Tina Raman

The effect of prophylactic vertebroplasty on the incidence of proximal junctional kyphosis and proximal junctional failure following posterior spinal fusion in adult spinal deformity: a 5-year follow-up study

BACKGROUND CONTEXT The incidence of proximal junctional kyphosis (PJK) ranges from 5% to 46% following adult spinal deformity surgery. Approximately 66% to 76% of PJK occurs within 3 months of surgery. A subset of these patients, reportedly 26% to 47%, develop proximal junctional failure (PJF) within 6 months postoperatively. To date, there are no studies evaluating the impact of prophylactic vertebroplasty on PJK and PJF incidence at long-term follow-up. PURPOSE The purpose of this study is to evaluate the long-term radiographic and clinical outcomes, and incidence of PJK and PJF, after prophylactic vertebroplasty for long-segment thoracolumbar posterior spinal fusion (PSF). STUDY DESIGN This is a prospective cohort study. PATIENT SAMPLE Thirty-nine patients, of whom 87% were female, who underwent two-level prophylactic vertebroplasty at the upper instrumented and supra-adjacent vertebrae at the time of index PSF were included in this study. OUTCOME MEASURES Clinical outcomes were assessed using the Scoliosis Research Society-22 (SRS-22), and Short-Form (SF) 36 questionnaires, and the Oswestry Disability Index (ODI). Radiographic parameters including PJK angle, and coronal and sagittal alignment, were calculated, along with relevant perioperative complications and revision rates. METHODS Of the 41 patients who received two-level prophylactic vertebroplasty at the upper instrumented and supra-adjacent vertebrae at the time of index PSF, and comprised a cohort with previously published 2-year follow-up data, 39 (95%) completed 5-year follow-up (average: 67.6 months). Proximal junctional kyphosis was defined as a change in the PJK angle ≥10° between the immediate postoperative and final follow-up radiograph. Proximal junctional failure was defined as acute proximal junctional fracture, fixation failure, or kyphosis requiring extension of fusion within the first 6 months postoperatively. RESULTS Thirty-nine patients with a mean age of 65.6 (41-87) years were included in this study. Of the 39 patients, 28.2% developed PJK (11: 7.7% at 2 years, 20.5% between 2 and 5 years), and 5.1% developed acute PJF. Two of the 11 PJK patients required revision for progressive worsening of the PJK. There were no proximal junctional fractures. There was no significant difference in preoperative, immediate postoperative, and final follow-up measurements of thoracic kyphosis, lumbar lordosis, and coronal or sagittal alignment between patients who developed PJK, PJF, or neither (p>.05). There was no significant difference in ODI, SRS-22, or SF-36 scores between those with and without PJK or PJF (p>.05). CONCLUSIONS This long-term follow-up demonstrates that prophylactic vertebroplasty may minimize the risk for junctional failure in the early postoperative period. However, it does not appear to decrease the incidence of PJK at 5 years.

Predictors of career choice in academic medicine among orthopaedic surgery residents.

In 2013, 1038 applicants, 833 of whom were U.S. graduates, applied for 693 orthopaedic residency spots. Orthopaedic residency program directors thoroughly screen applicant data, selecting those applicants who will be most successful during the residency. Although the most important consideration for program directors is choosing residents who will obtain competence and will pass the orthopaedic board examinations, many applicants are chosen also for their ability to contribute to the field through leadership, research, and teaching. Previous studies have analyzed attitudes of orthopaedic residents toward research and university-based careers1. Primary authorship of a publication and past research experience were associated with a greater interest in future research1. However, to the best of our knowledge, no study has been done to identify predictors of orthopaedic residents who actually obtain faculty positions in a university-based setting. We hypothesized that predictive factors exist for orthopaedic surgery residents who choose a university-based career. This study looked at both academic and socioeconomic criteria to identify factors that predict residents becoming assistant professors, associate professors, full professors, program directors, or program chairs. This study was approved by the institutional review board. It was performed in compliance with the Health Insurance Portability and Accountability Act regulations. ### Identifying Career Outcomes Among Orthopaedic Residency Graduates The orthopaedic surgery department at our hospital compiled a complete and sequential database of sixty residents who graduated from 2001 to 2010 and their career choices. No residents were excluded. If career choice data were not available for a former resident, a Google search was performed to find out the highest academic rank achieved by the graduate. Former residents were contacted by e-mail if they could not be found on a Google search. The careers of orthopaedic surgeons were analyzed and were separated into a university or community-based career choice. University-based orthopaedic surgeons had a full-time faculty appointment …

Cost-Effectiveness of Primary and Revision Surgery for Adult Spinal Deformity

Study Design. Retrospective comparative study. Objective. The purpose of this study is to compare functional outcomes, hospital resource utilization, and spine-related costs during 2 years in patients who had undergone primary or revision surgery for adult spinal deformity (ASD). Summary of Background Data. After surgery for ASD, patients may require revision for pseudarthrosis, implant complications, or deformity progression. Data evaluating cost-effectiveness of primary and, in particular, revision surgery, for ASD are sparse. Methods. We retrospectively reviewed records for 119 consecutive patients who had undergone primary or revision surgery for ASD. Two-year total spine-related medical costs were derived from hospital charge data. Functional outcome scores were extracted from prospectively collected patient data. Cost utility ratios (cost/quality-adjusted life-year [QALY]) at 2 years were calculated and assessed against a threshold of

Distal Fixation for Adult Lumbar Scoliosis: Indications and Techniques

154,458/QALY gained (three times the 2015 US per-capita gross domestic product). Results. The primary surgery cohort (n = 56) and revision cohort (n = 63) showed significant improvements in health-related quality-of-life scores at 2 years. Median surgical and spine-related 2-year follow-up costs were

Cost-Utility Analysis of Primary versus Revision Surgery for Adult Spinal Deformity

137,990 (interquartile range [IQR],

Primary versus Revision Surgery for Adult Spinal Deformity: An Analysis of Cost Effectiveness

84,186) for primary surgery and

Algorithm for the evaluation of the painful total shoulder arthroplasty: Searching for sepsis

115,509 (IQR,

Wednesday, September 26, 2018 10:35 AM – 12:00 PM Cervical Spine Trauma

63,753) for revision surgery and were not significantly different between the two groups (P = 0.12). We report 2-year QALY gains of 0.36 in the primary surgery cohort and 0.40 in the revision group (P = 0.71). Primary instrumented fusion was associated with a median 2-year cost per QALY of

Sacropelvic Fixation Using S2 Alar-Iliac (S2AI) Technique in Adult Spinal Deformity Patients Fused to the Sacrum: the Fate of the SI Joint at Five Years

197,809 (IQR,

Cost Effectiveness of Three-Column Osteotomy for Adult Spinal Deformity

187,350) versus