bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of Spinal Degenerative Stenosis in Patients with Spinal Tumors
Authors: Smekalenkov Oleg , Ptashnikov Dmitry , Zaborovskii Nikita , Mikhaylov Dmitry , Masevnin Sergei
Published: April 2016

Introduction

The evolution of conservative treatment, such as radiation therapy, chemotherapy has prolonged significantly life expectancy of patients with spinal tumors. Paradoxically, the complexity of decision making for this patient population increased due to chronic disease management. The purpose of our research is evaluation of health-related quality of life (HRQOL) parameters in patients with spinal tumors and degenerative spinal stenosis.

Material and Methods

Retrospective data were collected for 17 patients with spinal tumors (multiple myeloma ( n = 7), metastasis of breast cancer ( n = 5), renal cell carcinoma ( n = 4), bladder cancer ( n = 1)). Inclusion criteria were the following: spinal tumor lesions with 0–6 scores in Spinal Instability Neoplastic Score (SINS), degenerative spinal stenosis with neurological deficit (Frankel grade C-D), unsuccessful nonoperative treatment of degenerative disease (VAS 7–9). According to revised Tokuhashi scoring system, patients were divided into two groups. The first group included 11 patients with 0–8 scores (good prognosis). The second group consisted of 6 patients with 9–11 scores (moderate prognosis). All patients underwent degenerative stenosis surgery using foraminotomy and instrumentalization. Groups were evaluated with HRQOL-scales including VAS, ODI and Frankel. HRQOL-parameters and complications 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

HRQOL-scores (VAS, ODI, Frankel) of the patients were increased after operation in both groups. The HRQOL-scores after 18 months are slightly higher in the first group, but we did not get significant difference between groups (p > 0.05). The number of complications in the form of implant instability, proximal and distal junctional disorders was comparable (p > 0.05). No patients had progression of oncology disease or new metastasis of tumor during follow-up in the first group. In the second group tumor came out of remission in 1 case (new visceral and bone metastasis).

Conclusion

Management of spinal degenerative stenosis in patients with spinal tumors provides to increase quality of life. We believe that degenerative stenosis surgery does not affect on progression of oncology disease.
Defining Normative Quality Metrics in Complex High-Risk Deformity Cases: Results from the Scoli-Risk 1 Study
Authors: Berven Sigurd , Saigal Rajiv , Lafage Virginie , Kelly Michael , Kopjar Branko , Smith Justin , Dahl Benny , Cheung Kenneth M. C. , Carreon Leah Y. , Schwab Frank , Espinoza-Rebmann Kathrin , Shaffrey Christopher , Fehlings Michael , Lenke Lawrence , Ames Christopher
Published: April 2016

Introduction

Quality metrics are a component of the value calculation, and reflect the risk of care. There is significant variability in complication rates, and quality metric standards in spinal surgery. Case complexity or surgical invasiveness is an important predictor of perioperative complications, and normative standards for quality metrics should be stratified by case complexity. The purpose of this study is to define normative quality metrics for complex, high-risk spinal deformity cases, and to provide a standard and baseline data that may guide quality improvement in comparative research.

Material and Methods

Secondary analysis of a prospective, international multicenter observational study (Scoli-Risk1) The study cohort included adults with spinal deformity in the cervicothoracic or thoracolumbar regions. Quality metrics include cumulative readmission and reoperation rates (30, 90, 180 days), wound infection, and DVT rates. Chi Square analysis is used to measure the relationship between osteotomy type and readmission and reoperation. Linear regression is used to determine the association of age and procedure with readmission and reoperation.

Results

273 patients from the Scoli-Risk 1 study were included in the analysis. Cumulative readmission rates were 7.7 (4.8;11.5), 13.2 (9.4;17.8), 16.5 (12.3;21.4) percent at 30, 90 and 180 days after index surgery. Reoperation rates were 14.7 (10.7;19.4), 17.6 (13.3;22.6), 20.1 (15.6;25.4) percent at 30, 90 and 180 days after index surgery. Age was a significant predictor of readmission during the first 180 days after surgery (OR1.388 (1.068;1.803)), but not a significant predictor of the need for reoperation (OR=1.109 (0.903;1.361)). Osteotomy type (PSO/VCR vs SPO) was not a significant predictor of the need for readmission ( p = 0.986) or reoperation ( p = 0.753). The overall infection rate was 7.0%, including 3.3% deep infections. The rate of DVT was 3.7%.

Conclusion

Normative quality metrics are not established for complex deformity surgery in adult patients. This paper demonstrates that readmissions and reoperations in complex spinal reconstruction in adults occur at a higher rate than expected rates in less complex spine procedures. Age is an important independent predictor of readmission, but not the need for reoperation. For each decade older, patients are 1.4 times more likely to be readmitted within 6 months of surgery. This data may be useful to provide normative data for comparative studies of surgical outcomes with similar magnitude of deformity treated with operations of comparable invasiveness.
Correlation between Lumbopelvic and Sagittal Parameters and Health Related Quality of Life in Adults with Lumbosacral Spondylolisthesis
Authors: Gussous Yazeed , Theologis Alekos , Demb Joshua , Berven Sigurd
Published: April 2016

Introduction

The impact of sagittal plane imbalance has been demonstrated for adult deformity and pediatric spondylolisthesis. The association between lumbopelvic parameters, global sagittal balance, and health status has not been well-defined in adults with lumbosacral spondylolisthesis. The role for deformity reduction in lumbosacral spondylolisthesis in the adult has not been well-defined. The purpose of this study is to evaluate the impact of sagittal alignment and lumbosacral parameters on health status in adults with L5-S1 spondylolisthesis.

Methods

Secondary analysis of data from a multicenter, prospective study. Health status measures included SF-12 and SRS-30. Radiographic predictor variables included: C7 sagittal vertical axis deviation (SVA), T1 and T9 spinopelvic inclinations, pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), slip angle, Meyerding slip grade, and Labele classification. Pearson's correlations were calculated between each radiographic parameter and health status measure.

Results

Forty-five patients were included (male 15, female 30; average age 40.5 ± 18.7) as summarized in Table 1 . For low-grade slips, SVA had strong negative correlations with SF12-MCS, SRS-30 appearance, mental, and satisfaction domains (−0.57, −0.60, −0.58, −0.53, respectively; p < 0.05). PI had strong negative correlations with SRS-30 total, mental, and subscore domains (−0.57, −0.53, −0.57, respectively; p≤0.05). SS also had a strong negative correlation with SF12-MCS (−0.61; p = 0.02), while thoracic kyphosis had a strong positive correlation with SRS-activity (0.62; p = 0.02). For high-grade slips, slip angle had a moderate negative correlation with SF12-MCS (−0.36; p = 0.05). SVA had strong negative correlations with SF12-PCS, SRS-30 appearance, activity domains (−0.48, −0.48, 0.45; p < 0.05) and a moderate negative correlation with SRS-30 subscore (−0.37; p < 0.05). T1PI had a moderate negative correlation with SF12-PCS and SRS-22 appearance (−0.37, −0.36; p≤0.05).

Conclusion

Lumbosacral spondylolisthesis in adults negatively impacts mental and physical HRQoL. While HRQoL are similar between patients with low- and high-grade slips, multiple global and local radiographic sagittal parameters negatively impact HRQoLs for both groups. Improvement of global sagittal balance and lumbopelvic parameters in adults with lumbosacral spondylolisthesis may be useful in improving health status in adults. [Table: see text]
Maximal Access Surgery for Posterior Lumbar Interbody Fusion (PLIF) with Divergent, Cortical Bone Trajectory (CBT) Pedicle-screws
Authors: Pecoraro Michele Federico , Marengo Nicola , Vercelli Giovanni , Zenga Francesco , Garbossa Diego , Ducati Alessandro
Published: April 2016

Introduction

First advocated by Santoni et al. in 2009, the cortical bone trajectory (CBT) pedicle screw technique is an alternative to the traditional, convergent technique that shows comparable biomechanical features and potentially requires less aggressive tissue retraction. Aim of this therapeutical note is to describe this new technique focusing on main advantages and limitations.

Material and Methods

The authors provide a detailed description of the surgically relevant anatomy focusing on the positioning of the cortical trajectory screws. The surgical technique is then described in a precise step-by-step manner, stressing complication avoidance. Results and Conclusion: The maximal access surgery PLIF approach is a safe, reproducible procedure allowing for a traditional lumbar spine approach with the benefits of minimal facet joint manipulation and potentially preserving part of their neural innervation and a large part of the paraspinous musculature. A dedicated self-retaining retractor and directional neuromonitoring may guide surgeons during the procedure. Nevertheless, the surgeon's knowledge of anatomical landmarks, response to visual and tactile cues and intraoperative decision-making skills remain of paramount importance.
Outcome of Posterior Stabilisations for Metastatic Spinal Lesions
Authors: Julian Harriet , Thomson Stacey , Verzin Eugene , Darwish Nagy , McLorinan Greg , Hamilton Alistair , Eames Niall
Published: April 2016

Introduction

The objective of this study was to determine whether posterior only stabilization of metastatic spinal lesions provides adequate stability over the life span of the recipient patient. There are no gold standards for surgical stabilization of metastatic spinal lesions however National Institute of Clinical Excellence guidelines (UK) state that anterior reconstruction should be considered in patients with metastatic spinal cord compression who are likely to survive a year. Standard practice in our regional unit has been to stabilize metastatic spinal lesions through a posterior only approach. Our rationale is that posterior stabilization provides sufficient stability while avoiding the additional risks, time, and cost of anterior stabilization.

Materials and Method

Retrospective review of all cases of posterior only spinal stabilization performed for metastatic disease over a 5 year period. Patient demographics, pathology and metal work construct including number of levels stabilized was recorded. All post-operative imaging was reviewed. Failures and revisions were recorded. Clinical notes were reviewed for surviving patients.

Results

Of the 94 cases 49 were male, average age at time of surgery was 62. 77 (81.9%). Of the patients who were deceased by the study end date mean time from surgery to death was 504 (15 to 1865) days. 72 (93.5%) of constructs remained stable until death. 5 patients required further surgery. 3 had broken rods requiring revision and 2 required anterior decompression and stabilization for disease progression. None of the 17 alive patients required further surgery and all remained neurologically intact.

Conclusion

This case series revealed very low rates of posterior construct failure or need for further surgery for disease progression. This indicates that posterior only stabilization is a safe and effective surgical management option for metastatic spinal lesions.
Characteristics of Patients who Survived Less than Three Months or Greater than Two Years after Surgery for Spinal Metastases: Can We Avoid Inappropriate Patient Selection?
Authors: Verlaan Jorrit-Jan , Choi D. , Oner F. C.
Published: April 2016

Introduction

The survival of patients with metastatic cancer has improved at the cost of increased presentation with metastatic spinal disease. For patients with (impending) pathological spinal fractures and/or spinal cord compression, surgical intervention may relieve pain and improve mobility and quality of life. It is generally accepted that surgery is inappropriate if anticipated survival is less than three months, and survival greater than two years is uncommon. The aim of this international multicenter prospective cohort study was to analyze data from surgical patients who died within three months, or after two years from surgery, to identify any preoperative factors which might be associated particularly with poor survival, to avoid inappropriate selection of patients for surgery in the future.

Patients and Methods

A total of 1266 patients were treated surgically for (impending) pathological fractures and/or neurological deficits and were prospectively followed. Data collected included tumor characteristics, preoperative fitness (ASA), neurological status (ASIA), performance status (KPS), and quality of life (EQ-5D). Primary outcomes were survival at three months and two years postsurgery. Univariate and multivariate logistic regression analysis were used to find preoperative factors associated with short- and long term survival.

Results

In univariate analysis age, emergency surgery, KPS, EQ-5D, ASA, ASIA, and Tokuhashi/Tomita scores were all significantly associated with short survival. In multivariate analysis, however, only KPS was significantly associated with short survival (OR 1.40; CI 1.18–1.67). Associated with longer survival in univariate analysis were age, number of spinal levels included in the surgery, KPS, EQ-5D, ASIA, and Tokuhashi/Tomita scores. In multivariate analysis, only the number of affected spinal levels included in the surgery was significantly associated with longer survival (OR 1.21; CI 1.03–1.41).

Conclusion

Poor performance status at presentation is the strongest indicator of poor survival (less than 3 months), whereas a low disease load with fewer involved spinal levels is strongly associated with longer term survival.
Percutaneous Decompression and Fixation on Complex Spinal Metastases
Authors: Silva Alvaro , Illanes Juan Cristobal
Published: April 2016

Materials and Methods

Retrospectively analyzed the postoperative results of a series of 6 patients with vertebral metastases, with complicated mechanical pain and neurological involvement using a decompression technique and percutaneous fixation. Discuss the results with the literature.

Results

Total of 6 cases, 3 men and 3 women. Average age: 67.8 years (66–85), all with known primary tumor: 2 lungs tumor, 2 breast tumor, 1 prostate tumor and 1 renal tumor. Neurological compromise: L5 radicular pain paresis and one progressive thoracic myelopathy. SINS: 8,9,10,12,13,13. Tomita: 3,5,5,6,10,10. Surgical technique: posterolateral decompression, tube 5 Kapener decompression tube type 1, all percutaneous pedicle fixation. Complications: 1 patient L5 lumbar epidural hematoma resolved with surgical evacuation. Five of six went to early radiotherapy Evolution: In all of them neurological recovery and relief of mechanical and radicular pain.

Conclusions

Conventional treatment of patients with neurologic involvement secondary to vertebral metastasis is surgical decompression and open setting, this depending on the vital prognosis and patient status as mayor surgeries. The high rate of complications and fixing decompression percutaneous seem to offer an effective alternative in the management of the complication with minimal complications.
Multicolumn Spinal Cord Stimulation for Significant Low Back Pain in Failed Back Surgery Syndrome: A National, Multicentre, Randomized, Controlled Health Economics Study (Estimet)
Authors: Roulaud Manuel , Monlezun Olivier , Lorgeoux Bertille , Rigoard Philippe , Estimet Group
Published: April 2016

Introduction

Many studies have demonstrated the efficacy of spinal cord stimulation (SCS) for chronic neuropathic radicular pain over recent decades. But despite global favorable outcomes in Failed Back Surgery Syndrome (FBSS) with leg pain, the back pain component remains poorly controlled by neurostimulation. Technological and scientific progress has led to the development of new SCS leads, comprising a multicolumn design and a greater number of contacts. Their efficacy of multicolumn SCS lead configurations for the treatment of the back pain component of FBSS has recently been suggested by pilot studies. However, a randomized controlled trial must be conducted to confirm the efficacy of new generation multicolumn SCS. ESTIMET is a multicentre, randomized study designed to compare the clinical efficacy and health economics aspects of mono vs multicolumn SCS lead programming in FBSS patients with radicular pain and significant back pain.

Material and Methods

FBSS patients with a radicular pain VAS score ≥ 50mm, associated with a significant back pain component were recruited in 14 centers in France and implanted with multicolumn SCS. Before the lead implantation procedure, they were 1:1 randomized to monocolumn SCS (group 1) or multicolumn SCS (group 2). Programming was performed using only one column for group 1 and full use of the 3 columns for group 2. Outcome assessment was performed at baseline (pre-implantation), and 1, 3, 6 and 12 months post-implantation. The primary outcome measure was a reduction of the severity of low back pain (bVAS reduction ≥ 50%) at the 6-month visit. Additional outcome measures were changes in global pain, leg pain, paraesthesia coverage mapping, functional capacities, quality of life, neuropsychological aspects, patient satisfaction and healthcare resource consumption.

Results

Trial recruitment started in May 2012 and closed in October 2013. The 14 study centers have been initiated. The last visit last subject was performed in January 2015. This study received funding in 2012 from the French government NHS program “PSTIC 2011” (Program de Soutien aux Techniques Innovantes et Coûteuses). Each patient provided informed consent and approval was requested and obtained from the Poitiers University Hospital Ethics Committee (CPP Ouest III), the French National Agency for Medicines and Health Products Safety (ANSM) and the French Data Protection Authority (CNIL, No. 70108724P).

Conclusion

Preliminary results are expected to be analyze for the end of 2015 and published at the start of 2016.
Thoracic Volume Modeling in Virtual Sagittal Curve Progression
Authors: Ledonio Charles , Lee Po-Chih , Polly David W. , Jones Kristen E. , Erdman Arthur
Published: April 2016

Introduction

Scheuermann's kyphosis is a primary sagittal plane deformity that manifests in adolescence. The wedged vertebrae cause increased thoracic kyphosis and a foreshortened thoracic length. The effect on the thoracic volume has been less well studied. With the ability to accurately model thoracic volumes, we are now capable of virtually modeling the effect of increasing kyphosis on thoracic volume. Virtual modeling may allow us to determine the point of diminishing returns in deformity correction when trying to improve pulmonary status. We hypothesize the computed thoracic volume measured from a 3D virtual model decreases with progression of kyphosis from 50 to 100 degrees.

Methods

Blender software was used to create a threedimensional thorax model with normal coronal and sagittal balance. Virtual wedging of vertebral bodies was performed for the model to be progressively deformed by 10 degrees from 50100 degrees of kyphosis. Thoracic volume was calculated via shrinkwrap modifier applied to an uvsphere within the thoracic cavity.

Results

Virtual wedging of vertebral bodies was necessary to achieve virtual progression of sagittal curve. As kyphotic angle increased, more vertebral segments had to be wedged (>5 degrees). Thoracic volume in the virtual adult thorax with a 50degree kyphosis was 1679cc. This volume decreased in a linear fashion by a mean of 5.4% for every 10 degrees more of kyphosis. The final volume was 1218cc at 100 degrees of kyphosis, which was a 27% decrease in volume from baseline.

Conclusion

As the deformity progresses from 50 to 100 degrees there is a 27% decrease in the thoracic volume. The decrease appears linear. While there is not a direct relationship between thoracic volume and pulmonary functions, adequate thoracic volume is necessary for adequate pulmonary function. This study helps to establish the relative magnitude of volume decrease based upon the sagittal Cobb angle.
2-Year Outcome of a New Modified Luque Trolley Technque versus Traditional Growing Rods in the Management of Progressive Juvenile Onset Scoliosis
Authors: Cottam Andrew , Van Herwijnen Bart , Davies Evan
Published: April 2016

Introduction

Our objective was the long term evaluation of a new growth guidance technique compared with growing rods for posterior instrumentation of scoliosis. We performed a retrospective review of patient records and radiological imaging. A traditional Luque Trolley construct uses wires to hold growth guidance rods together. We describe a new technique which uses Domino end to side connectors in place of the wires with the aim of providing a stronger construct to limit curve progression. From a group of 28 patients treated with this technique we review 23 patients with a minimum of 2 year follow up. The mean age at surgery was 7.3 years (10 Male and 18 Female). The mean pre-operative Cobb angle was 69.1 degrees. All patients had posterior correction and modified Luque trolley construct with domino. We compared this to a group of 6 patients with a minimum 2 year follow up who were treated with growing rods. The mean age of this group was 7 years (2 Male 4 Female). The mean pre-operative Cobb angle was 56.5 degrees. All of these patients had posterior correction with growing rods.

Materials and Methods

Sequential measurement of Cobb angle and length of rods was performed, with recording of further surgical procedures and associated complications. This enabled us to demonstrate curve progression and growth of the construct in both patient groups.

Results

In the domino group the mean pre-operative curve was 69.1 degrees corrected to a mean post-operative angle of 36 degrees showing a mean percentage correction of 48.9%. This compared with a mean pre-operative curve of 56.5 degrees in the growing rods group, which was corrected to a mean post-operative angle of 36.1 degrees showing a mean percentage correction of 41.3%. In both groups the curves progressed despite surgery with a mean progression of 10.9 degrees after 1 year and 15.7 degrees at year 2 in the domino group and a mean progression of 3.3 degrees after year 1 and 14.9 degrees at year 2 in the growing rod group. In both groups the constructs had limited growth. The mean amount of growth at 2 years was 3.7mm (~0. 19cm per year) in the domino group and 10.8mm (~0.54cm per year) in the growing rod group.

Conclusion

Both techniques do not completely prevent progression of scoliosis. Our new domino technique demonstrates as good a capacity for initial curve correction and limiting further curve progression as a growing rod technique but has a more limited capacity for further longitudinal growth. However the new domino technique is vastly cheaper and avoided a mean of 3.4 surgeries in the 2 year period compared with the growing rods.
Low Body Weight in Patients with Adolescent Idiopathic Scoliosis
Authors: Junior Charbel Jacob , Cardoso Igor Machado , Junior José Lucas Batista , Maia Thiago Cardoso , Brazolino Marcus Alexandre Novo , Debom Tadeu Gervazoni , Roncaglio Bruno
Published: April 2016

Introduction

Scoliosis is a three-dimensional deformity of the spine that leads to more than 10° in the frontal plane. In adolescent idiopathic scoliosis (AIS) does not know the cause of the condition, and the search of the pathology source settings may involve the analysis of the nutritional status of patients. This study aims to investigate the nutritional status of patients (AIS) compared with asymptomatic population in the same age group.

Methods

A prospective, descriptive and comparative study with a sample of 60 subjects divided equally into two groups. The AIS group ( n = 30) represented by holders of AIS and control group ( n = 30) comprised healthy subjects both sexes and groups with equivalent age. We analyzed age, gender, menarche, weight, height and BMI.

Results

In terms of age: AIS Group: 14.3 ± 1.97 years; Control group: 14.23 ± 1.79 years. Regarding weight: Group AIS: 47.4 ± 13.8 kg; Control group: 55.6 ± 11.63 kg As for height: AIS Group:. 1.6 ± 0.1 m; Control group: 1.64 ± 0.08 m. As for BMI: AIS Group: 18.5 ± 3.7 kg / m2; Control group: 20.79 ± 2.92 kg / m2. Age and height did not achieve statistical difference when compared with the different AIS and control groups (p > 0.05). While statistically significant difference of body weight ( p = 0.01) and BMI ( p = 0.01) when comparing the AIS and control groups.

Conclusion

Patients with AIS have a low body weight.
Proximal Junctional Kyphosis in Pediatric Deformity: Analysis of Management with a Surgical Technique Limiting Cervical Extension
Authors: Pantoja Samuel , Chahin Andrés , Arriagada Gonzalo , Luna Felipe
Published: April 2016

Introduction

Proximal junctional kyphosis (PJK) is a relatively frequent complication of spinal deformity surgery which can result in significant symptoms and potential neurological compromise. Reconstruction of PJK in the cervico-thoracic junction usually entails proximal extension of fixation to the cervical spine, with a compromise of function in this young population.

Material and Methods

We designed a retrospective review of clinical and radiological features in a consecutive series of patients treated for PJK of the upper thoracic spine. Objective: discuss the use of an anterior plus posterior reconstructive technique which aims to avoid proximal extension into the cervical spine for the management of PJK in the pediatric deformity population. Patients: Three patients with spinal deformity (neuromuscular scoliosis 2, Scheuermanns kyphosis 1) developing progressive PJK were operated with an anterior and posterior reconstruction. Clinical and radiographic follow-up is analyses with a minimum of 9 months. 

Results

All patients were successfully managed with adequate control of the progressive deformity and proximal extension into the cervical spine was significantly limited with this anterior and posterior approach. 

Conclusions

For this selected group of patients with upper thoracic PJK, an interior and posterior surgical reconstruction was successful in managing the condition with limited extension into the cervical spine, thus avoiding greater future functional compromise.
The Use of MAGEC Growing Rods as a Temporary Distraction Rod in Severe Kyphoscoliosis: A Case Report
Authors: Smith John , Morgan Jessica
Published: April 2016

Background

The acute correction of severe spinal deformity can be associated with significant neurologic risk. Halo traction can be used as a method to slowly correct deformity while allowing for close neurologic monitoring during correction. However, this typically requires a prolonged hospital stay and significant costs.

Methods

This case reports using a magnetically controlled growing rod (MCGR) to continue correction of a severe spinal deformity after an initial period of halo traction to allow for safe correction a severe kyphoscoliosis.

Results

The patient is a female child, adopted from Ethiopia, with an estimated age between 10–13 years. She presented with a severe kyphoscoliosis measuring greater than 135 degrees. She is otherwise healthy. An MRI showed no abnormalities of the spinal cord. Due to the severity of her curve, we elected to use halo-gravity traction for 4 weeks. During that time, she gained 7 inches in height and her curve improved to 100 degrees. To continue her correction, we then placed a Magnetic Growing rod from T1-L3/4, and distracted on a monthly basis for 6 months; resulting in correction of her curve to 80 degrees. The patient then underwent removal of the MCGR, and had definitive posterior spinal instrumentation and fusion from T2-L4 with apical Ponte osteotomies. Her scoliosis corrected to 47 degrees and her kyphosis to 42 degrees. She was left with a visible cervical deformity that is currently asymptomatic.

Conclusion

Multiple authors have reported the use of traction as part of the treatment of severe scoliosis as a means to reduce neurologic risk during deformity correction.1,2 Surgical placement of temporary distraction rods have also been reported as part of a staged correction of severe scoliosis but is associated with loss of neuromonitoring signals in 41% of patients. These changes were reversible if the temporary traction was reversed. Cheung et al reported the use of a MCGR in a girl with severe spinal deformity where distractions were made daily for 2.5 months prior to definitive correction.3 The MCGR offers a safe option as a temporary distraction rod that can be lengthened gradually on an outpatient basis. This allows for neurological monitoring during gradual correction of the curve in anticipation of definitive correction. References Sponseller PD, Takenaga RK, Netown P, et al. The use of traction in the treatment of severe spinal deformity. Spine 2008;33:2305–2309 Buchowski JM, Bhatnagar R, Skaggs DL, Sponseller PD. Temporary internal distraction as an aid to correction of severe scoliosis. J Bone Joint Surg Am 2006;88:2035–2041 Cheung JP, Samartzis D, Cheung KM. A novel approach to gradual correction of severe spinal deformity in a pediatric patient using the magnetically-controlled growing rod. Spine J 2014;14:e7–e13
Surgical Management of Recurrent Compressive Myelopathy after Anterior Cervical Discectomy and Fusion
Authors: Negm Mohammad
Published: April 2016

Introduction

Recurrent myelopathy after anterior cervical discectomy and fusion is a rare condition, the literature in this entity were limited. This recurrence may occur at the same level or in adjacent level/s, usually the proximal level, the compressing element either anteriorly by a newly prolapsed disc or posteriorly by enfolding of the ligamentum flavum

Material and Methods

From 2008 to 2012, 9 cases of recurrent cervical myelopathy were treated surgically at Bab El-Sheria university hospital, all of them had an anterior cervical discectomy before with a good improvement after surgery. All patients were evaluated clinically by both JAO score and Nurick's grades and radiologically by plain X-ray and MRI, In MRI the pattern of compression were evaluated in T2 waited image and the cord was evaluated according Yasutsugu classification.. 6 out of the 9 cases were operated through anterior approach and 3 via posterior approach. The mean follow up period was 30.7 months.

Results

All cases in this study were improved clinically and radiologically, the average time of surgery were 65 minutes (45–80), the average blood loss 140cc (100–170cc), non of patient develop any major complication, only 4 cases suffering mild dysphagia which improved spontaneously, Improvement of JAO score was evaluated by the Recovery rate (RR), according to Hirabayashi's method. All patients were satisfied as they regain all or most of their previous activity and work. 7 out of 9 cases (77.8) classified as excellent result according to improvement of JAO, RR ˃ 70%. Other 2 cases classified as good result

Conclusion

Excellent results could be obtained through this procedure, improvement in clinical outcome and cord condition was evident.
Reliable Measure of Safe Zone for Cervical Spinal Surgery in Keeping of the Embryologic Origins of the Course of the Recurrent Laryngeal Nerve (RLN) on Right and Left
Authors: Rajabian Ali , Quraishi Nasir A.
Published: April 2016

Introduction

Considerable variations are observed of a “safe zone” for avoiding RLN injury during anterior cervical exposures. Most studies have attempted to accurately measure RLN versus the background of cervical vertebrae level. However all studies so far have not factored-in the unique embryology of RLN following the descent of the aortic arches. Thus, making it a floating structure separate from the bony spine. We aimed to measure the positional variation of this floating complex (RLN, Larynx, Esophagus) in fresh cadavers that are not yet fixed.

Methods

8 fresh cadavers were dissected to measure the point at which RLN on the right and left sides joined the tracheoesophageal groove TEG medially (considered safely protected) thence ascending to enter larynx. This was also measured against backdrop of the cervical level with neck in neutral and extension.

Results

The RLN joins the TEG 4.45 cm vertically inferior to laryngeal prominence on the right and 7.7 cm on the left (Range of +/− 0.5 cm). There were significant variations of this point (RLN joining TEG) measured with neck in neutral and extension by ~1.8 cm (+/− 0.3 cm) (the length of one vertebral level (Photographed).

Conclusion

While the use of vertebral level landmarks may work well for nerve structures exiting or attached to the “fixed” spine, landmarking of a totally free floating nerve, such as the RLN is not practical. This nerve is closely related embryologically to that of the pharyngeal pouches and aortic arches and can undergo positional variation as described. Neck positioning during anterior cervical procedures can produce variations in the location of the recurrent laryngeal nerve. This is due to this structure as a “free floating nerve” and its different embryological origins (to the spine). The RLN joins the TEG ~4.5cm and 8 cm below the laryngeal prominence on the right and left sides respectively. [Figure: see text]
Surgical Outcome of the Selective Posterior Spinal Fusions for Ossification of Posterior Longitudinal Ligament in the Cervical Spine
Authors: Mishiro Takuya , Manabe Hiroaki
Published: April 2016

Introduction

It is widely known that laminoplasty (LP) and anterior cervical fusions have been performed for ossification of posterior longitudinal ligament (OPLL). But progression of kyphosis and development of the ossification after surgery sometimes cause aggravation and revival of the symptoms. Recently, several authors reported that posterior cervical spinal fusion (PSF) for patients with OPLL. The purpose of this study is to assess surgical outcome of the selective spinal fusions for OPLL in the cervical spine.

Method

From 2010 to 2014, twenty seven patients with OPLL (mean age 68 years) who underwent surgical treatment with LP (14 patients) or PSF (13patients) were included in this study. Surgical outcomes were assessed by operative time, amount of bleeding and complications. Radiographic measurement included change of the alignment in C2/C7 (cervical lodosis), range of motion of cervical spine. Neurological function was assessed using a Japanese Orthopaedic Association Scale (JOA).

Result

Mean follow-up period is one year. The operative time was slightly longer in PSF group, but amount of bleeding was not significance. One patient had C5 paralysis in PSF group. In fixed range at PSF group, one interbody fixation was three cases, two fixations were seven cases and three fixations were three cases. On radiographic analysis, the mean change of alignment at last follow-up period were 2.8° ± 6.5° (LP) and 1.6° ± 6.9° (PSF). Range of motion of cervical spine were 8.6° ± 9.6° (LP) and 9.9°±7.6°(PSF). There was not significant difference between two groups at pre-operative JOA score. Improvement rate of JOA score were 55.7% ± 32.2% (LP) and 42.3% ± 25.4% (PSF). There was no significant difference between both groups in all categories.

Conclusion

It is natural to preserve as much as possible mobility in cervical spine. On the other hand, there is another opinion that instability of the cervical spine at boundary of ossification zone is related to development of ossification. It may prevent ossification to obtain stability of the cervical spine. In comparison with the LP, PSF did not adversely affect the clinical and radiographic outcomes in this study. This result suggested the possibility that PSF maintains a function of the cervical spine and prevents ossification. Limitation of our study include the short follow-up period and various fixed range. It is necessary to observe long-term progress.
Degenerative Scoliosis de Novo: Prospective Study of 50 Cases Operated with Stand-Alone ALIF with One Years Minimum Follow-Up
Authors: Norotte Gilles
Published: April 2016

Introduction

Posterior approach in degenerative scoliosis de novo is related to high rate of complications in elderly people. In a previous retrospective and comparative report in 2009 (French Spinal Society), Stand alone ALIF/OLIF proved a less iatrogenic procedure to relief the pain and meet patient's expectations. A prospective study including 50 patients has been performed to confirm this previous report, with at least one-year follow-up.

Material and Methods

The indications are based on a specific classification according to the biomechanism of the rotatory discogenic collapse. Therefore, two homogenic groups are compared. The details of the procedure are important with elderly people to avoid vascular complication or subsidence (preventive vertebral augmentation) due to osteoporosis. Stand alone ALIF/OLIF using a Peek cage. The cage and disk space are filled with nanoparticles of HAP. The outcomes are assessed with VAS, ODI, Kim&Kim score, standard radiography and spinogram at two, six and twelve-month follow-up periods.

Results

The two groups have specific physiopathology and epidemiology. But, outcomes are very similar after one-year follow-up. Surprisingly, it is not related to the number of disk's levels (1 to 4) operated on. According to Kim&Kim score: 30% have excellent outcome, 60% good result. VAS drops from 7/10 to 2/10 at one year. Complications (10% poor results) are mainly related to vertebral body fractures (upper endplate of L5). Posterior Vertebral augmentation was not efficient to improve the score. Symptomatic effect of sympathectomy is noted (8%) but with good acceptance. Revision rate is 6% mainly due to the persistence of a radiculopathy linked to posterior stenosis. A posterior decompression was performed after 4 months and relieved the symptoms. Radiologic fusion rate is 90% with HAP nanoparticles. It proves a low cost, less iatrogenic than BMP 2 and efficient solution in elderly people.

Conclusion

This prospective study confirms that Stand alone ALIF/OLIF is a better procedure to relieve the pain and meet patient's expectation compared with posterior instrumented surgery. Preserving posterior musculature and reshaping the anterior “lumbar arch,” Stand alone ALIF improves the sagittal balance in a physiological way. Osteoporosis required a “systematic” vertebral augmentation by anterior approach to lower subsidence or vertebral body fractures rate.
Use of a Sublaminar Decompression as an Alternative to Traditional Laminectomy in Degenerative Disorders of the Lumbar Spine
Authors: Peddada Kranti , Elder Benjamin , Ishida Wataru , Lo Sheng-Fu , Holmes Christina , Goodwin C. Rory , Witham Timothy
Published: April 2016

Introduction

The traditional treatment for lumbar stenosis with instability is laminectomy and posterolateral arthrodesis, ± interbody fusion. However, laminectomies remove the posterior elements and decrease available surface area for spinal fusion. A sublaminar decompression can achieve adequate decompression while preserving bone surface area to enhance spinal fusion.

Material and Methods

A retrospective review of 72 patients with degenerative pathology who underwent sublaminar decompression by a single surgeon at a single institution was performed. Data collected included baseline demographics, preoperative symptoms, operative data, symptoms at last follow-up (LFU), time to fusion, fusion rate, and radiographical measurements, consisting of thecal sac cross-sectional area, bilateral lateral recess height, and bilateral foraminal diameter on preoperative and postoperative scans. Paired t-tests were used to test significance of these changes.

Results

31 males and 41 females with median age 60 (range: 19-78) years underwent sublaminar decompression with fusion. A mean of 1.9 levels were fused. The mean VAS pain score improved from 6.8 preoperatively to 3.0 at last follow-up. Fusion imaging was available for 44 patients, with a fusion rate of 91%, and median time to fusion of 10.7 (range: 3.2-17.4) months. Preoperative and postoperative mean thecal sac cross-sectional area, right lateral recess height, left lateral recess height, right foraminal diameter, and left foraminal diameter were 153 and 209 mm2 (p = 0.000012), 5.9 and 5.9 mm (p = 0.5), 5.7 and 6.3 mm (p = 0.014), 4.6 and 5.2 mm (p = 0.0084), and 4.2 and 5.2 mm (p = 0.00012), respectively.

Conclusion

This study demonstrates that patients had sufficient decompression, as evidenced by improvement in clinical symptoms and statistically significant increases in thecal sac cross-sectional area and bilateral foraminal diameter. Therefore, sublaminar decompression may be an effective alternative to laminectomy in treating central and foraminal stenosis. Fusion rates in this study also compare favorably to traditional posterolateral technique with radiographic pseudoarthrosis occurring in only four patients.
Challenges in Spine: Management of Spinal Infections. A Flow-Chart to Guide Decision Making
Authors: Gasbarrini Alessandro , Ghermandi Riccardo , Girolami Marco , Bandiera Stefano , Brodano Giovanni Barbanti , Terzi Silvia , Babbi Lisa , Boriani Stefano
Published: April 2016

Introduction

Spinal infections are rare diseases, whose management highlights the importance of a multidisciplinary approach. Although treatment is based on antibiotics, always selected on coltural and antibiogram tests, surgery is required in case of development of spinal instability or deformity, progressive neurological deficits, drainage of abscesses, or failure of medical treatment. The first step of the algorithm is diagnosis, which is established on MRI with contrast, PET/CT scan, blood tests (CRP and ESR) and CT-guided needle biopsy. Evaluation of response to the specific antibiotic therapy is based on variations in Maximum Standardized Uptake Value (SUVmax) after 2 to 4 weeks of treatment. In selected cases, early minimally invasive surgery was proposed to provide immediate stability and avoid bed-rest.

Material and Methods

From 1997 to 2014, 182 patients affected by spinal infections have been treated at the same institution (Istituto Ortopedico Rizzoli – Bologna, Italy) according to the proposed algorithm. Mean age was 56 years (range 1 - 88). Male to female ratio was 1,46.

Results

Minimum follow-up was 1 year. Infections were mostly located in the lumbar spine (57%) followed by thoracic (37%) and cervical spine (6%). Conservative treatment based on antibiotics needed surgery (open and/or percuteneous minimally invasive) as an adjuvant in 83 patients out of 182 (46%).

Conclusion

Management of spinal infections still remains a challenge in spinal surgery and multisciplinary approach is mandatory. This algorithm represents the shared decision making process from diagnosis to the most appropriate treatment, led to successful outcomes with a low-complication rate.
The Role of Vancomycin Powder to Prevent Wound Infection in Spine Surgery: Protocol of Randomized Control Trail
Authors: Alhammoud Abduljabbar , Baco Abdul Moeen , Head Marcus , Mehrab Nasser , Arbash Mahmoud
Published: April 2016

Introuduction

Postoperative surgical site infection (SSI) continues to be an important problem after orthopedic procedures, especially spine surgery. Reported incidences of surgical-site infection among patients who undergo spine surgery range from 2% to 6% and > 10% after instrumented fusions. Postoperative surgical-site infection is associated with an important rate of complications and cost. One of the methods to decrees the incidence of SSI is using intrawound local vancomycin. The current evidence supporting the use of intra wound vancomycin powder in surgical wounds is limited and controversial

Material and Methods

A prospective, single-center, randomized, parallel group controlled trial will conduct in orthopedic department, Hamad General Hospital. 198 patients, 18 years or older patients, will undergo to open spine surgery with or without instrumentation, will be randomly assigned to receive intrawound vancomycin as intervention group or systemic antibiotic (stander of care) as control group. Exclusion criteria include hypersensitivity to vancomycin, Immune compromised status, Unable to continue in follow up.

Result

Primary outcome is the incidence of wound infection after open spine surgery for adult patients, and the secondary outcomes are total infection-related medical cost compared with the cost of vancomycin powder, Adverse effects of local vancomycin, Length of hospitalization. Wound infection will assess according to ASEPSIS score. Results will be analyzed using SPSS software (SPSS), Differences between two groups (control-intervention) will be tested using of t-test, Fisher's exact test.

Conclusion

The aim of this study is to detect the effectiveness of local vancomycin (intra-wound) in decreasing the post op surgical site infection in open spine surgery with or without instrumentation, and possible implanted as stander of care in Hamad General Hospital.
Are ESR and CRP Acceptable Predictors for Early Post Spinal Surgery Infectious Complication?
Authors: Safaei Saeid
Published: April 2016

Introduction

ESR and CRP are nonspecific markers of inflammation, used to evaluate post operative infection. CRP is a predictable consisting of a post operative rise and a peak followed by a decrease toward the normal value. Deviation from normal kinematics may be an indication of infection

Material and Methods

ESR and CRP collected before surgery – 1 – 3 – 7 – 14 – 30 – 45 days post operative in consecutive patients. All infection and abnormal elevation recorded. 60 patients collected with below criteria's (age – sex – etiology – blood loss –Hb – operation time – ESR & CRP before and after operation- temperature – levels of operation - anatomic area and operation approach).

Results

CRP increased post operative and then decreased slowly during 30 days post operatively, second rise or failure to decrease was not specific in our study. More than 80% of our patients had CRP & ESR elevated more than 30 days without symptoms and signs of infection. We had one superficial. CRP++ or+++ can be for 30 days and ESR more than 20 mm Hg can be 40 days without early post operative infection in spinal surgery. There were correlation between soft tissue damage (long op time – number of levels – combined ASF & PSF) and increased CRP and ESR. ASF alone had no high rise in CRP. In Lumbar PSF operation CRP riser was more than thoracic – cervical or ASF alone.

Conclusion

ESR and CRP are not predictable factors for early post spinal surgeries infection diagnosis, but specificity and sensitivity of CRP is higher than ESR, when a second rise will be happen.