Robert A Hart

Oregon Health and Science University, Portland, Oregon, United States

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Publications (144)342.64 Total impact

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    ABSTRACT: Somatosensory evoked potential (SSEP) and motor evoked potentials (MEP) are frequently fused to monitor neurological function during spinal deformity surgery. However, there are few studies regarding the utilization of intraoperative neuromonitoring during anterior lumbar interbody fusion (ALIF). This study presents the authors' experience with intraoperative neuromonitoring in ALIF.
    Journal of clinical neurophysiology: official publication of the American Electroencephalographic Society 08/2014; 31(4):352-5. DOI:10.1097/WNP.0000000000000073 · 1.60 Impact Factor
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    ABSTRACT: A retrospective data collection study with application of metastatic spine scoring systems.
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    International Meeting on Advanced Spine Techniques (IMAST) 21st annual meeting, Valencia, Spain; 07/2014
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    ABSTRACT: Retrospective review of a multicenter database of consecutive patients undergoing 3-column osteotomy for treatment of adult spinal deformity (ASD).
    Spine 07/2014; 39(15):1203-1210. DOI:10.1097/BRS.0000000000000382 · 2.45 Impact Factor
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    ABSTRACT: Study Design. Multi-center, prospective analysis of consecutive adult spinal deformity (ASD) patients.Objective. Identify age related radiographic parameters associated with poor health related quality of life (HRQOL) and treatment preferences for ASD.Summary of Background Data. ASD patients report discrepant severities of disability. Understanding age associated differences for reported disability and treatment preferences may improve ASD evaluation and treatment.Methods. Baseline demographic, radiographic and HRQOL values were evaluated in a multicenter, prospective cohort of consecutive ASD patients. Inclusion criteria: ASD, age >18 years, and no prior spine surgery. Patients were divided into those treated operatively (OP) or nonoperatively (NON) and stratified into 3 age groups; G1 = <50 years, G2 = 50-65 years, G3 = >65 years. HRQOL measures included Scoliosis Research Society questionnaire (SRS-22r), Oswestry Disability Index (ODI), Short Form-36 Health Survey (SF-36).Results. 497 patients (OP = 156, NON = 341), mean age 50.4 years, met inclusion criteria. OP was older (53.3 vs. 49.0 years), had larger scoliosis (49.3° vs. 43.3°), larger sagittal vertical axis (SVA; 33.2 vs. 13.7mm), greater pelvic incidence-lumbar lordosis mismatch (6.6° vs. 3.1°), and worse HRQOL scores than NON, respectively (p<0.05). Age stratification demonstrated worsening of SVA, spinopelvic alignment (SPA), and HRQOL scores with increasing age (p<0.05). Age/treatment stratification demonstrated younger OP had greater scoliosis than NON (G1OP = 49.9° vs. G1NON = 42.2°; G2OP = 56° vs. G2NON = 47.2°; p<0.05) but similar SPA as NON. Older OP had similar scoliosis, but larger SVA than NON (G3OP = 100.6 vs. G3NON = 66.4 mm; p<0.05). OP in all age groups reported worse HRQOL than NON (p<0.05).Conclusions. Poor HRQOL uniformly determined operative treatment for ASD. Spinal deformities differed between age groups. Younger OP had larger scoliosis but similar SPA and SVA than NON. Older OP had similar scoliosis but worse SVA than NON. Age associated differences for poor HRQOL must be considered when evaluating ASD patients.
    Spine 05/2014; 39(17). DOI:10.1097/BRS.0000000000000414 · 2.45 Impact Factor
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    ABSTRACT: Study Design Program director survey. Objectives To collect data on spine surgical experience during orthopedic and neurological surgery residency and assess the opinions of program directors (PDs) from orthopedic and neurological surgery residencies and spine surgery fellowships regarding current spine surgical training in the United States. Summary of Background Data Current training for spine surgeons in the United States consists of a residency in either orthopedic or neurological surgery followed by an optional spine surgery fellowship. Program director survey data may assist in efforts to improve contemporary spine training. Methods An anonymous questionnaire was distributed to all PDs of orthopedic and neurological surgery residencies and spine fellowships in the United States (N = 382). A 5-point Likert scale was used to assess attitudinal questions. A 2-tailed independent-samples t test was used to compare responses to each question independently. Results A total of 147 PDs completed the survey. Orthopedic PDs most commonly indicated that their residents participate in 76 to 150 spine cases during residency, whereas neurological surgery PDs most often reported more than 450 spine cases during residency (p < .0001). Over 88% of orthopedic surgery program directors and 0% of neurological surgery PDs recommended that their trainees complete a fellowship if they wish to perform community spine surgery (p < .001). In contrast, 98.1% of orthopedic PDs and 86.4% of neurological surgery PDs recommended that their trainees complete a fellowship if they wish to perform spinal deformity surgery (p = .038). Most PDs agreed that surgical simulation and competency-based training could improve spine surgery training (76% and 72%, respectively). Conclusions This study examined the opinions of orthopedic and neurological surgery residency and spine fellowship PDs regarding current spine surgery training in the United States. A large majority of PDs thought that both orthopedic and neurological surgical trainees should complete a fellowship if they plan to perform spinal deformity surgery. These results provide a background for further efforts to optimize contemporary spine surgical training.
    05/2014; 2(3):176–185. DOI:10.1016/j.jspd.2014.02.005
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    ABSTRACT: Study Design Multicenter, prospective, consecutive, surgical case series from the International Spine Study Group. Objectives To evaluate the effectiveness of surgical treatment in restoring spinopelvic (SP) alignment. Summary of Background Data Pain and disability in the setting of adult spinal deformity have been correlated with global coronal alignment (GCA), sagittal vertical axis (SVA), pelvic incidence/lumbar lordosis mismatch (PI-LL), and pelvic tilt (PT). One of the main goals of surgery for adult spinal deformity is to correct these parameters to restore harmonious SP alignment. Methods Inclusion criteria were operative patients (age greater than 18 years) with baseline (BL) and 1-year full-length X-rays. Thoracic and thoracolumbar Cobb angle and previous mentioned parameters were calculated. Each parameter at BL and 1 year was categorized as either pathological or normal. Pathologic limits were: Cobb greater than 30°, GCA greater than 40 mm, SVA greater than 40 mm, PI-LL greater than 10°, and PT greater than 20°. According to thresholds, corrected or worsened alignment groups of patients were identified and overall radiographic effectiveness of procedure was evaluated by combining the results from the coronal and sagittal planes. Results A total of 161 patients (age, 55 ± 15 years) were included. At BL, 80% of patients had a Cobb angle greater than 30°, 25% had a GCA greater than 40 mm, and 42% to 58% had a pathological sagittal parameter of PI-LL, SVA, and/or PT. Sagittal deformity was corrected in about 50% of cases for patients with pathological SVA or PI-LL, whereas PT was most commonly worsened (24%) and least often corrected (24%). Only 23% of patients experienced complete radiographic correction of the deformity. Conclusions The frequency of inadequate SP correction was high. Pelvic tilt was the parameter least likely to be well corrected. The high rate of SP alignment failure emphasizes the need for better preoperative planning and intraoperative imaging.
    05/2014; 2(3):219–225. DOI:10.1016/j.jspd.2014.01.003
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    ABSTRACT: Object Three-column resection osteotomies (3COs) are commonly performed for sagittal deformity but have high rates of reported complications. Authors of this study aimed to examine the incidence of and intercenter variability in major intraoperative complications (IOCs), major postoperative complications (POCs) up to 6 weeks postsurgery, and overall complications (that is, both IOCs and POCs). They also aimed to investigate the incidence of and intercenter variability in blood loss during 3CO procedures. Methods The incidence of IOCs, POCs, and overall complications associated with 3COs were retrospectively determined for the study population and for each of 8 participating surgical centers. The incidence of major blood loss (MBL) over 4 L and the percentage of total blood volume lost were also determined for the study population and each surgical center. Complication rates and blood loss were compared between patients with one and those with two osteotomies, as well as between patients with one thoracic osteotomy (ThO) and those with one lumbar or sacral osteotomy (LSO). Risk factors for developing complications were determined. Results Retrospective review of prospectively acquired data for 423 consecutive patients who had undergone 3CO at 8 surgical centers was performed. The incidence of major IOCs, POCs, and overall complications was 7%, 39%, and 42%, respectively, for the study population overall. The most common IOC was spinal cord deficit (2.6%) and the most common POC was unplanned return to the operating room (19.4%). Patients with two osteotomies had more POCs (56% vs 38%, p = 0.04) than the patients with one osteotomy. Those with ThO had more IOCs (16% vs 6%, p = 0.03), POCs (58% vs 34%, p < 0.01), and overall complications (67% vs 37%, p < 0.01) than the patients with LSO. There was significant variation in the incidence of IOCs, POCs, and overall complications among the 8 sites (p < 0.01). The incidence of MBL was 24% for the study population, which varied significantly between sites (p < 0.01). Patients with MBL had a higher risk of IOCs, POCs, and overall complications (OR 2.15, 1.76, and 2.01, respectively). The average percentage of total blood volume lost was 55% for the study population, which also varied among sites (p < 0.01). Conclusions Given the complexity of 3COs for spinal deformity, it is important for spine surgeons to understand the risk factors and complication rates associated with these procedures. In this study, the overall incidence of major complications following 3CO procedures was 42%. Risks for developing complications included an older age (> 60 years), two osteotomies, ThO, and MBL.
    Neurosurgical FOCUS 05/2014; 36(5):E18. DOI:10.3171/2014.2.FOCUS1422 · 2.14 Impact Factor
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    ABSTRACT: Study Design. Multicenter, prospective, consecutive case series. Objective. To assess prevalence and type of cervical deformity among adults with thoracolumbar (TL) deformity and to assess for associations between cervical deformities and different types of TL deformities. Summary of Background Data. Cervical deformity can present concomitantly with TL deformity and have implications for the management of TL deformity. Methods. Multicenter, prospective, consecutive series of adult (age >18 yr) patients with TL deformity. Parameters included pelvic tilt (PT), pelvic incidence (PI), lumbar lordosis (LL), C2–C7 sagittal vertical axis (C2–C7SVA), C7–S1SVA, and C2–C7 lordosis. Cervical deformity was defined as cervical lordosis more than 0° (cervical kyphosis [CK]) or C2–C7SVA more than 4 cm (cervical positive sagittal malalignment [CPSM]). Patients were stratified by the Scoliosis Research Society-Schwab classification of adult TL deformity, including curve type (N = sagittal deformity, T = thoracic scoliosis, L = lumbar scoliosis, and D = T + L scoliosis) and modifier grades: PT (0: <20°, +: 20°–30°, ++: >30°), C7–S1SVA (0: <4 cm, +: 4–9.5 cm, ++: >9.5 cm), and PI-LL mismatch (0: <10°, +: 10–20°, ++: >20°). Results. A total of 470 patients met criteria (mean age = 52 yr). Mean cervical lordosis and C2–C7SVA were −8° and 3.2 cm, respectively. CK and CPSM prevalence were 31% and 29%, respectively, and prevalence of CK and/or CPSM was 53%. CK prevalence differed by curve type (N = 15%, L = 27%, D = 37%, T = 49%; P < 0.001); CPSM prevalence did not differ by curve type (P = 0.19). Higher PT grades had lower CK prevalence (0 = 40%, += 27%, ++= 15%; P < 0.001) but greater CPSM prevalence (0 = 23%, += 28%, ++= 45%; P = 0.001). Similarly, higher SVA grades had lower CK prevalence (0 = 40%, += 23%, ++= 11%; P < 0.001) but greater CPSM prevalence (0 = 24%, += 24%, ++= 48%; P < 0.001). Higher PI-LL grades had lower CK prevalence (0 = 35%, += 31%, ++= 22%; P = 0.034) but no CPSM association (P = 0.46). Conclusion. Cervical deformity is highly prevalent (53%) in adult TL deformity. C7–S1SVA, PT, and PI-LL modifiers are associated with cervical deformity prevalence. These findings suggest that TL deformity evaluation should include assessment for concomitant cervical deformity and that further study is warranted to define their potential clinical impact. Level of Evidence: 3
    Spine 04/2014; 39(17):E1001-E1009. DOI:10.1097/BRS.0000000000000432 · 2.45 Impact Factor
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    ABSTRACT: Object Increased sagittal vertical axis (SVA) correlates strongly with pain and disability for adults with spinal deformity. A subset of patients with sagittal spinopelvic malalignment (SSM) have flatback deformity (pelvic incidence-lumbar lordosis [PI-LL] mismatch > 10°) but remain sagittally compensated with normal SVA. Few data exist for SSM patients with flatback deformity and normal SVA. The authors' objective was to compare baseline disability and treatment outcomes for patients with compensated (SVA < 5 cm and PI-LL mismatch > 10°) and decompensated (SVA > 5 cm) SSM. Methods The study was a multicenter, prospective analysis of adults with spinal deformity who consecutively underwent surgical treatment for SSM. Inclusion criteria included age older than 18 years, presence of adult spinal deformity with SSM, plan for surgical treatment, and minimum 1-year follow-up data. Patients with SSM were divided into 2 groups: those with compensated SSM (SVA < 5 cm and PI-LL mismatch > 10°) and those with decompensated SSM (SVA ≥ 5 cm). Baseline and 1-year follow-up radiographic and health-related quality of life (HRQOL) outcomes included Oswestry Disability Index, Short Form-36 scores, and Scoliosis Research Society-22 scores. Percentages of patients achieving minimal clinically important difference (MCID) were also assessed. Results A total of 125 patients (27 compensated and 98 decompensated) met inclusion criteria. Compared with patients in the compensated group, patients in the decompensated group were older (62.9 vs 55.1 years; p = 0.004) and had less scoliosis (43° vs 54°; p = 0.002), greater SVA (12.0 cm vs 1.7 cm; p < 0.001), greater PI-LL mismatch (26° vs 20°; p = 0.013), and poorer HRQOL scores (Oswestry Disability Index, Short Form-36 physical component score, Scoliosis Research Society-22 total; p ≤ 0.016). Although these baseline HRQOL differences between the groups reached statistical significance, only the mean difference in Short Form-36 physical component score reached threshold for MCID. Compared with baseline assessment, at 1 year after surgery improvement was noted for patients in both groups for mean SVA (compensated -1.1 cm, decompensated +4.8 cm; p ≤ 0.009), mean PI-LL mismatch (compensated 6°, decompensated 5°; p < 0.001), and all HRQOL measures assessed (p ≤ 0.005). No significant differences were found between the compensated and decompensated groups in the magnitude of HRQOL score improvement or in the percentages of patients achieving MCID for each of the outcome measures assessed. Conclusions Decompensated SSM patients with elevated SVA experience significant disability; however, the amount of disability in compensated SSM patients with flatback deformity caused by PI-LL mismatch but normal SVA is underappreciated. Surgical correction of SSM demonstrated similar radiographic and HRQOL score improvements for patients in both groups. Evaluation of SSM should extend beyond measuring SVA. Among patients with concordant pain and disability, PI-LL mismatch must be evaluated for SSM patients and can be considered a primary indication for surgery.
    Journal of neurosurgery. Spine 04/2014; DOI:10.3171/2014.3.SPINE13580 · 2.36 Impact Factor
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    ABSTRACT: Study Design. Multicenter, retrospective review.Objective. Assess rates, site variability, and risk factors for revision surgery (RS) following three-column osteotomy(3CO).Summary of Background Data. Complex spinal osteotomies, including 3CO, are being increasingly performed in the setting of adult spinal deformity (ASD) patients with sagittal plane deformity. 3CO procedures are associated with high complication and RS rates, but risk factors for complications and variability across centers for revision have not been well defined.Methods. The incidence and indications for RS in 335 ASD patients were analyzed. RS indications were classified as "mechanical"(MR: implant failure, pseudarthrosis, junctional failure, loss/lack of correction) or "non-mechanical"(NMR: neurologic deficit, infection, wound dehiscence, stenosis). Risks factors for RS were analyzed using generalized linear models.Results. Three-month and one-year RS incidences were 12.3% and 17.6%, respectively. Single-level 3CO (n = 311) had lower RS rates than multi-level 3CO(n = 24, 15.8% vs. 41.7%, p = 0.001). The 16.7% rate for single-level lumbar 3CO included 11.4% for MR and 5.7% for NMR. For all RS, 50% of MR and 78.6% of NMR occurred within three-months of the index surgery. There was significant variation in rates across sites(range = 6.3% to 31.9%, p = 0.001), however low- and high-volume sites had similar rates(18.2% vs. 16.2%, p = 0.503). Patients with MR were more likely to be sagittaly under-corrected at three-months(SVA = 7cm vs 3.2cm, p = 0.003). Patients with NMR had more caudal 3CO levels (L4 vs L3, p = 0.014) and larger 3CO bone resections than patients who did not(34° vs 24.5°, p = 0.003).Conclusions. 3CO procedures for ASD surgery can provide significant deformity correction and lead to marked improvement in function despite established complication and revision rates. This study shows that RS is associated with lower level osteotomy and higher residual SVA. There is significant variability in revision rates across sites independent of site volume, suggesting potential systems and practice variations that warrant further study.
    Spine 02/2014; DOI:10.1097/BRS.0000000000000304 · 2.45 Impact Factor
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    ABSTRACT: Object The ideal surgical management of high-grade spondylolisthesis remains unclear. Concerns regarding the original Bohlman transsacral interbody fusion technique with stand-alone autologous fibular strut include late graft fracture and incomplete reduction of lumbosacral kyphosis. The authors' goal was to evaluate the radiographic and surgical outcomes of patients treated for high-grade spondylolisthesis with either transsacral S-1 screws or standard pedicle screw fixation augmenting the Bohlman posterior transsacral interbody fusion technique. Methods A retrospective review of patients who underwent fusion for high-grade spondylolisthesis in which a Bohlman oblique posterior interbody fusion augmented with either transsacral or standard pedicle screw fixation was performed by 4 spine surgeons was completed. Estimated blood loss, operating time, perioperative complications, and need for revision surgery were evaluated. Upright pre- and postsurgical lumbar spine radiographs were compared for slip percent and slip angle. Results Sixteen patients (12 female and 4 male) with an average age of 29 years (range 9-66 years) were evaluated. The average clinical follow-up was 78 months (range 5-137 months) and the average radiographic follow-up was 48 months (range 5-108 months). Ten L4-S1 and 6 L5-S1 fusions were performed. Five fibular struts and 11 titanium mesh cages were used for interbody fusion. Six patients had isolated transsacral screws placed, with 2 (33%) of the 6 requiring revision surgery for nonunion. No nonunions were observed in patients undergoing spanning pedicle screw fixation augmenting the interbody graft. Six patients experienced perioperative complications including 3 iliac crest site infections, 1 L-5 radiculopathy without motor involvement, 1 deep vein thrombosis, and 1 epidural hematoma requiring irrigation and debridement. The average estimated blood loss and operating times were 763 ml and 360 minutes, respectively. Slip percent improved from an average of 62% to 37% (n = 16; p < 0.01) and slip angle improved from an average of 18° to 8° (n = 16; p < 0.01). No patient experienced L-5 or other motor deficit postoperatively. Conclusions The modified Bohlman technique for treatment of high-grade spondylolisthesis has reproducible outcomes among multiple surgeons and results in significant improvements in slip percent and slip angle. Fusion rates were high (14 of 16; 88%), especially with spanning instrumentation augmenting the oblique interbody fusion. Rates of L-5 motor deficit were low in comparison with techniques involving reduction of the anterolisthesis.
    Journal of neurosurgery. Spine 02/2014; DOI:10.3171/2014.1.SPINE12904 · 2.36 Impact Factor
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    ABSTRACT: Few studies have examined threshold improvements in health-related quality of life (HRQOL) by measuring minimal clinically important differences (MCIDs) in treatment of adult spinal deformity. We hypothesized that patients undergoing operative treatment would be more likely to achieve MCID threshold improvement compared with those receiving nonoperative care, although a subset of nonoperative patients may still reach threshold. We analyzed a multicenter, prospective, consecutive case series of 464 patients: 225 nonoperative and 239 operative. To be included in the study, patients had to have adult spinal deformity, be older than 18 years, and have both baseline and 1-year follow-up HRQOL measures (Oswestry Disability Index [ODI], Short Form-36 [SF-36] health survey, and Scoliosis Research Society-22 [SRS-22] questionnaire). We compared the percentages of patients achieving established MCID thresholds between operative and nonoperative groups using risk ratios (RR) with a 95% confidence interval (CI). Compared to nonoperative patients, surgical patients demonstrated significant mean improvement (P<0.01) and were more likely to achieve threshold MCID improvement across all HRQOL scores (ODI RR = 7.37 [CI 4.45, 12.21], SF-36 physical component score RR = 2.96 [CI 2.11, 4.15], SRS Activity RR = 3.16 [CI 2.32, 4.31]). Furthermore, operative patients were more likely to reach threshold MCID improvement in 2 or more HRQOL measures simultaneously and were less likely to deteriorate. Patients in both the operative and nonoperative treatment groups demonstrated improvement in at least one HRQOL measure at 1 year. However, surgical treatment was more likely to result in threshold improvement and more likely to lead to simultaneous improvement across multiple measures of ODI, SF-36, and SRS-22. Although a subset of nonoperative patients achieved threshold improvement, nonoperative patients were significantly less likely to improve in multiple HRQOL measures and more likely to sustain MCID deterioration or no change.
    Ochsner Journal 01/2014; 14(1):67-77.
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    ABSTRACT: Safety information in spine surgery is important for informed patient choice and performance-based payment incentives, but measurement methods for surgical safety assessment are not standardized. Published reports of complication rates for common spinal procedures show wide variation. Factors influencing variation may include differences in safety ascertainment methods and procedure types. In a prospective cohort study, adverse events were observed in all patients undergoing spine surgery at two hospitals during a 2-year period. Multiple processes for adverse occurrence surveillance were implemented, and the associations between surveillance methods, surgery invasiveness, and observed frequencies of adverse events were examined. The study enrolled 1,723 patients. Adverse events were noted in 48.3% of the patients. Reviewers classified 25% as minor events and 23% as major events. Of the major events, the daily rounding team reported 38.4% of the events using a voluntary reporting system, surgeons reported 13.4%, and 9.1% were identified during clinical conferences. A review of medical records identified 86.7% of the major adverse events. The adverse events occurred during the inpatient hospitalization for 78.1% of the events, within 30 days for an additional 12.5%, and within the first year for the remaining 9.4%. A unit increase in the invasiveness index was associated with an 8.2% increased risk of a major adverse event. A Current Procedural Terminology-based algorithm for quantifying invasiveness correlated well with medical records-based assessment. Increased procedure invasiveness is associated with an increased risk of adverse events. The observed frequency of adverse events is influenced by the ascertainment modality. Voluntary reports by surgeons and other team members missed more than 50% of the events identified through a medical records review. Increased surgery invasiveness, measured from medical records or billing codes, is quantitatively associated with an increased risk of adverse events.
    Instructional course lectures 01/2014; 63:271-86.
  • Paul A Anderson, Robert A Hart
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    ABSTRACT: Adverse events reporting in pivotal trials of new technologies, such as cervical total disk replacement, are essential to determine safety. Important questions concerning the adequacy of reporting about such new technologies in peer-reviewed publications have prompted this analysis to assess the safety of cervical disk replacement compared with fusion as presented in peer-reviewed publications and FDA summary reports. Identifying differences among these reports highlight the poor quality of adverse event reporting in the peer-reviewed literature. Nine peer-reviewed studies and five FDA summary reports documented excellent safety for both cervical fusion and disk arthroplasty. No differences in rates of adverse events were found to exist between the two treatments. The methods of recording and the actual reporting of adverse events were poor in peer-reviewed manuscripts, whereas they were comprehensive but difficult to clinically apply in the FDA summaries. Recommendations to improve documentation and reporting of adverse events are presented.
    Instructional course lectures 01/2014; 63:287-96.
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    ABSTRACT: Study Design. Multi-center, prospective analysis of consecutive ASD patients.Objective. Evaluate complications associated with rhBMP-2 use in ASDSummary of Background Data. Off-label rhBMP-2 use is common, however under-reporting of rhBMP-2 associated complications has been recently scrutinized.Methods. ASD patients consecutively enrolled into a prospective, multicenter database, were evaluated for type and timing of acute perioperative complications. Inclusion criteria: age ≥ 18 years, ASD, spinal arthrodesis >4 levels, and ≥3 months follow-up. Patients divided into those receiving rhBMP-2 (BMP) or no rhBMP-2 (NOBMP). BMP divided into location of use: posterior (PBMP), interbody (IBMP), and interbody + posterior spine (I+PBMP). Correlations between acute perioperative complications and rhBMP-2 use including total dose, dose/level and location of use were evaluated.Results. 279 patients (mean age 57 years, mean spinal levels fused 12.0, mean follow-up 28.8 months) met inclusion criteria. BMP (n = 172; average posterior dose = 2.5 mg/level, average interbody dose = 5 mg/level) had similar age, smoking history, previous spine surgery, total spinal levels fused, estimated blood loss, and duration of hospital stay as NOBMP (n = 107; p>0.05). BMP had greater Charlson Comorbidity Index (1.9 vs. 1.2), greater scoliosis (43° vs. 38°), longer operative time (488.2 vs. 414.6 minutes), more osteotomies/patient (4.0 vs. 1.6) and greater percentage of anteroposterior fusion (APSF; 20.9% vs. 8.4%) than NOBMP, respectively (p<0.05). BMP had more total complications/patient (1.4 vs.0.6) and more minor complications/patient (0.9 vs. 0.2) than NOBMP, respectively (p<0.05). NOBMP had more complications requiring surgery/patient than BMP (0.3 vs. 0.2; p<0.05). Major, neurological, wound, and infection complications were similar for NOBMP, BMP, PBMP, IBMP, and I+PBMP (p>0.05). Multivariate analysis demonstrated small to non-existent correlations between rhBMP-2 use and complications.Conclusions. RhBMP-2 use and location of rhBMP-2 use in ASD surgery, at reported doses, does not increase acute major, neurological or wound complications. Research is needed for higher rhBMP-2 dosing and long-term follow-up.
    Spine 11/2013; DOI:10.1097/BRS.0000000000000104 · 2.45 Impact Factor
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    ABSTRACT: Controversy persists regarding Recombinant Human Bone Morphogenetic Protein-2 (rhBMP-2) use in spine surgery. We compared minimum 2 year complications, fusion rates and clinical outcomes for BMP and NOBMP patients in a prospective, multicenter consecutive cohort.
    Congress of Neurological Surgeons, San Francisco; 10/2013
  • The Spine Journal 09/2013; 13(9):S27-S28. DOI:10.1016/j.spinee.2013.07.097 · 2.80 Impact Factor
  • Robert A. Hart, Bala Krishnamoorthy
    The Spine Journal 09/2013; 13(9):S148. DOI:10.1016/j.spinee.2013.07.377 · 2.80 Impact Factor
  • The Spine Journal 09/2013; 13(9):S116-S117. DOI:10.1016/j.spinee.2013.07.306 · 2.80 Impact Factor

Publication Stats

838 Citations
342.64 Total Impact Points


  • 2000–2015
    • Oregon Health and Science University
      • • Department of Orthopaedics & Rehabilitation
      • • Department of Surgery
      Portland, Oregon, United States
  • 2014
    • Otto-von-Guericke-Universität Magdeburg
      Magdeburg, Saxony-Anhalt, Germany
    • University of Oregon
      Eugene, Oregon, United States
    • University of California, San Francisco
      • Department of Neurological Surgery
      San Francisco, California, United States
    • Hospital for Special Surgery
      • Department of Orthopaedic Surgery
      New York, New York, United States
  • 2013
    • University of California, San Diego
      • Department of Medicine
      San Diego, California, United States
    • University of Virginia
      • Department of Neurosurgery
      Charlottesville, VA, United States
  • 2012
    • Southern Methodist University
      Dallas, Texas, United States
  • 2010
    • Clemenceau Medical Center
      Beyrouth, Beyrouth, Lebanon
  • 2009
    • Rhode Island Hospital
      Providence, Rhode Island, United States
  • 2007
    • Oregon State University
      Corvallis, Oregon, United States
    • Portland State University
      Portland, Oregon, United States
  • 2005
    • University of Michigan
      • Department of Orthopaedic Surgery
      Ann Arbor, MI, United States