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Full Schedule

Full Schedule

  • Sunday, March 19, 2023
  • 6:30 AM – 11:30 AM EST
    Registration
  • 6:30 AM – 12:15 PM EST
    (SPEAK) Speaker Ready Room
  • 7:00 AM – 7:30 AM EST
    Breakfast Case Discussions: Challenging Peripheral Nerve Cases Submitted by You

    Moderator: Zarina S. Ali, MD (she/her/hers) – University of Pennsylvania

    Moderator: Elias B. Rizk, MD, PhD, MSc – Department of Neurosurgery, Penn State Milton S. Hershey Medical Center

  • 7:00 AM – 7:45 AM EST
    Continental Breakfast
  • 7:30 AM – 9:30 AM EST
    (AB-5) Specialty Breakout 2: Trauma/General Spine Abstracts

    Moderator: Eve Tsai, MD, PhD – University of Ottawa

    Moderator: Erik Hayman, MD – University of South Florida

    Introduction: The Manufacturer and User Facility Database (MAUDE) provided by the Food and Drug Administration (FDA) organization is a regulatory tool for post market surveillance providing vital information regarding defects and adverse events pertaining to commercially available devices. Corpectomies devices have evolved over the years to the current expandable titanium cage commonly used. We present an overview of the adverse events of corpectomies reported in the MAUDE database.

    Methods: Retrospective data was collected on the MAUDE database between January 1, 2010 to October 18, 2022. Corpectomy cages included those manufactured by Medtronic, Globus, Depuy Synthes. Reports that were duplicates, contained insufficient information and involved non-corpectomy devices were excluded.

    Results: Overall, 348 adverse events met the inclusion criteria. Corpectomy devices (348) included Medtronic 158 (T2 Stratosphere), Globus Medical - 42 (Fortify - 28, XPAND – 14), Stryker – 83(VLIFT), Depuy Synthes – 60(XRL) and Ulrich Medical –5 (Solidity). Corpectomy related adverse events were grouped into 23 categories .Corpectomy breakage (18%) was the most widely reported adverse event followed by migration/expulsion of device (16%). Fracture (10%) altered mechanics (10%), activation failure (7%) and collapse (7%) were the other prominent device related complications. Of the reported events, patients commonly did not have any clinical signs/symptoms (72%) while 12% reports had inadequate patient related information. Other patient related complications included bone fracture, implant failure, hemorrhage, peripheral nerve injury, pain, post-operative wound infection, tissue damage etc. Corpectomy collapse was the most common device complication reported from Fortify (15/28) and Xpand (4/14) while the most common complication for VLIFT was corpectomy break (35/83). T2 Stratosphere reported migration or expulsion of device (45/158) and XRL reported mechanical complications (13/60) as the most common complication.

    Conclusion : MAUDE database serves as a valuable post market surveillance tool. Valuable information regarding device related complications can aid surgeons in clinical decision making.

    How to Improve Patient Care: Few corpectomy devices are commercially available. While the MAUDE database is not mandated, it provides a unique insight into the possible effectiveness of these devices

  • 7:30 AM – 9:30 AM EST
    (AB-6) Specialty Breakout 3: Tumor/General Spine Abstracts

    Moderator: Oren Gottfried, MD (he/him/his) – Duke University

    Moderator: Patricia Sullivan, MD – Department of Neurosurgery, The Warren Alpert Medical School of Brown University and Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island

    Introduction: Spinal surgery has historically relied on patient-reported outcome measures as the gold standard to assess post-operative outcomes. To supplement these subjective questionnaires, patient mobility data harvested from built-in accelerometry within smartphones was analyzed to provide granular information about a patient’s pre-operative and post-operative functional status. In this study, we utilized first-order derivatives of activity data to phenotype the pre-operative and post-operative courses of patients who underwent either lumbar decompression (LD) or fusion (LF) surgery.

    Methods: LD and LF patients were retrospectively consented and enrolled. Activity data (steps-per-day) recorded in Apple Health (Apple Inc., Cupertino, CA) over 2 years peri-operatively was classified into temporal epochs representing distinct functional states including pre-operative baseline, pre-operative decline, and post-operative recovery. The first-order derivatives of patient activity magnitude across time were then calculated for all epochs.

    Results: A total of 21 LD and 31 LF patients were included, encompassing over 70,000 datapoints. 66.7% (14/21) of LD and 67.7% (21/31) of LF patients experienced at least one period of activity decline pre-operatively, defined as diminished physical activity compared to baseline. During these declines, the mean first-order derivative for LD patient activity, representing the rate of activity decline during disease progression, was significantly more positive than that for LF (0.043 vs. -0.123, p = 0.045), indicating a greater rate of decline for LF compared to LD. During post-operative recovery, the LD first-order derivative was significantly higher than LF’s (0.003 vs. -0.060, p = 0.041), suggesting a more gradual functional recovery in LF compared to LD.

    Conclusion : First-order derivative analysis of patient activity data is a promising technique for phenotyping patient activity profiles and differentiating between different pathologies and the morbidity of surgical treatments. Comparing patient activity data undergoing different surgical procedures can help establish common presenting patterns of pre-operative patient activity as well as the unique contributions of specific surgical interventions to overall patient outcomes.

    How to Improve Patient Care:

  • 7:30 AM – 9:30 AM EST
    (AB-7) Specialty Breakout 4: Peripheral Nerve/Basic Science/General Spine Abstracts

    Moderator: Alexander E. Ropper, MD – Baylor College of Medicine Neurosurgery

    Moderator: Suzanne Tharin, MD, PhD, FAANS (she/her/hers) – Stanford University School of Medicine

    Introduction: A plethora of literature exists comparing outcomes between robot-assisted minimally invasive techniques and conventional open approaches; however, the comparison between robot-assisted percutaneous and robot-assisted open surgeries remains largely unknown. Determining differences between these cohorts can inform surgeons and patients during their preoperative planning. This is the first prospective, multicenter study of four geographically diverse institutions on robot-assisted spine surgery to compare the outcomes/complications between two robot-assisted techniques.

    Methods: Adult patients undergoing spine surgery with a bone-mounted robotic-assist with navigation confirmation were prospectively enrolled from 2020-2022 at 4 independent institutions, among 6 spine surgeons. A propensity score matching (PSM) algorithm was employed to control for potential selection bias between percutaneous and open surgery. The minimum follow-up was 90 days.

    Results: After PSM, 336 patients with 2,524 robot-assisted screws remained without significant differences in demographics/comorbidities, diagnoses, and operative factors. Overall, mean ASA 2.3±0.6, BMI 29.8±5.5kg/m², and length of stay (LOS) 3.1±1.8 days, with 9.0% nicotine users. Most common diagnoses: spondylolisthesis (40%), lumbar stenosis (21%), and deformity (15%); mean number of levels fused 4.0±3.1. Although no difference was found for operative time (195±88min open, 197±120min percutaneous, p=0.839), robot time/screw was significantly lower for open (4.3±2.5min open, 8.3±3.8min percutaneous, p< 0.001). There was no difference in robot abandonment (2.1% open, 0% percutaneous, p=0.081) and screw accuracy (99.1% open, 98.6% percutaneous, p=0.307); however, open was associated with screws not executed due to registration/unreachability issues (1% open, 0% percutaneous, p=0.001). Intraoperative blood loss was greater for open (301mL open, 108mL percutaneous, p< 0.001). No difference was observed for intraoperative complications, LOS, 90 day surgical/medical complications, and revision surgery.

    Conclusion : In the first prospective, multicenter robot-assisted surgery study, open approach was associated with shorter robot time/screw, higher robot-related registration/unreachability issues, and greater intraoperative blood loss compared to percutaneous approach. Both had high screw accuracy (99%) with no difference in robot abandonment, screw accuracy, LOS, revision surgery, and intraoperative/90 day postoperative complications between groups.

    How to Improve Patient Care:

  • 7:30 AM – 9:30 AM EST
    (AB-8) Specialty Breakout 5: Spinal Deformity/General Spine Abstracts

    Moderator: Darryl Lau, MD – NYU Langone

    Moderator: Harry Mushlin, MD – Department of Neurological Surgery, Renaissance School of Medicine at Stony Brook University

    Introduction: There is a high prevalence of cervical myelopathy that requires surgery; as such it is important to identify how different groups benefit from surgery. The AANS launched the Quality Outcomes Database prospective longitudinal registry that includes demographic, clinical, and patient-reported outcome data to measure the safety and quality of neurosurgical procedures. In this study we assess the impact of gender on patient reported outcomes in patients undergoing surgery for cervical myelopathy.

    Methods: We analyzed 1152 patients undergoing surgery for cervical myelopathy in the Quality Outcomes Database (QOD) cervical module. A univariate comparison of baseline patient characteristics between males and females undergoing surgery for CSM was performed, with statistical significance determined by a two-sided Wilcoxon rank sum test. Baseline characteristics that significantly differed between males and females were included in a multivariable generalized linear model comparing baseline and 1-year postoperative Neck Disability Index (NDI) scores.

    Results: This study included 546 females and 604 males. Females demonstrated a significantly greater improvement in NDI 1 year after surgery (p = 0.036). In addition to gender, the presence of axial neck pain and insurance status were also significantly predictive of improvement in NDI after surgery (p = 0.0013, and p = 0.0058 respectively). There was no significant difference in baseline NDI or NDI 1 year after surgery between the laminoplasty versus laminectomy/fusion group.

    Conclusion : Females are more likely to benefit from surgery for cervical myelopathy compared to males. Interestingly, presence of preoperative axial neck pain and insurance status are also associated with improvements in NDI post operatively. It is important to both identify gender differences in pre-operative baseline characteristics and postoperative outcomes after surgery in order to deliver more personalized and patient-centric care.

    How to Improve Patient Care:

  • 9:30 AM – 11:15 AM EST
    (SS-7) Scientific Session 7: Our Greater Purpose

    Moderator: Scott Meyer, MD (he/him/his) – Atlantic Neurosurgical Specialists

    Moderator: Charles Sansur, MD, MHSc – University of Maryland Medical Center

    This session will review and highlight the multi-disciplinary spine surgery success stories. We often focus on our complications and learn from them, but in a similar fashion we can also learn from our greatest success stories. This course will go through such cases and focus will be placed on critical components that led to the success of the case. Participants are encouraged to prepare and present cases for discussion.

    Socioeconomic

    Spine

  • 11:15 AM – 12:10 PM EST
    (SPECBUS) Special Session: Business Tips, Pearls, & Tactics (co-brand with CSNS/CSNS faculty)

    Moderator: Kurt M. Eichholz, MD, FACS, FAANS – St. Louis Minimally Invasive Spine Center

    Moderator: Yi Lu, MD PhD – Brigham and Women's Hospital

  • 12:10 PM – 12:35 PM EST
    (BUSMTG) DSPN Business Meeting

    Speaker: Adam S. Kanter, MD – Hoag Specialty Clinic

    Speaker: Juan S. Uribe, MD – Barrow Neurological Insitute

    Speaker: Luis M. Tumialan, MD – Barrow Brain and Spine

    Speaker: Domagoj Coric, MD – Carolina Neurosurgery & Spine Associates

    Speaker: Elad I. Levy, MD, MBA (he/him/his) – University at Buffalo Neurosurgery

    Speaker: John Knightly, MD, FAANS (he/him/his) – AANS

    Speaker: Joseph Cheng, MD, MS – University of Cincinnati College of Medicine