Publications by authors named "Alan S Hilibrand"

Study Design: Retrospective cohort.

Objective: To analyze the annual trends in the most prevalent topics, journals, and geographic regions of the top 100 spine surgery articles, as determined by altmetric attention scores (AASs). We also describe the relationship between AAS and traditional article metrics.

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  • A retrospective cohort study aimed to compare three socioeconomic status (SES) indexes and their association with outcomes after anterior cervical discectomy and fusion (ACDF) or lumbar fusion.
  • The study involved identifying adult patients who underwent these surgeries at a medical center from 2014 to 2020, analyzing their preoperative conditions and outcomes based on SES classifications derived from community-level indexes.
  • Results indicated that while patients from lower SES communities had worse preoperative outcomes, the community-wide SES indexes were ineffective in predicting surgical outcomes post-surgery.
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Study Design: Retrospective cohort.

Objective: To explore the relationship between symptomatic pseudoarthrosis requiring revision after lumbar fusion and antidepressant use.

Summary Of Background Data: Approximately 25% of patients undergoing spine surgery are taking antidepressants.

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Background Context: Previous research has demonstrated an association between socioeconomic status (SES) and patient health, specifically noting that patients of lower SES have poor health outcomes. Understanding how social factors, including socioeconomic status (SES), relate to disparities in health outcomes is critical to closing gaps in equitable care to patients. While several studies have examined the effect of SES on postoperative spine outcomes, there is limited spine literature evaluating SES in the context of barriers to spine care.

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Objective: A quarter of spine surgery patients take antidepressants. Basic science research has suggested serotonergic antidepressants impair platelet function. This has been supported by only a small number of works in the setting of spine surgery.

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Objective: Venous thromboembolism (VTE) is a serious postoperative adverse event after spine surgery. In patients with pain refractory to typical multimodal analgesia regimens after spine surgery, whom are often chronic opioid users, perioperative ketamine is an alternative analgesic that has grown in popularity. The aim of this study is to assess the risk of VTE in chronic opioid users undergoing spine surgery.

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Background: The purpose of this study is to determine the impact of community-level socioeconomic status (SES) on surgical outcomes and patient-reported outcome measures (PROMs) following revision lumbar fusion.

Methods: Adult patients who underwent revision lumbar fusion surgery from 2011-2021 were grouped by Distressed Community Index (DCI) into Prosperous, Comfortable, Mid-tier, and At-Risk/Distressed cohorts. Demographics, surgical information, and PROMs were compared based on DCI community status.

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  • The study highlights that about 20% of patients with metastatic spine disease experience depression, while approximately 17% struggle with anxiety, emphasizing the need for mental health awareness in this population.
  • Data was collected from patients over 18 years old who underwent treatment for metastatic spinal disease from 2017 to 2022, revealing a significant number of both depression and anxiety diagnoses among them.
  • The findings suggest that spine surgeons should actively screen for mental health issues in patients with spinal metastases to ensure timely referrals for psychological support.
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Background: Although diversity has improved across certain orthopaedic subspecialties, enhancing diversity within spine surgery has remained a challenge. We aimed to investigate the current state of sex, racial, and ethnic diversity among academic orthopaedic spine surgeons in the United States.

Methods: In January 2024, a cross-sectional analysis of orthopaedic spine surgery faculty in the United States was conducted using the Doximity database to identify eligible surgeons.

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Background Context: Lumbar spinal fusion is an increasingly common operation to treat symptoms related to degenerative disorders of the spine including radiculopathy and pain. As the volume of spine surgeries grows, it is becoming increasingly common for procedures to take place in nontertiary care centers, including orthopaedic specialty hospitals (OSH). While previous research demonstrates that surgical outcomes at an OSH are noninferior to those at a tertiary referral center (TRC), the implications of this difference on patient-reported outcome measures (PROMs) have not been sufficiently assessed.

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  • The study aimed to assess whether the baseline prognostic nutritional index (PNI) could predict surgical outcomes in patients with native spine infections.
  • Researchers analyzed records of adult patients diagnosed with spine infections from 2017-2022, calculating their PNI based on serum albumin and lymphocyte count to categorize them into high or low PNI groups.
  • Results showed that patients with low PNI were more likely to require surgery and experience complications compared to those with high PNI, suggesting that PNI is a valuable indicator for assessing the severity of spinal infections and potential need for surgery.
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Objective: To determine prescription trends across specialties in the perioperative care of patients undergoing spine surgery from 2018 to 2021.

Summary Of Background Data: A range of measures, including implementation of state prescription drug monitoring programs, have been instituted to combat the opioid epidemic. Considering the continued presence of opioids for spine-related pain management, a better understanding of the patterns of opioid prescription practices may be important for future intervention.

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Study Design: Retrospective cohort study.

Objective: To examine how community-level economic disadvantage impacts short-term outcomes following posterior cervical decompression and fusion (PCDF) for cervical spondylotic myelopathy.

Summary Of Background Data: The effects of socioeconomic factors, measured by the Distress Community Index (DCI), on postoperative outcomes after PCDF are underexplored.

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Purpose: To report the rate of fusion in a sample of patients undergoing lumbar fusion surgery and assess interrater reliability of computed tomography (CT)-based parameters for the assessment of fusion.

Methods: All adult patients who underwent lumbar fusion surgery from 2017 to 2021 were retrospectively identified. Patient demographics and surgical characteristics were collected through chart review of the electronic medical records.

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Study Design: Retrospective cohort study.

Objective: The purpose of this study is to determine which demographic, surgical, and radiographic preoperative characteristics are most associated with the need for subsequent fusion after decompression lumbar spinal surgery.

Summary Of Background Data: There is a relatively high rate of the need for repeat decompression or fusion after an index decompression procedure for degenerative spine disease.

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Background: The North American Spine Society (NASS) assembled the first ever comprehensive naming system for describing lumbar disc disease, including lumbar disc herniation. The objectives of this study were (1) to determine which NASS descriptors are most predictive of independent patient-reported outcomes after microdiscectomy and (2) to identify the inter-rater reliability of each NASS descriptor.

Methods: Adult patients (≥18 years) who underwent a lumbar microdiscectomy from 2014-2021 were retrospectively identified.

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  • - This study investigates how patients perceive the appearance and impact of scars after cervical spine surgery, aiming to fill a gap in existing research on surgical outcomes and psychosocial effects.
  • - Researchers conducted a retrospective review of over 800 patients who had surgery between 2017 and 2022, using the SCAR-Q survey to evaluate scar appearance, symptoms, and overall satisfaction.
  • - Findings show that patients unhappy with their surgical results reported significantly poorer scar-related scores, and female patients had more favorable perceptions of scarring than male patients.
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  • The study investigates the differing timing of chemoprophylaxis (specifically heparin) in postoperative spine surgery and its relation to the occurrence of venous thromboembolism (VTE) and unplanned reoperations for hematoma.! -
  • It includes a retrospective analysis of 8,704 patients over several years, categorizing them into "immediate" and "delayed" chemoprophylaxis groups based on when their heparin treatment started after surgery.! -
  • Results indicated a low overall rate of VTE (1.13%) and unplanned reoperations (0.62%), and analyses aimed to identify important factors influencing these outcomes based on the different timing of which the chemop
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Introduction: The factors most important in the spine fellowship match may not ultimately correlate with quality of performance during fellowship. This study examined the spine fellow applicant metrics correlated with high application rank compared with the metrics associated with the strongest clinical performance during fellowship.

Methods: Spine fellow applications at three academic institutions were retrieved from the San Francisco Match database (first available to 2021) and deidentified for application review.

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  • The study aimed to examine how resilience affects pain and neck disability outcomes in patients who had single- or double-level anterior cervical discectomy and fusion (ACDF).
  • Patients completed surveys on resilience, pain, and disability levels both before and after surgery, allowing researchers to categorize them based on their resilience levels.
  • Results showed that all patients improved post-surgery, but those with higher resilience reported better pain relief compared to those with lower resilience, indicating resilience may play a role in recovery outcomes.
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Objective: The Pfirrmann scoring system classifies lumbosacral disc degeneration based on magnetic resonance imaging signal intensity. The relationship between pre-existing disc degeneration and patient-reported outcome measures (PROMs) after one-level lumbar fusion is not well documented. The purpose of this study was to investigate the relationship between the severity of preoperative intervertebral disc degeneration and preoperative and postoperative PROMs in patients undergoing one-level lumbar fusion.

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Objectives: The purpose of this study is to identify if construct length affects the rate of surgical complications and instrumentation revision following surgical fixation of subaxial and thoracolumbar Type B and C fractures. This study evaluates the effect of ankylosing spondylitis/diffuse idiopathic skeletal hyperostosis (AS/DISH) within this population on outcomes.

Methods: Retrospective review of 91 cervical and 89 thoracolumbar Type B and C fractures.

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Introduction: Revision lumbar fusion is most commonly due to nonunion, adjacent segment disease (ASD), or recurrent stenosis, but it is unclear if diagnosis affects patient outcomes. The primary aim of this study was to assess whether patients achieved the patient acceptable symptom state (PASS) or minimal clinically important difference (MCID) after revision lumbar fusion and assess whether this was influenced by the indication for revision.

Methods: We retrospectively identified all 1-3 level revision lumbar fusions at a single institution.

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  • The modified Japanese Orthopaedic Association (mJOA) scale is commonly used for evaluating outcomes in degenerative cervical myelopathy (DCM) but doesn't account for neck pain or the full recovery process post-surgery.
  • The study aimed to reassess the effectiveness of riluzole in patients undergoing surgery for DCM using a comprehensive statistical approach that considers multiple outcome measures.
  • Results showed that patients taking riluzole had a significantly better chance of overall improvement compared to those on a placebo after one year, indicating riluzole's potential benefit in surgical outcomes for DCM patients.
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