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Kern Singh - One of the best experts on this subject based on the ideXlab platform.

  • comparison between cervical total disc replacement and anterior cervical discectomy and fusion of 1 to 2 levels from 2002 to 2009
    2014
    Co-Authors: Sreeharsha V Nandyala, Steven J Fineberg, Alejandro Marquezlara, Kern Singh
    Abstract:

    STUDY DESIGN Retrospective database analysis. OBJECTIVE To compare the perioperative patient characteristics, early postoperative outcomes, and costs between anterior cervical discectomy and fusion (ACDF) and cervical total disc replacement (TDR) in the United States. SUMMARY OF BACKGROUND DATA Cervical TDR and ACDF are indicated to treat symptomatic cervical Degenerative Pathology. The epidemiology, complication rates, and the cost differences between the 2 surgical approaches are not well characterized. METHODS Data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project was queried from 2002 to 2009. Patients undergoing cervical TDR or ACDF of 1 to 2 levels were identified. Patient demographics, comorbidities, length of stay, costs, and the in-hospital complications were assessed. SPSS (version 20) was used for statistical analysis with χ test for categorical data and independent-samples t test for continuous data. A value of P ≤ 0.001 denoted statistical significance. Multinomial regression analysis was used to identify the independent risk for complications in the TDR cohort compared with the ACDF cohort. RESULTS There were 141,230 ACDF cases of 1 to 2 levels and 1830 cervical TDR cases identified in the Nationwide Inpatient Sample database. The ACDF cohort was older and demonstrated a greater comorbidity burden than the TDR group (P < 0.001). The ACDF-treated patients demonstrated a significantly greater length of stay than the TDR group (P < 0.001). In contrast, there were no significant differences in the incidence of postoperative complications, mortality, or hospital costs between the surgical cohorts. Multinomial regression did not demonstrate significant differences in the risk for postoperative complications between the surgical techniques. CONCLUSION The ACDF cohort was significantly older and demonstrated a greater comorbidity burden that likely contributed to the greater length of stay when than the TDR cohort. Both cohorts demonstrated comparable incidences of early postoperative complications and costs. There were no significant differences in the risks for postoperative complications between the surgical cohorts. Further studies are warranted to characterize the long-term complications, costs, and patient outcomes between the 2 surgical techniques. LEVEL OF EVIDENCE 3.

  • epidemiological trends in cervical spine surgery for Degenerative diseases between 2002 and 2009
    2013
    Co-Authors: Matthew Oglesby, Steven J Fineberg, Alpesh A Patel, Miguel A Pelton, Kern Singh
    Abstract:

    STUDY DESIGN: Retrospective analysis of a population-based database. OBJECTIVE: To investigate national epidemiological trends of cervical spine surgical procedures from 2002-2009. SUMMARY OF BACKGROUND DATA: Anterior cervical fusion (ACF), posterior cervical fusion (PCF), and posterior cervical decompression (PCD) are procedures routinely performed for cervical Degenerative Pathology. Studies regarding epidemiological trends of these procedures is currently lacking in the literature. METHODS: Data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project was obtained for each year between 2002 and 2009. Patients undergoing ACF, PCF, and PCD for the diagnosis of cervical radiculopathy and myelopathy were identified. Demographics, costs, and mortality were assessed in the surgical subgroups. A P value of 0.001 was used to denote significance. RESULTS.: An estimated 1,323,979 cervical spine surgical procedures were performed between 2002 and 2009. There was a significant upward trend in the mean age of patients undergoing cervical spine surgery during this time period. ACF and PCF cohorts demonstrated statistically significant increases in comorbidities and costs from 2002-2009. The PCF group had the greatest mortality, comorbidities, costs, and longest hospitalizations compared with ACF and PCF cohorts across all time periods. CONCLUSION: Our study demonstrates that cervical spine surgical procedures have increased between 2002 and 2009 (P = 0.001). The primary increase in volume is due to the increasing number of ACFs. Despite older patients with more comorbidities undergoing ACF and PCF procedures, mortality has not changed. However, this patient population trended significant increases in costs during this time period. We hypothesize that these increased costs are due to an increased comorbidity burden in patients undergoing ACF or PCF. Results of this study can be used to set benchmarks for future epidemiological investigations in cervical spine surgery. LEVEL OF EVIDENCE: 4.

Clinton J Devin - One of the best experts on this subject based on the ideXlab platform.

  • predictors of the efficacy of epidural steroid injections for structural lumbar Degenerative Pathology
    2016
    Co-Authors: Ahilan Sivaganesan, Silky Chotai, Scott L Parker, Anthony L Asher, Matthew J Mcgirt, Clinton J Devin
    Abstract:

    Abstract Background Lumbar epidural steroid injection (LESI) is a valuable therapeutic option when administered to the appropriate patient, for the appropriate disease process, at the appropriate time. There is considerable variability in patient-reported outcomes (PROs) after LESI, creating uncertainty as to who will benefit from the therapy and who will not. Purpose We set out to identify patient attributes, which are important predictors for the achievement of a minimum clinically important difference (MCID) in the Oswestry Disability Index (ODI) after LESI. Study Design A prospective cohort study was carried out. Patient Sample A total of 239 consecutive patients undergoing LESI for back-related disability, back pain (BP), and leg pain (LP) associated with Degenerative Pathology comprised the patient sample. Outcome Measures Baseline and 3-month patient self-reported ODI, numeric rating scale-BP and LP, Euro-Qol-5D, and Short Form (SF)-12 scores were recorded. Methods A total of 239 consecutive patients undergoing LESI for Degenerative Pathology over a period of 2 years who were enrolled into a prospective web-based registry were included in the study. Using the previously reported anchor-based approach, an MCID threshold of 7.1% was established for ODI after LESI. Each enrolled patient was then dichotomized as a "responder" (achieving MCID) or a "non-responder." Multiple logistic regression analysis was then performed, with the achievement of MCID serving as the outcome of interest. Candidate variables included in the regression analyses were age, gender, employment, insurance type, smoking status, preoperative ambulation, preinjection narcotic use, comorbidities, predominant LP or BP symptoms, symptom duration, diagnosis, number of levels, prior surgery, baseline PROs, type of stenosis (central, lateral recesses, or foraminal), injection route (transforaminal, interlaminar, or caudal), and number of injections. Subsequently, we also randomly selected 80% of the patients to serve as the training data for a multiple logistic regression model. Once this predictive model was built, it was validated using the remaining 20% of patients. Results There were 124 (62%) patients who achieved MCID for ODI. The existence of central stenosis (p=.006), TF or IL injection route (p=.02) compared with caudal epidural steroid injection, higher baseline ODI (p=.00001), and a diagnosis of disc herniation (p=.02) increase the odds of achieving MCID for ODI at 3 months. Symptom duration for over a year (p=.006), prior surgery (p=.08), and preinjection anxiety (p=.001) decrease the odds of achieving MCID. The area under the curve (AUC) for our predictive model's receiver-operator characteristic was 0.81 when using the 80% training data set, and the AUC was 0.72 when using the 20% validation data. Conclusion We have identified patient attributes that are important predictors for the achievement of MCID in ODI 3 months after LESI. The use of these attributes, in the form of a predictive model for LESI efficacy, has the potential to improve decision making around LESI. Spine care providers can use the information to gain insight into the likelihood that a particular patient will experience a meaningful benefit from LESI.

  • effect of obesity on cost per quality adjusted life years gained following anterior cervical discectomy and fusion in elective Degenerative Pathology
    2015
    Co-Authors: Silky Chotai, Ahilan Sivaganesan, Scott L Parker, Matthew J Mcgirt, Alex J Sielatycki, Harrison L Kay, David P Stonko, Joseph B Wick, Clinton J Devin
    Abstract:

    Abstract Background Obese patients have greater comorbidities along with higher risk of complications and greater costs after spine surgery, which may result in increased cost and lower quality of life compared with their non-obese counterparts. Purpose The aim of the present study was to determine cost-utility following anterior cervical discectomy and fusion (ACDF) in obese patients. Study Design This study analyzed prospectively collected data. Patient Sample Patients undergoing elective ACDF for Degenerative cervical Pathology at a single academic institution were included in the study. Outcome Measures Cost and quality-adjusted life years (QALYs) were the outcome measures. Methods One- and two-year medical resource utilization, missed work, and health state values (QALYs) were assessed. Two-year resource use was multiplied by unit costs based on Medicare national payment amounts (direct cost). Patient and caregiver workday losses were multiplied by the self-reported gross-of-tax wage rate (indirect cost). Total cost (direct+indirect) was used to compute cost per QALY gained. Patients were defined as obese for body mass index (BMI) ≥35 based on the WHO definition of class II obesity. A subgroup analysis was conducted in morbidly obese patients (BMI≥40). Results There were significant improvements in pain (neck pain or arm pain), disability (Neck Disability Index), and quality of life (EuroQol-5D and Short Form-12) at 2 years after surgery (p Conclusions Anterior cervical discectomy and fusion provided a significant gain in health state utility in obese patients, with a mean 2-year cost-utility of $68,070 per QALYs gained, which can be considered moderately cost-effective. Morbidly obese patients had lower cost-effectiveness; however, surgery does provide a significant improvement in outcomes. Obesity, and specifically morbid obesity, should to be taken into consideration as physician and hospital reimbursements move toward a bundled model.

Achim Schneeberger - One of the best experts on this subject based on the ideXlab platform.

  • active immunization against alpha synuclein ameliorates the Degenerative Pathology and prevents demyelination in a model of multiple system atrophy
    2015
    Co-Authors: Markus Mandler, Elvira Valera, Edward Rockenstein, Michael Mante, Weninger Harald, Christina Patrick, Anthony Adame, Sabine Schmidhuber, Radmila Santic, Achim Schneeberger
    Abstract:

    Background Multiple system atrophy (MSA) is a neuroDegenerative disease characterized by parkinsonism, ataxia and dysautonomia. Histopathologically, the hallmark of MSA is the abnormal accumulation of alpha-synuclein (α-syn) within oligodendroglial cells, leading to neuroinflammation, demyelination and neuronal death. Currently, there is no disease-modifying treatment for MSA. In this sense, we have previously shown that next-generation active vaccination technology with short peptides, AFFITOPEs®, was effective in two transgenic models of synucleinopathies at reducing behavioral deficits, α-syn accumulation and inflammation.

  • active immunization against alpha synuclein ameliorates the Degenerative Pathology and prevents demyelination in a model of multiple system atrophy
    2015
    Co-Authors: Markus Mandler, Elvira Valera, Edward Rockenstein, Michael Mante, Weninger Harald, Christina Patrick, Anthony Adame, Sabine Schmidhuber, Radmila Santic, Achim Schneeberger
    Abstract:

    Multiple system atrophy (MSA) is a neuroDegenerative disease characterized by parkinsonism, ataxia and dysautonomia. Histopathologically, the hallmark of MSA is the abnormal accumulation of alpha-synuclein (α-syn) within oligodendroglial cells, leading to neuroinflammation, demyelination and neuronal death. Currently, there is no disease-modifying treatment for MSA. In this sense, we have previously shown that next-generation active vaccination technology with short peptides, AFFITOPEs®, was effective in two transgenic models of synucleinopathies at reducing behavioral deficits, α-syn accumulation and inflammation. In this manuscript, we used the most effective AFFITOPE® (AFF 1) for immunizing MBP-α-syn transgenic mice, a model of MSA that expresses α-syn in oligodendrocytes. Vaccination with AFF 1 resulted in the production of specific anti-α-syn antibodies that crossed into the central nervous system and recognized α-syn aggregates within glial cells. Active vaccination with AFF 1 resulted in decreased accumulation of α-syn, reduced demyelination in neocortex, striatum and corpus callosum, and reduced neurodegeneration. Clearance of α-syn involved activation of microglia and reduced spreading of α-syn to astroglial cells. This study further validates the efficacy of vaccination with AFFITOPEs® for ameliorating the neuroDegenerative Pathology in synucleinopathies.

Wenshiang Chen - One of the best experts on this subject based on the ideXlab platform.

  • comparative effectiveness of platelet rich plasma injections for treating knee joint cartilage Degenerative Pathology a systematic review and meta analysis
    2014
    Co-Authors: Kevin Chang, Chenyu Hung, Fanny Aliwarga, Tyngguey Wang, Dersheng Han, Wenshiang Chen
    Abstract:

    Abstract Objective To explore the effectiveness of platelet-rich plasma (PRP) in treating cartilage Degenerative Pathology in knee joints. Data Sources Electronic databases, including PubMed and Scopus, were searched from the earliest record to September 2013. Study Selection We included single-arm prospective studies, quasi-experimental studies, and randomized controlled trials that used PRP to treat knee chondral Degenerative lesions. Eight single-arm studies, 3 quasi-experimental studies, and 5 randomized controlled trials were identified, comprising 1543 participants. Data Extraction We determined effect sizes for the selected studies by extracting changes in functional scales after the interventions and compared the PRP group pooled values with the pretreatment baseline and the groups receiving placebo or hyaluronic acid (HA) injections. Data Synthesis PRP injections in patients with knee Degenerative Pathology showed continual efficacy for 12 months compared with their pretreatment condition. The effectiveness of PRP was likely better and more prolonged than that of HA. Injection doses ≤2, the use of a single-spinning approach, and lack of additional activators led to an uncertainty in the treatment effects. Patients with lower degrees of cartilage degeneration achieved superior outcomes as opposed to those affected by advanced osteoarthritis. Conclusions PRP application improves function from basal evaluations in patients with knee joint cartilage Degenerative Pathology and tends to be more effective than HA administration. Discrepancy in the Degenerative severity modifies the treatment responses, leading to participants with lower degrees of degeneration benefiting more from PRP injections.

Hamid Hassanzadeh - One of the best experts on this subject based on the ideXlab platform.

  • poor nutrition status and lumbar spine fusion surgery in the elderly readmissions complications and mortality
    2017
    Co-Authors: Varun Puvanesarajah, Amit Jain, Khaled M Kebaish, Christopher I Shaffrey, Daniel M Sciubba, Rafael De La Garzaramos, A J Khanna, Hamid Hassanzadeh
    Abstract:

    Study design Retrospective database review. Objective To quantify the medical and surgical risks associated with elective lumbar spine fusion surgery in patients with poor preoperative nutritional status and to assess how nutritional status alters length of stay and readmission rates. Summary of background data There has been recent interest in quantifying the increased risk of complications caused by frailty, an important consideration in elderly patients that is directly related to comorbidity burden. Preoperative nutritional status is an important contributor to both sarcopenia and frailty and is poorly studied in the elderly spine surgery population. Methods The full 100% sample of Medicare data from 2005 to 2012 were utilized to select all patients 65 to 84 years old who underwent elective 1 to 2 level posterior lumbar fusion for Degenerative Pathology. Patients with diagnoses of poor nutritional status within the 3 months preceding surgery were selected and compared with a control cohort. Outcomes that were assessed included major medical complications, infection, wound dehiscence, and mortality. In addition, readmission rates and length of stay were evaluated. Results When adjusting for demographics and comorbidities, malnutrition was determined to result in significantly increased odds of both 90-day major medical complications (adjusted odds ratio, OR: 4.24) and 1-year mortality (adjusted OR: 6.16). Multivariate analysis also demonstrated that malnutrition was a significant predictor of increased infection (adjusted OR: 2.27) and wound dehiscence (adjusted OR: 2.52) risk. Length of stay was higher in malnourished patients, though 30-day readmission rates were similar to controls. Conclusion Malnutrition significantly increases complication and mortality rates, whereas also significantly increasing length of stay. Nutritional supplementation before surgery should be considered to optimize postoperative outcomes in malnourished individuals. Level of evidence 3.

  • readmission rates reasons and risk factors in elderly patients treated with lumbar fusion for Degenerative Pathology
    2016
    Co-Authors: Varun Puvanesarajah, Ali Nourbakhsh, Hamid Hassanzadeh, Adam L Shimer, Francis H Shen, Anuj Singla
    Abstract:

    STUDY DESIGN Retrospective database review. OBJECTIVE To determine readmission rates after 1 to 2 level, primary, elective lumbar spinal fusion surgery for Degenerative Pathology and elucidate risk factors that predict increased risk of 30-day readmission SUMMARY OF BACKGROUND DATA.: Early postoperative readmissions after spine surgery represent a significant source of increased cost and morbidity. As the elderly population represents a demographic with a growing need for spine surgery, readmissions within this population are of significant interest. METHODS Medicare data (2005-2012) from an insurance database was queried for patients who underwent primary 1 to 2 level posterolateral lumbar spine fusion surgeries for Degenerative lumbar Pathology. After applying specific exclusion criteria to select for elderly patients (65-84 yr) undergoing mostly elective procedures, 52,567 patients formed the final study population. Readmission rates for medical, surgical, and all reasons were calculated within 30 days, 90 days, and 1 year postoperatively. Risk factors for medical, surgical, and all 30-day readmissions were also determined. RESULTS Within 30 days, 90 days, and 1 year, 1510 (2.9%), 2776 (5.3%), and 6574 (12.5%) patients were readmitted, respectively. At 30 days, surgical diagnoses constituted 50.1% of all readmissions. Wound infection was the reason for readmission in 25.8% of all readmissions within 30 days. Diagnoses of chronic pulmonary disease (OR 1.41 95% CI 1.22-1.63), obesity (OR 2.20 95% CI 1.90-2.54), and positive smoking history (OR 1.33 95% CI 1.15-1.54) were associated with increased risk of surgical readmission. CONCLUSION Elderly patients undergoing lumbar spine fusion experience 30-day, 90-day, and 1-year readmission rates of 2.9, 5.3, and 12.5% for both medical and surgical reasons. Surgical site infection and wound complications are the most common surgery-related reasons for readmission. Medical diagnoses are more predominant during later readmissions, highlighting the comorbidity burden present in elderly patients. LEVEL OF EVIDENCE 4.