Browsing by Author "Buell, TJ"

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    Evolving concepts in pelvic fixation in adult spinal deformity surgery
    (Seminars in Spine Surgery, 2023-01-01) Turner, JD; Schupper, AJ; Mummaneni, PV; Uribe, JS; Eastlack, RK; Mundis, GM; Passias, PG; DiDomenico, JD; Harrison Farber, S; Soliman, MAR; Shaffrey, CI; Klineberg, EO; Daniels, AH; Buell, TJ; Burton, DC; Gum, JL; Lenke, LG; Bess, S; Mullin, JP
    Long-segment adult spinal deformity (ASD) constructs carry a high risk of mechanical complications. Pelvic fixation was introduced to improve distal construct mechanics and has since become the standard for long constructs spanning the lumbosacral junction. Pelvic fixation strategies have evolved substantially over the years. Numerous techniques now use a variety of entry points, screw trajectories, and construct configurations. We review the various strategies for pelvic fixation in ASD in a systematic review of the literature and update the techniques employed in the International Spine Study Group Complex Adult Deformity Surgery database.
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    Intraoperative fluid management in adult spinal deformity surgery: variation analysis and association with outcomes
    (Spine Deformity, 2024-01-01) Cetik, RM; Gum, JL; Lafage, R; Smith, JS; Bess, S; Mullin, JP; Kelly, MP; Diebo, BG; Buell, TJ; Scheer, JK; Line, BG; Lafage, V; Klineberg, EO; Kim, HJ; Passias, PG; Kebaish, KM; Eastlack, RK; Daniels, AH; Soroceanu, A; Mundis, GM; Hostin, RA; Protopsaltis, TS; Hamilton, DK; Hart, RA; Gupta, MC; Lewis, SJ; Schwab, FJ; Lenke, LG; Shaffrey, CI; Ames, CP; Burton, DC
    Purpose: To evaluate the variability in intraoperative fluid management during adult spinal deformity (ASD) surgery, and analyze the association with complications, intensive care unit (ICU) requirement, and length of hospital stay (LOS). Methods: Multicenter comparative cohort study. Patients ≥ 18 years old and with ASD were included. Intraoperative intravenous (IV) fluid data were collected including: crystalloids, colloids, crystalloid/colloid ratio (C/C), total IV fluid (tIVF, ml), normalized total IV fluid (nIVF, ml/kg/h), input/output ratio (IOR), input–output difference (IOD), and normalized input–output difference (nIOD, ml/kg/h). Data from different centers were compared for variability analysis, and fluid parameters were analyzed for possible associations with the outcomes. Results: Seven hundred ninety-eight patients with a median age of 65.2 were included. Among different surgical centers, tIVF, nIVF, and C/C showed significant variation (p < 0.001 for each) with differences of 4.8-fold, 3.7-fold, and 4.9-fold, respectively. Two hundred ninety-two (36.6%) patients experienced at least one in-hospital complication, and ninety-two (11.5%) were IV fluid related. Univariate analysis showed significant relations for: LOS and tIVF (ρ = 0.221, p < 0.001), IOD (ρ = 0.115, p = 0.001) and IOR (ρ = −0.138, p < 0.001); IV fluid-related complications and tIVF (p = 0.049); ICU stay and tIVF, nIVF, IOD and nIOD (p < 0.001 each); extended ICU stay and tIVF (p < 0.001), nIVF (p = 0.010) and IOD (p < 0.001). Multivariate analysis controlling for confounders showed significant relations for: LOS and tIVF (p < 0.001) and nIVF (p = 0.003); ICU stay and IOR (p = 0.002), extended ICU stay and tIVF (p = 0.004). Conclusion: Significant variability and lack of standardization in intraoperative IV fluid management exists between different surgical centers. Excessive fluid administration was found to be correlated with negative outcomes. Level of evidence: III.
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    Presentation and Outcomes After Medical and Surgical Treatment Versus Medical Treatment Alone of Spontaneous Infectious Spondylodiscitis: A Systematic Literature Review and Meta-Analysis
    (Global Spine Journal, 2018-12-01) Taylor, DG; Buchholz, AL; Sure, DR; Buell, TJ; Nguyen, JH; Chen, CJ; Diamond, JM; Washburn, PA; Harrop, J; Shaffrey, CI; Smith, JS
    Study Design: Systematic literature review. Objectives: The aims of this study were to (1) describe the clinical features, disabilities, and incidence of neurologic deficits of pyogenic spondylodiscitis prior to treatment and (2) compare the functional outcomes between patients who underwent medical treatment alone or in combination with surgery for pyogenic spondylodiscitis. Methods: A systematic literature review was performed using PubMed according to PRISMA guidelines. No year restriction was put in place. Statistical analysis of pooled data, when documented in the original report (ie, number of patients with desired variable and number of patients evaluated), was conducted to determine the most common presenting symptoms, incidence of pre- and postoperative neurologic deficits, associated comorbidities, infectious pathogens, approach for surgery when performed, and duration of hospitalization. Outcomes data, including return to work status, resolution of back pain, and functional recovery were also pooled among all studies and surgery-specific studies alone. Meta-analysis of studies with subgroup analysis of pain-free outcome in surgical and medical patients was performed. Results: Fifty of 1286 studies were included, comprising 4173 patients undergoing either medical treatment alone or in combination with surgery. Back pain was the most common presenting symptom, reported in 91% of patients. Neurologic deficit was noted in 31% of patients. Staphylococcus aureus was the most commonly reported pathogen, seen in 35% of reported cases. Decompression and fusion was the most commonly reported surgical procedure, performed in 80% of the surgically treated patients. Combined anterior-posterior procedures and staged surgeries were performed in 33% and 26% of surgeries, respectively. The meta-analysis comparing visual analog scale score at follow-up was superior among patients receiving surgery over medical treatment alone (mean difference −0.61, CI −0.90 to −0.25), while meta-analysis comparing freedom from pain in patients receiving medical treatment alone versus combined medical and surgical treatment demonstrated superior pain-free outcomes among surgical series (odds ratio 5.35, CI 2.27-12.60, P <.001), but was subject to heterogeneity among studies (I 2 = 56%, P =.13). Among all patients, freedom from pain was achieved in 79% of patients, and an excellent outcome was achieved in 73% of patients. Conclusion: Medical management remains first-line treatment of infectious pyogenic spondylodiscitis. Surgery may be indicated for progressive pain, persistent infection on imaging, deformity or neurologic deficits. If surgery is required, reported literature shows potential for significant pain reduction, improved neurologic function and a high number of patients returning to a normal functional/work status.
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    Use of supplemental rod constructs in adult spinal deformity surgery
    (Seminars in Spine Surgery, 2023-01-01) Buell, TJ; Sardi, JP; Yen, CP; Okonkwo, DO; Kojo Hamilton, D; Gum, JL; Lenke, LG; Shaffrey, CI; Gupta, MC; Smith, JS
    Operative treatment for adult spinal deformity (ASD) commonly involves long posterior instrumented fusions with primary rods spanning from the base of the construct to the upper instrumented vertebra. Over the past decade, additional supplemental rods have been increasingly utilized to bolster the primary instrumentation and mitigate risk of primary rod fracture/pseudarthrosis at areas of high biomechanical stress (e.g., 3-column osteotomy [3CO], multiple posterior column osteotomies [PCOs], lumbosacral junction). Supplemental rods for 3CO include satellite rods (4-rod technique with 2 deeply recessed short rods independently attached to pedicle screws across the 3CO), accessory rods (attached to primary rods via side-to-side connectors), and delta rods (accessory rods contoured only at the proximal and distal attachments to primary rods). Utilizing more than 4 rods across a 3CO may increase posterior construct stability; however, diminished load transfer to the anterior vertebral column may increase risk of nonunion and instrumentation failure. Similar supplemental rod constructs can be utilized to support multiple PCOs and/or the lumbosacral junction. We generally recommend using bilateral accessory rods for a total of 4 rods to support the lumbosacral junction (2 accessory rods and 2 primary rods). The novel “kickstand rod” can help facilitate coronal correction and/or function as an accessory rod distally anchored to an independent iliac screw; appropriate nomenclature is “iliac accessory rod” in cases without true kickstand distraction. In this narrative review, we aim to (1) provide a brief historical overview of supplemental rod constructs, (2) describe current indications for supplemental rods, and (3) report our results from a longitudinal analysis (2008–2020) of supplemental rod constructs used by International Spine Study Group (ISSG) surgeons.