bluuebunny/crossref_metadata_2025 huggingface dataset:
A Novel Technique to Reconstruct Anterior Cervical Spine after Total Removal of C2 and C3 Vertebrae
Authors: Haghnegahdar Ali , Sedighi Mahsa
Published: April 2016

Introduction

Reconstruction of C2 body in cases who need removal of C2 body and Axis is a challenging issue, due to difficult approach and small area for instrumentation and grafting, especially in pediatric age group.

Material and Methods

Our patient underwent a two-stage surgery. During the first operation via a posterior approach, a subtotal resection of a C2 bony mass was performed. C3 was also subtotally resected due to tumor extension. Posterior fixation of C1–C5 was performed by C1 sublaminar hooks and C4 and C5 lateral mass screws. Ten days later, a total resection of the residual bony mass was performed through an anterior approach (between the sternocleidomastoid muscle and carotid sheath). Reconstruction of C1–C3 was performed with C1 anterior sublaminar wiring and an expandable titanium cage.

Results

Successful reconstruction of C2–C3 vertebral bodies was achieved. At 2-year follow-up, the child was symptom-free. Imaging studies revealed no recurrence of tumor or instability.

Conclusion

A novel technique for reconstruction of C2–C3 vertebral bodies is demonstrated for the youngest case (a 6-year-old boy) of osteoblastoma in the literature. We recommend this approach for cervical spine reconstruction in patients who have an intact C1 arc and resected lower bodies.
Cell Salvage Use, Benefits, and Costs at Ipswich Hospital Spinal Unit UK
Authors: Marjoram Tom , Kaleel Saajid , Cumming David , Lovell Robert , Bhagat Shaishav , Hudd Alisair , Sharp David , Powell John
Published: April 2016

Introduction

Blood Transfusions cost £122 per unit in the UK but they have other costs including 1:13000 incorrectly transfused. 1:7000 risk of adverse reaction. Infection in the UK overall is 1:1.2milliion for hepatitis B and 1:7million for HIV with a risk of 1:28million for hepatitis C.

Methods

We analyzed the use of cell saver and blood transfusion in the Ipswich Spinal Unit (UK). Identifying all cases in which cell saver might be used. Looking at the volume collected and re-infused to the patient, the pre- and post operative haemoglobin and the need for blood transfusion

Results

We found that Cell saver was being used for a variety of cases including Trauma, Revision surgery, Deformity Correction, Anterior Lumbar fusions, Trans-laminar interbody fusions and tumor work. Revision surgery alone did not have a significant need for blood transfusion and cell saver use in these cases was often (66%) of the time not required. ALIF surgery only utilized salvaged blood in 10% of cases but the bleeding in this case was significant and therefore the unit decided cell salvage would continue to be routine. Overall we found that the average drop in haemoglobin was comparable between those patients who had cell salvage technology utilized during their surgery compared with those who did not, this was echoed in the post operative blood transfusion rates. A cost analysis based upon the cost of cell salvage use vs the cost that would have theoretically been incurred if the same volume of donated blood had been used showed cell salvage to cost 43% more that the use of donated blood products.

Conclusion

Cell salvage is a more financially costly technology than transfusion from the blood bank. There are some procedures in which the routine use of cell salvage should be reserved for specific cases and some where the use in a small percentage is so beneficial that cell salvage will continue to be used despite a low overall re-infusion rate. The additional costs to the patients is to be considered when discussion donated blood transfusion. The Ipswich Spinal Unit believes more judicious use of cell salvage technology concentrating on the cases in which we found utilization to be highest would make it more cost effective.
Epidemiolgy of Multiple Contiguous and Non-contiguous Thoracolumbar Fractures in a Level 1 Trauma Center in Upper Egypt
Authors: Abdo Mohamed , Elmorshidy Essam
Published: April 2016

Introduction

Multiple level fractures of the thoracolumbar spine are not uncommon nowadays particularly after increased magnitude of trauma and the availability of screening facilities. However only few studies have reported its descriptive epidemiology. The aim of this study is to analyze the incidence, the characteristics of the patients, surgical incidence and mortality rate among hospitalized patients with multiple level thoracolumbar fractures in a level 1 trauma center in upper Egypt

Material and Methods

Out of 471 patients with thoracolumbar fractures admitted in Assiut University Hospital during the year (2014), there were 50 patients with multiple level fractures. The epidemiology of these 50 patients was described and analyzed including the method of treatment, complications and mortality rate.

Results

There were 21 males and 29 females. The mean age was 28.9+12.8 years. The commonest associated injury was fracture calcaneus in 20 patients. 43 patients had contiguous thoracolumbar fractures while 7 only had non contiguous fractures. The commonest mechanism of injury was falling from height in 41 patients.42 patients were neurologically free. 6 patients were treated conservatively while 44 patients received surgical treatment.

Conclusion

Treatment for the multilevel thoracolumbar fractures must follow the same guidelines for treatment as for the isolated fracture in the majority of circumstance; however, it requires particular attention and must be individualized.
Test Score (SI5): Assess Diagnostic of Sacroiliac Joint Dysfunction
Authors: Acevedo Juan , Quintero-Oliveros Silvia
Published: April 2016

Objective

The sacroiliac joint dysfunction is a known cause of low back pain. We think that a test score (SI5) may be performed to assess diagnostic utility of clinical signs of sacroiliac joint dysfunction. The primary aim of the present study was to conduct conducting the pilot study of our new test score SI5.

Methods

After reviewing the literature about of clinical characteristic, diagnostic test and imaging of the sacroiliac joint; we evaluated diagnostic utility of these aspects and developed the SI5 test score. The SI5 test score was performed in 22 patients with low back pain including completion of a standard questionnaire, history, physical examination performed by a physician, and evaluation of the results.

Results

The most sensitive clinical tests for diagnosing of sacroiliac joint dysfunction were Laguerre Test, sacroiliac rocking test and Yeomans test (Greater than 80% sensitivity). The tests with greater specificity ( > 80%) were Lewitt test, Piedallu test and Gillet test. The test score SI5 showed sensitivity of 73% and specificity of 71%.

Conclusions

Sacroiliac joints have been shown to be capable of producing pain in the low back; however, the diagnostic value of examination tests for sacroiliac joint pain has been questioned previously by other authors. The pilot study of SI5 test score showed good sensitivity and specificity. This study required statistical procedures that yield appropriate results.
Dorsal Fusion as Correction of Craniocervical and Atlantoaxial Instability in Patients with Benign and Malignant Lesions using O-Arm System
Authors: Mirchev Nikolay , Behr Robert
Published: April 2016

Introduction

A retrospective and prospective analysis of the surgical treatment and results of 99 patients with benign and malignant craniocervical, atlantoaxial and high cervical lesions operated during 36 – month period (2011–2014) at the Department of Neurosurgery, Klinikum Fulda gAG, Germany was performed. The aim of the analysis was to assess the factors affecting dorsal fusion as correction of craniocervical and high cervical instability.

Material and Methods

The mean age of the patients was 57 years. The female to male ratio was 1:1,3. The most frequent neurological symptoms were quadriparesis, discoordination, cranial and spinal nerves palsy and local pain. We analyzed 67 patients with traumatic lesions, 10 patients with inflammatory lesions, 8 patients with degenerative instability, and 14 patients with high cervical tumors. In the subgroup of patients with traumatic lesions we found 39 odontoid fracture II Type, 11 Hangemann fracture and 17 combined cervical fracture; in the subgroup of patients with tumors we observed 3 cases with plasmocytoma, 3 case with chordoma, 1 case with C2–3 schwanoma, and 7 cases with metastatic lesions; in the inflammatory subgroup we analyzed 6 cases with RA and 4 cases ankylose spondylitis.

Results

In 99 patients we performed 129 operations. We used posterior cervical, and craniocervical median approach. Because of craniocervical/cervical instability we made posterior screw fixation in all of 99 patients. In 47 patients we performed additionally decompressive laminectomy. To improve screw placement accuracy we performed intraoperative O-Arm in 82 cases. The operative duration was 2.25 hour. in O-Arm operations and 4.35 hour in C-arm operation. The most common operative complications were: CSF leak – in 2 cases, postoperative infection – in 4 cases, and without early operative mortality. The 12-monts follow-up showed good recovery in 65 patients, moderate disabling – 25 patients, severe disabling – 5 patients, vegetative state – 4 patients, death 3 patients with malignant lesions.

Conclusion

Early correction of craniocervical and high cervical instability facilitated neurological recovery by preserving the existent neurological function. Using of O-Arm increase operative screw placement accuracy, and preserve intraoperative nerve and vertebral artery injury. Recently because of the improvement of neuroimaging techniques, operative approaches, surgical techniques and neurointensive care the results of treatment of these lesions are optimal.
Safety and Efficacy of Harms' Technique in the Management of Atlantoaxial Instability. A Single Institution Experience and Review of the Literatures
Authors: Abou-Madawi Ali
Published: April 2016

Introduction

various procedures for the management of atlantoxial instability have reviewed in the literatures. Advantages and disadvantages of these procedures have been stressed. Harms' procedure is one of the recently introduced techniques. This is a retrospective descriptive clinical case study to evaluate the safety and efficacy of Harms' technique.

Patients and Methods

we reviewed our hospital medical records between 2009 and 2014. We were able to track 19 patients treated for atlantoaxial instability using Harms' technique with complete records. Patients' mean age was 19.6 years. Twelve were males and 7 were females. Surgical indications included: atlantoaxial ligamentous instability in 2, Os Odentadium in 2, Downs' syndrome in 3, type-II dens fracture in 5, atlantoaxia rotatory fixation in 7. All patients had plain radiography, CT scan, and MRI. According to the JOA-score 15 were normal, 3 were grade-1 and one was grade-2. All patients were operated with Hams' technique with iliac Bone graft. The following factors were evaluated; age, sex, pathology, neurological status, operative time, blood loss, hospital stay, morbidity, screw purchases, stability, fusion, and clinical outcome.

Results

mean operative time was 125 minute. Mean blood loss was 350 ml. Hospital stay was 4 days. Screw purchase was adequate in all cases but one. Stability was adequate in all. Fusion was sound in all but two. All intact patients remained intact. Other patients improved at least one grade on JOA-Score. One patient had vertebral artery perforation by a low seated screw. There were no added neurological deficits in any of our patients.

Conclusion

our experience demonstrates the safety and efficacy of the Harms' technique in the management of atlantoaxial instability. Meticulous technique and anatomical knowledge are mandatory for optimizing outcome.
Outcome of Patients with Occipitocervical Fusion for Acute Craniocervical Instability
Authors: Hoffmann Martin F. , Freund Kai , Schildhauer Thomas A.
Published: April 2016

Introduction

Occipitocervical fusion (OCF) is a safe and reliable method for stabilization of craniocervical instabilities caused by different mechanisms. Especially patients with acute instabilities and unaffected previous range of motion of the cervical spine, may be affected by the fusion procedure. The purpose of this study was to evaluate retrospectively surgical outcome and patient disability after OCF procedure for acute instabilities.

Methods

Over a 5-year period, 2009–2014, 33 consecutive patients from one academic trauma center were retrospectively identified as having been treated with OCF. Of these, 29 patients were diagnosed with traumatic or pathologic fractures or nonunion after previously failed surgical intervention. Average follow up was 25 months (range 4–55 months). Demographics were assessed. Fixation constructs were delineated. Nonunion, infection, implant failure, neurologic disabilities, and deaths were used as complication variables. Patient disability was addressed by the Neck Disability Index (NDI) and persistent pain (VAS).

Results

Traumatic and pathologic fractures were the main reason (90%) for an OCF procedure in our study population. Three patients (10%) suffered from a persistent instability after previously failed surgical stabilization. Fracture location was the odontoid process of C2 in 69% of the patients and 31% had a combined injury to C1 and C2. Fusion was performed between the occiput and C4 in 55%, C5 in 28%, and C3 in 17%. Fusion was enhanced by autologous bone in 14 patients (48%). 3 patients (10%) underwent a surgical revision due to screw misplacement (1) and infection (2). Related to the advanced patient age, 15 patients died before the evaluation. One patient died during hospital stay related to his preoperatively existing comorbidities. Fourteen patients were evaluated. Average age was 74.2 years (range 18–95 years). Regarding the clinical outcome, pain averaged 2.5 on the VAS (median 2). 64% of the patients reported no or minimal pain (VAS 0–2), 23% complained of mild pain (VAS 2–4). The NDI averaged 42% (range 16 – 80%).

Conclusion

OCF is a reliable and safe procedure for the treatment of craniocervical instabilities caused by different injuries and diseases. Overall, pain reduction was effective. Patients reported no or only mild pain (VAS 0–4) in 86% during our evaluation. Functional disability averaged 42% utilizing the NDI, which is rated as “medium disability.” The rate of 52% deceased patients reflects the fact that OCF is performed in our institution especially in elderly and patients with increased rates of comorbidities.
Predictors of Discharge Destination after Lumbar Spine Fusion Surgery
Authors: Aldebeyan Sultan , Aoude Ahmed , Fortin Maryse , Nooh Anas , Jarzem Peter , Ouellet Jean , Weber Michael
Published: April 2016

Introduction

Lumbar spine fusion surgery is a common surgical procedure used to treat a variety of lumbar spine conditions. A great number of patients fail to go home after surgery and require transfer to a rehabilitation center. Many Patients requiring transfer to rehabilitation centers often have an extended hospital length of stay due to lack of beds at rehabilitation centers. Each extra day spent at the hospital costs the health system approximately $1000 USD. The aim of this study was to identify predictive factors for discharging patients to an inpatient rehabilitation center after undergoing lumbar spine fusion surgery.

Methods

We retrospectively identified a total of 15,092 patients undergoing lumbar spine fusion from 2011 to 2013 using the ACS-NSQIP database. Patients were dichotomized based on discharge destination to patients who were discharged home ( N = 12,339) and others who were discharged to a rehabilitation center ( N = 2753). Outcomes included patient demographics, comorbidities, and clinical characteristics. A multivariate logistic regression was used to identify whether outcomes studied were predictive factors for discharging patients to a rehabilitation center after lumbar fusion surgery.

Results

Majority of patients were discharged home after lumbar fusion surgery (81.76%) with only some discharged to a rehabilitation center (18.24%). Multivariate analysis identified age ≥40, female gender, comorbidities (diabetes, COPD, CHF, and obesity), minor and major complications, hospital length of stay (LOS), operative time ≥ 259 minutes, multilevel surgery, and return to the operation room as significant predictive factors of discharging patients to a rehabilitation center after lumbar fusion surgery.

Conclusion

The identified predictive factors can help the health system in developing an algorithm for early recognition of patients requiring postoperative admission to a rehabilitation center and possibly decreasing their hospital LOS. This can significantly decrease the hospital costs for such patients.
Surgical Outcomes after Traumatic Spinal Injury in Patients with Ankylosing Spondylitis - A Review of Ireland's National Spinal Unit
Authors: Berney Mark , Morris Seamus , Nugent Mary
Published: April 2016

Introduction

Patients with ankylosing spondylitis have a significantly increased risk of spinal injury when compared with the general population. Due to the pathogenesis of this condition, they are prone to spinal fractures even with low-energy mechanisms of injury. Since being established, the National Spinal Unit has admitted a significant number of these patients with a wide range of spinal injuries for surgical management. In this study, we reviewed fractures in patients with ankylosing spondylitis to better define the mechanism of injury, associated neurological deficit, predisposing factors, management strategies, and clinical outcomes.

Material and Methods

Between January 2005 and September 2015, 28 patients with fractures were treated in the Unit. Imaging evaluation was obtained in all patients by using plain radiography, CT scan, and MRI. The ASIA Impairment Scale was used to evaluate the neurologic status of the patients. Management was based on the presence or absence of spinal instability. A retrospective chart review was performed to determine patient factors, mechanism of injury, pre-operative status, management, and post-operative course.

Results

Of 28 patients reviewed, 21 cervical fractures and 8 thoracic fractures were identified. 14 cases were caused by minor trauma. Post-traumatic neurological deficits demonstrated by ASIA assessment in 15 patients with neurological improvement seen in 8 of these cases.

Conclusion

Patients with ankylosing spondylitis are highly susceptible to spinal fracture and spinal cord injury even after only mild trauma. Initial CT or MR imaging of the whole spine is recommended even if the patient's symptoms are mild. The patient should also have early surgical stabilization to correct spinal deformity and avoid worsening of the patient's neurological status.
The Pathoanatomy of Congenital Cervical Stenosis: The Triangle Model
Authors: Mai Harry , Jenkins Tyler , Hsu Wellington
Published: April 2016

Introduction

Congenital cervical stenosis (CCS) describes a patient with a decreased spinal canal diameter at multiple levels of the cervical spine in the absence of degenerative changes. Despite recognition of CCS throughout the literature, the anatomical features that lead to this condition have not been established. Knowledge of the pathoanatomy behind CCS may lead to alterations in surgical technique for this patient population that may improve outcomes.

Methods

From 1,000 cervical MRIs between January 2000 to Dec 2014, CCS was identified in 68 patients using a strict definition of age less than 50 years with mid-sagittal canal diameters (<10 mm) at multiple sub-axial cervical levels (C3-C7). A total of 68 patients met the inclusion criteria for this group. Fourteen controls with normal SCDs (>14 mm) at all cervical levels were used for comparison. Anatomic measurements obtained at each level (C3-C7) included: coronal vertebral body, AP vertebral body, pedicle width, pedicle length, laminar length, AP lateral mass, posterior canal distance, lamina-pedicle angle and lamina-disc angle. Statistical significance was defined as p < 0.01.

Results

CCS patients demonstrated significantly different anatomical measurements when compared with controls. Significantly smaller lateral masses, lamina lengths, lamina-pedicle angles and larger lamina-disc angles were identified at levels C3-C7 in the CCS group ( p < 0.01). These anatomic components form a right triangle that illustrates the cumulative narrowing effect on space for the spinal cord.

Conclusions

The pathoanatomy of CCS is associated with a decrease in the lamina-pedicle angle and an increase in the lamina-disc angle. These changes in the alignment of the bony posterior elements lead to decrease in lamina length and ultimately to a smaller cross sectional area for the spinal cord. The global changes in CCS are best illustrated by this triangle model and driven by the posterior elements of the cervical spine.
Measuring Cobb's Angle in Scoliosis: Can Smartphones Match Manual Methods and Software Based Analysis? A Three Way Crossover Study
Authors: Sudarshan Pramod , Panda Aditya , Paramasivam Aghilavendan , Varma Vamsi Krishna , Hegde Sajan
Published: April 2016

Introduction

Cobb's angle in scoliosis has been widely accepted to analyze the extent of deformities and can be used as an indicator of the degree of correction obtained following a corrective surgery. Measurement has traditionally been manual using a pencil and protractor on radiographs. Smartphones have changed the way we live in every field of life. Use of apps in smartphones with accelerometers aids to measure the angle quickly. This study analyzes the accuracy and efficiency of the inclinometer app in smartphones to measure cobb's angle in scoliosis.

Material and Methods

We analyzed cobb's angle in scoliotic patients who underwent robotic guided corrective surgery at our center over the past 2 years. The Cobb angle measure tool in the software used in robotic surgery (Renaissance, Mazor robotics) was used as the gold standard (GS) as it was software based analysis. Clinometer app was used in the smartphone by the primary observer over the computer screen to measure the cobb angle and then manual method was used. Time taken to measure using both the techniques was noted by other observers. Another two observers then independently measured the angle using their smartphones to assess the interobserver variability. Data was tabulated and analyzed by a biostatistician.

Results

Cobb angle of 25 patients with mean age of 14.1 years were analyzed for primary and secondary curves separately. The mean Cobb angle of all measured X-rays was 48.9 degrees in the manual set and 47.9 degrees in the smartphone set as compared with 48.2 degrees as per GS. The mean time consumed was 13.5 seconds for the smartphone set, significantly shorter than that of the manual set which was 36.2 seconds (statistically significant – p < 0.05). 95% confidence intervals for inter-observer variability using smartphones were ±1.5degrees.

Conclusion

Cobb angle measurement using the smartphones was more accurate than the manual methods in our study. With significant time difference between the methods indicating the simplicity of the use of apps in our daily use and the minimal interobserver variability, smartphones indeed can replace the manual methods and can be a reliable tool in the hands of spinal deformity surgeons.
Treatment of Osteoporotic Vertebral Fractures with Elastoplasty: 1-year Results
Authors: Eichler Michael
Published: April 2016

Introduction

Vertebral compression fractures (VCF) are an increasing problem. Common surgical treatments are vertebroplasty and kyphoplasty. Both are mainly performed with PMMA bone cement. Recently a new elastomer (VK100) was developed as optional material for kyphoplasty instead of PMMA. This study investigated the outcome and safety of balloon kyphoplasty performed with the VK100 Vertebral Augmentation System over a follow-up period of 12 months.

Material and Methods

The study includes patients with osteoporotic fractures of one or two vertebrae. All patients were treated with balloon kyphoplasty using VK100 (Bonwrx, Lansing, Michigan, USA) instead of PMMA. VK100 is a radio opaque, bone adherent, non-exotermic elastomer, which is less stiff as PMMA and therefore more comparable to the natural bone. VAS and ODI of all patients was measured preoperative, postoperative, at 12 months. Additional cement leakage and additional fractures were documented.

Results

82 patients were included in the study (age: 63.69 ± 7.54). VAS improved significantly from preoperative 82.9 ± 10 mm to postoperative 18.3 ± 10.2 mm ( p = 0.0015) and improved significantly from postoperative to 8.92 ± 11.5 mm at the 12 months follow up ( p = 0.0163). ODI improved significantly from preoperative 72.92 ± 14.6% to postoperative 47.08 ± 16.35% ( p = 0.0015) and from postoperative to 20.15 ± 7.56 at 12 months ( p = 0.0022). There were no complications due to leakage. Patients showed no additional fractures within the follow up period.

Conclusion

VK100 showed good results in terms of VAS and ODI improvement and occurrence of adverse events. VK100 is an alternative to PMMA bone cement augmentation. Further studies are needed for longer implantation years.
Magnetically Controlled Growing Rods for the Management of Early-onset Scoliosis: Results and Complications at 3-year Follow-up
Authors: La Rosa Guido , Ruzzini Laura , Oggiano Leonardo
Published: April 2016

Introduction

A new method for the management of early-onset scoliosis (EOS) has been recently introduced: it consists of a magnetically controlled growing rod (MCGR) that allows gradual outpatient distractions under control of an external remote device. We present a series of 14 patients with EOS managed with MCGR (Ellipse TM MAGEC System, Irvine, CA).

Material and Methods

We implanted MCGR in 14 patients affected by EOS with various etiology. Scoliosis and kyphosis angles, T1-T12 and T1-S1 length were evaluated preoperatively, postoperatively, and at the last follow-up. A visual analogue scale score was used to evaluate pain during outpatient rod distraction procedures. The mean follow-up is 34 months. All patients attended distractions of the magnetic rod through an external remote control every 3 months. The mean predicted distraction was 3 mm at each lengthening session.

Results

The mean Cobb angle value was 64.7 ± 17.4 degrees (range, 45 to 100 degrees) preoperatively and 28.5 ± 13.9 degrees (range, 15 to 59 degrees) at the latest follow-up. The mean T1-S1 length value was 27.1 ± 5.4 cm (range, 16 to 34.8 cm) preoperatively and 32.8 ± 4 cm (range, 26.5 to 39 cm) at the latest follow-up. The mean T1-T12 length value was 16.2 ± 2.7 cm (range, 10 to 19 cm) preoperatively and 20.6 ± 2.9 cm (range, 15.5 to 23.5 cm) at the latest follow-up. The average monthly T1-T12 height increase was 0.8 mm, whereas the average monthly T1-S1 increase was 0.9 mm. Two patients experienced a rod breakage and 1 patient had a pull-out of the apical hooks. In cases of rod breakage, the magnetic rod was removed and replaced. In case of pull-out, apical pedicle screws have been positioned in substitution of hooks.

Conclusion

Although implant-related complications could occur, as in all EOS growing rods procedures, MCGR can be effectively used in patients with EOS. This spinal instrumentation can overcome many of the complications related with the traditional growing rods implants. In our experience, rod breakage occurred only in patients with a single magnetic rod instrumentation. First case was a patient with a severe thoracic kyphosis. In effect, the management of kyphosis with the MCRG is quite challenging. Moreover, a marked kyphosis was also the cause of pull-out of the apical hooks. Instead, in the second case of rod breakage, we reported a failure of the internal magnet of the rod. In conclusion, this procedure can be effectively used in outpatient settings, minimizing surgical scarring, surgical site infection, and psychological distress due to multiple surgeries needed in the traditional growing rods system, improving quality of life, and saving health care costs.
Validity of CT Scan Measurements of Thoracic and Lumbar Pedicle Dimensions
Authors: Apostolou Thomas , Chatziprodromidou Ioanna , Magras Ioannis , Foroglou Nikos
Published: April 2016

Introduction

The transverse and sagittal inner and outer pedicle diameter of thoracic and lumbar vertebrae were measured with an electronic caliper and with CT scan. To determine the validity of CT scan measurements, comparing with those taken by an electronic caliper.

Material and Methods

A total of 12 anatomic skeletal specimens were acquired from T1 to L5 in the mean age of 69.6 years. Each vertebral pedicle was measured with an electronic caliper and CT scan. A total of 1632 measurements of 408 pedicles were taken. The data were collected and analyzed using the t-test. The comparison of the measurements between left and right pedicle, males and females, as well as between electronic caliper and CT scan was evaluated.

Results

The sagittal diameter of the pedicle was always bigger than 7mm. In the mid-thoracic area (T3-T8), the transverse outer diameter could be less than 4mm, so there is need of use of pediatric screws (<4mm). In the opposite, caudally of T11, the transverse outer diameter was at least 7mm.

Conclusion

Significant statistically difference was found between the two genders, while pedicles from male spines were bigger. Additionally, the CT scan was proved to be precise and valid for the measurement of the transverse outer diameter of the pedicle. For this reason, this method becomes valuable for the preoperative evaluation of the pedicle dimension, especially in scoliosis surgery, helping the surgeon to choose the appropriate size of the screws.
Interspinous Motion Assessment in Anterior Cervical Discectomy and Fusion: Anterior Plate versus Zero Profile Implant
Authors: Ballesteros Vicente , Munjin Aleksandar , Lecaros Javier , Zamorano Juán José , Lecaros Miguel Angel , Larraín Cristián
Published: April 2016

Introduction

Anterior cervical discectomy and fusion's (ACDF) reported pseudarthrosis rate rises up to 20% for single-level and 50% for multi-level procedures. Interspinous motion based on functional cervical spine X-rays analysis has been proposed as tool for assessing spine fusion. Previous studies comparing this assessment with direct intra operative visualization during ACDF revision surgery in patients treated with an anterior plate report that an interspinous motion of less than 1 mm correlates with complete fusion. To our knowledge, there is no literature regarding this assessment in patients undergoing an ACDF using zero profile implants. The purpose of this study is to compare interspinous motion in patients treated with an ACDF using zero profile implants to those operated with an anterior plate, after complete spinal fusion confirmation with a computed tomography (CT).

Material and Methods

Cross-sectional study of 22 patients with a CT-confirmed spinal fusion after ACDF. Twelve patients (16 levels) were treated with an anterior plate, while a zero profile implant was used in the remaining ten patients (17 levels). Interspinous motion at the instrumented levels was evaluated in functional cervical spine X-rays for both groups, stratified by fused level (Student's t-test, ANOVA, Stata 12). Motion values were obtained independently by a radiologist and an orthopedic surgeon, following Song's guidelines (Song et al. J Bone Joint Surg Am 2014;96:557–63).

Results

Patients treated with an anterior plate had an interspinous motion of less than 1 mm, while those patients in which a zero profile implant was used presented a statistically significant greater motion at the fused level ( p = 0.0082). The instrumented level did not affect interspinous motion ( p > 0.05).

Conclusion

Patients treated with an anterior plate had an interspinous motion of less than 1 mm, while those patients in which a zero profile implant was used presented a statistically significant greater motion at the fused level ( p = 0.0082). The instrumented level did not affect interspinous motion ( p > 0.05).
Treatment of Thoracolumbar Osteoporotic Vertebral Compression Fractures with Vertebral Body Stenting: A Prospective Study
Authors: Alobaid Abdulrazzaq , Shehata Eslam , Almutair Abdulaziz
Published: April 2016

Introduction

Balloon kyphoplasty is a procedure to stabilize osteoporotic and/or cancer related VCFs. However, there is a technique inherent problem with the amount of reduction; when filling the balloons, an acceptable reduction is achieved. However, the resulting final reduction after cementing is ~25% lower due to the partial collapse after balloons deflation. To avoid loss of reduction, a newer technique has been introduced, based on the principles of balloon kyphoplasty and vascular stenting.

Methods

A prospective cohort study of clinical and radiographic results after vertebral body stenting(VBS) for treatment of vertebral compression fractures(VCFs). To evaluate effectiveness of VBS as a new technique to treat symptomatic VCFs. A total of 33 patients with 52 symptomatic VCFs were enrolled in a prospective study of VBS. Clinical outcomes were measured pre- and postoperatively using the visual analogue scale (VAS), Oswestry Disability Index (ODI) and ambulatory status (AS). All outcomes were assessed before the procedure, and at 1, 12, 24, and 36 weeks after the procedure.

Results

The median VAS scores went from 10.0 preoperatively to 1.0 at last follow-up. The pre-operative ODI score was 80 preoperatively, improved to 18 at last follow up. The ability to move independently and ease of ambulation significantly improved after the procedure (P ˂ 0.001). The median kyphosis angle was 15.0 degrees preoperatively and decreased by a median of 4.5 degrees postoperatively.

Conclusions

Patients with symptomatic VCFs had significant improvements in back pain, function, and quality of life following VBS. The results of percutaneous vertebral body stenting in osteoporotic fractures may encourage surgeons in future to widen the indications and use these techniques to successfully restore anterior column in traumatic non-osteoporotic fractures in conjunction with posterior instrumentation.
Combined Endovascular and Surgical Treatment of Spinal Dural Arteriovenous Fistulas
Authors: Vukic Miroslav , Ozretic David , Rados Marko , Marasanov Sergej , Rozankovic Marjan
Published: April 2016

Introduction

Type I spinal dural arteriovenous fistulas (SDAVFs) are the most common form of spinal vascular malformations. Even so, they are rare and still underdiagnosed. They are low-flow vascular shunts fed by radicular arteries in patients who most often present with myelopathy. Left untreated, they can lead to progressive neurological decline and considerate morbidity. We present our experiences and results in combined endovascular and surgical treatment of such lesions.

Material and Methods

We conducted a retrospective review of data from 14 adult patients with the diagnosis of SDAVFs who underwent treatment at University Hospital Center Rebro Zagreb between January 2012 and June 2014. We compared complication rates, recurrence rates and data on clinical and imaging follow up in these patients.

Results

12 out of 14 patients underwent endovascular embolization (Onyx was used in 1 patients and NBCA in 11 patients) as the first line therapy. Two patients underwent surgical ligation as initial therapeutic modality. Patients in both groups showed significant improvement in clinical status after treatment (using the Aminoff-Logue Scale score). One patient in endovascular group developed spinal infarction due to accidental embolization of posterior spinal artery. Six patients in embolization group had recurrence of fistula during the course of follow up requiring surgical ligation. Two patients in surgical group had recurrence of fistula during the course of follow- up and were reoperated.

Conclusion

Despite most fistulas are amenable to endovascular embolization, microsurgical obliteration is the treatment of choice in specific anatomic situations and usually the only solution in recurrent cases. A combined approach offers the best results after careful selection of patients based on imaging.
“Capac Ñan” Stairway Fashion Hemilaminectomy: A New Minimally Invasive Multilevel Option to Treatment of Cervical Stenosis. A Study with 24 Months of Follow-Up
Authors: Pesantez Carlos Fernando Arias
Published: April 2016

Introduction

There are many options to decompress the cervical spine on posterior way in multilevel disease, however the muscular injury and instrumentation is a big problem in traditional surgery, the minimally invasive procedures can achieve optimal decompression without muscle injury, preserving the posterior ligamentous tension band with less pain, bleeding and hospitalization, providing improvement in short time. Materials And Methods: We present an study with 15 patients with symptoms of multilevel cervical stenosis and MRI shows multilevel stenosis too, All the patients underwent minimally invasive uniportal multilevel decompression. We use VAS, Neck Disability index and Nurick clinical scale with follow up of 24 months. We made POP early (2 weeks) MRI and dynamics rx.

Results

The Vas preop was mean 9 and 2 on 24 monts. Neck Disability index was 20 preop and 10 POP 24 months. The Nurick clinical scale shows improvement of one time line. The surgical time was mean 22 minute(mean) each level, blood lose 11cc (mean) each level, hospital discharge on 23 hours after surgery and return to daily activities mean 10 days.

Conclusions

The “Capac Ñan” starway fashion minimally invasive hemilaminectomy procedure can be safe and efective to decompress a cervical spinal cord on multilevel disease without instability, muscular injury and let a better time to recovery and return to daily activities. We need more experience to make a final conclusions.
Results of Ballon Kyphoplasty in Osteoporotic Fractures with Posterior Wall Injury
Authors: Shawky Ahmed , Krajnovic Branko , Ezzati Ali
Published: April 2016

Introduction

Cement augmentation techniques are standard treatment for cases of osteoporotic vertebral fractures. Compared with vertebroplasty, kyphoplasty is associated with decreased rates of cement leak. Cases with posterior wall fractures are relative contraindications for both techniques. The aim of this study was to evaluate the results of balloon kyphoplasty in cases of osteoporotic fractures with posterior wall involvement

Patients and Methods

Forty-eight patients with osteoporotic fractures with injury of the posterior vertebral wall were included. Fractures between T4 and L5 were included. Cases with posterior ligamentous complex injury were excluded. Preoperative evaluation included plain X-rays, CT, MRI, and laboratory diagnosis of osteoporosis. All cases were operated upon with balloon kyphoplasty. Bilateral (bi-pedicular) approach was used in all cases. Injected cement volume and incidence of cement leak were evaluated. The minimum follow-up period was 6 months.

Results

18 males and 30 females were operated upon. The average age was 72.4 years. The most common affected vertebra was T12 in 19 patients. The average volume of injected cement was 6.2 ml. Posterior cement leak (in spinal canal) occurred in 2 cases and was asymptomatic. There were no neurologic or embolic complications.

Conclusion

Balloon kyphoplasty is safe in cases of osteoporotic fractures with posterior wall fractures. Type A3 and A4 fractures (according to AO classification) were not associated with increased incidence of cement leak in spinal canal. The volume of injected cement should not exceed the volume injected to inflate the ballon.
Treatment of Vertebral Body Metastases in Palliative Patients: Radiofrequency Ablation, a New and Secure Treatment Option
Authors: Müller-Broich Jacques Dominik , Kretschmar Tobias , Porten Marius , Demukaj Sadri , Saxler Guido
Published: April 2016

Introduction

About a quarter of all people dying in germany succumb to cancer. In 40% metastases of the spine are present. Potentially vertebro- or kyphoplasty in combination with a tumorablation may be a treatmentoption in painful metastases or metastases with fractures. Cementing alone leads to dislocation of metastases and scattering of tumoral mass in the patient. (Principle of Archimedes) Therefore local reduction of tumoral mass should be performed whenever possible.The use of ablation systems in the vicinity of nervous and vascular structures is potentially dangerous. The presented observational study is to assess the security and effectivity of a new spinal intravertebral radiofrequency-ablation sonde.

Materials and Methods

During the period from 11/2013 until 6/2015 we treated 24 patients (14f, 10m) with 58 vertebral bodies with the radiofrequency-ablation system followed by radiofrequency-kyphoplasty. The mean follow-up was 7,04 months (total 169 mon.). Mean age 67 years (Range 51–84 years). All vertebral bodies were treated unipedicular. Cancers treated were breast cancer (8), multiple myeloma (7), lung cancer (3), chondrosarcoma (1), prostate (1), urothel (1), cancer of unknown primary (1), gastric cancer (1) and fibrous dysplasia (1). In two patients this technique was combined with minimal-invasive percutaneous osteosynthesis. The ablationsystem contains a navigable, bipolar electrode with two temperature detection sondes, which allow for real-time temperaturemonitoring at the proximal end of the ablation zone. The ablation zones were planned preoperatively via computertomography and mri. Patients were examined for neurological or other deficits postopertively and during follow-up outpatient clinic visits.

Results

The ablation of the preoperatively determined areas were intraoperatively radiologically and via monitoring of temperature securely performed. The maneuverability of the ablation device allowed via unipedicular access the exact positioning of the device in the planned ablation zone. No patient presented neurological deficits or vascular lesions due to radiofrequency-ablation. One cementextravasation, while performing kyphoplasty at a site where the lateral wall of the vertebral body had already been preoperatively destroyed by the tumor, lead to affection of a peripheral nerve with intercostal neuralgia (<7 days).

Conclusions

The treatment of 24 tumorpatients in the advanced stadium of the cancer disease with percutaneous, minimally-invasive radiofrequency-ablation followed by cementaugmentation could be verified as secure treatmentoption for vertebral body metastases. The combination of a unipedicular access for radiofrequency-ablation and –kyphoplasty facilitates the careful and safe treatment of palliative cancer patients.
Routine Bone Biopsy during Percutaneous Vertebroplasty or Kyphoplasty in the Treatment of Osteoporotic Vertebral Fractures. Does it Change the Management Plan? Do we Know the Costs?
Authors: Shakokani Majeed , Robinson Tom , Cumming David , Lovell Robert , Bhagat Shaishav , Powell John , Kaleel Saajid
Published: April 2016

Introduction

According to the WHO, osteoporosis causes more than 8.9 million fractures annually worldwide. The lifetime risk for a wrist, hip or vertebral compression fracture (VCF) has been estimated to be in the order of 30% to 40% in developed countries. It is estimated that up to 2 people per 100,000 in England are currently treated with percutaneous vertebroplasty and percutaneous balloon kyphoplasty. There are other causes of vertebral compression fractures, and therefore a bone biopsy is recommended to rule out pathologies such as malignancy. There is debate about the necessity of routine biopsy and its cost- effectiveness.

Material and Methods

We conducted a retrospective study on a cohort of consecutive patients undergoing vertibroplasty/kyphoplasty and bone biopsy over a 2 year period between 2013 and 2015 at The Ipswich Spinal Unit. Patient's demographics, indication for surgery, level of augmentation, histopathology results, complications and outcomes were extracted from electronic records. Patients were grouped in to 2 major groups; suspected malignancy and unsuspected malignancy group. Subgroups included non-biopsy group, and routine biopsy group. The non-biopsy group was followed up until last point of care. Cost of a routine biopsy was calculated based on theater, surgeon, consumables and histopathology costs.

Results

64 patients, Mean age of 64, 129 levels were augmented, length of stay of 3 days, follow up of 22 weeks, and mean last point of care was 60 weeks. All underwent imaging and were discussed in a multi-disciplinary meeting (MDT). Out of the 64 patients, 22 malignancy group, 18 patients underwent biopsy. Out of the 42 patients in whom malignancy was not suspected, routine biopsy was performed in 17 patients. No malignancies (0%)found in the unsuspected malignancy group vs 5 positive samples in the suspected group. Routine biopsy did not change the management plan. Average Total cost of a routine biopsy was between £210 and £310.

Conclusion

Contrary to the previously published reports, our study shows that there is no specific role for routine biopsy during vertebroplasty procedure. This is a reflection of our MRI reporting and MDT approach. Therefore, we believe selective biopsy is more cost effective and value added approach in vertebral compression fractures.