Roger Härtl

Harvard University, Cambridge, Massachusetts, United States

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Publications (104)239.75 Total impact

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    ABSTRACT: To optimize intraoperative neuromonitoring during extreme lateral interbody fusion (XLIF) by adding transcranial electrical stimulation with motor evoked potential (TESMEP) to previously described monitoring using spontaneous EMG (sEMG) and peripheral stimulation (triggered EMG: tEMG). Twenty-three patients with degenerative lumbar scoliosis had XLIF procedures and were monitored using sEMG, tEMG and TESMEP. Spontaneous and triggered muscle activity, and the MEP of 5 ipsilateral leg muscles, 2 contralateral leg muscles and 1 arm muscle were monitored. During XLIF surgery decreased MEP amplitudes were measured in 9 patients and in 6 patients sEMG was documented. In 4 patients, both events were described. In 30 % of the cases (n = 7), the MEP amplitude decreased immediately after breaking of the table and even before skin incision. After reduction of the table break, the MEP amplitudes recovered to baseline. In two patients, the MEP amplitude deteriorated during distraction of the psoas with the retractor, while no events were reported using sEMG and tEMG. Repositioning of the retractor led to recovery of the MEP. Monitoring the complete nervous system during an XLIF procedure is found to be helpful since nerve roots, lumbar plexus as well as the intradural neural structures may be at risk. TESMEP has additional value to sEMG and tEMG during XLIF procedure: (1) it informed about otherwise unnoticed events, and (2) it confirmed and added information to events measured using sEMG.
    European Spine Journal 08/2015; DOI:10.1007/s00586-015-4182-9 · 2.07 Impact Factor
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    ABSTRACT: Open annular defects compromise the ability of the annulus fibrosus to contain nuclear tissue in the disc space, and therefore lead to disc herniation with subsequent degenerative changes to the entire intervertebral disc. This study reports the use of riboflavin crosslinked high-density collagen gel for the repair of annular defects in a needle-punctured rat-tail model. High-density collagen has increased stiffness and greater hydraulic permeability than conventional low-density gels; riboflavin crosslinking further increases these properties. This study found that treating annular defects with crosslinked high-density collagen inhibited the progression of disc degeneration over 18 weeks compared to untreated control discs. Histological sections of FITC-labeled collagen gel revealed an early tight attachment to host annular tissue. The gel was subsequently infiltrated by host fibroblasts which remodeled it into a fibrous cap that bridged the outer disrupted annular fibers and partially repaired the defect. This repair tissue enhanced retention of nucleus pulposus tissue, maintained physiological disc hydration, and preserved hydraulic permeability, according to MRI, histological, and mechanical assessments. Degenerative changes were partially reversed in treated discs, as indicated by an increase in nucleus pulposus size and hydration between weeks 5 and 18. The collagen gel appeared to work as an instant sealant and by enhancing the intrinsic healing capabilities of the host tissue. Copyright © 2015. Published by Elsevier Ltd.
    Acta biomaterialia 06/2015; 26. DOI:10.1016/j.actbio.2015.06.006 · 6.03 Impact Factor
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    ABSTRACT: Study Design Retrospective case series. Objective StaXx XD (Spine Wave, Inc., Shelton, CT, United States) is an expandable polyaryl-ether-ether-ketone (PEEK) wafer implant utilized in the treatment of lumbar degenerative disease. PEEK implants have been successfully used as interbody devices. Few studies have focused on expandable PEEK devices. The aim of the current study is to determine the radiographic and clinical outcome of expandable PEEK cages utilized for transforaminal lumbar interbody fusion in patients with lumbar degenerative diseases. Methods Forty-nine patients who underwent lumbar interbody fusion with implantation of expandable PEEK cages and posterior instrumentation were included. The clinical outcome was evaluated using the visual analog scale (VAS) and the Oswestry Disability Index (ODI). Radiographic parameters including disk height, foraminal height, listhesis, local disk angle of the index level/levels, regional lumbar lordosis, and graft subsidence were measured preoperatively, postoperatively, and at latest follow-up. Results At an average follow-up of 19.3 months, the minimum clinically important difference for the ODI and VAS back, buttock, and leg were achieved in 64, 52, 58, and 52% of the patients, respectively. There was statistically significant improvement in VAS back (6.42 versus 3.11, p < 0.001), VAS buttock (4.66 versus 1.97, p = 0.002), VAS leg (4.55 versus 1.96, p < 0.001), and ODI (21.7 versus 12.1, p < 0.001) scores. There was a significant increase in the average disk height (6.49 versus 8.18 mm, p = 0.037) and foraminal height (15.6 versus 18.53 mm, p = 0.0001), and a significant reduction in the listhesis (5.13 versus 3.15 mm, p = 0.005). The subsidence of 0.66 mm (7.4%) observed at the latest follow-up was not significant (p = 0.35). Conclusions Midterm results indicate that expandable PEEK spacers can effectively and durably restore disk and foraminal height and improve the outcome without significant subsidence.
    Global Spine Journal 06/2015; 5(3):169-78. DOI:10.1055/s-0035-1552988

  • Global Spine Journal 05/2015; 05(S 01). DOI:10.1055/s-0035-1554378

  • Global Spine Journal 05/2015; 05(S 01). DOI:10.1055/s-0035-1554151

  • Global Spine Journal 05/2015; 05(S 01). DOI:10.1055/s-0035-1554411

  • Global Spine Journal 05/2015; 05(S 01). DOI:10.1055/s-0035-1554225

  • Global Spine Journal 05/2015; 05(S 01). DOI:10.1055/s-0035-1554155
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    ABSTRACT: Asymmetric loss of disc height in adult deformity patients may lead to unilateral vertical foraminal stenosis and radiculopathy. The current study aimed to investigate whether restoration of foraminal height on the symptomatic side using extreme lateral interbody fusion (XLIF) would alleviate unilateral radiculopathy. In a retrospective study, patients with single-level unilateral vertical foraminal stenosis and corresponding radicular pain undergoing XLIF were included. Functional data (visual analog scale (VAS) for buttock, leg and back, as well as Oswestry Disability Index (ODI)) and radiographic measurements (bilateral foraminal height, disc height, segmental coronal Cobb angle and regional lumbar lordosis) were collected preoperatively, postoperatively and at the last follow-up. Twenty-three patients were included, among whom 61 % had degenerative scoliosis. History of previous surgery at the level of index was present in 43 % of patients. Additional instrumentation was performed in 91 %. The foraminal height on the stenotic side was significantly increased postoperatively (p < 0.001), and remained significantly increased at the last follow-up of 11 ± 3.7 months (p < 0.001). Additionally, VAS buttock and leg on the stenotic side, VAS back and ODI were significantly improved postoperatively and at the last follow-up (p ≤ 0.001 for all parameters). The foraminal height on the stenotic side showed correlation with the VAS leg on the stenotic side, both postoperatively and the last follow-up (r = -0.590; p = 0.013, and r = -0.537; p = 0.022, respectively). Single-level XLIF is an effective procedure for treatment of symptomatic unilateral foraminal stenosis leading to radiculopathy. In deformity patients with radicular pain caused by nerve compression at a single level, when not associated with other symptoms attributable to general scoliosis, treatment with single-level XLIF can result in short- and mid-term satisfactory outcome.
    European Spine Journal 04/2015; 24(S3). DOI:10.1007/s00586-015-3940-z · 2.07 Impact Factor
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    ABSTRACT: Object: The endoscopic endonasal approach (EEA) provides a minimally invasive corridor through which the cervicomedullary junction can be decompressed with reduced morbidity rates compared to those with the classic transoral approaches. The limit of the EEA is its inferior extent, and preoperative estimation of its reach is vital for determining its suitability. The aim of this study was to evaluate the actual inferior limit of the EEA in a surgical series of patients and develop an accurate and reliable predictor that can be used in planning endonasal odontoidectomies. Methods: The actual inferior extent of surgery was determined in a series of 6 patients with adequate preoperative and postoperative imaging who underwent endoscopie endonasal odontoidectomy. The medians of the differences between several previously described predictive lines, namely the nasopalatine line (NPL) and nasoaxial line (NAxL), were compared with the actual surgical limit and the hard-palate line by using nonparametric statistics. A novel line, called the rhinopalatine line (RPL), was established and corresponded best with the actual limit of the surgery. Results: There were 4 adult and 2 pediatric patients included in this study. The NPL overestimated the inferior extent of the surgery by an average (± SD) of 21.9 ± 8.1 mm (range 14.7-32.5 mm). The NAxL and RPL overestimated the inferior limit of surgery by averages of 6.9 ± 3.8 mm (range 3.7-13.3 mm) and 1.7 ± 3.7 mm (range -2.8 to 8.3 mm), respectively. The medians of the differences between the NPL and NAxL and the actual surgery were statistically different (both p = 0.0313). In contrast, there was no statistically significant difference between the RPL and the inferior limit of surgery (p = 0.4375). Conclusions: The RPL predicted the inferior limit of the EEA to the craniovertebral junction more accurately than previously described lines. The use of the RPL may help surgeons in choosing suitable candidates for the EEA and in selecting those for whom surgery through the oropharynx or the facial bones is the better approach.
    Neurosurgical FOCUS 04/2015; 38(4):E16. DOI:10.3171/2015.1.FOCUS14777 · 2.11 Impact Factor
  • Roger Haertl · Marjan Alimi ·

    Journal of Neurosurgery Spine 04/2015; 22(4):338-338. · 2.38 Impact Factor
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    Arvind von Keudell · Marjan Alimi · Harry Gebhard · Roger Härtl ·
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    ABSTRACT: We report the case of a 73-year-old female with severe degenerative scoliosis and back and leg pain that was successfully treated with stand- alone cages via an extreme lateral transpsoas approach. This patient had declined open surgery and instrumentation due to her advanced age concerns about potential side effects.
    04/2015; 3(2):124-9.
  • Halinder S. Mangat · Roger Härtl ·
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    ABSTRACT: Hyperosmolar agents are commonly used as an initial treatment for the management of raised intracranial pressure (ICP) after severe traumatic brain injury (TBI). They have an excellent adverse-effect profile compared to other therapies, such as hyperventilation and barbiturates, which carry the risk of reducing cerebral perfusion. The hyperosmolar agent mannitol has been used for several decades to reduce raised ICP, and there is accumulating evidence from pilot studies suggesting beneficial effects of hypertonic saline (HTS) for similar purposes. An ideal therapeutic agent for ICP reduction should reduce ICP while maintaining cerebral perfusion (pressure). While mannitol can cause dehydration over time, HTS helps maintain normovolemia and cerebral perfusion, a finding that has led to a large amount of pilot data being published on the benefits of HTS, albeit in small cohorts. Prophylactic therapy is not recommended with mannitol, although it may be beneficial with HTS. To date, no large clinical trial has been performed to directly compare the two agents. The best current evidence suggests that mannitol is effective in reducing ICP in the management of traumatic intracranial hypertension and carries mortality benefit compared to barbiturates. Current evidence regarding the use of HTS in severe TBI is limited to smaller studies, which illustrate a benefit in ICP reduction and perhaps mortality. © 2015 New York Academy of Sciences.
    Annals of the New York Academy of Sciences 02/2015; 1345(1). DOI:10.1111/nyas.12704 · 4.38 Impact Factor
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    ABSTRACT: Object: Surgical decompression is the intervention of choice for lumbar spinal stenosis (LSS) when nonoperative treatment has failed. Standard open laminectomy is an effective procedure, but minimally invasive laminectomy through tubular retractors is an alternative. The aim of this retrospective case series was to evaluate the clinical and radiographic outcomes of this procedure in patients who underwent LSS and to compare outcomes in patients with and without preoperative spondylolisthesis. Methods: Patients with LSS without spondylolisthesis and with stable Grade I spondylolisthesis who had undergone minimally invasive tubular laminectomy between 2004 and 2011 were included in this analysis. Demographic, perioperative, and radiographic data were collected. Clinical outcome was evaluated using the Oswestry Disability Index (ODI) and visual analog scale (VAS) scores, as well as Macnab's criteria. Results: Among 110 patients, preoperative spondylolisthesis at the level of spinal stenosis was present in 52.5%. At a mean follow-up of 28.8 months, scoring revealed a median improvement of 16% on the ODI, 2.75 on the VAS back, and 3 on the VAS leg, compared with the preoperative baseline (p < 0.0001). The reoperation rate requiring fusion at the same level was 3.5%. Patients with and without preoperative spondylolisthesis had no significant differences in their clinical outcome or reoperation rate. Conclusions: Minimally invasive laminectomy is an effective procedure for the treatment of LSS. Reoperation rates for instability are lower than those reported after open laminectomy. Functional improvement is similar in patients with and without preoperative spondylolisthesis. This procedure can be an alternative to open laminectomy. Routine fusion may not be indicated in all patients with LSS and spondylolisthesis.
    Global Spine Journal 01/2015; 04(S 01):1-14. DOI:10.3171/2014.11.SPINE13597
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    ABSTRACT: A herniated intervertebral disc often causes back pain when disc tissue is displaced through a damaged annulus fibrosus. Currently the only methods available for annulus fibrosus repair involve mechanical closure of defect, which does little to address biological healing in the damaged tissue. Collagen hydrogels are injectable and have been used to repair annulus defects in vivo. In this study, high-density collagen hydrogels at 5, 10 and 15 mg/ml were used to repair defects made to intact rat caudal intervertebral discs in vitro. A group of gels at 15 mg/ml were also crosslinked with riboflavin at 0.03 mM, 0.07 mM or 0.10 mM. These crosslinked, high-density collagen gels maintained presence in the defect under loading and contributed positively to the mechanical response of damaged discs. Discs exhibited increases to 95% of undamaged effective equilibrium and instantaneous moduli as well as up to four fold decreases in effective hydraulic permeability from the damaged discs. These data suggest that high density collagen gels may be effective at restoring mechanical function of injured discs as well as potential vehicles for delivery of biological agents such as cells or growth factors that may aid in the repair of the annulus fibrosus. This article is protected by copyright. All rights reserved.
    Journal of Biomedical Materials Research Part A 12/2014; 103(8). DOI:10.1002/jbm.a.35388 · 3.37 Impact Factor
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    ABSTRACT: Object: Increased intracranial pressure (ICP) in patients with traumatic brain injury (TBI) is associated with a higher mortality rate and poor outcome. Mannitol and hypertonic saline (HTS) have both been used to treat high ICP, but it is unclear which one is more effective. Here, the authors compare the effect of mannitol versus HTS on lowering the cumulative and daily ICP burdens after severe TBI. Methods: The Brain Trauma Foundation TBI-trac New York State database was used for this retrospective study. Patients with severe TBI and intracranial hypertension who received only 1 type of hyperosmotic agent, mannitol or HTS, were included. Patients in the 2 groups were individually matched for Glasgow Coma Scale score (GCS), pupillary reactivity, craniotomy, occurrence of hypotension on Day 1, and the day of ICP monitor insertion. Patients with missing or erroneous data were excluded. Cumulative and daily ICP burdens were used as primary outcome measures. The cumulative ICP burden was defined as the total number of days with an ICP of > 25 mm Hg, expressed as a percentage of the total number of days of ICP monitoring. The daily ICP burden was calculated as the mean daily duration of an ICP of > 25 mm Hg, expressed as the number of hours per day. The numbers of intensive care unit (ICU) days, numbers of days with ICP monitoring, and 2-week mortality rates were also compared between the groups. A 2-sample t-test or chi-square test was used to compare independent samples. The Wilcoxon signed-rank or Cochran-Mantel-Haenszel test was used for comparing matched samples. Results: A total of 35 patients who received only HTS and 477 who received only mannitol after severe TBI were identified. Eight patients in the HTS group were excluded because of erroneous or missing data, and 2 other patients did not have matches in the mannitol group. The remaining 25 patients were matched 1:1. Twenty-four patients received 3% HTS, and 1 received 23.4% HTS as bolus therapy. All 25 patients in the mannitol group received 20% mannitol. The mean cumulative ICP burden (15.52% [HTS] vs 36.5% [mannitol]; p = 0.003) and the mean (± SD) daily ICP burden (0.3 ± 0.6 hours/day [HTS] vs 1.3 ± 1.3 hours/day [mannitol]; p = 0.001) were significantly lower in the HTS group. The mean (± SD) number of ICU days was significantly lower in the HTS group than in the mannitol group (8.5 ± 2.1 vs 9.8 ± 0.6, respectively; p = 0.004), whereas there was no difference in the numbers of days of ICP monitoring (p = 0.09). There were no significant differences between the cumulative median doses of HTS and mannitol (p = 0.19). The 2-week mortality rate was lower in the HTS group, but the difference was not statistically significant (p = 0.56). Conclusions: HTS given as bolus therapy was more effective than mannitol in lowering the cumulative and daily ICP burdens after severe TBI. Patients in the HTS group had significantly lower number of ICU days. The 2-week mortality rates were not statistically different between the 2 groups.
    Journal of Neurosurgery 11/2014; 122(1):1-9. DOI:10.3171/2014.10.JNS132545 · 3.74 Impact Factor
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    ABSTRACT: Object: The gold-standard surgical approach to the odontoid is via the transoral route. This approach necessitates opening of the oropharynx and is associated with risks of infection, and swallowing and breathing complications. The endoscopic endonasal approach has the potential to reduce these complications as the oral cavity is avoided. There are fewer than 25 such cases reported to date. The authors present a consecutive, single-institution series of 9 patients who underwent the endonasal endoscopic approach to the odontoid. Methods: The charts of 9 patients who underwent endonasal endoscopic surgery to the odontoid between January 2005 and August 2013 were reviewed. The clinical presentation, radiographic findings, surgical management, complications, and outcome, particularly with respect to time to extubation and feeding, were analyzed. Radiographic measurements of the distance between the back of the odontoid and the front of the cervicomedullary junction (CMJ) were calculated, as well as the location of any residual bone fragments. Results: There were 7 adult and 2 pediatric patients in this series. The mean age of the adults was 54.8 years; the pediatric patients were 7 and 14 years. There were 5 females and 4 males. The mean follow-up was 42.9 months. Symptoms were resolved or improved in all but 1 patient, who had concurrent polyneuropathy. The distance between the odontoid and CMJ increased by 2.34 ± 0.43 mm (p = 0.03). A small, clinically insignificant fragment remained after surgery, always on the left side, in 57% of patients. Mean times to extubation and oral feeding were on postoperative Days 0.3 and 1, respectively. There was one posterior cervical wound infection; there were 2 cases of epistaxis requiring repacking of the nose and no instances of breathing or swallowing complications or velopharyngeal insufficiency. Conclusions: This series of 9 cases of endonasal endoscopic odontoidectomy highlights the advantages of the approach in permitting early extubation and early feeding and minimizing complications compared with transoral surgery. Special attention must be given to bone on the left side of the odontoid if the surgeon is standing on the right side.
    Journal of Neurological Surgery, Part B: Skull Base 10/2014; 122(3):1-8. DOI:10.3171/2014.9.JNS14733 · 0.72 Impact Factor
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    ABSTRACT: Object: Anterior cervical plating decreases the risk of pseudarthrosis following anterior cervical discectomy and fusion (ACDF). Dysphagia is a common complication of ACDF, with the anterior plate implicated as a potential contributor. A zero-profile, stand-alone polyetheretherketone (PEEK) interbody spacer has been postulated to minimize soft-tissue irritation and postoperative dysphagia, but studies are limited. The object of the present study was to determine the clinical and radiological outcomes for patients who underwent ACDF using a zero-profile integrated plate and spacer device, with a focus on the course of postoperative prevertebral soft-tissue thickness and the incidence of dysphagia. Methods: Using a surgical database, the authors conducted a retrospective analysis of all patients who had undergone ACDF between August 2008 and October 2011. All patients received a Zero-P implant (DePuy Synthes Spine). The Neck Disability Index (NDI) and visual analog scale (VAS) scores for arm and neck pain were documented. Dysphagia was determined using the Bazaz criteria. Prevertebral soft-tissue thickness, spinal alignment, and subsidence were assessed as well. Results: Twenty-two male and 19 female consecutive patients, with a mean age of 58.4 ± 14.68, underwent ACDF (66 total operated levels) in the defined study period. The mean clinical follow-up in 36 patients was 18.6 ± 9.93 months. Radiological outcome in 37 patients was assessed at a mean follow-up of 9.76 months (range 7.2-19.7 months). There were significant improvements in neck and arm VAS scores and the NDI following surgery. The neck VAS score improved from a median of 6 (range 0-10) to 0 (range 0-8; p < 0.001). The arm VAS score improved from a median of 2 (range 0-10) to 0 (range 0-7; p = 0.006). Immediate postoperative dysphagia was experienced by 58.4% of all patients. Complete resolution was demonstrated in 87.8% of affected patients at the latest follow-up. The overall median Bazaz score decreased from 1 (range 0-3) immediately postoperatively to 0 (range 0-2; p < 0.001) at the latest follow-up. Prevertebral soft-tissue thickness significantly decreased across all levels from a mean of 15.8 ± 4.38 mm to 10.1 ± 2.93 mm. Postoperative lordosis was maintained at the latest follow-up. Mean subsidence from the immediate postoperative to the latest follow-up was 4.1 ± 4.7 mm (p < 0.001). Radiographic fusion was achieved in 92.6% of implants. No correlation was found between prevertebral soft-tissue thickness and Bazaz dysphagia score. Conclusions: A zero-profile integrated plate and spacer device for ACDF surgery produces clinical and radiological outcomes that are comparable to those for nonintegrated plate and spacer constructs. Chronic dysphagia rates are comparable to or better than those for previously published case series.
    Journal of Neurosurgery Spine 08/2014; 21(4):1-9. DOI:10.3171/2014.6.SPINE12951 · 2.38 Impact Factor
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    ABSTRACT: Object: Extreme lateral interbody fusion (ELIF) is a popular technique for anterior fixation of the thoracolumbar spine. Clinical and radiological outcome studies are required to assess safety and efficacy. The aim of this study was to describe the functional and radiological impact of ELIF in a degenerative disc disease population with a longer follow-up and to assess the durability of this procedure. Methods: Demographic and perioperative data for all patients who had undergone ELIF for degenerative lumbar disorders between 2007 and 2011 were collected. Trauma and tumor cases were excluded. For radiological outcome, the preoperative, immediate postoperative, and latest follow-up coronal Cobb angle, lumbar sagittal lordosis, bilateral foraminal heights, and disc heights were measured. Pelvic incidence (PI) and PI-lumbar lordosis (PI-LL) mismatch were assessed in scoliotic patients. Clinical outcome was evaluated using the Oswestry Disability Index (ODI) and visual analog scale (VAS), as well as the Macnab criteria. Results: One hundred forty-five vertebral levels were surgically treated in 90 patients. Pedicle screw and rod constructs and lateral plates were used to stabilize fixation in 77% and 13% of cases, respectively. Ten percent of cases involved stand-alone cages. At an average radiological follow-up of 12.6 months, the coronal Cobb angle was 10.6° compared with 23.8° preoperatively (p < 0.0001). Lumbar sagittal lordosis increased by 5.3° postoperatively (p < 0.0001) and by 2.9° at the latest follow-up (p = 0.014). Foraminal height and disc height increased by 4 mm (p < 0.0001) and 3.3 mm (p < 0.0001), respectively, immediately after surgery and remained significantly improved at the last follow-up. Separate evaluation of scoliotic patients showed no statistically significant improvement in PI and PI-LL mismatch either immediately postoperatively or at the latest follow-up. Clinical evaluation at an average follow-up of 17.6 months revealed an improvement in the ODI and the VAS scores for back, buttock, and leg pain by 21.1% and 3.7, 3.6, and 3.7 points, respectively (p < 0.0001). According to the Macnab criteria, 84.8% of patients had an excellent, good, or fair functional outcome. New postoperative thigh numbness and weakness was detected in 4.4% and 2.2% of the patients, respectively, which resolved within the first 3 months after surgery in all but 1 case. Conclusions: This study provides what is to the authors' knowledge the most comprehensive set of radiological and clinical outcomes of ELIF in a fairly large population at a midterm follow-up. Extreme lateral interbody fusion showed good clinical outcomes with a low complication rate. The procedure allows for at least midterm clinically effective restoration of disc and foraminal heights. Improvement in coronal deformity and a small but significant increase in sagittal lordosis were observed. Nonetheless, no significant improvement in the PI-LL mismatch was achieved in scoliotic patients.
    Journal of neurosurgery. Spine 04/2014; 20(6). DOI:10.3171/2014.1.SPINE13569 · 2.38 Impact Factor
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    ABSTRACT: Radiculopathy caused by foraminal nerve root compression is a common pathology in the lumbar spine. Surgical decompression via a conventional open foraminotomy is the treatment of choice when surgery is indicated. Minimally invasive tubular foraminotomy through a contralateral approach is a potentially effective surgical alternative. The aim of this retrospective cohort study was to evaluate the efficacy and benefits of this approach for treatment of radiculopathy. Patients with unilaterally dominant lower extremity radiculopathy, who underwent minimally invasive lumbar foraminotomy through tubular retractors via a contralateral approach between 2010 and 2012, were included. Oswestry Disability Index (ODI) and the Visual Analogue Scale (VAS) for back and leg pain were evaluated pre-operatively, post-operatively, and at the latest follow-up. Functional outcome was evaluated using MacNab's criteria. For the total 32 patients, post-operatively there was significant improvement in the ODI (p=0.006), VAS back pain (p<0.0001), and VAS leg pain on the pathology and the approach side (p = 0.004, p=0.021, respectively). At follow-up of 12.3 ± 1.7 months, there was also significant improvement in the ODI (p<0.0001), VAS back pain (p=0.001), and VAS leg pain on the pathology and the approach side (p<0.0001, p = 0.001, respectively). The functional outcome was excellent and good in 95.2%. One patient required fusion (3.1%). A minimally invasive, facet-sparing contralateral approach is an effective technique for treatment of radiculopathy due to foraminal compression. It also allows for decompression of lumbar spinal stenosis and bilateral lateral recess decompression without the need for fusion.
    Neurosurgery 03/2014; 10(S 01). DOI:10.1227/NEU.0000000000000358 · 3.62 Impact Factor

Publication Stats

2k Citations
239.75 Total Impact Points


  • 2015
    • Harvard University
      Cambridge, Massachusetts, United States
  • 2007-2015
    • New York Presbyterian Hospital
      • Department of Neurological Surgery
      New York, New York, United States
  • 1995-2015
    • Weill Cornell Medical College
      • • Department of Neurological Surgery
      • • Department of Surgery
      New York, New York, United States
  • 1996-2013
    • Cornell University
      • • Department of Biomedical Engineering
      • • Department of Public Health
      • • Department of Neurological Surgery
      Итак, New York, United States
  • 2006
    • Barrow Neurological Institute
      • Department of Neurosurgery
      Phoenix, Arizona, United States
  • 1997
    • Humboldt-Universität zu Berlin
      Berlín, Berlin, Germany
  • 1993
    • Ludwig-Maximilians-University of Munich
      • Department of Neurosurgery
      München, Bavaria, Germany