Publications by authors named "Anthony L Mikula"
Objective: The purpose of this study was to evaluate the risk factors for loss of intraoperative correction, as measured by lumbar lordosis (LL), with an emphasis on rod characteristics.
Methods: A retrospective study identified patients at least 50 years of age who underwent instrumented fusion with an upper instrumented vertebrae (UIV) in the upper thoracic spine (T1-T6) or thoracolumbar junction (T10-L2) to the pelvis. Inclusion criteria included intraoperative x-rays that allowed for LL measurement, postop standing x-rays, and a minimum follow up of 24 months with the original rods still in place.
Objective: Hounsfield units (HUs) may better predict biomechanical complications of instrumented fusion than conventional bone quality measures. Typically, noncontrast axial slices are used. This study aims to address the influence of reconstruction plane and contrast administration on measured HUs in patients undergoing lumbar spine imaging.
View Article and Find Full Text PDFStudy Design: Survey study.
Objectives: The purpose of this study was to characterize the utility of 3D printed patient specific anatomic models for the planning of complex primary spine tumor surgeries.
Methods: A survey of individual members of an international study group of spinal oncology surgeons was performed.
Article Synopsis
- * Researchers compared two groups of patients: those who did not develop PJK or PJF and those who did, finding that patients with PJK/PJF had significantly lower muscle density and higher rates of severe sarcopenia.
- * The findings indicate that having severe sarcopenia and lower bone density increases the risk of these complications following thoracolumbar spinal fusion surgeries.
Article Synopsis
- This study aimed to assess how different osteoporosis medications affect bone density, measured in Hounsfield units (HU), among spine and nonspine surgery patients.
- A total of 318 patients participated, with significant improvements in HU observed in those treated with romosozumab for about 10.5 months and teriparatide for more than 23 months.
- The findings suggest that romosozumab is a strong option for enhancing bone density efficiently before elective spine fusion surgery, compared to other treatments.
Adult degenerative scoliosis (ADS) is a coronal plane deformity often accompanied by sagittal plane malalignment. Surgical correction may involve the major and/or distally-located fractional curves (FCs). Correction of the FC has been increasingly recognized as key to ameliorating radicular pain localized to the FC levels.
View Article and Find Full Text PDFStudy Design: Retrospective observational study of consecutive patients.
Objective: The purpose of the study was to evaluate VBQ as a predictor of interbody subsidence and to determine threshold values that portend increased risk of subsidence.
Summary Of Background Data: Many risk factors have been reported for the subsidence of interbody cages in anterior cervical discectomy and fusion (ACDF).
Objective: Unplanned returns to the operating room (RORs) constitute an important quality metric in surgical practice. In this study, the authors present a methodology to compare a department's unplanned ROR rates with national benchmarks in the context of large-scale quality of care surveillance.
Methods: The authors identified unplanned RORs within 30 days from the initial surgery at their institution during the period 2014-2018 using an institutional documentation platform that facilitates the collection of reoperation information by providers in the clinical setting.
Multisegmental pathologic autofusion occurs in patients with ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH). It may lead to reduced vertebral bone density due to stress shielding. This study aimed to determine the effects of autofusion on bone density by measuring Hounsfield units (HU) in the mobile and immobile spinal segments of patients with AS and DISH treated at a tertiary care center.
View Article and Find Full Text PDFObjective: To compare the prognostic power of Hounsfield units (HU) and Vertebral Bone Quality (VBQ) score for predicting proximal junctional kyphosis (PJK) following long-segment thoracolumbar fusion to the upper thoracic spine (T1-T6).
Methods: Vertebral bone quality around the upper instrumented vertebrae (UIV) was measured using HU on preoperative CT and VBQ on preoperative MRI. Spinopelvic parameters were also categorized according to the Scoliosis Research Society-Schwab classification.
Article Synopsis
- The study investigates the use of machine learning algorithms to predict postoperative range of motion (ROM) and determine ideal implant sizes for cervical disk arthroplasty (CDA) to enhance patient outcomes.
- Data was collected from 47 patients who had CDA, with factors such as demographics, disk heights, and outcomes analyzed using various machine learning models.
- The results indicated that the highest-performing model (k-nearest neighbors) yielded an average error of 7.6° in predicting ROM, with optimal implant size identified as 110% of the normal adjacent disk height, highlighting graft size as the most critical factor influencing ROM.
Introduction: Interspinous devices (ISDs) and interlaminar devices (ILDs) are marketed as alternatives to conventional surgery for degenerative lumbar conditions; comparisons with decompression alone are limited. The present study reviews the extant literature comparing the cost and effectiveness of ISDs/ILDs with decompression alone.
Methods: Articles comparing decompression alone with ISD/ILD were identified; outcomes of interest included general and disease-specific patient-reported outcomes, perioperative complications, and total treatment costs.
Background: Long-segment instrumentation, such as Harrington rods, offloads vertebrae within the construct, which may result in significant stress shielding of the fused segments. The present study aimed to determine the effects of spinal fusion on bone density by measuring Hounsfield units (HUs) throughout the spine in patients with a history of Harrington rod fusion.
Methods: Patients with a history of Harrington rod fusion treated at a single academic institution were identified.
Article Synopsis
- * A study of 116 patients undergoing PSO found that 44% experienced durotomy, with prior surgical history being a notable predictor, particularly previous decompression at the PSO site.
- * Patient factors like comorbidities, weight, and BMI didn't significantly differentiate those with and without durotomy, nor did surgeon training or surgical techniques; however, outcomes like hospitalization and reoperation rates were similar for both groups.
Article Synopsis
- * Researchers examined data from 100 patients treated for mobile spine metastases, finding that lower average HUs were linked to a higher risk of fractures, while VBQ did not show a significant correlation.
- * The study concluded that using HUs could be a more reliable predictor for pathologic fractures post-radiotherapy compared to VBQ, with specific thresholds providing insight into fracture risk.
Study Design: Retrospective observational study of consecutive patients.
Objective: The purpose of the study is to determine if a surgeon's qualitative assessment of bone intraoperatively correlates with radiologic parameters of bone strength.
Summary Of Background Data: Preoperative radiologic assessment of bone can include modalities such as computed tomography (CT) Hounsfield units (HUs), dual-energy x-ray absorptiometry (DXA) bone mineral density with trabecular bone score (TBS) and magnetic resonance imaging vertebral bone quality (VBQ).
Article Synopsis
- This study analyzed the relationship between Hounsfield units (HUs) and bone health measurements using biomechanical computed tomography (BCT) and dual-energy x-ray absorptiometry (DXA) in patients who underwent BCT for spine-related issues.
- It found a strong correlation between HUs and BCT measures of vertebral strength and trabecular bone mineral density (BMD), while DXA showed weak correlation with HUs.
- HUs effectively predicted osteoporosis and low BMD, with specific HU thresholds identified for diagnosis, suggesting their potential use as a reliable tool in assessing bone health.
Risk factors for sacral fracture following en bloc chordoma resection.
J Neurosurg Spine
November 2023
Objective: The purpose of this study was to analyze risk factors for sacral fracture following noninstrumented partial sacral amputation for en bloc chordoma resection.
Methods: A multicenter retrospective chart review identified patients who underwent noninstrumented partial sacral amputation for en bloc chordoma resection with pre- and postoperative imaging. Hounsfield units (HU) were measured in the S1 level.
Objective: Proximal junctional kyphosis (PJK) is a complication of surgical management for adult spinal deformity (ASD) with a multifactorial etiology. Many risk factors are controversial, and their relative importance is not fully understood. The authors aimed to elucidate the association between bone mineral density (BMD) and PJK.
View Article and Find Full Text PDFStudy Design: Retrospective cohort study.
Objective: The present study is the first to assess the impact of paraspinal sarcopenia on patient-reported outcome measures (PROMs) following cervical laminoplasty.
Background: While the impact of sarcopenia on PROMs following lumbar spine surgery is well-established, the impact of sarcopenia on PROMs following laminoplasty has not been investigated.
Article Synopsis
- The study aimed to assess spinopelvic parameters and spinal deformities in patients with idiopathic normal pressure hydrocephalus (iNPH) who underwent shunting.
- Seventeen patients were analyzed, showing a notable prevalence of sagittal plane deformities, with many exhibiting significant pelvic and lumbar discrepancies.
- The findings suggest that negative spinal alignment is common in these patients, potentially causing postural instability, and indicate a need for further evaluation and future studies to monitor changes post-surgery.
Article Synopsis
- The study aimed to evaluate surgical outcomes for patients suffering from severe neck pain who underwent laminoplasty for cervical spondylotic myelopathy (CSM).
- A total of 91 patients were analyzed retrospectively, with significant improvements in neck pain reported at 6 months and 1 year post-surgery, regardless of their preoperative pain severity.
- The findings suggest that patients with moderate to severe neck pain can achieve similar levels of pain relief and disability improvements as those with mild pain after the surgical procedure.
Background: The management of adult spinal deformity (ASD) relies upon retrospective data, but there have been calls for prospective trials to improve the evidentiary base. This study sought to define the state of the spinal deformity clinical trials and highlight trends to guide future research.
Methods: The ClinicalTrials.
Article Synopsis
- The study is a retrospective cohort analysis aimed at understanding how sarcopenia (muscle loss) affects the occurrence of proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) in patients after thoracolumbar spine fusion surgery.
- It found that patients with severe multifidus sarcopenia had a significantly higher risk of developing PJK (76%) and PJF (78%) compared to those without these complications (34%).
- The study concludes that factors such as low Hounsfield Units (a measure of tissue density) at the upper instrumented vertebra and moderate to severe multifidus sarcopenia increase the risk of these complications after surgery.*