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Mikhail Christopher Mina,Warburton Andrew,Girdler Steven Joseph,Platt Samantha,Cong Guang-Ting,Cho Samuel Kang-Wook 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.5
Study Design: A retrospective analysis of data from the Healthcare Cost and Utilization Project Nationwide Readmissions Database (HCUP-NRD). Purpose: To identify the perioperative characteristics associated with 30-day and 90-day readmission due to intestinal bowel obstructions (IBOs) following posterior lumbar fusion (PLF) procedure. Overview of Literature: PLF procedures are used to repair spinal injuries and curvature deformities. IBO is a common surgical complication and its repair often necessitates surgery that increases the readmission rates and healthcare costs. Previous studies have identified the preoperative risk factors for 30-day readmissions in PLF; however, no study has specifically investigated IBO or identified risk factors for 90-day readmissions. Methods: Data on demographic characteristics and medical comorbidities of patients who underwent PLF with subsequent readmission were obtained from the HCUP-NRD. The perioperative characteristics that were significantly different between patients readmitted with and without an active diagnosis of IBO were identified with bivariate analysis for both 30-day and 90-day readmissions. The significant characteristics were then included in a multivariate analysis to identify those that were independently associated with 30-day and 90-day readmissions. Results: Drug abuse (odds ratio [OR], 4.00), uncomplicated diabetes (OR, 2.06), having Medicare insurance (OR, 1.65), age 55–64 years (OR, 2.42), age 65–79 years (OR, 2.77), and age >80 years (OR, 3.87) were significant risk factors for 30-day readmission attributable to IBO after a PLF procedure. Conclusions: Of the several preoperative risk factors identified for readmission with IBO after PLF surgery, drug abuse had the strongest association and was likely to be the most clinically relevant factor. Physicians and care teams should understand the risks of opioid-based pain management regimens, attempt to manage pain with a multimodal approach, and minimize the opioid use.
Anterior Reconstruction Techniques for Cervical Spine Deformity
Murray Echt,Christopher Mikhail,Steven J. Girdler,Samuel K. Cho 대한척추신경외과학회 2020 Neurospine Vol.17 No.3
Cervical spine deformity is an uncommon yet severely debilitating condition marked by its heterogeneity. Anterior reconstruction techniques represent a familiar approach with a range of invasiveness and correction potential—including global or focal realignment in the sagittal and coronal planes. Meticulous preoperative planning is required to improve or prevent neurologic deterioration and obtain satisfactory global spinal harmony. The ability to perform anterior only reconstruction requires mobility of the opposite column to achieve correction, unless a combined approach is planned. Anterior cervical discectomy and fusion has limited focal correction, but when applied over multiple levels there is a cumulative effect with a correction of approximately 6° per level. Partial or complete corpectomy has the ability to correct sagittal deformity as well as decompress the spinal canal when there is anterior compression behind the vertebral body. If pathoanatomy permits, a hybrid discectomy-corpectomy construct is favored over multilevel corpectomies. The anterior cervical osteotomy with bilateral complete uncinectomy may be necessary for angular correction of fixed cervical kyphosis, and is particularly useful in the midcervical spine. A detailed understanding of the patient’s local anatomy, careful attention to positioning, and avoiding long periods of retraction time will help prevent complications and iatrogenic injury.
Biomaterials in Spinal Implants: A Review
Andrew Warburton,Steven J. Girdler,Christopher M. Mikhail,Amy Ahn,Samuel K. Cho 대한척추신경외과학회 2020 Neurospine Vol.17 No.1
The aim to find the perfect biomaterial for spinal implant has been the focus of spinal research since the 1800s. Spinal surgery and the devices used therein have undergone a constant evolution in order to meet the needs of surgeons who have continued to further understand the biomechanical principles of spinal stability and have improved as new technologies and materials are available for production use. The perfect biomaterial would be one that is biologically inert/compatible, has a Young’s modulus similar to that of the bone where it is implanted, high tensile strength, stiffness, fatigue strength, and low artifacts on imaging. Today, the materials that have been most commonly used include stainless steel, titanium, cobalt chrome, nitinol (a nickel titanium alloy), tantalum, and polyetheretherketone in rods, screws, cages, and plates. Current advancements such as 3-dimensional printing, the ProDisc-L and ProDisc-C, the ApiFix, and the Mobi-C which all aim to improve range of motion, reduce pain, and improve patient satisfaction. Spine surgeons should remain vigilant regarding the current literature and technological advancements in spinal materials and procedures. The progression of spinal implant materials for cages, rods, screws and plates with advantages and disadvantages for each material will be discussed.
Applications of Machine Learning Using Electronic Medical Records in Spine Surgery
John T. Schwartz,Michael Gao,Eric A. Geng,Kush S. Mody,Christopher M. Mikhail,Samuel K. Cho 대한척추신경외과학회 2019 Neurospine Vol.16 No.4
Developments in machine learning in recent years have precipitated a surge in research on the applications of artificial intelligence within medicine. Machine learning algorithms are beginning to impact medicine broadly, and the field of spine surgery is no exception. Electronic medical records are a key source of medical data that can be leveraged for the creation of clinically valuable machine learning algorithms. This review examines the current state of machine learning using electronic medical records as it applies to spine surgery. Studies across the electronic medical record data domains of imaging, text, and structured data are reviewed. Discussed applications include clinical prognostication, preoperative planning, diagnostics, and dynamic clinical assistance, among others. The limitations and future challenges for machine learning research using electronic medical records are also discussed.
Correction: Manipulation of cell adhesion and dynamics using RGD functionalized polymers
Li, Juyi,Yu, Yingjie,Kim, Myungwoong,Li, Kao,Mikhail, John,Zhang, Linxi,Chang, Chung-Chueh,Gersappe, Dilip,Simon, Marcia,Ober, Christopher,Rafailovich, Miriam Royal Society of Chemistry 2017 Journal of Materials Chemistry B Vol. No.
<P>Correction for ‘Manipulation of cell adhesion and dynamics using RGD functionalized polymers’ by Juyi Li <I>et al.</I>, <I>J. Mater. Chem. B</I>, 2017, DOI: 10.1039/c7tb01209h.</P>