Publications by authors named "Daniel P Ahern"

28 Publications

  • Page 1 of 1

A Systematic Review of Risk Factors Associated With Distal Junctional Failure in Adult Spinal Deformity Surgery.

Clin Spine Surg 2021 Jul 7. Epub 2021 Jul 7.

School of Medicine, Royal College of Surgeons in Ireland School of Medicine, Trinity College Dublin National Spinal Injuries Unit, Department of Trauma and Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland Division of Orthopedics, Walter Reed National Military Medical Center, Washington, DC Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, CA Rothman Institute, Thomas Jefferson University, Philadelphia, PA Mayo Clinic, Department of Orthopedics, Rochester, MN School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.

Background: The surgical management of adult spinal deformity (ASD) is a major surgical undertaking associated with considerable perioperative risk and a substantial complication profile. Although the natural history and risk factors associated with proximal junctional kyphosis (PJK) and proximal junctional failure are widely reported, distal junctional failure (DJF) is less well understood.

Study Design: A systematic review was carried out.

Objectives: The primary objective is to identify the risk factors associated with DJF. The secondary objective is to delineate the incidence rate and causative factors associated with DJF.

Methods: A systematic review of articles in Medline/PubMed and The Cochrane Library databases was performed according to preferred reporting items for systematic reviews and meta-analyses guidelines. Data was collated to determine the prevalence of DJF and overall revision rates, and identify potential risk factors for development of DJF.

Results: Twelve studies were included for systematic review. There were 81/2261 (3.6%) cases of DJF. Overall, DJF represented 27.3% of all revision surgeries. Anterior-posterior surgery had a reduced incidence of postoperative DJF [5.0% vs. 8.7%; P=0.08; relative risk (RR)=1.73], as did patients below 60 years of age at the time of surgery (2.9% vs. 3.9%; P=0.09; RR=1.34). There was a higher incidence of DJF among those patients who received interbody fusion (9.9% vs. 5.1%; P=0.06; RR=1.93) compared with those who did not. However, none of these findings reached statistical significance. There were significantly more rates of DJF for fusions ending on L5 compared with constructs fused to the sacrum (11.7% vs. 3.6%; P=0.02; RR=3.28).

Conclusions: Cohorts 60 years and above of age at the time of surgery and patients managed with posterior-only fusion or interbody fusion have increased incidences of DJF. Fusion to L5 instead of the sacrum significantly influences DJF rates. However, the quality of available evidence is low and further high-quality studies are required to more robustly analyze the clinical, radiographic, and surgical risk factors associated with the development of DJF after ASD surgery.
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http://dx.doi.org/10.1097/BSD.0000000000001224DOI Listing
July 2021

The impact of the SARS-CoV-2 pandemic on referral characteristics in a national tertiary spinal injuries unit.

Ir J Med Sci 2021 Jun 11. Epub 2021 Jun 11.

National Spinal Injuries Unit, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.

Background: The SARS-CoV-2 pandemic has had profound implications on healthcare institutions.

Aims: This study aims to assess and compare referral patterns during COVID-19 to corresponding dates for the preceding 3 years (2017-2019), in order to preemptively coordinate the logistics of the surgical unit for similar future experiences.

Methods: Retrospective review for our institution, a national tertiary referral centre for spine pathology. Two distinct time-points were chosen to represent the varied levels of social restriction during the current pandemic: (i) study period 1 (SP1) from 11 November 2020 to 08 June 2020 represents a national lockdown, and (ii) study period 2 (SP2) from 09 June 2020 to 09 September 2020 indicates an easing of restrictions. Both periods were compared to corresponding dates (CP1: 11 March-08 June and CP2 09 June-09 September) for the preceding 3 years (2017-2019). Data collected included age, gender, and mechanism of injury (MOI) for descriptive analyses. MOIs were categorised into disc disease, cyclist, road-traffic-accident (RTA), falls < 2 m, falls > 2 m, malignancy, sporting injuries, and miscellaneous.

Results: All MOI categories witnessed a reduction in referral numbers during SP1: disc disease (-29%), cyclist (-5%), RTAs (-66%), falls < 2 m (-39%), falls > 2 m (-17%), malignancy (-33%), sporting injuries (-100%), and miscellaneous (-58%). Four of 8 categories (RTAs, falls < 2 m, malignancy, miscellaneous) showed a trend towards return of pre-lockdown values during SP2. Two categories (disc disease, falls > 2 m) showed a further reduction (-34%, -27%) during SP2. One category (sporting injuries) portrayed a complete return to normal values during SP2 while a notable increase in cyclist-related referrals was witnessed (+ 63%) when compared with corresponding dates of previous years.

Conclusion: Spinal injury continues to occur across almost all categories, albeit at considerably reduced numbers. RTAs and falls remained the most common MOI. Awareness needs to be drawn to the reduction of malignancy-related referrals to dissuade people with such symptoms from avoiding presentation to hospital over periods of social restrictions.
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http://dx.doi.org/10.1007/s11845-021-02678-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8193012PMC
June 2021

A meta-analysis of the diagnostic accuracy of hounsfield units on computed topography relative to dual-energy X-ray absorptiometry for the diagnosis of osteoporosis in the spine surgery population.

Spine J 2021 Mar 13. Epub 2021 Mar 13.

National Spinal Injuries Unit, Department of Trauma & Orthopaedic Surgery, Mater Misericordiae University Hospital, DN, Ireland; School of Medicine and Medical Science, University College Dublin, DN, Ireland.

Background: The preoperative identification of osteoporosis in the spine surgery population is of crucial importance. Limitations associated with dual-energy x-ray absorptiometry, such as access and reliability, have prompted the search for alternative methods to diagnose osteoporosis. The Hounsfield Unit(HU), a readily available measure on computed tomography, has garnered considerable attention in recent years as a potential diagnostic tool for reduced bone mineral density. However, the optimal threshold settings for diagnosing osteoporosis have yet to be determined.

Methods: We selected studies that included comparison of the HU(index test) with dual-energy x-ray absorptiometry evaluation(reference test). Data quality was assessed using the standardised QUADAS-2 criteria. Studies were characterised into 3 categories, based on the threshold of the index test used with the goal of obtaining a high sensitivity, high specificity or balanced sensitivity-specificity test.

Results: 9 studies were eligible for meta-analysis. In the high specificity group, the pooled sensitivity was 0.652 (95% CI 0.526 - 0.760), specificity 0.795 (95% CI 0.711 - 0.859) and diagnostic odds ratio was 6.652 (95% CI 4.367 - 10.133). In the high sensitivity group, the overall pooled sensitivity was 0.912 (95% CI 0.718 - 0.977), specificity was 0.67 (0.57 - 0.75) and diagnostic odds ratio was 19.424 (5.446 - 69.275). In the balanced sensitivity-specificity group, the overall pooled sensitivity was 0.625 (95% CI 0.504 - 0.732), specificity was 0.914 (0.823 - 0.960) and diagnostic odds ratio was 14.880 (7.521 - 29.440). Considerable heterogeneity existed throughout the analysis.

Conclusion: In conclusion, the HU is a clinically useful tool to aide in the diagnosis of osteoporosis. However, the heterogeneity seen in this study warrants caution in the interpretation of results. We have demonstrated the impact of differing HU threshold values on the diagnostic ability of this test. We would propose a threshold of 135 HU to diagnose OP. Future work would investigate the optimal HU cut-off to differentiate normal from low bone mineral density.
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http://dx.doi.org/10.1016/j.spinee.2021.03.008DOI Listing
March 2021

3D bioprinting of prevascularised implants for the repair of critically-sized bone defects.

Acta Biomater 2021 05 8;126:154-169. Epub 2021 Mar 8.

Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland; Department of Mechanical, Manufacturing and Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland; Department of Anatomy, Royal College of Surgeons in Ireland, Dublin, Ireland; Advanced Materials and Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland and Trinity College Dublin, Dublin, Ireland. Electronic address:

For 3D bioprinted tissues to be scaled-up to clinically relevant sizes, effective prevascularisation strategies are required to provide the necessary nutrients for normal metabolism and to remove associated waste by-products. The aim of this study was to develop a bioprinting strategy to engineer prevascularised tissues in vitro and to investigate the capacity of such constructs to enhance the vascularisation and regeneration of large bone defects in vivo. From a screen of different bioinks, a fibrin-based hydrogel was found to best support human umbilical vein endothelial cell (HUVEC) sprouting and the establishment of a microvessel network. When this bioink was combined with HUVECs and supporting human bone marrow stem/stromal cells (hBMSCs), these microvessel networks persisted in vitro. Furthermore, only bioprinted tissues containing both HUVECs and hBMSCs, that were first allowed to mature in vitro, supported robust blood vessel development in vivo. To assess the therapeutic utility of this bioprinting strategy, these bioinks were used to prevascularise 3D printed polycaprolactone (PCL) scaffolds, which were subsequently implanted into critically-sized femoral bone defects in rats. Micro-computed tomography (µCT) angiography revealed increased levels of vascularisation in vivo, which correlated with higher levels of new bone formation. Such prevascularised constructs could be used to enhance the vascularisation of a range of large tissue defects, forming the basis of multiple new bioprinted therapeutics. STATEMENT OF SIGNIFICANCE: This paper demonstrates a versatile 3D bioprinting technique to improve the vascularisation of tissue engineered constructs and further demonstrates how this method can be incorporated into a bone tissue engineering strategy to improve vascularisation in a rat femoral defect model.
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http://dx.doi.org/10.1016/j.actbio.2021.03.003DOI Listing
May 2021

Impact of Sarcopenia on Degenerative Lumbar Spondylosis.

Clin Spine Surg 2021 03;34(2):43-50

The Mater Hospital, Dublin, Ireland.

Sarcopenia is characterized by progressive age-related and systematic loss of skeletal muscle mass, strength, and function. It was classified as an independent disease in 2016; thus, there is a sparsity of research on the association of sarcopenia with lower back pain and spinal diseases. Its prevalence is around 10% worldwide and it has been shown to be detrimental to quality of life in the elderly. Sarcopenia can be clinically identified by assessing muscle mass and physical performance measurements to show reduced strength (eg, grip strength chair rise and knee extensions) or function (eg, walking speed or distance). Radiographic imaging techniques such as computed tomography, ultrasound, or magnetic resonance imaging help diagnose sarcopenia in the lumbar spine by measuring either the cross-sectional area or the fatty infiltrate of the lumbar musculature. The presence of sarcopenia in patients preoperatively may lead to worse postoperative outcomes. Research in the treatment options for sarcopenia presurgery is still in its infancy but exercise (both aerobic and resistance exercise have been found to slow down the rate of decline in muscle mass and strength with aging) and nutrition have been utilized to varying success and show great promise in the future.
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http://dx.doi.org/10.1097/BSD.0000000000001047DOI Listing
March 2021

What Is the Superior Technique for Long Construct Spinopelvic Fixation in Adult Spinal Deformity Surgery: Iliac Screws or S2-Alar-Iliac Screws.

Clin Spine Surg 2020 Dec 7. Epub 2020 Dec 7.

National Spinal Injuries Unit, Department of Trauma & Orthopaedic Surgery, Mater Misericordiae University Hospital.

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http://dx.doi.org/10.1097/BSD.0000000000001121DOI Listing
December 2020

Regenerative Medicine Modalities for the Treatment of Degenerative Disk Disease.

Clin Spine Surg 2020 Dec 1. Epub 2020 Dec 1.

National Spinal Injuries Unit, Department of Trauma & Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.

Degenerative disk disease is a pathologic state associated with axial skeletal pain, radiculopathy, and myelopathy, and will inevitably increase in prevalence in parallel with an aging population. The objective of regenerative medicine is to convert the inflammatory, catabolic microenvironment of degenerative disease into an anti-inflammatory, anabolic environment. This comprehensive review discusses and outlines both in vitro and in vivo efficacy of regenerative treatment modalities for degenerative disk disease, such as; mesenchymal stem cells, gene therapy, tissue engineering, and biologic treatments. To date, clinical applications have been limited secondary to a lack of standardized high quality clinical data. Additional research should focus on determining the optimal cellular makeup and concentration for each of these interventions. Nevertheless, modern medicine provides a new avenue of confronting disease, with methods surpassing traditional methods of removing the pathology in question, as regenerative medicine provides the opportunity to recover from the diseased state.
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http://dx.doi.org/10.1097/BSD.0000000000001114DOI Listing
December 2020

Methods to Mitigate Industry Influence in Industry Sponsored Research.

Clin Spine Surg 2021 May;34(4):143-145

National Spinal Injuries Unit, Department of Trauma & Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.

Medical and surgical research has always had a long-standing relationship with industry-based funding from sources, such as drug and device companies. Concerns exist surrounding the association between funding sources, outcome from studies and publication bias. Studies demonstrating increased odds ratios associated with positive results in industry sponsored studies across medicine have stimulated Cochrane reviews, literature reviews and other articles to examine this relationship further. In spine surgery in particular, studies with positive results have an odds ratio of 3.3 of being published. This article discusses the biases associated with industry sponsorship, possible ways to reduce such biases and ways to improve transparency in research relationships. This article explores the types of bias that can be encountered at different stages of research including previous trials in spine surgery. The means of improving transparency including the Physician Payment Sunshine Act of 2010 and International Committee of Medical Journal Editors (ICJME) accreditation are discussed. We recognize that physicians undertaking industry sponsored research should be protected and not be liable to perverse incentives. We conclude that mitigating bias in industry sponsored research is a multistep process and needs a multifaceted approach. The main beneficiary of research should be patients and as such a collective effort from medical professionals, health care institutions, journals and industry should approach research, and publications with that in mind.
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http://dx.doi.org/10.1097/BSD.0000000000001098DOI Listing
May 2021

What Is the Optimal Surgical Treatment for Low-Grade Isthmic Spondylolisthesis? ALIF or TLIF?

Clin Spine Surg 2020 12;33(10):389-392

Spine Service, Department of Trauma & Orthopaedic Surgery, Tallaght University Hospital.

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http://dx.doi.org/10.1097/BSD.0000000000000926DOI Listing
December 2020

Does Conjugation With Structural Carriers Augment the Fusion Properties of Demineralized Bone Matrix?

Clin Spine Surg 2020 Jul 3. Epub 2020 Jul 3.

*Royal College of Surgeons in Ireland, St. Stephen's Green †School of Medicine, Trinity College Dublin ‡National Spinal Injuries Unit, Department of Trauma & Orthopaedic Surgery, Mater Misericordiae University Hospital §UCD School of Medicine & Medical Science, University College Dublin, Dublin, Ireland.

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http://dx.doi.org/10.1097/BSD.0000000000001043DOI Listing
July 2020

Two-stage anterior and posterior fusion versus one-stage posterior fusion in patients with Scheuermann's kyphosis.

Bone Joint J 2020 Oct;102-B(10):1368-1374

Spinal Deformity Unit, Royal National Orthopaedic Hospital, Stanmore, UK.

Aims: Whether a combined anteroposterior fusion or a posterior-only fusion is more effective in the management of patients with Scheuermann's kyphosis remains controversial. The aim of this study was to compare the radiological and clinical outcomes of these surgical approaches, and to evaluate the postoperative complications with the hypothesis that proximal junctional kyphosis would be more common in one-stage posterior-only fusion.

Methods: A retrospective review of patients treated surgically for Scheuermann's kyphosis between 2006 and 2014 was performed. A total of 62 patients were identified, with 31 in each group. Parameters were compared to evaluate postoperative outcomes using chi-squared tests, independent-samples -tests, and z-tests of proportions analyses where applicable.

Results: There were six postoperative infections in the two-stage anteroposterior group compared with three in the one-stage posterior-only group. A total of four patients in the anteroposterior group required revision surgery, compared with six in the posterior-only group. There was a significantly higher incidence of junctional failure associated with the one-stage posterior-only approach (12.9% vs 0%, p = 0.036). Proximal junction kyphosis (anteroposterior fusion (74.2%) vs posterior-only fusion (77.4%); p = 0.382) and distal junctional kyphosis (anteroposterior fusion (25.8%) vs posterior-only fusion (19.3%), p = 0.271) are common postoperative complications following both surgical approaches.

Conclusion: A two-stage anteroposterior fusion was associated with a significantly greater correction of the kyphosis compared with a one-stage posterior-only fusion, with a reduced incidence of junctional failure (0 vs 3). There was a notably greater incidence of infection with two-stage anteroposterior fusion; however, all were medically managed. More patients in the posterior-only group required revision surgery. Cite this article: 2020;102-B(10):1368-1374.
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http://dx.doi.org/10.1302/0301-620X.102B10.BJJ-2020-0273.R3DOI Listing
October 2020

Advantages and Design of PROMIS Questionnaires.

Clin Spine Surg 2020 12;33(10):408-410

Spine Service, Department of Trauma & Orthopaedic Surgery, Tallaght University Hospital.

The Patient-Reported Outcomes Measurement Information System (PROMIS) is a National Institute of Health initiative to improve the measurement of clinically important symptoms and outcomes. Patient-Reported Outcomes capture health outcomes that are relevant to the daily functioning of the patient and include the monitoring of physical, mental, and social health. PROMIS offers a standardized tool to measure Patient-Reported Outcomes for use in both the clinical and research setting. It is a flexible and dynamic tool for both patient and clinician, and its use is continuing to grow internationally. This article discusses the rationale and design of this tool, as well as its advantages to both research and clinical practice.
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http://dx.doi.org/10.1097/BSD.0000000000001056DOI Listing
December 2020

What Is Finite Element Analysis?

Clin Spine Surg 2020 10;33(8):323-324

Department of Orthopaedic Surgery, Royal College of Surgeons in Ireland, Cappagh National Orthopaedic Hospital.

Finite element analysis is a computational technique to predict how different materials will react when a range of forces are applied. In the field of orthopedics, this technique has predominantly been used for implant design and testing. As the technology improves, increasing clinical applications are being developed, offering promise in the areas of surgical planning and the opportunity to tailor implants to individual patient characteristics. This article introduces the various preclinical mechanical tests available, as well as providing a brief overview of the finite element analysis technology.
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http://dx.doi.org/10.1097/BSD.0000000000001050DOI Listing
October 2020

Discography or SPECT/CT: What is the Best Diagnostic Tool for the Surgical Assessment of Degenerative Disk Disease?

Clin Spine Surg 2020 Jul 8. Epub 2020 Jul 8.

School of Medicine & Medical Science, University College Dublin.

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http://dx.doi.org/10.1097/BSD.0000000000001042DOI Listing
July 2020

Are Carbon-fiber Implants More Efficacious Than Traditional Metallic Implants for Spine Tumor Surgery?

Clin Spine Surg 2020 May 15. Epub 2020 May 15.

National Spinal Injuries Unit, Department of Trauma & Orthopaedic Surgery, Mater Misericordiae University Hospital.

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http://dx.doi.org/10.1097/BSD.0000000000001007DOI Listing
May 2020

Timing of surgical fixation in traumatic spinal fractures.

Bone Joint J 2020 May;102-B(5):627-631

National Spinal Injuries Unit, Department of Trauma and Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland, UCD School of Medicine & Medical Science, Dublin, Ireland.

Aims: The timing of surgical fixation in spinal fractures is a contentious topic. Existing literature suggests that early stabilization leads to reduced morbidity, improved neurological outcomes, and shorter hospital stay. However, the quality of evidence is low and equivocal with regard to the safety of early fixation in the severely injured patient. This paper compares complication profiles between spinal fractures treated with early fixation and those treated with late fixation.

Methods: All patients transferred to a national tertiary spinal referral centre for primary surgical fixation of unstable spinal injuries without preoperative neurological deficit between 1 July 2016 and 20 October 2017 were eligible for inclusion. Data were collected retrospectively. Patients were divided into early and late cohorts based on timing from initial trauma to first spinal operation. Early fixation was defined as within 72 hours, and late fixation beyond 72 hours.

Results: In total, 86 patients underwent spinal surgery in this period. Age ranged from 16 to 88 years. Mean Injury Severity Score (ISS) was higher in the early stabilization cohort (p = 0.020). Age was the sole significant independent variable in predicting morbidity on multiple regression analysis (p < 0.003). There was no significant difference in complication rates based on timing of surgical stabilization (p = 0.398) or ISS (p = 0.482).

Conclusion: Our results suggest that these patients are suitable for early appropriate care with spinal precautions and delayed definitive surgical stabilization. Earlier surgery conferred no morbidity benefit and had no impact on length of stay. Cite this article: 2020;102-B(5):627-631.
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http://dx.doi.org/10.1302/0301-620X.102B5.BJJ-2019-1716.R1DOI Listing
May 2020

Surgeon proficiency in robot-assisted spine surgery.

Bone Joint J 2020 May;102-B(5):568-572

National Spinal Injuries Unit, Department of Trauma & Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.

Continuous technical improvement in spinal surgical procedures, with the aim of enhancing patient outcomes, can be assisted by the deployment of advanced technologies including navigation, intraoperative CT imaging, and surgical robots. The latest generation of robotic surgical systems allows the simultaneous application of a range of digital features that provide the surgeon with an improved view of the surgical field, often through a narrow portal. There is emerging evidence that procedure-related complications and intraoperative blood loss can be reduced if the new technologies are used by appropriately trained surgeons. Acceptance of the role of surgical robots has increased in recent years among a number of surgical specialities including general surgery, neurosurgery, and orthopaedic surgeons performing major joint arthroplasty. However, ethical challenges have emerged with the rollout of these innovations, such as ensuring surgeon competence in the use of surgical robotics and avoiding financial conflicts of interest. Therefore, it is essential that trainees aspiring to become spinal surgeons as well as established spinal specialists should develop the necessary skills to use robotic technology safely and effectively and understand the ethical framework within which the technology is introduced. Traditional and more recently developed platforms exist to aid skill acquisition and surgical training which are described. The aim of this narrative review is to describe the role of surgical robotics in spinal surgery, describe measures of proficiency, and present the range of training platforms that institutions can use to ensure they employ confident spine surgeons adequately prepared for the era of robotic spinal surgery. Cite this article: 2020;102-B(5):568-572.
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http://dx.doi.org/10.1302/0301-620X.102B5.BJJ-2019-1392.R2DOI Listing
May 2020

Do Equivalence Trials Display Superiority Over the Traditional Comparative Study Methods in Orthopedic Surgery?

Clin Spine Surg 2020 06;33(5):201-204

National Spinal Injuries Unit, Department of Trauma & Orthopaedic Surgery, Mater Misericordiae University Hospital.

Superiority and equivalence trials are 2 commonly encountered methods of designing randomized controlled trials. Traditionally, the goal of a randomized controlled trial is to show superiority. However, in more recent times, there has been a tendency to show equivalence in clinical randomized trials. These differing conclusions at first glance seem to be drawn on the basis of the results of the respective trials. However, to accurately reach these conclusions, there are stark contrasts in the methodologies of these different study types. This article provides a brief overview of superiority and equivalence trials, highlights the differences between the 2, and their relevance to orthopedic surgery.
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http://dx.doi.org/10.1097/BSD.0000000000000978DOI Listing
June 2020

Is the Adoption of ERAS Protocols into Spinal Surgery Inevitable?

Clin Spine Surg 2020 06;33(5):175-178

School of Medicine, Trinity College Dublin.

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http://dx.doi.org/10.1097/BSD.0000000000000900DOI Listing
June 2020

Management of Herniated Lumbar Disk Disease and Cauda Equina Syndrome in Pregnancy.

Clin Spine Surg 2019 12;32(10):412-416

National Spinal Injuries Units, Department of Trauma & Orthopaedic Surgery, Mater Misericordiae University Hospital.

Lower back pain is a commonly reported symptom during pregnancy. However, herniated lumbar disk disease is an uncommon cause for such pain. Cauda equina syndrome (CES) during pregnancy is a rare clinical scenario. This review highlights the epidemiology, diagnostic and treatment strategies, and challenges encountered when managing herniated lumbar disk disease and CES in pregnancy. Magnetic resonance imaging is the diagnostic modality of choice. Nonoperative treatment strategies are successful in the vast majority of cases in patients with a herniated disk in the absence of CES. CES and progressive neurological deficits remain absolute indications for surgical intervention regardless of gestational age. For such patients or those with debilitating symptoms refractory to nonoperative treatment strategies, surgery has been demonstrated to be safe in the pregnant patient population. However, surgery should be performed with obstetric and midwifery support should complications occur to the fetus.
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http://dx.doi.org/10.1097/BSD.0000000000000886DOI Listing
December 2019

Image-guidance, Robotics, and the Future of Spine Surgery.

Clin Spine Surg 2020 06;33(5):179-184

Department of Trauma and Orthopaedic Surgery, National Spinal Injuries Units, Mater Misericordiae University Hospital.

Spine surgery has seen considerable advancements over the last 2 decades, particularly in the fields of image-guidance and robotics. These technologies offer the potential to overcome the various technical challenges in spinal surgery, such as physical and mental fatigue, hand tremor, difficulties with manual dexterity, and surgical precision. This review provides an overview of the image-guidance and robotics systems currently available. It will also provide an insight into the emerging technologies in development in the field of spine surgery. Image-guided and robotic-assisted surgical systems have been demonstrated to be safe, accurate, and time-efficient. Future advancements in the field include "augmented reality" systems, which build on these navigation platforms, but are yet to come to market. These developing technologies have considerable potential to improve the field of spine surgery. Further research is required in this area to determine superiority of these developing technologies over conventional techniques before widespread use should be adapted.
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http://dx.doi.org/10.1097/BSD.0000000000000809DOI Listing
June 2020

A systematic review of the presentation of scan-negative suspected cauda equina syndrome.

Surgeon 2020 Feb 11;18(1):49-52. Epub 2019 Jun 11.

Spine Service, Department of Trauma & Orthopaedic Surgery, Tallaght University Hospital, Dublin, Ireland; National Spinal Injuries Unit, Department of Trauma & Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.

Background: A significant proportion of patients presenting with suspected cauda equina syndrome (CES) do not have associated radiological evidence to support the diagnosis, often termed 'scan-negative'. Due to the limited number of studies regarding the matter, there is no clear understanding for this presentation. As a result, no treatment protocol exists for the scan-negative group. The purpose of this review is to assess the potential contributing factors leading to the presentation of suspected CES with normal imaging.

Methods: A systematic review was conducted on PubMed and Cochrane databases. Bibliographies of key articles and Google Scholar were searched for additional results. The search strategy provided 204 results. Of those, 8 had no identifiable causation for suspected CES and were included for systematic review.

Results: 6 of 8 studies investigated for a difference in clinical presentation between cohorts that may indicate a normal scan. Studies were either inconclusive and contradictory. Two studies suggest a functional somatic disorder as reasoning for negative MRI, with positive provisional findings.

Conclusion: A psychogenic hypothesis is plausible and warrants further investigation. The need for additional studies is essential to scheming a potential treatment protocol for the scan-negative population, which currently does not exist.
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http://dx.doi.org/10.1016/j.surge.2019.04.003DOI Listing
February 2020

Timing of surgical fixation in traumatic spinal fractures: A systematic review.

Surgeon 2020 Feb 4;18(1):37-43. Epub 2019 May 4.

Spine Service, Department of Trauma & Orthopaedic Surgery, Tallaght University Hospital, Dublin, Ireland; National Spinal Injuries Unit, Department of Trauma & Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.

Background: The optimal timing of fracture fixation following spinal injury is controversial. Many spinal fractures occur as part of polytrauma requiring a complex management strategy. Whilst the decision to stabilize unstable spinal column injuries is without debate, the duration between injury and definitive fixation can impact on the incidence of post-operative complications. This study was designed to systemically summarize and compare the complication profile of early vs late stabilization of spinal injuries, in an attempt to unveil an appropriate treatment protocol for traumatic spinal fractures.

Methods: A comprehensive search strategy was performed on the PubMed, Cochrane, and Google Scholar databases using key words. The search strategy provided 1120 results. Forty-six articles were reviewed for full-text. Reference lists were analysed for potential additional texts.

Results: Sixteen articles met the inclusion criteria and were included for systematic review. Studies were controversial and the overall result was inconclusive. Several studies favour early stabilisation to reduce post-surgical complication rates, especially in cases of patients with high Injury Severity Scale (ISS) scores. However, this is challenged by a small number of studies reporting a higher mortality rate in the early-stabilisation cohort.

Conclusion: Due to limited studies and a small overall cohort, the authors would cautiously recommend the early surgical fixation of unstable spine fractures in the stable trauma patient. For severely injured patients, the discordance among literature warrants the need for further investigation.
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http://dx.doi.org/10.1016/j.surge.2019.04.002DOI Listing
February 2020

Is Multilevel Anterior Lumbar Interbody Fusion (ALIF) Superior to Pedicle Subtraction Osteotomy (PSO) for Degenerative Lumbar Deformity?

Clin Spine Surg 2020 02;33(1):1-4

Department of Trauma and Orthopaedic Surgery, Spine Service, Tallaght University Hospital.

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http://dx.doi.org/10.1097/BSD.0000000000000817DOI Listing
February 2020

Is the Use of a Cervical Collar Necessary in the Nonoperative Management of Type II Peg Fractures in the Elderly?

Clin Spine Surg 2020 04;33(3):95-98

Department of Trauma & Orthopaedic Surgery, Spine Service, Tallaght University Hospital.

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http://dx.doi.org/10.1097/BSD.0000000000000821DOI Listing
April 2020

The management of penetrating rectal and anal trauma: A systematic review.

Injury 2017 Jun 7;48(6):1133-1138. Epub 2017 Mar 7.

Department of Colorectal Disease, St. Vincent's University Hospital, Ireland.

Introduction: Traumatic injuries to the lower gastrointestinal tract (rectum and anus) have been largely reported in the military setting with sparse publications from the civilian setting. Additionally, there remains a lack of international consensus regarding definitive treatment pathways. This systematic review aimed to assess the current literature and propose a standardised treatment algorithm to aid management in the civilian setting.

Methods: A systematic review of available literature from 1999 to 2016 that was performed. Primary endpoints were the assessment and surgical management of reported rectal and anal trauma.

Results: Seven studies were included in this review, reporting on 1255 patients. 96.3% had rectal trauma and 3.7% had anal trauma. Gunshot wounds are the most common mechanism of injury (46.9%). The overwhelming majority of injuries occurred in males (>85%) and were associated with other pelvic injuries. Surgical management has substantially evolved over the last five decades, with no clear consensus on best management strategies.

Conclusion: There remains significant international discrepancy regarding the management of penetrating trauma to the rectum. Key management principals include the varying use of the direct primary closure, faecal diversion, pre-sacral drainage and/or distal rectal washout (rarely used). To date, there is sparse evidence regarding the management of penetrating anal trauma.
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http://dx.doi.org/10.1016/j.injury.2017.03.002DOI Listing
June 2017
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