The Virtual Spine Examination: Telemedicine in the Era of COVID-19 and Beyond

Global Spine Journal ◽

10.1177/2192568220947744 ◽

2020 ◽

pp. 219256822094774 ◽

Cited By ~ 1

Author(s):

Alexander M. Satin ◽

Isador H. Lieberman

Keyword(s):

Patient Safety ◽

Cervical Spine ◽

Lumbar Spine ◽

Study Design ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Narrative Review ◽

Examination Techniques

Study Design: Narrative review. Objectives: Describe a comprehensive spine telemedicine examination. Methods: We discuss telemedicine examination techniques for commonly encountered spine conditions. Results: Techniques to evaluate gait, the cervical spine, the lumbar spine, adult spinal deformity patients, and adolescent scoliosis patients via telemedicine are described. We review limitations of the spine telemedicine examination and discuss special considerations such as patient safety and criteria for in-person assessment. Conclusions: While there are limitations to the spine telemedicine examination, unique strategies exist to provide important information to the examiner. Efforts have already been undertaken to validate and expand the capabilities of the spine telemedicine examination.

Download Full-text

Narrative Review of Predictive Analytics of Patient-Reported Outcomes in Adult Spinal Deformity Surgery

Global Spine Journal ◽

10.1177/2192568220963060 ◽

2020 ◽

pp. 219256822096306

Author(s):

Kurt Lehner ◽

Jeff Ehresman ◽

Zach Pennington ◽

A. Karim Ahmed ◽

Daniel Lubelski ◽

...

Keyword(s):

Spinal Deformity ◽

Patient Reported Outcomes ◽

Predictive Analytics ◽

Adult Spinal Deformity ◽

Narrative Review ◽

Receiver Operating Curve ◽

Data Sets ◽

Significant Heterogeneity ◽

Model Accuracy ◽

Patient Reported

Study Design: Narrative review Objective: Decision making in surgery for adult spinal deformity (ASD) is complex due to the multifactorial etiology, numerous surgical options, and influence of multiple medical and psychosocial factors on patient outcomes. Predictive analytics provide computational tools to analyze large data sets and generate hypotheses regarding new data. In this review, we examine the use of predictive analytics to predict patient-reported outcomes (PROs) in ASD surgery. Methods: A search of PubMed, Web of Science, and Embase databases was performed to identify all potentially relevant studies up to February 1, 2020. Studies were included based on the use of predictive analytics to predict PROs in ASD. Results: Of 57 studies identified and reviewed, 7 studies were included. Multiple algorithms including supervised and unsupervised methods were used. Significant heterogeneity was observed with choice of PROs modeled including ODI, SRS22, and SF36, assessment of model accuracy, and with the model accuracy and area under the receiver operating curve values (ranging from 30% to 86% and 0.57 to 0.96, respectively). Models were built with data sets of patients ranging from 89 to 570 patients with a range of 22 to 267 variables. Conclusions: Predictive analytics makes accurate predictions regarding PROs regarding pain, disability, and work and social function; PROs regarding satisfaction, self-image, and psychologic aspects of ASD were predicted with the lowest accuracy. Our review demonstrates a relative paucity of studies on ASD with limited databases. Future studies should include larger and more diverse databases and provide external validation of preexisting models.

Download Full-text

228. Does interbody fusion protect against rod failure in the lower lumbar spine after long fusions to the sacrum: a comparative analysis of adult spinal deformity patients

The Spine Journal ◽

10.1016/j.spinee.2019.05.243 ◽

2019 ◽

Vol 19 (9) ◽

pp. S112

Author(s):

Mostafa H. El Dafrawy ◽

Keith H. Bridwell ◽

Owoicho Adogwa ◽

Maksim A. Shlykov ◽

Thamrong Lertudomphonwanit ◽

...

Keyword(s):

Comparative Analysis ◽

Lumbar Spine ◽

Spinal Deformity ◽

Interbody Fusion ◽

Adult Spinal Deformity ◽

Lower Lumbar Spine ◽

Lower Lumbar

Download Full-text

Spine Treatment Appraisal Report (STAR): Interbody Fusion Does not Fully Protect Against Rod Failure in Long Posterior Spinal Fusion for Adult Spinal Deformity

Global Spine Journal ◽

10.1177/2192568220972721 ◽

2020 ◽

Vol 11 (1) ◽

pp. 124-125

Author(s):

Joseph R. Dettori

Keyword(s):

Lumbar Spine ◽

Spinal Fusion ◽

Spinal Deformity ◽

Interbody Fusion ◽

Adult Spinal Deformity ◽

Posterior Spinal Fusion ◽

Primary Presentation

El Dafrawy M, Bridwell K, Adogwa O, Shlykov M, Koscso J, Lenke LG, Lertudomphonwanit T, Kelly MP, Gupta M. Rod fractures and nonunions after long fusion to the sacrum for primary presentation adult spinal deformity: a comparison with and without interbody fusion in the distal lumbar spine. Spine Deform. 2020. doi: 10.1007/s43390-020-00 174-6. Online ahead of print. PMID: 32 725 494

Download Full-text

Lumbar computed tomography scans are not appropriate surrogates for bone mineral density scans in primary adult spinal deformity

Neurosurgical FOCUS ◽

10.3171/2017.9.focus17476 ◽

2017 ◽

Vol 43 (6) ◽

pp. E4 ◽

Cited By ~ 6

Author(s):

Eitan M. Kohan ◽

Venu M. Nemani ◽

Stuart Hershman ◽

Daniel G. Kang ◽

Michael P. Kelly

Keyword(s):

Bone Mineral Density ◽

Lumbar Spine ◽

Femoral Neck ◽

Bone Mineral ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Mineral Density ◽

Number Of Patients ◽

Spine Ct ◽

The Mean

OBJECTIVEThe authors examined the correlation between lumbar spine CT Hounsfield unit (HU) measurements and bone mineral density measurements in an adult spinal deformity (ASD) population.METHODSPatients with ASD were identified in the records of a single institution. Lumbar CT scans were reviewed, and the mean HU measurements from L1–4 were recorded. Bone mineral density (BMD) was assessed using femoral neck and lumbar spine dual-energy x-ray absorptiometry (DEXA). The number of patients who met criteria for osteoporosis was determined for each imaging modality.RESULTSForty-eight patients underwent both preoperative DEXA and CT scanning. Forty-three patients were female and 5 were male. Forty-seven patients were Caucasian and one was African American. The mean age of the patients was 62.1 years. Femoral neck DEXA was more likely to identify osteopenia (n = 26) than lumbar spine DEXA (n = 8) or lumbar CT HU measurements (n = 6) (p < 0.001). There was a low-moderate correlation between lumbar spine CT and lumbar spine DEXA (r = 0.463, p < 0.001), and there was poor correlation between lumbar spine CT and femoral neck DEXA (r = 0.303, p = 0.036).CONCLUSIONSDespite the opportunistic utility of lumbar spine CT HU measurements in identifying osteoporosis in patients undergoing single-level fusion, these measurements were not useful in this cohort of ASD patients. The correlation between femoral neck DEXA and HU measurements was poor. DEXA assessment of BMD in ASD patients is essential to optimize the care of these complicated cases.

Download Full-text

Rod fractures and nonunions after long fusion to the sacrum for primary presentation adult spinal deformity: a comparison with and without interbody fusion in the distal lumbar spine

Spine Deformity ◽

10.1007/s43390-020-00174-6 ◽

2020 ◽

Vol 9 (1) ◽

pp. 231-237

Author(s):

Mostafa El Dafrawy ◽

Keith Bridwell ◽

Owoicho Adogwa ◽

Max Shlykov ◽

Jonathan Koscso ◽

...

Keyword(s):

Lumbar Spine ◽

Spinal Deformity ◽

Interbody Fusion ◽

Adult Spinal Deformity ◽

Primary Presentation

Download Full-text

Factors for the acquisition of 10° angular change at the lumbar spine through posterior column osteotomy in adult spinal deformity surgery

Journal of Neurosurgery Spine ◽

10.3171/2018.5.spine1858 ◽

2018 ◽

Vol 29 (6) ◽

pp. 667-673 ◽

Cited By ~ 1

Author(s):

Sanghyun Han ◽

Seung-Jae Hyun ◽

Ki-Jeong Kim ◽

Tae-Ahn Jahng ◽

Hyun-Jib Kim

Keyword(s):

Lumbar Spine ◽

Spinal Deformity ◽

Sagittal Plane ◽

Adult Spinal Deformity ◽

Posterior Column ◽

Control Group ◽

Disc Space ◽

Radiographic Measurements ◽

Angular Change ◽

Space Angle

OBJECTIVEPosterior column osteotomy (PCO) has been known to provide an angular change (AC) of approximately 10° in sagittal plane deformity. However, whether PCO can actually obtain an AC of ≥ 10° depending on the particular level in the lumbar spine and which factors can effect a gain of ≥ 10° AC after PCO remain to be elucidated. The aim of this study was to identify the factors that effect a gain of ≥ 10° AC through PCO by comparing radiographic measurements between an AC group and a control group before and after adult spinal deformity (ASD) surgery.METHODSForty consecutive patients who underwent multilevel PCOs for ASD at a single institution between 2012 and 2016 were included in this study. PCO was performed in 142 disc space levels in the lumbar spine. The authors defined the disc space level that obtained ≥ 10° AC in the sagittal plane by PCO as the AC group and the remaining patients as controls. The modified Pfirrmann grade, surgical level, implementation of the transforaminal lumbar interbody fusion (TLIF), and radiographic measurements were compared between the groups.RESULTSThere were 67 levels in the AC group and 75 in the control group. Multivariate analysis identified the surgical level at L4–5 (OR 3.802, 95% CI 1.127–12.827, p = 0.031), performing TLIF with PCO (OR 3.303, 95% CI 1.258–8.674, p = 0.015), and a preoperative kyphotic disc space angle (OR 1.397, 95% CI 1.231–1.585, p < 0.001) as the factors that significantly effected ≥ 10° AC in the sagittal plane after PCO.CONCLUSIONSIn ASD surgery, PCO cannot always achieve ≥ 10° AC in the sagittal plane. The factors that effected ≥ 10° AC in PCO for ASD were surgical level at L4–5, performing TLIF with PCO, and the preoperative kyphotic disc space angle.

Download Full-text

Surgical Management of the Lumbar Spine in Rheumatoid Arthritis

Global Spine Journal ◽

10.1177/2192568219886267 ◽

2019 ◽

Vol 10 (6) ◽

pp. 767-774

Author(s):

Peter Joo ◽

Laurence Ge ◽

Addisu Mesfin

Keyword(s):

Rheumatoid Arthritis ◽

Lumbar Spine ◽

Surgical Management ◽

Spinal Deformity ◽

Surgical Planning ◽

Chronic Inflammatory Disease ◽

Narrative Review ◽

Neurogenic Claudication ◽

Lower Back ◽

Optimal Medical Management

Study Design: Narrative review. Objective: To provide an overview on the diagnosis and surgical management of rheumatoid involvement of the lumbar spine. Rheumatoid arthritis (RA) is a chronic inflammatory disease of synovial joints, most commonly appendicular followed by axial. Although cervical spine involvement of RA is well documented, data on lumbar spine involvement and surgical management remains limited. Methods: Using PubMed, studies published prior to November 2018 with the keywords “RA, etiology”; “RA, spine management”; “RA, surgical management”; “RA, treatment”; “RA, DMARDs”; “RA, lumbar spine”; “RA, spine surgical outcomes”; “RA, imaging” were evaluated. Results: The narrative review addresses the epidemiology, manifestations, imaging, surgical complications, and operative and nonoperative management of RA involvement of the lumbar spine. Conclusions: Rheumatoid involvement of the lumbar spine can present with lower back pain, neurogenic claudication, radiculopathy, spinal deformity, and instability. Patients with RA have significantly higher rates of vertebral fractures and complications following surgical intervention. However, in the setting of instability and spinal deformity, thoughtful surgical planning in conjunction with optimal medical management is recommended.

Download Full-text

Spontaneous improvement of cervical alignment after correction of global sagittal balance following pedicle subtraction osteotomy

Journal of Neurosurgery Spine ◽

10.3171/2012.6.spine1250 ◽

2012 ◽

Vol 17 (4) ◽

pp. 300-307 ◽

Cited By ~ 90

Author(s):

Justin S. Smith ◽

Christopher I. Shaffrey ◽

Virginie Lafage ◽

Benjamin Blondel ◽

Frank Schwab ◽

...

Keyword(s):

Cervical Spine ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Linear Regression Analysis ◽

Pedicle Subtraction Osteotomy ◽

Surgical Correction ◽

Plumb Line ◽

Multivariate Linear Regression Analysis ◽

Cervical Lordosis ◽

Sagittal Malalignment

Object Sagittal spinopelvic malalignment is a significant cause of pain and disability in patients with adult spinal deformity. Surgical correction of spinopelvic malalignment can result in compensatory changes in spinal alignment outside of the fused spinal segments. These compensatory changes, termed reciprocal changes, have been defined for thoracic and lumbar regions but not for the cervical spine. The object of this study was to evaluate postoperative reciprocal changes within the cervical spine following lumbar pedicle subtraction osteotomy (PSO). Methods This was a multicenter retrospective radiographic analysis of patients from International Spine Study Group centers. Inclusion criteria were as follows: adults (>18 years old) with spinal deformity treated using lumbar PSO, a preoperative C7–S1 plumb line greater than 5 cm, and availability of pre- and postoperative full-length standing radiographs. Results Seventy-five patients (60 women, mean age 59 years) were included. The lumbar PSO significantly improved sagittal alignment, including the C7–S1 plumb line, C7–T12 inclination, and pelvic tilt (p <0.001). After lumbar PSO, reciprocal changes were seen to occur in C2–7 cervical lordosis (from 30.8° to 21.6°, p <0.001), C2–7 plumb line (from 27.0 mm to 22.9 mm), and T-1 slope (from −38.9° to −30.4°, p <0.001). Ideal correction of sagittal malalignment (postoperative sagittal vertical alignment < 50 mm) was associated with the greatest relaxation of cervical hyperlordosis (−12.4° vs −5.7°, p = 0.037). A change in cervical lordosis correlated with changes in T-1 slope (r = −0.621, p <0.001), C7–T12 inclination (r = 0.418, p <0.001), T12–S1 angle (r = −0.339, p = 0.005), and C7–S1 plumb line (r = 0.289, p = 0.018). Radiographic parameters that correlated with changes in cervical lordosis on multivariate linear regression analysis included change in T-1 slope and change in C2–7 plumb line (r2 = 0.53, p <0.001). Conclusions Adults with positive sagittal spinopelvic malalignment compensate with abnormally increased cervical lordosis in an effort to maintain horizontal gaze. Surgical correction of sagittal malalignment results in improvement of the abnormal cervical hyperlordosis through reciprocal changes.

Download Full-text