Papers by Kingsley Abode-iyamah
Spine Surgery and Related Research
The study is performed according to the Declaration of Helsinki and amendments. Informed consent ... more The study is performed according to the Declaration of Helsinki and amendments. Informed consent was obtained by all participants in this study. Data availability statement: The data and materials are available to strengthen the transparency and reliability of the study. The additional data could be requested by sending an e-mail to the corresponding author.
Neurosurgery, 2020
INTRODUCTION The COVID-19 pandemic has significantly impacted patients and health care systems ar... more INTRODUCTION The COVID-19 pandemic has significantly impacted patients and health care systems around the globe. Hospitals cancelled elective surgeries and telemedicine was adopted as a common tool to keep providing care while minimizing patients' risk of exposure to SARS-CoV-2. METHODS To respond to the spread of SARS-CoV-2 we implemented several measures to contribute to flattening the COVID-19 curve. Our neurosurgery department performed an evaluation of the upcoming clinic visits, and either converted to telemedicine or rescheduled patients that were considered not to be significantly impacted by a postponement. Until March 2020 almost 100% of our clinic visits were face-to-face, in April 55% of our clinic visits were via telemedicine. Telemedicine was performed as video with audio or by telephone call. Video visits were conducted via the application Zoom due to its HIPPA compliance and its integration with the electronic medical record Epic. RESULTS Telemedicine played a ke...
Introduction: Cervical myelopathy occurs when the cervical spinal cord is chronically compressed ... more Introduction: Cervical myelopathy occurs when the cervical spinal cord is chronically compressed due to bony or soft tissue impingement. It commonly affects adults over the age of 50 years and causes upper extremity numbness, loss of hand dexterity, gait disturbances, and decreased proprioception. Historically, neutral cervical spine images were the standard to determine if spinal cord impingement was present. However recent studies including flexion and extension MRI images of cervical spine have shown this disease is highly depended on the dynamic motion of the spine[1]. Little is understood regarding the spinal cord stress during cervical spinal motion which causes cervical myelopathy. Since measuring in vivo cord stress on human subjects is unfeasible several groups have used finite element (FE) modeling to investigate cord stress distributions[2,3]. While these models have given insight into stress distributions they are primitive given they either model only the cord, ignore important anatomic structures, or use basic material property assumptions. The goal of our study was to create a FE model which incorporates all major anatomic features of the C2-T1 spine and spinal cord to predict cord stress during flexion and extension. Methods: A 3D FE model of the cervical spine (C2-T1) was previously developed and validated[4]. A CAD model of the cervical spinal cord was created based on histologic sections from levels C3, C5, C8 and scaled to fit the geometry of the aforementioned C2-T1 model. IA-FEMesh was used to create a hexahedral mesh of the cord, from which quadrilateral elements were extracted to define the pia. In a similar manner, a quadrilateral mesh of the dura was generated. A convergence study was performed to ensure solution stability. The resulting cord, including the pia and dura, is defined by 42,239 elements. Once introduced into the C2-T1, the entire model consisted of 229,649 elements (Figure 1). Dentate and mengiovertebral ligaments were modeled as truss elements with no compression forces allowed. Placement of the dentate and mengiovertebral ligaments was based on anatomical reports[5]. The dura, pia, and cord were modeled as hyperplastic Mooney-Rivlen and material constants were calculated based on published in vitro tissue testing[6]. The dentate and mengiovertebral ligaments were modeled as linear elastic. The cerebral spinal fluid (CSF) was modeled as a fluid cavity enclosed by the dura and pia, while the pressure in the extradural and intradual space was based on published data[7]. General contact was used to define contact between all surfaces. The inferior endplate of the T1 vertebra was fixed in all directions as were the inferior most nodes of the spinal cord, pia, and dura. Using Abaqus 6.13-1/Standard a quasi-static rotation of 44.5° in flexion and 48.9° in extension was applied to the most superior portion of C2. This rotation corresponded to a reaction torque of-2 Nm and +2Nm, respectively. The cord, pia, and dura were allowed to move freely within the spinal canal. Axial stretch between cord root entries (cord stretch) was obtained as was the von Mises stress throughout the cord.
Clinical Neurology and Neurosurgery, 2020
OBJECTIVE Chronic opioid use (COU) remains on the rise globally, acting as a marker for patient m... more OBJECTIVE Chronic opioid use (COU) remains on the rise globally, acting as a marker for patient morbidity and a risk factor for adverse health outcomes. Opioid use is a risk factor for respiratory depression, which may lead to dysfunctional breathing, a known cause of atelectasis. The objective of this study was to determine whether COU is associated with increased rates of postoperative atelectasis among patients undergoing lumbar fusion. MATERIALS & METHODS Three State Inpatient Databases were used to identify patients who underwent an elective lumbar fusion through an anterior, posterior or circumferential approach in Florida, Kentucky and New York between 2013-2015. Patients with COU and those with postoperative atelectasis were identified using ICD diagnosis codes. Three operative groups were created and subsequently matched using propensity scores in order to provide comparable cohorts for analysis. Three-to-one propensity score matching was conducted using the variables of ag...
Cureus, 2020
No scientific evidence on restrictions for patients following an anterior cervical discectomy and... more No scientific evidence on restrictions for patients following an anterior cervical discectomy and fusion (ACDF) is available. The goal of this study is to assess the practice and patterns of restrictions after single-level and multilevel ACDF at an academic institution. We submitted two questionnaires, for restrictions after single-level and multilevel ACDF, to 18 spine surgeons at our institution. Questions included length of time in practice, use of cervical collar, postoperative restrictions and practices. We received 10 complete responses. Four (40%) of the respondents were in practice for less than 5 years; 3 (30%) 5 or more years, but less than 10; 1 (10%) 10 or more years, but less than 20; 2 (20%) 20 or more years. Only two (20%) surgeons recommend a cervical collar after a single-level ACDF, while seven (70%) do so after a multilevel ACDF, for an average of 9.1 weeks and standard deviation (SD) of 2.8. Nine surgeons (90%) reported providing lifting restrictions after a sing...
Neurosurgical Focus
OBJECTIVE There has been increasing interest in the use of spinal anesthesia (SA) for spine surge... more OBJECTIVE There has been increasing interest in the use of spinal anesthesia (SA) for spine surgery, especially within Enhanced Recovery After Surgery (ERAS) protocols. Despite the wide adoption of SA by the orthopedic practices, it has not gained wide acceptance in lumbar spine surgery. Studies investigating SA versus general anesthesia (GA) in lumbar laminectomy and discectomy have found that SA reduces perioperative costs and leads to a reduction in analgesic use, as well as to shorter anesthesia and surgery time. The aim of this retrospective, case-control study was to compare the perioperative outcomes of patients who underwent minimally invasive surgery (MIS)–transforaminal lumbar interbody fusion (TLIF) after administration of SA with those who underwent MIS-TLIF under GA. METHODS Overall, 40 consecutive patients who underwent MIS-TLIF by a single surgeon were analyzed; 20 patients received SA and 20 patients received GA. Procedure time, intraoperative adverse events, postope...
INTRODUCTION The COVID-19 pandemic created a major public health threat to patients and health ca... more INTRODUCTION The COVID-19 pandemic created a major public health threat to patients and health care systems around the world. Many hospitals cancelled elective surgeries to brace for the pandemic thus impacting many neurosurgical patients that had their surgeries postponed. METHODS We implemented several measures for staff and patients to minimize the risk of exposure to SARS-CoV-2. For surgical clearance, all patients needed to be tested for SARS-CoV-2 within 48h prior to the non-elective surgery. A triage protocol was implemented to manage patients in need of non-elective surgeries. A “drive-through” testing center was developed for preoperative surgical clearance to triage cases in need of non-elective surgery. Similarly, all patients admitted to the hospital were tested. Telemedicine played a big role in evaluating the need of surgery. We reviewed the clinical, radiographic, and laboratory data for all patients that underwent surgery within the neurosurgery department from March...
World Neurosurgery
BACKGROUND Incidental durotomy, a known complication of spinal surgery, can lead to persistent ce... more BACKGROUND Incidental durotomy, a known complication of spinal surgery, can lead to persistent cerebrospinal fluid (CSF) leak and pseudomeningocele if unrecognized or incompletely repaired. In this manuscript, we describe the use of ultrasound to visualize the site of durotomy, observe the aspiration of the pseudomeningocele, and guide the precise application of an EBP, under direct visualization in real time (US-EBP). METHODS A retrospective review was performed to determine demographic, procedural, and outcome characteristics for patients who underwent US-EBP for symptomatic postoperative pseudomeningocele. RESULTS Overall, 48 patients who underwent 49 unique episodes of care were included. The average age and BMI were 60.5 (+ 12.6) years and 27.8 (+ 4.50) kg/m2, respectively. The most frequent index operation was laminectomy (24.5%) and 36.7% of surgeries were revision operations. Durotomy was intended or recognized in 73.4% of cases, and the median time from surgery to symptom development was 7 (IQR 4-16) days. A total of 61 US-EBPs were performed, with 51.0% of patients experiencing resolution of their symptoms after the first US-EBP. An additional 20.4% were successful with multiple US-EBP attempts. Complications occurred in 14.3% of cases and the median clinical follow-up was 4.3 (IQR 2.4-14.5) months. CONCLUSIONS This manuscript represents the largest series in the literature describing US-EBP for the treatment of postoperative pseudomeningocele. The success rate suggests that routine utilization of US-guided EBP may allow for targeted treatment of pseudomeningoceles, without the prolonged hospitalization associated with lumbar drains or the risks of general anesthesia and impaired wound healing associated with surgical revision.
Neurosurgical Focus
OBJECTIVE Awake transforaminal lumbar interbody fusion (TLIF) is a novel technique for performing... more OBJECTIVE Awake transforaminal lumbar interbody fusion (TLIF) is a novel technique for performing spinal fusions in patients under conscious sedation. Whether awake TLIF can reduce operative times and decrease the hospital length of stay (LOS) remains to be shown. In this study, the authors sought to assess the differences in clinical outcomes between patients who underwent awake TLIF and those who underwent TLIF under general anesthesia by using institutional experience at the Mayo Clinic and the National Surgical Quality Improvement Program (NSQIP) database. METHODS Chart review was performed for a consecutive series of patients who underwent single-level minimally invasive surgery (MIS)–TLIF performed by a single surgeon (K.A.I.) at a single institution. Additionally, the NSQIP database was queried from 2016 to 2019 for patients who underwent awake TLIF as well as propensity score–matched patients who underwent TLIF under general anesthesia. RESULTS A total of 20 patients at Mayo...
Operative Neurosurgery
BACKGROUND Low bone mineral density (BMD) on dual energy x-ray absorptiometry (DXA) is likely a r... more BACKGROUND Low bone mineral density (BMD) on dual energy x-ray absorptiometry (DXA) is likely a risk factor for proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). However, prior instrumentation and degenerative changes can preclude a lumbar BMD measurement. Hounsfield units (HU) represent an alternative method to estimate BMD via targeted measurements at the intended operative levels. OBJECTIVE To determine if patients with lower HU at the upper instrumented vertebrae (UIV) and vertebral body superior to the UIV (UIV + 1) are at greater risk for PJK and PJF. METHODS A retrospective chart review identified patients at least 50 yr of age who underwent instrumented lumbar fusion with pelvic fixation, a UIV from T10 to L2, and a preoperative computed tomography (CT) encompassing the UIV. HU were measured at the UIV, UIV + 1, and the L3-L4 vertebral bodies. RESULTS A total of 150 patients (80 women and 70 men) were included with an average age of 66 yr and average ...
IntroductionRadiotherapy is considered standard of care for adjuvant peri-operative treatment of ... more IntroductionRadiotherapy is considered standard of care for adjuvant peri-operative treatment of many spinal tumors, including those with instrumented fusion. Unfortunately, radiation treatment has been linked to increased risk of pseudoarthrosis. Newerfocused radiotherapy strategies with enhanced conformalitycould offer improved fusion rates for these patients, but this has not been confirmed.MethodsWe performed a retrospective analysis of patients at three tertiary care academic institutions withprimary and secondary spinal malignancies that underwent resection, instrumented fusion, and peri-operative radiotherapy. Two board certified neuro-radiologists used theLenke fusion score to grade fusion status at6 and 12-months after surgery. Secondary outcomes includedclinical pseudoarthrosis, wound complications, and the effect of radiation timing, radiobiological dose delivered, the use of photons versus protons, tumor type, tumor location,and use of autograft on fusion outcomes.Result...
International Journal of Neuroscience
Viral infections have been associated with the deleterious damage to nervous system resulting in ... more Viral infections have been associated with the deleterious damage to nervous system resulting in impairment of the central nervous system as late sequalae infections. Since the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), several studies have reported patients developing adverse neurological signs and symptoms. Like the outbreak of SARS in 2003, the recent outbreak has undermined the norm of the nervous system. This review will summarize the possible mechanism of neurological manifestations, the clinical presentations of patients with such symptoms secondary to SARS coronaviruses, and the prospective role of neurology and neurosurgery practice in managing these symptoms in the current climate.
Mayo Clinic Proceedings: Innovations, Quality & Outcomes
Mayo Clinic Proceedings: Innovations, Quality & Outcomes
Clinical Spine Surgery: A Spine Publication
Journal of Neurosurgery: Spine
OBJECTIVE High-grade spinal glioma (HGSG) is a rare but aggressive tumor that occurs in both adul... more OBJECTIVE High-grade spinal glioma (HGSG) is a rare but aggressive tumor that occurs in both adults and children. Histone H3K27 M mutation correlates with poor prognosis in children with diffuse midline glioma. However, the role of H3K27 M mutation in the prognosis of adults with HGSG remains unclear owing to the rarity of this mutation, conflicting reports, and the absence of multicenter studies on this topic. METHODS The authors studied a cohort of 30 adult patients with diffuse HGSG who underwent histological confirmation of diagnosis, surgical intervention, and treatment between January 2000 and July 2020 at six tertiary academic centers. The primary outcome was the effect of H3K27 M mutation status on progression-free survival (PFS) and overall survival (OS). RESULTS Thirty patients (18 males and 12 females) with a median (range) age of 50.5 (19–76) years were included in the analysis. Eighteen patients had H3K27 M mutation–positive tumors, and 12 had H3K27 M mutation–negative ...
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Papers by Kingsley Abode-iyamah