Publications by authors named "Schwab F"
Objective: Malalignment following cervical spine deformity (CSD) surgery can negatively impact outcomes and increase complications. Despite the growing ability to plan alignment, it remains unclear whether preoperative goals are achieved with surgery. The objective of this study was to assess how good surgeons are at achieving their preoperative goal alignment following CSD surgery.
View Article and Find Full Text PDFRedefining Clinically Significant Blood Loss in Complex Adult Spine Deformity Surgery.
Spine (Phila Pa 1976)
December 2024
Study Design: Retrospective analysis of prospectively-collected data.
Objective: This study aims to define clinically relevant blood loss in adult spinal deformity (ASD) surgery.
Background: Current definitions of excessive blood loss following spine surgery are highly variable and may be suboptimal in predicting adverse events (AE).
Article Synopsis
- The study investigates how different reasons for revision surgery in adult spinal deformity (ASD) patients affect their postoperative outcomes, revealing a high incidence of reoperations.
- A sample of 891 ASD patients was analyzed retrospectively, categorizing their revisions by cause, and assessing complications, radiographic results, and disability metrics.
- Findings suggest that different etiologies (mechanical, infection, wound, and SI pain) lead to varying outcomes, with mechanical issues showing less improvement over time compared to others.
Background And Objectives: The spectrum of patients requiring adult spinal deformity (ASD) surgery is highly variable in baseline (BL) risk such as age, frailty, and deformity severity. Although improvements have been realized in ASD surgery over the past decade, it is unknown whether these carry over to high-risk patients. We aim to determine temporal differences in outcomes at 2 years after ASD surgery in patients stratified by BL risk.
View Article and Find Full Text PDFArticle Synopsis
- The study was a cross-sectional analysis aimed at evaluating if degenerative cervical myelopathy (DCM) contributes to the risk of major fragility fractures, particularly hip fractures, in older patients.
- Researchers targeted patients aged over 65 who had experienced hip fractures, finding that 15.6% showed signs of myelopathy, and the confirmed prevalence of DCM was estimated at 10.5%.
- The findings suggest that specific clinical signs such as hypertonic reflexes and cervical pain are important for diagnosing DCM, indicating a potentially significant link between DCM and hip fractures in the elderly.
Objective: The objective of this study was to identify baseline patient and surgical factors predictive of optimal outcomes in staged versus same-day combined-approach surgery.
Methods: Adult spinal deformity (ASD) patients with baseline and perioperative (by 6 weeks) data were stratified based on single-stage (same-day) or multistage (staged) surgery, excluding planned multiple hospitalizations. Means comparison analyses were used to assess baseline demographic, radiographic, and surgical differences between cohorts.
Objective: The goal of this study was to assess the impact of fractional curve (FC) severity on curve progression and postoperative outcomes in patients undergoing adult idiopathic scoliosis (AdIS) correction.
Methods: Patients with AdIS who had preoperative coronal plane deformity and who had undergone thoracolumbar fusion with a lowermost instrumented vertebra (LIV) between L1 and L4 were included. Patients were stratified by 6-week postoperative FC severity (small FC, ≤ 40th percentile, large FC, ≥ 60th percentile of the entire cohort; calculated as the Cobb angle between LIV and S1) and age groups.
Study Design: Retrospective analysis of prospectively collected data.
Objective: This study evaluates the impact of knee osteoarthritis (OA) and knee arthroplasty on alignments and patient-reported outcomes measures (PROMS) of patients undergoing adult spinal deformity (ASD) corrective surgery.
Background: The relationship between knee OA and spinal alignment in patients with ASD is incompletely understood.
Purpose: To investigate the impact of the Global Alignment and Proportion (GAP) score components on patient outcomes in Adult Spine Deformity (ASD) surgery.
Methods: Patients included underwent assessment via the GAP score and its individual components: pelvic version (GAP PV), lumbar lordosis (GAP LL), lumbar distribution index (GAP LDI) and spinopelvic component (GAP SP). Multivariable analyses assessed the association between alignment in these components and clinical outcomes in ASD patients.
In the last two decades, next-generation sequencing (NGS) has facilitated enormous progress in cancer medicine, in both diagnosis and treatment. However, the usefulness of NGS in older cancer patients is unclear. To determine the role of NGS in older cancer patients, we retrospectively assessed demographic, clinicopathologic, and disease-specific data from 100 randomly selected cancer patients (any subtype/stage) who underwent NGS testing in 2020 at our institution and compared the treatment outcomes (progression-free survival [PFS] and overall survival [OS]) in the younger and older patient cohorts (A [n = 34] and B [n = 66]: age < 70 and ≥70 years, respectively).
View Article and Find Full Text PDFPurpose: Understanding the mechanism and extent of preoperative deformity in revision procedures may provide data to prevent future failures in lumbar spinal fusion patients.
Methods: ASD patients without prior spine surgery (PRIMARY) and with prior short (SHORT) and long (LONG) fusions were included. SHORT patients were stratified into modes of failure: implant, junctional, malalignment, and neurologic.
Article Synopsis
- The study is a retrospective cohort analysis aimed at assessing the surgical outcomes of adult spinal deformity using AI-based clustering to categorize patients into different deformity types, including Moderate Sagittal, Severe Sagittal, Coronal, and Hyper-Thoracic Kyphosis.
- A total of 1062 patients were analyzed, showing that while all deformity clusters experienced similar improvements in health-related quality of life after surgery, those in the Severe Sagittal cluster had notably higher complication rates, especially regarding major complications, reoperations, and implant failures.
- Despite varying complication rates among clusters, the types of complications did not show significant differences, indicating that all clusters benefit equally from surgical interventions, achieving comparable rates of minimal clinically important difference in quality
Article Synopsis
- - The study is a secondary data analysis of an NIH-sponsored research focusing on cost-effectiveness between surgical and non-surgical treatments for Adult Symptomatic Lumbar Scoliosis (ASLS) eight years post-enrollment.
- - Previous analyses at the five-year mark showed a cost-effectiveness ratio (ICER) of $44,033 (As-Treated) and $27,480 (Intent-to-treat), while the current eight-year data suggests that surgical treatment is more economically favorable, with an ICER of $20,569 per Quality Adjusted Life Year (QALY) gained.
- - The conclusion highlights that operative treatment for ASLS presents a more cost-effective option compared to non-operative treatment, as indicated
Article Synopsis
- - The study investigates the impact of the Restifem® pessary on pelvic floor function in postpartum women, evaluating its effectiveness as both a preventive and therapeutic device from 6 weeks to 12 months after delivery.
- - 857 women participated, with 137 using the pessary and 133 not; findings revealed that pessary users experienced significantly worse pelvic floor function initially but showed greater improvement in scores related to bladder and pelvic organ prolapse over time.
- - The results suggest that using the pessary contributes to improved recovery of pelvic floor function, particularly for women experiencing higher levels of dysfunction postpartum, while also highlighting the study's legitimacy through registration in a clinical trials database.
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
- Tranexamic acid (TXA) is used in adult spinal deformity surgery to reduce blood loss, but there's no agreed-upon dosing method.
- A study analyzed data from 265 complex ASD patients, categorizing them into low, medium, and high TXA dose groups and measuring blood loss, complications, and RBC transfusions.
- Findings revealed that lower TXA doses resulted in significantly higher blood loss and increased RBC transfusions compared to high doses, suggesting that higher TXA dosing may be more effective in minimizing blood loss during surgery.
Article Synopsis
- This multicentric retrospective study aimed to establish normative values for proximal junctional angles (PJA) in adult spinal deformity (ASD) surgery patients, using data from healthy volunteers for comparison.
- The study analyzed data from 721 healthy individuals and 824 ASD surgery patients, assessing the rates of abnormal PJA values and comparing them with the rates of proximal junctional kyphosis (PJK) using different definitions.
- Findings revealed significant differences in PJK rates based on the criteria used, highlighting the need for more precise level-adjusted assessments of PJA values to better define abnormalities and challenge traditional definitions of PJK.
The Conceptualization and Derivation of the Cervical Lordosis Distribution Index.
Spine (Phila Pa 1976)
September 2024
Summary Of Background Data: Yilgor et al developed the lumbar Lordosis Distribution Index to individualize the pelvic mismatch to each patient's pelvic incidence. The cervical lordosis distribution in relation to its apex has not been characterized.
Objective: Tailor correction of cervical deformity by incorporating the cervical apex into a distribution index(CLDI) to maximize clinical outcomes while lowering rates of junctional failure.
Study Design: Retrospective cohort study.
Purpose: The impact of neuromuscular disorders such as multiple sclerosis (MS) on outcomes following long segment fusion is underreported. This study evaluates the impact of MS on two-year (2Y) postoperative complications and revisions following ≥ 4-level fusion for adult spinal deformity (ASD).
BackgroundCarriage of multidrug-resistant organisms (MDROs) in humans constitutes an important public health concern. Cross-transmission of bacteria between animals and humans has been demonstrated before.AimOur aim was to quantify the risk factor 'pet ownership' for MDRO colonisation in hospital patients.
View Article and Find Full Text PDFStudy Design: Case-based survey.
Objectives: This study aims to investigate what a group of surgeons learned from their own revisions, and what they would do differently today.
Methods: A multi-center database of ASD surgical patients was queried to identify those with at least 2 surgical procedures performed by the same surgeon between 2009 and 2019.
Background: Our understanding of the relationship between sagittal alignment and mechanical complications is evolving. In normal spines, the L1-pelvic angle (L1PA) accounts for the magnitude and distribution of lordosis and is strongly associated with pelvic incidence (PI), and the T4-pelvic angle (T4PA) is within 4° of the L1PA. We aimed to examine the clinical implications of realignment to a normal L1PA and T4-L1PA mismatch.
View Article and Find Full Text PDFOver the past five decades, DNA restriction enzymes have revolutionized biotechnology. While these enzymes are widely used in DNA research and DNA engineering, the emerging field of RNA and mRNA therapeutics requires sequence-specific RNA endoribonucleases. Here, we describe EcoToxN1, a member of the type III toxin-antitoxin family of sequence-specific RNA endoribonucleases, and its use in RNA and mRNA analysis.
View Article and Find Full Text PDFPurpose: To evaluate the variability in intraoperative fluid management during adult spinal deformity (ASD) surgery, and analyze the association with complications, intensive care unit (ICU) requirement, and length of hospital stay (LOS).
Methods: Multicenter comparative cohort study. Patients ≥ 18 years old and with ASD were included.