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Article ; Online: Presence of Cerebrospinal Fluid on Preoperative Imaging and the Associated Cervical Myelopathy Diagnosis and Outcome.

McNassor, Ryan / Shost, Michael / Grabel, Zachary J / Rabah, Nicholas M / Mroz, Thomas E

2024

Abstract: Study design: Retrospective chart review.: Objective: The objective of this study is to determine whether the presence of cerebrospinal fluid is associated with the severity of degenerative cervical myelopathy or postoperative outcomes.: Summary of ...

Abstract	Study design: Retrospective chart review. Objective: The objective of this study is to determine whether the presence of cerebrospinal fluid is associated with the severity of degenerative cervical myelopathy or postoperative outcomes. Summary of background data: Degenerative cervical myelopathy (DCM) is a clinical diagnosis characterized as neurologic dysfunction. Preoperative imaging is used to determine the source of cord compression. In clinical practice, cerebrospinal fluid (CSF) around the cord is often used as an indicator to determine whether stenosis is relevant. It is unclear if the presence of CSF around the cord can serve as a metric for clinically relevant cord compression. Methods: Patients undergoing single-level anterior cervical discectomy and fusion (ACDF) for cervical spondylotic myelopathy were identified from our institution's surgical database. Pre- and postoperative patient-reported health outcomes visual analog scale for neck pain (VAS-NP) and modified Japanese Orthopaedic Association (mJOA) were collected. The level of ACDF plus one level above and below were assessed for the presence of cerebrospinal fluid, as well as measuring the area of the spinal canal and spinal cord on preoperative magnetic resonance imaging. Results: Two hundred forty-nine patients were included. Spearman correlation test comparing cord/canal ratios at the level of compression and preoperative mJOA shows a significant negative correlation (Rho = -0.206, P= 0.043). There was no significant correlation with postoperative change in mJOA scores (Rho = -0.002, P= 0.986). Conclusion: The presence of CSF around the cord was weakly correlated with the severity of myelopathy; however, it had no correlation with postoperative outcomes. The presence of CSF around the cord should not in isolation be used to rule in or rule out operative levels in cervical myelopathy.
Language	English
Publishing date	2024-04-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	2849646-2
ISSN	2380-0194 ; 2380-0186
ISSN (online)	2380-0194
ISSN	2380-0186
DOI	10.1097/BSD.0000000000001635
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Article: Real-World Implementation of Artificial Intelligence/Machine Learning for Managing Surgical Spine Patients at 2 Academic Health Care Systems.

Habboub, Ghaith / Berven, Sigurd / Ames, Christopher / Peterson, Thomas / Mroz, Thomas

International journal of spine surgery

2023 Volume 17, Issue S1, Page(s) S11–S17

Abstract: Decision-making in spine surgery is complex due to patients' heterogeneity and complexity of spinal pathologies and the various surgical options applied to a given pathology. Artificial intelligence/machine learning algorithms provide an opportunity to ... ...

Abstract	Decision-making in spine surgery is complex due to patients' heterogeneity and complexity of spinal pathologies and the various surgical options applied to a given pathology. Artificial intelligence/machine learning algorithms provide an opportunity to improve patient selection, surgical planning, and outcomes. The purpose of this article is to present the experience and applications of in spine surgery at 2 large academic health care systems.
Language	English
Publishing date	2023-06-26
Publishing country	Netherlands
Document type	Journal Article
ISSN	2211-4599
ISSN	2211-4599
DOI	10.14444/8506
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Article ; Online: A sharp inequality for Kendall’s τ and Spearman’s ρ of Extreme-Value Copulas

Trutschnig Wolfgang / Mroz Thomas

Dependence Modeling, Vol 6, Iss 1, Pp 369-

2018 Volume 376

Abstract: We derive a new (lower) inequality between Kendall’s τ and Spearman’s ρ for two-dimensional Extreme-Value Copulas, show that this inequality is sharp in each point and conclude that the comonotonic and the product copula are the only Extreme-Value ... ...

Abstract	We derive a new (lower) inequality between Kendall’s τ and Spearman’s ρ for two-dimensional Extreme-Value Copulas, show that this inequality is sharp in each point and conclude that the comonotonic and the product copula are the only Extreme-Value Copulas for which the well-known lower Hutchinson-Lai inequality is sharp.
Keywords	concordance ; copula ; kendall tau ; spearman rho ; extreme value distribution ; 60e05 ; 62e10 ; 28a12 ; 62h05 ; Science (General) ; Q1-390 ; Mathematics ; QA1-939
Language	English
Publishing date	2018-12-01T00:00:00Z
Publisher	De Gruyter
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Exploring tribology and material contact science in spine surgery: implications for implant design.

Scariano, Gabrielle / Meade, Seth / Sultan, Assem / Shost, Michael / Benzel, Edward C / Krishnaney, Ajit / Mroz, Thomas / Steinmetz, Michael P / Habboub, Ghaith

Journal of neurosurgery. Spine

2024 , Page(s) 1–10

Abstract: Tribology, an interdisciplinary field concerned with the science of interactions between surfaces in contact and their relative motion, plays a well-established role in the design of orthopedic implants, such as knee and hip replacements. However, its ... ...

Abstract	Tribology, an interdisciplinary field concerned with the science of interactions between surfaces in contact and their relative motion, plays a well-established role in the design of orthopedic implants, such as knee and hip replacements. However, its applications in spine surgery have received comparatively less attention in the literature. Understanding tribology is pivotal in elucidating the intricate interactions between metal, polymer, and ceramic components, as well as their interplay with the native human bone. Numerous studies have demonstrated that optimizing tribological factors is key to enhancing the longevity of joints and implants while simultaneously reducing complications and the need for revision surgeries in both arthroplasty and spinal fusion procedures. With an ever-growing and diverse array of spinal implant devices hitting the market for static and dynamic stabilization of the spine, it is important to consider how each of these devices optimizes these parameters and what factors may be inadequately addressed by currently available technology and methods. In this comprehensive review, the authors' objectives were twofold: 1) delineate the unique challenges encountered in spine surgery that could be addressed through optimization of tribological parameters; and 2) summarize current innovations and products within spine surgery that look to optimize tribological parameters and highlight new avenues for implant design and research.
Language	English
Publishing date	2024-03-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	2158643-3
ISSN	1547-5646 ; 1547-5654
ISSN (online)	1547-5646
ISSN	1547-5654
DOI	10.3171/2024.1.SPINE231047
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Article ; Online: Review of mechanisms of expandable spine surgery devices.

Mao, Yuncong / Patel, Arpan A / Meade, Seth / Benzel, Edward / Steinmetz, Michael P / Mroz, Thomas / Habboub, Ghaith

Expert review of medical devices

2024 , Page(s) 1–10

Abstract: Introduction: Expandable devices such as interbody cages, vertebral body reconstruction cages, and intravertebral body expansion devices are frequently utilized in spine surgery. Since the introduction of expandable implants in the early 2000s, the ... ...

Abstract	Introduction: Expandable devices such as interbody cages, vertebral body reconstruction cages, and intravertebral body expansion devices are frequently utilized in spine surgery. Since the introduction of expandable implants in the early 2000s, the variety of mechanisms that drive expansion and implant materials have steadily increased. By examining expandable devices that have achieved commercial success and exploring emerging innovations, we aim to offer an in-depth evaluation of the different types of expandable cages used in spine surgery and the underlying mechanisms that drive their functionality. Areas covered: We performed a review of expandable spinal implants and devices by querying the National Library of Medicine MEDLINE database and Google Patents database from 1933 to 2024. Five major types of mechanical jacks that drive expansion were identified: scissor, pneumatic, screw, ratchet, and insertion-expansion. Expert opinion: We identified a trend of screw jack mechanism being the predominant machinery in vertebral body reconstruction cages and scissor jack mechanism predominating in interbody cages. Pneumatic jacks were most commonly found in kyphoplasty devices. Critically reviewing the mechanisms of expansion and identifying trends among effective and successful cages allows both surgeons and medical device companies to properly identify future areas of development.
Language	English
Publishing date	2024-04-01
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2250857-0
ISSN	1745-2422 ; 1743-4440
ISSN (online)	1745-2422
ISSN	1743-4440
DOI	10.1080/17434440.2024.2337295
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Article ; Online: Surgical classification using natural language processing of informed consent forms in spine surgery.

Shost, Michael D / Meade, Seth M / Steinmetz, Michael P / Mroz, Thomas E / Habboub, Ghaith

Neurosurgical focus

2023 Volume 54, Issue 6, Page(s) E10

Abstract: Objective: In clinical spine surgery research, manually reviewing surgical forms to categorize patients by their surgical characteristics is a crucial yet time-consuming task. Natural language processing (NLP) is a machine learning tool used to ... ...

Abstract	Objective: In clinical spine surgery research, manually reviewing surgical forms to categorize patients by their surgical characteristics is a crucial yet time-consuming task. Natural language processing (NLP) is a machine learning tool used to adaptively parse and categorize important features from text. These systems function by training on a large, labeled data set in which feature importance is learned prior to encountering a previously unseen data set. The authors aimed to design an NLP classifier for surgical information that can review consent forms and automatically classify patients by the surgical procedure performed. Methods: Thirteen thousand two hundred sixty-eight patients who underwent 15,227 surgeries from January 1, 2012, to December 31, 2022, at a single institution were initially considered for inclusion. From these surgeries, 12,239 consent forms were classified based on the Current Procedural Terminology (CPT) code, categorizing them into 7 of the most frequently performed spine surgeries at this institution. This labeled data set was split 80%/20% into train and test subsets, respectively. The NLP classifier was then trained and the results demonstrated its performance on the test data set using CPT codes to determine accuracy. Results: This NLP surgical classifier had an overall weighted accuracy rate of 91% for sorting consents into correct surgical categories. Anterior cervical discectomy and fusion had the highest positive predictive value (PPV; 96.8%), whereas lumbar microdiscectomy had the lowest PPV in the testing data (85.0%). Sensitivity was highest for lumbar laminectomy and fusion (96.7%) and lowest for the least common operation, cervical posterior foraminotomy (58.3%). Negative predictive value and specificity were > 95% for all surgical categories. Conclusions: Utilizing NLP for text classification drastically improves the efficiency of classifying surgical procedures for research purposes. The ability to quickly classify surgical data can be significantly beneficial to institutions without a large database or substantial data review capabilities, as well as for trainees to track surgical experience, or practicing surgeons to evaluate and analyze their surgical volume. Additionally, the capability to quickly and accurately recognize the type of surgery will facilitate the extraction of new insights from the correlations between surgical interventions and patient outcomes. As the database of surgical information grows from this institution and others in spine surgery, the accuracy, usability, and applications of this model will continue to increase.
MeSH term(s)	Humans ; Natural Language Processing ; Consent Forms ; Machine Learning ; Laminectomy ; Diskectomy
Language	English
Publishing date	2023-06-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	2026589-X
ISSN	1092-0684 ; 1092-0684
ISSN (online)	1092-0684
ISSN	1092-0684
DOI	10.3171/2023.3.FOCUS2371
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Article ; Online: Comparison of Health Care Worker Satisfaction Before vs After Implementation of a Communication and Optimal Resolution Program in Acute Care Hospitals.

Friedson, Andrew I / Humphreys, Abigail / LeCraw, Florence / Pelletreau, Barbara / Vierra, Priscilla / Mroz, Thomas A

JAMA network open

2023 Volume 6, Issue 3, Page(s) e232302

MeSH term(s)	Humans ; Communication ; Hospitals ; Health Personnel ; Personal Satisfaction
Language	English
Publishing date	2023-03-01
Publishing country	United States
Document type	Journal Article
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2023.2302
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Article: Transcervical, retropharyngeal odontoidectomy - Anatomical considerations.

Yakdan, Salim M / Greenberg, Jacob K / Krishnaney, Ajit A / Mroz, Thomas E / Spiessberger, Alexander

Journal of craniovertebral junction & spine

2023 Volume 14, Issue 4, Page(s) 393–398

Abstract: Context: Anterior craniocervical junction lesions have always been a challenge for neurosurgeons. Presenting with lower cranial nerve dysfunction and symptoms of brainstem compression, decompression is often required. While posterior approaches offer ... ...

Abstract	Context: Anterior craniocervical junction lesions have always been a challenge for neurosurgeons. Presenting with lower cranial nerve dysfunction and symptoms of brainstem compression, decompression is often required. While posterior approaches offer indirect ventral brainstem decompression, direct decompression via odontoidectomy is necessary when they fail. The transoral and endoscopic endonasal approaches have been explored but come with their own limitations and risks. A novel retropharyngeal approach to the cervical spine has shown promising results with reduced complications. Aims: This study aims to explore the feasibility and potential advantages of the anterior retropharyngeal approach for accessing the odontoid process. Methods and surgical technique: To investigate the anatomical aspects of the anterior retropharyngeal approach, a paramedian skin incision was performed below the submandibular gland on two cadaveric specimens. The subcutaneous tissue followed by the platysma is dissected, and the superficial fascial layer is opened. The plane between the vascular sheath laterally and the pharyngeal structures medially is entered below the branching point of the facial vein and internal jugular vein. After reaching the prevertebral plane, further dissection cranially is done in a blunt fashion below the superior pharyngeal nerve and artery. Various anatomical aspects were highlighted during this approach. Results: The anterior, submandibular retropharyngeal approach to the cervical spine was performed successfully on two cadavers highlighting relevant anatomical structures, including the carotid artery and the glossopharyngeal, hypoglossal, and vagus nerves. This approach offered wide exposure, avoidance of oropharyngeal contamination, and potential benefit in repairing cerebrospinal fluid fistulas. Conclusions: For accessing the craniocervical junction, the anterior retropharyngeal approach is a viable technique that offers many advantages. However, when employing this approach, surgeons must have adequate anatomical knowledge and technical proficiency to ensure better outcomes. Further studies are needed to enhance our anatomical variations understanding and reduce intraoperative risks.
Language	English
Publishing date	2023-11-29
Publishing country	India
Document type	Journal Article
ZDB-ID	2573344-8
ISSN	0976-9285 ; 0974-8237
ISSN (online)	0976-9285
ISSN	0974-8237
DOI	10.4103/jcvjs.jcvjs_112_23
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Article ; Online: Value of Adding Predictive Clinical Decision Tools to Spine Surgery.

Steinmetz, Michael P / Mroz, Thomas

JAMA surgery

2018 Volume 153, Issue 7, Page(s) 643

MeSH term(s)	Decision Making ; Humans ; Orthopedic Procedures ; Pain
Language	English
Publishing date	2018-03-07
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	2701841-6
ISSN	2168-6262 ; 2168-6254
ISSN (online)	2168-6262
ISSN	2168-6254
DOI	10.1001/jamasurg.2018.0078
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Article ; Online: Analysis of Patient-reported Outcomes Measures Used in Lumbar Fusion Surgery Research for Degenerative Spondylolisthesis.

Ravishankar, Pavitra / Winkleman, Robert / Rabah, Nicholas / Steinmetz, Michael / Mroz, Thomas

Clinical spine surgery

2021 Volume 35, Issue 6, Page(s) 287–294

Abstract: Study design: Meta-analyses.: Objective: This study aims to document the most common Patient-reported Outcome Measures (PROMs) used to assess lumbar fusion surgery outcomes and provide an estimate of the average improvement following surgical ... ...

Abstract	Study design: Meta-analyses. Objective: This study aims to document the most common Patient-reported Outcome Measures (PROMs) used to assess lumbar fusion surgery outcomes and provide an estimate of the average improvement following surgical treatment. Summary of background data: As health care institutions place more emphasis on quality of care, accurately quantifying patient perceptions has become a valued tool in measuring outcomes. To this end, greater importance has been placed on the use of PROMs. This is a systemic review and meta-analysis of randomly controlled trials published between 2014 and 2019 assessing surgical treatment of degenerative spondylolisthesis. Methods: A fixed effect size model was used to calculate mean difference and a 95% confidence interval (95% CI). Linear regression was used to calculate average expected improvement, adjusted for preoperative scores. Results: A total of 4 articles (7 study groups) were found for a total of 444 patients. The 3 most common PROMs were Oswestry Disability Index (ODI) (n=7, 100%), Short-Form-12 or Short-Form-36 (SF-12/36) (n=4, 57.1%), and visual analog scale-back pain (n=3, 42.8%). Pooled average improvement was 24.12 (95% CI: 22.49-25.76) for ODI, 21.90 (95% CI: 19.71-24.08) for SF-12/36 mental component score, 22.74 (95% CI: 20.77-24.71) for SF-12/36 physical component score, and 30.87 (95% CI: 43.79-47.97) for visual analog scale-back pain. After adjusting for preoperative scores, patients with the mean preoperative ODI (40.47) would be expected to improve by 22.83 points postoperatively. Conclusions: This study provides a range of expected improvement for common PROMs used to evaluate degenerative spondylolisthesis with the goal of equipping clinicians with a benchmark value to use when counseling patients regarding surgery. In doing so, it hopes to provide a comparison point by which to judge individual patient improvement. Level of evidence: Level II.
MeSH term(s)	Back Pain/etiology ; Humans ; Lumbar Vertebrae/surgery ; Patient Reported Outcome Measures ; Randomized Controlled Trials as Topic ; Spinal Fusion/adverse effects ; Spondylolisthesis/surgery ; Treatment Outcome
Language	English
Publishing date	2021-11-01
Publishing country	United States
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	2849646-2
ISSN	2380-0194 ; 2380-0186
ISSN (online)	2380-0194
ISSN	2380-0186
DOI	10.1097/BSD.0000000000001272
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