Matt El Kadi, MD, PhD

Board Certifications: Neurosurgery Specialty: Neurosurgery
Education: Second Moscow State Pirogov Medical Institute
Residency: Burdenko Neurosurgical Institute, Moscow, Russia, West Virginia University Hospital
Fellowships: University of Connecticut, Allegheny General Hospital

Update on Sublaminar Hook Fixation in Cervical Spine Trauma
James P. Burke, MD, PhD, Adnan A. Abla, MD (Pittsburgh, PA), Hikmat El Kadi, MD, PhD (Pittsburgh, PA), Jeffrey W. Bost, PAC (Pittsburgh, PA), Adib Abla (Pittsburgh, PA), Abir Abla (Pittsburgh, PA)

Authors: James P. Burke, MD, PhD, ; Adnan A. Abla, MD; Joseph C. Maroon, MD; Robert Relic, PAC; Jeffrey Bost, PAC; Hikmat El Kadi, MD, PhD; Adib Abla, ; Abir Abla,

Abstract:
Introduction: Anterior screw-plate fixation has become integral to the management of many pathological conditions of the subatlantal cervical spine. Complications of multilevel anterior cervical discectomy/fusions (ACDF) and corpectomies include implant failure with screw or plate dislodgement and pseudarthrosis with fibrous union at the fusion site, necessitating revision of the entire graft and instrumentation construct. We report radiographic and clinical outcomes following long-segment plating of the anterior cervical spine. Methods: From 1994 to 2000, one-hundred ten patients underwent multi-level ACDF and/or corpectomies using allograft bone and various anterior cervical plating systems. (Mean age 64.6 years, range 29-85; 90 males, 20 females). Pre-operative diagnoses were myeloradiculopathy (61), myelopathy (43), and other (6). In all cases, the etiology was degenerative disease. Anterior cervical instrumentation included Synthes' Cervical Spine Locking Plate (82), Sofamor-Danek's Atlantis (14) and Orion plates (13), and the Codman Locking Plate System (1). Fifty-eight three-level and 24 four-level ACDFs were performed; additionally, 16 three-level with corpectomy, 9 four-level with corpectomy and 3 five-level ACDFs with corpectomy were performed. Plate length ranged from 62 to 88mm; screw lengths were 12-16 mm (total screws, 860). Results: Radiographs at 1, 3, 6, 12, 18 and 24 months demonstrated fusion by 6 months in all patients. Two screw pullouts and one plate fracture were identified; no evidence of pseudoarthrosis or screw fracture was observed. Clinical outcome was excellent in all patients. Conclusions: We believe that meticulously shaving the endplates and placing the allograft bone plug in contact with the anterior rim of cortical bone provides for solid fusion. We conclude that, despite the technical challenges involved, many patients can safely and successfully undergo multi-level (>2 levels) ACDF and/or corpectomies with plating.

Authors: James P. Burke, MD, PhD, ; Adnan A. Abla, MD; Joseph C. Maroon, MD; Jeffrey Bost, PAC; Robert Relic, PAC; Hikmat El Kadi, MD, PhD; Adib Abla, ; Abir Abla,

Abstract:
Introduction: Lumbosacral pedicle screw fixation is a safe and effective technique for the promotion of spinal fusion. Postoperatively, a molded thoracolumbar orthosis (TLSO) has been prescribed for approximately 3 months, with "excessive exercise" avoided for the first few months. We present the outcome of 50 patients in whom a less rigid, smaller brace has been worn for only 2 months, with earlier initiation of physical therapy. Methods: Fifty patients underwent lumbosacral arthrodesis with TSRH pedicle screw instrumentation and lateral mass bone fusion. (Mean age 66.5 years, range 45-83; 29 females, 21 males). Surgical indications were degenerative spondylolisthesis, isthmic spondylolisthesis, post laminectomy spondylolisthesis, and severe spondylosis. Single and 2-level fusions were performed between L2-3 and L5-S1. Screw size ranged from 5.5 to 7.5 X 40 mm (total screws, 188). Postoperative radiographs were obtained at 2, 4, and 6 months. Results: No evidence of segmental instability or screw fracture was observed. In contrast to >300 similar patients, postoperative management included the Cybertech brace, a less rigid, smaller brace with better patient compliance than the traditional TLSO. Following the 2-month visit, physical therapy was started, and the brace discontinued, one month sooner than the prior group of patients. Return to work was permitted at 4 months, 2 months earlier than the prior group, resulting in a significant reduction in the socioeconomic cost of this operation. To date, good outcomes have been observed in all patients who were seen up to 6 months postoperatively. Conclusions: As spinal fusion, with its indications, criteria, and techniques, continues to evolve, advances in postoperative management are expected. We hope to continue to accelerate this process, as our patients appear to respond well to the aggressive recovery schedule.

Authors: James P. Burke, MD, PhD, ; Adnan A. Abla, MD; Joseph C. Maroon, MD; Jeff Bost, PAC; Robert Relic, MD; Hikmat El Kadi, MD, PhD; Adib Abla, ; Abir Abla,

Abstract:
Introduction: The technical difficulties of pedicle screw fusion following either prior fusion or prior laminectomy are well documented. Cerebrospinal fluid leaks and significant neural tissue trauma from dural scar removal are considered the greatest challenges of reoperative fusion. We present 45 patients who underwent "redo" lumbosacral spine fusion, and discuss techniques to avoid dural and nerve root injury. Methods: Forty-five patients underwent lumbosacral arthrodesis with TSRH pedicle screw instrumentation and lateral mass bone fusion. (Mean age 66.5 years, range 45-83; 24 females, 21 males). Surgical indications were degenerative spondylolisthesis, isthmic spondylolisthesis, post laminectomy spondylolisthesis, and severe spondylosis. Single and 2-level fusions were performed between L2-3 and L5-S1. Screw size ranged from 5.5 to 7.5 X 40 mm (total screws, 188). Postoperative radiographs were obtained at 2, 4, and 6 months. Results: Five screw fractures were identified. There were two post-operative infections. Clinically, all patients who were seen up to 24 months postoperatively had good outcomes, regardless as to whether a screw fracture had occurred. No patients required reoperation for spinal instrumentation, and no dural tears required additional surgical intervention. Conclusions: Our results suggest that this patient population can be operated on safely if several key points are followed. The most important point is the ability of the surgeon to locate normal anatomy. Locating normal anatomy can be done by dissecting medially towards the medial facet joint and exposing the residual bone under the scar tissue. Once completed bilaterally, the scar-covered dura can be identified and often exposed. Often scar attached to the dura can be left without compromising the decompression. These techniques and patient dissection have lead to better outcomes.

Authors: James P. Burke, MD, PhD, Adnan A. Abla, MD, (Pittsburgh, PA), Hikmat El Kadi, MD, PhD, (Pittsburgh, PA), Jeff Bost, PAC, (Pittsburgh, PA), Abir Abla, (Pittsburgh, PA), and Adib Abla(Pittsburgh, PA),

Abstract:
Objective: To evaluate the effect of age on the outcome of lumbosacral pedicle screw fixation. Methods: Between 1993 and 2000, 157 patients (range, 27 to 90 years) underwent pedicle screw arthrodesis of the lumbosacral spine for non-traumatic indications. Patients were grouped as those younger than 61 years (Group A: n=71, male 33, female 38, mean age 48.3 years), and those 61 years or greater (Group B: n=85, male 43, female 42, mean age 71.0 years). Fusion rates, complication rates, and clinical outcome were reviewed retrospectively. Outcome data included subjective, objective, and radiographic results. Results: Preoperative diagnoses differed significantly between the groups: isthmic spondylolisthesis accounted for 60% in Group A versus 10% in Group B, while degenerative spondylolisthesis accounted for 20% in Group A versus 52% in Group B. Preoperative motor scores, presence of fractures, and complications rates were the same in each group. Length of stay was not significantly different between the groups; however, 9% of the older patients required a rehabilitation stay post-hospitalization versus 3% of the younger patients. In Group B, 39% were fused at three or more levels versus only 15% of Group A patients. Outcomes, including fusion rates, clinical and subjective improvements, were similar between the groups. Conclusion: With the additional patients added to this analysis since 1998, there again is no significant difference in outcome based on patient age for lumbosacral pedicle screw arthrodesis. Again, we conclude that, using careful selection, adults of any age can safely undergo this operation

Authors: James P. Burke, MD, PhD, Adnan A. Abla, MD (Pittsburgh, PA), Hikmat El Kadi, MD, PhD (Pittsburgh, PA), Jeffrey W. Bost, PAC (Pittsburgh, PA), Adib Abla (Pittsburgh, PA), Abir Abla (Pittsburgh, PA)

Abstract:
OBJECTIVE: To further evaluate the success of sublaminar hook fixation in the treatment of spinal instability following cervical spine trauma. METHODS: Forty-one patients with unstable cervical spine fractures were treated with sublaminar hook fixation (ApoFix System¨, Sofamor-Danek) between 1993 and 2000. (59% male: 41% female; mean age, 54 years). The following injuries were treated: type II odontoid fractures (34%), unilateral or bilateral locked facets 20%), C1-C2 subluxation (19%), subaxial subluxation (20%), and angulated burst fractures (10%). Pre-operative examination was normal in 25 of the patients. Six patients had unilateral or bilateral radicular weakness, 5 were quadriplegic, and 5 had central cord syndrome. Twenty-seven (66%) of the patients underwent posterior cervical stabilization alone. These patients were positioned in mild extension, multiple radiographs were obtained to ensure alignment, and the sublaminar hooks were placed. The remainder of the patients also required anterior cervical discectomy and plating. All patients were placed in a hard cervical collar postoperatively. Average follow-up period was two years (range, 6 months to 3 years). RESULTS: No patient deteriorated neurologically from the procedure. All patients with radicular symptoms and central cord syndrome showed some improvement at 6 months. One of the four quadriplegic patients was ambulatory at three months. All patients showed radiographic evidence of fusion at 3 months, no patient developed late instability, and no patient required reoperation. CONCLUSION: Sublaminar hook fixation for cervical spine trauma continues to be a safe procedure and provides adequate support to prevent subluxation until bony fusion occurs.

1993-1994 University of Connecticut, Hartford, Connecticut Clinical Fellow Neurosurgery, Department of Neurosurgery

1994-1999 West Virginia University, Morgantown, West Virginia Resident Neurosurgery, Department of Neurosurgery

1997-1998 Allegheny General Hospital Pittsburgh, Pennsylvania Neurosurgery Fellow (with emphasis on complex spine cases with instrumentation)

SPECIAL TRAINING:

Courses: AO/ASIF Comprehensive and Advanced Spine Course, July 16-19, 1998. Montreal, Canada

Spine Review Hands-on: For Young Neurosurgeons, August 15-21,1998.

Albuquerque, New Mexico

APPOINTMENTS and POSITIONS

ACADEMIC:

1999-present University of Pittsburgh, Pittsburgh, Pennsylvania Clinical Assistant School of Medicine, Professor of Neurosurgery

1999-present West Virginia University, Morgantown, West Virginia Clinical Assistant School of Medicine Professor of Neurosurgery

CERTIFICATION

SPECIALTY CERTIFICATION:

American Board of Neurological Surgeons Dec 2002

MEDICAL LICENSURE

State Medical Board of Pennsylvania 1999

State Medical Board of Ohio 1999

State Medical Board of West Virginia 1995

State Medical Board of California 1994

MEMBERSHIPS IN PROFESSIONAL SOCIETIES

American Association of Neurological Surgeons 1995

American Medical Association 1999

Congress of Neurological Surgeons 1995

Pennsylvania Medical Society 2000

Allegheny County Medical Society 2000

Pennsylvania Neurosurgical Society 2000

North American Spine Society 2002

PUBLICATIONS

PEER-REVIEWED JOURNAL ARTICLES

1. Turkin AM, El-Kadi H, Kornienko VN, et al.: Magnetic resonance tomography

in the diagnosis of chronic intracranial hematomas. J Vop Neurochirugia

(Moscow) 3:6-10, 1988.

2. El-Kadi H: Pathogenesis and treatment of chronic subdural hematomas. J Vop Neurochirugia (Moscow), 2:47-52, 1988.

3. El-Kadi H, Likhterman LB, Kornienko VN: CT manifestations of chronic subdural hematomas. J Roentgen (Moscow) 3:80-86, 1990.

4. El-Kadi H, Likhterman LB, Kornienko VN: CT diagnosis and dynamics in the

treatment of chronic subdural hematoma in different age groups. J Neurol Psychiat

(Moscow) 90:120-123, 1990.

5. Konovalov AN, El-Kadi H, Likhterman LB: Differential treatment of chronic subdural hematoma. J Vop Neurochirugia (Moscow) 1:29:32, 1990.

6. Zlokovic BV, Banks WA, El-Kadi H: Erchegyi, Mackie JB, McComb JG and Kastin A: Transport, uptake, metabolism of blood-borne vasopression by the blood-brain barrier. Brain Research 590:213, 1992.

7. Oppenheimer J, Levy M, El-Kadi H, Appuzo MLJ: Radionecrosis secondary to radiobrachiotherapy: correlation of magnetic resonance and detailed histopathological autopsy findings. Neurosurgery 31:336-343, 1992.

8. Khosrovi H, Kauffman HH, Bloomfield SH, Prabhu V, El-Kadi H: Laproscopic assisted distal ventriculoperiotneal shunt revision. Surgical Neurology 49:127-135, 1998.

9. Khosrovi H, Sadrolhefazi A, El-Kadi H, Bloomfield S: Intradural convexity chondroma: A case report and review of diagnostic features. Scientific Newsfront, The West Virginia Medical Journal 96:612-616, 2000.

BOOK CHAPTERS

1. Dobrokhotiva TA, El-Kadi H: Psychopathological features of head injury in elderly and senile patients. In: Konovalov A. (ed), Actual problems of Neurotraumatology, Academy of Medical Sciences (Moscow), 1988, pp. 99-111.

2. El-Kadi H: Closed System drainage in the treatment of chronic subdural hematomas. In: Lichterman L (ed), Diagnosis and Tactical Mistakes in Neurotraumatology, Acadamy of Medical Sciences (Moscow), 1988, pp. 71-76.

3. El-Kadi H: Comparative analysis of radical and sparse surgical treatment of chronic subdural hematoma. In: Konovalov A. (ed), Actual problems of Neurotraumatology, Academy of Medica Sciences (Moscow), 1988, pp. 153-159.

4. Lichterman L, Patapov A, El-Kadi H: Clinical classification of sequalee of crainiocerebral trauma. In: Konovalov A. (ed), Classification of Craniocerebral Trauma, Autobank (Moscow),1992, pp.102-121.

5. El-Kadi H, Kaufman HH: Hygroma In: Kaufman HH (ed), Cerebrospinal Fluid Collections,American Association of Neurological Surgeons (San Francisco), 1998, pp. 157- 166.

6. Hogg JP, Peterson AM, El-Kadi H: Imaging of cranial and spinal cerebrospinal fluid collections. In: Kaufman HH (ed), Cerebrospinal Fluid Collections, American Association of Neurological Surgeons (San Francisco), 1998, pp. 19-56.

7. El-Kadi H: Prognosis of chronic subdural hematoma. In: Neurosurgery Clinics of North America. El-Kadi H, Kaufman HH (eds.), W.B. Saunders Company, Philadelphia PA, July 2000. pp. 553-567.

8. Kravtchouk AD, Likhterman LB, Potapov AA, El-Kadi H: Postoperative Complications of Chronic Subdural Hematomas: Prevention and Treatment, In: Neurosurgery Clinics of North America. El-Kadi H, Kaufman HH (eds.), W.B. Saunders Company, Philadelphia PA, July 2000. pp. 547-552.

9. El-Kadi H, Kaufman H: Brain death. In: Youmans Julian R., Neurological Surgery, new edition.

BOOKS

1. El-Kadi H, Kaufman H: Chronic Subdural Hematoma. Neurosurgery Clinics of North America. W.B. Saunders Company., Philadelphia, PA., July 2000.

ABSTRACTS

1. Zlokovic BV, Banks WA, El-Kadi H, et al.: Blood to brain transport and metabolism of circulating vasopression. (Abstract) Society of Neuroscience, 1991, pg. 140.

2. Likhterman L, El-Kadi H, Kravtchuk AD: The phase of clinic current of chronic subdural hematomas. (Abstract) In: Nakamura N, Thashimoto M, Yasue M (eds), Resent Advances in Neurotraumatology, Springer-Verlag, Tokyo, 1993, pg. 206.

3. Potapov A, Kravohuk, Likhterman L, and El-Kadi H: Closed external drainage and evolution of chronic subdural hematomas. (Abstract) In: Nakamura N, Thashimoto M, Yasue M (ed), Recent Advances in Neurotraumatology, Springer-Verlag, Tokyo, 1993, pg.110.

4. Likhterman L, El-Kadi H: Chronic subdural hematoma. (Abstract) In: Likhterman L (ed), Neurotraumatology Reference Book, VASAR-Ferrco, Moscow, 1994, pp. 199-201.

5. Burke JP, Abla AA, El-Kadi H, Bost J, Abla A, Abla Ad: Update to pedicle screw fixation and allograft arthrodesis in the young and elderly populations. AANS/CNS Section on Disorders of the Spine and Peripheral Nerves Meeting, Challenges in the Spine Specialty Program Book, Phoenix, AZ, February 14-17, 2001.

6. Burke JP, Abla AA, El-Kadi H, Bost J, Abla A, Abla Ad. Update on sublaminar hook fixation in cervical spinal trauma. AANS/CNS Section on Disorders of the Spine and Peripheral Nerves Meeting, Challenges in the Spine Specialty Program Book, Phoenix, AZ, February 14-17, 2001.

7. Koebbe, Christopher J.,MD, Maroon, Joseph C.,MD, Abla, Adnan, MD, El-Kadi, Hikmat, MD, PhD, and Bost, Jeffery, PAC. Lumbar microdiscetomy: a historical perspective and current technical considerations. Neurosurgery Focus, Volume 13/ August, 2002.

PRESENTATIONS

1. Bloomfield SM, Cross R, El-Kadi H: Intrathecal morphine infusion for chronic intractable benign pain. American Society for Stereotactic and Functional Neurosurgery, Los Angeles, March 9, 1995.

2. Bloomfield SM, Cross R, El-Kadi H: Stereotatic brain biopsy performed in the CT scanner: experience with 100 cases and advantages compared to stereotactic biopsies in the OR or free-hand CT-guided biopsy. Congress of Neurological Surgeons. San Francisco, October 18, 1995.

3. El-Kadi H: Decision Making in Spinal Surgery, Invited Lunch Time Learning, Wheeling Hospital, September 2001.

POSTERS

1. Levy ML, Rezai AR, Tang G, Apuzzo MLJ, El-Kadi H: Multifactorian analysis of gang-related craniocerebral penetrating injuries in a metropolitan area. American Association of Neurological Surgeons, San Francisco, April 20, 1991.

2. Bloomfield SM, Cross R, El-Kadi H: Intrathecal morphine infusion for chronic intractable benign

pain. American Society for Stereotactic and Functional Neurosurgery, Los Angeles, March 9, 1995.

3. Bloomfield SM, El-Kadi H, Haut M, Ortiz O, Ellis B: Stereotactic approaches to surgery on patients with occipital lobe brain tumor. American Society for Stereotactic and Functional Neurosurgery, Los Angeles, March 9, 1995.

4. El-Kadi H, Bloomfield SH, Ortiz O, Haut M, Ellis G: Alexia in patients with occipital lobe tumors: functional anatomy and multi-disciplinary stratigies to optimize surgical outcome. Congress of Neurological Surgeons, San Francisco, October 18, 1995.

5. El-Kadi H, Kaufman HH: In: Kaufman HH (ed), Cerebrospinal Fluid Collections, American Association of Neurological Surgeons (San Francisco), 1998, pp. 157-166.

7. Long-Segment Plating of the Anterior Cervical Spine: Radiographic and Clinical Outcome, James P. Burke, MD, PhD, ; Adnan A. Abla, MD; Joseph C. Maroon, MD; Robert Relic,PAC; Jeffrey Bost,PAC; Hikmat El-Kadi, MD, Ph.D,; Adib Abla,;Abir Abla, AANS 2002 Chicago

8. Advances in Postoperative Management of Lumbosacral Pedicle Screw Fusion Patients, James P. Burke, MD,Ph.D.,; Adnan A. Abla, MD; Joseph C. Maroon, MD; Jeffrey Bost, PAC; Robert Relic, PAC; Hikmat El-Kadi, MD, Ph.D.; Adib Abla; Abir Abla, AANS 2002 Chicago

9. Salvage Pedicle Screws for Post-Lamiectomy Spondylolisthesis and Failed Spinal Fusion, James P. Burke, MD, PhD; Adnan A. Abla, MD; Joseph C. Maroon, MD; Jeff Bost, PAC; Robert Relic,PAC; Hikmat El-Kadi,MD, PhD; Adir Abla; Adib Abla, AANS 2002 Chicago

RESEARCH GRANTS

1. Early prediction of severity of closed head injury in football accidents using neuropsychological testing, MRI and PET scanning. National Operating Committee on Standards for Athletic Equipment (NOCSAE) 1996.

2. Clinical Investigation of the Safety & Efficacy of Pulse Electromagnetic Fields (Cervical-Stim ™ as An Adjunct to Cervical Spinal Fusion to enhance Fusion Success. Investigators: Daniel Wecht MD (PI), Joseph Maroon MD, Adnan Abla MD, El-Kadi, H, Ghassan Bejjani MD, Neuroscience Research Foundation, Sponsor, 5/99 to present.

3. Comparison of Experience and Clinical Outcomes following Treatment of Degenerative Disc Disease using Synthes Spine, Co., Small Stature CSLP PI- El- Kadi H, M.D., Ph.D., Adnan A. Abla, M.D. 8/00 to present.

4. A study with VG2 Interbody Fusion for Patients with Discogenic Back Pain PI- El- Kadi H, M.D.,Ph.D. 4/01 to present

5. A study with VG2 Interbody Fusion and Pedicle Screw Fusion for Patients with Discogenic Back Pain PI- El- Kadi H, M.D., Ph.D. 6/01 to present.

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Clinical information is provided for educational purposes and not as a medical or professional service. Person(s) who are not medical professionals should have clinical information reviewed and interpreted or applied only by the appropriate health professional(s).

Matt El Kadi, MD, PhD	*Tri-State Neurosurgical Associates - UPMC, Western Pennsylvania, West Virginia and Ohio*
	Neurosurgeon and Spine Surgery Specialist