Ronald A Lehman

Uniformed Services University of the Health Sciences, 베서스다, Maryland, United States

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Publications (161)415.53 Total impact

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    ABSTRACT: Retrospective reviewOBJECTIVE. Report the two year operative and clinical outcomes of these service members with low lumbar fractures. The majority of spinal fractures occur at the thoracolumbar level with fractures caudal to L2 accounting for only 1% spine fractures. A previous report from this institution regarding combat-related spine burst fractures documented an increased incidence of low lumbar burst fractures in injured service membersMETHODS. Review of inpatient and outpatient medical records in addition to radiographs for all patients treated at our institution with combat-related burst fractures occurring at the L3-L5 levels. 24 patients with a mean age of 28.1± 7.2 underwent surgery for low lumbar (L3-L5) burst fractures. The mean number of thoracolumbar levels injured was 2.9±1.4. Eleven patients had neurologic injury, four of which were complete. The mean days to surgery were 16.8± 24.5. The mean number of levels fused was 4.3± 2.1, with fixation extending to the pelvis in four patients (17%). Fourteen (61%) patients had at least one postoperative complication, with seven (30%) requiring reoperation. Five patients had a post-operative wound infection. Five patients had deep venous thromboses, three had pulmonary emboli. Mean clinical follow-up was 3.3± 2.2 years. At latest follow-up, all were separated from military service, ten experienced persistent bowel/bladder dysfunction, fifteen had lower extremity motor deficits, ten had documented persistent low back pain. Nineteen had chronic pain with eighteen patients still taking pain medications and/or muscle relaxers. Low lumbar burst fractures are a rare injury with an increased incidence in combat casualties engaged in the wars in Iraq and Afghanistan. We found a high rate of acute postoperative complications (61%), as well as a high reoperation rate (30%). At approximately three years follow-up, most of these patients had persistent neurological symptoms and chronic pain.
    Spine 05/2015; [Epub Ahead of Print]. DOI:10.1097/BRS.0000000000001006 · 2.45 Impact Factor
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    Daniel Kang · Ronald Lehman · Scott Wagner
    05/2015; 05(S 01). DOI:10.1055/s-0035-1554505
  • Daniel Kang · Ronald Lehman · Scott Wagner
    05/2015; 05(S 01). DOI:10.1055/s-0035-1554157
  • 05/2015; 05(S 01). DOI:10.1055/s-0035-1554156
  • Daniel Kang · Scott Wagner · Ronald Lehman
    05/2015; 05(S 01). DOI:10.1055/s-0035-1554294
  • Daniel Kang · Ronald Lehman · Scott Wagner · K. Riew
    05/2015; 05(S 01). DOI:10.1055/s-0035-1554386
  • Scott Wagner · Daniel Kang · Ronald Lehman
    05/2015; 05(S 01). DOI:10.1055/s-0035-1554131
  • Ronald A Lehman · Daniel Gene Kang · Scott Cameron Wagner
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    ABSTRACT: Osteoporosis is a burgeoning clinical problem that is characterized by decreased bone strength and density. It predisposes patients to fragility fractures and debilitating spine deformities. Several complications are associated with spine surgery in patients with osteoporosis, and there is currently no treatment algorithm to guide the spine surgeon. A multidisciplinary approach to treatment of patients with osteoporosis and spine deformity or fracture is encouraged, and preoperative planning is crucial for successful surgical outcomes. Several surgical techniques have been developed to treat osteoporosis-related deformities, including posterior instrumentation with fusion. However, achieving fixation and fusion in these patients can be difficult secondary to poor bone stock. Augmentation methods to improve pedicle screw fixation have evolved, including instrumentation at multiple levels, bioactive cement augmentation, and fenestrated or expandable pedicle screws, but their impact on clinical outcomes remains unknown. Management of osteoporosis in patients undergoing spine surgery is challenging, but with appropriate patient selection, medical optimization, and surgical techniques, these patients can experience pain relief, deformity correction, and improved function. Copyright 2015 by the American Academy of Orthopaedic Surgeons.
    The Journal of the American Academy of Orthopaedic Surgeons 04/2015; 23(4):253-263. DOI:10.5435/JAAOS-D-14-00042 · 2.40 Impact Factor
  • Ronald A. Lehman · Daniel G. Kang · Scott C. Wagner
    The Journal of the American Academy of Orthopaedic Surgeons 04/2015; 23(4):2. · 2.40 Impact Factor
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    ABSTRACT: Transverse connectors (TC) are often used to improve the rigidity of posterior spinal instrumentation, as previous investigations have suggested that TC enhance torsional rigidity in long segment thoracic constructs. Posterior osteotomies, such as the pedicle subtraction osteotomy (PSO), are can used in severe thoracic deformities and provide a significant amount of correction; as a consequence, however, PSOs also induce three-column spinal instability. In theory, augmentation of longitudinal constructs with TC after a thoracic PSO may provide additional rigidity, but the concept has not been previously evaluated.
    The spine journal: official journal of the North American Spine Society 03/2015; 13(9). DOI:10.1016/j.spinee.2015.03.010 · 2.80 Impact Factor
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    ABSTRACT: Deep surgical site infections (SSIs) following spinal surgery are a significant burden to the patient, patient's family and the healthcare system. Due to increasing pressures to reduce SSIs and control costs, some spine surgeons have begun placing lyophilized vancomycin powder directly into the surgical wound at the conclusion of the procedure. However, the literature supporting this practice remains limited. To review the current literature examining the use of prophylactic intrasite vancomycin powder to control SSIs in spinal surgery, and determine if any standard recommendations can be made. Systematic review. Ovid MEDLINE and PubMed were searched to identify English language articles. No current guidelines are available for the use of intrasite vancomycin powder in preventing surgical site infections, and no standard dosage for the drug exists. Based on the limited literature currently available, there appears to be a protective effect of intrasite vancomycin powder on the incidence of SSI without evidence of significant risk of side effects, but the evidence is limited. However, case reports do exist describing systemic side effects following intrasite vancomycin powder during spine surgery. The interpretation of the available evidence supporting the use of intrasite vancomycin powder in surgical wounds is limited, and its extrapolation should be performed with caution. Despite the lack of significant high-quality evidence available in the literature, many surgeons have adopted this practice; anecdotally it continues to provide protection from infection without apparent significant risk of side effects. Copyright © 2015 Elsevier Inc. All rights reserved.
    The spine journal: official journal of the North American Spine Society 01/2015; 15(4). DOI:10.1016/j.spinee.2015.01.030 · 2.80 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
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    ABSTRACT: We set out to describe combat-related spine trauma over a 10-year period, and thereby determine the frequency of new onset radiculopathy secondary to injuries sustained in support of combat operations. We performed a retrospective analysis of a surgical database at three military institutions. Patients undergoing spine surgery following a combat-related injury in Afghanistan or Iraq between July 2003 and July 2013 were evaluated. We identified 105 patients with combat-related (Operations Enduring and Iraqi Freedom) spine trauma requiring operative intervention. Of these, 15 (14.3%) patients had radiculopathy as their primary complaint after injury. All patients were diagnosed with herniated nucleus pulposus. The average age was 39 years, with 80% injured in Iraq and 20% in Afghanistan. The most common mechanism of injury was mounted improvised explosive device (33%). The cervical spine was most commonly involved (53%), followed by lumbar spine (40%). Average time from injury to surgery was 23.4 months; 53% of patients had continued symptoms following surgery, and two patients had at least one revision surgery. Two patients were medically retired because of their symptoms. This study is the only of its kind evaluating the operative treatment of traumatic radiculopathy following combat-related trauma. We identified a relatively high rate of radiculopathy in these patients. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.
    Military medicine 11/2014; 180(2). DOI:10.7205/MILMED-D-14-00260 · 0.77 Impact Factor
  • Scott C Wagner · Ronald A Lehman · John M Rhee
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    ABSTRACT: Goode AP, Richardson WJ, Schectman RM, Carey TS. Complications, revision fusions, readmissions, and utilization over a 1-year period after bone morphogenetic protein use during primary cervical spine fusions. Spine J 2014;14:2051-9 (in this issue).
    The spine journal: official journal of the North American Spine Society 09/2014; 14(9):2060-2062. DOI:10.1016/j.spinee.2014.01.063 · 2.80 Impact Factor
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    ABSTRACT: The use of a rod reduction device can have deleterious consequences on pedicle screw pull-out strength (POS) in the thoracic spine. However, posterior-only osteotomies in the thoracic spine are often performed to improve flexibility of the spine and offset forces of deformity correction maneuvers.
    The spine journal: official journal of the North American Spine Society 07/2014; 15(1). DOI:10.1016/j.spinee.2014.07.017 · 2.80 Impact Factor
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    ABSTRACT: Sacral fractures are uncommon lesions and most often the result of high-energy trauma. Depending on the fracture location, neurological injury may be present in over 50% of cases. In this article, the authors conducted a comprehensive literature review on the epidemiology of sacral fractures, relevant anatomy of the sacral and pelvic region, common sacral injuries and fractures, classification systems of sacral fractures, and current management strategies. Due to the complex nature of these injuries, surgical management remains a challenge for the attending surgeon. Few large-scale studies have addressed postoperative complications or long-term results, but current evidence suggests that although fusion rates are high, long-term morbidity, such as residual pain and neurological deficits, persists for many patients.
    Neurosurgical FOCUS 07/2014; 37(1):E12. DOI:10.3171/2014.5.FOCUS1474 · 2.14 Impact Factor
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    ABSTRACT: Transforaminal lumbar interbody fusion (TLIF) is increasingly popular for the surgical treatment of degenerative lumbar disease. The optimal construct for segmental stability remains unknown.
    The spine journal: official journal of the North American Spine Society 06/2014; 15(8). DOI:10.1016/j.spinee.2014.06.015 · 2.80 Impact Factor
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    D. G. Kang · R. A. Lehman · D. M. Laufer · A. J. Bevevino
    06/2014; 2(2):e19-e19. DOI:10.2106/JBJS.CC.K.00146
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    ABSTRACT: Study Design. Human cadaveric biomechanical analysis.Objective. Investigate the effect on cervical spine segmental stability that results from a posterior foraminotomy following cervical disc arthroplasty (CDA).Summary of Background Data. Posterior foraminotomy offers the ability to decompress cervical nerves roots while avoiding the need to extend a previous fusion or revise an arthroplasty to a fusion. However, the safety of a foraminotomy in the setting of CDA is unknown.Methods. Segmental non-destructive range of motion (ROM) was analyzed in nine human cadaveric cervical spine specimens. Following intact testing, each specimen was sequentially tested according to the following four experimental groups: Group 1 = C56 CDA, Group 2 = C56 CDA with unilateral C56 foraminotomy, Group 3 = C56 CDA with bilateral C56 foraminotomy, and Group 4 = C56 CDA with C56 and C45 bilateral foraminotomy.Results. No differences in ROM was found between the intact, CDA, and foraminotomy specimens at C4-5 or C6-7. There was a step-wise increase in C5-6 axial rotation from the intact state (8°) to Group 4 (12°), although the difference did not reach statistical significance. At C5-6, the degree of lateral bending remained relatively constant. Flexion and extension at C5-6 was significantly higher in the foraminotomy specimens, Groups 2 (18.1°), 3 (18.6°), and 4 (18.2°), compared to the intact state, 11.2°. However, no ROM difference was found within foraminotomy Groups (2-4) or between the foraminotomy groups and the CDA group (Group 1), 15.3°.Conclusions. Our results indicate that cervical stability is not significantly decreased by the presence, number, or level of posterior foraminotomies in the setting of CDA. The addition of foraminotomies to specimens with a pre-existing CDA resulted in small and insignificant increases in segmental ROM. Therefore, biomechanically, posterior foraminotomy(s) may be considered a safe and viable option in the setting of recurrent or adjacent level radiculopathy following cervical disc replacement.
    Spine 06/2014; 39(19). DOI:10.1097/BRS.0000000000000469 · 2.45 Impact Factor

Publication Stats

2k Citations
415.53 Total Impact Points

Institutions

  • 2009–2015
    • Uniformed Services University of the Health Sciences
      • Department of Surgery
      베서스다, Maryland, United States
  • 2014
    • Washington University in St. Louis
      • Department of Orthopaedic Surgery
      San Luis, Missouri, United States
  • 2002–2014
    • Walter Reed National Military Medical Center
      • • Division of Orthopaedic Surgery
      • • Department of Orthopaedics and Rehabilitation
      Washington, Washington, D.C., United States
  • 2005–2006
    • Thomas Jefferson University
      • Department of Orthopaedic Surgery
      Philadelphia, PA, United States
  • 2003
    • Union Memorial Hospital
      Baltimore, Maryland, United States