Bio

Clinical Focus


  • Orthopaedic Surgery

Academic Appointments


Professional Education


  • Medical Education:Albany Medical College (1984) NY
  • Board Certification: Orthopaedic Surgery, American Board of Orthopaedic Surgery (1994)
  • Fellowship:University of Minnesota/Twin Cities Scoliosis Spine Center (1991) MA
  • Residency:Univ Of Pittsburgh Medical Ctr (1989) PA
  • Internship:Univ Of Pittsburgh Medical Ctr (1986) PA

Teaching

2019-20 Courses


Publications

All Publications


  • The Utility of Local Smoke Evacuation in Reducing Surgical Smoke Exposure in Spine Surgery: A Prospective Self-Controlled Study. The spine journal : official journal of the North American Spine Society Liu, N., Filipp, N., Wood, K. B. 2019

    Abstract

    BACKGROUND CONTEXT: Exposure to surgical smoke remains a potential occupational health concern to spine operating room personnel. Using a smoke evacuator (local exhaust ventilation) is currently regarded as a primary means of protection, yet few studies have evaluated its utility in actual surgeries.OBJECTIVE: To examine the utility of two common types of local smoke evacuators, a para incisional evacuator and a smoke evacuation pencil, in reducing surgical smoke exposure in spine surgery.STUDY DESIGN: A prospective self-controlled study.PATIENT SAMPLE: After the pre-estimation of sample size, 51 consecutive spine surgeries (25 and 26 patients using the para incisional smoke evacuator and the smoke evacuation pencil, respectively) were enrolled between February 2018 and March 2019.OUTCOME MEASURES: Two outcome measures were used to evaluate the level of surgical smoke exposure, which was defined as the concentration of ultrafine smoke particles in the air (number of particles per cm3, ppc) around the operating table: (a) the average smoke level was the arithmetic mean of all measurements recorded during the surgery; and (b) the peak smoke level was the highest measurement recorded.METHODS: Consecutive surgeries that involved bilateral symmetrical surgical exposure of the spine via a posterior midline incision were evaluated. Cauterized smoke was evacuated by two smoke evacuators: a "para incisional evacuator," which used a flat broad suction pad positioned immediately adjacent to the incision (25 patients), and a "surgical smoke evacuation pencil" which is an incorporated part of the electrocautery (26 patients). The level of smoke exposure was measured separately when surgically exposing the two sides of the spine: starting with one side (determined randomly) with the smoke evacuator being turned on and, then, the other side with the smoke evacuator off. The results were compared between the two sides.RESULTS: The para incisional smoke evacuator significantly reduced the average smoke level by an average of 59.7% [287 (IQR: 126, 526) vs. 1177 (IQR: 395, 2702), P<0.001]. The surgical smoke evacuation pencil also reduced the average smoke level by an average of 44.1% [917 (IQR: 448, 1936) vs. 1605 (IQR: 775, 4280), P<0.001]. Both evacuators significantly reduced peak smoke levels as well.CONCLUSIONS: This study provides evidence supporting the utility of local smoke evacuation in reducing surgical smoke exposure in spine surgery. Such technology may help to improve the occupational health protection for spine operating room workers.

    View details for DOI 10.1016/j.spinee.2019.09.014

    View details for PubMedID 31542472

  • Short-Term Outcomes of Staged Versus Same-Day Surgery for Adult Spinal Deformity Correction. Spine deformity Arzeno, A. H., Koltsov, J., Alamin, T. F., Cheng, I., Wood, K. B., Hu, S. S. 2019; 7 (5): 796

    Abstract

    STUDY DESIGN: Retrospective cohort study.OBJECTIVES: Assess differences between staged (?3 days) and same-day surgery in perioperative factors, radiographic measures, and complications.SUMMARY OF BACKGROUND DATA: Surgical adult spinal deformity correction may require combined anterior and posterior approaches. To modulate risk, some surgeons perform surgery that is expected to be longer and/or more complex in two stages. Prior studies comparing staged (?7 days) and same-day surgery demonstrated mixed results and none have examined results with shorter staging intervals.METHODS: Retrospective review of adults undergoing combined anterior/posterior approaches for spinal deformity over a 3-year period at a single institution (n=92). Univariate differences between staged and same-day surgery were assessed with chi-squared, Fisher exact, and Mann-Whitney U tests. Generalized estimating equations assessed whether differences in perioperative outcomes between groups remained after adjusting for differences in demographic and surgical characteristics.RESULTS: In univariate analyses, staged surgery was associated with a length of stay (LOS) 3 days longer than same-day surgery (9.2 vs. 6.3 days, p < .001), and greater operative time, blood loss, transfusion requirement, and days in intensive care unit (p < .001 for each). Staged surgery had a higher rate of thrombotic events (p = .011) but did not differ in readmission rates or other complications. Radiographically, improvements in Cobb angle (average 13 vs. 17, p = .028), lumbar lordosis (average 14 vs. 23, p = .019), and PI-LL mismatch (average 10 vs. 2 p = .018) were greater for staged surgery, likely related to more extensive use of osteotomies in the staged group. After risk adjustment, taking into account the procedural specifics including longer fusion constructs and greater number of osteotomies, LOS no longer differed between staged and same-day surgery; however, the total operative time was 98 minutes longer for staged surgery (p < .001). Differences in blood loss between groups was accounted for by differences in operative time and patient and surgical characteristics.CONCLUSIONS: Although univariate analysis of our results were in accordance with previously published works, multivariate analysis allowing individual case risk adjustment revealed that LOS was not significantly increased in the staged group as reported in previous studies. There was no difference in infection rates as previously described but an increase in thrombotic events was observed.LEVEL OF EVIDENCE: Level III.

    View details for DOI 10.1016/j.jspd.2018.12.008

    View details for PubMedID 31495481

  • Reliability of radiological measurements of type 2 odontoid fracture SPINE JOURNAL Karamian, B. A., Liu, N., Ajiboye, R. M., Cheng, I., Hu, S. S., Wood, K. B. 2019; 19 (8): 1324?30
  • The Association of Financial Distress With Disability in Orthopaedic Surgery. The Journal of the American Academy of Orthopaedic Surgeons Mertz, K., Eppler, S. L., Thomas, K., Alokozai, A., Yao, J., Amanatullah, D. F., Chou, L., Wood, K. B., Safran, M., Steffner, R., Gardner, M., Kamal, R. N. 2019; 27 (11): e522?e528

    Abstract

    INTRODUCTION: Increased out-of-pocket costs have led to patients bearing more of the financial burden for their care. Previous work has shown that financial burden and distress can affect outcomes, symptoms, satisfaction, and adherence to treatment. We asked the following questions: (1) Does patients' financial distress correlate with disability in patients with nonacute orthopaedic conditions? (2) Do patient demographic factors affect this correlation?METHODS: We conducted a cross-sectional, observational study of new patients presenting to a multispecialty orthopaedic clinic with a nonacute orthopaedic complication. Patients completed a demographics questionnaire, the InCharge Financial Distress/Financial Well-Being Scale, and the Health Assessment Questionnaire Disability Index. Statistical analysis was done using Pearson's correlation.RESULTS: The mean score for financial distress was 4.10 (SD, 2.09; scale 1 [low distress] to 10 [high distress]; range, 1.13 to 10.0), and the mean disability score was 0.54 (SD, 0.65; scale 0 to 3; range, 0 to 2.75). A moderate positive correlation exists between financial distress and disability (r = 0.43; P < 0.01). Financial distress and disability were highest for poor, uneducated, Medicare patients.CONCLUSIONS: A moderate correlation exists between financial distress and disability in patients with nonacute orthopaedic conditions, particularly in patients with low socioeconomic status. Orthopaedic surgeons may benefit from identifying patients in financial distress and discussing the cost of treatment because of its association with disability and potentially inferior outcomes. Further investigation is needed to test whether decreasing financial distress decreases disability.LEVEL OF EVIDENCE: Level III prospective cohort.

    View details for DOI 10.5435/JAAOS-D-18-00252

    View details for PubMedID 31125323

  • Lumbar epidural steroid injections for herniation and stenosis: incidence and risk factors of subsequent surgery SPINE JOURNAL Koltsov, J. B., Smuck, M. W., Zagel, A., Alamin, T. F., Wood, K. B., Cheng, I., Hu, S. S. 2019; 19 (2): 199?205
  • Lateral femoral sliding osteotomy in total knee arthroplasty with valgus deformity greater than twenty degrees. International orthopaedics Li, F., Liu, N., Li, Z., Wood, K. B., Tian, H. 2019

    Abstract

    PURPOSE: Lateral femoral sliding osteotomy has been reported as an effective technique for total knee arthroplasty (TKA) with significant valgus deformity. This study aims to investigate its utility in TKA with valgus deformity greater than 20, for which few studies have examined.METHODS: Consecutive TKA patients with valgus deformity treated with the sliding osteotomy at our institution were retrospectively studied. Constraint implants were not used. Radiological and clinical parameters at follow-ups were compared with those pre-operatively. Radiological parameters included the hip-knee-ankle angle (HKA), the anatomical lateral distal femoral angle (aLDFA), the anatomical lateral plateau ankle angle (aLPTA), and the angle between the femoral mechanical axis and transepicondylar line (femoral transepicondylar angle, FTEA) which was used to reflect concurrent extra-articular valgus and corresponding local alignment. Clinical outcome measures included the Knee Society Score and Functional Score.RESULTS: Twenty-five patients operated on between July 2011 and February 2017 were enrolled. The average follow-up time was 3.3 (1.5~7.9) years. The pre-operative HKA of 202.72.3 (equivalent to valgus of 22.72.3) was reduced to 180.42.3 at final follow-ups (P<0.001). The aLFDA, aLPTA, and FTEA were all significantly improved, with the last one increased from 84.21.8 to 89.61.6 (t=-11.35, P<0.001). All clinical scores were significantly improved without major complications.CONCLUSIONS: Lateral femoral sliding osteotomy can be effective and safe for TKA with severe valgus deformity greater than 20.

    View details for PubMedID 30659318

  • Reliability of Radiological Measurements of Type-2 Odontoid Fracture. The spine journal : official journal of the North American Spine Society Karamian, B. A., Liu, N., Ajiboye, R. M., Cheng, I., Hu, S. S., Wood, K. B. 2019

    Abstract

    It is recognized that radiological parameters of type 2 dens fractures, including displacement and angulation, are predictive of treatment outcomes and are used to guide surgical decision-making. The reproducibility of such measurements, therefore, is of critical importance. Past literature has shown poor inter-observer reliability for both displacement and angulation measurements of type 2 dens fractures. Since such studies however, various advancements of radiological review systems and measurement tools have evolved to potentially improve such measurements.To re-examine the interrater reliability of measuring displacement and angulation of type 2 dens fractures utilizing modern radiologic review systems. Besides quantitative measurements, the reliability of raters in identifying diagnostic classifications based on translational and angulational displacement was also examined.Radiographic measurement reliability and agreement study.Thirty-seven patients seen at a single institution between 2002 and 2017 with primary diagnosis of acute type II dens fracture with complete CT imaging.Radiological measurements included displacement and angulation. Diagnostic classifications based on consensus-based clinical cut-off points were also recorded.Measurements were performed by five surgeons with varying years of experience in spine surgery using the hospital's electronic medical record radiological measuring tools. The radiological measurements included displacement and angulation. Diagnostic classifications based on consensus-based clinical cut-off points were also recorded. Each rater received a graphic demonstration of the measurement methods, but had the autonomy to select a best cut from the sagittal CT to measure. All raters were blinded to patient information.Measurements for displacement and angulation among the five raters demonstrated "excellent" reliability. Intra-rater reliability was also "excellent" in measuring displacement and angulation. The reliability of diagnostic classification of displacement (above vs. below 5mm), was found to be "very good" among the raters. The reliability of diagnostic classification of angulation (above vs. below 11) demonstrated "good" reliability.Advancement of radiological review systems, including review tools and embedded image processing software, has facilitated more reliable measurements for type-2 odontoid fractures.

    View details for PubMedID 31078698

  • Abnormally high dislocation rate following constrained condylar knee arthroplasty for valgus knee: a case-control study. Journal of orthopaedic surgery and research Li, F., Liu, N., Li, Z., Wood, K. B., Tian, H. 2019; 14 (1): 268

    Abstract

    With the use of constrained condylar knee (CCK) prostheses, dislocation of the knee following total knee arthroplasty (TKA) with valgus deformity is rare. In our practice with such patients, however, an abnormally high dislocation rate was noted. It appeared to be associated with the extent of soft-tissue release which varied among surgeons following different sequences of release. We asked in CCK TKA with valgus deformity is releasing both the lateral collateral ligament (LCL) and popliteus tendon (PT) associated with the occurrence of dislocation.This is a case-control study of consecutive patients with valgus deformity who underwent primary CCK TKA between July 2008 and October 2015. The cases and controls were patients with and without postoperative dislocation of the knee, respectively. The extent of the release of lateral soft-tissue structures was compared between the two groups. Other patient characteristics including age, body mass index, pre- and post-operative valgus deformity, preoperative flexion-contracture, and height of the polyethylene insert were compared as well to reduce confounding.Forty-three consecutive patients with a minimum 2-year follow-up were enrolled. 9.3% (4/43) of the patients had postoperative dislocation of the knee. While the dislocated patients did not significantly differ from the controls on most characteristics, they were more likely to have both the LCL and PT released together during the surgery [100% (4/4) vs. 2.6% (1/39), P?

    View details for DOI 10.1186/s13018-019-1325-4

    View details for PubMedID 31443664

  • Postoperative Radiographic Evaluation Following Adult Spine Deformity Correction: The Impact on Subsequent Management and Associated Risk of Radiation Exposure. Spine deformity Boddu, C., Jacobson, M., Curtin, P. B., Lawlor, C. E., Wood, K., Grottkau, B. E. 2019; 7 (1): 146?51

    Abstract

    BACKGROUND: During the follow-up visits after Adult Spine Deformity (ASD) surgery, obtaining surveillance radiographs is a usual practice, and this study tried to identify evidence to support or refute such practice.METHODS: This is a retrospective, diagnostic case series (Level IV) of 49 patients. We identified the abnormal radiographic findings and their association with need for revision surgery. We determined the odds of obtaining an abnormal radiographs that lead to revision surgery at each of the given time intervals of follow-up. We also estimated the risk versus benefit of obtaining radiographs at each of the given time intervals of follow-up.RESULTS: We identified a total of 11 individual types of abnormal postoperative radiographic findings. Of them, the two radiographic findings that always needed revision surgery because of the associated clinical presentation were pedicle screw pullout and bilateral rod fracture. One abnormal radiographic finding that was never associated with revision surgery was the halo around a pedicle screw. In each of the given postoperative time intervals of follow-up at which the routine radiographs were obtained, we noted that the odds of noticing abnormal radiographic finding that lead to revision surgery was always >1. We found that the cumulative hazard rate for exposure to radiation was significantly higher during the initial follow-up visits when compared to subsequent follow-up visits.CONCLUSION: This study finds evidence to support the practice of routine postoperative radiographic evaluation of patients who come for follow-up after ASD surgery.

    View details for PubMedID 30587308

  • The Relationship Between Lumbar Lateral Listhesis and Radiculopathy in Adult Scoliosis. Spine Kleimeyer, J. P., Liu, N., Hu, S. S., Cheng, I., Alamin, T., Grottkau, B. E., Kukreja, S., Wood, K. B. 2019; 44 (14): 1003?9

    Abstract

    Retrospective review and prospective validation study.To develop a classification system of lumbar lateral listhesis that suggests different likelihoods of having radiculopathy in adult scoliosis.The association of lumbar lateral listhesis with radiculopathy remains uncertain.A retrospective cohort of patients with adult scoliosis enrolled from 2011 to 2015 was studied to develop a classification system of lateral listhesis that can stratify the likelihood of having radiculopathy. Four radiological aspects of lateral listhesis, including Nash and Moe vertebral rotation, L4-L5 lateral listhesis, the number of consecutive listheses, and the presence of a contralateral lateral listhesis at the thoracolumbar junction above a caudal listhesis, were evaluated on radiographs. Their associations with the presence of radicular leg pain were evaluated using multivariable logistic regression. The classification system of lateral listhesis was thus developed using the most influential radiological factors and then validated in a prospective cohort from 2016 to 2017.The retrospective cohort included 189 patients. Vertebral rotation is more than or equal to grade 2 (odds ratio [OR]?=?9.45, 95% confidence interval [CI]: 4.07-25.14) and L4-5 listhesis (OR?=?4.56, 95%CI: 1.85-12.35) were the two most influential listhesis factors associated with radiculopathy. The classification system of lateral listhesis was thus built based on the combinations of their respective presence: Type 0, 1, 2, 3 were defined as not having listhesis at all, none of the two factors present, one of the two presents, and both present, respectively. This classification significantly stratified the probability of radiculopathy, in both the retrospective cohort (0%, 6.4%, 33.8%, and 68.4% in Type 0, 1, 2, and 3, respectively; P?

    View details for DOI 10.1097/BRS.0000000000002986

    View details for PubMedID 30664100

  • A Structured Review Instrument Improves the Quality of Orthopaedic Journal Club JOURNAL OF SURGICAL EDUCATION Campbell, S. T., Kleimeyer, J. P., Young, J. L., Gardner, M. J., Wood, K. B., Bishop, J. A. 2019; 76 (1): 294?300
  • Selective Anterior Lumbar Interbody Fusion for Low Back Pain Associated With Degenerative Disc Disease Versus Nonsurgical Management SPINE Kleimeyer, J. P., Cheng, I., Alamin, T. F., Hu, S. S., Cha, T., Yanamadala, V., Wood, K. B. 2018; 43 (19): 1372?80

    Abstract

    This is a retrospective cohort study.To evaluate the long-term outcomes of selective one- to two-level anterior lumbar interbody fusions (ALIFs) in the lower lumbar spine versus continued nonsurgical management.Low back pain associated with lumbar intervertebral disc degeneration is common with substantial economic impact, yet treatment remains controversial. Surgical fusion has previously provided mixed results with limited durable improvement of pain and function.Seventy-five patients with one or two levels of symptomatic Pfirrmann grades 3 to 5 disc degeneration from L3-S1 were identified. All patients had failed at least 6 months of nonsurgical treatment. Forty-two patients underwent one- or two-level ALIFs; 33 continued multimodal nonsurgical care. Patients were evaluated radiographically and the visual analog pain scale (VAS), Oswestry Disability Index (ODI), EuroQol five dimensions (EQ-5D), and Patient-Reported Outcomes Measurement Information System scores for pain interference, pain intensity, and anxiety. As-treated analysis was performed to evaluate outcomes at a mean follow-up of 7.4 years (range: 2.5-12).There were no differences in pretreatment demographics or nonsurgical therapy utilization between study arms. At final follow-up, the surgical arm demonstrated lower VAS, ODI, EQ-5D, and Patient-Reported Outcomes Measurement Information System pain intensity scores versus the nonsurgical arm. VAS and ODI scores improved 52.3% and 51.1% in the surgical arm, respectively, versus 15.8% and -0.8% in the nonsurgical arm. Single-level fusions demonstrated improved outcomes versus two-level fusions. The pseudarthrosis rate was 6.5%, with one patient undergoing reoperation. Asymptomatic adjacent segment degeneration was identified in 11.9% of patients.Selective ALIF limited to one or two levels in the lower lumbar spine provided improved pain and function when compared with continued nonsurgical care. ALIF may be a safe and effective treatment for low back pain associated with disc degeneration in select patients who fail nonsurgical management.3.

    View details for PubMedID 29529003

  • Patient Perceptions Correlate Weakly With Observed Patient Involvement in Decision-making in Orthopaedic Surgery CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Mertz, K., Eppler, S., Yao, J., Amanatullah, D. F., Chou, L., Wood, K. B., Safran, M., Steffner, R., Gardner, M., Kamal, R. 2018; 476 (9): 1859?65
  • A Structured Review Instrument Improves the Quality of Orthopaedic Journal Club. Journal of surgical education Campbell, S. T., Kleimeyer, J. P., Young, J. L., Gardner, M. J., Wood, K. B., Bishop, J. A. 2018

    Abstract

    OBJECTIVE: We asked the following questions: 1. Does the use of an structured review instrument (SRI) at journal club increase presentation quality, as measured objectively by a standardized evaluation rubric? 2. Does SRI use increase the time required to prepare for journal club? 3. Does SRI use positively impact presenter perceptions about confidence while presenting, satisfaction, and journal club effectiveness, as measured by postparticipation surveys?DESIGN: A prospective study was designed in which a grading rubric was developed to evaluate journal club presentations. The rubric was applied to 24 presentations at journal clubs prior to introduction of the SRI. An SRI was developed and distributed to journal club participants, who were instructed to use it to prepare for journal club. The grading rubric was then used to assess 25 post-SRI presentations and scores were compared between the pre- and post-SRI groups. Presentations occurred at either trauma, pediatrics, or spine subspecialty journal clubs. Participants were also surveyed regarding time requirements for preparation, perceptions of confidence while presenting, satisfaction, and perceptions of overall club effectiveness.SETTING: A single academic center with an orthopaedic surgery residency program.PARTICIPANTS: Resident physicians in the department of orthopaedic surgery.RESULTS: Mean presentation scores increased from 14.0 5.9 (mean standard deviation) to 24.4 5.2 after introduction of the SRI (p < 0.001). Preparation time decreased from a mean of 47 minutes to 40 minutes after SRI introduction (p?=?0.22). Perceptions of confidence, satisfaction, and club effectiveness among trainees trended toward more positive responses after SRI introduction (confidence: 63% positive responses pre-SRI vs 72% post-SRI, p?=?0.73; satisfaction: 64% vs 91%, p?=?0.18; effectiveness: 64% vs 91%, p?=?0.19).CONCLUSIONS: The use of a structured review instrument to guide presentations at orthopaedic journal club increased presentation quality, and there was no difference in preparation time. There were trends toward improved presenter confidence, satisfaction, and perception of journal club effectiveness. SRI utilization at orthopaedic journal club may be an effective method for increasing the quality of journal club presentations. Future work should examine the relationship between presentation quality and overall club effectiveness.

    View details for PubMedID 30093334

  • Patient Perceptions Correlate Weakly With Observed Patient Involvement in Decision-making in Orthopaedic Surgery. Clinical orthopaedics and related research Mertz, K., Eppler, S., Yao, J., Amanatullah, D. F., Chou, L., Wood, K. B., Safran, M., Steffner, R., Gardner, M., Kamal, R. 2018

    Abstract

    BACKGROUND: Shared decision-making between patients and physicians involves educating the patient, providing options, eliciting patient preferences, and reaching agreement on a decision. There are different ways to measure shared decision-making, including patient involvement, but there is no consensus on the best approach. In other fields, there have been varying relationships between patient-perceived involvement and observed patient involvement in shared decision-making. The relationship between observed and patient-perceived patient involvement in decision-making has not been studied in orthopaedic surgery.QUESTIONS/PURPOSES: (1) Does patient-perceived involvement correlate with observed measurements of patient involvement in decision-making in orthopaedic surgery? (2) Are patient demographics associated with perceived and observed measurements of patient involvement in decision-making?METHODS: We performed a prospective, observational study to compare observed and perceived patient involvement in new patient consultations for eight orthopaedic surgeons in subspecialties including hand/upper extremity, total joint arthroplasty, spine, sports, trauma, foot and ankle, and tumor. We enrolled 117 English-literate patients 18 years or older over an enrollment period of 2 months. A member of the research team assessed observed patient involvement during a consultation with the Observing Patient Involvement in Decision-Making (OPTION) instrument (scaled 1-100 with higher scores representing greater involvement). After the consultation, we asked patients to complete a questionnaire with demographic information including age, sex, race, education, income, marital status, employment status, and injury type. Patients also completed the Perceived Involvement in Care Scale (PICS), which measures patient-perceived involvement (scaled 1-13 with higher scores representing greater involvement). Both instruments are validated in multiple studies in various specialties and the physicians were blinded to the instruments used. We assessed the correlation between observed and patient-perceived involvement as well as tested the association between patient demographics and patient involvement scores.RESULTS: There was weak correlation between observed involvement (OPTION) and patient-perceived involvement (PICS) (r = 0.37, p < 0.01) in decision-making (mean OPTION, 28.7, SD 7.7; mean PICS, 8.43, SD 2.3). We found a low degree of observed patient involvement despite a moderate to high degree of perceived involvement. No patient demographic factor had a significant association with patient involvement.CONCLUSIONS: Further work is needed to identify the best method for evaluating patient involvement in decision-making in the setting of discordance between observed and patient-perceived measurements. Knowing whether it is necessary for (1) actual observable patient involvement to occur; or (2) a patient to simply believe they are involved in their care can inform physicians on the best way to improve shared decision-making in their practice.LEVEL OF EVIDENCE: Level II, therapeutic study.

    View details for PubMedID 29965894

  • Lumbar Epidural Steroid Injections for Herniation and Stenosis: Incidence and Risk Factors of Subsequent Surgery. The spine journal : official journal of the North American Spine Society Koltsov, J. C., Smuck, M. W., Zagel, A., Alamin, T. F., Wood, K. B., Cheng, I., Hu, S. S. 2018

    Abstract

    BACKGROUND CONTEXT: Lumbosacral ESIs have increased dramatically despite a narrowing of the clinical indications for use. One potential indication is to avoid or delay surgery, yet little information exists regarding surgery rates after ESI.PURPOSE: The purpose of this research was to determine the proportion of patients having surgery after lumbar epidural steroid injection (ESI) for disc herniation or stenosis and to identify the timing and factors associated with this progression STUDY DESIGN/SETTING: This study was a retrospective review of nationally-representative administrative claims data from the Truven Health MarketScan databases from 2007 - 2014.PATIENT SAMPLE: The study cohort was comprised of 179,025 patients (5415 years, 48% female) having lumbar epidural steroid injections (ESIs) for diagnoses of stenosis and/or herniation.OUTCOME MEASURES: The primary outcome measure was the time from ESI to surgery.METHODS: Inclusion criteria were ESI for stenosis and/or herniation, age ?18 years, and health plan enrollment for 1 year prior to ESI to screen for exclusions. Patients were followed longitudinally until they progressed to surgery or had a lapse in enrollment, at which time they were censored. Rates of surgery were assessed with the Kaplan-Meier survival curves. Demographic and treatment factors associated with surgery were assessed with multivariable Cox proportional hazard models. No external funding was procured for this research and the authors' conflicts of interest are not pertinent to the present work.RESULTS: Within 6 months, 12.5% of ESI patients underwent lumbar surgery. By 1 year, 16.9% had surgery, and by 5 years, 26.1% had surgery. Patients with herniation had surgery at rates of up to 5 to 7 fold higher, with the highest rates of surgery in younger patients and those with both herniation and stenosis. Other concomitant spine diagnoses, male sex, previous tobacco use, and residence a rural areas or regions other than the Northeastern United States were associated with higher surgery rates. Medical comorbidities (previous treatment for drug use, CHF, obesity, COPD, hypercholesterolemia, and other cardiac complications) were associated with lower surgery rates.CONCLUSIONS: In the long-term, more than 1 out of every 4 patients undergoing ESI for lumbar herniation or stenosis subsequently had surgery, and nearly 1 of 6 had surgery within the first year. After adjusting for other patient demographics and comorbidities, patients with herniation were more likely have surgery than those with stenosis. The improved understanding of the progression from lumbar ESI to surgery will help to better inform discussions regarding the value of ESI and aid in the shared decision making process.

    View details for PubMedID 29959098

  • What Is the State of Quality Measurement in Spine Surgery? CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Bennett, C., Xiong, G., Hu, S., Wood, K., Kamal, R. N. 2018; 476 (4): 725?31

    Abstract

    Value-based healthcare models rely on quality measures to evaluate the efficacy of healthcare delivery and to identify areas for improvement. Quality measure research in other areas of health care has generally shown that there is a limited number of available quality measures and that those that exist disproportionately focus on processes as opposed to outcomes. The purpose of this study was to assess the current state of quality measures and candidate quality measures in spine surgery.(1) How many quality measures and candidate quality measures are currently available? (2) According to Donabedian domains and National Quality Strategy (NQS) priorities, what aspects or domains of care do the present quality measures and candidate quality measures represent?We systematically reviewed the National Quality Forum, the Agency for Healthcare Research and Quality, and the Physician Quality Reporting System for quality measures relevant to spine surgery. A systematic search for candidate quality measures was also performed using MEDLINE/PubMed and Embase as well as publications from the American Academy of Orthopaedic Surgeons, Congress of Neurological Surgeons, and the North American Spine Society. Clinical practice guidelines were included as candidate quality measures if their development was in accordance with Institute of Medicine criteria for the development of clinical practice guidelines, they were based on consistent clinical evidence including at least one Level I study, and they carried the strongest possible recommendation by the developing body. Quality measures and candidate quality measures were then pooled for analysis and categorized by clinical focus, NQS priority, and Donabedian domain. Our initial search yielded a total of 3940 articles, clinical practice guidelines, and quality measures, 74 of which met criteria for inclusion in this study.Of the 74 measures studied, 29 (39%) were quality measures and 45 (61%) were candidate quality measures. Fifty of 74 (68%) were specific to the care of the spine, and 24 of 74 (32%) were related to the general care of spine patients. The majority of the spine-specific measures were process measures (45 [90%]) and focused on the NQS priority of "Effective Clinical Care" (44 [88%]). The majority of the general care measures were also process measures (14 [58%]), the highest portion of which focused on the NQS priority of "Patient Safety" (10 [42%]).Given the large number of pathologies treated by spine surgeons, the limited number of available quality measures and candidate quality measures in spine surgery is inadequate to support the transition to a value-based care model. Additionally, current measures disproportionately focus on certain aspects or domains of care, which may hinder the ability to appropriately judge an episode of care, extract usable data, and improve quality. Physicians can steward the creation of meaningful quality measures by participating in clinical practice guideline development, assisting with the creation and submission of formal quality measures, and conducting the high-quality research on which effective guidelines and quality measures depend.

    View details for PubMedID 29480884

  • Commentary of Acute and Hyperacute Thoracolumbar Corpectomy for Traumatic Burst Fractures Using a Mini-open Lateral Approach SPINE Wood, K. B. 2018; 43 (2): E125

    View details for PubMedID 28858187

  • Does timing of transplantation of neural stem cells following spinal cord injury affect outcomes in an animal model? Journal of spine surgery (Hong Kong) Cheng, I., Park, D. Y., Mayle, R. E., Githens, M., Smith, R. L., Park, H. Y., Hu, S. S., Alamin, T. F., Wood, K. B., Kharazi, A. I. 2017; 3 (4): 567?71

    Abstract

    Background: We previously reported that functional recovery of rats with spinal cord contusions can occur after acute transplantation of neural stem cells distal to the site of injury. To investigate the effects of timing of administration of human neural stem cell (hNSC) distal to the site of spinal cord injury on functional outcomes in an animal model.Methods: Thirty-six adult female Long-Evans hooded rats were randomized into three experimental and three control groups with six animals in each group. The T10 level was exposed via posterior laminectomy, and a moderate spinal cord contusion was induced by the Multicenter Animal Spinal Cord Injury Study Impactor (MASCIS, W.M. Keck Center for Collaborative Neuroscience, Piscataway, NJ, USA). The animals received either an intrathecal injection of hNSCs or control media through a separate distal laminotomy immediately, one week or four weeks after the induced spinal cord injury. Observers were blinded to the interventions. Functional assessment was measured immediately after injury and weekly using the Basso, Beattie, Bresnahan (BBB) locomotor rating score.Results: A statistically significant functional improvement was seen in all three time groups when compared to their controls (acute, mean 9.2 vs. 4.5, P=0.016; subacute, mean 11.1 vs. 6.8, P=0.042; chronic, mean 11.3 vs. 5.8, P=0.035). Although there was no significant difference in the final BBB scores comparing the groups that received hNSCs, the group which achieved the greatest improvement from the time of cell injection was the subacute group (+10.3) and was significantly greater than the chronic group (+5.1, P=0.02).Conclusions: The distal intrathecal transplantation of hNSCs into the contused spinal cord of a rat led to significant functional recovery of the spinal cord when injected in the acute, subacute and chronic phases of spinal cord injury (SCI), although the greatest gains appeared to be in the subacute timing group.

    View details for PubMedID 29354733

  • Comparison of Decompression With and Without Fusion for Patients With Synovial Facet Cysts CLINICAL SPINE SURGERY van Dijke, M., Janssen, S. J., Cha, T. D., Wood, K. B., Borges, L. F., Harris, M. B., Bono, C. M., Schwab, J. H. 2017; 30 (10): E1399?E1404

    Abstract

    This is a retrospective study.To compare (1) recurrence of radiculopathy and (2) back pain after decompression with and without fusion for patients with a symptomatic synovial cyst.Previous work described favorable outcomes following cyst excision with and without fusion. Because of the association of facet cysts with spinal instability it is hypothesized that a decompression with fusion will lead to better outcomes. However, previous studies present contradicting results.We included 314 consecutive patients that underwent operative treatment for a facet cyst between 2003 and 2013 at 2 tertiary spine referral centers: 224 (71%) underwent decompression without fusion (35% spondylolisthesis), 90 (29%) underwent decompression with fusion (63% spondylolisthesis). Baseline data were compared between the groups. Bivariate log-rank analysis was used to compare outcomes between groups, followed by multivariable Cox regression analysis accounting for differences in baseline characteristics.Patients undergoing decompression with fusion presented with a higher incidence of back pain (P=0.004) and spondylolisthesis (P<0.001), had more often bilateral decompressions (P<0.001), more facetectomies (P<0.001), and more levels of decompression (P=0.004) than those who underwent decompression alone. We found a difference in recurrence of radiculopathy (no fusion: 25% vs. fusion: 9.4%, P=0.029) in bivariate analysis. However, this difference did not hold when accounting for confounders (hazard ratio, 0.50, 95% confidence interval, 0.19-1.31, P=0.16). There was no difference in recurrence of back pain in bivariate (no fusion: 29% vs. fusion: 22%, P=0.51) and multivariable analysis (hazard ratio 0.51, 95% confidence interval, 0.23-1.14, P=0.10).We found, with the numbers evaluated, no difference in recurrence of radiculopathy or back pain between patients undergoing decompression with or without fusion after accounting for confounders. The decision for fusion should be considered in light of the extent of decompression and the existence of other pathology.Level III-therapeutic study.

    View details for PubMedID 27753698

  • Surgery for Refractory Coccygodynia SPINE Kleimeyer, J. P., Wood, K. B., Lonne, G., Herzog, T., Ju, K., Beyer, L., Park, C. 2017; 42 (16): 1214?19

    Abstract

    This is a retrospective cohort study.To evaluate the long-term outcomes for patients with refractory coccygodynia treated with coccygectomy compared to a nonsurgical regimen of sitting aids, physical therapy, medications, and injections.The surgical treatment of coccygodynia remains controversial. To date, there has only been one small comparative study of surgical versus nonsurgical treatment.From 2004 to 2014, 109 patients presenting with coccygodynia were treated with either total coccygectomy or a nonsurgical course of sitting aids, physical therapy, anti-inflammatory medications, and injections. All had at least 2 years of symptoms before surgery. The patient principally made the treatment decision, counseled by the treating physician. Before surgery, all subjects underwent at least 2 years of conservative treatment and three-dimensional imaging (computed tomography and/or magnetic resonance imaging). Subjects completed visual analog pain scales, EuroQol five-dimension, components of the PROMIS measure, and a novel Coccygodynia Disability Index evaluation. Work status, complications, and satisfaction were recorded.A total of 61 patients received nonsurgical care; eight declined participation and five could not be located. Forty-eight patients underwent total coccygectomy; three declined participation and five could not be located. At an average 4.8 years of follow-up (range: 2-9), the nonsurgical visual analog pain scales was 5 and the surgical 2 (P?=?0.001); 79% of surgically treated patients were improved at 2 years versus 43% for the nonsurgical group. EuroQol five-dimension (P?=?0.002), Coccygodynia Disability Index (0.01), and PROMIS Pain interference scores (0.02) were also significantly improved in the surgical group. Eleven surgical patients (26%) had complications, all wound related with successful resolution; seven treated with dressing changes and four with surgical debridement.Total coccygectomy is a safe and effective surgical treatment of coccygodynia refractory to nonoperative care. Patient-reported outcome measures were improved after surgery compared with nonsurgical management. Postoperative wound care remains a concern.4.

    View details for PubMedID 28800569

  • Ranges of Cervical Intervertebral Disc Deformation During an In Vivo Dynamic Flexion-Extension of the Neck JOURNAL OF BIOMECHANICAL ENGINEERING-TRANSACTIONS OF THE ASME Yu, Y., Mao, H., Li, J., Tsai, T., Cheng, L., Wood, K. B., Li, G., Cha, T. D. 2017; 139 (6)

    Abstract

    While abnormal loading is widely believed to cause cervical spine disc diseases, in vivo cervical disc deformation during dynamic neck motion has not been well delineated. This study investigated the range of cervical disc deformation during an in vivo functional flexion-extension of the neck. Ten asymptomatic human subjects were tested using a combined dual fluoroscopic imaging system (DFIS) and magnetic resonance imaging (MRI)-based three-dimensional (3D) modeling technique. Overall disc deformation was determined using the changes of the space geometry between upper and lower endplates of each intervertebral segment (C3/4, C4/5, C5/6, and C6/7). Five points (anterior, center, posterior, left, and right) of each disc were analyzed to examine the disc deformation distributions. The data indicated that between the functional maximum flexion and extension of the neck, the anterior points of the discs experienced large changes of distraction/compression deformation and shear deformation. The higher level discs experienced higher ranges of disc deformation. No significant difference was found in deformation ranges at posterior points of all the discs. The data indicated that the range of disc deformation is disc level dependent and the anterior region experienced larger changes of deformation than the center and posterior regions, except for the C6/7 disc. The data obtained from this study could serve as baseline knowledge for the understanding of the cervical spine disc biomechanics and for investigation of the biomechanical etiology of disc diseases. These data could also provide insights for development of motion preservation surgeries for cervical spine.

    View details for PubMedID 28334358

  • In Vivo Characteristics of Nondegenerated Adjacent Segment Intervertebral Foramina in Patients With Degenerative Disc Disease During Flexion-Extension SPINE Cha, T. D., Moore, G., Liow, M., Zhong, W., Wu, M., Wang, S., Kang, J. D., Wood, K. B., Li, G. 2017; 42 (6): 359?65

    Abstract

    In vivo patient biomechanical study.To investigate the dimensions of lumbar intervertebral foramen (LIVF) of patients with degenerative disc disease (DDD) during a flexion-extension motion of the body.LIVF narrowing may result in nerve root compression. The area changes of degenerated and adjacent nondegenerated LIVFs in DDD patients under physiologic loading conditions are unknown.Nine symptomatic low back pain patients with radiological evidence of L4-S1 DDD were recruited. Each subject was magnetic resonance imaging scanned for construction of three-dimensional lumbar vertebral models, and fluoroscopically imaged when the body extended from 45 flexion to full extension for reconstruction of LIVF dimensions. The data of the adjacent segment L3/4 and diseased segments L4/5 and L5/S1 were compared with a normal control group at 45 flexion, upright, and full extension of the body.The mean LIVF areas of DDD segments were significantly smaller than those of the normal subjects in all positions (P?<0.05). In upright position, the LIVF areas of the DDD patients were 32.8% and 33.6% smaller than the normal subjects for L4/5 and L5/S1, respectively. For the adjacent L3/4, the LIVF area of the DDD patients was 32.3% smaller than that of the normal controls (P?<0.05). The total change of L3/4 LIVF area in DDD patients from flexion to extension was significantly smaller than that of the normal subjects, but the changes in L4/5 and L5/S1 LIVF areas were similar between the two groups (P?>0.05).Similar reductions of the LIVF dimensions were observed at the adjacent and the involved levels of the DDD patients, implying that biomechanical changes might have already occurred at the adjacent segment despite the lack of radiographic evidence of degeneration. Subsequent research should focus on the effects of surgical fusion on the biomechanical features of the adjacent segment.N/A.

    View details for PubMedID 27379419

  • Multiple-hook fixation in revision spinal deformity surgery for patients with a previous multilevel fusion mass: technical note and preliminary outcomes JOURNAL OF NEUROSURGERY-SPINE Liu, N., Wood, K. B. 2017; 26 (3): 368-373

    Abstract

    OBJECTIVE A previous multilevel fusion mass encountered during revision spinal deformity surgery may obscure anatomical landmarks, making instrumentation unworkable or incurring substantial blood loss and operative time. This study introduced a surgical technique of multiple-hook fixation for fixating previous multilevel fusion masses in revision spinal deformity surgeries and then evaluated its outcomes. METHODS Patients with a previous multilevel fusion mass who underwent revision corrective surgery down to the lumbosacral junction were retrospectively studied. Multiple hooks were used to fixate the fusion mass and linked to distal pedicle screws in the lumbosacral-pelvic complex. Radiological and clinical outcomes were evaluated. RESULTS The charts of 8 consecutive patients with spinal deformity were retrospectively reviewed (7 women, 1 man; mean age 56 years). The primary diagnoses included flat-back deformity (6 cases), thoracolumbar kyphoscoliosis (1 case), and lumbar spondylosis secondary to a previous scoliosis fusion (1 case). The mean follow-up duration was 30.1 months. Operations were performed at T3/4-ilium (4 cases), T7-ilium (1 case), T6-S1 (1 case), T12-S1 (1 case), and T9-L5 (1 case). Of 8 patients, 7 had sagittal imbalance preoperatively, and their mean C-7 plumb line improved from 10.8 2.9 cm preoperatively to 5.3 3.6 cm at final follow-up (p = 0.003). The mean lumbar lordosis of these patients at final follow-up was significantly greater than that preoperatively (35.2 12.6 vs 16.8 11.8, respectively; p = 0.005). Two perioperative complications included osteotomy-related leg weakness in 1 patient and a stitch abscess in another. CONCLUSIONS The multiple-hook technique provides a viable alternative option for fixating a previous multilevel fusion mass in revision spinal deformity surgery.

    View details for DOI 10.3171/2016.8.SPINE16432

    View details for PubMedID 27935449

  • The effect of short (2-weeks) versus long (6-weeks) post-operative restrictions following lumbar discectomy: a prospective randomized control trial EUROPEAN SPINE JOURNAL Bono, C. M., Leonard, D. A., Cha, T. D., Schwab, J. H., Wood, K. B., Harris, M. B., Schoenfeld, A. J. 2017; 26 (3): 905-912

    Abstract

    We sought to evaluate how short (2-week) versus long (6-week) post-operative restrictions following lumbar discectomy impacted outcomes and reherniation rates for a period up to 1year following surgery.This study included 108 patients undergoing index lumbar discectomy. Patients were randomized immediately following surgery. Outcomes included back and leg visual analog pain scales (VAS), Oswestry Disability Index (ODI), and reherniation rates at 2-weeks, 6-weeks, 3-months, and 1-year following surgery. Differences in reherniation rates were analyzed using Fisher's exact test. VAS and ODI scores were evaluated using Student's t test.Six patients (11%) in the 2-week restriction group had a reherniation event and four patients (7%) in the 6-week restriction group experienced a reherniation (p=0.52). VAS back pain (p<0.001), leg pain (p<0.001), and ODI scores (p<0.001) were significantly improved for both cohorts as compared to baseline at the 2-week time point and remained significantly improved through 1-year [VAS back (p<0.001); VAS leg (p<0.001); ODI (p<0.001)]. No significant differences in ODI, VAS back, or VAS leg scores were detected at any of the time points between the 2- and 6-week restriction groups.The results of this randomized trial suggest equivalent clinical outcomes irrespective of the length of post-operative restriction. From a clinical perspective, if patients are deemed at low risk for a reherniation event they may be confidence that early return to activity at 2weeks will not compromise outcomes and may not adversely impact the risk of reherniation. Level of Evidence II.

    View details for DOI 10.1007/s00586-016-4821-9

    View details for Web of Science ID 000396042000040

  • The effect of short (2-weeks) versus long (6-weeks) post-operative restrictions following lumbar discectomy: a prospective randomized control trial. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society Bono, C. M., Leonard, D. A., Cha, T. D., Schwab, J. H., Wood, K. B., Harris, M. B., Schoenfeld, A. J. 2017; 26 (3): 905?12

    Abstract

    We sought to evaluate how short (2-week) versus long (6-week) post-operative restrictions following lumbar discectomy impacted outcomes and reherniation rates for a period up to 1year following surgery.This study included 108 patients undergoing index lumbar discectomy. Patients were randomized immediately following surgery. Outcomes included back and leg visual analog pain scales (VAS), Oswestry Disability Index (ODI), and reherniation rates at 2-weeks, 6-weeks, 3-months, and 1-year following surgery. Differences in reherniation rates were analyzed using Fisher's exact test. VAS and ODI scores were evaluated using Student's t test.Six patients (11%) in the 2-week restriction group had a reherniation event and four patients (7%) in the 6-week restriction group experienced a reherniation (p=0.52). VAS back pain (p<0.001), leg pain (p<0.001), and ODI scores (p<0.001) were significantly improved for both cohorts as compared to baseline at the 2-week time point and remained significantly improved through 1-year [VAS back (p<0.001); VAS leg (p<0.001); ODI (p<0.001)]. No significant differences in ODI, VAS back, or VAS leg scores were detected at any of the time points between the 2- and 6-week restriction groups.The results of this randomized trial suggest equivalent clinical outcomes irrespective of the length of post-operative restriction. From a clinical perspective, if patients are deemed at low risk for a reherniation event they may be confidence that early return to activity at 2weeks will not compromise outcomes and may not adversely impact the risk of reherniation. Level of Evidence II.

    View details for PubMedID 27807771

  • Lumbar Osteotomy SPINE Wood, K. B. 2016; 41 (7): A23-A23

    Abstract

    When a patient presents with spine problems, the spine surgeon would do well to avoid use of, reliance on, and acceptance of radiographs as the sole or primary source of information. Measurement of pelvic incidence and lumbar lordosis, although crucial, does not take into account the effort the patient must make to move, the level of involvement of other parts of the body, and the history of previous procedures and outcomes. Radiographs may show pathology that is not consistent with the appearance of the patient. How should we assess this situation?

    View details for DOI 10.1097/BRS.0000000000001441

    View details for Web of Science ID 000374878500015

  • Lumbar Osteotomy. Spine Wood, K. B. 2016; 41 Suppl 7: S23

    Abstract

    When a patient presents with spine problems, the spine surgeon would do well to avoid use of, reliance on, and acceptance of radiographs as the sole or primary source of information. Measurement of pelvic incidence and lumbar lordosis, although crucial, does not take into account the effort the patient must make to move, the level of involvement of other parts of the body, and the history of previous procedures and outcomes. Radiographs may show pathology that is not consistent with the appearance of the patient. How should we assess this situation?

    View details for PubMedID 27015064

  • GAMMA-RAY FLARE ACTIVITY FROM PSR B1259-63 DURING 2014 PERIASTRON PASSAGE AND COMPARISON TO ITS 2010 PASSAGE ASTROPHYSICAL JOURNAL Caliandro, G. A., Cheung, C. C., Li, J., Scargle, J. L., Torres, D. F., Wood, K. S., Chernyakova, M. 2015; 811 (1)
  • CLASS SIZE AND STUDENT EVALUATIONS OF FACULTY JOURNAL OF HIGHER EDUCATION Wood, K., LINSKY, A. S., Straus, M. A. 1974; 45 (7): 524-534

Footer Links:

Stanford Medicine Resources: