Browsing by Author "Goodwin, C Rory"
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Item Open Access A blinded study using laser induced endogenous fluorescence spectroscopy to differentiate ex vivo spine tumor, healthy muscle, and healthy bone.(Scientific reports, 2024-01) Sperber, Jacob; Zachem, Tanner J; Prakash, Ravi; Owolo, Edwin; Yamamoto, Kent; Nguyen, Annee D; Hockenberry, Harrison; Ross, Weston A; Herndon, James E; Codd, Patrick J; Goodwin, C RoryTen patients undergoing surgical resection for spinal tumors were selected. Samples of tumor, muscle, and bone were resected, de-identified by the treating surgeon, and then scanned with the TumorID technology ex vivo. This study investigates whether TumorID technology is able to differentiate three different human clinical fresh tissue specimens: spine tumor, normal muscle, and normal bone. The TumorID technology utilizes a 405 nm excitation laser to target endogenous fluorophores, thereby allowing for the detection of tissue based on emission spectra. Metabolic profiles of tumor and healthy tissue vary, namely NADH (bound and free emission peak, respectively: 487 nm, 501 nm) and FAD (emission peak: 544) are endogenous fluorophores with distinct concentrations in tumor and healthy tissue. Emission spectra analyzed consisted of 74 scans of spine tumor, 150 scans of healthy normal bone, and 111 scans of healthy normal muscle. An excitation wavelength of 405 nm was used to obtain emission spectra from tissue as previously described. Emission spectra consisted of approximately 1400 wavelength intensity pairs between 450 and 750 nm. Kruskal-Wallis tests were conducted comparing AUC distributions for each treatment group, α = 0.05. Spectral signatures varied amongst the three different tissue types. All pairwise comparisons among tissues for Free NADH were statistically significant (Tumor vs. Muscle: p = 0.0006, Tumor vs. Bone: p < 0.0001, Bone vs. Muscle: p = 0.0357). The overall comparison of tissues for FAD (506.5-581.5 nm) was also statistically significant (p < 0.0001), with two pairwise comparisons being statistically significant (Tumor vs. Muscle: p < 0.0001, Tumor vs. Bone: p = 0.0045, Bone vs. Muscle: p = 0.249). These statistically significant differences were maintained when stratifying tumor into metastatic carcinoma (N = 57) and meningioma (N = 17). TumorID differentiates tumor tissue from normal bone and normal muscle providing further clinical evidence of its efficacy as a tissue identification tool. Future studies should evaluate TumorID's ability to serve as an adjunctive tool for intraoperative assessment of surgical margins and surgical decision-making.Item Open Access A Comprehensive Review of Complication Rates After Surgery for Adult Deformity: A Reference for Informed Consent.(Spine deformity, 2015-11) Sciubba, Daniel M; Yurter, Alp; Smith, Justin S; Kelly, Michael P; Scheer, Justin K; Goodwin, C Rory; Lafage, Virginie; Hart, Robert A; Bess, Shay; Kebaish, Khaled; Schwab, Frank; Shaffrey, Christopher I; Ames, Christopher P; International Spine Study Group (ISSG)Objective
An up-to-date review of recent literatures and a comprehensive reference for informed consent specific to ASD complications is lacking. The goal of the present study was to determine current complication rates after ASD surgery, in order to provide a reference for informed consent as well as to determine differences between three-column and non-three-column osteotomy procedures to aid in shared decision making.Methods
A review of the literature was conducted using the PubMed database. Randomized controlled trials, nonrandomized trials, cohort studies, case-control studies, and case series providing postoperative complications published in 2000 or later were included. Complication rates were recorded and calculated for perioperative (both major and minor) and long-term complication rates. Postoperative outcomes were all stratified by surgical procedure (ie, three-column osteotomy and non-three-column osteotomy).Results
Ninety-three articles were ultimately eligible for analysis. The data of 11,692 patients were extracted; there were 3,646 complications, mean age at surgery was 53.3 years (range: 25-77 years), mean follow-up was 3.49 years (range: 6 weeks-9.7 years), estimated blood loss was 2,161 mL (range: 717-7,034 mL), and the overall mean complication rate was 55%. Specifically, major perioperative complications occurred at a mean rate of 18.5%, minor perioperative complications occurred at a mean rate of 15.7%, and long-term complications occurred at a mean rate of 20.5%. Furthermore, three-column osteotomy resulted in a higher overall complication rate and estimated blood loss than non-three-column osteotomy.Conclusions
A review of recent literatures providing complication rates for ASD surgery was performed, providing the most up-to-date incidence of early and late complications. Providers may use such data in helping to counsel patients of the literature-supported complication rates of such procedures despite the planned benefits, thus obtaining a more thorough informed consent.Item Open Access Associations between urbanicity and spinal cord astrocytoma management and outcomes.(Cancer epidemiology, 2023-10) Sykes, David AW; Waguia, Romaric; Abu-Bonsrah, Nancy; Price, Mackenzie; Dalton, Tara; Sperber, Jacob; Owolo, Edwin; Hockenberry, Harrison; Bishop, Brandon; Kruchko, Carol; Barnholtz-Sloan, Jill S; Erickson, Melissa; Ostrom, Quinn T; Goodwin, C RoryBackground
The management of spinal cord astrocytomas (SCAs) remains controversial and may include any combination of surgery, radiation, and chemotherapy. Factors such as urbanicity (metropolitan versus non-metropolitan residence) are shown to be associated with patterns of treatment and clinical outcomes in a variety of cancers, but the role urbanicity plays in SCA treatment remains unknown.Methods
The Central Brain Tumor Registry of the United States (CBTRUS) analytic dataset, which combines data from CDC's National Program of Cancer Registries (NPCR) and NCI's Surveillance, Epidemiology, and End Results Programs, was used to identify individuals with SCAs between 2004 and 2019. Individuals' county of residence was classified as metropolitan or non-metropolitan. Multivariable logistic regression models were used to evaluate associations between urbanicity and SCA. Cox proportional hazard models were constructed to assess the effect of urbanicity on survival using the NPCR survival dataset (2004-2018).Results
1697 metropolitan and 268 non-metropolitan SCA cases were identified. The cohorts did not differ in age or gender composition. The populations had different racial/ethnic compositions, with a higher White non-Hispanic population in the non-metropolitan cohort (86 % vs 66 %, p < 0.001) and a greater Black non-Hispanic population in the metropolitan cohort (14 % vs 9.9 %, p < 0.001). There were no significant differences in likelihood of receiving comprehensive treatment (OR=0.99, 95 % CI [0.56, 1.65], p = >0.9), or survival (hazard ratio [HR]=0.92, p = 0.4) when non-metropolitan and metropolitan cases were compared. In the metropolitan cohort, there were statistically significant differences in SCA treatment patterns when stratified by race/ethnicity (p = 0.002).Conclusions
Urbanicity does not significantly impact SCA management or survival. Race/ethnicity may be associated with likelihood of receiving certain SCA treatments in metropolitan communities.Item Open 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 MItem Open 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 MInterest 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.Item Open 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 JItem Open Access 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 MIntroduction
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.Item Open 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 MBackground
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.Item Open Access 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 MThere 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.Item Open Access 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 MThe 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.Item Open Access Hepatocyte growth factor enhances death receptor-induced apoptosis by up-regulating DR5.(BMC Cancer, 2008-11-07) Li, Yang; Fan, Xing; Goodwin, C Rory; Laterra, John; Xia, ShuliBACKGROUND: Hepatocyte growth factor (HGF) and its receptor c-MET are commonly expressed in malignant gliomas and embryonic neuroectodermal tumors including medulloblastoma and appear to play an important role in the growth and dissemination of these malignancies. Dependent on cell context and the involvement of specific downstream effectors, both pro- and anti-apoptotic effects of HGF have been reported. METHODS: Human medulloblastoma cells were treated with HGF for 24-72 hours followed by death receptor ligand TRAIL (Tumor necrosis factor-related apoptosis-inducing ligand) for 24 hours. Cell death was measured by MTT and Annexin-V/PI flow cytometric analysis. Changes in expression levels of targets of interest were measured by Northern blot analysis, quantitative reverse transcription-PCR, Western blot analysis as well as immunoprecipitation. RESULTS: In this study, we show that HGF promotes medulloblastoma cell death induced by TRAIL. TRAIL alone triggered apoptosis in DAOY cells and death was enhanced by pre-treating the cells with HGF for 24-72 h prior to the addition of TRAIL. HGF (100 ng/ml) enhanced TRAIL (10 ng/ml) induced cell death by 36% (P<0.001). No cell death was associated with HGF alone. Treating cells with PHA-665752, a specific c-Met receptor tyrosine kinase inhibitor, significantly abrogated the enhancement of TRAIL-induced cell death by HGF, indicating that its death promoting effect requires activation of its canonical receptor tyrosine kinase. Cell death induced by TRAIL+HGF was predominately apoptotic involving both extrinsic and intrinsic pathways as evidenced by the increased activation of caspase-3, 8, 9. Promotion of apoptosis by HGF occurred via the increased expression of the death receptor DR5 and enhanced formation of death-inducing signal complexes (DISC). CONCLUSION: Taken together, these and previous findings indicate that HGF:c-Met pathway either promotes or inhibits medulloblastoma cell death via pathway and context specific mechanisms.Item Open Access High-Impact Chronic Pain Transition in Lumbar Surgery Recipients.(Pain medicine (Malden, Mass.), 2023-03) Cook, Chad E; George, Steven Z; Lentz, Trevor; Park, Christine; Shaffrey, Christopher I; Goodwin, C Rory; Than, Khoi D; Gottfried, Oren NObjective
High-impact chronic pain (HICP) is a term that characterizes the presence of a severe and troubling pain-related condition. To date, the prevalence of HICP in lumbar spine surgery recipients and their HICP transitions from before to after surgery are unexplored. The purpose was to define HICP prevalence, transition types, and outcomes in lumbar spine surgery recipients and to identify predictors of HICP outcomes.Methods
In total, 43,536 lumbar surgery recipients were evaluated for HICP transition. Lumbar spine surgery recipients were categorized as having HICP preoperatively and at 3 months after surgery if they exhibited chronic and severe pain and at least one major activity limitation. Four HICP transition groups (Stable Low Pain, Transition from HICP, Transition to HICP, and Stable High Pain) were categorized and evaluated for outcomes. Multivariate multinomial modeling was used to predict HICP transition categorization.Results
In this sample, 15.1% of individuals exhibited HICP preoperatively; this value declined to 5.1% at 3 months after surgery. Those with HICP at baseline and 3 months had more comorbidities and worse overall outcomes. Biological, psychological, and social factors predicted HICP transition or Stable High Pain; some of the strongest involved social factors of 2 or more to transition to HICP (OR = 1.43; 95% CI = 1.21-1.68), and baseline report of pain/disability (OR = 3.84; 95% CI = 3.20-4.61) and psychological comorbidity (OR = 1.78; 95% CI = 1.48-2.12) to Stable Stable High Pain.Conclusion
The percentage of individuals with HICP preoperatively (15.1%) was low, which further diminished over a 3-month period (5.1%). Postoperative HICP groups had higher levels of comorbidities and worse baseline outcomes scores. Transition to and maintenance of HICP status was predicted by biological, psychological, and social factors.Item Open Access Impact of US hospital center and interhospital transfer on spinal cord injury management: An analysis of the National Trauma Data Bank.(The journal of trauma and acute care surgery, 2021-06) Williamson, Theresa; Hodges, Sarah; Yang, Lexie Zidanyue; Lee, Hui-Jie; Gabr, Mostafa; Ugiliweneza, Beatrice; Boakye, Maxwell; Shaffrey, Christopher I; Goodwin, C Rory; Karikari, Isaac O; Lad, Shivanand; Abd-El-Barr, MuhammadBackground
Traumatic spinal cord injury (SCI) is a serious public health problem. Outcomes are determined by severity of immediate injury, mitigation of secondary downstream effects, and rehabilitation. This study aimed to understand how the center type a patient presents to and whether they are transferred influence management and outcome.Methods
The National Trauma Data Bank was used to identify patients with SCI. The primary objective was to determine association between center type, transfer, and surgical intervention. A secondary objective was to determine association between center type, transfer, and surgical timing. Multivariable logistic regression models were fit on surgical intervention and timing of the surgery as binary variables, adjusting for relevant clinical and demographic variables.Results
There were 11,744 incidents of SCI identified. A total of 2,883 patients were transferred to a Level I center and 4,766 presented directly to a level I center. Level I center refers to level I trauma center. Those who were admitted directly to level I centers had a higher odd of receiving a surgery (odds ratio, 1.703; 95% confidence interval, 1.47-1.97; p < 0.001), but there was no significant difference in terms of timing of surgery. Patients transferred into a level I center were also more likely to undergo surgery than those at a level II/III/IV center, although this was not significant (odds ratio, 1.213; 95% confidence interval, 0.099-1.48; p = 0.059).Conclusion
Patients with traumatic SCI admitted to level I trauma centers were more likely to have surgery, particularly if they were directly admitted to a level I center. This study provides insights into a large US sample and sheds light on opportunities for improving pre hospital care pathways for patients with traumatic SCI, to provide the timely and appropriate care and achieve the best possible outcomes.Level of evidence
Care management, Level IV.Item Open Access Importance of Spinal Alignment in Primary and Metastatic Spine Tumors.(World neurosurgery, 2019-12) Sankey, Eric W; Park, Christine; Howell, Elizabeth P; Pennington, Zach; Abd-El-Barr, Muhammad; Karikari, Isaac O; Shaffrey, Christopher I; Gokaslan, Ziya L; Sciubba, Daniel; Goodwin, C RorySpinal alignment, particularly with respect to spinopelvic parameters, is highly correlated with morbidity and health-related quality-of-life outcomes. Although the importance of spinal alignment has been emphasized in the deformity literature, spinopelvic parameters have not been considered in the context of spine oncology. Because the aim of oncologic spine surgery is mostly palliative, consideration of spinopelvic parameters could improve postoperative outcomes in both the primary and metastatic tumor population by taking overall vertebral stability into account. This review highlights the relevance of focal and global spinal alignment, particularly related to spinopelvic parameters, in the treatment of spine tumors.Item Open Access 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 MStudy 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.Item Open Access Insurance status as a mediator of clinical presentation, type of intervention, and short-term outcomes for patients with metastatic spine disease.(Cancer epidemiology, 2022-02) Price, Meghan J; De la Garza Ramos, Rafael; Dalton, Tara; McCray, Edwin; Pennington, Zach; Erickson, Melissa; Walsh, Kyle M; Yassari, Reza; Sciubba, Daniel M; Goodwin, Andrea N; Goodwin, C RoryBackground
It is well established that insurance status is a mediator of disease management, treatment course, and clinical outcomes in cancer patients. Our study assessed differences in clinical presentation, treatment course, mortality rates, and in-hospital complications for patients admitted to the hospital with late-stage cancer - specifically, metastatic spine disease (MSD), by insurance status.Methods
The United States National Inpatient Sample (NIS) database (2012-2014) was queried to identify patients with visceral metastases, metastatic spinal cord compression (MSCC) or pathological fracture of the spine in the setting of cancer. Clinical presentation, type of intervention, mortality rates, and in-hospital complications were compared amongst patients by insurance coverage (Medicare, Medicaid, commercial or unknown). Multivariable logistical regression and age sensitivity analyses were performed.Results
A total of 48,560 MSD patients were identified. Patients with Medicaid coverage presented with significantly higher rates of MSCC (p < 0.001), paralysis (0.008), and visceral metastases (p < 0.001). Patients with commercial insurance were more likely to receive surgical intervention (OR 1.43; p < 0.001). Patients with Medicaid < 65 had higher rates of prolonged length of stay (PLOS) (OR 1.26; 95% CI, 1.01-1.55; p = 0.040) while both Medicare and Medicaid patients < 65 were more likely to have non-routine discharges. In-hospital mortality rates were significantly higher for patients with Medicaid (OR 2.66; 95% CI 1.20-5.89; p = 0.016) and commercial insurance (OR 1.58; 95% CI 1.09-2.27;p = 0.013) older than 65.Conclusion
Given the differing severity in MSD presentation, mortality rates, and rates of PLOS by insurance status, our results identify disparities based on insurance coverage.Item Open Access 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 RoryObjective
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.Item Open Access 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 MTraumatic 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.Item Open Access Measuring Outcomes in Spinal Deformity Surgery(Neurosurgery Clinics of North America, 2023-01-01) Bergin, Stephen M; Abd-El-Barr, Muhammad M; Gottfried, Oren N; Goodwin, C Rory; Shaffrey, Christopher I; Than, Khoi DItem Open Access Metastatic extrapulmonary small cell carcinoma to the cerebellopontine angle: a case report and review of the literature.(Case Rep Oncol Med, 2015) Theodros, Debebe; Goodwin, C Rory; Crane, Genevieve M; Liauw, Jason; Kleinberg, Lawrence; Lim, MichaelExtrapulmonary small cell carcinomas (EPSCC) are rare malignancies with poor patient prognoses. We present the case of a 63-year-old male who underwent surgical resection of a poorly differentiated small cell carcinoma, likely from a small intestinal primary tumor that metastasized to the cerebellopontine angle (CPA). A 63-year-old male presented with mild left facial paralysis, hearing loss, and balance instability. MRI revealed a 15 mm mass in the left CPA involving the internal auditory canal consistent with a vestibular schwannoma. Preoperative MRI eight weeks later demonstrated marked enlargement to 35 mm. The patient underwent a suboccipital craniectomy and the mass was grossly different visually and in consistency from a standard vestibular schwannoma. The final pathology revealed a poorly differentiated small cell carcinoma. Postoperative PET scan identified avid uptake in the small intestine suggestive of either a small intestinal primary tumor or additional metastatic disease. The patient underwent whole brain radiation therapy and chemotherapy and at last follow-up demonstrated improvement in his symptoms. Surgical resection and radiotherapy are potential treatment options to improve survival in patients diagnosed with NET brain metastases. We present the first documented case of skull base metastasis of a poorly differentiated small cell carcinoma involving the CPA.