Publications by authors named "Jack Jallo"
Introduction: There is clinical equipoise regarding the ideal upper instrumented vertebrae (UIV) for elective posterior cervical decompression and fusion (PCDF). Instrumentation may be performed at the axial C2 level, or at the subaxial C3/C4 vertebrae. To our knowledge, a true "value" (outcomes per dollar spent) comparison axial versus subaxial UIV for PCDF has never been performed.
View Article and Find Full Text PDFBackground: The increasing prevalence of obesity has raised concerns about its impact on surgical outcomes and healthcare costs. This study evaluates the influence of Body Mass Index (BMI) on intraoperative costs and operative times during open Transforaminal Lumbar Interbody Fusion (TLIF) procedures using a Time-Driven Activity-Based Costing (TDABC) approach.
Methods: A retrospective analysis was conducted on 279 patients who underwent TLIF between 2019 and 2022.
Background: Many studies have evaluated the effect of preoperative disability status on functional outcomes following spine surgery. However, no research has compared the "value" (outcomes per dollar spent) of surgery for patients with different levels of diagnosis-specific disability.
Methods: We retrospectively reviewed 429 patients who underwent neurosurgical anterior cervical discectomy and fusion.
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.
Article Synopsis
- 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.
Article Synopsis
- 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.
Article Synopsis
- 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
Article Synopsis
- 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.
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.
View Article and Find Full Text PDFStudy Design: The present study is a single-center, retrospective cohort study of patients undergoing neurosurgical anterior cervical discectomy and fusion (ACDF).
Objective: Our objective was to use time-driven activity-based costing (TDABC) methodology to determine whether surgeons' case volume influenced the true intraoperative costs of ACDFs performed at our institution.
Summary Of Background Data: Successful participation in emerging reimbursement models, such as bundled payments, requires an understanding of true intraoperative costs, as well as the modifiable drivers of those costs.
Article Synopsis
- The study aimed to analyze and compare the marginal intraoperative costs of three methods for pedicle screw placement during transforaminal lumbar interbody fusions (TLIFs), specifically looking at robot-assisted TLIF, intraoperative navigation TLIF, and freehand TLIF.
- Data were collected from 2020 to 2022, involving 20 robot-assisted, 59 navigation, and 233 freehand procedures. Cost analysis included direct and indirect expenses, using software to extract resource usage from electronic medical records.
- Results indicated that robot-assisted TLIF was significantly more expensive ($24,838) than both intraoperative navigation TLIF ($15,991) and freehand TLIF ($
Background And Objectives: Percutaneous endoscopic lumbar diskectomy (PELD) is an effective, minimally invasive method for removal of lateral lumbar disk herniations. This minimally invasive technique can be applied with high success and lead to faster recovery than traditional methods. Unfortunately, adoption of these techniques in the United States has been slow.
View Article and Find Full Text PDFStudy Design: Retrospective Cohort Study.
Introduction: The 11-item modified Frailty index (mFI-11) by the ACS-NSQIP database was used to predict which patients are high risk for complications and inpatient mortality. ACS-NSQIP now has switched to the 5-item MFI.
Background: There is a lack of data on whether intracranial pressure (ICP)-guided therapy with an intraparenchymal fiberoptic monitor (IPM) or an external ventricular drain (EVD) leads to superior outcomes. Our goal is to determine the relationship between ICP-guided therapy with an EVD or IPM and mortality.
Methods: Retrospective analysis of severe traumatic brain injury cases that required IPM or EVD placement for ICP-guided therapy from January 1, 2010 to December 31, 2020.
Background: Although not a technically difficult operation, cranioplasty is associated with high rates of complications. The optimal timing of cranioplasty to mitigate complications remains the subject of debate.
Objective: To report outcomes between patients undergoing cranioplasty at ultra-early (0-6 weeks), intermediate (6 weeks to 6 months), and late (>6 months) time frames.
Study Design: Retrospective Cohort Study.
Objectives: To determine the ability of early vital sign abnormalities to predict functional independence in patients with SCI that required surgery.
Methods: A retrospective analysis of data extracted from the Pennsylvania Trauma Outcome Study database.
Background: Spinal synovial cysts are lesions that most commonly occur in the lumbar region. The need for an instrumented spinal fusion in addition to lumbar decompression with removal of the synovial cyst is unknown.
Objective: To test the hypothesis that select patients who underwent decompression with instrumented fusion for lumbar synovial cysts would be less likely to have subsequent surgery (SS) in a 2-year period than patients treated with laminectomy alone.
Background: Opioids are commonly prescribed for chronic pain before spinal surgery and research has shown an increased rate of postoperative adverse events in these patients.
Objective: This study compared the incidence of 2-year subsequent surgical procedures and postoperative adverse events in patients undergoing lumbar fusion with or without 90-day preoperative opioid use. We hypothesized that patients using preoperative opioids would have a higher incidence of subsequent surgery and adverse outcomes.
Article Synopsis
- * The text describes the first successful identification and treatment of a right-sided chyle leak during an ACDF, noting that only three right-sided cases have been documented.
- * The case aims to enhance clinical awareness and surgical practices among healthcare providers involved in ACDF procedures.
We report the case of a 62-year-old man who presented with a progressive myelopathy secondary to spinal cord compression from an odontoid process fracture and subaxial central canal stenosis. The patient underwent a C1-T2 posterior decompression and instrumented fusion (PCDF) and did well immediately postoperatively. However, on POD1, he developed a right hypoglossal nerve (HN) palsy attributed to direct mechanical compression or injury from the C1 lateral mass screw (LMS), which improved following a revision and screw replacement.
View Article and Find Full Text PDFIntroduction The American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) 2014 lumbar fusion guidelines for stenosis with degenerative spondylolisthesis (DS) support surgical decompression and fusion as an effective treatment option for symptomatic stenosis associated with DS. The association between the number of levels decompressed in patients with single-level fusion and clinical outcomes has never been published. Methods A retrospective analysis of a single-center, prospectively collected database was performed on 77 patients to compare the effect of the number of decompression levels in patients that received single-level fusion surgery.
View Article and Find Full Text PDFBackground: Cervical pseudarthrosis is a postoperative adverse event that occurs when a surgically induced fusion fails to establish bone growth connecting the 2 regions. It has both clinical and financial implications and may result in significant patient morbidity; it continues to be one of the leading causes of pain after surgery.
Methods: A retrospective longitudinal cohort study was performed.
Article Synopsis
- The study is a retrospective cohort analysis focused on how surgeon-specific factors influence patient outcomes, particularly looking at functional improvement after lumbar fusion surgery.
- It evaluates the effect of variables like years of experience and surgery volume on patient-reported outcomes, measured by the Oswestry Disability Index (ODI), at 6 months post-operation.
- The results indicate that both the surgeon's experience and the number of lumbar fusions they have performed are significant predictors of achieving important improvements in patient function, with adherence to evidence-based practices further enhancing these outcomes.
Study Design: Retrospective case-control study.
Objective: To compare health-related quality of life outcomes at one-year follow-up between patients who did and did not develop surgical site infection (SSI) after thoracolumbar spinal fusion.
Summary Of Background Data: SSI is among the most common healthcare-associated complications.
Background: Patients with a history of surgically treated cervical myelopathy and lumbar pathology requiring fusion present complex challenges, and literature describing patient-reported outcomes in this cohort beyond patients with tandem spinal stenosis is sparse. This has led to unclear guidelines in the literature. We present the first dataset comparing patient-reported outcomes for lumbar fusion in patients with isolated lumbar pathology versus patients with a history of surgically treated cervical myelopathy.
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