Browsing by Author "Shaffrey, CI"

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Open Access
148 Predictive Model for Return to Work After Elective Surgery for Lumbar Degenerative Disease: An Analysis From National Neurosurgery Quality Outcomes Database Registry
(Neurosurgery, 2016-08-01) Asher, AL; Chotai, S; Devin, CJ; Archer-Swygert, K; Parker, SL; Bydon, M; Hui, N; Harrell, F; Speroff, T; Dittus, R; Philips, S; Shaffrey, CI; Foley, KT; McGirt, MJ
INTRODUCTION: The current costs associated with spine care are unsustainable. The productivity loss and time away from work in gainfully employed patients contributes greatly to the financial burden. Therefore, it is vital to identify the factors associated with returning to work after lumbar spine surgery. We present a predictive model of ability to return to work (RTW) after lumbar spine surgery for degenerative spine disease.
Open Access
166 Predictive Modeling of Length of Hospital Stay Following Adult Spinal Deformity Correction: Analysis of 653 Patients With an Accuracy of 75% Within 2 Days
(Neurosurgery, 2016-08-01) Scheer, JK; Ailon, TT; Smith, JS; Hart, R; Burton, DC; Bess, S; Neuman, BJ; Passias, PG; Miller, E; Shaffrey, CI; Schwab, F; Lafage, V; Klineberg, E; Ames, CP
INTRODUCTION: The length of stay (LOS) following adult spinal deformity (ASD) surgery is a critical time period allowing for recovery to levels safe enough to return home or to rehabilitation. Thus, the goal is to minimize it for conserving hospital resources and third-party payer pressure. Factors related to LOS have not been studied nor has a predictive model been created. The goal of this study was to construct a preadmission predictive model based on patients' baseline variables and modifiable surgical parameters.
Open Access
A comparative cohort study of surgical approaches for adult spinal deformity at a minimum 2-year follow-up
(European Spine Journal, 2024-01-01) Kazarian, GS; Feuchtbaum, E; Bao, H; Soroceanu, A; Kelly, MP; Kebaish, KM; Shaffrey, CI; Burton, DC; Ames, CP; Mundis, GM; Bess, S; Klineberg, EO; Swamy, G; Schwab, FJ; Kim, HJ
Study design: This study was a retrospective multi-center comparative cohort study. Materials and methods: A retrospective institutional database of operative adult spinal deformity patients was utilized. All fusions > 5 vertebral levels and including the sacrum/pelvis were eligible for inclusion. Revisions, 3 column osteotomies, and patients with < 2-year clinical follow-up were excluded. Patients were separated into 3 groups based on surgical approach: 1) posterior spinal fusion without interbody (PSF), 2) PSF with interbody (PSF-IB), and 3) anteroposterior (AP) fusion (anterior lumbar interbody fusion or lateral lumbar interbody fusion with posterior screw fixation). Intraoperative, radiographic, and clinical outcomes, as well as complications, were compared between groups with ANOVA and χ2 tests. Results: One-hundred and thirty-eight patients were included for study (PSF, n = 37; PSF-IB, n = 44; AP, n = 57). Intraoperatively, estimated blood loss was similar between groups (p = 0.171). However, the AP group had longer operative times (547.5 min) compared to PSF (385.1) and PSF-IB (370.7) (p < 0.001). Additionally, fusion length was shorter in PSF-IB (11.4) compared to AP (13.6) and PSF (12.9) (p = 0.004). There were no differences between the groups in terms of change in alignment from preoperative to 2 years postoperative. There were no differences in clinical outcomes. While postoperative complications were largely similar between groups, operative complications were higher in the AP group (31.6%) compared to the PSF (5.4%) and PSF-IB (9.1) groups (p < 0.001). Conclusion: While there were differences in intraoperative outcomes (operative time and fusion length), there were no differences in postoperative clinical or radiographic outcomes. AP fusion was associated with a higher rate of operative complications.
Open Access
Adult Spinal Deformity Surgeons Are Unable to Accurately Predict Postoperative Spinal Alignment Using Clinical Judgment Alone
(Spine Deformity, 2016-07-01) Ailon, T; Scheer, JK; Lafage, V; Schwab, FJ; Klineberg, E; Sciubba, DM; Protopsaltis, TS; Zebala, L; Hostin, R; Obeid, I; Koski, T; Kelly, MP; Bess, S; Shaffrey, CI; Smith, JS; Ames, CP
Object Adult spinal deformity (ASD) surgery seeks to reduce disability and improve quality of life through restoration of spinal alignment. In particular, correction of sagittal malalignment is correlated with patient outcome. Inadequate correction of sagittal deformity is not infrequent. The present study assessed surgeons' ability to accurately predict postoperative alignment. Methods Seventeen cases were presented with preoperative radiographic measurements, and a summary of the operation as performed by the treating physician. Surgeon training, practice characteristics, and use of surgical planning software was assessed. Participants predicted if the surgical plan would lead to adequate deformity correction and attempted to predict postoperative radiographic parameters including sagittal vertical axis (SVA), pelvic tilt (PT), pelvic incidence to lumbar lordosis mismatch (PI-LL), thoracic kyphosis (TK). Results Seventeen surgeons participated: 71% within 0 to 10 years of practice; 88% devote >25% of their practice to deformity surgery. Surgeons accurately judged adequacy of the surgical plan to achieve correction to specific thresholds of SVA 69% ± 8%, PT 68% ± 9%, and PI-LL 68% ± 11% of the time. However, surgeons correctly predicted the actual postoperative radiographic parameters only 42% ± 6% of the time. They were more successful at predicting PT (61% ± 10%) than SVA (45% ± 8%), PI-LL (26% ± 11%), or TK change (35% ± 21%; p <.05). Improved performance correlated with greater focus on deformity but not number of years in practice or number of three-column osteotomies performed per year. Conclusion Surgeons failed to correctly predict the adequacy of the proposed surgical plan in approximately one third of presented cases. They were better at determining whether a surgical plan would achieve adequate correction than predicting specific postoperative alignment parameters. Pelvic tilt and SVA were predicted with the greatest accuracy.
Open Access
Anaplastic extramedullary cervical ependymoma with leptomeningeal metastasis.
(Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia, 2015-12) Pomeraniec, IJ; Dallapiazza, RF; Sumner, HM; Lopes, MB; Shaffrey, CI; Smith, JS
We present a rare extramedullary ependymoma with diffuse spinal metastatic disease, and review the previous reports of extramedullary spinal ependymomas. Ependymomas are the most common intramedullary spinal cord tumor in adults. These tumors rarely present as extramedullary masses. We treated a 23-year-old man with a history of progressive neck, shoulder and arm pain, with sensory and motor symptoms in the C7 dermatome. MRI of the cervical spine demonstrated a ventral contrast-enhancing lesion with evidence of enhancement along the dura and spinal cord of the upper cervical spine, thoracic spine, and cauda equina. He underwent a tumor debulking procedure without complications. Following surgery, he received craniospinal radiation to treat the remaining tumor and diffuse leptomeningeal disease. The final pathology of the tumor revealed that is was a World Health Organization Grade III anaplastic ependymoma. At the 1 year follow-up, the patient had stable imaging and had returned to his preoperative functional status. Of the 19 reported patients with primary intradural, extramedullary spinal ependymomas, two had extradural components and seven had anaplastic grades. Only one tumor with an anaplastic grade resulted in metastatic disease, but without spinal recurrence. To our knowledge, this is the first report of an intradural, extramedullary spinal ependymoma with an anaplastic grade, presenting with concomitant diffuse, nodular leptomeningeal metastasis involving the upper cervical spine, thoracic spine, conus medullaris, and cauda equina. Similar to the treatment of intramedullary ependymomas with metastasis, this patient underwent an aggressive debulking procedure followed by radiation therapy to the entire neuroaxis.
Open Access
Anterior versus posterior spinal correction and fusion for adolescent idiopathic scoliosis
(Cochrane Database of Systematic Reviews, 2014-09-29) Huitema, G; Willems, PC; van Rhijn, L; Kleijnen, J; Shaffrey, CI
This is the protocol for a review and there is no abstract. The objectives are as follows: To examine which intervention (anterior or posterior spinal correction and fusion) has the best functional clinical outcome (in terms of pain, participant satisfaction and function), the best radiographic results and the lowest complication rates in people with AIS.
Open Access
Assessment of impact of standing long-cassette radiographs on surgical planning for lumbar pathology: An international survey of spine surgeons
(Journal of Neurosurgery: Spine, 2015-11-01) Maggio, D; Ailon, TT; Smith, JS; Shaffrey, CI; Lafage, V; Schwab, F; Haid, RW; Protopsaltis, T; Klineberg, E; Scheer, JK; Bess, S; Arnold, PM; Chapman, J; Fehlings, MG; Ames, C
OBJECT: The associations among global spinal alignment, patient-reported disability, and surgical outcomes have increasingly gained attention. The assessment of global spinal alignment requires standing long-cassette anteroposterior and lateral radiographs; however, spine surgeons routinely rely only on short-segment imaging when evaluating seemingly isolated lumbar pathology. This may prohibit adequate surgical planning and may predispose surgeons to not recognize associated pathology in the thoracic spine and sagittal spinopelvic malalignment. The authors used a case-based survey questionnaire to evaluate if including long-cassette radiographs led to changes to respondents' operative plans as compared with their chosen plan when cases contained standard imaging of the involved lumbar spine only. METHODS: A case-based survey was distributed to AOSpine International members that consisted of 15 cases of lumbar spine pathology and lumbar imaging only. The same 15 cases were then shuffled and presented a second time with additional long-cassette radiographs. Each case required participants to select a single operative plan with 5 choices ranging from least to most extensive. The cases included 5 "control" cases with normal global spinal alignment and 10 "test" cases with significant sagittal and/or coronal malalignment. Mean scores were determined for each question with higher scores representing more invasive and/or extensive operative plans. RESULTS: Of 712 spine surgeons who started the survey, 316 (44%) completed the entire series, including 68% of surgeons with spine fellowship training and representation from more than 40 countries. For test cases, but not for control cases, there were significantly higher average surgical invasiveness scores for cases presented with long-cassette radiographs (4.2) as compared with those cases with lumbar imaging only (3.4; p = 0.002). The addition of long-cassette radiographs resulted in 82.1% of respondents recommending instrumentation up to the thoracic spine, a 23.2% increase as compared with the same cases presented with lumbar imaging only (p = 0.008). CONCLUSIONS: This study demonstrates the importance of maintaining a low threshold for performing standing long-cassette imaging when assessing seemingly isolated lumbar pathology. Such imaging is necessary for the assessment of spinopelvic and global spinal alignment, which can be important in operative planning. Deformity, particularly positive sagittal malalignment, may go undetected unless one maintains a high index of suspicion and obtains long-cassette radiographs. It is recommended that spine surgeons recognize the prevalence and importance of such deformity when contemplating operative intervention.
Open Access
Clinically Significant Thromboembolic Disease in Adult Spinal Deformity Surgery: Incidence and Risk Factors in 737 Patients
(Global Spine Journal, 2018-05-01) Kim, HJ; Iyer, S; Diebo, BG; Kelly, MP; Sciubba, D; Schwab, F; Lafage, V; Mundis, GM; Shaffrey, CI; Smith, JS; Hart, R; Burton, D; Bess, S; Klineberg, EO
Study Design: Retrospective cohort study. Objectives: Describe the rate and risk factors for venous thromboembolic events (VTEs; defined as deep venous thrombosis [DVT] and/or pulmonary embolism [PE]) in adult spinal deformity (ASD) surgery. Methods: ASD patients with VTE were identified in a prospective, multicenter database. Complications, revision, and mortality rate were examined. Patient demographics, operative details, and radiographic and clinical outcomes were compared with a non-VTE group. Multivariate binary regression model was used to identify predictors of VTE. Results: A total of 737 patients were identified, 32 (4.3%) had VTE (DVT = 14; PE = 18). At baseline, VTE patients were less likely to be employed in jobs requiring physical labor (59.4% vs 79.7%, P <.01) and more likely to have osteoporosis (29% vs 15.1%, P =.037) and liver disease (6.5% vs 1.4%, P =.027). Patients with VTE had a larger preoperative sagittal vertical axis (SVA; 93 mm vs 55 mm, P <.01) and underwent larger SVA corrections. VTE was associated with a combined anterior/posterior approach (45% vs 25%, P =.028). VTE patients had a longer hospital stay (10 vs 7 days, P <.05) and higher mortality rate (6.3% vs 0.7%, P <.01). Multivariate analysis demonstrated osteoporosis, lack of physical labor, and increased SVA correction were independent predictors of VTE (r2 =.11, area under the curve = 0.74, P <.05). Conclusions: The incidence of VTE in ASD is 4.3% with a DVT rate of 1.9% and PE rate of 2.4%. Osteoporosis, lack of physical labor, and increased SVA correction were independent predictors of VTE. Patients with VTE had a higher mortality rate compared with non-VTE patients.
Open Access
Complications of surgical intervention in adult lumbar scoliosis
(Current Reviews in Musculoskeletal Medicine, 2016-09-01) Christiansen, PA; LaBagnara, M; Sure, DR; Shaffrey, CI; Smith, JS
If nonoperative measures are unsuccessful in managing the pain and disability of adult spinal deformities, surgical correction may provide the potential for significant improvement in a patient’s quality of life. However, these procedures have a relatively high risk of complications. Identifying patients that may benefit from surgical intervention requires a thorough understanding of potential complications and managing the risks of any individual patient. Complications do not necessarily result in poor outcomes, and good outcomes are not always complication free. Higher risk patients potentially have more to gain, even if they experience complications. With the rapidly expanding senior population and expanded capabilities to manage high-risk patients, it is helpful to consider the lessons provided by ever expanding databases of outcome measures to refine the surgical decision-making process.
Open Access
Dorsal thoracic arachnoid web and the "scalpel sign": a distinct clinical-radiologic entity.
(AJNR. American journal of neuroradiology, 2013-05) Reardon, MA; Raghavan, P; Carpenter-Bailey, K; Mukherjee, S; Smith, JS; Matsumoto, JA; Yen, C-P; Shaffrey, ME; Lee, RR; Shaffrey, CI; Wintermark, M
Arachnoid webs are intradural extramedullary bands of arachnoid tissue that can extend to the pial surface of the spinal cord, causing a focal dorsal indentation of the cord. These webs tend to occur in the upper thoracic spine and may produce a characteristic deformity of the cord that we term the "scalpel sign." We describe 14 patients whose imaging studies demonstrated the scalpel sign. Ten of 13 patients who underwent MR imaging demonstrated T2WI cord signal-intensity changes, and 7 of these patients also demonstrated syringomyelia adjacent to the level of indentation. Seven patients underwent surgery, with 5 demonstrating an arachnoid web as the cause of the dorsal indentation demonstrated on preoperative imaging. Although the webs themselves are rarely demonstrated on imaging, we propose that the scalpel sign is a reliable indicator of their presence and should prompt consideration of surgical lysis, which is potentially curative.
Open Access
Evolution and Advancement of Adult Spinal Deformity Research and Clinical Care: An Overview of the Scoli-RISK-1 Study
(Global Spine Journal, 2019-05-01) Cerpa, M; Lenke, LG; Fehlings, MG; Shaffrey, CI; Cheung, KMC; Carreon, LY
Study Design: Narrative review. Objective: The prevalence of adult spinal deformity (ASD) has been cited anywhere between 2-32%, while the prevalence in the elderly population has been estimated at 68%. Neurologic complications following ASD surgery remains a concern. Previous literature reported incidence of neurologic complications varied between 1-10%, while non-neurologic complications reported were as high as 50%. To assess the incidence of neurologic deficits, complications, and outcomes following ASD surgery, an international group of spine deformity surgeons initiated a prospective, multicenter, international, observational study: Scoli-RISK-1. Methods: Two hundred seventy-two patients were enrolled from 15 centers with ASD having primary or revision surgery with a major Cobb≥80°, revision including an osteotomy, and/or a complex 3-column osteotomy. Patients had lower extremity muscle strength (LEMS) exams performed preoperatively and at specific time points through 2-year follow-up. Results: Preoperatively, 203 patients (74.9%) had no LEMS impairment (normal) and 68 (25.1%) had a LEMS of <50 (abnormal). Compared with baseline, 23.0% of all patients experienced a LEMS decline at discharge, with this rate decreasing to 17.1% at 6-weeks and to 9.9% at 6-months and remaining stable at 10.0% at 2-years. Conclusion: This study revealed that a decline in LEMS after complex ASD surgery is common and more frequent than previously reported. We identified such a decline in 23.0% of patients at discharge, with neurologic function recovering over time to a decline of 10.0% at 2-years postoperatively. The Scoli-RISK-1 study revealed valuable information regarding the incidence, natural history, and prognosis of neurologic and non-neurologic complications following ASD surgery and provides useful information for patient counseling.
Open Access
Evolving concepts in pelvic fixation in adult spinal deformity surgery
(Seminars in Spine Surgery, 2023-01-01) Turner, JD; Schupper, AJ; Mummaneni, PV; Uribe, JS; Eastlack, RK; Mundis, GM; Passias, PG; DiDomenico, JD; Harrison Farber, S; Soliman, MAR; Shaffrey, CI; Klineberg, EO; Daniels, AH; Buell, TJ; Burton, DC; Gum, JL; Lenke, LG; Bess, S; Mullin, JP
Long-segment adult spinal deformity (ASD) constructs carry a high risk of mechanical complications. Pelvic fixation was introduced to improve distal construct mechanics and has since become the standard for long constructs spanning the lumbosacral junction. Pelvic fixation strategies have evolved substantially over the years. Numerous techniques now use a variety of entry points, screw trajectories, and construct configurations. We review the various strategies for pelvic fixation in ASD in a systematic review of the literature and update the techniques employed in the International Spine Study Group Complex Adult Deformity Surgery database.
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
Geographic variations in clinical presentation and outcomes of decompressive surgery in patients with symptomatic degenerative cervical myelopathy: analysis of a prospective, international multicenter cohort study of 757 patients
(Spine Journal, 2018-04-01) Fehlings, MG; Kopjar, B; Ibrahim, A; Tetreault, LA; Arnold, PM; Defino, H; Kale, SS; Yoon, ST; Barbagallo, GM; Bartels, RHM; Zhou, Q; Vaccaro, AR; Zileli, M; Tan, G; Yukawa, Y; Brodke, DS; Shaffrey, CI; Santos de Moraes, O; Woodard, EJ; Scerrati, M; Tanaka, M; Toyone, T; Sasso, RC; Janssen, ME; Gokaslan, ZL; Alvarado, M; Bolger, C; Bono, CM; Dekutoski, MB
Background Context: Degenerative cervical myelopathy (DCM) is a progressive degenerative spine disease and the most common cause of spinal cord impairment in adults worldwide. Few studies have reported on regional variations in demographics, clinical presentation, disease causation, and surgical effectiveness. Purpose: The objective of this study was to evaluate differences in demographics, causative pathology, management strategies, surgical outcomes, length of hospital stay, and complications across four geographic regions. Study Design/Setting: This is a multicenter international prospective cohort study. Patient Sample: This study includes a total of 757 symptomatic patients with DCM undergoing surgical decompression of the cervical spine. Outcome Measures: The outcome measures are the Neck Disability Index (NDI), the Short Form 36 version 2 (SF-36v2), the modified Japanese Orthopaedic Association (mJOA) scale, and the Nurick grade. Materials and Methods: The baseline characteristics, disease causation, surgical approaches, and outcomes at 12 and 24 months were compared among four regions: Europe, Asia Pacific, Latin America, and North America. Results: Patients from Europe and North America were, on average, older than those from Latin America and Asia Pacific (p=.0055). Patients from Latin America had a significantly longer duration of symptoms than those from the other three regions (p<.0001). The most frequent causes of myelopathy were spondylosis and disc herniation. Ossification of the posterior longitudinal ligament was most prevalent in Asia Pacific (35.33%) and in Europe (31.75%), and hypertrophy of the ligamentum flavum was most prevalent in Latin America (61.25%). Surgical approaches varied by region; the majority of cases in Europe (71.43%), Asia Pacific (60.67%), and North America (59.10%) were managed anteriorly, whereas the posterior approach was more common in Latin America (66.25%). At the 24-month follow-up, patients from North America and Asia Pacific exhibited greater improvements in mJOA and Nurick scores than those from Europe and Latin America. Patients from Asia Pacific and Latin America demonstrated the most improvement on the NDI and SF-36v2 PCS. The longest duration of hospital stay was in Asia Pacific (14.16 days), and the highest rate of complications (34.9%) was reported in Europe. Conclusions: Regional differences in demographics, causation, and surgical approaches are significant for patients with DCM. Despite these variations, surgical decompression for DCM appears effective in all regions. Observed differences in the extent of postoperative improvements among the regions should encourage the standardization of care across centers and the development of international guidelines for the management of DCM.
Open Access
Impact of obesity on complications, infection, and patient-reported outcomes in adult spinal deformity surgery
(Journal of Neurosurgery: Spine, 2015-11-01) Soroceanu, A; Burton, DC; Diebo, BG; Smith, JS; Hostin, R; Shaffrey, CI; Boachie-Adjei, O; Mundis, GM; Ames, C; Errico, TJ; Bess, S; Gupta, MC; Hart, RA; Schwab, FJ; Lafage, V
OBJECT: Adult spinal deformity (ASD) surgery is known for its high complication rate. This study examined the impact of obesity on complication rates, infection, and patient-reported outcomes in patients undergoing surgery for ASD. METHODS: This study was a retrospective review of a multicenter prospective database of patients with ASD who were treated surgically. Patients with available 2-year follow-up data were included. Obesity was defined as having a body mass index (BMI) ≥ 30 kg/m2. Data collected included complications (total, minor, major, implant-related, radiographic, infection, revision surgery, and neurological injury), estimated blood loss (EBL), operating room (OR) time, length of stay (LOS), and patient-reported questionnaires (Oswestry Disability Index [ODI], Short Form-36 [SF-36], and Scoliosis Research Society [SRS]) at baseline and at 6 weeks, 1 year, and 2 years postoperatively. The impact of obesity was studied using multivariate modeling, accounting for confounders. RESULTS: Of 241 patients who satisfied inclusion criteria, 175 patients were nonobese and 66 were obese. Regression models showed that obese patients had a higher overall incidence of major complications (IRR 1.54, p = 0.02) and wound infections (odds ratio 4.88, p = 0.02). Obesity did not increase the number of minor complications (p = 0.62), radiographic complications (p = 0.62), neurological complications (p = 0.861), or need for revision surgery (p = 0.846). Obesity was not significantly correlated with OR time (p = 0.23), LOS (p = 0.9), or EBL (p = 0.98). Both groups experienced significant improvement over time, as measured on the ODI (p = 0.0001), SF-36 (p = 0.0001), and SRS (p = 0.0001) questionnaires. However, the overall magnitude of improvement was less for obese patients (ODI, p = 0.0035; SF-36, p = 0.0012; SRS, p = 0.022). Obese patients also had a lower rate of improvement over time (SRS, p = 0.0085; ODI, p = 0.0001; SF-36, p = 0.0001). CONCLUSIONS: This study revealed that obese patients have an increased risk of complications following ASD correction. Despite these increased complications, obese patients do benefit from surgical intervention; however, their improvement in health-related quality of life (HRQL) is less than that of nonobese patients.
Open Access
In response
(Spine, 2012-02-01) Williams, BJ; Smith, JS; Shaffrey, CI
Open Access
International Society for the Advancement of Spine Surgery Statement: Restorative Neurostimulation for Chronic Mechanical Low Back Pain Resulting From Neuromuscular Instability
(International Journal of Spine Surgery, 2023-10-30) Lorio, M; Lewandrowski, KU; Coric, D; Phillips, F; Shaffrey, CI
This International Society for the Advancement of Spine Surgery statement has been generated to respond to growing requests for background, supporting literature and evidence, and proper coding for restorative neurostimulation for chronic low back pain. Chronic low back pain describes the diverse experience of a significant proportion of the population. Conservative management of these patients remains the predominant care pathway, but for many patients, symptom relief is poor. The application of new techniques in patients who have exhausted traditional care paradigms should be undertaken with a detailed understanding of the pathology being treated, the mechanisms involved, and the data supporting efficacy. This statement on restorative neurostimulation places this technology in the context of the current understanding of the etiology of mechanical low back pain and the currently available evidence for this technique. In an appropriately selected cohort with a specific subset of chronic low back pain symptoms, this technique may provide benefit to payers and patients.
Open Access
Intraoperative Neurophysiological Monitoring in Spine Deformity Surgery
(Spine Deformity, 2012-09-01) Hwang, SW; Malhotra, NR; Shaffrey, CI; Samdani, AF
Although the incidence of neurologic injury in deformity surgery is low, the repercussions are devastating; therefore, every measure available should be adopted to minimize that risk. Advances in instrumentation have been paralleled by the development and improved understanding of intraoperative neurophysiological monitoring which enables lower morbidity in increasingly complex surgeries. Currently, multimodality intraoperative neurophysiological monitoring includes somatosensory-evoked potentials, transcranial motor–evoked potentials, triggered electromyographic stimulation, and mixed neurogenic evoked potentials. The combination of these monitoring modalities provides the greatest sensitivity in detecting impending neurologic compromise during deformity surgery.
Open Access
Introduction: Video Illustrations of Techniques and Strategies for Adult and Pediatric Spinal Deformity Surgery
(Neurosurgical Focus: Video, 2020-01-01) Smith, JS; Shaffrey, CI; Wang, M; Bydon, M; Lenke, L
Open Access
Longitudinal Assessment of Modern Spine Surgery Training: 10-Year Follow-up of a Nationwide Survey of Residency and Spine Fellowship Program Directors
(JBJS Open Access, 2023-08-01) Daniels, AH; Alsoof, D; McDonald, CL; Zhang, AS; Diebo, BG; Eberson, CP; Kuris, EO; Lavelle, W; Ames, CP; Shaffrey, CI; Hart, RA
Background:Spine surgeons complete training through residency in orthopaedic surgery (ORTH) or neurosurgery (NSGY). A survey was conducted in 2013 to evaluate spine surgery training. Over the past decade, advances in surgical techniques and the changing dynamics in fellowship training may have affected training and program director (PD) perceptions may have shifted.Methods:This study is a cross-sectional survey distributed to all PDs of ORTH and NSGY residencies and spine fellowships in the United States. Participants were queried regarding characteristics of their program, ideal characteristics of residency training, and opinions regarding the current training environment. χ2tests were used to compare answers over the years.Results:In total, 241 PDs completed the survey. From 2013 to 2023, NSGY increased the proportion of residents with >300 spine cases (86%-100%) while ORTH remained with >90% of residents with < 225 cases (p < 0.05). A greater number of NSGY PDs encouraged spine fellowship even for community spine surgery practice (0% in 2013 vs. 14% in 2023, p < 0.05), which continued to be significantly different from ORTH PDs (∼88% agreed, p > 0.05). 100% of NSGY PDs remained confident in their residents performing spine surgery, whereas ORTH confidence significantly decreased from 43% in 2013 to 25% in 2023 (p < 0.05). For spinal deformity, orthopaedic PDs (92%), NSGY PDs (96%), and fellowship directors (95%), all agreed that a spine fellowship should be pursued (p = 0.99). In both 2013 and 2023, approximately 44% were satisfied with the spine training model in the United States. In 2013, 24% of all PDs believed we should have a dedicated spine residency, which increased to 39% in 2023 (fellowship: 57%, ORTH: 38%, NSGY: 21%) (p < 0.05).Conclusion:Spine surgery training continues to evolve, yet ORTH and neurological surgery training remains significantly different in case volumes and educational strengths. In both 2013 and 2023, less than 50% of PDs were satisfied with the current spine surgery training model, and a growing minority believe that spine surgery should have its own residency training pathway.Level of Evidence:IV.

Browsing by Author "Shaffrey, CI"

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