Joseph R Dettori

Toronto Western Hospital, Toronto, Ontario, Canada

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Publications (81)

  • [Show abstract] [Hide abstract] ABSTRACT: Introduction: The objective of this study is to develop guidelines that outline the optimal timing of decompression in patients with traumatic spinal cord injury (SCI) and central cord syndrome. Methods: A systematic review of the literature was conducted to address the following key questions: (1) What is the efficacy of early decompression (=24 hours) compared with late decompression (>24 hours) based on clinically important change in neurological status? (2) Does timing of decompression influence functional or administrative outcomes? (3) What is the safety profile of early decompression compared with late decompression? (4) What is the evidence that early decompression has differential efficacy or safety in subpopulations? (5) What is the comparative cost-effectiveness of early vs late decompression? A multidisciplinary guideline development group used this information, in combination with their clinical expertise, to develop recommendations for the optimal timing of SCI. The benefits and harms, financial impact, acceptability, feasibility, and patient preferences of each recommendation were carefully considered. Results: The main conclusions from the systematic review included: (1) patients decompressed early were more likely to exhibit clinical improvement in neurological status at 6 months (cervical only) and at discharge from inpatient rehabilitation (all levels); (2) patients treated early for central cord syndrome achieved significantly greater improvements in neurological and functional status than those decompressed late; (3) there were no significant differences in length of acute care/rehabilitation stay or in rates of complications between treatment groups. Our recommendations included: "We suggest that early surgery be considered as a treatment option in adult patients with traumatic central cord syndrome" and "We suggest that early surgery be offered as an option for adult acute SCI patients regardless of level." Conclusion: These guidelines should be implemented into clinical practice to improve outcomes and reduce morbidity in patients with SCI by encouraging clinicians to make evidence-informed decisions.
    Article · Aug 2016 · Neurosurgery
  • Daniel C Norvell · Joseph R Dettori · Jens R Chapman
    Article · Jun 2016 · Global Spine Journal
  • Joseph R. Dettori · Jens R. Chapman · John G. DeVine · [...] · Noel S. Weiss
    [Show abstract] [Hide abstract] ABSTRACT: Study design: Retrospective cohort study using the Washington State Comprehensive Hospital Abstract Reporting System, the Washington State Cancer Registry, and Washington State death certificates. Objective: To study the possible association between recombinant human bone morphogenetic protein (rhBMP) and cancer risk. Summary of background data: The use of rhBMP in spine fusion surgery remains controversial with respect to its possible role in tumorigenesis. Methods: We compared adults who underwent spine fusion for degenerative disease with and without rhBMP between 2002 and 2010. Patients were matched on the basis of age, sex, and year of treatment. We excluded patients with a diagnosis of cancer prior to or at the index procedure. The primary outcome was the first diagnosis of cancer as identified in the records of the cancer registry. Results: We included 16,914 patients who had spine fusion, of whom 4246 received rhBMP. During the study period, 449 patients received a diagnosis of cancer: 117 (2.76% of 4246) in the rhBMP group and 332 (2.62% of 12 668) in the no rhBMP group. The incidence rate was similar between the rhBMP and no rhBMP 9.5 and 9.0 per 1000 person years, respectively (hazard ratio, 1.06; 95% CI, 0.86-1.30). There were no differences in the rate of cancer between the two groups in subgroups defined on the basis of site of fusion or surgical method. Conclusions: There was no increase in overall cancer incidence among those receiving rhBMP. An important limitation of this and other studies of recombinant human bone morphogenetic protein and cancer that have been conducted to date is their relatively limited duration of follow-up. The examination of cancer incidence following rhBMP administration must continue beyond just the first several years in order to adequately assess the potential of rhBMP to influence the occurrence of one or more types of malignancy. Level of evidence: 3.
    Article · Jun 2016 · Spine
  • Article · Apr 2016 · Global Spine Journal
  • Article · Apr 2016 · Global Spine Journal
  • Article · Mar 2016 · Global Spine Journal
  • Robert W. Molinari · Krystle Pagarigan · Joseph R. Dettori · [...] · Kenneth E. Dehaven
    Dataset · Feb 2016
  • Article · Jan 2016 · Global Spine Journal
  • Daniel C Norvell · Joseph R Dettori · Jens R Chapman
    Article · Jan 2016 · Global Spine Journal
  • [Show abstract] [Hide abstract] ABSTRACT: Study Design Systematic review. Clinical Questions Among athletes who undergo surgery of the cervical spine, (1) What proportion return to play (RTP) after their cervical surgery? (2) Does the proportion of those cleared for RTP depend on the type of surgical procedure (artificial disk replacement, fusion, nonfusion foraminotomies/laminoplasties), number of levels (1, 2, or more levels), or type of sport? (3) Among those who return to their presurgery sport, how long do they continue to play? (4) Among those who return to their presurgery sport, how does their postoperative performance compare with their preoperative performance? Objectives To evaluate the extent and quality of published literature on the topic of return to competitive athletic completion after cervical spinal surgery. Methods Electronic databases and reference lists of key articles published up to August 19, 2015, were searched to identify studies reporting the proportion of athletes who RTP after cervical spine surgery. Results Nine observational, retrospective series consisting of 175 patients were included. Seven reported on professional athletes and two on recreational athletes. Seventy-five percent (76/102) of professional athletes returned to their respective sport following surgery for mostly cervical herniated disks. Seventy-six percent of recreational athletes (51/67) age 10 to 42 years RTP in a variety of sports following surgery for mostly herniated disks. No snowboarder returned to snowboarding (0/6) following surgery for cervical fractures. Most professional football players and baseball pitchers returned to their respective sport at their presurgery performance level. Conclusions RTP decisions after cervical spine surgery remain controversial, and there is a paucity of existing literature on this topic. Successful return to competitive sports is well described after single-level anterior cervical diskectomy and fusion surgery for herniated disk. RTP outcomes involving other cervical spine diagnoses and surgical procedures remain unclear. Additional quality research is needed on this topic.
    Article · Jan 2016 · Global Spine Journal
  • Daniel C Norvell · Joseph R Dettori · Jens R Chapman
    Article · Dec 2015 · Global Spine Journal
  • Source
    Feras Waly · Mohammad M Alzahrani · Fahad H Abduljabbar · [...] · Joseph R Dettori
    [Show abstract] [Hide abstract] ABSTRACT: Study Design Systematic review. Objective Determine whether closed suction wound drains decrease the incidence of postoperative complications compared with no drain use in patients undergoing spine surgery for lumbar degenerative conditions. Methods Electronic databases and reference lists of key articles were searched up through January 22, 2015, to identify studies comparing the use of closed suction wound drains with no drains in spine surgery for lumbar degenerative conditions. Outcomes assessed included the cumulative incidence of epidural hematoma, superficial and deep wound infection, and postoperative blood transfusion. The overall strength of evidence across studies was based on precepts outlined by the Grades of Recommendation Assessment, Development and Evaluation Working Group. Results Five heterogeneous studies, three randomized controlled trials, and two cohort studies form the evidence basis for this report. There was no difference in the incidence of hematoma, superficial wound infection, or deep infection in patients with compared with patients without closed suction wound drains after lumbar surgery. The upper bounds of the 95% confidence interval for hematoma ranged from 1.1 to 16.7%; for superficial infection, 1.0 to 7.3%; and for deep infection, 1.0 to 7.1%. One observational study reported a 3.5-fold increase in the risk of blood transfusion in patients with a drain. The overall strength of evidence for these findings is considered low or insufficient. Conclusions Conclusions from this systematic review are limited by the quality of included studies that assessed the use of closed suction wound drains in lumbar spine surgeries for degenerative conditions. We believe that spine surgeons should not routinely rely on closed suction wound drains in lumbar spine surgery until a higher level of evidence becomes available to support its use.
    Full-text Article · Dec 2015 · Global Spine Journal
  • Feras Waly · Mohammad M. Alzahrani · Fahad H. Abduljabbar · [...] · Joseph R. Dettori
    Dataset · Dec 2015
  • Source
    Full-text Article · Aug 2015 · Ophthalmology
  • Daniel C Norvell · Joseph R Dettori · Jens R Chapman
    Article · Jun 2015 · Global Spine Journal
  • Robert W Molinari · Ahmed Saleh · Robert Molinari · [...] · Joseph R Dettori
    [Show abstract] [Hide abstract] ABSTRACT: Study Design Systematic review. Clinical Questions (1) What is the comparative efficacy of unilateral instrumentation compared with bilateral instrumentation in spine surgery? (2) What is the safety of unilateral instrumentation compared with bilateral instrumentation in spine surgery? Methods Electronic databases and reference lists of key articles were searched up to September 30, 2014, to identify studies reporting the comparative efficacy and safety of unilateral versus bilateral instrumentation in spine surgery. Studies including recombinant human bone morphogenetic protein 2 as adjunct therapy and those with follow-up of less than 2 years were excluded. Results Ten randomized controlled trials met the inclusion criteria: five compared unilateral with bilateral instrumentation using open transforaminal or posterior lumbar interbody fusion (TLIF/PLIF), one used open posterolateral fusion, and four used minimally invasive TLIF/PLIF. There were no significant differences between unilateral and bilateral screw instrumentation with respect to nonunion, low back or leg pain scores, Oswestry Disability Index, reoperation, or complications. Conclusions The existing literature does not identify significant differences in clinical outcomes, union rates, and complications when unilateral instrumentation is used for degenerative pathologic conditions in the lumbar spine. The majority of published reports involve single-level lumbar unilateral instrumentation.
    Article · Jun 2015 · Global Spine Journal
  • John C France · James M Schuster · Katherine Moran · Joseph R Dettori
    [Show abstract] [Hide abstract] ABSTRACT: Study Design Systematic review. Clinical Questions (1) Is autologous local bone (LB) graft as safe and effective as iliac crest bone graft (ICBG) in lumbar spine fusion? (2) In lumbar fusion using ICBG, does a single-incision midline approach reduce postoperative iliac crest pain compared with a two-incision traditional approach? Methods Electronic databases and reference lists of key articles were searched up to October 2014 to identify studies reporting the comparative efficacy and safety of ICBG versus LB graft or comparing ICBG harvest site for use in lumbar spine surgery. Studies including allograft, synthetic bone, or growth factors in addition to ICBG and those with less than 80% of patients with degenerative disease in the lumbar spine were excluded. Two independent reviewers assessed the level of the evidence quality using the Grades of Recommendation Assessment, Development and Evaluation criteria, and disagreements were resolved by consensus. Results Seven studies were identified as using ICBG fusion for degenerative disease in the lumbar spine. There were no differences in the fusion, leg pain, low back pain, or functional outcomes between patients receiving LB versus ICBG. There was a higher incidence of donor site pain and sensory loss in patients receiving ICBG, with no donor site complications attributed to LB. Compared with patients with the graft harvested through the two-incision traditional approach, patients with the graft harvested through the single-incision midline approach had lower mean pain scores over the iliac crest, with a higher proportion reporting no iliac crest tenderness. In patients with ICBG harvested through the single-incision midline approach on either the right or the left side of the ilium, only 36% of the patients were able to correctly identify the side when asked whether they knew which iliac crest was harvested. Only 19% of the patients with ICBG harvested through the single-incision midline approach on either the right or the left side of the ilium reported pain that was concordant with the side that was actually harvested. Conclusions LB is as safe and efficacious as ICBG for instrumented fusion in the lumbar spine to treat degenerative disease. When ICBG is used, graft harvest through the single-incision midline approach reduces postoperative iliac crest pain compared with a two-incision approach.
    Article · Jun 2015 · Global Spine Journal
  • [Show abstract] [Hide abstract] ABSTRACT: Study design: Systematic review. Objective: To identify cost-effective treatment strategies for lumbar spine degenerative diseases. Summary of background data: There is a paucity of literature assisting physicians and society regarding the cost-efficiency of management of lumbar spine conditions. Limited articles on selective operative and nonoperative therapies have been published for a variety of lumbar conditions. Methods: A systematic search of PubMed, EMBASE, the Cochrane Collaboration data base, University of York, Centre for Reviews and Dissemination (National Health Services Economic Evaluation Database and health technology assessment), and the Tufts CEA Registry was conducted through December 16, 2013. Three specific questions were addressed for adult patients: (1) What is the evidence that surgery is cost-effective compared with nonsurgical management for lumbar degenerative spondylolisthesis or stenosis? (2) What is the evidence that fusion is cost-effective compared with no fusion for degenerative spondylolisthesis or stenosis? and (3) What is the evidence that instrumentation is cost-effective compared with none for degenerative spondylolisthesis? The Quality of Health Economic Studies instrument was used to provide an initial basis for critical appraisal of included economic studies. Articles were further refined with individual review based on inclusion/exclusion criteria. Results: Initial search resulted in 122 potentially relevant citations, 115 of which were excluded at title and abstract levels and 3 at full-text reviews, leaving 5 for analysis. No non-English language text met inclusion/exclusion criteria. All studies illustrated a clinical benefit of surgical treatment as measured by quality-adjusted life year (0.11-8.05). Surgical treatments had a greater financial cost than nonoperative care ($5883-$26,035). Incremental cost-effectiveness ratio calculations noted operative treatment over nonoperative treatment for spondylolisthesis ($59,487-$115,600) per quality-adjusted life year. However, cost for patients without spondylolisthesis varied greatly from nonoperative treat dominating to $77,600 per quality-adjusted life year favoring surgery. Because the articles had heterogeneous methods and patient population, conclusion differed greatly on cost assessment. Conclusion: Limited quality data exist on cost-effective treatment of degenerative lumbar spinal conditions, despite more recent interest related to this topic. It is important that future research efforts focus on constructing higher quality trials in this area to help determine the most cost-effective care. Level of evidence: 3.
    Article · Oct 2014 · Spine
  • Paul Park · Darryl Lau · Erika D Brodt · Joseph R Dettori
    [Show abstract] [Hide abstract] ABSTRACT: Study Design Systematic review. Clinical Questions Compared with no stimulation, does electrical stimulation promote bone fusion after lumbar spinal fusion procedures? Does the effect differ based on the type of electrical stimulation used? Methods Electronic databases and reference lists of key articles were searched up to October 15, 2013, to identify randomized controlled trials (RCTs) comparing the effect of electrical stimulation to no electrical stimulation on fusion rates after lumbar spinal fusion for the treatment of degenerative disease. Two independent reviewers assessed the strength of evidence using the Grades of Recommendation Assessment, Development and Evaluation (GRADE) criteria. Results Six RCTs met the inclusion criteria. The following types of electrical stimulation were investigated: direct current (three studies), pulsed electromagnetic field (three studies), and capacitive coupling (one study). The control groups consisted of no stimulation (two studies) or placebo (four studies). Marked heterogeneity in study populations, characteristics, and design prevented a meta-analysis. Regardless of the type of electrical stimulation used, cumulative incidences of fusion varied widely across the RCTs, ranging from 35.4 to 90.6% in the intervention groups and from 33.3 to 81.9% in the control groups across 9 to 24 months of follow-up. Similarly, when stratified by the type of electrical stimulation used, fusion outcomes from individual studies varied, leading to inconsistent and conflicting results. Conclusion Given the inconsistency in study results, possibly due to heterogeneity in study populations/characteristics and quality, we are unable to conclude that electrical stimulation results in better fusion outcomes compared with no stimulation. The overall strength of evidence for the conclusions is low.
    Article · Oct 2014
  • Robin E Hashimoto · Erika D Brodt · Andrea C Skelly · Joseph R Dettori
    Article · Oct 2014

Publication Stats

1k Citations

Institutions

  • 2011
    • Toronto Western Hospital
      Toronto, Ontario, Canada
  • 2010
    • University of Pennsylvania
      • Department of Neurosurgery
      Philadelphia, PA, United States
    • University of Toronto
      • Division of Neurosurgery
      Toronto, Ontario, Canada
    • Barnes Jewish Hospital
      San Luis, Missouri, United States