Browsing by Subject "Vertebroplasty"

Now showing 1 - 2 of 2
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    Proximal Junctional Kyphosis Prevention Strategies: A Video Technique Guide.
    (Operative neurosurgery (Hagerstown, Md.), 2017-10) Safaee, Michael M; Osorio, Joseph A; Verma, Kushagra; Bess, Shay; Shaffrey, Christopher I; Smith, Justin S; Hart, Robert; Deviren, Vedat; Ames, Christopher P
    BACKGROUND:Proximal junctional kyphosis (PJK) is a well-recognized complication in patients undergoing posterior instrumented fusion procedures for adult spinal deformity. Strategies that reduce rates of PJK have the potential to improve the safety of these operations and decrease cost by eliminating the need for revision surgery. OBJECTIVE:To present a set of surgical techniques that can decrease rates of PJK in adults undergoing surgery for spinal deformity. METHODS:We summarize the use of vertebroplasty, transverse process hooks, terminal rod contouring, and ligament augmentation as means to reduce rates of PJK. RESULTS:We present PJK prevention strategies and a video technique guide that are safe, technically feasible, and add minimal operative time to these surgical procedures. When applied to appropriate high-risk patients, these techniques have the potential to dramatically reduce rates of PJK, which improves quality of life and decreases the cost associated with this treating adult spinal deformity. CONCLUSION:PJK prevention strategies represent a critical area for improvement in surgery for adult spinal deformity. We present a summary of techniques that are safe, feasible, and add minimal time to the overall procedure. These techniques warrant investigation in a thoughtful, prospective manner, but are supported by existing data and compelling biomechanical rationale. Our hope is that these strategies can be applied, particularly in high-risk patients, to help reduce rates of PJK.
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    ItemOpen Access
    Team Approach: Safety and Value in the Practice of Complex Adult Spinal Surgery.
    (JBJS reviews, 2020-04) Sethi, Rajiv K; Wright, Anna K; Nemani, Venu M; Bean, Helen A; Friedman, Andrew S; Leveque, Jean-Christophe A; Buchlak, Quinlan D; Shaffrey, Christopher I; Polly, David W
    Surgical management of complex adult spinal deformities is of high risk, with a substantial risk of operative mortality. Current evidence shows that potential risk and morbidity resulting from surgery for complex spinal deformity may be minimized through risk-factor optimization. The multidisciplinary team care model includes neurosurgeons, orthopaedic surgeons, physiatrists, anesthesiologists, hospitalists, psychologists, physical therapists, specialized physician assistants, and nurses. The multidisciplinary care model mimics previously described integrated care pathways designed to offer a structured means of providing a comprehensive preoperative medical evaluation and evidence-based multimodal perioperative care. The role of each team member is illustrated in the case of a 66-year-old male patient with previous incomplete spinal cord injury, now presenting with Charcot spinal arthropathy and progressive vertebral-body destruction resulting in lumbar kyphosis.