Papers by Oded Hershkovich
Journal of Clinical Medicine
Introduction: The efficacy of pharmacological interventions for acute lumbar radicular pain (ALRP... more Introduction: The efficacy of pharmacological interventions for acute lumbar radicular pain (ALRP) is limited, and systemic steroid use remains controversial. We evaluated the effectiveness and tolerance of systemic steroid use in a cohort of patients with ALRP. Methods: A retrospective cohort of 56 patients (including 24 females) were admitted with intractable ALRP resistance to conservative treatment of NSAIDs and opiates between the years 2016 and 2018. Medical records were studied for demographics, physical examination findings, Visual Analogue Score (VAS), IV steroids side effects, and recent imaging findings. All patients received a daily dose of IV 24 mg Dexamethasone until discharge, SNRB, or surgery. Results: The average IV steroid treatment was 3.9 (±2.8) days, with most patients showing significant pain relief allowing discharge (69.7%). SNRB was required in 19.6% and surgical intervention in 10.7% within the same admission. Multivariate analysis did not find any paramete...
Journal of Clinical Medicine
Background: Hallux valgus (HV) is a common adult foot deformity. There is uncertainty concerning ... more Background: Hallux valgus (HV) is a common adult foot deformity. There is uncertainty concerning the effect of HV surgery on foot width. We examined the effect of chevron first metatarsal osteotomy on forefoot width using calibrated pre and postoperative standing radiographs. Methods: A retrospective cohort of 50 patients underwent chevron osteotomy HV surgery. All had HVA > 30°, IMA > 11°, DMMA > 3°, >6-month follow-up, and calibrated pre and postoperative standing foot radiographs. Bony width (BW) and soft tissue width (STW) were used to measure the surgery’s effect on foot width. Measurements were made preoperatively and 3–6 months following surgery. Results: The study group included 42 women with an average age of 63.4 (±8.3) and a mean BMI of 28.7 (±4.9). Preoperative HVA and IMA were 31.7° (±6.8°) and 13.4° (±2.8°), respectively. Following surgery, HVA and IMA improved significantly, by 15.6° (±5.7°) and 8.7° (±2.3°), respectively. The preoperative average BW was 9...
Journal of Clinical Medicine
Objective: Examine Schober test’s (ST), Modified ST (MST), and Modified–Modified ST (MMST) surfac... more Objective: Examine Schober test’s (ST), Modified ST (MST), and Modified–Modified ST (MMST) surface markers’ accuracy in spanning lumbar L1-S1 motion segments and repeatability related to actual patient anatomy as measured on sagittal CT scans. Methods: The study included 25 patients of varying heights, weights, and gender without prior spinal surgery or deformity. Researchers assessed patients’ CT scans for ST, MST, and MMST skin levels of the measured cephalic and caudal endpoints. Results: The original ST failed to include at least one lumbar motion segment in all patients, omitting the L1-L2 motion segment in 17 patients and the L2-L3 in another eight. The additional cephalic length of the MST did not improve the inclusion of the actual L1-S1 components. The MMST measured 19 ‘patients’ entire L1-S1 motion segments, reaching a 76% accuracy rate. WMST, measuring 16 cm (instead of MMST’s 15 cm), improved the measurement significantly, measuring the L1-S1 motion segments in all cases...
Current Oncology
Background Context: The role of radiotherapy versus surgery in treating acute metastatic spinal c... more Background Context: The role of radiotherapy versus surgery in treating acute metastatic spinal cord compression (AMSCC) has changed over the years. Purpose: Our study evaluates neurological and functional outcomes following urgent surgery and radiotherapy (USFR) versus urgent radiotherapy alone in treating AMSCC. Study Design/Setting: A retrospective cohort of 54 patients with AMSCC with variable neurological deficits. Overall, 32 patients were treated with USFR, and 22 received urgent radiotherapy alone. Outcome Measures: Neurological status regarding the Asia and Frankel scores, continence and ambulation, and Kranofsky’s functional score and patient life span comprised the outcome measures. Methods: This was a retrospective EMR study. Results: USFR and radiotherapy cohorts were similar in age, gender, tumor origin, and the number of spinal metastases. The most common cause of AMSCC was carcinoma of the breast (24.1%), followed by carcinoma of the lung (16.7%) and multiple myeloma...
Journal of Clinical Medicine
Background: Low back pain (LBP) is a widespread medical complaint affecting many people worldwide... more Background: Low back pain (LBP) is a widespread medical complaint affecting many people worldwide and costing billions. Studies suggest a link between LBP and joint hypermobility. This study aimed to examine the association between symptomatic joint hypermobility (SJH), LBP, and gender. Methods: Data were obtained from a medical database containing 17-year-old candidates’ records before recruitment into mandatory military service. According to the Regulations of Medical Fitness Determination, information on disability codes associated with LBP and SJH was retrieved. Results: According to this national survey, the prevalence of SJH is 0.11% (1355 cases out of 1,220,073 subjects). LBP was identified in 3.7% of the cohort (44,755 subjects). Subjects were further subdivided into LBP without objective findings (LBPWF) (3.5%) and LBP with objective findings (LBPOF) (0.2%). The association between SJH and LBP was examined: the Odds Ratio (OR) was 2.912 (p < 0.0001). The odds rations for...
Physiotherapy Canada
Purpose: Our aim was to evaluate the Microsoft Kinect sensor (MKS) as a markerless system for mot... more Purpose: Our aim was to evaluate the Microsoft Kinect sensor (MKS) as a markerless system for motion capture and analysis of lower limb motion, compare it with a state-of-the-art marker-based system (MBS), and investigate its accuracy in simultaneously capturing several lower limb joint movements on several planes while participants walked freely. Method: Participants were asked to walk while gait data were simultaneously recorded by both the MKS and the MBS. Software for analysing the Kinect data stream was developed using Microsoft Visual Studio and Kinect for Windows software development kits. Visual three-dimensional (3D) C-Motion software was used to calculate 3D joint angles of the MBS. Deviation of the joint angles calculated by the two systems was calculated using root-mean-square error (RMSE) on the basis of a designated formula. Results: The calculated RMSE average was <5° between the two systems, a level of difference that has practically no clinical significance. Conc...
Journal of Clinical Medicine
Background: Studies have found that unilateral and bilateral kyphoplasty have comparable clinical... more Background: Studies have found that unilateral and bilateral kyphoplasty have comparable clinical outcomes. Only a few studies have compared the radiographic results of using unilateral vs. simultaneous bilateral approaches. We aimed to examine and compare the radiographic results of unilateral (UKP) vs. bilateral simultaneous double-balloon kyphoplasty (DKP) for treating symptomatic vertebral compression fractures (VCF). Methods: A retrospective cohort of all patients treated for VCF by DKP and UKP over five years in a single medical center. From 2009 to 2012, we routinely performed UKP; from 2012, DKP was the routine due to potential benefits in vertebral realignment. We evaluated pre- and post-surgical fracture characteristics including vertebral height, sagittal and coronal Cobb angle, and fracture reduction. Statistical analysis included a t-test for independent variables and Pearson’s correlation. Results: The study cohort consisted of 81 patients (75.8 years ± 10.86) who unde...
Geriatric Orthopaedic Surgery & Rehabilitation
Introduction Studies investigating the Covid-19 Pandemic’s orthopedic aspects are accumulating, i... more Introduction Studies investigating the Covid-19 Pandemic’s orthopedic aspects are accumulating, including reports on a 10-33% decrease in hip fracture incidence alongside shorter times to surgery. Osteoporotic vertebral compression fractures (VCF) have not yet been discussed. This study evaluated the effect of the Covid-19 pandemic’s first wave on VCF in the elderly. Method A retrospective cohort of elderly patients diagnosed with VCF between 2018-19 (Pre-Covid-19 pandemic) to 2020. Results The cohort included 172 patients above 65 years with VCF during 2018-2020. Patients’ age and gender were similar between the two study groups. We found a higher proportion of high-energy VCF during 2020 (10.5% vs 6.7%). Incidence of recurrent fractures was 7.5 times higher during 2020 (5.3% vs .7%, P =.06), and significantly higher rates of Ankylosing Spondylitis or Diffuse Idiopathic Skeletal Hyperostosis in 2020 (7.9% vs 1.5%, P=.04). VCF ED admission rates were similar, with 60% treated conser...
Geriatric Orthopaedic Surgery & Rehabilitation, 2022
Objective Examine the feasibility, safety, and results of a novel sacral percutaneous injection t... more Objective Examine the feasibility, safety, and results of a novel sacral percutaneous injection technique (“XX”) addressing both the vertical and horizontal aspects of sacral insufficiency fractures (SIF). Methods Prospective cohort study. Eight consecutive SIF patients with immobility and pain investigated using CT and nuclear imaging confirmed “H"-type fracture. Demographics, pain level, and ambulation status were recorded. The long-term quality of life was evaluated using the ODI questionnaire and pain VAS scores. Sacroplasty procedures in prone positioning using fluoroscopy were used to insert 2 bone trochars through the S1 pedicles and 2 trochars through the sacral ale aiming toward the SIJ, thus forming 2 “X” trochar formations. Balloon kyphoplasty was done through the trocars, and PMM was injected. Postoperative ambulation and VAS were recorded. Results Average age was 81.5 years (±3.4 years). The time from presenting symptoms to hospital admission was 2 days to 4 months...
The bone & joint journal, 2020
AIMS Significant correction of an adolescent idiopathic scoliosis in the coronal plane through a ... more AIMS Significant correction of an adolescent idiopathic scoliosis in the coronal plane through a posterior approach is associated with hypokyphosis. Factors such as the magnitude of the preoperative coronal curve, the use of hooks, number of levels fused, preoperative kyphosis, screw density, and rod type have all been implicated. Maintaining the normal thoracic kyphosis is important as hypokyphosis is associated with proximal junctional failure (PJF) and early onset degeneration of the spine. The aim of this study was to determine if coronal correction per se was the most relevant factor in generating hypokyphosis. METHODS A total of 95 patients (87% female) with a median age of 14 years were included in our study. Pre- and postoperative radiographs were measured and the operative data including upper instrumented vertebra (UIV), lower instrumented vertebra (LIV), metal density, and thoracic flexibility noted. Further analysis of the post-surgical coronal outcome (group 1 < 60% ...
Spine, 2020
STUDY DESIGN Multi-centre prospective study OBJECTIVES.: To analyse the cost of routine biopsy du... more STUDY DESIGN Multi-centre prospective study OBJECTIVES.: To analyse the cost of routine biopsy during augmentation of osteoporotic vertebral compression fractures (VCF) and the affect it has on further treatment. SUMMARY OF BACKGROUND DATA Vertebroplasty (VP) and Balloon Kyphoplasty (BKP) are accepted treatments for VCF. Bone biopsy is routinely performed during every VCF surgery in many centers around the world to exclude an incidental finding of malignancy as the cause of the pathological VCF. The incidence been reported as 0.7%-7.3%, however the published cohorts are small and do not discuss cost-benefit aspects. METHODS From 2008 to 2016 we performed 122 vertebral biopsies routinely on 116 patients in 3 hospitals. Twenty-three patients had history of malignancy (26 biopsies) and 4 were suspected of having malignancy based on imaging findings. The remaining 86 patients (99 biopsies) were presumed osteoporotic VCF. RESULTS Out of 99 biopsies in the VCF cohort group only one yielded an unsuspected malignancy (1.16%), positive for Multiple Myeloma (MM). The ability of clinical assessment and imaging alone to diagnose malignancy was found to be 91.7% sensitive and 84.2% specific in our cohort. CONCLUSION Routine bone biopsy during vertebral augmentation procedure is a safe option for evaluating the cause of the VCF but has significant cost to the health system. The cost of one diagnosed case of unsuspected malignancy was $31,000 in our study. The most common pathology was MM, which has not been proven to benefit from early diagnosis. When comparing clinical diagnosis with imaging, a previous history of malignancy was found in only 40.7% of VCF patients, whilst imaging was 100% accurate in predicting presence of malignancy on biopsy. This study reassures spine surgeons in their ability to diagnose malignant VCFs and does not support the significant cost of routine bone biopsies. LEVEL OF EVIDENCE 3.
International Journal of Spine Surgery, 2020
Purpose: We report a case of a patient with an acute symptomatic Schmorl node (SN) that spontaneo... more Purpose: We report a case of a patient with an acute symptomatic Schmorl node (SN) that spontaneously resolved with characteristic imaging findings. The extensive hematological investigations also allow some insight as to the likely pathophysiology of the painful lesion. Methods: Case report of an acute symptomatic SN. Results: A fit and athletic 44-year-old female participant in a competitive paddling event developed atypical thoracic pain and was admitted for further investigation. Normal blood results included complete blood cell count, clotting, and D-dimer. Creatine phosphokinase was 63 U/L (reference , 167 U/L) and troponin I levels were not raised. Her only hematological abnormality was an elevated C-reactive protein (CRP) at 60.2 mg/L (reference , 5 mg/L). Magnetic resonance imaging (MRI) scan showed signal hyperintensity involving T7 vertebral body, surrounding an enlarged SN. Patient was given oral nonsteroidal anti-inflammatory drugs, opioid analgesia, and gradually mobilized. After 3 days, the pain had sufficiently subsided and CRP was 17.8 mg/L. Follow-up MRI scan showed some reduction in the T2 hyperintensity and size of the intraosseous herniation. Patient gradually returned to full activities and had no recurrence of symptoms. MRI scan 8 months after the initial scan showed almost complete resolution of the T2 hyperintensity and pan-vertebral marrow edema. Conclusion: Symptomatic SN should be part of the differential diagnosis of unexplained thoracolumbar pain. Modality of choice for diagnosis would be MRI. Once diagnosed, several treatment options are available with the most likely being spontaneous resolution of symptoms and bone healing within a few months. The conservative approach is recommended when the symptoms can be medically well controlled.
The Bone & Joint Journal, 2020
Aims Diagnosis of cauda equina syndrome (CES) remains difficult; clinical assessment has low accu... more Aims Diagnosis of cauda equina syndrome (CES) remains difficult; clinical assessment has low accuracy in reliably predicting MRI compression of the cauda equina (CE). This prospective study tests the usefulness of ultrasound bladder scans as an adjunct for diagnosing CES. Methods A total of 260 patients with suspected CES were referred to a tertiary spinal unit over a 16-month period. All were assessed by Board-eligible spinal surgeons and had transabdominal ultrasound bladder scans for pre- and post-voiding residual (PVR) volume measurements before lumbosacral MRI. Results The study confirms the low predictive value of ‘red flag’ symptoms and signs. Of note ‘bilateral sciatica’ had a sensitivity of 32.4%, and a positive predictive value (PPV) of only 17.2%, and negative predictive value (NPV) 88.3%. Use of a PVR volume of ≥ 200 ml was a demonstrably more accurate test for predicting cauda equina compression on subsequent MRI (p < 0.001). The PVR sensitivity was 94.1%, specificit...
Clinical Spine Surgery, 2020
Peripheral blood samples were obtained from 25 patients with cervical spondylotic myelopathy (CSM... more Peripheral blood samples were obtained from 25 patients with cervical spondylotic myelopathy (CSM) and 13 healthy volunteers. Objectives: Our aim was to investigate the significance of neurodegenerative biomarkers in patients with CSM and correlate their expression with CSM severity. Summary of Background Data: CSM is a common disorder involving chronic progressive compression of the cervical spinal resulting in progressive neurological impairment that ranges from mild tingling in the upper limbs to complete quadriplegia. However, the immunological background related to the neurodegenerative damage and its significance in CSM is still unclear. Methods: Protein expression profiles of 14 neurodegenerative biomarkers were measured by multiplex Luminex bead assay and further analyzed by group comparison statistics, correlation studies, and receiver-operating characteristic analysis. Results: Eleven of 14 biomarkers were significantly elevated in CSM patients as compared with healthy subjects (P < 0.05). Specifically, the clinical severity of CSM on the scales of Nurick and modified Japanese Orthopedics Association scale (mJOA) was inversely related to neural cell adhesion molecule (NCAM) levels (r = −0.529, P = 0.007; r = −0.519, P = 0.001, respectively). Conclusions: Serum level of neural cell adhesion molecule may serve as a diagnostic biomarker correlating with the severity of CSM.
The Journal of Knee Surgery, 2018
Our aim was to report the prevalence of knee varus-valgus malalignment (KVVM) and its association... more Our aim was to report the prevalence of knee varus-valgus malalignment (KVVM) and its association with body mass index (BMI) and body height in a healthy and fit young adult population. Information on the disability codes associated with KVVM according to the Regulations of Medical Fitness Determination was retrieved from a medical database containing records of 17-year-old males and females before their recruitment into mandatory military service. Logistic regression models assessed the association between the BMI and body height to KVVM. The study cohort included 821,381 subjects (460,674 males and 360,707 females). The prevalence of KVVM was 0.9% in males and 0.6% for females. Under/overweight subjects were associated with higher prevalence of KVVM. The odds ratios (ORs) had a “J” curve pattern, increasing for underweight males and females, and even more so for above-normal BMIs (for obese males and for both overweight and obese females). The strongest association was between obe...
European Spine Journal, 2018
Introduction Vertebral involvement is found in a high percentage of multiple myeloma (MM) patient... more Introduction Vertebral involvement is found in a high percentage of multiple myeloma (MM) patients, often requiring multilevel surgical treatment to reduce pain and disability and to receive prompt access to oncological care. We describe the clinical use of washout technique for multilevel vertebroplasty in MM patients with diffuse spinal involvement. The aim of this technique is to reduce the risk of pulmonary fat embolism after cement injection and possibly to increment the amount of cement and treated levels in one surgical stage. Methods Three patients were treated with the washout technique prior to multilevel vertebroplasty for thoracolumbar diffuse spinal involvement in multiple myeloma. We describe the surgical technique and review the pertinent literature. Results The technique is clinically safe and effective in reducing pain, without significant complications. Two six-level vertebroplasties were performed in one case, allowing a larger amount of cement injected and a prompt start of the oncological treatment. Conclusions Multilevel vertebroplasty in MM patients with diffuse spinal involvement carries the advantages of reducing pain, avoid repeated surgeries and faster return to oncological regimen. Cardiovascular complications, including pulmonary embolism, are rare but can have fatal consequences. It is mainly due to bone marrow mobilization during cement injection and the risk increases with the amount of cement injected and the number of treated levels. Despite multilevel treatment at the same stage, we did not observe any significant complication in our series. Further studies are needed to confirm the preliminary results of this technique. Graphical abstract These slides can be retrieved under electronic supplementary material. Key points 1. Multiple myeloma patients may require vertebroplasty in multiple levels for spinal involvement.
The Journal of Knee Surgery, 2017
The Journal of Knee Surgery, 2016
Anterior cruciate ligament and meniscal injuries are associated with secondary osteoarthrosis whi... more Anterior cruciate ligament and meniscal injuries are associated with secondary osteoarthrosis which may lead to functional impairment and economic burden. The prevalence of knee injury has not been studied in depth. Our purpose was to report the prevalence of knee ligament and meniscal injuries and their associations with gender, body mass index (BMI), and height in young adults and to characterize individuals with meniscal injuries who gained full recovery. A cross-sectional, population-based study was conducted. Information on the disability codes of knee ligament and meniscal injury according to the Regulations of Medical Fitness Determination was retrieved from a medical database containing records of young prerecruits into mandatory service. Logistic regression assessed the association between genders, BMI, and body height to knee injuries. A total of 825,187 subjects were included. Prevalence of knee injuries was 0.35%. Males had 2.2-fold more knee injuries than females. Incre...
Reports in Medical Imaging, 2014
Shoulder pain is a very common complaint, and affects as many as 20% of all people at some point ... more Shoulder pain is a very common complaint, and affects as many as 20% of all people at some point during their lives. Despite the availability of more advanced imaging modalities, X-ray remains the first imaging test to be performed in the investigation of any shoulder pain. However, with their increasing availability, ultrasound and magnetic resonance imaging have in recent years become first-line techniques for the diagnostic imaging of the shoulder. Moreover, ultrasound of the shoulder is increasingly performed in lieu of radiography. Nevertheless, many patients who visit a shoulder specialist for their pain are referred by a family physician or community orthopedist without an X-ray having ever been performed. Shoulder pain can be caused by many conditions, including rotator cuff tears, calcification within the tendons of the rotator cuff, stiff shoulder, subacromial impingement, space-occupying lesions, degenerative changes, and rheumatoid arthritis. This paper reviews various types of shoulder injury and the radiographic symptomatology of each, with the goal of encouraging the use of radiography by demonstrating the importance of this basic tool in the diagnostic process for these injuries.
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Papers by Oded Hershkovich