bluuebunny/crossref_metadata_2025 huggingface dataset:
Percutaneous Vertebroplasty: A New Technique Minimizing Cement Leak
Authors: Elnoamany Hossam
Published: May 2015

Introduction

Since the introduction of vertebroplasty to clinical practice, the cement leak is considered the most frequent and hazardous complication. In literature, the cement extravasation ranged from 26 to 97% of the time. This study discussed a new technique for injecting cement in the affected vertebra.

Patients and Methods

A total of 123 patients were treated by vertebroplasty using the current technique. The package of the cement powder and the solvent was divided into five equal parts. Each part of the powder and the solvent was mixed as a single dose and injected to the affected vertebra. The duration between subsequent injections was 10 minutes. Each injection is formed of 1 to 1.5 mL of cement.

Results

This new technique gives the surgeon enough time to make multiple separate injections with the same package. The time interval between injections makes cement harden enough and makes it not pushed by the next cement injection. This technique of injection gives time to the injected cement to seal off the cracks and cavities in the vertebra and subsequently leads to a highly significant decreased in cement leak ( p < 0.001) compared with the literature.

Conclusion

This study demonstrates a previously unreported technique for vertebroplasty that adds more safety to the procedure by significantly decreasing cement leak. It also gives the surgeon much more relaxation time and self-confidence during performing the procedure.
Accuracy of Pedicle Screw placement in Revision Spine Surgery using Robotic Guidance
Authors: Bederman Samuel S. , Jain Nick , Woolwine Spencer , Kiester P.D. , Bhatia Nitin
Published: May 2015

Introduction

Pedicle screw instrumentation in revision spinal surgery can be challenging because of the altered anatomy and existing instrumentation. Malpositioned pedicle screws can result in surgical complications that may lead to persistent pain, dysfunction, and morbidity. Robotic-guided screw placement has been shown to be accurate in the setting of primary surgery, however, less is known about its accuracy in revision situations. The purpose of this study was to identify the accuracy rate of pedicle screws placed via robotic guidance in revision spine surgery.

Patients and Methods

Patients who underwent revision spinal instrumentation with robotic guidance during a 3-year period (2011–2014) at our institution were identified and included in the study if they had postoperative CT scans of the operated levels. Screw insertion was identified in revision levels and included for analysis if they were categorized as screw redirection, prior fusion without instrumentation, prior laminectomy, or a spinal level adjacent to a previously operated level. Postoperative CT scans were reviewed for pedicle screw accuracy by independent radiologists.

Results

A total of 36 patients met inclusion criteria (average age 61.6 years, 13 males and 26 females). Of the 682 total pedicle screws placed, 229 were placed in revision levels. Overall, 220 (96.1%) of the 229 revision screws were confirmed to be accurate by postoperative CT. Of the nine screws that were malpositioned, none were clinically significant nor required revision surgery. Of the nine malpositioned screws, there were five lateral breaches, and four medial breaches. One patient required revision surgery for cage migration at a similar level as a misplaced screw, however, pedicle screws were not revised.

Conclusion

Robotic-assisted pedicle screw placement in revision spinal surgery provides accuracy similar to other techniques in primary cases. In cases of previous laminectomy or fusion, robotic guidance can provide benefit to surgeons in navigating altered bony anatomy. Larger studies are needed to confirm these findings.
Chondrosarcomas of the Spine: Prognostic Variables for Local Recurrence and Mortality in a Multicenter Study
Authors: Versteeg Anne , Fisher Charles , Boriani Stefano , Varga Peter , Dekutoski Mark , Luzatti Alessandro , Gokaslan Ziya , Williams Richard , Reynolds Jeremy , Fehlings Michael , Bettegowda Chetan , Rhines Laurence
Published: May 2015

Introduction

Primary spinal chondrosarcomas are rare. Best available evidence consists of small case series, making it difficult to determine optimal management and risk factors for local recurrence and mortality. The application of the Enneking classification in the treatment of primary bone tumors in the appendicular skeleton has led to a longer life expectancy, yet the application of the Enneking system in the treatment of primary bone tumors in the spine has not been widely accepted. Therefore, the aim of this multicenter cohort study was to determine prognostic variables, including application of the Enneking classification, for local recurrence and mortality following surgical intervention for spinal chondrosarcomas.

Patients and Methods

AOSpine knowledge forum tumor developed a multicenter ambispective database of surgically treated patients with spinal chondrosarcoma. Patient data pertaining to demographics, diagnosis, treatment, cross-sectional survival, and local recurrence were collected. Tumors were classified according to the Enneking classification. Patients were analyzed in the following two different cohorts; Enneking appropriate (EA) and Enneking inappropriate (EI). EA was defined by the final pathology margin matching the Enneking recommended surgical margin and EI by not matching.

Results

Between 1987 and 2011, 112 patients (mean age at surgery = 47 ± 16 years) underwent surgical treatment for a primary spinal chondrosarcoma. EA surgery was performed in 61 (58%) patients. Overall, 15 patients (25%) suffered a local recurrence in the EA group and 21 (48%) in the EI group. EI approach significantly increased the risk for local recurrence ( p = 0.009). Overall, 38 (34%) patients died during the study period (mean follow-up = 3.6 ± 3.2 years); factors associated with increased overall survival were absence of adjuvant therapy ( p = 0.002), low-grade tumors ( p = 0.051), and involvement of one or two vertebral levels ( p = 0.038). Enneking appropriateness and surgical margin was not significantly associated with survival. Local recurrence was strongly related to mortality, with an odds ratio of 7.4.

Conclusion

This is the largest multicenter cohort of spinal chondrosarcomas. EI surgical management correlated with increased rates of local recurrence. This robust correlation strongly mandates to surgeons perform an EA resection with disease-free margins for spinal chondrosarcomas.
Osteosarcoma of the Spine: Prognostic Variables for Local Recurrence and Overall Survival, A Multicenter Ambispective Study
Authors: Clarke Michelle , Dekutoski Mark , Luzzati Alessandro , Rhines Laurence , Varga Peter , Rose Peter , Fisher Charles , Chou Dean , Fehlings Michael , Reynolds Jeremy , Williams Richard , Quraishi Nasir , Germscheid Niccole , Sciubba Daniel , Gokaslan Ziya , Boriani Stefano
Published: May 2015

Introduction

Primary spinal osteosarcomas are rare and aggressive neoplasms with poor outcomes. Enneking appropriate, en bloc resection is recommended for appendicular osteosarcomas. Obtaining even marginal margins is technically demanding in the spine, resulting in significant morbidity and possible functional sacrifice. The aim of this study was to identify prognostic variables on local recurrence and mortality, in surgically treated patients diagnosed with a primary osteosarcoma of the spine.

Methods

A multicenter ambispective database of surgically treated patients with primary spine osteosarcomas was developed by the AOSpine knowledge forum tumor. Patient demographic, diagnosis, treatment, perioperative morbidity, local recurrence, and cross-sectional survival data were collected. Tumors were classified according to Enneking principles and analyzed in the following two cohorts: Enneking appropriate (EA) and Enneking inappropriate (EI). EA was defined by the final pathology margin matching the Enneking recommended surgical margin and EI by not matching. Prognostic variables including age, previous spine tumor operation, biopsy type, spine level, tumor size, and chemotherapy timing were analyzed in reference to local recurrence and survival.

Results

Between 1987 and 2012, 57 patients (31 females and 26 males) underwent surgical treatment for a primary spinal osteosarcoma at a mean age of 36 ± 16 years. Patients were followed for a mean period of 3.4 ± 3.5 years (range, 0.5 days–14.3 years). Median survival for the entire cohort was 6.7 years postoperative. Overall, 24 (42%) patients died and 17 (30%) patients suffered a local recurrence, 10 (59%) of which died. Overall, 28 (52%) patients underwent EA resection while 26 (48%) patients were treated by EI resection. Median survival for patients with EA was 6.8 years postoperative, whereas median survival for EI patients was 3.7 years postoperatively ( p = 0.062). EI patients were at a higher risk of local recurrence than EA patients ( p = 0.002). Patient age, previous spine tumor operation, tumor size, spine level, and chemotherapy timing did not significantly influence recurrence and survival.

Conclusion

Osteosarcoma of the spine presents a significant challenge and most patients die from their disease in spite of aggressive surgery. There is a significant decrease in recurrence with en bloc resection when compared with intralesional resection.
Ewing Sarcoma of the Spine: Prognostic Variables for Survival and Local Control in Surgically Treated Patients
Authors: Rhines Laurence , Dirks Michael , Boriani Stefano , Luzzati Alessandro , Fehlings Michael , Fisher Charles , Dekutoski Mark , Williams Richard , Quraishi Nasir , Gokaslan Ziya , Bettegowda Chetan , Germscheid Niccole , Varga Peter
Published: May 2015

Introduction

Primary Ewing sarcoma of the spine is a challenging tumor to treat because of a high rate of local recurrence. The optimum role of surgery in the treatment of Ewing sarcoma is not clearly defined. The objective of this study was to analyze factors relevant to survival and local control in surgically treated patients diagnosed with primary Ewing sarcoma of the spine.

Materials and Methods

A multi-institutional international ambispective with cross-sectional follow-up data was gathered about patients who underwent surgery for primary Ewing sarcoma of the spine. The primary outcomes assessed were 5-year survival and local recurrence. Multiple variables including the Enneking appropriateness of the surgery were evaluated for relationships to the primary outcomes. An Enneking appropriate procedure for Ewing sarcoma is an en bloc resection with negative margins. Survival and recurrence were analyzed using Kaplan–Meier curves and log-rank tests.

Results

A total of 59 patients diagnosed with primary Ewing sarcoma of the spine underwent surgery. Enneking appropriateness of surgery was known for 55 patients; 30 treated Enneking appropriately (EA) and 25 treated Enneking inappropriately (EI). The 5-year survival was 73% ( n = 22) for EA patients and 48% ( n = 12) for EI patients. Median survival was not achieved within 5-year postoperative for EA patients and was 2.2 years for EI patients ( p = 0.124). Local recurrence occurred in 20% ( n = 6) of patients with an EA procedure versus 48% ( n = 11) of patients with an EI procedure. The rate of local control was favorable for EA-treated patients compared with EI-treated patients ( p = 0.046).

Conclusion

Primary spinal Ewing sarcoma requires multidisciplinary treatment. An Enneking appropriate surgical procedure is associated with longer survival and better local control. An Enneking appropriate procedure, when feasible, should be the surgical treatment of choice for primary spinal Ewing sarcoma.
Comparison of Clinical Outcomes for Anterior versus 360 Fusion at the Fusion Level of Lumbar Hybrid Surgery
Authors: Otero-Lopez Ernesto , Guyer Richard , Blumenthal Scott , Zigler Jack , Ohnmeiss Donna
Published: May 2015

Introduction

Options for treating two-level symptomatic disc degeneration after failure of nonoperative care includes fusion, total disc replacement (TDR), or a hybrid with fusion at one level and TDR at the other. Often the hybrid procedure involved an instrumented 360 fusion. However, the option for a standalone ALIF in a hybrid has rarely been addressed. The purpose of this study was to compare the outcomes of hybrid TDR/fusion surgery for ALIF versus 360 at the fusion level.

Methods

The study group included 135 patients undergoing hybrid surgery using TDR at one level and either ALIF ( n = 83) or instrumented 360 fusion ( n = 52) at the adjacent segment. The majority of cases were performed with TDR at L4–L5 and fusion at L5–S1. Only patients who had surgery at least 12 months before this study were included. The mean length of follow-up was similar in the two groups (∼24 months in both groups). Outcome measures included Oswestry Disability Index (ODI), visual analog scales (VAS) assessing back and leg pain, and reoperations.

Results

The mean operative blood loss was significantly less in the hybrid/ALIF group compared with the hybrid/360 group (71.7 vs. 142.1 mL; p < 0.01). The mean ODI scores before surgery were approximately 46 in both the groups. The scores improved significantly in both groups to the means of about 30 ( p < 0.01) with no significant difference between the two groups ( p > 0.40). Mean VAS back and leg pain scores also improved significantly in both groups with no significant differences between groups ( Fig. 1 ). [Figure: see text] The reoperation rate was significantly greater in the hybrid/360 group than in the hybrid/ALIF group (23.1 vs. 3.6%; p < 0.01). Reoperations in the hybrid/360 group included six reoperations for removal of painful posterior instrumentation, one to treat a wound infection, one decompression of the fusion level of the hybrid, three were for treatment of a symptomatic adjacent segment, and two were due to TDR malpositioning or displacement. Hybrid/ALIF reoperations included two patients undergoing decompression for stenosis and one underwent fusion two levels above the index surgery.

Discussion

This study found that the outcomes are similar between hybrids performed with ALIF versus 360 fusion adjacent to the TDR level with the exceptions of a significantly greater reoperation rate and mean blood loss in the hybrid/360 group. These results support that unless there is a defined indication for the posterior procedure, standalone ALIF is a viable option for lumbar hybrid surgery.
Tie2+ Cells of the Bovine Nucleus Pulposus are Progenitor Cells Capable of Differentiating into Osteocytes and Adipocytes
Authors: Tekari Adel , Chan Samantha , Wuertz Karin , Sakai Daisuke , Benneker Lorin M. , Grad Sibylle , Gantenbein Benjamin
Published: May 2015

Introduction

The intervertebral disc (IVD) has a limited regenerative potential and low back pain represents a leading cause of disability.1 IVD repair strategies require an appropriate cell source that is able to regenerate the damaged tissue such as progenitor stem cells. Recently, progenitor cells that are positive for the angiopoietin receptor (Tie2) in the nucleus pulposus were identified.2 These cells, which express type II collagen and aggrecan, were shown to have progenitor-like multipotency. Here, we isolated primary cells from bovine IVD aged 1 year and sorted bovine nucleus pulposus progenitor cells (NPPC) for the marker Tie2. Furthermore, we demonstrate that in contrast to Tie2− cells, Tie2+ expressing cells can differentiate into osteogenic and adipogenic lineages in vitro.

Materials and Methods

NP cells were obtained from 1-year-old bovine tails by sequential digestion with Pronase for 1 hour and collagenase overnight. Sorted Tie2− and Tie2+ cells were cultured in osteogenic and adipogenic medium containing 5% fetal bovine serum for 3 weeks. The formed cell layers from both subpopulations were stained for calcium deposition and fat droplets using alizarin red and red oil staining, respectively. Colony forming units (CFU) were prepared for both cell suspensions (Tie2− and Tie2 + ) in methylcellulose-based medium. The formed colonies (> 10 cells) were analyzed macroscopically and counted after 8 days.

Results

After 3 weeks of culture, sorted Tie2+ cells were able to differentiate into osteocytes and adipocytes as characterized by calcium deposition and fat droplet formation. By contrast, Tie2− cells generated a weak staining for calcium and no fat droplets were obtained ( Fig. 1 ). Sorted Tie2− and Tie2+ subpopulations of cells, both the formed colonies, however with different morphologies. The colonies formed from Tie2+ cells were spheroid in shape, whereas those fromTie2− cells were spread and fibroblastic. In addition, the highest frequency of the formed colonies was obtained for the Tie2+ cells after 8 days of culture in the methylcellulose-based medium. [Figure: see text]

Conclusion

Our data showed that Tie2+ cells of the nucleus pulposus cells are progenitor-like cells that are able to differentiate into osteogenic and adipogenic lineages. Sorting of NPPC for Tie2 may represent a promising strategy with the potential to be used in the clinics for treatment of intervertebral disc damage.

Acknowledgments

This project was funded by two projects of the Swiss National Science Foundation, grant numbers IZK0Z3_154384 and 310030_153411. References Freemont AJ. The cellular pathobiology of the degenerate intervertebral disc and discogenic back pain. Rheumatology (Oxford) 2009;48(1):5–10 Sakai D, Nakamura Y, Nakai T, et al. Exhaustion of nucleus pulposus progenitor cells with ageing and degeneration of the intervertebral disc. Nat Commun 2012;3:1264
Viable Cells Density and its Relationship with the Vascularization of the Endplate in Lumbar Discs
Authors: Martins Delio , Medeiros Valquiria , Paredes-Gamero Edgar , Buri Marcus , Wajchenberg Marcelo , Nader Helena , Puertas Eduardo , Faloppa Flavio
Published: May 2015

Introduction

The intervertebral disc is avascular and remains unknown if it has the capacity to maintain viable cells inside over the years. The vascularization of the endplate has a direct influence on the nutrition to the disc cells. This study aimed to analyze the vascularization of the endplate and its relation to the density of viable cells in lumbar intervertebral discs of young and old adult humans.

Materials and Methods

A total of 28 lumbar intervertebral discs were used and separated into two groups: Group 1 ( n = 15; younger than 50 years; Pfirrmann ≤ 3) and Group 2 ( n = 13; elder or equal to 80 years, Pfirrmann ≥ 4). Vascularization of the endplates was analyzed using Stereo Microscope Discovery V.8. Cell viability was assessed by MTT method. The cell density was measured by PicoGreen technique using amount of DNA as an estimate of total cell number.

Results

The viable cells remained steady in relation to the total cell density. The inferior endplate presented the highest number of holes ( p < 0.05). The greater number of cells was found in the annulus fibrosus ( p < 0.05). There was a positive correlation ( p < 0.05) between the density of viable cells and vascular openings in the inferior endplate.

Conclusion

The inferior endplate has the main supply of blood vessels to nourish the intervertebral disc and has direct bearing on the number of viable cells.

Acknowledgments

This work was supported by INFAR/UNIFESP Confocal and Flow Cytometry Facility and by grants from the “Fundacao de Amparo à Pesquisa do Estado de São Paulo” (FAPESP: Grant number: 2009/54793–6). D.E.M. was supported by a PhD's fellowship grant from CAPES (Coordenacao de Aperfeicoamento de Pessoal de Nível Superior).
Characteristics and Mechanisms of Adjusting Spinopelvic Sagittal Balance in Patients with Thoracic and Thoracolumbar Kyphosis
Authors: Sun Zhuo Ran , Li Wei Shi , Chen Zhong Qiang
Published: May 2015

Introduction

This study determined the mechanisms of adjusting trunk sagittal balance and the impact of surgery on spinopelvic sagittal morphology and alignment in patients with thoracic and thoracolumbar kyphosis.

Materials and Methods

Whole spine and standing lateral radiographs of 49 Chinese patients with thoracic and thoracolumbar kyphosis were obtained before surgery, immediately after surgery, and in the final follow-up. A total of 171 asymptomatic Chinese adults were recruited as controls. The age at which the patients developed kyphotic deformity was recorded. The pelvic and spinal parameters were measured and the correlations of all parameters were analyzed.

Results

The mean age at which the patients developed kyphosis was 7.1 years. Preoperative mean pelvic incidence was 35.1 degrees, and mean pelvic tilt was −0.1 degrees, significantly less than those of normal subjects. Preoperative mean lumbar lordosis was 68.0 degrees, significantly higher than that of normal subjects. After surgery, kyphosis and lumbar hyperlordosis were significantly corrected, however, the preoperative and postoperative pelvic sagittal morphology and alignment made no difference, even in the final follow-up. There were no correlations between spinal and pelvic parameters before surgery. In the final follow-up, the correlations were recovered.

Conclusion

The mechanisms of adjusting the trunk sagittal balance in patients with thoracic and thoracolumbar kyphosis not only including pelvis anteverting, but also lumbar hyperlordosis. The latter serves as the main mechanism once skeletal maturation has been established. Although kyphosis and lumbar hyperlordosis were corrected by surgery, pelvic sagittal morphology remained unchanged. Surgery can reestablish the spinal sagittal balance and recover the correlations between spinal and pelvic parameters.
Lumbofemoral Angle: A Novel Sagittal Parameter Related to Quality of Life in Patients with Adult Scoliosis
Authors: Zhu Feng , Bao Hongda , Wang Bin , Zhu Zezhang , Liu Zhen , Yu Yang , Qian Bang-Ping , Sun Xu , Qiu Yong
Published: May 2015

Introduction

PT and PI-LL sometimes offer limited utility in daily practice when evaluating QOL, especially in outpatient clinics with limited time and equipment facility. This study proposes a novel spinopelvic parameter, lumbofemoral angle (LFA). The purpose of this study is to analyze the correlation between LFA and health-related (HRQOL) in adult scoliosis patients.

Patients and Methods

A cohort of 100 asymptomatic adult volunteers and 50 patients with adult scoliosis were prospectively recruited. The following sagittal parameters including thoracic kyphosis (TK), LL, LFA, PI, PT, and sacral slope (SS) were measured on the long-cassette standing upright lateral radiographs. HRQOL measures included the VAS, ODI, and SF-36 instruments for patients with adult scoliosis.

Results

LFA, the novel regional lumbosacral parameter, averaged 0.68 ± 4.5 degrees in normal adults with the 95% CI value of −7 to 7 degrees. Higher intra- and interobserver intraclass correlations (ICC) and less measurement time were observed in LFA compared with PI-LL indicating that it is easy to quantitatively evaluate the regional alignment directly from X-ray films. Although LFA in patients with adult scoliosis was found to be significantly larger (11.8 ± 8.7 vs. 0.68 ± 4.5 degrees, p < 0.001), it showed strong correlations with the PT and PI-LL in both groups ( p < 0.001). Additionally, a summary of significant correlations between LFA and QOL measurements were identified ( p < 0.05)

Conclusion

LFA could be considered a novel, user-friendly sagittal parameter, strongly correlated with previously established sagittal spinopelvic parameters and HRQOL measurements. LFA showed high inter- and intraobserver reliability, faster measurement times and could be easily identified and read. Mean LFA in asymptomatic adult patients was nearly 0 degrees with 95% CI value of −7 to 7 degrees, and significantly increased in adult scoliosis patients
Implant Instability, Proximal Fractures, Quality of Life, and Outcomes of Global Spinal Alignments Correction using Short Fusion in Adults and Elderly
Authors: Ptashnikov Dmitry , Mikhaylov Dmitry , Masevnin Sergei , Zaborovskii Nikita , Lapaeva Olga
Published: May 2015

Introduction

The purpose of our research is studying of incidence of implant instability, proximal fractures of instrumented and adjacent vertebras, and evaluation of health-related quality of life (HRQOL) parameters depending on extent of the sagittal balance correction after short fusion using a posterior approach.

Patients and Methods

A study of 83 patients with Type L (SRS-Schwab) deformity, operated in our institute was held in the period between 2008 and 2011. Patients were divided into two groups. The first retrospective group included 43 patients who underwent short fusion of lumbar curve from T12 or L1 to L5. The second prospective group consisted of 40 patients, which were treated using short fusion from T9 to S1 extending to the pelvis. Groups were evaluated with HRQOL-scales including VAS, ODI, SF36, and SRS-24. Radiographical assessment included Cobb coronal angle, thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS), sagittal vertical axis (SVA). Radiographical, HRQOL-parameters and complications with a 3-year minimum follow-up were analyzed and compared between two groups. The comparisons were done by using independent sample Student t-test. A p-value of less than 0.05 was accepted as significant.

Results

In the first group the ideal sagittal balance was not achieved. The second group showed a better restoration of global spinal alignments compared with the first one ( p < 0.05). The HRQOL-scores (VAS, ODI, SF36, and SRS-24) of the patients after 3 years are slightly higher in the second group, but we did not get significant difference between groups ( p > 0.05). In the first group the number of complications in the form of implant instability ( n = 15, 35%) consists of loosening of screws at the end of fusion (T12/L1 or L4/5). The second group was obtained by a higher number of patients with complications ( n = 25, 63%) including loosening of screws at pelvis ( n = 15, 37.5%), proximal fractures of upper instrumented vertebra ( n = 7, 17.5%) and upper adjacent vertebra ( n = 8, 20%). Incidence of implant instability and proximal fractures in the second group was statistically more frequent ( p < 0.05).

Conclusion

The research showed that short fusion extending to the pelvis provided good sagittal balance, global spinal alignments, and likely HRQOL-parameters after 3 years follow-up. But, eventually, we obtained higher number of complications.
Crankshaft Phenomenon in Patients Operated for Adolescent Idiopathic Scoliosis
Authors: Hrustic Asmir , Vujadinovic Aleksandar , Isakovic Eldar , Delic Jasmin
Published: May 2015

Introduction

Crankshaft phenomenon is determined as a loss of three-dimensional correction of the scoliosis curve, which occurs after posterior fusion in children who have not completely finished skeletal growth. Dubousset named this phenomenon when he noticed that the entire spine and torso gradually turn and deform anterior spine, which continues to grow and rake around the axis of the fusion mass. This is mostly seen in infantile and juvenile idiopathic scoliosis, however this also occur in adolescents who are immature at the time of the last fusion.

Aim

To analyze this phenomenon in adolescents who have not finished skeletal growth and were operated for idiopathic scoliosis.

Material and Methods

This retrospective–prospective study analyzed 48 randomly selected adolescents operated for idiopathic scoliosis in Clinic for Orthopaedic and Traumatology in Tuzla between 1996 and 2011. Patients operated only with a posterior stabilization and fusion were divided into two groups. One group consisted of adolescents with intensive growth (12 years for girls and 14 years for boys) and another group consisted of adolescents at final stage of skeletal growth (14 years for girls and 16 years for boys). We measured Cobb angle at standard X-rays performed in an upright posture immediately after the surgery and at the latest X-rays done at the end of skeletal growth at the age of 18 years.

Results

Increasing Cobb angle was noted in 53% of studied patients. In group A higher values of Cobb angle noted in 69.56% examinees and in 36% in group B. When we analyzed both groups Cobb angle increased from preoperative 19.6 degrees to postoperative 22 degrees (2.4 degrees—12.2%) ( r = 0.98), In group A preoperative Cobb angle increased from preoperative 20.6% degrees to postoperative 24 degrees (3.4 degrees—16.22%) ( r = 0.97), while in group B from 18.60 to 20 degrees (1.4 degrees—7.52%) ( r = 0.98).

Conclusion

Postoperative deformity progression of anterior column in adolescents operated for idiopathic scoliosis could be seen even if the stable fusion achieved. The risk for progression is higher in younger patients.
Outcomes of Operative and Nonoperative Treatment for Adult Spinal Deformity (ASD): A Prospective, Multicenter Matched and Unmatched Cohort Assessment with Minimum 2-Year Follow-Up
Authors: Smith Justin , Lafage Virginie , Shaffrey Christopher , Schwab Frank , Hostin Richard , Boachie-Adjei Oheneba , Akbarnia Behrooz , Klineberg Eric , Gupta Munish , Deviren Vedat , Hart Robert , Burton Douglas , Bess Shay , Ames Christopher
Published: May 2015

Introduction

Adults with spinal deformity typically present with pain and disability.

Aim

Our objective was to compare outcomes for operative (op) and nonoperative (nonop) treatment for ASD based on a prospective, multicenter patient population.

Material and Methods

This is a multicenter, prospective analysis of consecutive ASD patients electing for op or nonop care at enrollment. Inclusion criteria: age > 18 year and ASD. Propensity scores were used to match op and nonop patients based on baseline (BL) ODI, SRS22, maximum thoracolumbar/lumbar Cobb angle, pelvic incidence to lumbar lordosis mismatch (PI-LL), and leg pain numeric rating scale (NRS) score.

Results

A total of 689 patients met with the criteria, including 286 op and 403 nonop, with mean ages of 53 and 55 years, minimum 2-year follow-up rates of 86 and 55%, and mean follow-up of 24.7 and 24.8 months, respectively. At BL, compared with nonop, op patients had significantly worse HRQL based on ODI, SRS22, SF36, and leg and back pain NRS ( p < 0.001) and had worse deformity based on pelvic tilt, PI-LL, and C7SVA ( p ≤ 0.002). Before reaching minimum 2-year follow-up 38 nonop patients converted to op treatment and were analyzed in the op group. At minimum 2-year follow-up all HRQL measures assessed significantly improved for op patients ( p < 0.001), but none of these measures improved significantly for nonop patients ( p ≥ 0.11). Total 97 matched op–nonop pairs were identified based on propensity scores. At last follow-up the 97 matched op patients had significant improvement in all HRQL measures assessed ( p < 0.001), but the 97 matched nonop patients lacked significant improvement in any of the HRQL measures ( p ≥ 0.20). Paired op–nonop analysis demonstrated the op patients to have significantly better HRQL scores at follow-up for all measures assessed ( p < 0.001), except SF36 MCS ( p = 0.058). Overall minor and major complication rates for op patients were 53 and 40%, respectively.

Conclusion

Op treatment for ASD can provide significant improvement of HRQL measures at minimum 2-year follow-up. In contrast, nonop treatment appears to at best maintain presenting levels of pain and disability.
Modified Posterior Vertebral Column Resection for the Treatment of Osteoporotic Fractures with Neurological Deficits in Elderly Patients
Authors: Enercan Meric , Erturer Erden , Kilic Mesut , Kahraman Sinan , Sanli Tunay , Ozturk Cagatay , Alanay Ahmet , Hamzaoglu Azmi
Published: May 2015

Introduction

The purpose of this retrospective study was to evaluate the results of spinal canal decompression and anterior column support via modified posterior vertebral column resection (PVCR) (Unilateral hemilaminectomy, pediculectomy, subtotal vertebrectomy) performed for eliminating the disadvantages of the anterior or combined A + P approaches, in the management of osteoporotic vertebral fractures with neurological deficits in elderly patients.

Patients and Methods

A total of 55 patients (40 females and 15 males) with more than 2 years of follow-up were included in this study. The fractures were in the thoracic spine in 16 patients, and thoracolumbar spine in 39 patients. Overall, 11 patients had ASIA grade C and 41 patients had ASIA grade D neurological deficits. Clinical and radiological outcome and complications were also evaluated. Surgical technique included placement of fenestrated titanium pedicle screws, followed by hemilaminectomy, unilateral pediculectomy, and decompression of the spinal canal by subtotal vertebrectomy, and support of anterior column by titanium cage. Contralateral facet joint fusion and grafting was made. Prophylactic vertebroplasties were made in one level above and one level below in all patients.

Results

Mean age was 74.2 years (range, 66–92), and mean follow-up was 43.5 months (range, 28–102). Mean operation time was 252 minutes (range, 160–340), and blood loss was 580 mL (range, 420–800). Mean preoperative local kyphosis angle was 18.5 degrees and improved to 4.2 degree after the operation and 4.8 degree at the final follow-up. Visual analog scale (VAS) score was eight before the operation and improved to two at final follow-up. Full neurological recovery was achieved in all patients. There were no pseudoarthroses. The major complication was adjacent segment fracture was made three patients (5.4%). The minor complications were superficial wound infections in five patients and dural tear in four patients (16.3%).

Conclusion

Treatment of osteoporotic vertebral fracture with neurological deficit is a challenging procedure in elderly patients. Modified PVCR provides effective decompression of neural structures. Contralateral intact lamina, pedicle, and cortex of the vertebra increase primary stability and provides more bony surface for fusion.
Prehab as an Alternative to Elective Spine Surgery
Authors: Urbonas Ryan , Hanscom David
Published: May 2015

Introduction

Hypothesis—A structured screening protocol including assessment of psychological well-being with subsequent self-directed physician supervised noninterventional treatment protocol can successfully avoid elective lumbar spine surgery while optimizing patient well-being. Background—Certain patients with chronic LBP without focal neurological deficits or significant instability or deformity may benefit from optimization of their psychological well-being before contemplating elective low-back surgery. In certain cases these interventions may actually ameliorate the patient symptoms to a degree that the originally planned surgery is no longer pursued while the patients experience a substantial improvement of their quality of life.

Material and Methods

From January 2012 onwards a routine protocol at the Swedish Neurosciences Institute required new patients presenting to our spine clinics to complete routine psychological testing for anxiety, depression, and irritability. All patients with abnormal scores in any of the categories were placed into a structured “prehab” program with a self-directed mental and physical health program. Only patients who had presented with degenerative lumbar disorders, such as central or foraminal spinal stenosis and mild degenerative spondylolisthesis that corresponded with their symptoms were considered candidates for surgery.

Results

During a required minimum 1-year follow-up of 25 patients selected for a formal “Prehab program” due to their abnormal psychological profiles we identified no cases of neurological decline, no conversions to surgery, and confirmed statistically significant improvement in patient-related outcomes scores (ODI, VAS, opiate index, and psychological wellness scores). Interestingly none of these patients required interventional spine management during our observation period while also increasing their functional activity profiles based on reported activity tolerances.

Conclusion

We identified two potential conclusions based on our early results: (1) Inclusion of psychological wellness testing including screening for anxiety, depression, and irritability may be a valuable adjuvant to routine other screening tests for elective lumbar spine surgery. (2) Emphasis on correction of abnormal psychological profiles in a formalized “Prehab program” may positively influence patients' subjective well-being to the point where surgical care may be delayed or not required anymore. Further investigation of a “mind body syndrome” in its spinal symptom manifestations may be warranted to optimize patient selection and treatment outcomes.
Transforaminal Epidural Injection for Cervical Disc Herniation: Clinical Outcomes
Authors: Vialle Emiliano , Guasque Joana , Vialle Luiz Roberto
Published: May 2015

Introduction

To investigate the effect and complications after transforaminal injection for cervical disc herniation.

Material and Methods

We retrospectively reviewed all the patients submitted to a fluoroscopic-guided transforaminal injection for radiculopathy caused by cervical disc herniation. During the past 7 years, 57 patients (39 females, 18 males, mean age 45.6 years) experiencing cervical radiculopathy underwent fluoroscopically guided nerve root infiltrations by posterolateral approach. The position of the needle was verified after injection of a small amount of contrast. Lidocaine 1% (0.5 mL) and a glucocorticosteroid (0.5 mL) were injected.

Results

The most treated root was C6 (31 procedures), 14 patients had injections at C7, 7 at C5, and 5 at C4. Eight patients (14%) had complications (three syncopes, three transient hoarseness, one worsening of symptoms, and one hematoma). 42.1% became asymptomatic after the procedure, therefore not requiring surgery. Around 57% needed surgery but it took at least 2 months to become symptomatic again.

Conclusion

Radicular block for cervical disc herniation is a safe way to avoid surgery. Some patients still need surgery but since they got better with the procedure, they can schedule it at a convenient date.
DISC (Degenerate-Disc Infection Study with Contaminant Control) Discussion on Methods, Interim Analysis, and the Pitfalls of not Sending Contaminant Control
Authors: Rao Prashanth J. , Reddy Rajesh , Fairhall Jacob , Coughlan Marc , Mews Peter , Scholsem Martin , Kohan Saeed , Davies Mark , Day Jerry , Phan Kevin , Thayaparan Ganesh , Scherman Daniel , Taylor Peter , Chau Christine , Salisbury Elizabeth , Lambie Neil , Mobbs Ralph J.
Published: May 2015

Introduction

Studies that implicate disc infection in the majority of patients with axial back/neck pain or leg/arm pain is potentially scandalous and irresponsible. The majority of these studies are underpowered and lack a contaminant arm, the current study is aimed to fulfil these basic criteria.

Material and Methods

A prospective case–control multicentric study (HREC 13/218) including cases discectomy for degenerative disc pathology and controls are patients undergoing discectomy for nondegenerate pathology. True disc positivity was inferred if the culture of disc was positive and the paraspinal tissue sample was negative. A total of 400 patients have been enrolled. In degenerative disc cases, 8.7% were true positive (disc +ve/paraspinal −ve) with paraspinal-positive samples in 38.4% on its own. In control cases there was 40% positive for disc culture together with paraspinal tissue. The organisms in disc or paraspinal culture were very similar with 85% having same organisms. On generalized linear model analysis of disc-culture positivity using binomial sets there were no statistical significant findings when comparing disc positivity to demography, type of surgery, modic changes or level of surgery.

Conclusions

(1) The true rate of disc culture positivity in the degenerative disc population is significantly lower than previous literature reports. (2) At the interim analysis stage, the DISC study heavily favors performing disc cultures strictly with a contaminant control.
Complications of the Anterior Approach to the Lumbar Spine
Authors: Griffiths-Jones William , Stokes Oliver , Chan Daniel , Budd H.
Published: May 2015

Introduction

Lumbar spine pathology, such as tumors and fractures, commonly affect vertebral bodies, making anterior access to the spine an important tool in the armamentarium of spinal surgeons. Furthermore, accessing the front of the spine via a posterior approach is associated with the potential for neural injury. Reports in the literature of high rates of complications, particularly vascular injury, has led to questions about the safety of the anterior lumbar approach. As a result, various recommendations have been made such as the used of “access” surgeons and ring retractor systems to reduce the complication rate. We present the complication rates from over 550 anterior approaches performed in Exeter, United Kingdom, by multiple surgeons over an 18-year period, without the use of an access surgeon or ring retractor system.

Materials and Methods

We retrospectively reviewed the notes of 567 consecutive patients having undergone an anterior approach to the lumbar spine for any procedure from 1996 to 2014. Information was collected from operation notes, anesthetic records, postoperative ward rounds, and clinic letters. Details were recorded on intraoperative blood loss and complications such as vascular injury and peritoneal opening as well as postoperative complications such as infection, DVT/PE, ileus, and hernias.

Results

There was an overall complication rate of 13.4%. The rate of vascular injury requiring suture repair was 3.2% and the rate requiring input from a vascular surgeon 0.8%.

Conclusion

We report a comprehensive and critical review of our practice over 18-years with a large series of consecutive patients undergoing anterior lumbar surgery for a wide range of pathology. This has been performed in a single center by multiple orthopedic spinal surgeons without the use of access surgeons or dedicated ring retractor systems. Our complication rates have been shown to be comparable to the existing literature demonstrating that in high volume centers the anterior approach to the lumbar spine is safe and effective for a multitude of applications.
Midterm Follow-Up of Cervical Disc Arthroplasty in Patients with Cervical Myelopathy
Authors: Berg Andrew , Tankel Jamie , Ansari Eanna , Killen Maire-Clare , Hernandez Miguel , Khan Shoaib , Bhatia Chandra , Friesem Tai
Published: May 2015

Introduction

Cervical myelopathy secondary to cord compression may require surgical decompression with the aim of surgery being to arrest the progression of myelopathy and associated symptoms. Theoretical concerns have been raised regarding the use of cervical disc arthroplasty (CDA) in patients with myelopathy due to the fear that continued motion may cause continuing microtrauma to the cord. As such there is a paucity of reported data. We report the clinical results of anterior cervical decompression and CDA in patients with cervical myelopathy at our institution.

Patients and Methods

Patients who had undergone one- or two-level anterior cervical decompression and CDA for myelopathy were identified from the authors' institution's database. Prospectively collected data including neck disability index (NDI), visual analogue scale (VAS) for neck and arm pain, patient reported activity level, and hospital anxiety and depression scale were reviewed. Statistical analysis was performed for significance.

Results

Demographics: 40 patients. Mean age at surgery 51.3 years (range, 35–75). Operated levels, 63: 17 one- and 23 two-level procedures. Seven patients had cord compression at both levels; 21 had myelomalacia at one level and 3 at two levels. The average duration of preoperative symptoms was 37.5 months. Mean follow-up was 3.2 years (range, 1–7.4 years). Surgery: Surgery was performed using four different implants; 28 PRESTIGE LP Cervical Disc System (Medtronic, Minnesota, United States), 24 NUNEC Cervical Arthroplasty System (RTI Surgical, Inc., Florida, United States), 10 Discocerv (Scient́x-Alphatec Spine, France), and one DISCOVER Cervical Arthroplasty Disc Replacement System (DePuy Spine, Inc., Massachusetts, United States). Overall, 34 procedures were performed at C5/6, 21 at C6/7, 7 at C4/5, and 1 at C3/4. Outcomes: Mean NDI improved from 47.7 to 33.96 ( p  < 0.01), VAS arm 6.4 to 3.8 ( p  < 0.01), VAS neck 6.5 to 3.3 ( p  < 0.01), depression 8.9 to 7.1 ( p = 0.01), and anxiety 9.4 to 7.8 ( p = 0.06). A total of 26 patients (65%) reported same or better activity level, 27 (68%) would be satisfied with their current condition for life. A total of 29 (73%) said they would have the treatment again.

Conclusion

We report the clinical results of anterior cervical decompression and CDA in 40 patients with cervical myelopathy, with follow-up up to 7.4 years. Statistically significant improvements were seen in NDI and VAS scores. The level of improvement or maintenance of activity level is likely a reflection of a general patient reported activity measure being used rather than a specific myelopathy scale. We believe our results support further investigation of CDA in myelopathy.
Comparison of Adjacent Segment Motion after Anterior Cervical Fusion Using Standalone Cage versus Total Disc Replacement Using Activ C
Authors: Kim Se-Hoon , Kim Bum-Joon , Choi Jong-Il , Ha Sung-Kon , Kim Sang-Dae , Lim Dong-Jun
Published: May 2015

Introduction

Anterior cervical discectomy and fusion (ACDF) has been a widely accepted procedure for treatment of cervical disc diseases. However, several reports about postfusion exacerbation of adjacent segments gave rise to development of motion preserving prosthesis. We present the retrospective analysis comparing total disc replacement (TDR) using Activ C (Aesculap, Germany) with ACDF using standalone cage.

Materials and Methods

From January 2010 to December 2012, among patients diagnosed of cervical disc diseases, patients who received either ACDF or TDR at single level were reviewed. Clinical outcome was assessed using visual analogue scale (VAS) of arm pain and neck pain. For all patients, lateral flexion and extension radiographs were taken at preoperative and 1 year after operation. The segmental range of motion (ROM) of operated level, rostral adjacent level, and caudal adjacent level were measured from plain dynamic radiographs using Cobb angle. Multilevel ACDF and hybrid method were not included in this series.

Results

A total of 40 patients (mean age 46.3 years) were reviewed. Fifteen patients were treated with TDR and the remaining 25 patients received ACDF. At the time of 1-year follow-up, the segmental ROM of operated level was significantly preserved in TDR group ( p = 0.017), whereas the motions of rostral and caudal adjacent levels were greater in ACDF group than TDR group (7.1 versus 6.6 degrees and 6.6 versus 5.1 degrees, respectively). However, the ROM of adjacent segments did not show statistical significance.

Conclusions

In the present study, we found that TDR using Activ C showed favorable motion preservation at the operated level. Radiologically, the ACDF group showed more increase of adjacent segment motion 1 year after surgery, which implies that TDR using Activ C may have advantages in preventing adjacent segmental diseases compared with ACDF.