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Maxwell Boakye - One of the best experts on this subject based on the ideXlab platform.
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trends in the use of bone morphogenetic protein as a substitute to autologous iliac crest bone grafting for Spinal Fusion procedures in the united states
Spine, 2011Co-Authors: Jay K Nathan, Maxwell BoakyeAbstract:STUDY DESIGN: Analysis of Nationwide Inpatient Sample (NIS) database for data related to Spinal Fusion procedures. OBJECTIVE: To identify trends in the use of bone morphogenetic protein (BMP) versus iliac crest bone grafts in various Spinal Fusion procedures performed in the United States, explore stratification by patient demographics, and analyze the impact on treatment cost. SUMMARY OF BACKGROUND DATA: BMP has been shown to achieve better clinical outcomes in anterior lumbar interbody Fusions procedures, which led to its Food and Drug Administration approval for this indication in 2002. Since then, significant off-label use has occurred, without a full description of the results. METHODS: We searched the NIS for data relating to BMP administration or iliac crest bone grafting in a variety of Spinal Fusion procedures performed from 1993 to 2006, based on International Classification of Diseases, Ninth Revision classification. The NIS is the largest all-payer inpatient care database, with demographic, outcome, and cost data from approximately eight million annual patient discharges throughout the United States. Demographics among patients treated with BMP versus iliac crest bone graft were compared to reduce the likelihood of bias in the analysis. RESULTS: BMP became applied more frequently in each type of Spinal Fusion procedure examined over our study period, with the exception of anterior lumbar interbody Fusions. Patients receiving iliac crest bone grafts versus BMP exhibited very similar demographic characteristics, including age, socioeconomic status, and type of health care setting. Although BMP typically increased the cost of the procedure itself, it improved outcomes and shorter hospital stays often provided a net benefit. CONCLUSION: BMP is increasingly being used in Spinal Fusion procedures, including ones for which it is not officially approved, because of the surgical and postsurgical benefits it provides. Given the morbidity that this may entail, monitoring outcomes trends will help to inform guidelines for BMP use and ensure that its benefits continue to outweigh its costs.
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national trends in Spinal Fusion for cervical spondylotic myelopathy
Surgical Neurology, 2009Co-Authors: Shivanand P Lad, Justin G Santarelli, Chirag G Patil, Scott C Berta, Maxwell BoakyeAbstract:Abstract Background The objective of this study is to provide a retrospective analysis using an NIS database to examine national trends in outcomes for CSM from 1993 to 2002. Methods Data for CSM admissions (n = 138 792) were extracted from the 1993 to 2002 NIS database to determine overall outcomes, as well as for those patients with CSM who underwent Spinal Fusion. Data from 1993 to 1997 (period 1) were compared with data from 1998 to 2002 (period 2). Results The number of patients admitted with CSM increased 2-fold from 3.73 to 7.88 per 100 000 US population. Approximately 10% of patients were admitted from the ED and 42% underwent Spinal Fusion. The number of patients with CSM that underwent Spinal Fusion increased 7-fold from 0.6 to 4.1 per 100 000 people over the period from 1993 to 2002. Most Spinal Fusions were performed in the 45- to 64-year age group. The number of patients with 2 or more comorbidities increased from 20% to 37%; however, the mortality and adverse outcome rates remained stable, and there was a slight decrease in LOS. Conclusions Cervical spondylotic myelopathy is one of the most common disorders treated by spine surgeons. There was a nearly 7-fold increase in the number of Spinal Fusions for CSM from 1993 to 2002. Despite continued increases in patient medical comorbidities, overall complication rates have remained stable at approximately 10.3% and mortality rates constant at 0.6%.
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cervical spondylotic myelopathy complications and outcomes after Spinal Fusion
Neurosurgery, 2008Co-Authors: Maxwell Boakye, Chirag G Patil, Justin G Santarelli, Wendy Tian, Shivanand P LadAbstract:Objective There is little information about in-hospital complication rates, adverse outcomes, and mortality after Spinal Fusion for cervical spondylotic myelopathy (CSM). The aim of this study was to report inpatient mortality, complications, and outcomes on a national level. Methods We used the National Inpatient Sample to identify 58,115 admissions of patients with CSM who underwent Spinal Fusion in the United States from 1993 to 2002. Multivariate analysis was performed to analyze the effects of patient and hospital characteristics on outcomes such as mortality, complications, discharge disposition, and length of stay. Results A total of 58,115 patients with CSM underwent Spinal Fusion with an average mortality rate of 0.6%, a complication rate of 13.4%, and a mean length of stay of 4 days. Pulmonary (3.6%) and postoperative hemorrhages or hematomas (2.3%) were the most common complications reported. One postoperative complication led to a 4-day increase in mean length of stay, increased the mortality rate 20-fold, and added more than $10,000 to hospital charges. Multivariate analysis identified age, comorbidity, and admission type as the main predictors of mortality, complication rate, and adverse outcome. Patients aged > or =85 or 65 to 84 years had respective 44- and 14-fold increases in mortality, compared with patients in the 18- to 44-year age group. Patients older than 84 years had a 40-fold increase in adverse outcomes and a 5-fold likelihood of medical complications. Patients with three or more comorbidities had an increased risk of medical complications (odds ratio [OR], 1.98), adverse discharge (OR, 2.17), and in-hospital mortality (OR, 2.36). Elective admissions were associated with much lower rates of mortality (OR, 0.28), complication (OR, 0.68), and adverse outcome (OR, 0.26). Complications were greater for posterior Fusion (16.4%) versus anterior Fusion (11.9%) procedures. Anterior Fusions were associated with a greater incidence of dysphagia (3%) and hoarseness (0.21%). Cervical spondylosis patients who presented without myelopathy had a much lower incidence of complications (6.3%). Conclusions We provide a national estimate of inpatient complications and outcomes after Spinal Fusion for CSM patients in the United States. We demonstrate the impacts of age, complications, and medical comorbidities on the outcome of surgery for patients with this common disorder. We provide complication rates stratified by age and medical comorbidities for elderly patients who present with CSM who need Spinal Fusion.
Jeanyves Lazennec - One of the best experts on this subject based on the ideXlab platform.
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what is the impact of a Spinal Fusion on acetabular implant orientation in functional standing and sitting positions
Journal of Arthroplasty, 2017Co-Authors: Jeanyves Lazennec, Ian C Clark, Dominique Folinais, Imen N Tahar, Aidin Eslam PourAbstract:Background This study used EOS imaging of primary total hip arthroplasty (THA) patients, with and without predating Spinal Fusion, to investigate (1) the impact of Spinal Fusion on acetabular implant anteversion and inclination, and (2) whether more extensive Spinal Fusion (Fusion starting above the thoracolumbar junction or extension of Fusion to the sacrum) affects acetabular implant orientation differently than lumbar only Spinal Fusion. Methods Ninety-three patients had Spinal Fusion (case group), and 150 patients were without Spinal Fusion (controls). None of the patients experienced dislocation. The change in sacral slope (SS) and cup orientation from standing to sitting was measured. Results Mean SS change from the standing to sitting positions was -7.9°in the Fusion group vs -18.4°in controls (P = .0001). Mean change in cup inclination from the standing to sitting positions was 4.9°in the Fusion group vs 10.2°in controls (P = .0001). Mean change in cup anteversion from standing to sitting positions was 7.1°in the Fusion group vs 12.1°in controls (P = .0001). For each additional level of Spinal Fusion, the change in SS from standing to sitting positions decreased by 1.6(95% confidence interval [CI], 2.2073-1.0741), the change in cup inclination decreased by 0.8(95% CI, 0.380-1.203), and the change in cup anteversion decreased by 0.9(95% CI, 0.518-1.352; P Conclusion Patients with Spinal Fusion demonstrated less adaptability of the lumbosacral junction. Longer Spinal Fusion or inclusion of the pelvis in the Fusion critically impacts hip-spine biomechanics and significantly affects the ability to compensate in the standing-to-sitting transition.
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what is the impact of a Spinal Fusion on acetabular implant orientation in functional standing and sitting positions
Journal of Arthroplasty, 2017Co-Authors: Jeanyves Lazennec, Ian C Clark, Dominique Folinais, Imen N Tahar, Aidin Eslam PourAbstract:Abstract Background This study used EOS imaging of primary total hip arthroplasty (THA) patients, with and without predating Spinal Fusion, to investigate (1) the impact of Spinal Fusion on acetabular implant anteversion and inclination, and (2) whether more extensive Spinal Fusion (Fusion starting above the thoracolumbar junction or extension of Fusion to sacrum) affects acetabular implant orientation differently than lumbar-only Spinal Fusion. Methods We retrospectively included all patients who underwent primary THA and had postoperative sitting and standing EOS® imaging. Ninety-three patients had Spinal Fusion (case group), and 150 patients were without Spinal Fusion (controls). None of the patients experienced dislocation. The change in sacral slope (SS) and cup orientation from standing to sitting was measured. Results Mean SS change from standing to sitting position was -7.9° in the Fusion group compared to -18.4° in controls (p=0.0001). Mean change in cup inclination from standing to sitting was 4.9° in the Fusion group compared to 10.2° in controls (p=0.0001). Mean change in cup anteversion from standing to sitting was 7.1° in the Fusion group compared to 12.1° in controls (p=0.0001). For each additional level of Spinal Fusion, the change in SS from standing to sitting decreased by 1.6° (95% CI: 2.2073 to 1.0741), the change in cup inclination decreased by 0.8° (95% CI: 0.380 to 1.203), and the change in cup anteversion decreased by 0.9° (95% CI: 0.518 to 1.352) (p Conclusions Patients with Spinal Fusion demonstrated less adaptability of the lumbosacral junction. Longer Spinal Fusion or inclusion of the pelvis in the Fusion critically impacts hip-spine biomechanics and significantly affects the ability to compensate in the standing-to-sitting transition.
Aaron J Buckland - One of the best experts on this subject based on the ideXlab platform.
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dislocation of a primary total hip arthroplasty is more common in patients with a lumbar Spinal Fusion
Journal of Bone and Joint Surgery-british Volume, 2017Co-Authors: Aaron J Buckland, V Puvanesarajah, Jonathan M Vigdorchik, Ran Schwarzkopf, Amit Jain, Eric O Klineberg, R A Hart, J J CallaghanAbstract:Aims Lumbar Fusion is known to reduce the variation in pelvic tilt between standing and sitting. A flexible lumbo-pelvic unit increases the stability of total hip arthroplasty (THA) when seated by increasing anterior clearance and acetabular anteversion, thereby preventing impingement of the prosthesis. Lumbar Fusion may eliminate this protective pelvic movement. The effect of lumbar Fusion on the stability of total hip arthroplasty has not previously been investigated. Patients and Methods The Medicare database was searched for patients who had undergone THA and Spinal Fusion between 2005 and 2012. PearlDiver software was used to query the database by the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedural code for primary THA and lumbar Spinal Fusion. Patients who had undergone both lumbar Fusion and THA were then divided into three groups: 1 to 2 levels, 3 to 7 levels and 8+ levels of Fusion. The rate of dislocation in each group was established using ICD-9-CM codes. Patients who underwent THA without Spinal Fusion were used as a control group. Statistical significant difference between groups was tested using the chi-squared test, and significance set at p < 0.05. Results At one-year follow-up, 14 747 patients were found to have had a THA after lumbar Spinal Fusion (12 079 1 to 2 levels, 2594 3 to 7 levels, 74 8+ levels). The control group consisted of 839 004 patients. The dislocation rate in the control group was 1.55%. A higher rate of dislocation was found in patients with a Spinal Fusion of 1 to 2 levels (2.96%, p < 0.0001) and 3 to 7 levels (4.12%, p < 0.0001). Patients with 3 to 7 levels of Fusion had a higher rate of dislocation than patients with 1 to 2 levels of Fusion (odds ratio (OR) = 1.60, p < 0.0001). When groups were matched for age and gender to the unfused cohort, patients with 1 to 2 levels of Fusion had an OR of 1.93 (95% confidence interval (CI) 1.42 to 2.32, p < 0.001), and those with 3 to 7 levels of Fusion an OR of 2.77 (CI 2.04 to 4.80, p < 0.001) for dislocation. Conclusion Patients with a previous history of lumbar Spinal Fusion have a significantly higher rate of dislocation of their THA than age- and gender-matched patients without a lumbar Spinal Fusion. Cite this article: Bone Joint J 2017;99-B:585–91.
Aidin Eslam Pour - One of the best experts on this subject based on the ideXlab platform.
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what is the impact of a Spinal Fusion on acetabular implant orientation in functional standing and sitting positions
Journal of Arthroplasty, 2017Co-Authors: Jeanyves Lazennec, Ian C Clark, Dominique Folinais, Imen N Tahar, Aidin Eslam PourAbstract:Background This study used EOS imaging of primary total hip arthroplasty (THA) patients, with and without predating Spinal Fusion, to investigate (1) the impact of Spinal Fusion on acetabular implant anteversion and inclination, and (2) whether more extensive Spinal Fusion (Fusion starting above the thoracolumbar junction or extension of Fusion to the sacrum) affects acetabular implant orientation differently than lumbar only Spinal Fusion. Methods Ninety-three patients had Spinal Fusion (case group), and 150 patients were without Spinal Fusion (controls). None of the patients experienced dislocation. The change in sacral slope (SS) and cup orientation from standing to sitting was measured. Results Mean SS change from the standing to sitting positions was -7.9°in the Fusion group vs -18.4°in controls (P = .0001). Mean change in cup inclination from the standing to sitting positions was 4.9°in the Fusion group vs 10.2°in controls (P = .0001). Mean change in cup anteversion from standing to sitting positions was 7.1°in the Fusion group vs 12.1°in controls (P = .0001). For each additional level of Spinal Fusion, the change in SS from standing to sitting positions decreased by 1.6(95% confidence interval [CI], 2.2073-1.0741), the change in cup inclination decreased by 0.8(95% CI, 0.380-1.203), and the change in cup anteversion decreased by 0.9(95% CI, 0.518-1.352; P Conclusion Patients with Spinal Fusion demonstrated less adaptability of the lumbosacral junction. Longer Spinal Fusion or inclusion of the pelvis in the Fusion critically impacts hip-spine biomechanics and significantly affects the ability to compensate in the standing-to-sitting transition.
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what is the impact of a Spinal Fusion on acetabular implant orientation in functional standing and sitting positions
Journal of Arthroplasty, 2017Co-Authors: Jeanyves Lazennec, Ian C Clark, Dominique Folinais, Imen N Tahar, Aidin Eslam PourAbstract:Abstract Background This study used EOS imaging of primary total hip arthroplasty (THA) patients, with and without predating Spinal Fusion, to investigate (1) the impact of Spinal Fusion on acetabular implant anteversion and inclination, and (2) whether more extensive Spinal Fusion (Fusion starting above the thoracolumbar junction or extension of Fusion to sacrum) affects acetabular implant orientation differently than lumbar-only Spinal Fusion. Methods We retrospectively included all patients who underwent primary THA and had postoperative sitting and standing EOS® imaging. Ninety-three patients had Spinal Fusion (case group), and 150 patients were without Spinal Fusion (controls). None of the patients experienced dislocation. The change in sacral slope (SS) and cup orientation from standing to sitting was measured. Results Mean SS change from standing to sitting position was -7.9° in the Fusion group compared to -18.4° in controls (p=0.0001). Mean change in cup inclination from standing to sitting was 4.9° in the Fusion group compared to 10.2° in controls (p=0.0001). Mean change in cup anteversion from standing to sitting was 7.1° in the Fusion group compared to 12.1° in controls (p=0.0001). For each additional level of Spinal Fusion, the change in SS from standing to sitting decreased by 1.6° (95% CI: 2.2073 to 1.0741), the change in cup inclination decreased by 0.8° (95% CI: 0.380 to 1.203), and the change in cup anteversion decreased by 0.9° (95% CI: 0.518 to 1.352) (p Conclusions Patients with Spinal Fusion demonstrated less adaptability of the lumbosacral junction. Longer Spinal Fusion or inclusion of the pelvis in the Fusion critically impacts hip-spine biomechanics and significantly affects the ability to compensate in the standing-to-sitting transition.
Michael P Glotzbecker - One of the best experts on this subject based on the ideXlab platform.
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simdiscovery a simulation based preparation program for adolescents undergoing Spinal Fusion surgery
Spine deformity, 2021Co-Authors: Lauren M Potthoff, Michael P Glotzbecker, Brianna Oconnell, Nora P Oneill, Kelsey Graber, Carrie A Byrne, Joseph M Tremmel, Peter Weinstock, Lauren MednickAbstract:Spinal Fusion surgery is associated with high levels of stress and anxiety for patients and their caregivers. Medical simulation has demonstrated efficacy in improving preparedness, knowledge, and overall experience prior to other medical procedures. The current study examines the utility of a multi-faceted preparation program (SIMDiscovery) using simulation techniques to reduce anxiety and increase preparedness among patients undergoing Spinal Fusion surgery and their caregivers. Participants attended SIMDiscovery where they received hands-on preparation about what to expect before, during, and after their surgery. Anxiety, preparedness, and knowledge about the procedure were assessed pre- and post-participation using self-report measures. Participants also completed a questionnaire at their first post-operative medical appointment. Differences from pre to post and between patients and caregivers were calculated with paired and independent sample t-tests. Participants included 22 patients and 29 caregivers. Post-SIMDiscovery, both groups demonstrated increased knowledge for the surgical process and lower state anxiety. Patients reported increased feelings of preparedness in all areas while caregivers reported increased feelings of preparedness in most areas. Families continued to report positive impact of the program 30 days after surgery; however, they also identified areas where they desired increased preparation. SIMDiscovery increased patients’ and caregivers’ knowledge regarding Spinal Fusion surgery and helped them feel less anxious and more prepared regarding most aspects of the surgical process. These changes were generally maintained throughout the post-operative period. Participants identified areas for increased preparation, highlighting the importance of continuing to adapt programs based on patient and family feedback. Level III.
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quantitative sensory changes following posterior Spinal Fusion in adolescent idiopathic scoliosis
Pediatrics, 2021Co-Authors: Nora P Oneill, Laura A B Lins, Semhal Z Ghessese, Daniel J Hedequist, Timothy Hresko, John B Emans, Lawrence I Karlin, Laura Cornelissen, Michael P GlotzbeckerAbstract:Purpose: Hypoesthesia (numbness) typically develops after posterior Spinal Fusion (PSF) to treat Adolescent Idiopathic Scoliosis (AIS). Anecdotally, patients frequently experience hypoesthesia along the incision and anterior rib cage (chest wall). However, such post-surgical sensory changes are not well described quantitatively in this population. This study aims to evaluate the presence, intensity, and duration of mechanical hypoesthesia in AIS patients postoperatively. Methods: A prospective cohort of AIS patients, 10-21 years old, was followed. Quantitative Sensory Testing (QST) included touch detection threshold (MDT) and …
