Browsing by Author "Lewis, SJ"

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Open Access
Fehlings et al respond
(Spine Journal, 2012-06-01) Fehlings, MG; Vaccaro, A; Wilson, JR; Kopjar, B; Harrop, JS; Aarabi, B; Shaffrey, CI; Dvorak, MF; Fisher, CG; Arnold, PM; Massicotte, EM; Lewis, SJ; Rampersaud, YR
Open Access
Intraoperative neuromonitoring has a poor correlation with postoperative neurological deficits in noncord level adult deformity surgery
(Spine Journal, 2024-09-01) Sardar, Z; Swamy, G; Yoshida, G; Kelly, MP; Strantzas, S; Basu, S; Kwan, K; Smith, JS; Pellise, F; Gupta, MC; Jones, KE; Charalampidis, A; Rocos, B; Lewis, SJ; Lenke, LG
BACKGROUND CONTEXT: Intraoperative neuromonitoring (IONM) is routinely used during spinal deformity surgery. While it is highly effective at detecting spinal cord level changes, the utility for surgery at a noncord level is less known. The purpose of this study is to evaluate rates of new neural deficits relative to IONM alerts in noncord-level spinal deformity surgery. PURPOSE: In noncord-level spinal deformity surgery, postop neural deficits are incompletely associated with IONM alerts. The purpose of this study was to assess the efficacy of neuromonitoring in detecting and preventing neurological deficits. STUDY DESIGN/SETTING: Prospective, international, multicenter cohort. PATIENT SAMPLE: A total of 197 adult patients undergoing spinal deformity surgery at a noncord level. OUTCOME MEASURES: IONM changes defined as loss of amplitude>50% in SSEP or MEP from baseline or sustained EMG activity lasting>10 seconds were recorded. Postoperative new neurological deficits were recorded. Other outcomes measured were baseline demographics, radiographic alignment parameters, events leading to and following IONM alerts. METHODS: Twenty international centers prospectively documented IONM (EMG, SSEP and MEP), demographics, radiographic findings, and surgical events of patients (10-80 years) undergoing spinal deformity surgery. Inclusion criteria: neurologically intact, spinal deformity correction with major Cobb>80° or involving any osteotomy. IONM change was defined as loss of amplitude>50% in SSEP or MEP from baseline or sustained EMG activity lasting>10 seconds. RESULTS: Of 197 patients, 22 (11.2%) had an IONM alert. More patients were undergoing revision surgery during an alert compared to those with no alert (40.9% vs 18.9%, p = 0.026). IONM alerts did not correlate with coronal cobb angle, deformity angular ratio, sagittal vertical axis, or coronal vertical axis. There were a total of 26 alerts in 22 patients - 4 patients (18.2%) had 2 IONM alerts, while the other 18 (81.8%) had 1 alert. MEPs were affected in 21 of 26 alerts (80.8%) and 15 (71.4%) of those were recovered. Isolated MEP changes were seen in 16 of 26 alerts (61.5%). SSEPs were affected in 8 of 26 alerts (30.8%). Isolated SSEP changes were seen in 3 (11.5%). Lastly, EMGs were affected in only 2 (7.7%) and were isolated. Five of 21 MEP alerts (23.8%) were bilateral, whereas 16 (76.2%) were unilateral. The most frequent event preceding an MEP change was an osteotomy in 6 (28.6%) of 21 patients. The most frequent nonsurgical event preceding an MEP alert was technical in 5 (23.8%), followed by systemic (low blood pressure/anemia) and anesthetic in 3 patients each (14.3%). Thirty-three of 197 patients (16.8%) developed a new postop neural deficit. Of these patients, 24 (72.7%) had no IONM alert. In the presence of an IONM alert 9 of 22 (40.9%) had a new neural deficit. IONM alert and development of new neural deficit had a crude negative predictive value (NPV) of 86.1%. CONCLUSIONS: In noncord-level spinal deformity surgery, IONM alerts occurred in 11.2% of patients, with osteotomy being the most frequent preceding surgical event. A new postop neural deficit was observed in 16.8% of all patients, and in 41% of patients with a IONM alert. A surprisingly high 73% of postop neural deficits occurred in patients who did not have an alert. This highlights the need for further refinement of IONM techniques and alert criteria for noncord-level surgery. FDA Device/Drug Status: This abstract does not discuss or include any applicable devices or drugs.
Open Access
Long-term follow-up of non‑neurologic and neurologic complications after complex adult spinal deformity surgery: results from the Scoli-RISK-1 study
(European Spine Journal, 2025-01-01) Cerpa, M; Zuckerman, SL; Lenke, LG; Carreon, LY; Cheung, KMC; Kelly, MP; Fehlings, MG; Ames, CP; Boachie-Adjei, O; Dekutoski, MB; Kebaish, KM; Lewis, SJ; Matsuyama, Y; Pellisé, F; Qiu, Y; Schwab, FJ; Smith, JS; Shaffrey, CI
Purpose: To report all complications that occurred during the 2 to 5-year postoperative period, describe reoperations during this time period, and compare patients who did and did not have major, surgery-related complications and/or reoperations during this time period. Methods: The Scoli-RISK-1 study enrolled 272 ASD patients undergoing surgery from 15 centers. Inclusion criteria were Cobb angle of > 80°, corrective osteotomy for congenital/revision deformity, and/or 3-column osteotomy. At each follow-up visit, any neurologic or non-neurologic adverse event(AE) was documented & categorized. Results: 77 patients had a minimum 5-year follow-up. 35 surgery-related AE’s occurred during the 2 to 5-year period in 25(32.5%) patients. 23/35(65.7%) major, surgery-related complications occurred in 17 patients, 22/35(62.9%) requiring reoperations in 16 patients. Rod fracture and/or pseudarthrosis was the most common complication. The most common minor, surgery-related complication was asymptomatic rod fractures with no alignment changes. Four neurological complications were reported, one of which did not require reoperation. One death occurred at 6.1 years postoperative after multiple reoperations for mechanical complications. 14/17(82.4%) patients with major, surgery-related complication had a preceding AE during the initial 2-year postoperative period. 53 non-surgery-related AEs occurred in 21(27.3%) patients with musculoskeletal(37.7%) occurring most often. No differences were observed in ODI or SRS-22r in those with/without major surgery-related complications or those with/without reoperation. Conclusion: During the study period, 25(32.5%) patients experienced 35 surgery-related complications, of which 23(65.7%) were major. Rod fracture with pseudarthrosis was the most common major, surgery-related complication. Neurologic complications were not found to be major drivers of reoperation. Surprisingly, PROs were similar in those with/without a major, surgery-related complication during the study period. Abstract presentation: This work has been presented as a podium presentation at the 55th Scoliosis Research Society annual meeting, Sep 9–13, 2020.
Open Access
Rapid response during spinal deformity surgery can successfully save spinal cord function using intraoperative monitoring.
(Spine Journal, 2024-09-01) Theologis, AA; Gupta, MC; Swamy, G; Yoshida, G; Kelly, MP; Strantzas, S; Basu, S; Kwan, K; Smith, JS; Pellise, F; Kato, S; Sardar, Z; Ames, CP; Jones, KE; Charalampidis, A; Rocos, B; Lenke, LG; Lewis, SJ
This abstract contains content that is significantly similar to the authors' previously published abstract in the Global Spine Journal Rapid Fire. For access to the original publication, please visit the following DOI: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11086046/pdf/10.1177_21925682241239518.pdf.
Open Access
Responding to Intraoperative Neuromonitoring Changes During Pediatric Coronal Spinal Deformity Surgery
(Global Spine Journal, 2019-05-01) Lewis, SJ; Wong, IHY; Strantzas, S; Holmes, LM; Vreugdenhil, I; Bensky, H; Nielsen, CJ; Zeller, R; Lebel, DE; de Kleuver, M; Germscheid, N; Alanay, A; Berven, S; Cheung, KMC; Ito, M; Polly, DW; Shaffrey, CI; Qiu, Y; Lenke, LG
Study Design: Retrospective case study on prospectively collected data. Objectives: The purpose of this explorative study was: 1) to determine if patterns of spinal cord injury could be detected through intra-operative neuromonitoring (IONM) changes in pediatric patients undergoing spinal deformity corrections, 2) to identify if perfusion based or direct trauma causes of IONM changes could be distinguished, 3) to observe the effects of the interventions performed in response to these events, and 4) to attempt to identify different treatment algorithms for the different causes of IONM alerts. Methods: Prospectively collected neuromonitoring data in pre-established forms on consecutive pediatric patients undergoing coronal spinal deformity surgery at a single center was reviewed. Real-time data was collected on IONM alerts with >50% loss in signal. Patients with alerts were divided into 2 groups: unilateral changes (direct cord trauma), and bilateral MEP changes (cord perfusion deficits). Results: A total of 97 pediatric patients involving 71 females and 26 males with a mean age of 14.9 (11-18) years were included in this study. There were 39 alerts in 27 patients (27.8% overall incidence). All bilateral changes responded to a combination of transfusion, increasing blood pressure, and rod removal. Unilateral changes as a result of direct trauma, mainly during laminotomies for osteotomies, improved with removal of the causative agent. Following corrective actions in response to the alerts, all cases were completed as planned. Signal returned to near baseline in 20/27 patients at closure, with no new neurological deficits in this series. Conclusion: A high incidence of alerts occurred in this series of cases. Dividing IONM changes into perfusion-based vs direct trauma directed treatment to the offending cause, allowing for safe corrections of the deformities. Patients did not need to recover IONM signal to baseline to have a normal neurological examination.
Open Access
Severe hip and knee osteoarthritis worsens patient-reported disability in adult spinal deformity patients
(Spine Journal, 2024-09-01) Balmaceno-Criss, M; Singh, M; Xu, A; Daher, M; Lafage, R; Lewis, SJ; Klineberg, EO; Eastlack, RK; Gupta, MC; Mundis, GM; Gum, JL; Hamilton, DK; Hostin, RA; Passias, PG; Protopsaltis, TS; Kebaish, KM; Kim, HJ; Shaffrey, CI; Smith, JS; Line, B; Lenke, LG; Ames, CP; Burton, DC; Bess, S; Schwab, FJ; Lafage, V; Diebo, BG; Daniels, AH
BACKGROUND CONTEXT: The complex interplay between lower extremity osteoarthritis and sagittal alignment in adult spinal deformity patients is of growing clinical interest. PURPOSE: To quantify the sequential effects of lower extremity OA on PROMs in ASD patients. STUDY DESIGN/SETTING: Retrospective review of prospectively collected data. PATIENT SAMPLE: ASD patients with no prior history of thoracolumbar surgery, and available baseline PROMs and standing radiographs were included. OUTCOME MEASURES: Baseline demographics, spinopelvic alignment, and PROMs. METHODS: Included patients with PROMs, standing xrays, no prior thoracolumbar surgery, and bilateral Kellgren-Lawrence (KL) hip/knee grade at baseline. Patients grouped into Spine (KL <3 BL hips & knees), Spine-Hip (KL>3 BL hips, KL <3 BL knees), Spine-Knee (KL>3 BL knees, KL>3 BL hips), Spine-Hip-Knee (KL>3 BL hips & knees). Baseline demographics, spinopelvic alignment, and PROMs were compared. Multivariate regression with forward stepwise selection predicted PROMs with variables (demographic, radiographic, OA severity) with significant association identified on Pearson correlation RESULTS: Included 160 patients: 56 Spine, 32 Spine-Knee, 20 Spine-Hip, and 52 Spine-Hip-Knee. Spine-Hip-Knee patients were older (Spine=62.2, Spine-Knee=61.2, Spine-Hip=59.1, Spine-Hip-Knee=68.5; p<.001) but similar in sex, comorbidities, and frailty; p>.05. Spine-Hip-Knee patients had higher SVA (50.0,30.6,60.5,83.5), T1PA (25.2,20.4,20.3,27.8), GSA (3.7,2.3,4.3,7.5), and KA (0.0,2.1,2.9,10.5); p<.005. SRS total and VR12 PCS scores were similar but VR12-2b climbing stairs (1.73,1.91,1.55,1.40, p=.014) and SRS-8 back pain at rest (2.29,2.84,1.95,2.71, p=.012) were lower in Spine-Hip-Knee and Spine-Hip, respectively. ODI (42.75,35.88,50.30,44.59, p=.040) and ODI Pain (2.88,1.84,2.90,2.46, p=0.019) were higher in Spine-Hip patients; ODI lifting was higher in hip OA patients but not significant (2.95,2.69,3.45,3.35, p>.05). In multivariate analyses, KOA changed the prediction of ODI pain from R2 0.052 to 0.086 and SRS-8 from R2 0.077 to 0.147. HOA changed the prediction of VR12-2b from R2 0.113 to 0.140 and ODI Lifting from R2 0.175 to 0.202. Frailty impacted PROMs across all models (p<.001) and GSA changed ODI, ODI pain, and VR12-2b models (p<.05). CONCLUSIONS: Severe hip and knee OA worsen patient-reported disability and physical function in ASD patients. These results quantify the impact of lower limb arthritis on patient reported outcomes, and highlight the need for integrated assessment and management of both spinal alignment and joint health in patients. FDA Device/Drug Status: This abstract does not discuss or include any applicable devices or drugs.
Open Access
Wound Closure and Wound Dressings in Adult Spinal Deformity Surgery From the AO Spine Surveillance of Post-Operative Management
(Global Spine Journal, 2024-01-01) Oe, S; Swamy, G; Gagliardi, M; Lewis, SJ; Kato, S; Shaffrey, CI; Lenke, LG; Matsuyama, Y
Study Design: An e-mail-based online survey for adult spinal deformity (ASD) surgeons. Objective: Wound closure and dressing techniques may vary according to the discretion of the surgeon as well as geographical location. However, there are no reports on most common methods. The purpose of this study is to clarify the consensus. Methods: An online survey was distributed via email to AO Spine members. Responses from 164 ASD surgeons were surveyed. The regions were divided into 5 regions: Europe and South Africa (ESA), North America (NA), Asia Pacific (AP), Latin America (LA), and Middle East and North Africa (MENA). Wound closure methods were evaluated by glue(G), staples(S), external non-absorbable sutures (ENS), tapes(T), and only subcuticular absorbable suture (SAS). Wound Dressings consisted of dry dressing (D), plastic occlusive dressing (PO), G, Dermabond Prineo (DP). Results: The number of respondents were 57 in ESA, 33 in NA, 36 in AP, 22 in LA, and 16 in MENA. S (36.4%) was the most used wound closure method. This was followed by ENS (26.2%), SAS (14.4%), G (11.8%), and T (11.3%). S use was highest in ESA (44.3%), NA (28.6%), AP (31.7%), and MENA (58.8%). D was used by 50% of surgeons postoperatively. AP were most likely to use PO (36%). 21% of NA used DP, while between 0%-9% of surgeons used it in the rest of the world. Conclusion: Wound closure and dressings methods differ in the region. There are no current guidelines with these choices. Future studies should seek to standardize these choices.