Mark Ehioghae

Background: Patients with end-stage renal disease who are dialysis-dependent are living longer, leading to an increased incidence of long-term dialysis complications, including those related to spondyloarthropathy requiring fusions. Here, we investigated the outcomes and complications associated with spinal fusion in patients undergoing dialysis. Methods: We performed 3 separate searches involving the lumbar, thoracic, and cervical spine using MEDLINE PubMed and Boolean operators. Results: Fourteen articles met the inclusion criteria. Conclusion: Although outcomes for lumbar and cervical spinal fusion in dialysis patients were comparable, complication and mortality rates were higher, likely due to the overall increased morbidity attributed to end-stage renal disease.

Background: Sacral metastases can cause severe pain, neurologic deficits, and sacroiliac instability, leading to substantial functional impairment. Although surgery is used for symptom palliation, patient-reported outcomes (PROs) following minimally invasive spinopelvic fixation remain poorly characterized. Methods: We retrospectively reviewed 10 patients (median age, 63 years) who underwent surgery for sacral metastases between 2015 and 2022. Procedures included posterior decompression alone or posterior decompression with minimally invasive spinopelvic fixation for sacroiliac instability. Eastern Cooperative Oncology Group (ECOG) performance status and PRO measurement information system (PROMIS) pain interference (PI), physical function (PF), and Depression scores were collected preoperatively and at 3 months postoperatively. Overall survival was estimated using Kaplan–Meier analysis. Results: Four patients underwent posterior decompression alone, and six underwent decompression with minimally invasive spinopelvic fixation. Mean ECOG improved from 2.5 preoperatively to 1.6 at 3 months ( P = 0.06). PROMIS PI improved by a mean of −8.7 ( P < 0.01), exceeding the minimum clinically important difference, while PF improved by 4.5 ( P = 0.03). Depression scores improved by −3.5 but were not statistically significant ( P = 0.20). In the instrumented subgroup, PROMIS PI improved by −8.5 ( P = 0.028), with trends toward improved ECOG and PF. Three surgery-related complications occurred, with no instrumentation failures. Median survival was 9 months, with 6-, 12-, and 24-month survival rates of 80%, 70%, and 35%, respectively. Conclusion: Surgery for sacral metastases provides clinically meaningful pain relief and short-term functional improvement. Minimally invasive spinopelvic fixation is a feasible option for patients with sacroiliac instability and supports durable symptom palliation.

Background: Intraoperative neuromonitoring (IONM) is widely used in spine surgery to detect neurological injury. However, rising healthcare costs necessitate an evaluation of the value of IONM, given the added expense and time associated with its use. Here, we identified risk factors contributing to significant IONM changes during anterior versus posterior versus circumferential cervical surgery. Methods: This retrospective study at a Level I trauma center (2012–2016) involved 663 trauma patients with myelopathy or radiculopathy who underwent anterior, posterior, or circumferential cervical surgery utilizing IONM. We focused on when significant changes occurred during these procedures and correlated them with neurological outcomes. Results: Of the 663 patients, averaging 54.8 years of age, 51 (7.7%) patients developed statistically significant IONM changes; in descending order, they occurred during posterior (10.8% [27/249]), circumferential (9.1% [2/22]), and anterior (5.6% [22/392]) operations. Notably, 5 (9.8%) of the 51 patients developed new postoperative neurologic deficits; 4/5 (80%) occurred following posterior and 1 (20%) after an anterior cervical procedure. Conclusion: Of 663 patients, 51 (7.7%) patients developed statistically significant IONM changes that were most frequent (i.e., in descending order), following posterior (10.8% [27/249]), circumferential (9.1% [2/22]), and anterior (5.6% [22/392]) operations.

COVID-19 can have severe consequences for immunocompromised individuals, including those with hematological malignancies. Prolonged infections causing pneumonia and lung injury are rare in patients with diffuse large B-cell lymphoma (DLBCL) treated with chimeric antigen receptor T-cell (CAR-T). A 43-year-old male with a history of DLBCL, in remission for 2 years after CAR-T therapy, developed a persistent COVID infection, as confirmed via positive polymerase chain reaction. This slowly progressed to symptomatic hypoxemic pneumonitis and biopsy-proven diffuse alveolar damage, which responded to corticosteroid treatment. COVID-19 poses increased risks to patients with a history of hematologic malignancies and can lead to severe respiratory distress and mortality. Studies have shown prolonged pneumonitis may require corticosteroids for improvement. However, data on appropriate regimen for managing prolonged COVID-19 pneumonitis are lacking. This case highlights challenges of the treatment of COVID-19 infections in immunocompromised individuals with hematological malignancies. Corticosteroid treatment shows benefits, but dosing and duration should be based on individual patient response. Extended monitoring, individualized treatment plans, and research are crucial for optimizing outcomes in this vulnerable population.

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Purpose of Review The surge in orthopedic surgeries strains the US healthcare system, necessitating innovative rehabilitation solutions. This review examines the potential of virtual reality (VR)-based interventions for orthopedic rehabilitation. Recent Findings The effectiveness of VR-based interventions in orthopedic surgery patients is scrutinized. While some studies suggest better patient-reported outcomes and satisfaction, mixed results emerge from others, demonstrating comparable or varied results compared to traditional rehabilitation. The underlying mechanisms of VR-based rehabilitation are elucidated, showing its positive impact on proprioception, pain management, agency, and balance. Challenges of unfamiliarity, patient engagement, and drop-out rates are identified, emphasizing the need for tailored approaches. Summary VR technology’s immersive environments and multisensory experiences offer a novel approach to addressing functional deficits and pain post-surgery. The conclusion drawn is that VR-based rehabilitation complements rather than replaces conventional methods, potentially aiding in pain reduction and functional improvement. VR-based rehabilitation holds promise for enhancing orthopedic surgery outcomes, presenting a dynamic approach to recovery. Its potential to reshape healthcare delivery and reimbursement structures underscores its significance in modern healthcare. Overall, VR-based rehabilitation offers a promising avenue for optimizing postoperative recovery in orthopedic surgery patients.

Purpose of Review Osteoarthritis (OA) is a prevalent and debilitating condition characterized by joint degeneration and pain. Current treatment options aim to alleviate symptoms and slow disease progression but lack curative potential. Stem cell therapies have emerged as a promising alternative. This article explores the epidemiology, pathophysiology, clinical manifestations of hip and knee OA, and the evolving role of stem cell therapies in their treatment. Recent Findings The global prevalence of OA, with knee OA being the most common form, has fueled the demand for stem cell therapies. Despite limited robust evidence supporting their efficacy, clinical trials investigating stem-cell treatments for OA have reported encouraging radiological and clinical improvements. Stem cell therapies offer potential disease-modifying benefits through immunomodulatory actions, growth factor secretion, and chondrogenic capabilities. Adipose-derived mesenchymal stem cells (ADMSCs) have shown promise in clinical trials for OA treatment, offering potential pain relief and functional improvement. ADMSCs possess advantages such as accessibility and a favorable safety profile, making them a viable option for OA management. Although other stem-cell types, including human embryonic stem cells (hESCs) and induced pluripotent stem cells (iPSCs), have been used in OA treatment, ADMSCs have demonstrated superior outcomes. Summary By providing a comprehensive overview of the evolving landscape of stem cell therapies for hip and knee OA, this article highlights the potential of stem-cell treatments to address the limitations of current therapies. However, further research is required to establish their long-term efficacy, identify optimal stem-cell types, and develop standardized protocols.

Background: Calcium pyrophosphate dihydrate (CPPD) deposition, also known as pseudogout, in the cervical ligamentum flavum (CLF), is a rare disease which can cause spinal cord signaling changes leading to rapid deterioration in function. The natural history of cervical myelopathy as a result of CPPD deposition within the CLF is not well understood. Our objective is to describe the presentation, imaging findings, and treatment options of CPPD deposition or pseudogout of the cervical spine. Methods: Using PubMed, we analyzed studies published from 1978 to 2022. Key words used were “pseudogout,” “CPPD deposit disease,” “cervical yellow ligament,” “CLF,” and “cervical spine.” We excluded “crowned dense syndrome” and “ossification of ligament flavum.” Using a department database, we queried for patients treated for CPPD of the cervical spine. Results: Twenty clinical studies on CPPD of the cervical spine with 69 patients aged between 15 and 92 years (mean = 72) were identified. Neck pain and numbness of the hands were the most common symptoms. Diabetes mellitus and hypertension were the most common comorbidities. Males and females were affected at equal rates. C4-C5 and C5-C6 were the most affected segments. Earlier surgical treatment produced better outcomes. A laminectomy and fusion or laminoplasty were the most common procedures performed with most patients experiencing some return of neurologic function. Conclusion: Although rare, CPPD deposit disease in the CLF should be readily considered as a differential diagnosis due to the continuously aging population. CPPD’s progressively worsening nature makes an early diagnosis and treatment important in improving the patient’s overall quality of life.