About

Dr. Brian A. Karamian is a Board Certified spine surgeon at the University of Utah who manages all aspects of the cervical, thoracic, and lumbar spine, including conditions such as stenosis, disc herniations, radiculopathy, myelopathy, deformity/scoliosis, trauma, tumors, and infection. He takes a patient-centered approach, utilizing both operative and non-operative interventions to help patients achieve their goals. His practice includes minimally invasive techniques and robotic surgery for the management of degenerative spine conditions, with a focus on improving patient outcomes. Dr. Karamian has a strong interest in advancing the field of spine surgery through basic science and clinical research, and he has received multiple research grants and awards. He has authored numerous publications, book chapters, and abstracts, and regularly presents at national and international meetings on topics related to spine diseases. His educational background includes graduating from UC Berkeley with honors and an Honors Thesis in Biochemistry, earning his medical degree from the University of Southern California with Dean's Recognition, completing his orthopaedic surgery residency at Stanford University where he was inducted into the Alpha Omega Alpha Medical Honor Society, and completing a two-year research and clinical spine surgery fellowship at the Rothman Institute/Thomas Jefferson University, regarded as one of the top spine fellowships in the country.

Research topics

• Medicine
• Surgery
• Physical therapy
• Internal medicine
• Anesthesia

Selected publications

• The Impact of CT-based Subsidence Assessment on Radiographic and Clinical Outcomes After Transforaminal Lumbar Interbody Fusion

  Clinical Spine Surgery A Spine Publication · 2026-03-18

  article

  STUDY DESIGN: Retrospective cohort. OBJECTIVE: This study aims to assess the effects of CT-based subsidence on lumbar sagittal alignment and patient-reported outcome measures (PROMs) after transforaminal lumbar interbody fusion (TLIF), and to determine if subsidence and cage properties are independent predictors of postoperative changes in regional lordosis. SUMMARY OF BACKGROUND DATA: Subsidence is a well-known complication following interbody fusion and has previously been associated with recurrence of preoperative symptoms and higher reoperation rates. There is incomplete evidence to characterize the effects of subsidence on lumbar alignment and PROMs following TLIF. METHODS: All adult patients who underwent 1- or 2-level TLIF at a multi-institutional academic center between 2017 and 2019 were retrospectively identified. Interbody subsidence at the superior and inferior endplate of each TLIF level was directly measured on both coronal and sagittal CT scans obtained between 6 months and 1 year postoperatively. Patients were grouped based on the maximum subsidence at each operative level: mild-moderate (<4 mm) or severe (≥4 mm). Preoperative, immediate (<3 mo), and intermediate (>6 mo) postoperative radiographic outcomes (local and global lumbar alignment) and PROMs (VAS Back, Oswestry Disability Index, PROMIS Physical Function and Mood) were collected. Univariate and multivariate analysis compared patient demographics, surgical factors, and changes in radiographic measures and PROMs across subsidence groups. Multiple linear regression analyzed independent effects of subsidence and cage characteristics on alignment. RESULTS: Sixty-seven patients with 85 unique fusion levels were included (55 with mild-moderate subsidence, 30 with severe subsidence). Levels with severe subsidence demonstrated significantly less regional lordosis at final follow-up than nonseverely subsided levels (6.4 vs. 9.1 degrees, P=0.032). No PROM significantly differed between severe and nonsevere subsidence subgroups. Linear regression analysis revealed that severe subsidence was a strong independent predictor of regional lordosis (P=0.029) at final follow-up. CONCLUSIONS: Severe subsidence negates perioperative improvements in regional lordosis following TLIF, while changes in regional alignment are maintained in the absence of severe subsidence. LEVEL OF EVIDENCE: Level III.

  PublisherDOI

• Implantation choices, fusion preferences and implant removal after fixation in C1-C2 fractures: An AO Spine Knowledge Forum expert survey

  European Spine Journal · 2026-05-14

  article
  PublisherDOI

• Cost and Utilization Trends of Lumbar Fusion

  JAMA Network Open · 2026-03-04 · 1 citations

  articleOpen access

  Importance: The increasing cost of lumbar fusion has invited payment reforms, such as mandatory price limits by Medicare in 2026. Objective: To examine the cost, utilization, and procedural case-mix trends for different types of lumbar fusion from 2002 to 2023 in the United States. Design, Setting, and Participants: This cross-sectional analysis used survey-weighted data from the 2002 to 2023 National Inpatient Sample (NIS) and the 2016 to 2022 Nationwide Ambulatory Surgical Sample (NASS). From this nationally representative sample of inpatient and hospital-owned outpatient discharges, information on US adults aged 20 years and older undergoing lumbar fusion for any indication from January 2002 to December 2023 were included. Exposures: Lumbar fusion of any type (1-disc level or multilevel as well as single vertebral column or both anterior-posterior columns) with nonfusion surgery as a comparison. Main Outcomes and Measures: The main outcomes were the survey-weighted annual total of procedures, the mean age of patients undergoing lumbar fusion, the inflation-adjusted hospital costs, and the annual procedure rates per 100 000 population. Results: A total of 5 033 772 lumbar fusion admissions between 2002 and 2023 were included. In 2023, the cohort of patients undergoing 274 750 procedures had a mean (SD) age of 63.2 (12.9), with 142 815 (52.0%) female patients. Excluding 54 620 complex fusions, which were mostly multilevel anterior-posterior column fusions, there were 164 105 (50.1%) multilevel fusions, and 109 130 (51.3%) combined anterior-posterior column fusions. The age-adjusted population rate of inpatient fusion procedures increased from 60.1 (95% CI, 58.8-90.3) per 100 000 in 2002 (148 823 admissions) to a peak of 89.9 (95% CI, 89.6-90.3) in 2016 (284 180 admissions), before declining to 80.0 (95% CI, 79.7-80.4) by 2023 (273 235 admissions). Lumbar fusion performed in hospital-owned outpatient facilities was minimal in 2016 (6132 procedures, or 2.1% of total lumbar fusions) and 6.9 per 100 000 (27 331 procedures, or 9.8% of total lumbar fusions) in 2022. Adjusted inpatient hospital costs increased 265.3% from $3.86 (95% CI, $3.81-$3.92) billion in 2002 to $14.1 (95% CI, $13.9-$14.2) billion in 2023, and mean inpatient per-procedure cost increased from $25 849 (95% CI, $25 684-$26 015) in 2002 to $45 458 (95% CI, $45 207-$45 709) in 2023. Lumbar fusion primarily shifted from single column at 1 or 2 disc levels in 2002 (mean cost, $24 515; 95% CI, $24 361-$24 669) to multilevel anterior-posterior column fusion in 2023 (mean cost, $55 034; 95% CI, $54 420-$55 650). Conclusions and Relevance: In this cross-sectional study, lumbar fusion trends were marked by greater utilization of procedures overall, and especially involving multilevel and combined anterior-posterior column approaches and by greater use in the outpatient setting. Costs also increased at both the national and per-procedure levels.

  PublisherOA PDFDOI

• An International Prospective Multicenter Study of Bracing vs No Bracing for the Nonoperative Management of A3/A4 Thoracolumbar Burst Fractures

  Brain and Spine · 2025-01-01

  articleOpen access
  PublisherDOI

• An international prospective multicenter study of bracing vs no bracing for the nonoperative management of A3/A4 thoracolumbar burst fractures

  Brain and Spine · 2025-01-01

  articleOpen access
  PublisherDOI

• Perioperative Change in Bone Quality Following Posterior Cervical Fusion and Its Effects on Postoperative Outcomes

  Clinical Spine Surgery A Spine Publication · 2025-09-25 · 1 citations

  article

  STUDY DESIGN: Retrospective cohort analysis. OBJECTIVE: To determine the effect of long-segment posterior cervical decompression and fusion (PCDF) on perioperative changes in vertebral Hounsfield Units (HUs) and the impact of these changes on radiographic outcomes and fusion status. SUMMARY OF BACKGROUND DATA: Low preoperative CT HUs have been associated with adverse outcomes after spinal fusion, including hardware complications and reoperation. No existing studies have investigated the preoperative to postoperative change in HUs after cervical spinal fusion. Stress shielding may decrease bone quality within the fusion construct. Whereas, altered junctional loading and increased segmental mobility may precipitate bony hypertrophy in the terminal and adjacent levels. METHODS: All adult patients who underwent C2-T2 PCDF for myelopathy/ myeloradiculopathy at an academic center between 2013 and 2020 were retrospectively identified. Preoperative and postoperative HUs were assessed on axial CT images in the cranial, middle, and caudal C2, C6, T2, and T3 vertebral bodies, outside of the region of instrumentation and artifact by 2 independent reviewers. Paired t test compared preoperative to postoperative changes in HUs. Preoperative and long-term postoperative cervical alignment, fusion, and revision rates were assessed. Univariate and regression analysis compared patient factors and outcomes between groups with perioperative increase versus decrease in vertebral HUs. RESULTS: One hundred patients were included. The average preoperative to postoperative change in HUs in the C2, C6, T2, and T3 vertebral bodies were -19.80 (P=0.008), -52.63 (P<0.001), 15.15 (P=0.014), and 9.41 (P=0.346), respectively. Perioperative increase in C2 HUs was predictive of increased postoperative distal junctional angle (β=3.41, P=0.048) and increased T1-T4 kyphosis (β=6.50, P=0.003). Perioperative increase in C6 HU predicted pseudoarthrosis (fusion odds ratio: 0.19, P=0.007). CONCLUSIONS: Significant perioperative decreases in C6 HUs within a long-fused construct may demonstrate stress shielding. The significant association between greater distal kyphosis and an increase in C2 HUs may be attributed to a stress riser effect. LEVEL OF EVIDENCE: Level III.

  PublisherDOI

• P17. Anterior cervical discectomy and fusion in the ambulatory surgery center versus outpatient and inpatient settings in a Medicare population: an analysis of complications and cost

  The Spine Journal · 2025-10-09

  articleSenior author
  PublisherDOI

• Narrative Review of Perioperative Glucagon-like Peptide-1 (GLP-1) Agonists in Spine Surgery

  Clinical Spine Surgery A Spine Publication · 2025-07-17 · 1 citations

  articleSenior authorCorresponding

  Spine surgeons are increasingly likely to encounter patients taking glucagon-like peptide-1 (GLP-1) receptor agonists for glycemic control and/or weight loss. GLP-1 receptor agonists present an attractive option for helping patients meet hemoglobin A1C and body mass index goals before elective surgeries and have already been implemented for these purposes. It is imperative for spine surgeons to understand the potential risks and benefits of these drugs during the perioperative period and their influence on patient outcomes. This review provides an overview of the history of GLP-1 receptor agonists, their mechanism of action and efficacy as a diabetic and weight loss treatment, as well as the clinical relevance to the field of spine surgery. Further studies are required to truly understand the impact of these medications on spine surgery and in the management of these patients in the perioperative period.

  PublisherDOI

• Updates on the prevention and treatment of cervicothoracic distal junctional failure: a narrative review

  AME Surgical Journal · 2025-08-01 · 3 citations

  reviewSenior author
  PublisherDOI

• Predictors of Full-Time Spine Surgeon Faculty Position at a University Hospital

  Journal of the American Academy of Orthopaedic Surgeons · 2025-06-24

  articleSenior author

  INTRODUCTION: Although spine surgery careers are influenced by a multitude of professional and personal factors, predictors of career trajectories and future research effect may be identifiable at the spine fellow applicant stage. As such, this study aimed to (1) determine factors predictive of University Hospital [UH] employment and research contributions and (2) compare the application metrics identified as most important to an academic career by spine surgery program directors (PD) to those predictive of career environments from prior spine fellows applications. METHODS: All applications of individuals applying for spine fellowship training between 2017 and 2021 at an academic institution were reviewed. Application metrics pertaining to research achievement, academic achievement, prior and current education, extracurricular involvement, leadership, examination scores, applicant interests, and letter of recommendation (LOR) reputation were extracted. The careers of all prior spine fellow applicants were grouped by the presence or absence of full-time university appointment and research effect (current H-index). A survey sent to spine PDs asked them to rank the importance of application factors to academic careers using analogous metrics to the application review. RESULTS: A total of 310 applications were reviewed. Residency publications (odds ratio [OR]: 1.09, P = 0.0116), preclinical publications (OR: 1.24, P = 0.0447), and expressed academic interest (OR: 2.25, P = 0.0229) predicted UH appointment. Applicant physician scientist interest (β: 2.41, P < 0.001), LOR writers' reputation (β: 0.05, P < 0.001), and journal reviewer positions (β: 0.80, P < 0.001) predicted current H-index. In the PDs survey, metrics predicting academic trajectory were ranked (descending): research achievements, physician scientist interest, academic interest, leadership positions, LOR writers' reputation, prestige of training, and United States Medical Licensing Examination scores. Research year(s), advanced degrees, and society leadership and membership positions, although theoretically deemed important by PDs, were in actuality minor contributors to the career environments of spine fellow applicants. CONCLUSION: Spine fellow academic interest, residency publications, and preclinical publications predicted full-time UH-based careers. LEVEL OF EVIDENCE: 3. STUDY DESIGN: Retrospective Cohort Analysis.

  PublisherDOI

Frequent coauthors

• Alexander R. Vaccaro

  Rothman Institute

  873 shared

• José A. Canseco

  Thomas Jefferson University

  773 shared

• Gregory D. Schroeder

  747 shared

• Christopher K. Kepler

  Thomas Jefferson University

  629 shared

• Alan S. Hilibrand

  Rothman Institute

  595 shared

• Mark J. Lambrechts

  Thomas Jefferson University Hospital

  511 shared

• Barrett I. Woods

  Thomas Jefferson University

  403 shared

• Jeffrey A. Rihn

  283 shared

Awards & honors

• Alpha Omega Alpha Medical Honor Society