Robert A Hart

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

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Publications (177)403.39 Total impact

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    ABSTRACT: To identify the effect of complications and reoperation on the recovery process following adult spinal deformity (ASD) surgery by examining health-related quality of life (HRQOL) measures over time via an integrated health state analysis (IHS). A retrospective review of a multicenter, prospective ASD database was conducted. Complication number, type, and need for reoperation (REOP) or not (NOREOP) were recorded. Patients were stratified as having no complication (NOCOMP), any complication (COMP), only minor complications (MINOR) and any major complications (MAJOR). HRQOL measures included Oswestry Disability Index (ODI), Short Form-36 (SF-36), and Scoliosis Research Society-22 (SRS22) at baseline, 6 weeks, 1 and 2 years postoperatively. All HRQOL scores were normalized to each patient's baseline scores and an IHS was then calculated. 149 patients were included. COMP, MINOR, and MAJOR had significantly lower normalized SRS mental scores at 1 and 2 years than NOCOMP (p < 0.05). REOP had significantly worse normalized 1 and 2 year mental component score (MCS), SRS mental, and total score than NOCOMP (p < 0.05). COMP, MINOR, and MAJOR all had significantly lower SRS mental IHSs than NOCOMP (p < 0.05). REOP had significantly lower IHSs for MCS and SRS satisfaction than NOREOP (p < 0.05). REOP had a significantly lower MCS and SRS mental IHS than NOCOMP (p < 0.05). An IHS analysis suggests there was a significantly protracted mental recovery phase associated with patients that had at least one complication, as well as either a minor and major complication. The addition of a reoperation also adversely affected the mental recovery as well as overall satisfaction.
    European Spine Journal 02/2015; DOI:10.1007/s00586-015-3787-3 · 2.47 Impact Factor
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    ABSTRACT: The goal of the present study was to compare the outcomes of operative and non-operative patients with adult spinal deformity (ASD) over 75 years of age. A retrospective review of a multicenter prospective adult spinal deformity database was conducted examining patients with ASD over the age of 75 years. Demographics, comorbidities, operation-related variables, complications, radiographs, and Health-related quality of life (HRQOL) measures collected included Oswestry Disability Index, Short Form-36, and Scoliosis Research Society-22 preoperatively, and at 1 and 2 years later. Minimum clinically important difference (MCID) was calculated and also compared. 27 patients (12 operative, 15 non-operative) were studied. There were no significant differences (p > 0.05) between operative and non-operative patients for age, body mass-index, and comorbidities, but operative patients had worse baseline HRQOL than non-operative patients. Operative patients had a significant improvement in radiographic parameters in 2-year HRQOL, whereas non-operative patients did not (p > 0.05). Operative patients were significantly more likely to reach MCID (range 41.7-81.8 vs. 0-33.3 %, p < 0.05). In the surgical group, 9 (75 %) patients had at least 1 complication (24 total complications). In the largest series to date comparing operative and non-operative management of adult spinal deformity in elderly patients greater than 75 years of age, reconstructive surgery provides significant improvements in pain and disability over a 2-year period. Furthermore, operative patients were more likely to reach MCID than non-operative patients. When counseling elderly patients with ASD, such data may be helpful in the decision-making process regarding treatment.
    European Spine Journal 02/2015; DOI:10.1007/s00586-015-3759-7 · 2.47 Impact Factor
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    ABSTRACT: Study Design. A multicenter, prospective review of surgical adult spine deformity patients Objective. Assessment of the incidence, risk factor and impact of radiographic and implant-related complications on health related quality of life measures. Summary of Background Data. This study provides assessment of the incidence of radiographic and implant-related complications (RIC: Table 1) in adult spinal deformity (ASD) surgery and impact of these complications on need for reoperation. Risk factors for development of RIC are also assessed, as well as the impact of these complications on health-related quality of life (HRQOL) outcomes measures. Methods. A multicenter, prospective database of surgical ASD patients was reviewed. All patients with complete two-year follow up were included. HRQOL was measured using the Oswestry Disability Index (ODI), General Health Survey (SF-36), and Scoliosis Research Society (SRS-22r) at baseline, 6 weeks, 1 year and 2 years postoperatively. Univariate testing was performed as appropriate. Multivariate logistic regression modeling was used to determine independent predictors of RIC. Multivariate repeated measures mixed models were used to examine HRQOL, accounting for confounders. Results. 245 patients met inclusion criteria. The incidence of RIC was 31.7%. 52.6% of those patients required reoperation. Rod breakage accounted for 47% of the implant-related complications, and proximal junctional kyphosis (PJK) accounted for 54.5% of radiographic complications. Univariate analysis identified the following potential risk factors for RIC: weight, American Society of Anesthesiologists Score (ASA), revision, stopping the fusion in the lower thoracic spine, worse SRS-Schwab classification modifiers (Pelvic Tilt (PT) ++, Pelvic incidence minus lumbar lordosis (PI-LL) ++, Sagittal Vertical Axis (SVA) ++), higher T1 Spino-pelvic inclination (T1SPTI), and higher T1 slope. Independent predictors of RIC as identified on multivariate logistic regression included: ASA (OR 1.75, p = 0.029) and SVA modifier ++ (OR 3.43, p = 0.0001). The RIC and no RIC groups each experienced significant improvement over time, as measured on the ODI (p = 0.0001), SF36 (p = 0.0001), and SRS-22r (p = 0.0001). However, the rate of improvement over time was less for patients with RIC (SRS-22r p = 0.043, SF36p = 0.0001). Conclusion. This study identified that nearly one-third of patients undergoing ASD surgery experienced a radiographic or implant-related complication, and that just over one-half of these complication patients required a re-operation within two years of surgery. These complications significantly affected HRQOL measures. Baseline patient characteristics and parameters of the SRS-Schwab classification can be used to help identify those patients at greater risk.
    Spine 01/2015; DOI:10.1097/BRS.0000000000001020 · 2.45 Impact Factor
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    ABSTRACT: Current spine surgeon training in the United States consists of either an orthopaedic or neurological surgery residency, followed by an optional spine surgery fellowship. Resident spine surgery procedure volume may vary between and within specialties. The Accreditation Council for Graduate Medical Education surgical case logs for graduating orthopaedic surgery and neurosurgery residents from 2009 to 2012 were examined and were compared for spine surgery resident experience. The average number of reported spine surgery procedures performed during residency was 160.2 spine surgery procedures performed by orthopaedic surgery residents and 375.0 procedures performed by neurosurgery residents; the mean difference of 214.8 procedures (95% confidence interval, 196.3 to 231.7 procedures) was significant (p = 0.002). From 2009 to 2012, the average total spinal surgery procedures logged by orthopaedic surgery residents increased 24.3% from 141.1 to 175.4 procedures, and those logged by neurosurgery residents increased 6.5% from 367.9 to 391.8 procedures. There was a significant difference (p < 0.002) in the average number of spinal deformity procedures between graduating orthopaedic surgery residents (9.5 procedures) and graduating neurosurgery residents (2.0 procedures). There was substantial variability in spine surgery exposure within both specialties; when comparing the top 10% and bottom 10% of 2012 graduates for spinal instrumentation or arthrodesis procedures, there was a 13.1-fold difference for orthopaedic surgery residents and an 8.3-fold difference for neurosurgery residents. Spine surgery procedure volumes in orthopaedic and neurosurgery residency training programs vary greatly both within and between specialties. Although orthopaedic surgery residents had an increase in the number of spine procedures that they performed from 2009 to 2012, they averaged less than half of the number of spine procedures performed by neurological surgery residents. However, orthopaedic surgery residents appear to have greater exposure to spinal deformity than neurosurgery residents. Furthermore, orthopaedic spine fellowship training provides additional spine surgery case exposure of approximately 300 to 500 procedures; thus, before entering independent practice, when compared with neurosurgery residents, most orthopaedic spine surgeons complete as many spinal procedures or more. Although case volume is not the sole determinant of surgical skills or clinical decision making, variability in spine surgery procedure volume does exist among residency programs in the United States. Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated.
    The Journal of Bone and Joint Surgery 12/2014; 96(23):e196. DOI:10.2106/JBJS.M.01562 · 4.31 Impact Factor
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    ABSTRACT: Object Improved understanding of rod fracture (RF) following adult spinal deformity (ASD) surgery could prove valuable for surgical planning, patient counseling, and implant design. The objective of this study was to prospectively assess the rates of and risk factors for RF following surgery for ASD. Methods This was a prospective, multicenter, consecutive series. Inclusion criteria were ASD, age > 18 years, ≥5 levels posterior instrumented fusion, baseline full-length standing spine radiographs, and either development of RF or full-length standing spine radiographs obtained at least 1 year after surgery that demonstrated lack of RF. ASD was defined as presence of at least one of the following: coronal Cobb angle ≥20°, sagittal vertical axis (SVA) ≥5 cm, pelvic tilt (PT) ≥25°, and thoracic kyphosis ≥60°. Results Of 287 patients who otherwise met inclusion criteria, 200 (70%) either demonstrated RF or had radiographic imaging obtained at a minimum of 1 year after surgery showing lack of RF. The patients' mean age was 54.8 ± 15.8 years; 81% were women; 10% were smokers; the mean body mass index (BMI) was 27.1 ± 6.5; the mean number of levels fused was 12.0 ± 3.8; and 50 patients (25%) had a pedicle subtraction osteotomy (PSO). The rod material was cobalt chromium (CC) in 53%, stainless steel (SS), in 26%, or titanium alloy (TA) in 21% of cases; the rod diameters were 5.5 mm (in 68% of cases), 6.0 mm (in 13%), or 6.35 mm (in 19%). RF occurred in 18 cases (9.0%) at a mean of 14.7 months (range 3-27 months); patients without RF had a mean follow-up of 19 months (range 12-24 months). Patients with RF were older (62.3 vs 54.1 years, p = 0.036), had greater BMI (30.6 vs 26.7, p = 0.019), had greater baseline sagittal malalignment (SVA 11.8 vs 5.0 cm, p = 0.001; PT 29.1° vs 21.9°, p = 0.016; and pelvic incidence [PI]-lumbar lordosis [LL] mismatch 29.6° vs 12.0°, p = 0.002), and had greater sagittal alignment correction following surgery (SVA reduction by 9.6 vs 2.8 cm, p < 0.001; and PI-LL mismatch reduction by 26.3° vs 10.9°, p = 0.003). RF occurred in 22.0% of patients with PSO (10 of the 11 fractures occurred adjacent to the PSO level), with rates ranging from 10.0% to 31.6% across centers. CC rods were used in 68% of PSO cases, including all with RF. Smoking, levels fused, and rod diameter did not differ significantly between patients with and without RF (p > 0.05). In cases including a PSO, the rate of RF was significantly higher with CC rods than with TA or SS rods (33% vs 0%, p = 0.010). On multivariate analysis, only PSO was associated with RF (p = 0.001, OR 5.76, 95% CI 2.01-15.8). Conclusions Rod fracture occurred in 9.0% of ASD patients and in 22.0% of PSO patients with a minimum of 1-year follow-up. With further follow-up these rates would likely be even higher. There was a substantial range in the rate of RF with PSO across centers, suggesting potential variations in technique that warrant future investigation. Due to higher rates of RF with PSO, alternative instrumentation strategies should be considered for these cases.
    Journal of neurosurgery. Spine 12/2014; 21(6):994-1003. DOI:10.3171/2014.9.SPINE131176 · 2.36 Impact Factor
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    North American Spine Society (NASS) 29th annual meeting, nternational Meeting on Advanced Spine Techniques (IMAST) 21st annual meeting, San Francisco, California, USA | Valencia, Spain; 11/2014
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    ABSTRACT: BACKGROUND CONTEXT: Patients with a spinal epidural abscess (SEA) may present gravely ill and with significant neurologic compromise. Management of these patients requires prompt recognition and often emergent surgical intervention. Appropriate care is effective in preventing both the mortality and morbidity associated with this condition. PURPOSE: To evaluate the clinical outcome of patients who underwent emergent surgical management for sepsis and neurologic deterioration due to a SEA Further, to identify significant risk factors for clinical and neurologic improvement following surgery. STUDY DESIGN/SETTING: A retrospective review of all consecutive patients with sepsis and neurologic deterioration due to a SEA treated at single, academic medical center over a 9-year period. PATIENT SAMPLE: 42 patients. OUTCOME MEASURES: Survival, neurologic improvement (ASIA Grade), occurrence of medical and surgical complications. METHODS: All patients were clinically septic and had a history of worsening neurologic status. No patient had undergone prior spine surgery at the site of the abscess. Surgery was performed emergently (! 6 hours) from the time of notification of the orthopedic spine service. Surgical approach was determined on location of the abscess in relation to the thecal sac. Eight occurred within the cervical spine (all anterior), 12 within the thoracic spine (6 anterior, 6 posterior), and 22 occurred in the lumbar spine (7 anterior, 15 posterior). All cervical SEA underwent an anterior decom-pression and structural grafting with plating, while anterior SEA within the thoracic and lumbar spines underwent anterior decompression and structural allograft followed by a staged, posterior instrumented fusion. Posterior SEA in the thoracic and lumbar spines underwent decompression and evacuation only. Preoperative neurologic function was ASIA Grade B in 16, C in 16, and D in 10. Neurologic deterioration was documented in the medical record for each patient. The mean time of neurologic deterioration was 24 hours (range: 6 hours-5 days). The identified bacteria was MSSA in 19 patients, MRSA in 11, Gram negative rod in 6, TB in 4, and Pseudomonas in 2. Step-wise multivariate regression analysis was employed to identify significant risk factors for survival and neurologic improvement, RESULTS: All patients survived surgery, although 6 patients (14%) died within one month of surgery. Significant risk factors for mortality were age O 70 years (p5.02), hospitalization O 5 days prior to surgery (p5.04), ASIA D (p5.01), diabetes (p5.01), MRSA sepsis (p5.03), and end-stage renal disease (p5.02). Of the surviving patients, the average improvement was 2.4 ASIA grades. Thirty-four of the 36 surviving patients (94%) regained the ability to ambulate. Significant factors for neurologic improvement included age ! 70 years (p5.01), neurologic deterioration documented to shorter than 24 hours (p5.01), a lumbar abscess not requiring fusion (p5.02), preoperative ASIA B or C (p5.01), and non-diabetics (p5.02). Major medical complications (prolonged mechanical ventilation or ICU stay O 72 hours, any major organ system failure) were more likely to occur in diabetics and those hospitalized greater than 48 hours prior to surgery, ASIA Grade D or E, and MRSA sepsis. Surgical complications requiring additional procedures occurred in 9 patients (21%), including: displaced thoracic strut graft in 2 patients, failed posterior thoracolumbar instrumentation in 4 patients, and epidural hematomas in 3 patients. CONCLUSIONS: Despite emergent surgical management, in our series, there was a 14% mortality rate in patients with sepsis and neurologic deterioration due to an SEA. However, in those who survived, there was a high likelihood of neurologic improvement and regaining the ability to ambulate. Older patients, diabetics, and those with a longer duration of preoperative neurologic deterioration and hospitalization had higher mortality rates and even with survival, were less likely to improve neuro-logically and more prone to complications. Prompt recognition and immediate surgical intervention is essential to maximize the outcome in these critically-ill patients FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
    29th Annual Meeting of the North American Spine Society, San Francisco, CA; 11/2014
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    ABSTRACT: Current spine surgeon training in the United States consists of either an orthopedic surgery or a neurological surgery residency followed by an optional spine surgery fellowship. In recent years, spine surgery has matured into a complex medical and surgical specialty, with a large number of procedures and techniques for spinal surgeons to understand and learn before entering independent practice. The current training system with two parallel paths to spine surgery may not be the optimal model to train tomorrow's spine surgeons. To propose a spinal surgery training pathway of categorical spine surgery residency which would complement (rather than replace) the existing training pathways. Review of literature and proposal of novel training pathway. Integration of the orthopedic spine and neurosurgical spine surgery educational programs offers one option to enhance spine surgeon training in an effort to improve patient outcomes and advance scientific knowledge. The development of categorical spine surgery residency programs would provide a focused and pertinent spine training experience aimed at training the next generation of spine surgeons. Potential benefits of unifying spine training appear substantial, although several barriers to a unified approach exist. Discussion regarding the future of spine surgery training and the possibility of creating dedicated categorical spine surgery residency training for the benefit of patients, spine surgeons, and society as a whole appears appropriate. Copyright © 2014 Elsevier Inc. All rights reserved.
    The spine journal: official journal of the North American Spine Society 11/2014; 15(7). DOI:10.1016/j.spinee.2014.08.452 · 2.80 Impact Factor
  • The Spine Journal 11/2014; 14(11):S56-S57. DOI:10.1016/j.spinee.2014.08.148 · 2.80 Impact Factor
  • The Spine Journal; 10/2014
  • The Spine Journal; 10/2014
  • The Spine Journal 10/2014; DOI:10.1016/j.spinee.2014.08.019 · 2.80 Impact Factor
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    ABSTRACT: Adult spinal deformity is a prevalent cause of pain and disability. Established measures of sagittal spinopelvic alignment such as sagittal vertical axis and pelvic tilt can be modified by postural compensation, including pelvic retroversion, knee flexion, and the use of assistive devices for standing. We introduce the T1 pelvic angle, a novel measure of sagittal alignment that simultaneously accounts for both spinal inclination and pelvic retroversion. The purpose of this study was to investigate the relationship of the T1 pelvic angle and other established sagittal alignment measures and to correlate these parameters with health-related quality-of-life measures.
    The Journal of Bone and Joint Surgery 10/2014; 96(19):1631-40. DOI:10.2106/JBJS.M.01459 · 4.31 Impact Factor
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    ABSTRACT: While metal or plastic interbody spinal fusion devices are manufactured to appropriate mechanical standards, mechanical properties of commercially prepared structural allograft bone remain relatively unassessed. Robust models predicting compressive load to failure of structural allograft bone based on easily measured variables would be useful. Three hundred twenty seven femoral rings from 34 cadaver femora were tested to failure in axial compression. Predictive variables included age, gender, bone mineral density (BMD), position along femoral shaft, maximum/minimum wall thickness, outer/inner diameter, and area. We used support vector regression and 10-fold cross-validation to develop robust nonlinear predictive models for load to failure. Model performance was measured by the root-mean-squared-deviation (RMSD) and correlation coefficients (r). A polynomial model using all variables had RMSD = 7.92, r = 0.84, indicating excellent performance. A model using all variables except BMD was essentially unchanged (RMSD = 8.12, r = 0.83). Eliminating both age and BMD produced a model with RMSD = 8.41, r = 0.82, again essentially unchanged. Compressive strength of structural allograft bone can be estimated using easily measured geometric parameters, without including BMD or age. As DEXA is costly and cumbersome, and setting upper age-limits for potential donors reduces the supply, our results may prove helpful to increase the quality and availability of structural allograft. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res
    Journal of Orthopaedic Research 10/2014; 32(10). DOI:10.1002/jor.22679 · 2.97 Impact Factor
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    ABSTRACT: Study Design. Systematic review of literatureObjective. To perform a comprehensive English language systematic literature review of proximal junctional kyphosis (PJK) and proximal junctional failure (PJF), concentrating on incidence, risk factors, HRQOL impact, prevention strategy, outcomes of revision surgery and classification systems.Summary of Background Data. PJK and PJF are well described clinical pathologies and is a frequent cause of revision surgery. The development of a PJK classification which correlates with clinical outcomes and guides treatment decisions and possible prevention strategies would be of significant benefit to patients and surgeons.Methods. The phrases "proximal junctional," "proximal junctional kyphosis," and "proximal junctional failure" were used as search terms in PubMed for all years up to 2014 to identify all articles that included at least one of these terms.Results. 53 articles were identified overall. 18 articles assessed for risk factors. 8 studies specially reviewed prevention strategies. There were no randomized prospective studies. There are 3 published studies that have attempted to classify PJK. The reported incidence of PJK ranged widely, from 5% to 46% in patients undergoing spinal instrumentation and fusion for adult spinal deformity (ASD). It is reported that 66% of PJK occurs within 3 months postoperatively, and 80% within 18 months. The reported revision rates due to PJK range from 13% to 55%. Modifiable and non-modifiable risk factors for PJK have been characterized.Conclusion. PJK and PJF affect many patients following long segment instrumentation following the correction of ASD. The epidemiology and risk factors for the disease are well defined. Preoperative risk factor scoring may help guide prevention strategy recommendations. The development and prospective validation of an SRS PJK Classification system is important considering the prevalence of the problem and its clinical and economic impact.
    Spine 09/2014; DOI:10.1097/BRS.0000000000000627 · 2.45 Impact Factor
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    ABSTRACT: Study Design. Prospective cohortObjective. To understand whether patients actually perceive increased limitations as compared to their pre-operative state due to stiffness following lumbar arthrodesis.Summary of Background Data. Lumbar arthrodesis by intention eliminates spinal motion in an attempt to decrease pain, deformity and instability. Independent of pain, loss of mobility can impact ability to perform certain activities of daily living (ADLs). The Lumbar Stiffness Disability Index (LSDI) is a validated measure of the effect of lumbar stiffness on functional activities. To date, no prospective evaluations of stiffness impacts on patient function following lumbar arthrodesis have been reported.Methods. The LSDI, Short Form-36 (SF-36) and Oswestry Disability Index (ODI) were administered pre-operatively and at 2-year minimum follow-up to 62 adult patients undergoing lumbar fusion for degenerative disease or spinal deformity. Patients also completed a satisfaction questionnaire at 2 years. Patients were separated according to the number of lumbar arthrodesis levels. Pre- and post-operative LSDI, SF-36 Physical Composite Score (PCS), and ODI scores were compared using paired t-tests.Results. Significant improvements in ODI were seen across all arthrodesis levels, and significant improvements in PCS were seen at 1-level and at 5 or more levels. Patients undergoing 1-level arthrodesis demonstrated statistically significant decreases in LSDI scores, indicating less impact from stiffness than at baseline. Patients with 3 or 4 levels and 5 or more levels of arthrodesis showed increases in LSDI scores, although none reached significance with the numbers available. Forty-six percent of patients reported that low back stiffness created significant limitations in ADLs, although 97% indicated that they would undergo the same procedure again and 91% reported that any increase in stiffness was an acceptable trade-off for their functional improvements from lumbar arthrodesis.Conclusions. Patients undergoing elective lumbar arthrodesis reported relatively limited functional deficit due to stiffness at 2-year follow-up. Paradoxically, patients undergoing 1-level arthrodesis actually reported significantly less limitation due to stiffness post-operatively. While the effects of stiffness did trend toward greater impacts among patients undergoing longer fusions, 91% of patients were satisfied with trade-offs of function and pain relief in exchange for perceived increases in lumbar stiffness.
    Spine 09/2014; 39(24). DOI:10.1097/BRS.0000000000000595 · 2.45 Impact Factor
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    ABSTRACT: Object The authors evaluated the efficacy of posterior instrumentation for the management of spontaneous spinal infections. Standard surgical management of spontaneous spinal infection is based on debridement of the infected tissue. However, this can be very challenging as most of these patients are medically debilitated and the surgical debridement requires a more aggressive approach to the spine either anteriorly or via an expanded posterior approach. The authors present their results using an alternative treatment method of posterior-only neuro-decompression and stabilization without formal debridement of anterior tissue for treating spontaneous spinal infection. Methods Fifteen consecutive patients were treated surgically by 2 of the authors. All patients had osteomyelitis and discitis and were treated postoperatively with intravenous antibiotics for at least 6 weeks. The indications for surgery were failed medical management, progressive deformity with ongoing persistent spinal infection, or neurological deficit. Patients with simple epidural abscess without bony instability were treated with laminectomy and were not included in this series. Fourteen patients were treated with posterior-only decompression and long-segment rigid fixation, without formal debridement of the infected area. One patient was treated with staged anterior and posterior surgery due to delay in treatment related to medical comorbidities. The authors examined as their outcome the ambulatory status and recurrence of deep infection requiring additional surgery or medical treatment. Results Of the initial 15 patients, 10 (66%) had a minimum 2-year follow-up and 14 patients had at least 1 year of followup. There were no recurrent spinal infections. There were 3 unplanned reoperations (1 for loss of fixation, 1 for early superficial wound infection, and 1 for epidural hematoma). Nine (60%) of 15 patients were nonambulatory at presentation. At final followup, 8 of 15 patients were independently ambulatory, 6 required an assistive device, and 1 remained nonambulatory. Conclusions Long-segment fixation, without formal debridement, resulted in resolution of spinal infection in all cases and in significant neurological recovery in almost all cases. This surgical technique, when combined with aggressive antibiotic therapy and a multidisciplinary team approach, is an effective way of managing serious spinal infections in a challenging patient population.
    Neurosurgical FOCUS 08/2014; 37(2):E6. DOI:10.3171/2014.6.FOCUS14142 · 2.14 Impact Factor
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    ABSTRACT: Adults with spinal deformity present with pain and disability. Our objective was to compare outcomes for op and nonop treatment for adult spinal deformity (ASD) based on a prospective, multicenter patient population.
    Neurosurgery; 08/2014
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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.
    Journal of Spinal Disorders & Techniques 08/2014; DOI:10.1097/BSD.0000000000000154 · 1.89 Impact Factor

Publication Stats

949 Citations
403.39 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