reza yassari | Montefiore Medical Center (original) (raw)

Papers by reza yassari

Research paper thumbnail of Blood loss after total en bloc spondylectomy

Journal of Spine Surgery

Blood loss in total en bloc spondylectomy for primary spinal bone tumours: a comparison of estima... more Blood loss in total en bloc spondylectomy for primary spinal bone tumours: a comparison of estimated blood loss versus actual blood loss in a single centre over 10 years.

Research paper thumbnail of Advancements and Updates on Operative Techniques in Spinal Deformity

Journal of Clinical Medicine

Spinal deformity involves a spectrum of abnormal spinal curvatures deviating from normal alignmen... more Spinal deformity involves a spectrum of abnormal spinal curvatures deviating from normal alignment [...]

Research paper thumbnail of An Artificial Neural Network Model for the Prediction of Perioperative Blood Transfusion in Adult Spinal Deformity Surgery

Journal of Clinical Medicine

Prediction of blood transfusion after adult spinal deformity (ASD) surgery can identify at-risk p... more Prediction of blood transfusion after adult spinal deformity (ASD) surgery can identify at-risk patients and potentially reduce its utilization and the complications associated with it. The use of artificial neural networks (ANNs) offers the potential for high predictive capability. A total of 1173 patients who underwent surgery for ASD were identified in the 2017–2019 NSQIP databases. The data were split into 70% training and 30% testing cohorts. Eighteen patient and operative variables were used. The outcome variable was receiving RBC transfusion intraoperatively or within 72 h after surgery. The model was assessed by its sensitivity, positive predictive value, F1-score, accuracy (ACC), and area under the curve (AUROC). Average patient age was 56 years and 63% were female. Pelvic fixation was performed in 21.3% of patients and three-column osteotomies in 19.5% of cases. The transfusion rate was 50.0% (586/1173 patients). The best model showed an overall ACC of 81% and 77% on the t...

Research paper thumbnail of The Effect of a Multidisciplinary Spine Clinic on Time to Care in Patients with Chronic Back and/or Leg Pain: A Propensity Score-Matched Analysis

Journal of Clinical Medicine

Chronic back and leg pain are leading causes of disability worldwide. The purpose of this study w... more Chronic back and leg pain are leading causes of disability worldwide. The purpose of this study was to compare the care in a unidisciplinary (USC) versus multidisciplinary (MSC) spine clinic, where patients are evaluated by different specialists during the same office visit. Adult patients presenting with a chief complaint of back and/or leg pain between June 2018 and July 2019 were assessed for eligibility. The main outcome measures included the first treatment recommendations, the time to treatment order, and the time to treatment occurrence. A 1:1 propensity score-matched analysis was performed on 874 patients (437 in each group). For all patients, the most common recommendation was physical therapy (41.4%), followed by injection (14.6%), and surgery (9.7%). Patients seen in the MSC were more likely to be recommended injection (p < 0.001) and less likely to be recommended surgery as first treatment (p = 0.001). They also had significantly shorter times to the injection order (...

Research paper thumbnail of Early Medical Complications and Delayed Discharge after Spinopelvic Fusion: A Comparative Analysis of 887 NSQIP Cases from 2006 to 2016

Spine Surgery and Related Research, 2020

Introduction: The effect of pelvic fixation on postoperative medical complications, blood transfu... more Introduction: The effect of pelvic fixation on postoperative medical complications, blood transfusion, length of hospital stay, and discharge disposition is poorly understood. Determining factors that predispose patients to increased complications after spinopelvic fusion will help surgeons to plan these complex procedures and optimize patients preoperatively. Methods: We conducted a retrospective cohort study using data from the ACS-NSQIP database between 2006 and 2016 of patients who underwent lumbar fusion with and without spinopelvic fixation. Data regarding demographics, complications, hospital stay, and discharge disposition were collected. Results: A total of 57,417 (98.5%) cases of lumbar fusion without spinopelvic fixation (LF) and 887 (1.5%) cases of lumbar fusion with spinopelvic fixation (SPF) were analyzed. The transfusion rate in the SPF group was 59.3% vs 13% in the LF group (p < 0.001). The mean length of stay (LOS) and discharge to skilled nursing facility (SNF) were significantly different (LOS: SPF 6.5 days vs LF 3.5 days p < 0.001; SNF: SPF 21.3% vs LF 10.4% p < 0.001). After controlling for demographic differences, the overall complication rates were not significantly different between the groups (p = 0.531). The odds ratio for transfusion in the SPF group was 2.9 (p < 0.001). The odds ratio for increased LOS and increased care discharge disposition were elevated in the SPF group (LOS OR: 1.3, p < 0.012, Discharge disposition OR: 1.8, p < 0.001). Conclusions: Patients who underwent SPF had increased complications, transfusion rate, LOS, and discharge to SNF or subacute rehab facilities as compared with patients who underwent LF. SPF remains an effective technique for achieving lumbosacral arthrodesis. Surgeons should consider the implications of the associated complication profile for SPF and the value of preoperative optimization in a select cohort of patients.

Research paper thumbnail of Commentary: Sarcopenia as a Prognostic Factor for 90-Day and Overall Mortality in Patients Undergoing Spine Surgery for Metastatic Tumors: A Multi-Center Retrospective Cohort Study

Research paper thumbnail of Trends in the Use of Bone Morphogenetic Protein–2 in Adult Spinal Deformity Surgery: A 10-Year Analysis of 54 054 Patients

International Journal of Spine Surgery, 2018

Background: Bone morphogenetic protein-2 (BMP-2) is an available bone graft option in spinal fusi... more Background: Bone morphogenetic protein-2 (BMP-2) is an available bone graft option in spinal fusion surgery. The purpose of this study is to investigate the trends of BMP-2 utilization in adult spinal deformity (ASD) surgery. Methods: The Nationwide Inpatient Sample database from 2002 to 2011 was reviewed. Inclusion criteria were patients over 18 years of age who underwent spinal fusion for ASD. Trends of BMP-2 use were examined over time, as well as stratified based on patient and surgical characteristics. All analyses were done after application of discharge weights to produce national estimates. Results: There were 54 054 patients who met inclusion criteria and were included in this study. The overall rate of BMP-2 use was 39.7% (95% confidence interval 35.0%-44.3%). Overall, there was steady increase in its use over time, with the highest peak in 2009 (55.3% of all cases used BMP-2), and then a decrease up to 37.9% in 2011 (P , .001). The rate of BMP-2 use was significantly higher for patients older than 54 years of age (compared to patients ,54, P , .001). It was also higher in females (P ¼ .009), Caucasian patients (P ¼ .006), and Medicare patients (P ¼ .006). Its use was 28.6% in the Northeast, 38.1% in the South, 45.2% in the Midwest, and 48.2% in the West (P ¼ .035). Circumferential procedures had the highest rate of BMP-2 use (44.3%, P ¼ .045). Average total hospital charges were 152,4036117,454forpatientswhodidnotreceiveBMP−2and152,403 6 117,454 for patients who did not receive BMP-2 and 152,4036117,454forpatientswhodidnotreceiveBMP−2and205,426 6 137,561 for patients who did (P , .001). Conclusion: After analysis of a large nationwide database, it was found that the rate of BMP-2 use in ASD surgery is approximately 40%. There was a significant increase in use from 2002 to 2009, and a decrease thereafter. The highest rates of use were found in older patients, female patients, white patients, Medicare patients, circumferential approaches, and patients undergoing surgery in the Midwest and West regions.

Research paper thumbnail of Risk Factors for 30-Day Readmissions and Reoperations After 3-Column Osteotomy for Spinal Deformity

Global Spine Journal, 2018

Study Design: Retrospective study of a prospectively collected database. Objective: To investigat... more Study Design: Retrospective study of a prospectively collected database. Objective: To investigate the rate and risk factors for 30-day readmissions and reoperations after 3-column osteotomy (3CO). Methods: The American College of Surgeons National Surgical Quality Improvement Program database (2012-2014) was reviewed. Inclusion criteria were adult patients who underwent 3CO. The rate of 30-day readmission/reoperation was examined, and the association between patient/operative characteristics and outcome was investigated via multivariate analysis. Results: There were 299 patients who underwent a 3CO for spinal deformity. The rate of 30-day readmission and reoperation was 11.0% and 8.4%, respectively; 7.7% of readmissions were related to the primary procedure and 3.3% were unrelated. The most common unique cause for readmission was wound infection in 27.2% of cases. Among reoperations, the most common unique indications were wound infection (20.0%) and implant-related complications (20.0%). On multivariate analysis, obesity (odds ratio [OR]

Research paper thumbnail of Spinal cord ischemia/infarct after cauda equina syndrome from disc herniation – A case study and literature review

Surgical Neurology International, 2019

Background: Spinal cord infarction is rare and occurs in 12/100,000; it represents 0.3%–2% of cen... more Background: Spinal cord infarction is rare and occurs in 12/100,000; it represents 0.3%–2% of central nervous system infarcts. Here, we present a patient who developed recurrent bilateral lower extremity paraplegia secondary to spinal cord infarction 1 day after a successful L4-5 microdiscectomy in a patient who originally presented with a cauda equina syndrome. Case Description: A 56-year-old patient presented with an acute cauda equina syndrome characterized by severe lower back pain, a right foot drop, saddle anesthesia, and acute urinary retention. When the lumbar magnetic resonance imaging (MRI) revealed a large right paracentral lumbar disc herniation at the L4-L5 level, the patient underwent an emergency minimally invasive right-sided L4-5 discectomy. Immediately, postoperatively, the patient regained normal function. However, 1 day later, while having a bowel movement, he immediately developed the recurrent paraplegia. The new lumbar MRI revealed acute ischemia and an infarc...

Research paper thumbnail of Predicting critical care unit-level complications after long-segment fusion procedures for adult spinal deformity

Journal of Spine Surgery, 2018

Background: To identify predictive factors for critical care unit-level complications (CCU compli... more Background: To identify predictive factors for critical care unit-level complications (CCU complication) after long-segment fusion procedures for adult spinal deformity (ASD). Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database [2010-2014] was reviewed. Only adult patients who underwent fusion of 7 or more spinal levels for ASD were included. CCU complications included intraoperative arrest/infarction, ventilation >48 hours, pulmonary embolism, renal failure requiring dialysis, cardiac arrest, myocardial infarction, unplanned intubation, septic shock, stroke, coma, or new neurological deficit. A stepwise multivariate regression was used to identify independent predictors of CCU complications. Results: Among 826 patients, the rate of CCU complications was 6.4%. On multivariate regression analysis, dependent functional status (P=0.004), combined approach (P=0.023), age (P=0.044), diabetes (P=0.048), and surgery for over 8 hours (P=0.080) were significantly associated with complication development. A simple scoring system was developed to predict complications with 0 points for patients aged <50, 1 point for patients between 50-70, 2 points for patients 70 or over, 1 point for diabetes, 2 points dependent functional status, 1 point for combined approach, and 1 point for surgery over 8 hours. The rate of CCU complications was 0.7%, 3.2%, 9.0%, and 12.6% for patients with 0, 1, 2, and 3+ points, respectively (P<0.001). Conclusions: The findings in this study suggest that older patients, patients with diabetes, patients who depend on others for activities of daily living, and patients who undergo combined approaches or surgery for over 8 hours may be at a significantly increased risk of developing a CCU-level complication after ASD surgery.

Research paper thumbnail of Multifocal Epidural Neurosarcoidosis Causing Spinal Cord Compression: A Case Report

Cureus, 2019

We describe a rare case of multifocal extramedullary epidural neurosarcoidosis that presented wit... more We describe a rare case of multifocal extramedullary epidural neurosarcoidosis that presented with myelopathy without motor deficits and perform a literature review for previous cases of epidural neurosarcoidosis. A 46-year-old woman presented with lower back pain, urinary incontinence, gait disturbance, and sensory loss without motor deficits. Spine magnetic resonance imaging (MRI) showed multiple epidural lesions, the largest causing spinal cord compression at the T5 level. A computed tomography (CT)-guided biopsy of the dominant lesion showed noncaseating granulomas consistent with neurosarcoidosis. She was treated with a course of dexamethasone and discharged home after a 10-day hospital course. She was discharged home on oral prednisone taper over a four-month period. At her latest follow-up, she is neurologically intact and gainfully employed. This case demonstrates that certain cases of epidural neurosarcoidosis causing spinal cord compression may be treated with medical therapy alone in the absence of severe neurological deficits.

Research paper thumbnail of Iliac screw versus S2 alar-iliac screw fixation in adults: a meta-analysis

Journal of Neurosurgery: Spine, 2018

OBJECTIVEIn a meta-analysis, the authors sought to compare outcomes after iliac screw (IS) versus... more OBJECTIVEIn a meta-analysis, the authors sought to compare outcomes after iliac screw (IS) versus S2 alar-iliac (S2AI) screw fixation in adult patients.METHODSA PubMed/MEDLINE database search was performed for studies comparing IS and S2AI screw fixation techniques in adults. Levels of evidence were assigned based on the North American Spine Society guidelines. Three outcomes were examined: 1) revision surgery rate secondary to mechanical failure or wound complications, 2) surgical site infection rate, and 3) screw prominence/pain. Data were pooled and outcomes compared between techniques. Absolute risk reductions (ARRs) were also calculated for outcome measures.RESULTSFive retrospective cohort studies (all level III evidence) were included in our analysis. A total of 323 adult patients were included—147 in the IS group (45.5%) and 176 in the S2AI group (54.5%). Overall, revision surgery due to mechanical failure or wound complications was needed in 66 of 323 patients (revision surg...

Research paper thumbnail of Effect of body mass index on surgical outcomes after posterior spinal fusion for adolescent idiopathic scoliosis

Neurosurgical Focus, 2017

OBJECTIVEObesity is an increasing public health concern in the pediatric population. The purpose ... more OBJECTIVEObesity is an increasing public health concern in the pediatric population. The purpose of this investigation was to examine the impact of body mass index (BMI) on 30-day outcomes after posterior spinal fusion for adolescent idiopathic scoliosis (AIS).METHODSThe American College of Surgeons National Surgical Quality Improvement Program Pediatric database (2013 and 2014) was reviewed. Patients 10–18 years of age who had undergone fusion of 7 or more spinal levels for AIS were included. Thirty-day outcomes (complications, readmissions, and reoperations) were compared based on patient BMI per age- and sex-adjusted growth charts as follows: normal weight (NW; BMI < 85th percentile), overweight (OW; BMI 85th–95th percentile), and obese (OB; BMI > 95th percentile).RESULTSPatients eligible for study numbered 2712 (80.1% female and 19.9% male) and had a mean age of 14.4 ± 1.8 years. Average BMI for the entire cohort was 21.9 ± 5.0 kg/m2; 2010 patients (74.1%) were classified ...

Research paper thumbnail of Large central lumbar disc herniation causing acute cauda equina syndrome with loss of evoked potentials during prone positioning for surgery

Surgical neurology international, 2018

Few studies in the literature discuss operative positioning for lumbar surgery precipitating acut... more Few studies in the literature discuss operative positioning for lumbar surgery precipitating acute cauda equina syndromes (CES). A 56-year-old male with a large L2-3-disc herniation was placed prone on a Jackson table. He immediately lost all motor and sensory evoked potentials. Signals returned to the baseline when surgery was aborted, and he was returned to the supine position. However, potentials were again lost when he was repositioned prone, following which the surgeons proceeded with surgical decompression with a good outcome. This case highlights the risk for patients with large acute lumbar disc herniation/stenosis and CES undergoing prone positioning for lumbar decompression. Here, despite the secondary loss of both sensory and motor evoked potentials, the patient successfully underwent lumbar decompressive surgery/discectomy performed on a Jackson table, resulting in full postoperative neurological recovery.

Research paper thumbnail of Thirty-day readmission and reoperation rates after single-level anterior cervical discectomy and fusion versus those after cervical disc replacement

Neurosurgical Focus, 2017

OBJECTIVE The goal of this study was to compare 30-day readmission and reoperation rates after si... more OBJECTIVE The goal of this study was to compare 30-day readmission and reoperation rates after single-level anterior cervical discectomy and fusion (ACDF) versus those after cervical disc replacement (CDR). METHODS The authors used the 2013–2014 American College of Surgeons National Surgical Quality Improvement Program database. Included were adult patients who underwent first-time single-level ACDF or CDR for cervical spondylosis or disc herniation. Primary outcome measures were readmission and/or reoperation within 30 days of the original surgery. Logistic regression analysis was used to assess the independent effect of the procedure (ACDF or CDR) on outcome, and results are presented as odds ratios with 95% confidence intervals. RESULTS A total of 6077 patients met the inclusion criteria; 5590 (92.0%) patients underwent single-level ACDF, and 487 (8.0%) patients underwent CDR. The readmission rates were 2.6% for ACDF and 0.4% for CDR (p = 0.003). When stratified according to age ...

Research paper thumbnail of In Reply to A Letter to the Editor regarding “The Impact of Hospital Teaching Status on Timing of Intervention, Inpatient Morbidity, and Mortality After Surgery for Vertebral Column Fractures with Spinal Cord Injury.”

Research paper thumbnail of Penetrating thoracic spinal cord injury with ice pick extending into the aorta. A technical note and review of the literature

Surgical Neurology International, 2016

Background: Penetrating spinal cord injuries pose a great challenge to both patients and the trea... more Background: Penetrating spinal cord injuries pose a great challenge to both patients and the treating physicians. Although the overall incidence of penetrating spinal cord injury is the highest in the military, the ubiquity of guns in our society continues to make penetrating spinal cord injury prevalent in the civilian population. These types of injuries are particularly complicated because, beyond the trauma to the neural elements and supporting structures, other organs can be affected and a team approach is required for successful treatment. Case Description: In this report, the authors present a unique case of an ice pick penetrating posteriorly through the spinal canal into the aorta. The described surgical management involved careful consideration and planning to prevent worsening vascular and neurological compromise. Among the challenges faced are neurological compromise, vascular injury, spinal instability, and cerebrospinal fluid leak. Conclusion: To the author's knowledge, this challenging case represents the first description of a successful removal of a penetrating thoracic spinal foreign body that terminated within the lumen of the thoracic aorta.

Research paper thumbnail of Prognostic value of preoperative Nurick grade and time with symptoms in patients with cervical myelopathy and gait impairment

World neurosurgery, Jan 5, 2017

To investigate the prognostic value of preoperative Nurick grade and time with symptoms for gait ... more To investigate the prognostic value of preoperative Nurick grade and time with symptoms for gait improvement and recovery in patients with ataxia secondary to cervical myelopathy. A retrospective chart review of all adult patients who underwent surgical decompression for cervical myelopathy between 1996 and 2013 was performed. Only adults with a Nurick grade of at least 2 or worse were included. Outcome measures included gait improvement and recovery. A total of 170 patients were identified. Gait improvement and gait recovery occurred in 57.7% and 45.9% of patients, respectively. Time to improvement occurred as early as 1 month up to 24 months postoperatively. A higher preoperative Nurick grade was associated with lower odds of gait improvement (OR 0.74; 95% CI, 0.53 - 0.99, p=0.048) and gait recovery (OR 0.27; 95% CI, 0.17 - 0.43, p<0.001). The proportion of patients with symptoms for 12 months or less that experienced gait improvement was 71.2%, compared to 36.4% for patients w...

Research paper thumbnail of Ultra-delayed lumbar surgical wound hematoma

Surgical Neurology International, 2016

Background: There exists an inherent risk of increased venous thromboembolism (VTE) in surgical s... more Background: There exists an inherent risk of increased venous thromboembolism (VTE) in surgical spine patients, which is independent of their existing risk factors. Prophylaxis and treatment of VTE is an imprecise practice and may have serious complications even well after the initial surgery. Furthermore, there are no clear guidelines on how to manage postoperative spine patients with regards to the timing of anticoagulation. Case Description: Here, we present the case of a middle-aged male, status post L2/3 laminectomy and discectomy who developed bilateral below the knee deep venous thrombosis. He was started on Enoxaparin and transitioned to Warfarin and returned with axial back pain, and was found to have a postoperative hematoma almost 3 weeks later in a delayed fashion. Conclusion: Delayed surgical wound hematoma with neural compression is an important complication to identify and should remain high on the differential diagnosis in patients on warfarin who present with axial spinal pain.

Research paper thumbnail of Ollier disease with anaplastic astrocytoma: A review of the literature and a unique case

Surgical neurology international, 2016

Ollier disease is a rare, nonfamilial disorder that primary affects the long bones and cartilage ... more Ollier disease is a rare, nonfamilial disorder that primary affects the long bones and cartilage of joints with multiple enchondromas. It is associated with a higher risk of central nervous system (CNS) malignancies; although the incidence is unknown. Here, we present the case of a 55-year-old woman who developed an anaplastic astrocytoma with a known diagnosis of Ollier disease with a survival time of over 3 years. This report draws attention to the rarity of this disease and the paucity of information regarding CNS involvement in Ollier disease, as well as reviews the current literature.

Research paper thumbnail of Blood loss after total en bloc spondylectomy

Journal of Spine Surgery

Blood loss in total en bloc spondylectomy for primary spinal bone tumours: a comparison of estima... more Blood loss in total en bloc spondylectomy for primary spinal bone tumours: a comparison of estimated blood loss versus actual blood loss in a single centre over 10 years.

Research paper thumbnail of Advancements and Updates on Operative Techniques in Spinal Deformity

Journal of Clinical Medicine

Spinal deformity involves a spectrum of abnormal spinal curvatures deviating from normal alignmen... more Spinal deformity involves a spectrum of abnormal spinal curvatures deviating from normal alignment [...]

Research paper thumbnail of An Artificial Neural Network Model for the Prediction of Perioperative Blood Transfusion in Adult Spinal Deformity Surgery

Journal of Clinical Medicine

Prediction of blood transfusion after adult spinal deformity (ASD) surgery can identify at-risk p... more Prediction of blood transfusion after adult spinal deformity (ASD) surgery can identify at-risk patients and potentially reduce its utilization and the complications associated with it. The use of artificial neural networks (ANNs) offers the potential for high predictive capability. A total of 1173 patients who underwent surgery for ASD were identified in the 2017–2019 NSQIP databases. The data were split into 70% training and 30% testing cohorts. Eighteen patient and operative variables were used. The outcome variable was receiving RBC transfusion intraoperatively or within 72 h after surgery. The model was assessed by its sensitivity, positive predictive value, F1-score, accuracy (ACC), and area under the curve (AUROC). Average patient age was 56 years and 63% were female. Pelvic fixation was performed in 21.3% of patients and three-column osteotomies in 19.5% of cases. The transfusion rate was 50.0% (586/1173 patients). The best model showed an overall ACC of 81% and 77% on the t...

Research paper thumbnail of The Effect of a Multidisciplinary Spine Clinic on Time to Care in Patients with Chronic Back and/or Leg Pain: A Propensity Score-Matched Analysis

Journal of Clinical Medicine

Chronic back and leg pain are leading causes of disability worldwide. The purpose of this study w... more Chronic back and leg pain are leading causes of disability worldwide. The purpose of this study was to compare the care in a unidisciplinary (USC) versus multidisciplinary (MSC) spine clinic, where patients are evaluated by different specialists during the same office visit. Adult patients presenting with a chief complaint of back and/or leg pain between June 2018 and July 2019 were assessed for eligibility. The main outcome measures included the first treatment recommendations, the time to treatment order, and the time to treatment occurrence. A 1:1 propensity score-matched analysis was performed on 874 patients (437 in each group). For all patients, the most common recommendation was physical therapy (41.4%), followed by injection (14.6%), and surgery (9.7%). Patients seen in the MSC were more likely to be recommended injection (p < 0.001) and less likely to be recommended surgery as first treatment (p = 0.001). They also had significantly shorter times to the injection order (...

Research paper thumbnail of Early Medical Complications and Delayed Discharge after Spinopelvic Fusion: A Comparative Analysis of 887 NSQIP Cases from 2006 to 2016

Spine Surgery and Related Research, 2020

Introduction: The effect of pelvic fixation on postoperative medical complications, blood transfu... more Introduction: The effect of pelvic fixation on postoperative medical complications, blood transfusion, length of hospital stay, and discharge disposition is poorly understood. Determining factors that predispose patients to increased complications after spinopelvic fusion will help surgeons to plan these complex procedures and optimize patients preoperatively. Methods: We conducted a retrospective cohort study using data from the ACS-NSQIP database between 2006 and 2016 of patients who underwent lumbar fusion with and without spinopelvic fixation. Data regarding demographics, complications, hospital stay, and discharge disposition were collected. Results: A total of 57,417 (98.5%) cases of lumbar fusion without spinopelvic fixation (LF) and 887 (1.5%) cases of lumbar fusion with spinopelvic fixation (SPF) were analyzed. The transfusion rate in the SPF group was 59.3% vs 13% in the LF group (p < 0.001). The mean length of stay (LOS) and discharge to skilled nursing facility (SNF) were significantly different (LOS: SPF 6.5 days vs LF 3.5 days p < 0.001; SNF: SPF 21.3% vs LF 10.4% p < 0.001). After controlling for demographic differences, the overall complication rates were not significantly different between the groups (p = 0.531). The odds ratio for transfusion in the SPF group was 2.9 (p < 0.001). The odds ratio for increased LOS and increased care discharge disposition were elevated in the SPF group (LOS OR: 1.3, p < 0.012, Discharge disposition OR: 1.8, p < 0.001). Conclusions: Patients who underwent SPF had increased complications, transfusion rate, LOS, and discharge to SNF or subacute rehab facilities as compared with patients who underwent LF. SPF remains an effective technique for achieving lumbosacral arthrodesis. Surgeons should consider the implications of the associated complication profile for SPF and the value of preoperative optimization in a select cohort of patients.

Research paper thumbnail of Commentary: Sarcopenia as a Prognostic Factor for 90-Day and Overall Mortality in Patients Undergoing Spine Surgery for Metastatic Tumors: A Multi-Center Retrospective Cohort Study

Research paper thumbnail of Trends in the Use of Bone Morphogenetic Protein–2 in Adult Spinal Deformity Surgery: A 10-Year Analysis of 54 054 Patients

International Journal of Spine Surgery, 2018

Background: Bone morphogenetic protein-2 (BMP-2) is an available bone graft option in spinal fusi... more Background: Bone morphogenetic protein-2 (BMP-2) is an available bone graft option in spinal fusion surgery. The purpose of this study is to investigate the trends of BMP-2 utilization in adult spinal deformity (ASD) surgery. Methods: The Nationwide Inpatient Sample database from 2002 to 2011 was reviewed. Inclusion criteria were patients over 18 years of age who underwent spinal fusion for ASD. Trends of BMP-2 use were examined over time, as well as stratified based on patient and surgical characteristics. All analyses were done after application of discharge weights to produce national estimates. Results: There were 54 054 patients who met inclusion criteria and were included in this study. The overall rate of BMP-2 use was 39.7% (95% confidence interval 35.0%-44.3%). Overall, there was steady increase in its use over time, with the highest peak in 2009 (55.3% of all cases used BMP-2), and then a decrease up to 37.9% in 2011 (P , .001). The rate of BMP-2 use was significantly higher for patients older than 54 years of age (compared to patients ,54, P , .001). It was also higher in females (P ¼ .009), Caucasian patients (P ¼ .006), and Medicare patients (P ¼ .006). Its use was 28.6% in the Northeast, 38.1% in the South, 45.2% in the Midwest, and 48.2% in the West (P ¼ .035). Circumferential procedures had the highest rate of BMP-2 use (44.3%, P ¼ .045). Average total hospital charges were 152,4036117,454forpatientswhodidnotreceiveBMP−2and152,403 6 117,454 for patients who did not receive BMP-2 and 152,4036117,454forpatientswhodidnotreceiveBMP−2and205,426 6 137,561 for patients who did (P , .001). Conclusion: After analysis of a large nationwide database, it was found that the rate of BMP-2 use in ASD surgery is approximately 40%. There was a significant increase in use from 2002 to 2009, and a decrease thereafter. The highest rates of use were found in older patients, female patients, white patients, Medicare patients, circumferential approaches, and patients undergoing surgery in the Midwest and West regions.

Research paper thumbnail of Risk Factors for 30-Day Readmissions and Reoperations After 3-Column Osteotomy for Spinal Deformity

Global Spine Journal, 2018

Study Design: Retrospective study of a prospectively collected database. Objective: To investigat... more Study Design: Retrospective study of a prospectively collected database. Objective: To investigate the rate and risk factors for 30-day readmissions and reoperations after 3-column osteotomy (3CO). Methods: The American College of Surgeons National Surgical Quality Improvement Program database (2012-2014) was reviewed. Inclusion criteria were adult patients who underwent 3CO. The rate of 30-day readmission/reoperation was examined, and the association between patient/operative characteristics and outcome was investigated via multivariate analysis. Results: There were 299 patients who underwent a 3CO for spinal deformity. The rate of 30-day readmission and reoperation was 11.0% and 8.4%, respectively; 7.7% of readmissions were related to the primary procedure and 3.3% were unrelated. The most common unique cause for readmission was wound infection in 27.2% of cases. Among reoperations, the most common unique indications were wound infection (20.0%) and implant-related complications (20.0%). On multivariate analysis, obesity (odds ratio [OR]

Research paper thumbnail of Spinal cord ischemia/infarct after cauda equina syndrome from disc herniation – A case study and literature review

Surgical Neurology International, 2019

Background: Spinal cord infarction is rare and occurs in 12/100,000; it represents 0.3%–2% of cen... more Background: Spinal cord infarction is rare and occurs in 12/100,000; it represents 0.3%–2% of central nervous system infarcts. Here, we present a patient who developed recurrent bilateral lower extremity paraplegia secondary to spinal cord infarction 1 day after a successful L4-5 microdiscectomy in a patient who originally presented with a cauda equina syndrome. Case Description: A 56-year-old patient presented with an acute cauda equina syndrome characterized by severe lower back pain, a right foot drop, saddle anesthesia, and acute urinary retention. When the lumbar magnetic resonance imaging (MRI) revealed a large right paracentral lumbar disc herniation at the L4-L5 level, the patient underwent an emergency minimally invasive right-sided L4-5 discectomy. Immediately, postoperatively, the patient regained normal function. However, 1 day later, while having a bowel movement, he immediately developed the recurrent paraplegia. The new lumbar MRI revealed acute ischemia and an infarc...

Research paper thumbnail of Predicting critical care unit-level complications after long-segment fusion procedures for adult spinal deformity

Journal of Spine Surgery, 2018

Background: To identify predictive factors for critical care unit-level complications (CCU compli... more Background: To identify predictive factors for critical care unit-level complications (CCU complication) after long-segment fusion procedures for adult spinal deformity (ASD). Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database [2010-2014] was reviewed. Only adult patients who underwent fusion of 7 or more spinal levels for ASD were included. CCU complications included intraoperative arrest/infarction, ventilation >48 hours, pulmonary embolism, renal failure requiring dialysis, cardiac arrest, myocardial infarction, unplanned intubation, septic shock, stroke, coma, or new neurological deficit. A stepwise multivariate regression was used to identify independent predictors of CCU complications. Results: Among 826 patients, the rate of CCU complications was 6.4%. On multivariate regression analysis, dependent functional status (P=0.004), combined approach (P=0.023), age (P=0.044), diabetes (P=0.048), and surgery for over 8 hours (P=0.080) were significantly associated with complication development. A simple scoring system was developed to predict complications with 0 points for patients aged <50, 1 point for patients between 50-70, 2 points for patients 70 or over, 1 point for diabetes, 2 points dependent functional status, 1 point for combined approach, and 1 point for surgery over 8 hours. The rate of CCU complications was 0.7%, 3.2%, 9.0%, and 12.6% for patients with 0, 1, 2, and 3+ points, respectively (P<0.001). Conclusions: The findings in this study suggest that older patients, patients with diabetes, patients who depend on others for activities of daily living, and patients who undergo combined approaches or surgery for over 8 hours may be at a significantly increased risk of developing a CCU-level complication after ASD surgery.

Research paper thumbnail of Multifocal Epidural Neurosarcoidosis Causing Spinal Cord Compression: A Case Report

Cureus, 2019

We describe a rare case of multifocal extramedullary epidural neurosarcoidosis that presented wit... more We describe a rare case of multifocal extramedullary epidural neurosarcoidosis that presented with myelopathy without motor deficits and perform a literature review for previous cases of epidural neurosarcoidosis. A 46-year-old woman presented with lower back pain, urinary incontinence, gait disturbance, and sensory loss without motor deficits. Spine magnetic resonance imaging (MRI) showed multiple epidural lesions, the largest causing spinal cord compression at the T5 level. A computed tomography (CT)-guided biopsy of the dominant lesion showed noncaseating granulomas consistent with neurosarcoidosis. She was treated with a course of dexamethasone and discharged home after a 10-day hospital course. She was discharged home on oral prednisone taper over a four-month period. At her latest follow-up, she is neurologically intact and gainfully employed. This case demonstrates that certain cases of epidural neurosarcoidosis causing spinal cord compression may be treated with medical therapy alone in the absence of severe neurological deficits.

Research paper thumbnail of Iliac screw versus S2 alar-iliac screw fixation in adults: a meta-analysis

Journal of Neurosurgery: Spine, 2018

OBJECTIVEIn a meta-analysis, the authors sought to compare outcomes after iliac screw (IS) versus... more OBJECTIVEIn a meta-analysis, the authors sought to compare outcomes after iliac screw (IS) versus S2 alar-iliac (S2AI) screw fixation in adult patients.METHODSA PubMed/MEDLINE database search was performed for studies comparing IS and S2AI screw fixation techniques in adults. Levels of evidence were assigned based on the North American Spine Society guidelines. Three outcomes were examined: 1) revision surgery rate secondary to mechanical failure or wound complications, 2) surgical site infection rate, and 3) screw prominence/pain. Data were pooled and outcomes compared between techniques. Absolute risk reductions (ARRs) were also calculated for outcome measures.RESULTSFive retrospective cohort studies (all level III evidence) were included in our analysis. A total of 323 adult patients were included—147 in the IS group (45.5%) and 176 in the S2AI group (54.5%). Overall, revision surgery due to mechanical failure or wound complications was needed in 66 of 323 patients (revision surg...

Research paper thumbnail of Effect of body mass index on surgical outcomes after posterior spinal fusion for adolescent idiopathic scoliosis

Neurosurgical Focus, 2017

OBJECTIVEObesity is an increasing public health concern in the pediatric population. The purpose ... more OBJECTIVEObesity is an increasing public health concern in the pediatric population. The purpose of this investigation was to examine the impact of body mass index (BMI) on 30-day outcomes after posterior spinal fusion for adolescent idiopathic scoliosis (AIS).METHODSThe American College of Surgeons National Surgical Quality Improvement Program Pediatric database (2013 and 2014) was reviewed. Patients 10–18 years of age who had undergone fusion of 7 or more spinal levels for AIS were included. Thirty-day outcomes (complications, readmissions, and reoperations) were compared based on patient BMI per age- and sex-adjusted growth charts as follows: normal weight (NW; BMI < 85th percentile), overweight (OW; BMI 85th–95th percentile), and obese (OB; BMI > 95th percentile).RESULTSPatients eligible for study numbered 2712 (80.1% female and 19.9% male) and had a mean age of 14.4 ± 1.8 years. Average BMI for the entire cohort was 21.9 ± 5.0 kg/m2; 2010 patients (74.1%) were classified ...

Research paper thumbnail of Large central lumbar disc herniation causing acute cauda equina syndrome with loss of evoked potentials during prone positioning for surgery

Surgical neurology international, 2018

Few studies in the literature discuss operative positioning for lumbar surgery precipitating acut... more Few studies in the literature discuss operative positioning for lumbar surgery precipitating acute cauda equina syndromes (CES). A 56-year-old male with a large L2-3-disc herniation was placed prone on a Jackson table. He immediately lost all motor and sensory evoked potentials. Signals returned to the baseline when surgery was aborted, and he was returned to the supine position. However, potentials were again lost when he was repositioned prone, following which the surgeons proceeded with surgical decompression with a good outcome. This case highlights the risk for patients with large acute lumbar disc herniation/stenosis and CES undergoing prone positioning for lumbar decompression. Here, despite the secondary loss of both sensory and motor evoked potentials, the patient successfully underwent lumbar decompressive surgery/discectomy performed on a Jackson table, resulting in full postoperative neurological recovery.

Research paper thumbnail of Thirty-day readmission and reoperation rates after single-level anterior cervical discectomy and fusion versus those after cervical disc replacement

Neurosurgical Focus, 2017

OBJECTIVE The goal of this study was to compare 30-day readmission and reoperation rates after si... more OBJECTIVE The goal of this study was to compare 30-day readmission and reoperation rates after single-level anterior cervical discectomy and fusion (ACDF) versus those after cervical disc replacement (CDR). METHODS The authors used the 2013–2014 American College of Surgeons National Surgical Quality Improvement Program database. Included were adult patients who underwent first-time single-level ACDF or CDR for cervical spondylosis or disc herniation. Primary outcome measures were readmission and/or reoperation within 30 days of the original surgery. Logistic regression analysis was used to assess the independent effect of the procedure (ACDF or CDR) on outcome, and results are presented as odds ratios with 95% confidence intervals. RESULTS A total of 6077 patients met the inclusion criteria; 5590 (92.0%) patients underwent single-level ACDF, and 487 (8.0%) patients underwent CDR. The readmission rates were 2.6% for ACDF and 0.4% for CDR (p = 0.003). When stratified according to age ...

Research paper thumbnail of In Reply to A Letter to the Editor regarding “The Impact of Hospital Teaching Status on Timing of Intervention, Inpatient Morbidity, and Mortality After Surgery for Vertebral Column Fractures with Spinal Cord Injury.”

Research paper thumbnail of Penetrating thoracic spinal cord injury with ice pick extending into the aorta. A technical note and review of the literature

Surgical Neurology International, 2016

Background: Penetrating spinal cord injuries pose a great challenge to both patients and the trea... more Background: Penetrating spinal cord injuries pose a great challenge to both patients and the treating physicians. Although the overall incidence of penetrating spinal cord injury is the highest in the military, the ubiquity of guns in our society continues to make penetrating spinal cord injury prevalent in the civilian population. These types of injuries are particularly complicated because, beyond the trauma to the neural elements and supporting structures, other organs can be affected and a team approach is required for successful treatment. Case Description: In this report, the authors present a unique case of an ice pick penetrating posteriorly through the spinal canal into the aorta. The described surgical management involved careful consideration and planning to prevent worsening vascular and neurological compromise. Among the challenges faced are neurological compromise, vascular injury, spinal instability, and cerebrospinal fluid leak. Conclusion: To the author's knowledge, this challenging case represents the first description of a successful removal of a penetrating thoracic spinal foreign body that terminated within the lumen of the thoracic aorta.

Research paper thumbnail of Prognostic value of preoperative Nurick grade and time with symptoms in patients with cervical myelopathy and gait impairment

World neurosurgery, Jan 5, 2017

To investigate the prognostic value of preoperative Nurick grade and time with symptoms for gait ... more To investigate the prognostic value of preoperative Nurick grade and time with symptoms for gait improvement and recovery in patients with ataxia secondary to cervical myelopathy. A retrospective chart review of all adult patients who underwent surgical decompression for cervical myelopathy between 1996 and 2013 was performed. Only adults with a Nurick grade of at least 2 or worse were included. Outcome measures included gait improvement and recovery. A total of 170 patients were identified. Gait improvement and gait recovery occurred in 57.7% and 45.9% of patients, respectively. Time to improvement occurred as early as 1 month up to 24 months postoperatively. A higher preoperative Nurick grade was associated with lower odds of gait improvement (OR 0.74; 95% CI, 0.53 - 0.99, p=0.048) and gait recovery (OR 0.27; 95% CI, 0.17 - 0.43, p<0.001). The proportion of patients with symptoms for 12 months or less that experienced gait improvement was 71.2%, compared to 36.4% for patients w...

Research paper thumbnail of Ultra-delayed lumbar surgical wound hematoma

Surgical Neurology International, 2016

Background: There exists an inherent risk of increased venous thromboembolism (VTE) in surgical s... more Background: There exists an inherent risk of increased venous thromboembolism (VTE) in surgical spine patients, which is independent of their existing risk factors. Prophylaxis and treatment of VTE is an imprecise practice and may have serious complications even well after the initial surgery. Furthermore, there are no clear guidelines on how to manage postoperative spine patients with regards to the timing of anticoagulation. Case Description: Here, we present the case of a middle-aged male, status post L2/3 laminectomy and discectomy who developed bilateral below the knee deep venous thrombosis. He was started on Enoxaparin and transitioned to Warfarin and returned with axial back pain, and was found to have a postoperative hematoma almost 3 weeks later in a delayed fashion. Conclusion: Delayed surgical wound hematoma with neural compression is an important complication to identify and should remain high on the differential diagnosis in patients on warfarin who present with axial spinal pain.

Research paper thumbnail of Ollier disease with anaplastic astrocytoma: A review of the literature and a unique case

Surgical neurology international, 2016

Ollier disease is a rare, nonfamilial disorder that primary affects the long bones and cartilage ... more Ollier disease is a rare, nonfamilial disorder that primary affects the long bones and cartilage of joints with multiple enchondromas. It is associated with a higher risk of central nervous system (CNS) malignancies; although the incidence is unknown. Here, we present the case of a 55-year-old woman who developed an anaplastic astrocytoma with a known diagnosis of Ollier disease with a survival time of over 3 years. This report draws attention to the rarity of this disease and the paucity of information regarding CNS involvement in Ollier disease, as well as reviews the current literature.