Tobias A. Mattei

St Louis University Hospital · Division of Neurosurgery

In 1934, Dr. John Robert Cobb moved to New York to serve as the Gibney Orthopedic Fellow at the Hospital for the Ruptured and Crippled, now known as the Hospital for Special Surgery. In this role, Cobb was faced with a unique task that would shape not only his personal career but also the fields of scoliosis and spine care: to design the first scol...

Background Traumatic pneumocephalus (TPC) following craniofacial injuries is common, but isolated TPC secondary to pneumorrhachis (PR) is the rare result of upward gas migration from the spinal canal. In the absence of craniofacial and grossly unstable spinal fractures, the etiology of TPC in polytrauma can be elusive and an underlying diagnosis of...

The general objectives of spine surgery are to alleviate pain, restore neurological function and prevent or treat spinal deformities or instability. The accumulating expanse of outcome measures has allowed us to more objectively quantify these variables and, therefore, gauge the success of treatments, ultimately improving the quality of the deliver...

Background and objective: Despite recent advancements in spinal cord stimulation (SCS) technology, the surgical instrumentation for placement of SCS paddle leads remains suboptimal. Therefore, we developed a novel instrument to improve the steerability of SCS paddle leads during surgical placement. Methods: A review of existing literature was pe...

INTRODUCTION Advancements in modern weaponry have vastly increased the incidence and severity of craniospinal injuries. Specifically, thermobaric weapons can cause devastating blast-related traumatic brain injury (bTBI). With recent use of these weapons in the war in Ukraine, clinicians and laypersons alike may benefit from an improved understandin...

Background: Tarlov cysts (TC), also known as perineural cysts are meningeal dilations of the posterior nerve root sheath that typically affect sacral nerve roots. TC are usually asymptomatic and found incidentally. We present the case of a patient with an enlarging sacral TC causing pain from spinopelvic instability secondary to extensive bone ero...

Background: Most professional spine societies have enacted formal guidelines for spine surgeons providing expert witness services. However, there is significant heterogeneity in existing recommendations, with most societies providing information that is limited in detail and scope. Objective: To provide a review of guidelines published by profes...

In patients with new-onset low-back pain, the cause is usually benign in origin. Nonetheless spinal cancer might present for the first time as an episode of new-onset back or neck pain. Therefore, imaging studies are essential in evaluating back pain in patients with a previous history of cancer. Such imaging exams are valuable tools for generating...

BACKGROUND CONTEXT Sports-related spinal injuries can be catastrophic in nature. Athletes competing in collision sports (e.g., football) may be particularly prone to injury given the high-impact nature of these activities. Due to the profound impacts on health and quality-of-life, sports-related spinal injuries are also associated with a risk of li...

Blast-related traumatic brain injury (bTBI) is a significant cause of wartime morbidity and mortality. In recent years, thermobaric weapons have emerged as particularly devastating weapons associated with bTBI. With recent documentation of the use of these weapons in the war in Ukraine, clinicians and laypersons alike may benefit from an improved u...

BACKGROUND CONTEXT : Medical malpractice litigation is associated with significant financial costs in the U.S. and often leads to the practice of defensive medicine. Among medical subspecialities, spine surgery is disproportionately impacted by malpractice claims. PURPOSE : To provide a comprehensive assessment of malpractice litigation claims inv...

On the morning of July 11, 1804, Major General Alexander Hamilton, an American statesman and one of the Founding Fathers of the United States, boarded a barge from Manhattan to the New Jersey shore. There, he met his political and private opponent, Aaron Burr, for a duel during which Burr shot a bullet that entered Hamilton’s torso, fractured a fal...

BACKGROUND The coronavirus (COVID-19) pandemic has caused unprecedented suspensions of neurosurgical elective surgeries, a large proportion of which constitutes spine surgery. The goal of this study is to report granular data on the impact of early COVID-19 pandemic operating room restrictions upon neurosurgical case volume, with attention to its s...

Objective: Glioblastomas(GBM) are the most common primary CNS tumors. Epidemiologic studies have investigated the effect of demographics on patient survival, but the literature remains inconclusive. Methods: This study included all adult patients with intracranial GBMs reported in the SEER-9 population database (1975-2018). The sample consisted...

Introduction Although statistical errors have been shown to be prevalent in the medical literature there has been a paucity of studies focusing on the prevalence of such errors in neurosurgery. In this article, we audit the contemporary neurosurgical literature for a common statistical mistake, namely, misinterpretations of null hypothesis signific...

Introduction Delayed Cerebral Ischemia (DCI) is an important cause of morbidity and mortality after aneurysmal Subarachnoid Hemorrhage (aSAH). Researchers have utilized various methods for predicting patients at risk for DCI progression. Methods An eight-year retrospective review of aSAH patients who presented to St Louis University Hospital. The...

BACKGROUND Management of gunshot wounds to the spine with subsequent spinal cord injury is a controversial topic among spine surgeons. Possible complications of retained intradural bullets include delayed neurological deficits, spinal instability, and lead toxicity. The authors’ purpose is to review the potential complications of retained intraspin...

Background context Zero-profile (also called self-lock- ing, anchored or stand-alone cages) have been recently proposed as an interesting alternative for anterior cervical discectomy and fusion (ACDF), as they are supposed to reduce the rates of post-operative cage extrusion without necessarily incurring in the additional surgical time and increase...

Sacral-alar iliac (SAI) screws constitute a relatively new technique for pelvic fixation. Since its initial description in 2007, it has gained wide popularity among the spine surgery community. In 2013 we have first described the possibility of using both S1 and S2 sacral-alar iliac screws for pelvic fixation in revision surgeries for adult degener...

The authors present the first report of a fracture of the tip of a kyphoplasty curette inside the vertebral body, which occurred during a procedure in a patient with non‐osteoporotic fracture. This highlights the need of further biomechanical research focused on the shear load failure properties of such type of pre‐bent curettes Further research on...

Background Music has been associated with therapeutic properties for thousands of years across a vast number of diverse regions and cultures. This study expands upon our current understanding of music’s influence on human neurophysiology by investigating the effects of various music genres on cerebral cortex activity using electroencephalography (E...

The Glasgow Coma Scale and its derived Score have been adopted throughout the world for assessing the degree of impaired responsiveness in traumatic brain injury and other kinds of acute brain damage. In this historical vignette, we describe how the foundations for their enduring success were laid during their initial development. In order to provi...

Heterogeneity among different subpopulations of human umbilical cord mesenchymal stem cell (hUCMSCs) lines is an ubiquitous phenomenon, with such variability being related to several factors including the identity of the individual donor, tissue source (Wharton’s jelly vs. umbilical cord blood), culture conditions, as well as random variations in t...

Background: Previous studies have described the association of spinal epidural lipomatosis with several conditions including chronic steroid therapy, Cushing's syndrome, obesity, Paget disease, and hypothyroidism. We present a report of rapid development of spinal epidural lipomatosis after treatment with second-generation anti-androgen therapy, a...

Background: During dissection of paraspinal muscles in posterior surgical approaches, the spine surgeon usually holds a subperiosteal (Cobb) elevator in 1 hand and a monopolar cautery in the other hand. In such a scenario, both the surgical smoke generated by the monopolar and eventual bleeding constitute a significant hindrance to simultaneous bi...

SUMMARY The spatial cognition corresponds to the individual's capacity to perceive the spatial relationship among objects and dealing with the notions of deepness, solidity and distance. This cognitive activity is bounded to spatial perception that can be understood as the final product of the integrative process that organizes sensorial stimuli, i...

The Nuremberg Trials were a sequence of tribunal sessions held by the Allied Forces between November 1945 and October 1946 with the intent of prosecuting prominent representatives of the Nazi Party for crimes committed before and during the war. Because medical experiments in human prisoners were among the most heinous offenses, a specific series o...

Bone quality of the spine should play an important role in the planning of surgical intervention for spinal deformities. Patients with osteoporosis may require spinal instrumentation for several reasons, including severe mechanical pain due to spinal imbalance associated with deformity, spinal stenosis associated with deformity (adult degene­rative...

Introduction: Callosum mutism (CM) is a rare complication of neurosurgical procedures. There is no previous report of its ocurrence after interventional endovascular procedures for intracranial lesions. Material and method: We present a case of CM after embolization of anterior cerebral artery branches for treatment of a left frontal arterio-venous...

In this commentary, I highlight the importance of a proper discussion of the pragmatic implications of John Doris's paradigm for allocation of personal responsibility proposed in his new book Talking to Our Selves . By employing some classic concepts of the American common law tradition, I discuss why Doris's valuational understanding of agency fai...

Introduction: The anatomical studies conducted in recent decades made possible the emergence of “free-hand” technique for pedicle screw instrumentation of the thoracic-lumbar spine based solely on anatomical parameters. However, the potential risks associated with such technique revealed the immediate need to create educational models for surgical...

Introduction: Recent studies have demonstrated the existence of a small fraction of glioma cells (specially in high-grade tumors) endowed with features of primitive neural progenitor cells and tumor-initiating function. As such neural stem cells have tremendous migratory potential for pathological areas in the central nervous system, they, theoreti...

Dermatofibrosarcoma protuberans is a rare neoplasm, usually presenting as a low-grade, non-invasive, slow-growing tumor, with a pronounced tendency to local recurrence. We present a rare case of a high-grade, histologically undifferentiated lesion, which eroded underlying bony structures. A wide local excision with careful pathologic analysis of ma...

The author describes a case of a non-osteoporotic adult presenting with multilevel compression fractures at the apex of the thoracic kyphosis after strenuous rope jumping. MRI demonstrated diffuse bone marrow changes in the vertebral bodies with only a very small unilateral endplate fracture. Besides highlighting the oftentimes neglected role of re...

A hidrocefalia de pressão normal, também chamada de síndrome de Adams e Hakim, é uma patologia relativamente infreqüente, mas que adquire relevância nos dias atuais, uma vez que consiste em importante causa reversível de demência. A tríade clínica clássica inclui distúrbios da marcha, demência e incontinência urinária. A cirurgia de derivação ventr...

Chondrosarcomas and chordomas are the most common malignant primary bone tumors involving the spine. Surgery is usually the initial treatment of these tumors. In the past two decades, surgery for spine tumors has evolved from palliative procedures to en bloc resections of tumors. In this chapter, the authors discuss the rationale for the surgical t...

Perioperative Management in Robotic Surgery covers perioperative considerations for robot-assisted surgery (RAS), from preoperative through to postoperative. This is the first extensive, evidence-based, clinical work covering the perioperative management of commonly performed and emerging RAS. Included inside are discussions of surgical procedures,...

Study Design: The authors performed a retrospective controlled study of patients diagnosed with lumbar degenerative disc disease who received surgical intervention (either total disc replacement [TDR]/Activ-L or anterior lumbar interbody fusion [ALIF]) at a single tertiary-care hospital from 2007-2010. Objectives: To investigate the clinical outcom...

Background: Previous studies have demonstrated lower rates of cement extravasation when comparing balloon kyphoplasty with vertebroplasty, an effect attributed to the low-pressure injection. However, in patients with isolated endplate fractures, balloon kyphoplasty may lead to further endplate damage and increased risks of intradiscal extravasatio...

Study design: Systematic review. Objective: There is a need for synthesizing data on effectiveness of treatments for patients with adult spinal deformity (ASD) due to its increasing prevalence and health care costs for these patients. The objective of this review was to estimate the effectiveness of surgery versus nonoperative care in patients w...

• A growing number of patients with spinal metastasis are living longer due to better systemic therapies. • The management of patients with spinal metastasis requires a multidisciplinary approach. • Primary care physicians should maintain a high level of suspicion for back pain in patients with cancer. • The use of multimodal imaging studies is man...

In order to evaluate the predictive effect of non-invasive preoperative imaging methods on surgical outcomes of lumbar fusion for patients with degenerative disc disease (DDD) and refractory chronic axial low back pain (LBP), the authors conducted a retrospective review of 45 patients with DDD and refractory LBP submitted to anterior lumbar interbo...

The existence of specific polymorphisms in genes of key hormones of the energy homeostasis network that have been shown to predispose to obesity and the so-called metabolic syndrome provides further biological support for the proposed insurance hypothesis. In a broader sense, such polymorphisms can be understood as biological imprints of an evoluti...

In patients with new-onset low-back pain the cause is usually benign in origin. Nonetheless spinal cancer might present for the first time as an episode of new-onset back or neck pain. Therefore imaging studies are essential in evaluating back pain in patients with a previous history of cancer. Such imaging exams are valuable tools for generating t...

Although nonlinear dynamics have been mastered by physicists and mathematicians for a long time (as most physical systems are inherently nonlinear in nature), the recent successful application of nonlinear methods to modeling and predicting several evolutionary, ecological, physiological, and biochemical processes has generated great interest and e...

The management of spine tumors has progressively evolved over the past years. Advanced imaging modalities now allow early diagnosis of tumoral lesions and a better comprehension of the relationship between tumor, neural elements, and paraspinal structures. Also, progressive advances in surgical technology, radiation, and chemotherapy have led to th...

Background: Although intravenous thrombolysis is the Food and Drug Administration-approved treatment for acute ischemic stroke (AIS) within 3 h, combined intravenous and intra-arterial thrombolysis with endovascular techniques may be able to extend this traditional time window. Case description: We present the clinical evolution of a 45-year-old...

Vertebroplasty and kyphoplasty are widely used for osteoporotic and cancer-related vertebral compression fractures refractory to medical treatment. Many aspects of these procedures have been extensively discussed in the literature during the last few years. In this article, we perform a critical appraisal of current evidence on effectiveness and on...

Because of the proximity of the oropharynx (a naturally contaminated region) to the spinal structures of the craniocervical junction, it is possible that small mucosal lacerations in the oropharynx caused by unstable traumatic craniocervical injuries may become contaminated and lead to secondary infection and osteomyelitis. In this report, the auth...

: PURPOSE: No standard strategy exists for the management of cervical kyphotic deformity in patients with severe osteoporosis. In fact, in such subpopulation, standard algorithms commonly used in patients with normal bone mineral density may not be applicable. In this Grand Rounds, the authors present a challenging case of a patient with Hajdu-Chen...

Introduction: Percutaneous vertebroplasty has been suggested to be a viable therapeutic option for the treatment of Schmorl’s nodes in patients presenting with refractory low-back pain and MRi findings of acute significant bone marrow edema as detected by STIR sequences and extensive inflammatory changes as detected by Bone-scan (99-Tc scintigraphy...

Due to the proximity of the oropharynx (a naturally contaminated region) to the spinal structures of the craniocervical junction, it is possible that small mucosal lacerations in the oropharynx caused by traumatic craniocervical injuries may become contaminated and lead to secondary infection and osteomyelitis. In this report the authors describe t...

Previous reports have already described the influence of several drugs (such as steroids) upon the behavior of epidural lipomatosis. Although there have been some previous reports of enlargement of subcutaneous lipomas after anti-androgen therapy, there is no previous report about symptomatic enlargment of epidural lipomatosis. In this report the a...

Glioblastoma is both the most common and most lethal primary CNS malignancy in adults, accounting for 45.6% of all malignant CNS tumors, with a 5-year survival rate of only 5.0%, despite the utilization of multimodal therapy including resection, chemotherapy, and radiation. Currently available treatment options for glioblastoma often remain limited...

BACKGROUND: Image-guided navigation systems (IGS) grant excellent clinical and radiological results, minimizing risks correlated with spinal instrumentation. However, there is some concern regarding the real need for IGS and its indications. OBJECTIVE: To analyze the accuracy, technical aspect, and radiation exposure data of the principal IGS based...

OBJECT Giant cell tumors (GCTs) of the spine are rare and complex to treat. They have a propensity for local recurrence and the potential to metastasize. Treatment is currently surgical and presents unique challenges due to the proximity of neural structures and the need for reconstruction. Denosumab has been shown in clinical trials to be an effec...

Introduction Percutaneous vertebroplasty has been suggested as a viable therapeutic option for the treatment of acute Schmorl’s nodes in patients presenting with refractory low-back pain and acute MRi findings of significant bone marrow edema as detected by STIR sequences and extensive inflammatory changes as detected by bone-scan (99-Tc scintigra...

Study Design Case report and literature review. Objective Spinal subdural hematomas are rare events that often progress with severe neurologic deficits. Although there have been several case reports in the literature of spontaneous spinal subdural hematomas in the setting of anticoagulation, antiplatelet therapy, or coagulation disorders, the exac...

Vertebral augmentation procedures are currently widely used for osteoporotic and cancer-related vertebral compression fractures refractory to medical treatment. Many aspects of these procedures have been extensively discussed in the literature and new evidences have been emerged from recent clinical trials. In this literature review, we perform a c...