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Article ; Online: Definition of Normal Vertebral Morphometry Using NHANES-II Radiographs.

Hipp, John A / Grieco, Trevor F / Newman, Patrick / Reitman, Charles A

JBMR plus

2022 Volume 6, Issue 10, Page(s) e10677

Abstract: A robust definition of normal vertebral morphometry is required to confidently identify abnormalities such as fractures. The Second National Health and Nutrition Examination Survey (NHANES-II) collected a nationwide probability sample to document the ... ...

Abstract	A robust definition of normal vertebral morphometry is required to confidently identify abnormalities such as fractures. The Second National Health and Nutrition Examination Survey (NHANES-II) collected a nationwide probability sample to document the health status of the United States. Over 10,000 lateral cervical spine and 7,000 lateral lumbar spine X-rays were collected. Demographic, anthropometric, health, and medical history data were also collected. The coordinates of the vertebral body corners were obtained for each lumbar and cervical vertebra using previously validated, automated technology consisting of a pipeline of neural networks and coded logic. These landmarks were used to calculate six vertebral body morphometry metrics. Descriptive statistics were generated and used to identify and trim outliers from the data. Descriptive statistics were tabulated using the trimmed data for use in quantifying deviation from average for each metric. The dependency of these metrics on sex, age, race, nation of origin, height, weight, and body mass index (BMI) was also assessed. There was low variation in vertebral morphometry after accounting for vertebrae (eg, L1, L2), and the
Language	English
Publishing date	2022-09-27
Publishing country	England
Document type	Journal Article
ISSN	2473-4039
ISSN (online)	2473-4039
DOI	10.1002/jbm4.10677
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Article: Threshold Limit Graphical Approach to Understanding Outcome Predictive Metrics: Data from the Osteoarthritis Initiative.

Hipp, John A / Chan, Elaine F

Cureus

2017 Volume 9, Issue 7, Page(s) e1447

Abstract: Scatter plots, bar charts, linear regressions, analysis of variance, and other graphics and tests are frequently used to document associations between an independent variable and an outcome. However, these methods are also frequently limited when ... ...

Abstract	Scatter plots, bar charts, linear regressions, analysis of variance, and other graphics and tests are frequently used to document associations between an independent variable and an outcome. However, these methods are also frequently limited when understanding how to use an independent variable in subsequent research or patient management. A novel graphical approach to visualizing data-the threshold limit graph-was therefore developed. Publically available data from the Osteoarthritis Initiative was used to illustrate the graphical approach to understanding the association between the change in joint space width (ΔJSW, independent variable) over four years, and knee symptoms at four years (using the Knee Injury and Osteoarthritis Outcome Score [KOOS], dependent variable). Using data for 4,202 knees, the traditional scatter plot and linear regression approach showed a significant but weak linear relationship between the symptom subscore of the KOOS and ΔJSW. However, the threshold level of ΔJSW that affects symptoms was not clear from the data. The same dataset was then plotted using the threshold limit graphical approach, which revealed a non-linear relationship between the variables. In contrast to the scatter plot, plotting the average KOOS symptom subscore for subgroups of the data, with each subgroup defined using sequentially increasing or decreasing ΔJSW thresholds revealed that symptoms got worse with joint space loss, but only when there was a significant amount of ΔJSW. A threshold limit analysis was repeated using small, randomly selected subsets of the data (N = ~100) to demonstrate the utility of the technique for identifying trends in smaller datasets. The threshold limit graph is a simple, graphical approach that may prove helpful in understanding how an independent variable might be used to predict outcomes. This approach provides an additional option for visualizing and quantifying associations between variables.
Language	English
Publishing date	2017-07-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.1447
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Article: The Assessment of Fusion Following Sacroiliac Joint Fusion Surgery.

Abbasi, Hamid / Hipp, John A

Cureus

2017 Volume 9, Issue 10, Page(s) e1787

Abstract: Sacroiliac joint fusions (SIJF) have been the subject of many research studies. The technical success of an SIJF is in part determined by whether osseous bridging occurs across the sacroiliac joint (SIJ). However, no validated SIJF assessment method has ... ...

Abstract	Sacroiliac joint fusions (SIJF) have been the subject of many research studies. The technical success of an SIJF is in part determined by whether osseous bridging occurs across the sacroiliac joint (SIJ). However, no validated SIJF assessment method has been described. Our objective was to document previously described SIJF assessment methods and define and validate a detailed assessment system for SIJF. Our results are only intended to establish computed tomography (CT)-based guidelines for SIJF to be used in a subsequent large clinical study to correlate them with clinical outcomes. The SIJF literature was reviewed to document previous descriptions of SIJF assessments. A detailed system was then developed for assessing SIJF from CT exams. To provide data that can be used to address a range of research questions, the system included assessing bridging bone relative to the SIJ anatomy, bridging bone immediately adjacent to the threaded implants crossing the joint, as well as bridging bone close to but not immediately adjacent to the implants. The system was applied to assessing SIJF from thin-slice CT exams in 19 patients 12 months following surgery. Two experienced radiologists implemented the assessment system, and in the event of a disagreement, an adjudicator was used. Most prior studies provide very little detail about how SIJF was assessed. Using the new assessment system, the agreement between the primary readers was substantial (0.67 using Gwet's AC1 statistic). Bridging bone representing a fusion of the SIJ was identified in most patients both immediately adjacent to the threaded implants crossing the joint, as well as distant to the implants. A detailed radiographic assessment system proved to be applicable to SIJF. The assessment system includes explicit language describing the location and extent of bridging bone across the SIJ. Standardization of the assessment of the SIJFs may allow for a more meaningful comparison of data between studies.
Language	English
Publishing date	2017-10-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.1787
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Article ; Online: Analysis of translation and angular motion in loaded and unloaded positions in the lumbar spine.

Braunstein, Jacob / Hipp, John A / Browning, Robert / Grieco, Trevor F / Reitman, Charles A

North American Spine Society journal

2020 Volume 4, Page(s) 100038

Abstract: Background context: Abnormalities in intervertebral rotation and translation are important to diagnosis and treatment planning for common spinal disorders. Tests that do not sufficiently load the spine can result in mis-diagnosed motion abnormalities. ... ...

Abstract	Background context: Abnormalities in intervertebral rotation and translation are important to diagnosis and treatment planning for common spinal disorders. Tests that do not sufficiently load the spine can result in mis-diagnosed motion abnormalities. Upright flexion and extension x-rays are commonly used despite known limitations. Additional evidence is needed in support of preliminary studies suggesting that the change from standing to supine may sufficiently stress the spine to diagnose motion abnormalities. Purpose: Compare intervertebral translation between flexion and extension to translation between upright and supine positions in a representative clinical population. Study design/setting: Prospective analysis of images retrospectively collected from routine clinical practices. Methods: After obtaining IRB approval for analysis of previously obtained images, patients were identified via chart reviews where a neutral-lateral x-ray and an MRI or CT exam were obtained for diagnosis of a spinal disorder and where flexion-extension x-rays had been obtained to help diagnose abnormal intervertebral motion. The mid-sagittal slice from the MRI or CT exam was paired with the neutral-lateral radiograph. Intervertebral translation at the L4-L5 and L5-S1 levels between supine and standing and between flexion and extension were measured from the images using previously validated methods. The translations were classified as normal or abnormal with reference to a previously obtained database of intervertebral motion in radiographically normal and asymptomatic volunteers. Results: At the L5-S1 level in particular, there tended to be greater translation between the supine and standing than between upright flexion and extension. On average, translations were below that found in asymptomatic volunteers. No abnormal translations were detected from flexion-extension radiographs whereas approximately 7% of levels had abnormal translations between supine and upright positions. Conclusions: Intervertebral translations between supine and standing, measured using the mid-sagittal slice from a MRI or CT exam and a lateral x-ray with the patient standing can help to identify abnormal motion. This would be particularly valuable for patients with limited flexion and extension. This study thereby adds to the evidence in support of measuring intervertebral motion between the supine and upright positions to detect abnormal intervertebral motion.
Language	English
Publishing date	2020-11-20
Publishing country	United States
Document type	Journal Article
ISSN	2666-5484
ISSN (online)	2666-5484
DOI	10.1016/j.xnsj.2020.100038
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Article ; Online: Efficacy of MRI for assessment of spinal trauma: correlation with intraoperative findings.

Zhuge, Wu / Ben-Galim, Peleg / Hipp, John A / Reitman, Charles A

Journal of spinal disorders & techniques

2015 Volume 28, Issue 4, Page(s) 147–151

Abstract: Study design: Observational diagnostic study on consecutive patients.: Objective: To assess the efficacy of magnetic resonance imaging (MRI) for detecting spinal soft tissue injury after acute trauma using intraoperative findings as a reference ... ...

Abstract	Study design: Observational diagnostic study on consecutive patients. Objective: To assess the efficacy of magnetic resonance imaging (MRI) for detecting spinal soft tissue injury after acute trauma using intraoperative findings as a reference standard. Summary of background data: Recognizing injuries to spinal soft tissue structures is critical for proper decision making and management for blunt trauma victims. Although MRI is considered the gold standard for imaging of soft tissues, its ability to identify specific components of soft tissue damage in acute spine trauma patients is poorly documented and controversial. Methods: Intraoperative findings were recorded for 21 acute spinal trauma patients (study group) and 14 nontraumatic spinal surgery patients (control group). Preoperative MRI's were evaluated randomly and blindly by 2 neuroradiologists. MRI and intraoperative findings were compared. By using the intraoperative findings as the reference standard, sensitivity, specificity, positive and negative predictive values of MRI in detecting spinal soft tissue injury were determined. Results: MRI was 100% sensitive and specific in detecting injury to the anterior longitudinal ligament. MRI was moderately sensitive (80%) but highly specific (100%) for injury to the posterior longitudinal ligament. In contrast, MRI was highly sensitive but less specific in detecting injury to paraspinal muscles (100%, 77%), intervertebral disk (100%, 71%), and interspinous ligament (100%, 64%). MRI was moderately sensitive and specific in detecting ligamentum flavum injury (80% and 86.7%) but poorly sensitive for facet capsule injury (62.5%). Conclusions: MRI demonstrated high sensitivity for spinal soft tissue injuries. However, MRI showed a definite trend to overestimate interspinous ligament, intervertebral disk, and paraspinal muscle injuries. On the basis of these results, we would consider MRI to be a useful tool for spine clearance after trauma. Conversely, caution should be applied when using MRI for operative decision making due to its less predictable specificity.
MeSH term(s)	Adolescent ; Adult ; Aged ; Female ; Humans ; Intervertebral Disc/injuries ; Ligamentum Flavum/injuries ; Longitudinal Ligaments/injuries ; Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Monitoring, Intraoperative ; Orthopedic Procedures/methods ; Paraspinal Muscles/injuries ; Reproducibility of Results ; Spinal Diseases/complications ; Spinal Injuries/diagnosis ; Spinal Injuries/surgery ; Young Adult
Language	English
Publishing date	2015-05
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	2075910-1
ISSN	1539-2465 ; 1536-0652
ISSN (online)	1539-2465
ISSN	1536-0652
DOI	10.1097/BSD.0b013e31827734bc
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Zs.A 2427: Show issues

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Article ; Online: C1 lateral mass screw placement via the posterior arch: a technique comparison and anatomic analysis.

Lin, James M / Hipp, John A / Reitman, Charles A

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

2013 Volume 13, Issue 11, Page(s) 1549–1555

Abstract: Background context: Instrumentation of C1 is becoming increasingly common. Starting points initially described for C1 lateral mass screws at the lateral mass/posterior arch junction are technically challenging. Recently, a number of techniques have ... ...

Abstract	Background context: Instrumentation of C1 is becoming increasingly common. Starting points initially described for C1 lateral mass screws at the lateral mass/posterior arch junction are technically challenging. Recently, a number of techniques have evolved advocating varying starting points and trajectories. Despite being technically easier, there are new safety concerns. Insufficient evidence exists for optimal C1 lateral mass screw placement with starting points in the posterior arch. Purpose: To determine anatomic variability of the C1 lateral mass and posterior ring and to compare safety and feasibility of C1 lateral mass screw placement techniques via the posterior arch. Study design: Descriptive anatomy for surgical technique. Methods: One hundred thin-cut cervical spine computed tomography scans were acquired and formatted for virtual surgery. Four different described techniques were used for virtual placement of C1 lateral mass screws. Success was defined as avoidance of critical structures including the transverse foramen, vertebral groove, and spinal dura. Anatomic variability of the C1 vertebra and safe zones for screw placement were also clarified. Results: Overall screw placement success for the four techniques was 50% (Resnick), 92% (Tan et al.), 58% (Ma et al.), and 85% (Christensen et al.). Average posterior arch height was 6.7±2.1 mm, and vertebral groove height 4.9±1.1 mm was the most limiting dimension to safe screw placement. A safe zone for screw placement was found in 100% of cases (200 screws), 17.0±1.1 mm from midline and a width of 12.6±1.7 mm. Posterior tubercle morphology was variable. Conclusions: C1 lateral mass screws could be virtually placed bilaterally in each of 100 clinical cases without violating critical structures. However, none of the previously described approaches worked in every case because of significant anatomic variability. The vertical starting point was particularly critical, and vertebral groove height was the most limiting variable. Although a reliable safe zone could be found in every case, preoperative planning is essential to avoid critical structures.
MeSH term(s)	Adult ; Atlanto-Axial Joint/diagnostic imaging ; Atlanto-Axial Joint/surgery ; Bone Screws ; Cervical Vertebrae/diagnostic imaging ; Cervical Vertebrae/surgery ; Female ; Humans ; Internal Fixators ; Male ; Middle Aged ; Radiography ; Spinal Fusion/instrumentation ; Spinal Fusion/methods ; Treatment Outcome
Language	English
Publishing date	2013-11
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	2037072-6
ISSN	1878-1632 ; 1529-9430
ISSN (online)	1878-1632
ISSN	1529-9430
DOI	10.1016/j.spinee.2013.06.006
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Article ; Online: Motion within the unstable cervical spine during patient maneuvering: the neck pivot-shift phenomenon.

Lador, Ran / Ben-Galim, Peleg / Hipp, John A

The Journal of trauma

2011 Volume 70, Issue 1, Page(s) 247–50; discussion 250–1

Abstract: Background: Cervical extrication collars are applied to millions of blunt trauma victims despite the lack of any evidence that a collar can protect against secondary injuries to the cervical spine. Cadaver studies support that in the presence of a ... ...

Abstract	Background: Cervical extrication collars are applied to millions of blunt trauma victims despite the lack of any evidence that a collar can protect against secondary injuries to the cervical spine. Cadaver studies support that in the presence of a dissociative injury, substantial motion can occur within the occipitocervical spine with collar application or during patient transfers. Little is known about the biomechanics of cervical stabilization; hence, it is difficult to develop and test improved immobilization strategies. Materials: Severe unstable injuries were created in seven fresh whole human cadavers. Rigid collars were applied with the body in a neutral position. Computed tomographic examinations were obtained before and after tilting the body or backboard as would be done during patient transport or to inspect the back. Relative displacements between vertebrae at the site of the injury were measured from the Computed tomographic examinations. The overall relative alignment between body and collar was assessed to understand the mechanisms that may facilitate motion at the injury site. Results: Intervertebral motion averaged 7.7 mm±6.8 mm in the axial plain and 2.9 mm±2.5 mm in the cranial-caudal direction. The rigid collars appeared to create pivot points where the collar contacts the head in the region under the ear and where the collar contacts the shoulders. Discussion: Rigid cervical collars appear to create pivot points that shift the center of rotation lateral to the spine and contribute to the intervertebral motions that were measured. Immobilization strategies that avoid these neck pivot-shift phenomena may help to reduce secondary injuries to the cervical spine. The whole cadaver model with simulation of patient maneuvers may provide an effective test method for cervical immobilization.
MeSH term(s)	Braces ; Cadaver ; Cervical Vertebrae/injuries ; Cervical Vertebrae/physiology ; Head Movements/physiology ; Humans ; Immobilization/methods ; Movement/physiology ; Neck/physiology ; Range of Motion, Articular/physiology
Language	English
Publishing date	2011-01
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	219302-4
ISSN	1529-8809 ; 0022-5282 ; 1079-6061
ISSN (online)	1529-8809
ISSN	0022-5282 ; 1079-6061
DOI	10.1097/TA.0b013e3181fd0ebf
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Article: Development of a novel radiographic measure of lumbar instability and validation using the facet fluid sign.

Hipp, John A / Guyer, Richard D / Zigler, Jack E / Ohnmeiss, Donna D / Wharton, Nicholas D

International journal of spine surgery

2015 Volume 9, Page(s) 37

Abstract: Background: Lumbar spinal instability is frequently referenced in clinical practice and the scientific literature despite the lack of a standard definition or validated radiographic test. The Quantitative Stability Index (QSI) is being developed as a ... ...

Abstract	Background: Lumbar spinal instability is frequently referenced in clinical practice and the scientific literature despite the lack of a standard definition or validated radiographic test. The Quantitative Stability Index (QSI) is being developed as a novel objective test for sagittal plane lumbar instability. The QSI is calculated using lumbar flexion-extension radiographs. The goal of the current study was to use the facet fluid sign on MRI as the "gold standard" and determine if the QSI is significantly different in the presence of the fluid sign. Methods: Sixty-two paired preoperative MRI and flexion-extension exams were obtained from a large FDA IDE study. The MRI exams were assessed for the presence of a facet fluid sign, and the QSI was calculated from sagittal plane intervertebral rotation and translation measurements. The QSI is based on the translation per degree of rotation (TPDR) and is calculated as a Z-score. A QSI > 2 indicates that the TPDR is > 2 std dev above the mean for an asymptomatic and radiographically normal population. The reproducibility of the QSI was also tested. Results: The mean difference between trained observers in the measured QSI was between -0.28 and 0.36. The average QSI was significantly (P = 0.047, one-way analysis of variance) higher at levels with a definite fluid sign (2.3±3.2 versus 0.60±2.4). Conclusions: Although imperfect, the facet fluid sign observed may be the best currently available test for lumbar spine instability. Using the facet fluid sign as the "gold standard" the current study documents that the QSI can be expected to be significantly higher in the presence of the facet fluid sign. This supports that QSI might be used to test for sagittal plane lumbar instability. Clinical relevance: A validated, objective and practical test for spinal instability would facilitate research to understand the importance of instability in diagnosis and treatment of low-back related disorders.
Language	English
Publishing date	2015-07-17
Publishing country	Netherlands
Document type	Journal Article
ISSN	2211-4599
ISSN	2211-4599
DOI	10.14444/2037
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Article ; Online: Isometric placement of lateral ulnar collateral ligament reconstructions: a biomechanical study.

Goren, David / Budoff, Jeffrey E / Hipp, John A

The American journal of sports medicine

2010 Volume 38, Issue 1, Page(s) 153–159

Abstract: Background: Lateral ulnar collateral ligament (LUCL) reconstruction using a tendon graft is a well-accepted procedure used in the treatment of posterolateral rotatory instability. However, unlike most other ligament reconstructions, anatomical ... ...

Abstract	Background: Lateral ulnar collateral ligament (LUCL) reconstruction using a tendon graft is a well-accepted procedure used in the treatment of posterolateral rotatory instability. However, unlike most other ligament reconstructions, anatomical guidelines for the isometric points for tunnel placement of LUCL reconstruction have not been defined. Purpose: To determine if isometric points exist for tunnel placement for LUCL reconstruction and, if so, to determine their anatomical guidelines. Study design: Controlled laboratory study. Methods: A series of 1.8-mm drill holes was placed in potential ligament reconstruction origin and insertion sites in 13 normal cadaveric elbows along the supinator crest of the ulna and in the lateral epicondyle of the humerus. The prepared specimens were mounted in a plastic test frame with electromagnetic sensors inserted into the drill holes. The distance between each potential pair of insertion sites was measured throughout the arc of elbow motion to determine the most isometric combinations of humeral and ulnar insertion sites. Results: We could not locate truly isometric points for tunnel placement for LUCL reconstruction. For LUCL reconstruction, the position of most isometric tunnel placement was on the supinator crest 16 to 20 mm distal to the proximal margin of the radial head for the proximal wall of the ulnar tunnel, and between the 3:00 and 4:30 o'clock positions on the lateral epicondyle for the posterior/distal wall of the humeral tunnel. Conclusion: Similar to the native LUCL, there is no truly isometric location for LUCL tendon graft reconstruction tunnels. Also similar to the native LUCL, the distance between the optimal tunnel position decreases in elbow extension and often increases in elbow flexion. Clinical relevance: The most isometric position for LUCL reconstruction tunnel placement was defined using anatomical references.
MeSH term(s)	Aged ; Analysis of Variance ; Biomechanical Phenomena ; Cadaver ; Collateral Ligaments/injuries ; Collateral Ligaments/surgery ; Elbow/surgery ; Elbow Joint/surgery ; Humans ; Humerus/surgery ; Isometric Contraction ; Ligaments, Articular/surgery ; Reconstructive Surgical Procedures/methods ; Ulna/surgery
Language	English
Publishing date	2010-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	197482-8
ISSN	1552-3365 ; 0363-5465
ISSN (online)	1552-3365
ISSN	0363-5465
DOI	10.1177/0363546509346049
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Article ; Online: Biomechanical effect of triquetral and scaphoid excision on simulated midcarpal arthrodesis in cadavers.

Scobercea, Razvan G / Budoff, Jeffrey E / Hipp, John A

The Journal of hand surgery

2009 Volume 34, Issue 3, Page(s) 381–386

Abstract: Purpose: To examine the biomechanical effects of triquetral and scaphoid excision on wrist motion and radiolunate contact characteristics in a cadaveric model after simulated 4-corner arthrodesis with rigid internal fixation.: Methods: Ten fresh- ... ...

Abstract	Purpose: To examine the biomechanical effects of triquetral and scaphoid excision on wrist motion and radiolunate contact characteristics in a cadaveric model after simulated 4-corner arthrodesis with rigid internal fixation. Methods: Ten fresh-frozen cadaveric upper extremities were studied. For all surgical manipulations, the motion was measured and contact characteristics were assessed using ultralow prescale pressure-sensitive film. Results: Compared with the intact specimen, simple 4-corner arthrodesis with scaphoid retention led to a significant decrease in flexion (-23%), extension (-69%), radial deviation (-129%), and ulnar deviation (-25%), but no significant change in radiolunate contact characteristics. After 4-corner arthrodesis with scaphoid excision, there was a significant increase in radial deviation (+213%) without significant change in radiolunate contact characteristics, but average radial deviation was still less than in the intact specimen. After further excision of the triquetrum, radial deviation increased significantly (+238%), to a mean value 5% greater than that of the intact state, but at the cost of a significant increase in mean radiolunate contact pressure (+44% compared to the intact state). Conclusions: When performing 4-corner arthrodesis, scaphoid and triquetrum excision may improve motion at the cost of increased mean radiolunate contact pressure.
MeSH term(s)	Aged ; Arthrodesis/methods ; Biomechanical Phenomena ; Bone Plates ; Cadaver ; Carpal Joints/surgery ; Humans ; Range of Motion, Articular/physiology ; Scaphoid Bone/surgery ; Triquetrum Bone/surgery ; Wrist Joint/physiology ; Wrist Joint/surgery
Language	English
Publishing date	2009-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	605716-0
ISSN	1531-6564 ; 0363-5023
ISSN (online)	1531-6564
ISSN	0363-5023
DOI	10.1016/j.jhsa.2008.11.027
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