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Article ; Online: Osseous Thoracic Foraminal Stenosis with Unilateral Congenital Absence of T1 Rib A Case Report.

Wang, Charles / Vira, Shaleen / Stieber, Jonathan

Bulletin of the Hospital for Joint Disease (2013)

2021 Volume 79, Issue 3, Page(s) 197–199

Abstract: A 43-year-old male with a congenital absence of his left T1 rib developed a left-sided T1-T2 spinal facet joint arthrosis and stenosis and clinical signs and symptoms of T1 radiculopathy. The patient was treated with a decompressive laminotomy and ... ...

Abstract	A 43-year-old male with a congenital absence of his left T1 rib developed a left-sided T1-T2 spinal facet joint arthrosis and stenosis and clinical signs and symptoms of T1 radiculopathy. The patient was treated with a decompressive laminotomy and partial medial facetectomy resulting in immediate resolution of symptoms. This report should alert clinicians to consider this potential etiology when evaluating patients with thoracic radiculopathy.
MeSH term(s)	Adult ; Constriction, Pathologic ; Decompression, Surgical ; Humans ; Laminectomy ; Male ; Ribs ; Spinal Stenosis/surgery ; Thoracic Vertebrae/diagnostic imaging ; Thoracic Vertebrae/surgery
Language	English
Publishing date	2021-10-01
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	390411-8
ISSN	2328-5273 ; 1936-9727 ; 1936-9719 ; 0018-5647 ; 0883-9344 ; 2328-4633
ISSN (online)	2328-5273 ; 1936-9727
ISSN	1936-9719 ; 0018-5647 ; 0883-9344 ; 2328-4633
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Article ; Online: Combination radiofrequency ablation and vertebral cement augmentation for spinal metastatic tumors: A systematic review and meta-analysis of safety and treatment outcomes.

Chen, Andrew L / Sagoo, Navraj S / Vannabouathong, Christopher / Reddy, Yashas / Deme, Sathvik / Patibandla, Sahiti / Passias, Peter G / Vira, Shaleen

North American Spine Society journal

2024 Volume 17, Page(s) 100317

Abstract: Background: The treatment of spine metastases continues to pose a significant clinical challenge, requiring the integration of multiple therapeutic modalities to address the multifactorial aspects of this disease process. Radiofrequency ablation (RFA) ... ...

Abstract	Background: The treatment of spine metastases continues to pose a significant clinical challenge, requiring the integration of multiple therapeutic modalities to address the multifactorial aspects of this disease process. Radiofrequency ablation (RFA) and vertebral cement augmentation (VCA) are 2 less invasive modalities compared to open surgery that have emerged as promising strategies, offering the potential for both pain relief and preservation of vertebral stability. The utility of these approaches, however, remains uncertain and subject to ongoing investigation.This systematic review and meta-analysis evaluates the available evidence and synthesize the results of studies that have investigated the combination of RFA and VCA for the treatment of spinal metastases, with the goal of providing a comprehensive and up-to-date assessment of the efficacy and safety of this therapeutic approach. Methods: A literature search was conducted using the electronic databases PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus from their inception to May 4th, 2022 in accordance with PRISMA guidelines. Studies were included if they met the following criteria: 1) spine metastases treated with RFA in combination with VCA, 2) available data on at least one outcome (i.e., pain palliation, complications, local tumor control), 3) prospective or retrospective studies with at least 10 patients, and 4) English language. Meta-analyses were conducted in R (R Foundation for Statistical Computing; Vienna, Austria), using the Results: In the 25 included studies, a total of 947 patients (females=53.9%) underwent RFA + VCA for spinal metastatic tumors. Out of 1,163 metastatic lesions, the majority were located in the lumbar region (585/1,163 [50.3%]) followed by thoracic (519/1,163 [44.6%]), sacrum (39/1,163 [3.4%]), and cervical (2/1,163 [0.2%]). 48/72 [66.7%] metastatic lesions expanded into the posterior elements. Preoperative pathologic vertebral fractures were identified in 115/176 [65.3%] patients. Between pre-procedure pain scores and postprocedure pain scores, average follow-up (FU) was 4.41±2.87 months. Pain scores improved significantly at a short-term FU (1-6 months), with a pooled mean difference (MD) from baseline of 4.82 (95% CI, 4.48-5.16). The overall local tumor progression (LTP) rate at short-term FU (1-6 months) was 5% (95% CI, 1%-8%), at mid-term FU (6-12 months) was 22% (95% CI, 0%-48%), and at long-term FU (>12 months) was 5% (95% CI, 0%-11%). The pooled incidence of total complications was 1% (95% CI, 0%-1%), the most frequent of which were transient radicular pain and asymptomatic cement extravasation. Conclusions: The findings of this meta-analysis reveal that the implementation of RFA in conjunction with VCA for the treatment of spinal metastatic tumors resulted in a significant short-term reduction of pain, with minimal total complications. The LTP rate was additionally low. The clinical efficacy and safety of this technique are established, although further exploration of the long-term outcomes of RFA+VCA is warranted.
Language	English
Publishing date	2024-02-23
Publishing country	United States
Document type	Journal Article ; Review
ISSN	2666-5484
ISSN (online)	2666-5484
DOI	10.1016/j.xnsj.2024.100317
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Article ; Online: Review of Craniocervical Sagittal Alignment.

Vira, Shaleen / Reddy, Nisha / Passias, Peter G

Bulletin of the Hospital for Joint Disease (2013)

2020 Volume 78, Issue 1, Page(s) 33–41

Abstract: Cervical alignment plays a critical role in the diagnosis and treatment of spinal pathology. There has been a proliferation of novel radiographic parameters to quantify cranial and cervical alignment. These parameters have been placed in clinical context ...

Abstract	Cervical alignment plays a critical role in the diagnosis and treatment of spinal pathology. There has been a proliferation of novel radiographic parameters to quantify cranial and cervical alignment. These parameters have been placed in clinical context by their correlation with health-related quality of life (HRQOL) scores. This article reviews these parameters and describes their utility in understanding spinal deformity and other pathologies of the cervical spine.
MeSH term(s)	Anatomic Landmarks ; Cervical Vertebrae/diagnostic imaging ; Cervical Vertebrae/pathology ; Humans ; Quality of Life ; Spinal Curvatures/diagnostic imaging ; Spinal Curvatures/pathology
Language	English
Publishing date	2020-04-08
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	390411-8
ISSN	2328-5273 ; 1936-9727 ; 1936-9719 ; 0018-5647 ; 0883-9344 ; 2328-4633
ISSN (online)	2328-5273 ; 1936-9727
ISSN	1936-9719 ; 0018-5647 ; 0883-9344 ; 2328-4633
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Article: Clinical Outcomes of Coccygectomy for Coccydynia: A Single Institution Series With Mean 5-Year Follow-Up.

Mulpuri, Neha / Reddy, Nisha / Larsen, Kylan / Patel, Ankit / Diebo, Bassel G / Passias, Peter / Tappen, Lori / Gill, Kevin / Vira, Shaleen

International journal of spine surgery

2022 Volume 16, Issue 1, Page(s) 11–19

Language	English
Publishing date	2022-02-17
Publishing country	Netherlands
Document type	Journal Article
ISSN	2211-4599
ISSN	2211-4599
DOI	10.14444/8171
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Article: Patient-Reported Outcome Metrics in Total Joint Arthroplasty.

Rana, Adam / Vira, Shaleen

Instructional course lectures

2017 Volume 66, Page(s) 647–652

Abstract: The Patient Protection and Affordable Care Act includes several provisions that focus on improving the delivery of health care in the United States. Reducing overall healthcare costs and improving the quality of care delivered are two overarching themes ... ...

Abstract	The Patient Protection and Affordable Care Act includes several provisions that focus on improving the delivery of health care in the United States. Reducing overall healthcare costs and improving the quality of care delivered are two overarching themes of the Patient Protection and Affordable Care Act. An evaluation of quality in total joint arthroplasty focuses on three main areas: complications, readmissions, and, more recently, patient-reported outcomes. Patient-reported outcomes allow surgeons and patients to objectively document pain relief and functional gain after total joint arthroplasty. Surgeons, groups, or hospitals that commit to the collection of patient-reported outcomes must consider which patient-reported outcomes to capture, the workflow and timing of postoperative patient-reported outcome collection, and how to minimize the burden of patient-reported outcome collection on both patients and surgeons.
MeSH term(s)	Arthroplasty ; Arthroplasty, Replacement, Hip ; Arthroplasty, Replacement, Knee ; Humans ; Patient Protection and Affordable Care Act ; Patient Reported Outcome Measures ; United States
Language	English
Publishing date	2017-06-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	802490-x
ISSN	0065-6895
ISSN	0065-6895
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Article: Validation of the ACS-NSQIP Risk Calculator: A Machine-Learning Risk Tool for Predicting Complications and Mortality Following Adult Spinal Deformity Corrective Surgery.

Pierce, Katherine E / Kapadia, Bhaveen H / Naessig, Sara / Ahmad, Waleed / Vira, Shaleen / Paulino, Carl / Gerling, Michael / Passias, Peter G

International journal of spine surgery

2022 Volume 15, Issue 6, Page(s) 1210–1216

Abstract: Objective: To calculate the risk for postoperative complications and mortality after corrective surgery of adult spinal deformity (ASD) patients using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) surgical ... ...

Abstract	Objective: To calculate the risk for postoperative complications and mortality after corrective surgery of adult spinal deformity (ASD) patients using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) surgical risk calculator (SRC). Methods: Patients aged ≥18 years undergoing corrective surgery for ASD were identified. Current procedural terminology (CPT) codes of 22800, 22802, 22804, 22808, 22801, 22812, 22818, 22819, 22843, 22844, 22846, 22847, 22842, and 22845 were assessed if the patient had an Results: A total of 9143 ASD patients (58.9 years, 56% females, 29.2 kg/m Conclusions: The ACS-NSQIP SRC predicts surgical risk in patients undergoing ASD corrective surgery. This tool can be used as a resource in preoperative optimization by deformity surgeons. Level of evidence: 3.
Language	English
Publishing date	2022-01-27
Publishing country	Netherlands
Document type	Journal Article
ISSN	2211-4599
ISSN	2211-4599
DOI	10.14444/8153
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Article: Impact of congestive heart failure on patients undergoing lumbar spine fusion for adult spine deformity.

Onafowokan, Oluwatobi O / Ahmad, Waleed / McFarland, Kimberly / Williamson, Tyler K / Tretiakov, Peter / Mir, Jamshaid M / Das, Ankita / Bell, Joshua / Naessig, Sara / Vira, Shaleen / Lafage, Virginie / Paulino, Carl / Diebo, Bassel / Schoenfeld, Andrew / Hassanzadeh, Hamid / Jankowski, Pawel P / Hockley, Aaron / Passias, Peter Gust

Journal of craniovertebral junction & spine

2024 Volume 15, Issue 1, Page(s) 45–52

Abstract: Background: With the increasing amount of elective spine fusion patients presenting with cardiac disease and congestive heart failure, it is becoming difficult to assess when it is safe to proceed with surgery. Assessing the severity of heart failure ( ... ...

Abstract	Background: With the increasing amount of elective spine fusion patients presenting with cardiac disease and congestive heart failure, it is becoming difficult to assess when it is safe to proceed with surgery. Assessing the severity of heart failure (HF) through ejection fraction may provide insight into patients' short- and long-term risks. Purpose: The purpose of this study was to assess the severity of HF on perioperative outcomes of spine fusion surgery patients. Study design/setting: This was a retrospective cohort study of the PearlDiver database. Patient sample: We enrolled 670,526 patients undergoing spine fusion surgery. Outcome measures: Thirty-day and 90-day complication rates, discharge destination, length of stay (LOS), physician reimbursement, and hospital costs. Methods: Patients undergoing elective spine fusion surgery were isolated and stratified by preoperative HF with preserved ejection fraction (P-EF) or reduced ejection fraction (R-EF) (International Classification of Diseases-9: 428.32 [chronic diastolic HF] and 428.22 [chronic systolic HF]). Means comparison tests (Chi-squared and independent samples t-tests, as appropriate) compared differences in demographics, diagnoses, comorbidities, procedural characteristics, LOS, 30-day and 90-day complication outcomes, and total hospital charges between those diagnosed with P-EF and those not R-EF. Binary logistic regression assessed the odds of complication associated with HF, controlling for levels fused (odds ratio [OR] [95% confidence interval]). Statistical significance was set at Results: Totally 670,526 elective spine fusion patients were included. Four thousand and seventy-seven were diagnosed with P-EF and 2758 R-EF. Overall, P-EF patients presented with higher rates of morbid obesity, chronic kidney disease, chronic obstructive pulmonary disease, diabetes mellitus, and hypertension (all Conclusions: When evaluating the severity of HF before spine surgery, R-EF was associated with a higher risk of major complications, especially the occurrence of a myocardial infarction 30 days postoperatively. During preoperative risk assessment, congestive HF should be considered thoroughly when thinking of postoperative outcomes with emphasis on R-EF.
Language	English
Publishing date	2024-03-13
Publishing country	India
Document type	Journal Article
ZDB-ID	2573344-8
ISSN	0976-9285 ; 0974-8237
ISSN (online)	0976-9285
ISSN	0974-8237
DOI	10.4103/jcvjs.jcvjs_186_23
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Article: Failure to Normalize Risk Profile of Spine Fusion Patients With Coronary Artery Disease Previously Treated With Percutaneous Stent Revascularization.

Ahmad, Waleed / Bell, Joshua / Krol, Oscar / Passfall, Lara / Kamalapathy, Pramod / Imbo, Bailey / Tretiakov, Peter / Williamson, Tyler / Joujon-Roche, Rachel / Moattari, Kevin / Kummer, Nicholas / Vira, Shaleen / Lafage, Virginie / Paulino, Carl / Schoenfeld, Andrew J / Diebo, Bassel / Hassanzadeh, Hamid / Passias, Peter

International journal of spine surgery

2023 Volume 17, Issue 1, Page(s) 139–145

Language	English
Publishing date	2023-02-07
Publishing country	Netherlands
Document type	Journal Article
ISSN	2211-4599
ISSN	2211-4599
DOI	10.14444/8392
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Article ; Online: Comparison of multilevel low-grade techniques versus three-column osteotomies in adult spinal deformity surgery: does harmonious correction matter?

Passias, Peter G / Williamson, Tyler K / Mir, Jamshaid M / Lebovic, Jordan A / Dave, Pooja / Tretiakov, Peter S / Joujon-Roche, Rachel / Imbo, Bailey / Krol, Oscar / Owusu-Sarpong, Stephane / Vira, Shaleen / Schoenfeld, Andrew J / Daniels, Alan H / Diebo, Bassel G / Lafage, Renaud / Lafage, Virginie

Journal of neurosurgery. Spine

2024 , Page(s) 1–7

Abstract: Objective: Recent debate has arisen between whether to use a three-column osteotomy (3CO) or multilevel low-grade (MLG) techniques to treat severe sagittal malalignment in adult spinal deformity (ASD) surgery. The goal of this study was to compare the ... ...

Abstract	Objective: Recent debate has arisen between whether to use a three-column osteotomy (3CO) or multilevel low-grade (MLG) techniques to treat severe sagittal malalignment in adult spinal deformity (ASD) surgery. The goal of this study was to compare the outcomes of 3CO and MLG techniques performed in corrective surgeries for ASD. Methods: ASD patients who had a baseline PI-LL > 30° and 2-year follow-up data were included. Patients underwent either 3CO or MLG (thoracolumbar posterior column osteotomies at ≥ 3 levels or anterior lumbar interbody fusion at ≥ 3 levels with no 3CO). The segmental utility ratio was used to assess relative segmental correction (segmental correction divided by overall correction in lordosis divided by the number of thoracolumbar interventions [interbody fusion, thoracolumbar posterior column osteotomies, and 3CO]). The paired t-test was used to assess lordotic distribution by differences in lordosis between adjacent lumbar disc spaces (e.g., L1-2 to L2-3). Multivariate analysis, controlling for age, sex, BMI, osteoporosis, baseline pelvic incidence, and T1 pelvic angle, was used to evaluate the complication rates and radiographic and patient-reported outcomes between the groups. Results: A total of 93 patients were included, 53% of whom underwent MLG and 47% of whom underwent 3CO. The MLG group had a lower BMI (p < 0.05). MLG patients received fewer previous fusions than 3CO patients (31% vs 80%, p < 0.001). MLG patients had 24% less blood loss but a 22% longer operative time (565 vs 419 minutes, p = 0.008). Using adjusted analysis, the 3CO group had greater segmental and relative correction at each level (segmental utility ratio mean 69% for 3CO vs 23% for MLG, p < 0.001). However, the 3CO group had lordotic differences between two adjacent lumbar disc pairs (range -0.5° to 9.0°, p = 0.009), while MLG was more harmonious (range 2.2°-6.5°, p > 0.4). MLG patients were more likely to undergo realignment to age-adjusted standards (OR 5.6, 95% CI 1.2-46.4; p = 0.033). MLG patients were less likely to develop neurological complications or undergo reoperation (OR 0.4, 95% CI 0.1-0.9; p = 0.041). Adjusted analysis revealed that MLG patients more often met a substantial clinical benefit in the Oswestry Disability Index score (OR 5.3, 95% CI 1.1-26.8; p = 0.043). Conclusions: MLG techniques showed better utility in lumbar distribution and age-adjusted global correction while minimizing neurological complications and reoperation rates by 2 years postoperatively. In selected instances, these techniques may offer the spine deformity surgeon a safer alternative when correcting severe adult spinal deformity.
Language	English
Publishing date	2024-03-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	2158643-3
ISSN	1547-5646 ; 1547-5654
ISSN (online)	1547-5646
ISSN	1547-5654
DOI	10.3171/2024.1.SPINE23802
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Article ; Online: The Evolution of Enhanced Recovery After Surgery: Assessing the Clinical Benefits of Developments Within Enhanced Recovery After Surgery Protocols in Adult Cervical Deformity Surgery.

Passias, Peter G / Tretiakov, Peter S / Onafowokan, Oluwatobi O / Galetta, Matthew / Lorentz, Nathan / Mir, Jamshaid M / Das, Ankita / Dave, Pooja / Lafage, Renaud / Yee, Timothy / Diebo, Bassel / Vira, Shaleen / Jankowski, Pawel P / Hockley, Aaron / Daniels, Alan / Schoenfeld, Andrew J / Mummaneni, Praveen / Paulino, Carl B / Lafage, Virginie

Clinical spine surgery

2024

Abstract: Study design: Retrospective cohort.: Objective: To investigate the impact of evolving Enhanced Recovery After Surgery (ERAS) protocols on outcomes after cervical deformity (CD) surgery.: Background: ERAS can help accelerate patient recovery and ... ...

Abstract	Study design: Retrospective cohort. Objective: To investigate the impact of evolving Enhanced Recovery After Surgery (ERAS) protocols on outcomes after cervical deformity (CD) surgery. Background: ERAS can help accelerate patient recovery and assist hospitals in maximizing the incentives of bundled payment models while maintaining high-quality patient care. However, there remains a paucity of literature assessing how developments have impacted outcomes after adult CD surgery. Methods: Patients with operative CD 18 years or older with pre-baseline and 2 years (2Y) postoperative data, who underwent ERAS protocols, were stratified by increasing implantation of ERAS components: (1) early (multimodal pain program), (2) intermediate (early protocol + paraspinal blocks, early ambulation), and (3) late (early/intermediate protocols + comprehensive prehabilitation). Differences in demographics, clinical outcomes, radiographic alignment targets, perioperative factors, and complication rates were assessed through Bonferroni-adjusted means comparison analysis. Results: A total of 131 patients were included (59.4 ± 11.7 y, 45% females, 28.8 ± 6.0 kg/m2). Of these patients, 38.9% were considered "early," 36.6% were "intermediate," and 24.4% were "late." Perioperatively, rates of intraoperative complications were lower in the late group (P= 0.036). Postoperatively, discharge disposition differed significantly between cohorts, with late patients more likely to be discharged to home versus early or intermediate cohorts [χ2(2) = 37.973, P< 0.001]. In terms of postoperative disability recovery, intermediate and late patients demonstrated incrementally improved 6 W modified Japanese Orthopedic Association scores (P= 0.004), and late patients maintained significantly higher mean Euro-QOL 5-Dimension Questionnaire and modified Japanese Orthopedic Association scores by 1 year (P< 0.001, P= 0.026). By 2Y, cohorts demonstrated incrementally increasing SWAL-QOL scores (all domains P< 0.028) domain scores versus early or intermediate cohorts. By 2Y, incrementally decreasing reoperation was observed in early versus intermediate versus late cohorts (P= 0.034). Conclusions: The present study demonstrates that patients enrolled in an evolving ERAS program demonstrate incremental improvement in preoperative optimization and candidate selection, greater likelihood of discharge to home, decreased postoperative disability and dysphasia burden, and decreased likelihood of intraoperative complications and reoperation rates.
Language	English
Publishing date	2024-04-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	2849646-2
ISSN	2380-0194 ; 2380-0186
ISSN (online)	2380-0194
ISSN	2380-0186
DOI	10.1097/BSD.0000000000001611
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