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Papers by David Cavanaugh

The Spine Journal, Sep 1, 2010

BACKGROUND CONTEXT: Advancements in the philosophy of ''motion preservation'' have led to the use... more BACKGROUND CONTEXT: Advancements in the philosophy of ''motion preservation'' have led to the use of total disc arthroplasty (TDA) as an alternative to fusion for degenerative disc disease (DDD) in the cervical spine. A commonly proposed theory is that TDA could reduce the incidence of adjacent segment disease. All the published clinical studies for TDA discuss the ''equal efficacy'' results of different investigational device exemption (IDE) trials between TDA and anterior cervical discectomy and fusion (ACDF) but have not addressed the issue of adjacent segment disease. PURPOSE: To present the comparison of outcome data with respect to clinical success rates, symptom-free period, and incidence of adjacent segment disease in 93 patients with one-and two-level cervical DDD treated with TDA or ACDF in three different Food and Drug Administration (FDA) investigational trials. STUDY DESIGN: Prospective, randomized, FDA IDE trials. PATIENT SAMPLE: Ninety-three patients with established symptomatic one-or two-level cervical disc disease who failed to respond to conservative treatment were randomized to receive TDA (59) or ACDF (34) as part of clinical trials involving three different artificial discs at our institution. Subjects were blind to the assigned group until after the surgery. OUTCOME MEASURES: Visual analog pain score (VAS), Neck Disability Index, and cervical spine radiographs were collected at 6 weeks and at 3, 6, 12, 24, 36, and 48 months after surgery. METHOD: Success of the index surgery was assessed based on outcome measures at the seven data points. Success was defined as reduction by more than 30 points in both VAS and Neck Disability Index, absence of neurological deficits, and no further intervention at the index level. Adjacent segment disease was established by radiology, neurophysiology, and subsequent interventions administered to the patients. RESULTS: At median follow-up of 37 months (range, 24-49 months), 64 (25 ACDF and 39 TDA) patients satisfied the criteria for clinical success. Neck Disability Index was a better predictor of outcome than pain score (p!.05). Sixteen percent of TDA patients and 18% ACDF patients developed adjacent segment degeneration and were treated actively (p5.3). Concurrent lumbar DDD significantly increased the risk of adjacent segment degeneration (p5.01). Age, gender, smoking habits, and number of levels at index surgery had no predictive value. CONCLUSION: Total disc arthroplasty is equivalent to ACDF for providing relief from symptoms in the treatment of one-and two-level DDD of cervical spine. The risk of developing adjacent segment degeneration is equivalent after both procedures but is significantly higher in patients with concurrent DDD in lumbar spine.

The Spine Journal, Oct 1, 2017

Spine, Apr 1, 2009

Study Design. Anecdotal case report. Objective. To report a very interesting and perplexing compl... more Study Design. Anecdotal case report. Objective. To report a very interesting and perplexing complication of cervical total disc arthroplasty that has not been previously reported in literature. Summary of Background Data. Although there has been increasing interest in the field of artificial disc replacement to treat cervical degenerative disc disease, not much has been mentioned in the literature about the potential complications of the disc itself. We encountered a delayed complication in 1 patient that has not been reported in the literature. Method. Thirty-nine-year-old white woman received total disc arthroplasty for herniated intervertebral disc at C5-C6 level uneventfully. She had recurrence of symptoms 9 months after the procedure and failed to respond to conservative measurements. Imaging revealed soft tissue mass posterior to the implanted disc encroaching the spinal cord. Results. Surgical explantation and exploration of the disc space revealed thick layer of abnormal hyaline cartilaginous tissue with chronic inflammatory debris. The patient had complete resolution of symptoms after the revision surgery. Conclusion. Although there is increased enthusiasm about motion preservation technology and disc replacement surgery for intervertebral disc herniation, unexpected complications like the present case need to be shared within the scientific community to better understand the risks associated with these new and promising devices.

The Spine Journal, Sep 1, 2008

The Spine Journal, May 1, 2008

The Spine Journal, Nov 1, 2014

adjacent-only level surgery. Subsequent surgeries that did not indicate a study failure such as h... more adjacent-only level surgery. Subsequent surgeries that did not indicate a study failure such as hematoma evacuation and surgeries at noncervical, adjacent levels (C7-T1) were included in the analysis. METHODS: TDR patients were treated with a Mobi-CÓ artificial disc (LDR Spine, USA). ACDFI patients were treated with allograft and anterior plate and screw instrumentation. Outcome measures were collected at baseline, 6 weeks, and at 3, 6, 12, 18, 24, 36, 46, and 60 months postoperatively. RESULTS: At 5 years, 4.47% of one-level TDR patients had subsequent surgery with 1.68% having an index only surgery, 1.12% having an adjacent and index surgery, and 1.68% having an adjacent only surgery. For one-level ACDF patients, 17.9% of patients had a subsequent surgery with a breakdown of 6.17% index only, 6.17% adjacent and index, and 4.94% adjacent only surgery patients. For the two-level treatment arm, 6.84% of TDR patients (4.70% index only, 0.43% adjacent and index, and 1.71% adjacent only), and 21.0% of ACDF patients (9.52% index only, 8.57% index and adjacent, and 2.85% adjacent only) had subsequent surgical intervention. Differences between the total subsequent surgery rates of TDR and ACDF patients were significant for both one-level (p50.0008) and two-level (p50.0002) treatment. When groups were analyzed based on surgery classification, no significant differences were observed in rate of index only or adjacent only surgeries for either cohort. However, one-level TDR patients did have a lower rate of surgeries involving both an adjacent and index level surgeries (p 50.032). Two-level TDR patients also showed a lower rate of subsequent surgeries performed at both an adjacent and index level (p 50.0002).Two TDR patients and 1 ACDF patient in the one-level treatment arm and 2 TDR patients and 3ACDF patients in the two-level arm ultimately had more than one subsequent surgery. When analyzing causation for secondary surgeries, the onelevel ACDF patients had a significantly higher rate of adjacent level indications (p50.004), as did the two-level ACDF patients (p50.004) when compared to TDR. CONCLUSIONS: Treatment with TDR demonstrates significantly lower subsequent cervical surgery rates compared to ACDF for both one and two levels at 5-year follow-up. Additionally, the rate of subsequent surgeries involving both an index and adjacent level was significantly lower in the one-and two-level TDR group FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.

The Spine Journal, Sep 1, 2010

BACKGROUND CONTEXT: Advancements in the philosophy of ''motion preservation'' have led to the use... more BACKGROUND CONTEXT: Advancements in the philosophy of ''motion preservation'' have led to the use of total disc arthroplasty (TDA) as an alternative to fusion for degenerative disc disease (DDD) in the cervical spine. A commonly proposed theory is that TDA could reduce the incidence of adjacent segment disease. All the published clinical studies for TDA discuss the ''equal efficacy'' results of different investigational device exemption (IDE) trials between TDA and anterior cervical discectomy and fusion (ACDF) but have not addressed the issue of adjacent segment disease. PURPOSE: To present the comparison of outcome data with respect to clinical success rates, symptom-free period, and incidence of adjacent segment disease in 93 patients with one-and two-level cervical DDD treated with TDA or ACDF in three different Food and Drug Administration (FDA) investigational trials. STUDY DESIGN: Prospective, randomized, FDA IDE trials. PATIENT SAMPLE: Ninety-three patients with established symptomatic one-or two-level cervical disc disease who failed to respond to conservative treatment were randomized to receive TDA (59) or ACDF (34) as part of clinical trials involving three different artificial discs at our institution. Subjects were blind to the assigned group until after the surgery. OUTCOME MEASURES: Visual analog pain score (VAS), Neck Disability Index, and cervical spine radiographs were collected at 6 weeks and at 3, 6, 12, 24, 36, and 48 months after surgery. METHOD: Success of the index surgery was assessed based on outcome measures at the seven data points. Success was defined as reduction by more than 30 points in both VAS and Neck Disability Index, absence of neurological deficits, and no further intervention at the index level. Adjacent segment disease was established by radiology, neurophysiology, and subsequent interventions administered to the patients. RESULTS: At median follow-up of 37 months (range, 24-49 months), 64 (25 ACDF and 39 TDA) patients satisfied the criteria for clinical success. Neck Disability Index was a better predictor of outcome than pain score (p!.05). Sixteen percent of TDA patients and 18% ACDF patients developed adjacent segment degeneration and were treated actively (p5.3). Concurrent lumbar DDD significantly increased the risk of adjacent segment degeneration (p5.01). Age, gender, smoking habits, and number of levels at index surgery had no predictive value. CONCLUSION: Total disc arthroplasty is equivalent to ACDF for providing relief from symptoms in the treatment of one-and two-level DDD of cervical spine. The risk of developing adjacent segment degeneration is equivalent after both procedures but is significantly higher in patients with concurrent DDD in lumbar spine.

Neurosurgical Focus, Sep 1, 2020

L ateraL lumbar interbody fusion (LLIF) and oblique lateral interbody fusion (OLIF) procedures ar... more L ateraL lumbar interbody fusion (LLIF) and oblique lateral interbody fusion (OLIF) procedures are a retroperitoneal approach to gain access to the lumbar spine for the purposes of disc resection, endplate preparation, graft implantation, and fusion. These approaches have grown in popularity as less invasive alternatives to isolated direct anterior and posterior access channels. Benefits of the lateral approach include preservation of the anterior longitudinal ligament maintaining segmental stability, significant muscle sparing, fewer abdominal visceral and vascular injuries, and fewer postoperative wound infections. 1-3 The central tenet of lateral surgery involves placement of an interbody cage between two preserved vertebral body endplates that allows for restoration of height, direct and indirect decompression of neural elements, restoration of the anterior column weight-bearing function, and

Neurosurgical Focus, 2018

D egenerative spondylolisthesis (DS) is often characterized by disc and facet degeneration that a... more D egenerative spondylolisthesis (DS) is often characterized by disc and facet degeneration that allows sagittal translation of the involved segment, commonly resulting in lateral recess and/or foraminal stenosis. 17 It disproportionally affects older females at the L4-5 level and is often associated with more sagittally oriented facet joints. 7 Treatment options have ranged from limited decompression to decompression with anterior and/or posterior fusion with or without listhesis correction to multilevel fusion for deformity correction. Recent randomized controlled trials have shown clinically significant improvement in patients with spondylolisthesis who

The Spine Journal, Aug 1, 2018

The Spine Journal, Sep 1, 2012

The Spine Journal, Oct 1, 2016

of 7072 authors who first published during 2000-2009, 1302 authors (18.4%) continued to publish 5... more of 7072 authors who first published during 2000-2009, 1302 authors (18.4%) continued to publish 5 years after their first publication. Women were less than half as likely to continue publishing after their first article (9.1% of female authors vs 19.6%, RR 0.46, 95% CI [0.44, 0.49], p<.001). This difference between female and male authors was more pronounced as senior authors (0.7 vs 1.4 articles, p<.001) than as first authors (1.2 vs 1.4 articles, p<.001). CONCLUSIONS: Female representation in academic spine research increased over threefold over the past 4 decades, although growth of female representation among senior authors has plateaued since the early 2000s. Female physician-investigators are half as likely to continue participating in spine-related research longer than 5 years and on average publish half as many articles as senior authors. In addition to recruiting more women into research, efforts should be made to identify and address barriers in research advancement and promotion for female physician-investigators. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.

The Spine Journal, Oct 1, 2015

The Spine Journal, Oct 1, 2016

The Journal of the Louisiana State Medical Society, Jul 1, 2010

Ganglioneuromas are rare benign tumors of the neural crest occurring in early childhood. They are... more Ganglioneuromas are rare benign tumors of the neural crest occurring in early childhood. They are occasionally diagnosed in young adults due to their mass-effect on adjacent structures. We report a case of ganglioneuroma incidentally diagnosed in an adult man. A 41-year-old man presented with left-sided cervical radiculopathy symptoms due to degenerative disc disease at the C5-6 and C6-7 levels. The diagnostic radiology work-up revealed a mass in the left side of the neck between the carotid artery and jugular vein. Surgical excision of the mass was performed and the histological diagnosis of ganglioneuroma was established. The patient developed left-sided Horner&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s syndrome post-operatively. The present case suggests that these tumors may have insidious presence in the adult population, and therefore, should be considered in the differential diagnosis of a lateral neck mass in asymptomatic adult patients.

Surgical Neurology, 2008

Background: With increasing advocacy for the use of TDR procedure as a surgical alternative to fu... more Background: With increasing advocacy for the use of TDR procedure as a surgical alternative to fusion in the management of lumbar DDD, intradiskal pressures at the adjacent levels of spine have generated considerable interest. The common belief is that adjacent-level disk pressures will be lower after a TDR as opposed to conventional fusion. The aim of this study is to present the effect of different constructs on adjacent-level disk pressures in lumbar spine. We hypothesized that the adjacent-segment disk pressures after 1-and 2-level TDR and/or a fusion-TDR hybrid procedure will show significant variance within physiological range of motion. Methods: Six adult spine segments T12-S1 with intact ligaments were harvested from cadavers and held firmly in a specially designed fixture. Intradiskal pressures, in motions of flexion, extension, and lateral bending, at L2-L3 and L3-L4 were measured using needle transducers after 2-level TDR L4 through S1, hybrid procedure, and 2-level fusion L4-S1 with femoral ring allograft and pedicle screws. Results: The pressures with lateral bending were not significantly lower than those with flexion and extension at both levels (P = .18). Although TDR and hybrid specimens recorded slightly lower pressures specifically during lateral bending, no statistical difference in pressures could be detected when movements were combined with various procedures. Conclusion: Contrary to the assumed hypothesis, the pressures at the adjacent-level disks (L3-4 and L2-3) did not depend upon the stabilization procedure (2-level disk replacement, hybrid, or 2-level fusion) performed after 2-level diskectomy in the lumbosacral spine.

The Spine Journal, Sep 1, 2007

Journal of Neurosurgery: Case Lessons, 2021

BACKGROUND Herniation of an intervertebral disc (IVD) is found predominantly in the lumbar and ce... more BACKGROUND Herniation of an intervertebral disc (IVD) is found predominantly in the lumbar and cervical spine of both children and adults, but herniated IVDs of the thoracic spine are a rare occurrence. However, approximately 40% of herniated thoracic disc cases are calcified. Approximately 0.65% of all spinal herniations are calcified herniated thoracic discs (CHTDs). CHTDs can be treated conservatively or invasively, depending on the symptoms and degree of neurological deficit present. OBSERVATIONS The authors report a 44-year-old male with near complete reabsorption and disappearance of a CHTD. A review of the available literature indicates that there are only seven adult patients in whom this phenomenon has been reported. LESSONS Determining the best form of invasive treatment is a challenge for surgeons given the complexity of this condition. While the disappearance of calcified herniated discs of the lumbar and cervical spine has been reported, reports of the regression of CHT...

The International Journal of Spine Surgery, 2016

Background Bone graft material for lumbar fusion was historically autologous bone graft (ABG). In... more Background Bone graft material for lumbar fusion was historically autologous bone graft (ABG). In recent years alternatives such as allograft, demineralized bone matrix (DBM), ceramics, and bone morphogenetic protein (BMP) have gained favor, although the complications of these are not fully understood. Bioactive amniotic suspension (BAS) with allograft is a new class of material derived from human amniotic tissue. Methods Eligible patients receiving a one or two level lumbar interbody fusion with Nucel, a BAS with allograft, were contacted and scheduled for a mininmim 12 month follow-up visit. Patients were evaluated for fusion using CT's and plain radiographs. Clincal outcomes, including ODI, VAS back and leg were collected, as well as comorbidities including BMI, smoking status, diabetes and previous lumbar surgery. Results One-level patients (N=38) were 71.1% female with mean age of 58.4 ± 12.7 and mean BMI of 30.6 ± 6.08. Two-level patients (N=34) were 58.8% female with mean age of 49.3 ±10.9 and mean BMI of 30.1 ± 5.82. Kinematic fusion was achieved in 97.4% of one-level patients and 100% of two-level patients. Baseline comorbidities were present in 89.5% of one-level patients and 88.2% of two-level patients. No adverse events related to BAS were reported in this study. Conclusion Fusion status is evaluated with many different biologics and varying methods in the literature. BAS with allograft in this study demonstrated high fusion rates with no complications within a largely comorbid population. Although a small population, BAS with allograft results were encouraging for one and two-level lumbar interbody fusion in this study. Further prospective studies should be conducted to investigate safety and efficacy in a larger population.

The Spine Journal, Sep 1, 2010

BACKGROUND CONTEXT: Advancements in the philosophy of ''motion preservation'' have led to the use... more BACKGROUND CONTEXT: Advancements in the philosophy of ''motion preservation'' have led to the use of total disc arthroplasty (TDA) as an alternative to fusion for degenerative disc disease (DDD) in the cervical spine. A commonly proposed theory is that TDA could reduce the incidence of adjacent segment disease. All the published clinical studies for TDA discuss the ''equal efficacy'' results of different investigational device exemption (IDE) trials between TDA and anterior cervical discectomy and fusion (ACDF) but have not addressed the issue of adjacent segment disease. PURPOSE: To present the comparison of outcome data with respect to clinical success rates, symptom-free period, and incidence of adjacent segment disease in 93 patients with one-and two-level cervical DDD treated with TDA or ACDF in three different Food and Drug Administration (FDA) investigational trials. STUDY DESIGN: Prospective, randomized, FDA IDE trials. PATIENT SAMPLE: Ninety-three patients with established symptomatic one-or two-level cervical disc disease who failed to respond to conservative treatment were randomized to receive TDA (59) or ACDF (34) as part of clinical trials involving three different artificial discs at our institution. Subjects were blind to the assigned group until after the surgery. OUTCOME MEASURES: Visual analog pain score (VAS), Neck Disability Index, and cervical spine radiographs were collected at 6 weeks and at 3, 6, 12, 24, 36, and 48 months after surgery. METHOD: Success of the index surgery was assessed based on outcome measures at the seven data points. Success was defined as reduction by more than 30 points in both VAS and Neck Disability Index, absence of neurological deficits, and no further intervention at the index level. Adjacent segment disease was established by radiology, neurophysiology, and subsequent interventions administered to the patients. RESULTS: At median follow-up of 37 months (range, 24-49 months), 64 (25 ACDF and 39 TDA) patients satisfied the criteria for clinical success. Neck Disability Index was a better predictor of outcome than pain score (p!.05). Sixteen percent of TDA patients and 18% ACDF patients developed adjacent segment degeneration and were treated actively (p5.3). Concurrent lumbar DDD significantly increased the risk of adjacent segment degeneration (p5.01). Age, gender, smoking habits, and number of levels at index surgery had no predictive value. CONCLUSION: Total disc arthroplasty is equivalent to ACDF for providing relief from symptoms in the treatment of one-and two-level DDD of cervical spine. The risk of developing adjacent segment degeneration is equivalent after both procedures but is significantly higher in patients with concurrent DDD in lumbar spine.

The Spine Journal, Oct 1, 2017

Spine, Apr 1, 2009

Study Design. Anecdotal case report. Objective. To report a very interesting and perplexing compl... more Study Design. Anecdotal case report. Objective. To report a very interesting and perplexing complication of cervical total disc arthroplasty that has not been previously reported in literature. Summary of Background Data. Although there has been increasing interest in the field of artificial disc replacement to treat cervical degenerative disc disease, not much has been mentioned in the literature about the potential complications of the disc itself. We encountered a delayed complication in 1 patient that has not been reported in the literature. Method. Thirty-nine-year-old white woman received total disc arthroplasty for herniated intervertebral disc at C5-C6 level uneventfully. She had recurrence of symptoms 9 months after the procedure and failed to respond to conservative measurements. Imaging revealed soft tissue mass posterior to the implanted disc encroaching the spinal cord. Results. Surgical explantation and exploration of the disc space revealed thick layer of abnormal hyaline cartilaginous tissue with chronic inflammatory debris. The patient had complete resolution of symptoms after the revision surgery. Conclusion. Although there is increased enthusiasm about motion preservation technology and disc replacement surgery for intervertebral disc herniation, unexpected complications like the present case need to be shared within the scientific community to better understand the risks associated with these new and promising devices.

The Spine Journal, Sep 1, 2008

The Spine Journal, May 1, 2008

The Spine Journal, Nov 1, 2014

adjacent-only level surgery. Subsequent surgeries that did not indicate a study failure such as h... more adjacent-only level surgery. Subsequent surgeries that did not indicate a study failure such as hematoma evacuation and surgeries at noncervical, adjacent levels (C7-T1) were included in the analysis. METHODS: TDR patients were treated with a Mobi-CÓ artificial disc (LDR Spine, USA). ACDFI patients were treated with allograft and anterior plate and screw instrumentation. Outcome measures were collected at baseline, 6 weeks, and at 3, 6, 12, 18, 24, 36, 46, and 60 months postoperatively. RESULTS: At 5 years, 4.47% of one-level TDR patients had subsequent surgery with 1.68% having an index only surgery, 1.12% having an adjacent and index surgery, and 1.68% having an adjacent only surgery. For one-level ACDF patients, 17.9% of patients had a subsequent surgery with a breakdown of 6.17% index only, 6.17% adjacent and index, and 4.94% adjacent only surgery patients. For the two-level treatment arm, 6.84% of TDR patients (4.70% index only, 0.43% adjacent and index, and 1.71% adjacent only), and 21.0% of ACDF patients (9.52% index only, 8.57% index and adjacent, and 2.85% adjacent only) had subsequent surgical intervention. Differences between the total subsequent surgery rates of TDR and ACDF patients were significant for both one-level (p50.0008) and two-level (p50.0002) treatment. When groups were analyzed based on surgery classification, no significant differences were observed in rate of index only or adjacent only surgeries for either cohort. However, one-level TDR patients did have a lower rate of surgeries involving both an adjacent and index level surgeries (p 50.032). Two-level TDR patients also showed a lower rate of subsequent surgeries performed at both an adjacent and index level (p 50.0002).Two TDR patients and 1 ACDF patient in the one-level treatment arm and 2 TDR patients and 3ACDF patients in the two-level arm ultimately had more than one subsequent surgery. When analyzing causation for secondary surgeries, the onelevel ACDF patients had a significantly higher rate of adjacent level indications (p50.004), as did the two-level ACDF patients (p50.004) when compared to TDR. CONCLUSIONS: Treatment with TDR demonstrates significantly lower subsequent cervical surgery rates compared to ACDF for both one and two levels at 5-year follow-up. Additionally, the rate of subsequent surgeries involving both an index and adjacent level was significantly lower in the one-and two-level TDR group FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.

The Spine Journal, Sep 1, 2010

BACKGROUND CONTEXT: Advancements in the philosophy of ''motion preservation'' have led to the use... more BACKGROUND CONTEXT: Advancements in the philosophy of ''motion preservation'' have led to the use of total disc arthroplasty (TDA) as an alternative to fusion for degenerative disc disease (DDD) in the cervical spine. A commonly proposed theory is that TDA could reduce the incidence of adjacent segment disease. All the published clinical studies for TDA discuss the ''equal efficacy'' results of different investigational device exemption (IDE) trials between TDA and anterior cervical discectomy and fusion (ACDF) but have not addressed the issue of adjacent segment disease. PURPOSE: To present the comparison of outcome data with respect to clinical success rates, symptom-free period, and incidence of adjacent segment disease in 93 patients with one-and two-level cervical DDD treated with TDA or ACDF in three different Food and Drug Administration (FDA) investigational trials. STUDY DESIGN: Prospective, randomized, FDA IDE trials. PATIENT SAMPLE: Ninety-three patients with established symptomatic one-or two-level cervical disc disease who failed to respond to conservative treatment were randomized to receive TDA (59) or ACDF (34) as part of clinical trials involving three different artificial discs at our institution. Subjects were blind to the assigned group until after the surgery. OUTCOME MEASURES: Visual analog pain score (VAS), Neck Disability Index, and cervical spine radiographs were collected at 6 weeks and at 3, 6, 12, 24, 36, and 48 months after surgery. METHOD: Success of the index surgery was assessed based on outcome measures at the seven data points. Success was defined as reduction by more than 30 points in both VAS and Neck Disability Index, absence of neurological deficits, and no further intervention at the index level. Adjacent segment disease was established by radiology, neurophysiology, and subsequent interventions administered to the patients. RESULTS: At median follow-up of 37 months (range, 24-49 months), 64 (25 ACDF and 39 TDA) patients satisfied the criteria for clinical success. Neck Disability Index was a better predictor of outcome than pain score (p!.05). Sixteen percent of TDA patients and 18% ACDF patients developed adjacent segment degeneration and were treated actively (p5.3). Concurrent lumbar DDD significantly increased the risk of adjacent segment degeneration (p5.01). Age, gender, smoking habits, and number of levels at index surgery had no predictive value. CONCLUSION: Total disc arthroplasty is equivalent to ACDF for providing relief from symptoms in the treatment of one-and two-level DDD of cervical spine. The risk of developing adjacent segment degeneration is equivalent after both procedures but is significantly higher in patients with concurrent DDD in lumbar spine.

Neurosurgical Focus, Sep 1, 2020

L ateraL lumbar interbody fusion (LLIF) and oblique lateral interbody fusion (OLIF) procedures ar... more L ateraL lumbar interbody fusion (LLIF) and oblique lateral interbody fusion (OLIF) procedures are a retroperitoneal approach to gain access to the lumbar spine for the purposes of disc resection, endplate preparation, graft implantation, and fusion. These approaches have grown in popularity as less invasive alternatives to isolated direct anterior and posterior access channels. Benefits of the lateral approach include preservation of the anterior longitudinal ligament maintaining segmental stability, significant muscle sparing, fewer abdominal visceral and vascular injuries, and fewer postoperative wound infections. 1-3 The central tenet of lateral surgery involves placement of an interbody cage between two preserved vertebral body endplates that allows for restoration of height, direct and indirect decompression of neural elements, restoration of the anterior column weight-bearing function, and

Neurosurgical Focus, 2018

D egenerative spondylolisthesis (DS) is often characterized by disc and facet degeneration that a... more D egenerative spondylolisthesis (DS) is often characterized by disc and facet degeneration that allows sagittal translation of the involved segment, commonly resulting in lateral recess and/or foraminal stenosis. 17 It disproportionally affects older females at the L4-5 level and is often associated with more sagittally oriented facet joints. 7 Treatment options have ranged from limited decompression to decompression with anterior and/or posterior fusion with or without listhesis correction to multilevel fusion for deformity correction. Recent randomized controlled trials have shown clinically significant improvement in patients with spondylolisthesis who

The Spine Journal, Aug 1, 2018

The Spine Journal, Sep 1, 2012

The Spine Journal, Oct 1, 2016

of 7072 authors who first published during 2000-2009, 1302 authors (18.4%) continued to publish 5... more of 7072 authors who first published during 2000-2009, 1302 authors (18.4%) continued to publish 5 years after their first publication. Women were less than half as likely to continue publishing after their first article (9.1% of female authors vs 19.6%, RR 0.46, 95% CI [0.44, 0.49], p<.001). This difference between female and male authors was more pronounced as senior authors (0.7 vs 1.4 articles, p<.001) than as first authors (1.2 vs 1.4 articles, p<.001). CONCLUSIONS: Female representation in academic spine research increased over threefold over the past 4 decades, although growth of female representation among senior authors has plateaued since the early 2000s. Female physician-investigators are half as likely to continue participating in spine-related research longer than 5 years and on average publish half as many articles as senior authors. In addition to recruiting more women into research, efforts should be made to identify and address barriers in research advancement and promotion for female physician-investigators. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.

The Spine Journal, Oct 1, 2015

The Spine Journal, Oct 1, 2016

The Journal of the Louisiana State Medical Society, Jul 1, 2010

Ganglioneuromas are rare benign tumors of the neural crest occurring in early childhood. They are... more Ganglioneuromas are rare benign tumors of the neural crest occurring in early childhood. They are occasionally diagnosed in young adults due to their mass-effect on adjacent structures. We report a case of ganglioneuroma incidentally diagnosed in an adult man. A 41-year-old man presented with left-sided cervical radiculopathy symptoms due to degenerative disc disease at the C5-6 and C6-7 levels. The diagnostic radiology work-up revealed a mass in the left side of the neck between the carotid artery and jugular vein. Surgical excision of the mass was performed and the histological diagnosis of ganglioneuroma was established. The patient developed left-sided Horner&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s syndrome post-operatively. The present case suggests that these tumors may have insidious presence in the adult population, and therefore, should be considered in the differential diagnosis of a lateral neck mass in asymptomatic adult patients.

Surgical Neurology, 2008

Background: With increasing advocacy for the use of TDR procedure as a surgical alternative to fu... more Background: With increasing advocacy for the use of TDR procedure as a surgical alternative to fusion in the management of lumbar DDD, intradiskal pressures at the adjacent levels of spine have generated considerable interest. The common belief is that adjacent-level disk pressures will be lower after a TDR as opposed to conventional fusion. The aim of this study is to present the effect of different constructs on adjacent-level disk pressures in lumbar spine. We hypothesized that the adjacent-segment disk pressures after 1-and 2-level TDR and/or a fusion-TDR hybrid procedure will show significant variance within physiological range of motion. Methods: Six adult spine segments T12-S1 with intact ligaments were harvested from cadavers and held firmly in a specially designed fixture. Intradiskal pressures, in motions of flexion, extension, and lateral bending, at L2-L3 and L3-L4 were measured using needle transducers after 2-level TDR L4 through S1, hybrid procedure, and 2-level fusion L4-S1 with femoral ring allograft and pedicle screws. Results: The pressures with lateral bending were not significantly lower than those with flexion and extension at both levels (P = .18). Although TDR and hybrid specimens recorded slightly lower pressures specifically during lateral bending, no statistical difference in pressures could be detected when movements were combined with various procedures. Conclusion: Contrary to the assumed hypothesis, the pressures at the adjacent-level disks (L3-4 and L2-3) did not depend upon the stabilization procedure (2-level disk replacement, hybrid, or 2-level fusion) performed after 2-level diskectomy in the lumbosacral spine.

The Spine Journal, Sep 1, 2007

Journal of Neurosurgery: Case Lessons, 2021

BACKGROUND Herniation of an intervertebral disc (IVD) is found predominantly in the lumbar and ce... more BACKGROUND Herniation of an intervertebral disc (IVD) is found predominantly in the lumbar and cervical spine of both children and adults, but herniated IVDs of the thoracic spine are a rare occurrence. However, approximately 40% of herniated thoracic disc cases are calcified. Approximately 0.65% of all spinal herniations are calcified herniated thoracic discs (CHTDs). CHTDs can be treated conservatively or invasively, depending on the symptoms and degree of neurological deficit present. OBSERVATIONS The authors report a 44-year-old male with near complete reabsorption and disappearance of a CHTD. A review of the available literature indicates that there are only seven adult patients in whom this phenomenon has been reported. LESSONS Determining the best form of invasive treatment is a challenge for surgeons given the complexity of this condition. While the disappearance of calcified herniated discs of the lumbar and cervical spine has been reported, reports of the regression of CHT...

The International Journal of Spine Surgery, 2016

Background Bone graft material for lumbar fusion was historically autologous bone graft (ABG). In... more Background Bone graft material for lumbar fusion was historically autologous bone graft (ABG). In recent years alternatives such as allograft, demineralized bone matrix (DBM), ceramics, and bone morphogenetic protein (BMP) have gained favor, although the complications of these are not fully understood. Bioactive amniotic suspension (BAS) with allograft is a new class of material derived from human amniotic tissue. Methods Eligible patients receiving a one or two level lumbar interbody fusion with Nucel, a BAS with allograft, were contacted and scheduled for a mininmim 12 month follow-up visit. Patients were evaluated for fusion using CT's and plain radiographs. Clincal outcomes, including ODI, VAS back and leg were collected, as well as comorbidities including BMI, smoking status, diabetes and previous lumbar surgery. Results One-level patients (N=38) were 71.1% female with mean age of 58.4 ± 12.7 and mean BMI of 30.6 ± 6.08. Two-level patients (N=34) were 58.8% female with mean age of 49.3 ±10.9 and mean BMI of 30.1 ± 5.82. Kinematic fusion was achieved in 97.4% of one-level patients and 100% of two-level patients. Baseline comorbidities were present in 89.5% of one-level patients and 88.2% of two-level patients. No adverse events related to BAS were reported in this study. Conclusion Fusion status is evaluated with many different biologics and varying methods in the literature. BAS with allograft in this study demonstrated high fusion rates with no complications within a largely comorbid population. Although a small population, BAS with allograft results were encouraging for one and two-level lumbar interbody fusion in this study. Further prospective studies should be conducted to investigate safety and efficacy in a larger population.