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Joseph S. Butler

Joseph S. Butler
Mater Misericordiae University Hospital & University College Dublin

BMedSc MB BCh BAO MA PhD FFSEM FEBOT FACS FRCS

About

238
Publications
43,010
Reads
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2,919
Citations
Introduction
Academic Spine Surgeon. Clinical interests are spine trauma, degenerative and deformity surgery. Basic science interests are bone development and bone regeneration.
Additional affiliations
July 2006 - October 2006
University of Washington
Position
  • Visiting Research Fellow - PhD
Description
  • Wnt/B-Catenin Signaling in Bone Development
June 2002 - September 2002
Mater Misericordiae University Hospital
Position
  • Research Assistant
Description
  • Pathogenesis of Post-Traumatic Osteoarthritis
July 2005 - June 2009
University College Dublin
Position
  • Research Fellow - PhD
Description
  • Molecular Mechanisms driving Bone Mass Regulation
Education
September 2009 - June 2011
Institute of Public Administration, Ireland
Field of study
  • Healthcare Management
August 2009 - June 2010
Institute of Public Administration, Ireland
Field of study
  • Public Management - Higher Diploma
September 2008 - June 2009
Institute of Public Administration, Ireland
Field of study
  • Healthcare Economics - Diploma

Publications

Publications (238)
Article
The prestige of publication has been based on traditional citation metrics, most commonly journal impact factor. However, the Internet has radically changed the speed, flow, and sharing of medical information. Furthermore, the explosion of social media, along with development of popular professional and scientific websites and blogs, has led to the...
Article
Background context: A variety of surgical approaches have been used for cage insertion in lumbar interbody fusion surgery. The direct anterior approach requires mobilization of the great vessels to access the intervertebral disc spaces cranial to L5/S1. With the lateral retroperitoneal transpsoas approach, it is difficult to access the L4/L5 inter...
Article
Background Tumor-related spinal surgery has been revolutionized by recent advances in spinal stabilization, modern neuroimaging, and perioperative intensive medicine. This study examines clinical outcomes and factors associated with complications following reconstruction of complex oncologic defects of the spine and sacrum, in an attempt to increas...
Article
Background context: Lumbar lordosis correlates with pelvic morphology and it has been demonstrated that as lumbar lordosis increases, the inflection point and apex of lordosis move cranially. This suggests that each segment of the lumbar spine relates to pelvic morphology in a unique way. Objectives: To establish whether there is a direct relati...
Article
Full-text available
Study Design Narrative Review. Objectives The premise of this review is to provide a review of the literature pertaining to studies describing outcomes of surgical cohorts when implementing C1 osteosynthesis for arch fractures with or without transverse atlantal ligamentous (TAL) injury. Methods A comprehensive search strategy was implemented acr...
Article
Full-text available
Background While growth factors have the potential to halt degeneration and decrease inflammation in animal models, the literature investigating the effect of dosage on human cells is lacking. Moreover, despite the completion of clinical trials using growth differentiation factor‐5 (GDF‐5), no results have been publicly released. Aims The overall...
Article
Full-text available
Background Parkinson’s Disease (PD) patients represent challenging spinal surgery candidates due to associated frailty and deformity. This study consolidates the literature concerning spinal surgery outcomes in PD versus non-PD patients, to evaluate if PD predisposes patients to worse post-operative outcomes, so that treatment protocols can be opti...
Article
Study Design Systematic review and meta-analysis. Objective Surgical management of osteoporotic vertebral compression fractures (OVCFs) has traditionally consisted of vertebroplasty or kyphoplasty procedures. Mechanical percutaneous vertebral body augmentation (MPVA) systems have recently been introduced as alternatives to traditional methods. How...
Article
Full-text available
Background and Objective: Managing postoperative pain in complex spine surgeries presents challenges due to high pain scores. While opioids are a crucial component of multi-modal pain management, concerns regarding tolerance and dependency necessitate exploring alternatives. Marijuana has shown promise as a potential pain-reliever in preclinical st...
Article
Full-text available
Introduction Anterior cervical discectomy and fusion (ACDF) is commonly performed with cage and plate constructs to stabilise diseased or injured cervical segments. Despite it being a commonly performed procedure, there are notable rates of associated morbidity reported in the literature. Stand-alone spacers represent a novel form of instrumentatio...
Article
Full-text available
Objective Conventional freehand methods of pedicle screw placement are associated with significant complications due to close proximity to neural and vascular structures. Recent advances in augmented reality surgical navigation (ARSN) have led to its adoption into spine surgery. However, little is known regarding its overall accuracy. The purpose o...
Article
Full-text available
Background A significant hurdle for potential cell‐based therapies is the subsequent survival and regenerative capacity of implanted cells. While many exciting developments have demonstrated promise preclinically, cell‐based therapies for intervertebral disc (IVD) degeneration fail to translate equivalent clinical efficacy. Aims This work aims to...
Chapter
Spinal cancer is primarily a metastatic disease with >90% having originated from another source. There is no proven curative treatment for metastatic spinal disease and therefore the goals are pain control and functional preservation. Many primary tumors affect persons of advanced age; therefore consideration for comorbidities, fitness for therapy,...
Article
Full-text available
Study design Systematic Review Objectives Vertebral Artery Injury (VAI) is a potentially serious complication of cervical spine fractures. As many patients can be asymptomatic at the time of injury, the identification and diagnosis of VAI can often prove difficult. Due to the high rates of morbidity and mortality associated with VAI, high clinical...
Article
Full-text available
Purpose The aim of this study is to identify risk factors associated with postoperative DJF in long constructs for ASD. Methods A retrospective review was performed at a tertiary referral spine centre from 01/01/2007 to 31/12/2016. Demographic, clinical and radiographic parameters were collated for patients with DJF in the postoperative period and...
Article
Full-text available
Background Traumatic injuries are among the leading causes of death and disability worldwide. Major trauma presenta- tions have seen a demographic shift recently from the young to the elderly, with significant associated neurological deficit. Aims To review the presentation and outcome of elderly patients presenting with cervical spinal injuries...
Article
Full-text available
Patients presenting with degenerative spinal changes are often poor surgical candidates due to associated co-morbidities, frailty, or sarcopenia. Additionally, surgeries of a degenerative spine can prove difficult due to the distortion of normal surgical anatomy. Therefore, many patients are managed conservatively with a variety of modalities, incl...
Article
Full-text available
Objectives Raised patient BMI is recognised as a relative contraindication to posterior lumbar interbody fusion (PLIF) due to the anaesthetic challenges, difficult positioning and increased intraoperative and postoperative complications, with the relative risk rising in patients with a BMI >25 kg/m2. The impact of obesity defined as a BMI > 30 kg/m...
Article
Frailty is a common geriatric syndrome, the relevance of which is becoming increasingly apparent in the clinical setting. It is often accompanied by varying degrees of sarcopenia and/or osteoporosis, leading to a decline in physical function, decreased levels of physical activity, and overall poorer health outcomes in older adults. Identifying this...
Article
Full-text available
Purpose Anterior lumbar interbody fusion (ALIF) is a well-established alternative to posterior-based interbody fusion techniques, with approach variations, such as retroperitoneal, transperitoneal, open, and laparoscopic well described. Variable rates of complications for each approach have been enumerated in the literature. The purpose of this stu...
Article
Full-text available
Objectives: Sarcopenia is postulated to be an influential factor in chronic low back pain. The aim of this study is to evaluate the relationship between traditional clinical measures of sarcopenia and novel radiographic methods which evaluate overall muscle status, such as adjusted psoas cross-sectional area (APCSA) and degree of fat infiltration (...
Article
The coronavirus disease 2019 (COVID-19) pandemic has had a dramatic impact on the provision of health care worldwide. The delivery of national spinal service for emergent surgery, elective surgery, and outpatient assessment has been incredibly challenging. A variety of innovative measures were undertaken to facilitate the safe provision of acute se...
Article
Full-text available
Introduction Major trauma has seen a demographic shift in recent years and it is expected that the elderly population will comprise a greater burden on the major trauma service in the near future. However, whether a similar trend exists in those undergoing operative intervention for spinal trauma remains to be elucidated. Aims To compare the prese...
Article
In recent years, machine learning (ML) and artificial neural networks (ANNs), a particular subset of ML, have been adopted by various areas of healthcare. A number of diagnostic and prognostic algorithms have been designed and implemented across a range of orthopaedic sub-specialties to date, with many positive results. However, the methodology of...
Article
Background: The surgical management of adult spinal deformity (ASD) is a major surgical undertaking associated with considerable perioperative risk and a substantial complication profile. Although the natural history and risk factors associated with proximal junctional kyphosis (PJK) and proximal junctional failure are widely reported, distal junc...
Article
Full-text available
Background The SARS-CoV-2 pandemic has had profound implications on healthcare institutions. Aims This study aims to assess and compare referral patterns during COVID-19 to corresponding dates for the preceding 3 years (2017–2019), in order to preemptively coordinate the logistics of the surgical unit for similar future experiences. Methods Retro...
Article
Introduction The COVID-19 pandemic has had a dramatic impact on the provision of healthcare worldwide. The delivery of a national spinal service for emergent surgery, elective surgery and outpatient assessment has been incredibly challenging. Method Prospectively collected data regarding referrals to, and operative workload of, the Irish National...
Article
Major spinal surgery causes significant postoperative pain. We tested the efficacy and safety of bilateral erector spinae block on quality of recovery and pain after thoracolumbar decompression. We randomly allocated 60 adults to standard care or erector spinae block. Erector spinae block improved the mean (SD) quality of recovery-15 score at 24 po...
Article
Background: Postoperative C5 palsy is a common complication following cervical decompression, occurring more frequently after posterior-based procedures. It has been theorized that this is the result of C5 nerve stretch resulting from spinal cord drift with these procedures. As such, it is thought to be less common after anterior cervical decompre...
Article
Introduction The Orthopaedic Trauma Association has recommended limitation of in-person encounters to absolute necessity. One method of ensuring standard patient care within these guidelines is through the implementation of telemedicine. Aims To evaluate the efficacy of telemedicine for elective orthopaedic patients in the recovery and/or rehabili...
Article
Background The preoperative identification of osteoporosis in the spine surgery population is of crucial importance. Limitations associated with dual-energy x-ray absorptiometry(DXA), such as access and reliability, have prompted the search for alternative methods to diagnose osteoporosis. The Hounsfield Unit(HU), a readily available measure on com...
Article
Study design: Meta-analysis. Objective: To compare the clinical, functional, and radiological outcomes of posterior-only versus combined anterior-posterior instrumentation in order to determine the optimal surgical intervention for thoracolumbar burst fractures. Summary of background data: Unstable thoracolumbar burst fractures warrant surgica...
Article
Degenerative disk disease is a pathologic state associated with axial skeletal pain, radiculopathy, and myelopathy, and will inevitably increase in prevalence in parallel with an aging population. The objective of regenerative medicine is to convert the inflammatory, catabolic microenvironment of degenerative disease into an anti-inflammatory, anab...
Article
Surgical intervention is commonly required in the management of cervical spondylotic myelopathy to arrest the progression of myelopathic symptoms. This can be achieved via an anterior, posterior, or circumferential decompression, with or without instrumented fusion. Posterior cervical decompression and fusion (PCDF) is considered safe and efficacio...
Article
Medical and surgical research has always had a long-standing relationship with industry-based funding from sources, such as drug and device companies. Concerns exist surrounding the association between funding sources, outcome from studies and publication bias. Studies demonstrating increased odds ratios associated with positive results in industry...
Article
Aims Whether a combined anteroposterior fusion or a posterior-only fusion is more effective in the management of patients with Scheuermann’s kyphosis remains controversial. The aim of this study was to compare the radiological and clinical outcomes of these surgical approaches, and to evaluate the postoperative complications with the hypothesis tha...
Article
Full-text available
Study design: Retrospective database review. Objectives: The incidence and risk factors for surgical delay of multilevel spine fusion for adult spinal deformity (ASD), and the complications corresponding therewith, remain unknown. The objectives of this study are to assess the incidence and risk factors for unexpected delay of elective multileve...
Article
Full-text available
Bilateral cervical facet dislocation (BCFD) is an uncommon injury with a high incidence of severe neurological impairment. We describe 4 cases of BCFD with preserved neurological function. Case 1: A 78 year old female who suffered two ground level falls (GLFs). Pre-operative American Spinal Injury Association (ASIA) Score was C5D. Imaging revealed...
Article
Sarcopenia is characterized by progressive age-related and systematic loss of skeletal muscle mass, strength, and function. It was classified as an independent disease in 2016; thus, there is a sparsity of research on the association of sarcopenia with lower back pain and spinal diseases. Its prevalence is around 10% worldwide and it has been shown...
Article
The Patient-Reported Outcomes Measurement Information System (PROMIS) is a National Institute of Health initiative to improve the measurement of clinically important symptoms and outcomes. Patient-Reported Outcomes capture health outcomes that are relevant to the daily functioning of the patient and include the monitoring of physical, mental, and s...
Article
Finite element analysis is a computational technique to predict how different materials will react when a range of forces are applied. In the field of orthopedics, this technique has predominantly been used for implant design and testing. As the technology improves, increasing clinical applications are being developed, offering promise in the areas...
Article
The management of thoracolumbar burst fractures is controversial with no universally accepted treatment algorithm. Several classification and scoring systems have been developed to assist in surgical decision-making. The most widely accepted are the Thoracolumbar Injury Classification and Severity Score (TLICS) and AOSpine Thoracolumbar Injury Clas...
Article
Full-text available
Uncomfortably Numb: Suicide and the Psychological Undercurrent of COVID-19. - Hannah Hughes, Maria Macken, Joseph Butler, Keith Synnott
Article
Aims: The timing of surgical fixation in spinal fractures is a contentious topic. Existing literature suggests that early stabilization leads to reduced morbidity, improved neurological outcomes, and shorter hospital stay. However, the quality of evidence is low and equivocal with regard to the safety of early fixation in the severely injured pati...
Article
Continuous technical improvement in spinal surgical procedures, with the aim of enhancing patient outcomes, can be assisted by the deployment of advanced technologies including navigation, intraoperative CT imaging, and surgical robots. The latest generation of robotic surgical systems allows the simultaneous application of a range of digital featu...
Article
Full-text available
Superiority and equivalence trials are 2 commonly encountered methods of designing randomized controlled trials. Traditionally, the goal of a randomized controlled trial is to show superiority. However, in more recent times, there has been a tendency to show equivalence in clinical randomized trials. These differing conclusions at first glance seem...
Article
Spinal surgery has been revolutionized by advances in instrumentation, bone graft substitutes, and perioperative care. Extensive dissection, creation of large areas of dead space, and the use of instrumentation in compromised patients, however, predisposes to high rates of wound complications. Postoperative wound complications in patients undergoin...
Article
Full-text available
Study Design Retrospective, single institution, multisurgeon case control series. Objective To determine whether there are differences in reoperation rates or outcomes for patients undergoing 2-level posterolateral fusion (PLF) augmented by a transforaminal lumbar interbody fusion (TLIF) at only one of the levels or at both. Methods A total of 41...
Article
Lower back pain is a commonly reported symptom during pregnancy. However, herniated lumbar disk disease is an uncommon cause for such pain. Cauda equina syndrome (CES) during pregnancy is a rare clinical scenario. This review highlights the epidemiology, diagnostic and treatment strategies, and challenges encountered when managing herniated lumbar...
Article
Spine surgery has seen considerable advancements over the last 2 decades, particularly in the fields of image-guidance and robotics. These technologies offer the potential to overcome the various technical challenges in spinal surgery, such as physical and mental fatigue, hand tremor, difficulties with manual dexterity, and surgical precision. This...
Chapter
Thoracolumbar fractures account for nearly 90% of all spinal fractures and are typically acquired through high-energy trauma most commonly in young- to middle-aged males. These fractures may be associated with spinal cord injury requiring the assessment of neurological function via the American Spinal Injury Association (ASIA) Impairment Scale (AIS...
Article
Background: A significant proportion of patients presenting with suspected cauda equina syndrome (CES) do not have associated radiological evidence to support the diagnosis, often termed 'scan-negative'. Due to the limited number of studies regarding the matter, there is no clear understanding for this presentation. As a result, no treatment proto...
Article
Background: The optimal timing of fracture fixation following spinal injury is controversial. Many spinal fractures occur as part of polytrauma requiring a complex management strategy. Whilst the decision to stabilize unstable spinal column injuries is without debate,the duration between injury and definitive fixation can impact on the incidence of...