Courtney Goodwin

Positions:

Assistant Professor of Neurosurgery

Neurosurgery
School of Medicine

Assistant Professor in Radiation Oncology

Radiation Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

B.S. 2002

University of Florida

Ph.D. 2008

Johns Hopkins University School of Medicine

M.D. 2010

Johns Hopkins University School of Medicine

Internship, Neurosurgery

Johns Hopkins Medicine

Residency, Neurosurgery

Johns Hopkins Medicine

Grants:

Health Related Quality of Life Outcomes in Spinal Metastases

Administered By
Neurosurgery
Awarded By
Robert Wood Johnson Foundation
Role
Principal Investigator
Start Date
End Date

Pain Outcomes in Single-High Dose vs. Hypofractionated SBRT for Spinal Metastases

Administered By
Neurosurgery
Awarded By
Neurosurgery Research and Education Foundation
Role
Principal Investigator
Start Date
End Date

Extent of Resection and Spinal Stabilization and Reconstruction in Spinal Tumors

Administered By
Neurosurgery
Awarded By
Medtronic, Inc.
Role
Co-Principal Investigator
Start Date
End Date

SUMOylation of PYK2 in breast cancer spinal metastases

Administered By
Neurosurgery
Role
Principal Investigator
Start Date
End Date

The Influence of Spinopelvic parameters on Spinal Tumor Outcomes

Administered By
Neurosurgery
Awarded By
North Carolina Spine Society
Role
Principal Investigator
Start Date
End Date

Publications:

Risk factors for prolonged length of stay in patients undergoing surgery for intramedullary spinal cord tumors.

Primary spine tumors are rare neoplasms that affect about 0.62 per 100,000 individuals in the US. Intramedullary spinal cord tumors (IMSCTs) are the rarest of all primary tumors involving the spine and can cause pain, imbalance, urinary dysfunction and neurological deficits. These types of tumors oftentimes necessitate surgical treatment, yet there is a lack of data on hospital length of stay and complication rates following treatment. Given that treatment candidacy, quality of life, and outcomes are tied so closely to potential for prolonged length of stay and postoperative complications, it is important to better understand the factors that increase the risk of these outcomes in patients with IMSCTs. METHODS: The National Surgical Quality Improvement Program (NSQIP) database was queried for all patients undergoing surgery for treatment of intramedullary spinal cord tumors between 2005 and 2017. Univariate and multivariate analysis were performed to assess patient risk factors influencing prolonged length of stay and post-op complications. RESULTS: A total of 638 patients were included in the analysis. Pre-operative American Society of Anesthesiology (ASA) physical status classification of 3 and above (OR 1.89; p = 0.0005), dependent functional status (OR 2.76; p = 0.0035) and transfer from facilities other than home (OR 8.12; p <0.0001) were independent predictors of prolonged length of stay (>5 days). The most commonly reported complications were pneumonia (5.7%), urinary tract infection (9.4%), septic shock (3.8%), superficial incisional infection (5.7%), organ or space infection (5.7%), pulmonary embolism (11.3%), DVT requiring therapy (15.1%) and wound dehiscence (5.7%). CONCLUSION: Our study demonstrated the significant influence of clinical variables on prolonged hospitalization of IMSCT patients. This should be factored into clinical and surgical decision making and when counseling patients of their expected outcomes.
Authors
Waguia, R; Wang, TY; Mehta, VA; Ramirez, L; McCray, E; Pennington, Z; Price, M; Dalton, T; Baëta, C; Sciubba, DM; Karikari, IO; Abd-El-Barr, MM; Rory Goodwin, C
MLA Citation
Waguia, Romaric, et al. “Risk factors for prolonged length of stay in patients undergoing surgery for intramedullary spinal cord tumors.J Clin Neurosci, vol. 91, Sept. 2021, pp. 396–401. Pubmed, doi:10.1016/j.jocn.2021.06.046.
URI
https://scholars.duke.edu/individual/pub1492632
PMID
34373058
Source
pubmed
Published In
J Clin Neurosci
Volume
91
Published Date
Start Page
396
End Page
401
DOI
10.1016/j.jocn.2021.06.046

A Prospective Comparison of the Effects of Instrument Tracking on Time and Radiation During Minimally Invasive Lumbar Interbody Fusion.

BACKGROUND: Minimally invasive surgical techniques have resulted in improved patient outcomes. One drawback has been the increased reliance on fluoroscopy and subsequent exposure to ionizing radiation. We have previously shown the efficacy of a novel instrument tracking system in cadaveric and preliminary clinical studies for commonplace orthopedic and spine procedures. In the present study, we examined the radiation and operative time using a novel instrument tracking system compared with standard C-arm fluoroscopy for patients undergoing minimally invasive lumbar fusion. METHODS: The radiation emitted, number of radiographs taken, and time required to complete 2 tasks were recorded between the instrument tracking systems and conventional C-arm fluoroscopy. The studied tasks included placement of the initial dilator through Kambin's triangle during percutaneous lumbar interbody fusion and placement of pedicle screws during both percutaneous lumbar interbody fusion and minimally invasive transforaminal lumbar interbody fusion with or without instrument tracking. RESULTS: A total of 23 patients were included in the analysis encompassing 31 total levels. For the task of placing the initial dilator into Kambin's triangle, an average of 4.21 minutes (2.4 vs. 6.6 minutes; P = 0.002), 15 fluoroscopic images (5.4 vs. 20.5; P = 0.002), and 8.14 mGy (3.3 vs. 11.4; P = 0.011) were saved by instrument tracking. For pedicle screw insertion, an average of 5.69 minutes (3.97 vs. 9.67; P < 0.001), 14 radiographs (6.53 vs. 20.62; P < 0.001), and 7.89 mGy (2.98 vs. 10.87 mGy; P < 0.001) were saved per screw insertion. CONCLUSIONS: Instrument tracking, when used for minimally invasive lumbar fusion, leads to significant reductions in radiation and operative time compared with conventional fluoroscopy.
Authors
Hamouda, F; Wang, TY; Gabr, M; Mehta, VA; Bwensa, AM; Foster, N; Than, KD; Goodwin, RC; Abd-El-Barr, MM
MLA Citation
Hamouda, Farah, et al. “A Prospective Comparison of the Effects of Instrument Tracking on Time and Radiation During Minimally Invasive Lumbar Interbody Fusion.World Neurosurg, vol. 152, Aug. 2021, pp. e101–11. Pubmed, doi:10.1016/j.wneu.2021.05.058.
URI
https://scholars.duke.edu/individual/pub1483241
PMID
34033952
Source
pubmed
Published In
World Neurosurg
Volume
152
Published Date
Start Page
e101
End Page
e111
DOI
10.1016/j.wneu.2021.05.058

Impact of Multidisciplinary Intraoperative Teams on Thirty-Day Complications After Sacral Tumor Resection.

OBJECTIVE: To evaluate the impact of multidisciplinary intraoperative teams on surgical complications in patients undergoing sacral tumor resection. METHODS: We reviewed all patients with primary or metastatic sacral tumors managed at a single comprehensive cancer center over a 7-year period. Perioperative complication rates were compared between those treated by an unassisted spinal oncologist and those treated with the assistance of at least 1 other surgical specialty. Statistical analysis involved univariable and stepwise multivariable logistic regression models to identify predictors of multidisciplinary management and 30-day complications. RESULTS: A total of 107 patients underwent 132 operations for sacral tumors; 92 operations involved multidisciplinary teams, including 54% of metastatic tumor operations and 74% of primary tumor operations. Patients receiving multidisciplinary management had higher body mass indexes (29.8 vs. 26.3 kg/m2; P = 0.008), larger tumors (258 vs. 55 cm³; P < 0.001), and higher American Society of Anesthesiologists scores (3 vs. 2; P = 0.049). Only larger tumor volume (odds ratio [OR], 1.007 per cm³; P < 0.001) and undergoing treatment for a malignant primary versus a metastatic tumor (OR, 23.4; P < 0.001) or benign primary tumor (OR, 29.3; P < 0.001) were predictive of multidisciplinary management. Although operations involving multidisciplinary teams were longer (467 vs. 231 minutes; P < 0.001) and had higher blood loss (1698 vs. 774 mL; P = 0.004), 30-day complication rates were similar (37 vs. 27%; P = 0.39). On multivariable analysis, only larger tumor volume (OR, 1.004 per cm³; P = 0.005) and longer surgical duration (OR, 1.002 per minute; P = 0.03) independently predicted higher 30-day complications. CONCLUSIONS: Although patients managed with multidisciplinary teams had larger tumors and worse baseline health, 30-day complications were similar. This finding suggests that the use of multidisciplinary teams may help to mitigate surgical morbidity in those with high baseline risk.
Authors
Schilling, A; Pennington, Z; Ehresman, J; Hersh, A; Srivastava, S; Hung, B; Botros, D; Cottrill, E; Lubelski, D; Goodwin, CR; Lo, S-F; Sciubba, DM
MLA Citation
Schilling, Andrew, et al. “Impact of Multidisciplinary Intraoperative Teams on Thirty-Day Complications After Sacral Tumor Resection.World Neurosurg, vol. 152, Aug. 2021, pp. e558–66. Pubmed, doi:10.1016/j.wneu.2021.06.040.
URI
https://scholars.duke.edu/individual/pub1488202
PMID
34144170
Source
pubmed
Published In
World Neurosurg
Volume
152
Published Date
Start Page
e558
End Page
e566
DOI
10.1016/j.wneu.2021.06.040

Inpatient palliative care utilization for patients with brain metastases.

Introduction: Given the high symptom burden and complex clinical decision making associated with a diagnosis of brain metastases (BM), specialty palliative care (PC) can meaningfully improve patient quality of life. However, no prior study has formally evaluated patient-specific factors associated with PC consultation among BM patients. Methods: We examined the rates of PC consults in a cohort of 1303 patients with BM admitted to three tertiary medical centers from October 2015 to December 2018. Patient demographics, surgical status, 30-day readmission, and death data were collected via retrospective chart review. PC utilization was assessed by identifying encounters for which an inpatient consult to PC was placed. Statistical analyses were performed to compare characteristics and outcomes between patients who did and did not receive PC consults. Results: We analyzed 1303 patients admitted to the hospital with BM. The average overall rate of inpatient PC consultation was 19.6%. Rates of PC utilization differed significantly by patient race (17.5% in White/Caucasian vs 26.0% in Black/African American patients, P = .0014). Patients who received surgery during their admission had significantly lower rates of PC consultation (3.9% vs 22.4%, P < .0001). Patients who either died during their admission or were discharged to hospice had significantly higher rates of PC than those who were discharged home or to rehabilitation (P < .0001). Conclusions: In our dataset, PC consultation rates varied by patient demographic, surgical status, discharging service, and practice setting. Further work is needed to identify the specific barriers to optimally utilizing specialty PC in this population.
Authors
Price, M; Howell, EP; Dalton, T; Ramirez, L; Howell, C; Williamson, T; Fecci, PE; Anders, CK; Check, DK; Kamal, AH; Goodwin, CR
MLA Citation
Price, Meghan, et al. “Inpatient palliative care utilization for patients with brain metastases.Neurooncol Pract, vol. 8, no. 4, Aug. 2021, pp. 441–50. Pubmed, doi:10.1093/nop/npab016.
URI
https://scholars.duke.edu/individual/pub1488917
PMID
34277022
Source
pubmed
Published In
Neuro Oncology Practice
Volume
8
Published Date
Start Page
441
End Page
450
DOI
10.1093/nop/npab016

Adult cervicothoracic lipomyelomeningocele.

Lipomyelomeningocele (LMM) as a cause of tethered cord syndrome (TCS) commonly presents in childhood in the lumbosacral spine. Patients frequently present with cutaneous manifestations, progressive neurological deterioration, bladder dysfunction, and intractable pain. Early surgical intervention with untethering is recommended for symptomatic patients. We report an unusual case of a woman who presented with a subcutaneous lump, pain, and neurological decline found to have a cervicothoracic LMM. The patient underwent laminectomy and subtotal resection of the mass; seventeen years later she was confined to a wheelchair with severe neurological decline ultimately requiring three additional attempts at surgical excision and repair. This case emphasizes the need for early recognition of and intervention in adult patients with LMM.
Authors
Abu-Bonsrah, N; Purvis, TE; Rory Goodwin, C; Petteys, RJ; De la Garza-Ramos, R; Sciubba, DM
MLA Citation
Abu-Bonsrah, Nancy, et al. “Adult cervicothoracic lipomyelomeningocele.J Clin Neurosci, vol. 32, Oct. 2016, pp. 157–59. Pubmed, doi:10.1016/j.jocn.2016.04.005.
URI
https://scholars.duke.edu/individual/pub1498784
PMID
27430413
Source
pubmed
Published In
J Clin Neurosci
Volume
32
Published Date
Start Page
157
End Page
159
DOI
10.1016/j.jocn.2016.04.005

Research Areas:

Bone metastasis
Ependymoma
Tumor Microenvironment
Tumor markers