Jacob M Buchowski

Washington University in St. Louis, San Luis, Missouri, United States

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Publications (138)289.01 Total impact

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    ABSTRACT: Study design: Prospective randomized and observational study OBJECTIVE.: Determine baseline variables affecting adult symptomatic lumbar scoliosis (ASLS) decision making to participate in randomization (RAND), observational nonsurgical (OBS-NS) or observational surgical (OBS-S) cohorts. Summary of background data: Multiple factors play a key role in a patient's decision to be randomized or to choose an OBS-NS or OBS-S course for ASLS. Studies evaluating these factors are limited. Methods: Eligible candidates (patients with ASLS and no prior spinal fusion deformity surgery) from 9 centers participated in a RAND, OBS-NS or OBS-S cohort study. Baseline variables (demographics, socioeconomics, patient-reported outcomes [PROs], Functional Treadmill Test, radiographs) were analyzed. Results: 295 patients were enrolled: 67 RAND, 115 OBS-NS, 113 OBS-S. Subanalysis of older patients (60-80 years) found 54% of OBS-NS had college degrees compared to 82% of RAND and 71% of OBS-S (p = 0.010). Patients deciding to be part of a RAND cohort have similar clinical characteristics to the OBS-S cohort. OBS-S had more symptomatic spinal stenosis (57% vs 39%, p-value = 0.029) and worse scores than OBS-NS based on PROs (Back Pain Numerical Rating Scale [NRS 6.3 vs 5.5, p = 0.007]; Scoliosis Research Society [SRS] Pain [2.8 vs 3.0, p = 0.018], Function [3.1 vs 3.4, p = 0.019] and Self-Image [2.7 vs 3.1, p = 0.002]; Oswestry Disability Index (ODI) [36.9 vs 31.8, p = 0.029]; post Treadmill back [5.8 vs 4.4, p = 0.002] and leg [4.3 vs 3.1,p = 0.037] pain NRS and larger lumbar coronal Cobb angles (56.5° vs 48.8°, p < 0.001). RAND had more baseline motor deficits (10.4% vs 1.7%, p = 0.036) and worse scores than OBS-NS based on ODI (38.8 vs 31.8, p = 0.006), SRS Function [3.1 vs 3.4, p = 0.034] and Self-Image [2.7 vs 3.1, p = 0.007]. Conclusion: Patients with worse PROs, more back pain, more back and leg pain with ambulation and larger lumbar Cobb angles are more inclined to select surgical over nonsurgical management. Level of evidence: 1.
    No preview · Article · Nov 2015 · Spine
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    ABSTRACT: Background context: Spinal giant cell tumors (SGCT) remain challenging tumors to treat. Although advancements in surgical techniques and adjuvant therapies have provided new options for treatment, evidence-based algorithms are lacking. Purpose: To review the peer-reviewed literature that addresses current treatment options and management of SGCT, in order to produce an evidence-based treatment algorithm. Study design/setting: Systematic review. Methods: Articles published between January 1, 1970 and March 31, 2015 were selected from PubMed and EMBASE searches using keywords "giant cell tumor" AND "spine" AND "treatment." Relevant articles were selected by the authors and reviewed. Results: A total of 515 studies were identified, of which 81 studies were included. Complete surgical resections of SCGT resulted in the lowest recurrence rates. However, morbidity of en bloc resections is high and in some cases surgery is not possible. Intralesional resection can be coupled with adjuvant therapies, but evidence-based algorithms for use of adjuvants remain elusive. Several recent advancements in adjuvant therapy may hold promise for decreasing SGCT recurrence, specifically stereotactic radiotherapy, selective arterial embolization, and medical therapy using denosumab and interferon. Conclusions: Complete surgical resection of SGCT should be the goal when possible, particularly if neurologic impairment is present. Denosumab holds promise as an adjuvant and perhaps stand-alone therapy for SGCT. SGCTs should be approached as a case-by-case problem, as each presents unique challenges. Collaboration of spine surgeons, radiation oncologists, and medical oncologists is the best practice for treating these difficult tumors.
    No preview · Article · Nov 2015 · The spine journal: official journal of the North American Spine Society

  • No preview · Article · Oct 2015

  • No preview · Article · Oct 2015
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    ABSTRACT: With recent advances in oncologic treatments, there has been an increase in patient survival rates and concurrently an increase in the number of incidence of symptomatic spinal metastases. Elderly patients are a substantial part of the oncology population, and therefore their treatments still need to be questioned as well as their possible impact on healthcare resources. We studied whether age has a significant influence on quality of life and survival in surgical interventions for spinal metastases. We used the data from a multicentre prospective study by the Global Spine Tumor Study Group (GSTSG) of 1,266 patients who were admitted for surgical treatments of symptomatic spinal metastases at 22 spinal centers from different countries, followed for 2 years after surgery. 1,266 patients were recruited between March 2001 and October 2014. Patient demographics were collected along with outcome measures including EQ-5D quality of life, neurological functions, complications and survival rates. We realized a multicentre prospective study of 1,266 patients admitted for surgical treatment of symptomatic spinal metastases. They were divided and studied into 3 different age groups, <70, 70-80 and > 80 years. Patients over 80 were more likely to undergo emergency surgery and palliative procedures compared to younger patients, despite a lack of statistical difference in American Society of Anesthesiology (ASA) score, Frankel neurological score or Karnofsky functional score at presentation. Post-operative complications were more common in the oldest age group (33.3% in the over 80s, 23.9% in the 70-80, and 17.9% for patients under 70 years old, p=0.004). EQ-5D improved in all groups, but survival expectancy was significantly longer in patients younger than 70 years old (p=0.02). Furthermore, neurological recovery after surgery was lower in patients older than 80 years. Surgeons should not be biased against operating elderly patients. Although survival rates and neurological improvements are lower than for younger patients, this is compounded by the fact that elderly patients undergo more emergency and palliative procedures, despite good ASA scores and functional status. Age in itself should not be a determinant of whether to operate or not, and operations should not be avoided in the elderly when indicated. Copyright © 2015 Elsevier Inc. All rights reserved.
    Full-text · Article · Jul 2015 · The spine journal: official journal of the North American Spine Society
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    ABSTRACT: Surgery for symptomatic spinal metastases aims to improve quality of life, pain, function, and stability. Complications in the postoperative period are not uncommon; therefore, it is important to select appropriate patients who are likely to benefit the greatest from surgery. Previous studies have focused on predicting survival rather than quality of life after surgery. To determine preoperative patient characteristics that predict postoperative quality of life and survival in patients who undergo surgery for spinal metastases. In a prospective cohort study of 922 patients with spinal metastases who underwent surgery, we performed preoperative and postoperative assessment of EuroQol EQ-5D quality of life, visual analog score for pain, Karnofsky physical functioning score, complication rates, and survival. The primary tumor type, number of spinal metastases, and presence of visceral metastases were independent predictors of survival. Predictors of quality of life after surgery included preoperative EQ-5D (P = .002), Frankel score (P < .001), and Karnofsky Performance Status (P < .001). Data from the largest prospective surgical series of patients with symptomatic spinal metastases revealed that tumor type, the number of spinal metastases, and the presence of visceral metastases are the most useful predictors of survival and that quality of life is best predicted by preoperative Karnofsky, Frankel, and EQ-5D scores. The Karnofsky score predicts quality of life and survival and is easy to determine at the bedside, unlike the EQ-5D index. Karnofsky score, tumor type, and spinal and visceral metastases should be considered the 4 most important prognostic variables that influence patient management. ASA, American Society of AnesthesiologistsCI, confidence intervalQoL, quality of life.
    No preview · Article · Jul 2015 · Neurosurgery
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    ABSTRACT: When relief from neuralgia cannot be achieved with traditional methods, neurectomy may be considered to abate the stimulus, and primary opposition of the terminal nerve ending is recommended to prevent neuroma. Nerve repair with autograft is limited by autologous nerves available for large nerve defects. Cadaveric allografts provide an unlimited graft source without donor-site morbidities, but are rapidly rejected unless appropriate immunosuppression is achieved. An optimal treatment method for nerve allograft transplantation would minimize rejection while simultaneously permitting nerve regeneration. This report details a novel experience of nerve allograft transplantation using cadaveric nerve grafts to desensitize persistent postoperative thoracic neuralgia. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Apr 2015 · The Annals of thoracic surgery
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    ABSTRACT: Retrospective analysis of inpatient and outpatient data from a single academic trauma center. To test the effectiveness of a conservative treatment algorithm for civilian spinal gunshot wounds (CSGSWs) by comprehensively evaluating neurological status and recovery, fracture type, concomitant injuries, indications for surgery, and complications. Few large studies exist to guide treatment of CSGSWs, and none have been published in nearly 20 years. A search of International Classification of Diseases, Ninth Revision (ICD-9) codes was performed for all hospital patients treated from 2003 to 2011 by either neurosurgery or orthopedic surgery to identify 159 consecutive patients who sustained CSGSWs. Mean follow-up was 13.6 months. American Spinal Injury Association grading was used to assess neurological injury. Fifty percent of patients had neurological deficits from CSGSW. Complete spinal injury was the most common injury grade; thoracic injuries had the most risk of complete injury (P < 0.001). Nearly 80% of patients had concomitant injuries to other organs. Operative treatment was more likely in patients with severe neurological injuries (P = 0.008) but was not associated with improved neurological outcomes (P = 1.00). Nonoperative treatment did not lead to any cases of late spinal instability or neurological deterioration. Overall, 31% of patients had an improvement of at least 1 American Spinal Injury Association grade by final follow-up. Nearly half of patients experienced at least 1 GSW-related complication; risk of complications was associated with neurological injury grade (P < 0.001) and operative treatment (P = 0.04). The vast majority of CSGSWs should be managed nonoperatively, regardless of neurological grade or number of spinal columns injured. Indications for surgery include spinal infection and persistent cerebrospinal fluid leaks. 3.
    Full-text · Article · Apr 2015 · Spine
  • Justin S. Yang · Jacob M. Buchowski · Vivek Verma
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    ABSTRACT: Retrospective cohort. The primary goal is to compare the clinical results of 2 types of constructs commonly used at the cervicothoracic junction: small rods (3.2-mm/3.5-mm rods) or transitional constructs. The secondary goal is to perform a case-control study of risk factors for pseudarthrosis at the cervicothoracic junction. Various constructs have been used to stabilize across the cervicothoracic junction; however, no study to date has objectively compared their outcome. Our hypothesis was that both constructs would have similar fusion and complication rates. A retrospective review of a prospectively collected database revealed 135 patients with the aforementioned constructs and having followed up with imaging at 6 months, 12 months, and 24 months. Univariate analysis comparing the 2 different construct groups was performed. Multivariate analysis for risk factors of pseudarthrosis was also performed. There were a total of 10 patients with pseudarthrosis at 2-year follow-up. There was no difference in pseudarthrosis rate between the small rods (7%) and transitional constructs (8.6%) (P = 0.99). The overall construct lengths were similar (5.8 levels in small rods, 6.7 levels in transitional construct). Blood loss was higher in transitional constructs (574 ± 69 mL) than in small rods (236 ± 53 mL) (P < 0.001). Transitional constructs also had longer operating times (249 min) than small rods (207 min) (P < 0.03). Overall complication rate was higher in the transitional constructs (P < 0.03). Tobacco use, corpectomy, lack of an anterior construct, and construct length were all risk factors for cervicothoracic junction pseudarthrosis in the multivariate analysis. Overall pseudarthrosis rates were similar between small rods and transitional constructs. There was higher complications rate, blood loss, and operating time associated with transitional constructs. Pseudarthrosis risk factors at the cervicothoracic junction include tobacco use, corpectomy, lack of an anterior construct, and longer constructs. 3.
    No preview · Article · Mar 2015 · Spine
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    ABSTRACT: Structured literature review.
    No preview · Article · Jan 2015
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    ABSTRACT: Structured literature review.
    No preview · Article · Jan 2015
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    Addisu Mesfin · Jacob M Buchowski · Ziya L Gokaslan · Justin E Bird
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    ABSTRACT: The skeletal system is the third most common site of metastases after the lung and liver. Within the skeletal system, the vertebral column is the most common site of metastases, and 8% to 15% of vertebral metastases are in the cervical spine, consisting, anatomically and biomechanically, of the occipitocervical junction, subaxial spine, and cervicothoracic junction. The vertebral body is more commonly affected than the posterior elements. Nonsurgical management techniques include radiation therapy (stereotactic and conventional), bracing, and chemotherapy. Surgical techniques include percutaneous methods, such as vertebroplasty, and palliative methods, such as decompression and stabilization. Surgical approach depends on the location of the tumor and the goals of the surgery. Appropriate patient selection can lead to successful surgical outcomes by restoring spinal stability and improving quality of life. Copyright 2014 by the American Academy of Orthopaedic Surgeons.
    Full-text · Article · Jan 2015 · The Journal of the American Academy of Orthopaedic Surgeons
  • Johnny Zhao · Jeffrey L. Gum · Dimar, J.R., II · Jacob M. Buchowski
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    ABSTRACT: Anterior lumbar interbody fusion (ALIF) was first reported in 1906 and is currently an acceptable option for surgical treatment of spondylolisthesis. A careful preoperative evaluation is critical, as most complications are approach related. Both retroperitoneal and transperitoneal approaches are utilized for exposing the lower lumbar levels most commonly associated with spondylolisthesis. A wide variety of options are available for the interbody graft, including autogenous bone grafts and titanium cages, as well as graft adjuncts such as bone morphogenetic protein (rhBMP-2). Both radiographic results and health related quality of life (HRQOL) studies have established ALIF as a reliable procedure for the treatment of spondylolisthesis. Known complications of ALIF include vascular damage, injury to peritoneal viscera, ileus, and retrograde ejaculation.
    No preview · Article · Jan 2015

  • No preview · Article · Nov 2014

  • No preview · Article · Oct 2014 · The Spine Journal
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    ABSTRACT: Study Design. Retrospective. Objective. The purpose of this study was to report the prevalence of abnormal neurological findings detected by physical examination in Scheuermann kyphosis and to correlate it to radiographs, magnetic resonance imaging (MRI) findings, and results of operative treatment. Summary of Background Data. There have been sporadic reports about abnormal neurological findings in patients with Scheuermann kyphosis. Methods. Among 82 patients with Scheuermann kyphosis who underwent corrective surgery, 69 primary cases were selected. Patients' charts were reviewed retrospectively in terms of pre and postoperative neurological examinations. Sensory or motor change was defined as an abnormal neurological examination. Their duration, associated problems, and various parameters on preoperative radiographs and MRI examinations were also measured to search for any atypical findings associated with an abnormal neurological examination. Results. There were 6 cases (9%) (group AbN), with an abnormal neurological examination ranging from severe myelopathy to a subtle change (e.g., sensory paresthesias on trunk). Five patients recovered to a normal neurological examination after corrective surgery. The remaining 1 patient with severe myelopathy also showed marked improvement and was ambulatory unassisted by 2-year follow-up. In patients with a normal neurological examination (group N, n = 63), only 1 patient had neurological sequelae because of anterior spinal artery syndrome after combined anterior-posterior correction. No preoperative radiographical parameters were significantly different between groups. Average age was 21.3 (AbN) and 18.6 (N) years (P = 0.55). Average preoperative T5-12 kyphosis was 69.0 degrees (AbN) and 72.5 degrees (N) (P = 0.61). Forty-two magnetic resonance images were obtained and all showed typical findings of Scheuermann kyphosis. Five patients in the AbN group (1 patient underwent computed tomography/myelography) and 37 patients in the N group underwent an MRI. Conclusion. The prevalence of abnormal neurological findings in Scheuermann kyphosis was 9%, emphasizing the importance of performing a detailed preoperative neurological examination. If congenital stenosis or a herniated thoracic disc is present, myelopathy can occur. No radiographical findings correlated with the abnormal preoperative neurological examinations. A normal MRI can exist in the face of an abnormal neurological examination, and conversely, a normal neurological examination can be seen with an abnormal MRI. Surgery was successful in alleviating abnormal neurological issues.
    No preview · Article · Oct 2014 · Spine
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    ABSTRACT: While interspinous motion analysis is commonly used to determine the status of an anterior cervical fusion, the accuracy of this technique is unclear. We believed that three questions needed to be answered. What degree of image magnification is ideal? How much motion should be considered "adequate" for making dynamic radiographs? What is the optimal amount of interspinous motion for detecting pseudarthrosis? We performed a retrospective study of 125 patients (109 fused segments and 153 pseudarthrotic segments) who had undergone reexploration with confirmation of fusion status. Interspinous motion at each operatively treated level and one superjacent level was measured by two independent investigators twice. Reliabilities of interspinous motion analysis at different magnification rates (25%, 100%, 150%, and 200%) were evaluated for fifty randomly selected segments to determine the optimal magnification, which we used for the remainder of the measurements. Fusion status was also determined on computed tomography (CT) by two other raters. We compared the intraoperative findings with those based on dynamic radiographs (with use of cutoff values of 1 and 2 mm of interspinous motion as the indication of pseudarthrosis) and CT. On radiographs, both 150% and 200% magnification yielded higher interobserver and intraobserver reliabilities compared with 25% and 100% magnification, and the reliabilities at 150% and 200% were similar to each other, so subsequent measurements were made at 150%. The cutoff value of interspinous motion for detecting pseudarthrosis was 0.9 mm as determined with receiver operating characteristic curve analysis. Compared with CT, interspinous motion of ≥1 mm showed relatively low sensitivity (79.5%) and negative predictive value (77.1%) and similar specificity (97.0%) and positive predictive value (97.4%). Using interspinous motion of ≥2 mm as the cutoff decreased the sensitivity and negative predictive value to 46.6% and 56.8%, respectively. Our evaluation of what constituted adequate dynamic motion for making the radiographs showed that, with use of interspinous motion of ≥1 mm as the cutoff for detecting pseudarthrosis, superjacent interspinous motion of ≥4 mm increased the sensitivity and negative predictive value (86.3% and 83.4%) compared with those associated with alternative cutoffs of superjacent interspinous motion (≥3.5, ≥5, and ≥6 mm), and the specificity (96.1%) and positive predictive value (96.9%) were reasonable. Use of interspinous motion of ≥1 mm as the cutoff for detection of anterior cervical pseudarthrosis on radiographs magnified 150% and made with superjacent interspinous motion of ≥4 mm yielded accuracies comparable with those of CT. Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
    Full-text · Article · Apr 2014 · The Journal of Bone and Joint Surgery
  • Jeffrey L Gum · Jacob M Buchowski
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    ABSTRACT: Gruskay JA, Webb ML, Grauer JN. Methods of evaluating lumbar and cervical fusion. Spine J 2014;14:531-9 (in this issue).
    No preview · Article · Mar 2014 · The spine journal: official journal of the North American Spine Society
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    ABSTRACT: Pulmonary cement embolization after vertebroplasty is a well-known complication but typically presents with minimal respiratory symptoms. Although this rare complication has been reported, the current literature does not address the need for awareness of symptoms of potentially devastating respiratory compromise. We present the case of a 29-year-old man who underwent T11 vertebroplasty and subsequently had chest pain develop several days later. His right lower lung lobe had infarcted owing to massive cement embolization to his pulmonary arterial circulation. Open pulmonary wedge resection and embolectomy were performed. The patient recovered from the embolectomy but had chronic, persistent respiratory symptoms after surgery. Operative management of vertebral compression fractures has included percutaneous vertebroplasty for the past 25 years. The reported incidence of pulmonary cement emboli after vertebroplasty ranges from 2.1% to 26% with much of this variation resulting from which radiographic technique is used to detect embolization. Symptoms of pulmonary cement embolism can occur during the procedure, but more commonly begin days to weeks, even months, after vertebroplasty. At least six deaths from cement embolization after vertebroplasty have been reported. Most cases of pulmonary cement emboli with cardiovascular and pulmonary complications are treated nonoperatively with anticoagulation. Endovascular removal of large cement emboli from the pulmonary arteries is not without risk and sometimes requires open surgery for complete removal of cement pieces. Pulmonary cement embolism is a potentially serious complication of vertebroplasty. If a patient has chest pain or respiratory difficulty after the procedure, chest radiography and possibly advanced chest imaging studies should be performed immediately.
    Full-text · Article · Feb 2014 · Clinical Orthopaedics and Related Research
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    ABSTRACT: Study Design Retrospective review. Objective The objective of this study is to describe the natural history of neurologic recovery after anterior cervical discectomy and fusion (ACDF). Methods Patients between 18 and 80 years of age, diagnosed with cervical radiculopathy, who underwent single-level ACDF and were followed for a minimum of 2 years were identified from a single-center database. Sensory and motor deficits were documented and graded based on physical examination findings at preoperative and postoperative visits, and used to calculate deficit rates. Results One hundred eighteen patients were included in the study. Mean age was 46 ± 9.2 years and mean follow-up time was 3.8 ± 2.1 years. At the time of surgery, 66% had a sensory deficit. Recovery of sensory function was seen in 85% of patients within 1 year. At final follow-up, new sensory deficits had developed in 30% of patients, 60% of whom had adjacent-level sensory deficits. Patients with preoperative sensory deficits tended to be more likely to develop a new deficit postoperatively (p = 0.05). At the time of surgery, 55% had a motor deficit. Recovery of motor function was seen in 95% of patients within 1 year, and 14% developed new postoperative motor deficits by final follow-up. Of those patients who developed a new motor deficit postoperatively, 76% did so at an adjacent level. Conclusions In our series, a high percentage of patients recovered neurologic function during the first year after ACDF. Adjacent-level and remote-level degeneration were large contributors to neurologic deficits that occurred in subsequent years.
    Preview · Article · Feb 2014 · Global Spine Journal

Publication Stats

2k Citations
289.01 Total Impact Points

Institutions

  • 2006-2015
    • Washington University in St. Louis
      • Department of Orthopaedic Surgery
      San Luis, Missouri, United States
  • 2011
    • University of Missouri - St. Louis
      Saint Louis, Michigan, United States
  • 2009-2010
    • Saint Louis University
      • Department of Orthopaedic Surgery
      Сент-Луис, Michigan, United States
    • Seoul National University
      • Department of Orthopaedic Surgery
      Seoul, Seoul, South Korea
  • 2000-2007
    • Johns Hopkins University
      • Department of Orthopaedic Surgery
      Baltimore, MD, United States
  • 2001-2005
    • Johns Hopkins Medicine
      • Department of Orthopaedic Surgery
      Baltimore, Maryland, United States