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79. Outcomes of a prone lateral single position approach to minimally invasive spine surgery [Meeting Abstract]

Passias, P G; Williamson, T; Krol, O; Imbo, B; Joujon-Roche, R; Tretiakov, P; Mir, J; Diebo, B G; Vira, S N; Shabani, S; Alan, N; Lafage, R; Moattari, K; Roberts, T T; Lafage, V
BACKGROUND CONTEXT: The institution of single positioning throughout a combined approach to adult spinal surgery has many theorized benefits, including minimizing surgical measures like operative time and estimated blood loss that are highly correlated with higher rates of postoperative complications. However, prone lateral positioning has yet to be correlated to other important outcomes, including radiographic realignment and patient-reported outcomes. PURPOSE: To investigate the surgical and postoperative outcomes of the prone lateral single-position approach to adult spinal deformity surgery. STUDY DESIGN/SETTING: Retrospective review of a single-center database. PATIENT SAMPLE: This study included 524 MIS patients. OUTCOME MEASURES: Perioperative outcomes [EBL, LOS, op-time, lvls fused], intraoperative and postoperative complication rates, patient-reported outcomes.
METHOD(S): Operative spine fusion patients available baseline (BL) and up to two-year (2Y) data from a single-center database were isolated. Patients were stratified into two groups based on undergoing a prone lateral single-position combined approach, Prone Lateral (PL) vs MIS Non-Prone Lateral (NPL). Descriptive analyses and means comparison tests identified differences in baseline (BL) demographics, surgical details, radiographic parameters, rates of intraoperative and postoperative complications, and follow-up patient-reported outcomes up to 2 years.
RESULT(S): A total of 233 patients (average age: 56.1+/-11.4 years, average BMI: 30.6+/-6.6 kg/m2, 54% of the cohort was male, CCI: 1.2+/-1.9) met inclusion criteria and underwent surgery (operative time: 320+/-152, EBL: 374+/-400 mL, levels fused: 2.4+/-1.2, LOS: 4.6+/-3.7 days). Regarding approach, 3 (1.3%) underwent lateral approach, 86 (38.6%) posterior, and 144 (60.1%) were combined. BL radiographic parameters: PI: 56.2+/-11.2, lumbar lordosis (LL): 53.0+/-12.9, PI-LL: 3.3+/-13.1, PT: 18.2+/-8.4, sacral slope (SS): 38.3+/-8.6. There were 103 same-day combined (lateral and posterior) procedures included in the cohort, with 22 of those being performed in the prone-lateral single position. When examining baseline demographics, the PL patients had mean age of 65.0+/-10.7, BMI of 28.3+/-4.7, CCI: 2.1+/-3.7, with 59% being male. Patients undergoing a prone lateral procedure had an average of 2.4+/-1.1 levels fused, EBL of 192+/-152 mLs, operative time of 200+/-103 minutes, while undergoing decompressions in 64% of procedures and osteotomies in 10%. Patients in the PL group were significantly older compared to non-PL patients (p <.001) with a lower BMI (p=.030) and higher CCI (p=.013). Patients undergoing PL procedures had lower EBL and operative time compared to non-PL patients (both p-value <.001), along with less osteotomies performed (10% vs. 43%, p=.002). Although, PL patients had a similar number of levels fused, they had a higher average LIV (L5 vs S1, p=.003) and UIV (L2 vs L3, p=.004) compared to the rest of the cohort. There were no radiographic differences preoperatively or postoperatively, although 50% of PL patients improved to aligned in PI-based sacral slope (GAP Relative Pelvic Version). PL patients suffered significantly less pulmonary (0% vs 4%, p=.019) and GI complications (0% vs 3%, p=.039), but endured higher rates of urinary retention (14% vs 5%, p=.032). This translated to a shorter length of stay (3.3 days vs 4.7, p=.004) for PL patients, with discharge to a rehab facility less often after leaving the hospital (0% vs 13%, p <.001). When examining patient-reported outcomes within one year after surgery, PL patients had greater improvement in NRS-Back (-6.0 vs -3.3, p=.031) and trending toward greater improvement in NRS-Leg (-4.6 vs -3.6, p=.132).
CONCLUSION(S): Patients undergoing prone lateral single-position procedures in this single-center database displayed less invasive procedures with similar degree of correction, endured lower rates of certain complications correlating to going home earlier and more often. These perioperative outcomes correlated to greater improvement of back pain following spinal corrective surgery. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
Copyright
EMBASE:2019803956
ISSN: 1878-1632
CID: 5510882

Mask Use for Athletes: A Systematic Review of Safety and Performance Outcomes

Lott, Ariana; Roberts, Timothy; Carter, Cordelia W
CONTEXT/UNASSIGNED:With the current Centers for Disease Control and Prevention recommendations for mask use to minimize transmission of coronavirus 2019 (COVID-19) coupled with concern for future pandemics that would require mask wearing, providing data-driven guidance with respect to athletic performance is essential. OBJECTIVE/UNASSIGNED:The purpose of this study was to perform a systematic review of existing literature on the use of face masks while exercising to assess the physiologic effects of face masks worn during athletic activities. DATA SOURCES/UNASSIGNED:A systematic review was conducted of studies on face mask use during exercise according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Potential studies were identified through searches of MEDLINE, Embase, Cochrane CENTRAL and CINAHL databases. STUDY SELECTION/UNASSIGNED:Screening was completed independently by 2 coauthors who sought to identify studies that described the effects of oronasal mask use, if any, on sports/exercise/physical activity, for any age, gender, or level of sport. Articles describing mask effects without exercise, articles published before 1980, and non-English language studies were excluded. STUDY DESIGN/UNASSIGNED:Systematic review. LEVEL OF EVIDENCE/UNASSIGNED:Level 3. DATA EXTRACTION/UNASSIGNED:Data extraction focused on physiologic parameters measured during physical activity performed while wearing a face mask. RESULTS/UNASSIGNED:Twenty-two articles met all inclusion criteria. Study analysis revealed that the use of masks in healthy volunteers during exercise had no significant effect on physiologic parameters measured including heart rate (HR), respiratory rate (RR), oxygen saturation, and perceived exertion. Of the studies that investigated N95 masks in the healthy adult population, 2 reported modest changes in RR and maximum power output indicative of decreased athletic performance when subjects were exercising at maximum effort. Similar findings were seen in studies of subpopulations including children and pregnant women. CONCLUSION/UNASSIGNED:Available data suggest that healthy individuals can perform moderate-to-vigorous exercise while wearing a face mask without experiencing changes in HR, RR, and oxygen saturation that would compromise individual safety or athletic performance. In the specific situation in which an N95 mask is worn, maximum power generated may be impaired. WHAT IS KNOWN ABOUT THE SUBJECT/UNASSIGNED:To date, there has been no systematic review of the existing literature to provide a clear consensus on whether face mask use significantly impacts athletic performance. Mask use has been demonstrated safe in the workplace; however, the use of face masks during exercise has not been examined on a large scale, particularly with respect to physiologic parameters. WHAT THIS STUDY ADDS TO EXISTING KNOWLEDGE/UNASSIGNED:This analysis highlights that available data suggest that healthy individuals can perform heavy exercise in face masks with minimal physiologic changes. This is the first systematic review of studies analyzing exercise use wearing masks. With the evidence presented here commonly cited concerns about both safety and performance decrements with mask use during physical activities may be allayed.
PMID: 35855525
ISSN: 1941-0921
CID: 5279032

Incidence of dysphagia following posterior cervical spine surgery

Zabat, Michelle A; Mottole, Nicole A; Patel, Hershil; Norris, Zoe A; Ashayeri, Kimberly; Sissman, Ethan; Balouch, Eaman; Maglaras, Constance; Protopsaltis, Themistocles S; Buckland, Aaron J; Roberts, Timothy; Fischer, Charla R
Abundant literature exists describing the incidence of dysphagia following anterior cervical surgery; however, there is a paucity of literature detailing the incidence of dysphagia following posterior cervical procedures. Further characterization of this complication is important for guiding clinical prevention and management. Patients ≥ 18 years of age underwent posterior cervical fusion with laminectomy or laminoplasty between C1-T1. Pre- and post-operative dysphagia was assessed by a speech language pathologist. The patient cohort was categorized by approach: Laminectomy + Fusion (LF) and Laminoplasty (LP). Patients were excluded from radiographic analyses if they did not have both baseline and follow-up imaging. The study included 147 LF and 47 LP cases. There were no differences in baseline demographics. There were three patients with new-onset dysphagia in the LF group (1.5% incidence) and no new cases in the LP group (p = 1.000). LF patients had significantly higher rates of post-op complications (27.9% LF vs. 8.5% LP, p = 0.005) but not intra-op complications (6.1% LF vs. 2.1% LP, p = 0.456). Radiographic analysis of the entire cohort showed no significant changes in cervical lordosis, cSVA, or T1 slope. Both group comparisons showed no differences in incidence of dysphagia pre and post operatively. Based on this study, the likelihood of developing dysphagia after LF or LP are similarly low with a new onset dysphagia rate of 1.5%.
PMID: 35240474
ISSN: 1532-2653
CID: 5174662

Cervical Total Disk Arthroplasty

Roberts, Timothy T; Filler, Ryan J; Savage, Jason W; Benzel, Edward C
In the United States, cervical total disk arthroplasty (TDA) is US Federal Drug Administration (FDA) approved for use in both 1 and 2-level constructions for cervical disk disease resulting in myelopathy and/or radiculopathy. TDA designs vary in form, function, material composition, and even performance in?vivo. However, the therapeutic goals are the same: to remove the painful degenerative/damaged elements of the intervertebral discoligamenous joint complex, to preserve or restore the natural range of spinal motion, and to mitigate stresses on adjacent spinal segments, thereby theoretically limiting adjacent segment disease (ASDis). Cervical vertebrae exhibit complex, coupled motions that can be difficult to artificially replicate. Commonly available TDA designs include ball-and-socket rotation-only prostheses, ball-and-trough rotation and anterior-posterior translational prostheses, as well as unconstrained elastomeric disks that can rotate and translate freely in all directions. Each design has its respective advantages and disadvantages. At this time, available clinical evidence does not favor 1 design philosophy over another. The superiority of cervical TDA over the gold-standard anterior cervical discectomy and fusion is a subject of great controversy. Although most studies agree that cervical TDA is at least as effective as anterior cervical discectomy and fusion at reducing or eliminating preoperative pain and neurological symptoms, the clinical benefits of motion preservation- that is, reduced incidence of ASDis-are far less clear. Several short-to-mid-term studies suggest that disk arthroplasty reduces the radiographic incidence of adjacent segment degeneration; however, the degree to which this is clinically significant is disputed. At this time, TDA has not been clearly demonstrated to reduce symptomatic?ASDis.
PMID: 29315121
ISSN: 2380-0194
CID: 3984742

Allergic or Hypersensitivity Reactions to Orthopaedic Implants

Roberts, Timothy T; Haines, Colin M; Uhl, Richard L
Allergic or hypersensitivity reactions to orthopaedic implants can pose diagnostic and therapeutic challenges. Although 10% to 15% of the population exhibits cutaneous sensitivity to metals, deep-tissue reactions to metal implants are comparatively rare. Nevertheless, the link between cutaneous sensitivity and clinically relevant deep-tissue reactions is unclear. Most reactions to orthopaedic devices are type IV, or delayed-type hypersensitivity reactions. The most commonly implicated allergens are nickel, cobalt, and chromium; however, reactions to nonmetal compounds, such as polymethyl methacrylate, antibiotic spacers, and suture materials, have also been reported. Symptoms of hypersensitivity to implants are nonspecific and include pain, swelling, stiffness, and localized skin reactions. Following arthroplasty, internal fixation, or implantation of similarly allergenic devices, the persistence or early reappearance of inflammatory symptoms should raise suspicions for hypersensitivity. However, hypersensitivity is a diagnosis of exclusion. Infection, as well as aseptic loosening, particulate synovitis, instability, and other causes of failure must first be eliminated.
PMID: 28953084
ISSN: 1940-5480
CID: 3066782

Classifications In Brief: American Spinal Injury Association (ASIA) Impairment Scale

Roberts, Timothy T; Leonard, Garrett R; Cepela, Daniel J
PMCID:5384910
PMID: 27815685
ISSN: 1528-1132
CID: 3984782

Open Navicular Dislocation With Midfoot Dissociation in a 45-Year-Old Man [Case Report]

Papaliodis, Dean N; Roberts, Timothy T; Vanushkina, Maria; Das, Shankar; Lisella, Jordan; DiPreta, John
Traumatic dislocation of an intact tarsal navicular is an uncommon injury. In this article, we report a case of open medial navicular dislocation in a 45-year-old man. The injury was managed with open reduction and stabilization with Kirschner wires within the acute period. Ten months after injury, the patient developed avascular necrosis of the navicular and exhibited progressive collapse of the medial midfoot. He underwent naviculocuneiform arthrodesis 1 year after the index surgery. Two years after fusion, he was pain-free and ambulating independently. Successful treatment of midfoot fractures and dislocations requires an intimate understanding of anatomy, biomechanics, and both short- and long-term sequelae of injury.
PMID: 28666050
ISSN: 1934-3418
CID: 3984802

Computer Assisted Cobb Angle Measurements: A novel algorithm

Papaliodis, Dean N; Bonanni, Pierino G; Roberts, Timothy T; Hesham, Khalid; Richardson, Nicholas; Cheney, Robert A; Lawrence, James P; Carl, Allen L; Lavelle, William F
BACKGROUND:The standard for evaluating scoliosis is PA radiographs using Cobb angle to measure curve magnitude. Newer PACS systems allow easier Cobb angle calculations, but have not improved inter/intra observer precision of measurement. Cobb angle and its progression are important to determine treatment; therefore, angle variability is not optimal. This study seeks to demonstrate that a performance equivalent to that achieved in the manual method is possible using a novel computer algorithm with limited user input. The authors compared Cobb angles from predetermined spinal levels in the average attending score versus the computer assisted approach. METHODS:Retrospective analysis of PA radiographs from 58 patients previously evaluated for scoliosis was collected. Predesignated spinal levels (e.g., T2-T10) were assigned for different curves and calculated by Cobb method. Four spine surgeons evaluated these Cobb angles. Their average scores were measured and compared to formulated values using the novel computer-based algorithm. Literature reports inter-observer reliability is 6.3-7.2degrees. Limits of accuracy were set at 5 degrees of average orthopedic surgeons' score. RESULTS:= 0.09. CONCLUSIONS:Our study showed the novel computer based algorithm was an efficient and reliable method to assess scoliotic curvature in the coronal plane with the possibility of expediting clinic visits, ensuring reliability of calculation and decreasing patient exposure to radiation. Level of Evidence: III.
PMCID:5537975
PMID: 28765805
ISSN: 2211-4599
CID: 3984812

Vertebral tumors of the elderly

Chapter by: Filler, RJ; Roberts, TT; Benzel, EC
in: Brain and spine surgery in the elderly by Berhouma, Moncef; Krolak-Salmon, Pierre (Eds)
Cham, Switzerland : Springer, [2017]
pp. ?-?
ISBN: 9783319402321
CID: 3984942

Importance of interbody spinal fusion at thoracolumbar and lumbosacral junctional levels

Chapter by: Haines, CM; Roberts, TT; Savage, J
in: Benzel's spine surgery : techniques, complication avoidance, and management by Steinmetz, Michael P; Benzel, Edward C (Eds)
Philadelphia, PA : Elsevier, [2017]
pp. ?-?
ISBN: 9996118525
CID: 3984962