Browsing by Author "Koffie, Robert M"
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Item Open Access Are Minimally Invasive Spine Surgeons or Classical Open Spine Surgeons More Consistent with Their Treatment of Adult Spinal Deformity?(World neurosurgery, 2022-09) Uribe, Juan S; Koffie, Robert M; Wang, Michael Y; Mundis, Gregory M; Kanter, Adam S; Eastlack, Robert K; Anand, Neel; Park, Paul; Smith, Justin S; Burton, Douglas C; Chou, Dean; Kelly, Michael P; Kim, Han Jo; Bess, Shay; Shaffrey, Christopher I; Schwab, Frank J; Lenke, Lawrence G; Mummaneni, Praveen VObjective
Spine surgeons have a heuristic sense of how to surgically restore alignment and address adult spinal deformity (ASD) symptoms, but consensus on the extent of treatment remains unclear. We sought to determine the variability of surgical approaches in treating ASD.Methods
Sixteen spine surgeons were surveyed on treatment approaches in 10 select ASD cases. We repeated the survey with the same surgeons 4 weeks later, with cases ordered differently. We examined the variability in length of construct, use of interbody spacers, osteotomies, and pelvic fixation frequency.Results
Treatment approaches for each case varied by surgeon, with some surgeons opting for long fusion constructs in cases for which others offered no surgery. There was no consensus among surgeons on the number of levels fused, interbody spacer use, or anterior/posterior osteotomies. Intersurgeon and intrasurgeon variability was 48% (kappa = 0.31) and 59% (kappa = 0.44) for surgeons performing minimally invasive surgery (MIS) versus 37% (kappa = 0.21) and 47% (kappa = 0.30) for those performing open surgery. In the second-round survey, 8 of 15 (53%) surgeons substantially changed the construct length, number of interbody spacers, and osteotomies in at least half the cases they previously reviewed. Surgeons performing MIS versus open surgery were less likely to extend constructs to the pelvis (42.5% vs. 67.5%; P = 0.02), but construct length was not correlated with whether a surgeon performed MIS or open surgery.Conclusions
Spinal deformity surgeons lack consensus on the optimal surgical approach for treating ASD. Classifying surgeons as performing MIS or open surgery does not mitigate this variability.Item Open Access Reliability of a Novel Classification System for Thoracic Disc Herniations.(Spine, 2023-05) Farber, S Harrison; Walker, Corey T; Zhou, James J; Godzik, Jakub; Gandhi, Shashank V; de Andrada Pereira, Bernardo; Koffie, Robert M; Xu, David S; Sciubba, Daniel M; Shin, John H; Steinmetz, Michael P; Wang, Michael Y; Shaffrey, Christopher I; Kanter, Adam S; Yen, Chun-Po; Chou, Dean; Blaskiewicz, Donald J; Phillips, Frank M; Park, Paul; Mummaneni, Praveen V; Fessler, Richard D; Härtl, Roger; Glassman, Steven D; Koski, Tyler; Deviren, Vedat; Taylor, William R; Kakarla, U Kumar; Turner, Jay D; Uribe, Juan SStudy design
Cross-sectional survey.Objective
To assess the reliability of a proposed novel classification system for thoracic disc herniations (TDHs).Summary of background data
TDHs are complex entities varying substantially in many factors, including size, location, and calcification. To date, no comprehensive system exists to categorize these lesions.Methods
Our proposed system classifies 5 types of TDHs using anatomical and clinical characteristics, with subtypes for calcification. Type 0 herniations are small (≤40% of spinal canal) TDHs without significant spinal cord or nerve root effacement; type 1 are small and paracentral; type 2 are small and central; type 3 are giant (>40% of spinal canal) and paracentral; and type 4 are giant and central. Patients with types 1-4 TDHs have correlative clinical and radiographic evidence of spinal cord compression. Twenty-one US spine surgeons with substantial TDH experience rated 10 illustrative cases to determine the system's reliability. Interobserver and intraobserver reliability were determined using the Fleiss kappa coefficient. Surgeons were also surveyed to obtain consensus on surgical approaches for the various TDH types.Results
High agreement was found for the classification system, with 80% (range 62-95%) overall agreement and high interrater and intrarater reliability (kappa 0.604 [moderate to substantial agreement] and kappa 0.630 [substantial agreement], respectively). All surgeons reported nonoperative management of type 0 TDHs. For type 1 TDHs, most respondents (71%) preferred posterior approaches. For type 2 TDHs, responses were roughly equivalent for anterolateral and posterior options. For types 3 and 4 TDHs, most respondents (72% and 68%, respectively) preferred anterolateral approaches.Conclusions
This novel classification system can be used to reliably categorize TDHs, standardize description, and potentially guide the selection of surgical approach. Validation of this system with regard to treatment and clinical outcomes represent lines of future study.