Publications by authors named "Miranda Bice"

6 Publications

  • Page 1 of 1

A Multicenter Evaluation of the Feasibility, Patient/Provider Satisfaction, and Value of Virtual Spine Consultation During the COVID-19 Pandemic.

World Neurosurg 2021 Aug 10. Epub 2021 Aug 10.

Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA. Electronic address:

Objective: To assess the feasibility, patient/provider satisfaction, and perceived value of telehealth spine consultation after rapid conversion from traditional in-office visits during the COVID-19 pandemic.

Methods: Data were obtained for patients undergoing telehealth visits with spine surgeons in the first 3 weeks after government restriction of elective surgical care at 4 sites (March 23, 2020, to April 17, 2020). Demographic factors, technique-specific elements of the telehealth experience, provider confidence in diagnostic and therapeutic assessment, patient/surgeon satisfaction, and perceived value were collected.

Results: A total of 128 unique visits were analyzed. New (74 [58%]), preoperative (26 [20%]), and postoperative (28 [22%]) patients were assessed. A total of 116 (91%) visits had successful connection on the first attempt. Surgeons felt very confident 101 times (79%) when assessing diagnosis and 107 times (84%) when assessing treatment plan. The mean and median patient satisfaction was 89% and 94%, respectively. Patient satisfaction was significantly higher for video over audio-only visits (P < 0.05). Patient satisfaction was not significantly different with patient age, location of chief complaint (cervical or thoracolumbar), or visit type (new, preoperative, or postoperative). Providers reported that 76% of the time they would choose to perform the visit again in telehealth format. Sixty percent of patients valued the visit cost as the same or slightly less than an in-office consultation.

Conclusions: This is the first study to demonstrate the feasibility and high patient/provider satisfaction of virtual spine surgical consultation, and appropriate reimbursement and balanced regulation for spine telehealth care is essential to continue this existing work.
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http://dx.doi.org/10.1016/j.wneu.2021.08.004DOI Listing
August 2021

Improving Secondary Fracture Prevention After Vertebroplasty: Implementation of a Fracture Liaison Service.

J Am Coll Radiol 2021 Sep 22;18(9):1235-1238. Epub 2021 Jun 22.

Director of Musculoskeletal Ultrasound and Fellowship Director for Musculoskeletal Imaging and Intervention, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. Electronic address:

Objective: The aim of our study was to evaluate a multidisciplinary fracture liaison service (FLS) to improve osteoporosis treatment and secondary fracture prevention for patients after vertebroplasty.

Methods: A retrospective chart review of consecutive vertebroplasty patients from January 2016 to January 2020. FLS began in December 2016 allowing for before-and-after comparison. Statistical analysis included patient demographics and procedure characteristics. Proportion of patients evaluated by the FLS clinic and treatment modification were evaluated. Opt-in versus opt-out referral strategies were compared. Dual energy x-ray absorptiometry scans or vitamin D levels within 3 months before or after vertebroplasty were assessed. Time to event analysis was used to evaluate secondary fracture occurrence.

Results: There were 137 vertebroplasty patients, 39 before FLS and 98 after FLS, included. Only 15% of all patients were already being treated in a bone health clinic. Of those referred and evaluated by the FLS, 73.0% had their osteoporosis treatment modified. Patients evaluated by the FLS were more likely to have a dual energy x-ray absorptiometry scan or a vitamin D level drawn (P < .001 for both). The opt-out referral was more effective with a 75.0% referral rate (P = .71). Secondary fracture of any kind occurred in 23.4% of all patients. Time to event analysis demonstrated a trend toward a reduced risk of secondary spinal fractures in the fracture prevention group with an adjusted hazard ratio of 0.39 (0.13-1.11, 95% confidence interval).

Discussion: A multidisciplinary FLS can be implemented for patients after vertebroplasty to evaluate osteoporotic risk factors and optimize osteoporosis therapy, both of which are important factors in preventing secondary vertebral fractures.
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http://dx.doi.org/10.1016/j.jacr.2021.06.004DOI Listing
September 2021

Clinical and Radiographic Outcomes of Lateral Interbody Fusion for Adjacent Segment Degeneration.

Int J Spine Surg 2021 Feb 18;15(1):74-81. Epub 2021 Feb 18.

Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine, Madison, Wisconsin.

Study Design: Retrospective cohort study.

Objective: Assessment of outcomes in patients undergoing lateral interbody fusion as part of the surgical treatment of adjacent segment deterioration after previous lumbar spine fusion.

Methods: Adult patients with previous lumbar posterior spinal fusion who presented with adjacent segment degeneration and stenosis refractory to nonoperative treatment and who underwent lateral lumbar interbody fusion were retrospectively analyzed. Clinical and radiographic outcomes were assessed and comparisons made between preoperative baseline and postoperative values.

Results: Thirty-six patients with symptomatic adjacent segment degeneration at 46 motion segments were included. Thirty (83.3%) of the 36 patients had complete relief of both preoperative lower extremity pain and back pain at the time of final follow-up. Six (16.7%) of the 36 patients had persistent pain, though in all 6 cases, the pain was less postoperatively than preoperatively. Oswestry Disability Index scores were improved significantly at final follow-up ( = .001). Compared with preoperative baseline parameters, initial and final postoperative radiographs had an increase in segmental lordosis ( < .001 and < .001, respectively), increase in overall lumbar lordosis ( < .05 and = .094, respectively), decrease in segmental coronal angulation ( = .63 and < .01, respectively), decrease in overall coronal angulation ( = .063 and = .009, respectively), and increase in intervertebral height ( < .001 and < .001, respectively).

Conclusion: Lateral lumbar interbody fusion achieves favorable clinical and radiographic outcomes for the treatment of adjacent segment degeneration after previous lumbar fusion.

Level Of Evidence: 4.
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http://dx.doi.org/10.14444/8010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7931741PMC
February 2021

Fluoroscopy-guided percutaneous needle aspiration of posterior epidural abscesses: a report of two cases.

Spinal Cord Ser Cases 2019 10;5:43. Epub 2019 May 10.

2Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, USA.

Introduction: Spinal epidural abscesses are most commonly treated with surgical decompression and antibiotics or in specific instances managed medically with antibiotic therapy alone. Image-guided percutaneous aspiration as an alternative to surgery has only rarely been reported in the literature.

Case Presentation: We report two cases of successful fluoroscopy-guided needle aspiration of posterior epidural abscesses. Case 1 is a 48-year-old man who presented with several days of escalating back pain and constitutional symptoms with MRI showing a posterior epidural abscess at L2-L3 causing spinal stenosis. The patient remained neurologically intact. Percutaneous needle aspiration of the collection provided dramatic pain relief with the aspirate growing methicillin sensitive . The patient made a full recovery on antibiotic therapy. Case 2 is an 81-year-old man who presented with worsening upper back pain and was found to have osteomyelitis/discitis with a large posterior epidural abscess in the thoracic spine. Needle drainage was performed with the sample growing . This patient also responded successfully to nonsurgical management with full recovery after appropriate antibiotic therapy.

Discussion: In carefully selected patients, image-guided needle aspiration of posterior epidural abscesses may be a viable and less invasive alternative to surgery.
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http://dx.doi.org/10.1038/s41394-019-0190-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6786395PMC
June 2020

A Prospective Multicenter Evaluation of the Value of the On-Call Orthopedic Resident.

J Grad Med Educ 2018 Feb;10(1):91-94

Background : Funding for graduate medical education is at risk despite the services provided by residents.

Objective : We quantified the potential monetary value of services provided by on-call orthopedic surgery residents.

Methods : We conducted a prospective, cross-sectional, multicenter cohort study design. Over a 90-day period in 2014, we collected data on consults by on-call orthopedic surgery residents at 4 tertiary academic medical centers in the United States. All inpatient and emergency department consults evaluated by first-call residents during the study period were eligible for inclusion. Based on their current procedural terminology codes, procedures and evaluations for each consult were assigned a relative value unit and converted into a monetary value to determine the value of services provided by residents. The primary outcome measures were the total dollar value of each consult and the percentage of resident salaries that could be funded by the generated value of the resident consult services.

Results : In total, 2644 consults seen by 33 residents from the 4 institutions were included for analysis. These yielded an average value of $81,868 per center for the 90-day study period, that is, $327,471 annually. With a median resident stipend of $53,992, the extrapolated average percentage of resident stipends that could be funded by these consult revenues was 73% of the stipends of the residents who took call or 36% of the stipends of the overall resident cohort.

Conclusions : The potential monetary value generated by on-call orthopedic surgery residents is substantial.
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http://dx.doi.org/10.4300/JGME-D-17-00277.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5821009PMC
February 2018

Mediating the Secondary Effects of Spinal Cord Injury Through Optimization of Key Physiologic Parameters.

J Am Acad Orthop Surg 2016 Mar;24(3):160-71

From the Department of Orthopaedics, Harborview Medical Center, Seattle, WA (Dr. Haller) and the Department of Orthopaedics, University of Utah, Salt Lake City, UT (Dr. Bice and Dr. Lawrence).

Spinal cord injury remains a challenging clinical entity with considerable socioeconomic impact on patients, their families, and the healthcare system. Advances in medical care and rehabilitation continue to improve, but treatment outcomes following tissue regeneration for spinal cord injury remain dismal. Therefore, attempts at mediating the secondary effects of spinal cord injury remain the mainstay of current treatment. Recent studies evaluating the timing of decompression suggest improved neurologic recovery with early surgical decompression and the maintenance of mean arterial pressures >85 mm Hg. With systemic and local treatments, including riluzole, minocycline, GM1 ganglioside, BA-210, and granulocyte-colony stimulating factor, remaining in their infancy, randomized controlled trials demonstrating efficacy are needed before adopting their widespread use.
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http://dx.doi.org/10.5435/JAAOS-D-14-00314DOI Listing
March 2016
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