Andrew J. Grossbach, MD, FAANS
@AJGrossbach
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Residency Program Director. Deformity and Robotic Spine Fellowship Director. The Ohio State University Department of Neurosurgery.
Columbus, OH
Joined June 2010
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Welcome to the newest member of The Ohio State University Department of Neurosurgery, James Anthony Grossbach! Mom and baby are doing great!
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32 yo M presents with progressive neck pain, L arm pain, and L arm numbness. History of hemophilia A and Ehlers-Danlos Syndrome. What’s your diagnosis and treatment plan?
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My baby has strong opinions on this. Never mind the backwards scrub hat.
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26 yo M presents to the ED 6 hours after a motor vehicle accident. ASIA A C5 level. What’s your plan for imaging, medical management, reduction, and fixation?
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Medical students: What nerve is affected by this tumor? Junior residents: what’s the most likely diagnosis? Fellows/attendings: what’s your approach for treatment?
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51yo M presents with gait instability. Can’t walk without a walker. Dropping objects. Problems with buttons, handwriting, and other fine motor tasks. What’s your plan? Stage it? Do it all at once? Cervical first? Thoracic first? How long between? First normal disc distal is 12/1
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Quiz: you’re a medical student watching a spine case. Screws are in. They are about to start working on the decompression. You glance at the monitor. What’s going on?
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Look at this monster! L4/5 disc herniation removed via minimally invasive microdiscectomy. Not much that’s more satisfying
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25yo male presents to the ED after a fall off a trampoline. Neck pain and burning paresthesias into the arms and hands. Otherwise intact. Students and residents, what’s the injury. Fellows and attendings, what’s your plan?
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A topic we don't get enough training on in neurosurgery. Complex sacral fractures. This one in a young female after a significant fall and associated with a lumbar fracture. Medical students: classify the spine fracture. Residents: classify the sacral fracture. What to do?
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Mid 50s male with thoracic pain worsening over 2 wks. Fevers. Pain is worse with movements. Radiating pain to lower chest. Full strength. Osteo/discitis at T7/8. What’s your plan? Antibiotics alone? Remove SCS? Lami to decompress? With or without fusion. VCR for anterior support?
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How would you reduce this posteriorly displaced odontoid fracture with associated comminuted Jefferson fracture and quadraplegia?
#Neurosurgery
#spine
#trauma
#spinesurgery
#OhioState
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Here is a diagnosis that can be made on a single X-ray. 40 yo F presents with axial back pain worse with movement. Intact. Students and residents, what’s the diagnosis? Fellows and attendings, what’s your management protocol?
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Cervical trauma after assault. Medical students: what’s the diagnosis? Residents: how do you reduce? Fellows/attendings: what’s your protocol? MRI? CTA? Reduce in the OR, ED, or ICU? Anterior vs posterior approach?
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35 yo F with severe progressive back pain and L5 radiculopathy. Failed all conservative management. What's your approach?
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Planning software can be helpful not only in thoracolumbar deformity, but also when planning cervical deformity correction/revision cases. Here is a 55 year old female who suffered graft subsidence, foraminal stenosis, and kyphosis after a 2 level stand line ADCF with laminectomy
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You asked for a disc herniation! This case highlights the importance of a thorough history, exam, and current imaging. L leg pain: large left L5/S1 disc MRI 18 mo later shows a left L4/5 synovial cyst with resorption of disc! No surgery. Don’t assume it’s still the same pathology
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My first clinic day at our new outpatient center in Dublin!
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56 yo M presents with transient weakness after a visit to the chiropractor with return to baseline. Bottom right axial is post contrast. No fractures on CT. What’s going on here?
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Although ALIFs and laterals are great, a properly performed TLIF can restore adequate lordosis and avoid the need for indirect decompression or a flip. 17 degree PI-LL mm w/foraminal stenosis from L3/4 to L5/S1. Note the b/l facetectomies for decompression and to aid lordosis.
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Honored to be providing neurosurgical coverage for the Ohio State vs Penn State game today. Go Bucks!!
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Here’s a problem that we see commonly. Low grade spondy with a synovial cyst at L4/5 in a 53yo F. Back pain and radiculopathy. Mild worsening of spondy upright vs supine. Widening of joints on MRI. 12mm tall disc. Failed conservative mgmt. Cyst resection, TLIF, Lateral/ALIF, MIS?
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Proud to provide neurosurgical coverage for The Ohio State Buckeyes!
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Ohio State Neurosurgery spine team! Proud to offer neurosurgical coverage for The Ohio State Buckeyes football team!
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32 yo male s/p L4-S1 posterolateral fusion 3 years ago (not my original case) now with progressive back pain and these images. What’s your strategy?
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54 yo M presents with 1 year history of worsening myelopathy. What’s your approach to these complex cervical cases? Medical students: what’s your diagnoses? (there are several answers) Residents and fellows: what complications would you be wary of?
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2 year follow up/outcomes are vital for deformity correction. And it’s very rewarding when you see these patients 2+ years later and they are doing great! Just saw this now 74 year old back looking fantastic.
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View after a far lateral lumbar microdiscectomy. Residents: what is the swelling in the nerve root? Medical students: what type of neuron is located there?
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Great view from the OSU Neurosurgery holiday party with my lovely wife!
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In Cape Town visiting Stellenbosch University and Tygerberg Hospital. They take care of patients with some remarkable pathology!
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64yo F presents s/p long segment fusion up to C2 after fall with worsening neck pain. Neuro intact. Students, what is the problem? Surgeons, what are several possible bail out/revision techniques? Any pros and cons to these?
#spine
#Neurosurgery
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Here is a long segment C2-pelvis fusion for severe kyphoscoliosis. Typically constructs this long are revisions after iatrogenic deformity or proximal junctional failure, but occasionally they are de novo.
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Great day hosting Dr. Wang! Not a bad way to spend a Saturday. A phenomenal talk from a real leader in neurosurgery followed by a cadaver lab on MIS spine surgery for the residents and medical students!
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44 yo M presents with 6 months of neck pain and gradual inability to look up or turn his head. What’s on your differential here?
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Pre-operative planning is essential in long segment fusions. Equally important is analysis of your cases to ensure you are achieving what you set out to achieve. New planning platforms that utilize AI and machine learning can make this process more reproducible.
#spine
#scoliosis
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It’s not just about lordosis. Where the lordosis is located matters. While the indications for surgery was a mobile spondylolisthesis with radic, our goal was also to optimize the lumbar distribution index to hopefully avoid problems down the road. LDI 43 to 71.
#neurosurgery
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Great turnout for the first Big Ten Neurosurgery Consortium. This has the potential to be huge!
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“Minimally invasive” means different things. 55 yo F with a mobile spondy at L4/5. Back pain and L4 radic. Failed conservative. Tall disc. Worried about fusion/subsidence with a small cage. You can put a large cage with tube approach. 32mm x 12mm tall cage via MIS TLIF. Home POD1
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54 yo male presents with chief complaint of dizziness when turning his head to either side. What’s the diagnosis? What’s your treatment plan?
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75yo M presents with neck pain and MRSA bacteremia. Neurologically intact. Has been on 4 weeks of IV abx. Medical students: what’s your diagnosis? Attendings/consultants: what’s your plan?
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Students and residents, based on these X-rays, what’s your diagnosis? Attendings, what are your indications for surgery and what’s your strategy?
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Adjacent segment disease is the bane of degenerative spinal surgery. Here is a prior L4-S1 with ASD. Underwent a L3/4 TLIF with what I thought was good restoration of lordosis. Unfortunately had ASD at L2/3 with a fracture at L3. Offered an XLIF to get a larger footprint
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Although we have a spine fellow confirmed for 2024-25, we have an opening for the 2023-24 academic year! Our fellowship is CAST approved. We are interviewing US trained, board-eligible neurosurgeons. Gain experience in deformity, MIS, laterals, trauma, ALIF, robotics, and more!
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The OR on weekends and holidays can be so quiet and peaceful.
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Throw back to a T8/T9 en bloc spondylectomy for primary bone tumor (sarcoma). En bloc resection is challenging but improves odds for survival and local control.
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Pre-operative planning software can be very helpful for spinal deformty. Note the reciprocal change in thoracic kyphosis before and after this L4 PSO. The patient was flattening their kyphosis as a compensatory mechanism. The plan (case) was spot on to her late follow up
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Follow up on a case I posted earlier. Here is out UNiD planning and execution for multilevel lumbar stenosis with thoracolumbar kyphosis.
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53yo male presents with cervical and thoracic myelopathy. 3-4/5 strength in UE/LE. Inability to walk unsupported. How would you address?
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Thought of this on my drive home today. I may need more hobbies.
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65 yo F presents with progressive myelopathy. What’s your diagnosis? Is that cord signal change from her stenosis? Any additional work up? What’s your surgical approach?
@NeurosurgeryOSU
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63 yo F presents with back pain, bilateral leg pain, urinary urgency, and gait instability. What’s on your differential and how would you approach?
@NeurosurgeryOSU
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65 yo M with a prior L1- L4 open lami at outside hospital presents with progressive back pain, bilateral radiculopathy, and difficulty standing. What’s your approach given the prior extensive posterior decompression? ALIF/laterals or posterior?
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Before and after MRIs from a lateral thoracic discectomy. A great approach for central and calcified thoracic discs causing myelopathy
#NeuroTwitter
#Neurosurgery
#neurosurgeon
#spine
#spinesurgery
#MedTwitter
#AcademicTwitter
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Some of my favorite patients to see back in clinic. Surgery is complex and life changing, often in multiple ways. This 60 yo F is now about 4 months out. No longer needing a wheelchair. Still a long ways to go!
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63 yo F with progressive pain, radiculopathy, and myelopathy. Front/back cervical fusions are big surgeries, but helpful for reducing cervical kyphosis and spondylolisthesis
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I’m a firm believer in height restoration in lumbar fusions
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62 yo F with progressive neck and back pain. Balance problems and difficulty standing for prolonged periods. What’s your game plan? Cervical first? If so where do you stop distally? Or address thoracolumbar curve at the same time?
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Don’t miss out on the second annual virtual NeuroSpine Research Forum scheduled for February 2nd! If your institution has a trainee or two (medical student, resident, fellow, etc.) who would like to present on a spinal research project, let us know! Last year was a huge success!
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Had a great time
@CNS_Update
#2023CNS
learning and networking with colleagues from around the world! Proud of the strong representation from
@NeurosurgeryOSU
! Until next year!
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Indications for surgery to correct scoliosis change in adulthood. Here a progressive curve was causing progressive back pain, radiculopathy from foraminal stenosis, and trunk shift.
#spine
#SpineSurgery
#Neurosurgery
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AANS was a success! Great to see former residency friends, OSU alumni, and neurosurgical mentors!
#AANS2022
#AANS
#neurosurgery
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Iatrogenic spinal deformity is a major cause of adult deformity. I try to avoid three-column osteotomies when at all possible, but here the prior fusion necessitated an extended PSO.
#spine
#deformity
@OSUWexMed
@NeurosurgeryOSU
@OSUNeuroInst
@OhioStateMed
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Great talk today from
@KatieOrrico
the Senior Vice President of
@neurosurgery
We presented her with an Ohio State frame, but she insisted on having this slide up. Guess we will see how the game goes tomorrow!
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54 yo F with progressive back and leg pain. Prior L4-S1 instrumentation years ago. Screws loose at L4 and S1. Progressive curve above. I thought we got good correction skipping interbody at L4/5, but has some residual spondy there. Any issues here if global alignment looks good?
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Nice coronal representation of why the fractional curve is the most common driver of radiculopathy in adult degenerative scoliosis. Check out the neuroforamen on the concavity of the fractional curve between L4-S1.
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The neurosurgery applicants this year are stellar! Very excited for interviews tomorrow!
Happy hour with the residents and applicants. Excited for the first day of interviews tomorrow!
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59 yo F presents with neck pain, mid and low back pain, cervical and lumbar radiculopathy, and subtle cervical myelopathy. What would be your game plan here?
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Our weekly spine research meeting. Grateful for a phenomenal team!
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Does transitional anatomy matter? Here’s a prior “L2-S1”. The level above has a pseudo rib. I’d call this L1-L5 with a sacralized L5. Stopping at L2 might be ok, but if it acts as L1, this pseudoathrosis is bound to happen. How do you go about dealing with transitional anatomy?
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69 to M with neck pain and radiculopathy. Subtle myelopathy. How do you think about approaches when it’s mainly radicular/foraminal stenosis at multiple levels? C6/7 foramen moderate. C2-6 are tight.
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Gorgeous surgical skills lab here at OSU!
@OSUWexMed
@OhioStateMed
@OSUNeuroInst
@NeurosurgeryOSU
#neurosurgery
#surgery
#BigTen
#match2021
#residency
#Buckeyes
#ERAS
#spine
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An honor to provide neurosurgical coverage for
@OhioStateFB
vs.
@HawkeyeFootball
yesterday. Both special programs to me, did my residency training
@IowaNeurosurg
and now with
@NeurosurgeryOSU
!
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Action shot utilizing some in-situ bending while tackling a big deformity case.
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Great meeting this morning with spine fellowship directors from around the country discussing CAST spine fellowship programs and requirements at
@spinesection
2024!
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Spinal osteomyelitis and epidural abscesses are on the rise. These patients can be complex and require complex surgical decompression and stabilization along with medical management. Here is a young male who presented with bacteremia, neck pain, and paraparesis.
@DanKreatsoulas
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MIS spine surgery is a great option for many patients, but severe coronal or sagittal deformity may need to be addressed with open fusion with osteotomies.
@OSUWexMed
@NeurosurgeryOSU
@OhioStateMed
@OSUNeuroInst
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Iatrogenic deformity correction is a tool any deformity surgeon must be prepared to tackle.
#spine
#medtwitter
#surgtwitter
#deformity
#OSU
#OhioState
#Neurosurgery
#residency
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A close defeat, but very proud of our residents competing in this years SANS challenge
@CNS_Update
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While I do most of my big cases at our main hospital
@OSUWexMed
, it’s nice to have the option to do ambulatory MIS cases at our OSU Hospital East Outpatient Surgery Center.
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Great talk from one of the national leaders of neurosurgery!
Honored to have
@EladLevyMD
from
@UB_Neurosurgery
as our 2023 Hunt Lectureship visiting professor! Truly a quadruple threat: clip, coil, investigate, innovate!
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Spinal shortening can be a powerful tool for patients with progressive deficits from tethered cord with prior detetherings.
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It’s an honor to provide neurosurgical coverage for The Ohio State Buckeyes football team. Unfortunately a hard fought loss yesterday, but we will bounce back!
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Great time tonight discussing neurosurgery with the new M1 and M2 students at the Ohio State Neurosurgery Interest Group tonight! Fun to spend time with such bright and energetic students!
@NeurosurgeryOSU
@OhioStateMed
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Great time kicking off the BigTen Neurosurgery Consortium last night!
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Great answers and discussion! C6 teardrop with C5/6 ligamentous disruption and mild central cord. Here’s what we did
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Thank you for the opportunity to speak on my experience utilizing UNiD for deformity correction!
@spinesection
@NeurosurgeryOSU
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38 yo F presents with thoracic and lumbar back pain. 91 degrees of thoracic kyphosis and 93 degrees of lumbar lordosis. Students: what’s going on here? Attendings/consultants: what’s your treatment strategy?
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Great representation from our superstar
@OhioStateMed
medical students at the Ohio State Neurosurgical Society 2023 annual meeting!!
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Awesome work! This is a big deal
Very excited to announce that The Ohio State Neurosurgery Program was recently awarded the NIH NINDS R25 Research Education Grant! The R25 will ensure our residents continue to do cutting edge research and go on to successful academic careers! 🧪 🧬 🧠
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Friday AM spine research meeting before heading to AANS!
#Neurosurgery
#spine
#spinesurgery
#MedTwitter
#AcademicTwitter
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We are looking for US trained graduates for our CAST approved complex reconstructive and robotic spine fellowship for 2022-2023 and 2023-2024! You will learn to free hand screws, correct complex deformities, utilize MIS techniques, and use robotics and navigation platforms!
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Presenting Dr. Shaffrey with a thank you gift for giving a great presentation at Ohio State’s annual Meagher lectureship. He is one of the foremost leaders in spine and I always learn so much listening to him talk.
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An increasing number of instrumented fusions means iatrogenic spinal deformity is becoming more common. Although MIS surgery is a great option for many, open deformity correction is an important skill set for spine surgeons!
@NaderDahdaleh
, think there is any role for MIS here?
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Early exposure to neurosurgery in medical school is key in today’s competitive environment. We are fortunate to have such an amazing, hard-working group of students!
Here’s some of our awesome
@OhioStateMed
students with their posters at the Ohio State Neurosurgical Society meeting. Great work
@adrianlam01
,
@Katelyn_Sette
, Yamenah Ambreen, Jacob Ward,
@JoshVignolles
, Seth Wilson, and Annie Chen!
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Great work by all our Hunt Summer Research Scholars this year! The Hunt Summer Scholars program is designed to get medical students experience in neurosurgical research early in their medical student careers. The future of neurosurgery is bright!
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65yo M with back pain and radic L4-S1. Failed all conservative management. L2/3 and L3/4 not too severe. Alignment on xrays good. Lateral recess/foraminal stenosis worst at L4/5 and 5/1. Thoughts on approach with that lordotic 5/1 disc and position of vessels at L4/5?
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68 yo F with hx of osteo/discitis, completed IV abx 3 mo prior. On suppressive abx. Presents with worsening neck pain and myelopathy. What would you do here?
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