Browsing by Author "Gragnaniello, Cristian"

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    Clinical and radiographic benefits of skipping C7 instrumentation in posterior cervicothoracic fusion: a retrospective analysis
    (AME, 2022-09) Patel, Saavan; Sadeh, Morteza; Tobin, Matthew K.; Chaudhry, Nauman S.; Gragnaniello, Cristian; Neckrysh, Sergey; Neurological Surgery, School of Medicine
    Background C7 instrumentation during posterior cervicothoracic fusion can be challenging because it requires additional work of either placing side connectors to a single rod or placing two rods. Our clinical observations suggested that skipping instrumentation at C7 in a multi-level posterior cervicothoracic fusion will result in minimal intraoperative complications and decreased blood-loss while still maintaining sagittal balance parameters of cervical fusion. The objective of this study is to determine the clinical and radiographic outcomes of skipping C7 instrumentation compared to instrumenting the C7 vertebra in posterior cervicothoracic fusion. Methods This is a retrospective chart review of 314 consecutive patients who underwent multilevel posterior cervical fusion (PCF) at our institution. Out of 314 patients, 19 were instrumented at C7 serving as the control group, while the remaining 295 patients were not. Evaluation of efficacy was based on intraoperative complications, operative time, estimated blood loss (EBL), significant long-term complications, and radiographic evidence of fusion. Results Skipping the C7 level resulted in a significant reduction in EBL (488±576 vs. 822±1,137; P=0.007); however, operative time was similar between groups (174±95 vs. 184±86 minutes; P=0.844). Complications were minimal in both groups and not statistically significant. Radiographic analysis revealed C7 bridge patients had a significantly increased postoperative sagittal vertical axis (SVA) (29.3±13.1 vs. 20.2±3.1 mm; P=0.008); however, there was no significant difference between groups in SVA correction (−0.3±16.2 vs. −16.1±16.0 mm; P=0.867), T1 slope correction (3.4°±9.9° vs. 3.2°±5.5°; P=0.127), or cervical cobb angle correction (−5.7°±14.2° vs. −7.0°±12.2°; P=0.519). There were no significant long-term complications in either group. Conclusions Skipping instrumentation at C7 in a multilevel posterior cervicothoracic fusion is associated with significantly reduced operative blood loss without loss of radiographic correction. This study demonstrates the clinical benefits of skipping C7 instrumentation in posterior cervicothoracic fusion with maintenance of radiographic correction parameters.
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    Letter: The Impact of the Coronavirus (COVID-19) Pandemic on Neurosurgeons Worldwide
    (Oxford University Press, 2020-05-20) El-Ghandour, Nasser M. F.; Elsebaie, Eman H.; Salem, Amany A.; Alkhamees, Abdullah F.; Zaazoue, Mohamed A.; Fouda, Mohammed A.; Elbadry, Rasha G.; Aly, Mohamed; Bakr, Hebatalla; Labib, Mohamed A.; Tobin, Matthew K.; Gragnaniello, Cristian; Gonzalez-Lopez, Pablo; Shamisa, Abdalla; Jhawar, Balraj S.; Soliman, Mohamed A. R.; Neurological Surgery, School of Medicine
    The aim of our study was to explore the impact of this pandemic on neurosurgeons with the hope of improving preparedness for future crisis. We created a 20-question survey designed to explore demographics (nation, duration and scope of practice, and case-burden), knowledge (source of information), clinical impact (elective clinic/surgery cancellations), hospital preparedness (availability of personal protective equipment [PPE] and cost of the supplies), and personal factors (financial burden, workload, scientific and research activities). The survey was first piloted with 10 neurosurgeons and then revised. Surveys were distributed electronically in 7 languages (Chinese, English, French, German, Italian, Portuguese, and Spanish) between March 20 and April 3, 2020 using Google Forms, WeChat used to obtain responses, and Excel (Microsoft) and SPSS (IBM) used to analyze results. All responses were cross-verified by 2 members of our team. After obtaining results, we analyzed our data with histograms and standard statistical methods (Chi-square and Fisher's exact tests and logistic regression). Participants were first informed about the objectives of our survey and assured confidentiality after they agreed to participate (Helsinki declaration). We received 187 responses from 308 invitations (60.7%), and 474 additional responses were obtained from social media-based neurosurgery groups (total responses = 661). The respondents were from 96 countries representing 6 continents (Figure ​(Figure11A-​A-11C).