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pubmed: (skolasky, richard l...

NCBI: db=pubmed; Term=(Skolasky, Richard L[Full Author Name]) OR (Cohen, David B[Full Author Name]) OR (Kebaish, Khaled M[Full Author Name]) OR (Neuman, Brian J[Full Author Name]) OR (Riley III, Lee H[Full Author Name])
  1. Beta-amyloid (Aβ) uptake by PET imaging in older HIV+ and HIV- individuals.

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    Beta-amyloid (Aβ) uptake by PET imaging in older HIV+ and HIV- individuals.

    J Neurovirol. 2020 Apr 08;:

    Authors: Mohamed M, Skolasky RL, Zhou Y, Ye W, Brasic JR, Brown A, Pardo CA, Barker PB, Wong DF, Sacktor N

    Abstract
    The causes of cognitive impairment among older HIV+ individuals may overlap with causes among elderly HIV seronegative (HIV-) individuals. The objective of this study was to determine if beta-amyloid (Aβ) deposition measured by [18F] AV-45 (florbetapir) positron emission tomography (PET) is increased in older HIV+ individuals compared to HIV- individuals. Forty-eight HIV+ and 25 HIV- individuals underwent [18F] AV-45 PET imaging. [18F] AV-45 binding to Aβ was measured by standardized uptake value ratios (SUVR) relative to the cerebellum in 16 cortical and subcortical regions of interest. Global and regional cortical SUVRs were compared by (1) serostatus, (2) HAND stage, and (3) age decade, comparing individuals in their 50s and > 60s. There were no differences in median global cortical SUVR stratified by HIV serostatus or HAND stage. The proportion of HIV+ participants in their 50s with elevated global amyloid uptake (SUVR > 1.40) was significantly higher than the proportion in HIV- participants (67% versus 25%, p = 0.04), and selected regional SUVR values were also higher (p < 0.05) in HIV+ compared to HIV- participants in their 50s. However, these group differences were not seen in participants in their 60s. In conclusion, PET imaging found no differences in overall global Aβ deposition stratified by HIV serostatus or HAND stage. Although there was some evidence of increased Aβ deposition in HIV+ individuals in their 50s compared to HIV- individuals which might indicate premature aging, the most parsimonious explanation for this is the relatively small sample size in this cross-sectional cohort study.

    PMID: 32270469 [PubMed - as supplied by publisher]

    https://www.ncbi.nlm.nih.gov/pubmed/32270469?dopt=Abstract
  2. Are preoperative depression and anxiety associated with patient-reported outcomes, health care payments, and opioid use after anterior discectomy and fusion?

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    Are preoperative depression and anxiety associated with patient-reported outcomes, health care payments, and opioid use after anterior discectomy and fusion?

    Spine J. 2020 Mar 13;:

    Authors: Harris AB, Marrache M, Puvanesarajah V, Raad M, Jain A, Kebaish KM, Riley LH, Skolasky RL

    Abstract
    BACKGROUND CONTEXT: Depression and anxiety are common psychiatric conditions among US adults, and anterior cervical discectomy and fusion (ACDF) is one of the most commonly performed spinal surgeries. Mental health conditions can affect physical health, and thus have the potential to contribute to adverse outcomes after spine surgery; however, a comprehensive assessment of long-term outcomes and the additive economic burden of these conditions in patients undergoing ACDF has not been well described.
    PURPOSE: Our goal was to assess the associations between depression/anxiety and adverse outcomes and health-resource utilization after anterior cervical discectomy and fusion (ACDF).
    STUDY DESIGN: Retrospective database study.
    PATIENT SAMPLE: We retrospectively analyzed a private administrative health claims database to identify patients who underwent ACDF in the United States from 2010 to 2013. A total of 16,306 patients met our inclusion criteria. Mean (± standard deviation) patient age was 50±7.9 years. Approximately 4,800 patients (30%) had a depression diagnosis and 4,000 (25%) had a diagnosis of anxiety.
    OUTCOME MEASURES: The primary outcomes of interest were intensive care unit admission, multiday hospitalization, discharge disposition, 30- and 90-day hospital readmission, 1- and 2-year rates of revision surgery, and chronic postoperative opioid use. Secondary outcomes were 1- and 2-year total cumulative health care payments and cumulative postoperative opioid consumption.
    METHODS: Regression models controlled for demographic and medical covariates, alpha=0.05.
    RESULTS: A preoperative diagnosis of depression was associated with higher odds of multiday hospitalization (odds ratio [OR] 1.09, 95% confidence interval [CI] 1.01-1.19), 90-day readmission (OR 1.71, 95% CI 1.46-2.02), revision surgery within 2 years (OR 1.43 95% CI 1.16-1.76), and chronic postoperative opioid use (OR 1.58, 95% CI 1.45-1.72) and an increase of $5,915 in adjusted 2-year health care payments (p<.001). Patients with a preoperative diagnosis of anxiety had higher odds of multiday hospitalization (OR 1.15, 95% CI 1.06-1.25), revision surgery within 2 years (OR 1.33, 95% CI 1.07-1.65), and chronic postoperative opioid use (OR 1.62, 95% CI 1.48-1.77) and an increase of $4,471 in adjusted 2-year health care payments (p<.001). Neither anxiety nor depression was associated with intensive care unit admission, discharge disposition, 30-day readmission, revision surgery within 1 year, 1-year cumulative health care payments, or cumulative postoperative opioid consumption.
    CONCLUSIONS: Patients with preoperative diagnoses of depression or anxiety have a greater likelihood of adverse outcomes, increased opioid consumption, and increased cumulative health care payments after ACDF compared with patients without depression or anxiety.

    PMID: 32179156 [PubMed - as supplied by publisher]

    https://www.ncbi.nlm.nih.gov/pubmed/32179156?dopt=Abstract
  3. Lupus and Perioperative Complications in Elective Primary Total Hip or Knee Arthroplasty.

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    Lupus and Perioperative Complications in Elective Primary Total Hip or Knee Arthroplasty.

    Clin Orthop Surg. 2020 Mar;12(1):37-42

    Authors: Aziz KT, Best MJ, Skolasky RL, Ponnusamy KE, Sterling RS, Khanuja HS

    Abstract
    Background: The number of patients with systemic lupus erythematosus (herein, lupus) undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) is increasing. There is disagreement about the effect of lupus on perioperative complication rates. We hypothesized that lupus would be associated with higher complication rates in patients who undergo elective primary THA or TKA.
    Methods: Records of more than 6.2 million patients from the National Inpatient Sample who underwent elective primary THA or TKA from 2000 to 2009 were reviewed. Patients with lupus (n = 38,644) were compared with those without lupus (n = 6,173,826). Major complications were death, pulmonary embolism, myocardial infarction, stroke, pneumonia, and acute renal failure. Minor complications were wound infection, seroma, deep vein thrombosis, hip dislocation, wound dehiscence, and hematoma. Patient age, sex, duration of hospital stay, and number of Elixhauser comorbidities were assessed for both groups. Multivariate logistic regression models using comorbidities, age, and sex as covariates were used to assess the association of lupus with major and minor perioperative complications. The alpha level was set to 0.001.
    Results: Among patients who underwent THA, those with lupus were younger (mean age, 56 vs. 65 years), were more likely to be women (87% vs. 56%), had longer hospital stays (mean, 4.0 vs. 3.8 days), and had more comorbidities (mean, 2.5 vs. 1.4) than those without lupus (all p < 0.001). In patients with THA, lupus was independently associated with major complications (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.1 to 1.7) and minor complications (OR, 1.2; 95% CI, 1.0 to 1.5). Similarly, among patients who underwent TKA, those with lupus were younger (mean, 62 vs. 67 years), were more likely to be women (93% vs. 64%), had longer hospital stays (mean, 3.8 vs. 3.7 days), and had more comorbidities (mean, 2.8 vs. 1.7) than those without lupus (all p < 0.001). However, in TKA patients, lupus was not associated with greater odds of major complications (OR, 1.2; 95% CI, 0.9 to 1.4) or minor complications (OR, 1.1; 95% CI, 0.9 to 1.3).
    Conclusions: Lupus is an independent risk factor for major and minor perioperative complications in elective primary THA but not TKA.

    PMID: 32117536 [PubMed - in process]

    https://www.ncbi.nlm.nih.gov/pubmed/32117536?dopt=Abstract
  4. Cost-Utility Analysis of rhBMP-2 Use in Adult Spinal Deformity Surgery.

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    Cost-Utility Analysis of rhBMP-2 Use in Adult Spinal Deformity Surgery.

    Spine (Phila Pa 1976). 2020 Feb 21;:

    Authors: Jain A, Yeramaneni S, Kebaish KM, Raad M, Gum JL, Klineberg EO, Hassanzadeh H, Kelly MP, Passias PG, Ames CP, Smith JS, Shaffrey CI, Bess S, Lafage V, Glassman S, Carreon LY, Hostin RA, International Spine Study Group

    Abstract
    STUDY DESIGN: Economic modeling of data from a multicenter, prospective registry.
    OBJECTIVE: To analyze the cost utility of recombinant human bone morphogenetic protein-2 (BMP) in adult spinal deformity (ASD) surgery.
    SUMMARY OF BACKGROUND DATA: ASD surgery is expensive and presents risk of major complications. BMP is frequently used off-label to reduce the risk of pseudarthrosis.
    METHODS: Of 522 ASD patients with fusion of 5 or more spinal levels, 367 (70%) had at least 2-year follow-up. Total direct cost was calculated by adding direct costs of the index surgery and any subsequent reoperations or readmissions. Cumulative quality-adjusted life years (QALYs) gained were calculated from the change in preoperative to final follow-up SF-6D health utility score. A decision-analysis model comparing BMP vs. no-BMP was developed with pseudarthrosis as the primary outcome. Costs and benefits were discounted at 3%. Probabilistic sensitivity analysis was performed using mixed first-order and second-order Monte Carlo simulations. One-way sensitivity analyses were performed by varying cost, probability, and QALY estimates. Alpha = 0.05.
    RESULTS: BMP was used in the index surgery for 267 patients (73%). The mean (± standard deviation) direct cost of BMP for the index surgery was $14,000 ± $6,400. Forty patients (11%) underwent revision surgery for symptomatic pseudarthrosis (BMP group, 8.6%; no-BMP group, 17%; P = 0.022). The mean 2-year direct cost was significantly higher for patients with pseudarthrosis ($138,000 ± $17,000) than for patients without pseudarthrosis ($61,000 ± $25,000) (P < 0.001). Simulation analysis revealed that BMP was associated with positive incremental utility in 67% of patients and considered favorable at a willingness-to-pay threshold of $150,000/QALY in >52% of patients.
    CONCLUSIONS: BMP use was associated with reduction in revisions for symptomatic pseudarthrosis in ASD surgery. Cost-utility analysis suggests that BMP use may be favored in ASD surgery; however, this determination requires further research.
    LEVEL OF EVIDENCE: 2.

    PMID: 32097274 [PubMed - as supplied by publisher]

    https://www.ncbi.nlm.nih.gov/pubmed/32097274?dopt=Abstract
  5. SpineCloud: image analytics for predictive modeling of spine surgery outcomes.

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    SpineCloud: image analytics for predictive modeling of spine surgery outcomes.

    J Med Imaging (Bellingham). 2020 May;7(3):031502

    Authors: De Silva T, Vedula SS, Perdomo-Pantoja A, Vijayan R, Doerr SA, Uneri A, Han R, Ketcha MD, Skolasky RL, Witham T, Theodore N, Siewerdsen JH

    Abstract
    Purpose: Data-intensive modeling could provide insight on the broad variability in outcomes in spine surgery. Previous studies were limited to analysis of demographic and clinical characteristics. We report an analytic framework called "SpineCloud" that incorporates quantitative features extracted from perioperative images to predict spine surgery outcome. Approach: A retrospective study was conducted in which patient demographics, imaging, and outcome data were collected. Image features were automatically computed from perioperative CT. Postoperative 3- and 12-month functional and pain outcomes were analyzed in terms of improvement relative to the preoperative state. A boosted decision tree classifier was trained to predict outcome using demographic and image features as predictor variables. Predictions were computed based on SpineCloud and conventional demographic models, and features associated with poor outcome were identified from weighting terms evident in the boosted tree. Results: Neither approach was predictive of 3- or 12-month outcomes based on preoperative data alone in the current, preliminary study. However, SpineCloud predictions incorporating image features obtained during and immediately following surgery (i.e., intraoperative and immediate postoperative images) exhibited significant improvement in area under the receiver operating characteristic (AUC): AUC = 0.72 ( CI 95 = 0.59 to 0.83) at 3 months and AUC = 0.69 ( CI 95 = 0.55 to 0.82) at 12 months. Conclusions: Predictive modeling of lumbar spine surgery outcomes was improved by incorporation of image-based features compared to analysis based on conventional demographic data. The SpineCloud framework could improve understanding of factors underlying outcome variability and warrants further investigation and validation in a larger patient cohort.

    PMID: 32090136 [PubMed]

    https://www.ncbi.nlm.nih.gov/pubmed/32090136?dopt=Abstract
  6. The engaged patient: patient activation can predict satisfaction with surgical treatment of lumbar and cervical spine disorders.

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    The engaged patient: patient activation can predict satisfaction with surgical treatment of lumbar and cervical spine disorders.

    J Neurosurg Spine. 2020 Feb 07;:1-7

    Authors: Harris AB, Kebaish F, Riley LH, Kebaish KM, Skolasky RL

    Abstract
    OBJECTIVE: Care satisfaction is an important metric to health systems and payers. Patient activation is a hierarchical construct following 4 stages: 1) having a belief that taking an active role in their care is important, 2) having knowledge and skills to manage their condition, 3) having the confidence to make necessary behavioral changes, and 4) having an ability to maintain those changes in times of stress. The authors hypothesized that patients with a high level of activation, measured using the Patient Activation Measure (PAM), will be more engaged in their care and, therefore, will be more likely to be satisfied with the results of their surgical treatment.
    METHODS: Using a prospectively collected registry at a multiprovider university practice, the authors examined patients who underwent elective surgery (n = 257) for cervical or lumbar spinal disorders. Patients were assessed before and after surgery (6 weeks and 3, 6, and 12 months) using Patient-Reported Outcomes Measurement Information System (PROMIS) health domains and the PAM. Satisfaction was assessed using the Patient Satisfaction Index. Using repeated-measures logistic regression, the authors compared the likelihood of being satisfied across stages of patient activation after adjusting for baseline characteristics (i.e., age, sex, race, education, income, and marital status).
    RESULTS: While a majority of patients endorsed the highest level of activation (56%), 51 (20%) endorsed the lower two stages (neither believing that taking an active role was important nor having the knowledge and skills to manage their condition). Preoperative patient activation was weakly correlated (r ≤ 0.2) with PROMIS health domains. The most activated patients were 3 times more likely to be satisfied with their treatment at 1 year (OR 3.23, 95% CI 1.8-5.8). Similarly, patients in the second-highest stage of activation also demonstrated significantly greater odds of being satisfied (OR 2.8, 95% CI 1.5-5.3).
    CONCLUSIONS: Patients who are more engaged in their healthcare prior to elective spine surgery are significantly more likely to be satisfied with their postoperative outcome. Clinicians may want to implement previously proven techniques to increase patient activation in order to improve patient satisfaction following elective spine surgery.

    PMID: 32032962 [PubMed - as supplied by publisher]

    https://www.ncbi.nlm.nih.gov/pubmed/32032962?dopt=Abstract
  7. Adult Lumbar Disk Herniation: Diagnosis, Treatment, Complications, Outcomes, and Evidence-Based Data for Patient and Health Professional Counseling.

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    Adult Lumbar Disk Herniation: Diagnosis, Treatment, Complications, Outcomes, and Evidence-Based Data for Patient and Health Professional Counseling.

    Instr Course Lect. 2020;69:607-624

    Authors: Harris A, Wilkening M, Marrache M, Passias P, Kelly M, Klineberg EO, Neuman BJ

    Abstract
    Symptomatic lumbar disk herniation is abundantly common in adult patients and can cause significant pain and disability in those affected. Both surgical and nonsurgical treatment options exist for the management of this heterogeneous condition; thus, it is important that surgeons and other healthcare providers understand the appropriate indications for surgical treatment of patients with lumbar disk herniation. Though there is still lack of consensus regarding the optimal treatment of lumbar disk herniation in all situations, many principles and preferred techniques are agreed upon in the literature. In this chapter, we provide an in-depth overview of the anatomy and pathophysiology, natural history, physical examination, treatment decision making, surgical treatment options, and postoperative complications pertaining to lumbar disk herniation.

    PMID: 32017755 [PubMed - indexed for MEDLINE]

    https://www.ncbi.nlm.nih.gov/pubmed/32017755?dopt=Abstract
  8. Changes in patients' depression and anxiety associated with changes in patient-reported outcomes after spine surgery.

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    Changes in patients' depression and anxiety associated with changes in patient-reported outcomes after spine surgery.

    J Neurosurg Spine. 2020 Jan 31;:1-20

    Authors: Rahman R, Ibaseta A, Reidler JS, Andrade NS, Skolasky RL, Riley LH, Cohen DB, Sciubba DM, Kebaish KM, Neuman BJ

    Abstract
    OBJECTIVE: The authors conducted a study to analyze associations between changes in depression/anxiety before and 12 months after spine surgery, as well as changes in scores using the Patient-Reported Outcomes Measurement Information System (PROMIS) at the same time points.
    METHODS: Preoperatively and 12 months postoperatively, the authors assessed PROMIS scores for depression, anxiety, pain, physical function, sleep disturbance, and satisfaction with participation in social roles among 206 patients undergoing spine surgery for deformity correction or degenerative disease. Patients were stratified according to preoperative/postoperative changes in depression and anxiety, which were categorized as persistent, improved, newly developed postoperatively, or absent. Multivariate regression was used to control for confounders and to compare changes in patient-reported outcomes (PROs).
    RESULTS: Fifty patients (24%) had preoperative depression, which improved in 26 (52%). Ninety-four patients (46%) had preoperative anxiety, which improved in 70 (74%). Household income was the only preoperative characteristic that differed significantly between patients whose depression persisted and those whose depression improved. Compared with the no-depression group, patients with persistent depression had less improvement in all 4 domains, and patients with postoperatively developed depression had less improvement in pain, physical function, and satisfaction with social roles. Compared with the group of patients with postoperatively improved depression, patients with persistent depression had less improvement in pain and physical function, and patients with postoperatively developed depression had less improvement in pain. Compared with patients with no anxiety, those with persistent anxiety had less improvement in physical function, sleep disturbance, and satisfaction with social roles, and patients with postoperatively developed anxiety had less improvement in pain, physical function, and satisfaction with social roles. Compared with patients with postoperatively improved anxiety, patients with persistent anxiety had less improvement in pain, physical function, and satisfaction with social roles, and those with postoperatively developed anxiety had less improvement in pain, physical function, and satisfaction with social roles. All reported differences were significant at p < 0.05.
    CONCLUSIONS: Many spine surgery patients experienced postoperative improvements in depression/anxiety. Improvements in 12-month PROs were smaller among patients with persistent or postoperatively developed depression/anxiety compared with patients who had no depression or anxiety before or after surgery and those whose depression/anxiety improved after surgery. Postoperative changes in depression/anxiety may have a greater effect than preoperative depression/anxiety on changes in PROs after spine surgery. Addressing the mental health of spine surgery patients may improve postoperative PROs.■ CLASSIFICATION OF EVIDENCE Type of question: causation; study design: prospective cohort study; evidence: class III.

    PMID: 32005017 [PubMed - as supplied by publisher]

    https://www.ncbi.nlm.nih.gov/pubmed/32005017?dopt=Abstract
  9. Clinical results and functional outcomes after three-column osteotomy at L5 or the sacrum in adult spinal deformity.

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    Clinical results and functional outcomes after three-column osteotomy at L5 or the sacrum in adult spinal deformity.

    Eur Spine J. 2020 Apr;29(4):821-830

    Authors: Funao H, Kebaish FN, Skolasky RL, Kebaish KM

    Abstract
    PURPOSE: Three-column osteotomies at L5 or the sacrum (LS3COs) are technically challenging, yet they may be needed to treat lumbosacral kyphotic deformities. We investigated radiographic and clinical outcomes after LS3CO.
    METHODS: We analyzed 25 consecutive patients (mean age 56 years) who underwent LS3CO with minimum 2-year follow-up. Standing radiographs and health-related quality-of-life scores were evaluated. A new radiographic parameter ["lumbosacral angle" (LSA)] was introduced to evaluate sagittal alignment distal to the S1 segment.
    RESULTS: From preoperatively to the final follow-up, significant improvements occurred in lumbar lordosis (from - 34° to - 49°), LSA (from 0.5° to 22°), and sagittal vertical axis (SVA) (from 18 to 7.3 cm) (all, p < .01). Mean Scoliosis Research Society (SRS)-22r scores in activity, pain, self-image, and satisfaction (p < .05), and Oswestry Disability Index scores (p < .01) also improved significantly. Patients with SVA ≥ 5 cm at the final follow-up experienced less improvement in SRS-22r satisfaction scores than those with SVA < 5 cm. Patients with LSA < 20° at the final follow-up had significantly lower SRS-22r activity scores than those with LSA ≥ 20° (p = .014). Two patients had transient neurologic deficits, and 11 patients underwent revision for proximal junctional kyphosis (5), pseudarthrosis (3), junctional stenosis (2), or neurologic deficit (1).
    CONCLUSIONS: LS3CO produced radiographic and clinical improvements. However, patients who remained sagittally imbalanced had less improvement in SRS-22r satisfaction score than those whose sagittal imbalance was corrected, and patients who maintained kyphotic deformity in the lumbosacral spine had lower SRS-22r activity scores than those whose lumbosacral kyphosis was corrected. These slides can be retrieved under Electronic Supplementary Material.

    PMID: 31993787 [PubMed - in process]

    https://www.ncbi.nlm.nih.gov/pubmed/31993787?dopt=Abstract
  10. Sacropelvic Fixation: A Comprehensive Review.

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    Sacropelvic Fixation: A Comprehensive Review.

    Spine Deform. 2019 Jul;7(4):509-516

    Authors: El Dafrawy MH, Raad M, Okafor L, Kebaish KM

    Abstract
    Sacropelvic fixation is indicated in various clinical settings, most notably long spinal arthrodesis, reduction of high-grade spondylolisthesis, and complex sacral fractures. The sacropelvis is characterized by complex regional anatomy and poor bone quality. These factors make achieving solid fusion across the lumbosacral junction challenging. However, a better understanding of spinal biomechanics at that level has led to much higher fusion rates than those of the past. The newer fixation techniques are biomechanically superior to previous methods mainly because they achieve bony purchase anterior to the pivot point-first described by McCord et al. in 1994. Today, the two most widely used fixation techniques are iliac screws and S2-alar-iliac screws. Although these techniques are associated with very high rates of fusion, instrumentation-related pain and reoperation remain problematic. This review provides an overview of the regional anatomy and biomechanics at the lumbosacral junction, as well as a summary of fixation techniques with an emphasis on the most widely used techniques today. LEVEL OF EVIDENCE: N/A.

    PMID: 31981134 [PubMed - in process]

    https://www.ncbi.nlm.nih.gov/pubmed/31981134?dopt=Abstract