Browsing by Author "Dettori, Joseph R"

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    ItemOpen Access
    Effectiveness of spinal fusion versus structured rehabilitation in chronic low back pain patients with and without isthmic spondylolisthesis: a systematic review.
    (Spine, 2011-10) Wood, Kirkham B; Fritzell, Peter; Dettori, Joseph R; Hashimoto, Robin; Lund, Teija; Shaffrey, Chris

    Study design

    Systematic review.

    Objective

    To determine if the presence of isthmic spondylolisthesis modifies the effect of treatment (fusion vs. multidimensional supervised rehabilitation) in patients with chronic low back pain (CLBP).

    Summary of background data

    Results of spinal surgery for CLBP are variable. It is unclear whether patients with CLBP and isthmic spondylolisthesis have more success with surgery versus a multidimensional supervised rehabilitation program when compared with those with CLBP but without spondylolisthesis.

    Methods

    A systematic search was conducted in MEDLINE and the Cochrane Collaboration Library for articles published through January 2011. Randomized controlled trials (RCTs) were included that compared spine fusion versus multidimensional supervised rehabilitation in patients with and without isthmic spondylolisthesis. Standardized mean differences (SMDs) and risk differences were calculated for common outcomes, and then compared to determine potential heterogeneity of treatment effect. The final strength of the body of literature was expressed as "high," "moderate," or "low" confidence that the evidence reflects the true effect.

    Results

    No studies were found that directly compared the two subgroups. Three RCTs compared fusion with supervised nonoperative care in patients with CLBP without isthmic spondylolisthesis; one RCT evaluated these treatments in patients with isthmic spondylolisthesis. There were study differences in patient characteristics, type of fusion, the nature of the rehabilitation, outcomes assessed, and length of follow-up. The SMDs for pain in favor of fusion were modest at 2 years for those without isthmic spondylolisthesis, but large in favor of fusion for those with isthmic spondylolisthesis compared with rehabilitation. Similarly, the SMDs for function in patients without isthmic spondylolisthesis compared with rehabilitation was small at 2 years, but appreciably higher in favor of fusion in patients with isthmic spondylolisthesis.

    Conclusion

    The overall strength of evidence evaluating whether the presence of isthmic spondylolisthesis modifies the effect of fusion compared with rehabilitation patients with CLBP is "low." Fusion should be considered for patients with low back pain and isthmic spondylolisthesis who have failed nonoperative treatment.

    Clinical recommendations

    We recommend considering fusion for patients with isthmic spondylolisthesis and lower back pain who have failed nonoperative treatment.

    Recommendation

    Weak.
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    ItemOpen Access
    Frequency, risk factors, and treatment of distal adjacent segment pathology after long thoracolumbar fusion: a systematic review.
    (Spine, 2012-10) Kasliwal, Manish K; Shaffrey, Christopher I; Lenke, Lawrence G; Dettori, Joseph R; Ely, Claire G; Smith, Justin S

    Study design

    Systematic review.

    Objective

    To systematically review the literature related to distal adjacent segment pathology (ASP) after long thoracolumbar fusions for deformity including frequency, risk factors, frequency differences between adolescents and adults, surgical approach for revision, and revision complications.

    Summary of background data

    Spinal deformity surgery complications include ASP. Although ASP at the rostral end of instrumented fusions has been well described, substantially less has been documented about distal ASP.

    Methods

    A systematic search was conducted in Medline and the Cochrane Collaboration Library for articles published between January 1, 1983, and March 15, 2012. We included all articles that described distal ASP after long thoracolumbar fusion for deformity. Radiographical ASP (RASP) was defined as evidence of ASP based on imaging, and clinical ASP (CASP) was defined as symptomatic ASP.

    Results

    Seven retrospective cohort studies met inclusion criteria. Distal CASP developed in 17.7% at 2- 6-year follow-up and 19.8% at 9-year follow-up, whereas reoperation due to CASP was reported in 15.6% at 2 to 6 years and 14.4% at 9 years. Distal RASP was more frequent (44.7%-65.5%). Preoperative sagittal imbalance was associated with increased risk of distal ASP. There was increased risk of CASP in patients with higher postoperative fractional curve and increased risk of RASP in younger patients and those with preoperative disc degeneration, longer fusions, circumferential procedures, and postoperative L5-S1 disc space narrowing. No studies meeting inclusion criteria compared distal ASP in adults and adolescents or defined the best approach or complications for distal ASP revision.

    Conclusion

    Low-quality evidence suggests a cumulative rate of 18% to 20% for CASP and 45% to 65% for RASP after long thoracolumbar fusion for spinal deformity during 9-year follow-up. Low-quality evidence suggests an association between preoperative sagittal imbalance and distal ASP, with greater risk of distal ASP in patients with sagittal imbalance. Low-quality evidence suggests increased risk of CASP in patients with higher postoperative fractional curve and increased risk of RASP in younger patients and those with preoperative disc degeneration, longer fusions, circumferential procedures, and postoperative L5-S1 disc space narrowing.

    Consensus statement

    1. The risk of developing new symptoms secondary to distal adjacent segment pathology following long thoracolumbar fusion for deformity is approximately 18–20% during a period of 9 years follow up, and most of these patients will require revision surgery. Strength of Statement: Weak. 2. The risk of developing distal adjacent segment pathology may be higher in those with preoperative sagittal imbalance, preoperative disc degeneration, longer fusions, circumferential procedures, and postoperative L5–S1 disc space narrowing. Strength of Statement: Weak.
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    ItemOpen Access
    Lateral mass screw fixation in the cervical spine.
    (Journal of neurosurgery. Spine, 2014-05) Coe, Jeffrey D; Vaccaro, Alexander R; Dailey, Andrew T; Sasso, Rick C; Ludwig, Steven C; Harrop, James S; Dettori, Joseph R; Shaffrey, Christopher I; Emery, Sanford E; Fehlings, Michael G
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    Predictors of pulmonary complications in blunt traumatic spinal cord injury.
    (Journal of neurosurgery. Spine, 2012-09) Aarabi, Bizhan; Harrop, James S; Tator, Charles H; Alexander, Melvin; Dettori, Joseph R; Grossman, Robert G; Fehlings, Michael G; Mirvis, Stuart E; Shanmuganathan, Kathirkamanathan; Zacherl, Katie M; Burau, Keith D; Frankowski, Ralph F; Toups, Elizabeth; Shaffrey, Christopher I; Guest, James D; Harkema, Susan J; Habashi, Nader M; Andrews, Penny; Johnson, Michele M; Rosner, Michael K

    Object

    Pulmonary complications are the most common acute systemic adverse events following spinal cord injury (SCI), and contribute to morbidity, mortality, and increased length of hospital stay (LOS). Identification of factors associated with pulmonary complications would be of value in prevention and acute care management. Predictors of pulmonary complications after SCI and their effect on neurological recovery were prospectively studied between 2005 and 2009 at the 9 hospitals in the North American Clinical Trials Network (NACTN).

    Methods

    The authors sought to address 2 specific aims: 1) define and analyze the predictors of moderate and severe pulmonary complications following SCI; and 2) investigate whether pulmonary complications negatively affected the American Spinal Injury Association (ASIA) Impairment Scale conversion rate of patients with SCI. The NACTN registry of the demographic data, neurological findings, imaging studies, and acute hospitalization duration of patients with SCI was used to analyze the incidence and severity of pulmonary complications in 109 patients with early MR imaging and long-term follow-up (mean 9.5 months). Univariate and Bayesian logistic regression analyses were used to analyze the data.

    Results

    In this study, 86 patients were male, and the mean age was 43 years. The causes of injury were motor vehicle accidents and falls in 80 patients. The SCI segmental level was in the cervical, thoracic, and conus medullaris regions in 87, 14, and 8 patients, respectively. Sixty-four patients were neurologically motor complete at the time of admission. The authors encountered 87 complications in 51 patients: ventilator-dependent respiratory failure (26); pneumonia (25); pleural effusion (17); acute lung injury (6); lobar collapse (4); pneumothorax (4); pulmonary embolism (2); hemothorax (2), and mucus plug (1). Univariate analysis indicated associations between pulmonary complications and younger age, sports injuries, ASIA Impairment Scale grade, ascending neurological level, and lesion length on the MRI studies at admission. Bayesian logistic regression indicated a significant relationship between pulmonary complications and ASIA Impairment Scale Grades A (p = 0.0002) and B (p = 0.04) at admission. Pulmonary complications did not affect long-term conversion of ASIA Impairment Scale grades.

    Conclusions

    The ASIA Impairment Scale grade was the fundamental clinical entity predicting pulmonary complications. Although pulmonary complications significantly increased LOS, they did not increase mortality rates and did not adversely affect the rate of conversion to a better ASIA Impairment Scale grade in patients with SCI. Maximum canal compromise, maximum spinal cord compression, and Acute Physiology and Chronic Health Evaluation-II score had no relationship to pulmonary complications.
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    ItemOpen Access
    Terminology.
    (Spine, 2012-10) Anderson, Paul A; Andersson, Gunnar BJ; Arnold, Paul M; Brodke, Darrel S; Brodt, Erika D; Chapman, Jens R; Chou, Dean; Dekutoski, Mark; Dettori, Joseph R; DeVine, John G; Ely, Claire G; Fehlings, Michael G; Fischer, Dena J; Fourney, Daryl R; Hansen, Mitchell A; Harrod, Christopher Chambliss; Hashimoto, Robin; Hermsmeyer, Jeffrey T; Hilibrand, Alan S; Kasliwal, Manish K; Kelly, Michael P; Kim, Han Jo; Kraemer, Paul; Lawrence, Brandon D; Lee, Michael J; Lenke, Lawrence G; Norvell, Daniel C; Raich, Annie; Riew, K Daniel; Shaffrey, Christopher I; Skelly, Andrea C; Smith, Justin S; Standaert, Christopher J; Van Alstyne, Ellen M; Wang, Jeffrey C