This site usescookies, tags, and tracking settings to store information that help give you the very best browsing experience. Dismiss this warning

Filter

Refine by Publication

Refine by Date
—

Refine by Access

Refine By Subjects

  • Print
  • Save

Search Results

You are looking at1-7of7items for

  • Author or Editor: Tarek R. Mansourx
  • Refine by Access: allx
Clear All Modify Search
Open access

Techniques for management and avoidance of ventriculoatrial shunt disconnection: illustrative cases

Thomas M. Zervos, Kenneth Kutschman, Tiberio Frisoli, Tarek R. Mansour, and Jason M. Schwalb

BACKGROUND

Ventriculoatrial (VA) shunt disconnection can result in distal catheter migration into the cardiopulmonary vasculature. There is little guidance in the current literature on how to prevent and manage this uncommon yet potentially serious complication. The authors reviewed the existing literature and described three instances of distal shunt migration VA shunts and offered insight on methods to mitigate such complications.

OBSERVATIONS

Eighteen patients were identified with VA shunts. Of these patients, seven were identified as having a connector in the neck, three of which were associated with distal disconnection and migration. In all three cases, the distal catheter was retrieved via an endovascular approach in conjunction with transesophageal echocardiography to assess for retrieval feasibility.

LESSONS

The authors recommended the avoidance of a straight connector when performing VA shunt placement. When distal catheter migration occurs, collaboration with interventional cardiology is advisable when possible.

InJournal of Neurosurgery: Case Lessons Volume 3 (2022): Issue 22 (May 2022)

Open access

Acute thoracic disc heralded by change in spinal cord stimulation pattern: illustrative case

Faraz Behzadi, Edvin Telemi, Tarek R. Mansour, Thomas M. Zervos, Muwaffak M. Abdulhak, and Ellen L. Air

BACKGROUND

Spinal cord stimulation (SCS) uses unique electric stimulation parameters to selectively treat specific regions of chronic or refractory back pain. Changing these parameters can lead to spreading paresthesia and/or pain beyond the desired region.

OBSERVATIONS

A patient with a history of stable, successful SCS treatment presented with acute development of paresthesias that were relieved by reduction of stimulation parameters. The patient required paradoxically lower SCS settings for control of chronic back pain. This presentation prompted further investigation, which revealed a new disc protrusion and cord compression at the level of the paddle lead.

LESSONS

In patients with SCS, a new onset of back pain accompanied by acute paresthesia that is reversible by reducing the SCS amplitude warrants investigation for new spine pathology.

InJournal of Neurosurgery: Case Lessons Volume 2 (2021): Issue 20 (Nov 2021)

Free access

The role of postoperative antibiotic duration on surgical site infection after lumbar surgery

Mohamed Macki, Travis Hamilton, Seokchun Lim, Tarek R. Mansour, Edvin Telemi, Michael Bazydlo, Lonni Schultz, David R. Nerenz, Paul Park, Victor Chang, Jason Schwalb, and Muwaffak M. Abdulhak

OBJECTIVE

Despite a general consensus regarding the administration of preoperative antibiotics, poorly defined comparison groups and underpowered studies prevent clear guidelines for postoperative antibiotics. Utilizing a data set tailored specifically to spine surgery outcomes, in this clinical study the authors aimed to determine whether there is a role for postoperative antibiotics in the prevention of surgical site infection (SSI).

开云体育世界杯赔率

The Michigan Spine Surgery Improvement Collaborative registry was queried for all lumbar operations performed for degenerative spinal pathologies over a 5-year period from 2014 to 2019. Preoperative prophylactic antibiotics were administered for all surgical procedures. The study population was divided into three cohorts: no postoperative antibiotics, postoperative antibiotics ≤ 24 hours, and postoperative antibiotics > 24 hours. This categorization was intended to determine 1) whether postoperative antibiotics are helpful and 2) the appropriate duration of postoperative antibiotics. First, multivariable analysis with generalized estimating equations (GEEs) was used to determine the association between antibiotic duration and all-type SSI with adjusted odds ratios; second, a three-tiered outcome—no SSI, superficial SSI, and deep SSI—was calculated with multivariable multinomial logistical GEE analysis.

RESULTS

在37161例患者中,术后antibiotics > 24 hours cohort had more men with older average age, greater body mass index, and greater comorbidity burden. The postoperative antibiotics > 24 hours cohort had a 3% rate of SSI, which was significantly higher than the 2% rate of SSI of the other two cohorts (p = 0.004). On multivariable GEE analysis, neither postoperative antibiotics > 24 hours nor postoperative antibiotics ≤ 24 hours, as compared with no postoperative antibiotics, was associated with a lower rate of all-type postoperative SSIs. On multivariable multinomial logistical GEE analysis, neither postoperative antibiotics ≤ 24 hours nor postoperative antibiotics > 24 hours was associated with rate of superficial SSI, as compared with no antibiotic use at all. The odds of deep SSI decreased by 45% with postoperative antibiotics ≤ 24 hours (p = 0.002) and by 40% with postoperative antibiotics > 24 hours (p = 0.008).

CONCLUSIONS

Although the incidence of all-type SSI was highest in the antibiotics > 24 hours cohort, which also had the highest proportions of risk factors, duration of antibiotics failed to predict all-type SSI. On multinomial subanalysis, administration of postoperative antibiotics for both ≤ 24 hours and > 24 hours was associated with decreased risk of only deep SSI but not superficial SSI. Spine surgeons can safely consider antibiotics for 24 hours, which is equally as effective as long-term administration for prophylaxis against deep SSI.

InJournal of Neurosurgery: Spine Volume 36: Issue 2 (Feb 2022)

Restricted access

Use of Patient Health Questionnaire–2 scoring to predict patient satisfaction and return to work up to 1 year after lumbar fusion: a 2-year analysis from the Michigan Spine Surgery Improvement Collaborative

Presented at the 2019 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves

Hesham Mostafa Zakaria, Tarek R. Mansour, Edvin Telemi, Karam Asmaro, Mohamed Macki, Michael Bazydlo, Lonni Schultz, David R. Nerenz, Muwaffak Abdulhak, Jason M. Schwalb, Paul Park, and Victor Chang

OBJECTIVE

The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a prospective, longitudinal, multicenter, quality-improvement collaborative. Using MSSIC, the authors sought to identify the relationship between a positive Patient Health Questionnaire–2 (PHQ-2) screening, which is predictive of depression, and patient satisfaction, return to work, and achieving Oswestry Disability Index (ODI) minimal clinically important difference (MCID) scores up to 2 years after lumbar fusion.

开云体育世界杯赔率

Data from a total of 8585 lumbar fusion patients were analyzed. Patient satisfaction was measured by the North American Spine Society patient satisfaction index. A positive PHQ-2 score is one that is ≥ 3, which has an 82.9% sensitivity and 90.0% specificity in detecting major depressive disorder. Generalized estimating equation models were constructed; variables tested include age, sex, race, past medical history, severity of surgery, and preoperative opioid usage.

RESULTS

多元分析性能ormed. Patients with a positive PHQ-2 score (i.e., ≥ 3) were less likely to be satisfied after lumbar fusion at 90 days (relative risk [RR] 0.93, p < 0.001), 1 year (RR 0.92, p = 0.001), and 2 years (RR 0.92, p = 0.028). A positive PHQ-2 score was also associated with decreased likelihood of returning to work at 90 days (RR 0.76, p < 0.001), 1 year (RR 0.85, p = 0.001), and 2 years (RR 0.82, p = 0.031). A positive PHQ-2 score was predictive of failure to achieve an ODI MCID at 90 days (RR 1.07, p = 0.005) but not at 1 year or 2 years after lumbar fusion.

CONCLUSIONS

A multivariate analysis based on information from a large, multicenter, prospective database on lumbar fusion patients was performed. The authors found that a positive score (≥ 3) on the PHQ-2, which is a simple and accurate screening tool for depression, predicts an inability to return to work and worse satisfaction up to 2 years after lumbar fusion. Depression is a treatable condition, and so in the same way that patients are medically optimized before surgery to decrease postoperative morbidity, perhaps patients should have preoperative psychiatric optimization to improve postoperative functional outcomes.

InJournal of Neurosurgery: Spine Volume 31: Issue 6 (Dec 2019)

Free access

The role of postoperative antibiotic duration on surgical site infection after lumbar surgery

Mohamed Macki, Travis Hamilton, Seokchun Lim, Tarek R. Mansour, Edvin Telemi, Michael Bazydlo, Lonni Schultz, David R. Nerenz, Paul Park, Victor Chang, Jason Schwalb, and Muwaffak M. Abdulhak

OBJECTIVE

Despite a general consensus regarding the administration of preoperative antibiotics, poorly defined comparison groups and underpowered studies prevent clear guidelines for postoperative antibiotics. Utilizing a data set tailored specifically to spine surgery outcomes, in this clinical study the authors aimed to determine whether there is a role for postoperative antibiotics in the prevention of surgical site infection (SSI).

开云体育世界杯赔率

The Michigan Spine Surgery Improvement Collaborative registry was queried for all lumbar operations performed for degenerative spinal pathologies over a 5-year period from 2014 to 2019. Preoperative prophylactic antibiotics were administered for all surgical procedures. The study population was divided into three cohorts: no postoperative antibiotics, postoperative antibiotics ≤ 24 hours, and postoperative antibiotics > 24 hours. This categorization was intended to determine 1) whether postoperative antibiotics are helpful and 2) the appropriate duration of postoperative antibiotics. First, multivariable analysis with generalized estimating equations (GEEs) was used to determine the association between antibiotic duration and all-type SSI with adjusted odds ratios; second, a three-tiered outcome—no SSI, superficial SSI, and deep SSI—was calculated with multivariable multinomial logistical GEE analysis.

RESULTS

在37161例患者中,术后antibiotics > 24 hours cohort had more men with older average age, greater body mass index, and greater comorbidity burden. The postoperative antibiotics > 24 hours cohort had a 3% rate of SSI, which was significantly higher than the 2% rate of SSI of the other two cohorts (p = 0.004). On multivariable GEE analysis, neither postoperative antibiotics > 24 hours nor postoperative antibiotics ≤ 24 hours, as compared with no postoperative antibiotics, was associated with a lower rate of all-type postoperative SSIs. On multivariable multinomial logistical GEE analysis, neither postoperative antibiotics ≤ 24 hours nor postoperative antibiotics > 24 hours was associated with rate of superficial SSI, as compared with no antibiotic use at all. The odds of deep SSI decreased by 45% with postoperative antibiotics ≤ 24 hours (p = 0.002) and by 40% with postoperative antibiotics > 24 hours (p = 0.008).

CONCLUSIONS

Although the incidence of all-type SSI was highest in the antibiotics > 24 hours cohort, which also had the highest proportions of risk factors, duration of antibiotics failed to predict all-type SSI. On multinomial subanalysis, administration of postoperative antibiotics for both ≤ 24 hours and > 24 hours was associated with decreased risk of only deep SSI but not superficial SSI. Spine surgeons can safely consider antibiotics for 24 hours, which is equally as effective as long-term administration for prophylaxis against deep SSI.

InJournal of Neurosurgery: Spine Publish Before Print

Restricted access

Postoperative opioid prescription and patient-reported outcomes after elective spine surgery: a Michigan Spine Surgery Improvement Collaborative study

Seokchun Lim, Hsueh-han Yeh, Mohamed Macki, Sameah Haider, Travis Hamilton, Tarek R. Mansour, Edvin Telemi, Lonni Schultz, David R. Nerenz, Jason M. Schwalb, Muwaffak Abdulhak, Paul Park, Ilyas Aleem, Richard Easton, Jad G. Khalil, Miguelangelo Perez-Cruet, and Victor Chang

OBJECTIVE

This study was designed to assess how postoperative opioid prescription dosage could affect patient-reported outcomes after elective spine surgery.

开云体育世界杯赔率

密歇根脊柱外科病人的Improvement Collaborative (MSSIC) from January 2020 to September 2021 were included in this study. Opioid prescriptions at discharge were converted to total morphine milligram equivalents (MME). A reference value of 225 MME per week was used as a cutoff. Patients were divided into two cohorts based on prescribed total MME: ≤ 225 MME and > 225 MME. Primary outcomes included patient satisfaction, return to work status after surgery, and whether improvement of the minimal clinically important difference (MCID) of the Patient-Reported Outcomes Measurement Information System 4-question short form for physical function (PROMIS PF) and EQ-5D was met. Generalized estimated equations were used for multivariate analysis.

RESULTS

Regression analysis revealed that patients who had postoperative opioids prescribed with > 225 MME were less likely to be satisfied with surgery (adjusted OR [aOR] 0.81) and achieve PROMIS PF MCID (aOR 0.88). They were also more likely to be opioid dependent at 90 days after elective spine surgery (aOR 1.56).

CONCLUSIONS

阿片类药物的流行对我国是一个严重的威胁l public health, and spine surgeons must practice conscientious postoperative opioid prescribing to achieve adequate pain control. The authors’ analysis illustrates that a postoperative opioid prescription of 225 MME or less is associated with improved patient satisfaction, greater improvement in physical function, and decreased opioid dependence compared with those who had > 225 MME prescribed.

InJournal of Neurosurgery: Spine Volume 38: Issue 2 (Feb 2023)

Restricted access

Association of prolonged symptom duration with poor outcomes in lumbar spine surgery: a Michigan Spine Surgery Improvement Collaborative study

Travis Hamilton, Seamus Bartlett, Nachiket Deshpande, Moustafa Hadi, Jared C. Reese, Tarek R. Mansour, Edvin Telemi, Kylie Springer, Lonni Schultz, David R. Nerenz, Muwaffak Abdulhak, Teck Soo, Jason Schwalb, Jad G. Khalil, Ilyas Aleem, Richard Easton, Miguelangelo Perez-Cruet, Paul Park, and Victor Chang

OBJECTIVE

There is a scarcity of large multicenter data on how preoperative lumbar symptom duration relates to postoperative patient-reported outcomes (PROs). The objective of this study was to determine the effect of preoperative and baseline symptom duration on PROs at 90 days, 1 year, and 2 years after lumbar spine surgery.

开云体育世界杯赔率

The Michigan Spine Surgery Improvement Collaborative registry was queried for all lumbar spine operations between January 1, 2017, to December 31, 2021, with a follow-up of 2 years. Patients were stratified into three subgroups based on symptom duration: < 3 months, 3 months to < 1 year, and ≥ 1 year. The primary outcomes were reaching the minimal clinically important difference (MCID) for the PROs (i.e., leg pain, Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS PF), EQ-5D, North American Spine Society satisfaction, and return to work). The EQ-5D score was also analyzed as a continuous variable to calculate quality-adjusted life years. Multivariable Poisson generalized estimating equation models were used to report adjusted risk ratios, with the < 3-month cohort used as the reference.

RESULTS

There were 37,223 patients (4670 with < 3-month duration, 9356 with 3-month to < 1-year duration, and 23,197 with ≥ 1-year duration) available for analysis. Compared with patients with a symptom duration of < 1 year, patients with a symptom duration of ≥ 1 year were significantly less likely to achieve an MCID in PROMIS PF, EQ-5D, back pain relief, and leg pain relief at 90 days, 1 year, and 2 years postoperatively. Similar trends were observed for patient satisfaction and return to work. With the EQ-5D score as a continuous variable, a symptom duration of ≥ 1 year was associated with 0.04, 0.05, and 0.03 (p < 0.001) decreases in EQ-5D score at 90 days, 1 year, and 2 years after surgery, respectively.

CONCLUSIONS

A symptom duration of ≥ 1 year was associated with poorer outcomes on several outcome metrics. This suggests that timely referral and surgery for degenerative lumbar pathology may optimize patient outcome.

InJournal of Neurosurgery: Spine Publish Before Print

Baidu
map