Joshua E Heller

Joshua E Heller
Thomas Jefferson University | Jefferson · Department of Neurological Surgery

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65
Publications
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584
Citations

Publications

Publications (65)
Article
OBJECTIVE There is currently a lack of consensus on the utility of intraoperative neuromonitoring (IONM) for decompression of Chiari type I malformation (CM-I). Commonly used monitoring modalities include somatosensory evoked potentials (SSEPs), motor evoked potentials (MEPs), and brainstem auditory evoked potentials (BAEPs). The purpose of this st...
Article
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Purpose of Review Sacroiliac dysfunction is an important cause of low back pain with significant impact on quality of life and daily activities. Minimally invasive sacroiliac joint fusion (MIS SI fusion) is an effective treatment for patients who failed non-surgical strategies. The purpose of this article is to review the clinical outcomes and comp...
Article
Objectives Patients with a history of surgically treated cervical myelopathy and lumbar pathology requiring fusion present complex challenges. There is a paucity of literature describing patient reported outcomes in this cohort beyond tandem spinal stenosis patients. This has led to unclear guidelines in the literature. We present the first dataset...
Article
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Background Clinically significant disc herniations in the thoracic spine are rare accounting for approximately 1% of all disc herniations. In patients with significant spinal cord compression, presenting symptoms typically include ambulatory dysfunction, lower extremity weakness, lower extremity sensory changes, as well as bowl, bladder, or sexual...
Article
BACKGROUND There is a paucity of information regarding treatment strategies and variables affecting outcomes of revision lumbar fusions. OBJECTIVE To evaluate the influence of primary vs different surgeon on functional outcomes of revisions. METHODS All elective lumbar fusion revisions, March 2018 to August 2019, were retrospectively categorized...
Article
OBJECTIVE The authors compared primary lumbar spine fusions with revision fusions by using patient Oswestry Disability Index (ODI) scores to evaluate the impact of the North American Spine Society (NASS) evidence-based medicine (EBM) lumbar fusion indications on patient-reported outcome measures of revision surgeries. METHODS This study was a retr...
Article
Background: Instrumented fusion procedures are essential in the treatment of degenerative lumbar spine disease to alleviate pain and improve neurologic function, but are being performed with increasing incidence and variability. Objective: We implemented a training module for neurosurgery residents that is based on evidence-based criteria for lu...
Article
Background Idiopathic spinal cord herniation (ISCH) is a rare pathology characterized by extravasation of the spinal cord through a dural defect. The optimal algorithm for choosing operative or non-operative management is not well elucidate, partially due to rarity of this pathology. We present the largest single-center series of ISCH and compare o...
Article
Full-text available
(Full text link provided above) Objective Anterior cervical discectomy and fusion (ACDF) is a common procedure for the treatment of cervical disease. Circumferential procedures are options for multilevel pathology. Potential complications of multilevel anterior procedures are dysphagia and pseudarthrosis, whereas potential complications of posteri...
Preprint
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Background Clinically significant disc herniations in the thoracic spine are rare accounting for approximately 1% of all disc herniations. In patients with significant spinal cord compression, presenting symptoms typically include ambulatory dysfunction, lower extremity weakness, lower extremity sensory changes, as well as bowl, bladder, or sexual...
Article
Full-text available
Study Design Retrospective observational cohort. Objective A review of efficiency and safety of fluoroscopy and stereotactic navigation system for minimally invasive (MIS) Sacroiliac (SI) fusion through a lateral technique. Methods Retrospective analysis of an observational cohort of 96 patients greater than 18 years old, that underwent MIS SI fu...
Article
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Abstract Study Design: Retrospective observational case series. Objective: To assess the outcome of patients with diffuse idiopathic skeletal hyperostosis (DISH) with dysphagia who underwent cricopharyngeal myotomy (CPM) in conjunction with anterior osteophytectomy (OP). Methods: This is a retrospective observational study of 9 patients that receiv...
Article
Background: Rheumatoid arthritis (RA) is a chronic inflammatory polyarthropathy that affects many synovial joints favoring the hands, knees, and vertebral articulations. Joint laxity manifests as sub-axial instability, atlantoaxial instability (AAI), and cranial settling (CS). Case description: 70-year-old female with past medical history of RA,...
Article
The utilization of robotics has been gaining increased popularity in spine surgery. It can be used to assist in pedicle screw insertion when anatomy is complex in deformity surgery, but is also helpful in degenerative spine as it can minimize tissue dissection and fluoroscopy use.1-6 We present an operative video that demonstrates the use of a robo...
Article
Background: Anterior cervical spine surgeries have low morbidity, sufficient surgical corridor, and quick recovery times. Although largely considered a safe and effective procedure to address cervical myelopathy, radiculopathy, and deformity, dysphagia is a frequent yet poorly understood adverse event. One treatment is cricopharyngeal myotomy (CPM...
Article
Full-text available
Background: Herpes simplex virus encephalitis (HSVE) is a viral neurological disorder that occurs when the herpes simplex virus (HSV) enters the brain. The disorder is characterized by the inflammation of the brain and a significant decline in mental status. HSVE reactivation after neurosurgery, although rare, can cause severe neurological deterio...
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Study design: Retrospective cohort study. Purpose: To evaluate surgical outcomes and complications of cervical spine fractures in ankylosing spondylitis (CAS) patients who were treated using either the posterior (P) or combined approach (C). Overview of literature: Ankylosing spondylitis typically causes progressive spinal stiffness that makes...
Article
Full-text available
Study Design Systematic analysis and review. Objective Evaluation of the presentation, etiology, management strategies (including both surgical and nonsurgical options), and neurological functional outcomes in patients with cervical spinal epidural abscess (SEA). Methods The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analys...
Article
Arachnoid cysts are an uncommon postoperative complication and can result in back pain, radiculopathy, and/or cauda equina syndrome. For symptomatic postoperative arachnoid cysts, surgical management is the accepted treatment. While excision of arachnoid cysts is the preferred surgical method, cysts with adhesions to nerve roots and/or dura can be...
Article
Full-text available
Purpose of review: Interspinous process devices (IPDs) are used in the surgical treatment of lumbar spinal stenosis. The purpose of this review is to compare the first generation with the next-generation devices in terms of complications, device failure, reoperation rates, symptom relief, and outcome. Recent findings: Thirty-seven studies were i...
Article
Background: Cervical spondylodiscitis is thought to carry a significant risk for rapid neurologic deterioration with a poor response to nonsurgical management. Methods: A retrospective surgical case series of the acute surgical management of cervical spondylodiscitis is reviewed to characterize the neurologic presentation and postoperative neuro...
Article
Thoracolumbar spondylodiscitis is a morbid disease entity, impacting a sick patient population with multiple comorbidities. Wherever possible, surgical measures in this population should limit the extent of soft tissue disruption and overall morbidity that is often associated with anteroposterior thoracolumbar decompression and fusion. The authors...
Article
Minimally invasive surgical techniques may decrease length of stay, operative duration and blood loss, and postoperative pain. Numerous technical challenges and concerns surround the placement of percutaneous pedicle screws at the lumbosacral level. Maximization of screw triangulation, bicortical purchase, and rostral bias toward the sacral promont...
Article
Teratomas of the spinal cord are incredibly rare, comprising less than 0.5% of all spinal cord tumors. These tumors are exceptionally rare in adults, with only a handful of cases reported in the literature. We present the case of a 49-year-old gentleman with new onset urinary incontinence who presented with a large intradural tumor of the thoracolu...
Article
Importance: Dysphagia is a frequently reported sequela of treatment for head and neck cancer and is often managed with esophageal dilation in patients with dysphagia secondary to hypopharyngeal or esophageal stenosis. Reported complications of esophagoscopy with dilation include bleeding, esophageal perforation, and mediastinitis. These, though ra...
Article
Case: We present the case of a fifty-eight-year-old woman who was initially treated with a C1 to C7 anterior-posterior cervical decompression and fusion for an epidural abscess and returned two years postoperatively with four days of progressive dysphagia and tongue deviation. She was diagnosed with a unilateral hypoglossal nerve (cranial nerve XI...
Article
Spinal paragangliomas (SP) are benign and overall rare extra-adrenal neuroendocrine tumors often diagnosed during workup for lower back pain. Complete surgical resection achieves both symptomatic relief and cure. We present a 32-year-old man with a longstanding history of lumbago and bilateral lower extremity pain found to have a lumbar paraganglio...
Article
The objective of this article is to review the epidemiology and pathophysiology of cervical disc herniation (CDH). A literature search was performed using PubMed as well as other online data sources (e.g., Science Direct). Reviews, case reports, and both prospective and retrospective studies were searched and have been referenced. The data regardin...
Article
BACKGROUND Although use of very high-dose recombinant human bone morphogenetic protein-2 (rhBMP-2) has been reported to markedly improve fusion rates in adult spinal deformity (ASD) surgery, most centers use much lower doses due to cost constraints. How effective these lower doses are for fusion enhancement remains unclear. OBJECTIVE To assess fus...
Article
Full-text available
Intraspinal synovial cysts are infrequent causes of back and radicular leg pain. Commonly associated with degenerative spinal disease, the majority of synovial cysts appear in the lumbar spine. Rarely, intracystic hemorrhage can occur through an unclear mechanism. Similarly rare, cysts may also become migratory. The pathogenesis of hemorrhagic syno...
Article
Retrospective database review of a prospectively maintained neurosurgical database. The surgical management of cervical spinal epidural abscesses (CSEA) is reviewed examining the shift from single to staged anteroposterior decompression and stabilization. CSEA management is guided by small case series. A retrospective review from 1997 - 2011 was co...
Article
Syringomyelia is a potentially debilitating disease that involves abnormal CSF flow mechanics; its incidence after traumatic spinal cord injury (SCI) is approximately 15%. Treatment consists of restoration of CSF flow, typically via arachnoidolysis and syrinx decompression. The authors present a case of pronounced syringomyelia in a patient with co...
Article
Tuberculosis (TB), the disease caused by Mycobacterium tuberculosis, is the second leading killer worldwide from a single infectious agent. Spinal TB is associated with pulmonary disease and may originate from hematogenous spread outside the central nervous system, sites located within the cranium (meningitis), or secondary extension from vertebral...
Article
Open-label Laboratory Investigational Study; Non-animal Surgical Simulation OBJECTIVES:: The authors perform a comparison of dural closure strength in a durotomy simulator across two different suture materials.
Article
Object: One often overlooked aspect of spinal epidural abscesses (SEAs) is the timing of surgical management. Limited evidence is available correlating earlier intervention with outcomes. Spinal epidural abscesses, once a rare diagnosis carrying a poor prognosis, are steadily becoming more common, with one recent inpatient meta-analysis citing an...
Article
Background: The reported incidence of concurrent traumatic brain (TBI) and spine or spinal cord injuries (SCI) is poorly defined, with widely variable literature rates from 16 to 74%. Objectives: To define the incidence of concurrent TBI and SCI, and compare the incidence over a twenty-year time period. Methods: To define the longitudinal inci...
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Adult degenerative cervical kyphosis is a debilitating disease that often requires complex surgical management. Young spine surgeons, residents, and fellows are often confused as to which surgical approach to choose due to lack of experience, absence of a systematic method of surgical management, and today's plethora of information regarding surgic...
Article
Study design: Retrospective case series. Objective: To demonstrate the microbial trends of spinal surgical site infections in patients who had previously received crystallized vancomycin in the operative bed. Summary of background data: Prior large, case control series demonstrate the significant decrease in surgical site infection with the ad...
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Full-text available
Object: Lumbopelvic fixation provides biomechanical support to the base of the long constructs used for adult spinal deformity. However, the failure rate of the lumbopelvic fixation and its risk factors are not well known. The authors' objective was to report the failure rate and risk factors for lumbopelvic fixation in long instrumented spinal fu...
Article
Objective: To understand better the scope of wrong-level lumbar spine surgery and current practices in place to help avoid such errors. Methods: The Joint Section on Disorders of the Spine and Peripheral Nerves (Spine Section) developed a survey on single-level lumbar spine decompression surgery. Invitations to complete the Web-based survey were...
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Full-text available
The goal of the current investigation was to evaluate the mechanisms through which administration of a selective cannabinoid-2 (CB2) agonist (O-1966) modifies inflammatory responses and helps to improve function following spinal cord injury. A comparison of motor function, autonomic function, and inflammatory responses was made between animals trea...
Article
Full-text available
Neuroendoscopy has grown rapidly in the last 20 years as a therapeutic modality for treating a variety of spinal disorders. Spinal endoscopy has been widely used to treat patients with cervical, thoracic, and lumbosacral disorders safely and effectively. Although it is most commonly used with minimally invasive lumbar spine surgery, endoscopy has g...
Article
The purpose of this study was to determine the structure and composition of the forearm interosseous membrane (IOM). The IOM of 12 cadaver forearms was fixed in formalin. After fixation 5 individual IOM fiber bundles per arm were separated by dissection, excised, and processed with hematoxylin-eosin, trichrome, and Verhoff-vanGeison stains. Nine ad...

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