William Clifton's research while affiliated with Burke Neurological Institute and other places

Publications (72)

Article
Background: Graduate surgical education is highly variable across regions and institutions regarding case volume and degree of trainee participation in each case. Dedicated educational curriculum using cadaveric tissue has been shown to enhance graduate surgical training, however with associated financial and utility burden to the institution. Ob...
Article
Background: Anterior approaches to the cervical spine are among the most common exposures by which neurosurgeons and orthopedic surgeons access the prevertebral space and ultimately the cervical disk and vertebral bodies. There is a paucity of literature describing the microanatomic fascial planes of the neck with respect to anterior cervical appr...
Article
Bone grafting replaces damaged or missing bone with new bone and is used for surgical arthrodesis. Patients benefit from a huge variety of bone graft techniques and options for spinal fusions. This article reviews the rich history of bone grafts in surgery with particular emphasis on spinal fusion. During the early years of bone grafting in spine s...
Article
Objective: Posterior costotransversectomy in the thoracic spine is commonly used for degenerative diseases, tumors, trauma, and other operative indications. It involves resection of the rib head after the ligamentous complexes have been disconnected from the transverse process and lateral vertebral body. The current literature provides only vague...
Article
The newest influx of young learners of anatomy in medical education belong to Generation Z (GenZ), a unique generation of individuals that are vastly different from the Millennial and Generation Z trainees before them. It has been shown that the first wave of GenZ members entering the workforce possess considerable talent for innovation and dedicat...
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BACKGROUND Brain mapping is the most reliable intraoperative tool for identifying surrounding functional cortical and subcortical brain parenchyma. Brain mapping procedures are nuanced and require a multidisciplinary team and a well-trained neurosurgeon. Current training methodology involves real-time observation and operation, without widely avail...
Article
Background Context Minimally invasive surgical transforaminal lumbar interbody fusion (MIS-TLIF) was developed in addition to open-TLIF to minimize iatrogenic soft-tissue damage. A potential disadvantage of MIS-TLIF is inadequate visualization, which may lead to incomplete neural decompression and a less robust arthrodesis. This may cause long-term...
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The pharyngeal plexus is an essential anatomical structure, but the contributions from the glossopharyngeal and vagus nerves and the superior cervical ganglion that give rise to the pharyngeal plexus are not fully understood. The pharyngeal plexus is likely to be encountered during various anterior cervical surgical procedures of the neck such as a...
Article
Arachnoid web (AW) is a rare phenomenon that has only been described in small case reports and case series[1], most commonly presenting with upper motor neuron (UMN) signs and subtle radiographic findings, such as the classically described “scalpel sign”[2]. In this report we demonstrate the use of imaging and operative techniques that haven’t been...
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Facet injections and other pain management interventions are commonly performed in combination with conservative therapy to address spinal pain. Joint mobilizations are a highly utilized intervention for manual practitioners to treat patients with spinal pain. Clinical reasoning and decision making models have not been well described in the literat...
Article
Background: During awake craniotomy, securing the patient's airway might be necessary electively or emergently. The objective of this study was to compare the feasibility of airway management using a laryngeal mask airway (LMA) and 4 alternative airway management techniques in an awake craniotomy simulation. Methods: After completing a questionn...
Article
Objective: The goal of this manuscript is to investigate the effects of a multidisciplinary multinational web-based teaching conference on trainee education, research and patient care. Methods: We present the structure, case selection and presentation of our educational lectures. We retrospectively reviewed our database to gather data on the num...
Article
In Reply I sincerely thank Sue-Chue-Lam for his interest in the published article in JAMA Surgery, “Reflections of a Millennial Surgeon: The Changing Face of Medical Education.”¹ His view on the importance of critical appraisal of teaching strategy within the constant flux of educational development between generations of learners is of paramount i...
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Commercial central line vascular access trainers are available but have significant limitations including cost, size, and limited durability when used for the complete procedure. A unique central venous access trainer was constructed using silicone loaf pan, ballistic gel, copper pipe and aluminum rods as vessels conduits, with varying inserts incl...
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Statement: Three-dimensional (3D) printing is rapidly growing in popularity for anatomical modeling and simulation for medical organizations across the world. Although this technology provides a powerful means of creating accurately representative models of anatomic structures, there remains formidable financial and workforce barriers to understan...
Article
Introduction Pedicle screw placement is the most common method of fixation in the thoracic spine. Use of the “superior facet rule” allows the operator to locate the borders of the pedicle reliably using posterior landmarks alone. This study investigated the ability of three-dimensionally (3D)-printed thoracic vertebrae, made from combined thermopla...
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The recent decline in available personal protective equipment (PPE) due to the novel coronavirus (COVID-19) pandemic has given rise to a host of three-dimensional (3D) printed prototypes for facemask and respirator units. Many of these models have been made open access and publicly available for printing and use, and have been promoted by various m...
Article
Introduction Three‐dimensional (3D) printing of anatomical structures is a growing method of education for students and medical trainees. These models are generally produced as static representations of gross surface anatomy. In order to create a model that provides educators with a tool for demonstration of kinematic and physiologic concepts in ad...
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Background The recent COVID-19 pandemic has demonstrated the need for innovation in cost-effective and easily produced surgical simulations for trainee education that are not limited by physical confines of location. This can be accomplished with the use of desktop three-dimensional (3D) printing technology. This study describes the creation of a l...
Article
Cervical radiculopathy from uncovertebral joint (UVJ) hypertrophy and nerve root compression often occurs anterior and lateral within the cervical intervertebral foramen, presenting a challenge for complete decompression through anterior cervical approaches owing to the intimate association with the vertebral artery and associated venous plexus. Co...
Article
Background Three-dimensional (3D) printing is a powerful tool for replicating patient-specific anatomical features for education and surgical planning. The advent of “desktop” 3D printing has created a cost-effective and widely available means for institutions with limited resources to implement a 3D printing workflow into their clinical applicatio...
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A common cause of cervical radiculopathy from degenerative foraminal stenosis is severe uncovertebral hypertrophy. It is difficult to accomplish complete foraminal decompression in these cases with posterior techniques without the removal of a large portion of the facet joint. Total removal of the uncovertebral joint from an anterior approach allow...
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Unstable traumatic cervical spine fracture is a commonly encountered neurosurgical issue. Concomitant vertebral artery injuries present a challenge in surgical decision-making regarding the timing and order of surgical intervention with respect to endovascular intervention and internal fixation of the unstable fracture. Currently, there are no stud...
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Three-dimensional (3D) printing has revolutionized medical training and patient care. Clinically it is used for patient-specific anatomical modeling with respect to surgical procedures. 3D printing is heavily implemented for simulation to provide a useful tool for anatomical knowledge and surgical techniques. Fused deposition modeling (FDM) is a co...
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Disorders of the spine are among the most common indications for neurosurgical and orthopedic surgical interventions. Spinal fixation in the form of pedicle screw placement is a common form of instrumentation method in the lower cervical, thoracic, and lumbar spine. A vital principle to understand for the safe and accurate placement of pedicle scre...
Article
Introduction: Ossification of the pterygospinous and pterygoalar ligaments has been well documented forming pterygospinous and pterygoalar bars. However, the actual ligaments have been rarely shown in the existing literature. Therefore, this study aimed to reveal the anatomy of the pterygoalar ligament/bar and pterygospinous ligament/bar, and its...
Article
Introduction: Three-dimensional printing and virtual simulation both provide useful methods of patient-specific anatomical modeling for assessing and validating surgical techniques. A combination of these two methods for evaluating the feasibility of spinal instrumentation techniques based on anatomical landmarks has not previously been investigat...
Article
Iatrogenic lumbar arachnoid cysts are a rare occurrence after intradural surgery1,2. To our knowledge, there is only one other previous case reported in the literature contributing to a symptomatic tethered cord3. We present a surgical video demonstrating the history, preoperative workup, and operative technique for exploration and fenestration of...
Article
We present a surgical video highlighting the technical demonstration and microsurgical anatomy of an L4-5 transforaminal lumbar interbody fusion utilizing a combination of thermoplastic polymers and 3-dimensional printing technology to create a biomimetic lumbar spine surgical simulator. The posterior elements of L4-5 and the inferior portion of L3...
Article
Geniculate neuralgia (GN) is an uncommon, but severe, condition that is characterized by excruciating paroxysmal pain in the seventh cranial nerve's cutaneous distribution of general somatic afferent fibers carried through the nervus intermedius (NI). GN becomes a surgical disease in refractory cases of pain after exhaustive medical management. Sur...
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Background Posterior instrumentation techniques are commonly employed for cervicothoracic fixation. The pedicles of the upper thoracic vertebrae can typically accommodate larger diameter screws than the subaxial cervical vertebrae. In many construct systems, this requires the use of a tapered rod, which can be technically challenging to place. Met...
Article
Three‐dimensional (3D) printing has revolutionized individualized medicine for patient‐specific anatomical modeling and surgical planning. The surge of investigations in model creation for preoperative assessments and patient education have demonstrated improvements in both operative factors and patient satisfaction. In addition, recent technologic...
Article
Surgical proficiency is classically acquired through live experience in the operating room. Trainee exposure to cases and complex pathologies is highly variable between training programs1. Currently, there is not a standard for neurosurgical skill assessment for specific operative techniques for trainees. Cadaveric simulation has been utilized to d...
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Access to affordable 3D printing technology has resulted in increased interest in the creation of medical phantom task trainers. Recent research has validated the use of these trainers in simulation education. However, task trainers remain expensive, limiting their availability to medical training programs. We describe the construction of a low-cos...
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Currently, there is a paucity of studies that describe prone cervicothoracic joint high-velocity low-amplitude (HVLA) thrust techniques using an anatomically accurate, biomimetic three-dimensional (3D) spine model for educational demonstration. The purpose of this technical report was to present a learning model for two prone cervicothoracic HVLA t...
Article
Anatomical knowledge is a key tenet in graduate medical and surgical education. Classically, these principles are taught in the operating room during live surgical experience. This puts both the learner and the patient at a disadvantage due to environment, time, and safety constraints. Educational adjuncts such as cadaveric courses and surgical ski...
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Background Cervical radiculopathy from uncovertebral joint hypertrophy and foraminal stenosis is a common indication for anterior cervical diskectomy and fusion (ACDF). Often, the uncinate hypertrophy extends lateral to the foramen and impinges on the nerve close to the vertebral artery as it travels in between the transverse foramina. Method Usin...
Chapter
Traumatic spinal injuries occur relatively frequently, with an annual incidence of about 12,000 patients per year in the United States. Modern advances in critical care management of patients with spinal injuries and spinal cord injuries have greatly decreased mortality. Therefore, the prevalence in the United States is more than 200,000 patients p...
Article
Otoscopy is a simple, yet fundamental tool for medical practitioners of all levels to diagnose common otologic conditions. Otoscopy is traditionally performed by a handheld light with a lens. This technique has several disadvantages, especially during teaching sessions since only a first-person view is available. Video otoscopy has the ability to p...
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The placement of C2 laminar screws is a safe and useful method of axis fixation. The freehand method of screw placement was originally described by Wright et al., and requires detailed knowledge of the C2 posterior element anatomy, relationship to vital neurovascular structures, and technical acumen. The current evidence, surgical anatomy and techn...
Article
We present a surgical video demonstrating the anatomy and technique of freehand C2 pedicle screw placement using a cadaveric specimen and 3-dimensional simulation software. C2 pedicle screws have been shown to augment cervical constructs and provide increased biomechanical stability compared with pars screws due to the increased length and bony pur...
Article
We present a surgical video highlighting the technical pearls for C7 pedicle screw placement with respect to cervicothoracic constructs. Pedicle screw placement into C7 has been shown to enhance the biomechanical stability of both cervical and cervicothoracic constructs and is safe for patient related outcomes.1,2 Rod placement across the cervicoth...
Article
We present a surgical video illustrating the technique for en bloc resection of an intradural-extramedullary lumbar tumor. The patient is a 63-yr-old woman presenting with worsening bilateral leg pain. Imaging of her lumbar spine showed an enhancing, circumscribed intradural-extramedullary tumor compressing her cauda equina at the L2 level. With in...
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Background: Cervical pedicle screws are advantageous in their biomechanical stability within cervical and cervicothoracic constructs. The seventh cervical vertebra contains relatively large pedicles and has a low incidence of vertebral artery localization within the transverse foramina. The freehand technique of pedicle screw insertion is advantag...
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There is significant variability in the realism, cost, and structural integrity of sonographic simulators available for use currently. A common material that is used for the production of sonographic simulators is synthetic ballistic gelatin, which requires a high melting temperature for molding. In this experiment, we investigated the structural i...
Article
Background Medical simulation for the teaching of procedural skills to health-care providers is an effective method of instruction to improve safety, quality, and procedural efficiency. There are several commercially available simulators for lumbar puncture training; however, there is currently no model available for lumbar drain intrathecal cathet...
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We present a narrated video simulation (Video 1) using 3-dimensional anatomic software demonstrating the proper landmarks and relevant neuroanatomy for successful bedside external ventricular drain placement. External ventricular drains are commonly inserted at the bedside for emergent intracranial pressure monitoring and/or treatment of elevated i...
Article
Physicians have cared for acutely ill patients throughout history; after the devastating poliomyelitis epidemics of the 1950s, a new specialty emerged. Initially, respiratory care units were created for these severely affected patients, but soon they were transformed into intensive care units (ICUs). Trauma units and transplant units soon followed....
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The third leading cause of spinal injuries are gunshot wounds to the spine, accounting for 15.2% of all spinal cord injuries. Treatment for gunshot wound spinal cord injuries (GSWSCI) remains variable, with indications for surgery being controversial. There is no clear evidence or guidelines that can help spine surgeons decide and direct surgical i...
Article
Background: 3D printed models have grown in popularity for resident training. Currently there is a paucity of simulators specifically designed for advanced cervical instrumentation. Our institution created a unique simulator for the instruction of freehand placement of C2 laminar screws using a specific 3-dimensional printing technique to replicat...
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Ancient Egyptian civilization is one of the oldest cultures in human history. Ancient Egyptians are well-known for pioneering the fields of art, medicine, and the documentation of discoveries as mythological tales. The Egyptians mastered the integration of anatomy and mythology into artistic symbols and figures. The mythology of Isis, Osiris, and H...
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Background Three-dimensional (3D) printing is a growing practice in the medical community for patient care and trainee education as well as production of equipment and devices. The development of functional models to replicate physiologic systems of human tissue has also been explored, although to a lesser degree. Specifically, the design of 3D pri...
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The ancient Egyptian and Peruvian Civilizations are two of the earliest cultures in human history. Through medical and architectural similarities, we wish to show a possible connection between these two cultures. A literature search was conducted by searching the database of Medline, National Geographic magazine, history books, and Google Scholar u...
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Background Medical simulation is an emerging field for resident training. Three-dimensional printing has accelerated the development of models for spine surgical simulation. Previous models have utilized augmented infill ratios to simulate the density difference between cortical and cancellous bone; however, this does not fully account for differen...
Article
C2 pars fractures occur most commonly after traumatic hyperextension injuries. Although a significant number of cases may heal with conservative measures, some require surgical intervention. Anatomical variations of the V3 segment of the vertebral artery are not uncommon and may present an obstacle to safe instrumentation. Intraoperative CT-guided...
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The use of navigational adjuncts for pedicle screw placement has increased in popularity among surgeons with access to this technology. However, it remains important to have a comprehensive understanding of posterior bony element anatomy with respect to the location of the pedicle in order to ensure safe placement of pedicle screws. Proper exposure...
Article
Background: Atlantoaxial fusion often requires C2 nerve transection for complete C1 lateral mass exposure. Nerve transection is made ideally at the preganglionic segment proximal to the dorsal root ganglion to minimize the risk of postoperative dysesthesias. If the nerve is transected too proximally, cerebrospinal fluid leak may be encountered by...
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There are many proposed classification systems for traumatic thoracolumbar fractures (TLF). More recently published are the AO Spine Classification System and the Thoraco-Lumbar Injury Classification System (TLICS). There has been a paucity of high-level evidence to link these classification system subtypes with clinical outcomes and/or management...
Article
Cervical disc herniations most often present with neck and arm pain resulting from direct nerve root compression from a paramedian or foraminal disc herniation. It is unusual to encounter unilateral lower extremity symptoms in the absence of other neurological symptoms due to a centrally herniated cervical disc. Because this clinical presentation i...
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Purpose Primary spinal cord tumors are rare, and evidence-based management of these patients remains a source of controversy. This study used a large cohort of low-grade spinal cord astrocytomas to determine the effectiveness of prognostic factors and survival. Methods The Surveillance, Epidemiology, and End Results (SEER) cancer registry was used...
Article
Background: Arachnoid cysts are a relatively common finding in adult patients, especially with the advent of advanced imaging techniques. The overall incidence ranges from 1%-2%, and the majority are clinically silent. Arachnoid cysts are postulated to arise by congenital anomalies or trauma. De novo formation of arachnoid cysts has been reported...
Article
Background Atlanto-occipital dislocation (AOD) is the most uncommon form of traumatic cervical spine injury. The majority of patients die before reaching higher-level care, and only a small percentage of patients with AOD survive the initial injury after receiving tertiary care. As such, there is a paucity of evidence-based management guidelines fo...
Article
Background: Primary central nervous system (CNS) histiocytic sarcoma is an extremely rare lymphoproliferative disorder that affects the CNS and behaves aggressively. Only 27 cases of primary CNS histiocytic sarcoma have been reported. The paucity of literature on this entity has made diagnosis and treatment difficult both for the surgeon and the p...

Citations

... The creation of patient-specific models is perhaps the most impactful application of 3DP technologies and has shown to enhance presurgical planning, surgical simulation with recreation of surgical scenarios and complications (e.g., intraoperative dural sinus injury), surgical training, patient education, and interdisciplinary communication BioMed Research International (e.g., awake craniotomies and endonasal endoscopic procedures) [70][71][72][73][74][75][76]. Patients expect utmost proficiency and mastery from their neurosurgeons. ...
... Patients with long-term low back and leg pain that has a detrimental effect on their quality of life and for whom conservative treatment has proven futile might consider surgery (2,3). Posterolateral lumbar interbody fusion, represented by transforaminal lumbar interbody fusion (TLIF), has long been widely used for the treatment of various LDDs (4). However, TLIF, including minimally invasive TLIF (MI-TLIF), not only requires intraoperative stripping of the paravertebral muscles but also results in complications, such as fusion collapse, nerve damage, cerebrospinal fluid leakage, and postoperative paravertebral muscle atrophy due to denervation, which affect the patient's postoperative quality of life (5). ...
... Recently, simulation devices have proven their potential to create a unique surgical environment that allows residents to operate in realistic conditions and, most importantly, to transfer new skills to the operating room [6][7][8][9]. However, no simulation tool is currently available (or able) to replicate the anatomical and technical nuances of the minimally invasive lateral retroperitoneal transpsoas approach to the lumbar spine; acquisition of new skills and performance improvement remain bound to the hospital setting and the classic teaching method. ...
... Recently, simulation devices have proven their potential to create a unique surgical environment that allows residents to operate in realistic conditions and, most importantly, to transfer new skills to the operating room [6][7][8][9]. However, no simulation tool is currently available (or able) to replicate the anatomical and technical nuances of the minimally invasive lateral retroperitoneal transpsoas approach to the lumbar spine; acquisition of new skills and performance improvement remain bound to the hospital setting and the classic teaching method. ...
... With the development of 3D-Slicer and 3D printing technology, 3D printing models have been used to customize anatomical models and medical implants 7,8 , such as plastic titanium plate, peek plate and other repair materials for skull defect repair. Accurate 3D printing model can help neurosurgeons clearly observe the three-dimensional spatial relationship between intracranial lesions and surrounding tissues, help patients and their families better understand the condition of lesions and the risk of surgery, and promote doctor-patient 7,9 have shown that 3D printed brain model provides good training materials for simulated surgery, contributes to preoperative design, experience accumulation and result verification, effectively improves the surgical effect and reduces surgical complications. Our team has skillfully used 3D-Slicer software for 3D reconstruction and Sina/MosoCam mobile phone app for virtual 3D projection for preoperative planning. ...
... Three-dimensional printing offers many advantages, but there are also a few limitations to 3D printing (Clifton et al., 2020). The major problem is that the mechanical hindrance of particles can only be simulated to a degree, but the multiplication of the electrostatic properties of the filter with 3D materials is a major challenge. ...
... One cause of dysphagia is dysfunction of the pharyngeal muscles, which comprise three circular muscles (superior, middle, and inferior constrictors) and three longitudinal muscles (stylophyryngeus, salpinogopharyngeus, and palatopharyngeus). These muscles are innervated by the pharyngeal plexus (PP), which is formed by the pharyngeal branches of the glossopharyngeal and vagus nerves and sympathetic trunk (Gutierrez et al., 2021;Standring, 2020). ...
... 25,26 3D models not only provide improved understanding of the anatomy of the spine but also help understand physiology and pathology better as was shown by Clifton et al. in their cervical spine model. 27 Burkhart et al. in their study have found haptically and biomechanically realistic simulation of posterior spinal procedures with 3D printed models which have outperformed sawbones. These can eventually also be used for preoperative simulations especially in complex cases. ...
... The goal was to design a solid and freely accessible online tool, to train residents in lumbar pedicle screws placement. Clifton et al. developed a free printable simulator (Spinebox®, Neurological Surgery, Mayo Clinic, Jacksonville, USA), composed of lumbar vertebrae hidden in a box [5]. The residents could carry out the procedure and then remove the box to check the positions of the screws. ...
... ACDF reportedly achieves an ideal curative effect through indirect decompression of intervertebral distraction and fixation and fusion of the surgical segments. However, while ACDF combined with UJ resection quickly relieves nerve root compression and pain, the potential complications include large intraoperative blood loss, vertebral artery damage, and subsidence of the titanium mesh cage [8][9][10][11][12]. ...