Publications by authors named "Zach Pennington"

Study Design: A meta-analysis approach to a systematic review.

Objective: Perform a systematic review to identify all reports directly comparing outcomes of lateral lumbar interbody fusion (LLIF) using static versus expandable interbody cages. Specifically focusing on periprocedural complications, intraoperative morbidity, and fusion outcomes.

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Objective: Hounsfield units (HUs) may better predict biomechanical complications of instrumented fusion than conventional bone quality measures. Typically, noncontrast axial slices are used. This study aims to address the influence of reconstruction plane and contrast administration on measured HUs in patients undergoing lumbar spine imaging.

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Summary Of Background Data: Although pseudoangina is most commonly caused by cervical disc herniation, several cases have been described where thoracic herniation produced symptoms of pseudoangina. If thoracic herniation can produce angina-like pain, then it is important to consider whether pathology of the thoracolumbar spine, in general, can trigger false pain syndromes distinct from pseudoangina.

Objective: We seek to provide the most comprehensive study regarding the diagnosis and treatment of spinal conditions causing false pain syndromes.

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 The American Association of Neurological Surgeons (AANS), North American Skull Base Society (NASBS), American Rhinologic Society (ARS), and American Neurotology Society (ANS) fellowship directories are important information repositories for skull base surgical fellowship programs. However, there is limited research on the amount and depth of information available through these resources. The objective of the present study is to assess Web site accessibility and information availability for individual fellowship programs listed within the AANS, NASBS, ARS, and ANS fellowship directories.

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Study Design: Survey study.

Objectives: The purpose of this study was to characterize the utility of 3D printed patient specific anatomic models for the planning of complex primary spine tumor surgeries.

Methods: A survey of individual members of an international study group of spinal oncology surgeons was performed.

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Objective: Intramedullary spinal cord lipomas without spinal dysraphism are rare. Although they are benign tumors, they can cause significant neurological deficits. Their tight adherence to the spinal cord presents a challenge for resection.

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Anterior column realignment via anterior, oblique, or lateral lumbar interbody fusion is increasingly recognized as a powerful mechanism for indirect decompression and sagittal realignment in flexible deformity. Single-position lateral surgery is a popular variation that places patients in the lateral decubitus position, allowing concomitant placement of lateral interbodies and posterior segmental instrumentation without the need for repositioning the patient. The addition of robotics to this technique can help to overcome ergonomic limitations of the placement of pedicle screws in the lateral decubitus position; however, its description in the literature is relatively lacking.

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Article Synopsis
  • This study aimed to assess how different osteoporosis medications affect bone density, measured in Hounsfield units (HU), among spine and nonspine surgery patients.
  • A total of 318 patients participated, with significant improvements in HU observed in those treated with romosozumab for about 10.5 months and teriparatide for more than 23 months.
  • The findings suggest that romosozumab is a strong option for enhancing bone density efficiently before elective spine fusion surgery, compared to other treatments.
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Adult degenerative scoliosis (ADS) is a coronal plane deformity often accompanied by sagittal plane malalignment. Surgical correction may involve the major and/or distally-located fractional curves (FCs). Correction of the FC has been increasingly recognized as key to ameliorating radicular pain localized to the FC levels.

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  • Tranexamic acid (TXA) is a medicine used during spine surgery to help reduce blood loss and the need for blood transfusions.
  • Researchers looked at many studies to compare different ways of using TXA during a specific type of back surgery.
  • They found that using TXA in different ways didn't make a big difference in surgery time or blood loss, suggesting all methods are pretty similar.
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  • Vagal neuropathy can occur after the placement of a vagal nerve stimulator (VNS), leading to vocal fold palsy, which is rare.
  • A case is highlighted where delayed nerve compression from the VNS coil caused progressive hoarseness and vocal cord paralysis.
  • To address the issue, coil removal and nerve decompression were performed, and larger coils were used for ongoing treatment to minimize the risk of similar complications in the future.
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Background: Spinal hemangioblastomas are often evaluated with catheter angiography for both workup and treatment planning. We report a unique longitudinal pulse-synchronous bouncing phenomenon observed during their angiographic evaluation and consider the association of pulse-synchronous bouncing with syringomyelia, another pathologic feature associated with hemangioblastomas.

Methods: Preoperative spinal angiograms and associated magnetic resonance imagings (MRIs) obtained over a 16-year period at a single institution were retrospectively evaluated.

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Article Synopsis
  • - The study investigated the safety of ventriculoperitoneal shunt placement in older patients with idiopathic normal pressure hydrocephalus (iNPH) who were either on anticoagulation therapy or not.
  • - Out of 234 patients reviewed, those on anticoagulants experienced a higher incidence of tract hemorrhage post-surgery (11.1% vs. 2.5%), but rates of other hemorrhagic complications were similar across both groups.
  • - The findings highlight the common use of anticoagulants in the iNPH patient population and suggest careful monitoring may be necessary for those undergoing shunt placement.
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Multisegmental pathologic autofusion occurs in patients with ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH). It may lead to reduced vertebral bone density due to stress shielding. This study aimed to determine the effects of autofusion on bone density by measuring Hounsfield units (HU) in the mobile and immobile spinal segments of patients with AS and DISH treated at a tertiary care center.

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Objective: To compare the prognostic power of Hounsfield units (HU) and Vertebral Bone Quality (VBQ) score for predicting proximal junctional kyphosis (PJK) following long-segment thoracolumbar fusion to the upper thoracic spine (T1-T6).

Methods: Vertebral bone quality around the upper instrumented vertebrae (UIV) was measured using HU on preoperative CT and VBQ on preoperative MRI. Spinopelvic parameters were also categorized according to the Scoliosis Research Society-Schwab classification.

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Objective: To analyze the extant literature describing the application of gene therapy to spinal fusion.

Methods: A systematic review of the English-language literature was performed. The search query was designed to include all published studies examining gene therapy approaches to promote spinal fusion.

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Article Synopsis
  • The study investigates the use of machine learning algorithms to predict postoperative range of motion (ROM) and determine ideal implant sizes for cervical disk arthroplasty (CDA) to enhance patient outcomes.
  • Data was collected from 47 patients who had CDA, with factors such as demographics, disk heights, and outcomes analyzed using various machine learning models.
  • The results indicated that the highest-performing model (k-nearest neighbors) yielded an average error of 7.6° in predicting ROM, with optimal implant size identified as 110% of the normal adjacent disk height, highlighting graft size as the most critical factor influencing ROM.
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Introduction: Interspinous devices (ISDs) and interlaminar devices (ILDs) are marketed as alternatives to conventional surgery for degenerative lumbar conditions; comparisons with decompression alone are limited. The present study reviews the extant literature comparing the cost and effectiveness of ISDs/ILDs with decompression alone.

Methods: Articles comparing decompression alone with ISD/ILD were identified; outcomes of interest included general and disease-specific patient-reported outcomes, perioperative complications, and total treatment costs.

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Background: Adult spinal deformity (ASD) occurs from progressive anterior column collapse due to disc space desiccation, compression fractures, and autofusion across disc spaces. Anterior column realignment (ACR) is increasingly recognized as a powerful tool to address ASD by progressively lengthening the anterior column through the release of the anterior longitudinal ligament during lateral interbody approaches. Here, we describe the application of minimally invasive ACR through an oblique antepsoas corridor for deformity correction in a patient with adult degenerative scoliosis and significant sagittal imbalance.

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 Meningiomas-the most common extra-axial tumors-are benign, slow-growing dural-based lesions that can involve multiple cranial fossae and can progress insidiously for years until coming to clinical attention secondary to compression of adjacent neurovascular structures. For complex, multicompartmental lesions, multistaged surgeries have been increasingly shown to enhance maximal safe resection while minimizing adverse sequela. Here, we systematically review the extant literature to highlight the merits of staged resection.

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Background: Long-segment instrumentation, such as Harrington rods, offloads vertebrae within the construct, which may result in significant stress shielding of the fused segments. The present study aimed to determine the effects of spinal fusion on bone density by measuring Hounsfield units (HUs) throughout the spine in patients with a history of Harrington rod fusion.

Methods: Patients with a history of Harrington rod fusion treated at a single academic institution were identified.

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Background: Lumbosacral transitional vertebrae (LSTV) are congenital anomalies of the L5-S1 segments characterized by either sacralization of the most caudal lumbar vertebra or lumbarization of the most cephalad sacral vertebra. This variation in anatomy exposes patients to additional surgical risks.

Methods: In order to shed light on surgical considerations reported for lumbar spine cases involving LSTV as described in the extant literature, we performed a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.

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Spinal robotics have the potential to improve the consistency of outcomes in adult spinal deformity (ASD) surgery. The objective of this paper is to assess the accuracy of pedicle and S2 alar-iliac (S2AI) screws placed with robotic guidance in ASD patients. PubMed Central, Google Scholar, and an institutional library database were queried until May 2023.

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Article Synopsis
  • * A study of 116 patients undergoing PSO found that 44% experienced durotomy, with prior surgical history being a notable predictor, particularly previous decompression at the PSO site.
  • * Patient factors like comorbidities, weight, and BMI didn't significantly differentiate those with and without durotomy, nor did surgeon training or surgical techniques; however, outcomes like hospitalization and reoperation rates were similar for both groups.
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Purpose: Primary osseous neoplasms of the spine, including Ewing's sarcoma, osteosarcoma, chondrosarcoma, and chordoma, are rare tumors with significant morbidity and mortality. The present study aims to identify the prevalence and impact of racial disparities on management and outcomes of patients with these malignancies.

Methods: The 2000 to 2020 Surveillance, Epidemiology, and End Results (SEER) Registry, a cancer registry, was retrospectively reviewed to identify patients with Ewing's sarcoma, osteosarcoma, chondrosarcoma, or chordoma of the vertebral column or sacrum/pelvis.

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