Browsing by Author "Wang, Timothy Y"
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Item Open Access A Novel Approach to Percutaneous Lumbar Surgeries via Kambin's Triangle - A Radiographic and Surgical Planning Analysis with Nerve Segmentation Technology.(World neurosurgery, 2023-06) Tabarestani, Troy Q; Sykes, David AW; Kouam, Romaric W; Salven, David S; Wang, Timothy Y; Mehta, Vikram A; Shaffrey, Christopher I; Wiggins, Walter F; Chi, John H; Abd-El-Barr, Muhammad MObjective
While Kambin's triangle has become an ever more important anatomic window given its proximity to the exiting nerve root, there have been limited studies examining the effect of disease on the corridor. Our goal was to better understand how pathology can affect Kambin's triangle thereby altering laterality of approach for percutaneous lumbar interbody fusion (percLIF).Methods
The authors performed a single-center retrospective review of patients evaluated for percLIF. The areas of Kambin's triangle were measured without and with nerve segmentation. For the latter, the lumbosacral nerve roots on 3D T2 MRI were manually segmented. Next, the borders of Kambin's triangle were delineated ensuring no overlap between the area and the nerve above.Results
15 patients (67.5 ± 9.7 years, 46.7% female) were retrospectively reviewed. 150 Kambin's triangles were measured. The mean areas from L1-S1 were 50.0 ± 12.3 mm2, 73.8 ± 12.5 mm2, 83.8 ± 12.2 mm2, 88.5 ± 19.0 mm2, and 116 ± 29.3 mm2, respectively. When pathology was present, the areas significantly decreased at L4-L5 (p = 0.046) and L5-S1 (p = 0.049). Higher spondylolisthesis and smaller posterior disc heights were linked with decreased areas via linear regression analysis (p < 0.05). When nerve segmentation was used, the areas were significantly smaller from L1-L5 (p < 0.05). Among 11 patients who underwent surgery, none suffered from postoperative neuropathies.Conclusion
These results illustrate the feasibility of pre-operatively segmenting lumbosacral nerves and measuring Kambin's triangle to help guide surgical planning and determine the ideal laterality of approach for percLIF.Item Open Access Advancing Prone-Transpsoas Spine Surgery: A Narrative Review and Evolution of Indications with Representative Cases.(Journal of clinical medicine, 2024-02) Drossopoulos, Peter N; Bardeesi, Anas; Wang, Timothy Y; Huang, Chuan-Ching; Ononogbu-Uche, Favour C; Than, Khoi D; Crutcher, Clifford; Pokorny, Gabriel; Shaffrey, Christopher I; Pollina, John; Taylor, William; Bhowmick, Deb A; Pimenta, Luiz; Abd-El-Barr, Muhammad MThe Prone Transpsoas (PTP) approach to lumbar spine surgery, emerging as an evolution of lateral lumbar interbody fusion (LLIF), offers significant advantages over traditional methods. PTP has demonstrated increased lumbar lordosis gains compared to LLIF, owing to the natural increase in lordosis afforded by prone positioning. Additionally, the prone position offers anatomical advantages, with shifts in the psoas muscle and lumbar plexus, reducing the likelihood of postoperative femoral plexopathy and moving critical peritoneal contents away from the approach. Furthermore, operative efficiency is a notable benefit of PTP. By eliminating the need for intraoperative position changes, PTP reduces surgical time, which in turn decreases the risk of complications and operative costs. Finally, its versatility extends to various lumbar pathologies, including degeneration, adjacent segment disease, and deformities. The growing body of evidence indicates that PTP is at least as safe as traditional approaches, with a potentially better complication profile. In this narrative review, we review the historical evolution of lateral interbody fusion, culminating in the prone transpsoas approach. We also describe several adjuncts of PTP, including robotics and radiation-reduction methods. Finally, we illustrate the versatility of PTP and its uses, ranging from 'simple' degenerative cases to complex deformity surgeries.Item Open Access Awake spinal anesthesia facilitates spine surgery in poor surgical candidates: A case series.(Neuro-Chirurgie, 2023-05) Sykes, David AW; Tabarestani, Troy Q; Salven, David S; Chaudhry, Nauman S; Wang, Timothy Y; Gottfried, Oren N; Shaffrey, Christopher I; Guinn, Nicole R; Gadsden, Jeffrey; Ayoub, Chakib M; Bullock, W Michael; Berger, Miles; Abd-El-Barr, Muhammad MBackground
Annually, hundreds of thousands of patients undergo surgery for degenerative spine disease (DSD). This represents only a fraction of patients that present for surgical consideration. Procedures are often avoided due to comorbidities that make patients poor candidates for general anesthesia (GA) and its associated risks. With increasing interest in awake surgery under spinal anesthesia (SA), the authors have observed that SA may facilitate spine surgery in patients with relative contraindications to GA. With this in mind, the authors set out to summarize the outcomes of a series of highly comorbid patients who received surgery under SA.Methods
Case logs of a single surgeon were reviewed, and patients undergoing spine surgery under SA were identified. Within this group, patients were identified with relative contraindications to GA, such as advanced age and medical comorbidities. For these patients, for whom surgery was facilitated by SA, the medical records were consulted to report demographic information and patient outcomes.Results
Ten highly comorbid patients were identified who received lumbar spine surgery for DSD under SA. Comorbidities included octogenarian status, obesity, and chronic health conditions such as heart disease. The cohort had a mean age of 75.5 and a mean American Society of Anesthesiologists Physical Status (ASA-PS) score of 3.1. The patients were predicted to have a 2.74-fold increase of serious complications compared to the average patient. There were no adverse events.Conclusion
For patients with symptomatic, refractory DSD and relative contraindications to GA, SA may facilitate safe surgical intervention with excellent outcomes.Item Open Access Beyond Placement of Pedicle Screws - New Applications for Robotics in Spine Surgery: A Multi-Surgeon, Single-Institution Experience(NEUROSURGERY, 2023) Tabarestani, Troy; Sykes, David; Murphy, Kelly Ryan; Wang, Timothy Y; Shaffrey, Christopher I; Goodwin, C Rory; Horne, Phillip; Than, Khoi Duc; Abd-El-Barr, Muhammad MItem Open Access Beyond Placement of Pedicle Screws - New Applications for Robotics in Spine Surgery: A Multi-Surgeon, Single-Institution Experience.(Frontiers in surgery, 2022-01) Tabarestani, Troy Q; Sykes, David; Murphy, Kelly R; Wang, Timothy Y; Shaffrey, Christopher I; Goodwin, C Rory; Horne, Phillip; Than, Khoi D; Abd-El-Barr, Muhammad MInterest in robotic-assisted spine surgery has grown as surgeon comfort and technology has evolved to maximize benefits of time saving and precision. However, the Food and Drug Administration (FDA) has currently only approved robotics to assist in determining the ideal trajectory for pedicle screw placement after extensive research supporting its efficacy and efficiency. To be considered a durable and effective option, robotics need to expand beyond the indication of just placing pedicle screws. This article aims to illustrate a multi-surgeon, single-institution experience with unique applications of robotic technologies in spine surgery. We will explore accessing Kambin's Triangle in percutaneous transforaminal interbody fusion (percLIF), iliac fixation in metastatic cancer, and sacroiliac (SI) fusions. Each of these topics will be covered in depth with associated background information and subsequent discussion. We show that with proper understanding of its limitations, robots can help surgeons perform difficult surgeries in a safe manner.Item Open Access Biomechanics, evaluation, and management of subaxial cervical spine injuries: A comprehensive review of the literature.(Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia, 2021-01) Wang, Timothy Y; Mehta, Vikram A; Dalton, Tara; Sankey, Eric W; Rory Goodwin, C; Karikari, Isaac O; Shaffrey, Christopher I; Than, Khoi D; Abd-El-Barr, Muhammad MStudy design
Literature review.Objectives
It has been reported that 2.4-3.7% of all blunt trauma victims suffer some element of cervical spine fracture, with the majority of these patients suffering from C3-7 (subaxial) involvement. With the improvement of first-response to trauma in the community, there are an increasing number of patients who survive their initial trauma and thus arrive at the hospital in need of further evaluation, stabilization, and management of these injuries.Methods
A comprehensive literature review compiled all relevant data on the biomechanics, imaging, evaluation, and medical and surgical management strategies for subaxial cervical spine fractures.Results
After review of the current literature on subaxial cervical spine biomechanics, imaging characteristics, evaluation strategies and surgical and orthopedic management techniques, the authors created a comprehensive review and protocol for management of subaxial cervical spine fractures.Conclusions
The subaxial cervical spine is biomechanically and anatomically unique from the remainder of the spinal axis. Evaluation of subaxial cervical spine injuries is nuanced, and improper management of these injuries can lead to significant patient morbidity and even death. This provides a comprehensive review combining anatomy, imaging characteristics, evaluation strategies, and surgical and orthopedic management principles for subaxial cervical spine fractures.Item Open Access Early Experience with Prone Lateral Interbody Fusion in Deformity Correction: A Single-Institution Experience.(Journal of clinical medicine, 2024-04) Bartlett, Alyssa M; Dibble, Christopher F; Sykes, David AW; Drossopoulos, Peter N; Wang, Timothy Y; Crutcher, Clifford L; Than, Khoi D; Bhomwick, Deb A; Shaffrey, Christopher I; Abd-El-Barr, Muhammad MBackground/Objectives: Lateral spine surgery offers effective minimally invasive deformity correction, but traditional approaches often involve separate anterior, lateral, and posterior procedures. The prone lateral technique streamlines this process by allowing single-position access for lateral and posterior surgery, potentially benefiting from the lordosing effect of prone positioning. While previous studies have compared prone lateral to direct lateral for adult degenerative diseases, this retrospective review focuses on the outcomes of adult deformity patients undergoing prone lateral interbody fusion. Methods: Ten adult patients underwent single-position prone lateral surgery for spine deformity correction, with a mean follow-up of 18 months. Results: Results showed significant improvements: sagittal vertical axis decreased by 2.4 cm, lumbar lordosis increased by 9.1°, pelvic tilt improved by 3.3°, segmental lordosis across the fusion construct increased by 12.2°, and coronal Cobb angle improved by 6.3°. These benefits remained consistent over the follow-up period. Correlational analysis showed a positive association between improvements in PROs and SVA and SL. When compared to hybrid approaches, prone lateral yielded greater improvements in SVA. Conclusions: Prone lateral surgery demonstrated favorable outcomes with reasonable perioperative risks. However, further research comparing this technique with standard minimally invasive lateral approaches, hybrid, and open approaches is warranted for a comprehensive evaluation.Item Open Access Hematocrit as a predictor of preoperative transfusion-associated complications in spine surgery: A NSQIP study.(Clinical neurology and neurosurgery, 2021-01) Mehta, Vikram A; Van Belleghem, Florence; Price, Meghan; Jaykel, Matthew; Ramirez, Luis; Goodwin, Jessica; Wang, Timothy Y; Erickson, Melissa M; Than, Khoi D; Gupta, Dhanesh K; Abd-El-Barr, Muhammad M; Karikari, Isaac O; Shaffrey, Christopher I; Rory Goodwin, CBackground context
Preoperative optimization of medical comorbidities prior to spinal surgery is becoming an increasingly important intervention in decreasing postoperative complications and ensuring a satisfactory postoperative course. The treatment of preoperative anemia is based on guidelines made by the American College of Cardiology (ACC), which recommends packed red blood cell transfusion when hematocrit is less than 21% in patients without cardiovascular disease and 24% in patients with cardiovascular disease. The literature has yet to quantify the risk profile associated with preoperative pRBC transfusion.Purpose
To determine the incidence of complications following preoperative pRBC transfusion in a cohort of patients undergoing spine surgery.Study design
Retrospective review of a national surgical database.Patient sample
The national surgical quality improvement program database OUTCOME NEASURES: Postoperative physiologic complications after a preoperative transfusion. Complications were defined as the occurrence of any DVT, PE, stroke, cardiac arrest, myocardial infarction, longer length of stay, need for mechanical ventilation greater than 48 h, surgical site infections, sepsis, urinary tract infections, pneumonia, or higher 30-day mortality.Methods
The national surgical quality improvement program database was queried, and patients were included if they had any type of spine surgery and had a preoperative transfusion.Results
Preoperative pRBC transfusion was found to be protective against complications when the hematocrit was less than 20% and associated with more complications when the hematocrit was higher than 20%. In patients with a hematocrit higher than 20%, pRBC transfusion was associated with longer lengths of stay, and higher rates of ventilator dependency greater than 48 h, pneumonia, and 30-day mortality.Conclusion
This is the first study to identify an inflection point in determining when a preoperative pRBC transfusion may be protective or may contribute to complications. Further studies are needed to be conducted to stratify by the prevalence of cardiovascular disease.Item Open Access Instrument Tracking for Prone Lateral Surgery.(World neurosurgery, 2023-01) Srinivasan, Ethan S; Hamouda, Farrah; Gnaedinger, Anika G; Wang, Timothy Y; Chan, Andrew K; Shaffrey, Christopher I; Erickson, Melissa M; Than, Khoi D; Abd-El-Barr, Muhammad MThe prone lateral transpsoas approach for lumbar interbody fusion and posterior instrumentation enables a large surface area implant without disruption of the posterior spine musculature from a single position.1,2 The addition of virtual live fluoroscopy instrument tracking navigation to surgery provides multiple benefits, including a reduction in patient and surgeon radiation exposure, highly accurate and dynamic spatial tool localization, and flexible equipment and patient positioning.3,4 Here, we highlight the use of virtual live fluoroscopy in prone lateral spine surgery. A 75-year-old man presented with prior L3-L5 fusion and progressive lower extremity pain and weakness. Using the described techniques, the patient underwent a lateral retroperitoneal interbody fusion and posterior instrumentation at L2-L3. The operation proceeded without complication, and the patient reported improved ambulation at 6-week follow-up. The prone lateral transpsoas approach and minimally invasive posterior instrumentation for lumbar interbody fusion permits effective fusion without significant posterior muscle disruption from a single position. The integration of virtual live fluoroscopy enables real-time instrument tracking throughout the minimally invasive case, with reductions in patient and surgeon radiation exposure. Video 1 depicts the use and benefits of this technology in lateral spine surgery. Compared with computed tomography-guided navigation, virtual live fluoroscopy technology enables rapid remapping to iatrogenic anatomic changes for more fluid progression through the operation.5 Virtual live fluoroscopy instrument tracking is a valuable tool that increases the safety and efficiency of single-position lateral spine surgery.Item Open Access Interhospital transfer status for spinal metastasis patients in the United States is associated with more severe clinical presentations and higher rates of inpatient complications.(Neurosurgical focus, 2021-05) De la Garza Ramos, Rafael; Park, Christine; McCray, Edwin; Price, Meghan; Wang, Timothy Y; Dalton, Tara; Baëta, César; Erickson, Melissa M; Foster, Norah; Pennington, Zach; Shin, John H; Sciubba, Daniel M; Than, Khoi D; Karikari, Isaac O; Shaffrey, Christopher I; Abd-El-Barr, Muhammad M; Yassari, Reza; Goodwin, C RoryObjective
In patients with metastatic spinal disease (MSD), interhospital transfer can potentially impact clinical outcomes as the possible benefits of transferring a patient to a higher level of care must be weighed against the negative effects associated with potential delays in treatment. While the association of clinical outcomes and transfer status has been examined in other specialties, the relationship between transfer status, complications, and risk of mortality in patients with MSD has yet to be explored. The purpose of this study was to examine the impact of transfer status on in-hospital mortality and clinical outcomes in patients diagnosed with MSD.Methods
The National (Nationwide) Inpatient Sample (NIS) database was retrospectively queried for adult patients diagnosed with vertebral pathological fracture and/or spinal cord compression in the setting of metastatic disease between 2012 and 2014. Demographics, baseline characteristics (e.g., metastatic spinal cord compression [MSCC] and paralysis), comorbidities, type of intervention, and relevant patient outcomes were controlled in a multivariable logistic regression model to analyze the association of transfer status with patient outcomes.Results
Within the 10,360 patients meeting the inclusion and exclusion criteria, higher rates of MSCC (50.2% vs 35.9%, p < 0.001) and paralysis (17.3% vs 8.4%, p < 0.001) were observed in patients transferred between hospitals compared to those directly admitted. In univariable analysis, a higher percentage of transferred patients underwent surgical intervention (p < 0.001) when compared with directly admitted patients. After controlling for significant covariates and surgical intervention, transferred patients were more likely to develop in-hospital complications (OR 1.34, 95% CI 1.18-1.52, p < 0.001), experience prolonged length of stay (OR 1.33, 95% CI 1.16-1.52, p < 0.001), and have a discharge disposition other than home (OR 1.70, 95% CI 1.46-1.98, p < 0.001), with no significant difference in inpatient mortality rates.Conclusions
Patients with MSD who were transferred between hospitals demonstrated more severe clinical presentations and higher rates of inpatient complications compared to directly admitted patients, despite demonstrating no difference in in-hospital mortality rates.Item Open Access Management of Acute Traumatic Spinal Cord Injury: A Review of the Literature.(Frontiers in surgery, 2021-01) Wang, Timothy Y; Park, Christine; Zhang, Hanci; Rahimpour, Shervin; Murphy, Kelly R; Goodwin, C Rory; Karikari, Isaac O; Than, Khoi D; Shaffrey, Christopher I; Foster, Norah; Abd-El-Barr, Muhammad MTraumatic spinal cord injury (TSCI) is a debilitating disease that poses significant functional and economic burden on both the individual and societal levels. Prognosis is dependent on the extent of the spinal injury and the severity of neurological dysfunction. If not treated rapidly, patients with TSCI can suffer further secondary damage and experience escalating disability and complications. It is important to quickly assess the patient to identify the location and severity of injury to make a decision to pursue a surgical and/or conservative management. However, there are many conditions that factor into the management of TSCI patients, ranging from the initial presentation of the patient to long-term care for optimal recovery. Here, we provide a comprehensive review of the etiologies of spinal cord injury and the complications that may arise, and present an algorithm to aid in the management of TSCI.Item Open Access Minimally invasive lateral retroperitoneal transpsoas approach for lumbar corpectomy and fusion with posterior instrumentation.(Neurosurgical focus: Video, 2022-07) Srinivasan, Ethan S; Wang, Timothy Y; Rapoport, Anna; Erickson, Melissa M; Abd-El-Barr, Muhammad M; Shaffrey, Christopher I; Than, Khoi DIn this video, the authors highlight the operative treatment of a 55-year-old man with chronic osteomyelitis discitis. The operation entailed a minimally invasive lateral retroperitoneal transpsoas approach for L3 and L4 corpectomies, L2-5 interbody fusion, and L2-5 minimally invasive posterior instrumentation. The operation proceeded in two stages, beginning in the lateral position with corpectomy of the L3 and L4 vertebral bodies and placement of a corpectomy cage. After closure of this access wound, the patient was turned to a prone position for the posterior element of the operation. Posterior instrumentation was placed with pedicle screws at L2 and L5. The video can be found here: https://stream.cadmore.media/r10.3171/2022.3.FOCVID2210.Item Open Access Novel Merging of CT and MRI to Allow for Safe Navigation into Kambin's Triangle for Percutaneous Lumbar Interbody Fusion-Initial Case Series Investigating Safety and Efficacy.(Operative neurosurgery (Hagerstown, Md.), 2023-03) Tabarestani, Troy Q; Sykes, David AW; Sykes, David AW; Maquoit, Gisselle; Wang, Timothy Y; Ayoub, Chakib M; Shaffrey, Christopher I; Wiggins, Walter F; Abd-El-Barr, Muhammad MBackground
For percutaneous lumbar fusion (percLIF), magnetic resonance imaging and computed tomography are critical to defining surgical corridors. Currently, these scans are performed separately, and surgeons then use fluoroscopy or neuromonitoring to guide instruments through Kambin's triangle. However, anatomic variations and intraoperative positional changes are possible, meaning that safely accessing Kambin's triangle remains a challenge because nerveroot visualization without endoscopes has not been thoroughly described.Objective
To overcome the known challenges of percLIF and reduce the likelihood of iatrogenic injuries by showing real-time locations of neural and bony anatomy.Methods
The authors demonstrate an intraoperative navigational platform that applies nerve root segmentation and image fusion to assist with percLIF. Five patients from a single institution were included.Results
Of the 5 patients, the mean age was 71 ± 8 years and 3 patients (60%) were female. One patient had general anesthesia while the remaining 4 patients underwent awake surgery with spinal anesthesia. The mean area for the L4-L5 Kambin's triangle was 76.1 ± 14.5 mm 2 . A case example is shown where the side of approach was based on the fact that Kambin's triangle was larger on one side compared with the other. The mean operative time was 170 ± 17 minutes, the mean blood loss was 32 ± 16 mL, and the mean hospital length of stay was 19.6 ± 8.3 hours. No patients developed postoperative complications.Conclusion
This case series demonstrates the successful and safe application of nerve segmentation using magnetic resonance imaging/computed tomography fusion to perform percLIF and provide positive patient outcomes.Item Open Access Perioperative Pain Management for Elective Spine Surgery: Opioid Use and Multimodal Strategies.(World neurosurgery, 2022-06) Corley, Jacquelyn A; Charalambous, Lefko T; Mehta, Vikram A; Wang, Timothy Y; Abdelgadir, Jihad; Than, Khoi D; Abd-El-Barr, Muhammad M; Goodwin, C Rory; Shaffrey, Christopher I; Karikari, Isaac OIn recent years, physicians and institutions have come to recognize the increasing opioid epidemic in the United States, thus prompting a dramatic shift in opioid prescribing patterns. The lack of well-studied alternative treatment regimens has led to a substantial burden of opioid addiction in the United States. These forces have led to a huge economic burden on the country. The spine surgery population is particularly high risk for uncontrolled perioperative pain, because most patients experience chronic pain preoperatively and many patients continue to experience pain postoperatively. Overall, there is a large incentive to better understand comprehensive multimodal pain management regimens, particularly in the spine surgery patient population. The goal of this review is to explore trends in pain symptoms in spine surgery patients, overview the best practices in pain medications and management, and provide a concise multimodal and behavioral treatment algorithm for pain management, which has since been adopted by a high-volume tertiary academic medical center.Item Open Access Preoperative optimization for patients undergoing elective spine surgery.(Clinical neurology and neurosurgery, 2021-01-14) Wang, Timothy Y; Price, Meghan; Mehta, Vikram A; Bergin, Stephen M; Sankey, Eric W; Foster, Norah; Erickson, Melissa; Gupta, Dhanesh K; Gottfried, Oren N; Karikari, Isaac O; Than, Khoi D; Goodwin, C Rory; Shaffrey, Christopher I; Abd-El-Barr, Muhammad MItem Open Access Pseudarthrosis rate following anterior cervical discectomy with fusion using an allograft cellular bone matrix: a multi-institutional analysis.(Neurosurgical focus, 2021-06) Bergin, Stephen M; Wang, Timothy Y; Park, Christine; Rajkumar, Shashank; Goodwin, C Rory; Karikari, Isaac O; Abd-El-Barr, Muhammad M; Shaffrey, Christopher I; Yarbrough, Chester K; Than, Khoi DObjective
The use of osteobiologics, engineered materials designed to promote bone healing by enhancing bone growth, is becoming increasingly common for spinal fusion procedures, but the efficacy of some of these products is unclear. The authors performed a retrospective, multi-institutional study to investigate the clinical and radiographic characteristics of patients undergoing single-level anterior cervical discectomy with fusion performed using the osteobiologic agent Osteocel, an allograft mesenchymal stem cell matrix.Methods
The medical records across 3 medical centers and 12 spine surgeons were retrospectively queried for patients undergoing single-level anterior cervical discectomy and fusion (ACDF) with the use of Osteocel. Pseudarthrosis was determined based on CT or radiographic imaging of the cervical spine. Patients were determined to have radiographic pseudarthrosis if they met any of the following criteria: 1) lack of bridging bone on CT obtained > 300 days postoperatively, 2) evidence of instrumentation failure, or 3) motion across the index level as seen on flexion-extension cervical spine radiographs. Univariate and multivariate analyses were then performed to identify independent preoperative or perioperative predictors of pseudarthrosis in this population.Results
A total of 326 patients met the inclusion criteria; 43 (13.2%) patients met criteria for pseudarthrosis, of whom 15 (34.9%) underwent revision surgery. There were no significant differences between patients with and those without pseudarthrosis, respectively, for patient age (54.1 vs 53.8 years), sex (34.9% vs 47.4% male), race, prior cervical spine surgery (37.2% vs 33.6%), tobacco abuse (16.3% vs 14.5%), chronic kidney disease (2.3% vs 2.8%), and diabetes (18.6% vs 14.5%) (p > 0.05). Presence of osteopenia or osteoporosis (16.3% vs 3.5%) was associated with pseudarthrosis (p < 0.001). Implant type was also significantly associated with pseudarthrosis, with a 16.4% rate of pseudarthrosis for patients with polyetherethereketone (PEEK) implants versus 8.4% for patients with allograft implants (p = 0.04). Average lengths of follow-up were 27.6 and 23.8 months for patients with and those without pseudarthrosis, respectively. Multivariate analysis demonstrated osteopenia or osteoporosis (OR 4.97, 95% CI 1.51-16.4, p < 0.01) and usage of PEEK implant (OR 2.24, 95% CI 1.04-4.83, p = 0.04) as independent predictors of pseudarthrosis.Conclusions
In patients who underwent single-level ACDF, rates of pseudarthrosis associated with the use of the osteobiologic agent Osteocel are higher than the literature-reported rates associated with the use of alternative osteobiologics. This is especially true when Osteocel is combined with a PEEK implant.Item Open Access Pushing the Limits of Minimally Invasive Spine Surgery-From Preoperative to Intraoperative to Postoperative Management.(Journal of clinical medicine, 2024-04) Drossopoulos, Peter N; Sharma, Arnav; Ononogbu-Uche, Favour C; Tabarestani, Troy Q; Bartlett, Alyssa M; Wang, Timothy Y; Huie, David; Gottfried, Oren; Blitz, Jeanna; Erickson, Melissa; Lad, Shivanand P; Bullock, W Michael; Shaffrey, Christopher I; Abd-El-Barr, Muhammad MThe introduction of minimally invasive surgery ushered in a new era of spine surgery by minimizing the undue iatrogenic injury, recovery time, and blood loss, among other complications, of traditional open procedures. Over time, technological advancements have further refined the care of the operative minimally invasive spine patient. Moreover, pre-, and postoperative care have also undergone significant change by way of artificial intelligence risk stratification, advanced imaging for surgical planning and patient selection, postoperative recovery pathways, and digital health solutions. Despite these advancements, challenges persist necessitating ongoing research and collaboration to further optimize patient care in minimally invasive spine surgery.Item Open Access Single-position prone transpsoas fusion for the treatment of lumbar adjacent segment disease: early experience of twenty-four cases across three tertiary medical centers.(European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2022-09) Wang, Timothy Y; Mehta, Vikram A; Sankey, Eric W; Shaffrey, Christopher I; Than, Khoi D; Taylor, William R; Pollina, John; Pimenta, Luiz; Abd-El-Barr, Muhammad MPurpose
Prone transpsoas fusion (PTP) is a minimally invasive technique that maximizes the benefit of lateral access interbody surgery and the prone positioning for surgically significant adjacent segment disease. The authors describe the feasibility, reproducibility and radiographic efficacy of PTP when performed for cases of lumbar ASD.Methods
Adult patients undergoing PTP for treatment of lumbar ASD at three institutions were retrospectively enrolled. Demographic information was recorded, as was operative data such as adjacent segment levels, operative time, blood loss, laterality of approach, open versus percutaneous pedicle screw instrumentation and need for primary decompression. Radiographic measurements including segmental and global lumbar lordosis, pelvic incidence, pelvic tilt, sacral slope and sagittal vertical axis were recorded both pre- and immediately post-operatively.Results
Twenty-four patients met criteria for inclusion. Average age was 60.4 ± 10.4 years and average BMI was 31.6 ± 5.0 kg/m2. Total operative time was 204.7 ± 83.3 min with blood loss of 187.9 ± 211 mL. Twenty-one patients had pedicle screw instrumentation exchanged percutaneously and 3 patients had open pedicle screw exchange. Two patients suffered pulmonary embolism that was treated medically with no long-term sequelae. One patient had transient lumbar radicular pain and all patients were discharged home with an average length of stay of 3.0 days (range 1-6). Radiographically, global lumbar lordosis improved by an average of 10.3 ± 9.0 degrees, segmental lordosis by 10.1 ± 13.3 degrees and sagittal vertical axis by 3.2 ± 3.2 cm.Conclusion
Single-position prone transpsoas lumbar interbody fusion is a clinically reproducible minimally invasive technique that can effectively treat lumbar adjacent segment disease.Item Open Access The Impact of Instrumentation and Implant Surface Technology on Cervical and Thoracolumbar Fusion.(Operative neurosurgery (Hagerstown, Md.), 2021-06) Wang, Timothy Y; Mehta, Vikram A; Sankey, Eric W; Shaffrey, Christopher I; Abd-El-Barr, Muhammad M; Than, Khoi DSpinal fusion has undergone significant evolution and improvement over the past 50 yr. Historically, spine fusion was noninstrumented and arthrodesis was based entirely on autograft. Improved understanding of spinal anatomy and materials science ushered in a new era of spinal fusion equipped with screw-based technologies and various interbody devices. Osteobiologics is another important realm of spine fusion, and the evolution of various osteobiologics has perhaps undergone the most change within the past 20 yr. A new element to spinal instrumentation has recently gained traction-namely, surface technology. New data suggest that surface treatments play an increasingly well-recognized role in inducing osteogenesis and successful fusion. Until now, however, there has yet to be a unified resource summarizing the existing data and a lack of consensus exists on superior technology. Here, authors provide an in-depth review on surface technology and its impact on spinal arthrodesis.Item Open Access The medicolegal impact of misplaced pedicle and lateral mass screws on spine surgery in the United States.(Neurosurgical focus, 2020-11) Sankey, Eric W; Mehta, Vikram A; Wang, Timothy Y; Than, Tracey T; Goodwin, C Rory; Karikari, Isaac O; Shaffrey, Christopher I; Abd-El-Barr, Muhammad M; Than, Khoi DSpine surgery has been disproportionately impacted by medical liability and malpractice litigation, with the majority of claims and payouts related to procedural error. One common area for the potential avoidance of malpractice claims and subsequent payouts involves misplaced pedicle and/or lateral mass instrumentation. However, the medicolegal impact of misplaced screws on spine surgery has not been directly reported in the literature. The authors of the current study aimed to describe this impact in the United States, as well as to suggest a potential method for mitigating the problem.This retrospective analysis of 68 closed medicolegal cases related to misplaced screws in spine surgery showed that neurosurgeons and orthopedic spine surgeons were equally named as the defendant (n = 32 and 31, respectively), and cases were most commonly due to misplaced lumbar pedicle screws (n = 41, 60.3%). Litigation resulted in average payouts of $1,204,422 ± $753,832 between 1995 and 2019, when adjusted for inflation. The median time to case closure was 56.3 (35.2-67.2) months when ruled in favor of the plaintiff (i.e., patient) compared to 61.5 (51.4-77.2) months for defendant (surgeon) verdicts (p = 0.117).