468 results on '"Riew, KD"'
Search Results
2. Surgical treatment of c3 and c4 cervical radiculopathies.
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Park MS, Kelly MP, Min WK, Rahman RK, and Riew KD
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- 2013
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3. Adverse events of cervical arthroplasty.
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Buchowski JM, Sekhon LHS, Yoon D, Nunley PD, Heller JG, Anderson PA, Sasso RC, Hacker RJ, and Riew KD
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- 2010
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4. Cervical disc arthroplasty compared with arthrodesis for the treatment of myelopathy. Surgical technique.
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Buchowski JM, Anderson PA, Sekhon L, Riew KD, Buchowski, Jacob M, Anderson, Paul A, Sekhon, Lali, and Riew, K Daniel
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Background: Although there have been case reports describing the use of cervical disc arthroplasty for the treatment of myelopathy, there is a concern that motion preservation may maintain microtrauma to the spinal cord, negatively affecting the clinical results. As we are not aware of any studies on the use of arthroplasty in this scenario, we performed a cross-sectional analysis of two large, prospective, randomized multicenter trials to evaluate the efficacy of cervical disc arthroplasty for the treatment of myelopathy.Methods: The patients in the current study were a cohort of patients who were enrolled in the United States Food and Drug Administration Investigational Device Exemption studies of the Prestige ST and Bryan disc replacements (Medtronic, Memphis, Tennessee). The inclusion criteria were myelopathy and spondylosis or disc herniation at a single level from C3 to C7. Clinical outcome measures were collected preoperatively and at six weeks, three months, six months, twelve months, and twenty-four months postoperatively.Results: A total of 199 patients were included in the present study; 106 patients (53%) underwent arthroplasty, whereas ninety-three (47%) underwent arthrodesis. The Neck Disability Index, Short Form-36 scores, and specific arm and neck pain scores improved significantly from baseline at all time points. Patients in all four groups had improvement in the postoperative neurological status and gait function; at twenty-four months after surgery, 90% (95% confidence interval, 77.8% to 96.6%) of the patients in the arthroplasty group and 81% (95% confidence interval, 64.9% to 92.0%) of those in the arthrodesis group had improvement in or maintenance of the neurological status in the Prestige ST trial and 90% (95% confidence interval, 75.8% to 97.1%) of the patients in the arthroplasty group and 77% (95% confidence interval, 57.7% to 90.1%) of those in the arthrodesis group had improvement in or maintenance of the neurological status in the Bryan trial.Conclusions: We found that patients in both the arthroplasty and arthrodesis groups had improvement following surgery; furthermore, improvement was similar between the groups, with no worsening of myelopathy in the arthroplasty group. While the findings at two years postoperatively suggest that arthroplasty is equivalent to arthrodesis for the treatment of cervical myelopathy for a single-level abnormality localized to the disc space, the present study did not evaluate the treatment of retrovertebral compression as occurs in association with ossification of the posterior longitudinal ligament, and we cannot comment on the treatment of this condition. [ABSTRACT FROM AUTHOR]- Published
- 2009
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5. The time course of range of motion loss after cervical laminoplasty: a prospective study with minimum two-year follow-up.
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Hyun SJ, Rhim SC, Roh SW, Kang SH, and Riew KD
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- 2009
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6. Predictors of outcome after anterior cervical discectomy and fusion: a multivariate analysis.
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Anderson PA, Subach BR, Riew KD, Anderson, Paul A, Subach, Brian R, and Riew, K Daniel
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- 2009
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7. Adverse events associated with anterior cervical spine surgery.
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Daniels AH, Riew KD, Yoo JU, Ching A, Birchard KR, Kranenburg AJ, Hart RA, Daniels, Alan H, Riew, K Daniel, Yoo, J U, Ching, Alexander, Birchard, Keith R, Kranenburg, Andy J, and Hart, Robert A
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- 2008
8. Comparison of adverse events between the bryan artificial cervical disc and anterior cervical arthrodesis.
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Anderson PA, Sasso RC, and Riew KD
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- 2008
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9. Salvage of C2 pedicle and pars screws using the intralaminar technique: a biomechanical analysis.
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Lehman RA Jr, Dmitriev AE, Helgeson MD, Sasso RC, Kuklo TR, Riew KD, Lehman, Ronald A Jr, Dmitriev, Anton E, Helgeson, Melvin D, Sasso, Rick C, Kuklo, Timothy R, and Riew, K Daniel
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- 2008
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10. Accuracy of intraoperative plain radiographs to detect violations of intralaminar screws placed into the C2 vertebrae: a reliability study.
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Lehman RA Jr, Sasso RC, Helgeson MD, Dmitriev AE, Gill NW, Rosner MR, Riew KD, Lehman, Ronald A Jr, Sasso, Rick C, Helgeson, Melvin D, Dmitriev, Anton E, Gill, Norman W, Rosner, Michael R, and Riew, K Daniel
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- 2007
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11. Magnetic resonance imaging clarity of the Bryan, Prodisc-C, Prestige LP, and PCM cervical arthroplasty devices.
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Sekhon LH, Duggal N, Lynch JJ, Haid RW, Heller JG, Riew KD, Seex K, and Anderson PA
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- 2007
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12. Prevalence of cervical spine stenosis. Anatomic study in cadavers.
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Lee MJ, Cassinelli EH, Riew KD, Lee, Michael J, Cassinelli, Ezequiel H, and Riew, K Daniel
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Background: The sagittal diameter of the cervical spinal canal is of clinical importance in traumatic, degenerative, and inflammatory conditions. A small canal diameter has been associated with an increased risk of injury; however, there is a lack of reliable normative data on spinal canal diameters in different age groups in the United States population. The purpose of this study was to use direct measurement of skeletal specimens to determine the spectrum of the sagittal diameters of the cervical spinal canal, the frequency of cervical stenosis in the general population, and the prevalence of cervical stenosis for different age groups, races, and sexes.Methods: Four hundred and sixty-nine adult skeletal specimens of the cervical spine were obtained from the Hamann-Todd Collection in the Cleveland Museum of Natural History. With use of digital calipers, the distance from the posteriormost aspect of the vertebral body to the anteriormost aspect of the spinolaminar structure was measured and recorded for each specimen at every level from C3 to C7. Cervical stenosis was defined as a canal diameter of <12 mm. We analyzed the direct measurements and then assessed those data after correcting for size increases in the current population compared with the Hamann-Todd Collection. Finally, we analyzed the data after both that size correction and adjustment for radiographic magnification.Results: The average anterior-posterior canal diameter (and standard deviation) in all specimens at all levels was 14.1 +/- 1.6 mm. The canal diameters ranged from 9.0 to 20.9 mm, with a median diameter of 14.4 mm. Men had significantly larger cervical spinal canals than women at all of the levels that were evaluated. Specimens from donors who were sixty years of age or more at the time of death had significantly narrower canals than specimens from younger donors. There were no significant differences, with the numbers available, between black and white groups. After correcting for increased body size and adjusting for radiographic magnification, we estimated that cervical stenosis was present in 4.9% of the adult population, 6.8% of the population fifty years of age or older, and 9% of the population seventy years of age or older.Conclusions: Cervical spine stenosis appears to be very common. The radiographic finding of cervical stenosis should therefore be correlated with the clinical presentation prior to decision-making regarding treatment. [ABSTRACT FROM AUTHOR]- Published
- 2007
13. Nerve root blocks in the treatment of lumbar radicular pain. A minimum five-year follow-up.
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Riew KD, Park J, Cho Y, Gilula L, Patel A, Lenke LG, Riew, K Daniel, Park, Jong-Beom, Cho, Yong-Sun, Gilula, Louis, Patel, Alpesh, Lenke, Lawrence G, and Bridwell, Keith H
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Background: In a previous prospective, randomized, controlled, double-blinded study on the effect of nerve root blocks on the need for operative treatment of lumbar radicular pain, we found that injections of corticosteroids were more effective than bupivacaine for up to thirteen to twenty-eight months. We performed a minimum five-year followup of those patients who had avoided surgery.Methods: All of the patients were considered to be operative candidates by the treating surgeon, and all had initially requested operative intervention. They had then been randomized to be treated with a selective nerve-root block with either bupivacaine or bupivacaine and betamethasone. Both the treating physician and the patient were blinded to the type of medication. Of fifty-five randomized patients, twenty-nine avoided an operation in the original study. Twenty-one of those twenty-nine patients were reevaluated with a follow-up questionnaire at a minimum of five years after the initial block.Results: Seventeen of the twenty-one patients still had not had operative intervention. There was no difference between the group treated with bupivacaine alone and the group treated with bupivacaine and betamethasone with regard to the avoidance of surgery for five years. At the five-year follow-up evaluation, all of the patients who had avoided operative treatment had significant decreases in neurological symptoms and back pain compared with the baseline values.Conclusions: The majority of patients with lumbar radicular pain who avoid an operation for at least one year after receiving a nerve root injection with bupivacaine alone or in combination with betamethasone will continue to avoid operative intervention for a minimum of five years. [ABSTRACT FROM AUTHOR]- Published
- 2006
14. The occurrence of adjacent-level ossification following anterior cervical fusion.
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Park J and Riew KD
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- 2006
15. Prospective measurement of function and pain in patients with non-neoplastic compression fractures treated with vertebroplasty.
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Prather H, Van Dillen L, Metzler JP, Riew KD, Gilula LA, Prather, Heidi, Van Dillen, Linda, Metzler, John P, Riew, K Daniel, and Gilula, Louis A
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Background: There has been an increasing number of reports regarding the benefits of vertebroplasty for the treatment of vertebral compression fractures. In this investigation, validated outcome tools were utilized to document the impact of vertebroplasty on pain and function.Methods: Fifty patients were recruited at a tertiary university hospital. Patients had been treated for intractable pain due to osteoporotic compression fracture(s) for at least four weeks. The vertebroplasty procedures were performed by a radiologist. The subjects were followed prospectively for one year and received conservative treatment in conjunction with the vertebroplasty. Validated outcome tools, including a visual analog scale, the Oswestry scale, and the Roland-Morris functional activity questionnaire, were used to evaluate changes in pain and functional capabilities.Results: Fifty patients, thirty-one women and nineteen men (mean age, 68.6 years), were followed prospectively for one year. One hundred and three fractures (fifty-nine thoracic and forty-four lumbar) were treated. The visual analog scale showed the greatest improvement between the baseline score (mean, 7.76) and the score at one month (mean, 2.9), and the score remained improved at one year (mean, 2.9). The Oswestry and Roland-Morris questionnaires demonstrated significant (p < 0.0001) functional improvement between the baseline and one-month scores. With the numbers available, there were no significant changes in any variable from one month to one year (p > 0.05).Conclusions: Vertebroplasty is an effective treatment for patients with intractable pain due to osteoporotic vertebral compression fractures. Improvement in pain scores and functional capabilities that were found at one month were maintained at one year. [ABSTRACT FROM AUTHOR]- Published
- 2006
16. Hypertrophy of ligamentum flavum in lumbar spinal stenosis associated with increased proteinase inhibitor concentration.
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Park JB, Lee JK, Park SJ, Riew KD, Park, Jong-Beom, Lee, Jin-Kyung, Park, Sung-Jin, and Riew, K Daniel
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Background: It is well known that age-related fibrosis, or decreases in the elastin-to-collagen ratio of the ligamentum flavum, along with hypertrophy of the ligamentum flavum, are associated with lumbar spinal stenosis. However, the molecular mechanism by which this fibrosis and hypertrophy develop is unknown. Tissue inhibitors of matrix metalloproteinase (TIMPs) are proteinase inhibitors that suppress extracellular matrix degradation. Elevated TIMP-1 and TIMP-2 expression has been implicated in various fibrotic diseases of the liver, kidney, lung, and heart. These TIMPs can also induce cellular proliferation and inhibit apoptosis in a wide range of cell types. These findings led us to postulate that TIMP-1 and TIMP-2 might also be associated with hypertrophy and fibrosis of the ligamentum flavum in lumbar spinal stenosis.Methods: We quantified and localized TIMP expression in ligamentum flavum tissues that had been obtained during surgery from thirty patients with spinal stenosis and from thirty gender-matched control patients with disc herniation. The thickness of the ligamentum flavum at the level of the facet joint was measured on axial T1-weighted magnetic resonance images. In addition, we examined ligamentum flavum tissues for the expression of markers of cellular proliferation and apoptosis.Results: The ligamentum flavum was significantly thicker in the patients with spinal stenosis (mean, 5.68 mm) than in the patients with disc herniation (mean, 2.70 mm) (p < 0.001). The concentration of TIMP-2 in the ligamentum flavum was significantly higher in the patients with spinal stenosis (mean, 12.62 ng/mL) than in those with disc herniation (mean, 8.85 ng/mL) (p = 0.028). TIMP-1 and TIMP-2 were detected in the cytoplasm of ligamentum flavum fibroblasts. TIMP-1 and TIMP-2 concentrations were associated with hypertrophy of the ligamentum flavum (p = 0.015 and p = 0.003, respectively). None of the samples from the patients with stenosis had evidence of proliferation of ligamentum flavum fibroblasts. The expression of markers for apoptosis was significantly higher in the patients with spinal stenosis (58.8%) than in those with disc herniation (26.6%) (p < 0.001).Conclusions: Increased TIMP expression has been implicated in fibrosis and hypertrophy of the extracellular matrix of several organs. Our results suggest that increased expression of TIMP-2 in ligamentum flavum fibroblasts is associated with fibrosis and hypertrophy of the ligamentum flavum in patients with spinal stenosis. [ABSTRACT FROM AUTHOR]- Published
- 2005
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17. Mitochondrial involvement in fas-mediated apoptosis of human lumbar disc cells.
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Park J, Lee J, Park S, Kim K, Riew KD, Park, Jong-Beom, Lee, Jin-Kyung, Park, Sung-Jin, Kim, Ki-Won, and Riew, K Daniel
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Background: Two main pathways of Fas-mediated apoptosis have been identified: the Type-I (death-inducing signaling complex) pathway and the Type-II (mitochondrial) pathway. While apoptotic cell death has been implicated in lumbar degenerative disc disease, we are not aware of any studies in which surgically removed discs from live humans have been examined to determine which of the two pathways is involved in the apoptosis of disc cells. As an initial step in the development of therapies to inhibit inappropriate or premature apoptosis of disc cells, our objective was to determine which pathway is involved.Methods: We examined thirty-two samples of herniated lumbar disc tissue with use of immunohistochemical staining and Western blot analysis to determine the presence of several proteins, including caspase-8 (associated with the Type-I pathway); BID (BH3 interacting domain death agonist), cytochrome-c, and caspase-9 (associated with the Type-II pathway); and caspase-3 (an executioner of apoptosis). The TUNEL (terminal deoxynucleotidyl transferase [TDT]-mediated dUTP nick end labeling) assay was performed to confirm the occurrence of apoptosis of the disc cells.Results: The proteins associated with the Type-II pathway (BID, cytochrome-c, and caspase-9) stained positively in all samples. Although the protein associated with the Type-I pathway (caspase-8) was not detected on immunohistochemical analysis, a small amount of caspase-8 was detected on Western blot analysis. However, the expression of Type-II proteins was still higher than the expression of caspase-8 on Western blot analysis. The expression of caspase-3 was identified in all samples with immunohistochemical and Western blot analysis. TUNEL-positive disc cells were identified in all samples.Conclusions: The results of the present study suggest that human disc cells are Type-II cells, which undergo apoptotic cell death through mitochondrial involvement. [ABSTRACT FROM AUTHOR]- Published
- 2005
18. Complications of fluoroscopically guided extraforaminal cervical nerve blocks. An analysis of 1036 injections.
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Ma DJ III, Gilula LA, Riew KD, Ma, Daniel J, Gilula, Louis A, and Riew, K Daniel
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Background: A number of serious complications associated with fluoroscopically guided extraforaminal cervical nerve blocks have been reported in the literature. The purpose of the present study was to determine the rate of complications associated with these blocks and to determine whether needle positioning during the procedure affected the prevalence of complications at one institution.Methods: Between October 1999 and June 2003, we performed 1036 fluoroscopically guided extraforaminal cervical nerve blocks in 844 patients. Plain radiographs documenting the procedure were made as part of the standard quality-assurance protocol. An independent observer who was uninvolved with the procedures reviewed a prospectively kept database on all patients. We subsequently reviewed the patient records to identify complications.Results: There were no catastrophic complications such as vessel damage, paralysis, or death. Overall, fourteen patients (1.66%) had a minor complication in association with the procedure. With the numbers available, the rate of complications associated with pdeep injection (798 blocks) was not significantly different from that associated with shallow injection (238 blocks) (1.89% compared with 0.84%). However, the rate of complications associated with anterior placement of the needle tip (thirty-three blocks) was higher than that associated with ideal placement of the needle tip (904 blocks) (6.06% compared with 1.55%) (p = 0.04).Conclusions: No catastrophic complications occurred in this series of 1036 nerve blocks. We found that the medial-lateral needle depth as seen on frontal-view radiographs was not associated with complications, although the anterior positioning of the needle as seen on lateral-view radiographs was associated with minor complications. Our results suggest that, with our technique, cervical nerve blocks are relatively safe procedures. [ABSTRACT FROM AUTHOR]- Published
- 2005
19. Pseudarthrosis of a thirty-nine-year-old dens fracture causing myelopathy. A case report.
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Rudzki JR, Lenke LG, Blanke K, Riew KD, Rudzki, Jonas R, Lenke, Lawrence G, Blanke, Kathy, and Riew, K Daniel
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- 2004
20. Accurate identification of adverse outcomes after cervical spine surgery.
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Edwards CC II, Karpitskaya Y, Cha C, Heller JG, Lauryssen C, Yoon ST, Riew KD, Edwards, Charles C 2nd, Karpitskaya, Yekaterina, Cha, Chuck, Heller, John G, Lauryssen, Carl, Yoon, S Timothy, and Riew, K Daniel
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Background: Retrospective clinical studies frequently utilize surgeon records as a source of outcomes data. The accuracy of data derived from surgeon records, however, is unknown. The purpose of the present study was to evaluate the accuracy of surgeon records in documenting the prevalence of subjective adverse outcomes.Methods: Consecutive patients who had undergone anterior cervical arthrodesis by four spine surgeons during a ten-month period were included. Surgeon records from the routine six-week, three-month, and six-month postoperative visits were examined for documentation of persistent dysphagia and dysphonia. Patients completed surveys inquiring about the presence and magnitude of symptoms at these three time-points. Agreement between the surgeon records and the patient surveys was analyzed with use of the kappa coefficient.Results: One hundred and sixty-six patients had 342 postoperative visits. Dysphagia was documented twenty-six times in the surgeon records, compared with 107 times on the patient surveys. Dysphagia was thus underreported in 80% of cases. Similarly, dysphonia was documented ten times in the surgeon records, compared with seventy-two times on the patient surveys. Poor correlation between the surgeon records and the patient surveys was observed regardless of symptom severity, previous anterior cervical surgery, anterior arthrodesis of three motion segments or more, arthrodesis cephalad to the fifth cervical level, and anterior cervical plate use. Poor correlation between the surgeon records and the patient surveys also was observed for each surgeon, regardless of subspecialty or institution.Conclusions: Correlation between the surgeon records and the patient surveys was consistently poor, regardless of the specific patient and surgeon factor analyzed. While we chose to study dysphonia and dysphagia, it is conceivable that the results may be generalizable to many situations in which office notes are utilized to ascertain the prevalence of subjective adverse outcomes. These results suggest that the prevalence of such outcomes may be seriously underreported in studies that rely on the retrospective analysis of surgeon records. [ABSTRACT FROM AUTHOR]- Published
- 2004
21. Long-term complications in adult spinal deformity patients having combined surgery a comparison of primary to revision patients.
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Lapp MA, Bridwell KH, Lenke LG, Riew KD, Linville DA, Eck KR, Ungacta FF, Lapp, M A, Bridwell, K H, Lenke, L G, Daniel Riew, K, Linville, D A, Eck, K R, and Ungacta, F F
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- 2001
22. The effect of nerve-root injections on the need for operative treatment of lumbar radicular pain. A prospective, randomized, controlled, double-blind study.
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Riew KD, Yin Y, Gilula L, Bridwell KH, Lenke LG, Lauryssen C, Goette K, Riew, K D, Yin, Y, Gilula, L, Bridwell, K H, Lenke, L G, Lauryssen, C, and Goette, K
- Abstract
Background: The purpose of the present study was to determine the effectiveness of selective nerve-root injections in obviating the need for an operation in patients with lumbar radicular pain who were otherwise considered to be operative candidates. Although selective nerve-root injections are used widely, we are not aware of any prospective, randomized, controlled, double-blind studies demonstrating their efficacy.Methods: Fifty-five patients who were referred to four spine surgeons because of lumbar radicular pain and who had radiographic confirmation of nerve-root compression were prospectively randomized into the study. All of the patients had to have requested operative intervention and had to be considered operative candidates by the treating surgeon. They then were randomized and referred to a radiologist who performed a selective nerve-root injection with either bupivacaine alone or bupivacaine with betamethasone. The treating physicians and the patients were blinded to the medication. The patients were allowed to choose to receive as many as four injections. The treatment was considered to have failed if the patient proceeded to have the operation, which he or she could opt to do at any point in the study.Results: Twenty-nine of the fifty-five patients, all of whom had initially requested operative treatment, decided not to have the operation during the follow-up period (range, thirteen to twenty-eight months) after the nerve-root injections. Of the twenty-seven patients who had received bupivacaine alone, nine elected not to have the operation. Of the twenty-eight patients who had received bupivacaine and betamethasone, twenty decided not to have the operation. The difference in the operative rates between the two groups was highly significant (p < 0.004).Conclusions: Our data demonstrate that selective nerve-root injections of corticosteroids are significantly more effective than those of bupivacaine alone in obviating the need for a decompression for up to thirteen to twenty-eight months following the injections in operative candidates. This finding suggests that patients who have lumbar radicular pain at one or two levels should be considered for treatment with selective nerve-root injections of corticosteroids prior to being considered for operative intervention. [ABSTRACT FROM AUTHOR]- Published
- 2000
23. Analysis of titanium mesh cages in adults with minimum two-year follow-up.
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Eck KR, Bridwell KH, Ungacta FF, Lapp MA, Lenke LG, Riew KD, Eck, K R, Bridwell, K H, Ungacta, F F, Lapp, M A, Lenke, L G, and Riew, K D
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- 2000
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24. Complications of buttress plate stabilization of cervical corpectomy.
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Riew KD, Sethi NS, Devney J, Goette K, Choi K, Riew, K D, Sethi, N S, Devney, J, Goette, K, and Choi, K
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- 1999
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25. Significant change or loss of intraoperative monitoring data: a 25-year experience in 12,375 spinal surgeries.
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Raynor BL, Bright JD, Lenke LG, Rahman RK, Bridwell KH, Riew KD, Buchowski JM, Luhmann SJ, and Padberg AM
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- 2013
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26. Methodology for the systematic reviews on an adjacent segment pathology.
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Norvell DC, Dettori JR, Skelly AC, Riew KD, Chapman JR, and Anderson PA
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- 2012
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27. The risk of adjacent-level ossification development after surgery in the cervical spine: are there factors that affect the risk? A systematic review.
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Kim HJ, Kelly MP, Ely CG, Riew KD, and Dettori JR
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- 2012
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28. Pedicle subtraction osteotomy in the cervical spine.
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Wollowick AL, Kelly MP, Riew KD, Wollowick, Adam L, Kelly, Michael P, and Riew, K Daniel
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- 2012
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29. Laminar closure after classic Hirabayashi open-door laminoplasty.
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Lee DH, Park SA, Kim NH, Hwang CJ, Kim YT, Lee CS, Riew KD, Lee, Dong-Ho, Park, Soo-An, Kim, Nam Heun, Hwang, Chang Ju, Kim, Yung-Tae, Lee, Choon Sung, and Riew, K Daniel
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- 2011
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30. Undetected vertebral artery groove and foramen violations during C1 lateral mass and C2 pedicle screw placement.
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Yeom JS, Buchowski JM, Park K, Chang B, Lee C, Riew KD, Yeom, Jin S, Buchowski, Jacob M, Park, Kun-Woo, Chang, Bong-Soon, Lee, Choon-Ki, and Riew, K Daniel
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- 2008
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31. Effect of fibrin sealant on drain output and duration of hospitalization after multilevel anterior cervical fusion: a retrospective matched pair analysis.
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Yeom JS, Buchowski JM, Shen HX, Liu G, Bunmaprasert T, and Riew KD
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- 2008
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32. Can a Novel Natural Language Processing Model and Artificial Intelligence Automatically Generate Billing Codes From Spine Surgical Operative Notes?
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Zaidat B, Tang J, Arvind V, Geng EA, Cho B, Duey AH, Dominy C, Riew KD, Cho SK, and Kim JS
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Study Design: Retrospective cohort., Objective: Billing and coding-related administrative tasks are a major source of healthcare expenditure in the United States. We aim to show that a second-iteration Natural Language Processing (NLP) machine learning algorithm, XLNet, can automate the generation of CPT codes from operative notes in ACDF, PCDF, and CDA procedures., Methods: We collected 922 operative notes from patients who underwent ACDF, PCDF, or CDA from 2015 to 2020 and included CPT codes generated by the billing code department. We trained XLNet, a generalized autoregressive pretraining method, on this dataset and tested its performance by calculating AUROC and AUPRC., Results: The performance of the model approached human accuracy. Trial 1 (ACDF) achieved an AUROC of .82 (range: .48-.93), an AUPRC of .81 (range: .45-.97), and class-by-class accuracy of 77% (range: 34%-91%); trial 2 (PCDF) achieved an AUROC of .83 (.44-.94), an AUPRC of .70 (.45-.96), and class-by-class accuracy of 71% (42%-93%); trial 3 (ACDF and CDA) achieved an AUROC of .95 (.68-.99), an AUPRC of .91 (.56-.98), and class-by-class accuracy of 87% (63%-99%); trial 4 (ACDF, PCDF, CDA) achieved an AUROC of .95 (.76-.99), an AUPRC of .84 (.49-.99), and class-by-class accuracy of 88% (70%-99%)., Conclusions: We show that the XLNet model can be successfully applied to orthopedic surgeon's operative notes to generate CPT billing codes. As NLP models as a whole continue to improve, billing can be greatly augmented with artificial intelligence assisted generation of CPT billing codes which will help minimize error and promote standardization in the process., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: JK, Stryker: Paid consultant, SK, FAAOS; AAOS: Board or committee member; American Orthopaedic Association: Board or committee member; AOSpine North America: Board or committee member; Cervical Spine Research Society: Board or committee member; Globus Medical: IP royalties; North American Spine Society: Board or committee member; Scoliosis Research Society: Board or committee member; Stryker: Paid consultant; KR, FAAOS; America: Stock or stock Options; AOSpine: Board or committee member; AxioMed: Stock or stock Options; Benvenue: Stock or stock Options; Biomet: IP royalties; Paid presenter or speaker; Clinics in orthopedics: Editorial or governing board; European Spine Journal: Editorial or governing board; Expanding Orthopedics, PSD: Stock or stock options; Global Spine Journal: Editorial or governing board; HAPPE Spine: Unpaid consultant; Medtronic: Paid presenter or speaker; Neurosurgery: Editorial or governing board; North American Spine Society: Board or committee member; Nuvasive: Paid consultant; Paid presenter or speaker; Paradigm Spine: Stock or stock Options; Spinal Kinetics: Stock or stock Options; Spine: Editorial or governing board; Spine Surgery Today: Editorial or governing board; Spineology: Stock or stock Options; Vertiflex: Stock or stock Options. The following individuals have no conflicts of interest or sources of support that require acknowledgement: BZ, JT, VA, BC, AD, EG, CD.
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- 2024
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33. Artificial Intelligence-Assisted MRI Diagnosis in Lumbar Degenerative Disc Disease: A Systematic Review.
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Liawrungrueang W, Park JB, Cholamjiak W, Sarasombath P, and Riew KD
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Study Design: Systematic review., Objectives: Lumbar degenerative disc disease (DDD) poses a significant global health care challenge, with accurate diagnosis being difficult using conventional methods. Artificial intelligence (AI), particularly machine learning and deep learning, offers promising tools for improving diagnostic accuracy and workflow in lumbar DDD. This study aims to review AI-assisted magnetic resonance imaging (MRI) diagnosis in lumbar DDD and discuss current research for clinical use., Methods: A systematic search of electronic databases identified studies on AI applications in MRI-based lumbar DDD diagnosis, following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Search terms included combinations of "Artificial Intelligence," "Machine Learning," "Deep Learning," "Low Back Pain," "Lumbar," "Disc," "Degeneration," and "MRI," targeting studies in English from January 1, 2010, to January 1, 2024. Inclusion criteria encompassed experimental and observational studies in peer-reviewed journals. Data extraction focused on study characteristics, AI techniques, performance metrics, and diagnostic outcomes, with quality assessed using predefined criteria., Results: Twenty studies met the inclusion criteria, employing various AI methodologies, including machine learning and deep learning, to diagnose lumbar DDD manifestations such as disc degeneration, herniation, and bulging. AI models consistently outperformed conventional methods in accuracy, sensitivity, and specificity, with performance metrics ranging from 71.5% to 99% across different diagnostic objectives., Conclusion: The algorithm model provides a structured framework for integrating AI into routine clinical practice, enhancing diagnostic precision and patient outcomes in lumbar DDD management. Further research and validation are needed to refine AI algorithms for real-world application in lumbar DDD diagnosis., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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34. Patients May Return to Work Sooner After Laminoplasty: Occupational Outcomes of the Cervical Spondylotic Myelopathy Surgical Trial.
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Miranda SP, Whitmore RG, Kanter A, Mummaneni PV, Bisson EF, Barker FG 2nd, Harrop J, Magge SN, Heary RF, Fehlings MG, Albert TJ, Arnold PM, Riew KD, Steinmetz MP, Wang MC, Heller JG, Benzel EC, and Ghogawala Z
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Background and Objectives: Return-to-work (RTW) is an important outcome for employed patients considering surgery for cervical spondylotic myelopathy (CSM). We conducted a post hoc analysis of patients as-treated in the Cervical Spondylotic Myelopathy Surgical Trial, a prospective, randomized trial comparing surgical approaches for CSM to evaluate factors associated with RTW., Methods: In the trial, patients were randomized (2:3) to either anterior surgery (anterior cervical decompression/fusion [ACDF]) or posterior surgery (laminoplasty [LP], or posterior cervical decompression/fusion [PCDF], at surgeon's discretion). Work status was recorded at 1, 3, 6, and 12 months postoperatively. For patients working full-time or part-time on enrollment, time to RTW was compared across as-treated surgical groups using discrete-time survival analysis. Multivariate logistic regression was used to assess predictors of RTW. Clinical outcomes were compared using a linear mixed-effects model., Results: A total of 68 (42%) of 163 patients were working preoperatively and were analyzed. In total, 27 patients underwent ACDF, 29 underwent PCDF, and 12 underwent LP. 45 (66%) of 68 patients returned to work by 12 months. Median time to RTW differed by surgical approach (LP = 1 month, ACDF = 3 months, PCDF = 6 months; P = .02). Patients with longer length-of-stay were less likely to be working at 1 month (odds ratio 0.51; 95% CI, 0.29-0.91; P = .022) and 3 months (odds ratio 0.39; 95% CI, 0.16-0.96; P = .04). At 3 months, PCDF was associated with lower Short-Form 36 physical component summary scores than ACDF (estimated mean difference [EMD]: 6.42; 95% CI, 1.4-11.4; P = .007) and LP (EMD: 7.98; 95% CI, 2.7-13.3; P = .003), and higher Neck Disability Index scores than ACDF (EMD: 12.48; 95% CI, 2.3-22.7; P = .01) and LP (EMD: 15.22; 95% CI, 2.3-28.1; P = .014), indicating worse perceived physical functioning and greater disability, respectively., Conclusion: Most employed patients returned to work within 1 year. LP patients resumed employment earliest, while PCDF patients returned to work latest, with greater disability at follow-up, suggesting that choice of surgical intervention may influence occupational outcomes., (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)
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- 2024
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35. Long-term results and surgical strategy development for degenerative disease treatment in athletes: a retrospective single-center study.
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Byvaltsev VA, Kalinin AA, Aliyev MA, Pestryakov YY, and Riew KD
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Purpose: To analyze of the results of spine surgical treatment of athletes with lumbar degenerative disease and development of a surgical strategy based on the preoperative symptoms and radiological changes in the lumbar spine., Methods: For 114 athletes with lumbar degenerative disease were included in the present study. Four independent groups were studied: (1) microsurgical/endoscopic discectomy (n = 35); (2) PRP therapy in facet joints (n = 41); (3) total disc replacement (n = 11); (4) lumbar interbody fusion (n = 27). We evaluated postoperative clinical outcomes and preoperative radiological results. The average postoperative follow-up was 5 (3;6), 3.5 (3;5), 3 (2;4) and 4 (3;5) years, respectively. The analysis included an assessment of clinical outcomes (initial clinical symptoms, chronic pain syndrome level according to the VAS, quality of life according to the SF-36 questionnaire, degree of tolerance to physical activity according to the subjective Borg Rating of Perceived Exertion Scale) and radiological data (Dynamic Slip, Dynamic Segmental Angle, degenerative changes in the facet joint according to the Fujiwara classification and disc according to the Pfirrmann classification; changes in the diffusion coefficient using diffusion-weighted MRI)., Results: The median and 25-75% quartiles timing of return to sports were 12.6 (10.2;14.1), 2.8 (2.4;3.7), 9 (6;12), and 14 (9;17) weeks, respectively. We examined the type of surgical treatment utilized, as well as the preoperative clinical symptoms, severity of degenerative changes in the intervertebral disc and facet joint, the timing of return to sports, the level of pain syndrome, the quality of life according to SF-36, and the degree of tolerance to physical activity. We then developed a surgical strategy based on individual preoperative neurological function and lumbar morphological changes., Conclusions: In this retrospective study, we report clinical results of four treatment options of lumbar spine degenerative disease in athletes. The use of developed patient selection criteria for the analyzed surgical techniques is aimed at minimizing return-to-play times., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2024
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36. Riluzole for Degenerative Cervical Myelopathy: A Secondary Analysis of the CSM-PROTECT Trial.
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Fehlings MG, Pedro KM, Alvi MA, Badhiwala JH, Ahn H, Farhadi HF, Shaffrey CI, Nassr A, Mummaneni P, Arnold PM, Jacobs WB, Riew KD, Kelly M, Brodke DS, Vaccaro AR, Hilibrand AS, Wilson J, Harrop JS, Yoon ST, Kim KD, Fourney DR, Santaguida C, Massicotte EM, and Huang P
- Subjects
- Humans, Male, Female, Middle Aged, Double-Blind Method, Aged, Spinal Cord Diseases surgery, Spinal Cord Diseases drug therapy, Spondylosis surgery, Spondylosis drug therapy, Treatment Outcome, Neuroprotective Agents therapeutic use, Riluzole therapeutic use, Cervical Vertebrae surgery
- Abstract
Importance: The modified Japanese Orthopaedic Association (mJOA) scale is the most common scale used to represent outcomes of degenerative cervical myelopathy (DCM); however, it lacks consideration for neck pain scores and neglects the multidimensional aspect of recovery after surgery., Objective: To use a global statistical approach that incorporates assessments of multiple outcomes to reassess the efficacy of riluzole in patients undergoing spinal surgery for DCM., Design, Setting, and Participants: This was a secondary analysis of prespecified secondary end points within the Efficacy of Riluzole in Surgical Treatment for Cervical Spondylotic Myelopathy (CSM-PROTECT) trial, a multicenter, double-blind, phase 3 randomized clinical trial conducted from January 2012 to May 2017. Adult surgical patients with DCM with moderate to severe myelopathy (mJOA scale score of 8-14) were randomized to receive either riluzole or placebo. The present study was conducted from July to December 2023., Intervention: Riluzole (50 mg twice daily) or placebo for a total of 6 weeks, including 2 weeks prior to surgery and 4 weeks following surgery., Main Outcomes and Measures: The primary outcome measure was a difference in clinical improvement from baseline to 1-year follow-up, assessed using a global statistical test (GST). The 36-Item Short Form Health Survey Physical Component Score (SF-36 PCS), arm and neck pain numeric rating scale (NRS) scores, American Spinal Injury Association (ASIA) motor score, and Nurick grade were combined into a single summary statistic known as the global treatment effect (GTE)., Results: Overall, 290 patients (riluzole group, 141; placebo group, 149; mean [SD] age, 59 [10.1] years; 161 [56%] male) were included. Riluzole showed a significantly higher probability of global improvement compared with placebo at 1-year follow-up (GTE, 0.08; 95% CI, 0.00-0.16; P = .02). A similar favorable global response was seen at 35 days and 6 months (GTE for both, 0.07; 95% CI, -0.01 to 0.15; P = .04), although the results were not statistically significant. Riluzole-treated patients had at least a 54% likelihood of achieving better outcomes at 1 year compared with the placebo group. The ASIA motor score and neck and arm pain NRS combination at 1 year provided the best-fit parsimonious model for detecting a benefit of riluzole (GTE, 0.11; 95% CI, 0.02-0.16; P = .007)., Conclusions and Relevance: In this secondary analysis of the CSM-PROTECT trial using a global outcome technique, riluzole was associated with improved clinical outcomes in patients with DCM. The GST offered probability-based results capable of representing diverse outcome scales and should be considered in future studies assessing spine surgery outcomes.
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- 2024
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37. Timing-dependent synergies between motor cortex and posterior spinal stimulation in humans.
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McIntosh JR, Joiner EF, Goldberg JL, Greenwald P, Dionne AC, Murray LM, Thuet E, Modik O, Shelkov E, Lombardi JM, Sardar ZM, Lehman RA, Chan AK, Riew KD, Harel NY, Virk MS, Mandigo C, and Carmel JB
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- Humans, Male, Female, Middle Aged, Adult, Spinal Cord Stimulation methods, Aged, Electric Stimulation methods, Motor Cortex physiology, Evoked Potentials, Motor, Spinal Cord physiology, Muscle, Skeletal physiology, Muscle, Skeletal innervation
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Volitional movement requires descending input from the motor cortex and sensory feedback through the spinal cord. We previously developed a paired brain and spinal electrical stimulation approach in rats that relies on convergence of the descending motor and spinal sensory stimuli in the cervical cord. This approach strengthened sensorimotor circuits and improved volitional movement through associative plasticity. In humans, it is not known whether posterior epidural spinal cord stimulation targeted at the sensorimotor interface or anterior epidural spinal cord stimulation targeted within the motor system is effective at facilitating brain evoked responses. In 59 individuals undergoing elective cervical spine decompression surgery, the motor cortex was stimulated with scalp electrodes and the spinal cord was stimulated with epidural electrodes, with muscle responses being recorded in arm and leg muscles. Spinal electrodes were placed either posteriorly or anteriorly, and the interval between cortex and spinal cord stimulation was varied. Pairing stimulation between the motor cortex and spinal sensory (posterior) but not spinal motor (anterior) stimulation produced motor evoked potentials that were over five times larger than brain stimulation alone. This strong augmentation occurred only when descending motor and spinal afferent stimuli were timed to converge in the spinal cord. Paired stimulation also increased the selectivity of muscle responses relative to unpaired brain or spinal cord stimulation. Finally, clinical signs suggest that facilitation was observed in both injured and uninjured segments of the spinal cord. The large effect size of this paired stimulation makes it a promising candidate for therapeutic neuromodulation. KEY POINTS: Pairs of stimuli designed to alter nervous system function typically target the motor system, or one targets the sensory system and the other targets the motor system for convergence in cortex. In humans undergoing clinically indicated surgery, we tested paired brain and spinal cord stimulation that we developed in rats aiming to target sensorimotor convergence in the cervical cord. Arm and hand muscle responses to paired sensorimotor stimulation were more than five times larger than brain or spinal cord stimulation alone when applied to the posterior but not anterior spinal cord. Arm and hand muscle responses to paired stimulation were more selective for targeted muscles than the brain- or spinal-only conditions, especially at latencies that produced the strongest effects of paired stimulation. Measures of clinical evidence of compression were only weakly related to the paired stimulation effect, suggesting that it could be applied as therapy in people affected by disorders of the central nervous system., (© 2024 The Authors. The Journal of Physiology © 2024 The Physiological Society.)
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- 2024
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38. The Association Between Cervical Foraminal Stenosis and Adhesive Capsulitis: An Imaging-based Case-Control Study.
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Russo S, Sharma A, Vardanyan R, Thavarajasingam SG, and Riew KD
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Study Design: Retrospective single-center imaging-based case-control study., Objective: To determine the association between cervical foraminal stenosis and adhesive capsulitis., Summary of Background Data: Patients with cervical spondylosis often exhibit shoulder symptoms. Cervical radiculopathies, particularly C5, can cause severe shoulder pain and reduced shoulder mobility, mimicking glenohumeral adhesive capsulitis (frozen shoulder), a common shoulder condition. This is the first study investigating the connection between adhesive capsulitis and cervical radiculopathy., Methods: 438 patients who underwent glenohumeral hydrodistension between 2012 and 2019 were reviewed. Included were individuals with unilateral frozen shoulder investigated using ultrasound and cervical spine MRI to investigate cervical spondylosis. Foraminal stenosis at C3/4, C4/5, C5/6 and C6/7 was graded in axial T2 MRI, ipsilateral and contralateral to the adhesive capsulitis. The presence of foraminal stenosis ipsilateral to the frozen shoulder (cases) was compared with the contralateral side (control). McNemar's exact test was used to assess the strength of a correlation., Results: Among 438 patients, 107 reported frozen shoulder and neck pain (24.5%), with 48 matching the study criteria. A significant association between ipsilateral frozen shoulder and C4/5 foraminal stenosis was observed (P=0.00000008636). Ipsilateral foraminal stenosis was observed in 57.3% of these cases, with bilateral stenosis in 29.1%. Additionally, 78% had neck pain on the same side as their frozen shoulder, and 44% had pain radiating to the shoulder. 48% patients underwent nerve-targeted interventions, with 44% addressing the C5 nerve (25% C5 steroid injection and 19% C4/5 anterior cervical discectomy and fusion)., Conclusion: A substantial association between C5 foraminal stenosis and ipsilateral frozen shoulder was found. C5 radiculopathy could be a risk factor for "neurogenic frozen shoulder". Those diagnosing frozen shoulder and cervicobrachialgia should recognize that frozen shoulder and C5 radiculopathy may coexist. A multidisciplinary approach involving both shoulder and spine specialists is recommended for a definitive diagnosis., Competing Interests: Conflicts of Interest and Source of Funding: None, (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2024
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39. Postoperative C5 Palsy after Anterior or Posterior Decompression for Degenerative Cervical Myelopathy: A Subgroup Analysis of the Multicenter, Prospective, Randomized, Phase III, CSM-Protect Clinical Trial.
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Bak AB, Moghaddamjou A, Alvi M, Ahn H, Farhadi HF, Shaffrey CI, Nassr A, Mummaneni P, Arnold PM, Jacobs WB, Riew KD, Kelly M, Brodke DS, Vaccaro AR, Hilibrand AS, Wilson J, Harrop JS, Yoon ST, Kim KD, Fourney DR, Santaguida C, Massicotte EM, Kopjar B, and Fehlings M
- Abstract
Study Design: Retrospective cohort study of prospectively accrued data., Objective: To evaluate a large, prospective, multicentre dataset of surgically-treated DCM cases on the contemporary risk of C5 palsy with surgical approach., Summary of Background Data: The influence of surgical technique on postoperative C5 palsy after decompression for degenerative cervical myelopathy (DCM) is intensely debated. Comprehensive analyses are needed using contemporary data and accounting for covariates., Methods: Patients with moderate to severe DCM were prospectively enrolled in the multicenter, randomized CSM-Protect clinical trial and underwent either anterior or posterior decompression between Jan 31, 2012, to May 16, 2017. The primary outcome was the incidence of postoperative C5 palsy, defined as onset of muscle weakness by at least one grade in manual muscle test at the C5 myotome with slight or absent sensory disruption after cervical surgery. Two comparative cohorts were made based on anterior or posterior surgical approach. Multivariate hierarchical mixed-effects logistic regression was used to estimate odds ratios (OR) with 95% confidence intervals (CI) for C5 palsy., Results: A total of 283 patients were included, and 53.4% underwent posterior decompression. The total incidence of postoperative C5 palsy was 7.4% and was significantly higher in patients that underwent posterior decompression compared to anterior decompression (11.26% vs. 3.03%, P=0.008). After multivariable regression, posterior approach was independently associated with greater than four times the likelihood of postoperative C5 palsy (P=0.017). Rates of C5 palsy recovery were comparable between the two surgical approaches., Conclusion: The odds of postoperative C5 palsy are significantly higher after posterior decompression compared to anterior decompression for DCM. This may influence surgical decision-making when there is equipoise in deciding between anterior and posterior treatment options for DCM., Level of Evidence: Therapeutic Level II., Competing Interests: Conflicts of Interest: None., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2024
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40. An Algorithmic Roadmap for the Surgical Management of Degenerative Cervical Myelopathy: A Narrative Review.
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Lee DH, Lee HR, and Riew KD
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Degenerative cervical myelopathy (DCM) is a leading cause of disability, and its surgical management is crucial for improving patient neurological outcomes. Given the varied presentations and severities of DCM, treatment options are diverse. Surgeons often face challenges in selecting the most appropriate surgical approach because there is no universally correct answer. This narrative review aimed to aid the decision-making process in treating DCM by presenting a structured treatment algorithm. The authors categorized surgical scenarios based on an algorithm, outlining suitable treatment methods for each case. Four primary scenarios were identified based on the number of levels requiring surgery and K-line status: (1) K-line (+) and ≤3 levels, (2) K-line (+) and ≥3 levels, (3) K-line (-) and ≤3 levels, and (4) K-line (-) and ≥3 levels. This categorization aids in determining the appropriateness of anterior or posterior approaches and the necessity for fusion, considering the surgical level and K-line status. The complexity of surgical situations and diversity of treatment methods for DCM can be effectively managed using an algorithmic approach. Furthermore, surgical techniques that minimize the stages and address challenging conditions could enhance treatment outcomes in DCM.
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- 2024
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41. Prospective Randomized Comparison of Minimally Invasive Tlif versus Open Tlif: Clinical Effectiveness and Restoration of Working Capacity in Railway Workers.
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Byvaltsev VA, Kalinin AA, Pestryakov YY, Hozeev DV, Kundubayev RA, Biryuchkov MY, and Riew KD
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Study Design: Randomized Clinical Trial., Objective: To compare the clinical efficacy and restoration of working capacity after MI (minimally invasive)-TLIF and O (open)-TLIF in railway workers with lumbar degenerative disease., Methods: 83 patients, who were indicated for two-level lumbar decompression and fusion were randomly assigned to one of two groups: group 1 (n = 44) had MI-TLIF procedure and group 2 (n = 39) had O-TLIF procedure. The functional status was assessed using SF-36, ODI and VAS for back and leg pain, preoperatively, at discharge, and at 3, 6, and 12 months postoperatively. MRI and CT were obtained 1-year follow-up. The percentage of patients who returned to work at 1-year, work intensity and the time to return to work post-operatively were analyzed., Results: At 1-year follow-up, the MI-TLIF group had significantly better ODI, VAS and SF-36 scores compared to the O-TLIF group. The postoperative MRIs revealed a statistically significantly less multifidus muscle atrophy in the MI group compared to the Open group. At 1-year follow-up, a comparable fusion ratio between MI group and Open group was recorded. After MI-TLIF procedure, depending on the workload, patients had a statistically significantly earlier return to work ( P < .05) and statistically significantly higher return to work rate compared with the O-TLIF group ( P < .05)., Conclusions: The use of two-level MI-TLIF in railway workers has made it possible to significantly improve long-term clinical results, reduce the risk of surgical complications, muscle atrophy and time to return to work compared to O-TLIF., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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42. The incidence of reoperation for pseudarthrosis after cervical spine surgery.
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Jo J, Lakomkin N, Zuckerman SL, Chanbour H, and Riew KD
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- Humans, Reoperation, Cervical Vertebrae surgery, Prospective Studies, Incidence, Postoperative Complications diagnosis, Retrospective Studies, Treatment Outcome, Pseudarthrosis epidemiology, Pseudarthrosis etiology, Pseudarthrosis surgery, Spinal Fusion adverse effects, Spinal Fusion methods
- Abstract
Introduction: Pseudarthrosis after cervical spine surgery represents an underreported and challenging complication. Using a large multi-center surgical database, we sought to: (1) report the incidence of cervical pseudarthrosis, (2) evaluate changes in rates of cervical pseudarthrosis, and (3) describe risk factors for suboptimal outcomes after cervical pseudarthrosis surgery., Methods: The American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2019 was used. The primary outcome was occurrence of a cervical fusion procedure with a prior diagnosis of pseudarthrosis. Fusion for pseudarthrosis was divided into anterior and posterior approaches. Post-operative complications were classified as major or minor. Prolonged LOS was defined as exceeding the 75th percentile for total hospital stay., Results: A total of 780 patients underwent cervical fusion for pseudarthrosis, and a significant increase in rates of surgery for pseudarthrosis was seen (0.25-1.2%, p < 0.001). The majority of cervical pseudarthrosis was treated with a posterior approach (66.5%). Postoperatively, 38 (4.9%) patients suffered a complication and 247 (31.7%) had a prolonged LOS. The three strongest risk factors for complications and extended LOS were > 10% weight loss preoperatively, congestive heart failure, and pre-operative bleeding disorder., Conclusion: Results from a large multi-center national database revealed that surgery to treat cervical pseudarthrosis has increased from 2012 to 2019. Most pseudarthrosis was treated with a posterior approach. Reoperation to treat cervical pseudarthrosis carried risk, with 5% having complications and 32% having an extended LOS. These results lay the groundwork for a future prospective study to discern the true incidence of cervical pseudarthrosis and how to best avoid its occurrence., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2024
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43. Is neck pain treatable with surgery?
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Redaelli A, Stephan SR, and Riew KD
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- Humans, Treatment Outcome, Neck Pain diagnosis, Neck Pain etiology, Neck Pain surgery, Cervical Vertebrae surgery, Radiculopathy surgery, Spinal Cord Diseases surgery
- Abstract
Introduction: Neck pain is one of the most common complaints in clinical practice and can be caused by a wide variety of conditions. While cervical spine surgery is a well-accepted option for radicular pain and myelopathy, surgery for isolated neck pain is controversial. The identification of the source of pain is challenging and subtle, and misdiagnosis can lead to inappropriate treatment. MATERIALS AND METHODS AND RESULTS: We conducted a thorough literature review to discuss and compare different causes of neck pain. We then supplemented the literature with our senior author's expert analysis of treating cervical spine pathology., Conclusions: This study provides an in-depth discussion of neck pain and its various presentations, as well as providing insight into treatment strategies and diagnostic pearls that may prevent mistreatment of cervical spine pathology., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2024
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44. Simultaneous Versus Staged Surgery For Double Crush Syndrome Of Cervical Radiculopathy And Peripheral Nerve Compression At The Wrist: A Retrospective Single-Center Study.
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Byvaltsev VA, Kalinin AA, Polkin RA, Kuharev AV, Almatov MS, Aliyev MA, and Riew KD
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Study Design: Retrospective single-center study., Objectives: to evaluate the results of surgical treatment in patients with double crush syndrome associated with cervical radiculopathy and upper limb peripheral nerve compression after staged and simultaneous operations., Summary of Background Data: Currently, choosing the optimal diagnostic and therapeutic modalities in treating patients with double crush syndrome remains unresolved., Methods: The study included 79 patients with double crush syndrome (cervical radiculopathy and syndrome of Guyon's canal or Carpal tunnel syndrome). Two independent groups were studied: In the Staged Group (n=35), we performed a cervical decompression with stabilization and peripheral nerve decompression at separate days due to ongoing clinical symptoms (average interval between interventions being 22 (18;26) days). In the Simultaneous Group (n=33), we performed both the cervical spine surgery, as well as the peripheral nerve procedures in one surgical session. Total operative time, estimate blood loss, length of hospitalization, complications and clinical data (NDI score, SF-36, VAS neck pain score, VAS arm pain score, Disabilities of Arm, Shoulder and Hand (DASH) score, Macnab scale) were compared. We used the Mann-Whitney (MW) test for intergroup comparisons, Wilcoxon criterion for dependent samples, and Fisher's exact test for binomial parameters., Results: There was a significantly lower operative time, duration of inpatient treatment and temporary disability in the Simultaneous Group (P=0.01, P=0.04 and P=0.006 respectively). Comparative analysis did not reveal significant intergroup differences using NDI, VAS and DASH (P>0.05), whereas, at discharge, significantly better clinical parameters were appreciated for the Simultaneous Group using SF-36 and Macnab scores (P=0.04 and P=0.03, respectively). At Last Follow-up, an intra-group analysis revealed comparable clinical effectiveness between the two approaches (P>0.05)., Conclusion: Comparison of the effectiveness of simultaneous and staged surgery revealed comparable long-term clinical outcomes. However, simultaneous surgery conveys clinically important advantages in terms of surgical time, anesthesia duration, length of hospitalization and patient disability., Level of Evidence: 3., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2024
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45. AO Spine Guideline for the Use of Osteobiologics (AOGO) in Anterior Cervical Discectomy and Fusion for Spinal Degenerative Cases.
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Meisel HJ, Jain A, Wu Y, Martin CT, Cabrera JP, Muthu S, Hamouda WO, Rodrigues-Pinto R, Arts JJ, Viswanadha AK, Vadalà G, Vergroesen PA, Ćorluka S, Hsieh PC, Demetriades AK, Watanabe K, Shin JH, Riew KD, Papavero L, Liu G, Luo Z, Ahuja S, Fekete T, Uz Zaman A, El-Sharkawi M, Sakai D, Cho SK, Wang JC, Yoon T, Santesso N, and Buser Z
- Abstract
Study Design: Guideline., Objectives: To develop an international guideline (AOGO) about the use of osteobiologics in anterior cervical discectomy and fusion (ACDF) for treating degenerative spine conditions., Methods: The guideline development process was guided by AO Spine Knowledge Forum Degenerative (KF Degen) and followed the Guideline International Network McMaster Guideline Development Checklist. The process involved 73 participants with expertise in degenerative spine diseases and surgery from 22 countries. Fifteen systematic reviews were conducted addressing respective key topics and evidence was collected. The methodologist compiled the evidence into GRADE Evidence-to-Decision frameworks. Guideline panel members judged the outcomes and other criteria and made the final recommendations through consensus., Results: Five conditional recommendations were created. A conditional recommendation is about the use of allograft, autograft or a cage with an osteobiologic in primary ACDF surgery. Other conditional recommendations are about the use of osteobiologic for single- or multi-level ACDF, and for hybrid construct surgery. It is suggested that surgeons use other osteobiologics rather than human bone morphogenetic protein-2 (BMP-2) in common clinical situations. Surgeons are recommended to choose 1 graft over another or 1 osteobiologic over another primarily based on clinical situation, and the costs and availability of the materials., Conclusion: This AOGO guideline is the first to provide recommendations for the use of osteobiologics in ACDF. Despite the comprehensive searches for evidence, there were few studies completed with small sample sizes and primarily as case series with inherent risks of bias. Therefore, high-quality clinical evidence is demanded to improve the guideline., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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46. The Relationship of Radiographic Parameters and Morphological Changes at Various Stages of Degeneration of the Lumbar Facet Joints: Cadaver Study.
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Byvaltsev VA, Kalinin AA, Shepelev VV, Pestryakov YY, Biryuchkov MY, Jubaeva BA, Boddapati V, Lehman RA, and Riew KD
- Abstract
Study Design: Cadaveric specimens., Objective: To perform a pathomorphological analysis of the degree of facet joint (FJ) degeneration utilizing fresh cadaveric models and correlating these structural changes with imaging findings., Methods: L1-L5 FSU including all tissue between the anterior longitudinal ligament to the posterior spinal structures were obtained on 28 patients at a mean of 5.7 hours post-mortem. The samples were fixed in an agar medium and CT and MRI were performed. The level of FJ degeneration was identified based on prior classifications Osteoarthritis Research Society International (OARSI), as was the facet angle and tropism. Pathomorphological assessment including articular cartilage cell density was performed according to prior established methodology., Results: Radiographically, a direct association was identified between FJ degeneration and patient age. Facet angle and tropism did not significantly vary by patient age. Pathomorphologically, there was a decrease in the cellular density of articular cartilage with increasing patient age. Similarly, there was a significant direct correlation between radiographic degree of degenerative changes in FJs with the age of cadavers and the degree of degeneration of FJs according to the morphological classification of OARSI, as well as a significant inverse correlation with cell density., Conclusion: A comprehensive assessment of various signs of FJ degeneration using cadaveric material has established that, based on radiographic imaging, it is possible to assess the microstructural state of FJ, including at an early stage of the disease. This data may be useful for surgeons in guiding therapeutic strategies based on individual biometric parameters of the FJ., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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47. Timing dependent synergies between motor cortex and posterior spinal stimulation in humans.
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McIntosh JR, Joiner EF, Goldberg JL, Greenwald P, Murray LM, Thuet E, Modik O, Shelkov E, Lombardi JM, Sardar ZM, Lehman RA, Chan AK, Riew KD, Harel NY, Virk MS, Mandigo C, and Carmel JB
- Abstract
Volitional movement requires descending input from motor cortex and sensory feedback through the spinal cord. We previously developed a paired brain and spinal electrical stimulation approach in rats that relies on convergence of the descending motor and spinal sensory stimuli in the cervical cord. This approach strengthened sensorimotor circuits and improved volitional movement through associative plasticity. In humans it is not known whether dorsal epidural SCS targeted at the sensorimotor interface or anterior epidural SCS targeted within the motor system is effective at facilitating brain evoked responses. In 59 individuals undergoing elective cervical spine decompression surgery, the motor cortex was stimulated with scalp electrodes and the spinal cord with epidural electrodes while muscle responses were recorded in arm and leg muscles. Spinal electrodes were placed either posteriorly or anteriorly, and the interval between cortex and spinal cord stimulation was varied. Pairing stimulation between the motor cortex and spinal sensory (posterior) but not spinal motor (anterior) stimulation produced motor evoked potentials that were over five times larger than brain stimulation alone. This strong augmentation occurred only when descending motor and spinal afferent stimuli were timed to converge in the spinal cord. Paired stimulation also increased the selectivity of muscle responses relative to unpaired brain or spinal cord stimulation. Finally, paired stimulation effects were present regardless of the severity of myelopathy as measured by clinical signs or spinal cord imaging. The large effect size of this paired stimulation makes it a promising candidate for therapeutic neuromodulation., Competing Interests: 5.1Competing interests Jason B. Carmel is a Founder and stock holder in BackStop Neural and a scientific advisor and stockholder in SharperSense. He has received honoraria from Pacira, Motric Bio, and Restorative Therapeutics. Michael S. Virk has been a consultant and has received honorarium from Depuy Synthes and BrainLab Inc; he is on the Medical Advisory Board and owns stock with OnPoint Surgical. K. Daniel Riew: Consulting: Happe Spine (Nonfinancial), Nuvasive; Royalties: Biomet, Nuvasive; Speaking and/or Teaching Arrangements: Nuvasive (Travel Expense Reimbursement); Stock Ownership: Amedica, Axiomed, Benvenue, Expanding Orthopedics, Happe Spine, Paradigm Spine, Spinal Kinetics, Spineology, Vertiflex. Ronald A. Lehman: Consulting: Medtronic; Royalties: Medtronic, Stryker. Zeeshan M. Sardar: Consulting: Medtronic; Grant/Research support from the Department of Defense. Joseph M. Lombardi: Consulting: Medtronic, Stryker. The other authors have nothing to disclose.
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- 2023
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48. Revision Strategies for Cervical Disc Arthroplasty.
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Roth SG, Robles Ortiz MJ, Vulapalli M, and Riew KD
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- Humans, Treatment Outcome, Neck surgery, Cervical Vertebrae surgery, Arthroplasty methods, Intervertebral Disc Degeneration surgery, Intervertebral Disc surgery, Spinal Fusion methods
- Abstract
Study Design: Narrative review., Objective: To review indications and strategies for revision of cervical disc arthroplasty (CDA)., Summary of Background Data: No data were generated as part of this review., Methods: A narrative review of the literature was performed., Results: No results were generated as part of this review., Conclusions: CDA is a proven, motion-sparing surgical option for the treatment of myelopathy or radiculopathy secondary to cervical degenerative disc disease. As is the case with any operation, a small percentage of CDA will require revision, which can be a technically demanding endeavor. Here we review available revision strategies and associated indications, a thorough understanding of which will aid the surgeon in finely tailoring their approach to varying presentations., Competing Interests: K.D.R. receives royalties from Biomet, Happe Spine, and Nuvasive, consulting fees from Happe Spine and Nuvasive, travel support from Nuvasive, and owns stock in Axiomed, Expanding Orthopedics, Spineology, Spinal Kinetics, Amedica, Vertiflex, Benvenue Medical, Paradigm Spine, and Happe Spine. The remaining authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2023
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49. Past, Present, and Future of Cervical Disc Arthroplasty: Insights From Presidents of the Cervical Spine Research Society.
- Author
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Du JY, Gonzalez GA, Albert TJ, Rhee JM, Riew KD, Vaccaro AR, and Harrop JS
- Subjects
- Humans, Arthroplasty, Neck, Cervical Vertebrae surgery, Diskectomy, Treatment Outcome, Intervertebral Disc surgery, Intervertebral Disc Degeneration surgery, Spinal Fusion
- Abstract
Competing Interests: J.M.R.: Alphatec Spine: Paid consultant; Paid presenter or speaker. Biomet: IP royalties. Cervical Spine Research Society: Board or committee member. Medtronic: Paid presenter or speaker. Stryker: IP royalties; Paid presenter or speaker. Wolters Kluwer Health—Lippincott Williams & Wilkins: Publishing royalties, financial or material support. Zimmer: Paid presenter or speaker. K.D.R.: Amedica: Stock or stock options. AOSpine: Board or committee member. AxioMed: Stock or stock options. Benvenue: Stock or stock options. Biomet: IP royalties; Paid presenter or speaker. Clinics in orthopedics: Editorial or governing board. European Spine Journal : Editorial or governing board. Expanding Orthopedics, PSD: Stock or stock options. Global Spine Journal : Editorial or governing board. HAPPE Spine: Unpaid consultant. Medtronic: Paid presenter or speaker. Neurosurgery : Editorial or governing board. North American Spine Society: Board or committee member. Nuvasive: Paid consultant; Paid presenter or speaker. Paradigm Spine: Stock or stock options. Spinal Kinetics: Stock or stock options. Spine : Editorial or governing board. Spine Surgery Today : Editorial or governing board. Spineology: Stock or stock options. Vertiflex: Stock or stock options. A.R.V.: Health Care Entity Relationships and Investments: Medtronics, Receipt of Royalty Payments; Stryker Spine, Receipt of Royalty Payments; Globus, Receipt of Royalty Payments, Stock / Stock Option Ownership Interests; Stout Medical, Stock / Stock Option Ownership Interests; Progressive Spinal Technologies, Stock / Stock Option Ownership Interests; Advanced Spinal Intellectual Properties, Stock / Stock Option Ownership Interests; Flagship Surgical, Stock / Stock Option Ownership Interests; Cytonics, Stock / Stock Option Ownership Interests; Electrocore, Stock / Stock Option Ownership Interests; AVKN Patient Driven Care, Stock / Stock Option Ownership Interests; FlowPharma, Stock / Stock Option Ownership Interests; Rothman Institute and Related Properties, Stock / Stock Option Ownership Interests; AO Spine, Member in good standing// Independent Contractor; Innovative Surgical Design, Stock / Stock Option Ownership Interests; Orthobullets, Stock / Stock Option Ownership Interests; Thieme, Receipt of Royalty Payments; Jaypee, Receipt of Royalty Payments; Elseviere, Receipt of Royalty Payments; Taylor Francis/Hodder and Stoughton, Receipt of Royalty Payments; Expert testimony, Member in good standing// Independent Contractor; Avaz Surgical, Stock/Stock Option Ownership Interests; Dimension Orthotics, LLC, Stock/Stock Option Ownership Interests; SpineWave, Receipt of Royalty Payments; Atlas Spine, Receipt of Royalty Payments, Stock/Stock Option Ownership Interests; Nuvasive, Stock/Stock Option Ownership Interests; Parvizi Surgical Innovation, Stock/Stock Option Ownership Interests; Jushi, Stock/Stock Option Ownership Interests; Deep Health, Stock/Stock Option Ownership Interests; ViewFi Health, Stock/Stock Option Ownership Interests; Sentryx, Service on Scientific Advisory Board/Board of Directors/Service on Committees,Stock/Stock Option Ownership Interests; National Spine Health Foundation (NSHF), Service on Scientific Advisory Board/Board of Directors/Service on Committees; Accellus, Service on Scientific Advisory Board/Board of Directors/Service on Committees, Stock/Stock Option Ownership Interests; Spinal Elements, Consulting/Independent Contractor, Receipt of Royalty Payments; Alphatec (Atec), Receipt of Royalty Payments; Harvard Medtech, Stock/Stock Option Ownership Interests.. T.J.A.: Augmedics: Stock or stock options. Back Story, LLC: Board or committee member. Biomet: IP royalties. Care Equity: Stock or stock options. CytoDyn Inc.: Stock or stock options. DePuy, A Johnson & Johnson Company: IP royalties. Hospital for Special Surgery: Board or committee member. HS2, LLC: Stock or stock options. In ViVo Therapeutics: Stock or stock options. Innovative Surgical Designs, Inc.: Stock or stock options. Journal of Bone and Joint Surgery — American : Editorial or governing board. JP Medical Publishers: Publishing royalties, financial or material support. Morphogenesis: Stock or stock options. Nuvasive: Paid consultant. Orthopedics Today : Board or committee member; Editorial or governing board. Paradigm Spine: Stock or stock options. Parvizi Surgical Innovations: Stock or stock options. Physician Recommended Nutriceuticals: Stock or stock options. Precision Orthopedics: Stock or stock options. Pulse Equity: Stock or stock options. Saunders/Mosby-Elsevier: Publishing royalties, financial or material support. Spine : Editorial or governing board. Spine Deformity Journal : Editorial or governing board. Spine Universe: Board or committee member. Spinicity: Stock or stock options. Springer: Publishing royalties, financial or material support. Strathspey Crown: Stock or stock options. Surg.IO LLC: Stock or stock options. Thieme: Publishing royalties, financial or material support. James S. Harrop, MD, MSHQS: DePuy: Honoraria. Stryker: Honoraria. NuVasive: Honoraria. The remaining authors no conflict of interest.
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- 2023
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50. Laminectomy with Laminar Reconstruction for Resection of Intradural Tumors at the Thoracolumbar Junction: A Technical Note.
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Byvaltsev VA, Polkin RA, Kalinin AA, Belykh E, and Riew KD
- Subjects
- Female, Humans, Middle Aged, Spine surgery, Laminectomy methods, Spinal Cord Neoplasms diagnostic imaging, Spinal Cord Neoplasms surgery, Spinal Cord Neoplasms complications
- Abstract
Objective: To introduce a new laminar reconstruction technique to treat primary spinal cord tumors., Methods: Laminectomy and laminoplasty techniques have been used to treat intradural spinal tumors. The advantage of laminectomy is its superior exposure of the spinal cord, whereas the advantage of laminoplasty is the reconstruction of the dorsal roof of the spine. In this technical note, we present a technique that combines a full laminectomy to maximize exposure, with a reconstructive technique to repair the lamina. This technique restores the posterior ligamentous complex to preserve spinal biomechanics., Results: In this illustrative case, a 55-year-old woman with severe back pain radiating to the right lower extremity was found to have an intradural tumor at the T12-L1 spinal level. Given the transitional level of the spine and potentially high biomechanical stresses on the posterior support structures, we used a T12 laminectomy to resect the tumor, followed by reconstruction using miniplates. The patient tolerated the surgery well, without any complications. She was discharged home and was doing well during the 3 months follow-up visit. Appropriate patient consent was obtained., Conclusions: Laminectomy and laminar reconstruction allow maximum visualization and manipulation of the tumor, followed by restoration of the dorsal roof of the spinal ring, and is an effective technique for treating spinal cord tumors., (Copyright © 2023 Elsevier Inc. All rights reserved.)
- Published
- 2023
- Full Text
- View/download PDF
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