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Improving Safety and Outcomes in Complex Spine Surgery: Advancements in Complication Prediction, Surgical Optimization, and Techniques

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: closed (23 March 2023) | Viewed by 10292

Special Issue Editor

Dr. Rafael De la Garza Ramos

E-Mail Website
Guest Editor
Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, 3316 Rochambeau Avenue, Bronx, NY, USA
Interests: spine surgery; spinal tumor; spinal deformity; cancer disparities; predictive analytics; machine learning

Special Issue Information

Dear Colleagues,

Complex spine surgery such as involving deformity or tumors has a high complication rate. Although the benefits of surgery have been proven, improving safety remains a primary objective in our field. Advancements in predictive analytics have allowed for preoperative risk stratification, patient counseling, and potential modification of surgical plans. The presence of two specialist surgeons in the operating room, the use of multidisciplinary approaches, minimally-invasive techniques, and other methods have also been shown to potentially decrease complications and improve outcomes in complex spinal disorders. Lastly, advancements such as intraoperative navigation or robotic spine surgery have allowed for improved accuracy and prompt identification or treatment of implant-related adverse events.

The current focus issue is seeking review and original articles on improving safety and outcomes in complex spine surgery. Papers addressing complex spinal disorders such as intractable back pain, spinal deformity, failed back syndrome, and spinal tumors are welcomed.

Dr. Rafael De la Garza Ramos
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • complications
  • spine surgery
  • deformity
  • scoliosis
  • spinal tumor
  • metastatic spine disease
  • revision surgery
  • predictive analytics

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Published Papers (5 papers)

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Editorial

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3 pages, 175 KiB  
Editorial
Can We Make Spine Surgery Safer and Better?
by Rafael De la Garza Ramos
J. Clin. Med. 2022, 11(12), 3400; https://doi.org/10.3390/jcm11123400 - 13 Jun 2022
Viewed by 1398
Abstract
Driven mostly by an aging population, the utilization of spine surgery has increased exponentially over the last decades [...] Full article
(This article belongs to the Special Issue Improving Safety and Outcomes in Complex Spine Surgery: Advancements in Complication Prediction, Surgical Optimization, and Techniques)

Research

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14 pages, 3060 KiB  
Article
Influences of Increasing Pedicle Screw Diameter on Widening Vertebral Pedicle Size during Surgery in Spinal Deformities in Children and Adolescents without Higher Risk of Pedicle and Vertebral Breaches
by Pawel Grabala, Ilkka J. Helenius, Michal Grabala and Suken A. Shah
J. Clin. Med. 2023, 12(16), 5368; https://doi.org/10.3390/jcm12165368 - 18 Aug 2023
Cited by 4 | Viewed by 1407
Abstract
Background: A very common technique for treating spinal deformities in children and adolescents is the use of segmental screws. In order to obtain proper stability and the best possible correction, the screws must first be precisely inserted. Additional factors influencing the quality and [...] Read more.
Background: A very common technique for treating spinal deformities in children and adolescents is the use of segmental screws. In order to obtain proper stability and the best possible correction, the screws must first be precisely inserted. Additional factors influencing the quality and success of the operation are the size and quality of the bone, the skills of the surgeon, and biomechanical factors, i.e., the width and length of the screws used during surgery. Our study was focused on evaluating the effect of increasing the diameter of the instrumented pedicles by pedicle screws and assessing the safety of expanding these pedicles with screws of various sizes in children with spinal deformities during the growth period, using preoperative magnetic resonance imaging and postoperative computed tomography (CT) to assess and compare preoperative size measurements from MRI to postoperative CT measurements. Methods: We obtained data for evaluation from the available medical records and treatment histories of patients aged 2 to 18 who underwent surgical treatment of spinal deformities in the years 2016–2023. In 230 patients (28 male and 202 female), 7954 vertebral bodies were scanned by preoperative MRI, and 5080 pedicle screws were inserted during surgery, which were then assessed by postoperative CT scan. For the most accurate assessment, patients were classified into three age groups: 2–5 years (Group 1), 6–10 years (Group 2), and 11–18 years (Group 3). In addition, we studied implant subgroups: vertebral bodies with inserted pedicles of screw sizes 5.0 mm and 5.5 mm (Group S), and pedicles of screw sizes 6.0 mm, 6.5 mm, and 7.0 mm (Group L). Results: The morphology of pedicles (Lenke classification) analyzed before surgery using MRI was 55.2% type A, 33.8% type B, 4.7% type C, and 6.3% type D. The postoperative lateral and medial breaches were noted, and these did not cause any complications requiring revision surgery. The mean pedicle diameter before surgery for T1–L5 vertebral pedicles was between 3.79 (1.44) mm and 5.68 (1.64) mm. The mean expanding diameter of pedicles after surgery for T1–L5 vertebral pedicles ranged from 1.90 (0.39) mm to 2.92 (0.28) mm, which corresponds to the extension of the pedicle diameter in the mean range of 47% (4.1)–71% (3.0). We noted that the mean vertebral pedicle expansion was 49% in Group 1, 52% in Group 2, and 62% in Group 3 (N.S.), and the mean expansion for 7.0 mm screw pedicles was 78%. Conclusions: Our study confirms that there is a wide range of expansion of the vertebral pedicle during screw insertion (up to 78%) with a low risk of lateral or medial breaches and without an increased risk of complications. The larger the diameter of the screw inserted into the pedicle, the more the pedicle expands. Pedicle measurements by preoperative MRI may be helpful for sufficient reliability in preoperative planning. Full article
(This article belongs to the Special Issue Improving Safety and Outcomes in Complex Spine Surgery: Advancements in Complication Prediction, Surgical Optimization, and Techniques)
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8 pages, 626 KiB  
Article
An Artificial Neural Network Model for the Prediction of Perioperative Blood Transfusion in Adult Spinal Deformity Surgery
by Rafael De la Garza Ramos, Mousa K. Hamad, Jessica Ryvlin, Oscar Krol, Peter G. Passias, Mitchell S. Fourman, John H. Shin, Vijay Yanamadala, Yaroslav Gelfand, Saikiran Murthy and Reza Yassari
J. Clin. Med. 2022, 11(15), 4436; https://doi.org/10.3390/jcm11154436 - 29 Jul 2022
Cited by 8 | Viewed by 2155
Abstract
Prediction of blood transfusion after adult spinal deformity (ASD) surgery can identify at-risk patients and potentially reduce its utilization and the complications associated with it. The use of artificial neural networks (ANNs) offers the potential for high predictive capability. A total of 1173 [...] Read more.
Prediction of blood transfusion after adult spinal deformity (ASD) surgery can identify at-risk patients and potentially reduce its utilization and the complications associated with it. The use of artificial neural networks (ANNs) offers the potential for high predictive capability. A total of 1173 patients who underwent surgery for ASD were identified in the 2017–2019 NSQIP databases. The data were split into 70% training and 30% testing cohorts. Eighteen patient and operative variables were used. The outcome variable was receiving RBC transfusion intraoperatively or within 72 h after surgery. The model was assessed by its sensitivity, positive predictive value, F1-score, accuracy (ACC), and area under the curve (AUROC). Average patient age was 56 years and 63% were female. Pelvic fixation was performed in 21.3% of patients and three-column osteotomies in 19.5% of cases. The transfusion rate was 50.0% (586/1173 patients). The best model showed an overall ACC of 81% and 77% on the training and testing data, respectively. On the testing data, the sensitivity was 80%, the positive predictive value 76%, and the F1-score was 78%. The AUROC was 0.84. ANNs may allow the identification of at-risk patients, potentially decrease the risk of transfusion via strategic planning, and improve resource allocation. Full article
(This article belongs to the Special Issue Improving Safety and Outcomes in Complex Spine Surgery: Advancements in Complication Prediction, Surgical Optimization, and Techniques)
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8 pages, 197 KiB  
Article
Is the Use of Intraoperative 3D Navigation for Thoracolumbar Spine Surgery a Risk Factor for Post-Operative Infection?
by Daniel Berman, Ananth Eleswarapu, Jonathan Krystal and Henry Hoang
J. Clin. Med. 2022, 11(8), 2108; https://doi.org/10.3390/jcm11082108 - 10 Apr 2022
Cited by 2 | Viewed by 1431
Abstract
Pedicle screw fixation is a technique used to provide rigid fixation in thoracolumbar spine surgery. Safe intraosseous placement of pedicle screws is necessary to provide optimal fixation as well as to avoid damage to adjacent anatomic structures. Despite the wide variety of techniques [...] Read more.
Pedicle screw fixation is a technique used to provide rigid fixation in thoracolumbar spine surgery. Safe intraosseous placement of pedicle screws is necessary to provide optimal fixation as well as to avoid damage to adjacent anatomic structures. Despite the wide variety of techniques available, none thus far has been able to fully eliminate the risk of malpositioned screws. Intraoperative 3-dimensional navigation (I3DN) was developed to improve accuracy in the placement of pedicle screws. To our knowledge, no previous studies have investigated whether infection rates are higher with I3DN. A single-institution, retrospective study of patients age > 18 undergoing thoracolumbar fusion and instrumentation was carried out and use of I3DN was recorded. The I3DN group had a significantly greater rate of return to the operating room for culture-positive incision and drainage (17 (4.1%) vs. 1 (0.6%), p = 0.025). In multivariate analysis, the use of I3DM did not reach significance with an OR of 6.49 (0.84–50.02, p = 0.073). Post-operative infections are multifactorial and potential infection risks associated with I3DN need to be weighed against the safety benefits of improved accuracy of pedicle screw positioning. Full article
(This article belongs to the Special Issue Improving Safety and Outcomes in Complex Spine Surgery: Advancements in Complication Prediction, Surgical Optimization, and Techniques)

Other

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12 pages, 1105 KiB  
Case Report
Cervical Paraspinal Chordoma: A Literature Review with a Novel Case Report
by Redwan Jabbar, Jakub Jankowski, Agnieszka Pawełczyk, Bartosz Szmyd, Julia Solek, Olaf Pierzak, Maciej Wojdyn and Maciej Radek
J. Clin. Med. 2022, 11(14), 4117; https://doi.org/10.3390/jcm11144117 - 15 Jul 2022
Cited by 2 | Viewed by 2765
Abstract
Chordomas are rare malignant neoplasms, accounting for 1–4% of all primary bone tumors. Most spinal chordomas occur in the sacrococcygeal region and the base of the skull; however, 6% of chordomas are observed in the cervical spine. In these cases, the lesion is [...] Read more.
Chordomas are rare malignant neoplasms, accounting for 1–4% of all primary bone tumors. Most spinal chordomas occur in the sacrococcygeal region and the base of the skull; however, 6% of chordomas are observed in the cervical spine. In these cases, the lesion is mainly located in the midline. These tumors slowly grow before becoming symptomatic and encase the surrounding vascular and nerve structures. Patients with advanced chordoma have a poor prognosis due to local recurrence with infiltration and destruction of adjacent bone and tissues. Systemic chemotherapy options have not been fully effective in these tumors, especially for recurrent chordomas. Thus, new combinations of currently available targeted molecular and biological therapies with radiotherapy have been proposed as potential treatment modalities. Here, the present paper describes the case of a 41-year-old male with a C2–C4 chordoma located paravertebrally, who underwent surgical resection with a debulking procedure for a cervical chordoma. Computed tomography angiography revealed a paraspinal mass with bone remodeling and the MRI showed a paravertebral mass penetrating to the spinal canal with a widening of the intervertebral C2–C3 foramen. Initially, the tumor was diagnosed as schwannoma based on its localization and imaging features; however, the histopathology specimen confirmed the diagnosis of chordoma. This case study highlights the effectivity of radical surgical resection as a mainstay treatment for chordomas, discusses neuroimaging, diagnosis, and the use of currently available targeted therapies and forthcoming treatment strategies, as alternative treatment options for chordoma. Full article
(This article belongs to the Special Issue Improving Safety and Outcomes in Complex Spine Surgery: Advancements in Complication Prediction, Surgical Optimization, and Techniques)
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