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Article: Femoral interference screw divergence as a result of anteromedial portal insertion and outside-in FlipCutter femoral tunnel drilling: A cadaveric study.

Gardner, Carson / Wu, Samuel / Zahir, Jamal / Dong, Oliver / Raji, Oluwatodimu / Leasure, Jeremi / McGahan, Patrick

2024 Volume 52, Page(s) 138–142

Abstract: Aims and objectives: To investigate whether interference screw fixation through an anteromedial portal into an outside-in drilled femoral tunnel via a flip cutter results in acceptable hardware position.: Materials & methods: 10 cadaveric knees ... ...

Abstract	Aims and objectives: To investigate whether interference screw fixation through an anteromedial portal into an outside-in drilled femoral tunnel via a flip cutter results in acceptable hardware position. Materials & methods: 10 cadaveric knees underwent ACL-reconstruction with patellar BTB autograft. Femoral tunnel drilling was performed utilizing an outside-in flip cutter drill and interference screws for femoral fixation. Lateral and anterior-posterior (AP) fluoroscopic images were taken to measure screw divergence within the femoral tunnel. The means of AP and lateral divergence angles were compared using two-tailed t-tests. Results: Using the flip cutter, the AP and lateral divergence angles were 7.3° ± 4.5° and 9.3° ± 9.3°, respectively, while the total divergence angles were 16.6° ± 11.8°. Divergence angles using a cannulated reamer were found to be 14.4° ± 2.5° and 6.8° ± 2.8° for AP and lateral, respectively and 21.1° ± 5.2° for the total divergence. The AP divergence angles using the flip cutter were significantly less than those reported using a cannulated reamer (p = 0.001). Conclusions: The flip cutter method resulted in significantly reduced divergence angle between the screw and graft when compared to previous cadaveric studies in the coronal plane. There was no significant difference in divergence angle in the sagittal plane. Both methods appear to result in divergence angles below the threshold which would be considered to significantly decrease pull-out strength. Large standard deviations also reflect limited sample size but may also suggest more variability in divergence when compared to historical control set. This study clearly establishes the outside-in technique using a retrograde reamer as a viable independent femoral drilling solution for ACL reconstruction when using a BTB autograft with a femoral interference screw.
Language	English
Publishing date	2024-03-31
Publishing country	India
Document type	Journal Article
ZDB-ID	2240839-3
ISSN	0972-978X
ISSN	0972-978X
DOI	10.1016/j.jor.2024.03.035
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Article: Interspinous-Interbody Fusion via a Strictly Lateral Surgical Approach: A Biomechanical Stabilization Comparison to Constructs Requiring Both Lateral and Posterior Approaches.

Hedman, Thomas P / Ohnmeiss, Donna D / Leasure, Jeremi / Raji, Oluwatodimu R / Hochschuler, Stephen H

Cureus

2023 Volume 15, Issue 7, Page(s) e41918

Abstract: Objective Lumbar fusion performed through lateral approaches is becoming more common. The interbody devices are generally supported by supplemental posterior fixation implanted through a posterior approach, potentially requiring a second incision and ... ...

Abstract	Objective Lumbar fusion performed through lateral approaches is becoming more common. The interbody devices are generally supported by supplemental posterior fixation implanted through a posterior approach, potentially requiring a second incision and intraoperative repositioning of the patient. A minimally invasive lateral interspinous fixation device may eliminate the need for intraoperative repositioning and avoid disruption of the supraspinous ligament. The objective of this in vitrobiomechanical study was to investigate segmental multidirectional stability and maintenance of foraminal distraction of a lateral interspinous fixation device compared to commonly used pedicle screw and facet screw posterior fixation constructs when combined with lumbar interbody cages. Methods Six human cadaver lumbar spine specimens were subjected to nondestructive quasistatic loading in the following states: (1) intact; (2) interspinous fixation device alone and (3) with lateral interbody cage; (4) lateral lumbar interbody cage with bilateral pedicle screws; (5) lateral lumbar interbody cage with unilateral pedicle screws; and (6) lateral lumbar interbody cage with facet screws. Multidirectional pure bending in 1.5 Nm increments to 7.5 Nm, and 7.5 Nm flexion-extension bending with a 700 N compressive follower load were performed separately with optoelectronic segmental motion measurement. Relative angular motions of L2-L3, L3-L4, and L4-L5 functional spinal units were evaluated, and the mean instantaneous axis of rotation in the sagittal plane was calculated for the index level. Foraminal height was assessed during combined flexion-extension and compression loading for each test construct. Results All implant configurations significantly restricted flexion-extension motion compared with intact (p < 0.05). No significant differences were found in flexion-extension when comparing the different posterior implants combined with lateral lumbar interbody cages. All posterior fixation devices provided comparable neuroforaminal distraction and maintained distraction during flexion and extension. Conclusions When combinedwith lateral lumbar interbody cages, the minimally invasive lateral interspinous fixation device effectively stabilized the spine and maintained neuroforaminal distraction comparable to pedicle screw constructs or facet screws. These results suggest the lateral interspinous fixation device may provide a favorable alternative to other posterior systems that require patient repositioning during surgery and involve a greater disruption of native tissues.
Language	English
Publishing date	2023-07-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.41918
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Article ; Online: In-vitro 3D Analysis of Sacroiliac Joint Kinematics: Primary and Coupled Motions.

Odeh, Khalid / Wu, Wei / Taylor, Ben / Leasure, Jeremi / Kondrashov, Dimitriy

Spine

2021 Volume 46, Issue 8, Page(s) E467–E473

Abstract: Study design: An in-vitro biomechanical study of human cadaver sacroiliac joints.: Objective: Our study aimed to develop a more comprehensive understanding of the native motion of the SIJ within the context of spinal kinematics and spinal implant ... ...

Abstract	Study design: An in-vitro biomechanical study of human cadaver sacroiliac joints. Objective: Our study aimed to develop a more comprehensive understanding of the native motion of the SIJ within the context of spinal kinematics and spinal implant evaluation. Summary of background data: Increasing attention has been given to the sacroiliac joint (SIJ) as a source of low back pain, despite its limited range of motion. We sought to characterize the rotational and translational motion in each axis utilizing standard pure moment flexion-extension (FE), lateral bending (LB), and axial rotation (AR) testing. Methods: Sixteen sacroiliac joints were evaluated from eight lumbosacral cadaver specimens (six females, two males) from subjects aged 28 to 57 years (mean age 46.8) with body mass index (BMI) 22 to 36 (mean BMI 30). Single leg stance was modeled by clamping the blocks on one ischium in a vise and letting the contralateral ischium hang freely. Pure moment loading was applied in FE, right/left AR, and right/left LB. Relative motions were collected with infrared markers. Results: The on-axis ratio was significantly lower in LB than in FE (P = 0.012) and in AR (P = 0.017). The rotation deviation angle measured 13.9 ± 9.1° in FE, 17.1 ± 8.7° in AR, and 35.7 ± 25.7° in LB. In LB the rotational deviation angle is significantly higher than both FE and AR (P = 0.003 and P = 0.011, respectively). In-plane translation was significantly higher (P = 0.005) in FE loading than in LB loading. Conclusion: A nontrivial amount of rotation and translation occurred out of the expected axis of motion. The largest amount of off-axis rotation was observed in lateral bending. Relative to resultant translation, in-plane translation was lowest in lateral bending. Our results indicate that rotation of the SIJ is not fully described with the in-plane metrics which are normally reported in evaluation of fusion devices. Future studies of the SIJ may need to consider including off-axis rotation measurements when describing SIJ kinematics.Level of Evidence: 5.
MeSH term(s)	Adult ; Biomechanical Phenomena/physiology ; Cadaver ; Female ; Humans ; Low Back Pain/pathology ; Low Back Pain/physiopathology ; Male ; Middle Aged ; Prostheses and Implants ; Range of Motion, Articular/physiology ; Rotation ; Sacroiliac Joint/pathology ; Sacroiliac Joint/physiology
Language	English
Publishing date	2021-03-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	752024-4
ISSN	1528-1159 ; 0362-2436
ISSN (online)	1528-1159
ISSN	0362-2436
DOI	10.1097/BRS.0000000000003841
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Article: Does the Bone Mineral Density of the Lumbar Spine Correlate With Dual-Energy X-ray Absorptiometry

Odeh, Khalid / Rosinski, Alexander / Mittal, Ashish / Wu, Wei / Pourtabib, Joseph / Leasure, Jeremi / Kondrashov, Dimitriy G

International journal of spine surgery

2023 Volume 17, Issue 1, Page(s) 132–138

Abstract: Background: Pedicle screw loosening is a complication of spinal instrumentation in osteoporotic patients. Dual-energy x-ray absorptiometry scans are not able to detect variations in bone mineral density (BMD) within specific regions of vertebrae. The ... ...

Abstract	Background: Pedicle screw loosening is a complication of spinal instrumentation in osteoporotic patients. Dual-energy x-ray absorptiometry scans are not able to detect variations in bone mineral density (BMD) within specific regions of vertebrae. The purpose of this study was to investigate whether spine Methods: Eleven cadaveric spines with a mean age of 73 years were digitally isolated by applying filters for cortical and cancellous bone on computed tomography images. Eleven L5 vertebrae were separated into 7 anatomical regions of interest using 3-dimensional software modeling. Hounsfield units (HU) were determined for each region and converted to cortical and cancellous BMD with calibration phantoms of known BMD. Correlations between Results: Mean vertebral Conclusions: There is a strong correlation between Clinical relevance: Patients with osteoporosis may especially benefit from the development of extrapedicular fusion strategies due to the relatively higher bone density of these fixation sites.
Language	English
Publishing date	2023-02-04
Publishing country	Netherlands
Document type	Journal Article
ISSN	2211-4599
ISSN	2211-4599
DOI	10.14444/8388
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Article: Pedicle Screws Challenged: Lumbar Cortical Density and Thickness Are Greater in the Posterior Elements Than in the Pedicles.

Odeh, Khalid / Rosinski, Alexander / Leasure, Jeremi / Kondrashov, Dimitriy

Global spine journal

2019 Volume 11, Issue 1, Page(s) 34–43

Abstract: Study design: Controlled laboratory study.: Objective: To measure the total bone mineral density (BMD), cortical volume, and cortical thickness in seven different anatomical regions of the lumbar spine.: Methods: Using computed tomography (CT) ... ...

Abstract	Study design: Controlled laboratory study. Objective: To measure the total bone mineral density (BMD), cortical volume, and cortical thickness in seven different anatomical regions of the lumbar spine. Methods: Using computed tomography (CT) images, 3 cadaveric spines were digitally isolated by applying filters for cortical and cancellous bone. Each spine model was separated into 5 lumbar vertebrae, followed by segmentation of each vertebra into 7 anatomical regions of interest using 3-dimensional software modeling. The average Hounsfield units (HU) was determined for each region and converted to BMD with calibration phantoms of known BMD. These BMD measurements were further analyzed by the total volume, cortical volume, and cancellous volume. The cortical thickness was also measured. A similar analysis was performed by vertebral segment. St Mary's Medical Center's Institutional Review Board approved this study. No external funding was received for this work. Results: The lamina and inferior articular process contained the highest total BMD, thickest cortical shell, and largest percent volumes of cortical bone. The vertebral body demonstrated the lowest BMD. The BMDs of the L4 and L5 segments were lower; however, there were no statistically significant differences in BMD between the L1-L5 vertebral segments. Conclusion: Extrapedicular regions of the lumbar vertebrae, including the lamina and inferior articular process, contain denser bone than the pedicles. Since screw pullout strength relies greatly on bone density, the lamina and inferior articular processes may offer stronger fixation of the lumbar spine.
Language	English
Publishing date	2019-11-22
Publishing country	England
Document type	Journal Article
ZDB-ID	2648287-3
ISSN	2192-5690 ; 2192-5682
ISSN (online)	2192-5690
ISSN	2192-5682
DOI	10.1177/2192568219889361
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Article ; Online: Motion Preservation at All Costs? Multilevel Hinge Nonunion, Plate Breakage, and Intradural Plate Migration After Cervical Laminoplasty: A Case Report and Literature Review.

Rosinski, Alexander / Odeh, Khalid / Leasure, Jeremi / Kondrashov, Dimitriy

World neurosurgery

2019 Volume 135, Page(s) 80–86

Abstract: Background: Cervical laminoplasty is a motion-preserving procedure that addresses spinal cord compression and avoids postlaminectomy kyphosis associated with cervical laminectomy. The most common complications include C5 nerve palsy, axial neck pain, ... ...

Abstract	Background: Cervical laminoplasty is a motion-preserving procedure that addresses spinal cord compression and avoids postlaminectomy kyphosis associated with cervical laminectomy. The most common complications include C5 nerve palsy, axial neck pain, hinge nonunion, and premature closure. Plating is a relatively newer method of laminoplasty fixation that may provide greater stabilization postoperatively and reduce the risk of laminoplasty closure compared with less rigid (e.g., suture) fixation techniques. Although prior studies have reported low rates of laminar/lateral mass screw back out, plate breakage and migration have not been previously described in the literature. The purpose of this paper is to present a case of multilevel hinge nonunion, plate breakage, and plate fragment migration. Although rare, plate failure may result in a dural tear and spinal cord injury/compression. Case description: In this case, a 61-year-old man with a history of cervical spondylotic myelopathy treated with C3-7 laminoplasty 7 years prior presented to our hospital with severe headaches and electrical-type pain through the left upper and lower extremities. Imaging studies revealed several broken laminoplasty plates and intradural migration of a fragment of the C7 plate. Conclusions: We provide recommendations for preventing hinge nonunion because resultant micromotion likely contributed to the plate breakages observed in this patient.
MeSH term(s)	Bone Plates ; Cervical Vertebrae/surgery ; Equipment Failure ; Foreign-Body Migration ; Humans ; Laminoplasty/methods ; Male ; Middle Aged ; Spondylosis/surgery
Language	English
Publishing date	2019-11-20
Publishing country	United States
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2019.11.074
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Article ; Online: In response to: Impaction durability of porous PEEK and titanium-coated PEEK interbody fusion devices.

Rosinski, Alexander / Balcescu, Cristian / Leasure, Jeremi / Kondrashov, Dimitriy

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

2019 Volume 19, Issue 12, Page(s) 2040–2041

MeSH term(s)	Ether ; Ketones ; Porosity ; Spinal Fusion ; Titanium
Chemical Substances	Ketones ; Ether (0F5N573A2Y) ; Titanium (D1JT611TNE)
Language	English
Publishing date	2019-11-20
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	2037072-6
ISSN	1878-1632 ; 1529-9430
ISSN (online)	1878-1632
ISSN	1529-9430
DOI	10.1016/j.spinee.2019.06.016
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Article ; Online: Non-Pedicular Fixation Techniques for the Treatment of Spinal Deformity: A Systematic Review.

Rosinski, Alexander / Odeh, Khalid / Ungurean, Victor / Leasure, Jeremi / Kondrashov, Dimitriy

JBJS reviews

2020 Volume 8, Issue 5, Page(s) e0150

Abstract: Background: In recent years, the use of pedicle screws has become the gold standard for achieving stable, 3-column fixation of the spine. However, pedicle screw placement may not always be ideal, such as in adolescent idiopathic scoliosis, because of ... ...

Abstract	Background: In recent years, the use of pedicle screws has become the gold standard for achieving stable, 3-column fixation of the spine. However, pedicle screw placement may not always be ideal, such as in adolescent idiopathic scoliosis, because of pedicle morphology. An understanding of the alternatives to pedicle screw fixation is therefore important in the treatment of patients with spinal deformity. The purpose of this article is to review the indications, advantages, disadvantages, and complications associated with non-pedicular fixation techniques of the thoracolumbar spine. Methods: Comprehensive literature searches of PubMed, Scopus, and Web of Science databases were performed for 10 methods of non-pedicular fixation. Articles published between January 1, 1990, and June 1, 2019, were considered. Non-English-language articles and studies involving fixation of the cervical spine were excluded from our review. Results: After reviewing >1,600 titles and abstracts pertaining to non-pedicular fixation, a total of 213 articles met our inclusion criteria. Non-pedicular fixation may be preferred in certain cases of spinal deformity and may provide stronger fixation in osteoporotic bone. The use of non-pedicular fixation techniques is often limited by the inability to place multilevel constructs on intact posterior elements. Additionally, some methods of non-pedicular fixation, such as spinous process tethering, primarily have utility for the end of constructs to minimize junctional problems. Conclusions: Pedicle screws remain the anchor of choice in spinal deformity surgery because of their ability to engage all 3 columns of the spine and provide safe correction in all 3 planes. Nevertheless, non-pedicular fixation may be useful in cases in which pedicle screw placement is extremely difficult. Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
MeSH term(s)	Humans ; Internal Fixators ; Orthopedic Procedures ; Spinal Curvatures/surgery
Language	English
Publishing date	2020-05-18
Publishing country	United States
Document type	Journal Article ; Systematic Review
ISSN	2329-9185
ISSN (online)	2329-9185
DOI	10.2106/JBJS.RVW.19.00150
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Article ; Online: Improving the Management of Patients with Osteoporosis Undergoing Spinal Fusion: The Need for a Bone Mineral Density-Matched Interbody Cage.

Falowski, Steven M / Koga, Sebastian F / Northcutt, Trent / Garamszegi, Laszlo / Leasure, Jeremi / Block, Jon E

Orthopedic research and reviews

2021 Volume 13, Page(s) 281–288

Abstract: With an increasingly aging population globally, a confluence has emerged between the rising prevalence of degenerative spinal disease and osteoporosis. Fusion of the anterior spinal column remains the mainstay surgical intervention for many spinal ... ...

Abstract	With an increasingly aging population globally, a confluence has emerged between the rising prevalence of degenerative spinal disease and osteoporosis. Fusion of the anterior spinal column remains the mainstay surgical intervention for many spinal degenerative disorders. However, decreased vertebral bone mineral density (BMD), quantitatively measured by dual x-ray absorptiometry (DXA), complicates treatment with surgical interbody fusion as weak underlying bone stock increases the risk of post-operative implant-related adverse events, including cage subsidence. There is a necessity for developing cages with advanced structural designs that incorporate bioengineering and architectural principles to tailor the interbody fusion device directly to the patient's BMD status. Specifically, lattice-designed cages that mimic the web-like structure of native cancellous bone have demonstrated excellent resistance to post-operative subsidence. This article provides an introductory profile of a spinal interbody implant designed intentionally to simulate the lattice structure of human cancellous bone, with a similar modulus of elasticity, and specialized to match a patient's bone status across the BMD continuum. The implant incorporates an open pore design where the degree of pore compactness directly corresponds to the patient's DXA-defined BMD status, including patients with osteoporosis.
Language	English
Publishing date	2021-12-14
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	2520718-0
ISSN	1179-1462 ; 1179-1462
ISSN (online)	1179-1462
ISSN	1179-1462
DOI	10.2147/ORR.S339222
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Article ; Online: Stand-alone anterior interbody fusion for substitution of iliac fixation in long spinal fixation constructs.

Khashan, Morsi / Camisa, William / Berven, Sigurd / Leasure, Jeremi

Archives of orthopaedic and trauma surgery

2018 Volume 138, Issue 4, Page(s) 479–486

Abstract: Introduction: The use of distal sacral anchorage solely, in long spinal fusions, may lead to substantial complications. Extending the fixation down to the ilium and the addition of anterior column support are both used to facilitate construct stability ... ...

Abstract	Introduction: The use of distal sacral anchorage solely, in long spinal fusions, may lead to substantial complications. Extending the fixation down to the ilium and the addition of anterior column support are both used to facilitate construct stability and improve fusion rates. In the current study, we aimed to determine whether supplementation of long thoracolumbar fixation constructs with stand-alone anterior interbody fusion (ALIF) cage with embedded screws can eliminate the biomechanical need for iliac screws fixation biomechanically. Methods: Seven lumbopelvic human cadavers (L1-full pelvis) were used. All specimens were tested with the following fixation constructs: bilateral L1-S1, bilateral L1-S1 with unilateral iliac screw, and bilateral L1-S1 with bilateral iliac screw. The three constructs were tested with and without the addition of stand-alone ALIF cage. We evaluated the multidirectional rigidity and the axial S1 screw strain. Results: The addition of an ALIF cage solely did not affect rigidity and resulted in mixed S1 screw strain results. One iliac screw was superior to ALIF in rigidity and inferior in S1 screws strain. Bilateral iliac fixation produced similar rigidity and lower S1 screws strain than unilateral iliac fixation. When ALIF was combined with bilateral iliac screws, it resulted in equal rigidity and lower S1 screws strain. Conclusion: Our results do not support stand-alone ALIF cage as a substitute for iliac fixation in in long posterior lumbosacral fusion. They do support the use of stand-alone ALIF for the supplementation of bilateral iliac fixation in long lumbosacral fusions.
MeSH term(s)	Bone Screws ; Humans ; Ilium/surgery ; Lumbar Vertebrae/surgery ; Models, Biological ; Sacrum/surgery ; Spinal Fusion/methods
Language	English
Publishing date	2018-04
Publishing country	Germany
Document type	Journal Article
ZDB-ID	80407-1
ISSN	1434-3916 ; 0003-9330 ; 0344-8444
ISSN (online)	1434-3916
ISSN	0003-9330 ; 0344-8444
DOI	10.1007/s00402-017-2865-x
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