Browsing by Author "Goodwin, CR"

Now showing 1 - 4 of 4
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    Augmented Reality in Spine Surgery Narrative Review: Seeing is Believing
    (Operative Techniques in Orthopaedics, 2023-12-01) Charles, AJ; Luo, E; Arango, A; Rowe, D; Goodwin, CR; Erickson, MM
    In recent years, augmented reality (AR) has emerged as a promising technology in spine surgery. Its benefits are numerous, including enhanced surgical accuracy, improved anatomic approximation, and uninterrupted visualization. It has proven particularly valuable in spinal fusion, allowing for meticulous planning of screw trajectories and precise alignment of screws, plates, and implants, resulting in low complication rates. Additionally, AR reduces radiation exposure by minimizing the need for intraoperative fluoroscopy. The technology has also been utilized for surgical education and training, enabling real-time feedback through telementoring. However, challenges exist. Discomfort and wearability issues are reported with current AR models, and the need for 3D image rendering prolongs procedure time. Accuracy is compromised in patients with larger body habitus, necessitating improvements in calibration to individual anatomies. Cost is another significant challenge as it requires advanced imaging capabilities in operating rooms, along with expenses for AR hardware, software, training, and personnel. Ongoing research is necessary to evaluate the sustained benefits and potential complications of AR in spine surgery. While AR demonstrates advantages in terms of patient outcomes and surgical accuracy, continued optimization is essential to enhance accessibility and success in spine surgery and orthopaedic surgery as a whole.
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    Central cord syndrome: Mechanisms, clinical presentation, and management strategies
    (Seminars in Spine Surgery, 2024-06-01) Charles, AJ; Andrade, K; Owolo, E; Barrett, C; Luo, E; Amakiri, IC; Goodwin, CR; Erickson, MM
    Central Cord Syndrome (CCS) is a prevalent form of incomplete spinal cord injury (SCI) characterized by distinct motor and sensory deficits. This paper discusses the nuances of CCS, covering epidemiology, etiology, mechanisms, clinical presentation, diagnosis, predictive factors for outcomes, management strategies, and emerging therapeutic approaches. CCS accounts for a significant portion of SCIs, with trauma, particularly hyperextension injuries in individuals with preexisting spinal stenosis, being the primary cause. Patient demographics reveal skewed distributions in age, sex, and race, influencing outcomes and care approaches. Symptoms impact patients' quality of life extensively, ranging from motor dysfunction to neuropathic pain and bladder complications. Diagnosis involves a multifaceted approach utilizing clinical assessment tools, radiological imaging, and electrophysiological tests. Predictive factors for outcomes include age, time to presentation, and injury severity, guiding treatment decisions between conservative and surgical approaches. Initial management strategies focus on trauma assessment, neuroprotection, and preventing secondary injury. While established treatments have evolved, emerging therapies present promising avenues, including GM1 gangliosides, riluzole, minocycline, stem cell therapy, and transcutaneous electrical spinal stimulation. In conclusion, this paper sheds light on the multifaceted nature of CCS, exploring various aspects from epidemiology to emerging therapeutic approaches. It offers valuable insights for the advancement of care and outcomes in individuals affected by CCS.
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    EphB2 receptor controls proliferation/migration dichotomy of glioblastoma by interacting with focal adhesion kinase.
    (Oncogene, 2012-12-13) Wang, SD; Rath, P; Lal, B; Richard, J-P; Li, Y; Goodwin, CR; Laterra, J; Xia, S
    Glioblastoma multiforme (GBM) is the most frequent and aggressive primary brain tumors in adults. Uncontrolled proliferation and abnormal cell migration are two prominent spatially and temporally disassociated characteristics of GBMs. In this study, we investigated the role of the receptor tyrosine kinase EphB2 in controlling the proliferation/migration dichotomy of GBM. We studied EphB2 gain of function and loss of function in glioblastoma-derived stem-like neurospheres, whose in vivo growth pattern closely replicates human GBM. EphB2 expression stimulated GBM neurosphere cell migration and invasion, and inhibited neurosphere cell proliferation in vitro. In parallel, EphB2 silencing increased tumor cell proliferation and decreased tumor cell migration. EphB2 was found to increase tumor cell invasion in vivo using an internally controlled dual-fluorescent xenograft model. Xenografts derived from EphB2-overexpressing GBM neurospheres also showed decreased cellular proliferation. The non-receptor tyrosine kinase focal adhesion kinase (FAK) was found to be co-associated with and highly activated by EphB2 expression, and FAK activation facilitated focal adhesion formation, cytoskeleton structure change and cell migration in EphB2-expressing GBM neurosphere cells. Taken together, our findings indicate that EphB2 has pro-invasive and anti-proliferative actions in GBM stem-like neurospheres mediated, in part, by interactions between EphB2 receptors and FAK. These novel findings suggest that tumor cell invasion can be therapeutically targeted by inhibiting EphB2 signaling, and that optimal antitumor responses to EphB2 targeting may require concurrent use of anti-proliferative agents.
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    High Prevalence of Cervical Myelopathy among Hip Fracture Patients
    (Operative Techniques in Orthopaedics, 2023-12-01) Zhang, H; Buell, T; Baldwin, E; Dalton, T; Crutcher, C; Abd-El-Barr, MM; Foster, N; Goodwin, CR; Erickson, M
    Hip fractures are devastating injuries for the elderly and an increasing burden to the healthcare system. Cervical spondylotic myelopathy (CSM), as a common cause of disability, instability, and falls in the elderly population, places patients at risk for hip fracture, and myelopathic patients are associated with increased complications after hip surgery. Myelopathy's relationship with hip fractures and impact, however, is not well understood. This study sought to 1) determine the prevalence of CSM among hip fracture patients and 2) hypothesized that hip fractures in CSM patients were associated with greater complexity and costs. In this institutional review board-exempt study, Medicare 1) hip fracture and 2) CSM patients between 2004 and 2014 were identified using the PearlDiver Patient Records Database (PearlDiver Technologies, Inc., CO) with International Classification of Diseases, Ninth Revision, (ICD-9) and Common Procedural Terminology codes. The prevalence of CSM within hip fracture patients was calculated, as was the incidence of hip fractures within CSM patients during this period. Hip fracture patients with CSM were compared with non-CSM hip fracture patients by age, medical comorbidities, average charges/payments, and average lengths of stay (LOS). Hip fracture patients with CSM who underwent cervical surgery were also compared with those who did not undergo cervical surgery, both before and after hip fracture. Statistical analysis with t-test and chi-squared test was performed, with statistical significance set at P < 0.05. Total 22,884 of 2,309,972 hip fracture patients (1.0%) from 2004 to 2014 also had CSM, representing approximately 9900 cases per million persons, higher than previous estimates of the CSM incidence in the general population. These 22,884 hip fracture patients were 4.6% of 496,939 patients with CSM diagnosed during this period, representing a hip fracture incidence of 419 cases per 100,000 persons/year, also higher than previous estimates of hip fracture incidence in the overall population. Hip fracture patients with CSM were significantly younger (P < 0.001) but had significantly greater incidence of hypertension, coronary artery disease, stroke, obesity, tobacco use, diabetes, and osteoporosis (P < 0.001) than non-CSM counterparts, as well as significantly greater average hip fracture-related LOS, per-patient charges, and per-patient payments (P < 0.001). Within this group of hip fractures with CSM, 441 patients (441/22,884; 1.9%) underwent cervical surgery prior to hip fracture, and 245 patients (245/22,884; 1.1%) underwent cervical surgery after hip fracture. These surgically treated patients with CSM were significantly younger but had higher incidence of medical comorbidities (P < 0.001) relative to hip fracture patients with CSM who did not receive cervical surgery at any point. Surgically treated CSM patients also had significantly lower per-patient charges and costs related to their hip fracture care relative to CSM patients with hip fracture who did not receive cervical surgery (P = 0.43, 0.84). This study describes for the first time a high prevalence of CSM in hip fracture patients on a populational level. The 1) prevalence of CSM among hip fracture patients and 2) incidence of hip fractures among CSM patients in this study far exceeded previous epidemiologic estimates. Hip fracture patients with CSM were seen to be significantly younger than hip fracture patients without CSM yet also were seen to have significantly more medical complexity. Hip fracture patients with CSM were also seen to have significantly greater per-patient costs and hip fracture related LOS, findings that are belied by low rates of surgical myelopathy treatment following hip fracture. This study describes for the first time a high prevalence of cervical myelopathy among hip fracture patients on a population level, with implications for both hip fracture prevention and cervical myelopathy diagnosis and treatment.