Hybrid Biosynthetic Autograft Extender for Use in Posterior Lumbar Interbody Fusion: Safety and Clinical Effectiveness

Autologous iliac crest bone graft is the preferred option for spinal fusion, but the morbidity associated with bone harvest and the need for graft augmentation in more demanding cases necessitates combining local bone with bone substitutes. The purpose of this study was to document the clinical effectiveness and safety of a novel hybrid biosynthetic scaffold material consisting of poly(D,L-lactide-co-glycolide) (PLGA, 75:25) combined by lyophilization with unmodified high molecular weight hyaluronic acid (10-12% wt:wt) as an extender for a broad range of spinal fusion procedures. We retrospectively evaluated all patients undergoing single- and multi-level posterior lumbar interbody fusion at an academic medical center over a 3-year period. A total of 108 patients underwent 109 procedures (245 individual vertebral levels). Patient-related outcomes included pain measured on a Visual Analog Scale. Radiographic outcomes were assessed at 6 weeks, 3-6 months, and 1 year postoperatively. Radiographic fusion or progression of fusion was documented in 221 of 236 index levels (93.6%) at a mean (±SD) time to fusion of 10.2+4.1 months. Single and multi-level fusions were not associated with significantly different success rates. Mean pain scores (+SD) for all patients improved from 6.8+2.5 at baseline to 3.6+2.9 at approximately 12 months. Improvements in VAS were greatest in patients undergoing one- or two-level fusion, with patients undergoing multi-level fusion demonstrating lesser but still statistically significant improvements. Overall, stable fusion was observed in 64.8% of vertebral levels; partial fusion was demonstrated in 28.8% of vertebral levels. Only 15 of 236 levels (6.4%) were non-fused at final follow-up

Lower urinary tract symptoms in women with spinal pathologies: a prospective prevalence study

Introduction: The relationship between spinal pathologies and lower urinary tract symptoms (LUTS) is largely unknown. The incidence of LUTS in patients with lumbar disk disease has been estimated to be between 27% and 92%. Further, the effect of spine surgery on lower urinary tract symptoms has not been definitively established. The objective of this study was to determine the prevalence of urinary dysfunction among female patients with spinal pathologies and to evaluate the effects of spinal surgery on these symptoms using validated questionnaires. Methods: After IRB approval, women with lower spine complaints were identified in the neurosurgery clinic. Patients were asked to fill out the Pelvic Floor Distress Inventory (PFDI‐20) and Pelvic Floor Impact Questionnaire (PFIQ‐7) at their initial visit. Exclusion criteria included primary spinal pathology in the cervical spine. If the patient elected to undergo spine surgery after their initial evaluation, questionnaires were obtained at 6 weeks and 6 months postoperatively. Patient demographics, medical and surgical history were obtained through a review of the electronic medical record. Results: A total of 169 patients were recruited between April 2017 and July 2019. See Table 1. At baseline, 72.7% answered “yes” to at least one question on the Urinary Distress Inventory (UDI‐6). The average score was 23.5/100. Those with higher UDI‐6 scores were strongly correlated to higher Urinary Impact Questionnaire (UIQ‐7) score (Pearson correlation coefficient= 0.69). Colorectal‐Anal Distress Inventory (CRADI‐8) was also evaluated with 64.3% presenting with some level of bowel complaints. The average score was only 14.4/100. Higher baseline UDI‐6 and CRADI‐8 scores were observed for patients with a history of a prior hysterectomy, use of stool softeners, and a spinal pathology including L3 (P \u3c 0.05). Postoperative questionnaires were obtained from 22 women at 6 weeks and 8 women at 6 months, with the average UDI‐6 scores being 19.9/100 and 31.2/100, respectively. Conclusion: Though the majority of women presented with some level of urinary bother, quality of life impact appeared low. More significant bother was seen in patients that had L3 spinal involvement at their initial assessment. At this point, there was no demonstrable influence of surgery on urinary symptoms, though the number of patients followed postoperatively was small

Detection of diagnostic and prognostic methylation-based signatures in liquid biopsy specimens from patients with meningiomas.

Recurrence of meningiomas is unpredictable by current invasive methods based on surgically removed specimens. Identification of patients likely to recur using noninvasive approaches could inform treatment strategy, whether intervention or monitoring. In this study, we analyze the DNA methylation levels in blood (serum and plasma) and tissue samples from 155 meningioma patients, compared to other central nervous system tumor and non-tumor entities. We discover DNA methylation markers unique to meningiomas and use artificial intelligence to create accurate and universal models for identifying and predicting meningioma recurrence, using either blood or tissue samples. Here we show that liquid biopsy is a potential noninvasive and reliable tool for diagnosing and predicting outcomes in meningioma patients. This approach can improve personalized management strategies for these patients

Detection of diagnostic and prognostic methylation-based signatures in liquid biopsy specimens from patients with meningiomas

Abstract Recurrence of meningiomas is unpredictable by current invasive methods based on surgically removed specimens. Identification of patients likely to recur using noninvasive approaches could inform treatment strategy, whether intervention or monitoring. In this study, we analyze the DNA methylation levels in blood (serum and plasma) and tissue samples from 155 meningioma patients, compared to other central nervous system tumor and non-tumor entities. We discover DNA methylation markers unique to meningiomas and use artificial intelligence to create accurate and universal models for identifying and predicting meningioma recurrence, using either blood or tissue samples. Here we show that liquid biopsy is a potential noninvasive and reliable tool for diagnosing and predicting outcomes in meningioma patients. This approach can improve personalized management strategies for these patients