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Dive into the research topics where John E. O'Toole is active.

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Featured researches published by John E. O'Toole.


Journal of Neurosurgery | 2009

Surgical site infection rates after minimally invasive spinal surgery

John E. O'Toole; Kurt M. Eichholz; Richard G. Fessler

OBJECT Postoperative surgical site infections (SSIs) have been reported after 2-6% of spinal surgeries in most large series. The incidence of SSI can be < 1% after decompressive procedures and > 10% after instrumented fusions. Anecdotal evidence has suggested that there is a lower rate of SSI when minimally invasive techniques are used. METHODS A retrospective review of prospectively collected databases of consecutive patients who underwent minimally invasive spinal surgery was performed. Minimally invasive spinal surgery was defined as any spinal procedure performed through a tubular retractor system. All surgeries were performed under standard sterile conditions with preoperative antibiotic prophylaxis. The databases were reviewed for any infectious complications. Cases of SSI were identified and reviewed for clinically relevant details. The incidence of postoperative SSIs was then calculated for the entire cohort as well as for subgroups based on the type of procedure performed, and then compared with an analogous series selected from an extensive literature review. RESULTS The authors performed 1338 minimally invasive spinal surgeries in 1274 patients of average age 55.5 years. The primary diagnosis was degenerative in nature in 93% of cases. A single minimally invasive spinal surgery procedure was undertaken in 1213 patients, 2 procedures in 58, and 3 procedures in 3 patients. The region of surgery was lumbar in 85%, cervical in 12%, and thoracic in 3%. Simple decompressive procedures comprised 78%, instrumented arthrodeses 20%, and minimally invasive intradural procedures 2% of the collected cases. Three postoperative SSIs were detected, 2 were superficial and 1 deep. The procedural rate of SSI for simple decompression was 0.10%, and for minimally invasive fusion/fixation was 0.74%. The total SSI rate for the entire group was only 0.22%. CONCLUSIONS Minimally invasive spinal surgery techniques may reduce postoperative wound infections as much as 10-fold compared with other large, modern series of open spinal surgery published in the literature.


Neurosurgery | 2007

Minimally invasive lumbar spinal decompression in the elderly: outcomes of 50 patients aged 75 years and older.

David S. Rosen; John E. O'Toole; Kurt M. Eichholz; Melody Hrubes; Dezheng Huo; Faheem A. Sandhu; Richard G. Fessler

OBJECTIVELumbar spinal stenosis and spondylosis are major causes of morbidity among the elderly. Surgical decompression is an effective treatment, but many elderly patients are not considered as candidates for surgery based on age or comorbidities. Minimally invasive surgical techniques have recently been developed and used successfully for the treatment of lumbar spinal disease. Our objective was to examine the safety and efficacy of minimally invasive lumbar spinal surgery for elderly patients. METHODSWe reviewed demographic information, pre- and postoperative Visual Analog Scale pain scores, Oswestry Disability Index scores, and Short-Form 36 scores of prospectively accrued patients who underwent minimally invasive decompression of lumbar degenerative disease at two institutions between January 2002 and December 2005. Data from patients who were at least 75 years old were selected. Statistical analysis methods included paired t test, multiple linear regression, and linear mixed effects modeling. RESULTSFifty-seven patients with a mean age of 81 years met the study criteria (median follow-up period, 7 mo; mean follow-up period, 10 mo). No major complications or deaths occurred. Fifty patients had sufficient outcomes data for analysis. Visual Analog Scale pain scores decreased from 5.7 to 2.2 for back pain and from 5.7 to 2.3 for symptomatic leg pain (P < 0.05). Oswestry Disability Index scores decreased from 48 to 27; Short-Form 36 Body Pain and Physical Function scores also showed statistically significant improvements after surgery (P < 0.05). The longitudinal analysis demonstrated durability of the symptom relief. CONCLUSIONMinimally invasive lumbar spine decompression is a safe and efficacious treatment for elderly patients with spinal stenosis and spondylosis. Elderly patients should be considered good candidates for lumbar surgical decompression using minimally invasive techniques.


Neurosurgery | 2003

Midline Ventral Intradural Schwannoma of the Cervical Spinal Cord Resected via Anterior Corpectomy with Reconstruction: Technical Case Report and Review of the Literature

John E. O'Toole; Paul C. McCormick

OBJECTIVE AND IMPORTANCESpinal cord schwannomas are intradural nerve sheath tumors that almost universally occupy a dorsolateral, lateral, or ventrolateral position. Therefore, resection of these lesions typically proceeds via a posterior or posterolateral approach. CLINICAL PRESENTATIONWe present a case of a midline ventral intradural schwannoma of the cervical spinal cord causing myelopathy. To the best of our knowledge, no previous reports specifically discuss purely midline ventral intradural schwannomas. INTERVENTIONResection of the tumor was performed via an anterior cervical corpectomy with spinal arthrodesis and fixation. We review possible causes for such an anomalous location for schwannoma as well as the advantages and disadvantages of various surgical strategies for removing the tumor. CONCLUSIONThis case exemplifies the usefulness of anterior approaches to the cervical spine in treating unusual intradural spinal cord tumors.


Neurosurgery | 2004

The value of magnetic resonance imaging in the evaluation of fatty filum terminale.

Ketan R. Bulsara; Ali R. Zomorodi; David S. Enterline; Timothy M. George; Ilhami Kovanlikaya; Chi Shing Zee; John E. O'Toole; Paul C. McCormick; Stephen L. Huhn; Daniel H. Kim; Thomas P. Naidich

OBJECTIVETo determine whether there are magnetic resonance imaging (MRI) characteristics of fatty fila that are correlated with neurological deficits, especially in the presence of a normal-level conus medullaris. METHODSLumbosacral MRI scans were reviewed for patients with fatty fila who were treated at Duke University Medical Center during a 5-year period. The patients were divided into three groups. Group I patients (n = 5) had fatty fila that were incidentally detected during evaluations for metastases or infections. Group II patients (n = 16) exhibited isolated low back pain but were in neurologically intact condition. Group III patients (n = 15) exhibited neurological impairments consistent with distal spinal cord dysfunction. Several characteristics were measured on the MRI scans, including the location of the conus medullaris, the filum thickness, and the distance of fat from the conus. These results were assessed for statistically significant correlation with the presence of clinical symptoms. RESULTSThe majority of patients in all three groups demonstrated the normal conus position (L2 or above) and thickened fila. The distance of fat from the conus was the only parameter that demonstrated a statistically significant difference among the groups. CONCLUSIONThe following findings were noted: 1) patients were likely to exhibit neurological deficits at a younger age (<22 yr in Group III versus 47 yr in Groups I and II); 2) a conus level below L2 was associated with neurological deficits (Group III); 3) filum thickness was not correlated with clinical presentation; 4) fat in the filum within 13 mm of the conus medullaris was most predictive of neurological deficits (Group III).


Neurosurgery | 2009

Minimally invasive posterolateral thoracic corpectomy: cadaveric feasibility study and report of four clinical cases.

Dae-Hyun Kim; John E. O'Toole; Alfred T. Ogden; Kurt M. Eichholz; John K. Song; Sean D. Christie; Richard G. Fessler

OBJECTIVETo demonstrate the feasibility of and initial clinical experience with a novel minimally invasive posterolateral thoracic corpectomy technique. METHODSSeven procedures were performed on 6 cadavers to determine the feasibility of thoracic corpectomy using a minimally invasive approach. The posterolateral thoracic corpectomies were performed with expandable 22 mm diameter tubular retractor paramedian incisions. The posterolateral aspects of the vertebral bodies were accessed extrapleurally, and complete corpectomies were performed. Intraprocedural fluoroscopy and postoperative computed tomography were used to assess the degree of decompression. In addition, 2 clinical cases of T6 burst fracture, 1 T4–T5 plasmacytoma, and 1 T12 colon cancer metastasis were treated using this minimally invasive approach. RESULTSIn the cadaveric study, an average of 93% of the ventral canal and 80% of the corresponding vertebral body were removed. The pleura and intrathoracic contents were not violated. Adequate exposure was obtained to allow interbody grafting between the adjacent vertebral bodies. The procedures were successfully performed in the 4 clinical cases using a minimally invasive technique, and the patients demonstrated good outcomes. CONCLUSIONBased on this study, minimally invasive posterolateral thoracic corpectomy safely and successfully allows complete spinal canal decompression without the tissue disruption associated with open thoracotomy. This approach may improve the complication rates that accompany open or even thoracoscopic approaches for thoracic corpectomy and may even allow surgical intervention in patients with significant comorbidities.


Global Spine Journal | 2015

Intramedullary Spinal Cord Tumors: Part I— Epidemiology, Pathophysiology, and Diagnosis

Dino Samartzis; Christopher C. Gillis; Patrick Shih; John E. O'Toole; Richard G. Fessler

Study Design Broad narrative review. Objectives Intramedullary spinal cord tumors (IMSCT) are rare neoplasms that can potentially lead to severe neurologic deterioration, decreased function, poor quality of life, or death. As such, a better understanding of these lesions is needed. The following article, part one of a two-part series, addresses IMSCT with regards to their epidemiology, histology, pathophysiology, imaging characteristics, and clinical manifestations. Methods The authors performed an extensive review of the peer-reviewed literature addressing the aforementioned objectives. Results Numerous IMSCT exist with varying epidemiology. Each IMSCT has its own hallmark characteristics and may vary with regards to how aggressively they invade the spinal cord. These lesions are often difficult to detect and are often misdiagnosed. Furthermore, radiographically and clinically, these lesions may be difficult to distinguish from one another. Conclusions Awareness and understanding of IMSCT is imperative to facilitate an early diagnosis and plan management.


Neurosurgery | 2008

MINIMALLY INVASIVE POSTERIOR OSTEOTOMIES

Jean-Marc Voyadzis; Vishal C. Gala; John E. O'Toole; Kurt M. Eichholz; Richard G. Fessler

OBJECTIVESurgery for thoracolumbar deformity can lead to significant muscle injury, excessive blood loss, and severe postoperative pain. The aim of the following studies was to determine the feasibility of minimally invasive posterior thoracic corpectomy and thoracolumbar osteotomy techniques for deformity in human cadavers and select clinical cases. METHODSHuman cadaveric specimens were procured for thoracic corpectomy and Smith-Petersen and pedicle subtraction osteotomy using a minimally invasive approach. Post-procedural computed tomography was used to assess the degree of decompression following corpectomy and the extent of bone resection after osteotomy. Pre and post-osteotomy closure Cobb angles were measured to evaluate the degree of correction achieved. RESULTSThe minimally invasive lateral extracavitary approach for thoracic corpectomy provided adequate exposure and allowed excellent spinal canal decompression while minimizing tissue disruption. Nearly complete osteotomies of both types could be achieved through a tubular retractor with a modest change in Cobb angle. CONCLUSIONThese techniques may play a role in deformity surgery for select cases with further technological advancements.


World Neurosurgery | 2013

Minimally invasive thoracic microendoscopic diskectomy: surgical technique and case series.

Justin S. Smith; Kurt M. Eichholz; Stephen Shafizadeh; Alfred T. Ogden; John E. O'Toole; Richard G. Fessler

OBJECTIVE To present operative details and clinical follow-up of a series of patients with thoracic disk herniation treated with the minimally invasive technique of thoracic microendoscopic diskectomy (TMED). METHODS TMED was performed in 16 consecutive patients (age range, 18-79 years old) with 18 thoracic disk herniations. One patient with a calcified herniation in a direct ventral location was not included in this series. Patients were positioned prone, and a tubular retractor system was placed through a muscle dilating approach. The procedure was performed with endoscopic visualization. Outcomes were assessed using modified McNab criteria. RESULTS There were no complications, and no case required conversion to an open procedure. The mean operative time was 153 minutes per level, and mean blood loss was 69 mL per level. Mean hospital stay was 21 hours. At a mean follow-up of 24 months (median, 22 months), 13 patients (81%) had excellent or good outcomes, 1 patient (6%) had a fair outcome, and 2 patients (13%) had poor outcomes. The two patients with poor outcomes had neurologic diagnoses (multiple sclerosis and multiple systems atrophy) that were ultimately found to be responsible for their symptoms and deficits. CONCLUSIONS TMED is a safe and effective minimally invasive posterolateral approach for the treatment of thoracic disk herniations that lacks the morbidity associated with traditional approaches.


Neurosurgery | 2007

Minimally invasive insertion of syringosubarachnoid shunt for posttraumatic syringomyelia: technical case report.

John E. O'Toole; Kurt M. Eichholz; Richard G. Fessler

OBJECTIVE Symptomatic posttraumatic syringomyelia affects up to 10% of patients with spinal cord injuries and manifests in a delayed manner as progressive sensorimotor changes below the level of the syrinx. Syrinx shunting, and in particular syringosubarachnoid shunting (SSAS), provides neurological improvement or stabilization in at least 50% of these patients. Given the debilitated condition of many of these patients, a minimally invasive approach to the insertion of these devices is desirable. We provide the first report of an SSAS inserted in a minimally invasive fashion through a tubular retractor. PATIENTS AND METHODS A 27-year-old woman presented 4 years after C6 to C7 fracture dislocation and incomplete spinal cord injury with increasing pain and spasticity below the midthoracic region. Magnetic resonance imaging scan revealed a midthoracic syrinx that had enlarged on serial imaging. SSAS was inserted using a minimally invasive technique via the X-Tube retractor (Medtronic Sofamor Danek, Memphis, TN). Through a 2.5-cm incision, hemilaminotomy was performed, and a midline durotomy and myelotomy were opened for SSAS insertion under microscopic visualization. RESULTS Intraoperative ultrasonography revealed successful syrinx decompression after SSAS insertion. The operative time was 150 minutes and estimated blood loss was less than 100 mL. The patient was mobilized on postoperative Day 1 and was discharged 38.5 hours after surgery with resolution of her preoperative symptoms. Postoperative magnetic resonance imaging scan revealed excellent decompression of the syrinx, and through 1 year of follow-up, the patient has had no recurrence of her syrinx-related symptoms. CONCLUSION This is the first report of minimal-access insertion of an SSAS. The minimally invasive technique appears to be a safe and effective means of implanting an SSAS. This approach allows for diminished blood loss and early mobilization and transfer to rehabilitation units for these patients.


Journal of Neurosurgery | 2014

Management of intended durotomy in minimally invasive intradural spine surgery: clinical article.

Lee A. Tan; Ippei Takagi; David Straus; John E. O'Toole

OBJECT Minimally invasive surgery (MIS) has been increasingly used for the treatment of various intradural spinal pathologies in recent years. Although MIS techniques allow for successful treatment of intradural pathology, primary dural closure in MIS can be technically challenging due to a limited surgical corridor through the tubular retractor system. The authors describe their experience with 23 consecutive patients from a single institution who underwent MIS for intradural pathologies, along with a review of pertinent literature. METHODS A retrospective review of a prospectively collected surgical database was performed to identify patients who underwent MIS for intradural spinal pathologies between November 2006 and July 2013. Patient demographics, preoperative records, operative notes, and postoperative records were reviewed. Primary outcomes include operative duration, estimated blood loss, length of bed rest, length of hospital stay, and postoperative complications, which were recorded prospectively. RESULTS Twenty-three patients who had undergone MIS for intradural spinal pathologies during the study period were identified. Fifteen patients (65.2%) were female and 8 (34.8%) were male. The mean age at surgery was 54.4 years (range 30-74 years). Surgical pathologies included neoplastic (17 patients), congenital (3 patients), vascular (2 patients), and degenerative (1 patient). The most common spinal region treated was lumbar (11 patients), followed by thoracic (9 patients), cervical (2 patients), and sacral (1 patient). The mean operative time was 161.1 minutes, and the mean estimated blood loss was 107.2 ml. All patients were allowed full activity less than 24 hours after surgery. The median length of stay was 78.2 hours. Primary sutured dural closure was achieved using specialized MIS instruments with adjuvant fibrin sealant in all cases. The rate of postoperative headache, nausea, vomiting, and diplopia was 0%. No case of cutaneous CSF fistula or symptomatic pseudomeningocele was identified at follow-up, and no patient required revision surgery. CONCLUSIONS Primary dural closure with early mobilization is an effective strategy with excellent clinical outcomes in the use of MIS techniques for intradural spinal pathology. Prolonged bed rest after successful primary dural closure appears unnecessary, and the need for watertight dural closure should not prevent the use of MIS techniques in this specific patient population.

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Richard G. Fessler

Rush University Medical Center

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Kurt M. Eichholz

Vanderbilt University Medical Center

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Manish K. Kasliwal

Rush University Medical Center

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Lee A. Tan

Rush University Medical Center

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Christopher C. Gillis

Rush University Medical Center

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John K. Song

Northwestern University

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