.046) and L5-S1 (p = 0.049). Higher spondylolisthesis and smaller posterior disc heights were linked with decreased areas via linear regression analysis (p < 0.05). When nerve segmentation was used, the areas were significantly smaller from L1-L5 (p < 0.05). Among 11 patients who underwent surgery, none suffered from postoperative neuropathies.

    Conclusion

    These results illustrate the feasibility of pre-operatively segmenting lumbosacral nerves and measuring Kambin's triangle to help guide surgical planning and determine the ideal laterality of approach for percLIF.
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    ItemOpen Access
    Advancing Prone-Transpsoas Spine Surgery: A Narrative Review and Evolution of Indications with Representative Cases.
    (Journal of clinical medicine, 2024-02) Drossopoulos, Peter N; Bardeesi, Anas; Wang, Timothy Y; Huang, Chuan-Ching; Ononogbu-Uche, Favour C; Than, Khoi D; Crutcher, Clifford; Pokorny, Gabriel; Shaffrey, Christopher I; Pollina, John; Taylor, William; Bhowmick, Deb A; Pimenta, Luiz; Abd-El-Barr, Muhammad M
    The Prone Transpsoas (PTP) approach to lumbar spine surgery, emerging as an evolution of lateral lumbar interbody fusion (LLIF), offers significant advantages over traditional methods. PTP has demonstrated increased lumbar lordosis gains compared to LLIF, owing to the natural increase in lordosis afforded by prone positioning. Additionally, the prone position offers anatomical advantages, with shifts in the psoas muscle and lumbar plexus, reducing the likelihood of postoperative femoral plexopathy and moving critical peritoneal contents away from the approach. Furthermore, operative efficiency is a notable benefit of PTP. By eliminating the need for intraoperative position changes, PTP reduces surgical time, which in turn decreases the risk of complications and operative costs. Finally, its versatility extends to various lumbar pathologies, including degeneration, adjacent segment disease, and deformities. The growing body of evidence indicates that PTP is at least as safe as traditional approaches, with a potentially better complication profile. In this narrative review, we review the historical evolution of lateral interbody fusion, culminating in the prone transpsoas approach. We also describe several adjuncts of PTP, including robotics and radiation-reduction methods. Finally, we illustrate the versatility of PTP and its uses, ranging from 'simple' degenerative cases to complex deformity surgeries.
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    ItemOpen Access
    Awake spinal anesthesia facilitates spine surgery in poor surgical candidates: A case series.
    (Neuro-Chirurgie, 2023-05) Sykes, David AW; Tabarestani, Troy Q; Salven, David S; Chaudhry, Nauman S; Wang, Timothy Y; Gottfried, Oren N; Shaffrey, Christopher I; Guinn, Nicole R; Gadsden, Jeffrey; Ayoub, Chakib M; Bullock, W Michael; Berger, Miles; Abd-El-Barr, Muhammad M

    Background

    Annually, hundreds of thousands of patients undergo surgery for degenerative spine disease (DSD). This represents only a fraction of patients that present for surgical consideration. Procedures are often avoided due to comorbidities that make patients poor candidates for general anesthesia (GA) and its associated risks. With increasing interest in awake surgery under spinal anesthesia (SA), the authors have observed that SA may facilitate spine surgery in patients with relative contraindications to GA. With this in mind, the authors set out to summarize the outcomes of a series of highly comorbid patients who received surgery under SA.

    Methods

    Case logs of a single surgeon were reviewed, and patients undergoing spine surgery under SA were identified. Within this group, patients were identified with relative contraindications to GA, such as advanced age and medical comorbidities. For these patients, for whom surgery was facilitated by SA, the medical records were consulted to report demographic information and patient outcomes.

    Results

    Ten highly comorbid patients were identified who received lumbar spine surgery for DSD under SA. Comorbidities included octogenarian status, obesity, and chronic health conditions such as heart disease. The cohort had a mean age of 75.5 and a mean American Society of Anesthesiologists Physical Status (ASA-PS) score of 3.1. The patients were predicted to have a 2.74-fold increase of serious complications compared to the average patient. There were no adverse events.

    Conclusion

    For patients with symptomatic, refractory DSD and relative contraindications to GA, SA may facilitate safe surgical intervention with excellent outcomes.
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    ItemOpen Access
    Awake Spinal Fusion Is Associated with Reduced Length of Stay, Opioid Use, and Time to Ambulation Compared to General Anesthesia: A Matched Cohort Study.
    (World neurosurgery, 2023-05) Sykes, David AW; Tabarestani, Troy Q; Chaudhry, Nauman S; Salven, David S; Shaffrey, Christopher I; Bullock, W Michael; Guinn, Nicole R; Gadsden, Jeffrey; Berger, Miles; Abd-El-Barr, Muhammad M

    Objective

    There is increasing interest in awake spinal fusion under spinal anesthesia (SA). Evidence supporting SA has been positive, albeit limited. The authors set out to investigate the effects of SA vs general anesthesia (GA) for spinal fusion procedures on length of stay (LOS), opioid use, time to ambulation (TTA), and procedure duration.

    Methods

    The authors performed a retrospective review of a single surgeon's patients who underwent lumbar fusions under SA vs GA from June of 2020 to June of 2022. SA patients were compared to demographically matched GA counterparts undergoing comparable procedures. Analyzed outcomes include operative time, opioid usage in morphine milligram equivalents (MME), TTA, and LOS.

    Results

    10 SA patients were matched to 10 GA counterparts. The cohort had a mean age of 66.77, a mean body mass index of 27.73 kg/m2, and a median American Society of Anesthesiologists Physical Status Score of 3.00. LOS was lower in SA vs GA patients (12.87 vs 50.79 hours, p=0.001). Opioid utilization was reduced in SA vs GA patients (10.76 vs 31.43 MME, p=0.006). TTA was reduced in SA vs GA patients (7.22 vs 29.87 hours, p=0.022). Procedure duration was not significantly reduced in SA patients compared to GA patients (139.3 vs 188.2 minutes, p=0.089).

    Conclusion

    These preliminary retrospective results suggest the use of SA rather than GA for lumbar fusions is associated with reduced hospital LOS, reduced opioid utilization, and reduced TTA. Future randomized prospective studies are warranted to determine if SA usage truly leads to these beneficial outcomes.
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    ItemOpen Access
    Beyond Placement of Pedicle Screws - New Applications for Robotics in Spine Surgery: A Multi-Surgeon, Single-Institution Experience
    (NEUROSURGERY, 2023) Tabarestani, Troy; Sykes, David; Murphy, Kelly Ryan; Wang, Timothy Y; Shaffrey, Christopher I; Goodwin, C Rory; Horne, Phillip; Than, Khoi Duc; Abd-El-Barr, Muhammad M
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    ItemOpen Access
    Beyond Placement of Pedicle Screws - New Applications for Robotics in Spine Surgery: A Multi-Surgeon, Single-Institution Experience.
    (Frontiers in surgery, 2022-01) Tabarestani, Troy Q; Sykes, David; Murphy, Kelly R; Wang, Timothy Y; Shaffrey, Christopher I; Goodwin, C Rory; Horne, Phillip; Than, Khoi D; Abd-El-Barr, Muhammad M
    Interest in robotic-assisted spine surgery has grown as surgeon comfort and technology has evolved to maximize benefits of time saving and precision. However, the Food and Drug Administration (FDA) has currently only approved robotics to assist in determining the ideal trajectory for pedicle screw placement after extensive research supporting its efficacy and efficiency. To be considered a durable and effective option, robotics need to expand beyond the indication of just placing pedicle screws. This article aims to illustrate a multi-surgeon, single-institution experience with unique applications of robotic technologies in spine surgery. We will explore accessing Kambin's Triangle in percutaneous transforaminal interbody fusion (percLIF), iliac fixation in metastatic cancer, and sacroiliac (SI) fusions. Each of these topics will be covered in depth with associated background information and subsequent discussion. We show that with proper understanding of its limitations, robots can help surgeons perform difficult surgeries in a safe manner.
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    Biomechanics, evaluation, and management of subaxial cervical spine injuries: A comprehensive review of the literature.
    (Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia, 2021-01) Wang, Timothy Y; Mehta, Vikram A; Dalton, Tara; Sankey, Eric W; Rory Goodwin, C; Karikari, Isaac O; Shaffrey, Christopher I; Than, Khoi D; Abd-El-Barr, Muhammad M

    Study design

    Literature review.

    Objectives

    It has been reported that 2.4-3.7% of all blunt trauma victims suffer some element of cervical spine fracture, with the majority of these patients suffering from C3-7 (subaxial) involvement. With the improvement of first-response to trauma in the community, there are an increasing number of patients who survive their initial trauma and thus arrive at the hospital in need of further evaluation, stabilization, and management of these injuries.

    Methods

    A comprehensive literature review compiled all relevant data on the biomechanics, imaging, evaluation, and medical and surgical management strategies for subaxial cervical spine fractures.

    Results

    After review of the current literature on subaxial cervical spine biomechanics, imaging characteristics, evaluation strategies and surgical and orthopedic management techniques, the authors created a comprehensive review and protocol for management of subaxial cervical spine fractures.

    Conclusions

    The subaxial cervical spine is biomechanically and anatomically unique from the remainder of the spinal axis. Evaluation of subaxial cervical spine injuries is nuanced, and improper management of these injuries can lead to significant patient morbidity and even death. This provides a comprehensive review combining anatomy, imaging characteristics, evaluation strategies, and surgical and orthopedic management principles for subaxial cervical spine fractures.
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    ItemOpen Access
    Canadian Spine Society: 23rd Annual Scientific Conference, Wednesday, March 1 - Saturday, March 4, Fairmont Le Château Frontenac, Québec, Que., Canada.
    (Can J Surg, 2023) Birk, Manjot; Sidhu, Kara; Filezio, Marina Rosa; Singh, Vishwajeet; Ferri-de-Barros, Fabio; Chan, Vivien; Shumilak, Geoffrey; Nataraj, Andrew; Langston, Holly; Yee, Nicholas J; Iorio, Carlo; Shkumat, Nicholas; Rocos, Brett; Ertl-Wagner, Birgit; Lebel, David; Camp, Mark W; Dimentberg, Evan; Saran, Neil; Laflamme, Melissa; Ouellet, Jean A; Wenghofer, Jessica; Livock, Holly; Beaton, Luke; Tice, Andrew; Smit, Kevin; Graham, Ryan; Duarte, Matias Pereira; Roy-Beaudry, Marjolaine; Turgeon, Isabelle; Joncas, Julie; Mac-Thiong, Jean-Marc; Labelle, Hubert; Barchi, Soraya; Parent, Stefan; Gholamian, Tara; Livock, Holly; Tice, Andrew; Smit, Kevin; Yoon, Samuel; Zulfiqar, Amna; Rocos, Brett; Murphy, Anne; Bath, Natasha; Moll, Stanley; Sorbara, Julia; Lebel, David; Camp, Mark W; Nallet, Jérémie Arthur; Rocos, Brett; Lebel, David Eduard; Zeller, Reinhard; Dermott, Jennifer A; Kim, Dorothy J; Anthony, Alison; Zeller, Reinhard; Lebel, David E; Wang, Zhi; Shen, Jesse; Kamel, Youssef; Liu, Jia; Shedid, Daniel; Al-Shakfa, Fidaa; Yuh, Sung-Joo; Boubez, Ghassan; Rizkallah, Maroun; Rizkallah, Maroun; Shen, Jesse; Boubez, Ghassan; Kamel, Youssef; Liu, Jia; Shedid, Daniel; Al-Shakfa, Fidaa; Lavoie, Frederic; Yug, Sung-Joo; Wang, Zhi; Alavi, Fatemeh; Nielsen, Christopher; Rampersaud, Raja; Lewis, Stephen; Cheung, Angela M; Cadieux, Chloe; Fernandes, Renan; Brzozowski, Pawel; Zdero, Radovan; Bailey, Chris; Rasoulinejad, Parham; Cherry, Ahmed; Manoharan, Ragavan; Xu, Mark; Srikandarajah, Nisaharan; Iorio, Carlo; Raj, Aditya; Nielsen, Christopher; Rampersaud, Raja; Lewis, Stephen; Beange, Kristen; Graham, Ryan; Livock, Holly; Smit, Kevin; Manoharan, Ragavan; Cherry, Ahmed; Srikandarajah, Nisaharan; Raj, Aditya; Xu, Mark; Iorio, Carlo; Nielsen, Christopher J; Rampersaud, Y Raja; Lewis, Stephen J; Nasrabadi, Ali Asghar Mohammadi; Moammer, Gemah; Phee, John Mc; Walker, Taryn; Urquhart, Jennifer C; Glennie, R Andrew; Rampersaud, Y Raja; Fisher, Charles G; Bailey, Chris S; Herrington, Brandon J; Fernandes, Renan R; Urquhart, Jennifer C; Rasoulinejad, Parham; Siddiqi, Fawaz; Bailey, Christopher S; Urquhart, Jennifer; Fernandes, Renan R; Glennie, R Andrew; Rampersaud, Y Raja; Fisher, Charles G; Bailey, Chris S; Yang, Michael MH; Riva-Cambrin, Jay; Cunningham, Jonathan; Casha, Steven; Cadieux, Chloe N; Urquhart, Jennifer; Fernandes, Renan; Glennie, Andrew; Fisher, Charles; Rampersaud, Raja; Xu, Mark; Manoharan, Ragavan; Cherry, Ahmed; Raj, Aditya; Srikandarajah, Nish; Iorio, Carlo; Nielsen, Christopher; Lewis, Stephen; Rampersaud, Raja; Cherry, Ahmed; Raj, Aditya; McIntosh, Greg; Manoharan, Ragavan; Murray, Jean-Christophe; Nielsen, Christopher; Xu, Mark; Srikandarajah, Nisaharan; Iorio, Carlo; Perruccio, Anthony; Canizares, Mayilee; Rampersaud, Raja; El-Mughayyar, Dana; Bigney, Erin; Richardson, Eden; Manson, Neil; Abraham, Edward; Attabib, Najmedden; Small, Chris; Kolyvas, George; LeRoux, Andre; Outcomes, Canadian Spine; Investigators, Research Network; Hebert, Jeff; Baisamy, Victor; Rizkallah, Maroun; Shen, Jesse; Cresson, Thierry; Vazquez, Carlos; Wang, Zhi; Boubez, Ghassan; Lung, Tiffany; Canizares, Mayilee; Perruccio, Anthony; Rampersaud, Raja; Crawford, Eric J; Ravinsky, Robert A; Perruccio, Anthony V; Rampersaud, Y Raja; Coyte, Peter C; Bond, Michael; Street, John; Fisher, Charles; Charest-Morin, Raphaele; Sutherland, Jason M; Bartolozzi, Arthur R; Barzilai, Ori; Chou, Dean; Laufer, Ilya; Verlaan, Jorrit-Jan; Sahgal, Arjun; Rhines, Laurence D; Scuibba, Daniel M; Lazary, Aron; Weber, Michael H; Schuster, James M; Boriani, Stefano; Bettegowda, Chetan; Arnold, Paul M; Clarke, Michelle J; Fehlings, Michael G; Reynolds, Jeremy J; Gokaslan, Ziya L; Fisher, Charles G; Dea, Nicolas; Versteeg, Anne L; Charest-Morin, Raphaele; Laufer, Ilya; Teixeira, William; Barzilai, Ori; Gasbarrini, Alessandro; Fehlings, Michael G; Chou, Dean; Johnson, Michael G; Gokaslan, Ziya L; Dea, Nicolas; Verlaan, Jorrit-Jan; Goldschlager, Tony; Shin, John H; O'Toole, John E; Sciubba, Daniel M; Bettegowda, Chetan; Clarke, Michelle J; Weber, Michael H; Mesfin, Addisu; Kawahara, Norio; Goodwin, Rory; Disch, Alexander; Lazary, Aron; Boriani, Stefano; Sahgal, Arjun; Rhines, Laurence; Fisher, Charles G; Versteeg, Anne L; Gal, Roxanne; Reich, Leilani; Tsang, Angela; Aludino, Allan; Sahgal, Arjun; Verlaan, Jorrit-Jan; Fisher, Charles G; Verkooijen, Lenny; Rizkallah, Maroun; Wang, Zhi; Yuh, Sung-Joo; Shedid, Daniel; Shen, Jesse; Al-Shakfa, Fidaa; Belguendouz, Céline; AlKafi, Rayan; Boubez, Ghassan; MacLean, Mark A; Georgiopoulos, Miltiadis; Charest-Morin, Raphaele; Germscheid, Niccole; Goodwin, C Rory; Weber, Michael; International, Ao Spine; Rizkallah, Maroun; Boubez, Ghassan; Zhang, Hao; Al-Shakfa, Fidaa; Brindamour, Pamela; Boule, Danielle; Shen, Jesse; Shedid, Daniel; Yuh, Sung-Joo; Wang, Zhi; Correale, Marcia Rebecca; Soever, Leslie Jayne; Rampersaud, Raja; Malic, Claudia Cristina; Dubreuil, Melanie; Duke, Kate; Kingwell, Stephen P; Lin, Zihan; MacLean, Mark A; Julien, Lisa C; Patriquin, Glenn; LeBlanc, Jason; Green, Ryan; Alant, Jacob; Barry, Sean; Glennie, R Andrew; Oxney, William; Christie, Sean D; Sarraj, Mohamed; Alqahtani, Abdullah; Thornley, Patrick; Koziarz, Frank; Bailey, Christopher S; Freire-Archer, Millaray; Bhanot, Kunal; Kachur, Edward; Bhandari, Mohit; Oitment, Colby; Malhotra, Armaan K; Balas, Michael; Jaja, Blessing NR; Harrington, Erin M; Hofereiter, Johann; Jaffe, Rachael H; He, Yingshi; Byrne, James P; Wilson, Jefferson R; Witiw, Christopher D; Brittain, Kennedy CM; Christie, Sean; Pillai, Saranyan; Dvorak, Marcel F; Evaniew, Nathan; Chen, Melody; Waheed, Zeina; Rotem-Kohavi, Naama; Fallah, Nader; Noonan, Vanessa K; Fisher, Charles G; Charest-Morin, Raphaële; Dea, Nicolas; Ailon, Tamir; Street, John; Kwon, Brian K; Sandarage, Ryan V; Galuta, Ahmad; Ghinda, Diana; Kwan, Jason CS; TsaI, Eve C; Hachem, Laureen D; Hong, James; Velumian, Alexander; Mothe, Andrea J; Tator, Charles H; Fehlings, Michael G; Shakil, Husain; Jaja, Blessing NR; Zhang, Peng; Jaffe, Rachael; Malhotra, Armaan K; Wilson, Jefferson R; Witiw, Christopher D; Rotem-Kohavi, Naama; Dvorak, Marcel F; Dea, Nicolas; Evaniew, Nathan; Chen, Melody; Waheed, Zeina; Xu, Jijie; Fallah, Nader; Noonan, Vanessa; Kwon, Brian; Dandurand, Charlotte; Muijs, Sander; Dvorak, Marcel; Schnake, Klaus; Cumhur; Ouml Ner; Greene, Ryan; Furlong, Bradley; Smith-Forrester, Jenna; Swab, Michelle; Christie, Sean D; Hall, Amanda; Leck, Erika; Marshall, Emily; Christie, Sean; Dvorak, Marcel F; Cumhur, F; Ouml Ner; Vaccaro, Alexander R; Benneker, Lorin M; Rajasekaran, Shanmuganathan; El-Sharkawi, Mohammad; Popescu, Eugen Cezar; Tee, Jin Wee; Paquet, Jerome; France, John C; Allen, Richard; Lavelle, William F; Hirschfeld, Miguel; Pneumaticos, Spyros; Dandurand, Charlotte; Cumhur; Ouml Ner; Muijs, Sander; Schnake, Klaus; Dvorak, Marcel; Fernandes, Renan Rodrigues; Thornley, Patrick; Urquhart, Jennifer; Kelly, Sean; Alenezi, Nasser; Alahmari, Abdulmajeed; Siddiqi, Fawaz; Singh, Supriya; Rasoulinejad, Parham; Bailey, Christopher; Evaniew, Nathan; Burger, Lukas D; Dea, Nicolas; Cadotte, David W; McIntosh, Greg; Jacobs, Bradley; St-Laurent-Lebeux, Loïc; Bourassa-Moreau, Étienne; Sarraj, Mohamed; Majeed, Meerab; Guha, Daipayan; Pahuta, Markian; Laflamme, Mathieu; McIntosh, Greg; Dea, Nicolas; Bak, Alex B; Alvi, Mohammed A; Moghaddamjou, Ali; Fehlings, Michael G; Silva, Yan Gabriel Morais David; Goulet, Julien; McIntosh, Greg; Bedard, Sonia; Pimenta, Newton; Blanchard, Jocelyn; Couture, Jerome; LaRue, Bernard; Investigators, Csorn; Adams, Tyler; Cunningham, Erin; El-Mughayyar, Dana; Bigney, Erin; Vandewint, Amanda; Manson, Niel; Abraham, Edward; Small, Chris; Attabib, Najmedden; Richardson, Eden; Hebert, Jeffery; Bond, Michael; Street, John; Fisher, Charles; Charest-Morin, Raphaele; Sutherland, Jason M; Hillier, Troy; Bailey, Chris S; Fisher, Charles; Rampersaud, Raja; Koto, Prosper; Glennie, R Andrew; Soroceanu, Alex; Nicholls, Fred; Thomas, Ken; Evaniew, Nathan; Lewkonia, Peter; Bouchard, Jacques; Jacobs, Brad; Ben-Israel, David; Crawford, Eric J; Fisher, Charles; Dea, Nicolas; Spackman, Eldon; Rampersaud, Raja; Thomas, Kenneth C; Srikandarajah, Nisaharan; Murray, Jean-Christophe; Nielsen, Christopher; Manoharan, Ragavan; Cherry, Ahmed; Raj, Aditiya; Xu, Mark; Iorio, Carlo; Bailey, Chris; Dea, Nicolas; Fisher, Charles; Hall, Hamilton; Manson, Neil; Thomas, Kenneth; Canizares, Mayilee; Rampersaud, Yoga Raja; Urquhart, Jennifer; Fernandes, Renan R; Glennie, R Andrew; Rampersaud, Y Raja; Fisher, Charles G; Bailey, Chris; Yang, Michael MH; Far, Rena; Sajobi, Tolulope; Riva-Cambrin, Jay; Casha, Steven; Bond, Michael; Street, John; Fisher, Charles; Charest-Morin, Raphaele; Sutherland, Jason M; Silva, Yan; Pimenta, Newton Godoy; LaRue, Bernard; Bedard, Sonia; Oviedo, Sonia Cheng; Goulet, Julien; Couture, Jerome; Blanchard, Jocelyn; McDonald, James; Al-Jahdali, Fares; Urquhart, Jennifer; Alahmari, Abdulmajeed; Rampersaud, Raja; Fisher, Charles; Bailey, Chris; Glennie, Andrew; Evaniew, Nathan; Coyle, Matthew; Rampersaud, Y Raja; Bailey, Christopher S; Jacobs, W Bradley; Cadotte, David W; Thomas, Kenneth C; Attabib, Najmedden; Paquet, Jérôme; Nataraj, Andrew; Christie, Sean D; Weber, Michael H; Phan, Philippe; Charest-Morin, Raphaële; Fisher, Charles G; Hall, Hamilton; McIntosh, Greg; Dea, Nicolas; Malhotra, Armaan K; Davis, Aileen M; He, Yingshi; Harrington, Erin M; Jaja, Blessing NR; Zhu, Mary P; Shakil, Husain; Dea, Nicolas; Jacobs, W Bradley; Cadotte, David W; Paquet, Jérôme; Weber, Michael H; Phan, Philippe; Christie, Sean D; Nataraj, Andrew; Bailey, Christopher S; Johnson, Michael G; Fisher, Charles G; Manson, Neil; Rampersaud, Y Raja; Thomas, Kenneth C; Hall, Hamilton; Fehlings, Michael G; Ahn, Henry; Ginsberg, Howard J; Witiw, Christopher D; Wilson, Jefferson R; Althagafi, Alwalaa; McIntosh, Greg; Charest-Morin, Raphaële; Rizzuto, Michael A; Ailon, Tamir; Dea, Nicolas; Evaniew, Nathan; Jacobs, Bradley W; Paquet, Jerome; Rampersaud, Raja; Hall, Hamilton; Bailey, Christopher S; Weber, Michael; Johnson, Michael G; Nataraj, Andrew; Attabib, Najmedden; Cadotte, David W; Manson, Neil; Stratton, Alexandra; Christie, Sean D; Thomas, Kenneth C; Wilson, Jefferson R; Fisher, Charles G; Charest-Morin, Raphaele; Bak, Alex B; Alvi, Mohammed A; Moghaddamjou, Ali; Fehlings, Michael G; Bak, Alex B; Alvi, Mohammed A; Moghaddamjou, Ali; Fehlings, Michael G; Soroceanu, Alex; Nicholls, Fred; Thomas, Ken; Evaniew, Nathan; Salo, Paul; Bouchard, Jacques; Jacobs, Brad; Dandurand, Charlotte; Laghaei, Pedram Farimani; Ailon, Tamir; Charest-Morin, Raphaele; Dea, Nicolas; Dvorak, Marcel; Fisher, Charles; Kwon, Brian K; Paquette, Scott; Street, John; Soroceanu, Alex; Nicholls, Fred; Thomas, Ken; Evaniew, Nathan; Bouchard, Jacques; Salo, Paul; Jacobs, Brad; Varshney, Vishal P; Sahjpaul, Ramesh; Paquette, Scott; Osborn, Jill; Bak, Alex B; Moghaddamjou, Ali; Fehlings, Michael G; Leck, Erika; Marshall, Emily; Christie, Sean; Elkaim, Lior M; Lasry, Oliver J; Raj, Aditya; Murray, Jean-Christophe; Cherry, Ahmed; McIntosh, Greg; Nielsen, Christopher; Srikandarajah, Nisaharan; Manoharan, Ragavan; Iorio, Carlo; Xu, Mark; Perruccio, Anthony; Canizares, Mayilee; Rampersaud, Yoga Raja; Stratton, Alexandra; Tierney, Sarah; Wai, Eugene K; Phan, Philippe; Kingwell, Stephen; Magnan, Marie-Claude; Soroceanu, Alex; Nicholls, Fred; Thomas, Ken; Evaniew, Nathan; Salo, Paul; Bouchard, Jacques; Jacobs, Brad; Spanninga, Barend; Hoelen, Thomáy-Claire A; Johnson, Scott; Arts, Jacobus JC; Bailey, Chris S; Urquhart, Jennifer C; Glennie, R Andrew; Rampersaud, Y Raja; Fisher, Charles G; Levett, Jordan J; Elkaim, Lior M; Alotaibi, Naif M; Weber, Michael H; Dea, Nicolas; Abd-El-Barr, Muhammad M; Cherry, Ahmed; Yee, Albert; Jaber, Nadia; Fehlings, Michael; Cunningham, Erin; Adams, Tyler; El-Mughayyar, Dana; Bigney, Erin; Vandewint, Amanda; Manson, Neil; Abraham, Edward; Small, Chris; Attabib, Najmedden; Richardson, Eden; Hebert, Jeffery; Werier, Joel; Smit, Kevin; Villeneuve, James; Sachs, Adam; Abdelbary, Hesham; Al-Mosuli, Yusra Kassim; Rakhra, Kawan; Phan, Philippe; Nagata, Kosei; Gum, Jeffrey L; Brown, Morgan E; Daniels, Christy L; Carreon, Leah Y; Bonello, John-Peter; Koucheki, Robert; Abbas, Aazad; Lex, Johnathan; Nucci, Nicholas; Whyne, Cari; Larouche, Jeremie; Ahn, Henry; Finkelstein, Joel; Lewis, Stephen; Toor, Jay; Lee, Nathan J; Orosz, Lindsay D; Gum, Jeffrey L; Poulter, Gregory T; Jazini, Ehsan; Haines, Colin M; Good, Christopher R; Lehman, Ronald A; Crawford, Eric J; Ravinsky, Robert A; Perruccio, Anthony V; Coyte, Peter C; Rampersaud, Y Raja; Freire-Archer, Millaray; Sarraj, Mohamed; AlShaalan, Fawaz; Koziarz, Alex; Thornley, Patrick; Alnemari, Haitham; Oitment, Colby; Bharadwaj, Lalita; El-Mughayyar, Dana; Bigney, Erin; Manson, Neil; Abraham, Edward; Small, Chris; Attabib, Najmedden; Richardson, Eden; Kearney, Jill; Kundap, Uday; Investigators, Csorn; Hebert, Jeffrey; Elkaim, Lior M; Levett, Jordan J; Niazi, Farbod; Bokhari, Rakan; Alotaibi, Naif M; Lasry, Oliver J; Bissonnette, Vincent; Yen, David; Muddaluru, Varun S; Gandhi, Pranjan; Mastrolonardo, Alexander; Guha, Daipayan; Pahuta, Markian A; Christie, Sean D; Vandertuin, Trevor; Ritcey, Gillian; Rainham, Daniel; Alhawsawi, Mamdoh; Mumtaz, Rohail; Abdelnour, Mark; Qumquji, Feras; Soroceanu, Alex; Swamy, Ganesh; Thomas, Kenneth; Wai, Eugene; Phan, Philippe; Bhatt, Fenil R; Orosz, Lindsay D; Yamout, Tarek; Good, Christopher R; Schuler, Thomas C; Nguyen, Tiffany; Jazini, Ehsan; Haines, Colin M; Oppermann, Marcelo; Gupta, Shaurya; Ramjist, Joel; Oppermann, Priscila Santos; Yang, Victor XD; Levett, Jordan J; Elkaim, Lior M; Niazi, Farbod; Weber, Michael H; Ioro-Morin, Christian; Bonizzato, Marco; Weil, Alexander G; Oppermann, Marcelo; Ramjist, Joel; Gupta, Shaurya; Oppermann, Priscila S; Yang, Victor XD; Jung, Youngkyung; Muddalaru, Varun; Gandhi, Pranjan; Guha, Daipayan; Koucheki, Robert; Bonello, John-Peter; Abbas, Aazad; Lex, Johnathan R; Nucci, Nicholas; Whyne, Cari; Yee, Albert; Ahn, Henry; Finkelstein, Joel; Larouche, Jeremie; Lewis, Stephen; Toor, Jay; Dhawan, Alaina; Dhawan, Jillian; Sharma, Ajay N; Azzam, Daniel B; Cherry, Ahmed; Fehlings, Michael G; Orosz, Lindsay D; Lee, Nathan J; Yamout, Tarek; Gum, Jeffrey L; Lehman, Ronald A; Poulter, Gregory T; Haines, Colin M; Jazini, Ehsan; Good, Christopher R; Ridha, Barzany B; Persad, Amit; Fourney, Daryl; Byers, Elizabeth; Gallagher, Michelle; Sugar, James; Brown, Justin L; Wang, Zhi; Shen, Jesse; Boubez, Ghassan; Al-Shakfa, Fidaa; Yuh, Sung-Joo; Shedid, Daniel; Rizkallah, Maroun; Singh, Manmohan; Singh, Pankaj Kumar; Lawrence, Peyton Lloyd; Dell, Shevaughn; Goodluck-Tyndall, Ronette; Wade, Kevin; Morgan, Mark; Bruce, Carl; Silva, Yan Gabriel Morais David; Pimenta, Newton; LaRue, Bernard; Aldakhil, Salman; Blanchard, Jocelyn; Couture, Jerome; Goulet, Julien; Bednar, Drew A; Raj, Ruheksh; Urquhart, Jennifer; Bailey, Chris; Christie, Sean D; Greene, Ryan; Chaves, Jennyfer Paulla Galdino; Zarrabian, Mohammed; Sigurdson, Leif; Manoharan, Ragavan; Cherry, Ahmed; Iorio, Carlo; Srikandarajah, Nisaharan; Xu, Mark; Raj, Aditya; Nielsen, Christopher J; Rampersaud, Yoga Raja; Lewis, Stephen J
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    Clinical and Radiographic Outcomes for Patients with Cervical Adjacent Segment Disease Treated with Anterior Cervical Discectomy and Fusion with Integrated Interbody Spacers.
    (World neurosurgery, 2023-12) Zaidi, Saif E; Venkatraman, Vishal; Sykes, David AW; Albanese, Jessica; Erickson, Melissa M; Crutcher, Clifford L; Goodwin, C Rory; Groff, Michael W; Grossi, Peter; Than, Khoi D; Haglund, Michael M; Abd-El-Barr, Muhammad M

    Introduction

    Anterior cervical discectomy and fusion (ACDF) is among the most common spine procedures. Adjacent segment disease (ASD), characterized by degenerative disease at an adjacent spinal level to a prior fusion, is a well-recognized and significant sequela following ACDF. Adjacent segment ACDF may be considered after the failure of non-surgical options for patients with symptomatic ASD. This study aimed to assess the incidence of dysphagia and other complications as well as radiographic outcomes in adult patients who have undergone ACDF with an integrated interbody spacer device for symptomatic ASD.

    Methods

    This was a retrospective review of patients who underwent ACDF for symptomatic ASD with commercially available integrated interbody spacers by three spine surgeons at an academic institution from March 2018 to April 2022. Demographic, radiographic, and postoperative data were collected, including dysphagia, device-related complications, and the need for revision surgery.

    Results

    There were 48 patients (26 male, 22 female) who met inclusion criteria (mean age 59.7 years, mean body mass index 19.5 kg/m2) who underwent ACDF for symptomatic ASD (1one-level, n = 44; 2-level, n = 4). Overall, 12 patients (25%) experienced dysphagia postoperatively before the first follow-up appointment. Nine of 44 (20.4%) of 1-level ACDF patients experienced dysphagia, and 3 of 4 (75%) of 2-level ACDF patients experienced dysphagia. Three patients had severe dysphagia which prompted an otolaryngology referral. Two of those patients remained symptomatic at 6 weeks postoperatively. Of 43 patients with prior plate cage systems, none required hardware removal at the time of surgery. Preoperative global and segmental lordosis were 9.07° ± 8.36° (P = 0.22) and 3.58° ± 4.57° (P = 0.14), respectively. At 6 weeks postoperatively, global and segmental lordosis were 11.44° ± 9.06° (P = 0.54) and 5.11° ± 4.44° (P = 0.44), respectively. This constitutes a change of +2.37° and +1.53° in global and segmental lordosis, respectively. The mean anterior disc height change between preoperative and immediate postoperative time points was 6.3 ± 3.1 mm. Between the immediate postoperative and 6-week postoperative time points, the mean anterior disc height change was -1.5 ± 2.7 mm. Between the immediate postoperative and 3-month postoperative time points, the mean anterior disc height change was -3.7 ± 5.0 mm. The posterior disc height changes at the same time points were 2.5 ± 1.7 mm, -0.4 ± 1.8. and -0.5 ± 1.4 mm, respectively. This fusion rate was 50% and 70% at 6 months and 1 year post-surgery, respectively.

    Conclusions

    ACDF with integrated spacer is a viable alternative to traditional plate-cage systems for symptomatic ASD. An advantage over traditional plate-cage systems is that the removal of prior instrumentation is not needed in order to place implants. Based on a review of the literature, these standalone systems allowed for a shorter operative time and had less incidence of dysphagia than plate-cage systems for ASD after ACDF. The different standalone and plate-cage systems used in treating ASD after ACDF surgeries should be compared in prospective studies.
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    ItemOpen Access
    Comparison of intraoperative and postoperative outcomes between open, wiltse, and percutaneous approach to traumatic thoracolumbar spine fractures without neurological injury: A systematic review and meta-analysis.
    (North American Spine Society journal, 2024-12) Al-Naseem, Abdulrahman O; Mehkri, Yusuf; Chakravarti, Sachiv; Johnson, Eli; Kelly-Hedrick, Margot; Kuo, Cathleen; Erickson, Melissa; Than, Khoi D; Rocos, Brett; Bhowmick, Deb; Shaffrey, Christopher I; Foster, Norah; Baaj, Ali; Dahdaleh, Nader; Goodwin, C Rory; Williamson, Theresa L; Lu, Yi; Abd-El-Barr, Muhammad M

    Background

    Traumatic thoracolumbar fracture fixation without neurological injury can be performed using the traditional open, mini-open Wiltse, and percutaneous approaches. This systematic review and meta-analysis aims to compare perioperative outcomes between these approaches.

    Methods

    PubMed, Web of Science, Scopus, Embase, and the Cochrane Library were searched for all relevant observational comparative studies.

    Results

    5 randomized trials and 22 comparative cohort studies were included. Compared to the traditional open approach (n=959), the Wiltse approach (n=410) was associated with significantly lower operative time, intraoperative estimated blood loss (EBL), and length of stay (LOS). There was no significant difference between the two in terms of postoperative visual analog scale (VAS) and Cobb angle. Compared to the percutaneous approach (n=980), the Wiltse approach was associated with shorter operative and fluoroscopy time, as well as significantly improved Cobb and vertebral body angles. The percutaneous approach was associated with improved vertebral body height. There was no significant difference between the two for blood loss, postoperative VAS, or LOS. Compared to the traditional open approach, the percutaneous approach was associated with shorter operative time, lower EBL, shorter LOS and better postoperative VAS and Oswestry Disability Index. There was no difference between the two in postoperative Cobb angle, vertebral angle, or vertebral body height. Overall study heterogeneity was high.

    Conclusions

    Utilization of minimally invasive surgical approaches holds great promise for lowering patient morbidity and optimizing care. A prospective trial is needed to assess outcomes and guide surgical decision making.
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    Demographics, Mechanism of Injury and Outcomes for Acute Upper and Lower Cervical Spinal Cord Injuries - An Analysis of 470 Patients in the Prospective, Multicenter North American Clinical Trials Network (NACTN) Registry.
    (Journal of neurotrauma, 2023-02) Futch, Brittany Grace; Kouam, Romaric Waguia; Ugiliweneza, Beatrice; Harrop, James; Kurpad, Shekar; Foster, Norah; Than, Khoi; Crutcher, Clifford; Goodwin, C Rory; Tator, Charles; Shaffrey, Christopher I; Aarabi, Bizhan; Fehlings, Michael; Neal, Chris J; Guest, James; Abd-El-Barr, Muhammad M
    There is a paucity of data comparing the demographics, mechanism of injury, and outcomes of upper versus lower cervical spinal cord injuries (cSCI). The study objective was to define different clinical manifestations of cSCI. Data were collected prospectively through centers of the North American Clinical Trials Network (NACTN). Data was collected on 470 patients (21% women, mean age 50 years). Cervical vertebral level was analyzed as an ordinal variable to determine a natural demarcation to classify upper versus lower cSCI. For continuous variable analysis, falls were associated with C3 more than C4 vertebral level injuries (60% vs. 42%) (p=0.0126), while motor vehicle accidents (MVA) were associated with C4 more than C3 (40% vs. 29%) (p=0.0962). Motor ISNSCI scores also demonstrated a natural demarcation between C3 and C4, with C3 having higher median ASIA motor scores (40 [4 - 73] vs. 11 [3 - 59], p= 0.0227). There were no differences when comparing C2 to C3 nor C4 to C5. Given the significant differences seen between C3 and C4, but not C2 and C3 nor C4 and C5, upper cSCI was designated as C1-C3, and lower cSCI was designated as C4-C7. Compared to a lower cSCI, patients with an upper cSCI were more likely to have a fall as their mechanism of injury (54% vs. 36%, p= 0.0072). Patients with an ASIA C cSCI were likely to have an upper cervical injury: 23% vs. 11% (p= 0.0226). Additionally, patients with an upper cSCI were more likely to have diabetes prior to injury, 37% vs. 22% respectively (p= 0.0084). Lower cSCI were more likely injured through sports (19% vs. 8%, p= 0.0171) and present with ASIA A (42% vs. 25%, p= 0.0186) neurological grade. Patients with lower cSCI were also significantly more likely to have complications such as shock, pulmonary embolism, and pleural effusion. In conclusion, there appears to be a natural demarcation of injury type between C3 and C4. Upper cSCI (C1-C3) was more associated with falls and diabetes, whereas lower cSCI (C4-C7) was more associated with sports, worse ASIA scores, and more complications. Further research will be needed to understand the mechanistic and biological differences between these two groups and whether different treatments may be appropriate for each of these groups.
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    Early Experience with Prone Lateral Interbody Fusion in Deformity Correction: A Single-Institution Experience.
    (Journal of clinical medicine, 2024-04) Bartlett, Alyssa M; Dibble, Christopher F; Sykes, David AW; Drossopoulos, Peter N; Wang, Timothy Y; Crutcher, Clifford L; Than, Khoi D; Bhomwick, Deb A; Shaffrey, Christopher I; Abd-El-Barr, Muhammad M
    Background/Objectives: Lateral spine surgery offers effective minimally invasive deformity correction, but traditional approaches often involve separate anterior, lateral, and posterior procedures. The prone lateral technique streamlines this process by allowing single-position access for lateral and posterior surgery, potentially benefiting from the lordosing effect of prone positioning. While previous studies have compared prone lateral to direct lateral for adult degenerative diseases, this retrospective review focuses on the outcomes of adult deformity patients undergoing prone lateral interbody fusion. Methods: Ten adult patients underwent single-position prone lateral surgery for spine deformity correction, with a mean follow-up of 18 months. Results: Results showed significant improvements: sagittal vertical axis decreased by 2.4 cm, lumbar lordosis increased by 9.1°, pelvic tilt improved by 3.3°, segmental lordosis across the fusion construct increased by 12.2°, and coronal Cobb angle improved by 6.3°. These benefits remained consistent over the follow-up period. Correlational analysis showed a positive association between improvements in PROs and SVA and SL. When compared to hybrid approaches, prone lateral yielded greater improvements in SVA. Conclusions: Prone lateral surgery demonstrated favorable outcomes with reasonable perioperative risks. However, further research comparing this technique with standard minimally invasive lateral approaches, hybrid, and open approaches is warranted for a comprehensive evaluation.
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    Evolution of the Transforaminal Lumbar Interbody Fusion (TLIF): From Open to Percutaneous to Patient-Specific.
    (Journal of clinical medicine, 2024-04) Drossopoulos, Peter N; Ononogbu-Uche, Favour C; Tabarestani, Troy Q; Huang, Chuan-Ching; Paturu, Mounica; Bardeesi, Anas; Ray, Wilson Z; Shaffrey, Christopher I; Goodwin, C Rory; Erickson, Melissa; Chi, John H; Abd-El-Barr, Muhammad M
    The transforaminal lumbar interbody fusion (TLIF) has seen significant evolution since its early inception, reflecting advancements in surgical techniques, patient safety, and outcomes. Originally described as an improvement over the posterior lumbar interbody fusion (PLIF), the TLIF began as an open surgical procedure, that notably reduced the need for the extensive neural retractation that hindered the PLIF. In line with the broader practice of surgery, trending toward minimally invasive access, the TLIF was followed by the development of the minimally invasive TLIF (MIS-TLIF), a technique that further decreased tissue trauma and postoperative complications. Subsequent advancements, including Trans-Kambin's Triangle TLIF (percLIF) and transfacet LIF, have continued to refine surgical access, minimize surgical footprint, and reduce the risk of injury to the patient. The latest evolution, as we will describe it, the patient-specific TLIF, is a culmination of the aforementioned adaptations and incorporates advanced imaging and segmentation technologies into perioperative planning, allowing surgeons to tailor approaches based on individual patient anatomy and pathology. These developments signify a shift towards more precise methods in spine surgery. The ongoing evolution of the TLIF technique illustrates the dynamic nature of surgery and emphasizes the need for continued adaptation and refinement.
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    Hematocrit as a predictor of preoperative transfusion-associated complications in spine surgery: A NSQIP study.
    (Clinical neurology and neurosurgery, 2021-01) Mehta, Vikram A; Van Belleghem, Florence; Price, Meghan; Jaykel, Matthew; Ramirez, Luis; Goodwin, Jessica; Wang, Timothy Y; Erickson, Melissa M; Than, Khoi D; Gupta, Dhanesh K; Abd-El-Barr, Muhammad M; Karikari, Isaac O; Shaffrey, Christopher I; Rory Goodwin, C

    Background context

    Preoperative optimization of medical comorbidities prior to spinal surgery is becoming an increasingly important intervention in decreasing postoperative complications and ensuring a satisfactory postoperative course. The treatment of preoperative anemia is based on guidelines made by the American College of Cardiology (ACC), which recommends packed red blood cell transfusion when hematocrit is less than 21% in patients without cardiovascular disease and 24% in patients with cardiovascular disease. The literature has yet to quantify the risk profile associated with preoperative pRBC transfusion.

    Purpose

    To determine the incidence of complications following preoperative pRBC transfusion in a cohort of patients undergoing spine surgery.

    Study design

    Retrospective review of a national surgical database.

    Patient sample

    The national surgical quality improvement program database OUTCOME NEASURES: Postoperative physiologic complications after a preoperative transfusion. Complications were defined as the occurrence of any DVT, PE, stroke, cardiac arrest, myocardial infarction, longer length of stay, need for mechanical ventilation greater than 48 h, surgical site infections, sepsis, urinary tract infections, pneumonia, or higher 30-day mortality.

    Methods

    The national surgical quality improvement program database was queried, and patients were included if they had any type of spine surgery and had a preoperative transfusion.

    Results

    Preoperative pRBC transfusion was found to be protective against complications when the hematocrit was less than 20% and associated with more complications when the hematocrit was higher than 20%. In patients with a hematocrit higher than 20%, pRBC transfusion was associated with longer lengths of stay, and higher rates of ventilator dependency greater than 48 h, pneumonia, and 30-day mortality.

    Conclusion

    This is the first study to identify an inflection point in determining when a preoperative pRBC transfusion may be protective or may contribute to complications. Further studies are needed to be conducted to stratify by the prevalence of cardiovascular disease.
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    Improved Dysphagia Outcomes in Anchored Spacers Versus Plate-Screw Systems in Anterior Cervical Discectomy and Fusion: A Systematic Review
    (Global Spine Journal) Gabr, Mostafa A; Touko, Elisabeth; Yadav, Amol P; Karikari, Isaac; Goodwin, C Rory; Groff, Michael W; Ramirez, Luis; Abd-El-Barr, Muhammad M
    Study Design: Systematic review and meta-analysis. Objective: To perform a systematic review of clinical outcomes between stand-alone anchored spacers and traditional cages with plate fixation for dysphagia and pseudoarthrosis using data from clinical trials. Methods: Our search protocol was added to PROSPERO register and systematic review using PRISMA method was performed. Then, we systematically searched for studies addressing stand-alone anchored spacers in patients who underwent ACDF. Mean Neck Disability Index (NDI), dysphagia incidence % (Dinc%), and Swallowing–Quality of Life (SQOL) scores during preoperative, immediate postoperative and last follow-up visits were extracted. Chi-square and analysis of variance (ANOVA) tests were used for statistical comparisons ( P ≤ .05). Results: The initial search generated 506 articles in CENTRAL and 40 articles in MEDLINE. Finally, 14 articles were included. Total number of patients was 1173 (583 anchored stand-alone and 590 plate). Dinc% scores were statistically significantly lower in the stand-alone anchored spacer compared to the plate-screw construct ( P ≤ .05). ANOVA showed no statistically significant difference in the comparisons of SQOL. On the other hand, NDI scores were statistically significantly lower in baseline of stand-alone anchored spacer and the plate-screw construct compared with both immediate postoperative and last follow-up visits ( P ≤ .05). Conclusions: Our study results revealed that the stand-alone anchored spacers were associated with less dysphagia in the immediate and last follow-up.
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    Instrument Tracking for Prone Lateral Surgery.
    (World neurosurgery, 2023-01) Srinivasan, Ethan S; Hamouda, Farrah; Gnaedinger, Anika G; Wang, Timothy Y; Chan, Andrew K; Shaffrey, Christopher I; Erickson, Melissa M; Than, Khoi D; Abd-El-Barr, Muhammad M
    The prone lateral transpsoas approach for lumbar interbody fusion and posterior instrumentation enables a large surface area implant without disruption of the posterior spine musculature from a single position.1,2 The addition of virtual live fluoroscopy instrument tracking navigation to surgery provides multiple benefits, including a reduction in patient and surgeon radiation exposure, highly accurate and dynamic spatial tool localization, and flexible equipment and patient positioning.3,4 Here, we highlight the use of virtual live fluoroscopy in prone lateral spine surgery. A 75-year-old man presented with prior L3-L5 fusion and progressive lower extremity pain and weakness. Using the described techniques, the patient underwent a lateral retroperitoneal interbody fusion and posterior instrumentation at L2-L3. The operation proceeded without complication, and the patient reported improved ambulation at 6-week follow-up. The prone lateral transpsoas approach and minimally invasive posterior instrumentation for lumbar interbody fusion permits effective fusion without significant posterior muscle disruption from a single position. The integration of virtual live fluoroscopy enables real-time instrument tracking throughout the minimally invasive case, with reductions in patient and surgeon radiation exposure. Video 1 depicts the use and benefits of this technology in lateral spine surgery. Compared with computed tomography-guided navigation, virtual live fluoroscopy technology enables rapid remapping to iatrogenic anatomic changes for more fluid progression through the operation.5 Virtual live fluoroscopy instrument tracking is a valuable tool that increases the safety and efficiency of single-position lateral spine surgery.
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    Interhospital Transfer delays care for spinal cord injury patients: A Report from the North American Clinical Trials Network for Spinal Cord Injury.
    (Journal of neurotrauma, 2023-04) Kelly-Hedrick, Margot; Ugiliweneza, Beatrice; Toups, Elizabeth G; Jimsheleishvili, George; Kurpad, Shekar N; Aarabi, Bizhan; Harrop, James S; Foster, Norah; Goodwin, Rory C; Shaffrey, Christopher I; Fehlings, Michael G; Tator, Charles H; Guest, James D; Neal, Chris J; Abd-El-Barr, Muhammad M; Williamson, Theresa
    The North America Clinical Trials Network (NACTN) for Spinal Cord Injury (SCI) is a consortium of tertiary medical centers that has maintained a prospective SCI registry since 2004, and has espoused that early surgical intervention is associated with improved outcome. It has previously been shown that initial presentation to a lower acuity center and necessity of transfer to a higher acuity center reduce rates of early surgery. The NACTN database was evaluated to examine the association between interhospital transfer (IHT), early surgery, and outcome, taking into account distance traveled and site of origin for the patient. Data from a 15-year period of the NACTN SCI Registry were analyzed (years 2005-2019). Patients were stratified into transfers directly from the scene to a level I trauma center (NACTN site) versus IHT from a level II or III trauma facility. The main outcome was surgery within 24 hours of injury (yes/no) while secondary outcomes were length of stay, death, discharge disposition, and 6-month AIS grade conversion. For the IHT patients, distance traveled for transfer was calculated by measuring the shortest distance between origin and NACTN hospital. Analysis was performed with Brown-Mood test and chi-square tests. Of 724 patients with transfer data, 295 (40%) underwent IHT and 429 (60%) were admitted directly from the scene of accident. Patients who underwent IHT were more likely to have a less severe SCI (AIS D) (p=.002), have a central cord injury (p=.004), and have a fall as their mechanism of injury (p<.0001) than those directly admitted to a NACTN center. Of the 634 patients who had surgery, direct admission to a NACTN site was more likely to result in surgery within 24 hours compared to IHT patients (52% vs. 38%) (p< .0003). Median IHT distance was 28 miles (interquartile range=13-62 miles). There was no significant difference in death, length of stay, discharge to a rehab facility versus home, or 6-month AIS grade conversion rates between the two groups. Patients who underwent IHT to a NACTN site were less likely to have surgery within 24 hours of injury, compared to those directly admitted to the level I trauma facility. While there was no difference in mortality rates, length of stay, or 6-month AIS conversion between groups, patients with IHT were more likely be older with a less severe level of injury (AIS D). This work suggests there are barriers to timely recognition of SCI in the field, appropriate admission to a higher level of care after recognition, and challenges related to the management of individuals with less severe SCI.
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    Interhospital transfer status for spinal metastasis patients in the United States is associated with more severe clinical presentations and higher rates of inpatient complications.
    (Neurosurgical focus, 2021-05) De la Garza Ramos, Rafael; Park, Christine; McCray, Edwin; Price, Meghan; Wang, Timothy Y; Dalton, Tara; Baëta, César; Erickson, Melissa M; Foster, Norah; Pennington, Zach; Shin, John H; Sciubba, Daniel M; Than, Khoi D; Karikari, Isaac O; Shaffrey, Christopher I; Abd-El-Barr, Muhammad M; Yassari, Reza; Goodwin, C Rory

    Objective

    In patients with metastatic spinal disease (MSD), interhospital transfer can potentially impact clinical outcomes as the possible benefits of transferring a patient to a higher level of care must be weighed against the negative effects associated with potential delays in treatment. While the association of clinical outcomes and transfer status has been examined in other specialties, the relationship between transfer status, complications, and risk of mortality in patients with MSD has yet to be explored. The purpose of this study was to examine the impact of transfer status on in-hospital mortality and clinical outcomes in patients diagnosed with MSD.

    Methods

    The National (Nationwide) Inpatient Sample (NIS) database was retrospectively queried for adult patients diagnosed with vertebral pathological fracture and/or spinal cord compression in the setting of metastatic disease between 2012 and 2014. Demographics, baseline characteristics (e.g., metastatic spinal cord compression [MSCC] and paralysis), comorbidities, type of intervention, and relevant patient outcomes were controlled in a multivariable logistic regression model to analyze the association of transfer status with patient outcomes.

    Results

    Within the 10,360 patients meeting the inclusion and exclusion criteria, higher rates of MSCC (50.2% vs 35.9%, p < 0.001) and paralysis (17.3% vs 8.4%, p < 0.001) were observed in patients transferred between hospitals compared to those directly admitted. In univariable analysis, a higher percentage of transferred patients underwent surgical intervention (p < 0.001) when compared with directly admitted patients. After controlling for significant covariates and surgical intervention, transferred patients were more likely to develop in-hospital complications (OR 1.34, 95% CI 1.18-1.52, p < 0.001), experience prolonged length of stay (OR 1.33, 95% CI 1.16-1.52, p < 0.001), and have a discharge disposition other than home (OR 1.70, 95% CI 1.46-1.98, p < 0.001), with no significant difference in inpatient mortality rates.

    Conclusions

    Patients with MSD who were transferred between hospitals demonstrated more severe clinical presentations and higher rates of inpatient complications compared to directly admitted patients, despite demonstrating no difference in in-hospital mortality rates.
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    Machine learning in the diagnosis, management, and care of patients with low back pain: a scoping review of the literature and future directions.
    (The spine journal : official journal of the North American Spine Society, 2024-09) Seas, Andreas; Zachem, Tanner J; Valan, Bruno; Goertz, Christine; Nischal, Shiva; Chen, Sully F; Sykes, David; Tabarestani, Troy Q; Wissel, Benjamin D; Blackwood, Elizabeth R; Holland, Christopher; Gottfried, Oren; Shaffrey, Christopher I; Abd-El-Barr, Muhammad M

    Background context

    Low back pain (LBP) remains the leading cause of disability globally. In recent years, machine learning (ML) has emerged as a potentially useful tool to aid the diagnosis, management, and prognostication of LBP.

    Purpose

    In this review, we assess the scope of ML applications in the LBP literature and outline gaps and opportunities.

    Study design/setting

    A scoping review was performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines.

    Methods

    Articles were extracted from the Web of Science, Scopus, PubMed, and IEEE Xplore databases. Title/abstract and full-text screening was performed by two reviewers. Data on model type, model inputs, predicted outcomes, and ML methods were collected.

    Results

    In total, 223 unique studies published between 1988 and 2023 were identified, with just over 50% focused on low-back-pain detection. Neural networks were used in 106 of these articles. Common inputs included patient history, demographics, and lab values (67% total). Articles published after 2010 were also likely to incorporate imaging data into their models (41.7% of articles). Of the 212 supervised learning articles identified, 168 (79.4%) mentioned use of a training or testing dataset, 116 (54.7%) utilized cross-validation, and 46 (21.7%) implemented hyperparameter optimization. Of all articles, only 8 included external validation and 9 had publicly available code.

    Conclusions

    Despite the rapid application of ML in LBP research, a majority of articles do not follow standard ML best practices. Furthermore, over 95% of articles cannot be reproduced or authenticated due to lack of code availability. Increased collaboration and code sharing are needed to support future growth and implementation of ML in the care of patients with LBP.
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    Management of Acute Traumatic Spinal Cord Injury: A Review of the Literature.
    (Frontiers in surgery, 2021-01) Wang, Timothy Y; Park, Christine; Zhang, Hanci; Rahimpour, Shervin; Murphy, Kelly R; Goodwin, C Rory; Karikari, Isaac O; Than, Khoi D; Shaffrey, Christopher I; Foster, Norah; Abd-El-Barr, Muhammad M
    Traumatic spinal cord injury (TSCI) is a debilitating disease that poses significant functional and economic burden on both the individual and societal levels. Prognosis is dependent on the extent of the spinal injury and the severity of neurological dysfunction. If not treated rapidly, patients with TSCI can suffer further secondary damage and experience escalating disability and complications. It is important to quickly assess the patient to identify the location and severity of injury to make a decision to pursue a surgical and/or conservative management. However, there are many conditions that factor into the management of TSCI patients, ranging from the initial presentation of the patient to long-term care for optimal recovery. Here, we provide a comprehensive review of the etiologies of spinal cord injury and the complications that may arise, and present an algorithm to aid in the management of TSCI.