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Article: Editors' Introduction: Advances in the Evolution of the Lateral Approach to the Thoracolumbar Spine.

Moss, Isaac L / Eastlack, Robert K

International journal of spine surgery

2022 Volume 16, Issue S1, Page(s) S7–S8

Language	English
Publishing date	2022-04-04
Publishing country	Netherlands
Document type	Journal Article
ISSN	2211-4599
ISSN	2211-4599
DOI	10.14444/8230
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Article: Establishing a Gold Standard for Noninvasive Identification of Painful Lumbar Discs: Prospective Comparison of Magnetic Resonance Spectroscopy vs Low-Pressure Provocation Discography.

Gornet, Matthew G / Peacock, James / Ryken, Timothy / Schranck, Francine W / Eastlack, Robert K / Lotz, Jeffrey C

International journal of spine surgery

2024

Language	English
Publishing date	2024-02-27
Publishing country	Netherlands
Document type	Journal Article
ISSN	2211-4599
ISSN	2211-4599
DOI	10.14444/8574
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Article: Multilevel Customized 3D-Printed Titanium Alloy Interbody Cages used to Treat Congenital Scoliosis: A Case Report.

Pesante, Benjamin D / Wellington, Ian J / Eastlack, Robert K / Singh, Hardeep

Journal of orthopaedic case reports

2023 Volume 13, Issue 10, Page(s) 58–64

Abstract: Introduction: Customized, patient-specific interbody cages have been used in the treatment of spinal neoplasia, degenerative disease, infection, congenital anomalies, and trauma. However, to date, their use has been limited to a single spinal level, and ...

Abstract	Introduction: Customized, patient-specific interbody cages have been used in the treatment of spinal neoplasia, degenerative disease, infection, congenital anomalies, and trauma. However, to date, their use has been limited to a single spinal level, and the utility of customized spinal implants in multiple spinal levels remains unclear. In addition, limited studies exist that compare outcomes following fusion and decompression surgery using customized implants to traditional, standard implants. Case report: We present two cases. Case 1 consists of a multilevel deformity surgery from L3-S1 ALIF and T10-Pelvis PSF in a patient with a congenital scoliosis (CS) using customized implants on multiple spinal levels. We compare Case 1 to Case 2, in which a patient underwent a lumbar decompression and fusion for CS using standard titanium implants. While the patient in Case 1 reported improved back pain and independent ambulation at 1-year post-operative and required no revision surgery, the patient in Case 2 required revision surgery 2 years post-operative due to pseudoarthrosis. Conclusion: CS with right wedge hemivertebrae may be treated with customized implants on multiple spinal levels, and customized implants may provide benefit standard implants.
Language	English
Publishing date	2023-10-11
Publishing country	India
Document type	Case Reports
ZDB-ID	2658169-3
ISSN	2250-0685
ISSN	2250-0685
DOI	10.13107/jocr.2023.v13.i10.3936
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Article ; Online: Anterior Column Realignment: Adult Sagittal Deformity Treatment Through Minimally Invasive Surgery.

Mundis, Gregory M / Eastlack, Robert Kenneth / LaMae Price, Amber

Neurosurgery clinics of North America

2023 Volume 34, Issue 4, Page(s) 633–642

Abstract: This article focuses on the treatment of sagittal spinal deformity using a minimally invasive technique, anterior column realignment. Traditional methods to address sagittal spine deformity have been associated with high morbidity, long operative times, ... ...

Abstract	This article focuses on the treatment of sagittal spinal deformity using a minimally invasive technique, anterior column realignment. Traditional methods to address sagittal spine deformity have been associated with high morbidity, long operative times, and excessive blood loss. This technique uses a minimally invasive lateral retroperitoneal approach to release the anterior longitudinal ligament and apply a hyperlordotic implant for interbody fusion to restore lumbar lordosis and sagittal alignment.
MeSH term(s)	Animals ; Adult ; Humans ; Minimally Invasive Surgical Procedures ; Longitudinal Ligaments ; Lordosis/diagnostic imaging ; Lordosis/surgery
Language	English
Publishing date	2023-07-23
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1196855-2
ISSN	1558-1349 ; 1042-3680
ISSN (online)	1558-1349
ISSN	1042-3680
DOI	10.1016/j.nec.2023.06.010
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Article ; Online: Magnetic resonance spectroscopy (MRS) identification of chemically painful lumbar discs leads to improved 6-, 12-, and 24-month outcomes for discogenic low back pain surgeries.

Gornet, Matthew F / Eastlack, Robert K / Peacock, James / Schranck, Francine W / Lotz, Jeffrey C

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 6, Page(s) 1973–1984

Abstract: Purpose: MRS was shown to reliably quantify relative levels of degenerative pain biomarkers, differentiating painful versus non-painful discs in patients with chronic discogenic low back pain (DLBP), and this correlates with surgical success rates. We ... ...

Abstract	Purpose: MRS was shown to reliably quantify relative levels of degenerative pain biomarkers, differentiating painful versus non-painful discs in patients with chronic discogenic low back pain (DLBP), and this correlates with surgical success rates. We now report results based on more patients and longer follow-up. Methods: Disc MRS was performed in DLBP patients who subsequently received lumbar surgery. Custom post-processing (NOCISCAN-LS®; Aclarion Inc.) calculated disc-specific NOCISCORES® that reflect relative differences in degenerative pain biomarkers for diagnosing chemically painful discs. Outcomes in 78 patients were evaluated using Oswestry Disability Index (ODI) scores. Surgical success (≥ 15-point ODI improvement) was compared between surgeries that were "Concordant" (Group C) versus "Discordant" (Group D) with NOCISCORE-based diagnosis for painful discs. Results: Success rates were higher for Group C versus Group D: 6 months (88% vs. 62%; p = 0.01), 12 months (91% vs. 56%; p < 0.001), and 24 months (85% vs. 63%; p = 0.07). Success rates for Group C surgeries were also higher than Group D surgeries in a variety of sub-group comparisons. Group C had a greater reduction in ODI from pre-operative to follow-up than Group D [absolute change (% change), (p)]: 6 months: - 35 (- 61%) versus - 23 (- 39%), (p < 0.05); 12 months: - 39 (- 69%) versus - 22 (- 39%), (p < 0.01); and 24 months: - 38 (- 66%) versus - 26 (- 48%), (p < 0.05). Conclusion: More successful, sustained outcomes were obtained when surgically treating chemically painful discs identified by NOCISCAN-LS post-processed disc MRS exams. Results suggest that NOCISCAN-LS provides a valuable new diagnostic tool to help clinicians better select treatment levels.
MeSH term(s)	Humans ; Low Back Pain/diagnostic imaging ; Low Back Pain/etiology ; Intervertebral Disc Degeneration/complications ; Intervertebral Disc Degeneration/diagnostic imaging ; Intervertebral Disc Degeneration/surgery ; Lumbar Vertebrae/diagnostic imaging ; Lumbar Vertebrae/surgery ; Lumbar Vertebrae/pathology ; Magnetic Resonance Spectroscopy ; Biomarkers ; Intervertebral Disc Displacement/complications ; Intervertebral Disc Displacement/diagnostic imaging ; Intervertebral Disc Displacement/surgery ; Treatment Outcome
Chemical Substances	Biomarkers
Language	English
Publishing date	2023-04-04
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1115375-1
ISSN	1432-0932 ; 0940-6719
ISSN (online)	1432-0932
ISSN	0940-6719
DOI	10.1007/s00586-023-07665-w
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Article ; Online: The influence of ligament biomechanics on proximal junctional kyphosis and failure in patients with adult spinal deformity.

Blais, Micah / Shahidi, Bahar / Anderson, Brad / O'Brien, Eli / Moltzen, Courtney / Iannacone, Tina / Eastlack, Robert K / Mundis, Gregory M

JOR spine

2023 Volume 6, Issue 3, Page(s) e1277

Abstract: Purpose: It is unknown whether the biomechanics of the posterior ligamentous complex (PLC) are impaired in individuals undergoing surgery for adult spinal deformity (ASD). Characterizing these properties may improve our understanding of proximal ... ...

Abstract	Purpose: It is unknown whether the biomechanics of the posterior ligamentous complex (PLC) are impaired in individuals undergoing surgery for adult spinal deformity (ASD). Characterizing these properties may improve our understanding of proximal junctional kyphosis (PJK; defined as proximal junctional angle [PJA] of >10 deg from UIV-1 to UIV + 2), as well as proximal junctional failure (PJF; symptomatic PJK requiring revision). The purpose of this prospective observational study is to compare biomechanical properties of the PLC in individuals with ASD who do, and do not develop PJK or PJF within 1 year of spinal fusion surgery. Methods: Intraoperative biopsies of PLC were obtained from 32 consecutive patients undergoing spinal fusions for ASD (>4 levels). Ligament peak force, tensile stress, tensile strain, and elastic modulus (EM) were measured with a materials testing system. Biomechanical properties and tissue dimensions were correlated with age, gender, BMI, vitamin D level, osteoporosis, sagittal alignment, PJA and change in PJA preoperatively, within 3 months, and at 1 year postoperatively. Results: Longer ligaments were associated with greater PJA change at 3 months ( Conclusions: The biomechanical properties of the PLC may be associated with higher risk for proximal failure. Ligaments that are longer, thinner, and less elastic are associated with higher postoperative PJA. Furthermore stiffer EM of the ligament is associated with the need for revision surgery.
Language	English
Publishing date	2023-08-25
Publishing country	United States
Document type	Journal Article
ISSN	2572-1143
ISSN (online)	2572-1143
DOI	10.1002/jsp2.1277
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Article ; Online: Establishing a Standardized Clinical Consensus for Reporting Complications Following Lateral Lumbar Interbody Fusion.

Mundis, Gregory M / Ito, Kenyu / Lakomkin, Nikita / Shahidi, Bahar / Malone, Hani / Iannacone, Tina / Akbarnia, Behrooz / Uribe, Juan / Eastlack, Robert

Medicina (Kaunas, Lithuania)

2023 Volume 59, Issue 6

Abstract: Background and Objectives: ...

Abstract	Background and Objectives:
MeSH term(s)	Humans ; Lumbar Vertebrae/surgery ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Spinal Fusion/adverse effects ; Spinal Fusion/methods ; Incidence ; Algorithms ; Retrospective Studies
Language	English
Publishing date	2023-06-15
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2188113-3
ISSN	1648-9144 ; 1010-660X
ISSN (online)	1648-9144
ISSN	1010-660X
DOI	10.3390/medicina59061149
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Article ; Online: Does the interfacing angle between pedicle screws and support rods affect clinical outcomes after posterior thoracolumbar fusion? A retrospective clinical study.

Noriega, David C / Eastlack, Robert K / Hernández, Gregorio Labrador / Kafchitsas, Konstantinos / Ryang, Yu-Mi / Spitz, Steven M / Lite, Israel Sánchez

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

2023 Volume 24, Issue 1, Page(s) 125–131

Abstract: Background context: Proper alignment and tightening of the pedicle screw/rod assembly after instrumented posterior fusion of the lower spine is known to be crucial in order to achieve satisfactory clinical results. Such interfacing angle mismatches ... ...

Abstract	Background context: Proper alignment and tightening of the pedicle screw/rod assembly after instrumented posterior fusion of the lower spine is known to be crucial in order to achieve satisfactory clinical results. Such interfacing angle mismatches indicate stress overloading of the implant system. Purpose: The objective of this study is to investigate the incidence of postoperative screw/rod interfacing angle mismatch and to analyze the impact of mismatches on clinical outcome in terms of (1) revision surgery, (2) adjacent segment degeneration (ASD), and (3) pain. Study design: This is a monocentric retrospective observational study. Patient sample: Patients underwent fusion surgery with pedicle screw/rod systems for predominantly degenerative pathologies. Outcome measures: Pedicle screw/rod interfacing angle mismatch (mismatch is the angular deviation from 90° formed by the rod axis and the pedicle screw head axis as an indicator for missing form-fit) revision rate, ASD at the immediately adjacent cranial segment and VAS pain. Methods: Revision refers to subsequent procedures in which all or part of the original implant configuration is changed or removed. Radiographic parameters are evaluated using a/p and lateral radiographs at final follow-up. The interfacing angle mismatch between pedicle screw and rod is measured as the angle between two parallel lines on either side of each pedicle screw head and a line laterally along the associated rod. Multiple comparisons are counteracted by Bonferroni correction, adjusted significance level is at p<.01. Results:* Pedicle screw and rod interfacing angle mismatch was found in 171/406 (42.1%) of patients undergoing fusion surgery, affecting 613/3016 (20.3%) screws. The overall revision incidence was 11.8% (48/406), and a new ASD occurred in 12.1% of all patients (49/406) with an average follow-up of 5 years. Mean VAS pain score at final follow-up was 2.0. Comparison of the two groups with and without mismatches revealed statistically significantly higher (1) numbers of revision procedures performed (26.9% vs 0.9%), (2) numbers of new ASD developed (27.5% vs 3.8%), and (3) higher VAS pain scores (2.8/10 vs 1.4/10) for cases with mismatch. When comparing patients who underwent intraoperative correction and/or reduction with those who did not, statistically significant more screw mismatches (63.4% vs 39.7%) and revision surgeries (29.3% vs 9.9%) were noted in patients who had these forceful maneuvers. Conclusions: Pedicle screw/rod interfacing angle mismatch is a frequent occurrence after fusion surgery. Mismatches indicate that the construct was assembled under mechanical stress. All preventable mechanical stresses, for example, unintentional uncontrolled forces on the instrumentation, should be avoided as much as possible, as they can negatively influence the clinical outcome.
MeSH term(s)	Humans ; Pedicle Screws/adverse effects ; Retrospective Studies ; Lumbar Vertebrae/diagnostic imaging ; Lumbar Vertebrae/surgery ; Pain ; Spinal Fusion/methods ; Treatment Outcome
Language	English
Publishing date	2023-09-17
Publishing country	United States
Document type	Observational Study ; Journal Article
ZDB-ID	2037072-6
ISSN	1878-1632 ; 1529-9430
ISSN (online)	1878-1632
ISSN	1529-9430
DOI	10.1016/j.spinee.2023.09.008
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Article ; Online: Metal-Free Cortico-Pedicular Device for Supplemental Fixation in Lumbar Interbody Fusion.

Nunley, Pierce D / Eastlack, Robert K / Miller, Larry E / Poelstra, Kornelis A / Cox, J Bridger / Shedden, Peter M / Stone, Marcus

World neurosurgery

2023 Volume 174, Page(s) 4–10

Abstract: Objective: Pedicle screw fixation is a commonly utilized adjunct for lumbar interbody fusion, yet risks include screw malposition, pullout, loosening, neurovascular injury, and stress transfers leading to adjacent segment degeneration. This report ... ...

Abstract	Objective: Pedicle screw fixation is a commonly utilized adjunct for lumbar interbody fusion, yet risks include screw malposition, pullout, loosening, neurovascular injury, and stress transfers leading to adjacent segment degeneration. This report describes the preclinical and initial clinical results of a minimally invasive, metal-free cortico-pedicular fixation device used for supplemental posterior fixation in lumbar interbody fusion. Methods: Safety of arcuate tunnel creation was evaluated in cadaveric lumbar (L1-S1) specimens. A finite element analysis study evaluated clinical stability of the device to pedicular screw-rod fixation at L4-L5. Preliminary clinical results were assessed by analysis of Manufacturer and User Facility Device Experience database complications, and 6-month outcomes in 13 patients treated with the device. Results: Among 35 curved drill holes in 5 lumbar specimens, no breaches of the anterior cortex were identified. The mean minimum distance from the anterior surface of the hole to the spinal canal ranged from 5.1 mm at L1-L2 to 9.8 mm at L5-S1. In the finite element analysis study, the polyetheretherketone strap provided comparable clinical stability and reduced anterior stress shielding compared to the conventional screw-rod construct. The Manufacturer and User Facility Device Experience database identified 1 device fracture with no clinical sequelae among 227 procedures. Initial clinical experience showed a 53% decrease in pain severity (P = 0.009), a 50% decrease in Oswestry Disability Index (P < 0.001), and no device-related complications. Conclusions: Cortico-pedicular fixation is a safe and reproducible procedure that may address limitations of pedicle screw fixation. Longer term clinical data in large clinical studies are recommended to confirm these promising early results.
MeSH term(s)	Animals ; Humans ; Phthiraptera ; Spinal Fusion/methods ; Lumbar Vertebrae/surgery ; Biomechanical Phenomena ; Pedicle Screws
Language	English
Publishing date	2023-03-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2023.02.119
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Article: An Integrated 3-Dimentional Navigation System Increases the Accuracy, Efficiency, and Safety of Percutaneous Thoracolumbar Pedicle Screw Placement in Minimally Invasive Approaches: A Randomized Cadaveric Study.

Lakomkin, Nikita / Eastlack, Robert K / Uribe, Juan S / Park, Paul / Ryu, Stephen I / Kretzer, Ryan / Mimran, Ronnie I / Holman, Paul / Veeravagu, Anand / Hassanzadeh, Hamid / Johnson, Michele M / Sullivan, Linda / Clark, Aaron / Mundis, Gregory M

Global spine journal

2024 , Page(s) 21925682231224394

Abstract: Study design: Cadaveric study.: Objectives: The purpose of this study was to compare a novel, integrated 3D navigational system (NAV) and conventional fluoroscopy in the accuracy, efficiency, and radiation exposure of thoracolumbar percutaneous ... ...

Abstract	Study design: Cadaveric study. Objectives: The purpose of this study was to compare a novel, integrated 3D navigational system (NAV) and conventional fluoroscopy in the accuracy, efficiency, and radiation exposure of thoracolumbar percutaneous pedicle screw (PPS) placement. Methods: Twelve skeletally mature cadaveric specimens were obtained for twelve individual surgeons. Each participant placed bilateral PS at 11 segments, from T8 to S1. Prior to insertion, surgeons were randomized to the sequence of techniques and the side (left or right). Following placement, a CT scan of the spine was obtained for each cadaver, and an independent reviewer assessed the accuracy of screw placement using the Gertzbein grading system. Outcome metrics of interest included a comparison of breach incidence/severity, screw placement time, total procedure time, and radiation exposure between the techniques. Bivariate statistics were employed to compare outcomes at each level. Results: A total of 262 screws (131 using each technique) were placed. The incidence of cortical breaches was significantly lower with NAV compared to FG (9% vs 18%; Conclusions: The use of NAV significantly decreased the incidence of cortical breaches, the severity of screw breeches, screw placement time, and radiation exposure to the surgeon when compared to traditional FG.
Language	English
Publishing date	2024-01-02
Publishing country	England
Document type	Journal Article
ZDB-ID	2648287-3
ISSN	2192-5690 ; 2192-5682
ISSN (online)	2192-5690
ISSN	2192-5682
DOI	10.1177/21925682231224394
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