bluuebunny/crossref_metadata_2025 huggingface dataset:
433 Orientation of the Lumbar Spine During Dynamic Compression Influences Fracture Characteristics
Authors: Cutlan Rachel , Shammout Nader , Khokhar Muhammad , Yoganandan Narayan , Frazer Lance , Jones Derek , Davis Matthew , Shender Barry S. , Sheehy James , Paskoff Glenn , Nicolella Daniel , Bentley Timothy , Shabani Saman , Stemper Brian D.
Published: March 2024

INTRODUCTION:

Characteristics of lumbar spine fractures dictate patient outcomes and clinical treatment decisions. Understanding injury biomechanics associated with different fracture types can assist injury prediction and development of safety enhancements.

METHODS:

Twenty human lumbar spines (T12-L5) were isolated and attached to novel whole-column experimental dynamic compressive loading apparatus. Specimens were attached to the lower platform on a drop tower and a decoupled upper platform held a mass to simulate the torso inertially loading the lumbar spine as the lower platform was decelerated at the drop tower base. Each specimen was tested at increasing deceleration magnitudes until failure. Pre-test x-rays were used for the measurements to quantify spinal orientation. Fractures were classified using post-test x-rays and CT scans.

RESULTS:

Fractures were classified into six categories [Wedge (AO Spine A1): n = 8, Burst (AO Spine A3/A4): n = 7, Hyperextension (AO Spine B2): n = 5]. Spines that sustained hyperextension fractures had significantly larger Cobb angles compared to spines that sustained burst fracture (p = 0.03). Spines that sustained wedge fracture had significantly larger lumbar spine angles (i.e., closer to vertical orientation) compared to spines that sustained burst (p = 0.03) and hyperextension (p = 0.02) fracture. Spines that sustained wedge fracture also had a nearly significant longer horizontal distance between the T12 centroid and the load location compared to spines that sustained burst fracture (p = 0.07).

CONCLUSIONS:

This study demonstrated that orientation of the lumbar spine at the time of dynamic load application affected fracture characteristics and, therefore, post-injury spinal stability and patient outcomes. The clinical importance of these findings includes a better understanding of injury mechanisms and a recognition that a wide variety of injury outcomes (stable versus unstable; anterior versus middle versus posterior column) can result from identical loading situations with different spinal orientations.
434 Concurrent Vascular and Traumatic Brain Injury: Effect on Patient Outcomes
Authors: Johnson Mark D. , Ventre Giancarlo Javier , Kaye Joel M. , Patel Hemchandra , Naveed Asad , Prestigiacomo Charles J. , Ngwenya Laura Benjamin
Published: March 2024

INTRODUCTION:

Dural venous sinus thrombosis (DVST) in select populations following traumatic brain injury (TBI), including those with blunt mechanism or depressed skull fractures, have been associated with an increased risk of mortality.

METHODS:

We performed a retrospective case-control study of data from our institutional trauma registry from 2004-2021. Patients were divided into three groups: those with imaging confirmed DVST, those with imaging confirmed DVST and blunt cerebrovascular injury (BCVI), and a control group of TBI patients with cerebrovascular imaging without DVST or BCVI. All age groups and injury mechanisms were included with a head abbreviated injury score (AIS) of = 3. Demographics, injury characteristics, and patient outcomes were collected. Between group differences were compared with non-parametric tests as appropriate. Multivariate logistic regression was carried out to identify predictors of inpatient mortality.

RESULTS:

We identified 9,875 patients over the time-period with TBIs, with a 1.64% incidence of DVST and 23.4% incidence of concurrent BCVI. Despite a more severe presenting injury profile in those with DVST, the presence of DVST itself was not significantly associated with inpatient mortality (OR 1.02; 0.26-3.69). On regression analysis an occlusive DVST (OR 1.34; 1.15-1.56) and not receiving treatment (OR 1.27; 1.01-1.60) were independently associated with inpatient mortality. Significantly worse functional outcomes were observed in those with DVST+BCVI at 6-months, though a high proportion of patients achieved a GOSE of 7 or 8.

CONCLUSIONS:

We observed an incidence of traumatic DVST of 1.64% in a mixed population of head injured patients, with 23.4% of patients having concurrent BCVI. The presence of DVST alone was not significantly associated with inpatient mortality.
435 Use of Optic Nerve Sheath Diameter in Extraventricular Drain Weaning in Adults With Post-hemorrhagic Hydrocephalus
Authors: Duncan Michael A. , Hess Ryan M. , Khan Asham , Davies Jason , Abdelmalik Peter
Published: March 2024

INTRODUCTION:

Optic nerve sheath diameter (ONSD) can be used as a noninvasive measurement of intercranial pressure. Few studies have evaluated the value of ONSD in predicting the need for ventriculoperitoneal shunt (VPS) placement after development of post-hemorrhagic hydrocephalus (PHH) in adults.

METHODS:

Adult patients 18 years or older, admitted with intracranial hemorrhage and hydrocephalus requiring EVD placement were included in the study. Demographics were recorded. CT imaging of ONSD was measured (mm) upon initial ED visit before EVD placement (pre-EVD), immediately after successful EVD removal (post-EVD), and if applicable, after EVD removal but immediately before VPS placement. Change in ONSD was calculated and groups were stratified by EVD only patients and EVD+VPS patients.

RESULTS:

Imaging for 30 patients were successfully retrieved and analyzed for bilateral ONSD values at all timepoints. A statistically significant convergence to a normally distributed mean ONSD was found for both groups (EVD and EVD+VPS). Additionally, a statistically significant increase was found in ONSD between the EVD+VPS group compared to the EVD only group. The EVD only group showed a mean EVD placement time of only 14 days (2 weeks) with an average decrease in ONSD (-0.905mm) compared with the EVD+VPS group who had an increase in ONSD at 14-days (+1.089 mm).

CONCLUSIONS:

Patients with hydrocephalus due to intracranial hemorrhage who went on to require VPS developed an increase in ONSD despite EVD use while patients who were successfully weaned from the EVD developed a decrease in ONSD. ONSD may be a useful adjunct tool to aid in the process of EVD weaning in this patient population.
437 Pressure Reactivity Index (PRx) as a Predictor for Outcome in Severe Traumatic Brain Injury
Authors: Chang Jason , Kepplinger David , Dowlati Ehsan , Felbaum Daniel , Mai Jeffrey C. , Mason Robert Bryan , Armonda Rocco , Aulisi Edward F.
Published: March 2024

INTRODUCTION:

The pressure reactivity index (PRx) is a surrogate for vascular cerebral autoregulation that evaluates moving correlation coefficients between intracranial pressure (ICP) and mean arterial blood pressure (MAP). Ideal threshold PRx values for distinguishing between poor and good outcome in severe traumatic brain injury (sTBI) is unclear.

METHODS:

Retrospective evaluation of consecutive patients over a three-year period with sTBI and polytrauma who received continuous ICP, MAP, and PRx monitoring. Good outcome was defined as patients who upon hospital discharge had a modified Rankin score < 4 and were discharged to an acute rehabilitation facility or home.

RESULTS:

36 patients received continuous monitoring. Nine patients were excluded for the following reasons: early palliative withdrawal, early death through multi-organ dysfunction not related to the sTBI, and continuous neuromonitoring < 24 hrs. Of the 27 patients evaluated, average PRx values for the good outcome group was 0.18 (+0.17) and 0.37 (+0.24) for the poor outcome group. Receiver operating characteristics (ROC) analysis showed that a PRx threshold value > 0.34 had the highest combined sensitivity and specificity for predicting poor outcome with an AUC (95% CI) = 0.775 (0.583-0.967). When dichotomized using ROC curve analysis, a threshold PRx value of greater than 0.34 was independently associated with higher odds of poor outcome (OR 18.63, 95% CI 1.17-297.21, p = 0.038) after adjustment for potential confounders.

CONCLUSIONS:

Higher mean PRx is an independent predictor for poor outcome in patients with sTBI. Further study is required to evaluate the temporal role of PRx changes to improve neuroprognostication.
438 Lesion Combination on Susceptibility-Weighted MRI Predicts Functional Recovery After Diffuse Axonal Injury
Authors: Walek Konrad , Trang Annie , Bodanapally Uttam , Olexa Joshua Robert , Chen Chixiang , Morales Will , Sansur Charles A. , Simard J. Marc , Crandall Kenneth M. , Woodworth Graeme , Eisenberg Howard M. , Oliver Jeffrey , Han Nathan , Caffes Nicholas , Abdulkareem Ahmed , Sharma Ashish , Serra Riccardo , Labib Mohamed , Cherian Jacob , Parker Whitney , Diaz Cara , Scarboro Maureen , Schwartzbauer Gary , Aarabi Bizhan
Published: March 2024

INTRODUCTION:

Early prediction of long-term functional outcome after diffuse axonal injury (DAI) remains controversial.

METHODS:

In a retrospective observational study, axonal injuries on MRI were correlated with long-term functional outcome. The predictive value of poor functional outcome (GOSE < 5) was determined by ROC analysis for clinical factors and location of combinations of DAI lesions in the connectome.

RESULTS:

Over a 10-year period, 451 patients underwent MRI within 30 days of severe blunt TBI of which 322 (71.4%) survived to = 6-month clinical follow-up. The mean age was 38.4 and 242 (75%) patients were male. Mechanisms of injury were motor vehicle crash (53%) and falls (26%). Mean Glasgow coma scale (GCS) score was 4.7. At 6-24 months, quality MRI and functional outcome data were available for 213 and 104 patients, respectively. The best single-area predictors of early and late long-term functional outcome were the ventral midbrain (AUC6mo 0.65 (95% CI 0.56-0.74), p = 0.010) and dorsal pons (AUC24mo 0.68 (95% CI 0.51-0.86) p = 0.001). The best multiple-lesion predictors of poor long-term functional outcome (GOSE < 5) were dorsal pons and splenium of corpus callosum (AUC24mo 0.92 (95% CI 0.84-0.99), p < 0.0001) and the dorsal and ventral pons (AUC24mo 0.91 (95% CI 0.79-1.00), p < 0.0001). The strength of these combinations’ predictive value was not improved by considering three or more areas. The 6-area cluster of internal capsule, corpus callosum genu, body, and splenium; and dorsal and ventral midbrain lesions was a good predictor of outcome at 24 months (AUC24mo 0.82 (95% CI 0.66-0.98), p < 0.0001).

CONCLUSIONS:

In patients with severe TBI, the strongest predictors of poor long-term functional outcome were combined lesions in the splenium and dorsal pons and the dorsal and ventral pons.
440 Retrospective Assessment of the Clinical Timeline and Predictors for Vasospasm Severity in Traumatic Brain Injury Within a Safety-Net Hospital Population
Authors: Windermere Sonora , Young Sara , Tran Dominic , Morris Sarah , Daneshmand Ali , Cervantes-Arslanian Anna
Published: March 2024

INTRODUCTION:

Unlike aneurysmal subarachnoid hemorrhage, vasospasm following traumatic brain injury (TBI) is poorly understood and no guidelines-based recommendations for surveillance exist.

METHODS:

TBI patients admitted to the surgical ICU 11/2014-12/2020 with 2+ instances of TCD-diagnosed vasospasm were included. Clinical timelines, TBI severity by Glasgow Coma Score (GCS) (mild = 13-15, moderate = 9-12, severe = 3-8), presence of subarachnoid hemorrhage (tSAH), and vasospasm severity (mild, moderate, or severe) were extracted from records. One-way ANOVA analysis compared the highest severity of vasospasm noted with date of onset and total days of vasospasm. Significant differences in means were further analyzed with Games-Howell post-hoc test. Stata® determined the dependence of vasospasm severity upon imaging findings or the GCS via Chi2 analysis.

RESULTS:

Forty-four patients were identified (31 male, 13 female, median age 40 (15-92) years). Amongst mild TBIs (13), vasospasm was mild (9), moderate (1), and severe (3). For moderate TBIs (2), vasospasm was mild (1), moderate (0), and severe (1). For severe TBIs (29), vasospasm was mild (16), moderate (6), and severe (7). Thirty-two patients had tSAH, 19 with mild, 6 moderate, and 7 with severe vasospasm. Of the 12 patients without tSAH, 7 had mild, 1 moderate, and 4 with severe vasospasm. Median time to onset did not differ between mild (Hospital Day (HD) 3), moderate (HD 4), and severe (HD 3) vasospasm (p = 0.47). Mean duration of mild vasospasm (2.35 days) differed from severe vasospasm (6.73 days), (p < 0.05). Neither presence of tSAH nor severity of TBI was related to severity of vasospasm (p = 0.11 and p = 0.61).

CONCLUSIONS:

Our study found that post-traumatic vasospasm can impact TBI patients, early, regardless of TBI severity or the presence of tSAH, suggesting early and routine surveillance for PTV may be warranted in all critically ill TBI patients.
442 A Ventriculomegaly Feature Computation Pipeline to Improve the Screening of Normal Pressure Hydrocephalus on Computed Tomography
Authors: Sridhar Sharada Kadaba , Gupta Rishabh , Kuang Rui , Samadani Uzma
Published: March 2024

INTRODUCTION:

Normal pressure hydrocephalus (NPH) commonly presents with a triad of gait disturbance, incontinence, and memory impairment. Shunt placement effectively treats symptoms; however, NPH is commonly misdiagnosed with below 20% of patients receiving a diagnosis. Given undiagnosed NPH elderly patients often present to the emergency room (ER) with falls, algorithmic identification of NPH using non-contrast CT (NCCT) may improve diagnosis rate.

METHODS:

NCCTs for 84 patients with NPH, 72 headache controls (HC), 97 Alzheimer’s Disease (AD) patients, and 61 post-traumatic encephalomalacia (PTE) patients were identified using Veterans Affairs Informatics and Computing Infrastructure. Image processing pipelines were developed to extract a novel feature capturing lateral ventricle eccentricity (MaxEccLV), a proxy-Splenial Angle (p-SA), the Evans indices (EI-x, y, z), Callosal angle (CA), third ventricle width (NMax-3VW), and CSF to brain volume ratio (CSF2BVR). T-tests were used to examine group differences and logistic regression to classify between NPH, AD, PTE, and HC.

RESULTS:

The AUC, sensitivity, and specificity for NPH versus AD+HC+PTE was 0.94, 83.0%, and 87.0% respectively. For NPH versus HC, it was 0.98, 98.8%, and 98.6% respectively. For NPH versus AD, it was 0.90, 84.5%, and 82.5% respectively. For NPH versus PTE, it was 0.95, 91.7%, and 86.9% respectively. Significant differences were seen between NPH and HC, AD, and PTE in MaxEccLV and all other features.

CONCLUSIONS:

The computational pipeline proposed here can identify NPH from HCs and ventriculomegaly-causing conditions using NCCT with a high sensitivity and specificity. This may help capture undiagnosed NPH patients receiving a NCCT due to presentation to the ER as a fall.
446 Management of Orbital Schwannomas, to Operate or Not? A Population-Based Case Series
Authors: El-Hajj Victor Gabriel , Singh Aman , Bohman Elin , Norin Cecilia , Edström Erik , Elmi-Terander Adrian
Published: March 2024

INTRODUCTION:

Schwannomas of the orbit (OS) are rare occurrences with no more than 500 cases documented worldwide. Traditionally, once discovered radical excision of the tumor, often requiring a multidisciplinary neuroophthalmological and neurosurgical approach, is sought to prevent tumor invasion of the delicate neuro-ophthalmic structures. However, inherent surgical risks, due to the complexity of the neurovascular configuration in the orbital region, warrant further investigation of a more conservative approach in the management of these benign entities.

METHODS:

The study center is the primary referral center for multidisciplinary evaluation, discussion, and management of orbital tumors, including schwannomas, in Sweden. During the period of 2005-2010, 16 patients with an OS diagnosis were identified and managed at the center.

RESULTS:

After weighing the risks and benefits of surgical and conservative treatment, four patients underwent immediate surgery where gross total resection (GTR) was achieved in 3 cases (75%). The remaining 12 patients were treated conservatively by watchful waiting and re-evaluation. Surgery with subtotal resection (STR) was later performed after an average of 17 months in three of these patients (25%). No recurrences or regrowth were detected on radiographic follow-up (mean 50 months), and all patients experienced postoperative improvement at clinical follow-up (mean 65 months). The remainder of the conservatively treated patients (n = 9) experienced no clinical progression (mean 30 months). A slight radiological tumor progression was only detected in one patient after 17 months.

CONCLUSIONS:

There were no differences in outcome between patients undergoing immediate surgery and those operated later after watchful waiting. Conservatively treated patients had minimal to no symptoms and remained clinically stable throughout the follow-up period. Based on these findings, watchful waiting, may successfully be adopted in cases whit mild symptoms and no imminent risk of neuro-ophthalmic impairment.
459 Outcome of Surgeries of Pan Brachial Plexus Injuries - Our 10 Years Experience
Authors: Agrawal Rati , Agrawal Deepak , Satyarthee Guru Datta , Mishra Shashwat , Kumar Hitesh , Meena Rajesh , Doddamani Ramesh S. , Jagdevan Amandeep , Verma Satish , Garg Kanwaljeet , Singh Pankaj Kumar
Published: March 2024

INTRODUCTION:

Brachial plexus injuries are very much devastating and lead to significant socioeconomic and mental burden to the affected person and his family. In the early days of 20th century many authors were in favour of conservative management even the amputation of affected limb. But in later decades due to development in technological advancement of operating microscope, intraoperative electrophysiological monitoring, biological tissue glue etc. the results of surgical repair are beyond the imagination that could be done previously.

METHODS:

Our study is a Retrospective observational analytical study in which we included patients of Pan brachial plexus injury operated under the Department of Neurosurgery from April 2011 till February 2023 (excluding covid period from March 2020 to September 2021) at apex trauma center AIIMS Delhi, India. Demographic details, mode of injury, surgery performed and outcome were analyzed. Data was extracted from patient’s casualty, ICU and OT records and analyzed using SPSS version 29.0.0.0. Analysis of outcome was taken in terms of improvement in motor power and quality of life.

RESULTS:

There were 113 patients diagnosed to have Pan brachial plexus injury by clinical examination and supported with brachial plexus MRI, NCV and EMG of the affected limb. 24 (21.24%) cases underwent Neurolysis only, 17 (15.04%) cases underwent Supraclavicular neurotization only, 24 (21.24%) cases were operated by infraclavicular neurotization and 48 (42.48%) patients were operated by supraclavicular and infraclavicular neurotization both. Respectively 25%, 23.52%, 25% and 35.42% cases had motor and sensory improvement and were able to perform few of their daily activities with lesser support.

CONCLUSIONS:

In our study at least 25% Patients of Pan brachial plexus injury after surgery got benefited in their routine activity and quality of life thus lesser affected in socioeconomic and psychological front.
460 Frame Navigation Guided Percutaneous Balloon Compression for Intractable Trigeminal Neuralgia Secondary to Multiple Sclerosis
Authors: Valerio Jose E. , Farfan Penelope Mantilla , Velandia Felipe Ramirez , Fernandez Gomez Maria Paula , Alvarez-Pinzon Andres M.
Published: March 2024

INTRODUCTION:

Patients with multiple sclerosis (MS) are more likely to develop trigeminal neuralgia (TN) compared to the regular population, due to scarring of the nerve and the development of a demyelination plaque. Despite treatment, approximately 10% of MS patients treated for TN experience symptom recurrence, including the development of MS-like symptoms such as optic neuritis and bilateral facial pain.

METHODS:

A computed tomography (CT) scan was performed preoperatively on two patients diagnosed with multiple sclerosis (MS) who experienced secondary trigeminal neuralgia (TN). The acquired images were then introduced into a navigation system for intraoperative navigation. The preliminary CT images were registered using the navigation system and the bony landmarks were set. Fluoroscopy-guided cannulation was performed under general anesthesia to complete the procedure.

RESULTS:

Two patients diagnosed with multiple sclerosis (MS) who experienced refractory trigeminal neuralgia (TN) underwent percutaneous balloon compression. The patients were 38 and 56 years old and complained of facial pain in the V1-V2 and V3 distribution. Initial conservative treatment and one dosage of Gamma Knife Radiosurgery (GKR) resulted in symptom control for a few weeks. However, both patients had an acute recurrence of pain; thus, percutaneous retrogasserian balloon compression was performed. During follow-up, the patients reported a 70% decrease in pain after the procedure, with minimal recurrence of shooting episodes.

CONCLUSIONS:

The management of trigeminal neuralgia secondary to drug-resistant multiple sclerosis presents a persistent challenge. The percutaneous technique for retrogasserian balloon compression may offer a solution for some patients, but it can be technically challenging. Microvascular decompression remains a debated approach for this population, given the complexity of the pathogenesis, target identification, and the potential absence of neurovascular conflict, while stereotactic radiosurgery may be a promising alternative.
461 Outcomes and Healthcare Utilization of Adult Spinal Cord Injury Associated With Time to Surgery: An Analysis of the National Trauma Data Bank (NTDB): 2019-2021
Authors: Pico Annemarie Campbell , Nosova Kristin , Deaver Courtney , Bauer Isabel L. , Dholaria Nikhil , Quiceno Esteban , Hussein Amna , Abdulla Ebtesam , Moniakis Alexandros , Khan Monis , Prim Michael Dyton , Bates Bryan , Keric Natasha , He Jack , Baaj Ali A.
Published: March 2024

INTRODUCTION:

Prior studies have established evidence that early surgical decompression following traumatic spinal cord injury (SCI) is associated with better outcomes. However, it is not clear whether increased time to surgery is correlated with worse complications and increased healthcare utilization.

METHODS:

Patients with traumatic SCIs were identified in NTDB. For surgical patients, time to surgery was extracted and patients classified by time to surgery of >=12 hours. Chi-sq and non-parametric tests were used.

RESULTS:

9,987 patients with SCI were identified; 40.49% were complete. 66.24% of incomplete and 56.66% of complete had a time to surgery greater than 12 hours. Those with incomplete SCI and surgery after 12 hours had increased Injury Severity Score (ISS) (μ = 0.36), ICU length of stay (LOS) (μ = 0.91 days), days on ventilation (μ = 2.01 days), and days to discharge (μ = 1.39 days) (p < 0.005). Those with complete SCI and surgery after 12 hours had increased ICU LOS (μ = 2.7 days, p < 0.0001). Mortality rate was not positively associated with time to surgery greater than 12 hours for complete and incomplete SCI group.

CONCLUSIONS:

Although prior studies support earlier surgical intervention for those experiencing SCI, the majority of patients are undergoing surgery more than 12 hours after their injury. Additionally, patients with incomplete SCI waiting >=12 hours have longer ICU stay, more ventilated days, longer hospitalization, and increased ISS. Additional studies are needed to identify barriers to earlier surgery and to establish cutoff times for maximum benefit.
464 Remote Cognitive Behavioral Therapy Utilizing an In-home Virtual Reality Toolkit (Vx Therapy TM) Reduces Pain, Anxiety, and Depression in Patients With Chronic Cervical and Lumbar Pain: A Potential Opiate Alternative in Multimodal Pain Management
Authors: McGirt Matthew J. , Holland Christopher Michael , Zuckerman Scott L. , Theodore Nicholas , Pfortmiller Deborah , Stanley Gerry
Published: March 2024

INTRODUCTION:

Virtual reality has reduced acute pain through visual and auditory distraction, as well as altered brain neurobiology. VR attenuates pain-induced brain activity without narcotic-related side effects or dependency. Cognitive behavioral therapy (CBT) has demonstrated improved pain-related anxiety, depression, physical disability, resiliency, and quality of life. CBT access remains a challenge in most care communities.

METHODS:

145 patients with chronic neck and back pain (63 cervical, 46 non-radicular lumbar, 36 radicular lumbar) enrolled into a 14 week Vx therapy CBT program with therapist guided utilization of an in-home VR system with 50 modules (education, meditation, distraction, entertainment). Pain and anxiety severity scores were recorded before and immediately after VR use as well as time to pain recurrence. PROMIS measures of daily pain intensity, pain behavior, pain interference, anxiety, and depression were recorded at baseline and after 14 weeks of Vx therapy.

RESULTS:

PROMIS domains were significantly improved after Vx treatment vs baseline for the entire cohort and each subgroup. VR acutely reduced pain during use on average by 33% (p < 0.05) across all 14 weeks lasting a mean 2.5 hours. VR acutely reduced anxiety during use on average by 46% (p < 0.05) across all 14 weeks lasting a mean 2.7 hours. The effect was similar for all three diagnosis groups.

CONCLUSIONS:

Remote CBT guided in-home VR toolkit (Vx therapyTM) provided effective multi-hour sustained pain relief in patients with chronic neck and back pain with and without radiculopathy. Significant improvement in overall pain, anxiety, and depression and reduced pain interference was observed. This non-invasive, non-pharmaceutical Vx therapy is an ideal option to improve outcomes in post-opioid pain management.
466 Primary Anterior Lumbar Interbody Fusion, With and Without Posterior Instrumentation: A 1377 Patient Cohort From a Multicenter Spine Registry
Authors: Laiwalla Azim , Chang Richard , Harary Maya , Alsalek Samir , Richards Hunter , Brara Harsimran Singh , Hirt Daniel , Harris Jessica , Terterov Sergei , Tabaraee Ehsan , Rahman Shayan
Published: March 2024

INTRODUCTION:

Anterior lumbar interbody fusion (ALIF) is a versatile and powerful technique for a variety of lumbar degenerative pathologies. Adding posterior supplementary fixation to ALIF (ALIF+PSF) is common and may confer benefits in terms of higher fusion rate but could contribute to adjacent segment disease (ASD) due to additional rigidity.

METHODS:

Adult patients who underwent primary ALIF for lumbar degenerative pathology between levels L4-S1 over a 12-year period were included. Cases of trauma, cancer, infection, supplemental decompression, noncontiguous fusions, prior lumbar fusions, and other interbody devices were excluded. Primary outcomes included reoperation for nonunion and ASD. Multivariable Cox proportional hazard regression was used to evaluate risks adjusting for patient characteristics.

RESULTS:

The study consisted of 1377 cases; 307 ALIF alone and 1070 ALIF+PSF. Mean follow-up time was 5.6-years. 5-year crude nonunion incidence was 2.4% for ALIF only and 0.5% for ALIF+PSF; after adjustment for covariates, a lower operative nonunion risk was observed for ALIF+PSF (HR = 0.22, 95% CI = 0.07-0.70). Of patients deemed potentially suitable for ALIF alone, one would need to add PSF in 53-patients to prevent one case of operative nonunion at a 5-year follow-up (number needed to treat). Five-year operative ASD incidence was 4.3% for ALIF only and 6.2% for ALIF+PSF; with adjustments, no difference was observed between the cohorts (HR = 0.96, 95% CI = 0.53-1.74).

CONCLUSIONS:

While addition of posterior instrumentation in ALIFs is associated with lower risk of operative nonunion compared to ALIF alone, it is rare in both techniques (<5%). Accordingly, surgeons should evaluate added risks associated with addition of PSF, and rather reserve PSF for patients at higher risk for operative nonunion. Rates of operative ASD were not statistically higher with addition of PSF suggesting concern regarding future ASD may be less supported.
470 Changes in CT Hounsfield Unit and T Score Before and After Osteoporosis Treatment With Teriparatide or Denosumab
Authors: Yaffe Noah , Herring Eric , Mauria Rohit , Labak Collin M. , Sharpe Megan , Wong Mandy , Okonmah Amanda , Patel Mohit , Smith Gabriel Alexander
Published: March 2024

INTRODUCTION:

In 2004, 10 million individuals over the age of 50 were estimated to suffer from osteoporosis in the US and this prevalence was expected to rise dramatically. Currently the standard for diagnosis is by defining the bone mineral density using a dual energy xray absorptiometry (DEXA) machine. Literature has demonstrated that the hounsfield (HU) on a CT of the lumbar spine vertebrae can be an extremely sensitive and specific metric towards identifying those with osteoporosis or osteopenia, however further evaluation of this measure and how it changes with osteoporosis treatment, specifically with newer treatment options (ie denosumab and teriparatide) is needed.

METHODS:

Chart review was completed for patients started on denosumab or teriparatide between 2014 and 2022. Patients were included if they were started on denosumab or teriparatide for osteoporosis or osteopenia treatment and had a DEXA and CT available at some point pre or post treatment. Demographic, medication information, pre and post treatment both DEXA based T scores and CT Hounsfield units (HU) at T12-L3 were collected. ANOVA and T tests were used for statistical analysis.

RESULTS:

A total of 38 patients were included in our study. Average premedication HU at T12, L1, L2, L3 were 106, 94, 92, and 83 respectively. Those treated with teriparatide showed a significant (p = 0.03) decrease in HU at L1 over the study period compared to those treated with Denosumab.

CONCLUSIONS:

HUs can serve as a widely available surrogate to both diagnose and monitor the treatment of osteoporosis.
472 Complications of 3D-Navigated Spinal Procedures: A Systematic Review
Authors: Suri Ikaasa , Suthakaran Sayahi , Ezzat Bahie , Arroyave Villada Juan Sebastian , Kwon Daniel , Martin Lily , Hu James , Yaeger Kurt , Carr Matthew Thomas
Published: March 2024

INTRODUCTION:

3D surgical navigation has revolutionized spinal surgery. However, information on the overall usability of these tools is limited and inconsistent, especially with regard to operative time and radiation exposure. Complication rates across institutions and platforms have not been systematically examined, leading to a lack of quantitative understanding on surgical success rates.

METHODS:

This study used PRISMA guidelines and a PROSPERO-registered protocol to identify studies on FDA-approved 3D navigation systems in spinal procedures from Ovid MEDLINE(R), Embase, and Cochrane CENTRAL. Results were assessed by two independent reviewers using inclusion/exclusion criteria and risk of bias tools.

RESULTS:

70 studies, totaling 3500 patients, were included. Complication and surgical success rates have remained constant since 2004, with overall rates of 5.18% and 93.74%, respectively. When segmented by spinal region, complication rates may be moderately positively correlated with frequency of cervical and thoracic procedures (r = 0.49, p = 0.40). 23 studies, totaling 1723 patients, compared the performance of 3D navigation to 2D fluoroscopy or freehand navigation. There was a significant difference of 6.47% between surgical success rates of the interventional and control groups (p = 0.01). However, there was no significant difference in radiation exposure or operative time between 3D navigated procedures and their controls.

CONCLUSIONS:

This study concludes that 3D navigation may have higher surgical success rates than 2D fluoroscopy and freehand navigation; increased surgeon comfort with riskier procedures on more complex segments of the spine may explain the slight increase in complication rates observed since 2004; and there is a need for improvement in 3D navigation tools to decrease operative time and radiation exposure.
474 Comparing the Reciprocal Changes of Single Level Transforaminal Interbody Fusions Versus Lateral Interbody Fusions: A Radiographic Analysis for Sagittal Alignment and Spinopelvic Parameters
Authors: Giraldo Juan Pedro , Zhou James , Farber Samuel Harrison , Moraes Vitor , Alan Nima , O'Neill Luke , Tumialan Luis Manuel , Uribe Juan S.
Published: March 2024

INTRODUCTION:

Transforaminal lumbar interbody fusion (TLIF) and lateral lumbar interbody fusion (LLIF) are two techniques that are widely used to treat single-level pathology at L4-5. To date, no studies have compared the two techniques in terms of their ability to address disc space pathology, such as loss of height and spondylolisthesis, and achieve spinopelvic alignment goals.

METHODS:

After IRB approval, this study retrospectively reviewed the records of 203 patients who underwent single-level L4-L5 TLIFs and single-level L4-L5 LLIFs between 2017 to 2022. Preoperative and postoperative scoliosis films were collected and analyzed using an automated calibrated radiographic tool to measure pre-postoperative SA and SPs. Two blinded readers measured the pre-postoperative variables. Independent Sample T-tests were used to analyze the radiographic outcomes between the two groups.

RESULTS:

This study evaluated the results of 203 single-level TLIFs and LLIFs (109 L4-L5 TLIFs, and 94 L4-L5 LLIFs). Among the surgeries analyzed, 90 were MIS TLIFs, 19 open TLIFs, 16 standalone LLIs, and 78 LLIFs with posterior instrumentation. Postoperative scoliosis films were taken at a median of 0.28 (± 0.4) months. The analysis focused on comparing the reciprocal changes between both procedures. Significant statistical differences was found for ΔGTilt (p = 0.036), ΔLPA (p = 0.12), ΔADH (p = 0.03), ΔPDH (p = 0.04), ΔFH (p = 0.001), and ΔS% (p = 0.01) in the LLIF group, among all the variables included in the analysis.

CONCLUSIONS:

L4-5 LLIF and TLIF resulted in statistically similar amounts of lordosis restoration and reciprocal change at proximal and distal lumbar levels. LLIF was found to be superior in restoration of anterior disc height, posterior disc height, and foraminal height compared to TLIF. LLIF was also superior in percentage reduction of spondylolisthesis.
475 Molybdenum-Rhenium Rods in Complex Adult Spine Surgery Without Rod Fractures: A Multicenter Retrospective Case Series
Authors: Enguidanos Stephen , Ammar Kevin N. , Poelstra Kornelis , Cormier Jason , Malcolm James , Scibelli Stephen , McGirt Matthew J. , Chang Michael S. , Seecharan Dave , Chen Yi-Ren , Sinha Maya , Mehta Ankit Indravadan , Cowart Pam
Published: March 2024

INTRODUCTION:

In complex spine surgery, current pedicle screw systems with 5.5 mm titanium, cobalt chromium or stainless steel rods have rod failure rates of approximately 9% with a minimum of 1-year follow-up. The fracture rate with these alloys increases to approximately 22% in PSO cases.1 Molybdenum-rhenium has demonstrated superior yield strength and fatigue endurance limit compared to Ti-6Al-4V and CoCr.

METHODS:

Retrospective, multicenter, case series. Inclusion criteria were = 4 levels posterior instrumented fusion with 4.5 mm molybdenum-rhenium rods, age = 18 yrs and 6 months or longer radiographic and followup.

RESULTS:

One hundred and fifty-nine (159) consecutive patients from ten different medical centers that had spinal surgery from August 2019 until April 2022 met inclusion criteria. Mean age was 63 ± 11.8 years; 50% women; 31% smokers; 19% diabetic and the mean BMI was 30 ± 7.3. The mean number of levels fused was 5.9 ± 2.7; 22.6% 4 levels, 64.2% 5-9 levels and 13.2% 10 levels or greater. Approximately half were thoracolumbar (27.7%) or thoracolumbar to pelvis (24.5%) and approximately half were lumbar-sacral (47.2%). Thirty-eight patients (24%) had a PSO and 59 patients (39%) had a SPO. All cases were done with molybdenum-rhenium 4.5 mm diameter rods. There were no RFs reported in the 159 cases (0/159; 0.0%) at 22.36 months mean follow-up.

CONCLUSIONS:

There was no incidence of RF in the 159 consecutive patients who underwent complex spine surgery involving multiple levels and osteotomies. A pedicle screw system based upon molybdenum-rhenium 4.5 mm rods provides superior fracture resistance particularly in complex spine procedures.

1 Smith JS, et al., Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal deformity. J Neurosurg Spine. 2014 Dec; 21(6): 994-1003.
479 BrainPacer: Wireless Battery-Free Neuromodulator Embedded in a Dural Graft
Authors: Garcia Diogo P. , Benbuk Ahmed , Gullick Daniel , Christen Jennifer , Quinones-Hinojosa Alfredo
Published: March 2024

INTRODUCTION:

Neuromodulation represents an emerging realm of disruptive technologies for brain/spine disorders with potential applications across disease states, including neurodegenerative, neoplastic, epilepsy, trauma and vascular disorders. However, current implants have limitations inherent to the use of wires, batteries that need replacement, infection, and implant failure that have hindered wider adoption.

METHODS:

A 100 µm-thick, biocompatible, flexible, and transparent Parylene/PDMS substrate was used. In vivo validation (120 stimulation bursts, 10 pulses, 4 rats and 4 implants) was pursued using motor cortex stimulation after identification of the hindlimb representation via direct cortical stimulation. Hindlimb motion and reliability of stimulation and movement were detected via a video analysis software. A comparison of efficiency was conducted between the proposed dura substitute method and conventional direct stimulation method.

RESULTS:

Benchtop testing demonstrates reliable monophasic voltage pulses with an amplitude of 20V that can be subsequently regulated. Stimulation through the dura substitute results in reduced efficiency by 60% due to current loss but it offers the same reliability, triggering a motor response at each stimulation onset with an average limb deflection of 5.2 ± 2.986 mm with 99% confidence level. At least 30 seconds of recordings were obtained in each animal at a stimulation frequency of 1 Hz.

CONCLUSIONS:

We designed, validated and tested both a novel wireless and battery-free implant and a novel embodiment for placement with revolutionary potential. The implant triggers motor response through an FDA-approved dura substitute, without contacting the cortical surface. Studies in free-moving animals for chronic response studies are ongoing.
480 Effect of Chronic DBS on Ventral Capsule Ventral Striatum-Specific Circadian Rhythm in Refractory Obsessive-Compulsive Disorder
Authors: Reddy Sandesh , Provenza Nicole , Rajesh Sameer Vikram , Diab Nabeel , Allam Anthony , Reyes Gabriel , Dang Huy , Najera Ricardo Andres , Katlowitz Kalman , Giridharan Nisha , Banks Garrett , Storch Eric , Herron Jeffrey , Goodman Wayne , Sheth Sameer A.
Published: March 2024

INTRODUCTION:

Deep brain stimulation (DBS) of the ventral capsule/ventral striatum (VC/VS) improves symptoms in ∼66% of patients with treatment-resistant obsessive-compulsive disorder (OCD). However, a common adverse effect of VC/VS DBS is hypomania, marked by decreased need for sleep and increased risk-taking behaviors. Modern DBS devices have enabled 24-hour collection of neural data, allowing for tracking of circadian rhythms reflected by VC/VS local field potentials (LFPs).

METHODS:

We implanted six patients with treatment-resistant OCD with a DBS device configured for constant VC/VS stimulation and recording. Spectral power in the 9 ± 2.5 Hz band was estimated onboard the device every 10 minutes for a median of 249 days (range 77-608). We assessed the rhythmicity of power in this spectral band by fitting 7-day retrospective rolling windows of per-day normalized LFP power to cosine functions using least-squared regression. Output metrics included acrophase (time of peak activity), amplitude, and fit significance. We quantified trends in acrophase over time using Pearson correlation.

RESULTS:

All six patients demonstrated consistent 24-hour cyclic LFP activity bilaterally. Two of the six had diurnal peaks which shifted significantly earlier across the study period. The remaining four patients had nocturnal peaks, all shifting significantly later over time. Notably, a patient in the latter group experienced three days of hypomania after DBS initiation associated with circadian disruptions even after clinical symptom resolution. Only after clinical DBS adjustment 2 weeks later did circadian rhythm rapidly return to pre-hypomanic levels.

CONCLUSIONS:

Study patients demonstrated evolving circadian VC/VS LFP activity across the course of DBS therapy, usually independent of cyclic whole-brain activity (i.e. sleep). Conversely, disruptions to these circadian patterns, as observed here during hypomania, may serve as biomarkers of region-specific stimulation side effects.
481 Spinal Cord Stimulator Promotes Neuroplasticity in Patients With Severe Spinal Cord Injury
Authors: Porceban Matheus Moreli , Angelin Leonidas Gomes , Alonso Angelica Castilho , Prota Cristina , Cavalcante de Abreu Christiane Pereira , Storer Ribeiro Lucia Helena , Barros Santos Jenniffer Grace , Cristina de Souza Juliana , Mayr de Biase Maria Eugenia , Sitthinamsuwan Bunpot , Majeed Nasir , Gabana Edelvan , Rodriguez Ferreira Ricardo José , Marcon Raphael Martus , D'Andrea Greve Julia Maria , Cristante Alexandre Fogaça , Lepski Guilherme Alves
Published: March 2024

INTRODUCTION:

Traumatic spinal cord injury (SCI) is one of the leading causes of morbidity and mortality worldwide. Recently, epidural electrical stimulation (EES) has been shown to restore voluntary motor control in patients with severe SCI.

METHODS:

To this date, three patients with SCI have been implanted with 5-6-5-Specify-Medtronic electrodes and Medtronic-Intellis pulse generator. All procedures were approved by the local Ethics Committee. The age of the patients ranged from 38-69 y, and the levels of the SCI were C6-D5. Clinically, they were classified ASIA A (2) or B (1). The time frame after injury was 2-7 y. Intraoperative electrophysiological mapping was performed to ensure correct location of the lead at the levels involved in the control of L3-S2 nerve roots. Clinical assessments were performed every 3 m. Additionally, we measured superficial EMG each month, through sensors equipped with accelerometers and gyroscopes.

RESULTS:

One patient completed 12 m of intense rehabilitation program. The other two patients are currently on training and to this date they completed respectively 6 and 3 months of the program. All 3 patients were able to perform walking activities on a treadmill and stationary bicycle with stimulation turned on. There was an important improvement in the scales related to motor skills and balance, at expense of worsening in pain scores. After 8 months the first patient started to present voluntary movements even with stimulation turned off.

CONCLUSIONS:

EES allows restoration of voluntary motor control of the legs after severe traumatic SCI. Moreover, after 8 months, a plastic effect could be observed, and a patient was able to control movements even with off stimulation. The observed improvement in overall patient’s performance occurred at expense of more pain, which need to be addressed carefully.
493 Predictors of Recurrence After Surgical Resection of Parafalcine and Parasagittal Meningiomas
Authors: Khanna Omaditya , Momin Arbaz , Barsouk Adam , Mahtabfar Aria , Andrews Carrie Elizabeth , Hafazalla Karim , Lan Matthews , Patel Pious D. , Baldassari Michael P. , Andrews David W. , Evans James J. , Farrell Christopher James , Judy Kevin D.
Published: March 2024

INTRODUCTION:

Parasagittal and parafalcine meningiomas are challenging tumors to resect, owing to their proximity to the sagittal sinus and associated collateralized venous channels. More research is needed to elucidate relevant factors that affect risk of recurrence.

METHODS:

This is a retrospective study of all patients who underwent resection of parasagittal and parafalcine meningiomas between 2012-2018. Multivariable Cox regression and Kaplan Meier analysis was performed to assess for factors that influence progression free survival (primary endpoint).

RESULTS:

A total of 110 consecutive subjects (mean age: 59.4+/-15.2 years, 67.3% female) with 74 parasagittal and 36 parafalcine meningiomas (92 WHO grade 1, 18 WHO grade 2/3) are included in the study. A total of 37 patients (33.6%) exhibited recurrence with median follow-up of 42 months (IQR: 10-71). In the overall cohort, parasagittal meningiomas exhibited shorter progression free survival compared to parafalcine meningiomas (p = 0.045). On univariate analysis, predictors of recurrence include WHO grade 2/3 vs. grade 1 tumors (HR 4.27, 95%CI: 2.01-9.09; p < 0.001), higher Ki-67 indices (HR, 1.11, 95% CI: 1.07-1.14; p < 0.001), partial (Sindou class 2-4) (HR 2.32, 95% CI: 1.03-5.19; p = 0.04) or complete (Sindou class 5-6) sinus invasion (HR 4.65, 95% CI: 2.07-10.42; p < 0.001), and subtotal resection (HR 4.13, 95% CI: 2.05-8.32; p < 0.001). Location along the anterior, middle or posterior third of the sagittal sinus did not influence risk of recurrence (HR 0.82, 95%CI: 0.30-2.28; p=0.71). Multivariable Cox regression analysis revealed high grade meningiomas (HR: 3.62, 95% CI: 1.60-8.22; p = 0.002), complete sinus invasion (HR: 3.00, 95% CI: 1.16-7.79; p = 0.024), and subtotal resection (HR: 3.10, 95% CI: 1.38-6.96; p = 0.006) portend increased risk of recurrence.

CONCLUSIONS:

This is the largest study to date that identifies predictors that confer increased risk of recurrence after resection of parasagittal and parafalcine meningiomas, which can be used to
495 Optimizing Drug Delivery to the Brain for Breast Metastasis: A Novel Method for Tumor Targeting
Authors: Krishnamurthy Satish , Oh Justin , Gautham Shruti , Li J. , Shen Yimin
Published: March 2024

INTRODUCTION:

Brain metastases are difficult to treat due to the blood-brain barrier limiting delivery of therapeutic agents to the brain effectively. Intraventricular drug delivery has not been well studied for intra-axial pathologies. However, our prior work demonstrated that intraventricular drug delivery in a hyperosmolar vehicle showed preferential accumulation of drug within breast cancer tissue compared to surrounding brain parenchyma.

METHODS:

We used an intracerebral breast cancer tumor model in adult female nude rats divided into six experimental groups. We examined three iron labeled dextran molecules (3 KD, 5KD, and 10 KD) in 337 mOsm/L solution and three different osmolarities of delivery solution (307, 353, 368 mOsm/L) with 10 KD dextran. 7T MR imaging was used to analyze dextran distribution at different time points. All animals were sacrificed after 2 hours and quantity of dextran particles was determined by histopathology.

RESULTS:

Breast cancer tumor cells were successfully implanted in all rats. MRI quantification of dextran concentration was well corroborated by histopathology. Varying the molecular size of dextran resulted in the smallest molecule reaching peak levels in tumor tissue earlier than the larger molecules but the larger molecules remained concentrated in tumor tissue for a longer time. Varying the osmolarity of the delivery solution resulted in preferential accumulation of 10 KD dextran in tumor tissue except for when dextran was delivered in 368 mOsm/L solution where no preferential distribution was seen.

CONCLUSIONS:

Hyperosmolar intraventricular delivery of chemotherapeutic drugs could be effective in preferentially delivering drugs to abnormal tumor tissues.