Publications by authors named "Ali Moghaddamjou"
Article Synopsis
- This study analyzed a large set of data to assess the risk of C5 palsy following two different surgical approaches (anterior vs posterior) for treating degenerative cervical myelopathy (DCM).
- Out of 283 patients, those who had posterior decompression showed a significantly higher incidence of postoperative C5 palsy (11.26%) compared to those who underwent anterior decompression (3.03%).
- The findings suggest that choosing the posterior approach increases the likelihood of C5 palsy by more than four times, which could impact surgical decision-making for DCM treatment.
Article Synopsis
- The study used a mixed-methods approach to investigate intra-operative spinal cord injury (ISCI), which lacks a uniform definition, leading to variable reports on its frequency and risk factors.
- A comprehensive review of existing literature was conducted, resulting in a table that summarizes risk factors for ISCI based on systematic analysis and expert input from a Guidelines Development Group.
- Key findings revealed that ISCI frequency can range from 0 to 61%, with older age and certain medical conditions increasing risk, while improved neurological status and intra-operative neuromonitoring decrease risk.*
Article Synopsis
- The article summarizes the 2023 AO Spine-Praxis guidelines for managing acute spinal cord injuries, focusing on recommendations for surgical and medical interventions.
- It emphasizes the importance of early surgical intervention while highlighting gaps in research regarding optimal decompression techniques and the effects of blood pressure on recovery.
- The guidelines were developed through systematic reviews and input from a multidisciplinary group, using established evaluation frameworks to ensure the quality of the recommendations.
A Clinical Practice Guideline for Prevention, Diagnosis and Management of Intraoperative Spinal Cord Injury: Recommendations for Use of Intraoperative Neuromonitoring and for the Use of Preoperative and Intraoperative Protocols for Patients Undergoing Spine Surgery.
Michael G Fehlings Mohammed Ali Alvi Nathan Evaniew Lindsay A Tetreault Allan R Martin Ali Moghaddamjou
Global Spine J
March 2024
Article Synopsis
- The study aimed to develop clinical guidelines for using intraoperative neuromonitoring (IONM) to detect spinal cord injuries during spine surgery, targeting high-risk patients and establishing management protocols.
- The research involved a systematic review following PRISMA standards and GRADE protocols, with an international team reaching consensus on recommendations for IONM effectiveness and diagnostic accuracy.
- Key recommendations included using IONM for high-risk spine surgery patients and promoting proactive identification and interdisciplinary management strategies for those at risk of intraoperative spinal cord injury.
Article Synopsis
- The study investigated how the Modified Frailty Index-5 (mFI-5) relates to neurological outcomes and health-related quality of life (HRQoL) in elderly patients undergoing surgery for degenerative cervical myelopathy (DCM).
- The analysis involved 261 patients 60 years and older from three major clinical trials, comparing outcomes between frail and nonfrail patients using various health assessments over 6-month and 1-year follow-ups.
- Results indicated that frail patients had worse initial health scores but experienced greater improvements in HRQoL after surgery, suggesting that mFI-5 can be a useful predictor of surgical outcomes in this population.*
Article Synopsis
- The study aimed to investigate how the level of frailty influences long-term neurological and functional outcomes in patients who underwent surgery for degenerative cervical myelopathy (DCM).
- Researchers analyzed data from 757 patients categorized into four frailty groups (not frail, pre-frail, frail, severely frail) and assessed functional and quality of life outcomes before and two years post-surgery.
- While more frail patients had significantly lower initial functional scores, the improvement in scores over two years did not significantly differ among the frailty groups, indicating similar recovery potential regardless of frailty level.
Article Synopsis
- Interhospital transfers for traumatic spinal cord injury (SCI) can lead to delays in care and strain on healthcare systems, prompting a study to compare long-term neurological outcomes between patients directly admitted to specialized trauma centers and those transferred from community hospitals.
- The study analyzed data from 970 patients with SCI across 11 trauma centers in the US and Canada, matching 283 pairs of transferred and directly admitted patients for a fair comparison of outcomes, focusing on neurological improvements as per standardized assessment scales.
- Results showed that directly admitted patients had significantly better neurological outcomes, with a higher percentage improving their impairment scale grade and better scores in upper-extremity motor function and light touch sensitivity compared to those who were transferred.
Article Synopsis
- Riluzole, a sodium-glutamate antagonist, is being studied for its effects on acute cervical traumatic spinal cord injuries (tSCI) following promising results in earlier trials and pre-clinical models.
- In a global Phase III trial, patients with cervical tSCI were randomized to receive either riluzole or a placebo, focusing on changes in Upper Extremity Motor (UEM) scores over 180 days.
- Although the trial was halted due to COVID-19, riluzole showed potential benefits for certain patient groups, with no serious drug-related side effects reported.
Article Synopsis
- The study aimed to understand and predict postsurgical outcomes for patients with degenerative cervical myelopathy (DCM), especially those with mild DCM, by analyzing data from two multicenter studies involving 757 patients.
- Researchers assessed functional recovery and quality of life at multiple time points post-surgery and identified two main recovery trajectories: good recovery and marginal recovery, with one-half to three-fourths of patients in the good recovery group.
- Key predictors for a marginal recovery trajectory included preoperative neck pain, smoking, and the type of surgical approach used, underscoring the varied recovery experiences of DCM patients following surgery.
Article Synopsis
- The use of methylprednisolone (MP) for treating acute traumatic spinal cord injury (ATSCI) is debated, prompting the creation of a new pooled data set based on past studies (NASCIS2 and Sygen) to re-evaluate MP's effectiveness.
- The new data set excluded patients based on specific criteria, totaling 31.6% fewer patients compared to the original NASCIS2 study, and classified injuries into five severity cohorts, revealing varying recovery outcomes.
- While the updated data showed some positive effects of MP on recovery in certain subgroups, modern statistical methods suggest that these results might be random and clinically insignificant, prompting further investigation into the drug's true effectiveness.*
Article Synopsis
- The study investigates how the mechanism of injury—high-energy versus low-energy—affects neurological recovery in patients with acute traumatic spinal cord injury affecting the cervical region.
- A total of 667 patients were analyzed, with the majority experiencing high-energy injuries; after matching for various factors, 118 patients were compared from each injury group.
- Results indicated that high-energy injury patients showed significantly poorer motor recovery, highlighting the importance of considering injury mechanism when predicting prognosis for spinal cord injuries.
Article Synopsis
- The study conducted an international survey to investigate current practices, knowledge, and barriers related to guidelines for managing acute spinal cord injuries (SCIs).
- The survey included responses from 593 members, primarily orthopaedic surgeons and neurosurgeons, with a notable representation from low and middle-income countries (LMICs).
- Results revealed that while many physicians recognize the importance of interventions like steroid use and early surgical decompression, substantial logistical barriers to implementing these guidelines exist, particularly in LMICs.
Article Synopsis
- - Neurotrauma leads to over 24,000 hospitalizations in Canada annually, with indigenous populations experiencing a disproportionate burden, prompting a scoping review to investigate contributing factors and strategies for improvement.
- - A review of literature identified 17 relevant studies, revealing that the main contributing factors to neurotrauma in indigenous communities are inadequate resources, social issues, and systemic healthcare challenges.
- - Suggested solutions focus on implementing system-level changes in healthcare, fostering community initiatives, and developing culturally appropriate strategies, emphasizing the importance of indigenous input in addressing these disparities.
Article Synopsis
- - Degenerative cervical myelopathy (DCM) refers to various age-related spinal conditions that cause long-term spinal cord compression, leading to symptoms like poor hand coordination and balance issues; common causes include cervical spondylotic myelopathy and degenerative disc disease.
- - There's significant variability in DCM's causes and progression, which complicates treatment approaches and sparks debates on the best timing and methods for intervention, especially regarding surgery.
- - Recent research has advanced our understanding of DCM's underlying mechanisms, enabling more personalized treatment options. The article reviews these treatment strategies, clinical evaluation methods, and the ongoing controversies related to DCM management.
Study Design: Prospective cross-sectional blinded-assessor cohort study.
Objective: The aim of this study was to determine the inter-rater reliability of the modified Japanese Orthopaedic Association (mJOA) score in a large cohort of degenerative cervical myelopathy (DCM) patients.
Summary Of Background Data: The mJOA score is widely accepted as the primary outcome measure in DCM; it has been utilized in clinical practice guidelines and directly influences treatment recommendations, but its reliability has not been established.
Article Synopsis
- Frailty, measured by the modified frailty index (MFI), is a better predictor of adverse surgical outcomes in patients with Degenerative Cervical Myelopathy (DCM) than age alone.
- The study analyzed data from over 41,000 DCM patients, finding that frailty significantly increases the risk of complications, longer hospital stays, and non-home discharges post-surgery.
- The MFI-5 index demonstrated strong predictive accuracy and is nearly equivalent to the MFI-11, suggesting it is a valuable tool for clinicians in assessing surgical risk in DCM patients.
Article Synopsis
- Degenerative cervical myelopathy (DCM) is a common condition that seriously affects various aspects of health, and a multidisciplinary care approach is recommended to best meet patient needs.
- The article outlines the significance of teamwork across different medical disciplines in managing DCM at all stages, from assessment to postoperative care.
- A successful treatment plan for DCM patients requires collaboration among various healthcare professionals, including surgeons, neurologists, therapists, and social workers, to provide personalized and effective care.
Article Synopsis
- The article had an error in the original version regarding the author's name.
- The incorrect name "Ali Moghadammjou" was used instead of the correct name "Ali Moghaddamjou."
- The author has issued an apology for the mistake and clarified the correct name in the updated article.
Article Synopsis
- The SMA syndrome leads to temporary weakness and a lack of movement on the opposite side of the body from the affected hemisphere due to lesions in the supplementary motor area (SMA).
- This report presents the first known case of isolated lower extremity SMA syndrome, emphasizing its significance in assessing postoperative neurological deficits.
- While earlier findings questioned the SMA's organization like the primary motor cortex, new evidence indicates there might be a sophisticated representation that could explain different clinical presentations.
Article Synopsis
- The understanding of degenerative cervical myelopathy (DCM) has advanced significantly in the last two decades, leading to improved assessment and diagnosis.
- New technologies, like multiparametric MRI and biomarkers, are being explored to objectively measure DCM severity.
- Innovations in pharmacological treatments and less invasive surgical techniques aim to enhance patient outcomes and the accuracy of diagnosis in future DCM management.