Vedat Deviren

Background The objective of this study was to evaluate if imbalance influences complication rates, radiological outcomes, and patient-reported outcomes (PROMs) following adult spinal deformity (ASD) surgery. Methods ASD patients with baseline and 2-year radiographic and PROMs were included. Patients were grouped according to whether they answered yes or no to a recent history of pre-operative loss of balance. The groups were propensity-matched by age, pelvic incidence–lumbar lordosis (PI-LL), and surgical invasiveness score. Results In total, 212 patients were examined (106 in each group). Patients with gait imbalance had worse baseline PROM measures, including Oswestry disability index (45.2 vs. 36.6), SF-36 mental component score (44 vs. 51.8), and SF-36 physical component score (p < 0.001 for all). After 2 years, patients with gait imbalance had less pelvic tilt correction (−1.2 vs. −3.6°, p = 0.039) for a comparable PI-LL correction (−11.9 vs. −15.1°, p = 0.144). Gait imbalance patients had higher rates of radiographic proximal junctional kyphosis (PJK) (26.4% vs. 14.2%) and implant-related complications (47.2% vs. 34.0%). After controlling for age, baseline sagittal parameters, PI-LL correction, and comorbidities, patients with imbalance had 2.2-times-increased odds of PJK after 2 years. Conclusions Patients with a self-reported loss of balance/unsteady gait have significantly worse PROMs and higher risk of PJK.

PurposeTo define the prevalence, characteristics, and treatment approach for proximal junction failure secondary to odontoid fractures in patients with prior C2-pelvis posterior instrumented fusions (PSF).MethodsA single institution’s database was queried for multi-level fusions (6+ levels), including a cervical component. Posterior instrumentation from C2-pelvis and minimum 6-month follow-up was inclusion criteria. Patients who sustained dens fractures were identified; each fracture was subdivided based on Anderson & D’Alonzo and Grauer’s classifications. Comparisons between the groups were performed using Chi-square and T tests.Results80 patients (71.3% female; average age 68.1±8.1 years; 45.0% osteoporosis) were included. Average follow-up was 59.8±42.7 months. Six patients (7.5%) suffered an odontoid fracture post-operatively. Cause of fracture in all patients was a mechanical fall. Average time …

Study Design.This is a cross-sectional survey.Objective.The aim was to assess the reliability of a proposed novel classification system for thoracic disc herniations (TDHs).Summary of Background Data.TDHs are complex entities varying substantially in many factors, including size, location, and calcification. To date, no comprehensive system exists to categorize these lesions.Methods.Our proposed system classifies 5 types of TDHs using anatomic and clinical characteristics, with subtypes for calcification. Type 0 herniations are small (≤ 40% of spinal canal) TDHs without significant spinal cord or nerve root effacement; type 1 are small and paracentral; type 2 are small and central; type 3 are giant (> 40% of spinal canal) and paracentral; and type 4 are giant and central. Patients with types 1 to 4 TDHs have correlative clinical and radiographic evidence of spinal cord compression. Twenty-one US spine surgeons …

Background:Height gain following a surgical procedure for patients with adult spinal deformity (ASD) is incompletely understood, and it is unknown if height gain correlates with patient-reported outcome measures (PROMs).Methods:This was a retrospective cohort study of patients undergoing ASD surgery. Patients with baseline, 6-week, and subanalysis of 1-year postoperative full-body radiographic and PROM data were examined. Correlation analysis examined relationships between vertical height differences and PROMs. Regression analysis was utilized to preoperatively estimate T1-S1 and S1-ankle height changes.Results:This study included 198 patients (mean age, 57 years; 69% female); 147 patients (74%) gained height. Patients with height loss, compared with those who gained height, experienced greater increases in thoracolumbar kyphosis (2.81 compared with− 7.37; p< 0.001) and thoracic kyphosis …

BackgroundAssess correlation between preoperative cervical sagittal alignment (T1 slope [T1S] and C2-C7 cervical sagittal vertical axis [cSVA]) and postoperative cervical sagittal balance after posterior cervical laminoplasty.MethodsConsecutive patients who underwent laminoplasty at a single institution with >6 weeks postoperative follow-up were divided into 4 groups based on preoperative cSVA and T1S (Group 1: cSVA <4 cm/T1S <20°; Group 2: cSVA ≥4 cm/T1S ≥20°; Group 3: cSVA <4 cm/T1S ≥20°; Group 4: cSVA <4 cm/T1S <20°). Radiographic analyses were conducted at 3 timepoints, and changes in cSVA, C2-C7 cervical lordosis (CL), and T1S -CL were compared.ResultsA total of 214 patients met inclusion criteria (28 patients had cSVA <4 cm/T1S <20° [Group 1]; 47 patients had cSVA ≥4 cm/T1S ≥20° [Group 2]; 139 patients had cSVA <4 cm/T1S ≥20° [Group 3]). No patients had cSVA ≥4 cm/T1S …

Study Design.Retrospective comparative studyObjective.To assess the relationship of fusion mass bone density on CT and the development of rod fractures (RFs) and proximal junctional kyphosis (PJK).Summary of Background Data.Few studies have evaluated the relationship of fusion mass bone density to mechanical complications.Methods:A retrospective review of adult spinal deformity patients who underwent thoracolumbar 3-column osteotomy from 2007 to 2017 was performed. All patients underwent routine 1-year CT imaging and had at least 24 months follow-up. Posterior fusion mass bone density was evaluated by measuring Hounsfield Unit (HU) on CT in 3 different regions (UIV, LIV, and osteotomy site), and were compared between patients with and without mechanical complications.Results:A total of 165 patients (63.2 years, 33.5% male) were included. Overall PJK rate was 18.8%, and 35.5% of these …

Study DesignCross-sectional observational.BackgroundThe use of social media by providers can enhance patient education, complement offline information, facilitate patient support, stimulate brand building, and strengthen the organization’s market position. Risks of social media include, but are not limited to, a lack of quality, reliability, misrepresentation of credentials, influence of hidden and overt conflicts of interest, content that may jeopardize patient privacy, HIPAA regulations, and physicians’ credentials and licensure. Physicians’ use of social media may also expose him/her to lawsuits if providing specific medical advice on media platforms.ObjectiveTo document the social media presence of a broad cohort of spine surgeons, and to discuss the benefits and risks of a social media presence.MethodsCross-sectional observational of 325 Spine Surgeons from 76 institutions across the US. Description statistic …

Materials and Methods: This study is a prospective trial of patients undergoing ASD surgery at a single institution over a three-year period. ASD patients treated with posterior spinal fusion of greater or equal to 10 vertebral segments for adult deformity were included. Only patients with 12 month follow up are included in this study. The primary outcome variable was performance on the Montreal Cognitive Assessment (MoCA) test of dementia and cognitive impairment, which was measured pre-operatively and at 12-month follow-up. We also collected outcome metrics including the Oswestry Disability Index (ODI), Scoliosis Research Society questionnaire (SRS-22) with mental health (MH), activity (ACT), pain (P), and self-image (SI) sub-components. Pre-operative and post-operative morphine equivalent dose (MED) of narcotic medication was collected using patient surveys and verified using prescription data. A multi …

BACKGROUND:For transforaminal lumbar interbody fusion (TLIF), there are equally good open and minimally invasive surgery (MIS) options.OBJECTIVE:To determine if frailty has a differential effect on outcome for open vs MIS TLIF.METHODS:We performed a retrospective review of 115 TLIF surgeries (1-3 levels) for lumbar degenerative disease performed at a single center; 44 MIS transforaminal interbody fusions and 71 open TLIFs were included. All patients had at least a 2-year follow up, and any revision surgery during that time was recorded. The Adult Spinal Deformity Frailty Index (ASD-FI) was used to separate patients into nonfrail (ASD-FI< 0.3) and frail (ASD-FI> 0.3) cohorts. The primary outcome variables were revision surgery and discharge disposition. Univariate analyses were performed to reveal associations in demographic, radiographic, and surgical data with the outcome variables. Multivariate …

OBJECTIVE Vertebral osteomyelitis is a rare complication of coccidioidomycosis infection. Surgical intervention is indicated when there is failure of medical management or presence of neurological deficit, epidural abscess, or spinal instability. The relationship between timing of surgical intervention and recovery of neurological function has not been previously described. The purpose of this study was to investigate if the duration of neurological deficits at presentation affects neurological recovery after surgical intervention. METHODS This was a retrospective study of all patients diagnosed with coccidioidomycosis involving the spine at a single tertiary care center between 2012 and 2021. Data collected included patient demographics, clinical presentation, radiographic information, and surgical intervention. The primary outcome was change in neurological examination after …

PurposeTo develop a model for factors predictive of Post-Acute Care Facility (PACF) discharge in adult patients undergoing elective multi-level (≥ 3 segments) lumbar/thoracolumbar spinal instrumented fusions.MethodsThe State Inpatient Databases acquired from the Healthcare Cost and Utilization Project from 2005 to 2013 were queried for adult patients who underwent elective multi-level thoracolumbar fusions for spinal deformity. Outcome variables were classified as discharge to home or PACF. Predictive variables included demographic, pre-operative, and operative factors. Univariate and multivariate logistic regression analyses informed development of a logistic regression-based predictive model using seven selected variables. Performance metrics included area under the curve (AUC), sensitivity, and specificity.ResultsIncluded for analysis were 8866 patients. The logistic model including significant …

Study Design.Retrospective comparative studyObjective.To assess the relationship of fusion mass bone density on computed tomography (CT) and the development of rod fractures (RFs) and proximal junctional kyphosis (PJK).Summary of Background Data.Few studies have evaluated the relationship of fusion mass bone density to mechanical complications.Materials and MethodsA retrospective review of adult spinal deformity patients who underwent thoracolumbar three-column osteotomy from 2007 to 2017 was performed. All patients underwent routine 1-year CT imaging and had at least 24 months follow-up. Posterior fusion mass bone density was evaluated by measuring hounsfield unit (HU) on CT in three different regions [upper instrumented vertebra (UIV), lower instrumented vertebra, and osteotomy site], and were compared between patients with and without mechanical complications.Results:A total of …

BACKGROUND:Rigid cervical deformity (CD) requires multilevel and/or high-grade osteotomies and long-construct fusions to achieve adequate correction. The incidence of mechanical complications (MCs) remains incompletely studied.OBJECTIVE:To define the incidence and risk factors for MC.METHODS:A retrospective review of consecutive patients with CD who underwent correction from 2010 to 2018 was performed. Inclusion criteria were cervical kyphosis> 20 and/or cervical sagittal vertical axis (cSVA)> 4 cm. MCs (junctional kyphosis/failure, pseudarthrosis, and implant failure) and reoperation at 1 and 2 yr were examined.RESULTS:Eighty-three patients were included. The mean age was 63.4 yr, and 61.0% were female. Fifty-three percent underwent 3-column osteotomies. After surgery, cervical parameters were significantly improved: cSVA (6.2 vs 3.8 cm, P<. 001), cervical lordosis (6.3 vs− 8.3, P<. 001 …

BACKGROUND:Lumbosacral deformities are caused by high-grade spondylolisthesis, fractures, iatrogenic flat back, and other etiologies. The S1 pedicle subtraction osteotomy (PSO) can facilitate reduction of spondylolisthesis and lower the pelvic incidence. There are limited reports on the indications and outcomes of this technique.OBJECTIVE:To present a technical description and literature review of the S1 PSO with video summary.METHODS:This was a retrospective review of a single case to highlight the use of S1 PSO for the treatment of high-grade spondylolisthesis. A literature review was performed in accordance with STROBE guidelines.RESULTS:A 47-year-old woman presented with back and right leg pain related to grade 4 spondylolisthesis at L5-S1 with sagittal imbalance and lumbosacral kyphosis. She was taken for an L2-pelvis instrumented fusion with S1 PSO. Three days later, she was taken for …

BackgroundProximal junctional failure (PJF) following multilevel thoracolumbar instrumented to the pelvis for adult spinal deformity (ASD) is relatively uncommon but considerably disabling. While the leading etiology is mechanical, other rarer etiologies can play a role in its development. The purpose of this study was to present a case series of ASD patients who experienced PJF secondary to proximal junctional spondylodiscitis (PJS) after long-segment thoracolumbar posterior instrumented fusions.MethodsAdult patients who underwent posterior instrumented fusions at a single academic center between 2017 and 2020 and subsequently developed PJS were retrospectively reviewed. Patient demographics, operative details, clinical presentation, culture data, and management approach were evaluated.ResultsThree patients developed PJS and were included for analysis (mean age 67 years [range, 58–76 …

BACKGROUND:The kickstand rod has been described for the treatment of severe coronal imbalance. We present a modified description that combines an asymmetric pedicle subtraction osteotomy (PSO) for correction of severe kyphoscoliosis.OBJECTIVE:To describe the use of a temporary kickstand rod.METHODS:Type 1 osteotomies were performed across the main and fractional curves. An asymmetric PSO was performed at the apex of the main curve, and a kickstand rod placed on the concavity anchored from the ilium to a temporary connector above the main curve. Distraction was applied across the kickstand rod because the PSO was closed on the convexity. A permanent rod was placed contralateral to the kickstand, followed by replacement of the kickstand with a permanent rod and bilateral accessory rods.RESULTS:A 66-year-old man presented with kyphoscoliosis causing severe coronal and sagittal …

Adult idiopathic scoliosis (ADIS) is the delayed form of adolescent idiopathic scoliosis (AIS) which is defined as a three-dimensional deformity with a lateral curvature of more than 10° in adults with prior history of AIS. Surgery is necessary for patients with symptoms of chronic pain, neuromotor deficits and cardiopulmonary problems with a Cobb angle exceeding 45°. In untreated patients, AIS may lead to ADIS which can cause serious problems like osteoarthritis, progressive deformity and spinal stenosis. In recent years, the kickstand rod technique has been introduced in addition to posterior transpedicular stabilization. A kickstand rod is an additional rod which is placed on a supporting iliac screw which is placed on the superior lateral edge of the ilium on the concave side of the deformity (or in other words on the ipsilateral side of the trunk shift) and is connected with a domino connector to the thoracolumbar …

Purpose To assess factors, including RAPT score, predictive of non-home discharges following adult spinal deformity (ASD) operations. Methods Adults who underwent thoracolumbar instrumented fusions to the pelvis for ASD (1/2019–1/2020) were reviewed. Patient demographics, RAPT metrics, hospital length of stay (LOS), operative details, and complications were compared between patients discharged home and non-home. Univariate and multivariate analyses were performed using logistic regression to determine the relative risk of non-home discharge. Area Under the Receiver Operating Characteristic curve (AUROC) for RAPT score and non-home discharge was also determined. Results Ninety-nine patients (average age 68 ± 9 years; female-64; average RAPT 8.6 ± 2.2) were analyzed. Operations had the following …

BACKGROUND:Despite formal cardiac clearance, a subset of 3-column osteotomy (3CO) patients still experience cardiac complications (CCs).OBJECTIVE:To define the incidence and risk factors for CC in 3CO patients who had formal cardiac clearance and assess the utility of the Revised Cardiac Risk Index (RCRI) and preoperative metabolic equivalent (MET) functional ability in predicting perioperative CC.METHODS:Patients with adult spinal deformity (ASD) who underwent 3CO deformity correction from 2006 to 2019 were retrospectively reviewed. Multivariate and recursive partitioning analyses were performed to assess risk factors.RESULTS:A total of 390 patients with ASD were included. The mean age was 64.6 years, and 60.3% were female. The CC rate was 9.7%. Patients with CCs were older (P<. 001), had an increased history of heart disease (P=. 001), and higher blood loss (P=. 045). RCRI score (P …

Methods:Consecutive adults who underwent revision cervical spine surgery for ASD at a single institution between 2014 and 2017 were retrospectively reviewed. Direct costs were identified from medical billing data and calculated for each revision surgery for ASD. Incomplete cost data for revision operations were used as a criterion for exclusion. Cost data were stratified based on the approach of the index and revision operations.Results:Eighty-five patients (average age 57±10 years) underwent revisions for cervical ASD, which summed to $2 million (average $23,702). Revisions consisted of 45 anterior operations (anterior cervical diskectomy and fusion, 34; corpectomy, 10; and cervical disk arthroplasty, 1), 32 posterior operations (posterior cervical fusion, 14; foraminotomy, 14; and laminoplasty, 4), and 8 circumferential operations. Circumferential revisions had notably higher average direct costs ($57,376) than …