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Michael J Lee - One of the best experts on this subject based on the ideXlab platform.
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unilateral acute angle closure glaucoma after lumbar Spine Surgery a case report and systematic review of the literature
Spine, 2016Co-Authors: Robert Stewart, David C Landy, Michael J LeeAbstract:Study design A case report and literature review is presented of a patient that developed acute angle-closure glaucoma (AACG) after undergoing Spine Surgery in the prone position. Objectives To report a case of AACG after undergoing Spine Surgery in the prone position and describe potential causes and implications for future care. Summary of background data Visual loss is a devastating complication after Spine Surgery and is most often due to ischemic optic neuropathy. Although far less common, three cases of AACG have previously been reported, all of which were bilateral. Mydriatric agents and prone positioning were hypothesized as precipitating factors as both are known to increase intraocular pressure. In contrast to other visual loss diseases after Spine Surgery, AACG is amenable to treatment if recognized and treated early; however, its diagnosis is often complicated by patients presenting days after Surgery. We report the case of a 65-year-old male who underwent multilevel revision Spine Surgery in the prone position and developed unilateral AACG after discharge on postoperative day 5. Methods The case report is described. A literature review was performed using PubMed and keywords. The resulting articles were evaluated and references checked for additional cases. Results The case herein resulted in no vision loss after the AACG was treated with laser iridotomy. The patient had a history of ocular issues in the affected side, highlighting the potential role anatomy plays in the development of AACG following Spine Surgery. Three reports of AACG were found after the literature review was performed. Conclusion Although it is not practical to screen all patients through ophthalmologic referral, there may be a role for targeted preoperative screening of patients with risk factors for AACG. Level of evidence 5.
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predicting surgical site infection after Spine Surgery a validated model using a prospective surgical registry
The Spine Journal, 2014Co-Authors: Michael J Lee, Amy M Cizik, Deven Hamilton, Jens R ChapmanAbstract:Abstract Background context The impact of surgical site infection (SSI) is substantial. Although previous study has determined relative risk and odds ratio (OR) values to quantify risk factors, these values may be difficult to translate to the patient during counseling of surgical options. Ideally, a model that predicts absolute risk of SSI, rather than relative risk or OR values, would greatly enhance the discussion of safety of Spine Surgery. To date, there is no risk stratification model that specifically predicts the risk of medical complication. Purpose The purpose of this study was to create and validate a predictive model for the risk of SSI after Spine Surgery. Study design This study performs a multivariate analysis of SSI after Spine Surgery using a large prospective surgical registry. Using the results of this analysis, this study will then create and validate a predictive model for SSI after Spine Surgery. Patient sample The patient sample is from a high-quality surgical registry from our two institutions with prospectively collected, detailed demographic, comorbidity, and complication data. Outcome measures An SSI that required return to the operating room for surgical debridement. Materials and methods Using a prospectively collected surgical registry of more than 1,532 patients with extensive demographic, comorbidity, surgical, and complication details recorded for 2 years after the Surgery, we identified several risk factors for SSI after multivariate analysis. Using the beta coefficients from those regression analyses, we created a model to predict the occurrence of SSI after Spine Surgery. We split our data into two subsets for internal and cross-validation of our model. We created a predictive model based on our beta coefficients from our multivariate analysis. Results The final predictive model for SSI had a receiver-operator curve characteristic of 0.72, considered to be a fair measure. The final model has been uploaded for use on SpineSage.com . Conclusions We present a validated model for predicting SSI after Spine Surgery. The value in this model is that it gives the user an absolute percent likelihood of SSI after Spine Surgery based on the patient's comorbidity profile and invasiveness of Surgery. Patients are far more likely to understand an absolute percentage, rather than relative risk and confidence interval values. A model such as this is of paramount importance in counseling patients and enhancing the safety of Spine Surgery. In addition, a tool such as this can be of great use particularly as health care trends toward pay for performance, quality metrics (such as SSI), and risk adjustment. To facilitate the use of this model, we have created a Web site ( SpineSage.com ) where users can enter patient data to determine likelihood for SSI.
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predicting medical complications after Spine Surgery a validated model using a prospective surgical registry
The Spine Journal, 2014Co-Authors: Michael J Lee, Amy M Cizik, Deven Hamilton, Jens R ChapmanAbstract:Abstract Background context The possibility and likelihood of a postoperative medical complication after Spine Surgery undoubtedly play a major role in the decision making of the surgeon and patient alike. Although prior study has determined relative risk and odds ratio values to quantify risk factors, these values may be difficult to translate to the patient during counseling of surgical options. Ideally, a model that predicts absolute risk of medical complication, rather than relative risk or odds ratio values, would greatly enhance the discussion of safety of Spine Surgery. To date, there is no risk stratification model that specifically predicts the risk of medical complication. Purpose The purpose of this study was to create and validate a predictive model for the risk of medical complication during and after Spine Surgery. Study design/setting Statistical analysis using a prospective surgical Spine registry that recorded extensive demographic, surgical, and complication data. Outcomes examined are medical complications that were specifically defined a priori. This analysis is a continuation of statistical analysis of our previously published report. Methods Using a prospectively collected surgical registry of more than 1,476 patients with extensive demographic, comorbidity, surgical, and complication detail recorded for 2 years after Surgery, we previously identified several risk factor for medical complications. Using the beta coefficients from those log binomial regression analyses, we created a model to predict the occurrence of medical complication after Spine Surgery. We split our data into two subsets for internal and cross-validation of our model. We created two predictive models: one predicting the occurrence of any medical complication and the other predicting the occurrence of a major medical complication. Results The final predictive model for any medical complications had a receiver operator curve characteristic of 0.76, considered to be a fair measure. The final predictive model for any major medical complications had receiver operator curve characteristic of 0.81, considered to be a good measure. The final model has been uploaded for use on SpineSage.com . Conclusion We present a validated model for predicting medical complications after Spine Surgery. The value in this model is that it gives the user an absolute percent likelihood of complication after Spine Surgery based on the patient's comorbidity profile and invasiveness of Surgery. Patients are far more likely to understand an absolute percentage, rather than relative risk and confidence interval values. A model such as this is of paramount importance in counseling patients and enhancing the safety of Spine Surgery. In addition, a tool such as this can be of great use particularly as health care trends toward pay-for-performance, quality metrics, and risk adjustment. To facilitate the use of this model, we have created a website ( SpineSage.com ) where users can enter in patient data to determine likelihood of medical complications after Spine Surgery.
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risk factors for medical complication after Spine Surgery a multivariate analysis of 1 591 patients
The Spine Journal, 2012Co-Authors: Michael J Lee, Amy M Cizik, Richard J Bransford, Carlo Bellabarba, Mark A Konodi, Jens R ChapmanAbstract:Abstract Background context Several studies have examined the occurrence of medical complication after Spine Surgery. However, many of these studies have been done using large national databases. Although these allow for analysis of thousands of patients, potentially influential covariates are not accounted for in these retrospective studies. Furthermore, the accuracy of these retrospective data collection in these databases has been called into question. Purpose Using multivariate analysis on a prospectively collected data registry to determine significant risk factors for medical complication after Spine Surgery. Study design Retrospective multivariate analysis of prospectively collected registry data. The registry is a prospectively collected database of all patients who underwent Spine Surgery in our two institutions from January 1, 2003 to December 31, 2004. Methods Extensive demographic and medical information were prospectively recorded as described previously by Mirza et al. Complications were defined in detail a priori, and they were prospectively recorded for at least 2 years after Surgery. We analyzed risk factors for medical complication after Spine Surgery using univariate and multivariate analyses. Results We analyzed data from 1,591 patients who met out inclusion criteria. The cumulative incidences of complication after Spine Surgery per organ system are as follows: cardiac, 8.4%; pulmonary, 13%; gastrointestinal, 3.9%; neurological, 7.35%; hematological, 10.75%; and urological complications, 9.18%. The occurrence of cardiac or respiratory complication after Spine Surgery was significantly associated with death within 2 years (relative risk, 4.11 and 10.76, respectively). Surgical invasiveness and age were significant risk factors for complications in five of the six organ systems evaluated. Individual organ system-specific elative risk values with 95% confidence intervals and p values are listed in Tables 3 and 4. Conclusions Risk factors identified in this study can be beneficial to clinicians and patients alike when considering surgical treatment of the Spine. Future analyses and models that predict the occurrence of medical complication after Spine Surgery may be of further benefit for surgical decision making.
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risk factors for unintended durotomy during Spine Surgery a multivariate analysis
The Spine Journal, 2012Co-Authors: Geoff A Baker, Amy M Cizik, Richard J Bransford, Carlo Bellabarba, Mark A Konodi, Jens R Chapman, Michael J LeeAbstract:Abstract Background context Incidental durotomy during Spine Surgery is a common occurrence, with a reported incidence ranging from 3% to 16%. Risk factors identified by prior studies include age, type of procedure, revision Surgery, ossification of the posterior longitudinal ligament, gender, osteoporosis, and arthritis. However, these studies are largely univariate analyses using retrospectively recorded data. Purpose To identify and quantify statistically significant risk factors for inadvertent durotomy during Spine Surgery. Study design Multivariate analysis of prospectively collected registry data. The University of Washington Spine End Results Registry 2003 and 2004 is a compilation of prospectively collected detailed data on 1,745 patients who underwent Spine Surgery during 2003 to 2004. Patient sample One thousand seven hundred forty-five patients underwent Spine Surgery from 2003 to 2004 at our two institutions. Outcome measures Cardiac, pulmonary, gastrointestinal, neurologic, renal, and urologic complications defined a priori data collection. Methods Using these data, univariate and multivariate statistical analyses were performed to identify and quantify risk factors for incidental durotomy during Spine Surgery. Relative risk (RR) values with valid confidence intervals and p values were determined using these data. Results Our multivariate analysis demonstrated that age, lumbar Surgery, revision Surgery, and elevated surgical invasiveness are significant risk factors for unintended durotomy. Of these, revision Surgery was the strongest risk factor for dural tear (RR, 2.21). Diabetes was a significant risk factor in the univariate analysis but not in the multivariate analysis. Conclusions Revision Surgery, age, lumbar Surgery, degenerative disease, and elevated surgical invasiveness are significant risk factors for unintended durotomy during Spine Surgery. These data can be useful to surgeons and patients when considering surgical treatment.
Jens R Chapman - One of the best experts on this subject based on the ideXlab platform.
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perioperative anticoagulation management in Spine Surgery initial findings from the ao Spine anticoagulation global survey
Global Spine Journal, 2020Co-Authors: Philip K Louie, Yoshiharu Kawaguchi, Thomas E Mroz, Michael G Fehlings, Jens R Chapman, James S Harrop, Garrett K Harada, Khalid Alsaleh, Giovanni Barbanti Brodano, Michael MayerAbstract:Study Design:Cross-sectional, international survey.Objectives:This study addressed the global perspectives concerning perioperative use of pharmacologic thromboprophylaxis during Spine Surgery alon...
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predicting surgical site infection after Spine Surgery a validated model using a prospective surgical registry
The Spine Journal, 2014Co-Authors: Michael J Lee, Amy M Cizik, Deven Hamilton, Jens R ChapmanAbstract:Abstract Background context The impact of surgical site infection (SSI) is substantial. Although previous study has determined relative risk and odds ratio (OR) values to quantify risk factors, these values may be difficult to translate to the patient during counseling of surgical options. Ideally, a model that predicts absolute risk of SSI, rather than relative risk or OR values, would greatly enhance the discussion of safety of Spine Surgery. To date, there is no risk stratification model that specifically predicts the risk of medical complication. Purpose The purpose of this study was to create and validate a predictive model for the risk of SSI after Spine Surgery. Study design This study performs a multivariate analysis of SSI after Spine Surgery using a large prospective surgical registry. Using the results of this analysis, this study will then create and validate a predictive model for SSI after Spine Surgery. Patient sample The patient sample is from a high-quality surgical registry from our two institutions with prospectively collected, detailed demographic, comorbidity, and complication data. Outcome measures An SSI that required return to the operating room for surgical debridement. Materials and methods Using a prospectively collected surgical registry of more than 1,532 patients with extensive demographic, comorbidity, surgical, and complication details recorded for 2 years after the Surgery, we identified several risk factors for SSI after multivariate analysis. Using the beta coefficients from those regression analyses, we created a model to predict the occurrence of SSI after Spine Surgery. We split our data into two subsets for internal and cross-validation of our model. We created a predictive model based on our beta coefficients from our multivariate analysis. Results The final predictive model for SSI had a receiver-operator curve characteristic of 0.72, considered to be a fair measure. The final model has been uploaded for use on SpineSage.com . Conclusions We present a validated model for predicting SSI after Spine Surgery. The value in this model is that it gives the user an absolute percent likelihood of SSI after Spine Surgery based on the patient's comorbidity profile and invasiveness of Surgery. Patients are far more likely to understand an absolute percentage, rather than relative risk and confidence interval values. A model such as this is of paramount importance in counseling patients and enhancing the safety of Spine Surgery. In addition, a tool such as this can be of great use particularly as health care trends toward pay for performance, quality metrics (such as SSI), and risk adjustment. To facilitate the use of this model, we have created a Web site ( SpineSage.com ) where users can enter patient data to determine likelihood for SSI.
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predicting medical complications after Spine Surgery a validated model using a prospective surgical registry
The Spine Journal, 2014Co-Authors: Michael J Lee, Amy M Cizik, Deven Hamilton, Jens R ChapmanAbstract:Abstract Background context The possibility and likelihood of a postoperative medical complication after Spine Surgery undoubtedly play a major role in the decision making of the surgeon and patient alike. Although prior study has determined relative risk and odds ratio values to quantify risk factors, these values may be difficult to translate to the patient during counseling of surgical options. Ideally, a model that predicts absolute risk of medical complication, rather than relative risk or odds ratio values, would greatly enhance the discussion of safety of Spine Surgery. To date, there is no risk stratification model that specifically predicts the risk of medical complication. Purpose The purpose of this study was to create and validate a predictive model for the risk of medical complication during and after Spine Surgery. Study design/setting Statistical analysis using a prospective surgical Spine registry that recorded extensive demographic, surgical, and complication data. Outcomes examined are medical complications that were specifically defined a priori. This analysis is a continuation of statistical analysis of our previously published report. Methods Using a prospectively collected surgical registry of more than 1,476 patients with extensive demographic, comorbidity, surgical, and complication detail recorded for 2 years after Surgery, we previously identified several risk factor for medical complications. Using the beta coefficients from those log binomial regression analyses, we created a model to predict the occurrence of medical complication after Spine Surgery. We split our data into two subsets for internal and cross-validation of our model. We created two predictive models: one predicting the occurrence of any medical complication and the other predicting the occurrence of a major medical complication. Results The final predictive model for any medical complications had a receiver operator curve characteristic of 0.76, considered to be a fair measure. The final predictive model for any major medical complications had receiver operator curve characteristic of 0.81, considered to be a good measure. The final model has been uploaded for use on SpineSage.com . Conclusion We present a validated model for predicting medical complications after Spine Surgery. The value in this model is that it gives the user an absolute percent likelihood of complication after Spine Surgery based on the patient's comorbidity profile and invasiveness of Surgery. Patients are far more likely to understand an absolute percentage, rather than relative risk and confidence interval values. A model such as this is of paramount importance in counseling patients and enhancing the safety of Spine Surgery. In addition, a tool such as this can be of great use particularly as health care trends toward pay-for-performance, quality metrics, and risk adjustment. To facilitate the use of this model, we have created a website ( SpineSage.com ) where users can enter in patient data to determine likelihood of medical complications after Spine Surgery.
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risk factors for medical complication after Spine Surgery a multivariate analysis of 1 591 patients
The Spine Journal, 2012Co-Authors: Michael J Lee, Amy M Cizik, Richard J Bransford, Carlo Bellabarba, Mark A Konodi, Jens R ChapmanAbstract:Abstract Background context Several studies have examined the occurrence of medical complication after Spine Surgery. However, many of these studies have been done using large national databases. Although these allow for analysis of thousands of patients, potentially influential covariates are not accounted for in these retrospective studies. Furthermore, the accuracy of these retrospective data collection in these databases has been called into question. Purpose Using multivariate analysis on a prospectively collected data registry to determine significant risk factors for medical complication after Spine Surgery. Study design Retrospective multivariate analysis of prospectively collected registry data. The registry is a prospectively collected database of all patients who underwent Spine Surgery in our two institutions from January 1, 2003 to December 31, 2004. Methods Extensive demographic and medical information were prospectively recorded as described previously by Mirza et al. Complications were defined in detail a priori, and they were prospectively recorded for at least 2 years after Surgery. We analyzed risk factors for medical complication after Spine Surgery using univariate and multivariate analyses. Results We analyzed data from 1,591 patients who met out inclusion criteria. The cumulative incidences of complication after Spine Surgery per organ system are as follows: cardiac, 8.4%; pulmonary, 13%; gastrointestinal, 3.9%; neurological, 7.35%; hematological, 10.75%; and urological complications, 9.18%. The occurrence of cardiac or respiratory complication after Spine Surgery was significantly associated with death within 2 years (relative risk, 4.11 and 10.76, respectively). Surgical invasiveness and age were significant risk factors for complications in five of the six organ systems evaluated. Individual organ system-specific elative risk values with 95% confidence intervals and p values are listed in Tables 3 and 4. Conclusions Risk factors identified in this study can be beneficial to clinicians and patients alike when considering surgical treatment of the Spine. Future analyses and models that predict the occurrence of medical complication after Spine Surgery may be of further benefit for surgical decision making.
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risk factors for unintended durotomy during Spine Surgery a multivariate analysis
The Spine Journal, 2012Co-Authors: Geoff A Baker, Amy M Cizik, Richard J Bransford, Carlo Bellabarba, Mark A Konodi, Jens R Chapman, Michael J LeeAbstract:Abstract Background context Incidental durotomy during Spine Surgery is a common occurrence, with a reported incidence ranging from 3% to 16%. Risk factors identified by prior studies include age, type of procedure, revision Surgery, ossification of the posterior longitudinal ligament, gender, osteoporosis, and arthritis. However, these studies are largely univariate analyses using retrospectively recorded data. Purpose To identify and quantify statistically significant risk factors for inadvertent durotomy during Spine Surgery. Study design Multivariate analysis of prospectively collected registry data. The University of Washington Spine End Results Registry 2003 and 2004 is a compilation of prospectively collected detailed data on 1,745 patients who underwent Spine Surgery during 2003 to 2004. Patient sample One thousand seven hundred forty-five patients underwent Spine Surgery from 2003 to 2004 at our two institutions. Outcome measures Cardiac, pulmonary, gastrointestinal, neurologic, renal, and urologic complications defined a priori data collection. Methods Using these data, univariate and multivariate statistical analyses were performed to identify and quantify risk factors for incidental durotomy during Spine Surgery. Relative risk (RR) values with valid confidence intervals and p values were determined using these data. Results Our multivariate analysis demonstrated that age, lumbar Surgery, revision Surgery, and elevated surgical invasiveness are significant risk factors for unintended durotomy. Of these, revision Surgery was the strongest risk factor for dural tear (RR, 2.21). Diabetes was a significant risk factor in the univariate analysis but not in the multivariate analysis. Conclusions Revision Surgery, age, lumbar Surgery, degenerative disease, and elevated surgical invasiveness are significant risk factors for unintended durotomy during Spine Surgery. These data can be useful to surgeons and patients when considering surgical treatment.
James D. Kang - One of the best experts on this subject based on the ideXlab platform.
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sustained preoperative opioid use is a predictor of continued use following Spine Surgery
Journal of Bone and Joint Surgery American Volume, 2018Co-Authors: Andrew J Schoenfeld, James D. Kang, Philip J Belmont, Justin A Blucher, Wei Jiang, Muhammad Ali Chaudhary, Tracey Perez Koehlmoos, Adil H HaiderAbstract:Background:Preoperative opioid use is known to increase the likelihood of complications and inferior outcomes following Spine Surgery. We evaluated the association of preoperative opioid use and other risk factors with postoperative opioid use.Methods:We queried 2006-2014 TRICARE insurance claims to
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prevalence of venous thromboembolic events after elective major thoracolumbar degenerative Spine Surgery
Journal of Spinal Disorders & Techniques, 2015Co-Authors: Justin B Hohl, Clinton J. Devin, James D. Kang, Joon Y Lee, Steven P Rayappa, Colin E Nabb, William Timothy Ward, William F. DonaldsonAbstract:STUDY DESIGN A case-control study. OBJECTIVE The purposes of this study were to establish the prevalence of venous thromboembolic disease in patients undergoing elective major thoracolumbar degenerative Spine Surgery and identify risk factors. SUMMARY OF BACKGROUND DATA Venous thromboembolic events (VTE) are a serious complication of orthopedic Surgery, but the prevalence of VTE after elective thoracolumbar degenerative Spine Surgery is not well known. METHODS This was a case-control study of 5766 consecutive elective thoracolumbar degenerative Spine surgeries. Symptomatic pulmonary emboli (PE) were diagnosed by spiral chest CT scans, nuclear scintigraphic ventilation-perfusion, and angiography. Deep vein thromboses (DVT) were diagnosed by venous duplex scans. The prevalence of VTE was analyzed according to patient demographic variables and type of Surgery performed. RESULTS The prevalence of developing a VTE was 1.5% (89/5766), with a prevalence of symptomatic PE of 0.88% (51/5766) and DVT of 0.66% (38/5766). There were 47% males and 53% females with a mean age of 60.3 years. In patients undergoing 5-segment fusions the prevalence of PE was 3.1% (P=0.022). Patients who had ≥4 segments fused had a prevalence of PE of 1.7% (P=0.014). The odds of having a PE in those above 65 years at the time of Surgery were 2.196 times as large as for those below 65 years. Noncontributory factors included sex, instrumentation, and revision Surgery. CONCLUSIONS This case-control study of 5766 patients who underwent elective thoracolumbar degenerative Spine Surgery revealed a prevalence of VTE of 1.5%, with a prevalence of PE of 0.88% and DVT of 0.66%. Patients with increasingly extensive Surgery had a higher risk of PE, specifically those undergoing fusion of ≥5 segments.
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vertebral artery injuries in cervical Spine Surgery
The Spine Journal, 2014Co-Authors: David Lunardini, James D. Kang, Mark S Eskander, Jesse L Even, James T Dunlap, Antonia F Chen, Timothy Ward, William F. DonaldsonAbstract:Abstract Background context Vertebral artery injuries (VAIs) are rare but serious complications of cervical Spine Surgery, with the potential to cause catastrophic bleeding, permanent neurologic impairment, and even death. The present literature regarding incidence of this complication largely comprises a single surgeon or small multicenter case series. Purpose We sought to gather a large sample of high-volume surgeons to adequately characterize the incidence and risk factors for VAI, management strategies used, and patient outcomes after VAI. Study design The study was constructed as a cross-sectional study comprising all cervical Spine patients operated on by the members of the international Cervical Spine Research Society (CSRS). Patient sample All patients who have undergone cervical Spine Surgery by a current member of CSRS as of the spring of 2012. Outcome measures For each surgeon surveyed, we collected self-reported measures to include the number of cervical cases performed in the surgeon's career, the number of VAIs encountered, the stage of the case during which the injury occurred, the management strategies used, and the overall patient outcome after injury. Methods An anonymous 10-question web-based survey was distributed to the members of the CSRS. Statistical analysis was performed using Student t tests for numerical outcomes and chi-squared analysis for categorical variables. Results One hundred forty-one CSRS members (of 195 total, 72%) responded to the survey, accounting for a total of 163,324 cervical Spine surgeries performed. The overall incidence of VAI was 0.07% (111/163,324). Posterior instrumentation of the upper cervical Spine (32.4%), anterior corpectomy (23.4%), and posterior exposure of the cervical Spine (11.7%) were the most common stages of the case to result in an injury to the vertebral artery. Discectomy (9%) and anterior exposure of the Spine (7.2%) were also common time points for an arterial injury. One-fifth (22/111) of all VAI involved an anomalous course of the vertebral artery. The most common management of VAI was by direct tamponade. The outcomes of VAIs included no permanent sequelae in 90% of patients, permanent neurologic sequelae in 5.5%, and death in 4.5%. Surgeons at academic and private centers had nearly identical rates of VAIs. However, surgeons who had performed 300 or fewer cervical Spine surgeries in their career had a VAI incidence of 0.33% compared with 0.06% in those with greater than 300 lifetime cases (p=.028). Conclusions The overall incidence of VAI during cervical Spine Surgery reported from this survey was 0.07%. Less experienced surgeons had a higher rate of VAI compared with their more experienced peers. The results of VAI are highly variable, resulting in no permanent harm most of the time; however, permanent neurologic injury or death occur in 10% of cases.
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Cerebrospinal fluid leaks following cervical Spine Surgery.
Journal of Bone and Joint Surgery American Volume, 2008Co-Authors: David Hannallah, Mustafa H. Khan, William F. Donaldson, James D. KangAbstract:Background: A cerebrospinal fluid leak during cervical Spine Surgery is a feared complication. However, little is known about the prevalence, management, and long-term course of these events. Methods: The medical records of 1994 patients who had elective cervical Spine Surgery during an eleven-year period (1994 through 2005) were reviewed. Patients with cervical cerebrospinal fluid leaks identified at the time of Surgery were followed both clinically and radiographically for an average of 5.4 years postoperatively. The prevalence, etiology, management, and outcome of all of the cervical cerebrospinal fluid leaks were analyzed. Results: The overall prevalence of cerebrospinal fluid leaks was 1%. The prevalence of cerebrospinal fluid leaks was higher in patients with a diagnosis of ossification of the posterior longitudinal ligament (12.5%), patients having a revision anterior procedure (1.92%), men (1.56%), and patients undergoing an anterior cervical corpectomy and arthrodesis (1.77%). Conclusions: Many cervical dural tears can be managed by observation alone or by placement of a lumbar cerebrospinal fluid shunt either during the index procedure or in the postoperative period. At an average follow-up of 5.4 years, there were no long-term sequelae of the cervical dural tears in our series. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.
William F. Donaldson - One of the best experts on this subject based on the ideXlab platform.
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prevalence of venous thromboembolic events after elective major thoracolumbar degenerative Spine Surgery
Journal of Spinal Disorders & Techniques, 2015Co-Authors: Justin B Hohl, Clinton J. Devin, James D. Kang, Joon Y Lee, Steven P Rayappa, Colin E Nabb, William Timothy Ward, William F. DonaldsonAbstract:STUDY DESIGN A case-control study. OBJECTIVE The purposes of this study were to establish the prevalence of venous thromboembolic disease in patients undergoing elective major thoracolumbar degenerative Spine Surgery and identify risk factors. SUMMARY OF BACKGROUND DATA Venous thromboembolic events (VTE) are a serious complication of orthopedic Surgery, but the prevalence of VTE after elective thoracolumbar degenerative Spine Surgery is not well known. METHODS This was a case-control study of 5766 consecutive elective thoracolumbar degenerative Spine surgeries. Symptomatic pulmonary emboli (PE) were diagnosed by spiral chest CT scans, nuclear scintigraphic ventilation-perfusion, and angiography. Deep vein thromboses (DVT) were diagnosed by venous duplex scans. The prevalence of VTE was analyzed according to patient demographic variables and type of Surgery performed. RESULTS The prevalence of developing a VTE was 1.5% (89/5766), with a prevalence of symptomatic PE of 0.88% (51/5766) and DVT of 0.66% (38/5766). There were 47% males and 53% females with a mean age of 60.3 years. In patients undergoing 5-segment fusions the prevalence of PE was 3.1% (P=0.022). Patients who had ≥4 segments fused had a prevalence of PE of 1.7% (P=0.014). The odds of having a PE in those above 65 years at the time of Surgery were 2.196 times as large as for those below 65 years. Noncontributory factors included sex, instrumentation, and revision Surgery. CONCLUSIONS This case-control study of 5766 patients who underwent elective thoracolumbar degenerative Spine Surgery revealed a prevalence of VTE of 1.5%, with a prevalence of PE of 0.88% and DVT of 0.66%. Patients with increasingly extensive Surgery had a higher risk of PE, specifically those undergoing fusion of ≥5 segments.
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vertebral artery injuries in cervical Spine Surgery
The Spine Journal, 2014Co-Authors: David Lunardini, James D. Kang, Mark S Eskander, Jesse L Even, James T Dunlap, Antonia F Chen, Timothy Ward, William F. DonaldsonAbstract:Abstract Background context Vertebral artery injuries (VAIs) are rare but serious complications of cervical Spine Surgery, with the potential to cause catastrophic bleeding, permanent neurologic impairment, and even death. The present literature regarding incidence of this complication largely comprises a single surgeon or small multicenter case series. Purpose We sought to gather a large sample of high-volume surgeons to adequately characterize the incidence and risk factors for VAI, management strategies used, and patient outcomes after VAI. Study design The study was constructed as a cross-sectional study comprising all cervical Spine patients operated on by the members of the international Cervical Spine Research Society (CSRS). Patient sample All patients who have undergone cervical Spine Surgery by a current member of CSRS as of the spring of 2012. Outcome measures For each surgeon surveyed, we collected self-reported measures to include the number of cervical cases performed in the surgeon's career, the number of VAIs encountered, the stage of the case during which the injury occurred, the management strategies used, and the overall patient outcome after injury. Methods An anonymous 10-question web-based survey was distributed to the members of the CSRS. Statistical analysis was performed using Student t tests for numerical outcomes and chi-squared analysis for categorical variables. Results One hundred forty-one CSRS members (of 195 total, 72%) responded to the survey, accounting for a total of 163,324 cervical Spine surgeries performed. The overall incidence of VAI was 0.07% (111/163,324). Posterior instrumentation of the upper cervical Spine (32.4%), anterior corpectomy (23.4%), and posterior exposure of the cervical Spine (11.7%) were the most common stages of the case to result in an injury to the vertebral artery. Discectomy (9%) and anterior exposure of the Spine (7.2%) were also common time points for an arterial injury. One-fifth (22/111) of all VAI involved an anomalous course of the vertebral artery. The most common management of VAI was by direct tamponade. The outcomes of VAIs included no permanent sequelae in 90% of patients, permanent neurologic sequelae in 5.5%, and death in 4.5%. Surgeons at academic and private centers had nearly identical rates of VAIs. However, surgeons who had performed 300 or fewer cervical Spine surgeries in their career had a VAI incidence of 0.33% compared with 0.06% in those with greater than 300 lifetime cases (p=.028). Conclusions The overall incidence of VAI during cervical Spine Surgery reported from this survey was 0.07%. Less experienced surgeons had a higher rate of VAI compared with their more experienced peers. The results of VAI are highly variable, resulting in no permanent harm most of the time; however, permanent neurologic injury or death occur in 10% of cases.
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Cerebrospinal fluid leaks following cervical Spine Surgery.
Journal of Bone and Joint Surgery American Volume, 2008Co-Authors: David Hannallah, Mustafa H. Khan, William F. Donaldson, James D. KangAbstract:Background: A cerebrospinal fluid leak during cervical Spine Surgery is a feared complication. However, little is known about the prevalence, management, and long-term course of these events. Methods: The medical records of 1994 patients who had elective cervical Spine Surgery during an eleven-year period (1994 through 2005) were reviewed. Patients with cervical cerebrospinal fluid leaks identified at the time of Surgery were followed both clinically and radiographically for an average of 5.4 years postoperatively. The prevalence, etiology, management, and outcome of all of the cervical cerebrospinal fluid leaks were analyzed. Results: The overall prevalence of cerebrospinal fluid leaks was 1%. The prevalence of cerebrospinal fluid leaks was higher in patients with a diagnosis of ossification of the posterior longitudinal ligament (12.5%), patients having a revision anterior procedure (1.92%), men (1.56%), and patients undergoing an anterior cervical corpectomy and arthrodesis (1.77%). Conclusions: Many cervical dural tears can be managed by observation alone or by placement of a lumbar cerebrospinal fluid shunt either during the index procedure or in the postoperative period. At an average follow-up of 5.4 years, there were no long-term sequelae of the cervical dural tears in our series. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.
Claus Herberhold - One of the best experts on this subject based on the ideXlab platform.
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recurrent laryngeal nerve palsy during anterior cervical Spine Surgery a prospective study
Journal of Neurosurgery, 2005Co-Authors: Axel Jung, Johannes Schramm, Kai Lehnerdt, Claus HerberholdAbstract:Object. Recurrent laryngeal nerve (RLN) palsy is a well-known complication of cervical Spine Surgery. Nearly all previous studies were performed without laryngoscopy in asymptomatic patients. This prospective study was undertaken to discern the true incidence of RLN palsy. Because not every RLN palsy is associated with hoarseness, the authors conducted a prospective study involving the use of pre- and postoperative laryngoscopy. Methods. Prior to anterior cervical Spine Surgery preoperative indirect laryngoscopy was performed in 123 patients to evaluate the status of the vocal cords as a sign of function of the RLN. To assess postoperative status in 120 patients laryngoscopy was repeated, and in cases of vocal cord malfunction follow-up examination was conducted 3 months later. In the group of 120 patients who attended follow-up examination, two (1.6%) had experienced a preoperative RLN palsy without hoarseness. Postoperatively the rate of clinically symptomatic RLN palsy was 8.3%, and the incidence of RLN palsy not associated with hoarseness (that is, clinically unapparent without laryngoscopy) was 15.9% (overall incidence 24.2%). At 3-month follow-up evaluation the rate had decreased to 2.5% in cases with hoarseness and 10.8% without hoarseness. Thus, the overall rate of early persisting RLN palsy was 11.3%. Conclusions. Laryngoscopy revealed that the true incidence of initial and persisting RLN palsy after anterior cervical Spine Surgery was much higher than anticipated. Especially in cases without hoarseness this could be proven, but the initial incidence of hoarseness was higher than expected. Only one third of new RLN palsy cases could be detected without laryngoscopy. Resolution of hoarseness was approximately 70% in those with preoperative hoarseness. The true rate of RLN palsy underscores the necessity to reevaluate the Surgery- and intubation-related techniques for anterior cervical Spine Surgery and to reassess the degree of presurgical patient counseling.
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recurrent laryngeal nerve palsy during anterior cervical Spine Surgery a prospective study
Journal of Neurosurgery, 2005Co-Authors: Axel Jung, Johannes Schramm, Kai Lehnerdt, Claus HerberholdAbstract:Object. Recurrent laryngeal nerve (RLN) palsy is a well-known complication of cervical Spine Surgery. Nearly all previous studies were performed without laryngoscopy in asymptomatic patients. This prospective study was undertaken to discern the true incidence of RLN palsy. Because not every RLN palsy is associated with hoarseness, the authors conducted a prospective study involving the use of pre- and postoperative laryngoscopy. Methods. Prior to anterior cervical Spine Surgery preoperative indirect laryngoscopy was performed in 123 patients to evaluate the status of the vocal cords as a sign of function of the RLN. To assess postoperative status in 120 patients laryngoscopy was repeated, and in cases of vocal cord malfunction follow-up examination was conducted 3 months later. In the group of 120 patients who attended follow-up examination, two (1.6%) had experienced a preoperative RLN palsy without hoarseness. Postoperatively the rate of clinically symptomatic RLN palsy was 8.3%, and the incidence of RLN palsy not associated with hoarseness (that is, clinically unapparent without laryngoscopy) was 15.9% (overall incidence 24.2%). At 3-month follow-up evaluation the rate had decreased to 2.5% in cases with hoarseness and 10.8% without hoarseness. Thus, the overall rate of early persisting RLN palsy was 11.3%. Conclusions. Laryngoscopy revealed that the true incidence of initial and persisting RLN palsy after anterior cervical Spine Surgery was much higher than anticipated. Especially in cases without hoarseness this could be proven, but the initial incidence of hoarseness was higher than expected. Only one third of new RLN palsy cases could be detected without laryngoscopy. Resolution of hoarseness was approximately 70% in those with preoperative hoarseness. The true rate of RLN palsy underscores the necessity to reevaluate the Surgery- and intubation-related techniques for anterior cervical Spine Surgery and to reassess the degree of presurgical patient counseling.
