Publications by authors named "Frank Acosta"

Study Design: Retrospective cohort study.

Objective: The aim of this study was to compare the incidence of proximal junctional kyphosis (PJK), proximal junctional failure (PJF), and clinical outcomes of patients who did and did not receive posterior ligament complex (PLC) augmentation using a semitendinosus allograft when undergoing long-segment posterior spinal fusion for adult spinal deformity.

Summary Of Background Data: Clinical research on the augmentation of the PLC to prevent PJK and PJF has been limited to small case series without a comparable control group.

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Background: Treatment of spondylolisthesis can be difficult with regard to patients with high sacral slopes that may prohibit placement of interbody grafts for fusions across that segment. Here, we describe placement of a reverse Bohlman technique from an anterior approach to obtain fusion across a low-grade spondylolisthesis with a high sacral slope to obtain anterior fusion.

Methods: A chart review was conducted on this single patient regarding his clinical course and outcome.

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Study Design: Case-control study.

Objectives: Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord injury in adults aged over 55 years. However, since the onset is typically insidious, accurately diagnosing CSM can be challenging, often requiring referral to a subspecialist and advanced imaging.

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This comprehensive narrative literature review aims to extract studies related to frailty indices and their use in elective spine procedures, as limited studies regarding frailty exist in the spine literature. Most studies are retrospective analyses of prospectively collected databases. Evidence suggests a positive correlation between frailty level and mortality rate, postoperative complication rate, length of stay, and the possibility of discharge to a skilled nursing facility; these correlations have been illustrated across various spine procedures.

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Article Synopsis
  • The study aimed to evaluate if adding intrathecal morphine (ITM) to standard pain management reduces the need for postoperative pain relief after pediatric spine surgery.
  • A meta-analysis of 5 studies involving 636 participants showed that ITM significantly prolonged the time before the first pain demand and reduced overall analgesic consumption at both 24 and 48 hours after surgery.
  • While ITM improved pain management, it did not significantly affect pain scores or the incidence of common side effects like nausea and respiratory depression compared to the control group.
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Study Design: This is a cross-sectional study.

Objective: To investigate spine surgeons' attitudes regarding preoperative anxiety measurement, management, and responsibility.

Summary Of Background Data: The vast majority of patients scheduled for spine surgery experience preoperative anxiety.

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Background: Supplemental intrathecal morphine (ITM) represents an option to manage postoperative pain after spine surgery due to ease of administration and ability to confer effective short-term analgesia at low dosages. However, whether ITM increases risk of surgical site infections (SSI), cerebrospinal fluid (CSF) leak, and incidental dural tears (IDT) has not been investigated. Therefore, this study was performed to determine the rates of SSI, CSF leak, and IDT in patients that received ITM.

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Study Design: This was a cross-sectional study.

Objective: The objective of this study was to determine spine surgeons' preferences for the intraoperative and postoperative management of intraoperative durotomy (IDT) in decompression and spinal fusion surgeries.

Summary Of Background Data: Management guidelines for IDT remain elusive.

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Background: The optimum pattern of pedicle screw (PS) fixation during long-segment thoracic fixation has not been determined.

Objective: To evaluate rod stress and construct stability with minimal, alternating, skipped, and bilateral PS constructs in the iatrogenically destabilized thoracic spine.

Methods: Eight cadaveric thoracic specimens (T3-T12) were initially tested intact to ±5 Nm using a custom 6 degree-of-freedom spine testing apparatus in flexion-extension (FE), lateral bending (LB), and axial rotation.

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Study Design: Retrospective cohort study.

Objectives: Lateral interbody fixation is being increasingly used for the correction of segmental sagittal parameters. One factor that affects postoperative correction is the resistance afforded by posterior hypertrophic facet joints in the degenerative lumbar spine.

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Study Design: Retrospective review.

Objective: To review the feasibility of a posterior-only approach for instrumented reconstruction in lumbar burst fractures.

Background: Burst fractures of the lumbar spine have been treated through a variety of techniques, including anterior, posterior, or combined approaches.

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There has been a conscious effort to address osteoporosis in the aging population. As bisphosphonate and intermittent parathyroid hormone (PTH) therapy become more widely prescribed to treat osteoporosis, it is important to understand their effects on other physiologic processes, particularly the impact on spinal fusion. Despite early animal model studies and more recent clinical studies, the impact of these medications on spinal fusion is not fully understood.

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Study Design: Retrospective analysis of a nationwide private insurance database. Chi-square analysis and linear regression models were utilized for outcome measures.

Purpose: The purpose of this study was to investigate any relationship between lumbar degenerative disc disease, diabetes, obesity and smoking tobacco.

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Background: Bow Hunter's syndrome (BHS) is a rare condition characterized by vertebrobasilar insufficiency associated with rotational vertebral artery occlusion during head movement. Many existing reports describe surgical management, although no single technique has proven superior.

Objective: To review all reported cases of BHS with focus on outcomes of individual techniques as well as to present a video report of a posterior decompression without fusion performed at the authors' institution.

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Study Design: Meta-analysis of randomized controlled trials (RCTs).

Objective: The aim of this study was to evaluate the effectiveness of intrathecal morphine (ITM) in reducing postoperative pain and opioid analgesic consumption following spine surgery.

Summary Of Background Data: The use of ITM following adult spine surgery is of particular interest because of the ease of access to the thecal sac and the potential to provide adequate analgesia at low doses.

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Background Context: Watertight dural repair is crucial for both incidental durotomy and closure after intradural surgery.

Purpose: The study aimed to describe a perfusion-based cadaveric simulation model with cerebrospinal fluid (CSF) reconstitution and to compare spine dural repair techniques.

Study Design/setting: The study is set in a fresh tissue dissection laboratory.

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Background Context: Surgical treatment of symptomatic adjacent segment disease (ASD) typically involves extension of previous instrumentation to include the newly affected level(s). Disruption of the incision site can present challenges and increases the risk of complication. Lateral-based interbody fusion techniques may provide a viable surgical alternative that avoids these risks.

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The past several years have demonstrated an increased recognition of operative videos as an important adjunct for resident education. Currently lacking, however, are effective methods to record video for the purposes of illustrating the techniques of minimally invasive (MIS) and complex spine surgery. We describe here our experiences developing and using a shoulder-mounted camera system for recording surgical video.

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Animal and human studies demonstrate the anabolic properties of low-magnitude mechanical stimulation (LMMS) in its ability to improve bone formation by enhancing the proliferation of mesenchymal stem cells and their subsequent commitment down an osteoblastic lineage. Response to mechanical strains as low as 10μɛ have been seen, illustrating the sensitivity of mechanosensory cells to mechanotransduction pathways. Applications to the spine include treatment of osteoporosis in preparation for instrumented fusion, fracture reduction in spinal cord injury patients to slow bone mineral density loss, and bone tissue engineering and enhancement of bone-implant osseointegration for pseudarthrosis and hardware failure.

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Objectives: This study describes the efforts to implement electronic charting in a large public psychiatric outpatient clinic with the objective to improve clinical documentation.

Methods: Data made available through the quality review process are utilized to evaluate the effectiveness of the electronic intervention. The study is a comparative analysis of the three years before and three years after the point of implementation of electronic charting.

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Proximal junctional kyphosis is an increasingly recognized complication following long-segment posterior spinal fusion for adult spinal deformity. The authors describe a novel technique for interspinous ligament reinforcement at the proximal adjacent levels using a cadaveric semitendinosus tendon graft secured with an Ethibond No. 2 double filament (Ethicon, Somerville, New Jersey) via the Krackow suture weave.

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Background: Spinal osteochondromas are typically benign tumors, but patients may present with myelopathy and neurologic deficits if there is tumor encroachment within the spinal canal.

Case Description: We report here a case of a large solitary osteochondroma originating from the posterior vertebral body of T9 causing spinal cord compression and myelopathy. A 17-year-old man presented with 3 months of bilateral feet numbness and gait difficulty.

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Study Design Biomechanical cadaveric study. Objective Clinical studies indicate that using less-rigid fixation techniques in place of the standard all-pedicle screw construct when correcting for scoliosis may reduce the incidence of proximal junctional kyphosis and improve patient outcomes. The purpose of this study is to investigate whether there is a biomechanical advantage to using supralaminar hooks in place of pedicle screws at the upper-instrumented vertebrae in a multilevel thoracic construct.

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Wheeler DL, Fredericks DC, Dryer RF, Bae HW. Allogeneic mesenchymal precursor cells (MPCs) combined with an osteoconductive scaffold to promote lumbar interbody spine fusion in an ovine model. Spine J 2016:16:389-99 (in this issue).

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