John Caridi | The Mount Sinai School of Medicine (original) (raw)

Papers by John Caridi

Research paper thumbnail of Enhanced Recovery After Neurosurgery: Paradigm Shift and Call to Arms

Research paper thumbnail of Coagulation Profile as a Risk Factor for 30- Day Morbidity and Mortality Following Posterior Lumbar Fusion

SPINE, 2016

Retrospective cohort study. To identify associations between abnormal coagulation profile and pos... more Retrospective cohort study. To identify associations between abnormal coagulation profile and postoperative morbidity and mortality in patients undergoing posterior lumbar fusion (PLF). The literature suggests that abnormal coagulation profile is associated with postoperative complications, notably the need for blood transfusion. However, there is little research that directly addresses the influence of coagulation profile on postoperative complications following PLF. The American College of Surgeons National Surgical Quality Improvement Program database (ACS-NSQIP) was utilized to identify patients undergoing PLF between 2006 and 2013. 9,295 patients met inclusion criteria. Multivariate analysis was utilized to identify associations between abnormal coagulation profile and postoperative complications. Low platelet count was an independent risk factor for organ space surgical site infections (SSI) (OR = 6.0, P < 0.001), ventilation > 48 hours (OR = 4.5, P = 0.002), Acute renal failure (OR = 5.8, P = 0.007), transfusion (OR = 1.6, P < 0.001), sepsis (OR = 2.2, P = 0.037), reoperation (OR = 2.5, P = 0.001), and death (OR = 3.7, P = 0.049). High PTT was an independent risk factor for ventilation > 48 hours (OR = 5.6, P = 0.002), CVA/ stroke with neurological deficit (OR = 5.1, P = 0.011), cardiac arrest (OR = 5.4, P = 0.030), transfusion (OR = 1.5, P = 0.020), and death (OR = 4.5, P = 0.050). High INR was an independent risk factor for pneumonia (OR = 8.7, P = 0.001), pulmonary embolism (OR = 5.6, P = 0.021), DVT/ Thrombophlebitis (OR = 4.8, P = 0.011), Septic shock (OR = 8.4, P = 0.048), and death (OR = 9.8, P = 0.034). Bleeding disorder was an independent risk factor for organ space SSI (OR = 5.4, P = 0.01), pneumonia (OR = 3.0, P = 0.023), and sepsis (OR = 4.4, P < 0.001). Abnormal coagulation profile was an independent predictor of morbidity and mortality in patients undergoing PLF. As such, it should be considered in preoperative optimization and risk stratification.

Research paper thumbnail of A Comparative Analysis Among the SRS M&M, NIS, and KID Databases for the Adolescent Idiopathic Scoliosis

Spine Deformity, 2016

Retrospective cohort analysis. A growing number of publications have utilized the Scoliosis Resea... more Retrospective cohort analysis. A growing number of publications have utilized the Scoliosis Research Society (SRS) Morbidity and Mortality (M&M) database, but none have compared it to other large databases. The objective of this study was to compare SRS complications with those in administrative databases. The Nationwide Inpatient Sample (NIS) and Kid's Inpatient Database (KID) captured a greater number of overall complications while the SRS M&M data provided a greater incidence of spine-related complications following adolescent idiopathic scoliosis (AIS) surgery. Chi-square was used to obtain statistical significance, with p < .05 considered significant. The SRS 2004-2007 (9,904 patients), NIS 2004-2007 (20,441 patients) and KID 2003-2006 (10,184 patients) databases were analyzed for AIS patients who underwent fusion. Comparable variables were queried in all three databases, including patient demographics, surgical variables, and complications. Patients undergoing AIS in the SRS database were slightly older (SRS 14.4 years vs. NIS 13.8 years, p < .0001; KID 13.9 years, p < .0001) and less likely to be male (SRS 18.5% vs. NIS 26.3%, p < .0001; KID 24.8%, p < .0001). Revision surgery (SRS 3.3% vs. NIS 2.4%, p < .0001; KID 0.9%, p < .0001) and osteotomy (SRS 8% vs. NIS 2.3%, p < .0001; KID 2.4%, p < .0001) were more commonly reported in the SRS database. The SRS database reported fewer overall complications (SRS 3.9% vs. NIS 7.3%, p < .0001; KID 6.6%, p < .0001). However, when respiratory complications (SRS 0.5% vs. NIS 3.7%, p < .0001; KID 4.4%, p < .0001) were excluded, medical complication rates were similar across databases. In contrast, SRS reported higher spine-specific complication rates. Mortality rates were similar between SRS versus NIS (p = .280) and SRS versus KID (p = .08) databases. There are similarities and differences between the three databases. These discrepancies are likely due to the varying data-gathering methods each organization uses to collect their morbidity data. Level IV.

Research paper thumbnail of Frailty Index is a Significant Predictor of Complications and Mortality Following Surgery for Adult Spinal Deformity

Spine, Jan 31, 2016

Retrospective study of prospectively collected data. To determine if the modified frailty index (... more Retrospective study of prospectively collected data. To determine if the modified frailty index (mFI) could be used to predict postoperative complications in patients undergoing surgery for adult spinal deformity (ASD). Surgery for patients with ASD is associated with high complication rates and significant concerns present during risk stratification with older patients. The mFI is an evaluation tool to describe the frailness of an individual and how their preoperative status may impact postoperative survival and outcomes. Using a large nationwide database we assessed the utility of this instrument in patients undergoing surgery for ASD. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) is a large multicenter clinical registry that prospectively collects preoperative variables, patient demographics, operative factors, and 30-day postoperative morbidity and mortality outcomes from about 400 hospitals nationwide. Current Procedural Terminology ...

Research paper thumbnail of To operate or not?: A literature review of surgical outcomes in 95 patients with Parkinson's disease undergoing spine surgery

Clinical Neurology and Neurosurgery, 2015

Degenerative spondylosis and kyphoscoliosis are increasingly recognized entities in patients with... more Degenerative spondylosis and kyphoscoliosis are increasingly recognized entities in patients with Parkinson's disease. Surgical treatment with spinal fusion can be complicated due to poor bone quality and muscular dysfunction in this patient population. The goal of this paper is to investigate surgical outcomes in Parkinson's patients undergoing spine surgery. We performed a literature review using the PubMed and Google Scholar search engines investigating "Parkinson's disease and spinal fusion surgery" from the period of 2000 to 2013. The inclusion criteria included only English articles with Parkinson's patients that underwent spinal surgery. We identified and reviewed all six articles that included ninety-five patients with Parkinson's disease who underwent spinal surgery. A total of 95 patients with Parkinson's disease who underwent spinal fusion surgery were reviewed with average patient age of 69 and a 3:4 male to female ratio. With an average follow up of 40 months, 46 out of 73 patients (63%) were judged to have satisfactory outcomes with poor outcomes noted in the remaining 37%. These included but were not limited to pseudoarthrosis, hardware failure/pullout, development of adjacent level disease, persistent kyphosis or sagittal imbalance, and no improvement or worsening in their postoperative visual analog pain scale. There was a 45% (29/65) revision rate and a 59% (30/51) complication rate following the index procedure. It remains unclear whether Parkinson's patients benefit from spinal fusion surgery. Further prospective research is warranted to investigate surgical outcomes in this subset of patients.

Research paper thumbnail of MRI evidence that glibenclamide reduces acute lesion expansion in a rat model of spinal cord injury

Spinal Cord, 2013

Study design: Experimental, controlled, animal study. Objectives: To use non-invasive magnetic re... more Study design: Experimental, controlled, animal study. Objectives: To use non-invasive magnetic resonance imaging (MRI) to corroborate invasive studies showing progressive expansion of a hemorrhagic lesion during the early hours after spinal cord trauma and to assess the effect of glibenclamide, which blocks Sur1-Trpm4 channels implicated in post-traumatic capillary fragmentation, on lesion expansion. Setting: Baltimore. Methods: Adult female Long-Evans rats underwent unilateral impact trauma to the spinal cord at C7, which produced ipsilateral but not contralateral primary hemorrhage. In series 1 (six control rats and six administered glibenclamide), hemorrhagic lesion expansion was characterized using MRI at 1 and 24 h after trauma. In series 2, hemorrhagic lesion size was characterized on coronal tissue sections at 15 min (eight rats) and at 24 h after trauma (eight control rats and eight administered glibenclamide). Results: MRI (T2 hypodensity) showed that lesions expanded 2.3±0.33-fold (Po0.001) during the first 24 h in control rats, but only 1.2 ± 0.07-fold (P40.05) in glibenclamide-treated rats. Measuring the areas of hemorrhagic contusion on tissue sections at the epicenter showed that lesions expanded 2.2 ± 0.12-fold (Po0.001) during the first 24 h in control rats, but only 1.1 ± 0.05-fold (P40.05) in glibenclamide-treated rats. Glibenclamide treatment was associated with significantly better neurological function (unilateral BBB scores) at 24 h in both the ipsilateral (median scores, 9 vs 0; Po0.001) and contralateral (median scores, 12 vs 2; Po0.001) hindlimbs. Conclusion: MRI is an accurate non-invasive imaging biomarker of lesion expansion and is a sensitive measure of the ability of glibenclamide to reduce lesion expansion.

Research paper thumbnail of Reoperations Following Cervical Disc Replacement

Asian Spine Journal, 2015

Cervical disc replacement (CDR) has emerged as an alternative surgical option to cervical arthrod... more Cervical disc replacement (CDR) has emerged as an alternative surgical option to cervical arthrodesis. With increasing numbers of patients and longer follow-ups, complications related to the device and/or aging spine are growing, leaving us with a new challenge in the management and surgical revision of CDR. The purpose of this study is to review the current literature regarding reoperations following CDR and to discuss about the approaches and solutions for the current and future potential complications associated with CDR. The published rates of reoperation (mean, 1.0%; range, 0%-3.1%), revision (mean, 0.2%; range, 0%-0.5%), and removal (mean, 1.2%; range, 0%-1.9%) following CDR are low and comparable to the published rates of reoperation (mean, 1.7%; range; 0%-3.4%), revision (mean, 1.5%; range, 0%-4.7%), and removal (mean, 2.0%; range, 0%-3.4%) following cervical arthrodesis. The surgical interventions following CDR range from the repositioning to explantation followed by fusion or the reimplantation to posterior foraminotomy or fusion. Strict patient selection, careful preoperative radiographic review and surgical planning, as well as surgical technique may reduce adverse events and the need for future intervention. Minimal literature and no guidelines exist for the approaches and techniques in revision and for the removal of implants following CDR. Adherence to strict indications and precise surgical technique may reduce the number of reoperations, revisions, and removals following CDR. Long-term follow-up studies are needed, assessing the implant survivorship and its effect on the revision and removal rates.

Research paper thumbnail of Association Between Surgeon Experience and Complication Rates in Adult Scoliosis Surgery: A Review of 5,117 Cases from the Scoliosis Research Society Database 2004-2007

Spine, Jan 20, 2015

Retrospective review of a multicenter database. To evaluate whether surgeon experience is associa... more Retrospective review of a multicenter database. To evaluate whether surgeon experience is associated with complication rates in adult spinal deformity (ASD) surgery. Multiple patient- and surgery-related factors have been shown to increase the risk of complications in ASD. No study exists evaluating surgeon experience as an associated factor with complications in ASD. The Scoliosis Research Society Morbidity and Mortality database was queried for patients aged >18 years who underwent ASD from 2004-2007. Patient demographics, surgical characteristics, complications and surgeon membership status were analyzed. Two-tailed t-test and chi-square tests were performed with p<0.05 considered significant. A total of 5,117 patients underwent ASD surgery. The average patient age was 51.8 years. Patients operated by candidate members were older than those operated by active members (53.1 versus 51.4, p = 0.003). Active members performed 3,836 (75%) cases while candidate members performed ...

Research paper thumbnail of The 100 Most Influential Articles in Cervical Spine Surgery

Global Spine Journal, 2015

Study Design Literature review. Objective To identify and analyze the top 100 cited articles in c... more Study Design Literature review. Objective To identify and analyze the top 100 cited articles in cervical spine surgery. Methods The Thomson Reuters Web of Knowledge was searched for citations of all articles relevant to cervical spine surgery. The number of citations, authorship, year of publication, journal of publication, country of publication, and institution were recorded for each article. Results The most cited article was the classic from 1991 by Vernon and Mior that described the Neck Disability Index. The second most cited was Smith&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 1958 article describing the anterior cervical diskectomy and fusion procedure. The third most cited article was Hilibrand&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 1999 publication evaluating the incidence, prevalence, and radiographic progression of symptomatic adjacent segment disease following anterior cervical arthrodesis. The majority of the articles originated in the United States (65), and most were published in Spine (39). Most articles were published in the 1990s (34), and the three most common topics were cervical fusion (17), surgical complications (9), and biomechanics (9), respectively. Author Abumi had four articles in the top 100 list, and authors Goffin, Panjabi, and Hadley had three each. The Department of Orthopaedic Surgery at Hokkaido University in Sapporo, Japan, had five articles in the top 100 list. Conclusion This report identifies the top 100 articles in cervical spine surgery and acknowledges those individuals who have contributed the most to the advancement of the study of the cervical spine and the body of knowledge used to guide evidence-based clinical decision making in cervical spine surgery today.

Research paper thumbnail of Posterior-Only Circumferential Decompression and Reconstruction in the Surgical Management of Lumbar Vertebral Osteomyelitis

Global Spine Journal, 2015

Study Design Case report. Objective The purpose of this report is to discuss the surgical managem... more Study Design Case report. Objective The purpose of this report is to discuss the surgical management of lumbar vertebral osteomyelitis with a spinal epidural abscess (SEA) and present a single-stage, posterior-only circumferential decompression and reconstruction with instrumentation using an expandable titanium cage and without segmental nerve root sacrifice as an option in the treatment of this disease process. Methods We report a 42-year-old man who presented with 3 days of low back pain and chills who rapidly decompensated with severe sepsis following admission. Magnetic resonance imaging of his lumbosacral spine revealed intramuscular abscesses of the left paraspinal musculature and iliopsoas with SEA and L4 vertebral body involvement. The patient failed maximal medical treatment, which necessitated surgical treatment as a last resort for infectious source control. He underwent a previously undescribed procedure in the setting of SEA: a single-stage, posterior-only approach for circumferential decompression and reconstruction of the L4 vertebral body with posterior segmental instrumented fixation. Results After the surgery, the patient&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 condition gradually improved; however, he suffered a wound dehiscence necessitating a surgical exploration and deep wound debridement. Six months after the surgery, the patient underwent a revision surgery for adjacent-level pseudarthrosis. At 1-year follow-up, the patient was pain-free and off narcotic pain medication and had returned to full activity. Conclusion This patient is the first reported case of lumbar osteomyelitis with SEA treated surgically with a single-stage, posterior-only circumferential decompression and reconstruction with posterior instrumentation. Although this approach is more technically challenging, it presents another viable option for the treatment of lumbar vertebral osteomyelitis that may reduce the morbidity associated with an anterior approach.

Research paper thumbnail of Curvularia abscess of the brainstem

World neurosurgery

To present a unique case of a brainstem Curvularia fungal infection and review the diagnosis and ... more To present a unique case of a brainstem Curvularia fungal infection and review the diagnosis and management of this rare phenomenon. A 33-year-old immunocompetent African American male presented with 2 weeks of headache, nausea, and vomiting in a setting of a recent 20-lb weight loss. Neurological examination was positive for multiple cranial nerve palsies, hemisensory loss, and gait instability. Magnetic resonance imaging demonstrated an enhancing medullary lesion. Metastatic and infectious workup revealed a left lung lesion, which on subsequent biopsy was positive for a granuloma yielding no further clues to the etiology of the brainstem lesion. On surgical exploration of the cranial lesion, a puss-filed, encapsulated lesion was encountered that was tightly adherent to the brainstem. Intraoperative biopsy of the lesion capsule was initially negative but on postoperative day 9, fungal hyphae were encountered identified on morphology as Curvularia species. The patient was started on...

Research paper thumbnail of Fatal Intraoperative Cardiac Arrest After Application of Surgifoam Into a Bleeding Iliac Screw Defect

Research paper thumbnail of The Top 100 Classic Papers in Lumbar Spine Surgery

Spine, 2015

Study Design. Bibliometric review of the literature. Objective. To analyze and quantify the most ... more Study Design. Bibliometric review of the literature. Objective. To analyze and quantify the most frequently cited papers in lumbar spine surgery and to measure their impact on the entire lumbar spine literature. Summary of Background Data. Lumbar spine surgery is a dynamic and complex fi eld. Basic science and clinical research remain paramount in understanding and advancing the fi eld. While new literature is published at increasing rates, few studies make long-lasting impacts. Methods. The Thomson Reuters Web of Knowledge was searched for citations of all papers relevant to lumbar spine surgery. The number of citations, authorship, year of publication, journal of publication, country of publication, and institution were recorded for each paper. Results. The most cited paper was found to be the classic paper from 1990 by Boden et al that described magnetic resonance imaging fi ndings in individuals without back pain, sciatica, and neurogenic claudication showing that spinal stenosis and herniated discs can be incidentally found when scanning patients. The second most cited study similarly showed that asymptomatic patients who underwent lumbar spine magnetic resonance imaging frequently had lumbar pathology. The third most cited paper was the 2000 publication of Fairbank and Pynsent reviewing the Oswestry Disability Index, the outcome-measure questionnaire most commonly used to evaluate low back pain. The majority of the papers originate in the United States (n = 58), and most were published in Spine (n = 63). Most papers were published in the 1990s (n = 49), and the 3 most common topics were low back pain, biomechanics, and disc degeneration. Conclusion. This report identifi es the top 100 papers in lumbar spine surgery and acknowledges those individuals who have From the The Thomson Reuters Web of Science, a research platform that provides bibliographic database services and ranks journals contributed the most to the advancement of the study of the lumbar spine and the body of knowledge used to guide evidence-based clinical decision making in lumbar spine surgery today. Classic Papers in Lumbar Spine Surgery • Steinberger et al Spine www.spinejournal.com 741

Research paper thumbnail of The finding of alleged tubercle bacilli in the blood

Research paper thumbnail of The Effect of Increasing Pedicle Screw Size on Thoracic Spinal Canal Dimensions

Spine, 2014

Objective. To determine whether the thoracic spinal canal diameter decreases when the pedicle is ... more Objective. To determine whether the thoracic spinal canal diameter decreases when the pedicle is allowed to expand with increasing screw diameter. To observe whether osseous breach occurs medially or laterally. Summary of Background Data. Insertion of a pedicle screw that is larger in diameter than that of the native pedicle has been shown to expand the pedicle and increase biomechanical fi xation strength. With this technique, there is concern for medial expansion of the pedicle causing decrease in spinal canal diameter, especially in the concavity of scoliosis, resulting in spinal cord compression. Also, large pedicle screws that are inserted correctly may still cause undetected medial bony breach during surgery. Methods. A total of 162 pedicles from 81 thoracic vertebrae (T1-T12) of 7 fresh-frozen adult cadavers were analyzed. After undertapping the pedicle by 1 mm, pedicle screws were inserted in increasing diameter (range, 4.0-9.5 mm) bilaterally until there was an osseous breach in the pedicle. A total of 938 screws were used. Transverse spinal canal diameter and pedicle circumference were measured (in millimeters) before and after each pedicle screw placement. Photographs and fl uoroscopic images of representative specimens were obtained for visual assessment. Results. The average transverse spinal canal diameter was 17.7 mm. The average transverse canal diameter with the largest screw inserted before bony breach was detected was 17.6 mm ( P = 0.92). The average diameter of the largest screw inserted before breach From the The manuscript submitted does not contain information about medical device(s)/drug(s).

Research paper thumbnail of Progressive multifocal leukoencephalopathy presenting as a single ring-enhancing lesion

Clinical Neurology and Neurosurgery, 2014

Research paper thumbnail of Meningioma: Viewpoint—Surgery

Principles and Practice of Stereotactic Radiosurgery, 2014

Research paper thumbnail of Meningioma: Surgery Perspective

Principles and Practice of Stereotactic Radiosurgery, 2008

... performed by Zanobi Pecchiolo (1801–1866) at Siena University. In a vast surgical series publ... more ... performed by Zanobi Pecchiolo (1801–1866) at Siena University. In a vast surgical series published in 1847, 1524 cases were described, one of which was a large meningioma removed from the right sinciput through a triangular flap. Then on December 15, 1887, William W ...

Research paper thumbnail of Outcomes and Trends of Parkinson’s Disease Patients undergoing Degenerative Lumbar Spine Surgery

Research paper thumbnail of The 100 Classic Papers in Spinal Deformity Surgery

Spine Deformity, 2014

Bibliometric review of the literature. To identify and analyze the top 100 cited articles in spin... more Bibliometric review of the literature. To identify and analyze the top 100 cited articles in spinal deformity surgery. The field of spinal deformity surgery is an ever-growing and complex field that owes its development to the work and visions of many dedicated individuals. The authors searched the Thomson Reuters Web of Knowledge for citations of all articles relevant to scoliosis and spinal deformity surgery. The number of citations, authorship, year, journal, and country and institution of publication were recorded for each article. The most cited article was the 2001 work by Lenke et al. describing a new 2-dimensional classification system of adolescent idiopathic scoliosis used to determine the appropriate vertebral levels to be included in an arthrodesis. The second most cited was Harrington&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s 1962 article describing the first instrumented method for the treatment of scoliosis. The third most cited article was the 1983 study by King et al. recommending specific vertebral levels for inclusion into spinal arthrodesis. Most articles originated in the United States (62), and most were published in Spine (32). Most were published in the 1990s (28), and the 3 most common topics, in descending order, were adolescent idiopathic scoliosis (28), spinal instrumentation (18), and surgical complications (5). Author Suk had 5 articles in the top 100 list, whereas authors Kim, Liljenqvist, Lonstein, and Weinstein had 3 each. Washington University in St. Louis had 7 articles in the top 100 list. This report&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s identification of the 100 classic articles in spinal deformity surgery allows insight into the development and trends of this challenging subspecialty of spine surgery. Furthermore, this article identifies individuals who have contributed the most to the advancement of spinal deformity surgery and the body of knowledge used to guide evidence-based clinical decision making in spinal deformity surgery today.

Research paper thumbnail of Enhanced Recovery After Neurosurgery: Paradigm Shift and Call to Arms

Research paper thumbnail of Coagulation Profile as a Risk Factor for 30- Day Morbidity and Mortality Following Posterior Lumbar Fusion

SPINE, 2016

Retrospective cohort study. To identify associations between abnormal coagulation profile and pos... more Retrospective cohort study. To identify associations between abnormal coagulation profile and postoperative morbidity and mortality in patients undergoing posterior lumbar fusion (PLF). The literature suggests that abnormal coagulation profile is associated with postoperative complications, notably the need for blood transfusion. However, there is little research that directly addresses the influence of coagulation profile on postoperative complications following PLF. The American College of Surgeons National Surgical Quality Improvement Program database (ACS-NSQIP) was utilized to identify patients undergoing PLF between 2006 and 2013. 9,295 patients met inclusion criteria. Multivariate analysis was utilized to identify associations between abnormal coagulation profile and postoperative complications. Low platelet count was an independent risk factor for organ space surgical site infections (SSI) (OR = 6.0, P &amp;amp;amp;amp;lt; 0.001), ventilation &amp;amp;amp;amp;gt; 48 hours (OR = 4.5, P = 0.002), Acute renal failure (OR = 5.8, P = 0.007), transfusion (OR = 1.6, P &amp;amp;amp;amp;lt; 0.001), sepsis (OR = 2.2, P = 0.037), reoperation (OR = 2.5, P = 0.001), and death (OR = 3.7, P = 0.049). High PTT was an independent risk factor for ventilation &amp;amp;amp;amp;gt; 48 hours (OR = 5.6, P = 0.002), CVA/ stroke with neurological deficit (OR = 5.1, P = 0.011), cardiac arrest (OR = 5.4, P = 0.030), transfusion (OR = 1.5, P = 0.020), and death (OR = 4.5, P = 0.050). High INR was an independent risk factor for pneumonia (OR = 8.7, P = 0.001), pulmonary embolism (OR = 5.6, P = 0.021), DVT/ Thrombophlebitis (OR = 4.8, P = 0.011), Septic shock (OR = 8.4, P = 0.048), and death (OR = 9.8, P = 0.034). Bleeding disorder was an independent risk factor for organ space SSI (OR = 5.4, P = 0.01), pneumonia (OR = 3.0, P = 0.023), and sepsis (OR = 4.4, P &amp;amp;amp;amp;lt; 0.001). Abnormal coagulation profile was an independent predictor of morbidity and mortality in patients undergoing PLF. As such, it should be considered in preoperative optimization and risk stratification.

Research paper thumbnail of A Comparative Analysis Among the SRS M&M, NIS, and KID Databases for the Adolescent Idiopathic Scoliosis

Spine Deformity, 2016

Retrospective cohort analysis. A growing number of publications have utilized the Scoliosis Resea... more Retrospective cohort analysis. A growing number of publications have utilized the Scoliosis Research Society (SRS) Morbidity and Mortality (M&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;M) database, but none have compared it to other large databases. The objective of this study was to compare SRS complications with those in administrative databases. The Nationwide Inpatient Sample (NIS) and Kid&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 Inpatient Database (KID) captured a greater number of overall complications while the SRS M&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;M data provided a greater incidence of spine-related complications following adolescent idiopathic scoliosis (AIS) surgery. Chi-square was used to obtain statistical significance, with p &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;lt; .05 considered significant. The SRS 2004-2007 (9,904 patients), NIS 2004-2007 (20,441 patients) and KID 2003-2006 (10,184 patients) databases were analyzed for AIS patients who underwent fusion. Comparable variables were queried in all three databases, including patient demographics, surgical variables, and complications. Patients undergoing AIS in the SRS database were slightly older (SRS 14.4 years vs. NIS 13.8 years, p &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;lt; .0001; KID 13.9 years, p &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;lt; .0001) and less likely to be male (SRS 18.5% vs. NIS 26.3%, p &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;lt; .0001; KID 24.8%, p &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;lt; .0001). Revision surgery (SRS 3.3% vs. NIS 2.4%, p &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;lt; .0001; KID 0.9%, p &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;lt; .0001) and osteotomy (SRS 8% vs. NIS 2.3%, p &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;lt; .0001; KID 2.4%, p &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;lt; .0001) were more commonly reported in the SRS database. The SRS database reported fewer overall complications (SRS 3.9% vs. NIS 7.3%, p &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;lt; .0001; KID 6.6%, p &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;lt; .0001). However, when respiratory complications (SRS 0.5% vs. NIS 3.7%, p &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;lt; .0001; KID 4.4%, p &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;lt; .0001) were excluded, medical complication rates were similar across databases. In contrast, SRS reported higher spine-specific complication rates. Mortality rates were similar between SRS versus NIS (p = .280) and SRS versus KID (p = .08) databases. There are similarities and differences between the three databases. These discrepancies are likely due to the varying data-gathering methods each organization uses to collect their morbidity data. Level IV.

Research paper thumbnail of Frailty Index is a Significant Predictor of Complications and Mortality Following Surgery for Adult Spinal Deformity

Spine, Jan 31, 2016

Retrospective study of prospectively collected data. To determine if the modified frailty index (... more Retrospective study of prospectively collected data. To determine if the modified frailty index (mFI) could be used to predict postoperative complications in patients undergoing surgery for adult spinal deformity (ASD). Surgery for patients with ASD is associated with high complication rates and significant concerns present during risk stratification with older patients. The mFI is an evaluation tool to describe the frailness of an individual and how their preoperative status may impact postoperative survival and outcomes. Using a large nationwide database we assessed the utility of this instrument in patients undergoing surgery for ASD. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) is a large multicenter clinical registry that prospectively collects preoperative variables, patient demographics, operative factors, and 30-day postoperative morbidity and mortality outcomes from about 400 hospitals nationwide. Current Procedural Terminology ...

Research paper thumbnail of To operate or not?: A literature review of surgical outcomes in 95 patients with Parkinson's disease undergoing spine surgery

Clinical Neurology and Neurosurgery, 2015

Degenerative spondylosis and kyphoscoliosis are increasingly recognized entities in patients with... more Degenerative spondylosis and kyphoscoliosis are increasingly recognized entities in patients with Parkinson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease. Surgical treatment with spinal fusion can be complicated due to poor bone quality and muscular dysfunction in this patient population. The goal of this paper is to investigate surgical outcomes in Parkinson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s patients undergoing spine surgery. We performed a literature review using the PubMed and Google Scholar search engines investigating &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Parkinson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease and spinal fusion surgery&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; from the period of 2000 to 2013. The inclusion criteria included only English articles with Parkinson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s patients that underwent spinal surgery. We identified and reviewed all six articles that included ninety-five patients with Parkinson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease who underwent spinal surgery. A total of 95 patients with Parkinson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease who underwent spinal fusion surgery were reviewed with average patient age of 69 and a 3:4 male to female ratio. With an average follow up of 40 months, 46 out of 73 patients (63%) were judged to have satisfactory outcomes with poor outcomes noted in the remaining 37%. These included but were not limited to pseudoarthrosis, hardware failure/pullout, development of adjacent level disease, persistent kyphosis or sagittal imbalance, and no improvement or worsening in their postoperative visual analog pain scale. There was a 45% (29/65) revision rate and a 59% (30/51) complication rate following the index procedure. It remains unclear whether Parkinson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s patients benefit from spinal fusion surgery. Further prospective research is warranted to investigate surgical outcomes in this subset of patients.

Research paper thumbnail of MRI evidence that glibenclamide reduces acute lesion expansion in a rat model of spinal cord injury

Spinal Cord, 2013

Study design: Experimental, controlled, animal study. Objectives: To use non-invasive magnetic re... more Study design: Experimental, controlled, animal study. Objectives: To use non-invasive magnetic resonance imaging (MRI) to corroborate invasive studies showing progressive expansion of a hemorrhagic lesion during the early hours after spinal cord trauma and to assess the effect of glibenclamide, which blocks Sur1-Trpm4 channels implicated in post-traumatic capillary fragmentation, on lesion expansion. Setting: Baltimore. Methods: Adult female Long-Evans rats underwent unilateral impact trauma to the spinal cord at C7, which produced ipsilateral but not contralateral primary hemorrhage. In series 1 (six control rats and six administered glibenclamide), hemorrhagic lesion expansion was characterized using MRI at 1 and 24 h after trauma. In series 2, hemorrhagic lesion size was characterized on coronal tissue sections at 15 min (eight rats) and at 24 h after trauma (eight control rats and eight administered glibenclamide). Results: MRI (T2 hypodensity) showed that lesions expanded 2.3±0.33-fold (Po0.001) during the first 24 h in control rats, but only 1.2 ± 0.07-fold (P40.05) in glibenclamide-treated rats. Measuring the areas of hemorrhagic contusion on tissue sections at the epicenter showed that lesions expanded 2.2 ± 0.12-fold (Po0.001) during the first 24 h in control rats, but only 1.1 ± 0.05-fold (P40.05) in glibenclamide-treated rats. Glibenclamide treatment was associated with significantly better neurological function (unilateral BBB scores) at 24 h in both the ipsilateral (median scores, 9 vs 0; Po0.001) and contralateral (median scores, 12 vs 2; Po0.001) hindlimbs. Conclusion: MRI is an accurate non-invasive imaging biomarker of lesion expansion and is a sensitive measure of the ability of glibenclamide to reduce lesion expansion.

Research paper thumbnail of Reoperations Following Cervical Disc Replacement

Asian Spine Journal, 2015

Cervical disc replacement (CDR) has emerged as an alternative surgical option to cervical arthrod... more Cervical disc replacement (CDR) has emerged as an alternative surgical option to cervical arthrodesis. With increasing numbers of patients and longer follow-ups, complications related to the device and/or aging spine are growing, leaving us with a new challenge in the management and surgical revision of CDR. The purpose of this study is to review the current literature regarding reoperations following CDR and to discuss about the approaches and solutions for the current and future potential complications associated with CDR. The published rates of reoperation (mean, 1.0%; range, 0%-3.1%), revision (mean, 0.2%; range, 0%-0.5%), and removal (mean, 1.2%; range, 0%-1.9%) following CDR are low and comparable to the published rates of reoperation (mean, 1.7%; range; 0%-3.4%), revision (mean, 1.5%; range, 0%-4.7%), and removal (mean, 2.0%; range, 0%-3.4%) following cervical arthrodesis. The surgical interventions following CDR range from the repositioning to explantation followed by fusion or the reimplantation to posterior foraminotomy or fusion. Strict patient selection, careful preoperative radiographic review and surgical planning, as well as surgical technique may reduce adverse events and the need for future intervention. Minimal literature and no guidelines exist for the approaches and techniques in revision and for the removal of implants following CDR. Adherence to strict indications and precise surgical technique may reduce the number of reoperations, revisions, and removals following CDR. Long-term follow-up studies are needed, assessing the implant survivorship and its effect on the revision and removal rates.

Research paper thumbnail of Association Between Surgeon Experience and Complication Rates in Adult Scoliosis Surgery: A Review of 5,117 Cases from the Scoliosis Research Society Database 2004-2007

Spine, Jan 20, 2015

Retrospective review of a multicenter database. To evaluate whether surgeon experience is associa... more Retrospective review of a multicenter database. To evaluate whether surgeon experience is associated with complication rates in adult spinal deformity (ASD) surgery. Multiple patient- and surgery-related factors have been shown to increase the risk of complications in ASD. No study exists evaluating surgeon experience as an associated factor with complications in ASD. The Scoliosis Research Society Morbidity and Mortality database was queried for patients aged >18 years who underwent ASD from 2004-2007. Patient demographics, surgical characteristics, complications and surgeon membership status were analyzed. Two-tailed t-test and chi-square tests were performed with p<0.05 considered significant. A total of 5,117 patients underwent ASD surgery. The average patient age was 51.8 years. Patients operated by candidate members were older than those operated by active members (53.1 versus 51.4, p = 0.003). Active members performed 3,836 (75%) cases while candidate members performed ...

Research paper thumbnail of The 100 Most Influential Articles in Cervical Spine Surgery

Global Spine Journal, 2015

Study Design Literature review. Objective To identify and analyze the top 100 cited articles in c... more Study Design Literature review. Objective To identify and analyze the top 100 cited articles in cervical spine surgery. Methods The Thomson Reuters Web of Knowledge was searched for citations of all articles relevant to cervical spine surgery. The number of citations, authorship, year of publication, journal of publication, country of publication, and institution were recorded for each article. Results The most cited article was the classic from 1991 by Vernon and Mior that described the Neck Disability Index. The second most cited was Smith&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 1958 article describing the anterior cervical diskectomy and fusion procedure. The third most cited article was Hilibrand&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 1999 publication evaluating the incidence, prevalence, and radiographic progression of symptomatic adjacent segment disease following anterior cervical arthrodesis. The majority of the articles originated in the United States (65), and most were published in Spine (39). Most articles were published in the 1990s (34), and the three most common topics were cervical fusion (17), surgical complications (9), and biomechanics (9), respectively. Author Abumi had four articles in the top 100 list, and authors Goffin, Panjabi, and Hadley had three each. The Department of Orthopaedic Surgery at Hokkaido University in Sapporo, Japan, had five articles in the top 100 list. Conclusion This report identifies the top 100 articles in cervical spine surgery and acknowledges those individuals who have contributed the most to the advancement of the study of the cervical spine and the body of knowledge used to guide evidence-based clinical decision making in cervical spine surgery today.

Research paper thumbnail of Posterior-Only Circumferential Decompression and Reconstruction in the Surgical Management of Lumbar Vertebral Osteomyelitis

Global Spine Journal, 2015

Study Design Case report. Objective The purpose of this report is to discuss the surgical managem... more Study Design Case report. Objective The purpose of this report is to discuss the surgical management of lumbar vertebral osteomyelitis with a spinal epidural abscess (SEA) and present a single-stage, posterior-only circumferential decompression and reconstruction with instrumentation using an expandable titanium cage and without segmental nerve root sacrifice as an option in the treatment of this disease process. Methods We report a 42-year-old man who presented with 3 days of low back pain and chills who rapidly decompensated with severe sepsis following admission. Magnetic resonance imaging of his lumbosacral spine revealed intramuscular abscesses of the left paraspinal musculature and iliopsoas with SEA and L4 vertebral body involvement. The patient failed maximal medical treatment, which necessitated surgical treatment as a last resort for infectious source control. He underwent a previously undescribed procedure in the setting of SEA: a single-stage, posterior-only approach for circumferential decompression and reconstruction of the L4 vertebral body with posterior segmental instrumented fixation. Results After the surgery, the patient&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 condition gradually improved; however, he suffered a wound dehiscence necessitating a surgical exploration and deep wound debridement. Six months after the surgery, the patient underwent a revision surgery for adjacent-level pseudarthrosis. At 1-year follow-up, the patient was pain-free and off narcotic pain medication and had returned to full activity. Conclusion This patient is the first reported case of lumbar osteomyelitis with SEA treated surgically with a single-stage, posterior-only circumferential decompression and reconstruction with posterior instrumentation. Although this approach is more technically challenging, it presents another viable option for the treatment of lumbar vertebral osteomyelitis that may reduce the morbidity associated with an anterior approach.

Research paper thumbnail of Curvularia abscess of the brainstem

World neurosurgery

To present a unique case of a brainstem Curvularia fungal infection and review the diagnosis and ... more To present a unique case of a brainstem Curvularia fungal infection and review the diagnosis and management of this rare phenomenon. A 33-year-old immunocompetent African American male presented with 2 weeks of headache, nausea, and vomiting in a setting of a recent 20-lb weight loss. Neurological examination was positive for multiple cranial nerve palsies, hemisensory loss, and gait instability. Magnetic resonance imaging demonstrated an enhancing medullary lesion. Metastatic and infectious workup revealed a left lung lesion, which on subsequent biopsy was positive for a granuloma yielding no further clues to the etiology of the brainstem lesion. On surgical exploration of the cranial lesion, a puss-filed, encapsulated lesion was encountered that was tightly adherent to the brainstem. Intraoperative biopsy of the lesion capsule was initially negative but on postoperative day 9, fungal hyphae were encountered identified on morphology as Curvularia species. The patient was started on...

Research paper thumbnail of Fatal Intraoperative Cardiac Arrest After Application of Surgifoam Into a Bleeding Iliac Screw Defect

Research paper thumbnail of The Top 100 Classic Papers in Lumbar Spine Surgery

Spine, 2015

Study Design. Bibliometric review of the literature. Objective. To analyze and quantify the most ... more Study Design. Bibliometric review of the literature. Objective. To analyze and quantify the most frequently cited papers in lumbar spine surgery and to measure their impact on the entire lumbar spine literature. Summary of Background Data. Lumbar spine surgery is a dynamic and complex fi eld. Basic science and clinical research remain paramount in understanding and advancing the fi eld. While new literature is published at increasing rates, few studies make long-lasting impacts. Methods. The Thomson Reuters Web of Knowledge was searched for citations of all papers relevant to lumbar spine surgery. The number of citations, authorship, year of publication, journal of publication, country of publication, and institution were recorded for each paper. Results. The most cited paper was found to be the classic paper from 1990 by Boden et al that described magnetic resonance imaging fi ndings in individuals without back pain, sciatica, and neurogenic claudication showing that spinal stenosis and herniated discs can be incidentally found when scanning patients. The second most cited study similarly showed that asymptomatic patients who underwent lumbar spine magnetic resonance imaging frequently had lumbar pathology. The third most cited paper was the 2000 publication of Fairbank and Pynsent reviewing the Oswestry Disability Index, the outcome-measure questionnaire most commonly used to evaluate low back pain. The majority of the papers originate in the United States (n = 58), and most were published in Spine (n = 63). Most papers were published in the 1990s (n = 49), and the 3 most common topics were low back pain, biomechanics, and disc degeneration. Conclusion. This report identifi es the top 100 papers in lumbar spine surgery and acknowledges those individuals who have From the The Thomson Reuters Web of Science, a research platform that provides bibliographic database services and ranks journals contributed the most to the advancement of the study of the lumbar spine and the body of knowledge used to guide evidence-based clinical decision making in lumbar spine surgery today. Classic Papers in Lumbar Spine Surgery • Steinberger et al Spine www.spinejournal.com 741

Research paper thumbnail of The finding of alleged tubercle bacilli in the blood

Research paper thumbnail of The Effect of Increasing Pedicle Screw Size on Thoracic Spinal Canal Dimensions

Spine, 2014

Objective. To determine whether the thoracic spinal canal diameter decreases when the pedicle is ... more Objective. To determine whether the thoracic spinal canal diameter decreases when the pedicle is allowed to expand with increasing screw diameter. To observe whether osseous breach occurs medially or laterally. Summary of Background Data. Insertion of a pedicle screw that is larger in diameter than that of the native pedicle has been shown to expand the pedicle and increase biomechanical fi xation strength. With this technique, there is concern for medial expansion of the pedicle causing decrease in spinal canal diameter, especially in the concavity of scoliosis, resulting in spinal cord compression. Also, large pedicle screws that are inserted correctly may still cause undetected medial bony breach during surgery. Methods. A total of 162 pedicles from 81 thoracic vertebrae (T1-T12) of 7 fresh-frozen adult cadavers were analyzed. After undertapping the pedicle by 1 mm, pedicle screws were inserted in increasing diameter (range, 4.0-9.5 mm) bilaterally until there was an osseous breach in the pedicle. A total of 938 screws were used. Transverse spinal canal diameter and pedicle circumference were measured (in millimeters) before and after each pedicle screw placement. Photographs and fl uoroscopic images of representative specimens were obtained for visual assessment. Results. The average transverse spinal canal diameter was 17.7 mm. The average transverse canal diameter with the largest screw inserted before bony breach was detected was 17.6 mm ( P = 0.92). The average diameter of the largest screw inserted before breach From the The manuscript submitted does not contain information about medical device(s)/drug(s).

Research paper thumbnail of Progressive multifocal leukoencephalopathy presenting as a single ring-enhancing lesion

Clinical Neurology and Neurosurgery, 2014

Research paper thumbnail of Meningioma: Viewpoint—Surgery

Principles and Practice of Stereotactic Radiosurgery, 2014

Research paper thumbnail of Meningioma: Surgery Perspective

Principles and Practice of Stereotactic Radiosurgery, 2008

... performed by Zanobi Pecchiolo (1801–1866) at Siena University. In a vast surgical series publ... more ... performed by Zanobi Pecchiolo (1801–1866) at Siena University. In a vast surgical series published in 1847, 1524 cases were described, one of which was a large meningioma removed from the right sinciput through a triangular flap. Then on December 15, 1887, William W ...

Research paper thumbnail of Outcomes and Trends of Parkinson’s Disease Patients undergoing Degenerative Lumbar Spine Surgery

Research paper thumbnail of The 100 Classic Papers in Spinal Deformity Surgery

Spine Deformity, 2014

Bibliometric review of the literature. To identify and analyze the top 100 cited articles in spin... more Bibliometric review of the literature. To identify and analyze the top 100 cited articles in spinal deformity surgery. The field of spinal deformity surgery is an ever-growing and complex field that owes its development to the work and visions of many dedicated individuals. The authors searched the Thomson Reuters Web of Knowledge for citations of all articles relevant to scoliosis and spinal deformity surgery. The number of citations, authorship, year, journal, and country and institution of publication were recorded for each article. The most cited article was the 2001 work by Lenke et al. describing a new 2-dimensional classification system of adolescent idiopathic scoliosis used to determine the appropriate vertebral levels to be included in an arthrodesis. The second most cited was Harrington&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s 1962 article describing the first instrumented method for the treatment of scoliosis. The third most cited article was the 1983 study by King et al. recommending specific vertebral levels for inclusion into spinal arthrodesis. Most articles originated in the United States (62), and most were published in Spine (32). Most were published in the 1990s (28), and the 3 most common topics, in descending order, were adolescent idiopathic scoliosis (28), spinal instrumentation (18), and surgical complications (5). Author Suk had 5 articles in the top 100 list, whereas authors Kim, Liljenqvist, Lonstein, and Weinstein had 3 each. Washington University in St. Louis had 7 articles in the top 100 list. This report&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s identification of the 100 classic articles in spinal deformity surgery allows insight into the development and trends of this challenging subspecialty of spine surgery. Furthermore, this article identifies individuals who have contributed the most to the advancement of spinal deformity surgery and the body of knowledge used to guide evidence-based clinical decision making in spinal deformity surgery today.