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Article ; Online: Economic comparisons of endoscopic spine surgery: a systematic review.

Golan, Jeff D / Elkaim, Lior M / Alrashidi, Qais / Georgiopoulos, Miltiadis / Lasry, Oliver

European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society

2023 Volume 32, Issue 8, Page(s) 2627–2636

Abstract: Purpose: Full-endoscopic techniques are minimally invasive surgery alternatives to traditional spinal surgery. We performed a systematic review of the literature to assess the costs of these techniques compared to traditional approaches.: Methods: A ... ...

Abstract	Purpose: Full-endoscopic techniques are minimally invasive surgery alternatives to traditional spinal surgery. We performed a systematic review of the literature to assess the costs of these techniques compared to traditional approaches. Methods: A systematic review of the literature was performed for economic evaluations that compare endoscopic decompressions of the lumbar spine for stenosis or disc herniation to open or microsurgical decompressions. The search was performed in the following databases: Medline, Embase Classic, Embase, and Central Cochrane library, from January 1, 2005, to October 22, 2022. The included studies were each evaluated according to a formal assessment checklist to evaluate the quality of economic evaluations based on 35 criteria. Result: A total of 1153 studies were identified, with 9 articles included in the final analysis. In evaluating the quality of economic evaluations, the study with the fewest met criteria scored 9/35 and the study with the most met criteria scored 28/35. Only 3 studies completed cost-effectiveness analyses. Surgical procedure duration varied between studies, but hospital length of stays were consistently shorter with endoscopy. While endoscopy was more frequently associated with higher operating costs, studies that measured healthcare and societal costs found endoscopy to be advantageous. Conclusion: Endoscopic spine surgery was found to be cost-effective in treating patients with lumbar stenosis and disc herniation when compared to standard microscopic approaches from a societal perspective. More well-designed economic evaluations investigating the cost-effectiveness of endoscopic spine procedures are needed to further support these findings.
MeSH term(s)	Humans ; Intervertebral Disc Displacement/surgery ; Constriction, Pathologic ; Endoscopy/methods ; Minimally Invasive Surgical Procedures/methods ; Lumbar Vertebrae/surgery ; Cost-Benefit Analysis
Language	English
Publishing date	2023-04-19
Publishing country	Germany
Document type	Systematic Review ; Journal Article ; Review
ZDB-ID	1115375-1
ISSN	1432-0932 ; 0940-6719
ISSN (online)	1432-0932
ISSN	0940-6719
DOI	10.1007/s00586-023-07699-0
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Article ; Online: Ultrasound-based navigated pedicle screw insertion without intraoperative radiation: feasibility study on porcine cadavers.

Gueziri, Houssem-Eddine / Georgiopoulos, Miltiadis / Santaguida, Carlo / Collins, D Louis

The spine journal : official journal of the North American Spine Society

2022 Volume 22, Issue 8, Page(s) 1408–1417

Abstract: Background: Navigation systems for spinal fusion surgery rely on intraoperative computed tomography (CT) or fluoroscopy imaging. Both expose patient, surgeons and operating room staff to significant amounts of radiation. Alternative methods involving ... ...

Abstract	Background: Navigation systems for spinal fusion surgery rely on intraoperative computed tomography (CT) or fluoroscopy imaging. Both expose patient, surgeons and operating room staff to significant amounts of radiation. Alternative methods involving intraoperative ultrasound (iUS) imaging have recently shown promise for image-to-patient registration. Yet, the feasibility and safety of iUS navigation in spinal fusion have not been demonstrated. Purpose: To evaluate the accuracy of pedicle screw insertion in lumbar and thoracolumbar spinal fusion using a fully automated iUS navigation system. Study design: Prospective porcine cadaver study. Methods: Five porcine cadavers were used to instrument the lumbar and thoracolumbar spine using posterior open surgery. During the procedure, iUS images were acquired and used to establish automatic registration between the anatomy and preoperative CT images. Navigation was performed with the preoperative CT using tracked instruments. The accuracy of the system was measured as the distance of manually collected points to the preoperative CT vertebral surface and compared against fiducial-based registration. A postoperative CT was acquired, and screw placements were manually verified. We report breach rates, as well as axial and sagittal screw deviations. Results: A total of 56 screws were inserted (5.50 mm diameter n=50, and 6.50 mm diameter n=6). Fifty-two screws were inserted safely without breach. Four screws (7.14%) presented a medial breach with an average deviation of 1.35±0.37 mm (all <2 mm). Two breaches were caused by 6.50 mm diameter screws, and two by 5.50 mm screws. For vertebrae instrumented with 5.50 mm screws, the average axial diameter of the pedicle was 9.29 mm leaving a 1.89 mm margin in the left and right pedicle. For vertebrae instrumented with 6.50 mm screws, the average axial diameter of the pedicle was 8.99 mm leaving a 1.24 mm error margin in the left and right pedicle. The average distance to the vertebral surface was 0.96 mm using iUS registration and 0.97 mm using fiducial-based registration. Conclusions: We successfully implanted all pedicle screws in the thoracolumbar spine using the ultrasound-based navigation system. All breaches recorded were minor (<2 mm) and the breach rate (7.14%) was comparable to existing literature. More investigation is needed to evaluate consistency, reproducibility, and performance in surgical context. Clinical significance: Intraoperative US-based navigation is feasible and practical for pedicle screw insertion in a porcine model. It might be used as a low-cost and radiation-free alternative to intraoperative CT and fluoroscopy in the future.
MeSH term(s)	Animals ; Cadaver ; Feasibility Studies ; Fluoroscopy/methods ; Lumbar Vertebrae/diagnostic imaging ; Lumbar Vertebrae/surgery ; Pedicle Screws ; Prospective Studies ; Reproducibility of Results ; Spinal Fusion/methods ; Surgery, Computer-Assisted/methods ; Swine
Language	English
Publishing date	2022-05-04
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2037072-6
ISSN	1878-1632 ; 1529-9430
ISSN (online)	1878-1632
ISSN	1529-9430
DOI	10.1016/j.spinee.2022.04.014
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Article ; Online: Efficacy, Safety, and Duration of a Frameless Fiducial-Less Brain Biopsy versus Frame-based Stereotactic Biopsy: A Prospective Randomized Study.

Georgiopoulos, Miltiadis / Ellul, John / Chroni, Elisabeth / Constantoyannis, Constantine

Journal of neurological surgery. Part A, Central European neurosurgery

2018 Volume 79, Issue 1, Page(s) 31–38

Abstract: Background/objective: We compared the efficacy, duration, safety, length of hospital stay of a frameless fiducial-less brain biopsy with those of the standard frame-based stereotactic biopsy.: Patients and methods: This prospective cohort study ... ...

Abstract	Background/objective: We compared the efficacy, duration, safety, length of hospital stay of a frameless fiducial-less brain biopsy with those of the standard frame-based stereotactic biopsy. Patients and methods: This prospective cohort study enrolled 56 adult patients: (1) for whom no conclusive diagnosis could be reached noninvasively; (2a) who had lesions involving deep-seated and eloquent areas, multifocal lesions, or lesions for which craniotomy and lesion removal was not indicated, or (2b) were poor candidates for craniotomy (> 80 years of age and/or with serious comorbidities). Frameless and frame-based biopsy were performed in 28 patients each RESULTS: A diagnosis was not made in four cases (14.3%) of the frame-based biopsy group and in three cases (10.7%) of the frameless biopsy group, in spite of accurate targeting ( Conclusions: The frameless fiducial-less brain biopsy was equally efficacious and safe compared with the standard stereotactic frame-based biopsy. The overall duration of frameless biopsy is shorter than that of frame-based biopsy, mainly because the preparatory steps in frameless biopsy require less time. However, the overall time spent in the OR did not differ between the two groups. The LOS also did not differ significantly.
MeSH term(s)	Adult ; Aged ; Biopsy/methods ; Brain/diagnostic imaging ; Brain/pathology ; Brain Neoplasms/diagnostic imaging ; Brain Neoplasms/pathology ; Female ; Fiducial Markers ; Humans ; Male ; Middle Aged ; Prospective Studies ; Stereotaxic Techniques ; Tomography, X-Ray Computed
Language	English
Publishing date	2018-01
Publishing country	Germany
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	2651663-9
ISSN	2193-6323 ; 2193-6315
ISSN (online)	2193-6323
ISSN	2193-6315
DOI	10.1055/s-0037-1602697
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Article ; Online: Syringobulbia: A delayed complication following spinal cord injury - case report.

Mousele, Christina / Georgiopoulos, Miltiadis / Constantoyannis, Constantine

The journal of spinal cord medicine

2018 Volume 42, Issue 2, Page(s) 260–264

Abstract: Context: Syringobulbia is a very rare progressive disorder of central nervous system, with several possible underlying conditions. Rarely, it is also encountered as a late complication of syringomyelia.: Findings: In the present manuscript, a case of ...

Abstract	Context: Syringobulbia is a very rare progressive disorder of central nervous system, with several possible underlying conditions. Rarely, it is also encountered as a late complication of syringomyelia. Findings: In the present manuscript, a case of a paraplegic patient, due to traumatic spinal cord injury (thoracolumbar fracture), presenting after years progressively developing symptoms of the lower cranial nerves and upper extremities, owed to syringomyelia and syringobulbia, the surgical treatment applied and its outcomes are described. We performed a syringo-peritoneal shunting procedure using a T-tube. The patient's symptoms resolved postoperatively and the cavity's size was reduced to a great degree. Conclusion/clinical relevance: The late appearance of cranial nerve deficits or symptoms-signs of the upper extremities in a patient with traumatic thoracic spinal cord injury should raise suspicion that post-traumatic syringomyelia or syringobulbia has occurred. In such cases, radiologic evaluation and early surgical drainage of the cyst as a means of preventing significant delayed neurologic deficit is advocated.
MeSH term(s)	Adult ; Brain Diseases/complications ; Brain Diseases/etiology ; Brain Diseases/pathology ; Brain Diseases/surgery ; Brain Stem/pathology ; Brain Stem/surgery ; Cerebrospinal Fluid Shunts ; Cranial Nerve Diseases/etiology ; Cranial Nerve Diseases/physiopathology ; Humans ; Male ; Spinal Cord Injuries/complications ; Syringomyelia/complications ; Syringomyelia/etiology ; Syringomyelia/pathology ; Syringomyelia/surgery ; Upper Extremity/physiopathology
Language	English
Publishing date	2018-02-27
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	1223949-5
ISSN	2045-7723 ; 1079-0268
ISSN (online)	2045-7723
ISSN	1079-0268
DOI	10.1080/10790268.2018.1439437
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Zs.A 2416: Show issues

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Article ; Online: A twitter analysis of patient and family experience in pediatric spine surgery.

Levett, Jordan J / Elkaim, Lior M / Weber, Michael H / Yuh, Sung-Joo / Lasry, Oliver / Alotaibi, Naif M / Georgiopoulos, Miltiadis / Berven, Sigurd H / Weil, Alexander G

Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery

2023 Volume 39, Issue 12, Page(s) 3483–3490

Abstract: Background: There is little data on patient and caregiver perceptions of spine surgery in children and youth. This study aims to characterize the personal experiences of patients, caregivers, and family members surrounding pediatric spine surgery ... ...

Abstract	Background: There is little data on patient and caregiver perceptions of spine surgery in children and youth. This study aims to characterize the personal experiences of patients, caregivers, and family members surrounding pediatric spine surgery through a qualitative and quantitative social media analysis. Methods: The Twitter application programming interface was searched for keywords related to pediatric spine surgery from inception to March 2022. Relevant tweets and accounts were extracted and subsequently classified using thematic labels. Tweet metadata was collected to measure user engagement via multivariable regression. Sentiment analysis using Natural Language Processing was performed on all tweets with a focus on tweets discussing the personal experiences of patients and caregivers. Results: 2424 tweets from 1847 individual accounts were retrieved for analysis. Patients and caregivers represented 1459 (79.0%) of all accounts. Posts discussed the personal experiences of patients and caregivers in 83.5% of tweets. Pediatric spine surgery research was discussed in few posts (n=90, 3.7%). Within the personal experience category, 975 (48.17%) tweets were positive, 516 (25.49%) were negative, and 533 (26.34%) were neutral. Presence of a tag (beta: -6.1, 95% CI -9.7 to -2.5) and baseline follower count (beta<0.001, 95% CI <0.001 to <0.001) significantly affected tweet engagement negatively and positively, respectively. Conclusions: Patients and caregivers actively discuss topics related to pediatric spine surgery on Twitter. Posts discussing personal experience are most prevalent, while posts on research are scarce, unlike previous social media studies. Pediatric spine surgeons can leverage this dialogue to better understand the worries and needs of patients and their families.
MeSH term(s)	Adolescent ; Child ; Humans ; Social Media ; Spine/surgery ; Family ; Caregivers
Language	English
Publishing date	2023-06-24
Publishing country	Germany
Document type	Journal Article
ZDB-ID	605988-0
ISSN	1433-0350 ; 0302-2803 ; 0256-7040
ISSN (online)	1433-0350
ISSN	0302-2803 ; 0256-7040
DOI	10.1007/s00381-023-06019-7
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Article: Neck angioedema after anterior cervical discectomy and fusion with coexistent epiglottic cyst.

Georgiopoulos, Miltiadis / Papadakos, Dimitrios / Kraniotis, Pantelis / Lygeros, Spyridon / Margaritis, Vasilios / Karnabatidis, Dimitrios / Gatzounis, Georgios

Surgical neurology international

2020 Volume 11, Page(s) 459

Abstract: Background: We present a case and reviewed the literature regarding airway obstruction and angioedema after an anterior cervical discectomy and fusion (ACDF).: Case description: A 60-year-old female with degenerative cervical myelopathy and a ... ...

Abstract	Background: We present a case and reviewed the literature regarding airway obstruction and angioedema after an anterior cervical discectomy and fusion (ACDF). Case description: A 60-year-old female with degenerative cervical myelopathy and a previously undiagnosed epiglottic cyst underwent a C5-C6 ACDF; notably, the anesthesiologist found an epiglottic cyst when the patient was first intubated. Two hours postoperatively, the patient acutely developed severe neck swelling with airway obstruction due to angioedema. She was immediately treated with hydrocortisone and required a tracheostomy. The edema decreased markedly in the next 12 h and by the 3 Conclusion: Patients with epiglottic cysts who need cervical spine surgery should either first have the cyst treated or should be closely monitored postoperatively.
Language	English
Publishing date	2020-12-22
Publishing country	United States
Document type	Case Reports
ISSN	2229-5097
ISSN	2229-5097
DOI	10.25259/SNI_808_2020
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Article ; Online: Modulating the activity of human nociceptors with a SCN10A promoter-specific viral vector tool.

Mouchbahani-Constance, Stephanie / Lagard, Camille / Schweizer, Justine / Labonté, Isabelle / Georgiopoulos, Miltiadis / Otis, Colombe / St-Louis, Manon / Troncy, Eric / Sarret, Philippe / Ribeiro-Da-Silva, Alfredo / Ouellet, Jean A / Séguéla, Philippe / Paquet, Marie-Eve / Sharif-Naeini, Reza

Neurobiology of pain (Cambridge, Mass.)

2023 Volume 13, Page(s) 100120

Abstract: Despite the high prevalence of chronic pain as a disease in our society, there is a lack of effective treatment options for patients living with this condition. Gene therapies using recombinant AAVs are a direct method to selectively express genes of ... ...

Abstract	Despite the high prevalence of chronic pain as a disease in our society, there is a lack of effective treatment options for patients living with this condition. Gene therapies using recombinant AAVs are a direct method to selectively express genes of interest in target cells with the potential of, in the case of nociceptors, reducing neuronal firing in pain conditions. We designed a recombinant AAV vector expressing cargos whose expression was driven by a portion of the SCN10A (Na
Language	English
Publishing date	2023-01-30
Publishing country	United States
Document type	Journal Article
ISSN	2452-073X
ISSN (online)	2452-073X
DOI	10.1016/j.ynpai.2023.100120
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Article: Adult Spinal Deformity Surgery and Frailty: A Systematic Review.

Laverdière, Carl / Georgiopoulos, Miltiadis / Ames, Christopher P / Corban, Jason / Ahangar, Pouyan / Awadhi, Khaled / Weber, Michael H

Global spine journal

2021 Volume 12, Issue 4, Page(s) 689–699

Abstract: Study design: Systematic review.: Objectives: Adult spinal deformity (ASD) can be a debilitating condition with a profound impact on patients' health-related quality of life (HRQoL). Many reports have suggested that the frailty status of a patient ... ...

Abstract	Study design: Systematic review. Objectives: Adult spinal deformity (ASD) can be a debilitating condition with a profound impact on patients' health-related quality of life (HRQoL). Many reports have suggested that the frailty status of a patient can have a significant impact on the outcome of the surgery. The present review aims to identify all pre-operative patient-specific frailty markers that are associated with postoperative outcomes following corrective surgery for ASD of the lumbar and thoracic spine. Methods: A systematic review of the literature was performed to identify findings regarding pre-operative markers of frailty and their association with postoperative outcomes in patients undergoing ASD surgery of the lumbar and thoracic spine. The search was performed in the following databases: PubMed, Embase, Cochrane and CINAHL. Results: An association between poorer performance on frailty scales and worse postoperative outcomes. Comorbidity indices were even more frequently employed with similar patterns of association between increased comorbidity burden and postoperative outcomes. Regarding the assessment of HRQoL, worse pre-operative ODI, SF-36, SRS-22 and NRS were shown to be predictors of post-operative complications, while ODI, SF-36 and SRS-22 were found to improve post-operatively. Conclusions: The findings of this review highlight the true breadth of the concept of "frailty" in ASD surgical correction. These parameters, which include frailty scales and various comorbidity and HRQoL indices, highlight the importance of identifying these factors preoperatively to ensure appropriate patient selection while helping to limit poor postoperative outcomes.
Language	English
Publishing date	2021-03-26
Publishing country	England
Document type	Journal Article
ZDB-ID	2648287-3
ISSN	2192-5690 ; 2192-5682
ISSN (online)	2192-5690
ISSN	2192-5682
DOI	10.1177/21925682211004250
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Article ; Online: Perception of frailty in spinal metastatic disease: international survey of the AO Spine community.

Journal of neurosurgery. Spine

2023 , Page(s) 1–11

Abstract: Objective: Frailty has not been clearly defined in the context of spinal metastatic disease (SMD). Given this, the objective of this study was to better understand how members of the international AO Spine community conceptualize, define, and assess ... ...

Abstract	Objective: Frailty has not been clearly defined in the context of spinal metastatic disease (SMD). Given this, the objective of this study was to better understand how members of the international AO Spine community conceptualize, define, and assess frailty in SMD. Methods: The AO Spine Knowledge Forum Tumor conducted an international cross-sectional survey of the AO Spine community. The survey was developed using a modified Delphi technique and was designed to capture preoperative surrogate markers of frailty and relevant postoperative clinical outcomes in the context of SMD. Responses were ranked using weighted averages. Consensus was defined as ≥ 70% agreement among respondents. Results: Results were analyzed for 359 respondents, with an 87% completion rate. Study participants represented 71 countries. In the clinical setting, most respondents informally assess frailty and cognition in patients with SMD by forming a general perception based on clinical condition and patient history. Consensus was attained among respondents regarding the association between 14 preoperative clinical variables and frailty. Severe comorbidities, extensive systemic disease burden, and poor performance status were most associated with frailty. Severe comorbidities associated with frailty included high-risk cardiopulmonary disease, renal failure, liver failure, and malnutrition. The most clinically relevant outcomes were major complications, neurological recovery, and change in performance status. Conclusions: The respondents recognized that frailty is important, but they most commonly evaluate it based on general clinical impressions rather than using existing frailty tools. The authors identified numerous preoperative surrogate markers of frailty and postoperative clinical outcomes that spine surgeons perceived as most relevant in this population.
Language	English
Publishing date	2023-03-03
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	10.3171/2023.1.SPINE221433
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Article: Minimizing technical failure of percutaneous balloon compression for trigeminal neuralgia using neuronavigation.

Georgiopoulos, Miltiadis / Ellul, John / Chroni, Elisabeth / Constantoyannis, Constantine

ISRN neurology

2014 Volume 2014, Page(s) 630418

Abstract: Unlabelled: Objective. Percutaneous balloon compression (PBC) is an effective and safe management for medically refractory trigeminal neuralgia; however, technical failure to cannulate the foramen ovale (FO) using only fluoroscopy is a significant ... ...

Abstract	Unlabelled: Objective. Percutaneous balloon compression (PBC) is an effective and safe management for medically refractory trigeminal neuralgia; however, technical failure to cannulate the foramen ovale (FO) using only fluoroscopy is a significant problem in some cases. In this paper, we suggest the use of intraoperative navigation, in cases of reoperation due to prior technical failure to cannulate the FO under fluoroscopy. Methods. A total of 174 patients underwent PBC for TN since 2003. In 9 cases the penetration of the FO was not accomplished. Five of those patients were reoperated on for PBC using navigation from March 2012 to September 2012. Surgical technique: preoperatively, a head Computed Tomography (CT) scan is performed and the acquired images are imported into the navigation system. Intraoperatively, a small reference frame is strapped firmly to the patient's forehead, the CT images are registered, and cannulation is performed under the guidance of the navigation system. Results. In all patients, the operation overall was completed successfully. Moreover, all patients reported complete pain relief immediately postoperatively and no complications were recorded overall. Conclusions. We suggest the use of neuronavigation in cases of technical failure of PBC. That technique involves technology with significant advantages helping the successful cannulation of the FO and seems more efficient and safer.
Language	English
Publishing date	2014-03-09
Publishing country	Egypt
Document type	Journal Article
ZDB-ID	2612992-9
ISSN	2090-5513 ; 2090-5505
ISSN (online)	2090-5513
ISSN	2090-5505
DOI	10.1155/2014/630418
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