Publications by authors named "Harrop J"

Purpose: This study aimed at comparing the costs of spinal fusion surgery between patients with and without diabetes.

Methods: Following PRISMA guidelines, a systematic search of four databases was conducted. A meta-analysis was performed on comparative studies examining diabetic versus non-diabetic adults undergoing cervical/lumbar fusion in terms of cost.

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Diabetic peripheral neuropathy (DPN) is the most common form of diabetic neuropathy, representing 75% of cases and posing a substantial public health challenge. Emerging evidence from animal studies indicates that stem cell therapy holds significant promise as a potential treatment for diabetic neuropathy. Nevertheless, a comprehensive evaluation of the safety and efficacy of stem cell therapy for DPN in animal studies remains outstanding.

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Background And Objectives: A few studies have compared the value (outcomes per dollar spent) provided by transforaminal endoscopic discectomy (TED) vs microdiscectomy (MD) for lumbar disc herniations. Here, we attempt to address this gap using a novel Operative Value Index (OVI), which combines a procedure-specific patient-reported outcome with intraoperative cost data based on time-driven activity-based costing.

Methods: MD (n = 95) and TED (n = 23) performed by neurosurgeons at our institution from 2017 to 2022 were retrospectively identified.

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Study Design: Systematic Review and Meta-Analyses.

Objective: To assess the 30- and 90-day readmission rates after a traumatic spinal cord injury (SCI).

Methods: A systematic search of MEDLINE and Embase was performed.

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One recent innovation in the health care landscape is the integration of Digital Twin (DT) in the field of spine surgery. DT, first used in 2002 is defined as the replication of physical entities in a virtual environment. It has emerged as a transformative tool for optimizing complex systems.

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Study Design: Cross-sectional, observational study.

Objective: Investigate the frequency of intraoperative neuromonitoring (IONM) utilization among Medicare patients diagnosed with cervical spondylosis (CS), both with and without myelopathy.

Background: IONM is widely used as a tool in spine surgery.

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Article Synopsis
  • - A study was conducted to evaluate the effectiveness and safety of stem cell therapy for diabetic peripheral neuropathy (DPN) through a detailed literature review of clinical trials, which included seven relevant studies.
  • - Stem cell treatments primarily involved bone marrow and umbilical cord-derived cells, leading to significant improvements in nerve conduction speeds and reductions in various clinical scoring metrics, along with minor side effects like pain and swelling at injection sites.
  • - The findings indicate that stem cell therapy holds promise for enhancing DPN treatment outcomes, but further research is needed to refine therapy methods and verify results.
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  • Minimally invasive spine surgery (MISS) is gaining popularity due to its benefits like smaller incisions and quicker recovery times, but online information about it often exceeds readable levels for patients.
  • A study assessed the responses from ChatGPT to 15 frequently asked questions about MISS, focusing on clinical appropriateness and readability as judged by three neurosurgeons.
  • Results showed that all generated responses had readability scores above the recommended levels for patient education, indicating they were difficult for average patients to understand, particularly for intraoperative questions.
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Central cord syndrome (CCS) is the most common form of incomplete spinal cord injury, with an increasing incidence with the aging population. This is a clinical diagnosis defined by weakness greater in the upper than lower extremities and often prominent sensory complaints in the hands. CCS is typically seen in individuals with underlying cervical canal stenosis from spondylosis who experience sudden forceful movement of the neck, especially hyperextension, resulting in contusion of the spinal cord.

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  • The management of type II odontoid fractures in elderly patients is complex due to their multiple health issues, which can complicate surgery and healing with nonsurgical treatments.
  • Advances in technology and evolving surgeon perspectives may change treatment preferences, with a focus on achieving either bony healing or a stable fibrous union as an acceptable outcome.
  • New surgical techniques, such as the use of BMP-2 and temporary posterior fixation, are being explored, and a better understanding of treatment options could enhance decision-making and patient outcomes for older adults with these fractures.
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  • This study examines the effectiveness and safety of a new bioresorbable polymer scaffold, Neuro-Spinal Scaffold (NSS), in patients with complete spinal cord injuries compared to standard surgery.* -
  • A randomized clinical trial (INSPIRE 2.0) involved 20 patients, split into two groups: those receiving NSS implantation and those undergoing standard spine surgery within a week of injury.* -
  • Results showed that at 6 months, the NSS group had a 20% improvement in spinal function, while the control group had 30%, leading to the trial being closed early as it did not meet the success criteria.*
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  • - The study investigated the safety and feasibility of a new spinal electrical stimulation technology called RISES, which allows real-time adjustments to stimulation settings while collecting various data.
  • - Four participants with spinal cord injuries (SCIs) were tested, and results showed no serious adverse effects, with stable skin integrity, vital signs, and pain levels; however, fatigue increased post-stimulation.
  • - The trial compared open-loop and closed-loop stimulation methods, finding that while open-loop sessions had longer stimulation durations, there were no significant differences in setup time or other health measures between the two methods.
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  • This study examined trends in spinal cord injury (SCI) admissions in the U.S. over the past decade, focusing on patients under and over 70 years old.
  • Data from 8,137 patients revealed that while falls decreased among the elderly, vehicle accidents increased, showing a shift in causes of SCI.
  • Notably, while complete injuries diminished overall and recovery rates improved for certain injuries, the mortality rates for elderly patients dropped significantly in both hospital stays and one-year follow-ups.
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  • Total disc replacement (TDR) is an alternative to anterior cervical discectomy and fusion (ACDF), and this study compares their costs as we shift towards value-based healthcare.
  • Using time-driven activity-based costing (TDABC), researchers reviewed the costs of both procedures, analyzing direct and indirect costs through observation and data collection from various departments.
  • The results showed that TDRs had significantly higher total intraoperative costs ($12,026) compared to ACDFs ($6,776), with the majority of the cost difference attributed to more expensive supply items, particularly implants.
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  • There has been a growing number of cervical fusion surgeries in the U.S., but there's a lack of research on how well surgeons follow evidence-based medicine (EBM) guidelines, particularly as patients turn to large language models (LLMs) for decision-making assistance.* -
  • An observational study tested four LLMs—Bard, BingAI, ChatGPT-3.5, and ChatGPT-4—against the 2023 North American Spine Society (NASS) cervical fusion guidelines, and found that none fully adhered, with only ChatGPT-4 and Bing Chat achieving 60% compliance.* -
  • The findings suggest a need for better training of LLMs on clinical guidelines and highlight the necessity of
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  • Neuropathic pain (NP) is a challenging condition that can occur after spinal cord injury (SCI), and this study investigates the brain area called the periaqueductal gray (PAG) and how it relates to NP development using resting-state functional MRI (rsfMRI).
  • The research involved 20 participants: 10 SCI patients (with and without NP) and 10 healthy controls, examining differences in functional connectivity (FC) between the PAG and other brain regions.
  • Findings revealed decreased FC in SCI patients with NP compared to healthy controls and increased FC in other areas when compared to SCI patients without NP, suggesting significant brain connectivity alterations linked to neuropathic pain after spinal cord injury.
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  • Degenerative cervical myelopathy (DCM) affects about 2% of adults, and there is a lack of standardized outcomes in clinical research, leading to inconsistencies in study results; creating a standardized minimum data set could enhance comparability.* -
  • The study used a modified Delphi method to develop a core outcome set (COS), core data elements (CDEs), and a core measurement set (CMS) for DCM research, with input from an international stakeholder group.* -
  • In total, 28 outcomes were identified across 6 key domains, culminating in a structured data set that can be utilized in future clinical trials to ensure consistency and improve measurement accuracy in DCM research.*
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Background: The National Spinal Cord Injury Registry of Iran (NSCIR-IR) and the National Trauma Registry of Iran (NTRI) were established to meet the data needs for research and assessing trauma status in Iran. These registries have a group of patients shared by both registries, and it is expected that some identical data will be collected about them. A general question arises whether the spinal cord injury registry can receive part of the common data from the trauma registry and not collect them independently.

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  • The study investigates the differing timing of chemoprophylaxis (specifically heparin) in postoperative spine surgery and its relation to the occurrence of venous thromboembolism (VTE) and unplanned reoperations for hematoma.! -
  • It includes a retrospective analysis of 8,704 patients over several years, categorizing them into "immediate" and "delayed" chemoprophylaxis groups based on when their heparin treatment started after surgery.! -
  • Results indicated a low overall rate of VTE (1.13%) and unplanned reoperations (0.62%), and analyses aimed to identify important factors influencing these outcomes based on the different timing of which the chemop
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  • Elective lumbar fusions are often criticized for being used improperly, prompting a study using a new Operative Value Index (OVI) to evaluate the cost-effectiveness of evidence-based lumbar fusions.
  • A retrospective analysis of 294 patients found that a majority (92.9%) underwent evidence-based surgeries, with OVI measuring patient improvement per dollar spent showing significantly better outcomes for these procedures compared to non-evidence-based ones.
  • The results indicate that adhering to evidence-based guidelines leads to greater patient improvement (2% per $1000 spent) and highlights the potential for systematic improvements in lumbar fusion practices.
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Fat embolism syndrome is a common occurrence after orthopedic trauma and surgery. Cerebral fat embolism (CFE) may arise after fat globules enter the arterial circulation. The neurological manifestations of CFE vary and generally carries a favorable outcome.

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  • This study analyzes the return-to-work (RTW) rates of patients who underwent surgery for cervical spondylotic myelopathy (CSM) as part of a larger clinical trial comparing different surgical methods.
  • Of the 163 patients studied, 68 were employed before surgery, with 66% successfully returning to work within 12 months; the time it took to return varied by surgical type, with laminoplasty (LP) being the quickest.
  • The analysis found that a longer hospital stay negatively impacted RTW likelihood, and patients undergoing posterior cervical decompression/fusion (PCDF) reported worse physical outcomes compared to those who had anterior cervical decompression/fusion (ACDF) and LP.
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  • The modified Japanese Orthopaedic Association (mJOA) scale is commonly used for evaluating outcomes in degenerative cervical myelopathy (DCM) but doesn't account for neck pain or the full recovery process post-surgery.
  • The study aimed to reassess the effectiveness of riluzole in patients undergoing surgery for DCM using a comprehensive statistical approach that considers multiple outcome measures.
  • Results showed that patients taking riluzole had a significantly better chance of overall improvement compared to those on a placebo after one year, indicating riluzole's potential benefit in surgical outcomes for DCM patients.
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Background And Objectives: Endoscopic lumbar diskectomy (ED) is a minimally invasive option for addressing lumbar disk herniations. With the introduction of value-based care systems, assessing the true cost of certain procedures is critical when creating reimbursement models and comparing procedures. Here, we compared the costs of performing a microdiskectomy (MD) and ED using time-driven activity-based costing.

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