Publications by authors named "Vincent C Traynelis"

119 Publications

Nonunion Rates After Anterior Cervical Discectomy and Fusion: Comparison of Polyetheretherketone vs Structural Allograft Implants.

Neurosurgery 2021 Jun;89(1):94-101

Department of Neurological Surgery, Rush University, Chicago, Illinois, USA.

Background: Although advances in implant materials, such as polyetheretherketone (PEEK), have been developed aimed to improve outcome after anterior cervical discectomy and fusion (ACDF), it is essential to confirm whether these changes translate into clinically important sustained benefits.

Objective: To compare the radiographic and clinical outcomes of patients undergoing up to 3-level ACDF with PEEK vs structural allograft implants.

Methods: In this cohort study, radiographic and symptomatic nonunion rates were compared in consecutive patients who underwent 1 to 3 level ACDF with allograft or PEEK implant. Prospectively collected clinical data and patient-reported outcome (PRO) scores were compared between the allograft and PEEK groups. Regression analysis was performed to determine the predictors of nonunion.

Results: In total, 194 of 404 patients met the inclusion criteria (79% allograft vs 21% PEEK). Preoperative demographic variables were comparable between the 2 groups except for age. The rate of radiographic nonunion was higher with PEEK implants (39% vs 27%, P = .0035). However, a higher proportion of nonunion in the allograft cohort required posterior instrumentation (14% vs 3%, P = .039). Patients with multilevel procedures and PEEK implants had up to 5.8 times the risk of radiographic nonunion, whereas younger patients, active smokers, and multilevel procedures were at higher risk of symptomatic nonunion.

Conclusion: Along with implant material, factors such as younger age, active smoking status, and the number of operated levels were independent predictors of fusion failure. Given the impact of nonunion on PRO, perioperative optimization of modifiable factors and surgical planning are essential to ensure a successful outcome.
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http://dx.doi.org/10.1093/neuros/nyab079DOI Listing
June 2021

Clinicians' User Experience of Telemedicine in Neurosurgery During COVID-19.

World Neurosurg 2021 02 24;146:e359-e367. Epub 2020 Oct 24.

Department of Neurological Surgery, Rush University, Chicago, Illinois, USA. Electronic address:

Background: Restricted access to hospitals due to the 2019 novel coronavirus disease (COVID-19) pandemic has significantly altered practice patterns for elective neurosurgical care. Particularly, telemedicine has become the primary modality of patient visits for nonemergent conditions. This study aimed to characterize user experiences of neurosurgeons and advanced practice providers focusing on perceived utility and barriers of telemedicine in management of elective neurosurgical patients during COVID-19.

Methods: An online survey was sent to clinicians involved in neurosurgical care using telemedicine with questions focusing on frequency of utilization, duration of patient encounters, benefits of telemedicine, and barriers to current forms of remote patient visits. Survey responses were stratified by clinical position (neurosurgeon vs. advanced practice provider) and subspecialty focus (cranial vs. spinal neurosurgery).

Results: The survey was completed by 14 of 17 eligible clinicians. Respondents included 10 neurosurgeons and 4 APPs with 57% specializing in cranial neurosurgery and 43% specializing in spinal neurosurgery. During the COVID-19 period, 78% of respondents used teleconference/video conference visits multiple times in a week, and 86% planned to continue using telemedicine after the pandemic. The most common barrier for telemedicine was the inability to perform a neurological examination, while the most common perceived benefit was increased convenience for patients.

Conclusions: During the COVID-19 period, telemedicine was heavily relied on to ensure the continuation of perioperative care for patients with elective neurosurgical pathologies. While clinicians identified numerous barriers for current telemedicine platforms, the use of telemedicine will likely continue, as it has provided unique benefits for patients, clinicians, and hospitals.
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http://dx.doi.org/10.1016/j.wneu.2020.10.101DOI Listing
February 2021

Systematic review of telemedicine in spine surgery.

J Neurosurg Spine 2020 Oct 30:1-10. Epub 2020 Oct 30.

Objective: The use of telemedicine (TM) has long been available, but recent restrictions to hospitals due to the coronavirus disease 2019 (COVID-19) pandemic have accelerated the global implementation of TM. However, evidence on the effectiveness of this technology for the care of spine surgery patients is limited. In this systematic review the authors aimed to examine the current utilization of TM for spine surgery.

Methods: Using PubMed, Scopus, and the Cochrane Library, the authors performed a systematic review of the literature focused on the themes of telemedicine and spine surgery. Included in the search were randomized controlled trials, cohort studies, and case-controlled studies. Two independent reviewers conducted the study appraisal, data abstraction, and quality assessments of the studies.

Results: Out of 1463 references from the initial search results, 12 studies met the inclusion criteria. The majority of TM interventions focused on improving perioperative patient communication and patient education by using mobile phone apps, online surveys, or online materials for consent. The studies reported the feasibility of the use of TM for perioperative care and positive user experiences from the patients.

Conclusions: The current increase in TM adoption due to the COVID-19 crisis presents an opportunity to further develop and validate this technology. Early evidence in the literature supports the use of TM as an adjunct to traditional in-person clinical encounters for certain perioperative tasks such as supplemental patient education and postoperative surveys.
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http://dx.doi.org/10.3171/2020.6.SPINE20863DOI Listing
October 2020

Integrity of the tectorial membrane is a favorable prognostic factor in atlanto-occipital dislocation.

Br J Neurosurg 2020 Aug 5;34(4):470-474. Epub 2020 May 5.

Department of Neurosurgery, Sheba Medical Center, Ramat-Gan, Israel (affiliated to Sackler School of Medicine, Tel Aviv University).

Atlanto-occipital dislocation is usually considered to be a fatal injury or one that leaves the victim with serious neurological deficits. The aim of this study is to illustrate a novel positive prognostic factor for atlanto-occipital dislocation, based on cervical MRI studies of patients who suffered this injury. Over the course of the past year, the authors have treated three consecutive patients with atlanto-occipital dislocation who attained an excellent clinical outcome. We retrospectively evaluated clinical, surgical and radiographic parameters in search of a common denominator to explain the excellent outcome of these patients. All patients presented with severe polytrauma that required urgent surgical intervention including two laparotomies and a thoracotomy. The patients were subsequently treated with an occipitocervical fusion. No patient developed neurological deficits on long-term follow-up. The cervical MRI studies of all patients were notable for a having a preserved tectorial membrane, while other primary stabilizers of the craniocervical junction such as the apical, alar and cruciate ligaments were shown to be severely disrupted. We consider this anatomical distinction to account for their benign clinical course. A preserved tectorial membrane appears to be an important favorable prognostic factor in atlanto-occipital dislocation and may serve to mitigate neurological outcome in such injuries. To determine the integrity of the ligament and consequently affect clinical management, expeditious MRI of the cranio-cervical junction should be considered routinely in such injuries in addition to cervical CT scans.
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http://dx.doi.org/10.1080/02688697.2020.1761292DOI Listing
August 2020

Cervical disc arthroplasty versus anterior cervical discectomy and fusion: a meta-analysis of rates of adjacent-level surgery to 7-year follow-up.

J Spine Surg 2020 Mar;6(1):217-232

Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA.

Background: Anterior cervical discectomy and fusion (ACDF) is an effective treatment for cervical spondylosis. A limitation of ACDF is the risk of adjacent-segment degeneration (ASD), owing to arthrodesis of a motion segment. Cervical disc arthroplasty (CDA) has hence garnered significant attention; yet, compelling evidence of reduction in ASD requiring surgery is lacking. This systematic review and meta-analysis sought to compare long-term longitudinal adjacent-level operation rates with CDA versus ACDF.

Methods: An electronic literature search was conducted. Eligible studies were multi-center randomized controlled trials (RCTs) comparing CDA with ACDF for one- or two-level symptomatic cervical spondylosis. The primary outcome was adjacent-level operation. Index-level reoperation was a secondary outcome. Outcomes were evaluated at 1-year intervals from the index operation to last reported follow-up by random-effects meta-analyses.

Results: Eleven RCTs met criteria. For one-level spondylosis, there was no difference in the rate of adjacent-level operation between CDA (2.3%) and ACDF (3.6%) at 2 years. However, a large difference favoring CDA became evident at 5 years and persisted at 7 years (4.3% 10.8%, P<0.001). Significantly fewer patients who underwent CDA required index-level reoperation at all time points out to 7 years (5.2% 12.7%, P<0.001). Similar to one-level operations, there was no significant difference in adjacent-level operations with two-level CDA (1.7%) versus two-level ACDF (3.4%) at 2 years. At 7 years, a significant difference favoring CDA became apparent (5.1% 10.0%, P=0.014). Two-level CDA resulted in fewer index-level reoperations out to 7 years (4.2% 13.5%, P<0.001).

Conclusions: In this meta-analysis, the short-term rate of adjacent-level operation was similar with CDA or ACDF. However, around 5 years, a statistically significant divergence emerged, where the rate of adjacent-level surgery rose steeply for ACDF. Index-level reoperations were less frequent with CDA in both the short- and long-term. These data indicate CDA may have a superior longevity to ACDF with regard to need for subsequent adjacent-level operation.
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http://dx.doi.org/10.21037/jss.2019.12.09DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7154351PMC
March 2020

Analysis and Temporal Evolution of Extubation Parameters for Patients Undergoing Single-Stage Circumferential Cervical Spine Surgery.

Neurospine 2020 Sep 2;17(3):630-639. Epub 2020 Feb 2.

Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA.

Objective: Airway obstruction after postoperative extubation is a dreaded but uncommon complication in patients undergoing circumferential cervical spine surgery (CCSS). The cuff leak test (CLT) has been utilized to assess air leak around the endotracheal tube which may reflect airway swelling. In this prospective observational study, we analyze the temporal evolution of CLT and perioperative factors that may influence it.

Methods: Twenty patients undergoing single-stage CCSS were managed according to our extubation protocol. Patients were maintained intubated overnight following surgery. They were extubated if a CLT > 200 mL and both intensive care unit (ICU) and Neurosurgery teams agreed that it was safe. Patients extubated in the first postoperative day (8 of 20) comprised the early group, and the remaining patients (12 of 20) the delayed group. Patient and operative data were analyzed as a single group and comparing both groups.

Results: The main indication for surgery was cervical deformity. Median number of levels fused was 5 anteriorly (range, 1-6) and 6 (range, 1-13) posteriorly. Patients were kept intubated for an average of 73.6 hours (range, 26-222 hours) and stayed in the ICU for 119.1 hours (range, 36-360 hours). There were 4 failed extubations and 3 patients (15%) required a tracheostomy. Patient profiles between both groups were very similar across most patient variables but differed significantly regarding infraglottic luminal area (p < 0.05). Patients with larger preoperative cuff leak values tended to have a shorter intubation period (p = 0.053).

Conclusion: This study objectively demonstrates the difficulties in airway management following CCSS and provides useful insight for preoperative planning and counseling. Local anatomic factors influence airway outcome more than operative factors. The study format does not allow for testing of interventions but we suggest that patients with favorable anatomy (larger infraglottic luminal area) may benefit from a less strict airway management protocol.
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http://dx.doi.org/10.14245/ns.1938382.191DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7538349PMC
September 2020

Expression of degenerative markers in intervertebral discs of young and elderly asymptomatic individuals.

PLoS One 2020 27;15(1):e0228155. Epub 2020 Jan 27.

Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States of America.

Intervertebral disc (IVD) degeneration is a remodeling process mediated by several growth factors and cytokines. This process has been extensively studied in vitro and with pathologic specimens obtained during surgery for scoliosis or back pain. However, the occurrence and temporal evolution of these molecules during normal aging, particularly in the cervical segment, is not known. Our objective was to study and compare the presence of putative mediators in the IVD of young (<35 years, G1) and elderly (>65 years, G2) presumably asymptomatic individuals. Thirty C4-5 and C5-6 discs and thirty L4-5 and L5-S1 discs per group were collected during the autopsy of individuals whose family members denied a history of neck or back pain. Discs were divided into anterior, central (lumbar only) and posterior sectors for analysis. Immunohistochemistry for TNF-α, IL-1β, VEGF, NGF-β, BDNF, TIMP-1, MMP-1, -2 and -3 was performed and reactivity compared between groups and sectors. All of these molecules were detected in every disc sector of both G1 and G2. Most statistical comparisons (25/45, 55.6%) revealed an increase in mediator expression in G2 in relation to G1. Regional differences in the expression of remodeling enzymes were rare; NGF-β and BDNF had slightly higher expression in the cervical segment of elderly individuals. A senescent profile with elevated VEGF, MMP-2 and MMP-3 was observed across most G2 disc regions and were generally elevated from G1. In conclusion, the mere presence of any of the studied molecules inside the IVD cannot be considered pathologic. Expression of remodeling enzymes and inflammatory mediators is relatively similar across different vertebral segments and disc regions leading to a common degenerated pattern, while neurotrophins have slightly higher expression in cervical discs. These findings support the concept that disc remodeling in different segments follows a similar pathway that can be potentially mediated to avoid structural failure.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0228155PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6984735PMC
April 2020

Cervical disc replacement: examining "real-world" utilization of an emerging technology.

J Neurosurg Spine 2020 Jan 17:1-7. Epub 2020 Jan 17.

6Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois.

Objective: Cervical disc replacement (CDR) has emerged as an alternative to anterior cervical discectomy and fusion (ACDF) for the management of cervical spondylotic pathology. While much is known about the efficacy of CDR within the constraints of a well-controlled, experimental setting, little is known about general utilization. The authors present an analysis of temporal and geographic trends in "real-world" utilization of CDR among those enrolled in private insurance plans in the US.

Methods: Eligible subjects were identified from the IBM MarketScan Databases between 2009 and 2017. Individuals 18 years and older, undergoing a single-level CDR or ACDF for cervical radiculopathy and/or myelopathy, were identified. US Census divisions were used to classify the region where surgery was performed. Two-level mixed-effects regression modeling was used to study regional differences in proportional utilization of CDR, while controlling for confounding by regional case-mix differences.

Results: A total of 47,387 subjects met the inclusion criteria; 3553 underwent CDR and 43,834 underwent ACDF. At a national level, the utilization of single-level CDR rose from 5.6 cases for every 100 ACDFs performed in 2009 to 28.8 cases per 100 ACDFs in 2017. The most substantial increases occurred from 2013 onward. The region of highest utilization was the Mountain region (Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, and Wyoming), where 14.3 CDRs were performed for every 100 ACDFs (averaged over the 9-year period of study). This is in contrast to the East South Central region (Alabama, Kentucky, Mississippi, and Tennessee), where only 2.1 CDRs were performed for every 100 ACDFs. Patient factors that significantly increased the odds of undergoing a CDR were age younger than 40 years (OR 15.9 [95% CI 10.0-25.5]; p < 0.001), no clinical evidence of myelopathy/myeloradiculopathy (OR 1.5 [95% CI 1.4-1.7]; p < 0.001), and a Charlson Comorbidity Index score of 0 (OR 2.7 [95% CI 1.7-4.2]; p < 0.001). After controlling for these factors, significant differences in utilization rates remained between regions (chi-square test = 830.4; p < 0.001).

Conclusions: This US national level study lends insight into the rate of uptake and geographic differences in utilization of the single-level CDR procedure. Further study will be needed to ascertain specific factors that predict adoption of this technology to explain observed geographic discrepancies.
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http://dx.doi.org/10.3171/2019.10.SPINE19919DOI Listing
January 2020

Minimizing Blood Loss in Spine Surgery.

Global Spine J 2020 Jan 6;10(1 Suppl):71S-83S. Epub 2020 Jan 6.

Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Study Design: Broad narrative review.

Objective: To review and summarize the current literature on guidelines, outcomes, techniques and indications surrounding multiple modalities of minimizing blood loss in spine surgery.

Methods: A thorough review of peer-reviewed literature was performed on the guidelines, outcomes, techniques, and indications for multiple modalities of minimizing blood loss in spine surgery.

Results: There is a large body of literature that provides a consensus on guidelines regarding the appropriate timing of discontinuation of anticoagulation, aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and herbal supplements prior to surgery. Additionally, there is a more heterogenous discussion the utility of preoperative autologous blood donation facilitated by erythropoietin and iron supplementation for healthy patients slated for procedures with high anticipated blood loss and for whom allogeneic transfusion is likely. Intraoperative maneuvers available to minimize blood loss include positioning and maintaining normothermia. Tranexamic acid (TXA), bipolar sealer electrocautery, and topical hemostatic agents, and hypotensive anesthesia (mean arterial pressure (MAP) <65 mm Hg) should be strongly considered in cases with larger exposures and higher anticipated blood loss. There is strong level 1 evidence for the use of TXA in spine surgery as it reduces the overall blood loss and transfusion requirements.

Conclusion: As the volume and complexity of spinal procedures rise, intraoperative blood loss management has become a pivotal topic of research within the field. There are many tools for minimizing blood loss in patients undergoing spine surgery. The current literature supports combining techniques to use a cost- effective multimodal approach to minimize blood loss in the perioperative period.
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http://dx.doi.org/10.1177/2192568219868475DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6947684PMC
January 2020

Ambulatory Surgical Centers: Improving Quality of Operative Spine Care?

Global Spine J 2020 Jan 6;10(1 Suppl):29S-35S. Epub 2020 Jan 6.

Rush University Medical Center, Chicago, IL, USA.

Study Design: Narrative review with commentary.

Objective: Present healthcare reform focuses on cost-optimization and quality improvement. Spine surgery has garnered particular attention; owing to its costly nature. Ambulatory Surgical Centers (ASC) present a potential avenue for expenditure reduction. While the economic advantage of ASCs is being defined, cost saving should not come at the expense of quality or safety.

Methods: This narrative review focuses on current definitions, regulations, and recent medical literature pertinent to spinal surgery in the ASC setting.

Results: The past decade witnessed a substantial rise in the proportion of certain spinal surgeries performed at ASCs. This setting is attractive from the payer perspective as remuneration rates are generally less than for equivalent hospital-based procedures. Opportunity for physician ownership and increased surgeon productivity afforded by more specialized centers make ASCs attractive from the provider perspective as well. These factors serve as extrinsic motivators which may optimize and improve quality of surgical care. Much data supports the safety of spine surgery in the ASC setting. However, health care providers and policy makers must recognize that current regulations regarding safety and quality are less than comprehensive and the data is predominately from selected case-series or comparative cohorts with inherent biases, along with ambiguities in the definition of "outpatient."

Conclusions: ASCs hold promise for providing safe and efficient surgical management of spinal conditions; however, as more procedures shift from the hospital to the ASC rigorous quality and safety data collection is needed to define patient appropriateness and track variability in quality-related outcomes.
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http://dx.doi.org/10.1177/2192568219849391DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6947680PMC
January 2020

Perioperative complications with multilevel anterior and posterior cervical decompression and fusion.

J Neurosurg Spine 2019 Sep 20:1-6. Epub 2019 Sep 20.

1Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois; and.

Objective: Cervical spondylotic myelopathy (CSM) is a progressive degenerative pathology that frequently affects older individuals and causes spinal cord compression with symptoms of neck pain, radiculopathy, and weakness. Anterior decompression and fusion is the primary intervention to prevent neurological deterioration; however, in severe cases, circumferential decompression and fusion is necessary. Published data regarding perioperative morbidity associated with these complex operations are scarce. In this study, the authors sought to add to this important body of literature by documenting a large single-surgeon experience of single-session circumferential cervical decompression and fusion.

Methods: A retrospective analysis was performed to identify intended single-stage anterior-posterior or posterior-anterior-posterior cervical spine decompression and fusion surgeries performed by the primary surgeon (V.C.T.) at Rush University Medical Center between 2009 and 2016. Cases in which true anterior-posterior cervical decompression and fusion was not performed (i.e., those involving anterior-only, posterior-only, or delayed circumferential fusion) were excluded from analysis. Data including standard patient demographic information, comorbidities, previous surgeries, and intraoperative course, along with postoperative outcomes and complications, were collected and analyzed. Perioperative morbidity was recorded during the 90 days following surgery.

Results: Seventy-two patients (29 male and 43 female, mean age 57.6 years) were included in the study. Fourteen patients (19.4%) were active smokers, and 56.9% had hypertension, the most common comorbidity. The most common clinical presentation was neck pain in 57 patients (79.2%). Twenty-three patients (31.9%) had myelopathy, and 32 patients (44.4%) had undergone prior cervical spine surgery. Average blood loss was 613 ml. Injury to the vertebral artery was encountered in 1 patient (1.4%). Recurrent laryngeal nerve palsy was observed in 2 patients (2.8%). Two patients (2.8%) had transient unilateral hand grip weakness. There were no permanent neurological deficits. Dysphagia was encountered in 45 patients (62.5%) postoperatively, with 23 (32%) requiring nasogastric parenteral nutrition and 9 (12.5%) patients ultimately undergoing percutaneous endoscopic gastrostomy (PEG) placement. Nine of the 72 patients required a tracheostomy. The incidence of pneumonia was 6.9% (5 patients) overall, and 2 of these patients were in the tracheostomy group. Superficial wound infections occurred in 4 patients (5.6%). Perioperative death occurred in 1 patient. Reoperation was necessary in 10 patients (13.9%). Major perioperative complications (permanent neurological deficit, vascular injury, tracheostomy, PEG tube, stroke, or death) occurred in 30.6% of patients. The risk of minor perioperative complications (temporary deficit, dysphagia, deep vein thrombosis, pulmonary embolism, urinary tract infection, pneumonia, or wound infection) was 80.6%.

Conclusions: Single-session anterior-posterior cervical decompression and fusion is an inherently morbid operation required in select patients with cervical spondylotic myelopathy. In this large single-surgeon series, there was a major perioperative complication risk of 30.6% and minor perioperative complication risk of 80.6%. This overall elevated risk for postoperative complications must be carefully considered and discussed with the patient preoperatively. In some situations, shared decision making may lead to the conclusion that a procedure of lesser magnitude may be more appropriate.
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http://dx.doi.org/10.3171/2019.6.SPINE198DOI Listing
September 2019

The utility of radionucleotide imaging in the surgical management of axial neck pain from cervical facet joint arthropathy.

J Neurosurg Spine 2019 Nov;32(2):168-173

3Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois.

Objective: Axial neck pain is common and often debilitating. Diagnosis of the specific pain source can be a challenge, and this confounds effective treatment. Cervical facet arthropathy is implicated in many of these cases. The diagnosis is readily made on conventional cross-sectional imaging modalities, particularly CT imaging. However, this modality falls short in determining if an osteoarthritic facet joint is truly the source of symptoms. Radionucleotide imaging presents a noninvasive radiological adjunct to conventional cross-sectional imaging in the workup of patients with suspected facetogenic pain. Herein, the authors present the patient-reported outcomes (PROs) following posterior instrumented arthrodesis of the subaxial cervical spine from a consecutive case series of patients with a diagnosis of cervical facet joint arthropathy and a concordant positive radionucleotide tracer uptake.

Methods: The clinical case series of patients treated by the senior author at a single tertiary care institution between September 2014 and April 2018 was reviewed. Patients were selected for inclusion if their primary symptom at presentation was axial neck pain without neurological deficits and if CT imaging revealed facet arthropathy of the cervical spine. These patients underwent radionucleotide imaging in the form of a planar 99mTc methylene diphosphonate (99mTc MDP) bone scintigraphy study. Those with a finding of radionucleotide tracer uptake at a location concordant with the facet arthropathy were selected to undergo posterior cervical instrumented arthrodesis of the affected levels. PROs were recorded at the time of surgical consultation (i.e., after nonoperative treatment) and at 6 weeks, 3 months, 6 months, and 1 year following surgery. These included neck and arm pain, the Neck Disability Index (NDI) and the 12-Item Short Form Health Survey responses.

Results: A total of 11 patients were included in this retrospective case series. The average reported neck pain and NDI scores were high at baseline; 7.6 ± 2.3 and 37.1 ± 13.9 respectively. Twelve months after surgical intervention, a significant decrease in reported neck pain of -4.5 (95% CI -6.9, -2.1; p = 0.015) and a significant decrease in NDI of -20.0 (95% CI -29.4, -10.6; p = 0.014) was observed.

Conclusions: This case series represents the largest to date of patients undergoing surgical arthrodesis following a finding of facet arthropathy with a concordant positive radioisotope image study. These observations add support to a growing body of evidence that suggests the utility of radioisotope imaging for identification of a facetogenic pain generator in patients with primary axial neck pain and a finding of cervical facet arthropathy. These preliminary data should serve to promote future prospective, controlled studies on the incorporation of radionucleotide imaging into the workup of patients with suspected facetogenic pain of the cervical spine.
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http://dx.doi.org/10.3171/2019.8.SPINE19806DOI Listing
November 2019

Normal aging in human lumbar discs: An ultrastructural comparison.

PLoS One 2019 20;14(6):e0218121. Epub 2019 Jun 20.

Department of Anatomy, Instituto de Ciencias Biomedicas, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil.

The normal aging of the extracellular matrix and collagen content of the human lumbar intervertebral disc (IVD) remains relatively unknown despite vast amounts of basic science research, partly because of the use of inadequate surrogates for a truly normal, human IVD. Our objective in this study was to describe and compare the morphology and ultrastructure of lumbar IVDs in 2 groups of young (G1-<35 years) and elderly (G2->65 years). Thirty L4-5 and L5-S1 discs per group were obtained during autopsies of presumably-asymptomatic individuals and analyzed with magnetic resonance imaging (MRI), a morphological grading scale, light microscopy, scanning electron microscopy (SEM) and immunohistochemistry (IHC) for collagen types I, II, III, IV, V, VI, IX and X. As expected, a mild to moderate degree of degeneration was present in G1 discs and significantly more advanced in G2. The extracellular matrix of G2 discs was significantly more compact with an increase of cartilaginous features such as large chondrocyte clusters. Elastic fibers were abundant in G1 specimens and their presence correlated more with age than with degeneration grade, being very rare in G2. SEM demonstrated persistence of basic structural characteristics such as denser lamellae with Sharpey-type insertions into the endplates despite advanced age or degeneration grades. Immunohistochemistry revealed type II collagen to be the most abundant type followed by collagen IV. All collagen types were detected in every disc sector except for type X collagen. Statistical analysis demonstrated a general decrease in collagen expression from G1 to G2 with an annular- and another nuclear-specific pattern. These results suggest modifications of IVD morphology do not differ between the anterior or posterior annulus but are more advanced or happen earlier in the posterior areas of the disc. This study finally describes the process of extracellular matrix modification during disc degeneration in an unselected, general population and demonstrates it is similar to the same process in the cervical spine as published previously.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0218121PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6586280PMC
February 2020

Comparison of radiographic parameters after anterior cervical discectomy and fusion with semiconstrained translational versus rotational plate systems.

Clin Neurol Neurosurg 2019 Aug 28;183:105379. Epub 2019 May 28.

Department of Neurological Surgery, Rush University Medical Center, 1725 W. Harrison St., Suite 855, Chicago, Illinois, USA. Electronic address:

Objective: A plate is commonly applied after anterior cervical discectomy and fusion (ACDF); particularly in cases of multilevel fusion. Recent comparative studies have focused on constrained versus semiconstrained plates, however little data is available to assess differences between semiconstrained plates.

Patients And Methods: A retrospective review of 60 consecutive adult patients undergoing a 1, 2 or 3 level ACDF with a lordotic allograft for treatment of symptomatic cervical spondylosis was conducted at a single center. The cohort was separated into two groups depending on the cervical plating system used. Patients in the first group had a semiconstrained translational plate and those in the second group had a semiconstrained rotational plate. Plain neutral radiographs were assessed preoperatively, immediately after surgery and at most recent follow-up. The measured radiographic parameters focused on sagittal alignment, adjacent segment pathology, fusion rate and implant failure.

Results: There were 30 patients in each group. There were no significant differences in demographic characteristics or distribution of levels fused between groups. All patients had at least 6 months of follow-up and mean follow-up was 14.8 ± 6.2 months in the translational plate group and 13.1 ± 4.8 months in the rotational plate group (p = 0.227). Significant improvement in sagittal segmental alignment was noted in both groups following surgery. The translational plate group improved from 1.0 ± 7.5 degrees to 4.8 ± 7.6 degrees (p = 0.03) and the rotational group improved from 2.7 ± 9.1 degrees to 8.4 ± 7.8 degrees (p = 0.001). This significant sagittal correction was maintained through follow-up for those in the rotational plate group; 5.5 ± 9.1 degrees (p = 0.002). However, a partial loss of segmental lordosis was observed in the translational plate group leading to a failure to maintain significance of the lordotic correction; 1.7 ± 8.3 degrees (p = 0.280) over the follow-up period. Segmental fusion rates were not significantly different between groups. However, there was a higher rate of screw breakage within the rotational plate group (4 instances versus 0 instances in the translational plate group).

Conclusion: This comparative cohort series suggests that performing an ACDF with a lordotic allograft using either semiconstrained translational or rotational plate system allows for correction and maintenance of cervical alignment, however the rotational plate appears more effective at maintaining segmental lordotic correction. Further prospective controlled study will be needed to determine if this may come at the expense of greater rates of instrumentation failure in the rotational plate group.
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http://dx.doi.org/10.1016/j.clineuro.2019.105379DOI Listing
August 2019

Surgical management of patients with coexistent multiple sclerosis and cervical stenosis: A systematic review and meta-analysis.

J Clin Neurosci 2019 Jul 20;65:77-82. Epub 2019 Apr 20.

Department of Neurological Surgery, UCSF Medical Center, San Francisco, CA, United States. Electronic address:

Multiple sclerosis (MS) and cervical stenosis (CS) are two unique pathologies that can present with overlapping symptoms. In patients with concurrent MS and CS, the exact cause for worsening of symptoms is often difficult to decipher. In this study, we aimed to review the medical literature on the benefits of surgical decompression surgery in patients with coexisting CS and MS. We systematically reviewed the literature for articles published prior to December 1st, 2018 describing outcomes (improvement of symptoms of radiculopathy, myelopathy, and neck pain) in patients with coexisting MS and CS undergoing cervical decompression surgery. Effect sizes were calculated demonstrating the effect of surgical decompression on improving symptoms. We identified eight articles that satisfied our selection criteria, of which six provided data regarding symptoms after surgery. Our meta-analysis indicates that cervical decompression surgery in patients with coexisting MS and CS is beneficial in improving symptoms of myelopathy (ES 0.74, 95% CI 0.38-1.10, p < 0.0001), radiculopathy (ES 1.29, 95% CI 0.15-2.42, p < 0.001), and neck pain (ES 1.66, 95% CI 1.02-2.31, p < 0.0001). Our meta-analysis indicates that there is paucity of high level of evidence studies regarding the benefit of cervical decompression surgery in patients with concomitant CS and MS. However, the literature suggests that cervical decompression may be beneficial to such patients, providing stabilization or improvement in symptoms of myelopathy, radiculopathy, and neck pain. Spine surgeons must carefully delineate the cause of symptoms in patients to decide whether this is the optimal treatment for each individual patient.
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http://dx.doi.org/10.1016/j.jocn.2019.04.001DOI Listing
July 2019

Fusion rate following three- and four-level ACDF using allograft and segmental instrumentation: A radiographic study.

J Clin Neurosci 2019 Apr 25;62:142-146. Epub 2019 Jan 25.

Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA.

Cervical spine degenerative pathologies remain one of the most common spinal conditions treated by spine surgeons worldwide. Surgery is recommended in all patients with symptomatic cervical spinal stenosis with either moderate to severe myelopathy, degeneration, or refractory radiculopathy. As the number of levels increases the potential for complications associated with anterior surgery can be significant, especially dysphagia and pseudarthrosis. The objective of this study was to analyze the fusion rate following three- or more level anterior cervical discectomy and fusion (ACDF). A retrospective review was performed analyzing patients who underwent three or more level ACDF. Fusion was evaluated using post-operative dynamic upright radiographs Relevant post-operative complications especially dysphagia requiring dietary modifications or placement of feeding tube was also noted. A total of 72 patients were included in the study. Of the 232 levels fused, pseudarthrosis occurred at 47 (14%) levels. Overall 45.8% of patients (33/72) had a pseudarthrosis. The incidence of pseudarthrosis was higher in patients with 4 level ACDF as compared to those with 3 level ACDF [56% (9/16) versus 42% (24/56)]. At last follow up, the number of patients that were symptomatic from their pseudarthrosis and required posterior spinal instrumentation was 8/72 (11.1%). Fusion rates in a large cohort of patients with three- and four-level ACDF performed utilizing allograft and segmental instrumentation is reported. The study demonstrates that 3-4 level, stand-alone anterior cervical arthrodeses result in at least one level of pseudarthrosis in almost half of patients, especially at the caudal level of the construct.
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http://dx.doi.org/10.1016/j.jocn.2018.11.040DOI Listing
April 2019

Safety of Outpatient Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-Analysis.

Neurosurgery 2020 01;86(1):30-45

Department of Neurological Surgery, UCSF Medical Center, San Francisco, California.

Background: Anterior cervical discectomy and fusion (ACDF) is being increasingly offered on an outpatient basis. However, the safety profile of outpatient ACDF remains poorly defined.

Objective: To review the medical literature on the safety of outpatient ACDF.

Methods: We systematically reviewed the literature for articles published before April 1, 2018, describing outpatient ACDF and associated complications, including incidence of reoperation, stroke, thrombolytic events, dysphagia, hematoma, and mortality. A random-effects analysis was performed comparing complications between the inpatient and outpatient groups.

Results: We identified 21 articles that satisfied the selection criteria, of which 15 were comparative studies. Most of the existing studies were retrospective, with a lack of level I or II studies on this topic. We found no statistically significant difference between inpatient and outpatient ACDF in overall complications, incidence of stroke, thrombolytic events, dysphagia, and hematoma development. However, patients undergoing outpatient ACDF had lower reported reoperation rates (P < .001), mortality (P < .001), and hospitalization duration (P < .001).

Conclusion: Our meta-analysis indicates that there is a lack of high level of evidence studies regarding the safety of outpatient ACDF. However, the existing literature suggests that outpatient ACDF can be safe, with low complication rates comparable to inpatient ACDF in well-selected patients. Patients with advanced age and comorbidities such as obesity and significant myelopathy are likely not suitable for outpatient ACDF. Spine surgeons must carefully evaluate each patient to decide whether outpatient ACDF is a safe option. Higher quality, large prospective randomized control trials are needed to accurately demonstrate the safety profile of outpatient ACDF.
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http://dx.doi.org/10.1093/neuros/nyy636DOI Listing
January 2020

Surgical Resection of a Cervical Dumbbell Tumor: 2-Dimensional Operative Video.

Oper Neurosurg (Hagerstown) 2018 Dec;15(6):E77

Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois.

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http://dx.doi.org/10.1093/ons/opy033DOI Listing
December 2018

Machined cervical interfacet allograft spacers for the management of atlantoaxial instability.

J Craniovertebr Junction Spine 2017 Oct-Dec;8(4):332-337

Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA.

Background: The use of cervical interfacet spacers (CISs) to augment stability and provide solid arthrodesis at the atlantoaxial joint has not been studied in detail. The aim of this work is to report the outcomes with the use of machined allograft CISs at C1-2.

Methods: A retrospective review of 19 patients who underwent an atlantoaxial fusion with the use of CISs was performed. All patients had instability documented with flexion and extension lateral radiographs. This instability was due to trauma, degenerative stenosis, symptomatic C1-2 arthropathy, and os odontoideum. Clinical and radiological outcomes were assessed. Fusion was determined based on a lack of hardware failure, absence of motion on flexion and extension plain X-ray films, and presence of bridging trabecular bone which was most often demonstrated by a computed tomography.

Results: The mean age was 69.1 ± 12.9 years. Eight patients had traumatic fractures, six patients had degenerative stenosis, two patients had C2 neuralgia due to C1-2 arthropathy, two patients had C1-2 ligamentous subluxation, and one patient had an unstable os odontoideum. The occiput or subaxial spine was included in the arthrodesis in 10 patients. Rib autograft was utilized in most patients. No patient had postoperative neurological worsening, malposition of hardware, or vertebral artery injury and there were no mortalities. The fusion rate was 95%. The mean follow-up was 12.1 ± 5.5 months.

Conclusions: CIS is a promising adjuvant for the treatment of atlantoaxial instability.
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http://dx.doi.org/10.4103/jcvjs.JCVJS_87_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5763590PMC
February 2018

Treatment of Axis Body Fractures: A Systematic Review.

Clin Spine Surg 2017 Dec;30(10):442-456

Department of Orthopaedic Surgery, University of British Columbia, Vancouver, BC, Canada.

Study Design: Evidence-based systematic review.

Objectives: To define the optimal treatment of fractures involving the C2 body, including those with concomitant injuries, based upon a systematic review of the literature.

Summary Of Background Data: Axis body fractures have customarily been treated nonoperatively, but there are some injuries that may require operative intervention. High-quality literature is sparse and there are few class I or class II studies to guide treatment decisions.

Materials And Methods: A literature search was conducted using PubMed (MEDLINE), Cochrane Central Register of Controlled Trials, and Scopus (EMBASE, MEDLINE, COMPENDEX). The quality of literature was rated according to a grading tool developed by the Center for Evidence-based Medicine. Operative and nonoperative treatment of axis body fractures were compared using fracture bony union as the primary outcome measure. As risk factors for nonunion were not consistently reported, cases were analyzed individually.

Results: The literature search identified 62 studies, of which 10 were case reports which were excluded from the analysis. A total of 920 patients from 52 studies were included. The overall bony union rate for all axis body fractures was 91%. Although the majority of fractures were treated nonoperatively, there has been an increasing trend toward operative intervention for Benzel type III (transverse) axis body fractures. Nearly 76% of axis body fractures were classified as type III fractures, of which 88% united successfully. Nearly all Benzel type I and type II axis body fractures were successfully treated nonoperatively. The risk factors for nonunion included: a higher degree of subluxation, fracture displacement, comminution, concurrent injuries, delay in treatment, and older age.

Conclusions: High rates for fracture union are reported in the literature for axis body fractures with nonoperative treatment. High-quality prospective studies are required to develop consensus as to which C2 body fractures require operative fixation.
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http://dx.doi.org/10.1097/BSD.0000000000000309DOI Listing
December 2017

Cervical Spine Deformity-Part 3: Posterior Techniques, Clinical Outcome, and Complications.

Neurosurgery 2017 Dec;81(6):893-898

Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois.

The goals of cervical deformity surgery include deformity correction, restoration of horizontal gaze, decompression of neural elements, spinal stabilization with a biomechanically sound construct, and meticulous arthrodesis technique to prevent pseudoarthrosis and minimizing surgical complications. Many different surgical options exist, but selecting the correct approach that ensures the optimal clinical outcome can be challenging and often controversial. In this last part of the cervical deformity review series, various posterior deformity correction techniques are discussed in detail, along with an overview of surgical outcome and postoperative complications.
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http://dx.doi.org/10.1093/neuros/nyx477DOI Listing
December 2017

Intubation biomechanics: validation of a finite element model of cervical spine motion during endotracheal intubation in intact and injured conditions.

J Neurosurg Spine 2018 01 20;28(1):10-22. Epub 2017 Oct 20.

1Department of Mechanical Engineering, School of Biomedical Engineering, Orthopaedic Bioengineering Research Laboratory, Colorado State University, Fort Collins, Colorado.

OBJECTIVE Because of limitations inherent to cadaver models of endotracheal intubation, the authors' group developed a finite element (FE) model of the human cervical spine and spinal cord. Their aims were to 1) compare FE model predictions of intervertebral motion during intubation with intervertebral motion measured in patients with intact cervical spines and in cadavers with spine injuries at C-2 and C3-4 and 2) estimate spinal cord strains during intubation under these conditions. METHODS The FE model was designed to replicate the properties of an intact (stable) spine in patients, C-2 injury (Type II odontoid fracture), and a severe C3-4 distractive-flexion injury from prior cadaver studies. The authors recorded the laryngoscope force values from 2 different laryngoscopes (Macintosh, high intubation force; Airtraq, low intubation force) used during the patient and cadaver intubation studies. FE-modeled motion was compared with experimentally measured motion, and corresponding cord strain values were calculated. RESULTS FE model predictions of intact intervertebral motions were comparable to motions measured in patients and in cadavers at occiput-C2. In intact subaxial segments, the FE model more closely predicted patient intervertebral motions than did cadavers. With C-2 injury, FE-predicted motions did not differ from cadaver measurements. With C3-4 injury, however, the FE model predicted greater motions than were measured in cadavers. FE model cord strains during intubation were greater for the Macintosh laryngoscope than the Airtraq laryngoscope but were comparable among the 3 conditions (intact, C-2 injury, and C3-4 injury). CONCLUSIONS The FE model is comparable to patients and cadaver models in estimating occiput-C2 motion during intubation in both intact and injured conditions. The FE model may be superior to cadavers in predicting motions of subaxial segments in intact and injured conditions.
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http://dx.doi.org/10.3171/2017.5.SPINE17189DOI Listing
January 2018

Cervical Spine Deformity-Part 2: Management Algorithm and Anterior Techniques.

Neurosurgery 2017 Oct;81(4):561-567

Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois.

A sound operative plan based on solid understanding of the pathology and biomechanics is the most important part of cervical deformity correction. Many different surgical options exist for operative management of cervical spine deformities. However, selecting the correct approach that ensures the optimal clinical outcome can be challenging and often controversial. In Part 2 of this three-part review series, we discuss the pre-operative planning, management algorithm, and anterior surgical techniques for cervical deformity correction.
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http://dx.doi.org/10.1093/neuros/nyx388DOI Listing
October 2017

Editorial. Cervical kyphotic deformity.

J Neurosurg Spine 2017 11 25;27(5):485-486. Epub 2017 Aug 25.

Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois.

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http://dx.doi.org/10.3171/2016.11.SPINE161033DOI Listing
November 2017

Cervical Spine Deformity-Part 1: Biomechanics, Radiographic Parameters, and Classification.

Neurosurgery 2017 Aug;81(2):197-203

Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois.

Cervical spine deformities can have a significant negative impact on the quality of life by causing pain, myelopathy, radiculopathy, sensorimotor deficits, as well as inability to maintain horizontal gaze in severe cases. Many different surgical options exist for operative management of cervical spine deformities. However, selecting the correct approach that ensures the optimal clinical outcome can be challenging and is often controversial. We aim to provide an overview of cervical spine deformity in a 3-part series covering topics including the biomechanics, radiographic parameters, classification, treatment algorithms, surgical techniques, clinical outcome, and complication avoidance with a review of pertinent literature.
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http://dx.doi.org/10.1093/neuros/nyx249DOI Listing
August 2017

Surgical considerations in posterior C1-2 instrumentation in the presence of vertebral artery anomalies: case illustration and review of literature.

Br J Neurosurg 2019 Aug 29;33(4):422-424. Epub 2017 Jun 29.

a Department of Neurosurgery, Rush University Medical Center , Chicago , IL , USA.

Vascular anomalies involving the V3 segment of the vertebral artery are common and may complicate posterior atlantoaxial instrumentation. We report a patient with a fenestrated vertebral artery that underwent successful C1-2 instrumentation and fusion. Various vertebral artery anomalies are discussed with a review of pertinent literature.
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http://dx.doi.org/10.1080/02688697.2017.1346170DOI Listing
August 2019

Prevalence and Outcomes in Patients Undergoing Reintubation After Anterior Cervical Spine Surgery: Results From the AOSpine North America Multicenter Study on 8887 Patients.

Global Spine J 2017 Apr 1;7(1 Suppl):96S-102S. Epub 2017 Apr 1.

Columbia University, New York, NY, USA.

Study Design: A multicenter, retrospective cohort study.

Objective: To evaluate clinical outcomes in patients with reintubation after anterior cervical spine surgery.

Methods: A total of 8887 patients undergoing anterior cervical spine surgery were enrolled in the AOSpine North America Rare Complications of Cervical Spine Surgery study. Patients with or without complications after surgery were included. Demographic and surgical information were collected for patients with reintubation. Patients were evaluated using a variety of assessment tools, including the modified Japanese Orthopedic Association scale, Nurick score, Neck Disability Index, and Short Form-36 Health Survey.

Results: Nine cases of postoperative reintubation were identified. The total prevalence of this complication was 0.10% and ranged from 0% to 0.59% across participating institutions. The time to development of airway symptoms after surgery was within 24 hours in 6 patients and between 5 and 7 days in 3 patients. Although 8 patients recovered, 1 patient died. At final follow-up, patients with reintubation did not exhibit significant and meaningful improvements in pain, functional status, or quality of life.

Conclusions: Although the prevalence of reintubation was very low, this complication was associated with adverse clinical outcomes. Clinicians should identify their high-risk patients and carefully observe them for up to 2 weeks after surgery.
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http://dx.doi.org/10.1177/2192568216687753DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5400189PMC
April 2017

C5 Palsy After Cervical Spine Surgery: A Multicenter Retrospective Review of 59 Cases.

Global Spine J 2017 Apr 1;7(1 Suppl):64S-70S. Epub 2017 Apr 1.

Boston Medical Center, Scituate, MA, USA.

Study Design: A multicenter, retrospective review of C5 palsy after cervical spine surgery.

Objective: Postoperative C5 palsy is a known complication of cervical decompressive spinal surgery. The goal of this study was to review the incidence, patient characteristics, and outcome of C5 palsy in patients undergoing cervical spine surgery.

Methods: We conducted a multicenter, retrospective review of 13 946 patients across 21 centers who received cervical spine surgery (levels C2 to C7) between January 1, 2005, and December 31, 2011, inclusive. values were calculated using 2-sample test for continuous variables and χ tests or Fisher exact tests for categorical variables.

Results: Of the 13 946 cases reviewed, 59 patients experienced a postoperative C5 palsy. The incidence rate across the 21 sites ranged from 0% to 2.5%. At most recent follow-up, 32 patients reported complete resolution of symptoms (54.2%), 15 had symptoms resolve with residual effects (25.4%), 10 patients did not recover (17.0%), and 2 were lost to follow-up (3.4%).

Conclusion: C5 palsy occurred in all surgical approaches and across a variety of diagnoses. The majority of patients had full recovery or recovery with residual effects. This study represents the largest series of North American patients reviewed to date.
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http://dx.doi.org/10.1177/2192568216688189DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5400195PMC
April 2017

Epidemiology and Outcomes of Vertebral Artery Injury in 16 582 Cervical Spine Surgery Patients: An AOSpine North America Multicenter Study.

Global Spine J 2017 Apr 1;7(1 Suppl):21S-27S. Epub 2017 Apr 1.

Columbia University, New York, NY, USA.

Study Design: A multicenter retrospective case series was compiled involving 21 medical institutions. Inclusion criteria included patients who underwent cervical spine surgery between 2005 and 2011 and who sustained a vertebral artery injury (VAI).

Objective: To report the frequency, risk factors, outcomes, and management goals of VAI in patients who have undergone cervical spine surgery.

Methods: Patients were evaluated on the basis of condition-specific functional status using the Neck Disability Index (NDI), modified Japanese Orthopaedic Association (mJOA) score, the Nurick scale, and the 36-Item Short-Form Health Survey (SF-36).

Results: VAIs were identified in a total of 14 of 16 582 patients screened (8.4 per 10 000). The mean age of patients with VAI was 59 years (±10) with a female predominance (78.6%). Patient diagnoses included myelopathy, radiculopathy, cervical instability, and metastatic disease. VAI was associated with substantial blood loss (770 mL), although only 3 cases required transfusion. Of the 14 cases, 7 occurred with an anterior-only approach, 3 cases with posterior-only approach, and 4 during circumferential approach. Fifty percent of cases of VAI with available preoperative imaging revealed anomalous vessel anatomy during postoperative review. Average length of hospital stay was 10 days (±8). Notably, 13 of the 14 (92.86%) cases resolved without residual deficits. Compared to preoperative baseline NDI, Nurick, mJOA, and SF-36 scores for these patients, there were no observed changes after surgery ( = .20-.94).

Conclusions: Vertebral artery injuries are potentially catastrophic complications that can be sustained from anterior or posterior cervical spine approaches. The data from this study suggest that with proper steps to ensure hemostasis, patients recover function at a high rate and do not exhibit residual deficits.
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http://dx.doi.org/10.1177/2192568216686753DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5400180PMC
April 2017

Rare Complications of Cervical Spine Surgery: Pseudomeningocoele.

Global Spine J 2017 Apr 1;7(1 Suppl):109S-114S. Epub 2017 Apr 1.

University of Virginia, Charlottesville, VA, USA.

Study Design: This study was a retrospective, multicenter cohort study.

Objectives: Rare complications of cervical spine surgery are inherently difficult to investigate. Pseudomeningocoele (PMC), an abnormal collection of cerebrospinal fluid that communicates with the subarachnoid space, is one such complication. In order to evaluate and better understand the incidence, presentation, treatment, and outcome of PMC following cervical spine surgery, we conducted a multicenter study to pool our collective experience.

Methods: This study was a retrospective, multicenter cohort study of patients who underwent cervical spine surgery at any level(s) from C2 to C7, inclusive; were over 18 years of age; and experienced a postoperative PMC.

Results: Thirteen patients (0.08%) developed a postoperative PMC, 6 (46.2%) of whom were female. They had an average age of 48.2 years and stayed in hospital a mean of 11.2 days. Three patients were current smokers, 3 previous smokers, 5 had never smoked, and 2 had unknown smoking status. The majority, 10 (76.9%), were associated with posterior surgery, whereas 3 (23.1%) occurred after an anterior procedure. Myelopathy was the most common indication for operations that were complicated by PMC (46%). Seven patients (53%) required a surgical procedure to address the PMC, whereas the remaining 6 were treated conservatively. All PMCs ultimately resolved or were successfully treated with no residual effects.

Conclusions: PMC is a rare complication of cervical surgery with an incidence of less than 0.1%. They prolong hospital stay. PMCs occurred more frequently in association with posterior approaches. Approximately half of PMCs required surgery and all ultimately resolved without residual neurologic or other long-term effects.
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http://dx.doi.org/10.1177/2192568216687769DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5400191PMC
April 2017
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