Publications by authors named "Srikanth N Divi"

Article Synopsis
  • This study is a retrospective analysis comparing various metrics (mean work RVUs, operative time, and efficiency measured as wRVUs/min) for single- and multilevel cervical spine fusions conducted from 2011 to 2020.
  • The researchers examined data for nearly 101,000 patients, focusing on anterior cervical discectomy and fusion (ACDF) versus posterior cervical decompression and fusion (PCDF), finding that anterior fusions were typically quicker but varied in efficiency depending on the number of fusion levels.
  • Results highlighted significant differences between the surgical approaches, indicating that while anterior fusions had lower wRVUs in single and multi-level procedures, they were more efficient in the 1- and 2-level categories
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Study Design: Systematic Review and meta-analysis.

Objective: To conduct an updated systematic review and meta-analysis of complications associated with different anterior fusion techniques/approaches and adjuvant resources (i.e.

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Article Synopsis
  • This study is a Level 3 retrospective database investigation focusing on trends in various RVUs (work, practice expense, and malpractice) and MS-DRG reimbursements for cervical spine fusion surgeries from 2011 to 2023, particularly during the COVID-19 pandemic.
  • The analysis showed no changes in work RVUs, while practice expense RVUs experienced a slight decline and malpractice RVUs saw a modest increase; all facility prices for the procedures decreased when adjusted for inflation.
  • The research findings indicated that, despite stable RVU reimbursement, there were slight variations in MS-DRG metrics like length of stay, with different yearly percent changes for each code, highlighting complexities in reimbursement trends for cervical spine fusions.
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Study Design: Basic Science.

Objective: The objective of this study was to identify a unique serum profile of circulating miRNAs and inflammatory markers in patients with degenerative cervical myelopathy (DCM) compared with healthy controls (HC).

Summary Of Background Data: Currently, DCM is diagnosed with a combination of history, physical examination, and close correlation to advanced imaging.

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Article Synopsis
  • - The study conducted a scoping review to investigate how preference sensitivity influences treatment decisions for lumbar spinal stenosis (LSS), using shared decision-making (SDM) as a reference point for analysis.
  • - A total of 16 studies from various time periods were included, revealing a focus on patient and surgeon preferences, and the effectiveness of decision aids (DAs), with most studies suggesting that SDM positively affects treatment choice and patient satisfaction.
  • - The review found a significant gap in extensive research specifically addressing preference sensitivity and the role of DAs in LSS treatment decisions, highlighting the need for further studies to explore these areas.
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Degenerative spine disease is increasing in prevalence as the global population ages, indicating a need for targeted therapies and continued innovations. While autograft and allograft have historically demonstrated robust results in spine fusion surgery, they have significant limitations and associated complications such as infection, donor site morbidity and pain, and neurovascular injury. Synthetic grafts may provide similar success while mitigating negative outcomes.

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Article Synopsis
  • The rise in popularity of cervical disc arthroplasty (CDA) has sparked interest in its application for more conditions than those initially studied by the FDA.
  • Off-label uses now being considered include treating multiple disc levels, hybrid surgical approaches, and more complex cases such as previous failed surgeries and specific spinal deformities.
  • This review aims to summarize the existing research on these new indications for CDA to provide a comprehensive understanding of its expanded use.
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Artificial intelligence (AI) is a broad term that is widely used but inconsistently understood. It refers to the ability of any machine to exhibit human-like intelligence by making decisions, solving problems, or learning from experience. With its ability to rapidly process large amounts of information, AI has already transformed many industries such as entertainment, transportation, and communications through consumer-facing products and business-to-business applications.

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Background: Social media offers a powerful and expanding platform for sharing the patient experience with a large audience through an unsolicited perspective. The content may influence future perceptions around surgical care.

Objective: To analyze publicly available content on a major social media outlet related to microdiscectomy surgery based on perspective, location, timing, content, tone, and patient satisfaction.

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Study Design: A retrospective cohort study from a multisite academic medical center.

Objective: To construct, evaluate, and interpret a series of machine learning models to predict outcomes related to inpatient health care resource utilization for patients undergoing anterior cervical discectomy and fusion (ACDF).

Summary Of Background Data: Reducing postoperative health care utilization is an important goal for improving the delivery of surgical care and serves as a metric for quality assessment.

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Purpose Of Review: Diabetes and metabolic syndrome are highly prevalent in patients undergoing spine surgery. This review aims to capture both the findings of recently published literature investigating the effects of diabetes and metabolic syndrome on spine surgery outcomes and the current best practices in patient management.

Recent Findings: Diabetes and metabolic syndrome both contribute to worse outcomes in patients undergoing spine surgery.

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Introduction: The management of degenerative spine pathology continues to be a significant source of costs to the US healthcare system. Besides surgery, utilization of healthcare resources after spine surgery drives costs. The responsibility of managing costs is gradually shifting to patients and providers.

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Purpose Of Review: Vitamin D is an essential micronutrient for human bone health and maintenance. Patients undergoing orthopaedic surgery with hypovitaminosis D may be at greater risk for worsened clinical outcomes. This narrative review aims to compile the current literature studying the effects of low preoperative vitamin D on spine surgery outcomes, creating a resource that clinicians can use to inform their practice.

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Article Synopsis
  • Social determinants of health (SDH) include various environmental and socioeconomic factors that impact patient health outcomes, particularly outside hospital settings.
  • Current literature has identified a connection between SDH and spine surgery outcomes, highlighting that lower income, education, and healthcare access can lead to poorer post-operative results, such as increased pain and longer recovery times.
  • This review article aims to fill the gap in research by exploring the relationship between SDH and spine surgery, organizing findings into themes like education, geography, race, healthcare access, and economics.
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Purpose Of Review: Hypothyroidism is a common medical comorbidity and has been linked to adverse surgical outcomes. However, its effect on spine surgery outcomes is less clear. The aim of this review is to compile current literature to serve as a guide for spine surgeons when treating patients with hypothyroidism.

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Study Design: Cross-sectional study.

Objective: To analyze publicly available content on a major social media outlet related to anterior cervical discectomy and fusion (ACDF) surgery based on perspective, location, timing, content, tone, and patient satisfaction.

Summary Of Background Data: Social media offers a powerful platform for sharing the patient experience with the public through an unfiltered perspective.

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Study Design: Retrospective cohort study.

Objective: The aim of this study was to determine the incidence of and risk factors for persistent opioid use after elective cervical and lumbar spine procedures and to quantify postoperative healthcare utilization in this patient population.

Methods: Patients were retrospectively identified who underwent elective spine surgery for either cervical or lumbar degenerative pathology between November 1, 2013, and September 30, 2018, at a single academic center.

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Study Design: Prospective cohort study.

Objective: The aim was to determine the relationship between serum inflammatory mediators, preoperative cervical spine disease severity, and clinical outcomes after anterior cervical discectomy and fusion (ACDF).

Summary Of Background Data: Given the role of the inflammatory cascade in spinal degenerative disease, it has been hypothesized that inflammatory markers may serve as a predictor of patient outcomes after surgery.

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Study Design: This was a retrospective cohort study.

Objective: To determine the extent to which the upper cervical spine compensates for malalignment in the subaxial cervical spine, and how changes in upper cervical spine sagittal alignment affect patient-reported outcomes.

Summary Of Background Data: Previous research has investigated the relationship between clinical outcomes and radiographic parameters in the subaxial cervical spine following anterior cervical discectomy and fusion (ACDF).

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Background: The presence of predominant pain in the arm vs the neck as a predictor of postoperative outcomes after anterior cervical discectomy and fusion (ACDF) has been seldom reported; therefore, the purpose of this study was to determine whether patients with predominant neck pain improve after surgery compared to patients with predominant arm pain or those with mixed symptoms in patients undergoing ACDF for radiculopathy.

Methods: A retrospective cohort study was conducted on patients who underwent ACDF at a single center from 2016 to 2018. Patients were split into groups based on preoperative neck and arm pain scores: neck (N) pain dominant group (visual analog scale [VAS] neck ≥ VAS arm by 1.

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Purpose Of Review: In recent years, machine learning techniques have been increasingly utilized across medicine, impacting the practice and delivery of healthcare. The data-driven nature of orthopaedic surgery presents many targets for improvement through the use of artificial intelligence, which is reflected in the increasing number of publications in the medical literature. However, the unique methodologies utilized in AI studies can present a barrier to its widespread acceptance and use in orthopaedics.

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Introduction: Lumbar spinal fusion (LSF) may increase the risk of dislocation in patients who have undergone total hip arthroplasty (THA), especially when the LSF was done before the THA. Most publications evaluated patients who had undergone THA using a posterior approach to the hip, yet there are little data on the influence of other surgical approaches. The goal of this study was to evaluate the risk of THA dislocation with anterior supine-based surgical approaches to the hip in patients who have undergone surgical management of concurrent hip and spine pathology.

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Purpose Of Review: Cannabis is among the most used illicit substances globally, with medical applications, increased legalization, and shifting social attitudes leading to increased use in recent years. Cannabinoids are a group of psychoactive substances found within the cannabis plant, with the most common being Δ-tetrahydrocannabinol and cannabidiol. Due to the high prevalence of use, it is increasingly important to evaluate the effects of cannabis and cannabinoids on spine patients, in both operative and nonoperative settings.

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Background: No prior work has explored whether the presence of degenerative spondylolisthesis impacts patient-reported outcome measurements (PROMs) after an anterior cervical discectomy and fusion (ACDF); therefore, the goal of the current study was to determine whether the presence of a spondylolisthesis affects PROMs after an ACDF.

Methods: A retrospective cohort study was conducted on patients over the age of 18 who underwent a 1- or 2-level ACDF. All patients received preoperative standing lateral x-rays and were placed into 1 of 2 groups based on the presence of cervical spondylolisthesis from C2-T1: (1) no spondylolisthesis (NS) group or (2) spondylolisthesis (S) group.

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Objective: The aim of this study was to assess rates of adjacent segment degeneration (ASDeg), adjacent segment disease (ASDis), and reoperation rates as a result of adjacent segment pathology in patients who have undergone anterior cervical discectomy and fusion (ACDF) versus cervical disc arthroplasty (CDA).

Methods: A comprehensive search of randomized controlled trials was performed in PubMed from 2012 to 2019. Relevant studies included were assessed for quality using the Cochrane Beck Review Group guidelines.

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