bluuebunny/crossref_metadata_2025 huggingface dataset:
277 Clinical Outcome With and Without Adherence to Evidence-based Medicine Guidelines for Lumbar Degenerative Spondylolisthesis Fusion Patients
Authors: Gonzalez Ozuna Glenn Arturo , Porto Guilherme Bastos , Jingya Miao , Hines Kevin , Franco Daniel , O'Leary Matthew , Thalheimer Sara , Harrop James S.
Published: March 2024

INTRODUCTION:

Degenerative lumbar spondylolisthesis (DS) patients are treated with instrumented fusion, following EBM guidelines, and typically have excellent clinical outcomes. However, not all lumbar fusion procedures adhere to EBM guidelines, typically due to a lack of prospective data.

METHODS:

This study compared outcomes of lumbar fusion procedures for degenerative spondylolisthesis in two groups: 125 patients treated according to EBM guidelines and 21 patients without EBM literature support. ODI scores were collected pre- and post-surgery and categorized into SCB, MCID, no MCID, or no change/worsening. Statistical analysis included χ2, Fisher exact, and t-student tests. Multivariate logistic regression analyzed the odds of achieving MCID after six months of follow-up.

RESULTS:

The study included a total of 146 lumbar fusion patients, with the majority (125/146) adhering to EBM guidelines (EBM concordant) while a smaller proportion (21/146) did not (EBM discordant). The EBM concordant group demonstrated a statistically significant improvement in ODI scores compared to the EBM discordant group (p = 0.02). Compliance with EBM guidelines was associated with higher odds of achieving MCID, with an odds ratio of 2.93 and a confidence interval of 1.128-7.58 (p = 0.027). In the EBM concordant group, 42% of patients achieved SCB, and 64.8% showed MCID, whereas in the EBM discordant group, only 14% achieved SCB, and 38.1% showed MCID. These findings suggest that adherence to EBM guidelines in lumbar fusion procedures may lead to better clinical outcomes for patients.

CONCLUSIONS:

Patients whose lumbar fusions met the EBM criteria exhibited better self-reported outcomes at six months compared to those who did not meet the requirements. In order to strengthen EBM-guided patient care, an expanded knowledge base is needed.
278 Lateral Anterior Column Release in Short Construct... Is It Worth It?
Authors: Flores-Milan Gabriel , Carballo Cesar
Published: March 2024

INTRODUCTION:

Adjacent Segment Disease (ASD) is a common complication after lumbar spinal fusions. Ways to reduce the rates for ASD are highly sought after mainly to avoid re-operation.

METHODS:

We conducted a retrospective cohort study that consisted of patients that underwent 1-2 level LLIF for degenerative spine disease from 2014-2020. Patients needed to have at least one year of follow-up and have postoperative standing x-rays. Preoperative demographics, perioperative surgical characteristics, and postoperative outcomes were recorded.

RESULTS:

92 patients were included for analysis after inclusion criteria. Median follow-up period of 25 months. 54% F, 64 years of age, BMI 31. 11 patients (12%) developed ASD at a median follow up of 29 months. In the patients with ASD, 9 (82%) underwent anterior column release (ACR) with the placement of hyper-lordotic cages > 20 degrees. In our cohort of short construct LLIF ACR was done 9 patients (L3/4 (7 patients) and L4/5 (2 patients). In the univariate analysis we found that age-adjusted PI-LL mismatch (p < 0.003), the use of a hyperlordotic cage (p = 0.003), and ACR release (p < 0.001) were significantly associated with ASD. A multivariate logistic regression model was created and showed only that ACR was predictive for ASD (Odds Ratio: 69.1, 95% confidence interval: 10.71-446.3, p < 0.001).

CONCLUSIONS:

ACR was predictive for developing ASD in lumbar degenerative disease patients that undergo short-segment LLIF. While other factors may play a role, this was the predominant factor identified in our cohort with at least 10-fold increase risk. ACR is a powerful tool to be use in only spinal deformity. We recommend against ACR in short construct LLIF.
283 Decoding Mechanotransduction in Spinal Pseudoarthrosis: A Mouse Model of Spinal Fusion for Developing Mechanosensitive Osteobiologics
Authors: Connolly Ian David , Burns Ryan P. , Kiapour Ali , Phan Duy , Esposito Eric , Kahle Kristopher Thomas , Shin John H. , Hadzipasic Muhamed , Shankar Ganesh
Published: March 2024

INTRODUCTION:

Pseudoarthrosis (PA), represents a significant complication after spinal fusion. Efforts to reduce its occurrence predominantly involve the use of osteobiologics, the majority of which, are linked to various complications. It is well known that bone formation relies heavily on mechanical signaling cues. Recently, Piezo 1 has emerged as an important mechanosensitive calcium channel with a role in bone formation during development.

METHODS:

Normal human spine bone samples and PA tissue samples were collected intraoperatively. Samples underwent biomechanical and histologic characterization. Mice underwent spinal fusion surgery using iliac crest allograft. Weekly micro CT scans were performed over 4 weeks. Explanted mouse fusion bed (week 4) and normal spine underwent three-point bending testing.

RESULTS:

Human PA tissue was an elastic tissue that did not contain any mineralized bone with a mechanical stiffness of 12±4.1 N/mm. Bone had a measured stiffness of 341 ± 70 N/mm. Immunostaining showed that bone contained Piezo 1 expressing cells. PA demonstrated loss of osteocytes and loss of Piezo 1 expression. Mouse micro CT imaging of fusion bed at week 4 showed contiguous areas of fused bone. Fused mouse spine had a stiffness of 5.87 ± 2 N/mm. Normal mouse spine had a stiffness of 1.17 ± 0.47 N/mm.

CONCLUSIONS:

Human PA tissue is biomechanically and histologically distinct from normal bone with loss of Piezo 1 and osteocytes. Mice that underwent fusion surgery displayed radiographic and biomechanical evidence of bone fusion in a Piezo1-dependent manner, revealing a role for targeting mechanosensitive channels as a local biologic to promote arthrodesis.
289 Mental Health Comorbidities in Workers Compensation Patients and the Effect on Pain, Disability, Quality of Life, and Return to Work After Lumbar Spine Surgery
Authors: Monk Steve Hubert , Hani Ummey , Pfortmiller Deborah , Stanley Gerry , Bohl Michael , Kim Paul Keetae , Holland Christopher Michael , McGirt Matthew J.
Published: March 2024

INTRODUCTION:

Outcomes after lumbar spine surgery in workers’ compensation (WC) patients have been reported to be worse than the general population. Anxiety and depression are modifiable risk factors that also adversely affect outcomes after lumbar spine surgery.

METHODS:

We queried a nationwide, prospective surgical outcomes registry (AANS-QOD) for all patients undergoing lumbar spine surgery at over 200 hospital systems from 2012 to 2021. Perioperative safety, facility utilization, one-year patient-reported outcomes (pain, disability, and quality-of-life), and return to work (RTW) were measured as a function of WC and mental health comorbidity status.

RESULTS:

A total of 27,525 patients (1018 WC, 26,507 non-WC) undergoing 1-4 level lumbar spine surgery (14,914 laminectomy, 12,611 fusion) were reviewed. WC patients were younger, healthier (lower ASA grade), more likely to be minorities, less educated, more likely to smoke, and had greater baseline back pain, disability, and quality of life compared to non-WC patients. The prevalence of anxiety and depression was similar between groups. WC patients had worse outcomes for all measures and lower rates of RTW compared to non-WC patients. WC patients with anxiety and depression demonstrated even greater disparities in all outcomes. After propensity matching, WC patients with anxiety or depression (n = 107) continued to demonstrate significantly worse outcomes in comparison to WC patients without anxiety or depression (n = 107).

CONCLUSIONS:

Disparities in outcomes after lumbar spine surgery in WC patients are exacerbated in patients with anxiety and depression. WC patients with mental health comorbidities receive the least benefit from lumbar spine surgery and may represent the most vulnerable subset of patients with spinal pathology. Addressing mental health comorbidities preoperatively may represent an opportunity for valuable resource allocation and surgical optimization in the WC population.
291 Supra-maximal Extent of Resection is Associated With Improved Progression-Free Survival in Patients With IDH Wild-Type Glioblastoma Once Negative TERT Promoter Molecular Margins are Achieved
Authors: Smith William , Massaad Elie , Bradley Joseph , Esposito Eric , Curry William T. , Barker Frederick George , Carter Bob S. , Nahed Brian V. , Cahill Daniel P. , Shankar Ganesh
Published: March 2024

INTRODUCTION:

The standard of care for isocitrate dehydrogenase (IDH) wild-type GBM involves safe maximal resection with subsequent chemoradiation. TERT promoter (TERTp) mutations are clonal in >85% of IDH wild-type GBMs, detectable in all tumor cells. Advances in surgical management have focused on optimizing maximal resection given the positive correlation between extent of resection (EOR) and post-operative outcomes.

METHODS:

TERTp mutation detection in margin specimens was performed via a novel 30min qPCR-based method. A machine learning algorithm incorporating preoperative anatomic and intraoperative characteristics was developed using 148 patients to predict EOR. This model was prospectively applied to 44 patients to assess the correlation between a TERTp mutation negative margin and survival in cases when GTR was predicted.

RESULTS:

Retrospective analysis of 148 patients who underwent resection of GBM revealed significant improvement in 36-month survival with residual volume (RV) <4.9 cc). The primary predictive characteristics for achieving this RV were tumor volume, ventricular contact, multifocality, and Sawaya grade. Prospective analysis of 44 patients showed that, in cases where GTR was predicted and achieved, 26% obtained a TERTp negative margin. Although small, this group's PFS was significantly prolonged (0% vs 75% event-free at 30 months, p = 0.02), and a numerically superior prolonged OS was observed, while survival in GTR with positive molecular margin was indistinguishable from STR.

CONCLUSIONS:

These findings provide novel evidence supporting the utility of supramaximal resection targeting a “molecular margin” to maximize postoperative survival for a subset of patients with “localized” GBM. Further study is warranted to assess intraoperative, quantitative testing of TERTp mutation in GBM specimens to guide marginal resection in these patients.
293 The Impact of Tumor Mutational Status on Protoporphyrin IX Accumulation in Tumor-Associated Macrophages in Glioblastoma Patients
Authors: Lock Emily Katherine , Alber Daniel Alexander , Smith Andrew , Lee Sangwon Karl , Movah-Ezazi Misha , Hollon Todd Charles , Oermann Eric Karl , Orringer Daniel A.
Published: March 2024

INTRODUCTION:

Immunotherapies provide promising new treatment options for lung cancer and melanoma, however success in glioblastoma (GBM) patients has been much rarer and uneven. Identifying candidates with GBM that are most likely to benefit from immunotherapy remains a challenge. The abundance of tumor-associated macrophages (TAMs) correlates response to immunotherapy in GBM patients. Here we leverage a new imaging technique for quantifying TAMs via tandem stimulated Raman histology (SRH) and two-photon excitation fluorescence microscopy (TPEF) to assess the impact of genetic classification on the abundance of TAMs.

METHODS:

We conducted tandem SRH and TPEF on specimens from 79 patients undergoing high-grade glioma resection with 5-ALA. We trained a MaskR-CNN deep neural network to identify TAMs and compute their density in each specimen. Corresponding clinical, demographic, genomic and methylomic data were collected for each patient. Independent sample t-tests were used to identify significant correlations between genetic markers, treatment, and TAM density.

RESULTS:

We analyzed 3,121,524 300 x 300 micron fields of view, from 151 fresh specimens, enabling segmentation of 611,789 TAMs. IDH-mutant tumors had significantly lower TAM density than IDH-wildtype tumors (p < 0.01). The absence of MGMT promoter hypermethylation was associated with significantly higher TAM density (p = 0.03). Tumors with EGFR amplification averaged significantly lower TAM density than EGFR wildtype specimens (p < 0.01). Recurrent tumors possessed 31.5% lower TAM density than primary resections.

CONCLUSIONS:

Tandem SRH and TPEF can estimate variations in TAM density in human GBMs. We found TAM density to be associated with IDH status, MGMT promoter methylation, and EGFR amplification. This imaging technique creates a new avenue for forecasting response to immunotherapy in GBM patients.
302 Targeted Inhibition of the Epigenetically Activated miR-483-5p IGF-2 Pathway as a Novel Therapeutic Strategy for Meningioma
Authors: Uhlmann Erik , Mackel Charles E. , Deforzh Evgeny , Rabinovsky Rosalia , Brastianos Priscilla , Varma Hemant , Krichevsky Anna , Vega Rafael A.
Published: March 2024

INTRODUCTION:

Meningioma is the most common primary central nervous system tumor. These are usually treated by surgical resection with curative intent, however gross total resection is not always feasible and there are many cases of recurrent and refractory disease despite adjuvant radiotherapy. Presently, there is no effective pharmacotherapeutic options for these tumors.

METHODS:

Small RNA sequencing was performed on meningioma tumor samples to study grade-dependent changes in microRNA expression. Gene expression was analyzed by chromatin marks, qRT-PCR and western blot. miRNA modulation, anti-IGF-2 neutralizing antibodies, and inhibitors against IGF1R were evaluated in a tumor-derived primary cultures of meningioma cells.

RESULTS:

Meningioma tumor samples showed high, grade-dependent expression of miR-483-5p, associated with high mRNA and protein expression of its host gene IGF-2. Inhibition of miR-483-5p reduced the growth of cultured meningioma cells, whereas a miR-483 mimic increased cell proliferation. Similarly, inhibition of this pathway with anti-IGF-2 neutralizing antibodies reduced meningioma cell proliferation. Small molecule tyrosine kinase inhibitor blockade of the IGF-2 receptor (IGF1R) resulted in rapid loss of viability of cultured meningioma tumor-derived cells, suggesting that autocrine IGF-2 feedback is obligatory for meningioma tumor cell survival and growth. The observed IGF1R-inhibitory IC50 for GSK1838705A and Ceritinib in cell-based assays along with the available pharmacokinetics data predicted that effective drug concentration could be achieved in vivo as a new medical treatment of meningioma.

CONCLUSIONS:

Meningioma cell growth is critically dependent on autocrine miR-483/IGF-2 stimulation and the IGF-2 pathway provides a new feasible meningioma treatment target.
307 Active Exchange of CSF for Rapid Removal of Blood in Hemorrhagic Stroke—Multicenter Experience in 40 Patients
Authors: Jahromi Behnam Rezai , Soini Silja , Baig Ammad , Wilson Jennifer , Bhinder Vikram , Hess Ryan M. , Göhre Felix , Hijazy Ferzat , Tanskanen Päivi , Siironen Jari , Levy Elad I. , Niemela Mika Risto , Siddiqui Adnan Hussain , Brandmeir Nicholas
Published: March 2024

INTRODUCTION:

Spontaneous Intracerebral hemorrhage (ICH) and subarachnoidal hemorrhages (SAH) can represent with intraventricular hemorrhage (IVH). Previous studies have demonstrated, patients with IVH have higher mortality and morbidity. Neuroinflammation due to organization of blood in cerebrospinal fluid (CSF) is one of the key contributing factors to poor outcome.

METHODS:

Data utilizing the new active EVD system were collected from six leading centers in the EU and USA. 40 patients were analyzed, 21 patients had SAH, 13 patients had spontaneous ICH related IVH, and six patient had vascular anomaly related hemorrhage. Blood removal from ventricular system was calculated utilizing daily CT imaging. Actual and expected shunt dependency were calculated for SAH patients with CHESS score.

RESULTS:

Removal of blood from CSF system with the active EVD was achieved safely. Pace of blood removal was highly related to irrigation volume used during treatment. All the 13 spontaneous ICH patients had IVH clearance of median 91.3% (0.7-100%) in average 7.6 days. Additionally, in the SAH patients, there was lower shunt (2) dependency compared to those observed in literature and to expected (11) calculated based on CHESS score. Vascular anomaly cohort had median IVH clearance 91.3% in average 8.0 days.

CONCLUSIONS:

It is safe and feasible to remove blood from CSF system in an accelerated fashion via active EVD. Active removal of blood reduced adverse events in this patient population. Removal of blood is highly related to irrigation rate. Prospective trials are needed to demonstrate the target population who will benefit the most from CSF exchange during hemorrhagic stroke treatment.
311 Rupture-Risk Stratifying Patients With Cerebral Arteriovenous Malformations Using Quantitative Hemodynamic Flow Measurements
Authors: Nico Elsa , Hossa Jessica , McGuire Laura Stone , Alaraj Ali
Published: March 2024

INTRODUCTION:

Up to 60% of cerebral arteriovenous malformations (AVMs) present with an intracranial hemorrhage, however, noninvasive neuroimaging has increasingly diagnosed incidental AVMs. AVM management depends on weighing the lifetime rupture risk against the risks of intervention. Although AVM rupture risk relies primarily on angioarchitectural features, measuring hemodynamic flow is gaining traction. An accurate understanding of AVM hemodynamic flow parameters will help stratify patients by rupture risk and select treatment plans.

METHODS:

The literature was reviewed for articles that quantified AVM flow.

RESULTS:

Quantitative digital subtraction angiography (QDSA), 4D spin-labeled magnetic resonance angiography (4D-SL-MRA), and 4D-Flow magnetic resonance imaging (4D-Flow-MRI) studies measure relative flow; 3D phase-contrast MRI (PC-MRI) studies measure relative and true flow; and quantitative MRA (QMRA) studies measure true flow. QDSA studies have correlated increased rupture risk with prolonged venous outflow, however there are mixed findings with respect to arterial inflow. Similarly, a higher AVM inflow-to-outflow ratio has been associated with greater rupture risk in studies using PC-MRI. 4D-SL-MRA studies, on the other hand, have demonstrated a lower time-to-peak draining-vein-to-feeder-artery ratio in patients with AVM rupture. Finally, 4D-Flow-MRI studies have shown inconsistent findings whereas QMRA studies have found no significant associations between AVM hemodynamic flow parameters and rupture risk.

CONCLUSIONS:

Quantitative hemodynamic studies on the relationship between AVM flow and rupture risk have not reached a clear consensus; however, the preponderance of data suggests that higher arterial inflow and lower venous outflow in the AVM nidus contribute to increased hemorrhagic risk. Future studies should consider using larger sample sizes and standardized definitions of hemodynamic parameters to reach a consensus. In the meantime, classic angioarchitectural features may be more strongly correlated with AVM rupture than the amount of blood flow.
314 Long-term Follow-up of Cerebral Aneurysms Completely Occluded at 6 Months After Intervention With the Woven EndoBridge (WEB) Device: A Retrospective Multicenter Observational Study
Authors: El Naamani Kareem , Mastorakos Panagiotis , Adeeb Nimer , Lan Matthews , Castiglione James , Khanna Omaditya , Zanaty Mario , Ghosh Ritam , Abbas Rawad , Tjoumakaris Stavropoula I. , Gooch Michael Reid , Herial Nabeel , Rosenwasser Robert H.
Published: March 2024

INTRODUCTION:

The Woven EndoBridge (WEB) device has been widely used to treat intracranial wide neck bifurcation aneurysms. Initial studies have demonstrated that approximately 90% of patients have the same or improved long-term aneurysm occlusion after the initial 6-month follow-up.

METHODS:

This is an analysis of a prospectively maintained database across 13 academic institutions. We included patients with previously untreated cerebral aneurysms embolized using the WEB device who achieved complete occlusion at first follow-up and had available long-term follow-up.

RESULTS:

A total of 95 patients with a mean age of 61.6 ± 11.9 years were studied. The mean neck diameter and height were 3.9 ± 1.3 mm and 6.0 ± 1.8 mm, respectively. The mean time to the first and last follow-up was 5.4 ± 1.8 and 14.1 ± 12.9 months, respectively. Out of all the aneurysms that were completely occluded at 6 months, 84 (90.3%) showed complete occlusion at the final follow-up, and 11(11.5%) patients did not achieve complete occlusion. The positive predictive value (PPV) of complete occlusion at the first follow was 88.4%. Importantly, this did not differ between Digital Subtraction Device (DSA), Magnetic Resonance Angiography (MRA), or Computed Tomography Angiography (CTA).

CONCLUSIONS:

This study underlines the importance of repeat imaging in patients treated with the WEB device even if complete occlusion is achieved short term. Follow-up can be performed using DSA, MRA, or CTA with no difference in positive predictive value.
315 A Propensity Score-matched Comparative Study of Balloon Guide Catheters Versus Conventional Guide Catheters for Mechanical Thrombectomy With Stenting in Tandem Strokes: Comparison of 1st-pass Effect, Symptomatic ICH, and 90-day Functional Outcomes
Authors: Baig Ammad , Waqas Muhammad , Turner Ryan C. , Kuo Cathleen , Donnelly Brianna M. , Lai Rosalind , Raygor Kunal P. , Bouslama Mehdi , Lim Jaims , Neumaier Jenna L. , Cappuzzo Justin Mark , Davies Jason , Snyder Kenneth Vincent
Published: March 2024

INTRODUCTION:

Extensive clot burden in tandem strokes accounts for poor mechanical thrombectomy (MT) outcomes. Several studies have shown benefit of balloon guide catheters (BGC) in MT and carotid artery stenting.

METHODS:

Tandem stroke patients identified from our endovascular database were dichotomized into groups treated with BGCs versus conventional guide catheters. One-to-one PSM adjustment for baseline demographics and treatment selection bias using nearest-neighbor matching was performed. Patient demographics, presentation characteristics, and procedural details were recorded. Outcomes assessed were final modified thrombolysis in cerebral infarction (mTICI) grade, periprocedural symptomatic intracranial hemorrhage (sICH) rate, in-hospital mortality, and 90-day modified Rankin Scale (mRS) score. Mann-Whitney U-test and multivariate logistic regression were performed to compare procedural parameters and clinical outcomes.

RESULTS:

Concurrent carotid revascularization (stenting with/without angioplasty) and MT was performed in 125 cases (BGC: 85; no BGC: 40). After PSM (40 patients/group), BGC group had a significantly shorter procedure duration (77.9 vs. 61.5 min; odds ratio [OR] = 0.996; p = 0.006), lower discharge National Institutes of Health Stroke Scale score (8.0 vs. 11.0; OR = 0.987; p = 0.042), and higher odds of 90-day mRS 0-2 score (52.3% vs. 27.5%; OR = 0.34; p = 0.040). On multivariate regression, BGC group had a significantly higher first-pass effect rate (mTICI: 2B-3) (OR = 1.115, 95% confidence interval [CI] = 1.015-1.432; p = 0.013) and lower periprocedural sICH rate (OR = 0.615; 95% CI = 0.406-0.932; p = 0.025). No difference in in-hospital mortality was observed (OR = 1.591; 95% CI = 0.976-2.593; p = 0.067).

CONCLUSIONS:

BGCs used for concurrent MT–carotid revascularization with flow arrest were safe and resulted in superior clinical and angiographic outcomes in tandem stroke patients.
320 Intraoperative Angiography in Neurosurgery: Temporal Trend, Access Site, and Operative Indication Considerations From a Six-year Institutional Experience
Authors: Tudor Thilan , Sussman Jonathan , Sioutas Georgios , Salem Mohamed M. , Muhammad Najib , Romeo Dominic , Tarbay Antonio Corral , Kim Yohan , Ng Jinggang , Rhodes Isaiah , Gajjar Avi A , Choudhri Omar , Zager Eric L. , Srinivasan Visish M. , Janko Brian T.
Published: March 2024

INTRODUCTION:

Historically, the transfemoral approach (TFA) has been the most common access site for cerebral intraoperative angiogram (IOA). However, in line with trends in cardiac interventional vascular access preferences, transradial approach (TRA) and transulnar approach (TUA) are gaining popularity due to favorable safety and patient satisfaction outcomes.

METHODS:

Between July 2016 and December 2022, 317 angiograms were included based on our case definition, comprising 59 TRA cases, 11 TUA cases, 243 TFA, and four transpopliteal cases. Fluoroscopy time, contrast dose, reference air kerma (RAK), and dose area products (DAP) per target vessel catheterized were the primary endpoints of interest. Univariate and multivariate regression analyses were conducted to evaluate predictors of elevated contrast dose and radiation exposure metrics.

RESULTS:

Contrast dose per vessel catheterized was significantly lower in TRA/TUA cases versus TFA cases (p = 0.001), but radiation exposure metrics did not differ between access site groups. TRA/TUA versus TFA does not significantly predict elevated levels of radiation exposure or contrast dose. Aneurysm cases were associated with significantly lower odds of elevated radiation exposure for all radiation metrics (p < 0.05) whereas AVM cases had higher odds of elevated radiation exposure across all measures (p < 0.01). There was a significant relationship between case number and operative indication over the study period (p < 0.001) with a decrease in the proportion of cases for aneurysm treatment offset by increases in total cases for the management of AVF and AVM.

CONCLUSIONS:

TRA and TUA are safe and effective access site options for neurointerventional procedures and are increasingly employed. Cases using wrist access may be associated with a lower contrast dosing for patients.
325 The Economic Impact of Pediatric and Adolescent Gunshot Wound Mortality
Authors: Liles Campbell , Leech Ashley , Bhamidipati Akshay , Dambrino Robert J. , Chambless Lola Blackwell , Patrick Stephen , Shannon Chevis N. , Wellons John C.
Published: March 2024

INTRODUCTION:

Gunshot wounds (GSW) are the leading cause of pediatric/adolescent mortality in the United States. The total economic impact of lost productivity has not been previously quantified.

METHODS:

The CDC WONDER database was utilized to document GSW fatalities of individuals 19 years and younger between 2001-2021. The weighted net present value (NPV) of potential future lost income for each child was calculated based on the Social Security Administration’s estimated NPV of lifetime earnings at age 20, using a 4% discount rate, and factoring in updated US census data on education status, graduation rates, and wage-gaps. Each year’s total lost income was adjusted to 2022 USD using the CPI-W. Sensitivity analysis tested the robustness of our model parameters’ variability on our model results.

RESULTS:

64,503 total pediatric/adolescent GSW mortalities have occurred since 2001. Total estimated NPV income loss in 2022 USD is $58.78 Billion. This correlates with an estimated loss to Social Security of $7.29 Billion. Sensitivity analyses found that changes in salary had the highest potential impact on the final outcomes. Overall, the worst-case income scenario (-20% change in base salary) showed an estimated $47 Billion economic loss in 2022 USD. A similar analysis for total pediatric mortality due to neurological disease showed an economic loss of $18.86 Billion.

CONCLUSIONS:

The economic impact of income lost due to pediatric GSW fatalities between 2001-2021 is estimated to be $58.78 billion, with minimum value of $47 billion after sensitivity analysis. This estimate likely undervalues the total economic impact of pediatric gun violence since it is based on median salaries and excludes medical treatment, long-term disability/morbidity, multiplier effects, or future offspring productivity. The total cost to society of pediatric GSW mortality significantly exceeds all neurologic-related mortality and is too high for physicians and policymakers to ignore.
342 Systematic Review of Disparities in Treatment, Surgical Management, Outcomes by Race and Insurance Status Disparities in Spine Oncology
Authors: Dennis Daniella , Natchiappan Nivedha , Braun Maxime , Banerjee Mitali , Paro Mitch , McNeill Ian Thomas
Published: March 2024

INTRODUCTION:

Healthcare disparities within neurosurgery and spine surgery have been documented with respect to race and insurance type. To date, there has not been a systematic review of disparities in spinal oncology access, treatment and outcomes.

METHODS:

A systematic review was performed following PRISMA guidelines with a strategy to identify disparities broadly within spine oncology using the following MeSH terms: “spinal neoplasms,” “healthcare disparities,” “race,” “insurance status,” and “socioeconomic status.” Studies were included and excluded based on pre-established criteria.

RESULTS:

Out of a total of 400 papers, 17 papers were reviewed. Black patients with spine oncologic conditions experienced decreased access to care and disparities in treatment modalities offered when compared to non-Black patients. Further, when minority and white patients were compared, differences were seen in the clinical presentation of symptoms and in-hospital outcomes. Minority patients were found to have longer postoperative length of stay and higher rates of surgical complications. A similar trend is seen when comparing Medicaid patients versus privately insured patients with respect to access to treatment and differences in treatment modality. Furthermore, patients with public insurance experienced higher rates of postoperative mortality compared to those with private insurance.

CONCLUSIONS:

Disparities within the treatment of spine oncology patients are present with respect to factors such as race, socioeconomic status, and insurance type. Further exploration into the root causes for these disparities should be performed to inform policy and programs aimed at establishing equity for the care of spine oncology patients.
350 Surgical Treatment of Refractory Low Back Pain Using BurstDR Capable Spinal Cord Stimulation (SCS) in Patients Without Options for Corrective Surgery; 12-month Results From a Paddle Lead Cohort
Authors: Falowski Steven M. , Heros Robert , Sales J. Rafe , Tavel Edward , Lansford Todd , Weinand Martin E. , Baxi Nrupen , Garber Jason E. , Forage James , Telfeian Albert Edward , Christopher Anne , Haddad Souheil F. , Dorsi Michael J. , Gilligan Chris , Mirzadeh Zaman , Deer Timothy Ray , Jameson Jessica , Moeschler Susan , Desai Mehul , Pilitsis Julie G. , Okaro Udoka , Yue James
Published: March 2024

INTRODUCTION:

DISTINCT is a randomized controlled trial evaluating passive recharge burst SCS compared to CMM in improving pain and pain-related physical function in patients suffering from chronic back pain without prior lumbar surgery, and for whom corrective surgery is not an option. Sub analysis of outcome measures are presented for subjects implanted with paddle leads at both 6 and 12 months.

METHODS:

An independent board-certified spine surgeon reviewed each case confirming a lack of corrective surgical options. Out of 29 sites and 115 implants, 10 sites implanted 50 subjects with paddle leads. Primary and secondary endpoints assessed improvements in low back pain intensity (NRS), low back pain-related disability (ODI), pain catastrophizing (PCS), and patient global impression of change (PGIC).

RESULTS:

Data are available for 47 and 44 subjects at 6 and 12 months respectively. Subjects reported significant reductions in pain relief at 6 and 12 months, decreasing from 7.8 ± 1.2 at baseline to 2.0 ± 1.6 and 2.2 ± 2.2 respectively (p < 0.0001). Disability was substantially (< 20 points) reduced from severe to mild at 6 and 12 months; ODI reduced from 54.4 ± 15.0 at baseline to 19.9 ± 14.1 and 22.1 ± 13.6 respectively (p < 0.0001). Pain catastrophizing improved to reflect the average of a non-chronic pain population; decreased from 27.6 ± 13.1 at baseline to 8.1 ± 8.2 and 7.8 ± 9.9 (p < 0.0001). 76% report definite and meaningful improvements on PGIC. One lead related event was reported and resolved by repositioning

CONCLUSIONS:

Passive recharge bursts using paddle leads provide substantial relief to patients suffering from severe, debilitating, NSLBP. Patients report dramatic improvements in pain, function, and pain-related emotional distress. In addition, the rate of adverse events is low supporting a favorable safety profile.
352 Outcomes After Microvascular Decompression for Sole Arterial Versus Venous Compression in Trigeminal Neuralgia
Authors: Nair Sumil , Xie Michael , Ran Kathleen Renee , Kilgore Collin , Kalluri Anita , Huang Judy , Lim Michael , Bettegowda Chetan , Xu Risheng
Published: March 2024

INTRODUCTION:

In most cases of trigeminal neuralgia (TN), the trigeminal nerve is compressed by the arterial vasculature.

METHODS:

We retrospectively reviewed all patients undergoing microvascular decompression at our institution, identifying patients with either sole arterial or venous compression. We dichotomized patients into arterial or venous groups and obtained demographics and postoperative complications for each case. Barrow Neurological Index (BNI) pain scores were collected preoperatively, postoperatively, and at final follow-up, as well as recurrence of pain. Differences were calculated via Chi-squared tests and t-tests. Ordinal regression was used to account for variables known to influence TN pain. Kaplan-Meier analysis was used to determine recurrence-free survival.

RESULTS:

Of 1044 patients, 642 (61.7%) had either sole arterial or venous compression. 472 of these cases demonstrated arterial compression, and 170 displayed sole venous compression. Patients in the venous compression group were significantly younger (p < 0.001). Patients with sole venous compression demonstrated worse preoperative (p = 0.04) and final follow-up (p < 0.001) pain scores. Patients with sole venous compression had significantly higher rate of pain recurrence (p = 0.02) and BNI score at pain recurrence (p = 0.04). On ordinal regression, venous compression was found to independently predict worse BNI pain scores (OR = 1.66, p = 0.003). Kaplan-Meier analysis demonstrated a significant relationship between sole venous compression and increased risk of pain recurrence (p = 0.03).

CONCLUSIONS:

TN patients with sole venous compression demonstrate worse pain outcomes following MVD compared to those with only arterial compression.
366 Frailty Is a Risk Factor for Mortality in Operative and Non-operative Type II Odontoid Fracture Patients: An ACS-TQIP Survival Analysis of 22,440 Patients
Authors: Courville Evan , Owodunni Oluwafemi , Schmidt Meic H. , Crandall Cameron , Norii Tatsuya , Shin Peter C. , Bowers Christian
Published: March 2024

INTRODUCTION:

Type II Odontoid Fractures (T2OF) are the most prevalent cervical spine fractures in adults =65 years old. Nonetheless, there is insufficient data regarding the influence of frailty on outcomes for both nonoperative and operative, treatment approaches.

METHODS:

We conducted a retrospective review of T2OF patients from 2015 to 2020 using the ACS-TQIP® database. Using unmatched and propensity score-matched (PSM) risk-adjusted models we assessed the association between frailty and all adverse outcomes. Survival probabilities were examined using Kaplan-Meier (K-M) plots and frailty-based risk stratification. Our outcomes include major complications, hospital length of stay (LOS), nonhome discharge (NHD), mortality rates, and survival probabilities.

RESULTS:

There were 22,440 T2OF patients, comprised of 31.8% (n = 7,138) robust, 35.2% (n = 7,913) typical, 22.9% (n = 5,158) frail, and 9.9% (n = 2,231) very frail patients. Results from unmatched multivariable analyses revealed a dose-dependent relationship between frailty and all outcomes, in both cohorts (p < 0.05). PSM resulted in 3,942 nonoperative and operative matched pairs. Preoperative characteristics were similar between cohorts, except for age: 75 years (IQR: 60-83) nonoperative and 70 years (IQR: 56-78) operative, and male sex: nonoperative 1,799 (55.8%) and operative 439 (61.1%). Significant mortality reductions (43-77%; p < 0.05) were observed in the operative cohort compared to the nonoperative cohort across all frailty strata. As expected, the operative cohort had longer LOS and increased NHD risk ranging from 64-97%, p < 0.001. In K-M analyses, survival declined significantly across increasing frailty strata p < 0.001.

CONCLUSIONS:

Increasing frailty in T2OF patients was independently associated with major complications, LOS, NHD, and decreased survival. Interestingly, operative patients exhibited improved survival compared to nonoperative patients across all frailty strata. These findings highlight the importance of frailty in T2OF management and care coordination.
368 Preoperative Soft Tissue Imaging Features Elucidated by Artificial Intelligence May Best Predict Radiographic Proximal Junction Kyphosis Following Adult Spinal Deformity Surgery
Authors: Johnson Graham Walter , Chanbour Hani , Chen Jeffrey , Metcalf Tyler , Doss Derek , Younus Iyan , Jonzzon Soren , Ali Mir Amaan , Roth Steven G. , Abtahi Amir , Stephens Byron , Zuckerman Scott L.
Published: March 2024

INTRODUCTION:

Proximal junction kyphosis (PJK) following adult spinal deformity surgery (ASD) remains difficult to predict. In a cohort of patients undergoing ASD surgery, we used artificial intelligence to compare three models of preoperatively predicting PJK using: 1) traditional radiographic measurements and demographics 2) raw preoperative scoliosis x-rays, and 3) raw preoperative thoracic T1 MRIs.

METHODS:

A single-institution retrospective cohort study was undertaken for patients undergoing ASD surgery from 2009-21. PJK was defined as a sagittal Cobb angle of upper-instrumented vertebra (UIV) and UIV+2>10° and a postoperative change in UIV/UIV+2>10°. For Model-1, A support vector machine was used to predict PJK within 2 years postoperatively using clinical and traditional sagittal/coronal radiographic variables and intended levels of instrumentation. Next, for Model-2, a convolutional neural network (CNN) was trained on raw preoperative lateral/posterior-anterior scoliosis x-rays. Finally, for Model-3, a CNN was trained on raw thoracic T1 MRIs.

RESULTS:

A total of 187 patients underwent ASD surgery with at least 2-year follow-up and 89 (47.6%) developed radiographic PJK within 2 years. Model-1: Using clinical variables and traditional radiographic measurements, the support vector machine predicted PJK with a sensitivity:57.2% and specificity:56.3%. Model-2: a CNN with raw scoliosis x-rays predicted PJK with sensitivity:68.2% and specificity:58.3%. Model-3: a CNN with raw thoracic MRIs predicted PJK with sensitivity:73.1% and specificity:79.5%. Finally, an attention map outlined the imaging features used by Model-3 to predict PJK. Soft tissue features predominated all true positive PJK predictions.

CONCLUSIONS:

The use of raw MRIs in an artificial intelligence model improved the accuracy of PJK prediction compared to raw scoliosis X-rays and traditional clinical/radiographic measurements. The improved predictive ability using MRI may indicate that PJK is best predicted by soft-tissue degeneration and muscle atrophy.
372 Differences in Oligodendrogenesis Between Human and Rodent Spinal Cord Stem Cells
Authors: Sandarage Ryan Vimukthie , Galuta Ahmad , Tsai Eve C.
Published: March 2024

INTRODUCTION:

Research in pre-clinical rodent models suggests that targeting the endogenous neural stem/progenitor cells (NSPCs) in the spinal cord may hold the key to stimulating oligodendrocyte regeneration. However, it remains to be seen whether human spinal cord NSPCs possess the same regenerative potential as their rat counterparts.

METHODS:

To assess the potential for oligodendrogenesis between human and rat spinal cord NSPCs, primary tissue from adult donors and female rats was harvested and cultured using the Neurosphere assay. To induce spontaneous differentiation, primary-derived NSPCs were treated with 1% fetal bovine serum (n = 15 humans, n = 10 rats). To further promote oligodendrocyte differentiation, pdNSPCs were treated with 40 ng/µL or 100 ng/µL of platelet-derived growth factor AA (PDGF-AA) (n = 3 humans, n = 3 rats). Immunocytochemistry and RNA sequencing were then employed to compare the transcriptomes, with the differentially expressed genes and gene sets analyzed via DESeq and GSEA.

RESULTS:

Human NSPCs showed a reduced potential for oligodendrocyte generation compared to rat NSPCs (0.013 ± 0.01% and 0.029 ± 0.01% O4+ after one and two weeks in humans; 4.9 ± 0.4% and 6.3 ± 0.6% O4+ after one and two weeks in rats). PDGF-AA treatment at 40 ng/µL for one week was able to effectively promote oligodendrocyte differentiation in rat NSPCs, but had a minimal effect on human NSPCs (8.5 ± 1.4 fold increase in O4+). OLIG1/2, SOX10, and CNP gene transcripts were enriched in rat NSPCs.

CONCLUSIONS:

We compared the potential of oligodendrogenesis between primary human and rat spinal cord NSPCs and found a significantly lower capacity in the human NSPCs both functionally and transcriptionally, which could be an obstacle to the successful application of myelinating techniques.
374 Feasibility of Postoperative Diffusion Weighted Imaging to Assess Neural Recovery in Cervical Spondylotic Myelopathy
Authors: Zhang Justin , Javeed Saad , Greenberg Jacob K. , Botterbush Kathleen , Benedict Braeden Christopher , Song Sheng-Kwei , Ray Wilson Zachary
Published: March 2024

INTRODUCTION:

Following decompressive surgery for cervical spondylotic myelopathy (CSM), advanced diffusion-weighted MRI, such as diffusion basis spectrum imaging (DBSI), may hold significant value by quantifying and tracking spinal cord microstructure. However, there is a paucity of studies investigating this topic, likely due to challenges in resolving signal distortions from spinal instrumentation.

METHODS:

A single-center prospective study enrolled 50 CSM patients and 20 control patients. All patients underwent preoperative and repeat diffusion-weighted MRI at two-year follow-up. All CSM patients underwent decompressive cervical surgery. DBSI metrics were extracted from the C3 spinal cord level only to minimize image artifact and reduce partial volume effects. DBSI anisotropic tensors evaluated white matter tracts through fractional anisotropy, axial diffusivity, radial diffusivity, and fiber fraction. DBSI isotropic tensors assessed extra-axonal pathology through restricted and non-restricted fraction.

RESULTS:

Of 50 CSM patients, 27 patients underwent both baseline and postoperative diffusion-weighted MRI scans with sufficient quality for analysis. This included 15 mild, 7 moderate, and 5 severe CSM patients, who were followed up to 23.2 (5.6, range 11.1-32.8) months. All preoperative C3 DBSI measures were significantly different between CSM and control patients (p < 0.001), except DBSI fractional anisotropy (p = 0.31). At two-year follow-up, the same significance pattern was found, except DBSI radial diffusivity lost statistical significance (p = 0.75). When assessing change in C3 DBSI measures, CSM patients exhibited significant decreases in DBSI radial diffusivity (p = 0.02). Among control patients, there was no significant difference in DBSI metrics between timepoints.

CONCLUSIONS:

DBSI may have potential in the postoperative setting to inform clinicians of white matter tract recovery after decompressive cervical surgery for CSM.
379 Meningioma Molecular Groups Predict Response to Adjuvant Radiotherapy Following Surgery
Authors: Wang Justin Z. , Nassiri Farshad , Patil Vikas , Landry Alexander , Liu Jeffrey , Cohen-Gadol Aaron A. , Barnholtz-Sloan Jill , Tabatabai Ghazaleh , Chotai Silky , Sahm Felix , Aldape Kenneth , Zadeh Gelareh
Published: March 2024

INTRODUCTION:

Aside from surgery, radiotherapy (RT) remains the only treatment for meningiomas. However, patient selection for adjuvant RT remains controversial.

METHODS:

We utilized publicly available molecular datasets of meningiomas and generated de novo DNA-methylation and RNA-sequencing data. Meningiomas were classified into different molecular and methylation groups based on the methodologies of their original publications (Nassiri et al. [2021], Bayley et al. [2022], Choudhury et al. [2022], Sahm et al.[2017]) and progression-free survival (PFS) following surgery with and without adjuvant RT were analyzed.

RESULTS:

A total of 2029 meningiomas from 11 different institutions with adjuvant RT data were included. Adjuvant RT was associated with improved PFS in WHO grade 1 meningiomas following subtotal resection (STR), WHO grade 2 meningiomas following gross total resection (GTR) or STR, and immunogenic (COCA1) and NF2-wildtype (COCA2) meningiomas following STR. Multivariable analysis using Cox proportional hazards regression models showed that having a meningioma belonging to a hypermetabolic (COCA3) (HR 2.49, 95% CI 1.71-3.62), or proliferative (COCA4) (HR 3.77, 95% CI 2.78-5.10) group were associated with worse PFS when controlling for age, gender, extent of resection, and receipt of adjuvant RT. Meningiomas belonging to DKFZ MC-intermediate, MC-malignant, MenGC, and UCSF hypermitotic groups were also associated with worse outcomes. These relationships held true even in subgroup analysis with only WHO grade 2 meningiomas and following propensity score matching for the same clinical covariates above. Nearly all molecular and methylation classifications predicted 5-year PFS following surgery and adjuvant RT (area under the curve [AUC] 0.61-0.72) better than WHO grade (AUC 0.51).

CONCLUSIONS:

Molecular classification improves outcome prediction for meningiomas following surgery and adjuvant radiotherapy, supporting the rationale for molecularly informed treatment decisions and clinical trial stratification.
386 Seizure Presentation in IDH WT Glioma is Related to Upregulated Synaptic Signaling and Ionic Transport Genes
Authors: McDonald Malcolm F. , Khan Basit , Athukuri Prazwal , Lozzi Brittney , Harmanci Akdes , Deneen Benjamin , Mandel Jacob , Rao Ganesh
Published: March 2024

INTRODUCTION:

IDH wildtype glioblastoma is the most common malignant brain tumor in adults and is universally lethal. Seizures often occur as a presenting sign of tumor. Recent studies have implicated tumor-neuron communication facilitating synaptic remodeling and peritumoral circuit hyperactivity influencing tumor growth.

METHODS:

63 tumor samples were analyzed for clinical characteristics. Bulk RNA sequencing data was used to identify differentially expressed genes (DEGs), gene sets enrichment analysis (GSEA), and gene ontologies (GO).

RESULTS:

24 IDH WT GBM patients presented with seizures compared to 39 patients presenting with other symptoms. There were no significant differences between age at presentation, sex, tumor lobe, tumor location, or grade of tumor. GSEA of gene ontologies revealed upregulated genes in the seizure cohort were largely related to synaptic signaling and ionic transport (a., p-val < 0.05). Alternatively downregulated gene sets were related to extracellular matrix organization, and inflammatory and immune response (b., p-val < 0.05). Focusing on significantly upregulated DEGs (padj < 0.05) biological processes related to glutamatergic synaptic transmission and cellular components related to synaptic structures were upregulated. Alternatively, significantly downregulated DEGs (padj < 0.05) were related to biological processes of immunity and extracellular matrix organization and cellular components related to the extracellular matrix. Upregulated genes include IGFN1 and THBS4 both involved in synapse assembly, and SLC17A3, involved in presynaptic glutamate sorting (LogFC > 1, padj < 0.05). The downregulated genes include numerous collagen related genes and immune related genes and KCNJ15 an inward rectifying potassium channel and GABRR1 a GABA-rho subunit.

CONCLUSIONS:

Using bulk RNA sequencing in a clinically similar set of IDH WT tumors, we found gene sets and gene ontologies related to synaptic signaling and glutamatergic signaling upregulated in patients with seizures while genes related to both extracellular matrix and immune inflammation were downregulated.