Jang Yoon

• MD, MS
• Director of Minimally Invasive Spine at University of Pennsylvania

Background: Adult spinal deformity (ASD) is a prevalent condition often treated with circumferential spinal fusion (CF), which can be performed as staged or same-day procedures. However, evidence guiding the choice between these approaches is lacking. Objective: This study aims to compare patient outcomes following staged and same-day CF for ASD....

INTRODUCTION: Endoscopic lumbar decompression is a common surgical intervention for radiculopathy, offering potential benefits over open decompression, such as shorter operative times and faster postoperative recovery. Both endoscopic and open approaches improve patient quality of life, but further studies are needed to fully understand the advant...

OBJECTIVE Smartphones and wearable devices can be effective tools to objectively assess patient mobility and well-being before and after spine surgery. In this retrospective observational study, the authors investigated the relationship between these longitudinal perioperative patient activity data and socioeconomic and demographic correlates, asse...

OBJECTIVE The aim of this study was to describe the effect of opioid prescribing guideline implementation for elective spine surgery cases on prescribing and consumption behaviors in a multisite academic hospital system. The effectiveness of an automated text messaging system as a tool to monitor postoperative opioid use and pain outcomes and infor...

OBJECTIVE Surgical correction of adult spinal deformity (ASD) is associated with a high rate of hardware complication that can be challenging to predict. Hardware integrity and alignment after surgery are typically followed with standing radiography, where pedicle screw loosening may be incidentally identified but the clinical significance of which...

Purpose This study aimed to investigate the relationship of preoperative hemoglobin levels as an independent prognostic factor for hospital and intensive care unit (ICU) length of stay (LOS) in patients undergoing surgery for adult spinal deformity (ASD), with the intent of determining whether there exists a correlation and enhancing patient preope...

The accurate extraction of surgical data from electronic health records (EHRs), particularly operative notes through manual chart review (MCR), is complex, crucial, and time-intensive, limited by human error due to fatigue and the level of training. This study aimed to develop and validate a novel Natural Language Processing (NLP) algorithm integra...

Objective: The development of adjacent segment disease or the progression of spondylosis following the surgical treatment of spinal stenosis and spondylolisthesis is well documented and can lead to subsequent functional decline after a successful index surgery. The early detection of negative inflection points during patients’ functional recovery c...

BACKGROUND Adult spinal deformity (ASD) is a prevalent condition often treated with circumferential spinal fusion (CF), which can be performed as Staged or Same-Day procedures. However, evidence guiding the choice between these approaches is lacking. OBJECTIVE This systematic review and meta-analysis aimed to evaluate patient outcomes following St...

UNSTRUCTURED The rapid integration of Artificial Intelligence (AI) in healthcare emphasizes the transformative potential it holds for improving patient outcomes through data-driven decision-making. There is a drive toward implementing more complex predictive algorithms for disease diagnosis and prognosis. However, there are unique implications of A...

BACKGROUND AND OBJECTIVES Race has implications for access to medical care. However, the impact of race, after access to care has been attained, remains poorly understood. The objective of this study was to isolate the relationship between race and short-term outcomes across patients undergoing a single, common neurosurgical procedure. METHODS In...

UNSTRUCTURED This cross-sectional study evaluates the clinical accuracy, relevance, clarity, and emotional sensitivity of responses to inquiries from patients undergoing surgery provided by large language models (LLMs), highlighting their potential as adjunct tools in patient communication and education. Our findings demonstrated high performance o...

This cross-sectional study evaluates the clinical accuracy, relevance, clarity, and emotional sensitivity of responses to inquiries from patients undergoing surgery provided by large language models (LLMs), highlighting their potential as adjunct tools in patient communication and education. Our findings demonstrated high performance of LLMs across...

BACKGROUND AND OBJECTIVES Smartphone activity data recorded through high-fidelity accelerometry can provide accurate postoperative assessments of patient mobility. The “big data” available through smartphones allows for advanced analyses, yielding insight into patient well-being. This study compared rate of change in functional activity data betwee...

Background: Patients often undergo circumferential (anterior and posterior) spinal fusions to maximize adult spinal deformity (ASD) correction and achieve adequate fusion. Currently, such procedures are performed in staged (ST) or same-day (SD) procedures with limited evidence to support either strategy. This study aims to compare perioperative ou...

Objective: Preoperative management requires the identification and optimization of modifiable medical comorbidities, though few studies isolate comorbid status from related patient-level variables. This study evaluates Charlson Comorbidity Index (CCI) - an easily derived measure of aggregate medical comorbidity - to predict outcomes from spinal fu...

Objective: Patient-reported outcome measures (PROMs) are the gold standard for assessing postoperative outcomes in spine surgery. However, PROMs are also limited by the inherent subjectivity of self-reported qualitative data. Recent literature has highlighted the utility of patient mobility data streamed from smartphone accelerometers as an object...

Background Anterior skull base fractures represent a unique challenge for neurosurgical repair due to the potential for orbital injury and the proximity to the air sinuses, yielding increased possibility for infection, and persistent cerebrospinal fluid (CSF) leak. While multiple techniques are available for the repair of anterior skull base defect...

INTRODUCTION C-arm fluoroscopy and O-arm navigation are vital tools in modern spine surgeries, but their repeated usage can endanger spine surgeons. While a surgeon’s chest and abdomen are protected by lead aprons, the eyes and extremities generally receive less protection. METHODS This prospective cohort study includes 65 consecutive spine surger...

INTRODUCTION Minimally invasive techniques and awake surgery have changed the nature of fusion surgery, though these effects are not yet fully characterized due to the subjective nature of patient reported outcome measures (PROMs). Physical activity data measured from smartphone accelerometers offer the ability to objectively quantify the benefits...

INTRODUCTION The development of accurate and generalizable machine learning algorithms requires sufficient quantities of diverse data. This poses a challenge in healthcare due to the sensitive and siloed nature of biomedical information. Decentralized algorithms through a federated learning (FL) paradigm avoid the need for data aggregation by inste...

Background: There remains a number of factors thought to be associated with survival in spinal metastatic disease, but evidence of these associations is lacking. In this study, we examined factors associated with survival among patients undergoing surgery for spinal metastatic disease. Methods: We retrospectively examined 104 patients who underw...

Background: Lumbar interbody fusion (LIF) techniques have seen impressive innovation in recent years, leading to an expansion of the LIF lexicon. Objective: This study systematically analyzes LIF nomenclature in contemporary literature and proposes a standardized classification system for reporting LIF terminology. Methods: A search query was...

Study design: Prospective cohort study. Summary of background data: C-arm fluoroscopy and O-arm navigation are vital tools in modern spine surgeries, but their repeated usage can endanger spine surgeons. Although a surgeon's chest and abdomen are protected by lead aprons, the eyes and extremities generally receive less protection. Objective: I...

Background: Augmented reality (AR) and virtual reality (VR) implementation in spinal surgery has expanded rapidly over the past decade. This systematic review summarizes the use of AR/VR technology in surgical education, preoperative planning, and intra-operative guidance. Methods: A search query for AR/VR technology in spine surgery was conduct...

Study design: This article is a research methodology study. Objective: We summarize current ambiguities and inaccuracies regarding lumbar interbody fusion nomenclature and propose a standardized reporting method to improve the clarity of future research and communication among spine surgeons and researchers. Summary of background data: Lumbar...

Background: The development of accurate machine learning algorithms requires sufficient quantities of diverse data. This poses a challenge in health care because of the sensitive and siloed nature of biomedical information. Decentralized algorithms through federated learning (FL) avoid data aggregation by instead distributing algorithms to the dat...

Background Lumbar lateral interbody fusion (LLIF) is traditionally performed in two stages: placing the interbody cage in the lateral decubitus position, followed by percutaneous pedicle screw placement in the prone position. Performing interbody fusion and posterior fixation simultaneously could improve operative efficiency and clinical outcomes a...

Objective A hallmark of surgical training is resident involvement in operative procedures. While resident-assisted surgeries have been deemed generally safe, few studies have rigorously isolated the impact of resident post-graduate year (PGY) level on post-operative outcomes in a neurosurgical patient population. The objective of this study is to e...

In 2021, the surgical arena is replete with minimally invasive spine surgery (MISS) and accruing robotic adjuncts for this popular technique. However, in order to continue advancing surgical practice and driving development within this field, a concise synthesis of progress made in robotic surgery for MISS is critical. In this chapter, we briefly c...

INTRODUCTION Spine surgery outcomes are currently assessed using patient-reported outcome measures (ODI, EQ-5D). However, such tools are limited by the inherent subjectivity of the data, as well as collection at discrete timepoints without regard to each patient’s unique clinical course. In contrast, patient mobility data streamed from smartphones...

INTRODUCTION Spinal fusions represent one of the most common neurosurgical procedures. The LACE (Length of Stay, Acuity of Admission, Charlson Comorbidity Index (CCI) Score, Emergency Department (ED) visits within the previous 6 months) index was developed to predict readmissions, but has not been tested in a large, homogenous spinal fusion populat...

OBJECTIVE Treatment of degenerative lumbar spine pathologies typically escalates to surgical intervention when symptoms begin to significantly impair patients’ functional status. Currently, surgeons rely on subjective patient assessments through patient-reported outcome measures to estimate the decline in patient wellness and quality of life. In th...

Objective Many surgical options exist for multi-level lumbar interbody fusion, including anterior (ALIF) and lateral (LLIF) lumbar interbody fusions. While current technique of repositioning patients between supine ALIF and lateral decubitus LLIF offers many benefits, intra-operative repositioning can be cumbersome. We present a novel approach that...

Background: Spine surgery outcomes assessment currently relies on patient-reported outcome measures, which satisfy established reliability and validity criteria, but are limited by the inherently subjective and discrete nature of data collection. Physical activity measured from smartphones offers a new data source to assess postoperative functiona...

OBJECTIVE Spinal fusion is one of the most common neurosurgical procedures. The LACE (length of stay, acuity of admission, Charlson Comorbidity Index [CCI] score, and emergency department [ED] visits within the previous 6 months) index was developed to predict readmission but has not been tested in a large, homogeneous spinal fusion population. The...

Background: There is a paucity of literature covering the spinal alignment changes following adult spinal deformities (ASD) corrective surgeries. In theory, patients' posture and overall alignment may vary with postoperative pain, bracing, and other external variables requiring further radiographic follow-up. The purpose of the study is to investi...

Objectives Investigating the development of acute thrombocytopenia, differential etiologies, and potentially the rare manifestation of disseminated intravascular coagulation after brain tumor resection of primary and secondary malignancies. Materials and methods We performed a retrospective review of a case series of post-operative neurosurgical p...

There is an ongoing desire for the development of motion-preserving facet replacement devices as an alternative to rigid fixation in hopes of better preserving the natural kinematics of the lumbar spine. Theoretically, such a construct would simultaneously address pain associated with spinal instability and prevent abnormal load distribution and ad...

Multilevel lateral interbody fusion is an acceptable surgical technique in patients with severe degenerative adult spinal deformity (ASD). The current standard-of-care in spine surgery includes the use of patient reported outcome measures (PROMs) to assess post-operative improvement. Objective activity data during the peri-operative period may prov...

Background: Clinical practice in postoperative bracing after posterior lumbar spine fusion (PLF) is inconsistent between providers. This paper attempts to assess the effect of bracing on short-term outcomes related to safety, quality of care, and direct costs. Methods: Retrospective cohort analysis of consecutive patients undergoing multilevel P...

Background The surgical treatment of normal pressure hydrocephalus (NPH) with shunting remains controversial due to the difficulty in distinguishing such pathology from other neurological conditions that can present similarly. Thus, patients with suspected NPH should be carefully selected for surgical intervention. Historically, clinical improvemen...

Objective. Holographic mixed reality (HMR) allows for the superimposition of computer-generated virtual objects onto the operator’s view of the world. Innovative solutions can be developed to enable the use of this technology during surgery. The authors developed and iteratively optimized a pipeline to construct, visualize, and register intraoperat...

Background: We present a "Do-It-Yourself" method to build an affordable augmented reality heads-up display system (AR-HUD) capable of displaying intraoperative images. All components are commercially available products, which the surgeons may use in their own practice for educational and research purposes. Methods: Moverio BT 35-E smart glasses...

Background: In order to deliver optimal patient care, spine surgeons must integrate technological changes to arrive at novel measures of functional outcomes. Historically, subjective patient-reported outcome (PRO) surveys have been used to determine the relative benefit of surgical treatments. Using smartphone-based accelerometers, surgeons now hav...

The history of modern surgery has run parallel to the invention and development of intra-operative visualization techniques. The first operating room, built in 1804 at Pennsylvania Hospital, demonstrates this principle: illumination of the surgical field by the Sun through an overhead skylight allowed surgeries to proceed even prior to the inventio...

Background Evolution within spine surgery is driven by a surgeon’s desire for expertise and significant improvement in their patients’ quality of life. As surgeons move away from using subjective patient-reported outcome (PRO) surveys, there must be an alternative objective metric in its place. Modern iPhone (Apple Inc., Cupertino, CA) technology...

Background: The LACE+ (Length of stay, Acuity of admission, Charlson Comorbidity Index [CCI] score, and Emergency department [ED] visits in the past 6 mo) index risk-prediction tool has never been successfully tested in a neurosurgery population. Objective: To assess the ability of LACE+ to predict adverse outcomes after supratentorial brain tum...

Objectives The LACE + index risk prediction tool has not been successfully used to predict short-term outcomes after neurosurgery. This study assessed the ability of LACE + to predict 30-day (30D) adverse outcomes after supratentorial brain tumor surgery. Patients and Methods LACE + scores were retrospectively calculated for consecutive patients (...

Presence of a cervical rib results from overdevelopment of the seventh cervical vertebrae.1-3 The cervical rib along with scalene muscles can cause neurogenic thoracic outlet syndrome.4,5 Rib resection is typically done via anterior approach, using either supraclavicular or transaxillary route.6,7 We present an operative video detailing supraclavic...

Background: With the COVID-19 pandemic disrupting many facets of our society, physicians and patients have begun using telemedicine as a platform for the delivery of health care. One of the challenges in implementing telemedicine for the spine care provider is completing a comprehensive spinal examination. Currently, there is no standardized metho...

Background In a standard surgical operating room, advanced imaging is projected on a separate monitor screen away from the surgical field of view. This setup requires surgeons to repeatedly shift their attention between the operative field and a screen. Such movement may result in a disruption of focus that can extend surgical time, cause physical...

OBJECTIVE Spinal peripheral nerve sheath tumors (PNSTs) are a group of rare tumors originating from the nerve and its supporting structures. Standard surgical management typically entails laminectomy with or without facetectomy to gain adequate tumor exposure. Arthrodesis is occasionally performed to maintain spinal stability and mitigate the risk...

The field of minimally invasive spine surgery (MISS) has rapidly evolved over the past 3 decades. This review follows the evolution of techniques and principles that have led to significant advances in the field. While still representing only a subset of spine surgeries, MISS’s goals of reducing soft-tissue trauma and mitigating the morbidity of su...

Cervical disc herniations most often present with neck and arm pain resulting from direct nerve root compression from a paramedian or foraminal disc herniation. It is unusual to encounter unilateral lower extremity symptoms in the absence of other neurological symptoms due to a centrally herniated cervical disc. Because this clinical presentation i...

Background Gram-negative surgical site infections (SSI) following spine surgery are becoming increasingly more common owing to a broad perioperative antibiotic usage targeting gram-positive organisms. Enterobacter species have been reported to be the most common gram-negative bacteria following spine surgery. Methods We queried our institutional d...

Significant advances in the design and understanding of the materials and systems of 1-100 nm have provided unprecedented tools to probe, diagnose, and treat diseases at the molecular level with greater efficiency and accuracy. In particular, optical and chemical properties of nanomaterials are being exploited to improve the effectiveness of neuro-...

Background: Glioblastomas (GBMs) are one of the most devastating primary tumors in humans and often results in minimal survival rates. Over the past 2 decades, patients have accessed the internet to obtain information related to their diagnoses. In this study, we aimed to evaluate the accuracy and the reliability of GBM-related YouTube videos. Me...

Introduction Since the introduction of wearable head‐up displays, there has been much interest in the surgical community adapting this technology into routine surgical practice. Methods We used the keywords augmented reality OR wearable device OR head‐up display AND surgery using PubMed, EBSCO, IEEE and SCOPUS databases. After exclusions, 74 publi...

Background: Traumatic cervical pseudomeningoceles (TCP) occur secondary to traction of the cervical nerve roots resulting in violation of the dura. Surgical repair is not necessary in most cases, because pseudomeningoceles have a high propensity to spontaneously resolve with conservative management alone. Currently, there are a limited number of c...

Background: Congenital agenesis of the inferior vena cava (IVC) can lead to the development of a prominent venous collateral system within and around the spine due to the development of venous collaterals. Surgery on such patients can harbor the risk of catastrophic bleeding or decompensation of a delicate venous drainage pattern during spinal man...

With image guidance technology, surgeons are able to correlate surgical anatomy with radiographic images in vivo during surgery. Image guidance provides valuable intraoperative feedback to the surgeon and can help guide different tasks in spinal surgery procedures including dissection of the spinal anatomy in revision cases, location of the skin in...

Granulomatous angiitis of the central nervous system (GACNS) is a rare cerebrovascular disorder. It usually presents with multifocal neurologic symptoms symptoms including stroke, encephalopathy, and headache. A limited number of case reports describe neurological deficits resulting from GACNS as the manifesting symptoms of Hodgkin's lymphoma (HL)....

Introduction: Extraforaminal disk herniation (EDH) accounts for 3-11% of all disk herniations. Despite the heterogeneity of spinal procedures, there is a paucity of literature comparing the outcomes from different surgical approaches. Methods: We performed a systematic review and meta-analysis of available literature on EDHs. We compared patient...

Background: Dural arteriovenous fistula (DAVF) is an abnormal vascular connection between arterial and venous channels within dura mater. Although DAVFs have been linked to other types of intracranial tumors, this is the first case reporting the association between DAVF and an epidermoid tumor. Case description: A middle aged patient with chroni...

Background: Wearable technology is growing in popularity as a result of its ability to interface with normal human movement and function. Methods: Using proprietary hardware and software, neuronavigation images were captured and transferred wirelessly via a password-encrypted network to the head-up display. The operating surgeon wore a loupe-mou...

Background: Unilateral anterior spinal artery (ASA) occlusion resulting in bilateral medullary pyramidal (BMP) infarction is a rare and devastating stroke subtype. We present two cases highlighting the diagnostic and clinical challenges of BMP infarction. Methods: Case reports and literature review. Results: A 57-year-old man rapidly had sever...

Aim: Wearable technology interfaces with normal human movement and function, thereby enabling more efficient and adaptable use.We developed a wearable display system for use with intra-operative neuronavigation for brain tumor surgery. Material and methods: The Google glass head-up display system was adapted to surgical loupes with a video-strea...

This is a 42-year old male patient who suffered from complications of tumor seeding as a result of biopsy of a clival chordoma. The patient was previously biopsied for this lesion via a sublabial transnasal route at initially pituitary tumor was suspected, the pathology was consistent with chordoma, and the patient radiotherapy of 6400 cGy in 32 fr...

Purpose: Complications from RA can involve the thoracolumbar spine and cause severe spine instability and sagittal deformity. We present a surgical strategy to restore sagittal balance in a patient with chronic rheumatoid arthritis. Methods: A retrospective chart review was performed. Results: We report the case of a 53-year-old woman with RA and s...

Introduction: We report a case of a 49-year-old man who sustained a left brachial plexus injury and traumatic brain injury after a motor vehicle accident and subsequently developed a giant left cervical pseudomeningocele. The patient suffered multiple fractures in the cervical and thoracic ribs, transverse processes and the scapula. Physical examin...