Browsing by Author "Vaccaro, AR"

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    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.
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    Treatment of isolated cervical facet fractures: A systematic review
    (Journal of Neurosurgery: Spine, 2016-02-01) Kepler, CK; Vaccaro, AR; Chen, E; Patel, AA; Ahn, H; Nassr, A; Shaffrey, CI; Harrop, J; Schroeder, GD; Agarwala, A; Dvorak, MF; Fourney, DR; Wood, KB; Traynelis, VC; Yoon, ST; Fehlings, MG; Aarabi, B
    OBJECTIVE: In this clinically based systematic review of cervical facet fractures, the authors' aim was to determine the optimal clinical care for patients with isolated fractures of the cervical facets through a systematic review. METHODS: A systematic review of nonoperative and operative treatment methods of cervical facet fractures was performed. Reduction and stabilization treatments were compared, and analysis of postoperative outcomes was performed. MEDLINE and Scopus databases were used. This work was supported through support received from the Association for Collaborative Spine Research and AOSpine North America. RESULTS: Eleven studies with 368 patients met the inclusion criteria. Forty-six patients had bilateral isolated cervical facet fractures and 322 had unilateral isolated cervical facet fractures. Closed reduction was successful in 56.4% (39 patients) and 63.8% (94 patients) of patients using a halo vest and Gardner-Wells tongs, respectively. Comparatively, open reduction was successful in 94.9% of patients (successful reduction of open to closed reduction OR 12.8 [95% CI 6.1-26.9], p < 0.0001); 183 patients underwent internal fixation, with an 87.2% success rate in maintaining anatomical alignment. When comparing the success of patients who underwent anterior versus posterior procedures, anterior approaches showed a 90.5% rate of maintenance of reduction, compared with a 75.6% rate for the posterior approach (anterior vs posterior OR 3.1 [95% CI 1.0-9.4], p = 0.05). CONCLUSIONS: In comparison with nonoperative treatments, operative treatments provided a more successful outcome in terms of failure of treatment to maintain reduction for patients with cervical facet fractures. Operative treatment appears to provide superior results to the nonoperative treatments assessed.