Lawrence G Lenke

Washington University in St. Louis, San Luis, Missouri, United States

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Publications (476)1190.52 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The authors analyzed patients who underwent posterior vertebral column resection (PVCR). All patients had spinal cord monitoring (SCM) attempted but some did not have predictable and usable tracings.
    07/2015; 3(4):352-359. DOI:10.1016/j.jspd.2014.11.009
  • 07/2015; 3(4):327-331. DOI:10.1016/j.jspd.2014.11.008
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    ABSTRACT: Studies have demonstrated sustained improvements in patient-reported outcomes (PROs) following 3-column osteotomies (3-CO), but no study has evaluated what factors impact long-term outcomes. To investigate factors associated with PROs in patients (pts) who underwent 3-CO at a minimum 5 years postoperatively. Retrospective review of prospective database. All pts who had a 3-CO at a single institution and completed clinical evaluations after at least 5 years postoperative were included. Oswestry disability index (ODI), Scoliosis Research Society (SRS) scores, and radiographic parameters were assessed at baseline and a minimum 5 years postoperatively. Analysis of 120 pts who underwent 3-CO (96-pedicle subtraction osteotomy/24-vertebral column resection) was performed. The mean age was 48 years (range 8-79) and clinical follow up was 7 years (range 5-14). Separate multivariable linear regression analyses were performed to determine factors associated with 1) ODI, 2) SRS average, and 3) SRS satisfaction while controlling for time since surgery and baseline outcome scores. Average PROs were significantly improved from baseline at a minimum 5 years follow up (ODI: 48 to 28, p<0.01; SRS: 2.8 to 3.5, p<0.01). The average SRS satisfaction score was 4.0. Average sagittal alignment (C7 plumb) improved 74 mm, with 81% of pts <95mm. Major surgical complications occurred in 32 pts (27%) with major reoperations in 30 pts (25%). Multivariable regression analysis found that prior surgery and major reoperations were risk factors for worse ODI scores. A diagnosis of adult idiopathic scoliosis and final sagittal alignment <95mm were associated with improved SRS scores. Improvement in major coronal cobb and final pelvic tilt <30° were associated with increased SRS satisfaction. With a minimum 5-year follow-up, PROs in patients undergoing 3-CO were associated with improvements in radiographic alignment, but negatively effected by prior surgery and complications necessitating revision surgery. Copyright © 2015 Elsevier Inc. All rights reserved.
    The spine journal: official journal of the North American Spine Society 06/2015; DOI:10.1016/j.spinee.2015.06.044 · 2.80 Impact Factor
  • Samuel K Cho, Yongjung J Kim, Lawrence G Lenke
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    ABSTRACT: Proper understanding and restoration of sagittal balance is critical in spinal deformity surgery, including conditions such as adolescent idiopathic scoliosis and Scheuermann kyphosis. One potential complication following spinal reconstruction is proximal junctional kyphosis. The prevalence of proximal junctional kyphosis varies in the literature, and several patient- and surgery-related risk factors have been identified. To date, the development of proximal junctional kyphosis has not been shown to lead to a negative clinical outcome following spinal fusion for adolescent idiopathic scoliosis or Scheuermann kyphosis. Treatment options range from simple observation in asymptomatic cases to revision surgery with extension of the fusion proximally. Several techniques and technologies are emerging that seek to address and prevent proximal junctional kyphosis. Copyright 2015 by the American Academy of Orthopaedic Surgeons.
    The Journal of the American Academy of Orthopaedic Surgeons 05/2015; DOI:10.5435/JAAOS-D-14-00143 · 2.40 Impact Factor
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    ABSTRACT: Retrospective review of a multicenter database. To evaluate whether surgeon experience is associated with complication rates in adult spinal deformity (ASD) surgery. Multiple patient- and surgery-related factors have been shown to increase the risk of complications in ASD. No study exists evaluating surgeon experience as an associated factor with complications in ASD. The Scoliosis Research Society Morbidity and Mortality database was queried for patients aged >18 years who underwent ASD from 2004-2007. Patient demographics, surgical characteristics, complications and surgeon membership status were analyzed. Two-tailed t-test and chi-square tests were performed with p<0.05 considered significant. A total of 5,117 patients underwent ASD surgery. The average patient age was 51.8 years. Patients operated by candidate members were older than those operated by active members (53.1 versus 51.4, p = 0.003). Active members performed 3,836 (75%) cases while candidate members performed 1,281 cases. There were 1,110 (21.7%) revisions. A total of 681 (13.3%) complications were recorded, 498 (13.0%) for active and 183 (14.3%) for candidate members, respectively (p = 0.24). Mortality rate was 0.29%. Spinal cord complications accounted for 0.68% of all cases. Active members had 21 (0.55%) spinal cord complications, while candidates had 14 (1.1%) (p = 0.049). There were a total of 174 (3.4%) surgical site infections (SSI). Active members had 82 (2.1%) deep SSI, while candidate members had 36 (2.8%) deep SSI (p = 0.164). Active members had 33 (0.9%) superficial SSI while candidate members had 23 (1.8%) superficial SSI (p = 0.008). There was a statistically significant, two-fold increase in the rate of spinal cord complications and superficial SSI among candidate compared to active members. Overall complication rates were similar between candidate and active members.
    Spine 05/2015; DOI:10.1097/BRS.0000000000000993 · 2.45 Impact Factor
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    ABSTRACT: To describe curve patterns in patients with Chiari malformation I (CIM) without syringomyelia, and compare to patients with Chiari malformation with syringomyelia (CIM + SM). Review of medical records from 2000 to 2013 at a single institution was performed to identify CIM patients with scoliosis. Patients with CIM were matched (1:1) by age and gender to CIM + SM. Radiographic curve patterns, MRI-based craniovertebral junction parameters, and associated neurological signs were compared between the two cohorts. Eighteen patients with CIM-associated scoliosis in the absence of syringomyelia were identified; 14 (78 %) were female, with mean age of 11.5 ± 4.5 years. Mean tonsillar descent was 9.9 ± 4.1 mm in the CIM group and 9.1 ± 3.0 mm in the CIM + SM group (p = 0.57). Average syrinx diameter in the CIM + SM group was 9.0 ± 2.7 mm. CIM patients demonstrated less severe scoliotic curves (32.1° vs. 46.1°, p = 0.04), despite comparable thoracic kyphosis (43.7° vs. 49.6°, p = 0.85). Two (11 %) patients with CIM demonstrated thoracic apex left deformities compared to 9/18 (50 %) in the CIM + SM cohort (p = 0.01). Neurological abnormalities were only observed in the group with syringomyelia (6/18, or 33 %; p = 0.007). In the largest series specifically evaluating CIM and scoliosis, we found that these patients appear to present with fewer atypical curve features, with less severe scoliotic curves, fewer apex left curves, and fewer related neurological abnormalities than CIM + SM. Notably, equivalent thoracic kyphosis was observed in both groups. Future studies are needed to better understand pathogenesis of spinal deformity in CIM with and without SM.
    European Spine Journal 05/2015; DOI:10.1007/s00586-015-4011-1 · 2.47 Impact Factor
  • 05/2015; 05(S 01). DOI:10.1055/s-0035-1554156
  • 05/2015; 05(S 01). DOI:10.1055/s-0035-1554345
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    ABSTRACT: Chiari Malformation, Type 1, with syringomyelia (CIM+SM) is often associated with spinal deformity. The safety of scoliosis surgery this population is controversial, and has never been directly compared with adolescent idiopathic scoliosis (AIS). Compare the safety and subjective outcomes of spinal deformity surgery between patients with Chiari Malformation I associated scoliosis and a matched Adolescent Idiopathic Scoliosis cohort. Retrospective matched cohort analysis PATIENT SAMPLE: Patients with CIM+SM and treated with spinal fusion for spinal deformity were identified in the surgical records of a single institution and were matched, 1:1, with AIS patients undergoing spinal fusion at the same institution. Neurological monitoring data quality and integrity, radiographic parameters, Scoliosis Research Society-22 Scores. A clinical database was reviewed for patients undergoing spinal reconstruction for CIM+SM associated spinal deformity at our institution from 2000 to 2012. Thirty-six CIM+SM patients were identified and matched to an AIS cohort (1:1) based on age, gender, major curve magnitude, fusion length, and revision status. Demographics, deformity morphology, surgical details, neuromonitoring data, and pre- and postoperative SRS-22 scores were recorded at a minimum 2-year followup. Changes in SRS-22 scores were compared within and between groups. Complications and neurological monitoring data issues were compared between groups. Mean age was 14.5±5 years (CIM+SM: 14.6±5; AIS: 14.4±5), and 42% of patients were male. Preoperative mean major coronal Cobb measured 58°±25 vs. 57°±17 (p=0.84) with mean kyphosis 52°±17 vs. 41°±20 (p=0.018). An average of 10.4±2.6 vertebral levels were fused (10.4±2.8 vs. 10.4±2.3, p=0.928). No differences existed in surgical approach (p=0.336), estimated blood loss (680mL±720 vs. 660±310, p=0.845), or duration of surgery (6.0 hours ±2.2 vs. 5.6 ± 2, p=0.434). Complication rate was comparable between the two groups (33% vs. 14%, p=0.052). CIM+SM experienced more neurological complications (11% vs. 0%, p=0.04) and neuromonitoring difficulties (28% vs. 3%, p=0.007) than the AIS cohort. Mean curve correction was comparable at 2 years (58% CIM+SM vs. 64% AIS, p=0.2). At follow-up, both CIM+SM and AIS groups demonstrated improved cumulative SRS-22 outcome subscores (CIM+SM: +0.4, p=0.027; AIS: +0.3, p<0.001). No difference in outcome subscores existed between CIM+SM and AIS groups. While CIM+SM patients undergoing spine reconstruction can expect similar deformity corrections and outcomes scores to AIS patients, they also experience higher rates of neuromonitoring difficulties and neurological complications related to surgery. Surgeons should be prepared for these difficulties, particularly in children with larger syrinx size. Copyright © 2015 Elsevier Inc. All rights reserved.
    The spine journal: official journal of the North American Spine Society 05/2015; DOI:10.1016/j.spinee.2015.04.048 · 2.80 Impact Factor
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    ABSTRACT: Longitudinal cohort. To evaluate the relationship between Scoliosis Research Society-22R (SRS22-R) domains and satisfaction with management in patients who underwent surgical correction for adult spine deformity. The SRS-22R is used to measure clinical outcomes in adult spine deformity patients. The relationship between patient satisfaction and SRS-22R domain scores, the Oswestry Disability Index (ODI) and radiographic parameters has not been reported at 5-year follow-up. One hundred thirty five patients with adult spinal deformity at a single institution who underwent a posterior spinal fusion of 5 levels or more to the sacrum and had complete SRS-22R pre- and minimum 5 years post-op were identified. Wilcoxon tests were used to compare preop and 5-year postop scores. Spearman correlations were used to evaluate associations between the 5-year SRS-22R Satisfaction score and changes in SRS-22R domain scores, SubScore (SRS-22R Total - Satisfaction), ODI, and radiographic parameters. There were 125 females and 10 males with a mean BMI of 26.6 kg/m2 and mean age of 53.6 years. There were 74 primary and 61 revision surgeries with a mean 9.9 levels fused and mean follow-up of 67 months. There was a statistically significant improvement between paired pre- and 5-year post-op SRS-22R domain scores and most radiographic parameters, commonly p ≤ 0.001. The majority of patients had an SRS-22R Satisfaction score of ≥ 3.0 (88%) or ≥ 4.0 (67%), consistent with a moderate ceiling effect. Correlations for SRS-22R domain scores were all statistically significant and either weak (Mental (0.26), Activity (0.27), Pain (0.35)) or moderate (Appearance (0.59)). SRS-22R SubScore (0.54) and ODI (0.43) also had a moderate correlation. Correlations for all radiographic and operative parameters were either very weak or weak. SRS-22R Appearance, SubScore, and ODI correlate most with patient satisfaction in adult deformity patients undergoing ≥ 5 level fusion to the sacrum at 5-year follow-up.
    Spine 04/2015; 14(11). DOI:10.1097/BRS.0000000000000961 · 2.45 Impact Factor
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    ABSTRACT: Retrospective radiographic benchmark study.
    03/2015; 3(2). DOI:10.1016/j.jspd.2014.09.048
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    ABSTRACT: Retrospective case series.
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    ABSTRACT: Study Design. Retrospective study.Objective. To evaluate long-term effectiveness of central hook-rod constructs for posterior spinal osteotomy closure.Summary of Background Data. During osteotomy site closure various techniques are used, including patient positioning, rod cantilevering, extending fixation points and compressing through pedicle fixation points. All add premature stress on fixation points and may lead to loosening/eventual fixation failure. To avoid this, we often use a central compression hook-rod construct for osteotomy closure.Methods. 56 consecutive patients with fixed sagittal imbalance were treated with multilevel posterior column osteotomies (N = 19); pedicle subtraction osteotomy (N = 31); or vertebral column resection (N = 6). All 56 patients had osteotomy closure utilizing central compression hook-rod constructs and were analyzed at ≥5-year follow-up. Compression hooks were inserted into the fusion mass or lamina above/below the osteotomy and centrally attached to a short rod connected to pedicle screw-based rods via a crosslink. Diagnoses included sagittal imbalance associated with scoliosis (N = 39), degenerative sagittal imbalance (N = 14), ankylosing spondylitis (N = 2), and Scheuermann's kyphosis (N = 1). There were 55 revision cases and 1 primary. Radiographic/clinical analysis was performed to evaluate the efficacy/complications of this technique.Results. Overall lumbar lordosis increased an average 31.7° and local lordosis through the osteotomy site increased an average of 29.3°. Sagittal balance improved by an average 92 mm. In all cases, osteotomy closures were performed without screw loosening or loss of correction intraoperatively. At ≥5-year follow-up, no failures of the hook-rod construct were seen, but there were 3 patients with partial implant failure, however no symptomatic pseudarthroses at the osteotomy sites occurred. Seven patients developed pseudarthrosis below the construct.Conclusion. A central hook-rod construct is safe, controlled and effective for applying compressive forces to close various spinal osteotomies without fixation failure or pseudarthrosis at the osteotomy site noted at ≥5-year follow-up. It adds fixation strength to the overall construct avoiding undue stress on pedicle screws.
    Spine 01/2015; 40(7). DOI:10.1097/BRS.0000000000000783 · 2.45 Impact Factor
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    ABSTRACT: The literature regarding pulmonary function in adult patients with spinal deformity is limited, and the effect of spinal deformity surgery on pulmonary function has not been clearly understood. We hypothesized that adult patients with spinal deformity who had preoperative pulmonary impairment (a percent-predicted value of <65% forced expiratory volume in one second [FEV1] as measured by pulmonary function test) or who were undergoing revision surgery may be at risk for exacerbated decline in pulmonary function. Pulmonary function test results were prospectively collected for 164 adult patients with spinal deformity (mean age, 45.9 years) who underwent surgical treatment at a single institution and were followed for a minimum of two years (mean, 2.8 years). One hundred (61%) of the patients underwent primary surgery, and sixty-four (39%) of the patients had revision surgery. For the majority of patients (77%), a posterior-only surgical approach was used. Radiographs for 154 patients were analyzed for major thoracic and sagittal T5-T12 curve magnitude/correction. For all patients, we noted a significant change in major thoracic Cobb angle, from a mean of 47.4° to 24.9°(p < 0.001), and in sagittal Cobb angle, from a mean of 35.5° to 30.0°(p < 0.001), as well as a significant decline in absolute and percent-predicted pulmonary function values, with percent-predicted FEV1 and percent-predicted forced vital capacity (FVC) decreasing 5.3% (p < 0.001) and 5.7% (p < 0.001), respectively. A clinically significant decline (a decline of ≥10% in percent-predicted FEV1) was observed in 27% of the patients. The number of patients with pulmonary impairment increased nonsignificantly from seventeen (10%) preoperatively to twenty-three (14%) after surgery (p = 0.31). Patients with preoperative pulmonary impairment demonstrated a significant improvement in absolute and percent-predicted FEV1 after surgery compared with those without preoperative impairment (2.7% compared with -6.2%; p < 0.001). Patients who underwent revision surgery did not differ from primary surgery patients in terms of postoperative percent-predicted results. However, revision surgery more frequently resulted in a significant decline in pulmonary function (twenty-three patients [36%] compared with twenty-two [22%]; p = 0.05). There was no difference in pulmonary function when comparing surgical approaches (anterior/combined anterior-posterior or posterior-only) or when comparing results by upper-instrumented vertebra (UIV). We found a significant decline in absolute and percent-predicted results of pulmonary function tests following surgical correction for spinal deformity in adults. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.
    The Journal of Bone and Joint Surgery 01/2015; 97(1):32-39. DOI:10.2106/JBJS.N.00408 · 4.31 Impact Factor
  • The Spine Journal 11/2014; 14(11):S56. DOI:10.1016/j.spinee.2014.08.147 · 2.80 Impact Factor
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    ABSTRACT: Retrospective matched-cohort comparative study.
    Spine 10/2014; 39(22):1899-1904. DOI:10.1097/BRS.0000000000000556 · 2.45 Impact Factor

Publication Stats

14k Citations
1,190.52 Total Impact Points

Institutions

  • 1992–2015
    • Washington University in St. Louis
      • • Department of Orthopaedic Surgery
      • • Department of Anesthesiology
      San Luis, Missouri, United States
  • 1995–2014
    • Barnes Jewish Hospital
      San Luis, Missouri, United States
  • 2012
    • University of California, Los Angeles
      • Department of Orthopaedic Surgery
      Los Angeles, CA, United States
    • University of British Columbia - Vancouver
      • Department of Orthopaedics
      Vancouver, British Columbia, Canada
  • 2010
    • University of Washington Seattle
      Seattle, Washington, United States
  • 2008–2010
    • Saint Louis University
      • Department of Orthopaedic Surgery
      Сент-Луис, Michigan, United States
    • Chungnam National University
      • Department of Orthopaedic Surgery
      Daiden, Daejeon, South Korea
  • 2009
    • Shriners Hospitals for Children
      Tampa, Florida, United States
    • Keio University
      Edo, Tōkyō, Japan
    • Rady Children's Hospital
      San Diego, California, United States
  • 2005–2008
    • University of California, San Diego
      • Department of Orthopaedic Surgery
      San Diego, CA, United States
    • Inha University
      Chemulpo, Incheon, South Korea
    • California State University, Sacramento
      Sacramento, California, United States
  • 2002–2008
    • Walter Reed National Military Medical Center
      • • Department of Orthopaedics and Rehabilitation
      • • Division of Orthopaedic Surgery
      Washington, Washington, D.C., United States
    • University of Missouri
      • Department of Orthopaedic Surgery
      Columbia, MO, United States
    • Madigan Army Medical Center
      Tacoma, Washington, United States
  • 2007
    • Wooridul Spine Hospital Group
      Sŏul, Seoul, South Korea
  • 2006
    • University of Utah
      Salt Lake City, Utah, United States
  • 2003
    • Loyola University Chicago
      Chicago, Illinois, United States
  • 2000
    • Children's Hospital of Richmond
      Ричмонд, Virginia, United States
  • 1998
    • The Ohio State University
      Columbus, Ohio, United States
  • 1993
    • Johns Hopkins Medicine
      • Department of Neurology
      Baltimore, MD, United States