Publications by authors named "Darren Lebl"
Article Synopsis
- Robotic-assisted spine surgery enhances the precision and safety of procedures like pedicle screw placement, minimizing blood loss and reducing hospital stays while alleviating postoperative pain.
- Recent advancements allow robotic systems to perform not only screw insertion but also critical tasks like surgical decompression and bone preparation, transitioning from experimental models to actual human applications.
- The Mazor X Stealth Edition Spine Robotic System facilitates these procedures by combining advanced software for planning and real-time imaging, leading to more efficient and accurate minimally invasive transforaminal lumbar interbody fusion (MI-TLIF).
Study Design: Review of cohort studies.
Objective: To ascertain if previous hip (THA) or knee (TKA) arthroplasty was associated with patients' outcomes assessments of subsequent lumbar surgery, specifically overall satisfaction, less disability due to pain, and an affective appraisal reflecting emotional assessment of results.
Background: Hip, knee, and lumbar symptoms often co-exist and increasingly are managed with surgery.
Background: The modified frailty index (mFI-5) has been shown to be a reliable risk stratification tool in different spine procedures. Its usefulness to predict complications after 1-level or 2-level anterior cervical decompression and fusion (ACDF) has not been studied extensively.
Purpose: We aimed to assess the usefulness of the mFI-5 in 1-level or 2-level ACDF surgery by asking the following questions: (1) Is the mFI-5 a reliable tool to predict complications after 1-level or 2-level ACDF? (2) Is the mFI-5 useful in predicting prolonged hospital stay after 1-level or 2-level ACDF? (3) Is the mFI-5 useful in predicting readmission after 1-level or 2-level ACDF?
Methods: We performed a retrospective analysis of the medical records of patients who underwent 1-level or 2-level ACDF at our institution.
Background Context: Preoperative imaging for lumbar spine surgery often includes magnetic resonance imaging (MRI) for soft tissues and computer tomography (CT) for bony detail. While CT scans expose patients to ionizing radiation, whereas MRI scans do not. Emerging MRI techniques allow CT-like 3-dimensional (3D) visualization of bony structures, potentially removing the need for ionizing radiation from CT scans.
View Article and Find Full Text PDFArticle Synopsis
- The study examines the relationship between prior hip or knee arthroplasty and patient satisfaction after lumbar spine surgery, focusing on whether patients' expectations are met post-surgery.
- It pooled data from three prospective studies, evaluating preoperative and postoperative expectations using a survey that measured expected versus actual improvements in symptoms and function.
- Results showed that while patients with prior arthroplasty had similar high expectations compared to those without, they experienced a lower fulfillment rate of those expectations, with various factors influencing this outcome, including preoperative expectations and psychological factors.
Article Synopsis
- Upper cervical spine instrumentation is risky due to the anatomical complexities, including the proximity of critical structures like vertebral arteries and nerve roots, making precise surgery difficult.
- Recent advancements in 3D imaging and computer-assisted navigation (CAN) are improving the accuracy of screw placement and reducing surgical risks, though these techniques have been less commonly applied in cervical spine surgeries compared to lumbar and thoracic procedures.
- This manuscript provides a detailed technique using CAN for upper cervical instrumentation, specifically for various screw placements in patients with different cervical pathologies, demonstrating the importance of tailored approaches based on individual anatomical variations.
Article Synopsis
- A recent study examined how preoperative factors impact recovery outcomes after cervical spine surgery, focusing specifically on patient-reported outcome measures (PROMs) to predict postoperative success in pain relief and functionality.
- The research analyzed data from 139 patients who underwent surgery, using measures like the Neck Disability Index (NDI) and PROMIS assessments before and after the procedure.
- Findings indicated that for overall patients, a 1-point increase in preoperative disability scores decreased the odds of achieving a satisfactory symptom state post-surgery, especially among those with radiculopathy, while showing different results for myelopathy patients.
Article Synopsis
- The study focused on developing a minimally invasive technique for lumbar decompression using robotic-assisted navigation, with an emphasis on advanced imaging for planning and execution.
- The procedure involved mapping out bone removal using CT scans and a specialized robotic drill, completed successfully in a cadaver and then in a 72-year-old patient with lumbar spinal stenosis.
- Postoperative imaging confirmed effective decompression with minimal impact on surrounding structures, leading to significant symptom improvement and a quick recovery time for the patient.
Pedicle Screw Placement with Augmented Reality Versus Robotic-Assisted Surgery.
Spine (Phila Pa 1976)
September 2024
Study Design: This was a single-center prospective clinical and radiographic analysis of pedicle screw instrumentation with Robotic-assisted navigation (RAN) and augmented reality (AR).
Objective: This study aimed to compare the accuracy of lumbosacral pedicle screw placement with RAN versus AR.
Summary Of Background Data: RAN and AR have demonstrated superior accuracy in lumbar pedicle screw placement compared to conventional free-hand techniques.
Study Design: Retrospective review, single-institution cohort studies.
Objective: To compare patients with earlier ( i.e.
Cervical Disk Arthroplasty: Updated Considerations of an Evolving Technology.
J Am Acad Orthop Surg
December 2024
Article Synopsis
- Anterior cervical diskectomy and fusion have been the standard treatment for cervical radiculopathy/myelopathy, but there are rising concerns about adjacent segment issues, leading to an increase in cervical disk arthroplasty (CDA) due to its ability to preserve motion.
- Recent CDA designs focus on mimicking the natural cervical disk's movement and compression by tweaking stability constraints and material choices, which can promote either unrestricted or semi-restricted motion.
- While clinical studies show promising short-term benefits and cost savings for CDA, long-term effects and potential complications (like ossification and migration) are still under investigation, requiring careful patient selection and further research on multi-level procedures.
Purpose: Surgeons' preoperative expectations of lumbar surgery may be associated with patient-reported postoperative outcomes.
Methods: Preoperatively spine surgeons completed a validated Expectations Survey for each patient estimating amount of improvement expected (range 0-100). Preoperative variables were clinical characteristics, spine-specific disability (ODI), and general health (RAND-12).
Background: Anterior cervical discectomy and fusion (ACDF) is known to elicit adverse biomechanical effects on immediately adjacent segments; however, its impact on the kinematics of the remaining nonadjacent cervical levels has not been understood. This study aimed to explore the biomechanical impact of ACDF on kinematics beyond the immediate fusion site. We hypothesized that compensatory motion following single-level ACDF is not predictably distributed to adjacent segments due to compensation from noncontiguous levels.
View Article and Find Full Text PDFBackground Only a few studies have examined the impact of the coronavirus disease 2019 pandemic on spine ambulatory surgeries and changes in trends. Therefore, we investigated trends during the pre-pandemic period and three pandemic stages in patients undergoing lumbar decompression procedures in the ambulatory surgery (AMS) setting. Methodology A total of 2,670 adult patients undergoing one- or two-level lumbar decompression surgery were retrospectively reviewed.
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- The study conducted a retrospective analysis of revisions for cervical disk arthroplasty (CDA) using the MAUDE database, aiming to understand the complications associated with different CDA designs.
- A total of 678 revisions were identified, with the most common complications being migration, neck pain, and heterotopic ossification, varying by specific CDA type.
- The results indicate significant variability in complications among different CDA devices, which can inform decision-making in surgeries involving cervical disk replacements.
Purpose: To test equivalency of deep-learning 3D lumbar spine MRI with "CT-like" contrast to CT for virtual pedicle screw planning and geometric measurements in robotic-navigated spinal surgery.
Methods: Between December 2021 and June 2022, 16 patients referred for spinal fusion and decompression surgery with pre-operative CT and 3D MRI were retrospectively assessed. Pedicle screws were virtually placed on lumbar (L1-L5) and sacral (S1) vertebrae by three spine surgeons, and metrics (lateral deviation, axial/sagittal angles) were collected.
Article Synopsis
- Biplanar imaging (2D) has traditionally been used for positioning pedicle screws (PS), but recent advancements with intraoperative 3D imaging using the Gertzbein-Robbins system (GRS) may provide more accurate assessments.
- A study analyzed data from 204 patients undergoing spinal surgery, finding that many screws could be falsely validated as correctly placed using only 2D imaging, whereas 3D imaging confirmed their actual positioning.
- The research concluded that intraoperative 3D scans are as reliable as postoperative CT scans in assessing PS placement, suggesting that they could be a better method to avoid misreading screw positions with 2D imaging before surgery ends.
Article Synopsis
- This study investigates the use of preoperative MRI techniques (ZTE and SPGR) to aid in robotic-assisted spine surgery for accurately placing lumbar pedicle screws.
- The research involved using MRI scans on a cadaver and then navigating a surgical robot to position the screws, later verified by a CT scan.
- Results showed that all screws were placed accurately (graded A), with minimal deviation of around 0.25 mm, indicating a promising direction for reducing radiation exposure in spine surgeries.
Article Synopsis
- DISH is a condition that causes hardening of ligaments in the spine, leading to swallowing difficulties.
- A 68-year-old man with sudden trouble swallowing had radiographic imaging show DISH lesions in his spine.
- He was treated successfully with computer-assisted navigation in surgery, resulting in complete relief of symptoms within two weeks.
Objectives: To develop a three-stage convolutional neural network (CNN) approach to segment anatomical structures, classify the presence of lumbar spinal stenosis (LSS) for all 3 stenosis types: central, lateral recess and foraminal and assess its severity on spine MRI and to demonstrate its efficacy as an accurate and consistent diagnostic tool.
Methods: The three-stage model was trained on 1635 annotated lumbar spine MRI studies consisting of T2-weighted sagittal and axial planes at each vertebral level. Accuracy of the model was evaluated on an external validation set of 150 MRI studies graded on a scale of absent, mild, moderate or severe by a panel of 7 radiologists.
Article Synopsis
- Machine learning is increasingly recognized in orthopedics for its potential to improve patient risk assessment, specifically in identifying factors that could lead to unplanned inpatient conversions after outpatient ACDF surgery.
- Researchers conducted a study to develop a machine-learning algorithm using retrospective data from patients who underwent ACDF, comparing models like Logistic Regression and Random Forest to predict length of stay and conversion rates.
- The study involved categorizing patients based on their length of stay and included various demographic and clinical factors in the model, ultimately using a training and validation dataset to assess prediction accuracy.
Objectives: Symptomatic lumbar spinal stenosis (LSS) leads to functional impairment and pain. While radiologic characterization of the morphological stenosis grade can aid in the diagnosis, it may not always correlate with patient symptoms. Artificial intelligence (AI) may diagnose symptomatic LSS in patients solely based on self-reported history questionnaires.
View Article and Find Full Text PDFUnlabelled: Poor bone quality is a risk factor for complications after spinal fusion surgery. This study investigated pre-operative bone quality in postmenopausal women undergoing spine fusion and found that those with small bones, thinner cortices and surgeries involving more vertebral levels were at highest risk for complications.
Purpose: Spinal fusion is one of the most common surgeries performed worldwide.