Papers by Mick Perez-Cruet
Neurosurgery, Apr 1, 2023
INTRODUCTION: The number of outpatient surgeries have quadrupled over the past several decades. A... more INTRODUCTION: The number of outpatient surgeries have quadrupled over the past several decades. Although studies have shown increased efficacy and cost-effectiveness of surgery done in an outpatient setting, few studies have compared outpatient surgeries performed at a hospital versus an ambulatory surgery facility (ASF) METHODS: The Michigan Spine Surgery Improvement Collaborative was queried for patients undergoing cervical and/or lumbar spine surgery between 1/1/2021 to 12/31/2021 performed at an ASF or hospital with same day discharge. A 4-to-1 propensity score matching using BMI, location (lumbar, cervical), ASA > 2, fusion procedure and number of levels as the matching variables for lumbar and cervical surgeries. Primary outcomes included: achieving MCID for PROMIS physical function, EQ-5D, Return-to-Work and NASS patient satisfaction. Complications were a secondary outcome and included: Surgical site Infection (SSI), urinary retention, hospital readmission/ED visit, return-to-OR, Axial pain, new radicular findings, weakness, Ileus (lumbar only), and Dysphagia (cervical only). RESULTS: A total of 2,763 patients were identified prior to matching. Of the 1,665 patients that were matched, 1,332 had surgery at a hospital and 333 in an ASF. There were no statistically significant differences for patient satisfaction, PROMIS-PF MCID, or Return-to-Work at 90-days. Patients who had surgery at an ASF had higher rates of axial pain (10% vs 5%, p = 0.002) and new radicular findings(19% vs 12%, p < .001) compared to surgery at a hospital. Dysphagia was also higher in the ASF group (5% vs 0%, p = .006). There were no differences in SSI, readmission, urinary retention, return-to-OR or ED visits between sites CONCLUSIONS: Outpatient spine surgery at an ASF demonstrated no significantly increased surgical morbidity compared to hospitals. Although ASFs had a higher rate of new radicular findings and axial pain, there were no differences in patient satisfaction and PROs after surgery.
Neurosurgery, Aug 20, 2019
INTRODUCTION Racial disparities have been demonstrated to affect healthcare outcomes over a wide ... more INTRODUCTION Racial disparities have been demonstrated to affect healthcare outcomes over a wide range of disease processes. This goal of this study is to evaluate how race may influence outcomes after elective lumbar spine surgery. METHODS MSSIC was queried for all lumbar operations. Race is a patient reported measure and was stratified into three groups (Caucasian, African-American, others). Demographic information, pre-existing comorbidities, baseline PROs including ODI, NRS, EQ5D, and procedure type (number of levels, fusion) were compared across the three groups. Primary outcome measures were the NASS Patient Satisfaction Index, meeting the MCID for PROs, and return to work at 1 and 2 yr after surgery. Poisson GEE models were done to assess racial differences while adjusting for other patient characteristics. RESULTS A total of 19 191 patients were included in this analysis, 16 788 Caucasian, 1436 African-American, 967 other. Compared to Caucasians, African-Americans had higher proportions of smokers (23% vs 17%), diabetes (32% vs 20%), depression (40% vs 34%), and fusions (56% vs 49%), and greater baseline ODI (55.6 ± 16.0 vs 47.7 ± 16.2). African-American patients had significant associations with dissatisfaction after surgery (RR 1.74 at 1 yr, RR 1.86 at 2 yr), less likely to achieve MCID for ODI (RR 0.87 at 1 yr, RR 0.85 at 2 yr), and less likely to return to work (RR 0.78 at 1 yr, RR 0.82 at 2 yr). After adjusting for baseline factors and postoperative factors (ongoing depression, improvement in PRO, complications) the only significant associations were for patient dissatisfaction (RR 1.36 at 1 yr, RR 1.41 at 2 yr). CONCLUSION Despite significant baseline differences, when adjusting for potential confounding factors, there appears to be an association with race and satisfaction after surgery. Further study into factors to mitigate this disparity are necessary to enhance delivery of care and patient perceptions, regardless of race.
Journal of Visualized Experiments, Apr 3, 2017
The human umbilical cord (UC) and placenta are non-invasive, primitive and abundant sources of me... more The human umbilical cord (UC) and placenta are non-invasive, primitive and abundant sources of mesenchymal stromal cells (MSCs) that have increasingly gained attention because they do not pose any ethical or moral concerns. Current methods to isolate MSCs from UC yield low amounts of cells with variable proliferation potentials. Since UC is an anatomically-complex organ, differences in MSC properties may be due to the differences in the anatomical regions of their isolation. In this study, we first dissected the cord/placenta samples into three discrete anatomical regions: UC, cord-placenta junction (CPJ), and fetal placenta (FP). Second, two distinct zones, cord lining (CL) and Wharton's jelly (WJ), were separated. The explant culture technique was then used to isolate cells from the four sources. The time required for the primary culture of cells from the explants varied depending on the source of the tissue. Outgrowth of the cells occurred within 3 -4 days of the CPJ explants, whereas growth was observed after 7 -10 days and 11 -14 days from CL/WJ and FP explants, respectively. The isolated cells were adherent to plastic and displayed fibroblastoid morphology and surface markers, such as CD29, CD44, CD73, CD90, and CD105, similarly to bone marrow (BM)-derived MSCs. However, the colony-forming efficiency of the cells varied, with CPJ-MSCs and WJ-MSCs showing higher efficiency than BM-MSCs. MSCs from all four sources differentiated into adipogenic, chondrogenic, and osteogenic lineages, indicating that they were multipotent. CPJ-MSCs differentiated more efficiently in comparison to other MSC sources. These results suggest that the CPJ is the most potent anatomical region and yields a higher number of cells, with greater proliferation and self-renewal capacities in vitro. In conclusion, the comparative analysis of the MSCs from the four sources indicated that CPJ is a more promising source of MSCs for cell therapy, regenerative medicine, and tissue engineering.
Neurosurgery, Apr 1, 2023
Journal of Brachial Plexus and Peripheral Nerve Injury, 2018
Neurosurgical Focus, 2011
Spine surgery as we know it has changed dramatically over the past 2 decades. More patients are u... more Spine surgery as we know it has changed dramatically over the past 2 decades. More patients are undergoing minimally invasive procedures. Surgeons are becoming more comfortable with these procedures, and changes in technology have led to several new approaches and products to make surgery safer for patients and improve patient outcomes. As more patients undergo minimally invasive spine surgery, more long-term outcome and complications data have been collected. The authors describe the common complications associated with these minimally invasive surgical procedures and delineate management options for the spine surgeon.
British Journal of Neurosurgery, 2007
This is a large comprehensive text book of over 800 pages. It is divided into three sections, fun... more This is a large comprehensive text book of over 800 pages. It is divided into three sections, fundamentals, non-surgical techniques including image guidance and monitoring and then surgical techniques which are divided into the three sections cervical, thoracic and lumbar spines. It is a multi-author book, the main contributors are from neurosurgery and orthopaedic surgery. There are many illustrations of the anatomy in colour, radiographs as well as operative photographs. They are clear and augment the text appropriately. The first section on fundamentals is very comprehensive covering the history of minimally invasive spine surgery and an excellent succinct and clear anatomy of the spine. There are good sections on the biomechanics and the concept of degenerative disease which highlight the concept that detailed knowledge of the anatomy especially of the muscles allows a minimally invasive approach to be undertaken with little damage. The biomechanical section is well laid out for practising clinicians and is not too complicated. The instantaneous access of rotation (centre of rotation) and the concept of sagittal balance are well laid out and relevant to the practising surgeon and easily understandable. The problem of stability is well discussed and the three stability schemes of Denis, White and Punjabi and Benzyl are all well described. In the section of degenerative disc disease a clear and succinct description of the concept of discogenic pain is described and the mechanisms and the concept as well as the clinical manifestations are pragmatically considered. The case for minimally invasive spinal surgery is well discussed and an important point is that this is not a revolution but rather an evolution towards less morbidity. There are interesting sections on setting up a minimally invasive spine centre and the important point of informed consent is well described. Complications are described and key points made include patient selection, specialist additional training to undertake these procedures and that there are steep learning curves. The non-surgical section is interesting and describes the image-guided concept which has no radiation involved as opposed to the traditional fluoroscopy. The evolution of endoscopy is well described and electrophysiological monitoring is considered in detail. Interestingly they describe this monitoring being used for percutaneous placement of pedicle screws as well as needle techniques. The third section which describes minimally invasive spinal surgery for the cervical, thoracic and lumbar spine is very extensive and comprehensive. In regard to the cervical spine, anterior and posterior procedures are described and the impression is that much of what is described is similar to what most of us are doing in regard to minimal approach, accurate radiographic localisation and the use of the microscope which is described using a little less dissection and tubular retractors which are progressively inserted to obtain a working channel. Anterior cervical foraminotomy is described as a day case outpatient procedure, however the description describes a number of patients staying up to four days! In regard to anterior cervical discectomy and fusion again the same approach except more blind dissection is used and then protection of the anatomical structures with the use of a tubular retractor. This again is just an extension of what we do at the present but it would be clearly very important for operators undertaking this approach to be very knowledgeable of the anatomy and very experienced in the minimal blunt dissection approach or damage unrecognised could be incurred. This is encompassed in the concept of the steep learning curve. In regard to posterior instrumented fixation in the cervical and lumbar spines multiple entries through tubular ports is described and of course specialised instrumentation is required in order to complete this internally. Interestingly the comment is made that insertion, placement and fixation of the rods can be challenging! In regard to the micro-endoscopic lumbar discectomy again my feeling was that this is similar to what most of us do in the true microdiscectomy approach and the incision is not that much smaller. Importantly, endoscopically the operator is working on a two planar image whereas with the microscope it is in three dimensions. There are comprehensive sections on thoracic endoscopic discectomy, percutaneous vertebroplasty and kyphoplasty and endoscopic decompression for lumbar stenosis. There are multiple chapters regarding the different pedicle screw systems for the percutaneous lumbar fixation. There are also sections on cervical and lumbar artificial discs again through similar ports of entry except the exposure is held through a tubular retractor. British Journal of Neurosurgery, April 2007; 21(2): 243 – 244
BENTHAM SCIENCE PUBLISHERS eBooks, Jan 25, 2016
IntechOpen eBooks, Sep 28, 2022
LOWARD initially described lumbar interbody fusion without posterior instrumentation in 1953. 4 A... more LOWARD initially described lumbar interbody fusion without posterior instrumentation in 1953. 4 Although his procedure was performed by others, it failed to be widely adopted and results were equivocal. The combination of lumbar interbody fusion and posterior lumbar instrumentation improved surgical outcomes for axial lumbar pain. 1,13,14 Since these initial reports, the TLIF operation, which requires a one-sided approach to the intravertebral space, has become widely accepted. Several minimally invasive approaches for the TLIF procedure have been reported. 5,9 In this paper, we describe a modification of the minimally invasive TLIF technique in which unilateral pedicle screw instrumentation is used. The minimally invasive approach makes unilateral instrumentation particularly appealing. The purpose of this study is to evaluate clinical outcomes in patients undergoing a minimally invasive TLIF with unilateral instrumentation. Clinical Material and Methods Patient Characteristics Prospective data were collected in 34 patients undergoing a one-level minimally invasive TLIF procedure. Twenty patients with 6 months or more of follow up were included in the study. The patients' mean age was 49 years (range 33-55 years), and there were eight women and 12 men. Workers' Compensation litigation was pending for four patients. The vertebral levels involved included L5-S1 (11 patients), L4-5 (eight), and L3-4 (one).
Neurosurgery, Apr 1, 2023
Minimally Invasive Spine Surgery - Advances and Innovations
Lumbar stenosis is the most common pathology seen and treated by spine surgeons. It is often seen... more Lumbar stenosis is the most common pathology seen and treated by spine surgeons. It is often seen in the elderly population who frequently have multiple medical co-morbidities. Traditional approaches remove the spinous process and detach paraspinous muscles to achieve adequate canal decompression. This approach can damage the posterior tension band leading to permanent muscle damage, scar tissue formation, iatrogenic flatback syndrome, and increase risk of adjacent segment disease requiring reoperation. Performing lumbar laminectomy in a cost-effective manner is critical in effectively treating patients with lumbar stenosis. This chapter reviews a minimally invasive muscle-sparing approach to treating lumbar stenosis. The technique is performed through a tubular retractor. Direct decompression of the spinal stenosis is achieved while preserving the paraspinous muscle attachments and spinous process. This technique has multiple advantages and can potentially reduce load stress on adj...
Frontiers in Genetics
Human mesenchymal stem cells (MSCs) are isolated from various adult and perinatal tissues. Althou... more Human mesenchymal stem cells (MSCs) are isolated from various adult and perinatal tissues. Although mesenchymal stem cells from multiple sources exhibit similar morphology and cell surface markers, they differ in their properties. In this study, we determined that the expression of integrin alpha 6 (ITGA6) and ITGA6 antisense RNA (ITGA6-AS1) correlates with the proliferation, cell size, and differentiation potential. The expression of ITGA6 was inversely correlated with ITGA6-AS1 in MSCs. The expression of ITGA6 was higher, but ITGA6-AS1 was lower in MSCs from cord placenta junction, cord tissue, and Wharton’s jelly. In contrast, ITGA6 expression was lower, while ITGA6-AS1 was higher in MSCs from the placenta. The bioinformatic analysis showed that ITGA6 genomic DNA transcribes ITGA6-AS1 from the reverse strand, overlapping ITGA6 exon-2. Additionally, we identify several putative promoters (P1-P10) of ITGA6. ITGA6-P10 is CG rich and contains CGI. EMBOSS Cpgplot software revealed a C...
Frontiers in Surgery
Minimally-Invasive robotic spine surgery (MARSS) has expanded the surgeons armamentarium to treat... more Minimally-Invasive robotic spine surgery (MARSS) has expanded the surgeons armamentarium to treat a variety of spinal disorders. In the last decade, robotic developments in spine surgery have improved the safety, accuracy and efficacy of instrumentation placement. Additionally, robotic instruments have been applied to remove tumors in difficult locations while maintaining minimally invasive access. Gross movements by the surgeon are translated into fine, precise movements by the robot. This is exemplified in this chapter with the use of the da Vinci robot to remove apical thoracic tumors. In this chapter, we will review the development, technological advancements, and cases that have been conducted using MARSS to treat spine pathology in a minimally invasive fashion.
The Spine Journal, 2007
The Spine Journal, Volume 7, Issue 5, Pages 109S-110S, September 2007, Authors:Kenneth Yonemura, ... more The Spine Journal, Volume 7, Issue 5, Pages 109S-110S, September 2007, Authors:Kenneth Yonemura, MD; Ali Araghi, MD; John Carrino, MD, MPH; Larry Khoo, MD; Mick Perez-Cruet, MD; Ron Von Jako, MD; Micheal Finn, MD. Journal Home, ...
Journal of Clinical Neuroscience, 2012
The purpose of this study was to assess the clinical and radiological outcomes of minimally invas... more The purpose of this study was to assess the clinical and radiological outcomes of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) surgery for lumbar spondylolisthesis. A prospective analysis was conducted of 23 consecutive patients with grade I or grade II lumbar spondylolisthesis who underwent a MI-TLIF using image guidance between August 2008 and September 2010. The patient group comprised 13 males and 10 females (mean age 57 years), 22 of whom underwent single level fusion and one patient with a two level fusion. All patients underwent postoperative CT scans to assess pedicle screw and cage placement and fusion at six months. The Oswestry Disability Index (ODI) scores were recorded preoperatively and at the six-month follow-up. We found that 22 of 23 (95.7%) patients showed evidence of fusion at six months with a mean improvement of 26.7 on ODI scores. The mean length of hospital stay was four days. The mean operative time was 172 minutes. Anatomical reduction of the spondylolisthesis was complete in 16 patients and incomplete in seven. Regarding complications, we observed: one of 94 (1.1%) pedicle screws misplaced, which did not require revision postoperatively; one of 23 patients (4.3%) with a pulmonary embolism and one of 23 (4.3%) patients with transient nerve root pain. There were no occurrences of infection and no postoperative cerebrospinal fluid leaks. We conclude that MI-TLIF offers patients a safe and effective surgical option for lumbar spondylolisthesis treatment. Furthermore, it may offer patients additional advantages in terms of postoperative pain and recovery.
Neurosurgery, 2002
OBJECTIVE The microendoscopic discectomy (MED) technique was initially developed in 1997 to treat... more OBJECTIVE The microendoscopic discectomy (MED) technique was initially developed in 1997 to treat herniated lumbar disc disease. Since then, thousands of cases have been successfully performed at more than 500 institutions. This article discusses the technical aspects of this procedure and presents a consecutive case series. METHODS A total of 150 consecutive patients underwent MED. MED is performed by a muscle-splitting approach using a series of tubular dilators with consecutively increasing diameters. A tubular retractor is then inserted over the final dilator, and a specially designed endoscope is placed inside the tubular retractor. The microdiscectomy is performed endoscopically while the surgeon views the procedure on a video monitor. RESULTS Clinical outcomes were determined using a modified MacNab criteria, which revealed that 77% of patients had excellent, 17% had good, 3% had fair, and 3% had poor outcomes. The average hospital stay was 7.7 hours. The average return to wo...
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Papers by Mick Perez-Cruet