Publications by authors named "Andy Ton"
Traditional open lumbar decompression techniques have long been used to relieve spinal canal pressure caused by lumbar spinal stenosis. However, these procedures are associated with significant postoperative pain and prolonged recovery. Over the past few decades, there has been a shift toward minimally invasive surgical (MIS) techniques designed to minimize tissue trauma, postoperative pain, and recovery time.
View Article and Find Full Text PDFStudy Design: Retrospective cohort analysis.
Objective: Identify demographic and clinical predictors for revision discectomy and compare postoperative complications between primary microdiscectomy (MD) and revision discectomy.
Methods: Patients who underwent one-level primary lumbar MD and subsequent one-level revision discectomy for lumbar disc herniation were identified using the PearlDiver national database.
Objective: The purpose of this study is to describe utilization, demographics, complications, and revisions for patients with degenerative spondylolisthesis (DS) with stenosis undergoing decompression or decompression with fusion in the United States.
Methods: A national insurance database was used to identify patients who underwent either decompression and fusion or decompression alone for management of DS from 2010-2022. Utilization trends, demographics, and complications for each procedure were compared.
Study Design: Systematic review and meta-analysis.
Objective: To compare radiographic outcomes across lumbar interbody fusion (LIF) techniques, assessing segmental and global lumbar lordosis restoration.
Summary Of Background Data: LIF is a commonly utilized procedure to treat various spinal conditions, including degenerative pathology and adult spinal deformity.
Calcium pyrophosphate dihydrate deposition (CPPD), commonly known as pseudogout, is an inflammatory arthropathy primarily affecting the knee, wrist, hip, and shoulder joints. However, it can occasionally deposit in various structures surrounding the spinal column, including the facet joints, ligamentum flavum, bursae, and intervertebral discs. Such occurrences are typically asymptomatic or associated with mild neck pain.
View Article and Find Full Text PDFArticle Synopsis
- Vertebral compression fractures (VCFs) are a significant health concern associated with increased rates of illness and death, yet many patients do not follow prescribed osteoporosis treatments (AOTs).
- This study analyzed data from over 637,000 patients with VCFs from 2010 to 2021 to assess the rate of hip fractures following VCFs and examined patterns of AOT prescriptions and surgical interventions.
- Results showed a higher subsequent hip fracture rate among patients who started AOT after their VCF, indicating a potential selection bias and underscoring the need to improve adherence to osteoporosis management guidelines.
Objective: The present study compares postoperative outcomes between patients with and without sickle cell disease (SCD) undergoing 1-to 3-level lumbar spinal fusion for degenerative pathologies.
Methods: Patients who underwent 1-to 3-level lumbar spinal fusion for degenerative pathologies from 2010 to 2021 were identified using the PearlDiver database. Patients were separated into 1) SCD and 2) non-SCD groups and were propensity-matched 1:1 for age, sex, Elixhauser Comorbidity Index, surgical approach, and various comorbidities.
Article Synopsis
- The systematic review and meta-analysis aimed to examine how osteoporosis affects outcomes in patients with lumbar degenerative spine disease after surgery, focusing on complications and recovery.
- Findings indicated that patients with osteoporosis had higher rates of adjacent segment disease and cage subsidence but had lower reoperation rates compared to non-osteoporotic patients.
- Although osteoporosis was linked to increased complications like longer hospital stays and higher costs, it did not show a significant impact on overall clinical outcomes or fusion rates.
Background: Risk assessment is critically important in elective and high-risk interventions, particularly spine surgery. This narrative review describes the evolution of risk assessment from the earliest instruments focused on general surgical risk stratification, to more accurate and spine-specific risk calculators that quantified risk, to the current era of big data.
Methods: The PubMed and SCOPUS databases were queried on October 11, 2023 using search terms to identify risk assessment tools (RATs) in spine surgery.
Study Design: Systematic Review.
Objectives: While substantial research has explored the impact of osteoporosis on patients undergoing adult spinal deformity (ASD) correction, the literature remains inconclusive. As such, the purpose of this study is to synthesize and analyze existing studies pertaining to osteoporosis as a predictor of postoperative outcomes in ASD surgery.
Background: This review outlines clinical data and characteristics of current Food and Drug Administration (FDA)-approved implants in cervical disc replacement/cervical disc arthroplasty (CDR/CDA) to provide a centralized resource for spine surgeons.
Methods: Randomized controlled trials (RCTs) on CDR/CDA were identified using a search of the PubMed, Web of Science, and Google Scholar databases. The initial search identified 69 studies.
Background: In recent years, the use of intraoperative computer tomography-guided (CT-guided) navigation has gained significant popularity among health care providers who perform minimally invasive spine surgery. This review aims to identify and analyze trends in the literature related to the widespread adoption of CT-guided navigation in spine surgery, emphasizing the shift from conventional fluoroscopy-based techniques to CT-guided navigation.
Methods: Articles pertaining to this study were identified via a database review and were hierarchically organized based on the number of citations.
Article Synopsis
- The growing elderly population is facing challenges due to osteoporosis, which affects bone strength and can lead to complications in cervical spine surgeries.
- A systematic review evaluated postoperative outcomes for patients with cervical degenerative disease or deformity, focusing on factors like bone density and complication rates.
- Results indicated that lower bone mineral density in osteoporotic patients is linked to higher rates of equipment failure and increased risk of complications, although the impact on other surgical outcomes is mixed.
Article Synopsis
- The study examines trends in long-term opioid (LTO) and nonsteroidal anti-inflammatory drug (LTN) use among patients with low back pain in the U.S. and the impact on postoperative complications after lumbar fusion surgery.
- A rise in LTO usage and a decline in LTN usage were noted post-2015, with LTO users facing higher inpatient costs and longer hospital stays, while LTN users experienced fewer acute infections and complications at admission.
- Overall, LTN users had lower readmission rates compared to LTO users, but higher odds of hardware failure were noted in LTN users within 300 days post-surgery.
Background: Robot-guided lumbar spine surgery has evolved rapidly with evidence to support its utility and feasibility compared with conventional freehand and fluoroscopy-based techniques. The objective of this study was to assess trends among the top 25 most-cited articles pertaining to robotic-guided lumbar spine surgery.
Methods: An "advanced document search" using Boolean search operator terms was performed on 16 November 2022 through the Web of Science and SCOPUS citation databases to determine the top 25 most-referenced articles on robotic lumbar spine surgery.
Background Context: Several studies have shown that factors such as insurance type and patient income are associated with different readmission rates following certain orthopaedic procedures. The literature, however, remains sparse with regard to these demographic characteristics and their associations to perioperative lumbar spine fusion outcomes.
Purpose: The purpose of this study was to assess the associations between hospital type, insurance type, and patient median income to both 30-day complication and readmission rates following lumbar spine fusion.
Background: Previously reported estimates of vertebral artery injuries (VAIs) during cervical spine surgery relied on self-reported survey studies and retrospective cohorts, which may not be reflective of national averages. The largest study to date reports an incidence of 0.07%; however, significant variation exists between different cervical spine procedures.
View Article and Find Full Text PDFStudy Design/setting: Retrospective cohort analysis.
Objectives: This study evaluates utilization and demographic trends for sacroiliac joint (SIJ) fusions across the United States (US).
Methods: Patients who underwent SIJ fusion from 2010-2021 were identified within the PearlDiver national database using International Classification of Disease (ICD-9, ICD-10) and Current Procedural Terminology (CPT) codes.
Objective: The objective of this study is to assess differences in complication profiles between 3-level posterior column osteotomy (PCO) and single-level pedicle subtraction osteotomy (PSO) as both are reported to provide similar degrees of sagittal correction.
Methods: The PearlDiver database was queried retrospectively using International Classification of Disease, 9th and 10th edition and Current Procedural Terminology codes to identify patients who underwent PCO or PSO for degenerative spine disease. Patients under age 18 or with history of spinal malignancy, infection, or trauma were excluded.
Cementless fixation during total hip arthroplasty (THA) is the predominant mode of fixation utilized for both acetabular and femoral components during elective primary THAs performed in the United States. This study aims to compare early complication and readmission rates between primary THA patients receiving cemented versus cementless femoral fixation. The 2016-2017 National Readmissions Database was queried to identify patients undergoing elective primary THA.
View Article and Find Full Text PDFObjective: Studies have reported the detrimental effects of depression following spine surgery; however, none have evaluated whether preoperative depression screening in patients with a history of depression is protective from adverse outcomes and lowers health care costs. We studied whether depression screenings/psychotherapy visits within 3 months before 1- to 2-level lumbar fusion were associated with lower medical complications, emergency department utilization, readmissions, and health care costs.
Methods: The PearlDiver database from 2010 to 2020 was queried for depressive disorder (DD) patients undergoing primary 1- to 2-level lumbar fusion.
Study Design: Retrospective cohort analysis.
Objective: To characterize the impact of COVID-19 on utilization of the ten most common spine procedures and percentages of outpatient procedures.
Methods: The PearlDiver national database was queried from January 2010 to April 2021 for short (<6 segments) and long segment posterior instrumented fusion posterior cervical fusion, anterior cervical decompression and fusion (ACDF), cervical laminectomy, laminoplasty, and disc arthroplasty, lumbar laminectomy, microdiscectomy, and interbody fusion.
Study Design: Retrospective cohort study.
Objective: The purpose of this study was to characterize the infection risk of preoperative epidural steroid injection (ESI) in patients undergoing posterior cervical surgery.
Summary Of Background Data: ESI is a helpful tool for alleviating pain and is often used as a diagnostic tool before cervical surgery.
Background: Cervical disc arthroplasty (CDA) was originally approved by the US Food and Drug Administration (FDA) in 2007 as a motion-sparing procedure to treat cervical degenerative disc disease. Since then, promising results from randomized control trials have led to increasing popularity. However, data discussing monetary trends are limited.
View Article and Find Full Text PDFIntroduction: Surgical excisions of upper and lower extremity malignancies are increasing annually, due in part to the rising incidence of sarcomas. The purpose of this study is to compare readmissions, reoperation rate, and complications following surgical excision of soft/connective tissue vs bone malignancies of the upper and lower extremities.
Methods: The Nationwide Readmissions Database (NRD) was queried from 2016-2017 to conduct a retrospective analysis of 16,435 patients diagnosed with malignant neoplasms of the long bone (ULLB, = 1,433) and soft tissue (ULST, = 2,049) of the upper limb and malignant neoplasms of the long bone (LLLB, = 5,422) and soft tissue (LLST, = 7,531) of the lower limb.