Minimally Invasive Lateral Access Corpectomy for a Solitary Renal Cell Carcinoma Spinal Metastasis: A Case Report

Spinal metastases can present with neurological symptoms due to cord compression which often requires urgent surgical decompression and fixation. However, the posterior spinal approach has limitations in cord decompression. We describe our institution’s experience of a Thoracic 12 corpectomy done via a minimally invasive retropleural approach for a patient with a metastatic spinal tumour. A 63 year old presented with a 1 month history of worsening atraumatic back pain with lower limb radicular pain and weakness. Magnetic Resonance Imaging (MRI) showed a T12 pathological fracture with vertebral body retropulsion causing cord compression. A Computed Tomography (CT) abdomen scan showed a heterogenous enhancing mass in the superior pole of the right kidney, suspicious of a renal cell carcinoma. He underwent initial posterior pedicle screw instrumentation from T10-L2 and a T12 bilateral laminectomy with right T12 pedicle bone biopsy, followed by a minimally invasive lateral access T12 corpectomy. His weakness improved and he had subsequent radiation therapy, chemotherapy and a right nephrectomy with good recovery. Minimally invasive lateral access retropleural approach can be considered in metastatic spinal tumour cases with cord compression as it allows for circumferential decompression while avoiding risks of anterior spinal surgery

C1/C2 osteomyelitis secondary to malignant otitis externa complicated by atlantoaxial subluxation—a case report and review of the literature

10.21037/acr.2020.03.04AME Case Reports419-1

A Systematic Review of Complications Associated withInitial Learning Curve of Endoscopic Spine SurgeryHighlighting the Necessity of Introducing an EffectiveFellowship to Train Competent Endoscopic SpineSurgeons

10.37421/jsp.2020.9.456Journal of Spine95Jo

Minimally Invasive Lateral Access Corpectomy for a Solitary Renal Cell Carcinoma Spinal Metastasis: A Case Report

10.21182/jmisst.2018.00360Journal of Minimally Invasive Spine Surgery and Technique3270-7

Overview of Tips in Overcoming Learning Curve in Uniportal and Biportal Endoscopic Spine Surgery

10.21182/jmisst.2020.00024Journal of Minimally Invasive Spine Surgery and Technique6Suppl 1S84-S9

Telemedicine use in orthopaedics: Experience during the COVID-19 pandemic

10.1177/1357633X211041011JOURNAL OF TELEMEDICINE AND TELECAR

Habit and automaticity in medical alert override: cohort study

Prior literature suggests that alert dismissal could be linked to physicians' habits and automaticity. The evidence for this perspective has been mainly observational data. This study uses log data from an electronic medical records system to empirically validate this perspective.Ministry of Education (MOE)Published versionThis research received funding from the Social Science Research Council, Ministry of Education, Singapore

Do Caucasians and East Asians have Different Outcomes Following Surgery for the Treatment of Degenerative Cervical Myelopathy?: Results From the Prospective Multicenter AOSpine International Study

WOS: 000384032700012PubMed ID: 26974832Study Design.A prospective multicenter cohort study.Objective.The aim of this study was to compare outcomes of surgery for the treatment for degenerative cervical myelopathy (DCM) between Caucasians and East Asians.Summary of Background Data.Numerous studies have indicated that race can influence both disease prevalence and clinical prognosis in a variety of medical conditions; however, none have evaluated the impact of race on surgical outcomes in patients with DCM.Methods.Four hundred and seventy-nine patients with symptomatic DCM were enrolled in the prospective AOSpine CSM-International study at 16 global sites. Preoperatively, and at each follow-up, patients were evaluated using the modified Japanese Orthopedic Association scale (mJOA), the Nurick score, the Neck Disability Index (NDI), and the Short- Form 36 (SF-36) Health Survey. A mixed-model analytic approach was used to evaluate differences in outcomes between races at 24 months postoperatively, while controlling for relevant baseline characteristics and surgical factors.Results.Three hundred and twenty-four (67.64%) patients were Caucasian and 106 (22.13%) were East Asian. There was no difference in the incidence of ossification of the posterior longitudinal ligament (OPLL) between the two races; however a greater percentage of Caucasians in India (46.15%) and Turkey (41.38%) displayed evidence of OPLL than Caucasians in other regions (P<0.001). The frequency of spondylosis was significantly higher in Caucasians (P<0.001). Caucasians had a longer duration of symptoms (27.3334.47 months) than East Asians (23.1135.68 months) (P<0.001), and a lower preoperative score on the SF-36 Physical Component Score (33.85 +/- 9.04) than East Asians (37.47 +/- 8.67) (P<0.001). At 24 months after surgery, there were no differences in functional status or QOL between East Asians and Caucasians, after adjusting for baseline characteristics, surgical preferences, and disease causation. Rates of perioperative complications were not significantly different between the races (P=0.261).Conclusion.Decompressive surgery for DCM results in comparable functional gains and is equally safe in Caucasians and East Asians.Level of Evidence: 2AOSpine InternationalAOSpine International grant funds were received in support of this work

Artificial intelligence in sepsis early prediction and diagnosis using unstructured data in healthcare

Sepsis is a leading cause of death in hospitals. Early prediction and diagnosis of sepsis, which is critical in reducing mortality, is challenging as many of its signs and symptoms are similar to other less critical conditions. We develop an artificial intelligence algorithm, SERA algorithm, which uses both structured data and unstructured clinical notes to predict and diagnose sepsis. We test this algorithm with independent, clinical notes and achieve high predictive accuracy 12 hours before the onset of sepsis (AUC 0.94, sensitivity 0.87 and specificity 0.87). We compare the SERA algorithm against physician predictions and show the algorithm’s potential to increase the early detection of sepsis by up to 32% and reduce false positives by up to 17%. Mining unstructured clinical notes is shown to improve the algorithm’s accuracy compared to using only clinical measures for early warning 12 to 48 hours before the onset of sepsis.Ministry of Education (MOE)Published versionThis work is supported by the Ministry of Education, Singapore, under the Social Science Research Council Thematic Grant. Grant number: MOE2017-SSRTG-030